Ex Libris 
 C. K. OGDEN
 
 X
 
 OjUot Wcnodt* 
 
 THE 
 NEW PSYCHIATRY 
 
 Being the Morison Lectures delivered 
 
 at the Royal College of Physicians of 
 
 Edinburgh in March 1915 
 
 W. H. B. STODDART, M.D., F.RC.P. 
 
 LECTURER ON MENTAL DISEASES TO ST THOMAS'S HOSPITAL; 
 LATE RESIDENT PHYSICIAN AND MEDICAL SUPERINTENDENT 
 OF BETHLEM KOYAL HOSPITAL ; EXAMINER IN PSYCHOLOGY 
 AND MENTAL DISEASE AT THE UNIVERSITY OF LONDON, ETC. 
 
 LONDON 
 BAILLIERE, TINDALL AND COX 
 
 8 HENRIETTA STREET, OOVENT GARDEN 
 1915
 
 PREFACE. 
 
 THE following lectures are a brief, almost too brief, summary of 
 the principles and practice of psycho-analysis, and they are now 
 published in book form at the suggestion of many friends who 
 have not the time to wade through the very extensive literature 
 of the subject. The almost unjustifiable brevity was in the first 
 instance necessitated by the obligation to condense the matter 
 within the space of three hours ; but I have agreed to publish the 
 lectures for the most part as they were delivered, as I am told 
 that they are clear and comprehensible as they stand. 
 
 In the domain of mental disease this new psychiatry, which 
 has not yet received sufficient recognition in this country, is one 
 of the most important problems of the day ; but it is an in- 
 trinsically difficult subject, concerning which a complete doctrine 
 has not yet been elaborated, although an enormous amount of 
 patient labour has been expended upon it during the last twenty 
 years. 
 
 Psycho-analysis has, of course, met with captious criticism, 
 the inevitable destiny of a new truth, but this has been especially 
 severe in the case of our new psychiatry for four reasons : 
 
 (1) The critics do not read psycho-analytic articles, or they 
 do so only superficially, so that they arrive at quite extraordinary 
 misconceptions. 
 
 (2) Not one of them has given the method a full and practical 
 trial. 
 
 (3) Basing their criticisms upon sentiment and prejudice, they 
 assume an attitude of moral indignation or haughty contempt, 
 seeking an answer to the question, "Are these principles to my 
 liking ? " instead of the question, " Are these principles true ? " 
 
 (4) The critics have been somewhat justified, in that a number 
 of medical men, especially in Germany, practise in various 
 sanatoria and in private what they conceive to be psycho- 
 analysis, without having attempted to master the subject, with 
 the result that they have done their patients more harm than 
 
 1081599
 
 iv PREFACE 
 
 good by filling their minds with all sorts of filthy ideas, and 
 making the most objectionable suggestions by way of therapeutic 
 advice. I need hardly say that such charlatans, for they are 
 neither more nor less, have through their ignorance brought 
 discredit upon the new psychiatry which it does not deserve, 
 for their methods, as I hope to show, are the very antithesis of 
 those of psycho-analysis. 
 
 At the present time it would be asking too much of my 
 readers to accept as a scientific truth doctrines which have 
 had their birth in Austria and Germany, where truth appears 
 to be monopolised by professors and divines for academic 
 purposes only, and scientific discoveries are prostituted for 
 purposes of outrage and destruction of civilisation and all 
 that civilisation means, were it not that I can give assurances 
 that those doctrines have been tested and accepted by earnest 
 workers and profound thinkers in Switzerland, America and 
 Great Britain. As a matter of fact, Freud himself has no 
 German blood in him, but is a pure Jew. After all, Science 
 knows no nationality and the present account is an attempt at 
 compromise between, and combination of, the opinions of many 
 great men. 
 
 I desire to take this opportunity of thanking Dr Ernest 
 Jones for revising the proof-sheets and making many valuable 
 suggestions. 
 
 I have also to thank the editors of the Journal of Neurology 
 and Psychiatry for their kindness in allowing me the use of their 
 type, as set up for publication of these lectures in that Journal. 
 
 W. H. B. S. 
 
 CAVENDISH SQUARE, LONDON, W., 
 22nd June 1915.
 
 THE NEW PSYCHIATRY. 
 
 CHAPTER I. 
 FUNDAMENTAL PYSCHICAL MECHANISMS. 
 
 Instinct. In order to gain clear insight into the principles 
 of abnormal psychology, let us by way of preliminary examine the 
 human instincts. 
 
 Instinct is the blind prompting inherent in an animal to act 
 without deliberation in a certain way. An instinctive action is 
 practically perfect on the very first attempt, although there has 
 been no previous education in its performance, and it is of such 
 a nature as to produce certain ends without foresight of those 
 ends. Instincts are perhaps most characteristic among the lower 
 animals. As examples, sexual acts, migration, the first-year bird 
 building her nest and sitting on her eggs, nutrition and care of 
 the young, the lion stalking his prey, and the congregation of 
 certain animals into shoals, flocks, and herds. In man one may 
 instance the first attempt at speech by the human infant, the 
 first attempts to walk, the avoidance of filth, making collections 
 of all sorts of things, seeking the company of the opposite sex, 
 nurture of the young, and the congregation into towns and cities. 
 These are but a few examples but, even if the list were complete, 
 it would be found possible to group all the instincts under two 
 headings, viz.: those subserving the function of preserving the 
 individual and those subserving the function of perpetuating the 
 race. They have also been classed into three categories, according 
 as they are moved by the promptings of self-preservation, nutri- 
 tion or sex. 
 
 The Herd Instinct. Now Dr Wilfred Trotter, in two very 
 able articles in the Sociological Review for 1908 and 1909, has 
 drawn attention to the existence and importance of a fourth
 
 THE NEW PSYCHIATRY 
 
 instinct, gregariousness or, as he calls it, the herd instinct. 
 Although this has long been recognised, it had never before 
 been seriously contemplated and studied. When we come to 
 think of it, man is much more dependent upon communal life 
 than appears at first sight. Left to himself, he is not only 
 extremely miserable, but his faculty of speech is useless to 
 him and he stands little chance of survival among the other 
 animals. Moreover, his conduct is very largely regulated by 
 the customs of his tribe. 
 
 The advantage of gregariousness lies in the homogeneity of 
 the herd, which enables large numbers to act in concert. In 
 hunting and warfare, for example, the benefit of this is obvious, 
 for the prey or enemy is more easily vanquished by a large number 
 of hunters than by a single unit. Such homogeneity is assured by 
 an inherent impulse of each individual to behave in the same way 
 as his fellows and those who depart from the usual customs of 
 the herd cease to benefit from the advantages of gregariousness, 
 if they are not actually killed. The herd instinct, like other 
 instincts, is maintained by natural selection. 
 
 So it happens that in company there is an unanalysable feeling 
 of comfort, in solitude there is an unanalysable sense of restless- 
 ness and discomfort. This is just instinct. Similarly, if we 
 depart from the customs of our particular " set " in matters 
 of dress, amusement, religion or politics, either we feel 
 uncomfortable or we are regarded as eccentric, and ostracised. 
 Stage fright and shyness are the outcome of an instinctive desire 
 to leave one's conspicuous position and to become once more one 
 of the herd. Dr Bernard Hart recently drew my attention to 
 a latter-day exemplification of the influence of the herd instinct 
 in the fact that a man, who worries about the ultimate result 
 of the war, ceases to do so when he has enlisted in Kitchener's 
 Army. He has the unconscious feeling that he is within the 
 fold. 
 
 Again, man is readily prepared to accept suggestions which 
 are in accordance with the traditions of his particular herd ; 
 but he is disinclined to receive new truths which have been 
 revealed by experience. People refused to look through Galileo's 
 telescope, Darwin was considered a madman, the clinical ther- 
 mometer was laughed at, people refuse to believe in vaccination 
 or inoculation of any kind, new diseases are figments of the
 
 TRADITION v. EXPERIENCE 3 
 
 imagination of their discoverers, and psycho-analysis is immoral, 
 because the new must always encounter the opposition of the 
 herd tradition. But it must also be remembered that in such 
 instances herd tradition has to encounter opposition from the 
 new, and may be gradually overcome until the experience becomes 
 incorporated with the herd tradition. 
 
 In matters of opinion, however, such as politics, religion, 
 finance, education, art, literature and all sorts of public problems, 
 the opinions of the people ranged on loth sides are based on herd 
 traditions and no amount of argument will induce them to see 
 the opposite point of view or even to adopt the only rational 
 position in such matters, viz. : that of suspended judgment. On 
 the contrary they find more and more justification for the opinions 
 they hold. In other words, belief comes first, reasons for the 
 belief come second. This process is known as " rationalisation ". 
 It may, of course, be used in support of or in opposition to 
 scientific truths; but even then "rationalisation" is dependent 
 on the herd instinct for its existence. 
 
 How then are we to know whether any opinion we hold is 
 rational or non-rational ? If we find that we base the opinion on 
 the feeling that any inquiry into the matter would be useless, 
 barren and superfluous and that it is foolish, unpatriotic, wicked 
 or " bad form " to think otherwise, then it must be regarded as 
 irrational, but if our opinion is based on experience, then it is 
 rational. 
 
 We have so far been discussing the influence of the herd 
 instinct on intellectual processes, but we shall find that it also lies 
 at the basis of our moral sentiments. Whenever a man does 
 anything which he knows would meet with the disapprobation of 
 friends he experiences a feeling of uneasiness, similar to that 
 caused by isolation, solitude or separation from the tribe, a 
 feeling of guilt; and when he does something which would be 
 applauded by his fellows, he has a sense of happiness and self- 
 satisfaction. This is, then, the basis of the moral sentiment with 
 which the voice of conscience is indissolubly associated. A non- 
 gregarious animal can do what it likes ; it has only itself to 
 consider. 
 
 There is a fundamental difference between this herd instinct 
 and the personal instincts of self-preservation, nutrition and sex. 
 These are dependent on the impulse of the moment ; but the herd
 
 4 THE NEW PSYCHIATRY 
 
 instinct is a controlling force from without, which is perpetually 
 acting in antagonism to the other three. The child is taught 
 from the cradle to respect the feelings of its companions, to resist 
 its own impulses in order to protect others, to comply with their 
 desires and not to be selfish or greedy. And when the sexual 
 passion asserts itself he finds that it is antagonised by a very strict 
 code of conduct, with which it becomes his instinct to comply. 
 Not only must such a passion be denied free play, but he must 
 never allow his genitalia to be seen, and he must not discuss 
 sexual topics or even think about them. The whole subject of 
 sex is taboo, and this is one of the chief reasons why psycho- 
 analysis has encountered severe antagonism. For a long time 
 gynaecology was in the same position for a similar reason. 
 
 We find, then, that it is instinct which governs the whole of our 
 mental life. Instinct is no more and no less than "psychical 
 energy," the driving force of mentation to which Jung has applied 
 the name " horme ". This word " horme " has a wide signification, 
 y applicable to all the instincts, and corresponds to the " libido " in 
 reference to the sexual instinct. " Horme " means psychical energy, 
 desire plus a conative trend. In short, I conceive it as being 
 more or less synonymous with instinct, the driving force of our 
 mental life. Every individual is endowed with a certain quantity 
 of horme. Sometimes it is active in one direction, sometimes in 
 another ; it is never quiet. Comparable to physical energy, which 
 may display itself as movement, sound, heat, light, electricity or 
 chemical action, it is never lost, and the principle of the conserva- 
 tion of energy is to be regarded as equally applicable to both 
 psychical and physical energy. If a certain amount of horme or 
 psychical energy in a given patient appears to be lost, it becomes 
 our duty to discover where it has gone ; but I will return to this 
 subject later. 
 
 There is, as I have just suggested, a constant play between the 
 instincts, one giving place to another as occasion arises ; but when 
 a herd impulse becomes displaced by the driving force of some 
 other instinct, mental conflict ensues, there is a situation to be 
 faced and a way out of the difficulty must be found. " Twixt love 
 and duty" has always been a favourite theme with artists, 
 novelists, poets and philosophers. If duty fails, that is to say, if 
 the herd instinct fails, some way must be found to pacify the guilty 
 conscience.
 
 THE UNCONSCIOUS 5 
 
 The conflict may be resolved in one of four ways. 
 
 Firstly, the influence of the herd instinct may be recognised 
 and its influence voluntarily ignored, the delinquent avowing to 
 himself that he has a perfect right to do as he likes. The herd 
 instinct is so strong that this process is, as a rule, difficult ; but 
 everybody knows that such unscrupulous persons undoubtedly 
 exist. 
 
 Secondly, the offence may be condoned by "rationalisation", 
 the offender excusing himself on the ground that he is otherwise 
 a very good fellow. He goes to church regularly, subscribes to 
 the charities, and is a good patriotic citizen, the logical fallacy 
 here being, of course, the ignoratio elenchi. 
 
 Thirdly, the emotional tone or affect of worry may gradually 
 pass off as years roll by and he becomes occupied with other 
 matters, in just the same way as we do not feel, after the lapse of 
 time, the loss of a dear friend to the same extent as when we first 
 hear the news of his death. 
 
 And lastly, the incident may refuse to become assimilated to 
 the existing content of consciousness and be forgotten. The 
 memory is banished from consciousness, but this does not mean 
 that it is banished from the mind. It means that an attempt is 
 made to repress it into a department of mentation from which it 
 can never again enter phenomenal consciousness and disturb the 
 normal stream of associative though! Later on we shall have 
 to discuss what happens should this repression subsequently fail, 
 as it frequently does. 
 
 The Unconscious. This brings me to one of the fundamental 
 bases of Freudian psychology, viz. : the conception of the un- 
 conscious. 
 
 At any given moment during a stream of thought there are 
 only one or two ideas present in phenomenal consciousness. 
 Under certain conditions in the psychological laboratory it is 
 possible to demonstrate that as many as six or seven ideas may 
 be present in consciousness at the same time, but in practical 
 thought seldom more than two ideas occupy the field of attention. 
 
 In close association with these ideas, however, at what is 
 sometimes called the fringe of consciousness, but outside the field 
 of attention for the moment, there is a much larger number of 
 percepts, ideas and other mental states. These have been grouped 
 together for practical purposes and called the " subconscious ".
 
 6 THE NEW PSYCHIATRY 
 
 There still remains a large number of ideas and memories quite 
 outside the field of attention, but capable of recall when required. 
 These are known as the " foreconscious " or " preconscious ". 
 
 Now there is an enormous number of ideas of past experiences, 
 incidents and situations which we cannot by any possibility 
 remember, no matter how hard we try. For these there is a life- 
 long amnesia. Nevertheless, they are not lost. They sometimes 
 flash into the mind in moments of abstraction and during dreams ; 
 it is said that they are all passed in review during drowning, and 
 they can be recovered by such artifices as hypnotism, crystal- 
 gazing and psycho-analysis. This group of ideas is called the 
 " unconscious ". The name is perhaps a little unfortunate, because 
 " unconsciousness " has nothing to do with these phenomena, 
 which were recognised in this country long before Freud's day 
 and were described as " unconscious cerebration ". I believe that 
 the name was then the chief reason for their non-acceptance, for 
 it was rightly contended that "unconscious cerebration" is a 
 contradiction in terms. If hybrids were tolerated, I would suggest 
 some such name as " hypoconscious " for such mental states. It 
 is not pretended that every incident that has ever happened in 
 our lives is conserved in the unconscious (although Bergson does), 
 but it would certainly be true to say that all experiences which have 
 been accompanied by a strong affective tone are conserved, even 
 right back into early infancy. 
 
 Psychical Determinism. Another fundamental doctrine of 
 Freudian psychology is that of "psychical determinism" which 
 postulates that every mental process is predestined and fore- 
 ordained. According to Jung, such predestination is due to the 
 conscious activity of a higher power, God or world-consciousness ; 
 but Freud ascribes it to an unerring scientific law of causation. 
 
 While recognising that there are certain characteristic 
 tendencies and reactions, physical and psychical, common to all 
 mankind, and given to us by heredity and evolution (the inherited 
 instincts already mentioned), we must also take into account the 
 fact that the experiences of every one of us differ from those of all 
 other people. Instinct is the driving force which causes A and B 
 to act in the same way when confronted with a given situation, but 
 their thoughts and actions in association therewith are differently 
 carried out because their individual experiences are entirely 
 different. These, and other considerations to be discussed
 
 COMPLEXES 7 
 
 presently, led Freud to the study of " individual psychology ", 
 one outcome of which has been the enunciation of the doctrine 
 that for every psychic fact there have been efficient and logical 
 antecedent causative mental states in the present life-history of 
 the individual and that there is a continuity of mental associa- 
 tions from the cradle to the grave. In other words, there is 
 no such thing as chance in the determination of a thought. 
 
 To take a favourite example. Suppose I ask you to think of a 
 number, and you take the trouble to investigate your particular 
 association with the number selected, you will find that the 
 number has some relationship with an item of your experience 
 associated with the present content of your consciousness. Under 
 the circumstances, no other number could have occurred to your 
 mind ; the mental process concerned is absolutely governed by the 
 laws of association of ideas. 
 
