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JAMA 75 Years Ago
August 3, 2011

POSTTRAUMATIC NEUROSES

JAMA. 2011;306(5):558. doi:10.1001/jama.2011.1035

FOREIGN LETTERS

BELGIUM
(From Our Regular Correspondent)
May 12, 1936.

Congress on Forensic Medicine

The International Congress on Forensic Medicine was held recently at Brussels.

POSTTRAUMATIC NEUROSES

Dr. Castedoat stated that posttraumatic neuroses are of many varieties. They differ from ordinary neuroses only by virtue of the circumstances under which they occur. The symptoms are similar to those of apparently spontaneous neuroses and neuroses of constitutional origin. Accordingly it is to be asked what influence, if any, the traumatism exercised. A true neurasthenia involving the entire organism can apparently be created by a shock directly affecting the nerve centers. Manifestations of hysteria do not occur subsequent to traumatism excepting among predisposed persons, but one should be loath to regard such a predisposition as a pathologic state or even as specific. It is difficult to evaluate the ingenuousness of apparently hysterical manifestations in a given case. If analysis of somatic symptoms furnishes no clue and the mental condition of the hysterical patient presents absolutely nothing characteristic, one can only resort to extramedical arguments, devoid of real scientific value. Moreover, certain cases exhibit an apparent combination of good and bad faith. These considerations have influenced the development of the policy adopted by civil experts in cases of industrial accidents (grant of a small income convertible into capital) as well as that adopted by military experts in time of war (presumption in favor of the victim's good faith and abstention from imposition of disciplinary penalties). Posttraumatic neurasthenia is due, at least in some instances, to active organic lesions or to cerebral and meningeal cicatrices. In general the dysfunctions manifested are genuine and important. Emotional neurosis and psychasthenia observed following traumatism may be without exception considered as preexistent; the accident acts only to externalize and aggravate these latent conditions. Sinistrosis is not a specific disease. The term may apply to diverse mental conditions, some of which, wholly or in part, are of a pathologic nature, while others may be imputed to a bad faith bred of avarice. Thus by a veritable abuse of the term, the character of pathologic conditions may be attributed to actual simulations. Correct usage of the word “sinistrosis” is therefore not easy. Even if hysterotraumatism is no longer indemnified according to the “ready reckoners” established in 1915 for service men, indemnification continues to be granted on the basis of these tables in cases of industrial accidents. Only motivation of other than a medical nature can explain this discordance.

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