-** PSYCHOLOGY AND PSYCHOTHERAPY d] LIBRARY UNIVERSITY OF CALIFOBNIA SANTA BAliBAJSA FOREWORD BY WILLIAM ALDREN TURNER, C.B., M.D. FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, PHYSICIAN AND SENIOR NEUROLOGIST, KINO'S COLLEGE HOSPITAL, AND PHYSICIAN 10 THB NATIONAL HOSPITAL FOR THE PARALYZED AND EPILEPTIC, QUEEN SQUARE, LONDON. Late Temporary Colonel A.M.S. AN increased general interest in psychology and psychotherapy has been one of the minor conse- quences of the war. This is shown to some extent in the large output during recent months of books upon the psychogenic origin of neurasthenia and functional nervous disorder. In the present work the author has stated the psychological factors underlying those forms of nervous reaction, which form the borderline disorders known as hysteria, neurasthenia, psychasthenia and the compulsion neuroses. He has not attempted to give a clinical picture of these reactions, but more especially his object has been to indicate the psychological mechanism of their causation and the principles concerned in their treatment by psycho- therapy. Dr. Brown has brought to his task a well-equipped mind, and his book is the outcome of a large practical experience obtained both during the war and subse- quently. He has had the rare opportunity of being able to study the psychoneuroses of war, first as a Ti PSYCHOLOGY AND PSYCHOTHERAPY medical officer treating acute cases of the neuroses in their early stages in an advanced Neurological Centre and later in their chronic and more persistent phases in the special Neurological Hospitals at home. Since the war a tendency towards a cleavage be- tween functional and organic diseases of the nervous system has shown itself, with the result that the treatment of the former is passing into the hands of a specialized class of practitioner. The essentials to success in psychotherapy do not differ from those relating to other branches of medicine. These entail a sound knowledge of general medicine and more particularly of neurology and psychiatry. Psycho- therapeutic treatment should invariably be preceded by a clinical examination of the physical state before a psychological investigation of the mental symptoms is made. Psychotherapy, as now understood, has found its place amongst the recognized measures of treatment, and the reader of Dr. Brown's book will find the principles on which it is based clearly stated and discussed. W. A T. AUTHOR'S PREFACE IN this little book an attempt has been made to show the psychological principles underlying the modern theory and practice of psychotherapy. Opportunity has not arisen for dealing with the neurological aspects of the subject, but the author is in agreement with Dr. Aldren Turner in holding that a sound knowledge of general medicine, and more particularly of neurology and psychiatry, is important for com- pletely satisfactory work in this domain. In devoting so much space to a consideration of the doctrine of psycho-analysis, the author is actuated by the desire to render to Freud the things that are Freud's, but he is far from being able to accept Freud's views in their entirety. The position taken up in the text is based upon the results of psycho-analyses which he has carried out on a large number of patients during the past eight years with the express purpose of testing the theory. On the other hand, the method of psycho-analysis (" free " association) is, in his opinion, of the utmost value in psychotherapy. The author desires to express his thanks to the Editors of the British Medical Journal, Lancet, British Journal of Psychology (General and Medical viii PSYCHOLOGY AND PSYCHOTHERAPY Sections), Sociological Review, and Journal of Neurology and Psychopathology, for allowing him to reproduce long extracts from articles contributed by him to these periodicals. His thanks are also due to the Editor and Publisher of King's College Leclures on Immortality for their permission to reproduce a portion of one of the chapters in that publication, and to Mr. R. J. Bartlett, who made the index. W. B. 13, WELBECK STBEET, W. 1. December, 1920. CONTENTS FOREWORD BY DR. W. A. TURNER . . V AUTHOR'S PREFACE . . . . vii PART I INTRODUCTORY CHAPTER I PSYCHO-PATHOLOGY AND DISSOCIATION . . 1 I. Hysteria and Dissociation. II. Hypnotism and Hysteria. III. Psycho-catharsis or Abreaction. IV. Sexual Theory of Freud. V. Theory of Jung. VI. Hypnotism and Psycho-analysis. VII. Illus- trative Cases of Hypnotic Analysis. CHAPTER II DEGREES OF DISSOCIATION : MULTIPLE PER- SONALITY . . . . .24 I. Psychasthenia and Hysteria. II. Subconscious, Co-conscious, Subliminal. III. Multiple Person- ality. IV. Neurasthenia. V. Compulsion Neurosis, Anxiety Hysteria. PART II THEORETICAL CHAPTER III FREUD'S THEORY OF DREAMS . . 37 I. Dream Analysis. II. Dream Synthesis. III. Objections Met. x PSYCHOLOGY AND PSYCHOTHERAPY CHAPTER IV PAGE FREUD'S THEORY OF THE UNCONSCIOUS . . 58 I. The General Laws of Mental Process. II. Re- pression and Wish-Fulfilment. III. Psycho- Analysis and "Free" Association. IV. Word- Association Method. V. Physiological Theories. CHAPTER V THEORIES OF EMOTION . . . .87 I. Emotion and Instinct. II. Classification of Emotions. III. Emotion and Sentiment. IV. Freud's Theory of Instinct. PART III PSYCHOTHERAPY CHAPTER VI FACTORS IN PSYCHOTHERAPY . . .98 I. Re-association and Psycho-catharsis. II. Hyp- notism and Suggestion. III. Autognosis. IV. "Freudian" Cases of Analysis. V. Transference (Uebertragung) and Suggestion. CHAPTER VII THEORETICAL VIEWS ON EMOTIONAL REVIVAL .112 PART IV LESSONS OF THE WAR CHAPTER VIII THE PSYCHO-NEUROSES OF WAR (l) . . 118 Essential Factors in Causation and Treatment Emotional Origin of the Symptoms Treatment Abreaction Results of Treatment Other Treat- ment Summary. CONTENTS xi CHAPTER IX PAGE THE PSYCHO-NEUROSES OF WAR (ll) . .133 Neurological Cases during a Push Causation : Dissociation of Psycho-physical Functions Cases of Delayed Onset of Symptoms Amnesia Blood Pressure : Disturbances of Endocrine Glands After-histories of Patients treated in the Field Mental Analysis : Autognosis. CHAPTER X THE PSYCHO-NEUROSES OF WAR (ill) . .153 Three War Cases : Case I. Total Loss of Memory. Case II. Disordered Action of the Heart. Case III. Auditory Hallucinations of Speech, with Consequent Delusions of Supervision. PART V MIND AND BRAIN CHAPTER XI RELATION OF MIND TO BRAIN: PSYCHICAL RE- SEARCH ..... 168 I. Psycho-physical Materialism. II. Psycho-physi- cal Parallelism. III. Psycho-physical Interactionism. IV. Bergson's Theory of Interaction. V. Hypno- tism and Psychical Research : Survival of Bodily Death. LIST OF BOOKS OF REFERENCE . . .192 SUBJECT INDEX . . . . .193 INDEX OF NAMES . , 196 PART I-INTRODUCTORY CHAPTER I PSYCHO-PATHOLOGY AND DISSOCIATION PSYCHO-PATHOLOGY is the science of the morbid or pathological working of the mind. Psychology considers the laws of working of the normal mind, the mind that is in adequate adaptation to its en- vironment, physical and mental. Psycho-pathology considers the laws of working of the mind that is ont of harmony with its environment because of Borne degenerative process. The difficulty is to find one guiding idea to carry us along in this very complicated subject. The hint comes from normal psychology. Not many years ago our own British psychologists developed a system of association psychology, explaining the mind in terms of association of ideas that is, regarding the mind as something gradually built up on the basis of what is given through impressions from without and of what is inherited within. So in psycho -pathology we might begin our discussion by considering facts of dissociation indeed, that is the word to conjure with in our subject dissocia- tion, splitting up of the mind, the antithesis of association. We shall take as examples of patho- 2 l 2 PSYCHOLOGY AND PSYCHOTHERAPY logical states the so-called borderline cases hysteria, neurasthenia, psychasthenia, and compulsion neurosis. If we go beyond these we come to what are called the psychoses, which are recognized forms of insanity. Much the same kind of explanation will cover all types of mental disease, but the attempt to produce a satisfactory science of mental dissociation was begun within the domain of borderline cases, other- wise known as the psycho-neuroses. These diseases may also be called functional nervous diseases. In them there is no demonstrable lesion of the nervous system. The nervous system is apparently intact, but is functioning wrongly or inadequately. We shall base our introductory remarks upon the case of hysteria, because it illustrates most clearly the psychological mechanisms at work. I. HYSTERIA AXD DISSOCIATION. In hysteria we have very obviously a case of dissociation ; certain parts of the mind, certain sensations, certain powers of movement, certain memories, are lost to the main consciousness, but still exist somewhere or other, in some form or other, and can be restored under appropriate conditions. The anaesthesias that hysterical patients suffer from are a good instance of the kind of dissociation that occurs. A hysterical patient may suffer from anaesthesia of the hand, or of the hand and lower arm, or of the hand and arm up to the shoulder, ending in a straight line round the ehoulder, or, again, from hemianaesthesia extending down the right or left side of the body and ending accurately in the middle line. Many other forms of anaesthesia are possible. All these types correspond in their PSYCHO-PATHOLOGY AND DISSOCIATION 3 extent to ordinary, uneducated concepts of the divisions of the body ; for example, the hand, in ordinary unscientific thought, is considered as one entity, the whole arm is considered as an entity, ending in a straight line round the shoulder. This holds good even for purposes of tactile association, but from anatomy we know that the nerves supply irregular areas, consisting, for example, of a strip down the forearm, extending towards the fingers of the hand, so that, if there were an organic disturb- ance of a cutaneous nerve, we would find an irregular area of anaesthesia the more irregular the smaller the number of nerves affected we would not find an area of anaesthesia corresponding to the hand or the arm. Pierre Janet emphasized these distinc- tions between what are called functional anaesthesias and organic anaesthesias, and pointed out that the anaesthesia illustrates the state of mind of the hysteric, who has lost the power of holding together in one unity all the sensations from the different parts of his body. A patient may receive a blow on the arm, causing a mental shock, as a result of which his whole arm may become anaesthetic, and the anaesthetic area may end in a straight line round the shoulder- joint. That area does not correspond to the distribution of any set of nerve - fibres, but it does correspond with the patient's own conception of his cutaneous sensibility. More- over, it can be proved indirectly that the sensations in this part of the body still exist. Sometimes we can do this by a trick, as Janet pointed out : We can ask the patient to say " yes " when he feels a pin -prick, " no " when he does not. We get him to close his eyes, and then silently explore different parts of his body. Whenever he is pricked on the normal part of the skin he will say " yes." When he is pricked on the so-called anaesthetic area of the skin he will often say " no," whereas if the area were really anaesthetic he would not know that it had been touched at all. Yet he is probably quite genuine in his belief that he has not felt the pin-prick though of course we must be certain that he is not malingering. It is very important in considering hysteria to be familiar with the various types of malingering. Cases like this, of anaesthesia com- bined with functional paralysis of the arm, occurred frequently during the late war. I have dwelt on hysterical anaesthesia, not because it is very important, but because it well illustrates this theory of functional dissociation. There is dissociated from the entire mind one psycho-physical power, in this particular case cutaneous sensitivity the power of reacting consciously to stimuli presented to some part of the body. Again, the patient may have loss of motor power : he may be suffering from loss of power in the legs cannot stand or walk ; yet if we investigate his nervous system we may find that it is perfectly normal. Nevertheless, there is loss of sensory power, or loss of motor power, and also, very frequently, a greater or less degree of amnesia, or loss of memory. To sum up the state of mind of the hysterical individual, we may say that it is a state of mental dissociation dissociation of certain psycho-physical functions from the main personality. Yet these dissociated functions remain, and under appropriate conditions can be recovered for example, under hypnosis. Hysterical patients are easily hypnotized ; in fact, Charcot and Janet hold that any person who is easily hypnotizable is ipso facto hysterical, and that, if an ordinary person be PSYCHO-PATHOLOGY AND DISSOCIATION 5 hypnotized, he is made hysterical by dissociating his mind a form of dissociation has been started. With this view I agree. II. HYPNOTISM AND HYSTERIA. It is worth while considering this matter a little further. To hypnotize a person we get him to fix a bright object with his eyes, to relax his muscles, and to give his mind up to sleep to turn his mind away from everything active. We continue to talk to him all the time, telling him to think of sleep, and saying that his eyelids will begin to get heavy, that he will lose feeling in his limbs, and that he will gradually become more and more drowsy. After he has fixed the bright object for a short time and his expectation of sleep has been encouraged hi this way and his thoughts fixed on sleep, which (though we have as yet no satisfactory theory of sleep) may be provisionally said to be a quieting down of the mental powers, he will appear to lose consciousness. But there is one power of the mind that is not quieted down, and that is the power of hearing the physician's voice. The physician is talking almost the whole time, and whenever he speaks the patient, until he gets very deeply hypnotized, can respond. Thus we produce dis- sociation of the power of hearing a particular kind of sound from the rest of the mind. The rest of the mind is lulled to sleep ; it is a case of partial sleep. But more than that, there is an emotional element at work. A patient cannot be hypnotized by a gramophone, unless he has been hypnotized before and has an extreme tendency to yield to this kind of suggestion. The patient has to feel an interest in the physician, either of fear or of confidence. 6 PSYCHOLOGY AND PSYCHOTHERAPY Those are the two forms of mental reaction. Different people hypnotize in different ways ; some have a tendency to hypnotize through fear, others through arousing confidence one might even say affection in the patient. There is always an emotional element involved. We shall have later to consider a theory that makes a great deal of this emotional element. In the case of a normal person such an emotional appeal must be very strong ; in the case of a hysterical person it need not be so strong, because the patient already shows a tendency towards dissociation ; the hypnotic effects appear more readily. Charcot considered the hypnotic state a form of artificially induced hysteria. Janet agreed with him, and so do I, though many people think that, because almost every one can be hypnotized to some degree, this theory must be wrong. But there is a tendency to mental dissociation in all of us, based on emotional conflicts. No one is a complete mental unity. Finally, as an example of a hysterical patient, let me take the condition of almost any bad case of shell shock on the Western front, or any of the other fronts, during the past five years any of the cases as they reached the casualty clearing station. The patient's condition was always that of dissocia- tion. All the hysterical cases agree in showing loss of memory of greater or less extent. They may have forgotten everything that has happened since the shell burst, and they will exhibit other losses of function, greater or less, according to circumstances. They may show loss of voice, of powers of walking, of powers of hearing, of the power of voluntary control. I would emphasize their loss of memory. It will be found that such a patient is very easily hypnotized ; if it be suggested to him that he will PSYCHO-PATHOLOGY AND DISSOCIATION 7 remember the circumstances of his injury with hallucinatory vividness, he will act again the whole circumstances, and in that process his various dissociated functions will return. If he has been dumb, he will now speak, without the necessity of suggesting this. If he has been paralyzed, move- ment will occur in his limbs. I do not say that he will at once be able to take up his bed and walk, but his limbs will move about, showing that there is power in them, and that the power is linked up with the lost memory. What has been done here ? We have re-associated him by bringing up these lost memories. With the memories we have brought up the lost functions. But we have done more than that, we have given him an outlet for an emotion which was originally experienced by him with too great intensity with so great an intensity that he could not keep it consciously within bounds, and his mind split in the attempt. The way in which these patients live again through their experiences shows what terrible sensations they must have had. They roll about, gripping at the sides of the stretcher, or rolling on the floor, tearing at their hair with their hands, contorting themselves in every possible way, foaming at the mouth, becoming purple in the face, their eyes starting out of their heads, all their muscles tense. While under shell fire the conscious per- sonality was trying to suppress the emotion of fear, partly from a sense of duty the duty of a soldier partly in self-defence anything to get away from it. There occurs a mental conflict an attempt to get rid of the painful emotion.- The attempt succeeds at the expense of the mental machinery ; clouding of consciousness supervenes, the patient goes into a state of stupor, where he is not completely 8 PSYCHOLOGY AND PSYCHOTHERAPY unconscious, but where he is dazed. He gradually recovers from this, but has no memory of it later. We see here the mechanism at work explaining the dissociation. The dissociation is obviously a fact, but it is not an ultimate fact. There is a cause for it, and that cause is mental conflict, an attempt at repression, an attempt which has succeeded to a certain extent, but only at the cost of the production of a pathological symptom or set of symptoms. In curing the patient we bring up the repressed experience once more, we encourage him to work off the emotion involved in it. Just as a person who grieves for some one he has lost finds relief in tears, so we let these patients work off their fear. Thus we are concerned not only with the linking up of the dissociation, but also with the working off of fear, of a certain amount of emotional energy that has, metaphorically speaking, been bottled up in the patient. In this way the repres- sion is overcome and the mental energy (repressing force) becomes again available for general use. III. PSYCHO -CATHARSIS OR ABREACTION. This illustrates the advance that Joseph Breuer and Sigmund Freud made on Janet hi explaining hysteria. Janet explains hysteria simply hi terms of dissociation. He says that the patient suffers from weakness of mental synthesis. He compares the hysteric to an old lady who has gone shopping and has made too many purchases. She comes back with her arms laden with parcels. Some of these fall to the ground ; she stoops to pick them up, and others fall. So, he says, is it with the hysteric after a shock. He loses the power of holding all his psycho-physical functions simultaneously in PSYCHO-PATHOLOGY AND DISSOCIATION 9 his mind so that some of them are lost, and he suffers from an anaesthesia and paraplegia. If you cure him of this by suggestion, later on he will, perhaps, as the result of some slight shock, show some other functional symptom he may lose his voice or his hearing. Some other hysterical symptom will take the place of the original one unless he is cured of his general mental state. But Janet did not undertake to explain why the dissociation took place. Breuer and Freud found, after an investigation of some hysterical cases under hypnosis, that there was very frequently loss of memory, that such memories were always of an emotional character, and that the symptoms ^^app^-ryred if the memories were brniiyht. to the surface to use his own words. We shall consider this theory more fully in Chapters III and IV. Later on he found, after analysing a number of his own cases, that the emotional tendencies which were repressed were all of a sexual nature, and so he enunciated his dictum that no neurosis is possible in a normal sexual life, and that, if a patient is suffering from neurosis, there must have been some disturbance in his sexual life. IV. SEXUAL THEORY OF FREUD. That is the extreme form of the Freudian theory, which I do not accept, though the Freudian school make it an essential part of their doctrine. Freud thinks that we can find evidence of sexuality in the early years of childhood namely, feelings of attraction of the boy towards his mother and of the girl towards her father, combined with hatred and jealousy felt towards the parent of the same sex and that these feelings are shortly afterwards repressed. A mental conflict takes place in the child's mind, and sexual repression occurs, partly through the further normal development of the child's mind other interests arise and crowd out these feelings partly through the fact of development of feelings of sympathy and of morality, and these repressed tendencies ojjjj^^jrm a complicating factor if shocks occur later in the child's life. I have already referred to the production of hysterical symptoms as being due to an emotional shock. That seems to be the general rule an emotional shock will produce hysteria in persons whose inherited make-up is suited for it. The PSYCHO-PATHOLOGY AND DISSOCIATION 11 hysteric is born, not made, but the hysterical symptom is originated through some emotional shock. Freud considered that these emotional shocks were repressed and dissociated from the mind, and continued to act as a foreign body in consequence, but that these repressed memories could be brought to the surface either by hypnotism or by his method of psycho-analysis. In his earlier work he thought that he could prove in every case the actual occurrence of a shock in early childhood of a sexual nature. Later on, however, he discovered that some of the memories brought up by these methods were false memories that the patient had imagined them but this did not alter his theory very much. He said that the fact that the patient had the power of imagining such events - showed that there was maldevelopment of the N sexual life at that time, so that he then explained the neurosis in terms of the process of development of the psycho-sexual life of the child. There is in his view a form of infantile sexuality consisting of sexual processes concerned with the feeling of pleasure produced by sucking, pleasure in connection with the excretions, as well as pleasure arising from the infliction of pain (sadism) and the suffering of pain (masochism), pleasure in ex- hibition, etc. Such tendencies as these sometimes appear un- changed, or even exaggerated, in adults, and are known to medical science as perversions. These partial processes undergo certain degrees of repression or transformation, especially between the ages of five and thirteen or fourteen, and what is left con- verges towards the production of the normal sexual instinct and life of the adult. 12 PSYCHOLOGY AND PSYCHOTHERAPY His theory of functional nervous disease is that it is the outcome and sign of maldevelopment of the sex-instinct. These partial processes have either been repressed too intensely, or their mutual relations have taken an abnormal course. Some have persisted when they should have been out- grown, etc. The hysteric suffers from repression of perverted sexuality. If the repression had not occurred, the patient would have shown, not a normal, but a perverted sexual life. He is incapable of a normal sexual life, because the kind he would show would be out of harmony with his own character and his social environment. The patient realizes that a seemingly insoluble mental conflict is going on inside him, but by the psycho-analysis he is enabled to " sublimate " it that is, other channels. This opens up a path along which solution of the conflict may take place, the impulse can find its fulfilment in another way. Energy is put at the disposal of the patient, and he directs it towards other ends. We have, then, already moved far away from the conception of catharsis, and we find a change in the psychological dynamics involved. Whereas Breuer spoke of emotion as something that could be worked out, now Freud speaks Qf libido, something perhaps phy^sjc.aJLraJJjej^JtliMijn^nj^l, which can be shifted from one idea to another, and which, when dammed up, may produce either physical or mental symptoms. If the repressed libido fails to find an outlet in physical symptoms the paralyses, contractures, anaesthesias, etc., of so-called conversion hysteria it appears in consciousness as an anxiety state. In PSYCHO-PATHOLOGY AND DISSOCIATION 13 other words, repressed emotion appears in conscious- ness as anxiety. To be a thoroughgoing Freudian one must be able to accept this theory, and for many of us it is because we cannot fully subscribe to it that we should not call ourselves Freudians. V. THEORY OF JUNG. C. G. Jung of Zurich was one of Freud's most brilliant pupils, and at first an enthusiastic supporter of his views. Later, however, Jung's researches led him to believe that these earlier emotional memories of the child were not an essential factor in the pro- duction of neurosis, but that the principal factor was the present condition of the patient. When a patient falls ill of a psycho -neurosis it is because he is not adequately adapted to his present social and physical environment. Life is too great a task for him ; he cannot hold his own ; he has not sufficient courage to face facts, with the result that, if he is of a hysterical temperament, his mind turns back to childhood's memories and to more childish modes of conscious activity. What Jung calls " regression " takes place. The mental energy of the individual, which Jung has rather unfortunately called the libido (corresponding very closely to Bergson's elan vital), is reflected back, and revives earlier memories of childhood, not only memories of actual occurrences in childhood, but also early phantasies. These phantasies may be of a sexual nature or they may not. The libido in that way becomes linked up with earlier memories or phantasies, and is no longer of use to the individual in his present mental situation thus he becomes still less competent to deal with his environment. 