Psychosomatic Medicine 7:15-21 (1945)
© 1945 American Psychosomatic Society

Psychic Concomitants in Wartime Injuries

¹ U. S. Public Health Service, U. S. Marine Hospital, Ellis .Island, N. Y.

A state of unconsciousness implies that psychological as well as apparent organic phenomena have occurred. In an unconscious state psychic activity invariably takes place and asserts itself when the patient awakens. A characteristic of "psychic workings" is that unconscious mechanisms attach themselves to preexisting or present organic pathology so that the latter pathology becomes exaggerated and distorted.

A patient with a history of classical convulsive seizures of grand mal type was found to have abnormal electro-cortical activity on the electroencephalogram. His attacks started six years before and were precipitated by an emotional upset. Under hypnosis convulsive seizures were induced by discovering and suggesting the specific psychic conflict. No other means of stimulation could produce a seizure. Electroencephalographic readings could be altered by suggesting that the patient under hypnosis regress to an age prior to his first convulsion. The problem of "epilepsy" in this individual demonstrated a predisposing constitutional background which produced no symptoms until a psychic conflict precipitated the clinical entity. There is an emotional threshold whose limits determine a convulsive seizure. Abnormal electro-cortical activity per se is of little clinical importance until a unique problem acts as a trigger which stimulates cortical activity beyond his "normal" level.

In two cases of middle-aged men, whose pretraumatic physical states indicated moderate arteriosclerosis, war experiences with consequent head injuries resulted in clinical entities resembling advanced arterioscleriosis with mental confusion and memory impairment. These states were largely reversible and resulted in clinical improvement.

In organic injuries caused by war action the pre-existing psychologic state is of great importance. The men involved were under constant anxiety and tension. An individual whose pre-traumatic personality was that of a rigid emotionally repressed individual sustained a head injury with unconsciousness. The resulting symptoms resembled those of brain deterioration. He was greatly relieved and improved when a great amount of anxiety which was involved with lifelong psychic conflict, was released.

Note:
The author wishes to express his gratitude for the kind cooperation of Dr. S. D. Vestermark, Chief of Neuropsychiatric Service and Dr. J. B. Train.