Abstract
This thesis is concerned mainly with a study of some of the physiological
functions of neurotic cases with effort intolerance. It is convenient,
for research purposes to retain the use of the term 'effort syndrome' (E.S.)
to indicate cases with effort intolerance as distinct from other types of
neuroses --- the alternative would have been to use the psychiatric diagnosis
and add 'with effort intolerance' in brackets.
The term, effort syndrome, as used here, refers to a relatively excessive
response to effort as manifested by breathlessness, palpitation, and subjective
feeling of fatigue on even mild exercise, along with excessive vegetative
liability on emotional excitement, e.g.; sweating, palpitation, giddiness, etc.,
as described by the patient or objectively observed. If there is a known organic
cause, then that diagnosis is, of course, used in preference to the term
effort syndrome. "Syndrome" is a descriptive term generally used to avoid
premature aetiological conception; there is apparently no common aetiology to
E.S.; and as a descriptive term is generally favoured, the American preference
for the term "neurocirculatory asthenia" seems reasonable.
In the majority of patients seen here, constitutional (including
personality) factors would appear to be more important than psychogenic factors;
thus when a breakdown occurs there may be no pronounced affective disorder, and
no adequate psychopathology to explain the illness. From this it follows that
existing psychiatric classifications, based on aetiological or descriptive
grounds, would be difficult to apply. It therefore seems reasonable to use a
classification which takes into account constitution and personality more fully
than do existing classifications. One can divide the E.S. material into
three broad. groups (1) Where the poor physical endowment is the primary factor
in producing symptoms. Here we are siupiy dealing with a poor machine, which
shows excessive response to physical effort. Here the patient has effort
intolerance which has been present since earliest recollection. (2) As above,
but the patient responds in a neurotic manner to his constitutional inferiority.
in this sense there is a psychological aetiology, but the constitutional factor
is the basic one. The emotional reaction may take any ;form, depending on the
personality and may simply amount to displeasure. Here the patient feels that
he has an effort intolerance, but his disability may actually be less than he
believes it to be. Such patients usually give a history of effort intolerance
since childhood, but the mere disability of Group 1 frequently changes under .
stress to the neurotic attitude of Group 2. (3) Primarily neurotic sere the
usual aetiological factors determining/a neurosis will apply. The form may be
determined by the constitutional physical inferiority which, if present, colours
the whole picture, but is of only secondary importance; or it may be wholly
psychogenically determined. Such "illness" tends in our experience to be of
comparatively recent origin, and is particularly prone to result from the
emotional and physical stresses of wartime.
By neurosis is meant an upset of the normal harmonious functioning of the
mind and body resulting from some personal inadequacy to meet a psychological
situation or problem. Poor general health, weak physical constitution, low
intelligence, etc., may predispose to such a neurosis, but these are in themselves
not enough; the individual has failed to meet the demands of his environment
or of his conscience, and a conflict has been set up. Thus, the Group 1 E.S.
has the, symptomatology of the other two groups, but his physical limitation
has been satisfactorily met and presents no handicap, so he has no neurosis.
The opposite is true of Group 2 E.S.
This division into 3 groups of E.S. proved convenient, but unfortunately
only an occasional group 1 E.S. was seen (from the definition it is clear that
they would only be discovered when examining a large random sample of controls
because they do not regard themselves as ill, and therefore would not report
sick), and no detailed study of this group has been possible.