14 PSYCHOLOGY AND PSYCHOTHERAPY But Jung would use the same method that Freud uses in treating the patient the method of psycho- analysis, because, he says, we want to get back these earlier memories for the sake of the libido that is linked up with them. Psycho-analysis is simply the method of free association. If the patient is suffering from some hysterical symptom you get him to let his mind pass into a passive state to recline on a couch, say, with his eyes closed and passively follow up the sequence of ideas as they occur to him one after another, without any prompting. He begins, say, to think of the time when the symptom first developed, and then just watches his mind drift as it will gets into a state of meditation and tells the doctor from moment to moment what he is thinking about without reservation or criticism. His thinking seems to be undirected, to be just determined by free associa- tion. The result is that more and more ideas and memories from the past come to his mind, and perhaps eventually memories that are of great significance for his symptom. This occurs because the method is not really a method of free association at all. The series of ideas is, it is true, not determined by conscious mental process ; it is determined by unconscious mental process. By letting the conscious selective activity fall into abeyance, trends of un- conscious mental activity come nearer to the surface of the mind and guide the ideas, and these belong to the same world as those mental tendencies which are at the basis of the hysterical symptom. The difference between Freud and Jung, then, is, that Freud says that earlier memories and earlier imaginations are directly responsible for the hysterical symptom ; Jung says that failure of adaptation at PSYCHO-PATHOLOGY AND DISSOCIATION 15 the present moment causes a regression or reflection of mental energy back to the past, and that this revives earlier imaginations and memories and so produces the hysterical symptom. Both agree in adopting the method of psycho-analysis, which proceeds to recall these earlier memories and phantasies. These, briefly, seem to be the fundamental ideas of Freud and Jung on hysteria, as contrasted with the ideas of Janet. They go a step further to the cause of the dissociation that is, mental conflict and repression. Link up this dissociation and remove this repression and the patient is cured. VI. HYPNOTISM AND PSYCHO-ANALYSIS. Freud, who originally used hypnosis, gave it up, partly because he found that he could only hypnotize about one-third of his patients, whereas psycho- analysis, though it took much longer, could be applied to every case, and produced eventually much the same results. His second objection to hypnotism was that certain resistances are overcome by the recall of particular memories, but in this process the resistance in other directions is increased, so that the mind is limited rather than expanded. He also suggested the germs of the theory that Ferenczi worked out in detail afterwards namely, that in hypnosis there is really a transference of emotional feeling, of the early sexual feelings of childhood, to the person of the physician. Ferenczi points to the fact that there are two main methods of hypnotizing : the method of command, corre- sponding to the paternal method with the child, and the method of coaxing and soothing, which 16 PSYCHOLOGY AND PSYCHOTHERAPY corresponds to the attitude the mother adopts towards the child. He then argues that in both types of hypnosis there is a revival in the patient's mind of his early modes of response. When a patient is hypnotized he responds to the physician just as he responded to his father or his mother in early years that is, by a reaction that is of a sexual nature hence the patient's early sexual feelings are fixed on the physician. What has thus really been done is to replace one set of symptoms by another. Hysterical symptoms, like loss of the power of walking or loss of voice, may thus be got rid of, but in the place of these the psycho-sexual dependence of the patient upon oneself has been produced, and this also is bad. What evidence has Ferenczi for this view ? He says that it is taken from actual experience of patients whom he originally treated by hypnotism, but later on psycho-analysed. He found evidence of such transference of feeling in them. These, then, are Freud's three objections to the method of hypnotism : (1) Failure of the method in certain cases. (2) Its tendency to produce other symptoms in place of those of which the patient is cured. (3) Fear of the transference of sexual feeling to the person of the physician. 1 With regard to the last objection we might urge that Ferenczi's theory is a petitio principii ; the patient may respond to the physician as he did to his father or his mother in childhood, not necessarily, however, because of sexual feelings, but perhaps 1 But all Freudians regard such " transference " as an essential stage in the process of cure, and expect to produce it, in every case, in the course of psycho-analysis. They subsequently " resolve " the transference by further analysis. PSYCHO-PATHOLOGY AND DISSOCIATION 17 simply because at that time he was more suggestible than in later life. A young child has only a few facts in his mind, and if any suggestion is made to him he tends to believe it unquestioningly. He comes into the world with a tendency to what is called " primitive credulity " a very important attribute. Most of what he learns in early life is learnt through suggestion, not by means of logical reasoning. We like to encourage a child to reason, but if we made it think out everything for itself we should only confuse it and hamper its development, instead of forwarding it. And if that is true of the intellectual side of the child's life, it is much more true of the moral side. We can explain the child's response simply in terms of greater suggestibility. We get our patient into a state in which he is willing to accept the suggestions that are made to him in the same way as he accepted them in his early childhood. The hypnotic method of analysis is much quicker than that of psycho-analysis, and can produce equally satisfactory results in simple cases. I will give two illustrations. VII. ILLUSTRATIVE CASES OF HYPNOTIC ANALYSIS. One is that of a signaller in the Flying Corps who was blown up by an aeroplane bomb whilst taking refuge in a disused trench in France. He became unconscious, and on coming to he found that the trench seemed to be turned round at right angles to the position in which he had expected it to be. When he arrived at the barracks the same thing had occurred everything seemed to be twisted at right angles to its ordinary position. This feeling of disorientation, as we may call it, persisted for many 3 18 PSYCHOLOGY AND PSYCHOTHERAPY months. When he came home to England it still showed itself in the following ways : When walking along a street which bent roughly in the form of a semicircle, thus IL, he would have the irresistible feeling that he had been walking like this ~~|. If he were riding on the top of a bus, and the bus turned at a right angle, he would have the feeling that he was continuing to go in a straight line, although he knew that the bus had turned a corner. He would think that the whole room he was hi, everything, had twisted round through a right angle. I hypnotized this patient and put him through his experiences again, with the result that the occasions on which he got this feeling of disorientation became roughly about half as frequent as before, but the disorienta- tion continued to occur from time to time. He was better, but by no means cured. A few days later he came to tell me that his mother had informed him that at the age of six, as the result of a fall, he had shown much the same symptom ; while crossing the Tower Bridge one day he had told her that the bridge was turned " the other way round." I hypnotized him, and put him through this experi- ence again. He lived it through with much vividness. He is sitting on a wooden horse (white with red stripes) in the dining-room. His aunt comes into the room and wishes to wash him ; he declines, and edges away from her ; the horse tips up on the edge of the hearthrug, and he falls on to the fender. He knows no more until he wakes up and finds himself in bed, with his aunt bathing his face. He continues to recall his experiences, and remembers crossing the Tower Bridge and finding it turned at right angles. After recalling this incident the patient was much better, but a few days later he PSYCHO-PATHOLOGY AND DISSOCIATION 19 went to the theatre to see Going Up (it is true that there is an aeroplane in Going Up), and he suddenly found that the theatre was the wrong way round. He went home, and in the middle of the night he woke up with the feeling of disorientation, got out of bed, and went towards what he thought was the window, and put his hand through the looking-glass. Thus he was by no means cured. I pointed out that there must be some memory in the first six years of his life which was the cause of the trouble. He tried to recall it, but did not make much progress. I then put him through his fourth birthday under hypnosis, and he remembered a frightening dream in which he had thought that there was an animal under the table. He had crawled downstairs and waked up halfway down. The next morning he had thought that the pier was the wrong way round, and had told his mother so. I interpreted his dream for him while he was in the hypnotic trance. He had seen the Giant Ape in a glass case at the Natural History Museum, South Kensington. This had frightened him, and it was this creature which he had thought was under the table in his dream. I took the precaution to get another doctor (Captain P. A. Galpin, R.A.M.C.) to come and see me hypnotize this patient the next time. I then suggested to him that he would go through his first experience of disorientation. When I put my hand on his forehead he shouted out, " Hot coffee ! " It appeared that when a child of nearly three he had gone into the kitchen one morning, and had pulled the coffee- pot, which was on the table, towards him by pulling at the tablecloth. The coffee upset and poured down his right arm. He felt it as a pain in his left side, over his heart. He knew no more until 20 PSYCHOLOGY AND PSYCHOTHERAPY he woke up in bed, when he saw his father come into the room, and he felt the bed to be the wrong way round. That was his first experience of disorienta- tion the first he could remember. It occurred to me, as a possible explanation of the dissociation, that the scalding of his arm produced a fainting fit, in which he fell to the left and everything twisted round to the right he fell through a right angle. That was the beginning of his disorientation. To make quite sure of this I hypnotized him again to bring up an earlier memory still. I suggested to him that he would remember his second birthday. He suddenly began to shout out : " He has bit me Gordon has bit me ! " Before I woke him up, I asked him all about it, but he could not tell me very much whilst in the hypnotic state he had gone back to a period when he was too young to be able to describe his experiences. I told him that he would continue to remember all that he had just gone through, and I then woke him up. He told me that Gordon was not a dog, but a little cousin of his. They had been in bed together, standing up in bed, and it appears that he had punched Gordon in the face, and that Gordon had retaliated by biting him in the left arm. He could remember that at that time he was living near a fire station could remember all the details of the incident, and could remember definitely that he had had no feeling of disorientation. The revival of this incident brought no memory of any earlier disorientation. The next day after this treatment he felt more disorientated than ever, for he had been going through these experiences very vividly. I let him stay in bed, and after two days he recovered completely, and very soon applied for his discharge. I let him PSYCHO-PATHOLOGY AND DISSOCIATION 21 go, but asked him to write to me if the feeling of disorientation ever recurred. I have never heard of him since. This case seems to me to show that such memories date from very early life, and more than that, it shows that the memories need not always be of a sexual nature, because at the age of two even Freud would admit that there can be very little sex, and it is very difficult to see where the sexual experience could come in in such a case. The other case is a much simpler one, but it is what I would call a crucial case of the value of abreaction, or the removal of repression and the working off of emotion under hypnosis. It is the case of a gunner who was admitted to the hospital where I was working, after he had spent two years in military hospitals of different kinds. He was suffering from a tremor of the right hand, dating from the time when he had been blown up at Ypres. He did not remember any- thing more until he reached hospital, and the memory of this interval had never been recalled to him by any of the doctors he had previously seen. I sent him to sleep that took just about three seconds and then suggested to him that he should live again through the experience of Ypres. He did so, and began to shout out all sorts of things which showed what had happened at the time. German shells were falling nearer and nearer to the gun-pit. He was apparently serving the gun, and some one else was handing him ammunition, and this person had evidently lost his head, for my patient shouted out : " What the do you mean by pulling the pin out of that fuse ?" Then I noticed that he was moving the handle l with his right hand ; his hand 1 To serve the gun. 22 PSYCHOLOGY AND PSYCHOTHERAPY began to shake violently, and soon he was shaking all over, but especially in his right hand. Then he suddenly became absolutely still. I suggested to him that he would continue to remember all that he had just gone through and then woke him up. He looked at his hand, which was absolutely still, with amazement, and expressed his gratitude, but his mind still appeared somewhat confused, so I told him to go and sleep it off. An hour later he came back and told me that he had not been to sleep, but that he had been thinking it all over. He knew everything that had happened, and told me that he had not been suffering from shell shock, but from gun shock. His gun had been blown up, and the emotion which this experience had excited in him had been bottled up for two years, with the result that he had suffered from this tremor in his hand. The next morning he was able to shave himself with an ordinary razor, for the first time since his illness. Now, was this working off of the emotion the cause of the recovery ? The alternative explanation is that the recovery is due to suggestion. When this man came to me, however, he certainly did not expect me to cure him. I saw him the first day that he came to the ward and treated him at once, and he was not likely to have more confidence in me than in any one else who had treated him. As regards the hypnosis, he went off straight away without realizing that he was being hypnotized it was not that that impressed him. As far as one can make out there was no expectation worked up it was simply the working off of the emotion that reassociated his mind and cured him. That is why I call this a crucial case. In many other cases it may be argued PSYCHO-PATHOLOGY AND DISSOCIATION 23 that the cure is the result of suggestion for example, in the case of the disorientated man but this case of the gunner was not of that sort. I do not for a moment wish to deny the working of suggestion in curing such cases, but I wish to emphasize the curative effect of the working off of emotion as a fundamental factor. It Is a more causative treat- ment than suggestion. Suggestion removes the symptom ; abreaction removes the cause of the symptom. We shall find this illustrated again and again in cases quoted later on. Abreaction of repressed emotion sweeps away the repression, and so frees energy which had been previously needed to hold the repressed memories apart from the rest of the mind and away from clear consciousness. This freed energy is thus put once more at the general disposal of the personality. The previous "fixation" of this repressing energy and its deviation from the common fund of energy of the personality probably explains, to some extent, the feeling of fatigue that generally accompanies a psycho-neurosis. CHAPTER II DEGREES OF DISSOCIATION. MULTIPLE PERSONALITY I. PSYCHASTHENIA AND HYSTEEIA. WE have seen that Pierre Janet's general psycho- logical theory is that the personality is a synthesis of mental elements, and that disease of the person- ality is an interference with this synthesis. The disease or derangement may take one or other of two general forms. There may be, on the one hand, a widespread weakening of the synthesis, which alters the individual's idea of his own personality. This is psychasihenia. While the simpler activities of the personality, such as perception and memory, are unimpaired, the individual's judgments on these activities, recognition, reflective thought and voli- tion, may be seriously affected. The psychasthenic Bays : " It is not I who feel, it is not I who eat, it is not I who speak, it is not I who suffer, it is not I who sleep ; I am dead, and it is not I who Bee clearly," etc. Janet writes : " This incomplete character of the disturbances of the personality is found in all the accidents of these psychasthenic patients ; they have obsessions, but are not com- pletely insane, and always recognize the absurdity of their obsessing ideas ; they have impulses, but do not carry them out ; they have phobias concern- ing acts, but never real inability to perform acts, DEGREES OF DISSOCIATION 25 or real paralyses ; they have interminable doubts, but no true amnesias. It is the striking trait of their character that they never have any symptom in its completeness, and this incomplete character of the disturbances of their personality falls within a general law." * On the other hand, these symp- toms may be carried to their completeness, the synthesis of the personality may be not merely weakened but actually destroyed ior certain of the mental elements. This is hysteria. Sensation from certain areas of the skin, power over certain volun- tary muscles, memory for certain ideas or for a certain period of the individual's life, may be com- pletely lost to the personality itself, although by indirect methods they may be proved still to exist. II. SUBCONSCIOUS, CO-CONSCIOUS, SUBLIMINAL. Ideas like these, which can be shown to exist in independence of the main personality and con- temporaneously with it, were called by Janet " sub- conscious," and this is the original meaning of the much misused term " subconsciousness " in the literature of the subject. It would perhaps be less ambiguous and therefore better to call such ideas " co-conscious," as Morton Prince has suggested, but if the original term is preserved at all it should always be used in its original sense. There are, of course, other senses in which the word has been employed, the most extreme being that in which it is identical with the " subliminal self "of F. W. H. 1 " A Symposium on the Subconscious," iv, by Pierre Janet. Jvumal of Abnormal Psychology, vol. ii, 1907-8, p. 60. 26 PSYCHOLOGY AND PSYCHOTHERAPY Myers. As every one knows, Myers regarded the normal waking consciousness with its memories as but a small fraction of the entire personality. Below the threshold of consciousness and the activities of everyday life is a much larger portion, the subliminal self, which comprises aspects of the personality undeveloped in this mundane life, though conceivably capable of development under other conditions of existence. This subliminal portion is separated from the supraliminal self (the everyday self) by a semi-permeable " psychical diaphragm," through which ideas and mental powers may pass in either direction. In the anaesthesias and paralyses of hysteria the sensations and powers fall from the supraliminal into the subliminal, while in the in- spirations of genius and other super-normal activities of the soul there is a " subliminal uprush of faculty " into the supraliminal. Through the subliminal we may come into closer mental relations with one another and with the spiritual universe. This theory has been subjected to much criticism at the hands of psychologists. Its main weakness is that it furnishes an over-elaborate explanation of the well-attested facts of abnormal, i.e. supernormal and subnormal, psychology, while allowing undue weight to the less certain and inadequately verified facts of telepathy, mediumships, and spirit appari- tions. The prefix sub- in " subliminal " is unfor- tunate, since there is nothing essentially inferior about it. A more non-committal term is the " un- conscious," which is coming into favour at the present day, especially through the influence of Freud. Memories, impulses, and motives when not actually before the mind, i.e. conscious, may still retain all their other mental characteristics, and from their DEGREES OF DISSOCIATION 27 place outside of consciousness may continue to exert influences upon consciousness. They form part of the unconscious, but are still psychical in nature. It is not a contradiction in terms to speak of " unconscious psychical processes," unless we identify the psychical with the conscious, for which there is really no justification. Of course there is the alternative view that these processes, when out of consciousness, are merely physiological changes in the brain. Apart from the metaphysical diffi- culties involved in such a view, difficulties which we cannot go into here, there are scientific reasons which make it more satisfactory to think of the unconscious in mental rather than in physical terms, in most cases. It need hardly be added that these unconscious mental processes have in all probability their own physiological correlates or counterparts in the workings of the brain, but our knowledge of the nature of these brain changes must be even more speculative than that of the unconscious processes themselves. III. MULTIPLE PERSONALITY. In extreme cases of hysteria, loss of memory and disintegration of personality may go so far as to produce either an alternation or a doubling of personality. Instances of this are a matter of common knowledge, and do not need detailed explanation and illustration here. Suffice it to say that they show all degrees of mental disag- gregation, from mere alternation of mood and conflict of motive compatible with mental health to extreme cases where two souls seem to share the tenancy of one body. The best known recent 28 PSYCHOLOGY AND PSYCHOTHERAPY example of the latter case is that of Miss Beauchamp, which Morton Prince has described with such a wealth of detail in his book The Dissociation of a Personality. This individual was at a certain stage of her life possessed of three distinct personalities or centres of consciousness. Two of these alternated with one another, each retaining her own series of memories, but amnesic for the experiences of the other, while the third, the now notorious " Sally Beauchamp," not only had a separate consciousness of her own, with a cheerful and irresponsible temperament quite alien to those of the others, but claimed that even when not alternating with them she had direct knowledge of the thoughts, feelings and even the dreams of one of them. Morton Prince eventually cured Miss Beauchamp by hypnotism, suppressing " Sally " entirely, and re-synthetizing the other two personalities with their separate memories and experiences into a normal individual similar to the original personality as she had been before the emotional shock which was the cause of all the trouble. More recently Morton Prince has met with another case of dissociated personality quite as remarkable as that of Miss Beauchamp, and closely similar in several respects. He calls her B C A. 1 C is the normal personality as she was before and after her mental illness, and B and A are the two dis- sociated personalities into which she disintegrated as the eventual result of several years of severe nervous and emotional strain. B and A alternated with one another, but whereas A had no direct know- ledge of B's existence, B was immediately aware of 1 See Journal of Abnormal Psychology, vol. iii, 1908-9, passim. DEGREES OF DISSOCIATION 29 A's thoughts and memories even when herself in abeyance. B and C also shared each other's memories as well as those of A, but A was entirely shut up within her own circle of memories and ex- periences. Neither C nor A remembered her own dreams, but /S, the hypnotic personality corresponding to B, was able to recall the dreams of both. A was neurasthenic and represented the ethical and religious aspects of the original personality. She lived in a continual mental atmosphere of gloomy and appre- hensive conscientiousness, and was appalled by the freakish and irresponsible behaviour of B, who lived only for pleasure, was completely egoistic and " emancipated," and during her periods of alternation enjoyed the most robust health. B thus showed a close resemblance to " Sally " in the Beauchamp case, and the importance of this resemblance will perhaps be clearer when we con- sider it in the light of Freud's theory of hysteria. We may note that B was co-conscious with A, or existed simultaneously as a subconsciousness, in Janet's sense of that term. Morton Prince was able to prove this in various ways, apart from the statements of B herself and of her hypnotic person- ality /S. One illustration will suffice. It was arranged with (unknown to A) that she should add together certain figures while A was present, and should show that she really had carried out the operation co-consciously by giving the answer immediately upon A being changed to ft. She, of course, was not told what actual figures would be given. A was then brought and was asked to write out some lines of poetry in the middle of a large sheet of paper (8|" x 11"), in the left-hand upper corner of which was written the number 30 PSYCHOLOGY AND PSYCHOTHERAPY 53, and in the right-hand lower corner the number 61. A repeated aloud what she was writing and commented upon her mistakes of memory, showing that she was alert and not in a somnambulistic state. On being questioned afterwards she averred that she had noticed no other writing, such as numbers, on the paper. It had appeared quite blank. Even if she had noticed the numbers she would not have known what was to be done with them, since she is amnesic for B and /3. A was changed to /?. " Immediately on appearing j8 exclaimed, almost shouted : '114,' which is cor- rect." More complicated arithmetical calculations were carried out under similar circumstances with equal success. Certain memories of the patient's earlier years, which were lost to all the personalities even in hypnosis, were recovered by automatic writing. In this way it was discovered that her irrational fear of cats took origin from an incident of her childhood, when she was intensely frightened by a white cat she was holding having a fit. Her dreams were frequently of cats, accompanied by a feeling of intense horror. This case is of especial interest, in that Morton Prince prevailed upon both C (or, rather, B C A.) and B to write full introspective records of their experiences during and after the disease. 