 Complews. The number is one unit of a constellation of ideas, 
 another unit of which is one idea now present in your conscious- 
 ness. When such a constellation is repressed and partly uncon- 
 scious, it is known as a " complex ". 
 
 I give a few examples to make my meaning clear. 
 
 While preparing these lectures, any patient exhibiting a good 
 example of the mental processes I am now endeavouring to explain 
 caused me to think of the Morison lectures, as also did mannerisms 
 of people I met in the street, certain items of information in 
 books, thoughts of the unconscious motives of war, and incidents 
 of psychological interest on the battlefield, papers read to less 
 distinguished audiences, mental facts in niy own life and a host of 
 other things. In other words, I have had a " Morison lecture " 
 constellation of ideas. It has not been repressed and should 
 therefore not be called a " complex ". 
 
 I meet a man in the street who at one time did me a consider- 
 able injury by reason of certain jealousies &c. He is the centre 
 of a number of ideas of difficult situations and incidents which 
 caused me perplexity at the time, but are now repressed and partly 
 forgotten ; but I feel annoyed when I see him. This is one of my 
 complexes. 
 
 A favourite example is that of a young man in love. His 
 emotional state tends to constellate ail his ideas to the one central 
 figure, his lady-love, no matter how remote the association may 
 be. The act of writing at his office desk reminds him of writing
 
 8 THE NEW PSYCHIATRY 
 
 to his adored one, a luxurious motor car makes him think how 
 she would look in it, a chance resemblance causes him to wonder 
 " Is it she ? " The sermon at church contains many allusions to 
 his love for her and all nature echoes his happiness. It is the 
 "love" constellation or complex. In fact, the whole of our 
 unconscious mind is made up of complexes, and the total mass of 
 these taken together constitutes the " ego-complex ". 
 
 A complex, then, may be defined as a repressed system of 
 ideas having a constant conative trend or emotional tone, and 
 directed towards determinate actions and thoughts. A complex 
 is therefore possessed of a certain amount of energy and, since 
 complexes can generally be referred to some instinct, we may 
 regard this energy as a manifestation of the horme we have 
 already discussed. The liberation of this energy by discharge, 
 either by an outburst of emotion or by the fulfilment or realisation 
 of the conative object of the complex, is known as " abreaction ". 
 Abreaction of the love-complex, for example, is the possession of 
 the desired object of affection. 
 
 Conflict. We are now in a position to consider in rather 
 more detail the phenomenon of " conflict ". When there develop 
 in the mind two complexes which are out of harmony with one 
 another and mutually repel or paralyse each other, conflict 
 ensues. A hypothetical instance of conflict between two nutri- 
 tion complexes is given in the fable of the animal which died 
 of starvation when, suffering equally from hunger and thirst, it 
 found itself midway between a basket of food and a pail of water. 
 Conflict occurs between two self-preservation complexes when 
 a man finds himself stranded on the high Alps, when inactivity 
 means death from starvation and an attempt to reach the valley 
 threatens death from precipitation. Conflict arises when a man 
 finds he has fallen in love with two women at the same time. 
 But conflict never arises between a nutrition complex and a 
 sexual complex, or between a self-preservation complex and 
 a nutrition complex unless, of course, the nutrition complex is 
 so urgent (as in the above instance) that it constitutes at the 
 same time a self-preservation complex. Conflict between a sexual 
 complex and a self-preservation complex is fairly common and 
 either may win, as in the question of plunging into a marriage 
 which is inimical to one's life interests or facing death to save 
 a loved one from danger.
 
 CONFLICT 9 
 
 In practical experience, however, we find that by far the 
 greater majority of conflicts occur between a personal complex 
 and a herd complex, that is to say, between morality, religion, 
 ethics or fashion, on the one hand, and nutrition, self-preservation 
 or sex on the other. Now the only ways in which nutrition 
 complexes and self-preservation complexes can conflict with the 
 herd instinct are by such crimes as murder, theft and dishonesty ; 
 but there is only one way in which satisfaction of the sexual 
 instinct does not conflict with the herd instinct, viz.: by 
 legitimate wedlock. 
 
 Masturbation, homo-sexuality, adultery, incest, fetichism, sad- 
 ism, exhibitionism and bestiality, many of which are exceedingly 
 common, are all under the ban of the herd; and it so happens 
 that we find, as a matter of practical experience, that by far the 
 majority of conflicts, which we find on psycho-analysis to lie at 
 the root of the neuroses and psychoses, are between a sexual 
 and a herd complex. 
 
 Now a conflict cannot be allowed to persist for ever. It is 
 a biological necessity that some way out of the difficulty must 
 be found. The normal and logical way out of the situation is 
 to face it, to recognise that there is a conflict, to consider what 
 is the right and proper course to pursue and to take that course, 
 at the same time admitting to oneself that such a conflict has 
 existed. 
 
 If, on the other hand, the victim refuses to face the situation 
 and attempts to evade it, this may be done, as I have already 
 mentioned, in one of four ways. 
 
 Firstly, he may recognise the influence of the herd instinct 
 and refuse to be guided by it. In my experience this is, as a 
 rule, not very successful. The herd instinct is a true instinct 
 and refuses to be repressed, with the result that the patient 
 suffers from remorse, usually accompanied by an unexplained 
 headache and other neurasthenic symptoms which are very diffi- 
 cult to dislodge. 
 
 Secondly, he may seek refuge in " rationalisation ", keeping his 
 conflicting personal complex in a " logic-tight compartment " of 
 the mind. The swindling financier refuses to acknowledge to 
 himself that he, as a financier, is the same individual who reads 
 the lessons at church and built the local almshouses, or he 
 condones his swindles with acts of piety and charity. This is
 
 10 THE NEW PSYCHIATRY 
 
 an example of what is known as " dissociation " or, as Janet 
 calls it, the " splitting of consciousness ". This phenomenon occurs 
 quite commonly when, for example, we converse on one subject 
 and write a letter about another, and it is quite possible for 
 our financier, while reading the lessons, to be at the same time 
 devising some scheme whereby he may succeed in transferring 
 somebody else's banking account to his own. 
 
 In pathological domains we observe a similar splitting of 
 consciousness in the general paralytic who, while believing himself 
 to be God Almighty, begs his attendant for a cigarette, and in 
 the asylum queen, who is elated in being the chosen patient 
 to wait on the nurses. 
 
 Dissociation occurs also during the "automatic writing" of 
 certain hysterical patients. If such a patient be given a pencil 
 and a piece of paper and be held in conversation while a third 
 person whispers questions into the patient's ear, she will correctly 
 answer the questions by writing, all the while being unconscious 
 of the fact that she is writing. 
 
 Another variety of dissociation occurs in the cases of " double 
 consciousness." Here the patient has two entirely different 
 personalities, each being independent and unaware of the existence 
 of the other. Robert Louis Stevenson has dramatised the 
 condition in the familiar play, " Dr Jekyll and Mr Hyde " and I 
 need not quote the well-known case of the Rev. Ansel Bourne, 
 reported by James and Weir-Mitchell. Gilles de la Tourette 
 placed on record the case of a man who remembered nothing 
 between being about his business in Paris and returning to his 
 normal personality on board a ship bound for Bombay. Records 
 of many similar cases are to be found distributed throughout the 
 literature. 
 
 Thirdly, our victim of conflict may allow the energy of his 
 complex to be diverted into other channels than the natural one. 
 This process is called " sublimation ", and the best examples are 
 again to be found in the domain of sex. 
 
 The old maid has at one time been possessed of a sexual instinct 
 quite as strong as that of her married sisters, but its natural 
 outlet has been denied her. What outlets can she find for her 
 pent-up energy? She devotes much to dress, which is often 
 extravagant, or she indulges in all sorts of gaieties or she takes to 
 nursing or, by a kind of transference, she interests herself in
 
 SUBLIMATION 11 
 
 Society news, especially of the type to be found in so-called 
 " Society newspapers " and she loves to read the details of 
 marriages and scandals. Moreover, her maternal complex has to 
 be satisfied, so she reads the columns of births daily and bestows 
 her maternal affection on cats, dogs and parrots. 
 
 A rnan may sublimate his sexual instincts into dangerous 
 sports. In the early days of aviation, when it was much more 
 dangerous than it is now, an acquaintance of mine took to this 
 sport when the circumstances of his marriage became somewhat 
 distressing. Sexual sublimation in men also takes the form of 
 academic interests, increased professional activity, travel, collecting 
 manias and alcoholic excesses. For reasons which need not be 
 discussed for thepresent, Freud regards smoking as being frequently 
 a sexual sublimation ; but I am sure that it is a common sublima- 
 tion of other complexes. 
 
 Sometimes sublimation takes the form of inversion or repre- 
 sentation of the opposite. The old maid, for example, often 
 betrays her sexual complex by extreme prudery or by devoting 
 herself to excessive religious exercises. 
 
 Displacement of masturbation usually takes the form of the 
 victim handling his body in other ways, such as nail-picking, nail- 
 biting, or nose-picking ; but these should not be called sublima- 
 tions, because this term always means diversion to useful, 
 social aims. 
 
 Fourthly, lastly, and most important of all, the conflicting 
 personal complex may refuse to become assimilated to the normal 
 content of consciousness and become forgotten. Perhaps a better 
 way of putting this is to say that the victim refuses to admit to 
 himself that such a complex ever existed. The popular way of 
 expressing this is to say that he " puts it out of his mind ", but 
 what really happens is, as we shall see later, that he puts it into 
 his mind, pushes it in deeper into the unconscious or, as we say 
 technically, " represses " it. This is the phenomenon of " repres- 
 sion ", really another form of " dissociation " or " splitting of 
 consciousness ". It differs, however, from the previously discussed 
 variety in that a complex dissociated by repression has an 
 autonomous existence. There is a constant resistance against the 
 elements of a repressed complex becoming associated with those of 
 phenomenal consciousness. This resistance, which is nothing more 
 than a continuation of the original repression, is called by Freud
 
 12 THE NEW PSYCHIATRY 
 
 the "censure" and has been personified by his English and 
 American translators into the " censor ". 
 
 Now it is clear that it must be a very difficult matter for the 
 normal train of thought to proceed year in and year out without 
 once touching upon some idea which tends to become associated 
 with some element of the repressed complex. Such ideas and 
 other mental states are bound to occur and, since the " censor " 
 will not allow repressed ideas to enter consciousness, the only 
 possible alternative is that conscious ideas become anchored to 
 the unconscious complex. The result is that the unconscious 
 tends to grow at the expense of the conscious ; and it may be 
 taken as a rule that the greater the emotional tone of the original 
 complex, the greater does that complex grow when it becomes 
 unconscious. The fact that the unconscious grows constantly at 
 the expense of the conscious explains why a case of long duration 
 takes so much longer to cure than a case of recent onset. 
 
 " Dissociation " and " repression " are closely allied to one 
 another and it will also be observed that " sublimation " usually 
 involves " repression ". The old maid's prudery is an obviously 
 successful method of repressing her sexual complex and her 
 fondness for domestic pets subserves the repression of her 
 maternal complex. 
 
 It is not to be supposed that sublimation and repression are 
 usually pathological or abnormal. On the contrary, they take 
 place to an enormous extent in the earlier years of us all and 
 play an important role in early education, whereby our naturally 
 vicious animal energies are repressed into the unconscious and 
 sublimated into useful activities. It follows that our unconscious 
 consists for the most part of infantile complexes and this accounts 
 to some extent for the amnesia which veils the first years of 
 childhood. It is true that this amnesia is partly due to the fact 
 that many of the cerebral neurons are not yet myelinised, but 
 that this is not the only reason is evidenced by the fact that 
 the amnesia is here and there broken by isolated memories of 
 unimportant incidents. Freud has called these " cover-memories ", 
 because they serve to displace memories of important events. 
 
 When these repressions or sublimations for any reason fail, 
 we have the conditions necessary for the development of neurosis 
 or psychosis, conflict occurring between the repressed complex 
 and the existing content of phenomenal consciousness. Under
 
 THE SEXUAL INSTINCT 13 
 
 such circumstances the complex escaping from repression is 
 distorted and disguised by way of an attempt to render it accept- 
 able to consciousness, and its distorted manifestations constitute 
 the symptoms of the disease. Solution of the difficulty and cure 
 of the disease are accomplished by revealing to the patient, 
 through his own association mechanisms, the full content of the 
 repressed complex. How this is to be done I will explain in 
 the next chapter. 
 
 I have already mentioned that complexes related to the sexual 
 instinct are repressed more than any other. It is, therefore, not 
 surprising to find that these play an enormous role in the psychoses, 
 and a knowledge of the development of the sexual instinct is 
 so essential to any comprehension of the new psychiatry that I 
 must discuss this matter in some detail. I ought to say that this 
 knowledge has been gained, in the first instance, entirely through 
 psycho-analysis. 
 
 The Seymal Instinct. Those who have devoted their attention 
 to the study of disease in children, especially nervous disease, will 
 be the first to admit that sexuality is not a function which suddenly 
 springs into being at puberty, but that it gradually develops from 
 small beginnings in the earliest infancy. Freud considers that 
 sucking the mother's breast is partly a sexual act, but Jung dissents 
 from this view and considers the act of sucking the breast to be 
 purely nutritive in function. Both these leaders of thought agree, 
 however, that thumb-sucking, which follows shortly afterwards, 
 is of undoubted sexual import, and many shrewd mothers are 
 independently capable of discerning masturbatory significance in 
 this common infantile action. Indeed, any action in which the 
 child habitually handles the body, such as nose-picking, nail-biting 
 or rubbing its abdomen, is to be regarded as betokening a masturba- 
 tion complex. 
 
 Now in adult life many of the sense organs are capable of 
 stimulating the sexual instinct ; for example, the eye (in seeing a 
 beautiful face or figure), the ear (in hearing a beautiful voice or 
 the rustle of a dress), the nose (in sensing certain odours 
 characteristic of the opposite sex) and the skin (in feeling the 
 skin of a member of the opposite sex or even, with some people, 
 experiencing a sense of pain) ; but the centre of maximal stimulus 
 is the genital organ. In the child, however, there is no centre of 
 maximal stimulation to be discovered, the pleasure-arousing area
 
 14 THE NEW PSYCHIATRY 
 
 being equally diffused all over the body and therefore so much 
 the less stimulating in any given zone. 
 
 Freud has discovered, however, that even in the young child 
 there are certain areas the irritation of which produces greater 
 gratification than elsewhere. Although these lie at the foundation 
 of the sexual instinct, it is not suggested that the child himself 
 has any idea of the nature and significance of these sensations. 
 These areas, which I am about to mention, have been called by 
 Freud the " erogenous zones ". 
 
 I have already referred to the mouth. Freud and others 
 discern something of the nature of an orgasm when a satisfied 
 baby becomes flushed, leaves the breast, and sinks into slumber. 
 It has also been observed that thumb-suckers are liable to 
 manipulate or rub their breasts during pleasure-sucking, and this 
 is said to be the first step towards masturbation. Energetic 
 suckers in infancy are said to be very fond of kissing when they 
 reach adult life and, if at any time the complex becomes repressed, 
 there are produced such symptoms as hysterical vomiting, 
 aversion from eating, hysterical globus, choking sensations, 
 snoring in the throat or disturbances in eating. These are some 
 of the arguments used in support of the view that the mouth is an 
 erogenous zone and some of the symptoms suggest that Freud is 
 right in his view that breast-sucking for the purpose of nourish- 
 ment is partly of sexual import. It is at least obvious that the 
 first sensory stimulus the mouth receives is from the mother's 
 breast and our other considerations suggest that the baby's mouth 
 should not be stimulated more than is necessary for purposes of 
 nutrition. This is an argument I have not previously heard 
 against the use of " dummies " or " comforters ". 
 
 Another important erogenous zone lies at the other end of 
 the alimentary canal, the anus. It is often observed that 
 the " intestinal catarrhs " of infancy give rise to " nervousness ", 
 but the erogenous significance of the anus is noticeable in children 
 who voluntarily retain their faeces until violent muscular con- 
 tractions necessitate expulsion. The pain caused by the passage 
 of the larger accumulation is accompanied by a pleasurable sensa- 
 tion, which the child seeks to experience again. It is a variety 
 of masturbation. This habit, which is a sure premonition of 
 subsequent eccentricity or neurosis, plays an important part in 
 the production of the constipation so common in neurotic patients,
 
 EROGENOUS ZONES 15 
 
 and Ernest Jones has recently shown that it lies at the foundation 
 of the sadistic complex which is responsible for the compulsion 
 neurosis. Incidentally I may mention that a large number of 
 such patients have private secret customs and ceremonials of 
 their own, which they habitually observe when they retire to 
 evacuate their bowels. People who have succeeded in repressing 
 the complex become in after life methodical, thrifty and head- 
 strong. It would appear that the desire to retain faeces becomes 
 sublimated into the desire to retain money, and those who have 
 had experience of psycho-analysis know how commonly in the 
 neurotic " faeces " symbolises " money ". 
 
