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Christopher D. Green
York University, Toronto, Ontario
ISSN 1492-3173
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By William H.R. Rivers (1920)
Posted May 2000
APPENDIX VI
"WIND-UP"[1]
The expression "wind-up" was probably used originally for any state of mingled excitement and apprehension called into being by an unusual occurrence, and especially the prospect or actual presence of danger. It has, however, gradually come to be used in the army as a means of expressing fear in one or other of its forms, an expression by means of which a soldier will talk about fear without explicitly acknowledging the presence of this emotion. I propose here to use the word as a definite expression for fear.
Fear is the emotional or affective aspect of the instinctive process called into activity by danger. It is the modification of consciousness which accompanies certain instinctive forms of action in response to danger, and especially the response by flight. It is especially intense when there is interference with this or any other form of reaction to danger.
It is only in Man that we are able to study by means of introspection the various forms of fear. The first distinction to be made is between the emotional state or states accompanying the actual presence of danger and the various forms of fear which arise when there is only the prospect of danger, while in pathological states a large group of fears or states allied to fear occur independently of either actual or prospective danger.
Reaction to actual danger. -- The most frequent reaction to danger in Man is one of heightened capacity for the activities by which the danger may be met without any trace of the fear which, if present, would inevitably interfere with this capacity. A man in the presence of danger will carry but with the utmost coolness, and often with a degree of skill surpassing that which he usually shows, the measures necessary for the aversion of the [p. 242] danger or his escape from it. In such a case there is complete suppression of the emotion of fear which the danger might be expected to produce, and this suppression is nearly always accompanied by suppression of pain, so that an injury the dangerous object, or from any other source, is not perceived.
A second mode of reaction is the assumption of an aggressive attitude towards the source of danger with the accompaniment of the affective state of anger. In this case there is not a simple suppression of fear, but its place is taken by another emotion belonging to the instinct of aggression. If these lines of action fail, if the serviceable activity which would lead to escape from the danger is interfered with or becomes impossible to carry out, or if the aggressive reaction does not succeed, fear supervenes as an accompaniment either of flight or of the collapse which is apt to occur when the more normal and serviceable reactions fail. In some cases, however, the suppression of fear is so well established that this emotion remains completely absent even when the danger is so insistent and unavoidable that death or violent injury is inevitable. Thus, the emotion of fear may be completely absent during the fall and crash of an aeroplane in which death seems certain, being replaced by an interest such as might be taken by the mere witness of a spectacle, or by some apparently trivial line of thought. It is when some line of action is still possible, but this action is recognised to be fruitless and in vain, that fear, often in the acute form we call terror, is likely to supervene.
Reactions to prospective danger. -- The state most commonly produced by prospective danger is one of that degree of fear which we call apprehension. This may be so intense as to become indistinguishable from the fear which accompanies the actual presence of danger, but it is more usually a vague discomfort, with minor degrees of the tremor and muscular weakness which accompany fear.
This state of apprehension may occur, often in a relatively intense form, in men who become perfectly cool and collected as soon as the danger becomes actual, when the state of apprehension [p. 243] completely disappears so that there is no interference with the activity by which the danger may be averted The apprehension preceding the occurrence of danger is of exactly the same order as stage-fright or the fright preceding any other public performance, and just as the best actors and orators are liable to stage-fright, so may those who show the utmost coolness and bravery in the actual presence of danger be liable to apprehensions while the danger is still only in prospect.
In other cases the apprehensions at the prospect of danger are so acute, and so accompanied by physical manifestations which make appropriate action impossible, that the actual occurrence of danger only serves to bring about complete collapse.
Pathological fears. -- Fear is a very frequent accompaniment of pathological .states, and many of its more extreme forms only occur in adult Man as part of such states.
The most frequent form in which such intense fears arise is the nightmare or the night-terror of the half-waking state. These are especially characteristic of childhood, but they may occur in adult life in those who seem otherwise healthy, while they have recently become familiar as the most prominent symptom of states of anxiety arising out of the war.
