CHAPTER 29
PSYCHOLOGICAL ASPECTS
A disaster in human life of such magnitude as a sudden transection or severe injury to the
spinal cord, which throws the body completely out ofgear, inevitably disrupts the psycho-
physical entity of the organism resulting in pronounced effects on the paralysed patient's
mind. This complex and challenging problem has been the subject of a number of studies,
in particular during the last quarter of this century (Guttmann, 1945, 1953; Poer, 1946;
Kennedy, 1946; Weiss & Bors, 1948; Negler, 1950; Michaelis, 1950; Wittkower
el al. y
1954; Labhardt, 1962; Mueller, 1962; Bosches, 1963; Fordyce, 1964; Gunther, 1969).
I have made my studies on the mental behaviour ofparaplegics and tetraplegics during
and after the Second World War from individual interviews in my office, during routine
activities in the ward, physiothrapy department, workshop and later in hostels and settle
ments, and last, but by no means least, on the sports field. Formal psychiatric inter
views and specialized psychology tests were necessary only in very selected cases and
specialist psychiatric treatment was very rarely indicated in this Centre. In my studies
I found of invaluable help self-written reports by the patients about their reactions to the
injury, including their reactions and attitude towards their family and other visitors.
In this respect, a very significant remark about the frame of mind of people meeting
paraplegics for the first time was the expression of one of our earliest patients—a priest
wounded in 1943—who wrote: 'One of the most difficult tasks of a paraplegic is to cheer
up his visitors.'
In the establishment of the psychological pattern in paraplegics and tetraplegics, the
pre-traumatic personality, general mental ability, educational background, social stand
ing, profession, age, as well as the severity and duration of the paralysis and the type and
efficiency of the initial treatment following injury, were found to be essential factors.
In this connection, the importance of the disastrous psychological effect of prolonged,
enforced inactivity in hospital as well as later unsatisfactory housing conditions, sexual
frustration, lack of suitable transport facilities and delayed employment cannot be
emphasized too much.
The mental disorders observed can be divided into various groups, which, however,
may pass indistinguishably into each other:
A. MENTAL DISORDERS RELATED
TO THE SPINAL INJURY
(i) Disorders due to septic conditions
These are associated mainly with the infection of the urinary tract and pressure sores,
and the most characteristic symptom is increased tiredness progressing to complete
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