 The third erogenous zone is the neck of the bladder. Freud 
 has discovered that, whenever enuresis nocturna is not caused 
 by epilepsy, it represents a pollution corresponding to a sexual 
 dream. It may, of course, have its physical causes such as 
 adhesion of the prepuce, but that does not affect the main 
 question. It is not commonly apprehended that bed-wetting 
 is a source of gratification to the infant. Bed-wetting in child- 
 hood plays an important rdle when neurosis develops in after life. 
 
 The fourth erogenous zone ia the inner surface of the thighs. 
 Pleasure experienced by rubbing the thighs together is often to be 
 observed in quite young infants, especially females. 
 
 Even in the earliest years, therefore, there is a tendency for 
 such pleasurable sensations to be localised to the neighbourhood 
 of the genital area and Nature appears to have made special 
 provision for their periodical excitation by uncleanliness and 
 consequent cleansing. 
 
 The period we have been discussing is characterised by the 
 infant finding a kind of gratification in the stimulation of parts of 
 its own body. About the third or fourth year, however, the 
 whole of this infantile sexuality becomes repressed by education 
 and by the development of feelings of shame, loathing, disgust and 
 morality. It is during this stage of repression, the "latency 
 period" as it is called, that the infantile germs of sexuality 
 become sublimated and applied to refining, cultural and social 
 ends; but, should misadventure or adversity befall this sub- 
 limating process, the child is destined to become the victim of 
 neurosis. 
 
 From the fifth or sixth year onwards, in what Jung has termed 
 the " pre-pubertal period ", we begin to observe a recrudescence of
 
 16 THE NEW PSYCHIATRY 
 
 sexuality, but it differs from the first period in that the child now 
 strives to come into closer relationship with the outside world. 
 The first was a period of " subject love " or autoeroticism. This is 
 a period of " object-love " and the child seeks to love somebody 
 other than itself. Naturally the first object of its affection is the 
 person with whom it is brought into closest relationship, viz. : 
 the mother or the nurse. This is, of course, due to a feeling of 
 dependence and is therefore very strong. Even as early as this 
 we can discern some psychical differentiation between the sexes, 
 for the boy's love is mostly directed towards his mother and the 
 girl's towards her father. It is also to be noticed that a boy loves 
 his sisters more than his brothers, and a girl loves her brothers 
 more than her sisters. Even childish love affairs with others are 
 of greater significance than is usually thought. It has been 
 erroneously supposed that fixation of a boy's love on his father or 
 of a girl's love on her mother, during this undifferentiated period, 
 lays the foundations of inversion or homosexuality, either manifest 
 or unconscious, but psycho-analytic experience gives no support to 
 this view. On the contrary, it is found, curiously enough, that 
 inversion arises from fixation on and identification with the parent 
 of the opposite sex, as I shall explain presently. 
 
 The child's sexuality at this stage is, as Freud has termed 
 it, " polymorphous-perverse " and untoward incidents are liable to 
 direct his instinct into wrong channels. Encouragement of the 
 natural tendency to undress before others may lead to exhibitionism ; 
 the habit of inspecting one another's genitals, if opportunity is 
 allowed, may lead to the " peeping tendency " and desire to see 
 the genitals of others, especially of their elders. Such curiosity 
 begets an aggressive disposition, which in turn serves as a ground- 
 work for the sadistic instinct, whose special feature is the 
 association of cruelty with the sexual impulse. Masochism, in 
 which the sexual impulse is aroused by certain experiences of 
 meatal or physical pain, can most often be traced to punishments 
 inflicted during childhood. 
 
 Inversion or homosexuality arises in this way : It is normal 
 for the child to develop curiosity respecting sex and birth pro- 
 cesses. Indeed, it is only natural that he should want to know 
 where a new brother or sister comes from, for such a person 
 threatens to displace him and to absorb the love of his mother 
 which has previously been lavished on him. He is jealous ; but
 
 SEX PEKVERSIONS 17 
 
 this is a digression. The normal boy imagines all people, in- 
 cluding his mother, to be fashioned like himself in every detail. 
 Accordingly, if the time when he is disillusioned arrives too late 
 and incest barriers demand that his affection should be transferred 
 elsewhere, he can only fall in love with a person fashioned like 
 himself. Such individuals, therefore, seek as cohabitors either 
 boys or effeminate men. Girls, who develop the converse phantasy, 
 become homosexuals in a similar way. 
 
 As I have just hinted, the normal change which takes place at 
 puberty is the erection of incest barriers, whereby the love for the 
 parents becomes gradually weakened as the adolescent becomes 
 attracted to persons of the same age, but of the opposite sex. I 
 say " of the opposite sex ", but it must be remembered that the 
 sweetheart is of the same sex as the child's first love. Moreover, 
 the parents usually serve as an unconscious pattern for the mates 
 of young people. Boys have a natural inclination to some girl 
 resembling their mother, and girls to some boy resembling their 
 father. 
 
 There are some individuals who linger over intermediate sexual 
 attractions so that their libido becomes permanently fixated on 
 these, instead of passing them over rapidly on the way to an 
 ultimate sexual goal. Such a condition is known as fetichism 
 and the victims are fetichists. They find an ultimate sexual 
 goal in seeing or feeling the hand, foot or hair of a woman or in 
 hearing her voice; or their libido becomes fixated on some 
 impersonal object such as a shoe, a handkerchief, fur, velvet &c. 
 
 When these perversities are manifest to any given person and 
 self -avowed, they do no harm to his nervous system ; indeed, many 
 perverts have shown themselves to be of exceptional intellectual 
 ability. Voltaire has confessed to systematic masturbation, 
 Eousseau was an avowed masochist and it will be easy for you 
 to recall the names of homosexuals of great ability in professional 
 directions; but, when such perversities are repressed in an 
 individual, he constantly runs the risk of neurosis through his 
 repressed complex escaping the repression. If, for example, a 
 repressed homosexual, that is to say, a person who has developed 
 unconscious homosexual tendencies and does not know it, gets 
 married, he is almost certain to develop neurosis or psychosis. 
 
 Now when conflict arises between a repressed complex and 
 phenomenal consciousness ; in other words, when an unconscious
 
 18 THE NEW PSYCHIATEY 
 
 complex strives for recognition, and consciousness, or perhaps I 
 ought rather to say subconsciousness, endeavours to maintain the 
 repression, neither one nor the other achieves success, and the 
 result of the conflict is a compromise, this being none other than 
 a symptom or group of symptoms of neurosis or psychosis. The 
 discussion of the various mechanisms which come into play in 
 this process I will postpone until the consideration of dreams in 
 my next lecture, for the mechanism of dreams is almost exactly 
 the same as that of the insanities. We shall find that, in its 
 attempt to escape repression, a complex becomes distorted and 
 disguises itself in such a way that its true nature is not revealed 
 to consciousness. 
 
 Some of the infantile complexes to which I have referred will 
 still remain somewhat obscure unless their nature is fully 
 apprehended, and I must revert to the relationship between 
 parents and children, as it is unconsciously conceived by the 
 child. As I have already submitted, the mother is the boy's 
 and the father is the girl's favourite parent. Now, this means 
 a great deal more than appears at first sight, for it has been 
 established from the study of children and from the dreams of 
 adults that the boy's love for his mother is of such a character 
 that he resents sharing his mother's love with anyone else, 
 especially the father. A very large number of boys ask their 
 mother at some time or other whether she loves him or ' daddy " 
 the more, and the child usually receives (quite rightly from an 
 educational point of view) a disappointing answer. The boy is 
 jealous of his father and, similarly, the girl is jealous of her 
 mother. Each, in fact, wishes the parent of the same sex out 
 of the way and may go so far as to dream of the death of this 
 parent. We shall see in the next lecture that a dream is the 
 realisation of a wish. 
 
 This incest-complex, which exists in the unconscious of every 
 individual, normal or abnormal, is known, in the case of a man, 
 as the (Edipus-complex and, in the case of a woman, as the 
 Electra-complex. (Edipus was a king of Thebes who had the 
 misfortune to slay his own father and unwittingly to marry his 
 mother. Electra was the daughter of Agamemnon and Clytaem- 
 nestra ; she assisted in the murder of her own mother to avenge 
 the death of her father. 
 
 In a very large number of cases it can be demonstrated by
 
 ONLY CHILDREN 19 
 
 psycho-analysis that such complexes play an important part. 
 We expect to discover it especially in patients who, in spite 
 of normal heterosexuality and in spite of encountering many 
 opportunities of and even calls to marriage, have reached middle 
 age without having engaged in matrimony. This is especially 
 to be found in only children, whose fixation of libido upon their 
 parents is exceptionally difficult of transference elsewhere and 
 whose parents tend to foster the delusion that there does not 
 exist in the wide world a suitable mate for their darling child. 
 
 The conclusion at which we have arrived from all these con- 
 siderations is that our unconscious mind is on a lower, less mental, 
 more neural and more animal plane than our conscious mind, and 
 it is pervaded with sexual thoughts and desires. Indeed I believe 
 that I am not misrepresenting Freud when I say that he thinks 
 that the unconscious mind is almost all sexual ; but then it must 
 be recognised that he uses the word "sexual" in a very wide 
 sense. Attraction, friendliness, shame, modesty and disgust are 
 all included under this term by Freud. Nevertheless, psycho- 
 analysis has revealed that, if our repressed mental material had 
 free play, uncontrolled by consciousness, every one of us " would 
 probably remain a selfish, impulsive, aggressive, dirty, immodest, 
 cruel, egocentric and conceited animal, inconsiderate of the needs 
 of others and unmindful of the complicated social and ethical 
 standards that go to make civilised society ". 1 To the ordinary 
 man, whose " herd instinct " has repressed such intolerable features 
 of his character into the unconscious and converted him into a 
 moral, social, ethical, modest and .esthetic being, it is incredible 
 and absurd that his mental constitution and disposition are funda- 
 mentally so brutal. He is prepared to accept the fact that his 
 anatomical and physiological characteristics are identical with 
 those of the lower animals ; but his mental characteristics never ! 
 And so from time to time we find in the medical journals energetic 
 objections to our new psychiatry, of course by people who have 
 not studied it. These letters are interesting examples of what is 
 technically known as the " resistance ", which we shall study in our 
 next lecture and are unwitting arguments in support of Freudian 
 doctrines. 
 
 In the Medical Press and Circular for 13th June 1894 is to 
 be found a paper by the late Dr Hughlings Jackson, entitled 
 
 1 Ernest Jones, Brit. Med. ASK. Ann. Meeting, 1914.
 
 20 THE NEW PSYCHIATRY 
 
 " The Factors of Insanities " and it will be there seen that that 
 great man foresaw the fundamental principles of our new psychiatry. 
 He pointed out that there is a positive and a negative element 
 in every case of insanity, the negative being defect of conscious- 
 ness or loss of some consciousness, the positive being activity of 
 the consciousness remaining (on a lower level). For example, 
 when a patient believes himself to be the Emperor of Europe, 
 Hughlings Jackson points out that the chief defect (negative 
 element) of consciousness is that he does not know that he is a 
 clerk in the city, and the notion that he is the Emperor of 
 Europe is due to the positive activity of a lower level of 
 mentation. This is exactly what has been proved by our modern 
 school of psychiatry. So far as consciousness is concerned, we 
 know that it always loses something of its content, a complex 
 which is repressed into the unconscious, while the positive 
 symptoms of an insanity are due to the distorted activities of 
 the unconscious (a lower level of mentation). While, therefore, 
 we study and admire the insight and patient labour of the 
 great Austrian psychologist, Professor Freud of Vienna, let us 
 at the same time pay homage to the great English father of 
 neurology, who taught us to understand the nervous system, 
 Dr Hughlings Jackson.
 
 PSYCHO-ANALYSIS 21 
 
 CHAPTER II. 
 PSYCHO-ANALYSIS. 
 
 THIS chapter is intended as a description of psycho-analysis, its 
 aims, objects, uses and technique. 
 
 Psycho-analysis is a method of obtaining a complete history of 
 the patient's illness and an insight into his modes of thought, such 
 as can be obtained in no other way. A detailed history of a 
 mental disorder includes an account, not only of the manifest 
 disturbances of conduct, but also of the patient's thoughts in 
 association therewith and of the various experiences and events 
 which led up to it, together with their bearings on one another 
 from the patient's point of view. 
 
 When all this has been ascertained, it becomes necessary to 
 trace the patient's particular habits of thought back to their 
 origin. Psycho-analysis achieves this result by reviving his 
 memory for numerous incidents and events which he had for- 
 gotten, and by unearthing his hidden, repressed and therefore 
 unconscious complexes, such as were considered in the first lecture, 
 especially those having relationship with his present illness. 
 
 The true relationship is then discussed in such a way as to 
 place these complexes in their true light. This is in reality a 
 kind of re-education whereby the patient acquires self-realisation 
 and develops his character and personality. 
 
 When all this is accomplished the recovery of the patient, 
 which is the chief aim of psycho-analysis, results as a matter of 
 course. 
 
 So far I have constantly referred to " the patient ", but it must 
 be understood that psycho-analysis can be practised with benefit 
 upon a normal individual. It is, in fact, desirable and a duty for 
 every physician who contemplates using the method either to be 
 psycho-analysed or to psycho-analyse himself, so that he shall not 
 read his own complexes into his patients, shall come to his work, 
 so to speak, with clean hands, gain a knowledge of himself such as 
 cannot be obtained in any other way and achieve that unity with 
 himself which will give him self-confidence. 
 
 I might here mention that part of the mental equipment of
 
 22 THE NEW PSYCHIATRY 
 
 a successful psycho-analyst consists of a knowledge of ancient 
 mythology. Psycho-analysis of the many beautiful stories of the 
 ancients gives him a thorough knowledge of the development of 
 human thought. A study of the symbols of the Church and of 
 the Egyptians, Indians and Chinese, of the totemism of the North 
 American Indians, and the superstitions of uneducated people is 
 also helpful ; for they all throw light upon the history of the 
 development of the human mind. In each one of us our mental 
 development is to be regarded as a recapitulation of the mental 
 development of the human race, just as the development of the 
 embryo is a recapitulation of the anatomical development of 
 man. 
 
 I ought to say at once that psycho-analysis is not easy, even 
 for those who have far greater experience of the method than I 
 have, and it takes a very great deal of time. It is customary to 
 spend with each patient an hour a day five or six times a week. 
 It then takes a fortnight to obtain a complete history and a clear 
 insight into the nature of the case, and at least three months to 
 accomplish a cure. Most cases take longer than this, and even 
 Freud himself, purposely selecting very difficult cases, has spent 
 as much as three years over a single patient before he effected 
 recovery. It is satisfactory to note that a partial analysis is often 
 beneficial and we are constantly endeavouring to discover " short 
 cuts ", but even then we are bound to acknowledge the difficulty 
 that psycho-analysis is expensive. It is not more so, however, 
 than many surgical operations, and the gratitude expressed by 
 patients is sufficient testimony that all this time and expense are 
 well worth while. 
 
 I now come to the question " What patients are suitable for 
 psycho-analysis ? " and this resolves itself practically into " What 
 patients are unsuitable for psycho-analysis ? " 
 
 As I have already said, psycho-analysis requires intelligent 
 co-operation of the patient. It follows, therefore, that the patient 
 must be intelligent. He must have some pretence to education, 
 and I do not recommend the employment of this method with the 
 labouring classes, although successful analyses have been reported. 
 Similarly it is not wise, at any rate for a beginner, to attempt the 
 analysis of young children, as it requires very special tact. 
 
 It also follows that the patient must be willing to co-operate. 
 You cannot analyse a patient who does not wish it. It is true 
 that it is quite possible to learn much about his complexes by
 
 CLASSIFICATION 23 
 
 conversation and critical observation, but you will be unable to 
 reveal them satisfactorily to himself. Then there is the type of 
 patient who proclaims that he is perfectly willing to be analysed ; 
 but, when the work has well begun, he does not take it seriously 
 and plays his part in a desultory way. Such patients flit from 
 one doctor to another, always dissatisfied with the last, and expect 
 to be cured without making any effort themselves. All such 
 patients should be left severely alone. 
 
 Lastly, it is practically useless to attempt psycho-analysis 
 on a patient who has passed middle age. At best, the analysis 
 of a person who has passed his fiftieth year is sure to be 
 lengthy. 
 
 In order to render clear what classes of mental disorder are 
 suitable for analysis, let me first explain how I classify them : 
 
 I. The Neuroses. 
 
 Neurasthenia. The anxiety neurosis. Some forms of 
 hypochondriasis. 
 
 II. The Psychoneuroses. 
 
 Hysteria. 
 
 The Compulsion Neuroses : Obsessions, morbid fears 
 and compulsions. 
 
 III. The Psychoses. 
 
 Maniacal - depressive insanity. Dementia praecox 
 Paranoia. 
 
 IV. Confusional Insanities. (Synoptic Rebuff.} 
 
 Exhaustion insanities from overwork, worry and mental 
 shock. Infection insanities, including febrile and 
 post-febrile delirium. 
 
 Toxic insanities (alcohol, hashish, belladonna c.). 
 
 V. Thyroiyenous Insanities. 
 
 Myxoedema, exophthalmic goitre, cachexia strumipriva, 
 (cretinism). 
 