1 The documents are of the greatest importance, especially as their authenticity and objective accuracy is vouched for by two other distinguished American neurologists besides Morton Prince himself. We learn from B's account how this co-conscious self commenced first as a definite emotionally tinged 1 Op cit., pp. 240-260, 311-334, DEGREES OF DISSOCIATION 31 complex or system of ideas clearly known by C or B C A. She writes : " A very long time ago (she was twenty at the time) C received an emotional shock which it seems to me, as I look at it now, resulted in the first little cleavage of personality. This emotion was one of fright and led to rebellion against the conditions of her life, and formed a small vague complex which persisted in the sense that it recurred from time to time, though it was always immediately suppressed. This complex, it seems to me, was the same, though only slightly developed, as that which appeared later and is described as complex B." Twenty years later the sudden and prolonged illness of her husband emphasized the feelings of fright and rebellion, which now showed as " a long- ing for happiness, a disinclination to give up the pleasures of life which the conditions required ; and there was a certain determination to have those pleasures in spite of everything, and this resulted in a constant struggle between C and this complex." After her husband's death, C became thoroughly neurasthenic, and the B complex grew stronger. She would find herself doing and enjoying " things that she disapproved of and knew that she dis- approved of." Finally, a year after her husband's death, " a third shock of a strongly emotional nature " produced a sudden change. C disappeared, and the B complex became a personality, with the general characteristics we have already recorded. But a month later a fourth emotional shock (felt of course by B) brought back C as the dominant personality, in the neurasthenic and psychasthenic form which we have called A. B subsequently alternated with A, and at the same time became also a co-conscious- ness, and the conflicts between the two now took 32 PSYCHOLOGY AND PSYCHOTHERAPY the form of antagonism between two distinct per- sonalities. C's autobiography gives vivid descrip- tions of these conflicts. She writes : " I would often wake in the morning, as A, to find a note on my pillow or on the table usually of a jeering tone- telling me to ' cheer up ' or to ' weep no more,' etc. ; sometimes these notes would be in rhyme and nearly all advised me not to trouble Dr. Prince so much. These notes were written by B when I ' changed ' in the night, but as A, I supposed, when I first found them, that I had written them in my sleep. If my condition had been one of remorse, it was now one of despair. After a time, as A, I destroyed all the notes I found without reading them, hoping in this way to discourage B's fondness for writing. As a result I found one morning a sheet of paper pasted directly hi the middle of my mirror. It was fastened at each corner with large red seals, and bore the inscription ' READ THIS,' and contained information which it was quite necessary A should have. As B my attitude towards myself as A was something like that of a gay, irresponsible, pleasure- loving girl toward an older, more serious-minded sister. I, as B, had no patience with A's scruples and morbid ideas, and actually enjoyed doing things which I knew would shock or annoy myself as A, though occasionally as B I felt a little sorry for A." The following are extracts from the joint diary which this curiously assorted pair kept at Morton Prince's request : Under the date July 23, 190-, B writes : " I am here again to-night, B, I am. I may as well tell all I have done, I suppose. For one thing I had a facial massage there is no need of being a mass of wrinkles. I know A doesn't care how she looks, but I do. The Q's spent the evening here DEGREES OF DISSOCIATION 33 and if I don't tell, S will, I suppose I smoked a cigarette. S was terribly shocked and angry with me. Now, A, don't go and tell Dr. Prince, you don't have to tell him everything you do it, though. I must have a little fun." The following day A writes : " I have struggled through another day. B has told what she did. How can I bear it ? How explain ? I am so humiliated, so ashamed. Why should I do things which so mortify my pride ? Quite ill all day I am, as usual, paying for B's ' fun.' It is not to be borne." August 20 : " Terrible day one of the worst for a long time. I cannot live this way, it is not to be expected. I am so confused I have lost so much time now that I can't seem to catch up. What is the end to be ? What will become of me ? " August 21, B writes : " Good gracious ! how we fly around ! A has been ill all day could not sleep last night. I hope he (Dr. Prince) won't send for us, for he will put a quietus on me, and as things are now I am gaming on A. Had a gay evening no discussions of religion or psychology, no dissecting of hearts and souls while I am in the flesh." August 25 : "I wonder if A is really dead for good and all ? It seems like it. The thought rather frightens me someway, as if I had lost my balance-wheel. She wants to die, she really does, for she thinks it to herself all the time. I wish I were myself alone, and neither A nor B ; I cannot bear to hear A groan, she cannot bear my glee." August 26th : " Such a day ! A got away from me for a little while and tried to write a letter to Dr. Prince. It was a funny looking letter, for I kept saying to her ' you cannot write, you cannot move your hand,' but she had enough will power to write some and directed it. The 4 34 PSYCHOLOGY AND PSYCHOTHERAPY effort used her up, however, and I came and the letter was not mailed." August 27th, A writes : " I am too much bewildered to write. I have succeeded in writing Dr. Prince, if I can only mail it. Oh, but I am tired ! Such an awful struggle ! " C was eventually resynthetized by means of hypnosis. After many fruitless attempts, the cor- responding hypnotic personality y was obtained, and, as Morton Prince says, " on being waked up, a personality was found which possessed the combined memories of A and B, and was free from the patho- logical stigmata which respectively characterized each." A still more recent cage of multiple personality is that of " Doris Fischer," recorded by Dr. W. F. Prince and summarised by Dr. T. W. Mitchell in the Proceedings of the Society for Psychical Research, vol. xxxi. IV. NEURASTHENIA. In contrast to the crude and obvious dissociation of hysteria, with its loss of psycho-physical functions and, in many cases, its breaks in the memory con- tinuum, we find in neurasthenia a dissociation at a higher level of consciousness. As the result of mental and physical fatigue, and especially after the strain of a debilitating illness, the patient may find himself worrying about his bodily functions his digestion, the action of his heart or of his kidneys, etc. and getting into the habit of doing so, a habit which he becomes more and more powerless to break. A vicious circle is thus set up. A slight disturbance of function arouses worry, and this worry throws the function out of gear Btill more, and so the trouble DEGREES OF DISSOCIATION 35 grows. The patient suffers from a preoccupation about his health or it may be about his business or his general position in the world. Such is, in brief, the view which D^jerine holds of the nature of neurasthenia. He considers that the state of mind of the neurasthenic is characterized by abnormal suggestibility with regard to his symptoms, a sug- gestibility much greater than that of the hysteric. The dissociation here is relative, not absolute. The patient finds exceptional difficulty in thinking about matters unconnected with his preoccupation, and on relaxing his mental effort falls back at once into the treadmill of his worrying thoughts. V. COMPULSION NEUROSIS. ANXIETY HYSTERIA. In compulsion neurosis the patient is obsessed with an irresistible impulsion to perform apparently unimportant actions, such as washing the hands repeatedly, carrying out certain stereotyped move- ments, certain forms of ceremonial apparently meaningless, etc ; or the obsession may take the form of doubts and fears of apparently harmless things and actions. Freud would explain this psycho-neurosis as a result of mental conflict and repression, in a special type of character. The ob- session is a reaction formation, concealing and holding down certain repressed tendencies dating from very early life such as sadism, anal eroticism, etc. It is a disguised form of self-reproach, dating from childhood. Only by prolonged psycho-analysis can these cases be cured. Often they are allowed to become too chronic for treatment to be of much use. Two examples of this type of psycho-neurosis are given 36 PSYCHOLOGY AND PSYCHOTHERAPY in Chapter VI. The type falls under Janet's head ing of psychasthenia, but it has well-marked and definite characteristics which call for a special name. The remaining cases of psychasthenia are mostly forms of anxiety-hysteria, in Freud's classi- fication, in which repressed emotion or " affect," instead of being converted into physical symptoms which form the "compromise formations" of con- version-hysteria, remain in consciousness, but in the transformed character of anxiety. A useful non- committal term, independent of any one school of thought, is the term " anxiety-states," which covers all cases showing anxiety as a prominent symptom. We must now pass on to a more detailed state- ment of Freud's psychology, and will begin in the next chapter with his theory of dreams. PART II THEORETICAL CHAPTER HI FREUD'S THEORY OF DREAMS I. DREAM- ANALYSIS. ACCORDING to the theory of Freud, every dream is the fulfilment of some wish. In the great majority of cases the wish is one that has been repressed by the waking consciousness^ and its fuihimcnt'in the dream is disguised according to rules that are both complicated and diverse. It is for these reasons that the general law has so long escaped notice, and scientists have been so ready to deny all signifi- cance to dreams. This state of things is inevitable so long as attention is restricted to the dream simply as it appears in consciousness and as it is remembered by the dreamer. But corresponding to this ^mani- fest content " of the dream there is a^"latent content " which constitutes its meaning, and when discovered by the method of psycho-analysis is found invariably to be the fulfilment of some wish. The manifest content is made up of memories from the past life of the dreamer, patched together in apparently quite random order and according to the most superficial laws of association. The laws of rational connexion, especially those of causation, which dominate waking consciousness, seem to be in abeyance, and in their place the only laws of connexion observable are those of association by contiguity and association by similarity. As a 3T 38 PSYCHOLOGY AND PSYCHOTHERAPY general rule the memories most commonly aroused are those of the " dream-day " (the day before the dream) and those of early childhood. Memories of the dream-day form part of every dream without exception. Actual bodily disturbances, either of the external sense organs or of the internal organs, are, when not too intense, incorporated in the dream- thought in a disguised form. In this way every f dream may be regarded as fulfilling at least one wish, viz. the wish to go on sleeping. If these actual stimuli were recognized for what they are, the dreamer would no longer be asleep but awake, and this is what happens when they become too intense. Thirst arising during sleep may produce the dream -experience of drinking water in huge draughts. In this way are fulfilled the two wishes, to continue sleeping and to drink. Other bodily needs arising during sleep may receive imaginary satisfaction in the same way. Instances like these illustrate very clearly the function of dreams in acting as thejguardians of sleep. Freud relates an amusing story of a medical student who was very fond of his bed, and could only with the greatest difficulty get up in time for his work at the hospital. One morning on being called by the maid, who shouted through the door, " Get up ; you must go to the hospital," he half awoke, and then proceeded to dream of a ward in the hospital in which he found himself lying upon a bed with a card hung over the head of it stating his name, age, and occupation. Remarking to himself : " Since I am already in the hospital I do not need to get up and go there," he turned over and continued his eleep. Numerous instances may be quoted in which FREUD'S THEORY OF DREAMS 39 the fulfilment of a wish appears in the dream in clear and undisguised form. The dreams of young children are almost invariably of such a nature. Desires, of which the satisfaction has been denied them during the day, again and again appear as fulfilled in the dreams of the following night. This kind of evidence is obviously of the highest importance for the theory of dreams, since the child's consciousness shows the laws of mental process in their simplest and most fundamental forms. The wish-fulfilments of adults are as a rule expressed somewhat less directly, even when they do not belong to those unconven- tional and consequently " repressed " forms which will engage our attention more fully presently. Some years ago, while working for a medical ex- amination which it was most important that I should pass at the very first opportunity, and for which I had been able to find very little time for preparation, I dreamt one night that some one showed me the examination paper, although it was some days before the date of the examination. Not until some time after the dream did I realize its true significance and its connexion with my intense desire to pass. On another occasion, while anxiously waiting for the appearance of certain reviews which I had written for one of the daily newspapers, I dreamt that I received yet another batch of books from the same source. This -dream was evidently a slightly indirect fulfilment of my wish that the other reviews of mine had not mis- carried and would shortly appear. Instances of such clear wish-fulfilments in dreams must be frequent in every one's experience, and it may with some degree of plausibility be objected that they do not necessitate any theory more elaborate 40 PSYCHOLOGY AND PSYCHOTHERAPY than the one most generally accepted, viz. that dreams are simply the revival, in chance order, of memories aroused during the condition of sleep. For the imagined fulfilment of wishes may reappear as memories, just as other forms of consciousness do. Freud, however, does not admit this, since be finds that every kind of dream, whatever the nature of the memories which unite to form its " manifest content," shows under the treatment of psycho-analysis a clear reference to the fulfilment of a wish or wishes, which often gives the dream aji entirely new aspect. v^The method of psycho-analysis is simply a method of free association. The subject whose dream is being interpreted is asked to adopt the mental attitude of meditative expectancy, and in this frame of mind to consider the parts of the dream one after another and say just what ideas spon- taneously occur to him in connexion with each. It is essential to the success of the method that Ihe should rigidly keep in abeyance any tendency rto criticize, modify, or reject any of these ideas as jbhey arise, and that he should make a faithful record of all of them, however absurd or objection- able some of them may appear to be. The ideas which thus arise by free association will be founcl all to converge to one system^ j)f ideas concerned with tne fulfilment of a wish. This system of ideas dream, or the " dream- thought," and gives the dream its meaning and its raison d'&tre. The wish involved in it is one Ithat is not in harmony with the conventional and ethicaj ideas of the developed personality, and is therefore entirely repressed during waking conscious- ness, and can only attain realization in the dream- FREUD'S THEORY OF DREAMS 41 consciousness of sleep in underhand and round- about ways which have still to be described. The repressing factor in the waking consciousness is named by Freud the endopsychic censor. The term is somewhat figurative, but lends itself well to the purposes of vivid description. In sleep this censor is still active, though not to the same degree nor with the same watchfulness. If only the re- pressed wish can disguise itself sufficiently, it may succeed in slipping past him unnoticed, and BO rise into the half-light of dream -consciousness. Before discussing in detail the various ways in which the wish may accomplish this disguise, and which Freud classifies under the general heading of Traumarbeit, or dream-work, I will give a des- cription of one of his own dreams, together with a summary of its psycho-analysis. 1 I must, however, first summarize his preliminary explanation which alone makes the dream intelligible. Freud heard in 1897 that two professors of his university had proposed him for the position of professor extraordinarius, election to which he doubtless greatly desired. After receiving this news, and on the day before the dream, a colleague, who had for some time waited without result for the success of his own nomination to a similar professor- ship, visited him and told him that he had at last gone to a high authority about the matter, and had learnt that his non-success was due to his religion and nationality. Freud suffered from the same dis- advantages, and so might on this score draw but a discouraging conclusion from the news as to the probable fate of his own nomination. " On the morning after this visit," writes Freud, " I had the 1 See Trautndeutung, funfto Auflage, 1919, S. 96-99. 42 PSYCHOLOGY AND PSYCHOTHERAPY following dream. ... 1. Friend R. is my uncle. I feel tender affection for him. 2. I see his face somewhat altered before me. It is, as it were, drawn out lengthwise, a yellow beard which sur- rounds it stands out with exceptional clearness." At first Freud was inclined to dismiss the dream as an absurdity, but remembering that in the case of his own patients this tendency often indicated that the meaning of the dream was a disagreeable one, and such that the person was loth to admit even to himself, he proceeded to analyse it, pondering over it sentence by sentence and noting what ideas occurred to his mind while doing so. It then became clear to him that the face was, as it were, a^com- pogite photograph of the friend of the previous evening's conversation and oneofhis uncles, who had been unfortunate enough to jbme within the arm of the law. His father was in the habit of attributing this uncle's downfall not to wickedness but to weakmindedness. Consequently the dream purports to say that his frienjUl. is _wej&kminded or stupid, like his uncle. Further reflection brings to light the memory of a conversation with another colleague who had likewise been unsuccessfully nominated for professor, and who attributed his failure to an accusation brought against him by one of his patients. The courts had dismissed the charge as entirely unfounded and malicious, but the incident could not fail to injure his prospects. The meaning of the dream is now clear. The uncle represents just those two colleagues of Freud who had been unsuccessful in their nominations for professorships. By disingenuously insinuating that one of them is^ stupid and the other auniminal the dream clears the way for the success of Freud's FREUD'S THEORY OF DREAMS 43 own nomination, since on these assumptions the fact of his religion need not weigh against him. The dream represents the ivish that this might be~l the real state Of affairs a wish that Freud would I not for a moment entertain in the waking state or | even in manifest form in a dream. The tender affection experienced in the dream still needs explanation, since it is much more pro- nounced than that which Freud had ever felt t his uncle or for his friend. Reflection shows that it does not belong to the latent content. It is directly contrary to this content aji hiding the full sinificancesof t,hft from the di-fta-m^r hiaoif This indeed is its real purpose. By changing the appropriate feeling-tone of the latent content into its opposite the wish has succeeded in evading the censor and achieving its own dream-fulfilment. Other ways in which the latent content may disguise itself are by transferring the failing-tone from one part of the manifest content to another. by altering tne emphasis ol different elements in the manifest content, so that a prominent element corresponds To an unimportant part of the latent content, and conversely, and, above all, by the use of symbolism. This symbolism is, to some extent, different lor different persons, and also for different nationalities, since it partly depends upon the chance associations of experience and upon the similarities ot words representing ditterent objects. But some symbol* would seem to be common to the majority of people, especially in matters connected with eex. Sexual relations may be represented byi/ walking up and down stairs, by flying, or by journey- ing in a train or other vehicle. Entering into water 44 PSYCHOLOGY AND PSYCHOTHERAPY may symbolize, by opposites, the fact of birth. Hats and shoes in dreams often have reference to sex. Many other symbolisms are met with which are too obvious to need mention here. Freud records the case of a woman who dreamt that she saw her fifteen-year-old daughter lying dead in a box, in which psycho-analysis showed that the latent content of the dream was a wish dating fifteen years back that the child might die before it- was born. This is a good illustration, in Freud's , of the way in which wishes may persist for years in the unconscious rm infltif r>p [ fir 1 ^y T -**>* * ~~~ 's opinion a very large proportion of ie raprgsfjejj -wishes which realize ^themselves in the dream __pf adults nriprmfl.f,ft^ ii| (ff""ly ^ilHVinnH % They are also, he thinks, predominantly sexual in/ nature, the sexual mental life of the child beginning I much earlier than scientists have generally supposed. The sexual inclinations may find their earliest objects in the parents, and then undergo vigorous repression as the result of further development and education. These repressed wishes may show themselves later in dreams, or, when very strong and very firmly repressed, may give rise to more serious symptoms. The attraction is accompanied by feelings of hatred and jealousy towards the parent of the opposite sex. These are repressed in the same way and for the same reasons, and may in later life produce dreams of the death of the father or the mother, as the case may be. The legend of (Edipus, who unwittingly kills his own father, Laius, and marries his own mother, Jocasta, and, though guiltless in intent, pays the penalty for this unholy act, is a mythical represen- FREUD'S THEORY OF DREAMS 45 tation of this general tendency in human nature. Freud would explain the mystery of Hamlet in the same way. Hamlet is unable to take vengeance on the man who has supplanted and murdered his father because he himself in his early youth had wished his father's death. The wish has been vigorously repressed, and he is at present uncon- scious of it, but it still exists in his unconscious and produces the inhibitory effects depicted in the play. Freud considers that repressed wishes of this nature are the principal factor in the pfftdnntion of >all the psycho-neuroaes. If we "bear in mind that children's ideas of death are very vague and in most cases correspond simply to " permanent absence," the theory is not so outrageous as it might otherwise seem to be. The " naturalness " of family affection has undoubtedly been greatly exaggerated by earlier thinkers, and tfy^ passipns of hostility aroused within the family circlejare often very fierceT As the children grow up these feelings generally disappear and make way for the more conventional and intellectualized forms of sentiment, but deep down in the uncon- scious recesses of their souls persist the traces of earlier conflicts. It may be thought surprising that such an im- moral wish as that of death should ever succeed in passing the censor and attaining to a dream - fulfilment. Two facts sufficiently explain it. In the first place the wish is the last in the world that we should ever consciously entertain, and for this reason the censor is unprepared for its appearance. In the second place the wish-fulfilment is accom- panied in the dream by a feeling of intense sorrow which seems to receive a sufficient explanation in f\ c 46 PSYCHOLOGY AND PSYCHOTHERAPY the anxiety for the person's welfare which the dreamer has genuinely felt in more recent times, especially during the dream -day, and which might be expected to persist as a memory in the dream. The real source of the sorrow is the fact that the censor has been overpowered. These considerations suggest the probable ex- planation of all forms of anxiety dreams, which are accompanied by pain, and seem therefore in such flagrant contradiction to the wish theory. Freud writes : The anxiety dream only occurs when the censor is partly or entirely overpowered, and on the other hand the over- powering of the censor is facilitated when anxiety as an actual sensory experience is already given from bodily sources. It thus becomes evident to what end the censor exercises its function and brings about the distortion of dreams ; it does BO in order to guard against the development of anxiety or other forms of painful