The Soldier at the Western Front – Military Psychiatry
Source 5: Discourse in the Journal for the whole Neurology and Psychiatry (Zeitschrift für die gesamte Neurologie und Psychiatrie)
The Kaufmann-Method was widely used and modified during the war. The exemplary treatment of patients with speech impediment, caused by a psychogenic trauma is described in the following. The treating physician further developed the Kaufmann-Method and assumed that his patients were simulants.
“A very powerful tool for those sick persons can be seen in the military discipline and the pressure to accept the treatment. In cases of severe aphonia, that had resisted to all forms of therapy until recently, the treatment was used […] and always resulted in a quick recovery: The sick person was told that an operation was necessary to resume the capability to speak. Therefore he required anesthesia, so that he wouldn’t feel any pain. But in any case he would be able to speak when he will be awake. […] All attempts to influence the patient during the state of excitation failed. The little degree of excitation during anesthesia was remarkable. After the corneal reflexes were gone the anesthesia was suspended and we waited until the patient showed first hints of the possibility to connect him. Immediately we applied strong faradaic stimulus on the earlobes and on the nasal mucous membrane while the patient was told, in a very vigorously way, that he was able to speak now and that he had talked during anesthesia. The majority was healed immediately and quickly. […] As soon as the patients started to phonate they had to recite poems until they were fully awake. If the phonation diminished immediately strong faradaic stimulation were applied. At the same time they were told that they talked loudly and that further mumbling would be considered as a bad habit or ill will and would be punished. All patients suffered amnesia for the time of the treatment, they neither remembered that they been electrocuted nor what they were told, and it wasn’t told to them neither. […] In the end slight disabilities that hinder the patient neither in their social nor professional live, even though they might make it impossible to serve on the frontline, can be detained more affectionately." Robert Hirschfeld: Zur Behandlung im Krieg erworbener hysterischer Zustände, insbesondere von Sprachstörungen (trans.: On the Treatment of Acquired Histarical Disorders, especially Speech Impedement), in: Zeitschrift für die gesamte Neurologie und Psychiatrie 34 (1916), H. 1, pp. 195-205, here pp. 200 f.A further impression concerning the medicinal view on war neurosis might be gained by the speech of Robert Gaupp the head of the psychiatric clinic of the University of Tubingen, delivered on the occasion of the combined war conference of the German society of neurologists association of psychiatry in 1916. “The number of war neurosis is comparable small concerning the total number of our army, even though remarkable high in its absolute value. […] Pilcz believes that within the Austrian mixture of nations the Slav is more vulnerable than the German. The high degree of hysteria among the Polish is known to be through peace time experience of recent years. If the speaker of a Romance language gets a neurosis easier than the German is something we want now until the end of the war.”
“This leads us to the most controversial aspect in the science of war neurosis: to the question of the importance of abnormal preposition. For the psychiatric trained medical physician, who is accompanied by experience and talent in the treatment of mental disorders, there is no doubt that most of the neurotics who fell ill during the war are unstable and soft, often fearsome by nature, psychopaths with the tendency for pathological behavior in reaction of acute or chronically emotions, […]”
“Experience teaches us therefore the great importance of the mental state of the soldier for the procedure of a disorder, caused by the tremendous vehemence of modern warfare, especially by the bombardment of the heavy artillery […] But we shall never forget: hundred thousand times the grenades burst next to our warriors, […] but the elastic nature of healthy men, who affirm the necessity to sustain in war, soon lifts itself up again and only a small percentage subjects and flees into the illness.”
„The ways of recovery are manifold. The physician heals through his personality, not with his methods. How many of the disorderly symptoms can be withdrawn at once was shown by Nonne, Kaufmann and many more and because of my own experience I can agree with them. The physician has to apply the healing therapy by himself. Interesting observations proof the healing abilities of terror concerning symptoms that have been caused by terror. The moral condemnation of certain harsh methods like those of Kaufmann, Rothmann, Jellinek and Muck don’t seem to be appropriate. If the moral of the physician during a therapy is uncontestable, if he is only guided by his will to heal, any method is appropriated as long as it really helps. This is by no doubts also true for hypnosis if implemented by an experienced expert. […] The importance of military authority and disciplinarian force cannot be doubted.“ Robert Gaupp: Kriegsneurosen (trans.: War Neurosis), in: Zeitschrift für die gesamte Neurologie und Psychiatrie 34 (1916), H. 1, pp 357-390, here pp. 361 f., 367, 383 and 388.
The described methods have been criticized already during the war. Because hypnosis, electro shock therapy and forced drill might immediately alter the symptoms of mental disorder soldiers but in most cases this couldn’t heal. At this point following the work of Sigmund Freud the psychotherapeutic therapy became important. „The aim of this article is to show how rewarding the application of the Freudian considerations can be, even in cases of war neurosis. The good results Nonne had with the application of hypnosis stand in no contradiction to this. Because on the one hand there are quite a number of cases where hypnosis only had a temporarily effect, and often not even that, on the other hand even the complete removal of a symptom by hypnosis can only tell as much as that it hadn’t been organic and that it hadn’t been strongly mentally rooted. Nobody would really doubt that the causes might considerably differ from the remedy. Because somatic functionally, non-hysterical disorders can be influenced in the same way. The suggestive treatment doesn’t ask for the special conditions the symptoms developed and is satisfied with the symptomatic success. Generally speaking there is no objection to this, even though in the interest of a long lasting effect of the healing an etiologic therapy might be preferred in comparison with a simple treatment of the symptoms. […]
I prefer the method following Frank that worked excellent even in the combat support hospital. Basically it is nothing else than the consequent implementation of the principles originally formulated by Breuer and Freud […].” Willibald Sauer: Zur Analyse und Behandlung der Kriegsneurosen (trans. On the Analysis and Treatment of War Neurosis), in: Zeitschrift für die gesamte Neurologie und Psychiatrie 36 (1917), H. 1, pp. 26-45, here pp. 27 f.