 VI. Epileptic Insanities.
 
 24 THE NEW PSYCHIATRY 
 
 VII. Organic Insanities. 
 
 Cerebral thrombosis, tumour, aneurysm and abscess. 
 Acute and chronic meningitis. 
 General paralysis. 
 Huntington's chorea. 
 
 VIII. Chronic Cortical Atrophy. 
 
 Insanities of involution (abiotrophic). 
 Arteriopathic dementia (syphilitic, senile and renal). 
 
 IX. Congenital Mental Defect (Amentia). 
 
 Idiocy, imbecility, defective children, cretins &c. 
 
 Let us consider these in the reverse order. Cases of congenital 
 mental defect cannot be psycho-analysed because there is insufficient 
 intelligence for co-operation. Besides, no benefit could result from 
 the analysis of such cases. 
 
 Patients, who are suffering from organic cerebral changes, and 
 fall within the groups VII. and VIII., are unsuited to psycho- 
 analysis, because the method cannot cure such diseases. It is, of 
 course, quite possible that a patient suffering from a cerebral 
 tumour might be benefited by the method, but it would be 
 obviously incorrect treatment. 
 
 Of epilepsy there appear to be two varieties, one of toxic 
 origin (probably the most common variety of idiopathic epilepsy), 
 and the other of psychical origin. The differentiation between 
 these can be made by inquiry into the history, when it will be 
 found that in the toxic variety the convulsions are of more or less 
 regular recurrence and are not traceable to any immediate exciting 
 cause ; while in the psychogenic variety the convulsions are 
 usually induced by some mental shock or incident of psychical 
 importance. In the former variety mental therapeutics can 
 accomplish nothing, but much is to be expected from psycho- 
 analysis of the psychogenic cases. Indeed, several cases of cure 
 by this method have been reported, and it is probable that those 
 epileptics recorded as having been cured by hypnotism were also 
 cases of psychogenic epilepsy. 
 
 Thyroigenous insanities are, of course, best treated with appro- 
 priate medicines.
 
 UNSUITABLE CASES 25 
 
 In the fourth group, mental confusion is so profound that 
 psycho-analysis is impossible. You will observe that the alcoholic 
 insanities fall within this group, but I must direct your attention 
 to the fact that alcoholic intoxication and the tendency to drink 
 excessively are two different things. The latter is to be regarded 
 rather as a psychasthenic compulsion and would therefore fall 
 under Class II. Alcohol is often taken as a refuge from mental 
 conflict and, when this is the case, psycho-analysis would be the 
 proper method of cure. 
 
 We now have the first three groups left for consideration, and 
 these are all of interest to the medical psychologist. 
 
 Maniacal-depressive insanity is a psychosis characterised by 
 attacks of mania and melancholia, and it may be taken as a general 
 rule that no attempt should be made to analyse these patients 
 during the course of one of their attacks. A maniacal patient is 
 in too excited a condition to co-operate, and psycho-analysis 
 during an attack of melancholia tends to make the patient worse. 
 The analysis should be undertaken between the attacks, and many 
 medical psychologists have come to the conclusion that it should 
 not be pushed too far. A partial analysis of a few hours, 
 laying bare the most obvious of the patient's repressed complexes, 
 which are very near the surface, is often sufficient to effect a 
 permanent recovery ; whereas anything like a complete Freudian 
 analysis only does harm. Some of the most experienced psycho- 
 analysts, however, disagree with me on this point. I ought to say 
 that the psycho-analyst may often obtain a hint as to the nature 
 of these complexes by a careful study of the patient's conduct, 
 delusions and apparently incoherent remarks during an attack ; but 
 the analysis itself should be postponed until the attack is over. 
 
 The analysis of dementia prsecox should certainly not be 
 attempted by the beginner. Most of the cases are too inacces- 
 sible mentally, while some of the earlier cases are too accessible, 
 by which I mean that within a week of starting the analysis the 
 patient has flooded you with an enormous tangle of repressed 
 sexual complexes, out of which there seems to be no possibility 
 of escape. The most favourable cases are those of katatonia. I 
 must warn the beginner against cases of dementia paranoides for 
 his own sake. Negative transference, which I shall be explaining 
 later, is liable to be set up, and may induce the patient to inflict 
 actual bodily injury upon his doctor, which may go as far as
 
 26 
 
 murder, a most undesirable sequel to the doctor's patient 
 efforts. 
 
 The same state of affairs may arise in the analysis of cases of 
 paranoia, but we also encounter another difficulty. The patient 
 suffers from a systematised delusional state on which he bases his 
 whole attitude to the outside world, and he refuses to believe that 
 there is anything amiss with his mentation. This being the case, 
 it is only to be expected that he will refuse mental treatment of 
 all kinds. I have not myself had the opportunity of attempting 
 psycho-analysis of a patient of this kind, but some of my colleagues 
 have told me that they have been successful with some cases. I 
 understand, however, that most psycho-analysts regard the prog- 
 nosis of this disease as unfavourably as it was deemed before the 
 introduction of their method of treatment. 
 
 In Class II. we come to the cases for which psycho-analytic 
 treatment is pre-eminently satisfactory. These are the cases upon 
 which Freud made his earlier and, indeed, the greater part of his 
 studies. These are the cases that the psycho-analyst likes to meet. 
 Many hysterical patients can be cured by other means, and 
 there is no necessity for psycho-analysis until such means have 
 failed or unless persistent relapse occurs after the treatment. 
 
 For the compulsion neurosis, however, imperative ideas, obses- 
 sions, morbid fears, irrepressible thoughts and morbid impulses, 
 there is no other treatment than psycho-analysis, which is 
 remarkably efficient and satisfactory. 
 
 Of course, no psycho-analyst claims that his method is infallible, 
 even in cases of hysteria and psychasthenia. It is necessary to 
 say this because many of the critics like to say that he does put 
 forward such claims. Psycho-analysis has its failures as well as 
 its successes, just like any other mode of treatment ; but we do 
 claim that psycho-analysis is more successful than other methods 
 in suitable cases, the reason being that each patient is treated as 
 an individual with a mind of his own, peculiar to himself, and not 
 as a person suffering from a disease for which the panacea is a 
 " rest-cure ", now well-known to be inefficient in many cases. 
 
 The disorders of Class I. are also suitable for psycho-analysis, 
 but it is soon found that a complete psycho-analysis is unnecessary, 
 because the cause of the trouble is soon found and appropriate 
 advice can be given accordingly. I shall refer to such matters 
 in the next chapter.
 
 THE ASSOCIATION TEST 27 
 
 Technique. Before beginning a course of psycho-analysis it is 
 necessary to make sure that it can be continued. You must be 
 sure that neither your own engagements nor those of the patient 
 are likely to interrupt it. To leave the patient with a half- 
 revealed complex for more than a day or two will only make him 
 worse. For this reason psycho-analysis is ill adapted to institution 
 work. At any rate, it cannot be carried out by medical officers 
 whose time is occupied by administrative duties. In private, the 
 financial aspect must also be considered and you must be satisfied 
 that the patient can afford to continue the treatment for at least 
 four months, not only because a doctor cannot afford to spend an 
 hour a day without remuneration, but because free cases are for 
 some reason unsatisfactory to treat. 
 
 The patient is first systematically examined, and a provisional 
 diagnosis made. All defects in physical health are remedied, such 
 as errors of refraction, carious teeth, sources of septic infection, 
 nasal obstructions, and so forth. 
 
 When it has been decided that the patient is a suitable case 
 for psycho-analysis, he is directed to sit in a comfortable arm- 
 chair by the consulting-room table, more or less facing the doctor. 
 This is my own method, but some physicians arrange that the 
 patient shall face another way, so as not to be distracted by his 
 examiner's changes of expression. Freud himself recommends 
 that the patient lie on a comfortable couch and that the physician 
 sit at the head of it, so that the patient cannot see his face. 
 
 Many physicians begin with an association experiment with, 
 or more usually without, the use of a galvanometer, sphygmograph, 
 and stethograph. If it is decided to employ these instruments, the 
 sphygmograph and stethograph are fitted with a Marey's tambour 
 and revolving drum for recording alterations in the frequency 
 of the pulse and respiration. The galvanometer, if used, should 
 be delicate, astatic and of high resistance, and it should be 
 arranged with its two poles lying in two basins of water. The 
 circuit is completed through the patient, each of his hands lying 
 in one of the basins of water. A galvanic cell generating a weak 
 electrical current may or may not be introduced into the circuit. 
 In an association experiment with an ordinary patient, all these 
 instruments are mere accessories, but they may play an important 
 part in attempting the analysis of a suspected criminal. 
 
 The physician now takes a list of quite ordinary words, usually
 
 28 
 
 THE NEW PSYCHIATRY 
 
 
 about a hundred, and reads them one by one to the patient. These 
 are known as "stimulus words", and the patient is required to 
 react to each in succession by stating the first word that comes 
 to his mind in association with the stimulus word. The physician 
 works with a stop-watch and the patient is required to react as 
 quickly as possible; a normal reaction takes about two seconds. 
 Opposite each stimulus word the psycho-analyst writes the "re- 
 action word" and the time taken by the reaction. 
 
 I append here a list of suitable words, but it is as well for 
 the doctor to introduce here and there words which appear to 
 have some bearing upon the patient's own malady. 
 
 Quiet 
 
 Law 
 
 Correct 
 
 To play 
 
 Despise 
 
 Wall 
 
 Trouble 
 
 Pencil 
 
 Threaten 
 
 Tooth 
 
 Journey 
 
 Whisky 
 
 Woods 
 
 Habit 
 
 Book 
 
 Bible 
 
 Justice 
 
 Yellow 
 
 Dance 
 
 Wild 
 
 Apple 
 
 Work 
 
 Dream 
 
 Afraid 
 
 Box 
 
 Salt 
 
 Lion 
 
 Insolent 
 
 Child 
 
 Thirsty 
 
 Tobacco 
 
 Hammer 
 
 Ride 
 
 Sing 
 
 Hard 
 
 Cottage 
 
 Crowd 
 
 Soldier 
 
 Frog 
 
 Moon 
 
 Love 
 
 Paint 
 
 Thief 
 
 Proud 
 
 Glass 
 
 Sorrow 
 
 Rent 
 
 Green 
 
 Wool 
 
 Sympathy 
 
 Sheep 
 
 Ring 
 
 Joy 
 
 Doctor 
 
 Street 
 
 Water 
 
 To listen 
 
 Quarrel 
 
 Brother 
 
 Harm 
 
 False 
 
 Kiss 
 
 Choose 
 
 Men 
 
 To tell 
 
 Wash 
 Rich 
 
 Policeman 
 Soft 
 
 Deep 
 
 Mouth 
 
 Health 
 Mountain 
 
 Boy 
 Table 
 
 Dark 
 
 Stork 
 
 Anxiety 
 
 Rough 
 
 Duty 
 
 Window 
 
 Luck 
 
 Friend 
 
 Bed 
 
 Ink 
 
 Wish 
 
 Foot 
 
 Smooth 
 
 Girl 
 
 Carpet 
 
 Dog 
 
 Change 
 
 Dirty 
 
 Blood 
 
 Knee 
 
 These words are read through a second time and the associa- 
 tions again noted, but it is not necessary to record the reaction 
 time on repetition. 
 
 The doctor now searches his results for what are known as 
 "complex indicators." These are: 
 
 (1) Undue prolongation of the reaction time (four seconds or 
 
 more). 
 
 (2) Failure to react to a word. 
 
 (3) Strange and incoherent associations. 
 
 (4) Apparent contradictions. 
 
 (5) Perturbation of several reactions following a certain 
 
 association. 
 
 (6) Failure to react with the same word on repetition of the 
 
 test. 

 
 COMPLEX INDICATORS 29 
 
 (7) Accompanying motor and vasomotor phenomena, such as 
 
 restlessness, lip-biting, nail-picking, blushing, &c. 
 
 (8) Increase of frequency of the pulse and respiration. 
 
 (9) The generation of weak electrical currents by the body, 
 
 or, if a cell is introduced into the circuit, alteration 
 of the electrical resistance of the body. 
 
 By a little detective work it is often possible to make a shrewd 
 guess at some of the patient's repressed complexes ; but your own 
 conclusions should never be communicated to the patient. It is 
 legitimate to ask him a question which forces him to admit some- 
 thing that he is obviously withholding, but it is not permissible 
 to do more than this. 
 
 The various "complex indicators" just mentioned are due to 
 intra-psychic " resistances ". Some of these are between the pre- 
 conscious and the conscious, and constitute resistance to a dis- 
 closure of the complex to you. Others are between the unconscious 
 and the preconscious, and constitute a resistance to disclosing 
 an unconscious complex to the patient's own consciousness, and 
 incidentally to you. 
 
 These " resistances " have to be overcome, and the method is to 
 take each of the associations which have revealed themselves as 
 complex indicators, and get the patient to explain them. This he 
 can very readily do with many of his associations by relating some 
 incident in his past experience. Some will prove valueless and be 
 discarded, others worth noting. 
 
 Some of his associations, however, will turn out to be a puzzle 
 to himself. These are important and should be followed up. 
 What is called "continuous association" may first be tried, the 
 patient being told not to stop at the first association, but to go on 
 from one word to another until some light is thrown on the first 
 association ; or the particular reaction may be used as a starting 
 point for a " free association " to be described presently. If during 
 a series of continuous associations the patient comes to a stop, a 
 block, a resistance, he should be urged to find an association. You 
 say to him, for example, " Go on, you must think of something ! " 
 then, after a short pause, especially when he shows some motor 
 restlessness, " What is in your mind now ? You must tell me ". 
 In this way you work through all the reactions and, by the end of 
 the test, you have a very fair amount of material to work upon.
 
 30 THE NEW PSYCHIATRY 
 
 The method of "free association" is conducted in much the 
 same way, except that no stimulus words are given. The patient 
 is directed to make himself quite comfortable and to assume a 
 passive, inert frame of mind. He is then told to allow his thoughts 
 to flow as they will and to exercise no control of them whatever. 
 As they flow in this way he is to speak everything that comes to 
 his mind ; no matter how incoherent his speech may seem, or how 
 painful or repugnant the thought may be, he must speak it out. 
 He is to allow his thoughts and speech to run wild. In this way 
 his associations will here and there tap the unconscious. After 
 a few sittings you can sometimes tap the unconscious almost as 
 soon as he enters the consulting room by making some utterance 
 which calls for no specific reply, such as " Yes ? " or " Well ? " and 
 waiting for him to speak. It may seem ungracious or uncere- 
 monious that you should not enter into the conversation, but you 
 must let him do all the talking. 
 
 In the course of a free association you will again come 
 across " resistances ". The patient will tell you that his mind is 
 a blank and that he can think of nothing. You reply, "Never 
 mind: go on talking". Or he will become silent. Your reply 
 is to become silent too. You wait for seven or eight minutes 
 sometimes, looking at him expectantly the whole time, until 
 something comes up from the unconscious ; or you interrupt the 
 silence suddenly with " Talk ! what is the matter with you ? Go 
 on talking ! " or, at the slightest sign of restlessness, you say, 
 " What are you thinking of now ? Why don't you tell me ? " 
 
 These resistances are difficult to describe because they vary 
 so much with different patients. I have seen a patient fall over 
 the side of the chair, as if collapsed, remarking, " Oh, doctor ! 
 what are you doing to me?" a patient, mind you, who went 
 about his business during the rest of the day as if there were 
 nothing the matter with him, although he was constantly 
 tormented by psychomotor hallucinations and other symptoms. 
 
 From time to time it is well to recapitulate to the patient 
 what he has told you and get him to draw his own conclusions 
 as to the nature and cause of his malady. I wish to insist a 
 little on this point, that he tells you and that you do not tell 
 him, because the critics like to say that the psycho-analyst puts 
 suggestions into the patient's mind. It is true that the patient 
 will sometimes ask, " Is that right, doctor ? " to which my usual
 
 BAD PSYCHO-ANALYSIS 31 
 
 reply is, " Of course it is right, because it is your mind that has 
 come to this conclusion, not mine, and the malady is yours, not 
 mine." Sometimes, of course, it is necessary to counteract some 
 absurd conclusion, but I have found that such conclusions usually 
 originate in a suggestion given to the patient by another person. 
 Beginners in psycho-analysis are liable to make this very mistake. 
 They tell the patient their conclusions as to the nature of his 
 complexes before he has discovered them for himself. These are 
 what Freud has termed the " Wild psycho-analysts ". Sometimes 
 their conclusions are correct, sometimes incorrect. One patient 
 of mine told me that a certain doctor after one week's analysis 
 informed him that he was in love with his mother, to which, 
 not understanding what was meant, he replied, " Of course I'm in 
 love with my mother". Now it happens that the doctor was 
 right ; the patient's libido was unconsciously fixated on his mother, 
 so much so that, although he was forty years of age and had 
 been in love many times, he could never bring himself to marry 
 the girl of his choice. Psycho-analysis, as a method of bringing 
 hidden complexes to light, has been compared to opening an 
 abscess ; but this doctor's method was more like hitting an abscess, 
 not opening it. 
 
 I can here foresee an objection that there is no need for the 
 psychologist if he be not allowed to supply interpretations of the 
 patient's data or even to engage in conversation, and I have indeed 
 had the experience of a patient who, while admitting her recovery, 
 remarked " But I do not see what you have done ". I accepted 
 that as a very great compliment. 
 