feeling (loc. cit. 185). And again in another passage (p. 163), distinguishing two types of anxiety dreams : On the one hand, the anxiety in the dreams may be a psychoneurotic one, springing from psycho -sexual excitations, where the anxiety corresponds to repressed libido. In this case the anxiety, and the entire anxiety dream, have the significance of a neurotic symptom, and we stand on the borderline, where the wish-fulfilling tendency of the dream Buffers shipwreck. In other anxiety dreams, however, the anxiety feeling is given in the bodily conditions (e.g. acci- dental difficulty in breathing, as in the cases of heart- and lung-patients), and then this feeling is made use of to help such energetically repressed wishes to a dream-fulfilment, the dreaming of which from psychical motives would have aroused the same anxiety feeling. I have quoted these passages in the author's words because they are so crucial for his whole theory FREUD'S THEORY OF DREAMS 47 both in its psychological and in its pathological aspects. For my own part, and on the basis of my own experiences, I find it very difficult to agree entirely with this explanation. It may not be special pleading, but it seems very much like it. Why this persistent and almost impertinent faithfulness to one idea ? Are not fears just as primitive as wishes and just as capable of repression without annihilation ? May we not broaden the basis of our explanatory system ? Freud has considered these and other possibilities, and on the basis of experience rejects them. But it is difficult to see how experience can force us to the wish-explanation when the huge class of anxiety dreams require such complications of the theory before they can be brought into line with the others. In this connexion I might mention a striking experience of fear-repression with persistence in the unconscious that happened to me some years ago. One day while out hunting I had two bad falls in rapid succession, but in the excitement of the chase felt none of the organic disturbances of fear, much to my own surprise. That night I dreamt of the entire hunt from start to finish, but with intense fear. My heart felt literally in my mouth the whole time. Even months later the feeling sometimes recurred at night, although during the day I felt nothing of it and did not find it interfere > with riding. Psycho-analysis showed nothing in the " latent content " to explain this fear. It is difficult to explain a dream of this kind in terms of wish-fulfilment, although the other part of the theory, the repression, is well illustrated by it. Freud's theory would fall much more completely into line with the views of modern psychology if SYCHOLOGY AND PSYCHOTHERAPY in it he replaced " wish " by " emotional or in- nf.innf.ivft |.findfir|cj,pa " Examples of such emotional tendencies are fear, anger, self-assertion, self-abase- ment, and disgust, and systems of ideas tinged by these emotions may be on occasion driven from the main consciousness into the unconscious and reappear, under certain conditions, in dreams. II. DREAM-SYNTHESIS. We have still to consider Freud's theory of dream- synthesis as distinguished from dream-analysis. Many different kinds of processes may be detected in the Traumarbeit, or dream-work. In the first place there are those processes of disguise adopted by the latent content which I have in outline already described. Secondly, there are the means which the dream-thought employs to represent those thought-relations, or relations of predication, which the manifest content cannot directly express in their real form. Logical connexion in general in the latent content is represented by simultaneity in the manifest content. The relation of causality may be represented either by a mere succession of dream images or by an observable transformation of one into another. In the first case the succession is often between one dream and the next. Similarity is jffprp^^d J?y unification, in the form eilner of identification or of a composite picture. These expressions of similarity often serve to represent a desired similarity. Relations are often represented in tne manifest content in a reversed form ; even in the succession representing causality the effect is frequently put before the cause. The explanation of this is, of course, the desire to evade the censor. FREUD'S THEORY OF DREAMS 49 Lack of clearness in the dream often represents actual uncertainty in the dream-thought. One of Freud's patients at first refused to relate her dream to him " because it was so indefinite and confused." Finally, after some persuasion, she said " that there were several persons present in the dream, herself, her husband, and her father, and that she didn't seem to know whether her husband was her father, or who her father really was, or something of that sort." The explanation was that she was expecting a child, and that her friends had been bothering her to know " who exactly the father was." Evi- & dently in such a case as this the lack of clearness is really a part of the dream-thought. There are two general characteristics of dreams which deserve special mention. One is " conden- sation " (Verdichtung), where, through appropriate \ '-J^ choice of material for the manifest content, the \ dream expresses the fulfilment of several wishes in I ^S A The manifest content 1 is a.R it were a nodal point or a number of nnfla.1 points from whicn important trains of agBO- ciatiqm foad in different directions to eventually reach and sustain a number of wish-fulfilments. Each part^of the manifest content JB.jojvjBTj^etgrjgiined, BO that "overdetermination" (Ueberdeterminierung) is simply the other aspect of condensation. The second characteristic is that of " displacement " v\^> ( ( Verschiebung), and has already been mentioned in another connexion. It consists in a shifting of emphasis or of psychical intensity from one part of the dream to another, " a transvaluation of all values " as Freud calls it, and produces a distortion of the dream which helps the repressed wish to evade the censor. 5 50 PSYCHOLOGY AND PSYCHOTHERAPY A tendency towards the rationalizing of the mani- fest content along lines different from those of the hidden wish-fulfilment may often be detected in a dream, and may also continue to exert an influence on it after waking. This is what Freud has named " secondary elaboration." and is, of course, the work of tfift ^">"rv The influence of the censor is""alsoto be seen in the tendency to forget one's dreams, which may even extend to the interpretation of them. One may wake up from a dream during the night, interpret it, and fall to sleep again, and find the next morning that both dream and inter- pretation are forgotten. A fact like this is sufficient to refute Dr. Morton Prince's criticism that the forgetting of dreams is simply a special instance of the forgetting of dissociated states of conscious- ness. The forgetting iff flft ffftt^ v ? pFooesa of re- pression similar to the repression which first drove the wish into the unconscious. All dreams, without exception, are egoigiip. They are the fulfilment of wishes of an entirely selfish nature. In dreams where the dreamer himself does not seem to be present, it will be found that he is represented by some other personage. If several of these are present the ego is to be identified, thinks Freud, with the one who carries the "jiffect." Professor Freud has worked out an elaborate psychological system to explain the phenomena of dreams and psychoneuroses, which I deal with more fully in the next chapter. Like many other psychologists, he regards the " psychical " as some- thing very much wider than the " conscious." Of (the latter he writes : " Consciousness appears to us to be a sort of sense-organ, which perceives a content given from elsewhere " (p. 101). This FREUD'S THEORY OF DREAMS 51 content, when not illuminated by consciousness, may yet persist as an unconscious psychical process. But Freud makes a new and important contribution to psychological theory in distinguishing between two kinds of unconscious ideas, to which he gives the names " preconscious " and " unconscious " re- spectively. Describing the mind as a sensori-motor system made up of subsidiary systems or " instances," he writes : The last of the systems at the motor end we call the " pro- conscious, 1 ' in order to indicate that the excitation processes talcing"* place within it can rise to consciousness without further hindrance, provided that certain conditions are fulfilled, e.g. the attainment of a certain intensity, a certain distribution of that function which is known as attention, and so forth. It is also the system which holds the key to voluntary movement. The system behind this we call the " unconscious,' 1 because it has no access to consciousness except through the preconscious, during which progress its excitation process necessarily undergoes alteration (p. 403). Put quite briefly, the distinction would seem to be one between repressed and unrepressed memories. The " unconscious " contains those tendencies ex- perienced, or at least existent, during our past life, especially during the early years of childhood, which have been energetically repressed, and the censor, which is the allegorical^ name for f|na raorftMinn is therefore situated between the unconscious and the preconscious. That is to say, the censor is itself unconscious (or preconscious), although at the time when the repression of the infantile tendencies first took place it may have been conscious. Freud also inclines to the view that there is some evidence for the existence of a second censor between the preconecious and the conscious. I 62 PSYCHOLOGY AND PSYCHOTHERAPY Now, it is the preconscious which furnishes the material of the " manifest content " of our dreams, and in it may be found not only wishes, but fears, anxieties, hopes, and all the other conative tendencies displayed by the mind. On the other hand, the unconscious contains wishes, and wishes only. These date from early childhood and are mainly sexual in nature, since few other wishes would have met with the vigorous repression necessary to drive them into the unconscious. Freud brings forward some interesting arguments in favour of this theory of the fundamental nature of wishing in early life. The wishes of the adult consciousness, even when repressed, are in Freud's view seldom intense enough to serve single-handed as the motive to the formation of any dream, and in most cases, if not in all, need the co-operation of unconscious infantile wishes. It is these latter which supply the requisite energy, although themselves remaining hidden until revealed by psycho-analysis. They transfer their psychical energy to corresponding elements in the preconscious, and so attain to a vicarious fulfilment. The only wish derived from the preconscious which is a primary constituent of any dream is the wish to continue sleeping, and this wish is an essential [part of every dream. It might perhaps be regarded as an infantile wish which has never been repressed and has never undergone modification in the course of mental development. III. OBJECTIONS MET. Before setting out Professor Freud's elaborate " Psychology of Dream Processes " as given in the concluding chapter of the Traumdeutung, and FREUD'S THEORY OF DREAMS 53 using it as the basis of criticism of his theory from the point of view of modern psychology, it will be well for us to consider two rather obvious objections which, if valid, would stultify the theory from the very outset. In the first place it may be contended that the memory for dreams, which is our only source of knowledge of them, is notoriously fallacious. Not only is it fragmentary, showing complete for- getfulness of whole stretches of the dream-experience, , but it falsifies those parts that are retained. If a person is asked to describe his dream at different periods after the actual dream-experience, the various accounts which he gives are found to be not only different, but even in many respects inconsistent with one another. He also feels very uncertain about the precise nature of the events described. Morton Prince regards this difficulty in remembering as merely a special instance of " amnesia for dis- sociated states of consciousness," and a proof that dream-experiences are nothing but such dissociated states brought about by the condition of sleep. But such an explanation can hardly be valid, since Freud and others have found that if they wake up from a dream in the course of the night, interpret it by their method, and then fall to sleep again, they are the next morning often unable to remember either the dream or its interpretation. Now, the interpretation is not a " dissociated state," so that Morton Prince's explanation here falls to the ground. . The true explanation in Freud's view is that the! forgetting is due to the action of the " censor,"/ which in such cases as these suppresses the memory] not only of the dream, but also of its interpretation .\ It is merely the oontJnmation in the waking state of that process of distortion and secondary elaboration 64 PSYCHOLOGY AND PSYCHOTHERAPY which we have seen to result from the activity of the censor throughout the dream-experience. And since the laws of these processes are known, the amnesia and falsification present no insuperable difficulty to analysis and interpretation. The frag- ments of the dream that remain in the memory are as a rule sufficient to give the clue to the under- lying dream-thoughts when submitted to the tech- nique of psycho-analysis. The feeling of uncertainty which the dreamer often has about the memory of his dream is also to be attributed to the_a,ction of the censor, and only by rigorously ignoring this feelingfanct treating all his memories as on. t.fre/ samf. level of reliability can he hope to _Q3GMCome the resistance suHJcieritrv^tO T)enetrfl.tft t,o ^iAa_ Atea/m - meaning. Freud has often found, in the case of his hysterical patients, that a dream which the patient has apparently quite forgotten may suddenly rise to memory in the course of a psycho-analysis where a resistance connected with the patient's symptoms has at last been overcome, showing most convincingly that the amnesia for the dream must have been due to a similar, if not the same, resist- ance. The second objection is aimed at the re- liability of the method of psycho-analysis. It is contended that a chain of free associations starting from any particular portion of the dream may end anywhere, and that then, when another portion is submitted to the same treatment, the associations are no longer completely " free," since they are to some extent, however slightly, determined and con- strained by the result of the previous association series. Consequently it is no wonder that in the final result the various chains of association are FREUD'S THEORY OF DREAMS 65 found all to converge to one and the same system of dream-thoughts. To this we may reply, firstly, that the inter- connexions discovered by this method between the manifest and the latent contents are far too complex and far too full of surprises, cross-connexions, and remarkable coincidences to be regarded as merely , the products of the method itself. But, secondly, the method is not with complete accuracy called one of free association. All associations without exception are dominated by some interest or purpose, and when the subject's voluntary and conscious purposes are allowed to fall into abeyance in the non-critical attitude adopted in psycho-analysis, . unconscious purposes take their place and guide the course of the ideas. It is because of this fact that psycho-analysis is able to give us an insight into the nature and structure of the unconscious. The other great method that has been found successful in the same task is that of hypnotism, but Freud's objections to hypnotism are that it is not sufficiently universal only a small proportion of patients are amenable to hypnotism and also that, although it overcomes some resistance and so widens the field of mental life open to observation, . it accentuates the resistances at the border of this I field and thus makes complete analysis of the un- t- conscious in any direction impossible. Dr. C. G. Jung, of Zurich, has supplemented Freud's method by employing lists of words, previously selected and arranged, and calling them out to the subject. The subject is told to reply to each as quickly as possible with the first word that comes into his mind. The times taken in replying the association-times as they are called are measured in fifths of a second 56 PSYCHOLOGY AND PSYCHOTHERAPY by means of a stop-watch, and are as valuable as the associations themselves in revealing the workings of the unconscious. Those words which strike on an unconscious emotional " complex " or system of ideas give prolonged association-times in hysterical patients as long as six or seven seconds instead of the normal one-and-a-fifth seconds. Sometimes the subject is quite unable to give any associated word. Such failure or difficulty in responding reveal the resistances to which the ideas in the unconscious are exposed. The ideas themselves can only rise to consciousness when these resistances have been completely overcome. The essence of Freud's dream-hypothesis from the purely theoretical point of view is his distinction of two kinds of mental mechanism, a primary and a secondary. It is the laws of the secondary mechanism that are given in ordinary text-books of psychology. Those of the primary mechanism are in some respects very different. They include the processes of .Con- densation, displacement, " drfl.iyn'ngr-nffi " ^f enprp-v or intensity from one idea to another, and finally regression,, which we snail describe in the next chapter. Freud claims to find the same processes active in cases of hysteria, and seems to regard his view of each of these two classes of facts as confirmatory of the other. All these processes, although psychical in nature, may occur indepen- dently of consciousness. Consciousness, in Freud's view, is merely a kind of sense-organ which does or does not perceive these psychical processes and products according to the distribution at the moment jof the mental energy which we call attention. This account of consciousness will hardly satisfy psycholo- gists, but many of them will be ready to admit the FREUD'S THEORY OF DREAMS 57 real existence of the unconscious in the Freudian sense, as well as of the preconscious. Many of Freud's difficulties are difficulties of terms rather than 61 facts. We may accept his facts and value them as new discoveries, while rejecting some of his terms and descriptions as misleading. The term " censor " corresponds to a verifiable fact, but the figurative use which Freud makes of it is not without danger. The censor is not an entity existing by itself and in its own right, nor is it really intelligible apart from all reference to consciousness, as Freud would have it to be ; and when he speaks of a second censor between the pre-conscious and con- sciousness, one feels a still greater difficulty in knowing exactly what meaning to attach to the word. Yet the term is useful as emphasizing the fact of repression, and for descriptive purposes is wellnigh indispensable. I CHAPTER IV FREUD'S THEORY OF THE UNCONSCIOUS FREUD summarizes his fundamental views as to the nature and laws of working of the human mind, which he has formed on the basis of a detailed study of dreams and functional diseases, in the final chapter of the Traumdeutung . In fact, no one who has failed to master this most difficult chapter can justly claim any real insight into the theoretical and psychological aspects of Freud's work. It is only here that the exact meanings of such con- ceptions as "wish-fulfilment" (Wunscherfiillung), "repression" (Verdrangung), and the "censor" (Zensur) are to be found, and the popular and figurative nature of much of the Freudian termin- ology is corrected. I shall therefore make this chapter the basis of my discussion. I. THE GENERAL LAWS OF MENTAL PROCESS. We have seen that dreams, like hysterical symp- toms, are regarded by Freud as being the disguised fulfilments of repressed wishes. The manifest con- tent of a dream is made up of a collection of memories from the waking life joined together by the most superficial forms of association. Organic sensations and other sensory disturbances occurring during sleep, if not sufficiently intense to produce awaken- ing, are either ignored or woven into the texture THEORY OF THE UNCONSCIOUS 59 of the dream by arousing corresponding memories after the manner of an illusion. The method of psycho-analysis, to which we shall refer again later, enables us to find a meaning for this dream-forma- ( tion in a set of latent dream -thoughts which are invariably of the nature of wish-fulfilments. Since, according to Freud, the repressed wishes to which hysterical symptoms likewise point are always derived from an infantile source, he is strongly inclined , to the view that the dream-wishes are also either I themselves infantile wishes or else wishes analogous i to and sustained by wishes dating from the period of early childhood. He admits that this view has not yet been conclusively proved, but contends that it cannot be disproved. A large proportion of the dream -interpretations hitherto made do, as a fact, point to infantile wishes as the underlying motive power. The discrepancy between the manifest dream- content and the latent dream-thoughts is due primarily to the resistance of the endopsychic censor. In order to evade this resistance and reach consciousness, the latent wishes undergo certain changes which may be summed up in the words " condensation," " displacement," " dramatization," and " secondary elaboration." In "condensation " the numerous dream-thoughts are replaced by a much smaller number of ideas selected because they act as nodal points in many intersecting trains of ideas and allude to these rather than directly represent them. " Displacement " refers to the shifting of psychic accent from one part to another of the manifest content whereby the direct corre- spondence between it and the latent content is masked. Affects may also be displaced to produce the same 60 PSYCHOLOGY AND PSYCHOTHERAPY result. " Dramatization," or regard for dramatic presentability (Rucksicht auf Darstellbarkeit), is pro- vided for by the important process of " regression," in which the dream-thoughts are reduced to their raw material, viz. sensory (chiefly visual) presenta- tions, of hallucinatory vividness. These three changes constitute what is known as the " dream- work," and are characteristic of a form of mental activity neglected by normal psychology and almost unknown to normal waking consciousness, but identical with that responsible for the symptoms of hysterical patients. The fourth change, " secon- dary elaboration," is a process akin to that of waking consciousness, being an attempt to rationalize these strange and perplexing dream-formations and knit *frtP W i* 1 * a storv r event with some degree of coherence. This process continues after the dreamer awakes, and is one of the causes of the falsification of his memory of the dream during the following day. Freud, in his attempt to form a general explana- tory system within which these various psychical processes may be co-ordinated and rendered intelli- gible, finds it convenient to approach the subject with a number of " auxiliary ideas " which, like auxiliary equations in mathematics, act as a sort of scaffolding in the discussion and are to be aban- doned or drastically modified later on, according to the needs of the argument. Borrowing from Fechner the idea of a difference of " psychic locality " in dream-formation, he conceives the mind as a system made up of a number of subsidiary systems placed in a definite order one behind another, so that mental activity will involve the excitation of these systems in a definite sequence. The spatial idea THEORY OF THE UNCONSCIOUS 61 is here used metaphorically and has no necessary relation to the neural changes underlying mental activity. The following diagram * sums up this first tentative hypothesis : Mem. Mem. Unc. Force P. represents the perceptual system, devoid of memory. Mem. is the system conserving the lasting traces of individual perceptions, in front of which are situated a series of other memory-systems, Mem', corresponding to the various forms of asso- ciation between these memories simultaneity, similarity, etc. and also, presumably, to higher thought-relations. Normal functioning of the psychical apparatus involves a transmission of excitation from the perceptual system in a progje- 1 dient direction through the various memory systems i to discharge itself eventually in motor innervation. r But Freud draws an important distinction between two classes of memories or unconscious processes, one of which (Force.) is in more immediate relation to movement (M.) than the other (Unc.). It is called the " preconscious " (das Vorbewusste) or foreconscious, and the other is the " unconscious " (das Unbewusste). Excitations in the preconscious can reach consciousness and pass over to movement so soon as they attain a certain degree of intensity and thus attract sufficient attention to themselves. Those in the unconscious can only reach conscious- ness and control of the motor system by passing 1 Traumdeuiung (Brill's translation), 429. * i 62 PSYCHOLOGY AND PSYCHOTHERAPY through the preconscious. In so doing they undergo certain changes. If, however, one inferred from this that, according to Freud, the preconscious is " the censor " (die Zensur) of the dream-theory, one would probably be wrong, for he distinctly refers to the latter as " the resistance watching on the boundary between the unconscious and the preconscious," l and in several other passages seems to make it clear that his conception of the censor is that of a " non- conscious resistance " situated between the two systems of the unconscious. There is also a second censor between the preconscious and consciousness. 2 For consciousness, in Freud's view, is to be regarded as simply a " sense-organ for the perception of psychic qualities, "3 and even ideas in the preconscious may, if objectionable, be denied entrance to con- sciousness. The various processes we have been hitherto describing, and in fact all those of which the mind is capable, are to be regarded as running their course independently of consciousness. The true function of consciousness will be revealed later, when we come to closer grip with the central problem of psychological explanation. We may, however, conveniently quote at this stage of our discussion the significant words of Freud on " unconscious psychical process : " " Everything con- scious has its preliminary step in the unconscious, whereas the unconscious may stop with this step and still claim full value as a psychic activity. Properly speaking, the unconscious is the real psychic ; its inner nature is just as unknown to us as the reality of the external world, and it is just as imperfectly re- ported to us through the data of consciousness as is * Op. cit., 430. Op. cit., 490. 