The Mental Sequelae of Head Injury

Abstract

The psychiatrist is brought into contact with the patient who has received a blow on the head some time after the event in the majority of cases. His task is in many instances to be shared with the neurological surgeon. The Army psychiatrist is called upon to see such a large number of such cases that the following somewhat exoteric account is offered as covering some of the major considerations involved.A blow to the head may result simply in stunning, in which case the patient thereafter remembers, if vaguely, the essentials of his behaviour and experience, or the alteration of consciousness may be more severe and for some recognizable interval he may subsequently possess a true amnesia, in which case we speak of concussion.The degree of concussion clearly comprehends a wide range of disturbance of function which may almost immediately be fatal.Thirdly, the patient may be killed outright.Functionally considered, therefore, there are three degrees of effect from head injury : stunning, concussion, and death. Structurally we have no real parallelism of observed pathology, since it is only cases of severe concussion which characteristically come to autopsy. Consequently nothing is known for certain concerning the pathology of concussion. Cerebral contusion is therefore clearly inadmissible as a synonym, although its existence may be presumed in severe cases.As regards the after-effects of head injury it is clear that the disturbance of function may be psychogenic or physiogenic, or a mixture of the two, and in discussing the physiogenic results there are two main clinical methods of approach. In the first our interest is focused on syndrome production, and in the second we are more concerned with individual function. Clinical orientation, however, as in all psychiatry, can only be achieved by the former.