 As a matter of fact, the work of the psychologist is at times 
 very great in overcoming resistances, which sometimes last for 
 several sittings. One form of resistance for which you must be 
 on the watch is what the Germans call vorbeireden as we should 
 say, "talking past the point." The patient suddenly becomes 
 loquacious and hurries past a certain association, just as a hostess 
 at a dinner-party may suddenly become talkative and change the 
 conversation, knowing that it is getting dangerously near a tender 
 subject for one of her guests. The analyst's duty is the reverse 
 of this. He brings his patient back to the point, discusses it right 
 out and perhaps starts a new series of associations. Then again 
 it is desirable to encourage associations which promise to revive 
 infantile memories. Such memories are usually strongly visual
 
 32 THE NEW PSYCHIATKY 
 
 and difficult to associate with words ; it is therefore well on such 
 occasions to ask the patient to close his eyes, to see pictures, and 
 to relate what he sees. Indeed it is helpful in all psycho-analysis 
 that the patient should keep his eyes closed. His mental and 
 bodily attitude should resemble that of going to sleep in that the 
 mind should be allowed to wander, but there is the difference that 
 the subject's attention is directed to his own psychical activities. 
 Of course he requires a certain amount of practice before he is 
 able to do this successfully. 
 
 His part of the work is by no means easy and many a patient 
 attains peace of mind at the expense of his hair turning grey ; not 
 as a result of the difficulty of technique, but as a result of 
 overcoming resistances. 
 
 I now come to the interpretation of dreams which Freud has 
 designated the " royal road " to the unconscious. In sleep, those 
 parts of the nervous system which subserve phenomenal con- 
 sciousness are more or less in abeyance and they are only aroused 
 temporarily by associative stimulation from the nervous mechanisms 
 subserving unconscious activities. If these unconscious activities 
 were allowed to become conscious, if they were allowed to rouse 
 the nervous arrangements subserving consciousness to full activity, 
 sleep would of necessity cease : but the constant desire of the 
 sleeper to go on sleeping prevents unconscious activities from 
 becoming conscious in an undisguised form, so that sleep continues 
 under the guardianship of the dream. This will become clearer 
 as I proceed. 
 
 The interpretation of dreams, being the royal road to the 
 unconscious, constitutes a very important part of psycho- 
 analysis. 
 
 We have to recognise the " manifest " and the "latent " content 
 of a dream. The manifest content is contained in a description of 
 the incidents of the dream as the dreamer would relate them at 
 the breakfast table the following morning ; but, by studying the 
 mental associations of dreams, Freud has discovered that each 
 contains a deeper meaning, which has been called the latent 
 content. This latent content is invariably the imagined fulfilment 
 of an unconscious wish. This is the real purpose of dreaming, to 
 gratify unconscious desires which can obtain gratification in no 
 other way ; while it is the distortion of the dream which serves as 
 the guardianship of sleep.
 
 THE SOURCES OF DREAMS 33 
 
 In children and imbeciles, who are children who have not 
 mentally grown up, the wish-fulfilment is undisguised. If a child 
 dreams that it has a rocking-horse, or that it is driving its father's 
 motor car, this means that he would like a rocking-horse or he 
 would like to drive the car. In a child very little repression has 
 yet taken place and therefore unconscious mentation plays a very 
 small role in the mind of the child. In an adult, on the other 
 hand, the wish-fulfilment is disguised and distorted so as to be 
 unrecognisable by the phenomenal consciousness of the dreamer. 
 I shall not have time to discuss fully the psychology of this 
 distortion, but I may say that roughly it is necessitated by the 
 censorship existing between the unconscious and the preconscious. 
 The disguise is assumed so that the dream material may pass the 
 censor into consciousness. 
 
 Before discussing the mechanism of this distortion, let me say 
 that the material upon which a dream is based consists of : 
 
 (1) Some incident of psychical importance on the day before 
 the dream the dream-day or at least some memory, occurring 
 during the dream-day, of some recent incident of psychical 
 importance. 
 
 (2) Some memory of long ago, usually early childhood. 
 
 (3) The fulfilment of an unconscious wish. This may be 
 incited by a wish during the dream-day which circumstances 
 prevented being gratified, or by a wish unfulfilled and suppressed 
 during the dream-day, or by some wish arising from the un- 
 conscious during the night, or by an actual wish-incitement 
 occurring during sleep, such as thirst or distension of the seminal 
 vesicles. Freud considers, however, that a wish occurring during 
 the dream-day is insufficient to provoke a dream unless it is 
 reinforced by an infantile wish. 
 
 It may be taken as a general rule that all the dreams occurring 
 in the same night refer to the same subject, and most people have 
 had the experience of a series of dreams occurring on successive 
 nights, obviously relating to the same subject. In such a series 
 the wish fulfilment is more boldly expressed and less concealed in 
 the latter dreams than in the earlier. It is therefore wise to 
 start the analysis of such a series by taking the last dream first. 
 
 That the dream actually has a secret meaning which turns out 
 to be a wish fulfilled must be proved afresh for every case by 
 means of an analysis; but it is helpful to know what are the 
 
 3
 
 34 THE NEW PSYCHIATRY 
 
 mechanisms of distortion, although dreamers themselves will tell 
 you this to a certain extent as the analysis proceeds. 
 
 The mechanisms of distortion are exactly the same as those 
 which produce symptoms of the psychoses and psychoneuroses, 
 viz. : Displacement, Condensation, Symbolisation and Dramatisa- 
 tion. These and some other features of dreams I will briefly 
 explain. 
 
 1. Displacement. The unimportant details of a dream are often 
 the most significant, as also are the parts which are vague, subse- 
 quently forgotten (repressed), or are related differently on being 
 told a second time (" secondary elaboration " to which I shall refer 
 again). It is best to start analysing a dream at such parts. 
 Similarly when a person has a " dream within a dream ", when he 
 dreams that he wakes up from a dream and goes on dreaming, 
 saying to himself " Why, I was only dreaming ", such " dream 
 within a dream " is important. By this I mean that disguise is 
 regarded by the censor as incomplete and that analysis should 
 therefore be so much less difficult. 
 
 2. Condensation. Almost every element of a dream represents 
 not one, but a number of unconscious thoughts fused into one 
 conscious thought, so that the element is said to be " over- 
 determined". For example, Freud relates that a lady dreamed 
 that she had crushed a June bug (" ladybird ", as we would call it) 
 in shutting down a window. This incident in the dream condensed 
 the following thoughts : She had allowed a moth to drown in a 
 glass of water ; she had read a story the evening before of some 
 boys throwing a cat into boiling water ; she was occupied with the 
 subject of cruelty to animals ; years before her daughter used to be 
 cruel to insects by pulling off their wings ; she also used to collect 
 butterflies, and used arsenic to kill them ; during the same year 
 there was a pest of ladybirds and the children used to crush 
 them, at the same time she saw a person tear off their wings and 
 eat them, and so on. 
 
 Ernest Jones tells of a patient who dreamed that he met a 
 man named Lysanias, who is mentioned in Luke iii. 1 as being the 
 tetrach of Abilene. Analysis revealed that the patient had in- 
 dulged in licentious sexual practices when at the Zyceum (as they 
 called his school) in an old abbey with a boy named Leney. This 
 is, of course, a remarkable instance, but such condensation is not 
 an exception, but the rule. Persons, for example, who are
 
 DREAM DISTORTION 35 
 
 unknown to the dreamer are regularly composite persons con- 
 structed from several people he does know. Sometimes such 
 condensation is accomplished by the presentation of the features 
 of one person with the mannerisms and speech of another. Con- 
 densation causes vividness of the presentation and, vice versd, 
 vividness implies condensation. 
 
 3. This is a convenient place to mention that dreams are 
 always egotistic, and that the dreamer himself is always repre- 
 sented. Indeed he is always the chief actor, and a person in the 
 dream whose features he cannot recognise may be himself. If 
 there is difficulty in deciding which of two unknown persons 
 represents the dreamer, it is a safe rule to assume that it is that 
 one whose emotional experience is the greater. This brings me 
 to another subject. 
 
 4. Emotional Affect in Dreams. The emotional tone attaching 
 to any percept in a dream is never distorted. It is always correct. 
 It is true that the affective tone may not appear, but when it does, 
 it is always the correct one for the situation. The situation, 
 however, is disguised; so that pleasure may be felt when the 
 dreamer meets three lions in the desert, the lions symbolising 
 three friends, or fear may be expressed when the dreamer has the 
 chain of mayoralty placed around his neck, if the chain symbolises 
 the hangman's rope. This brings me to the subject of 
 
 5. Symbolisation, which is rife in Dreams. In the majority 
 of cases, symbols are a cloak for some sexual idea. Long objects, 
 such as sticks, umbrellas, ships and airships, snakes and trees, 
 commonly represent the penis. A patient of mine dreamed that 
 he was climbing a marble pillar ; on analysis it turned out that 
 the pillar represented the penis and that climbing it symbolised 
 masturbation. Caskets, boxes, wagons and such articles usually 
 indicate the female body. Tunnels and passages represent the 
 vagina. Rhythmical movements, such as sawing, tiling, horse- 
 riding and going upstairs, are symbolic of the sexual act. 
 Emperor and empress and king and queen are the dreamer's 
 father and mother. Right and left often mean right and wrong 
 in a moral sense. Architectural symbolism is quite commonly 
 employed for the architecture of the body ; and the associations 
 belonging to plant life and to cooking are often chosen to conceal 
 sexual images. 
 
 6. In this connection I may refer to " somatic displacement ".
 
 36 THE NEW PSYCHIATRY 
 
 The nose or an arm may symbolise the penis, and the head may 
 symbolise the uterus. A patient of mine dreamed that she had 
 an intense headache which was relieved by her emitting masses 
 of red flesh from her mouth. Analysis revealed that the dream 
 was the disguised fulfilment of a wish to have another child, 
 the headache symbolising labour pains and the masses of flesh 
 representing the baby. She suffered from the anxiety neurosis 
 and her husband had practised coitus interruptus since the birth 
 of her first and only child seven years previously, when she 
 experienced great suffering from the difficult labour. 
 
 7. Inversion or representation of the opposite is common. As 
 examples, another person's attempt to kill you may represent an 
 unconscious wish on your part to get rid of him. A tree carried 
 on a man's back may be symbolic of his penis. The sequence of 
 events may also be transposed. I ought here to contradict in 
 part what I have said about the emotions in dreams, viz., that 
 they are always correct if applied to the latent content. It happens 
 occasionally that an emotion is represented in a dream by its 
 opposite. Inversion of some particular element usually means 
 that something else in the dream is also inverted. 
 
 8. The doctor himself, the psycho-analyst, is often represented 
 in the dreams of patients. In a particularly transparent dream a 
 patient of mine found herself in church. There was a large 
 congregation including a certain clergyman the Rev. X. while 
 another clergyman whom I will call Y. was conducting the service. 
 The Rev. Y. and the whole congregation then vanished or left the 
 church with the exception of the Rev. X. and my patient. On 
 analysis the Rev. Y. turned out to be myself, and when I tell you 
 that a crowd or multitude of people signifies a secret, the interpreta- 
 tion becomes clear. The patient had a secret which she did not 
 wish to reveal to me, but wished to do so to the Rev. X. There 
 was no congregation, i.e., no secret, when I had gone. 
 
 9. Dramatisation. Incidents, people and things are selected 
 and arranged so as to present the dream in a more or less dramatic 
 form. Both past and future become the present so as to fit into 
 the picture. 
 
 Conjunctions such as " if ", " although ", " as though ", " either- 
 or ", and " because ", do not occur in dreams. Logical relationship 
 is represented by simultaneity, " because " by succession in time, 
 and " either-or " is equivalent to " and " in the dream. 
 
 .
 
 ANALYSIS OF DREAMS .".7 
 
 10. Secondary Elaboration. Dreams are not commonly related 
 with the strictest accuracy, even when the sleeper wakes, and 
 they are frequently changed here and there on being related a 
 second time. In waking moments the censor is more alert, and 
 the latent content becomes still further disguised in order to 
 render it acceptable to clear consciousness and just in those parts 
 where there is an unconscious feeling that the disguise is not 
 sufficiently complete. These, therefore, are favourable points for 
 starting the analysis of a dream. 
 
 A dream is usually analysed easily if there has been much 
 resistance to relating it, or when there are such remarks as "But 
 it was only a dream ! " or " What is the use of telling it ? That 
 will not help me ". Attention should always be paid to such com- 
 ments on the dream and they should be regarded as part of the 
 latent content. 
 
 In analysing a dream, it should be taken item by item. The 
 patient should be asked who or what is represented by the item. 
 He should be directed to form a series of associations with it 
 and told to speak everything that comes to his mind, as has been 
 described as free association. Often it is useful to start again 
 from the beginning, when it is usually found that the associations 
 lead by another path to the same conclusion, except where there 
 is condensation. 
 
 The associations of various items are then reviewed and the 
 patient is asked to state his conclusions as to the meaning of 
 the dream. The doctor then assigns it to its particular complex 
 for future use. 
 
 Of course an experienced psycho-analyst can often see the 
 meaning of a dream more readily than the patient, but he should 
 always offer any interpretation tentatively, saying, for example, 
 " Of course, you will be able to tell me whether the interpretation 
 I am about to suggest is correct or not. If I am wrong, please 
 say so." If the interpretation is right, the patient will often 
 acquiesce quite readily. If incorrect, his reply is something like, 
 " Oh, no ! I am sure it does not mean that ". If the interpretation 
 is only partial or if it is partly right and partly wrong, he will 
 say, " It might be " or " I don't think so ", indicating some 
 uncertainty. It quite frequently happens, however, that a 
 correct interpretation induces the strongest denial and resistance 
 to insight ; but his protestation is too much and the very stout-
 
 38 THE NEW PSYCHIATRY 
 
 ness of his disclaimer betrays the fact that the interpretation is 
 correct. It is better, however, to leave a dream unexplained 
 than to force your own construction on the patient. 
 
 Again, in psycho-analysis generally, it may be desirable, after 
 recapitulating the data already obtained, to explain your own 
 interpretation of the patient's symptoms. For example, symptoms 
 occasionally arise as a result of repressed homosexuality, the 
 patient having no idea what homosexuality is, or even knowing 
 that it exists. In such a case it would be necessary to explain 
 this to the patient. 
 
 I will conclude my remarks about dreams by quoting a foot- 
 ^ \uu\ta- note from Freud : " In general it is doubtful in the interpretation 
 of every element of the dream whether it 
 
 (a) is to be regarded as having a negative or positive sense 
 
 (relation of opposition) ; 
 
 (b) is to be interpreted historically (as a reminiscence) ; 
 (e) is symbolic ; or whether 
 
 (d) its valuation is to be based upon the sound of its 
 verbal association. 
 
 " In spite of this manifold signification, it may be said that the 
 representation of dream activity does not impose upon the trans- 
 lator any greater difficulties than the ancient writers of hiero- 
 glyphics imposed upon their readers." 
 
 Dreams are so important and helpful in psycho-analysis that 
 I have taken them as a pattern of the various clues and hints of 
 what is going on in the unconscious; but we can often obtain 
 many suggestions from apparently trifling incidents and habits 
 occurring in the patient's everyday life. 
 
 I have already mentioned the " press of conversation " or 
 vorbeireden occurring during an analysis as a complex indicator. 
 Similarly, the patient may assume a sudden laughter or merriment 
 during the serious work, an obvious attempt to disguise a painful 
 thought. He may abruptly start picking his nails, or a woman 
 may toy with her hair or write figures with her finger on her lap. 
 Twitches of the mouth and eyes and many such trifles, all of which 
 I have seen in patients, all mean something and the meaning has 
 to be elicited by analysis. 
 
 I have referred in Chapter I. to such " symbolic actions " as
 
 SYMBOLIC ACTIONS 39 
 
 the old maid keeping many pets or interesting herself in the 
 newspaper reports of divorce scandals. 
 
 A common experience of psycho-analysts is that patients leave 
 some of their belongings after a satisfactory interview. This is an 
 unconscious way of expressing a wish to return for further 
 treatment. 
 
 People who have displayed a tendency during childhood to 
 pilfer or lie and still have an unconscious tendency in the same 
 direction are scrupulously careful to pay for everything " on the 
 nail ", as the saying is, or to be excessively precise and truthful 
 whenever they make a statement, thus giving a hint of their 
 repressed complex. 
 
 Ask any nurse why she took up the nursing profession and 
 she will give all sorts of reasons why she was justified in consider- 
 ing herself a born nurse; but, if you will take the trouble to 
 investigate her history, you will find in quite the majority of cases 
 that there has been some unhappiness in her domestic circle or 
 that a younger sister has found a husband. They would not 
 admit such reasons, even to themselves, and I make no complaint 
 against their work. 
 
 A spendthrift usually has all the apparatus for saving money 
 cash-box, ledger, day-book and the rest of it, but his unconscious 
 tendency prevents him from using them. 
 