3 Op. cit., 121, 453, 488. THEORY OF THE UNCONSCIOUS 63 the, external world through the indications of our sensory organs." * In this passage Freud is using the term " unconscious " in the wider sense sub- scribed to by many modern psychologists, but in his own conception of the unconscious, as distinguished from the preconscious, we have an entirely new contribution to psychological theory. Freud's un- conscious comprises the memories and mental processes of very early childhood, which have been repressed or abandoned in later life, but which still retain their power of indirectly influencing conscious- ness by transferring the energy at their disposal to analogous ideas repressed from the preconscious thus making these also unconscious. Before leaving this first approximation to an explanation of the working of the mind, we may use it to illustrate what is meant by " regression " in the Freudian system. Regression occurs when I the excitation within the psychical apparatus takes a regressive instead of a progressive direction. This L is, in Freud's view, the cause of the hallucinatory nature of dreams, and indeed of all hallucinations. Repelled 'toy the censor ana attracted by infantile wishes in the unconscious which transfer to them their energy, the latent dream-thoughts abandon the progressive path through the preconscious to- wards movement and consciousness, and pass back- wards through the various memory systems until they reach the perceptual system. The intensi- fication necessary for this penetration to the percep- tual system is mainly accounted for by the processes of condensation and displacement, although in the case of dreams the cessation of the progressive stream of excitation present in waking life is a contribu- 1 Op. tit., 486. 64 PSYCHOLOGY AND PSYCHOTHERAPY tory factor. In this way consciousness is aroused at the sensory end of the apparatus, and the dream has succeeded in evading the censor rather than surmounting it. The lowered activity of the censor during sleep, which Freud also assumes, only explains the formation of those few dreams which lack the dramatic character, and come to consciousness as thoughts, not as images. These pursue the pro- gressive course throughout. In regression, on the other hand, " the structure of the dream-thoughts is broken up into its raw materials," * and the thoughts are transformed into images. As an instance of a hysterical hallucination pro- duced by the same mechanism we may mention the case, given by Freud, of a twelve-year-old boy who was prevented from sleeping by a terrifying vision of green faces with red eyes. This hallucina- tion corresponded to a suppressed memory, dating four years back, of a boy companion who had taught him many bad habits, including onanism. The patient's mother had remarked at the time that this boy had an unhealthy greenish countenance and red-rimmed eyes, and warned her little son that such wicked boys become backward at school and die young. The explanations of hallucinations given in psy- chological text-books are for the most part physio- logical in nature and tend to slur over, if indeed they do not ignore, the problem of the " meaning " of the hallucination. Thus James a explains these phenomena in the following way : The sensory vividness of an actual percept is due to (or, rather, correlated with) the passage of afferent nerve currents ' Op. cit., 431. * Principles of Psychology, 1890, ii, 123, 124. THEORY OF THE UNCONSCIOUS 65 at high potential across the synapses of the sensory centre in the cerebral cortex. A mental image, on the other hand, lacks sensory vividness because it is due to the excitation of the sensory centre by nerve currents of low potential flowing along asso- ciation fibres from other parts of the cortex. While falling asleep, however, or under abnormal conditions in waking life, the synaptic resistances of the centre increase, so that the nerve-currents of low potential which are continually flowing to it along association paths can no longer pass through it and drain away into efferent fibres. The result is that nervous energy accumulates, the potential of the nerve-currents rises until it once more overcomes the synaptic resistance and produces an " explosive discharge " of the nerve-cells corresponding in intensity to that accompanying perception. Hence the subjective hallucinatory experience. This theory assumes an identity of physiological site for the percept and the corresponding mental image, whereas for Freud the P system and the Mem. system are quite distinct, since he considers that the former must be quite devoid of memory if it is to perform its functions adequately. Moreover, Freud does at least attempt to explain why certain mental contents are chosen to form an hallucination and not others. Those are selected which are recent and in themselves unimportant, since they have not had time or opportunity to enter into far-reaching associative 1 connexions in the preconscious, and therefore are suitable material to receive the " transference " (Uebertragung) of energy from desires in the uncon- scious. Their unimportance and superficial con- nexions with one another also protect them from the censorship. 6 66 PSYCHOLOGY AND PSYCHOTHERAPY The idea of regression is also to be found in McDougalFs explanation of hallucination. McDougall writes : " It is known that in many cases of hallu- cination there is chronic irritation of a sense-organ ; in cases of auditory hallucination, for example, it has sometimes been found that there is disease of the ear leading to continual irritation of the sensory neurones. We may suppose that disease induces an irritable weakness of a certain system of paths in one of the sensory areas of the cortex, so rendering them paths of abnormally low resistance, and that any impulses passing up from the corre- sponding sense-organ, and possibly also from other sense -organs, are therefore liable to be diverted to them from their normal paths, so re-exciting the chains of cortical neurones in their whole length, and producing a representation of sensory vividness." l In Freud's theory, however, such an " irritable weakness of a certain system of paths " would not in itself suffice to produce the hallucination without the aid of energy from the powerful wishes of the unconscious which also determines the exact form which it shall take. II. REPRESSION AND WISH-FULFILMENT. In attempting a more accurate statement of his theory, Freud attributes to his unconscious and preconscious systems two different kinds of psychical process, viz. a " primary process " and a " secondary process " respectively. The one fundamental differ- ence between these, which accounts for all the others, is that the secondary process is capable of " in- hibition," while the primary is not. The primary is 1 W. McDougall, Physiological Psychology, 86 (italics mine) THEORY OF THE UNCONSCIOUS 67 the primitive and infantile, although even in earliest childhood it is probably not entirely unaccompanied by at least the germs of the secondary process. Its activity is limited to that of " wishing," and it strives to satisfy desire solely by reviving the memories of previous satisfactions and by intensifying them to hallucinatory vividness. Since permanent satis- faction is not to be obtained in this way, the mind has had to develop a secondary process which treats the memory of a previous satisfaction not as an end in itself but merely as a means to a more roundabout process of reinstating the actual satisfying object, or one like it. The primary process strives after a " perception identity," the secondary after a " thought-identity." In both cases the motive power is a wish, since, as Freud says, " nothing but a wish can impel our psychic apparatus to activity." ' But Freud's fundamental explanatory principle is that of a Besetzungsenergie, or " occupation energy," which is subjected to different distributions within the psychic apparatus under different circumstances. Within the system of the unconscious this occupa- tion energy is capable of a complete displacement from one presentation to another, so that ultimately one or a few presentations, which may be regarded as representing the rest, become sufficiently intense to penetrate to the perceptual system of the psychic apparatus. This is, of course, the primary process of wish-fulfilment ; and the processes which we have hitherto classified under the heading of the " dream- work " are nothing but aspects of the primary process. It is the same process which is responsible for the 1 Op. cit., 447. This sentence indicates one fundamental weakness of Freud's system, since conations below the idea- tional level are, of course, motive forces of the mind. 68 PSYCHOLOGY AND PSYCHOTHERAPY symptoms of hysteria, where the effects of conden- sation (" identification " or " composition ") and regression are clearly visible. The distribution of " occupation energy " under the influence of the secondary process is quite a different one. Freud writes : " The manifold activity of the second system, tentatively sending forth and retracting energy, must on the one hand have full command over all memory material, but on the other hand it would be a superfluous expendi- ture for it to send to the individual mental paths large quantities of energy which would thus flow off to no purpose, diminishing the quantity available for the transformation of the outer world. In the interests of expediency I therefore postulate that the second system succeeds in maintaining the greater part of the occupation energy in a dormant state and in using but a small portion for the purposes of displacement." x This is what he calls regulation by the " principle of the smallest expediture of innervation " (Prinzip des kleinsten Innervationsauf- wandes). Another principle which is obeyed by both systems is the " principle of pain " (Unlustprinzip). This is simply the deviation of the psychic process from any memory involving pain. By virtue of it, " the first system is altogether incapable of introducing any- thing unpleasant into the mental associations. The system cannot do anything but wish." * Such a mere turning away from a painful memory is " the model and first example of ' psychic repression ' (Verdrangung)." The second system retains control over painful memories in the face of this principle by so " occupy- * Op. cit., 475. Op. cit., 476. THEORY OF THE UNCONSCIOUS 69 ing " them that the pain attaching to them which, like pleasure, is an efferent process analogous to a motor or secretory innervation is almost completely inhibited. Now, owing to the insufficient develop- ment of the secondary process in the first two or three years of childhood, the memories and wishes of this' period remain beyond control and inaccessible to the consciousness of later life. Some of these unconscious wishes are in conflict with the later wishes of the preconscious, so that their fulfilment would now produce pain instead of pleasure ; " and it is just this transformation of affect," says Freud, " that constitutes the nature of what we designate as ' repression,' in which we recognize the infantile first step of passing adverse sentence or of rejecting through reason." l An example of this transforma- tion of affect is the appearance of " disgust " at a cer- tain point in infantile development while previously absent. These unconscious infantile memories are the pre- condition of all later repression. They are able to transfer their energy to any neglected or suppressed thoughts of the preconscious whose content may happen to stand in some relation with their own. The preconscious then turns away from these thoughts of transference in accordance with the principle of pain, and thus they are, as it were, drawn into the unconscious. This deviation from thoughts "capitalized" by wishes in the unconscious is what is known as " repression." We thus see that "repression" (Verdrangung) is not quite the same thing as "suppression" (Unterdruckung), and has a definite technical meaning of its own in the Freudian system of psychology. 1 Op cit., 479. 70 PSYCHOLOGY AND PSYCHOTHERAPY The repressed thoughts originating from the pre- conscious are now strong enough to persist in an independent and unconscious existence of their own, but can only attain to consciousness, if at all, by pursuing a regressive course and reaching the perceptual system. This is the way in which hys- terical symptoms paralyses, anaesthesias, aphonias, tics, contractures, convulsions, phobias, etc. originate, although it appears that another universal condition of their production is that a counter-wish from the preconscious, generally of the nature of a self -punishment, should also be present and fulfilled by the same symptoms. Hysterical symptoms are thus to be regarded as " compromise-formations," satisfying as well as may be a wish from the pre- conscious and one or more wishes from the uncon- scious. The dreams of normal persons are exactly analogous to such symptoms, being a compromise between the wish to sleep of the preconscious, and unconscious wishes aroused during the previous day or in the course of the night. An essential part of Freud's theory of the psycho- neuroses is the view that " only sexual wish-feelings from the infantile life experience repression (emo- tional transformation) during the developmental period of childhood." ' These are partly autoerotic, and partly directed towards the parents, or their substitutes, and constitute the well-known " (Edipus complex " or " Electra complex," according to the sex. It is because they are capable of an organic reinforcement in later life, especially at the time of puberty, that they endanger the mental equilibrium as no other tendencies can do. As regards the dreams of normal persons, Freud prefers to leave 1 Op. cit., 480. THEORY OF THE UNCONSCIOUS 71 it undecided whether these are ultimately based upon sexual wishes of the unconscious. 1 Indeed, in some passages of the Traumdeutung, he definitely leans towards the view that tendencies like hunger, thirst, and the desire for power are fully competent to produce dreams without further aid from the unconscious. Anxiety dreami;, are certainly sexual in pignififininfiPi '* nnf ^ilwaya sn in origm. The feeling of anxiety is due to an overpowering of the second system by the first, and indicates a failure in that " compromise " to which we have already referred. Thus the function of compromise-forma- tions, such as dreams and hysterical symptoms, is to guard against the outbreak of anxiety. Freud illustrates this by reference to the case of agoraphobia. " Suppose a neurotic incapable of crossing the street alone, which we would justly call a ' symptom.' We attempt to remove this symptom by urging him to the action which he deems himself incapable of. The result will be an attack of anxiety, just as an attack of anxiety in the street has often been the cause of establishing an agoraphobia. We thus learn that the symptom had been constituted in order to guard against the outbreak of the anxiety. The phobia is thrown before the anxiety like a fortress on the frontier." * But in some cases the originating cause is the intense pain of certain organic sensations aroused during sleep, especially with people who suffer from disease of the heart or lungs. The anxiety thus somatically aroused gains a psychical interpretation in the dream by liberating uncon- scious wishes, the fulfilment of which in face of the censorship would be accompanied by a similar feeling of anguish. ' Cf p. 481. Op. cit., 459. III. PSYCHO-ANALYSIS AND " FEEE " ASSOCIATION. With regard to the use of " symbols " in dreams, it is only necessary for us, in the interests of theory, to point out that these are not products of dream- activity. The symbolizing tendency is already present in the latent dream- thoughts, and is identical with that responsible for our myths and legends. The predominant use which the dream makes of BUCh Symbols is d lift tf> tJlPJ TL jfl ram.fl.fi r\ fj t r\ paa and their freedom from the censorship. Although certain of these symbols" f endTto Tiave the same meaning among a whole class of individuals, it must never be forgotten that their significance in any single case can only be accurately determined by means of psycho-analysis. It is because Pierre Janet has failed to realize this that so much of his recent .criticism of the Freudian school is uncon- vincing. 1 Psycho-analysis is something more than a mere catechizing of the patient. Experience has shown that certain memories which are inaccessible under I. ordinary circumstances will rise to the surface of the mind if the patient adopts an attitude of uncritical meditation and follows the sequence of associated ideas as they appear, rejecting none of them, how- ever painful, objectionable, or absurd they may seem to be. In the case of dream-interpretation, the separate sections of the manifest content are taken as the independent starting-points for these chains of " free " associations ; in the case of a psycho-neurosis the symptoms serve the same pur- 1 P. Janet, " Psycho-analysis," Seventeenth International Congress of Medicine, London, 1913, Section xii., 13-64. See especially p 26 for the point here raised. THEORY OF THE UNCONSCIOUS 73 pose. It is important to realize that these chains of ideas are not truly free or aimless associations. When, by adopting the attitude of uncritical reverie, the patient succeeds in freeing himself from " consciously purposeful mental activity " (bekannte Zielvorstellungen), his mind does not cease to be purposive, but is now dominated by " unconscious trends of activity " (unbewusste Zielvorstellungen), which determine what ideas shall rise to consciousness. The ideas which in this way are eventually reached are found to allude to, if not to form an integral part of, a system of preconscious thoughts which had by transference been dragged into the uncon- scious and which constitute the interpretation of the dream or the psycho -neurotic symptom, as the case may be. The process of psycho-analysis, by bringing these thoughts once more under the control of the preconscious, ipso facto brings about the re- solution of the hysterical symptoms and the cure of the patient. It is in this sense that we are to take the dictum of Breuer and Freud that " solution and treatment go hand in hand." 1 The course of treatment is as a rule a lengthy one and makes considerable demands upon the tact and energy of the physician, since the trains of associations are being continually interrupted by " resistances " which the patient is unable to cope with single- handed, despite his best intentions, and it is only with the aid of penartent urging on the part of the physician that the hindrances are overcome and the ideasjjgain continue to flow. In order that the cure may be complete the patient must be able to live HBjfa through the intense emotions attached^ to the repressed ideas and direct them upon the person- 1 Op. cit., 83. 74 PSYCHOLOGY AND PSYCHOTHERAPY ality of the physician. This indispensable cathartic process is known as " abreaction " (Abreagierung). IV. WORD-ASSOCIATION METHOD. The well-known " word-association method " of C. G. Jung is very useful as an adjunct of psycho- analytic procedure, and in the case of some of the psychoses is the only suitable method. It serves to indicate the principal unconscious " complexes," i.e. systems of repressed and emotionally tinged ideas, from which the patient is suffering. The clearest and most frequent sign of the existence of such a complex is : ( 1 ) a prolonged reaction time ; but it should not be forgotten that there are other " com- plex-indicators " of equal importance. These are (2) a failure to react ; (3) an over-reaction, giving more than is asked for, many words, with supple- mentary explanations, instead of one ; (4) a repeti- tion of the stimulus word ; (5) an identical word-reaction to the most varied stimulus words ; (6) a superficial association, especially if combined with a prolonged association time ; (7) a meaningless reaction ; (8) an assimilation of the stimulus word, where it is misread, misunderstood, or taken in an unusual sense under the influence of the complex, being thus " assimilated " to the complex ; (9) a failure in reproduction, the patient giving a different reaction-word on a second presentation of the stimulus-word, although asked to reply if possible with the same word as before. The chief theoretical interest of Jung's work on / association is that he has succeeded in giving an experimental proof of the validity of the main assumptions upon which Freud's psycho-analytic technique is based. THEORY OF THE UNCONSCIOUS 75 A Case of Extensive Amnesia of Remote Date cured by Psycho -Analysis and Hypnosis. The following case illustrates the use of the word-association method, combined with hypnosis, in clearing up a hysterical loss of memory : On April 24, 1913, the patient, a man aged thirty- eight and married, was brought into King's College Hospital suffering from the effects of a fainting fit, which had followed upon the strain of giving evidence as plaintiff in a law suit. Dr. W. Aldren Turner examined him and came to the conclusion that he was suffering from functional amnesia or loss of memory, and invited me to undertake the further investigation of the case. The patient's history showed a series of lapses of consciousness on different occasions, following on periods of mental stress and entailing a dimness or slight loss of memory for events immediately preceding the attacks. 1. At the age of two and a half years he fell from a linen basket, carried by a nurse-girl on her head, upon the stone floor, with resultant bleeding at the mouth and concussion. 2. In 1893 (aged eighteen) he fainted in his office, and showed a slight loss of memory upon recovery. 3. In 1896 (aged twenty -one) he went down to stay with his prospective father-in-law at S , and was found in the bathroom unconscious. He was ill in bed for a week. His memory for this event was very vague. 4. In 1900 (aged twenty-five) his really serious loss of memory occurred. One evening towards the beginning of February while taking off his boots he suddenly became unconscious, and on regaining 76 PSYCHOLOGY AND PSYCHOTHERAPY consciousness it was found that he had entirely lost his memory for all the past events of his life since September, 1897, that is, for a period of two years and five months. During the two or three months just before this attack he had been greatly worried and overworked fighting the directors of a company of which he had been appointed manager. He was taken to a well-known nerve specialist, who advised rest and complete change of occupation, and up to the time of undergoing treatment from me during May, 1913, he had almost completely failed to recover any of these lost memories. When I saw him the last thing he could remember prior to his amnesic period was attending a friend's wedding in September, 1897. I interviewed his wife and mother, and obtained from them as full details as possible of his past history, and especially of the events occurring between September, 1897, and February, 1900. According to his wife's statement, this period of memory loss corresponded exactly with the time during which he had been concerned with the business scheme which had caused him so much worry those few months just preceding his loss of consciousness in February, 1900. As manager of a certain company, he had come into conflict with the directors, who were missionaries, mainly because of his disinclina- tion to mix business and religion. He was also especially antagonistic to a man, whom I will call X., who had been brought in as secretary, and waa continually interfering with his plans. Another man towards whom he felt intense aversion was the < managing director, Y., who towards the end threatened that he would have the patient's name " erased " from the door as manager. His wife THEORY OF THE UNCONSCIOUS 77 told me that this did eventually happen, just before his loss of consciousness in February. He was married in June, 1898, and lost his memory for this event with the others. When he loses consciousness he falls and remains unconscious for about half an hour. On coming to, he stretches and complains of cold, and later on goes to sleep. His father suffered from similar I attacks, and on one occasion was aphasic for an I hour. The patient on seeing me referred at once to the attack of 1896 as probably having something to do with his more serious attack of amnesia in 1900, and volunteered the information that he had been greatly worried just about that time by the serious business troubles of his father, which he explained to me in some detail. In his last attack in April, 1913, he had amnesia for the events of the previous two or three months, but this disappeared almost immediately. The history of the case suggested showed pretty clearly that it was one of hysteria, with occasional hysterical attacks. On the base of the results of a preliminary psycho-analysis I formed the theory that the lost memories included a worry complex which had become so disturbing that it was re- pressed that is, the mind turned mechanically away ' from it, taking advantage of the temporary lapse of consciousness to do so, or perhaps the worry itself joined forces with an innate or acquired cerebral feebleness to bring about both the unconsciousness and the amnesia. This complex had carried with it all other memories relating to the same period of the patient's life. If this unconscious complex could be once more 78 PSYCHOLOGY AND PSYCHOTHERAPY dragged up into consciousness, it would lose the power it at present had of disturbing the mind, and the patient would then be less liable to such attacks in the future, since at present the unconscious memories formed a centre of attraction, and tended to drag down later memories connected with worry of a business nature. Psycho-analysis, in the form of word-association tests, was tried for three days. All the association times were longer than normal (normal = one to two seconds), but some were especially so, being as long as twenty to thirty seconds. These were the associa- Itions given with the stimulus words that bore upon the submerged business worry. Only one or two vague memories were recovered by this means, but from a scientific point of view the results were interesting. On Wednesday, May 14th, I put the patient into the hypnoidal state (using a metronome), and gained the memories from September 1897 to Christmas 1897. On Friday, May 16th, I tried hypnosis. The patient lost consciousness in two minutes, and proceeded to give a detailed account of whatever part of the amnesic period I chose to ask him about. | His memories were in many cases charged with I strong emotion, and, as he himself remarked, they Useemed to be those of yesterday. After he had talked for three-quarters of an hour I gave him the post- hypnotic suggeston that, after waking up, when I should say to him, " Now, you remember all that you were describing to me in that chair just now, and will continue to remember them," he would remember them. I then woke him up, and he re- membered nothing of what had taken place during hypnosis ; but when, ten minutes later, I said the THEORY OF THE UNCONSCIOUS 79 words just quoted, he sat up in his chair, looked at me in a surprised and somewhat startled way, and remembered everything. On Saturday, May 17th, he still retained these memories, but now experienced a difficulty in realiz- ing that he had ever been without them. On Monday, May 19th, I psycho-analysed him with the same words that I had used previous to the hypnosis, and now got very different replies. The hypnosis had evidently broken down much of the previous resistance, but an interesting point was that this second psycho-analysis succeeded now in overcoming still other resistances, thus seeming to conflict with Freud's view that hypnotism, while overcoming some resistances, increases the stubborn- ness of those which it does not succeed in subduing. In the accompanying table (p. 80) are given a few selections from the psycho-analytic results obtained with " significant " words. Many other associations were equally significant, but for reasons of confidence cannot be quoted here. The results carry their own explanation with them, and confirm the theory which I had formed at the commencement of the treatment. The analysis of the patient's dreams pointed to the same con- clusion. The general impression that I gained while treating the case was that psycho-analysis prepared the patient's mind for hypnosis, and made the latter much easier of attainment than it otherwise would have been, and that a combined method of treat- ment, in this order, is far superior to the use of * either separately. The treatment seemed to do the patient good, quite apart from the actual recovery of his past memories. His mind had obviously gained in stability 80 PSYCHOLOGY AND PSYCHOTHERAPY o O 00 00 CM O CO O O O > i ^ j Xfi p had e worry o ; O 140 mm., and much more than one-half had a blood pressure > 130 mm. The normal blood pressure of a healthy man of about thirty years of age is generally given as 120 mm.