Similar intense fears may occur in the first stage or following the administration of an anaesthetic, or attacks of terror may occur in the waking state as part of an anxiety-neurosis. Another pathological form taken by fear is shown by the various phobias, in each of which some special stimulus may arouse fear in one who otherwise may not know what fear means. The stimulus, which thus arouses fear, often in a very intense form, may be one which in other persons not only wholly fails to arouse this emotion, but may be a source of definite pleasure. Thus, a man who does not know fear in the presence of actual danger to life or limb, may suffer from acute fear at the sight of a cat or harmless snake, or an airman who is only stimulated by the utmost dangers of aerial warfare may suffer from acute apprehension in a lift or on a ladder only a few feet from the ground. These highly-specialised fears also occur in relation to definite sources of danger; thus, one who is undisturbed by most [p. 244] of the dangerous situations of warfare may have some special fear, whether of searchlights, sniping, or some special kind of shell.
Still another form of fear is the more or less persistent state of anxiety which forms so prominent a feature of the functional nervous disorder arising out of warfare that it has been adopted in the nomenclature of one of the most frequent forms taken by these disorders. In the healthy person anxiety is a state which comes into existence in consequence of some prospective misfortune or danger, but in morbid conditions it shows itself in the form of more or less continuous apprehension colouring the whole mental life, so that even the most ordinary occurrence are seen in the blackest light as sources of trouble or danger.
Suppression and repression in relation to fear. -- In the form of reaction to danger which seems to be characteristic of the normal healthy man, there is a complete absence of fear. No effort is needed to keep this emotion out of the mind for it shows no tendency to appear in consciousness. Fear in the presence of danger is, however, so necessary a part of the mental equipment of animals and is so frequently manifested in childhood, that we can confidently assume this emotion to be potentially present, but in a state of suppression. This assumption is supported by several lines of evidence. A man who when exposed to danger experiences no trace of fear, and behaves with the utmost coolness and bravery, may yet suffer: subsequently from acute fear in his dreams. If, as there is much reason to believe, suppressed affective states find expression in dreams owing to the weakening of control normally exerted in the waking state, the occurrence of fear in dreams following a dangerous experience would be a natural consequence of its ordinary existence in a state of suppression.
Still more important and conclusive is the occurrence of fear as the result of shock or long-continued strain and fatigue which lower the efficiency of the higher controlling levels of mental activity. Thus, one of the earliest signs of the strain of warfare is the occurrence of apprehensions in one who until then has passed through the dangers of warfare without fear. The [p. 245] occurrence of fear either manifestly, or in the form of vague apprehension lowered, when shock or strain had lowered efficiency is naturally explained if the fear has been there throughout, but in so complete a state of suppression that it never passed the threshold of consciousness.
When fear or apprehension begins to show itself in consciousness, a new process comes into action. The fear, no longer held unwittingly in check, has now to be voluntarily repressed. One who has down or fought without fear, perhaps for many months, finds himself the subject of apprehensions which he regards with shame and strives to banish from his mind. A short rest at such a time, by allowing the unwitting controlling process to regain the upper hand, will often bring about the disappearance of the apprehensions, so that danger can again be faced with equanimity and without the necessity for witting repression. Or, the lowered efficiency of the controlling forces may be temporary, and the recuperative power of the sufferer may be so great that recovery Of the normal state of suppression may come about, and witting repression again becomes unnecessary. More frequently, however, the voluntary repression of fears or apprehensions only adds to the strain and fatigue which has led to the failure of suppression. The fears become stronger and call for still stronger efforts of repression. Through the vicious circle thus set up there is produced a state of persistent anxiety in which even ordinary incidents of life, incidents wholly devoid of danger, come to be viewed with apprehension. The fears which are repressed with apparent success during the day find expression in an accentuated form at night, when the control exerted by day is removed in sleep or weakened in the state preceding or following sleep. The interference with rest so produced only serves to increase the state of strain and fatigue upon which the nightmares or disturbing night-thoughts depend, while disturbances of digestion or circulation secondary to the anxiety may react on and accentuate the state to which they are primarily due. Finally, some shock or additional strain, a slight accident which a few months before would only have raised a laugh, a misunderstanding with a superior officer, or [p. 246] some domestic trouble, will bring about a crisis and reduce the soldier to a state in which he becomes wholly unfit for any kind ;of duty. The morbid state which most frequently supervenes is that known as anxiety-neurosis, which is only an exaggeration of the morbid state of anxiety which preceded his definite breakdown. In other cases the trouble map find expression in some mimetic disability usually known as hysteria, while in those of psychopathic disposition, there may be complete mental collapse, or the unbearable situation may be solved by the occurrence of those false rationalisations we call delusions.