 These are generalities, but patients and others often supply 
 particular examples of the work of the unconscious. Dr Bernard 
 Hart quotes a patient, for example, who had an irresistible impulse 
 to examine the number of every bank note which came into her 
 hands. Analysis revealed that this habit dated from an occasion 
 when she asked a man, with whom she was in love, to change a 
 coin for her. He complied with her wish and, putting the coin in 
 his pocket, said that he would not part with it. This remark 
 raised her hopes that her love was reciprocated, and any money 
 passing through her hands always reminded her of the incident. 
 The man passed out of her li-fe, however, and she strove to banish 
 the episode from her memory and to forget that such a desire 
 ever crossed her mind. The repression was successful and the 
 complex was thenceforward only allowed to enter consciousness in 
 disguise, viz. : as an interest in money, which became crystallised 
 into her exaggerated preoccupation with the numbers of bank 
 notes.
 
 40 THE NEW PSYCHIATRY 
 
 An illustration from Jung. An old female patient of an asylum 
 spent all her time huddled up and performing a stereotyped action 
 resembling that of a cobbler sewing boots. Investigation showed 
 that she had, as a young girl, been engaged to a shoemaker, and 
 that the engagement was suddenly broken off. 
 
 Freud has demonstrated that the forgetting of proper names, 
 far from being fortuitous, is always due to the activity of the 
 intra-psychic censor. Whenever a name is forgotten or incorrectly 
 remembered a reason can always be discovered, usually by a 
 quite superficial analysis, why it has been forgotten. Some dis- 
 agreeable memory is the common cause, associated either with 
 the individual or with a person or place of the same or a similar 
 sounding name. In other words, the forgetting is neither more 
 nor less than a repression. Examples of this occur in everybody's 
 experience every day. I always have a difficulty in remembering 
 the name of a certain town in Italy, Ferrara, where owing to 
 a piece of foolishness I had to run for nearly a mile in record 
 time in order to catch a train in which I had already placed my 
 luggage. The forgetting of resolutions belongs to the same 
 category of unconscious phenomena, the commonest example 
 being that we are more liable to forget having borrowed money 
 than having lent it, although none of us would admit to ourselves 
 that we have dishonest propensities. 
 
 The mislaying of objects gives another series of clues to the 
 unconscious. I have already mentioned that patients are liable to 
 leave some of their belongings, usually an umbrella, in the halls 
 or waiting-rooms of psycho-analysts. Bills are more apt to be 
 mislaid than cheques. If a cheque is mislaid, you will find that 
 you have a feeling that you have not given sufficient value for 
 the money or that you have failed to declare it to the income- 
 tax authorities or that you do not like the person who gave it 
 to you or there is some other unpleasant association with the 
 cheque. 
 
 Mistakes in speaking, reading and writing (lapsus linguae et 
 calami} belong to the same category. They are betrayals of 
 repressed complexes and no psycho-analyst allows such a mistake 
 made by himself to pass without searching for the hidden cause 
 of it. 
 
 A psycho-analyst always gets his patients to relate to him such 
 symbolic actions, failures of memory and lapses of the tongue and
 
 PROJECTION 41 
 
 pen, so that he may investigate them and thus gain access to the 
 unconscious tendencies of his patients. 
 
 I must here refer to another psychological mechanism which 
 often serves as an indicator of repressed complexes, not only in 
 nervous disorder, but also in every-day life. I refer to " projection ". 
 
 The peculiarity of this phenomenon is that the effects of the 
 repressed complex are attributed by the individual possessing it, 
 not to himself, but to some other person. A few examples will 
 explain my meaning. People who are guilty of some failing, 
 imperfection or weakness, of which they are ashamed, are 
 exceedingly liable to attribute the same fault to others. If a thief 
 loses an article, his first thought is that somebody has stolen it 
 from him, and the man who is ever ready to disbelieve any 
 statement made to him is himself a person who is habitually 
 economical of the truth. The dishonest financier is always on the 
 alert lest somebody should swindle him and he is exceedingly 
 intolerant of anybody who succeeds in doing so. The man who 
 is unfaithful to his wife is usually suspicious that she may have 
 been unfaithful to him, and how often have we all heard an asylum 
 patient declare that his wife is insane, or a drunkard accuse his 
 consort of insobriety. Self-reproach is so unpleasant to conscious- 
 ness that it is repressed and converted into reproach of other people. 
 
 The mechanism of projection is common in many forms of 
 insanity. I remember a patient who travelled all over England in 
 search of an imaginary lady, whom he supposed to be in love with 
 him, the real truth being that he himself had an unconscious 
 desire to get married ; and some unmarried ladies at the 
 climacteric have their libido unconsciously fixated on some un- 
 fortunate individual, with the result that they think that he has 
 fallen in love with them or is paying them undesired attention. 
 
 Hallucinations sometimes arise in this way. The patient, 
 instead of accusing himself of some fault, refuses to acknowledge 
 to himself that he possesses it, and believes that other people 
 are accusing him, the hallucinations being in reality symbolised 
 self-reproaches. 
 
 Perhaps I ought to mention two other methods of tapping the un- 
 conscious, which do not, however, belong to psycho-analysis proper. 
 
 Crystal-gazing is one. It does not require much practice and 
 is quite easy for a neurotic patient. He is directed to abstract 
 his mind from all normal sensory impressions and to gaze intently
 
 sions and awake only to those of his sub-conscious self is probably 
 in a mild state of hypnosis. 
 
 42 THE NEW PSYCHIATRY 
 
 into a glass sphere. A black background is preferable and it is 
 advisable not to have too much illumination. Clouds appear 
 in the ball at first, which advance and retire synchronously with 
 respiration. Then the many reflections are unconsciously com- 
 bined to form an illusory picture, which is at first vague and 
 indistinct, but the unconscious soon fills in the details. Definite 
 hallucinations then form which ultimately take on movement. 
 These hallucinations represent some forgotten incident of the past 
 life of the individual, with much less distortion than takes place in 
 dreams. The percipient, being detached from surrounding impres- 
 
 : V Lw.f*' J 
 
 The patient relates to the doctor all that he sees in the crystal 
 ball and, the memory of some incident having been revived, he 
 is urged to connect it with his present content of consciousness by 
 the association methods already described. 
 
 The method is not much used, but I have sometimes found it 
 helpful in overcoming resistances in the interpretation of dreams. 
 
 Hypnosis is the last method which I shall mention of penetrat- 
 ing the field of the unconscious. It is explained to the patient 
 that he is to be hypnotised and the object of the procedure is 
 expounded to him. He is directed to offer no resistance, but to 
 allow his mind and body to become perfectly supple and flaccid, 
 and he is told that failure to hypnotise him will be due to 
 resistance on his part, all hypnosis being in fact auto-hypnotism. 
 One of the various methods in common use is then employed. 
 
 On account of unconscious resistance, however, it is quite 
 unusual, except in cases of hysteria, to obtain deep hypnosis in a 
 neuropathic patient. Should the hypnotism be so successful as to 
 abolish his normal consciousness, his unconscious mind is laid bare 
 and it becomes possible to discuss with him details of incidents 
 which in the waking state are completely forgotten. Such a state 
 would be ideal for the recovery of repressed complexes if it could 
 be easily induced ; but it was this very difficulty that caused Freud 
 to give it up in favour of his method of free association. 
 
 It is a matter of experience that persons who have been partly 
 psycho-analysed are very easily, but not deeply, hypnotised ; but 
 people who have been completely psycho-analysed right back into 
 their earliest years of infancy cannot be hypnotised at all, 
 presumably because they have no unconscious.
 
 THE TRANSFERENCE 43 
 
 If a person is to be psycho-analysed I prefer that he should 
 not be hypnotised. For some reason or other, previous hypnosis 
 appears to increase resistance, to augment the power of the censure. 
 Patients who have undergone a course of hypnotism are in my 
 experience unsatisfactory to treat by psycho-analysis. Hypnotism 
 should, as a rule, be used for post-hypnotic suggestion only. 
 
 The Transference. In the first lecture I explained that every 
 constellation of ideas which we call a " complex " is possessed of a 
 certain amount of psychical energy or horme, desire plus a conative 
 trend ; and it is this horme or libido which usually conflicts with 
 the herd instinct and brings about that mental conflict which 
 secures adjustment by repression of the whole complex into the 
 unconscious. 
 
 Fixation of the libido in the unconscious may be on the father 
 ((Edipus-complex) or on the mother (Electra-complex), on a person 
 of the same sex as the patient (homosexual-complex), on a person 
 of the opposite sex who has passed out of the patient's life or 
 even on an inanimate object (money, for example). When, there- 
 fore, by the methods I have described, an unconscious complex 
 becomes conscious, this libido becomes conscious too, but this time 
 its object is not available. The method of psycho-analysis has 
 itself divorced the libido from its former object. There is there- 
 fore a certain amount of libido, synonymously psychical energy, 
 floating free, so to speak. What becomes of it ? Such a state of 
 affairs cannot possibly persist. It becomes attached to or fixated 
 on the personality of the physician. This is a stage which must 
 be attained by every patient and is known as " the transference ". 
 To some extent a similar feeling of dependence and confidence 
 occurs in every patient, whether he be suffering from heart disease, 
 phthisis, cancer or any other organic disease ; but it is enormously 
 exaggerated in a neuropath who is undergoing treatment. 
 
 All psycho-analysis proceeds vid transference. Psycho- 
 analysis means using transference for the purposes of treatment, it 
 being the only way in which buried memories can be recovered. 
 It is often difficult to see how on earth certain infantile fixated 
 relationships can possibly be transferred to the physician, but the 
 patient's unconscious mind discovers a way, usually with the help 
 of a dream. When, as commonly happens, the infantile fixation 
 is of a hostile nature, the patient's unconscious mind is most 
 insulting to the physician, although superficially he is as polite as
 
 44 THE NEW PSYCHIATRY 
 
 ever. Under such conditions, when the transference has been 
 effected, it may be very disagreeable and indeed dangerous. In 
 patients suffering from delusions of persecution for example, the 
 patient then regards the physician as his persecutor. Jung of 
 Zurich told me of a patient of his, who presented him on recovery 
 with a loaded pistol which, during the stage of transference, was 
 intended to be levelled at him. This is known as " negative 
 transference ". It must never be forgotten that during the trans- 
 ference the neurosis is as active as ever. There is a recrudescence 
 of many of the symptoms of the former neurosis with the differ- 
 ence th^t some earlier person is replaced by the person of the 
 physician. A similar transference on the part of the physician 
 has to be guarded against ("reversed transference" it is called) 
 and is to be avoided by self-analysis. 
 
 It is the commonest complaint of neurotic patients that they 
 are not understood, but in the psycho-analyst they have found a 
 man who listens sympathetically, tries to understand them and 
 never gets annoyed by their constantly recurring resistances. 
 The doctor has become a kind of father confessor who has 
 penetrated the secrets of his soul far deeper than any father 
 confessor ever does, while the patient has found a prop against 
 which he may lean for evermore. He considers the situation 
 ideal and resists all attempts to alter it, even reverting to all his 
 former phantasies in their new relationship. 
 
 This is the state in which the father confessor would leave him, 
 but the psycho-analyst must place the patient upon his own feet. 
 In other words, the next stage in the treatment is dissolution of 
 the transference relation. This is the most difficult part of psycho- 
 analysis, because the resistances are stronger than ever. It is to 
 be accomplished in exactly the same way in which the transference 
 relation was produced, viz., by psycho-analysis. 
 
 In this, dream interpretation will again play an important part, 
 for it will now prove a useful guide in our search for the future 
 object of the libido. We must find new interests for the patient 
 and encourage him in them, so that he may come once more into 
 practical relationship with the world around him. During this 
 process all his symptoms crumble away and, in the end, he finds 
 himself neither better nor worse than other members of the 
 community around him, but just a normal person.
 
 APPLICATIONS AND RESULTS 45 
 
 CHAPTER III. 
 APPLICATIONS AND RESULTS. 
 
 IN this Chapter various matters are discussed which have been 
 elucidated by psycho-analytic methods respecting the neuroses, 
 psychoneuroses and psychoses. 
 
 Freud recognises two neuroses proper, viz. : Neurasthenia and 
 the Anxiety Neurosis. Probably a few cases of hypochondriasis 
 are due to the same etiological factors as these neuroses and 
 should therefore be included in the same group. 
 
 Neurasthenia is a term which hitherto has been used very 
 loosely and the separation of the Anxiety Neurosis as a distinct 
 disease is due to the clinical insight of Freud. The term 
 " Neurasthenia " is now limited to a class of case which exhibits 
 very definite symptoms, the chief of which is an undue tendency 
 to fatigue. This is well demonstrated in ergographic tracings 
 from neurasthenic patients. In a normal person such tracing 
 shows a gradual increase of power at the beginning of the 
 experiment, so that the lever rises more and more with each 
 successive contraction. This is ascribed to the effect of practice. 
 Subsequent contractions remain at the same level before fatigue 
 sets in, when the level rises less and less until, the finger 
 becoming absolutely useless, the tracing becomes a straight 
 line. With a neurasthenic, on the other hand, the initial increase 
 of power due to the effect of practice is not shown. The first 
 few contractions may be of an average height, but fatigue sets 
 in immediately and the contractions become weaker and weaker. 
 
 The same phenomenon is shown in experiments devised for 
 the purpose of investigating the laws of mental fatigue. In 
 Weygandt's method, for instance, the patient is given a sheet 
 of paper with columns of figures to be added. He starts at the 
 first column and, at the end of a minute writes down his result 
 so far as he has gone. Then he passes to the next column, adds 
 for a minute and puts down the result as before, and so on 
 through the whole series. In a normal person, at first the 
 effect of practice is noticeable in that the added portions of the 
 column get longer and longer until, fatigue setting in, they grow
 
 46 THE NEW PSYCHIATRY 
 
 shorter and shorter. In the neurasthenic, on the other hand, 
 the added portions shorten from the very first. Mistakes in 
 the addition also occur earlier than in a normal individual. 
 
 The so-called " irritable eye " exemplifies the muscular fatigue, 
 the patient complaining that the eyes ache on reading for a short 
 time, although no error of refraction can be found. Examination 
 with the perimeter soon fatigues the retina and, unless carried 
 out quickly, the visual field will be found contracted or spiral. 
 
 These patients are anxious enough to be busy about their 
 affairs like other people ; but all effort, mental or physical, leads 
 to an intense feeling of fatigue. In many cases, even the thought 
 of doing anything causes the patient to tremble and to break 
 into a profuse perspiration. Other symptoms are a sense of 
 pressure on the top of the head, often localised to one spot on 
 the left of the middle line, and various parc^esthesias, especially 
 of the joints and muscles and the back of the head over the 
 occipital spine. The last is explained as a "crawling" or 
 "screwy" sensation, and was aptly described by one patient, 
 whose case was related to me, as a feeling as if there were a 
 black-beetle inside the skull lying on its back and kicking to 
 get on its legs again. Feelings of abdominal discomfort also 
 occur and there may be hypochondriacal notions respecting the 
 genito-urinary apparatus. 
 
 Similar symptoms frequently occur in states of general debility, 
 such as chlorosis, and in the early stages of organic nervous disease, 
 such as disseminated sclerosis or general paralysis. In these con- 
 ditions the case should, of course, not be labelled " Neurasthenia " ; 
 but when the above symptom-complex occurs independently of 
 any other disease, then we have to deal with a case of true 
 neurasthenia. 
 
 Now, in all cases of this kind, without exception, there is 
 always to be found one essential etiological factor, viz. : sexual 
 excess. In the majority of cases this takes the form of masturba- 
 tion, but in a few patients the disease is traceable to frequent 
 nocturnal pollutions and I have come across a still smaller 
 number of neurasthenics who, being habitual route, owe their 
 neurosis to excessive indulgence in normal sexual intercourse. 
 These last cases differ in recovering easily and rapidly as soon as 
 the cause of their malady is explained and removed. Freud 
 and many of his followers, however, believe that neurasthenia 
 has essentially an auto-erotic etiology.
 
 THE ANXIETY NEUROSIS 47 
 
 The pathogenic influence of masturbation is easily compre- 
 hensible when we consider the severity of the mental conflict 
 which must occur in association with every act, and it has been 
 suggested that the outflow of energy is excessive because it corres- 
 ponds to the amount discharged by loth partners to a normal 
 sexual act. 
 
 Suitable advice and recommendations as to mental hygiene are 
 the proper remedy ; but it is often necessary to carry out a 
 certain amount of psycho-analysis in order to trace and uproot 
 the complexes which constitute the foundation of such irregular 
 sexual impulses. 
 
 The " Anxiety Neurosis " is characterised, as its name implies, 
 by a persistent state of anxiety or fear, usually without obvious 
 cause, but sometimes initiated by some real cause for anxiety. 
 This state is always out of proportion to its cause and the other 
 symptoms of the neurosis are exaggerations of the normal physical 
 signs of fear. Such are irregularity and an increased frequency of 
 the pulse, palpitation, anginal attacks, general vasomotor con- 
 striction with coldness and blueness of the extremities, dry ness of 
 the mouth, perspiration (especially of the hands), polyuria, diarrhoea, 
 respiratory oppression and air hunger, even attacks of asthma, 
 vertigo, tremor, attacks of ravenous appetite, nausea and some- 
 times actual vomiting, night terrors and insomnia, hyperresthesia 
 for visual impressions and especially for noises, and a general 
 apprehensiveness. 
 