- 130 mm. I correlated these blood pressures with the corresponding pulse-rates and obtained a zero correlation co-efficient. These results may possibly indicate a preliminary increase of adrenalin out- put in some of the severer cases of war neurosis. In like manner one might infer from the com- bination of tachycardia with fine tremors of the out- stretched hands found in so many cases a disturbance of thyroid secretion. In two or three cases I also noticed a tendency to exophthalmos and thyroid enlargement, but I was surprised at its rarity, in view of the emotional aetiology assigned to it in the text-books. The importance which Sir Frederick Mott has attributed to disturbances of the endocrine glands in the symptomatology of the war neuroses is likely to be more and more emphatically justified ai the THE PSYCHO-NEUROSES OF WAR H9 results of observations made by different observers in this field of research are accumulated and compared. The same holds good of Mott's views with regard to the role played by the physical manifestations of the emotions in determining the form which the war neuroses take. The far-reaching extent of the bodily changes, involving cardio-vascular and glan- dular activity in addition to that of the voluntary and involuntary musculature, explains the intract- ableness of so many of these cases, to which the diagnosis of hysteria in its ordinary sense would hardly apply. Nevertheless, if the originating cause was a mental disturbance, we may theoretically expect that psycho -therapy may help to readjust the balance once more even in such widespread physio- logical disturbances, and practical success, although slow and partial in many cases, seems to justify this expectation. After-histories of Patients Treated in the Field. I have a series of twenty -two completed after-histories of patients treated by me in France. I had used light hypnosis with all these cases, which were severe, and cleared up their amnesias and other pronounced hysterical symptoms (mutism, paralysis, spasmodic contractures, etc.) by this means. In only one of these cases did relapse or the appearance of other hysterical symptoms occur later on. This case suffered from deaf -mutism, with extensive amnesia following upon exposure to the explosion of a shell, all of which symptoms cleared up completely. He eventually reached a neurological hospital in the north of England suffering from weakness of the lower limbs. Mental analysis brought to light earlier pre-war mental shocks, and when these hacl 150 PSYCHOLOGY AND PSYCHOTHERAPY been talked out all functional symptoms completely disappeared. It was gratifying to find that fifteen of these cases (66 per cent.) eventually returned to duty. One of them had been buried in a dug-out and suffered from amnesia for the events of the accident, hypereesthesia of the right side of the neck corre- sponding to the second and third cervical areas, and fixation of the head owing to tonic contraction of the neck muscles. Another had fallen into a shell hole full of mud, and had been dragged out by traction on the left arm. Immediately thereafter his left arm became completely paralyzed, with anaesthesia, vasomotor disturbances, and exaggerated tendon reflexes. There was evidently organic trouble, due to traction on the brachial plexus, but this was overlaid by a con- siderable degree of " functional " disturbance. The patient was very easily hypnotized, and then lived through his painful experiences once more, showing some movement of the arm while doing so. This treatment, helped out by physical methods, produced a great improvement in his powers of movement and sensation during the following few days. Like the preceding case, this patient made a complete recovery in England and returned to duty. While working in a London hospital I saw a similar case of monoplegia which had not been treated before reaching England. The paralysis was still complete, and improvement under treat- ment took place much more slowly, although the final result was satisfactory. The general conclusion which I would draw from these cases, and from a few others whom I have my- self treated at Craiglockhart after having previously THE PSYCHO-NEUROSES OF WAR 151 had them as my patients in France, is that the early recall of submerged emotional memories by my method of modified light hypnosis not only removes the accompanying functional symptoms without danger of consequent relapse, but also greatly shortens the period of convalescence which these severe cases need before final discharge from hospital. If again subjected to great strain, no doubt these patients would succumb more quickly than they would have done had they not experienced their original shock. But this holds good of all methods. One does not need to work long in the field to dis- cover this fact. Twenty-one per cent, of my Cambrai cases had been in neurological hospitals (not my own) before. It should not be brought forward as a criticism of any method where severe nervous dis- orders are concerned. Mental Analysis: Autognosis. Patients seen at a late stage of their illness show the well-known fixation of symptoms so conspicuous by its absence at the front. But more serious than the symptoms themselves is the patient's state of mind. A distorted view of his illness has developed and has become linked up by numerous bonds of association with earlier emotional incidents of his life equally mis- understood by him. We have here to deal with the preoccupations of the neurasthenic rather than with the crude dissociation, or, as it were, mental care- lessness of the hysteric. The method to be employed is that of long per- suasive talks with the patient, such as Dejerine advo- cates, and Rows, Rivers, and others have adopted in England, in the course of which one enters into his past mental conflicts and worries, explains fully the 152 PSYCHOLOGY AND PSYCHOTHERAPY origin of his present symptoms, and helps him to Bee both the past and the present experiences in their right proportions. This analytic method aims at giving the patient a true insight into his mental condition, and I have therefore called it the method of autognosis. Hypnosis may often be used as a supplementary aid in the course of the analysis, to bring up earlier emotional experiences with the requisite vividness. Examples of the application of this method are only convincing if reported in full. I give full notes of two such cases in the following chapter. It is only needed for the more intractable chronic cases of war neurosis, when it may extend over months. In the majority of acute and subacute cases these prolonged analyses are certainly not necessary. Nevertheless it is the most complete of the purely psycho-therapeutic methods, and theoretically the other methods (exclusive of mere suggestion) might be regarded as abbreviations of it. CHAPTER X THE PSYCHO-NEUROSES OF WAR (III) THE following are full notes on three of my war cases, the first having been seen by me in France in 1916, the second and third in England in 1915. CASE I Total Loss of Memory. No. 2993. Private J. M , 6th Brigade, Machine Gun Company, A.I.F. Aged 32. Single. Seven months exposed to shell fire. Previous occu- pation : surveyor. This patient was admitted to No. 21 C.C.S. on the evening of December 5, 1916, with complete loss of memory. He was sent to me from a New Zealand Hospital with a card marked " Unidentified." He could speak, but was quite unable to give any account whatever of himself, and appeared to be in a dazed, almost stuporose, condition. I hypnotized him immediately, and reached a deep stage within one minute. I then obtained the following account (abbreviated) from him : " Was pushed out of a car by somebody who was drunk. Fell on the back of my head. Was stunned." Patient remembers being blown up by a shell. Came here in a car. Does not remember getting into the car, but remembers getting out here. Asked about his memories of earlier events, he says that, 153 154 PSYCHOLOGY AND PSYCHOTHERAPY when a boy, he lived in England and worked at lace-making. His address was : " King Street, Long Eaton, near Derby." He has three brothers and two sisters. He remembers his father, " Alf M ," who was an engine-driver. He now remembers that his own name is Jack M . Remembers going into the line at Factory Trench, near Flers. Was near Bapaume afterwards. He was blown up by a shell just inside the trench on the left-hand side. Was blown up, but does not remember losing consciousness. He was a surveyor in Sydney, N.S.W., and went to New Guinea just before the war. Patient was then brought out of the hypnotic sleep. Physical Examination. Plantar reflexes : flexor. K.J. + Arm reflexes, biceps and triceps, -f . Spas- ticity of limbs, and slight tendency to katatonia. Hypertonicity of leg muscles. Eyes normal. Tongue clean and steady. Pulse 68. Heart normal. Ab- dominal reflexes normal. No ankle clonus. Patient complains of acute pain at the back of the head. He was again hypnotized on the following day (December 6th) in the presence of Col. H. E. M. Douglas, V.C., R.A.M.C. I found that he was a very good hypnotic subject, and by appropriate suggestions I was able to produce rigidity and anaesthesia of the limbs, and visual hallucinations, e.g. of a bright red light, and of my photograph on a blank sheet of paper. I tested the latter hallucinations by showing him six blank cards, all apparently of identical size and appearance, except that one of them had two very faint and small crosses in pencil near opposite corners. I showed him these cards, and on showing the marked THE PSYCHO-NEUROSES OF WAR 155 card I suggested that it was a photograph of myself. He said that he could see it plainly, and that it was a good likeness. I then shuffled the cards together and asked him to pick out the photograph card, which he did immediately. Putting a bottle in his left hand, I suggested that he was unable to drop it, however hard he tried. He made vigorous efforts to extend hie fingers, but failed to relax his grip of the bottle, which was tightly clasped by the metacarpals and proximal phalanges. I then suggested that he was unable to get out of the chair, in spite of all his efforts. He made frantic efforts, strongly contracting the muscles which would have enabled him to get up, but at the same time contracting many of the opposing muscles equally vigorously, so that he merely writhed in the chair, without being able to get out of it. Before waking him up, I gave him the post- hypnotic suggestions that his headache would com- pletely disappear, that he would sleep soundly that night, and that at 3 p.m. that afternoon he would give the sister a cigarette for me. All these sugges- tions were carried out. At 3 p.m. the sister was not in the ward, so he gave the cigarette to the orderly to hand to me. On December llth I again hypnotized the patient, and tested his memory for events at different times of his life by suggesting that he would live again through the events of his birthday at the age of twelve years, six years, three years, two years, and also on the day when he was six months old. He gave vivid descriptions for all these dates, which I briefly summarize as follows : Twelve years old : Going to work at West End Mills. 156 PSYCHOLOGY AND PSYCHOTHERAPY His work is to strip mill of shuttles. Some one is throwing black lead about, and they are all laughing. It is now 8.30 a.m., and he is having bacon for breakfast, with Holbrooke's Sauce. He is now walking along with Jack Smith, who is thirteen years old. Now he is putting bobbins into the steam oven. Six years old : " Am going down the canal side, dodging school. Have my boots and stockings off and am sitting with my feet in the water." It is his birthday, March 7th, and a fine warm day. He had a handkerchief for a present. In the evening his mother found out that he had been playing truant and " took the stick " to him. He begged his mother not to tell his father what he had been doing. Three years old : " Am walking to school at Long Eaton. Started to go. to school two days before. Got rock sweets for a birthday present." He sees other little boys sewing handkerchiefs. He has learnt the first three letters of the alphabet. Two years old : " Mother is carrying me downstairs, and sits me in a chair." Has bread and bacon for breakfast, and falls asleep in the chair. On waking up, he sees his sister Annie (whom he calls " Ally "), who gives him sugar. Six months old : " I am crying. Mother is carrying me down a street, and hands me to another woman, who carries me for a bit and then gives me back to my mother." Ten years old: "I am in school, reading a Standard V book. The story I am reading is headed ' Robert in a Snow Storm.' ' Patient says he can see the page, and on being urged to read it, he reads : " Robert was a brave man, he thought not of THE PSYCHO-NEUROSES OF WAR 157 himself. ..." Patient then seemed to fall asleep (in hypnosis). On December 13th I hypnotized M again, in the presence of Lieut. -Colonel C. S. Myers, R.A.M.C., F.R.S. I then suggested that he was twelve years old (forgetting that I had fixed upon this date, among others, for the previous tests). Patient said : "I am getting up. ... Cooking bacon on the gas stove in the kitchen. Am now eating bacon. All the others are in bed. Time, 6 a.m. Am now going to work at the West End Mills. The work is to strip cotton out of the shuttles. I am laughing, and some one is throwing black lead about." It was then suggested that patient is in the trenches, at the time of his nervous shock. He says : " Shell flash ! Shell came on right side." He cannot at first remember his officer's name. Later on he says that it is Lieut. Lilley. " I am putting up my gun. A shell comes in on my right and kills one man and wounds four. I helped to pick them up. Another shell flash ! Two men are killed, Crisp and Upton are wounded. ... I am going into the dug-out to dismount the machine gun. Can smell gas. I go along the trench shouting Gas ! I remember coming out of the trenches, but was queer and had pains in my head." It was then suggested to the patient that he would see what happened to him after he left the trenches, and I thus got an incomplete account of his move- ments between then and the time of his admission to No. 21 C.C.S. The patient said : "I went on leave to Amiens the day after we came out of the trenches. . . . Had very little to drink in Amiens, only one or two beers. . . . About 7 p.m. tried to return to Melincourt by train, but found there were 158 PSYCHOLOGY AND PSYCHOTHERAPY no trains, so got into a motor lorry going to Albert." Picked up some jovial Australians on the way, one of whom pushed him out. He remembers falling on the right side of his head. His memories after this are confused, so, upon Colonel Myers's advice, I give him the post-hypnotic suggestion that he will remember everything that he has now recalled, when he wakes up. I then wake him up. The post- hypnotic suggestion proves to be successful, and the facial expression of the patient is noticed to be different, free from the bewildered look which he had previously had. Prior to this moment, the patient had had a very vague idea of his own personality during the normal waking state. On December 16th I again hypnotized him, and succeeded in filling up the gaps in his account of his accident. He was picked up from the road by a motor car and taken to Amiens, where he wandered about aimlessly, noticing that everybody in the street stared at him. He was eventually taken to the New Zealand Hospital, and then transferred to No. 21 C.C.S. On December 19th I evacuated him to the base, with his memory fully restored. I have tested in three other cases the greatly enhanced power of recall (so-called increase of memory) which is usually found in the hypnotized subject, and is illustrated by the above case, and have succeeded in reviving memories dating from the age of one month, six weeks, and two months respectively, as the earliest memories capable of recall. If one could obtain independent evidence of the objective validity of these memories, one might tentatively draw the conclusion from these cases THE PSYCHO-NEUROSES OF WAR 159 that the life of memory begins as early as the first month. CASE II Disordered Action of the Heart. Lance- Corporal W , 2nd Gordon Highlanders. Aged 31. Canadian. Weak heart irregular. Excitable. Very tremulous on first admission (May, 1915). Was in the firing line in France during October, 1914. Out of eighteen men of a section he was the only survivor. A close friend of his was shot by his side his head being blown clean off his body. He was under shell fire on October 23rd, and for hours after he could hear nothing else but the groans of wounded and dying men. Psycho-analysis. July, 1915. Patient gives a history of many frights. Aged 29 : He was engineer on the Grand Trunk Railway. Through a fireman falling asleep and the pumps breaking down, water in the boilers got too low. The strain of getting the pumps working again, with imminent risk of the boilers bursting, told on his nerves. Aged 27 : He was working in M 's Wood- working Factory, arranging for the cleaning of two boilers. He got into one at 12 p.m. after she had had 125 Ib. of steam at 6 p.m. He was in from twelve till two cleaning it out. It was exceedingly hot. Aged 11 : His younger brother fell against a toy wheelbarrow and damaged the bridge of his nose. His younger sister put 2 Ib. of steak on his face, and patient, not knowing of this, and coming into the room suddenly, on taking the bandage off got a serious fright, because he thought the steak was really his brother's face, and that his brother was dead. Aged 8 : His father returned from a drinking bout late at night drunk, and lined up the four children (patient was the eldest) and threatened to cut their throats. Aged 17 : Spanner incident originally an uncon- scious memory. He was an apprentice in an engine-room. When on night duty he was frightened repeatedly by a black- smith, who dressed up as a tramp with a long beard and slouch hat. On the first night he was so fright- ened that he took refuge between the shafts in the engine-room, and they had to stop the four engines to get him out. On the following night the engineer tied him to a plank, on which he was lying asleep, and he was again frightened by the blacksmith. After one or two nights of this, patient became desperate, and eventually seized a spanner and threw it at the blacksmith through a window and hit him on the top of the head. The blacksmith was in bed for three weeks from the injury. This incident preyed on the patient's mind for two or three years. In the course of this analysis it was a dream which the patient had which brought up the memory on the following day. He learnt from the other patients in the ward that he had shouted out in his sleep, " I will kill you with this spanner ! " He could not recall the dream itself. Aged 27 : During a thunderstorm at night, while walking to a window to shut it, a lightning flash passed by him. He was dazed and both his arms were benumbed. * THE PSYCHO-NEUROSES OF WAR 161 He cannot now go near a window during a thunder- storm. A thunderstorm here at Maghull brought up the memory and the phobia. Patient was first troubled with his heart in India in 1907, at the age of twenty-three, after an attack of malarial fever. He was very ill with his heart after that and was in hospital six weeks. Aged 15 : Had several terrifying experiences in connection with machinery. (M Coal Co.) Patient has always been of a worrying temperament. Since his marriage this has become intensified. His wife suffers from asthma. He had to work very hard when quite young, when ten years old, because his father drank. In the summer holidays he worked from 3 a.m. till 8 p.m. in a market-garden. Began engineering work at the age of fourteen years. Apparently he has a kind of " athlete's heart." Patient discharged in apparently normal condition after two months' psycho-analysis. He showed rapid improvement as the result of conversations in which the above facts became revealed. Prior to July 1915 he had received no psycho-analytic (" autognotic ") treatment in hospital, and had remained stationary in health for weeks. CASE III Auditory Hallucinations of Speech with Consequent Delusions of Supervision. Private B. S. R , aged 31, 2nd South Staffs. Ad- mitted August 6, 1915, with delusions of " supervision " by his family through telepathy. He heard the voices of members of his family upbraiding him, checking him when about to 12 162 PSYCHOLOGY AND PSYCHOTHERAPY do certain things, and telling him what to do. There were also delusions about other people, to be mentioned later. Patient was under- sized, had lost weight, had pronounced wrinkles of perplexity and depression on his forehead, and was continually twisting his hair between his fingers while being spoken to. History. In 1910 he attempted suicide by cutting his throat, because of a big upset at home. He was a bank clerk, and had just come home from three months' holiday at Brighton a holiday gained on the plea of ill-health. While at Brighton he had gone with a prostitute. This was his first and only offence of the kind, although for some years past he had smoked and drunk too much. After this holiday he was stationed at South Wales till October, 1910, when he returned home. Coming back in the train he was sick and vomited. When he reached home his family seemed to behave queerly towards him. Voices seemed to speak to him from the walls, imitating his brother's voice. While cleaning his teeth he heard words like " teeth," etc. coming from the wall. He was sent to a private asylum for some ten months, and then, after eight months in a colliery office in North Staffs, went to British Columbia. Here voices troubled him again, and he returned to England. At the outbreak of the war he enlisted in Kitchener's Army. When in France voices spoke to him while marching, saying " Give up ! " and similar words. He was transferred to an office at the base, but continued to have the same feelings of supervision and to hear voices. He was therefore sent back to England. Used to wear elevators in his boots, and to hope THE PSYCHO-NEUROSES OF WAR 163 that no accident would occur when he was wearing them. August Wth. Heard voices all day yesterday. They comment on his thoughts and actions. It is impossible to please them. Their supervision is too strict and severe. He always worried about being short (5 feet 4 inches). He was operated on for appendicitis at the age of eighteen. His parents used to come and try to cheer him up by saying that he would grow a great deal afterwards. The disappointment after this was, he thinks, too severe. While at the private asylum he thought he recog- nized a piano-tuner, who used to tune the piano at home, as one of the inmates. He also heard his voice. This piano-tuner came from Brighton, and patient thought he was connected with the affair of the prostitute. August 2,4th. Voices continue and seem to answer his thoughts. E.g., when he starts taking his spectacles off, an imitation of the voice of one of his sisters says, " Take your spectacles off." The voice comes sometimes before, sometimes after, his decision has been made or his thought completed. These voices, ho thinks, belong to a secret society, a secret police. The piano-tuner was sent by them to the asylum to make an example of him. Patient has heard his voice continually since. Before 1910 (about 1909), a younger sister with spinal curvation fell ill of scarlet fever and was very ill one night. The nurse had lost the needle of her hypodermic syringe, and patient brought down his own needle which he had bought some time before for photographic (sic /) work, as a mere whim. The sister died some months later. Patient 164 PSYCHOLOGY AND PSYCHOTHERAPY now worries that the voices might persecute his other sister (a nurse) over this. He thinks the " secret police " employed the woman at Brighton to bring a young fool like him to book. Voices repeat his thoughts, translate his thoughts into words. Fellow patients here seem to change their appear- ance from day to day, and to resemble people he knows. He thinks the voices are now supervising him because he never got his legal discharge from the previous private asylum where he was. He went to British Columbia in 1912. While chopping wood there a voice (of the piano-tuner) said, " Be careful ! " He was later deported as an undesirable. (Betrayed, he thinks now, by the Canadian doctor whom he consulted.) Patient thinks that the voices told the authorities and brought this about. Referred to a pocket-dictionary meaning of tran- substantiation. 