FRACTURE-DISLOCATION OF THE CERVICAL SPINE AND ITS OPEN REDUCTION

For descriptive purposes we might say that she suffered from " psychosis with gross brain lesion," or, in Meyerian terms, that an oligergastic individual had become dysergastic. The Adlerians would have something to say about a If will to power"; the Freudians could scarcely fail to be lured by the obvious narcissism and mother-identification; while the sleep pattern would doubtless be seized upon by others as a survival of archaic hibernation. If she escaped from the clutches of the " septic focus " school with her carious teeth still in her head she would be fortunate; but, notwithstanding the retention of these deadly poison producers, her lymphocyte count returned to normal in due course. Her stature' and her sugar reactions w6uld no doubt have proved of absorbing interest to the endocrinologists ; in fact, almost any school of psychiatric theory would welcome her case as a convincing demonstration of the validity of its teachings. In the sense that there is truth in each of these theories we believe that they are all right-it depends entirely upon the aspect of the individual which one is considering. But the task of the clinical psychiatrist is to understand how the patient got into the condition in which she is seen ; only then is he in a position to determine What factors are capable of modification, so that the " working agreement " between the patient and the cultural environment is once again operative. There is no need for ingenious theory; a simple chronological record of her life, together with a conception of levels of function and of integration, of the adaptative function of the nervous system, and of the final common path, appears to us to be sufficient. Despite her gross organic handicaps she reached a stabilized condition in the convalescent villa of a mental hospital, remaining there of her own volition, doing useful work, happy and contented, enjoying parole beyond the grounds, and going to entertainments. She found, in fact, a new milieu with which her damaged adaptative mechanism could reach a working agreement, and which, we believe, she would never have reached if she had not been forced by gross temporary organic disablement to retreat from an endeavour quite beyond her natural capabilities. Who knows but that she too might have developed a paranoid schizophrenic state had she been stricken with peripheral neuritis instead of encephalitis lethargica.