Here then, instead of a hysterical pseudodementia, was a case of hebephrenia or perhaps catatonia. Possibly there had been no pseudodementia, but actually an elementary disorder in the associative process. Possibly the defects which the patient early showed, in his responses, for example, were really genuine schizophrenic blocking.
According to Lewandowsky, almost all cases of neurasthenia, of hysteria, and of the so-called traumatic neuroses, stand out very clearly as functional. Bonhoeffer is far less certain that the diagnosis can be made readily in all cases. Antebellum conditions have not been continued in wartime; hysteria was a female affair antebellum, but under war conditions, it is found necessary to draw many differential diagnoses in the male betwixt schizophrenics, epileptics, and psychotics, on the one hand, and hysterics on the other.
_Re_ the so-called Ganser symptom, Hesnard has dealt especially with the value of what he calls the symptom of “absurd answers,” finding the differential diagnosis between dementia praecox and simulation particularly difficult. Hesnard states that incoherence is very hard to simulate. The answers of the Ganser patient are not always incorrect, and not always absurd. The patient strikes one as intact except for the absurd answers; intimidation and other external conditions affect the symptom greatly. Drugs are refused by the Ganser patient.
A shell burst about twenty-five meters away from a soldier, 21, but he continued in the military service thereafter for one month, having only one symptom, a trembling of the arm. This persisting, he was evacuated to Calais, then to Dury to the hospital for the insane where he stayed six months. He was transferred from Dury to the Belgian Hospital for the Insane at Chateaugiron on August 20, 1915. He remembered nothing of his stay at Dury, Calais, or of anything that happened after the shell-shock. He had no complaint and wanted to go back to the front. He was well oriented for time and space and had no disorders of association or perception. Besides the persistent, retrograde amnesia, he showed certain neurological disorders, occasional slight vertigo, a generalized tremor especially affecting the arms but disappearing almost completely at rest, lively tendon reflexes, intense dermographia and cardiac erethism. Diagnosis was made of acute, convulsional psychosis with agitation, convalescent phase.