1 September 1 5th. Complains of Government super- 1 While in his tent, in British Columbia, one night he began to shiver, and a voice (piano-tuner) said, " It is alcohol which produced it." Patient then commenced to go over his past life, in thought, and protested within himself that he had kept clear of alcohol and women for many years. The voice then said : " Simply say, ' Kathie come.' " Patient repeated these words, and then seemed to change in shape into the body of his dead sister Kathie (referred to in the text). Patient went to see the doctor next morning about this. The latter must have reported it to the authorities, who sent him to an asylum for a few days, and then shipped him to England. The word " transubstantiatiou " came up to his mind in this connection. THE PSYCHO-NEUROSES OF WAR 165 vision. The adjutant at Boulogne, where he was doing clerical work, spoke with the voice of hia brother-in-law I and of his family doctor. September 23rd. Hears voices very rarely now. Haa recently heard imitations of the voices of his eldest sister and of a patient in the private asylum, where he was previously. On one occasion, when he was thinking about something, his sister's voice seemed to say, " Of course it is," commenting on his thought. Patient now agrees that the voices arc imaginary. Patient thinks people can read his thoughts. Once the adjutant said, " Tut ! tut !" in his brother- in-law's voice, in answer to his thoughts. The voices distract his thoughts and ruin his work. The hearing of voices began after he returned from South Wales in the October of 1910. He was at Brighton in the preceding May, when he was led astray by the prostitute. Patient doesn't think he worried about the Brighton escapade during this interval, but tended to attribute the phenomena to it afterwards in order to get an explanation of them. He says, " It was that, or else his getting his holiday on apparently false pretences." 2 October 5th. Patient says that he no longer hears the voices, and that he wants to go out of hospital. The last distinct voice heard was on September 23rd. 1 Brother-in-law is husband of patient's eldest sister a doctor. Patient only hears his voice when supervision gets very intense. The doctor never upbraided him, and spoke always very rationally and tolerantly about liis Brighton escapade and his attempted suicide. Patient dreams very little, and can never remember his dreams. * Patient was ordered three months' holiday from hia bank work by the doctor, because of hia ill-health. At that time 166 PSYCHOLOGY AND PSYCHOTHERAPY While watching the sunset, in the grounds, a voice like the voice of his eldest sister said, " Stay till finish." " Neither need you." He never obeys the voices except when he chooses to do the same thing on his own account. October IQth. No more voices. Patient has given up the idea of supervision. He is very much stronger and better in every way. His forehead is still rather wrinkled, but he is not so depressed. November llth. Returned from one week's pass, greatly improved in health. No voices. December 8th. No voices. Patient quite recovered. In good physical health. Patient asks, " What shall I do, sir, if the voices return ? " He unreservedly accepts the explanation of his hallucinations and delusions which I have been giving him throughout the treatment (" autognosis "). Voices come to patient from the outside, but are not localized by him. He explains this by saying that he always avoided attending to the voices as far as he possibly could, since they distracted him so. Treatment- The patient was treated by the autog- nostic method throughout. All his past memories and experiences were arranged and explained to him in their true light. It was explained to him that the voices really came from within, and were a self-reproach for the Brighton affair. [Thoughts of the voices now always bring up, and always have brought up, thoughts of this Brighton episode.] When strongly under the influence of self-reproach ho was in poor health, nervous, depressed, and unequal to his work. His brother tells me that when a child he was somewhat reserved and different from the other boys. He was greatly upset by the death of his sister Kathie. THE PSYCHO-NEUROSES OF WAR 167 he attempted suicide, and then later the delusion of supervision became grafted on to the memory of this mad deed. Later on the various delusions began to show signs of systematization. By vigorous argument and persuasion week by week I succeeded in arresting this systematization process, and in explaining away the various voices and delusions. PART V-MIND AND BRAIN CHAPTER XI RELATION OF MIND TO BRAIN : PSYCHICAL RESEARCH IT is well known that consciousness is related directly to only a very small part of the human organism indeed, it is related directly to only a very small part of the brain, the cerebral cortex. At least, until quite recently it was considered that conscious- ness was related only to this very small part of the brain. Recently, however, Dr. Henry Head has brought forward evidence which tends to show that certain kinds of consciousness are related to certain of the so-called sub-cortical centres, masses of brain matter, cells and fibres, cells predominating, in the optic thalamus and the corpus striatum below the cortex. In any case, we can say that there is only a very small part indeed of the body that is directly related to consciousness. And how is it related to consciousness ? Investiga- tions in cerebral localization have shown us that sensory powers and motor powers are linked up with definite parts of the cortex. The occipital area the part at the back of the head mediates visual sensations ; consciousness involving sound is bound up with changes in the temporal cortex at the side of the head ; consciousness of cutaneous sensation is linked up with changes in the post- central convolution, etc. Further, these various m RELATION OF MIND TO BRAIN 169 sensory centres are linked up with the sense-organs of the opposite side of the body. And similarly with the various movements. Voluntary initiation of movement seems to be linked up with definite systems of nerve cells in the pre-central convolution. The localization is very detailed there, and these centres are linked up with muscles on the opposite side of the body. For taste and smell sensations the localization is not so definitely determined. Feeling-tone and emotion are correlated with changes in the optic thalamus. I. PSYCHO-PHYSICAL MATERIALISM. Starting on this basis we have three possible theories of the relation of consciousness to the brain, and so eventually to the body. One theory is the theory of psycho-physical materialism or automatism. According to this theory the changes in the brain are the causes of different kinds of consciousness. A change which occurs in the occipital cortex causes visual sensation, a change which occurs in the temporal cortex causes auditory sensation, a change in the pre-central convolution causes consciousness of volitional movement, etc. The brain change comes first in every case, the change in consciousness comes second. There is a definite causal relation, always in one direction, from matter to mind or spirit. Consciousness, according to this theory, might be regarded as a sort of phosphorescence playing over the nerves of the brain. . . . Many people in the last generation would have considered a theory like this the obvious theory, would have thought that it fitted in best with the facts of natural science which we had been able 170 PSYCHOLOGY AND PSYCHOTHERAPY to collect. As we study the evolution of the brain from lower organisms to higher, we find that it becomes more and more complicated, especially the cerebral cortex, and this would correspond to an evolution of consciousness. Consciousness is a sort of by-product of the development of cerebral activity. All activity is really physiological activity. There is no such thing as mental activity this is an illusion. When we seem to be active, our cerebral cortex is active one way or other, and this produces in us a feeling of activity. But, on this hypothesis, intellectual activity would be illusory, and consequently all the products of intellectual activity, one of which is this theory of psycho-physical materialism, would be illusory also, eo that the theory is refuted by itself. This should be a sufficient argument to dismiss psycho-physical materialism, but I should like to refer to one or two other arguments brought against it, because they come into our discussion of other parts of the subject. If we explain consciousness in terms of brain change we are also explaining intellectual processes, which are a part of conscious- ness, in this way. That is to say, we are explaining consciousness in terms of something which needs consciousness for its explanation. If you consider the theories of specialists in the various sciences, you will find that they all go back to the employ- ment of certain concepts to the formation and use of certain thought-systems so that the structure of the various sciences is dependent on the nature and power of the intellect. But it is really an absurdity to try to explain the intellect in terms of that which needs the intellect for its explanation. A third argument against this theory is an argu- RELATION OF MIND TO BRAIN 171 ment from the causal relation which it assumes. The theory postulates that brain process produces the various forms of consciousness, and yet this consciousness, when it is produced, has no further effect upon the brain it is simply thrown off from the brain from moment to moment. These gleams of consciousness that are thrown off fade and make way for others. . . . Thus a sequence of mental changes are produced by physiological change, but when produced these do not go on to produce any- thing else. If, however, you consider the working of causation in any of the other sciences, you will find that every effect in its turn becomes a cause. If anything is produced by anything else, it in its turn becomes a cause producing something else. If I push this glass of water off the desk, my act is the cause, the effect is falling glass. This in its turn becomes a cause and produces a smashing noise, which is the effect of the fall, the noise produces some other effect, and so on there is a continual chain of causation. But according to psycho- physical materialism this does not happen with consciousness. As soon as a conscious state is produced it disappears and is followed by another, produced by another physiological change. II. PSYCHO-PHYSICAL PARALLELISM. We come now to an attempt to get over these difficulties without giving up the belief in the efficacy of brain change and the importance of brain change in every phase and at every moment of conscious life. The theory of psycho-physical materialism does not need much elaboration to become a theory which seems more philosophical, viz. that of psycho- 172 PSYCHOLOGY AND PSYCHOTHERAPY physical parallelism. If we say that mental processes, instead of being produced by processes in the cortex, are merely additional properties of these processes, we seem to get over the causal difficulty. We may assert, for example, that change in the occipital cortex, instead of producing vision, is so complex that it carries with it as a part of its nature the consciousness of the object, that is to say, no change of that degree of complexity can occur in my occipital cortex without at the same time having as one of its properties the consciousness of a visual sensation and so with other parts of the brain. Thus, if we represent consciousness by Greek letters and changes in the cortex by English letters, then, according to psycho-physical materialism, A produces a and also B, B produces ft and also C, and so on ; but a does not produce ft, nor ft, y, etc. These are simply thrown off by the physiological activity. According to the theory of psycho-physical parallel- ism, on the other hand, A carries with it essentially and necessarily the further characteristic a, the psychological process. A-a is one entity, and can go on to produce B-/3 ; B-/? goes on to produce C-y, and so on. In that way you get over the difficulty of transeunt causation between the physical and the psychical. One does not cause the other they are two sides of the same thing. There are many difficulties in the way of this theory. One is that, whereas the physical part of the cerebral cortex is continuous with the rest of the body and so with the physical universe, the psychical side is limited. Only certain parts of the brain are connected with consciousness, yet the psychical is capable of representing the whole world the world of art, literature, etc. ; the part RELATION OF MIND TO BRAIN 173 mirrors the whole. You have linked up conscious- ness with a very small part of your own body, linked it up with it in a very intimate way by making it a property of certain physiological changes, and then you go on to say that consciousness is capable of knowing the whole world. This seems an exceed- ingly improbable theory, and one which we could hardly accept unless we were forced to do so by very convincing evidence. An attempt has been made to make the theory more philosophical by making it a form of a general system of Idealism. According to this form of psycho- physical parallelism the reality is consciousness. These conscious processes constitute the reality. The brain processes with which they are linked up are not something additional, but are the way in which one consciousness appears to another. At the present moment you cannot look into my mind, but you could conceivably look into my brain. If my skull were opened and a special apparatus were invented by means of which my cerebral cortex became visible under a very powerful microscope, conceivably you could see my cerebral cortex working. Nevertheless, you would not be seeing what I see you would not see my consciousness, say, of this light and this green lamp-shade, at which I am look- ing, you would simply see movements of molecules in my occipital cortex. There are not two things present, my consciousness and the changes in the cerebral cortex, but the former appears to you under the form of the latter. And so, according to this theory of psycho-physical idealism, the consciousness of any person is the reality of his cerebral cortex. But if this is so, what becomes of the reality of the est of his brain and of the rest of his body ? Accord- 174 PSYCHOLOGY AND PSYCHOTHERAPY ing to this theory, the consciousness corresponding to that is a wider consciousness it is the consciousness of the whole universe. The whole physical universe is in its reality mental, spiritual. It obeys certain laws, the Law of the Conservation of Energy, etc., and is differentiated into a number of centres conscious individuals within an All-inclusive Consciousness, which corresponds to the entire physical universe. The consciousness of men and animals are related to the Absolute Consciousness just in the same way as the cerebral cortex in man and in the animals is related to the rest of their body and to the rest of the physical world. This is the theory of Psycho-physical Idealism. It is more satisfying than parallelism, but it involves grave assumptions, and, in a way, wipes out all possibility of survival after death, for we know that the brain disintegrates at death, and, if conscious- ness is related to certain changes in the brain, we may assume that the individual consciousness comes to an end when the brain dies. This theory is becoming more and more unsatis- factory, even to those who were once most enthusiastic in its support. III. PSYCHO-PHYSICAL INTERACTIONISM. We come next to the theory of interaction a theory held by people of all nations at all stages of history. The mind is distinct from the brain ; the brain is the organ of the mind ; the two interact with one another. In our more passive states the brain acts on the mind ; in our more active aspects of consciousness it is the mind that acts on the brain. When I will to move my arm, my mind ia RELATION OF MIND TO BRAIN 175 acting on the motor centre of my brain, producing a change there, and this is conducted down the nerve fibres to the muscles of my arm, and my arm moves. In the earlier form of the theory it was thought that all nerve fibres converged to one point in the brain, which was the seat of the soul. Descartes thought that the pineal gland, which was the only unpaired organ he knew of, was the seat of the soul. Later research has, of course, shown that there is no one point where all fibres meet, so that a soul cannot come into relation with a brain at any one point. Lotze got over this difficulty by saying that the soul is where it acts in the occipital cortex, temporal cortex, and so on. . . . This theory has not been very popular with philosophers, because it assumes interaction between two orders of existences that are so very different from one another, i.e. interaction between matter and mind. According to the ordinary views of the nature of matter and mind which have been handed down to us, matter is extended in space ; mind, on the other hand, is not extended, is not in space ; in fact, roughly speaking, we hold the view that : " What is mind ? No matter ! What is matter ? Never mind ! " We have so divided up the universe into matter and mind that the two are mutually exclusive. The one has just those properties which the other does not possess. But if you take that view of matter and mind you will have a very serious difficulty in bringing the two together at all, and if you believe that the one can act upon the other, and try to think this out, you will find it very difficult to do so. I will ask you to consider this question in the light of the ordinary views of mind and matter. Change in my occipital cortex can only be thought 176 PSYCHOLOGY AND PSYCHOTHERAPY of as a form of matter in motion. However advanced you may be as a physicist in your view of the nature of matter and of material change, you will find that you are thinking of something absolutely different from the visual sensation which the experiencing individual will have at the moment. However you envisage the changes in my cortex, as material they will be absolutely different from the consciousness I have, for instance, of this green lamp-shade. There seems to be no resemblance between the two, so that if you say that the one produces the other, you are saying something that may perhaps be accepted as a statement, but that cannot be thought out. If you consider the theories about the physical world in any of the sciences, you will find that the theories about any subject-matter are of such a nature that the mind can pass smoothly and easily from one thing to another. In Physics, for example, if you are considering any change that occurs, say the heat that is generated when a mass of metal is rubbed against another mass of metal (suppose I take a brass button and rub it on this desk the button becomes hot), Physics will enable your mind to pass from the one phenomenon to the other quite easily and smoothly, for Physics says that matter is made up of small particles which oscillate about a mean position, and the heat of the button will correspond to the frequency or the amplitude of the oscillations. If you rub the button against the desk you increase the molecular emotion and the particles vibrate at a greater rate or with greater amplitude. Thus the mind passes from one fact to the other, and can thus use the causal concept, for there are quantitative relations between cause and effect. But in a causal relation between physical RELATION OF MIND TO BRAIN 177 and psychical you have nothing of that sort. You have simply a sort of pre-established harmony. You cannot show that certain physical changes must produce certain mental changes. Another objection to the theory is that the Principle of the Conservation of Energy is violated. According to this principle the sum-total of energy in the universe is constant whatever changes may occur in it. If, however, physical changes in the brain can act on the mind and produce mental changes, you will have loss of energy from the physical system, and again, at the moment of an exertion of the will, energy will pass from the mind into the brain. But it has been pointed out as regards this objection, that the principle is merely a generalization of a statement about finite and closed systems. What has been definitely proved is that if you take a finite and closed system, sur- rounded by non-conducting walls, then, if you assume changes to go on inside such a chamber, whatever the changes may be, you will find at the end, if you measure the total amount of energy inside, that the amount of energy will be the same as at the beginning, if no energy has passed in or out through the walls. If you generalize this, you simply get the result that all finite and closed systems obey the Principle of the Conservation of Energy. You can extend this result to the whole physical universe, if that is a finite and closed system. But, as Professor Ward has pointed out, we have no right to make the assumption that the whole physical universe is a finite and closed system, and, if it is not, this principle does not apply to the whole universe, and therefore does not invalidate our argument for psycho-physical interaction. 13 178 PSYCHOLOGY AND PSYCHOTHERAPY These are the two main arguments against psycho- physical interaction, taking " matter " and " spirit " in their usual connotations. The arguments in favour of interaction are many. One is the argument from the character of the unity of consciousness. Consciousness is a unity ; on the other hand, the cerebral cortex, which is in direct relation with consciousness, is not by any manner of means a unity, and it is difficult to imagine the changes occurring in different parts of the cortex ever producing a consciousness which is a unity, or being the other aspect of a unitary consciousness. You can only explain the compounding of the multiplicity of changes in the different parts of the cortex if you believe in a unitary soul. (Lotze's argument.) Two forces can combine their results to produce a unitary result, but only if they meet at a point. If you use what is called the parallelogram of forces as an illustration you need a point of psycho - physical interaction, and this point is given you in the unity of the soul, although there is no unity on the physical side. (The parallelist, however, would say that there is a unity of the brain too. But we have to remember that only a small part of the brain is in direct relation to consciousness.) Another argument for interaction is the argu- ment from the biological principle of utility. Con- sciousness would only have evolved if it had been of use to the organism, for : Nothing has evolved which has not been of use to the organism ; conscious- ness has evolved ; therefore we may assume that consciousness has been of use to the organism, and we cannot conceive how this can be the case without the hypothesis of interaction. For, if consciousness RELATION OF MIND TO BRAIN 179 is only the other side of brain activity, it is difficult to see how it can have been of use. This is an objection to psycho-physical materialism, but not so much to psycho-physical parallelism. It is not an objection to psycho-physical idealism, because there the reality is the consciousness, only this has different degrees of intensity and has collected, as it were, around different centres of unity. Thus this argument from biological utility is not particularly helpful to psycho-physical interaction. IV. BERGSON'S THEORY OF INTERACTION. I come now to a different kind of theory altogether. Those which I have been describing are theories which have taken our ordinary concepts of matter and mind at their face value, and have tried to bring the two together. Bergson, an extremely acute thinker, has devoted an entire book (Matter and Memory) to this question of the relation of mind to brain, and has dealt with it in a new way. He has first asked himself the question, What exactly is matter and what is mind ? Of course, philosophers had asked themselves that question before, but Bergson tries to start from a psychological point of view. He realizes that the basis of our knowledge of the material world is perception, and BO he starts his inquiry by an investigation into the nature of perception and gives us a theory of perception before he passes on to the theory of the psycho-physical relation. Instead of accepting the view that the universe is neither coloured, nor sounding, nor having any of the characteristics of sense, and that the mind has all these characteristics, he holds the view that matter has all the properties 180 PSYCHOLOGY AND PSYCHOTHERAPY we see in it. The only difference between matter as we see it and matter as it is in itself is that we see only a small part it is a difference of part and whole. The nervous system is built up of sensory and motor fibres with a view to reaction, to adaptation to environment, and the sense-organs play a part in that. They receive stimuli from outside and produce reaction. We see any particular object as it is, but we do not see all of it, we only see just those characteristics to which we can react. When I look at this lamp-shade I get certain visual sensa- tions. I see that the shade is green ; it has the tactile properties I should find if I stretched out and touched it. They are not produced through the interaction between the object and my mind, nor through the interaction between the changes in my cerebral cortex, aroused by the stimulus, and my mind. I see the object as it is, because my nervous system is so built that I am able to react to whatever comes within the scope of my vision. In what is called " pure " perception, which is a moment of experience, the nervous system serves to put us in direct relationship with any particular object we are perceiving. We see in the object itself just that part of it to which we can react, so that pure perception is virtually action it ie the reflection, as it were, of the object in ourselves, the reflection of our power of action upon the object. The object possesses many other characteristics, but our body is not developed enough to enable us to react to them, and so we are not aware of them. Changes are not first produced by the object in our organs of sense and then brought to the cerebral cortex, where further changes produce awareness of the object, but our mind is in direct relation RELATION OF MIND TO BRAIN 181 with the object through a physical system. It is not that the cortical system acts on our mind and produces consciousness of the object (that is the theory of representation). When we see the object we do not see it through a veil of representation, we see it as it is. But, Bergson says, in ordinary perception we have something more than pure per- ception. Pure perception is a moment of experience, but actually perception takes some time at least, for what happens is that memory comes into play and we summate a number of rapidly successive views of the object in our consciousness. Memory is of the nature of spirit ; perception in itself is physical l it is simply a physical way of bringing physical bodies into relation with my body and so with my mind but memories are a part of the mind itself. In ordinary perception memory comes into play, so that one gets more than perception one gets a sort of cinematograph summation of instantaneous views of the object. Thus what science proves to us to be rapid vibrations seem to us to be, say, a colour. This lamp-shade seems to me to be green because my memory has summated a whole number of rapid vibrations which physical science proves constitute the colour. If my mind could be so slowed down that it could count the successive vibrations, I should see the shade as a series of vibrations, which is more like what the phy- sicist says it is. This summation of vibrations results 1 But pure perception is also conscious perception, because of the indetermination involved in perceptual reaction to the environment, as compared with the fixed and inevitable response which occurs in spinal reflex action. Its conscious- ness is a measure of freedom of choice of alternative modes of motor response. 