Editing W. H. R. Rivers (section)

=== Instinct and the Unconscious: A Contribution to a Biological Theory of the Psycho-Neuroses ===
Following his appointment at Craiglockhart War Hospital, Rivers published the results of his experimental treatment of patients in ''[[The Lancet]]'', "On the Repression of War Experience",<ref name=":2">{{cite journal|url=http://net.lib.byu.edu/~rdh7/wwi/comment/rivers.htm|journal=The Lancet|title=The Repression of War Experience|author=W. H. Rivers|date=2 February 1918|volume=11|issue=Sect Psych|pages=1–20|issn=0140-6736 |doi=10.1016/S0140-6736(01)23233-4 |pmid=19980290|pmc=2066211}}</ref><ref>{{cite web|url=http://www.firstworldwar.com/features/rivers1.htm|author=Michael Duffy|title=Feature Articles: The Repression of War Experience by W. H. Rivers|access-date=8 January 2007|date=9 February 2003}}</ref> and began to record interesting cases in his book ''Conflict and Dream,'' which was published a year after his death by his close friend [[Grafton Elliot Smith]].<ref name="ConflictDream" />

In the same year he published his findings in ''The Lancet'', Rivers also composed an article on the various types of "[[Psychotherapy|psycho-therapeutics]]" in practice at the time.<ref name="slobodin" /><ref>{{Cite book|title = Encyclopædia of Religion and Ethics: Picts-Sacraments|last = Rivers |first=W. H. R. |publisher = Charles Scribner's Sons|year = 1919|location = New York|pages = 433–440|editor-last = Hastings|editor-first = James|volume=10 |chapter=Psycho-therapuetics}}</ref> Rivers' personal and complete theory on the origin of the "psycho-neuroses", including the war neuroses, was not to be published until 1920 with the publication of ''Instinct and the Unconscious: A Contribution to a Biological Theory of the Psycho-Neuroses''.<ref name="instinct" />

River's theory of the neuroses incorporates everything he had researched up until this point and was designed to "consider the general biological function of the process by which experience passes into the region of the unconscious...."<ref name="instinct" /> (pp.&nbsp;5–6). In other words, Rivers' goal was to outline an umbrella theory which would both explain neuroses and neurological issues as he had encountered them (see the subsection "A Human Experiment in Nerve Division" above).

In attempting to construct such an umbrella theory, Rivers accepted that the unconscious exists and that the contents of the unconscious are entirely inaccessible to a person except through the processes of hypnosis, dreaming, or psychoanalysis. Rivers further defined the unconscious as a repository of instincts and associated experiences (i.e. memories) which are painful or not useful to the organism.<ref name="instinct" />

"Instincts", in this regard, are actions which an organism performs without learning and which are executed without the mediating influence of thought. As such, the action has an "all-or-none" aspect to it: it either does not occur at all or it occurs with all of its force. To this end, Rivers included the protopathic sensations,<ref name="NerveDivision" /> mass-reflex actions (as observed in spinal-cord injury patients), and basic emotions (i.e. anger, fear) as instincts.<ref name="instinct" />

Rivers further asserted that all painful or un-useful instincts are naturally kept out of conscious awareness (i.e. in the unconscious) by suppression. Suppression—in this view—is a natural and "unwitting" (unintentional) method for removing painful instincts from consciousness and confining them in the unconscious. Neuroses, therefore, develop when something in the natural process of suppression is disrupted so that a suppressed instinct and its associated emotion are released from the unconscious. Rivers cites two possible reasons for the "escape" of such instincts from the unconscious: either the instinct became too strong to contain, or the normal reserves which typically suppress it were weakened. It is important to note, however, that the etiology of war neuroses is not simply the escape of instincts from the unconscious and the ensuing conflict. More often than not, Rivers believed that the way in which such conflict is resolved (or is attempted to be resolved) also greatly influences the manifestation of the neuroses.<ref name="instinct" />

In regards to the war neuroses, Rivers believed that the disease's manifestation stems from the escape of the "self-preservation" or "danger instincts" from the unconscious. These "danger instincts", as Rivers conceives of them, include at least five types of reflexive reactions to danger: (i) fear as manifested by flight, (ii) aggression as manifested by fighting, (iii) the suppression of all emotion in order to complete complex tasks which leads to safety, (iv) terror as manifested by immobility, and (v) the suppression of all physical resources as manifested by collapsing. Typically, reactions i, ii, iv, and v are suppressed so that humans can remain calm in the face of fear and can complete complex actions which lead to safety. When all five "self-preservation" instincts are repeatedly aroused for long periods of time, such as during exposure to war, the instincts gain power and eventually "escape" from the unconscious. As such, the emotions of fear, aggression, and terror arise into consciousness, as do their associated responses. These emotions and their suggested actions create great conflict in the consciousness, however: "fear" and "terror" are far from socially acceptable in war. In order to deal with the conflict created by the "escaped" instincts, Rivers posited that the mind must do something to provide immediate relief.  It is this attempt to achieve relief from mental conflicts that leads to war neuroses.<ref name="instinct" />

For example, Rivers proposed that officers and soldiers who have night terrors do so because they are trying to wittingly repress emotions and their associated instincts back into the unconscious.<ref name=":2" /> Repression, according to Rivers, is never adequate for removing conflict; it is only fruitful when a person can exert a conscious effort to do so. As a result, the repressed instincts, along with their associated emotions and memories, seep into consciousness when soldiers are sleeping.<ref name="instinct" /><ref name=":2" /> The result is night terrors.

In an alternative scenario, wartime hysteria can be explained as the body's suppression of normal physiological functioning in order to avoid the scenario which activates the danger instincts and releases the associated emotion of fear into consciousness. Hysterical soldiers often presented with symptoms of paralysis and diminished or lost sensory capacities, even in the absence of anxiety or depression. These physiological symptoms, although distressing in themselves, make it impossible for a soldier to be returned to the front line. Thus, the body compensates for its inability to suppress the danger instincts in the face of war by making it so that the soldier must avoid warfare altogether.<ref name="instinct" />

Overall, Rivers attributed the neuroses to both (i) the escape of painful instincts and their associated emotions from the unconscious and (ii) the mind's unsuccessful efforts to force such instincts and their emotions back into the conscious.<ref name="instinct" /> While Rivers' theory contains some [[Freudian]] elements,<ref name="slobodin" /> it is not simply a restatement of psychoanalytic theory; Rivers' theory of the neuroses draws heavily on the neurological observations and conclusions Rivers and [[Henry Head]] drew from their work on nerve regeneration.<ref name="NerveDivision" />

In retrospect, Rivers' particular method of treating the war neuroses and his theory of the origin of neuroses—while pioneering in their day—have failed to leave a huge mark on the history of psychology.<ref name=":4" /> However, the ''general'' contributions of [[Shell shock|psychiatrists treating war neuroses]], in combination with the overwhelming prevalence of the neuroses during the [[World War I|Great War]], led to a revolution in the British perspective of [[Mental Illness|mental illness]] and its treatment.