W.H.R.Rivers

“ One of the most striking features of the war from which we have recently emerged -- perhaps its most important feature from the medical point of view -- has been the enormous scale on which it produced those disturbances of nervous and mental function which are grouped together by the physician under the heading of psycho-neurosis. ”

“ The first result of the dispassionate study of the psycho-neuroses of warfare, in relation to Freud's scheme, was to show that in the vast majority of cases there is no reason to suppose [p. 5] that factors derived from the sexual life played any essential part in causation, but that these disorders became explicable as the result of disturbance of another instinct, one even more fundamental than that of sex-the instinct of self-preservation especially those forms of it which are adapted to protect the animal from danger. ”

“ The danger-instincts, as they may be called, are not only fundamental, but they are far simpler both in their nature and their effect than the instincts which are concerned in continuing the species or maintaining the harmony of society. ”

“ The striking success in coping with the infectious diseases, which in all other recent wars have been far more deadly than the weapons of the enemy, shows that modern medicine war prepared for this aspect of the war, and had ready for use the main lines of treatment which would take the sting from these scourges of warfare. ”

“ It soon became clear, however, that the great majority of the functional nervous disorders of warfare are not traumatic in the strict sense, but occur in pronounced forms either in the complete absence of any physical shock, or after exposure to shell explosions of a kind very unlikely to have caused physical injury. It became evident that the shell-explosion or other event which forms the immediate antecedent of the illness is only the spark which sets into activity a morbid process for which the mental stresses and strains of warfare have long prepared the ground. ”

“ Surgery also was forewarned and forearmed for its task of dealing with the wounds inflicted by modern weapons. Any increase in the deadly power of these weapons is due to the greater number they can reach rather than to the greater deadliness of the injuries they inflict upon the individual. ”

“ The aim of this book is to consider these mechanisms in their relation to the more normal processes of the animal organism, and especially to the mechanism by which certain parts of experience become so separated from the rest that they are no longer capable of recall to consciousness by the ordinary processes of memory. ”

“ Common as these disorders are in civil life, they are left almost without notice in medical education, while those who had paid special attention to the subject were torn asunder by fierce differences of opinion, not only concerning the nature of these disturbances of nervous and mental function, but also in regard to the practical measures by which they might be treated or prevented. ”