BY WHAT AMOUNTED TO the accidental cure of a profound anxiety neurosis, my attention was directed, or rather redirected, from the use of suggestion in treatment to the great importance of carefully examining the emotional history in this condition; and it appeared worth while to test, in a series of cases, the result of reducing the suggestive factor to a minimum, and to rely solely upon the simple expedient of going through each detail of the patient’s war history. The case which suggested this experiment is quoted in full:

Man of 34 of powerful physique

M aged 34, powerful physique; non-neurotic history. He was brought up to the clinic in November last year to be considered for removal to an asylum. There was a vague history of gradual mental deterioration since he was lightly wounded in the retreat from Mons. Shortly after his discharge he had given up the little work he had begun to do, became morose, and made one attempt to end his life.

On his first visit he presented an extreme degree of what I have come to describe as “mental auto-intoxication.” He was stuporous and dejected, and his expression anxious and abstracted. His wife complained that he was excitable at night, and walked considerable distances in his sleep, but in the day avoided company and resented interference. He passed his urine in the consulting-room chair.

For a time nothing could be got from him, but after a few sessions he wrote down how he was wounded. At the fourth session, he confessed that the death of his child five years previously weighed on his mind, but it was not till the sixth session that he described a German atrocity that he had witnessed in the retreat.

He and a comrade had come to a Belgian farm to ask for refreshment, when a little girl (in age and appearance reminding him of his own dead child), came and warned them of the approach of German cavalry. Some of the enemy soon arrived, but for a time both sides were content with threats, believing the other had reinforcements within call.

Soon, however, a German struck at the little girl (killing her, he believed), and M drove his bayonet through the man’s head.

In narrating this episode he became very excited, and got up and placed the chairs to represent the parties engaged. His speech became more intelligible, till, at the end, he cried out “By God! That’s what has been driving me mad!”

After this the patient spoke quite normally and made so rapid a recovery that within two months of his first visit he was able to resume full work as a boiler-riveter.

“A German struck at the little girl (killing her M believed), and so M drove his bayonet through the man’s head. In narrating this episode he became very excited, and got up and placed the chairs to represent the parties engaged. His speech became more intelligible, till, at the end, he cried out ‘By God! That’s what has been driving me mad!’ ”

In view of this somewhat dramatic result several cases of anxiety psychoses were selected for their severity and chronicity and were subjected to no further treatment than a thorough examination of the main incidents in their military careers, and of their dreams as being likely to indicate which experiences had most emotional significance. In no case was there anything but the most trifling inquiry into the pre-war history and the questions of sex never arose.

Suggestion is a factor which it is impossible to eliminate entirely, but the suggestive element was avoided so far as possible. No hint was given that the examination was more than a preliminary to treatment; no assurance of a beneficial result was afforded, and drugs were withheld.

There was no such startling effect as in the first case quoted. But improvement and freedom from relapse were on the whole more decided than is generally the case where such cases are treated chiefly by suggestion.

It might have been thought that the benefits of confession were too obvious and well-known to need exposition. But at the Lancaster clinic not one man in ten has been encouraged, throughout the course of often protracted treatment in hospital, to seek relief by telling out the past.

In the various special hospitals recently organised, things are no doubt better, but in the majority even of these the main reliance is placed on suggestion. Yet it will almost invariably be found that, when the history is systematically investigated and when the patient co-operates in rediscovering war memories by describing all that he has been through to his friends, his attitude will rapidly change for the better. Dreams will cease; he will sleep and emotional control be re-established.

One ventures the opinion that more rapid and more permanent results will be obtained when confession and not suggestion is made the main feature in the treatment of the anxiety psychoses.