 Such patients are liable to exacerbations of their various 
 symptoms, in which the sense of terror may be extremely severe, 
 with a feeling of congestion in the head and a dread of impending 
 death. It is even said that there may be temporary loss of 
 consciousness, but I have not seen such a case. 
 
 It may seem extraordinary that a disease with such a wealth of 
 symptoms should not have been recognised before, but it is simply 
 due to the fact that these cases have hitherto been labelled 
 " Neurasthenia ", a term which possessed the vaguest significance, 
 while the physician remained puzzled. 
 
 It is to Freud that we owe the recognition of this disease, and 
 it was Freud who discovered the essential etiological factor. He 
 and all who have subsequently investigated the matter are agreed 
 that the anxiety neurosis owes its origin to an accumulation of 
 mental excitement which finds no somatic outlet, and further
 
 48 THE NEW PSYCHIATEY 
 
 that this excitement is almost always, probably always, of a 
 sexual nature. Accordingly we meet with this neurosis among 
 engaged couples who cannot afford to get married, in widows and 
 widowers, in women whose husbands practise coitus interruptus 
 (this is the commonest cause), in women during the climacteric 
 whose husbands have reached senility, in patients who with great 
 effort have renounced masturbation, and such persons. Some 
 authorities regard the mental factor as more important than the 
 somatic and explain the anxiety neurosis as the result of sexual 
 excitation under circumstances in which the mental constituent 
 (desire) is not allowed to reach consciousness. Ernest Jones, for 
 example, says, "The desire is diverted from consciousness and 
 becomes converted into its opposite namely, dread ; morbid dread 
 is sexual desire that the subject does not wish to feel." 
 
 While sexual abstinence in its many forms is the chief cause 
 of the anxiety neurosis, it is not pretended that there are not 
 important contributory factors. Heredity is one, and the con- 
 dition also arises from overwork and exhaustion, especially after 
 severe illness and prolonged watching by the bedside of a sick 
 relative by night as well as by day. 
 
 Unfortunately, the obvious remedy for such a neurosis is 
 often impracticable and it is my custom, in these cases, to seek 
 by means of a short analysis interests of the patient into which 
 his repressed energy may be directed (sublimation of the sexual 
 impulse) and, in the meantime, to prescribe some anaphrodisiac 
 medicine, my favourite mixture for such purposes being a 
 combination of the monobromate of camphor with the extract 
 of black willow. 
 
 The psychoneuroses and psychoses are on an entirely different 
 plane from the neuroses. The neuroses, as we have seen, owe 
 their origin to existing causes, probably of a chemical nature, 
 at the time of the malady, but the psychoneuroses and psychoses 
 are compromise formations between repressed wishes and the 
 forces which repress them ; that is to say, that their mechanism 
 is exactly the same as that of dreams. The obvious differences 
 between dreams and the psychoneuroses are that, in the one, 
 the subject is asleep and desires to go on sleeping while, in the 
 other, he is awake; and also that dreams are normal while 
 psychoneuroses are abnormal. Yet even these differences are not 
 absolute ; for, on the one hand, certain neurotic symptoms, such as
 
 CINDERELLA 49 
 
 somnambulism, night terrors and nocturnal paralyses, are definitely 
 associated with sleep and, on the other hand, we have to bear 
 in mind the day-dreams of certain hysterical patients. Again, 
 certain anxiety dreams occur in neurotic patients only. 
 
 The similarity is therefore closer than appears at first sight, and 
 in both we have exactly the same mechanisms of distortion the 
 frequent importance of minor symptoms, condensation, trans- 
 ference of the affect, symbolism, somatic displacement, ellipses, 
 inversion and dramatisation. 
 
 One might see a difference in the fact that, in the psycho- 
 neuroses and psychoses, the patient actually lives his dream ; yet 
 even here we must be cautious, for I have known two or three 
 patients whose first symptom was a dream which was believed on 
 waking and has since remained in the respective patients' minds 
 as a memory of an incident which actually occurred. 
 
 Perhaps I may be allowed for purposes of elucidation to take a 
 purely imaginary case of a pretty young girl who, in a household 
 of three persons, acts as the servant and drudge of her two older 
 stepsisters and is not allowed to appear as a member of the family 
 lest some eligible young man's attentions should be diverted from 
 one of the older sisters to the youngest. Her natural wish is that 
 she should escape such slavery and happily marry some handsome 
 young man of wealth and position; but such a wish has to be 
 brushed aside as impracticable and it is repressed into the 
 unconscious. If she reads the fairy tale of Cinderella, being 
 a normal person, she thinks how delightful such happenings 
 would be if they occurred to her, but she puts the thought aside 
 with the book and resumes her drudgery. 
 
 At night her wish escapes repression in a dream in which she 
 herself is Cinderella and, as the midnight hour strikes, she awakes 
 to find that it was all a dream. 
 
 If, however, she is a psychotic person, she may first develop 
 ideas of persecution by her elder sisters and, after passing through 
 a morose period, develop hallucinations of vision and hearing and, 
 living in a world of her own, believe that she is really Cinderella 
 and marries the prince. Ultimately she becomes an asylum 
 queen. Her wish is fulfilled and she is a case of dementia 
 prsecox. 
 
 If, instead of this, our patient develops a condition of motor 
 excitement with boastfulness and loquacity, playing all the while
 
 50 THE NEW PSYCHIATRY 
 
 with the idea that she is destined to become a princess, but always 
 holding to her relationship with the outside world, she is then 
 a case of acute mania, with every probability of recovery, but 
 subsequently always running the risk of a repetition of such an 
 attack should her environment, or even perhaps a chance remark 
 by association, bring her repressed wish within the realm of 
 consciousness. 
 
 Now let us conceive the relationship between our paradigms 
 to be that of half-sister instead of stepsister and, being children 
 of the same parent and brought up together, let us suppose that 
 at one time our Cinderella had a certain amount of affection for 
 her half-sisters and that at some period of her life there may 
 have been a conflict between love and hatred of them. Her love 
 has been repressed and now her whole affective tone is one of 
 hatred. She has even played with the notion that some fatal 
 accident might occur to them and that she might thus be released 
 from her unfortunate position. She will not admit to herself that 
 such an idea has ever crossed her mind, and it becomes in turn 
 repressed. In course of time the repression fails and the unconscious 
 wish reappears in consciousness in a distorted form let us suppose 
 in an inverted form, so that she suffers from a constant fear that 
 some fatal accident may happen to her. She is the victim of a 
 hysterical phobia and would be classed as a psychasthenic. 
 
 On the other hand, her former love for her sisters may have 
 had such a permanent influence on her mind that her affection 
 is for ever afterwards unconsciously directed towards people of 
 the same sex as they are, the same sex as herself. In other 
 words she is a repressed homosexual. Her unconscious reasoning 
 then runs thus : " I do not like men " ; this by projection 
 becomes " Men do not like me ", " Men hate me ", " I am persecuted 
 by men ". She is then a paranoiac. 
 
 Lastly, if her mental conflict is not between her repressed 
 wish and repressing forces, but between the repressed wish and 
 an inhibition, she becomes a case of hysteria. Her unconscious 
 wish is to go forth and seek her predestined lover ; the inhibition 
 is that she must busy herself about the house and do menial 
 work. A compromise is sought between the two and she develops, 
 for example, a hysterical paraplegia which excuses her both from 
 her work and from carrying out her unconscious desire. 
 
 I now consider these various disorders in slight detail. The
 
 HYSTERIA 51 
 
 essential characteristic of any hysterical manifestation, as I have 
 just suggested, is that it is a compromise formation between a 
 repressed wish and an inhibition. I desire to lay stress on this 
 as an important point. 
 
 There are two varieties of hysteria anxiety hysteria and 
 conversion hysteria. The former comprises hysterical phobias, 
 hysterical day-dreams and what one may call hysterical attacks ; 
 the last includes cases in which the repressed complexes are 
 converted into somatic symptoms. 
 
 Phobias or morbid fears may occur in many forms of mental 
 disorder. Hitherto there has been a tendency to refer them all to 
 the obsessional or compulsion psychoneurosis, but psycho-analysis 
 has revealed that they frequently take their origin in a conflict 
 between a repression and an inhibition. As this is one of the 
 characteristic features of a hysterical symptom, we must therefore 
 recognise the existence of a hysterical phobia. . 
 
 Hysterical day-dreams or hypnoid states are interesting in 
 that they closely resemble ordinary dreams. Brill gives several 
 excellent examples, which I will quote, and he agrees with Freud 
 in stating that they invariably occur in patients who have renounced 
 masturbation and refuse to relieve an over-stimulated sexual 
 impulse. 
 
 Three stages of these dreams are to be noted, the first being 
 one of euphoria with fantastic exaltation, the content of which 
 deals with the individual's aspirations, the second a dream-like 
 withdrawal from reality in which the patient is no longer controlled 
 by logical reason and judgment, and the third is an absent-minded 
 depressive stage. These three stages correspond with and replace 
 those of masturbation : (1) fantastic euphoria, (2) self-absorption 
 and gratification, and (3) depression. 
 
 A young woman used to imagine herself married to a handsome, 
 wealthy man. She had three most beautiful children. They all 
 lived in blissful happiness on a magnificent yacht and entertained 
 most charming people. Then the whole structure crumbled ; her 
 husband and children died and she was left alone in a terrible 
 depression lasting for days. 
 
 A young weaver, who thought he was persecuted by his 
 employer, used to think what he would do if he had 400 a year. 
 He imagined himself starting a shop and earning much money by 
 oppressing his employees. The business grew until he had
 
 52 THE NEW PSYCHIATRY 
 
 hundreds of people working for him. He became greater and 
 greater until he found he had lost all his money on the Stock 
 Exchange. 
 
 A young journalist imagined himself running a race and 
 winning, when he was struck in the thigh by the spiked shoe of 
 one of the competitors. He is bleeding and his trainers try to 
 stop him, but he strikes them aside and runs on, winning the race. 
 Then he collapses exhausted and is carried off amidst the cheers of 
 the crowd. 
 
 A case from Freud. A lady fancied herself in delicate 
 relationship with a piano virtuoso whom she did not know 
 personally. In her fancy she bore him a child. He de- 
 serted her, leaving her and her child in misery. She then 
 suddenly found herself in tears in the street along which she 
 happened to be walking. 
 
 Those who are familiar with psycho-analysis will discern the 
 sexual complexes underlying these day-dreams : the desire for 
 marriage in the first and last, the sadistic complex in the second, 
 and the exhibition tendency in the third. 
 
 I have said that these hysterical day-dreams are said to occur 
 in patients who have renounced masturbation, but we must go 
 deeper than this to explain the content of the dream, and this 
 leads me to the essence of Freud's theory of hysteria. 
 
 I ought to say that I have come across cases of hysterical day- 
 dreaming in which masturbation certainly played no part. Only 
 recently I had a lady under my observation, who imagined that 
 she knew a soldier, named Paul Graham, in the Royal Field 
 Artillery in the trenches. He would come home on leave and she 
 would meet him at Brighton. On analysis, Paul was identified 
 with a character in a novel she had read, and Graham suggested 
 Graham White. This was one of many day-dreams she had had 
 in her life, but masturbation certainly played no part in this case. 
 On the other hand, she had been subjected to many sexual assaults 
 between the ages of six and fifteen. 
 
 Freud's theory of hysteria depends on the recognition of the 
 infantile development of sexuality. Many incidents of sexual 
 import occur during childhood which at the time have no sexual 
 significance, but the recollection of them after maturity is dis- 
 proportionately exciting because puberty has in the meantime 
 incomparably increased the reacting capacity of the sexual
 
 INFANTILE MEMORIES 53 
 
 apparatus. More than twenty years ago Breuer thought that 
 these occurrences were of the nature of gross sexual assaults on the 
 child, but ever since that time Freud has recognised that they are 
 in reality nothing more than commonplace events whose importance 
 is exaggerated by the patient after puberty. I mention this 
 especially because some authors are still keeping up the idea of 
 the infantile psychic trauma which all responsible authorities 
 have abandoned for many years. Ordinary infantile ideas tend to 
 fade with time, but sexual infantile memories are accentuated 
 during normal biological development and are reinforced at puberty 
 and during later life in a way in which no other experiences are 
 strengthened ; but inasmuch as they can then find no appropriate 
 sexual outlet or reaction, they are repressed into the unconscious 
 and, if particularly strong, form an abiding focus of mental irrita- 
 tion. 
 
 These unconscious infantile memories influence the whole 
 sexual life of the individual and in the cases we have just 
 considered are the determining cause of the masturbation. When 
 the repression fails we find that fantasies have been weaved 
 round the original experience and they reappear as such 
 hysterical day-dreams as I have just related. 
 
 These hypnoid states, as they have been called, are sub- 
 conscious rather than unconscious manifestations of hysteria. 
 Sometimes, however, the fantasies or memories assume an 
 unconscious form and then we have the so-called hysterical 
 attacks. These consist of a series of emotional displays which 
 are rendered comprehensible when the physician has discovered 
 the underlying thought, for he is then able to see that such 
 emotional manifestations are such as might be expected to occur 
 in response to the given stimulus. They are indeed, as a rule, 
 grossly exaggerated; but they occur independently of any idea 
 in the patient's true consciousness of the situation to which he 
 is reacting. The affective state is entirely dissociated from the 
 situation which gives rise to it. In common with the dreain the 
 hysterical attack represents the fulfilment of an unconscious wish. 
 Attitudes are assumed which look as if the patient is trying 
 to avert some danger or he (more commonly she) assumes 
 lascivious postures which leaves no doubt in the mind of the 
 onlooker that some sexual idea underlies the clinical picture. 
 Those who have any doubt on this point might with advantage
 
 54 THE NEW PSYCHIATRY 
 
 look at the beautiful illustrations in Richet's book on hysteria, 
 which were produced long before the sexual etiology was seriously 
 proclaimed. 
 
 Lastly, we have " conversion hysteria " which results from a 
 persistent strife between some painful memory and the restraint 
 of the censor from its coming to the surface, the result of the 
 struggle being a compromise whereby the idea by distortion 
 becomes converted into a somatic symptom, some bodily motor 
 or sensory innervation or inhibition. 
 
 Freud relates the interesting case of a patient who consulted 
 him for an intractable facial neuralgia. By psycho-analysis 
 this was traced to an occasion when she was insulted by her 
 husband. The insult was forgotten but subsequently appeared 
 in symbolic form as "a slap in the face". The same patient 
 suffered from globus hystericus which symbolised " I have to 
 swallow that ". 
 
 In some cases astasia-abasia is symbolic of dependence and 
 helplessness, inability to make headway, having no support, and 
 so forth. 
 
 Somatic displacement occurs. Jung mentions a case of a 
 hysterical patient in whom a stiff arm symbolised an erect penis, 
 and one of Brill's patients suffered from a hysterically painful 
 breast which was directly traceable to an occasion when, during 
 an embrace, she felt the pressure against her thigh. 
 
 The common symptom, hysterical vomiting, is frequently 
 traceable to some sexual basis. In one case it signified disgust 
 or self-reproach, because the patient has perceived a genital 
 sensation on the occasion of a kiss. 
 
 It will have been gathered that psycho-analysis is to be 
 regarded as the most radical form of treatment of hysteria and 
 other functional mental disorders to be presently discussed, but I 
 might refer also to other methods in common use. Weir- 
 Mitchell's " rest-cure " is quite fashionable at the present time 
 and undoubtedly gives good results in many cases, provided it 
 be used rationally and in combination with some psychical influence 
 at the same time. Suggestion is most commonly used and 
 Weir-Mitchell's private opinion of the whole procedure was that 
 it acted mainly as a suggestive agency. The prolonged mental 
 and physical rest are beneficial, the removal from home sur- 
 roundings has the advantage of withdrawing the patient from
 
 THE COMPULSION NEUROSIS 55 
 
 an environment which has usually proved somewhat irritating, 
 the massage and possibly the electricity tend to improve 
 metabolism, and the over-feeding is well suited to patients who 
 are ill-nourished. Let me say at once, however, that this method 
 is worse than useless in any other condition than hysteria and, 
 even in this disease, failures are far from uncommon. Moreover, 
 the expense is often as great as for psycho-analysis. 
 
 Hypnotism may often be employed with advantageous and 
 often dramatically successful results in hysteria. Hypnosis is 
 much more easily achieved in this disease than in other mental 
 disorder and it may be used in one of three ways : 
 
 (1) To get the patient into an extremely suggestible mood so 
 
 that suggestion of recovery may be given. 
 
 (2) To recover buried memories. 
 
 (3) To get the patient to react emotionally to such buried 
 
 memories or, as Freud would put it, to obtain an 
 
 abreaction to a repressed complex. 
 
 The compulsion neurosis is a disease which shows itself in a 
 large number of ways. The patients have clear intellect and 
 good memory and they are well orientated in time and place, but 
 they suffer from mental symptoms into whose morbidity they 
 have clear insight. They suffer from irrepressible thoughts which 
 often take the form of metaphysical questionings, such as " When 
 was the beginning of all things ? " " What existed before that ? " 
 " Who created God ? " or they attach undue importance to 
 superstitions or they cannot help repeating in their minds 
 things they have heard. 
 