182 PSYCHOLOGY AND PSYCHOTHERAPY from the action of memory. Theoretically, however, pure perception is absolutely distinct from memory. " Pure " memory is absolutely unconscious. What we call memories are memories on their way to perception. In all the parts of our consciousness, so far as they are conscious, earlier memories come in and find a connection with the same motor system which is a continuation of our present perception. Our present perception is a continuous process, passing over into physical reaction to the object. Our conscious life is a result of the working of that perception, together with unconscious memories which insert themselves into the series of motor reactions which serve for our perceptual activity. Those memories come to the surface at any moment which fit in with the motor prolongation of our present perceptual experience. According to this theory the brain is merely a motor organ. It has sensory centres as well as motor centres, but they are all linked up with the physical environment, and the mind is something distinct but not different from the brain. The reason why the two matter and mind seem so different and why it is so difficult to relate them to one another is that we have not done full justice to either. Matter, we have said, is ex- tended in space. It has no intensity, no energy, but is quantitative only. We have given all the other, qualitative, properties to mind. The same qualities, Bergson says, are in both. You can bridge the gap between the quantity of matter and the quality of mind if you adopt the theory of a difference of tension, of rhythm or rate of moving, between matter and mind. Our minds move at a certain rhythm, a rhythm which condenses thousands of millions of vibrations into a single moment, and RELATION OF MIND TO BRAIN 183 this is why in a single psychological moment we see colour instead of seeing vibrations. Bergson says that both we and the physicist are right, and if we could slow down our mental process, so that the vibrations were separate one from another, we should see them as vibrations. The colour would gradually become more and more " diluted," though it would never disappear completely. There is a transition between the objects of physical science and psychical sensations the difference is a differ- ence of degree, not of kind. " Pure " memory is not directly related to the brain ; there are no memory centres in the brain. Bergson has various arguments to bring forward in support of this contention : Firstly, if we believe that memory is lodged in the brain, the theory we should hold would be that perceptions, when they occur, leave traces in the brain which, when re-excited, produce corresponding memories. But he points out, as psychologists have noticed again and again, that the power of perception in a certain sphere can be lost though the corresponding memories remain, and the power of memory can be lost while the perceptions remain. Again, he points out the great distinction of pure memory from rote memory, which he identifies with habit. In learning a lesson by heart, we build up a motor mechanism having all the marks of a habit. " Like a habit, it is acquired by the repetition of the same effort. Like a habit, it demands first a decomposition and then a recomposition of the whole action. Lastly, like every habitual bodily exercise, it is stored up in a mechanism which is set in motion as a whole by an initial impulse, in a closed system of automatic movements which 184 PSYCHOLOGY AND PSYCHOTHERAPY succeed each other in the same order and, together, take the same length of time. The memory of each several reading, on the contrary, the second or the third for instance, has none of the marks of a habit. Its image was necessarily imprinted at once on the memory, since the other readings form, by their very definition, other recollections. It is like an event in my life : its essence is to bear a date, and consequently to be unable to occur again." (Matter and Memory, pp. 89, 90.) This distinction is absolutely essential for Bergson's theory of memory. Corresponding to it he finds two distinct kinds of recognition, one entirely me- chanical, based on the working of pre-formed motor mechanisms, the other starting from memories, among which the mind places itself by an act sui generis, at a bound, and working back to the perceptual and motor plane of the present. Cases of " mental blindness," or loss of the power of recogni- tion, whether visual or auditory, are not due to a real loss of the corresponding memories, but to injury or obstruction of the motor mechanisms which give these memories the opportunity of being realized as supplementary parts of an actual percep- tion. The facts of psycho-pathology, especially those of aphasia in all its forms, seem to support this view. Bergson's view, then, is that memory is spirit, and that all our memories remain in our mind from the earliest times, as a series in time, although in a condition of complete interpenetration, the character- istic of each memory being its particular date it occurs at one moment and not at another, and those we use come up because of their relationship to our present needs. There is no such thing as a real loss of memory resulting from brain lesion ; RELATION OF MIND TO BRAIN 185 a pathological change in the brain simply prevents the memories from actualizing themselves. Memories are unconscious, but if the motor mechanism of the brain is excited they may come to the mind as conscious memory. If the mechanism is out of order, then the memories cannot come to the surface. This does not mean that they are lost, but simply that they are in abeyance they are there from the beginning of time. V. HYPNOTISM AND PSYCHICAL RESEARCH : SURVIVAL OP BODILY DEATH. I come now to a number of facts which seem to bear out his theory that memory is there from the earliest times. It has recently been observed in a large number of cases of loss of memory following on shock that these memories can be brought back quickly and completely by the use of hypnosis. If we go further and put the patient into a deep hypnotic state, we can bring up memories from any part of his life, if he is a satisfactory subject. We can make him go back to his various birthdays, which were definite moments in his life. We can make him go back as early as his first year, and can get him to go back again and again and find that the same memories come up on successive occasions. The question may now be asked, how far definite facts of this kind throw light upon the survival of the mind after the death of the body. If we accepted the theories of psycho-physical parallelism or of automatism we should be inclined to put aside all evidence for continued existence of the mind as fallacious. But if we adopt the theory of psycho- physical interaction, at any rate the door is left 186 PSYCHOLOGY AND PSYCHOTHERAPY open to us and we feel that there is nothing on that side to hinder us, as long as our facts are reliable and are gained in a reliable way. Of course, for a long time now the Society for Psychical Research and people working independently of that Society have been bringing forward fact after fact, system after system, in favour of the continued exist- ence of mind after death. I would call your atten- tion to that system of " cross-correspondence " that was thought to be observed many years ago in regard to messages supposed to be coming from discarnate intelligences to human organisms. The difficulty of demonstrating the mental origin of such messages is due to the existence of the alternative theory of telepathy. Telepathy is the power that one mind has of acting upon another mind otherwise than through the medium of the senses. Many people have denied the existence of telepathy. It docs not always occur when it is expected or hoped for, and you have to take each case on its own merits ; but if you do that you find that there is an enormous mass of evidence for telepathy one incarnate mind acting on another incarnate mind. In hypnosis telepathy is increased, and quite astound- ing results are sometimes obtained. But this theory may be used to explain a great deal that might previously have been explained in terms of the action of outside spirits upon the body. This system of cross-correspondence, for instance, was thought to have been devised by F. W. H. Myers after his death to give evidence to which the argument of telepathy would not apply . . It was given to people in two different parts of the world. Mutilated messages were coming through to Mrs. Holland in India, whilst a lady in Cambridge was also getting RELATION OF MIND TO BRAIN 187 mutilated messages, and it was found that when put together these messages made definite sense, and seemed to be a message coming from (I believe) F. W. H. Myers at any rate from some one who had passed over. This method seems to be admirably adapted to prove the existence of outside intelligences without telepathy coming into play, as neither of the people in question had any knowledge of the real message, so that one could not have passed it on to the other by telepathy. The criticism one could bring against this is, firstly, that there might be some third person living who was thinking some message, different parts of which might go to two different people. This objection, of course, is rather trivial. Another objection is that one can easily over-estimate the coherence of these messages. They seem to fit together, but what they actually state is not very much, and it may be by mere chance that two such mutilated messages when brought together seem to make sense. If you take any two mutilated messages and bring them together you will find that they make more sense than each one does by itself. This is the sort of objection that would carry some weight. The facts, however, are innumerable, and these facts claim to prove the continued existence of mind after death. What I wish to do is to emphasize the truth that many facts of this kind can be ex- plained in other ways. You have to be prepared to discount such facts in the light of pathological psychology. If, for instance, you hypnotize a good patient, and then suggest to him that he will see something that is going on a long way off, you will find that he will seem to see what is happening, say, at home. He will see it as a dream, perhaps, but the 188 PSYCHOLOGY AND PSYCHOTHERAPY peculiarity of the dream will be that it goes on at the ordinary rate of experience (not very rapidly, as we conceive our dreams to do). He will see, say, his wife at the wash-tub, sewing, in the kitchen will see her sit down and write a letter, and he will be able to read the letter she has written. He will be able to go about from room to room of the house and will seem to see everything, and at the end, when he wakes up, he will say that he is quite certain that he has been at home. You can do that with dozens of patients. You might say that it is just a matter of telepathy. If it is telepathy, we should presume that there was telepathy between the individual and, say, his wife ; but you must note that he also sees things going on in other parts of the house, where his wife is not, and this might lead you to make the further hypothesis that it is an external spirit which helps the individual to see what is going on. But it must be noted that these results do not always correspond with what is actually taking place. Now and then one does get coincidences, but in quite a large number of cases one finds that what the patient sees is something which has not happened at all, something which could not have been happening at that time, and which has no relation to anything that the person thought about was doing, or might have been doing. One feels forced to believe that, in most of the instances, the patient's mind has become so suggestible that the thought, say, of home brings up automatically certain characteristics of his home, and then the mind improvises as it goes along, and goes along at a definite rate. If one finds certain correspondences afterwards, if these are few and are not characterized RELATION OF MIND TO BRAIN 189 by any special incident, they must be held to be contradicted by the other facts which do not corre- spond. Note the proviso, however, for it is very important. You may find that when the patient sees what actually does occur he is in a much more excited state and feels much more convinced of the genuineness of his experience than when he does not see what actually occurs. This should be noted if it occurs. As far as I can discover, there is not much evidence of this kind. Taking all these cases as on the same level, one may say that they are simply false percepts due to suggestion. Such facts at any rate show how careful we need to be, for, after all, a lot of the work of mediums is simply the result of what seems to come to them automatically, either by word of mouth or through automatic writing, and it is quite conceivable that the medium may be in a state where suggestion works automatically and where the mind improvises. Automatic writing, for instance, will often bring up memories from earlier life that cannot be restored in other ways. Dr. Morton Prince has described the case of a girl who was very frightened of cats. He hypnotized her very deeply in order to try to get back the original memory which would explain why she feared cats, but he failed to do so. But when he put a pencil into her hand, the hand auto- matically wrote a detailed account of a fright she had had as a young child, when a white kitten had had a fit in her arms. Such cases are common in this rather shadowy land of the occult. We can bring back memories from the earlier life of a hypno- tized subject, and such memories are often extremely accurate and seem to bear out Bergeon's view. But other memories are not BO accurate. I remember 190 PSYCHOLOGY AND PSYCHOTHERAPY one patient I had who described his christening with great detail. The padre, however, made inde- pendent inquiries and had the register looked up, and it was found that he had been christened much later than he thought (viz. when he was two or three years old, and not when he was six months old, as he declared), so that this particular bit of evidence fell to the ground. It was simply imagina- tion. Again, one of my patients was supposed to see some one related to me, when he was in a hypnotic trance. He gave me a very circumstantial account of the scene he could see them on the pier at Brighton could see this, that and the other. My corporal took down the account. I knew, however, that it was not true, and later on it came out that it was a memory of a time the patient himself had once spent at Brighton. You will find instances of this sort occurring again and again. In mentioning these facts I do not want to cast any doubt on the results of scientific investigations into spiritism I have no right to do that I merely wish to sound a note of caution, to suggest that all this borders very closely on the realm of pathological psychology, and that in such investigations you need to be quite sure that the mind concerned is a normal one and for this you need to make investigations of other kinds. I do not say that all mediums are pathological cases, but in any case it is obvious that the medium should be investigated from that point of view, and that people who are not educated in pathological psychology are not likely to be such reliable witnesses as people who have made investigations along this line. You really need, it seems to me, to have stored in your minds a lot of facts of pathological psychology, so RELATION OF MIND TO BRAIN 191 that you can discount any possibility of this kind. But when one reads the literature relating to these facts, however anxious one is to be convinced of the evidence for continued existence and no one could be more anxious for this than I am one feels that one can never be quite convinced unless one can see the case for oneself, for one does not find sufficient details to be quite sure that the states described are not simply pathological mental states, rather than something that is completely normal. BOOKS OF REFERENCE BERGSON, H. : Matter and Memory. English Translation, 1911. BREUER and FKEUD : Studien iiber Hysterie. Dritte Auflage, 1916. DEJERINE and GAUCKLER. : Psychoneuroses and Psychotherapy. 2nd English Edition, 1913. FREUD, S. : Vorleaungen zur Einfuhrung in die Psychoanalyse, Zweite Auflage, 1918. Traumdeutung. Fiinfte Auflage, 1919. HEAD, H. : Studies in Neurology. 1920. JANET, P. : Lea Medications Psychologiques. 1919. JUNO, C. G. : Analytical Psychology. 2nd Edition, 1917. McDouoALL, W. : Introduction to Social Psychology. 15th Edition, 1920. Psychology. (Home University Library.) MILLER, H. C., and others : Functional Nerve Disease, 1920. MOTT, SIR FREDERICK : War Neuroses, 1919. MYERS, C. S. : Textbook of Experimental Psychology. 2nd Edition, 1911. PRINCE, MORTON : The Unconscious. 1914. RIBOT, TH. : Psychologic des Sentiments. Essai sur lea Passions. RIVERS, W. H. R. : Instinct and the Unconscious. 1920. SHAND, A. F. : The Foundations of Character. 2nd Edition, 1920. TURNER, W. A., and STEWART, T. G. : A Textbook of Nervous Diseases. 1910. WARD, J. : Psychological Principles. 1919. SUBJECT INDEX Abreaction, 8, 21, 74, 100, 112, 115, 117, 125, 147 Abreagierung, 74 Absolute consciousness, 174 Acquisition, 91 Admiration, 92 Affect, 36, 50, 59, 69, 113 After histories, 149 Agoraphobia, 71 Amnesia, 4, 53, 75, 99, 123, 137, 145 Anesthesia, 2, 3, 26, 92 Anger, 90 Anonymous emotions, 91 Anxiety dreams, 46 ; hysteria, 35; states, 12, 36, 116 Aphasia, 184 Aspiration, 91 Association, 1, 37, 49 ; " Free," 54, 66, 72; times, 78 Astasia abasia, 86 Attention, 51, 61, 83 Autognosis, 102, 111, 116, 122, 151 Automatic writing, 30, 189 Automatism, 169 Auxiliary ideas, 60 B.C.A., 28 Besetzungsenergie, 67, 84 Brain, 168 Blood -pressure, 148 Censor, 41, 51, 53, 57, 58, 62 Co-conscious, 25 Complexes, 74 Compromise formations, 36, 70 Compulsion neuroses, 2, 35, 96, 108 Conations, 67 Conative tendencies, 52 Condensation, 49, 56, 59, 70 Consciousness, 56, 62 Conservation of Energy, 174, 177 Construction, 91 Conversion hysteria, 83 Cross correspondence, 186 Curiosity, 90 Deaf mutes, 128 Deafness, 99, 137 Death, 185 Defence hysterias, 100 Delayed onset of symptoms, 141 Dementia prsecox, 108 Diathesis, 94 Discharge, 65 Disgust, 69, 90 Disorientation, 17 Displacement, 49, 56, 59 Dispositions, 92 Dissociation, 1, 2, 4, 24, 34, 125, 139 Distractivity, 127 Doris Fischer, 34 Drainage theory, 85 Draining off, 56 Dramatization, 59 Dream analysis, 37, 104 ; con- tent, 59 ; day, 38 ; syn- thesis, 48; thought, 40, 59, 64 ; work, 41, 48, 60, 67 Dreams, 9, 37, 58, 103, 123 Elaboration, 50, 59 Alan vital, 13 Elation, 91 Electra complex, 70 Emotion, 7, 12, 87, 100, 125, 132 Emotional revival, 112 Endocrine glands, 148 Endopsychic censor, 41 Energy, 12, 56, 66, 67, 83, 174, 177 Equivalents, 127 Explosive discharge, 65 14 193 194 PSYCHOLOGY AND PSYCHOTHERAPY Fear, 30, 47, 90, 99, 105, 119, 122, 125, 144 Ferenczi's theory, 15 Fixation, 23, 119 Fixed idea, 94 Flight, 90 Freudian cases, 102 ; school, 10; theory, 10. Freud's theory of dreams, 37 ; hysteria, 20 ; instinct, 95 ; the unconscious, 58 General Laws of Mental Pro- cess, 58 Gregarious instinct, 91 Habit, 183 Hallucinations, 64, 138, 161 Hallucinatory vividness, 7, 60, 67, 114, 116, 126, 129 Hate, 93 Hemiplegia, 120, 141, 142 Hypnoidal state, 78 Hypnosis, 5, 75, 83, 133 ; light, 99, 112, 124, 131, 133, 145, 149 Hypnotic analysis, 17 Hypnotism, 5, 15, 55, 101, 185 Hysteria, 2, 5, 11, 24, 27, 35, 66, 83, 96, 100, 108, 118, 131 Idealism, 173 Imitation, 91 Impulse, 87, 90, 91, 95, 107 Inhibition, 66, 84 Innate dispositions, 88 Inner vat ion, 68, 86 Insomnia, 131, 147 " Instances," 51 Instinct, 87, 90, 95 Intellect, 116, 170 Interaction, 174, 179 Intuition, 103 James- Lange theory, 88, 112 Jealousy, 94 Joy, 91, 95 Jung, theory of, 13 Latent content, 37, 40, 59 Libido, 12, 13, 46, 107, 108, 110, 115 Love, 92 Manifest content, 37, 40, 49, 52, 59 Masochism, 11, 96, 104 Memory, 182 ; loss of, 6, 9, 27, 75, 99, 112, 140, 145, 153; "pure," 182 Mental analysis, 100, 133, 151 ; blindness, 184 ; diathesis, 94; disposition, 114; syn- thesis, 8 Mind, 168 Multiple personality, 27 Mutism, 11, 120, 123, 137 Narcissism, 108 Negative self-feeling, 90 Neurasthenia, 2, 34, 118, 131 Neurokyme, 85 Neurosis, 2, 35, 96 Occupation energy, 67 (Epidus complex, 44, 70, 105, 107 Optic thalamus, 169 Organic sensations, 88 Organlust, 96 Over-determination, 49 Pain, 46, 68, 91 ; principle of, 68 Paralysis, 4, 26, 99 Paranoia, 108 Paraphrenia, 108 Paraplegia, 138 Parental instincts, 91 Passions, 93 Pathos, 91 Perception, 179, 181 ; identity, 67; "pure," 181 Persuasion, 100, 119, 133, 134, 151 Phantasy, 107 Physiological theories, 83 Pineal gland, 175 Pity, 91 Pleasure, 91, 96 SUBJECT INDEX 195 Positive self-feeling, 91 Preconscious, 51, 61 Preoccupation, 35 Primary process, 66 Primitive credulity, 17 Psychasthenia, 2, 24, 118, 129 Psychic accent, 59 ; locality, 60 ; repression, 68 Psychical diaphragm, 26 ; Re- search, 168, 185 Psycho-analysis, 14, 15, 40, 54, 72, 75, 103; -catharsis, 8, 74, 98, 100, 103, 111 ; -neuroses, 2, 13, 70, 98, 118, 133, 153; -pathology, 1 ; -physical idealism, 174 ; physical interactionism, 174; -physical materialism, 169 ; -physical parallelism, 171; -synthesis, 99, 111; -therapy, 98 Psychoses, 2 Pugnacity, 90 Reaction formation, 35 Reason, pure, 89 Re-association, 98, 117 Redintegration, 99, 146 Regression, 13, 56, 60, 63, 107 Repentance, 91 Repression, 9, 11, 58, 66, 69, 84, 104, 117 Reproach, 91 Repulsion, 90, 93 Resistance, 73, 79, 104 Retention hysterias, 100 Sadism, 11, 96, 104 Sally Beauchamp, 28 Second state, 99 Secondary elaboration, 50, 59 ; process, 66 Self-abasement, 90 ; -assertion, 91 ; -display, 91 ; -feeling, 90 ; -regarding sentiment, 95 ; -reproach, 35 Sentiment, 92 Sexual instinct, 91 ; theory, 10 Sorrow, 91, 95 Spirit, 184 Spiritism, 190 Stammering, 128 Sthenic emotion, 120 132 Subconscious, 25 Subject-object relationship, 113 Subjection, 90 Sublimation, 12, 81, 96 Subliminal, 25 Suggestibility, 17, 81 Suggestion, 91, 100, 101, 108, 111 Suggestivity, 127 Suppression, 69 Supra-liminal, 26 Survival of bodily death, 185 Symbolism, 43, 72 Sympathy, 91, 97 Telepathy, 186 Temperament, 94 Tender emotion, 91 Terror, 136 Theory, Drainage (McDougall), 85 ; Ferenczi's, 51 ; Freud- ian, 10 ; James-Lange, 88, 112, 113; Janet's, 24; of Dejerine, 35, 120, 144; of dreams (Freud), 37 ; of emotion, 87 ; of hysteria (Freud), 29 ; of instinct (Freud), 95 ; of interaction (Bergson), 179; of Jung, 13 ; of memory (Berg- son), 117; of neurasthenia (Dejerine), 35 ; of Psycho- physical Idealism, 174 ; of Psycho physical interaction- ism, 174 ; of Psycho-physi- cal Materialism, 169 ; of Psycho-physical Parallelism, 171 ; of reciprocal innerva- tion (Sherrington), 86 ; of suggestion (Babinski), 120, 140 ; of the unconscious (Freud) 58 ; Physiological, 83 ; Sexual (Freud), 10 Thought identity, 67 Trance, 136 Transference, 65, 81, 107 ; neu- roses, 96, 108 Traumarbeit, 41, 48 Traumdeuiung, 41, 52, 58, 61, 71 Treatment, 111, 118, 123 Trieb, 95 Ueberdeterminierung, 49 Uebertragung, 65, 108 Unbewusste, das, 61 Unconscious, 26, 51, 58, 61, 63 Unlustprinzip, 68 Unterdruckung, 69 Values, 49, 89, 116 Verdichtung, 49 Verdrangung, 58, 68 Vicarious fulfilment, 52 Volition, 95 Vorbevmsate, das, 61 Wish (Freudian), 67 Wish-fulfilment, 58, 66 Wonder, 90 Word-association method, 74 Wunscherfiillung, 58 Zensur, 58, 62 INDEX OF NAMES Babinski, 120, 140 Bergson, 13, 117, 179, 181-185, 189 Breuer, 8, 9, 12, 73, 100 Charcot, 4, 6, 83, 127, 139 Dejerine, 35, 120, 144, 151 Descartes, 175 Fechner, 60 Ferenczi, 15, 16, 81, 82 Freud, 8ff., 21, 26, 29, 35 ff., 95 ff., 100, 104 ff., 108 ff., 115, 122, 125, 145 Head, 168 James, 64, 88, 95 Janet, 3, 4, 6, 8, 9, 15, 14, 24, 29, 36, 72, 81, 126, 127 Jung, 13, 14, 15, 55, 74 Lange, 88 Lotzo, 175, 178 McDougall, 66, 84 ff., 90, 95, 97, 101, 102, 108, 114, 115, 145 Mitchell, 34 Morton Prince, 25, 28 ff., 50, 53 Mott, 148 Myers, C. S., 99, 140, 157 Myers, F. W. H., 25, 186, 187 Prince, 34 Ribot, 87, 90, 93, 94, 97 Rivers, 151 Rows, 151 Schopenhauer, 88, 102 Shakespeare, 91 Shand, 90, 91, 93, 94, 97 Sherrington, 86 Ward, 177 Printed in Qreat Britain by UHWIN BROTHERS, LIMITED, THE OBK8HAM PRESS, WOKINO AM> LONDON 96 University of California SOUTHERN REGIONAL LIBRARY FACILITY 305 De Neve Drive - Parking Lot 17 Box 951388 LOS ANGELES, CALIFORNIA 90095-1388 Return this material to the library from which it was borrowed. MAY 1 2097 ,.! SOUTHERN REGIONAL LIBRARY FACILIT I M HIM III III . A 001 049 236 1