The special feature of practical importance in the foregoing statement of the various forms taken by the emotion of fear is that the occurrence of this emotion may be a symptom, often the earliest symptom, of a state of fatigue and strain. Owing to the way in which the society to which we belong, and especially those whose business it is to fight, look upon fear, its occurrence, especially without adequate cause, arouses other emotions, and especially that of shame, which greatly enhance the strain to which the fear is primarily due.
Treatment. -- It is evident that the state so produced is one which gives ample scope for treatment, both preventive and curative. There is no department of medicine in which a medical officer can gain results so definite as in the treatment of the early stages of the anxiety-neurosis of warfare. The earlier he can act the better, for the longer the state of anxiety is allowed to last, the greater the witting repression which becomes necessary, the longer is the period of rest which is required to enable the process of suppression to become again effective. Moreover, the occurrence of disturbances of circulation, of digestion, and of other organic functions may produce complications which greatly prolong the process of recovery. Nowhere is the adage more appropriate that "a stitch in time saves nine."
A medical officer can only hope to succeed if he is on such terms with those under his care that they are ready to give him their full confidence, for owing to the general sentiment regarding fear, it is only with the greatest reluctance that its. presence is acknowledged. It is here that the expression "wind-up" has [p. 247] its peculiar utility in that it enables one in whom strain is producing apprehensions to refer, half seriously, half humourously to his trouble. The first step in the treatment is to assure the patient that there is no cause for shame, that the fear he experiences is a well-recognised symptom of strain and is due to the temporary failure of the mechanism by which in the healthy and normal man fear is kept under adequate control. If sleep is already disturbed by dreams, a second line of treatment will be to induce the sufferer to give up the process of voluntary repression to which, in the vast majority of cases, these dreams are due. Having by this process of education put the patient on the road to recovery, a short rest followed perhaps by a period of limited duty, will usually restore him to his normal level of efficiency. To send him for a holiday without the necessary process of education and reassurauce is open to the serious risk that he will only continue during the holiday to repress or brood over his painful thoughts and feelings, with the result that the state of anxiety is accentuated and becomes a fixed habit.
In conclusion, it must be pointed out that this line of treatment only holds good for those in whom the occurrence of fear is clearly the result of shock or strain. Those who are naturally apprehensive require a different line of treatment. Their case is far more difficult and less hopeful than that in which fear is secondary to strain or shock, but much can be done with them by sympathetic encouragement in fighting their disability, and when possible, by introducing them gradually to the conditions which rouse their apprehensions. There is reason to believe that in some cases such apprehensions are the definite sequel to some emotional shock in childhood or youth which has set up faulty trends in feeling and behaviour. In such cases a thorough and sympathetic discussion of the history of their fears may be of great service, and may at least allow the medical officer to recognise how far the state is capable of amendment, whether there is a reasonable hope that the patient may acquire that state of suppression of fear which in his more fortunate comrades has come into existence in childhood.
Footnote
[1] A report to the Air Medical Investigation Committee.