 Many suffer from morbid fears, fear of open spaces, of closed 
 doors, of heights, of vermin, of broken glass, of pins, knives and 
 so forth. Others are in fear of blushing under certain circum- 
 stances, with the inevitable result that they do blush, or they are 
 afraid that their bowels will act at an inopportune moment, as in 
 church, at a concert or in the train, again with the not unusual 
 result that their fears become justified. 
 
 Then there are the morbid, irresistible impulses in which the 
 patient feels impelled to perform certain acts against his will. As 
 examples, arithmomania or the impulse to count things, to count 
 one's steps, the rails of a fence, the rungs of a ladder, the windows 
 of a house, &c. ; the impulse to read every advertisement or 
 placard one comes across or even another person's newspaper or
 
 56 THE NEW PSYCHIATRY 
 
 letters, the impulse to steal (kleptomania), the impulse to set things 
 on fire (pyromania), or to commit homicidal and suicidal acts. 
 
 Some authorities regard certain motor agitations, such as the 
 tics, as obsessions. This may be right in the early stages of a tic, 
 but it would be wrong to do so when the tic ceases to be con- 
 sciously performed. 
 
 Some of these patients have feelings of incompleteness in action, 
 in intellectual problems, in emotional reaction and in perception. 
 Others have strange feelings of unreality and of depersonalisation, 
 called by Janet psycholeptic crises. 
 
 The unity of this disease has been recognised for many years in 
 spite of its multifarious symptoms. Fifty years ago it was called 
 "volitional insanity", on the hypothesis that the essential basis 
 was a weakness of will-power. Then it was called "obsessional 
 insanity", a term which was justifiable in that it offered no 
 explanation. The mind is obsessed or besieged by such thoughts, 
 fears or impulses. 
 
 Janet advanced a step by recognising what he called a " split- 
 ting of consciousness" or "-mental dissociation" induced by a 
 " lowering of the psychological tension ", the psychical response of 
 a psychasthenic to his environment being inadequate. 
 
 Freud regards the compulsion neurosis as a disease of the 
 unconscious. From his laborious investigations on individual 
 psychology by means of psycho-analysis he interprets the condition 
 on a purely sexual basis and regards the symptoms as substitutions 
 for certain repressed sexual ideas and emotions. They are due to 
 failure of the repression, whereby the sexual ideas are enabled to 
 find conscious expression in symptom formation. Moreover, two 
 characteristics of these patients have emerged. One is a special 
 aggressiveness during childhood, which mainly shows itself in an 
 intensive activity of the impulse to learn about sexual matters and 
 the mystery of birth by looking, gazing and peeping on the one 
 hand and by aggressive questioning on the other ; the other is an 
 incessant conflict between love and hatred, a continual existence of 
 these two emotions in the highest intensity side by side toward 
 the same person. An intensive elaboration of the feelings of 
 affection and hostility towards the parents, brothers and sisters, 
 in conjunction with infantile sexual curiosity regarding sex and 
 birth processes, forms the essential nuclear complex of this 
 psychoneurosis.
 
 THE COMPULSION NEUROSIS 57 
 
 Love and hate cannot, of course, exist together indefinitely 
 and the conflict is ultimately resolved by one or the other, usually 
 the hatred, being repressed into the unconscious. 
 
 The symptoms of this psychoneurosis then take their origin 
 from a conflict between conscious attachment and unconscious 
 sadism. The sexual experiences of the early childhood of these 
 patients are pleasurably accomplished aggressions and pleasurably 
 experienced participation in sexual acts. In this psychoneurosis, 
 therefore, the repressed complex is one of sexual activity, whereas 
 the repressed complex in hysteria is one of sexual passivity. 
 
 It is true that by psycho-analysis of such patients one is 
 ultimately able to disclose some infantile sexual experience in 
 which the patient played a passive role and which awakened his 
 interest in sexual matters. This in turn is followed by actions of 
 sexual aggression. This period is brought to an end by the 
 appearance of sexual maturity, often self-ripened. Reproaches 
 then attach themselves to the sexual memories and they are 
 repressed and replaced by primary symptoms of defence. The 
 patient is apparently normal and healthy, but in reality he is in 
 a state of successful defence, the only symptoms being scrupulous- 
 ness, shame and diffidence. 
 
 The next period is failure of the defence with return to 
 consciousness of the repressed reminiscences and revival of the 
 reproaches, but always in a changed form, the change being 
 necessary in order to escape the watchfulness of the censor. 
 There is a compromise formation between the repressed and the 
 repressing ideas, this compromise formation becoming conscious 
 as an obsession or an obsessive effect. 
 
 The form which the disease assumes depends upon whether it 
 is the memory of the reproachful acts themselves which forces 
 itself upon consciousness or the memory of the reproach affect, the 
 emotion of self-reproach. In the first case the feeling tone is 
 merely one of discomfort; if the memory of the reproachful acts 
 had not been distorted, the feeling tone would of course be one of 
 reproach. In the second case, the reproach affect is changed into 
 some other unpleasant emotional feeling, such as shame, hypo- 
 chondriacal, social or religious anxiety, fear of being observed or 
 tempted, and so forth. You will easily see that this symbolisation 
 of the reproach affect renders diagnosis very difficult. 
 
 Besides these compromise symptoms there are others which
 
 58 THE NEW PSYCHIATRY 
 
 Freud groups together under the name of " secondary defence ". 
 These are protective measures against the obsessions, actions 
 which, if performed at the time of the reproachful action, would 
 have prevented it from occurring. Many patients perform cere- 
 monials which are apparently meaningless until the forgotten 
 action against which they are directed is known. 
 
 The patient has no conscious knowledge of the action against 
 which his obsessive acts are directed, and he explains them to 
 himself in some transcendental or abstract thought (1) an actual 
 occurrence is put in place of a past experience and (2) something 
 sexual is replaced by something analogous, but non-sexual. 
 
 Dr Ernest Jones, who is the greatest English authority on the 
 psychology of the neuroses, has recently discovered that the origin 
 of the repressed hatred in the compulsion neurosis is traceable 
 to anal eroticism in infancy. Compulsory education of the 
 sphincters in opposition to anal erotic tendencies, such as were 
 described in the first lecture, is responsible for the patient's 
 conflict with the outer world. The anal eroticism is, of course, 
 repressed in very early infancy; but the hatred, usually 
 of one or other parent, remains for a considerable time. Our 
 conclusion, therefore, with regard to the psychoneurosis is 
 that an obsession represents a compensation or substitute for 
 an unbearable sexual idea of very early infancy, and takes its 
 place in consciousness, whereas a hysterical symptom is the 
 realisation of an unconscious fancy serving as a wish-fulfilment 
 and corresponds to the return of a sexual gratification which 
 was real in later infancy, but has been repressed since then ; 
 the obsession being due to a conflict between a repressed idea 
 and the repressing forces, and the hysterical symptom to a 
 conflict between the repressed idea and an inhibition. 
 
 Psycho-analysis has proved the only really successful method 
 of treating the compulsion neurosis, but hypnotism may be used 
 in much the same way as for hysteria, viz. : (1) for suggestion, 
 (2) to recover buried memories and (3) to obtain an emotional 
 reaction to a repressed complex. 
 
 Some cases of obsession may be traced in the first instance 
 to some forgotten incident to which the patient did not react 
 at the time ; with the result that there appears to be a certain 
 amount of latent emotion, floating about free, as it were, and 
 unattached. It then becomes attached to other subjects, people,
 
 MANIACAL DEPRESSIVE INSANITY 59 
 
 situations and ideas, so as to give them some unusual and 
 unintelligible significance to the patient. The mechanism is 
 known as " transvaluation." 
 
 For example, a patient came across some broken glass in some 
 mashed potato she was eating. The occasion was forgotten, but 
 reappeared years later in the disguise of a fear lest poisons in 
 glass bottles should escape and become attached to her person. 
 On account of this, she would never pass a chemist's shop on 
 the same side of the road. Such a patient might have been 
 hypnotised and made to live over again the unfortunate meal, 
 this time reacting with an emotion of terror, so that such emotion 
 should not in future become attached to glass bottles. As a fact, 
 she was psycho-analysed and deeper sources of the psychoneurosis 
 were discovered. 
 
 Dubois' method of treatment by appeal to the patient's reason 
 may be dismissed as grotesque and possessing no novelty, for 
 has not every young asylum medical officer tried to argue with 
 patients that there is no ground for their morbid fears or delusions 
 and has he not invariably learned that such a method is futile ? 
 
 " Resynthesis " and " transmutation " are more rational. For 
 both of these it is necessary that the physician should first devote 
 a considerable amount of time to obtaining a complete history of 
 the patient's life, the ultimate object of the first method (resyn- 
 thesis) being to direct the patient's attention to other points 
 of view than he at present takes, and that of the second method 
 (transmutation) being to divert his interests and energies into 
 new channels, these being selected in sympathy with his natural 
 trends. The latter treatment is known in America as "side- 
 tracking" and is really an attempt at what I have already 
 described as " sublimation ". Both resynthesis and transmutation 
 have been characterised as methods of re-education. In resynthesis 
 some workers, especially of the French school, employ such 
 artificial aids as hypnosis and crystal-gazing. 
 
 I need not discuss these modes of treatment in detail, but will 
 proceed to some consideration of the psychoses. 
 
 Maniacal-depressive insanity is a disorder in which the patient 
 is liable to attacks of mania, melancholia or stupor, these being 
 in some cases accompanied with, or replaced by, some delusional 
 state. 
 
 As I have already stated, it is useless to attack this psychosis
 
 60 THE NEW PSYCHIATRY 
 
 while the patient is passing through one of these acute phases of 
 the disorder. Radical treatment of the disease must be under- 
 taken during a period of sanity or, as the populace would say, 
 during a " lucid interval ". It is interesting, moreover, that psycho- 
 analysts, who have had experience of these cases, have come to 
 the conclusion that a very short analysis is most successful in 
 effecting a cure, while a complete analysis, in the Freudian sense, 
 only leads to relapse ; but, as I said before, many psycho-analysts 
 of experience differ from me on this point. 
 
 A case of my own will serve as an example. She was married 
 in 1910 at the age of 37. In January 1911 she began to lose 
 flesh, suffered from amenorrhoea, which continued until the 
 beginning of April, when she gradually became more and more 
 excited, and remained in a state of acute mania from which she 
 recovered at the end of July. Exactly the same series of events 
 took place in 1912 and 1913. In January 1914 she again began 
 to lose weight. She consulted me and I analysed her for not 
 more than an hour and a half, during which time I discovered a 
 couple of repressed complexes. She afterwards improved in health, 
 had no attack last year, and this year she is doing her ordinary 
 work with no signs of failing health. I regret that I can give 
 no further details, partly because time will not permit, but also 
 for the stronger reason that the patient might be recognised. I 
 can say, however, that the repressed complexes were not of 
 infantile origin. 
 
 Dementia prveeox has been most carefully studied by Jung 
 from a psychological point of view and the conclusion at which he 
 arrives is that there is a remarkable psychological resemblance 
 between dementia praecox and hysteria. The complexes and the 
 mechanism of their repression are exactly the same, yet hysteria is 
 an eminently curable disease, while dementia prsecox is conspicu- 
 ously incurable. The catatonic symptoms can easily be conceived 
 as purely repressive devices and it has been definitely proved in 
 some cases that certain stereotyped actions are distorted repre- 
 sentations of the fulfilment of repressed wishes ; but at the same 
 time we must not lose sight of the fact that these same symptoms 
 also occur in certain organic cerebral diseases, whose origin is at 
 least much more organic than psychical. Again, the question is 
 npt yet absolutely settled whether dementia praecox is a psycho- 
 genie or organic disease. Alzheimer and others have described
 
 DEMENTIA PR^COX 61 
 
 areas of gliosis in the deepest layers of the cortex, others have 
 discovered fatty degeneration of the nerve cells, others again 
 have observed cerebellar changes, all of which might very well 
 be due to excess or defect of certain internal secretions. 
 
 This idea, surmised by Kraepelin, has been rendered probable 
 by Mott's discovery that certain glands possessing internal 
 secretions, especially the ovaries and testes, are more or less 
 atrophied in dementia praecox. On the other hand, Jung appears 
 to have cured or, at least, considerably ameliorated some oases 
 of dementia paranoides by psycho-analysis only. 
 
 Jung recognises all these difficulties and gets out of them by 
 supposing that the mental conflicts of dementia praecox give rise 
 to toxins which act deleteriously upon the cerebral substance. I 
 must confess that to me this idea does not appeal very strongly ; 
 but Kraepelin, who will have nothing to do with psycho-analysis, 
 is curiously enough rather pleased with the suggestion. 
 
 The chief characteristic of patients suffering from dementia 
 praecox is that they are living a dream and, in the end, completely 
 retire from the world of reality (autism). Up to the present very 
 little psychological investigation of the disease has been made ; 
 but we hope to learn much from the investigation now going on 
 at Zurich. For the present, therefore, we must regard the 
 pathology of dementia praecox as still undetermined. By various 
 psychological means, especially by resynthesis, attempts are made 
 to re-form the mental structure of these patients in the early 
 stages ; but hitherto the results have not been encouraging. 
 
 The last disease I must submit for your consideration is Paranoia. 
 This is a mental disorder of the fourth or fifth decade as a rule 
 and it is characterised by the progressive development of system- 
 atised delusions. The patients, being of a suspicious temperament, 
 see hidden meanings in incidents which possess no unusual value 
 for the ordinary man and from the inevitable accumulation of such 
 misinterpretations they evolve a system of delusions which vary 
 from patient to patient. 
 
 The cases are divided into two main classes : 
 
 (1) The eccentrics or mattoids, the borderland cases of insanity, 
 including faddists and cranks of all kinds, anarchists, revolu- 
 tionaries, Christian Scientists, vegetarians, anti - vaccinationists, 
 anti-all-sorts-of-other-things and, in general, people who get 
 a distorted view of life through attaching undue importance to
 
 62 THE NEW PSYCHIATRY 
 
 minor details (this class has not been submitted to modern 
 psychological investigation). 
 
 (2) The egocentrics, including patients who suffer from delusions 
 of persecution, jealousy, exaltation and ill-health (hypochondriacs). 
 To this class also belong patients who think that some person of 
 the opposite sex makes signs that they are in love with them and 
 also those who believe that they have some religious mission to 
 perform. 
 
 All these patients are perfectly clear mentally, have no halluci- 
 nations, behave well and can think intelligently apart from their 
 particular delusions; but they are firmly convinced that there is 
 nothing mentally wrong with them and therefore always feel 
 aggrieved when they are involuntarily placed under care for 
 their malady. 
 
 Since the advent of our new psychiatry many patients of 
 this class have been analysed by modern psychological methods 
 all over the civilised world and the outcome has been the 
 remarkable discovery that paranoia is a psychosis erected on 
 the invariable basis of repressed homosexuality. Naturally enough 
 the idea that a person has homosexual inclinations is usually 
 repugnant to him, he refuses to admit it to himself and it is 
 repressed into the unconscious. Should such repression fail, the 
 homosexual complex reappears in consciousness in the disguised 
 form of paranoia or, I may add, as dementia paranoides, for it 
 has been shown that the same psychical mechanism is at work 
 in this variety of dementia praecox, designated by Kraepelin in 
 his most recent edition, by the way, as " paraphrenia ". 
 
 Freud himself has rendered one of these latter cases classical 
 by his analysis of it. Dr David Paul Schreber, a lawyer who was 
 sufficiently eminent to have become President of the Saxon Senate, 
 was under observation from 1893 to 1902 for dementia paranoides. 
 He was released as the result of a legal decision in which the 
 delusions are thus summarised : " He considers himself called to 
 save the world and to bring back the lost state of beatitude. 
 This he could do only by changing himself from a man to a 
 woman ". The following year Dr Schreber published a clinical 
 history of his own case, which Freud subsequently analysed with 
 notable psychological insight and showed that the patient was a 
 repressed homosexual. 
 
 The researches in paranoia are particularly interesting in that
 
 TARANOIA 63 
 
 they throw a certain amount of light on the mechanisms of un- 
 conscious reasoning. Unconsciously the paranoiac always starts 
 with the premise, " I love the man " (1 am assuming the patient to 
 be a male). The arguments in the several varieties of paranoia 
 then run as follows: 
 
 Persecuted Paranoia. " I love the man " an intolerable idea, 
 therefore becoming " I do not love him ; I hate him ". This by 
 projection becomes " He hates me " " I am persecuted by him ". 
 
 Exalted Paranoia. " I love him " again an intolerable idea, 
 therefore " I do not love him, I love myself ". This by projection 
 becomes " Everybody loves me " " I am a great person ". 
 
 Jidigious Paranoia. "I love him", being intolerable, becomes "I 
 love Him " (spelt with a capital H), meaning " I love God". This by 
 projection becomes " God loves me " " I am the chosen one of God ". 
 
 Amorous Paranoia. The intolerable " I love him " becomes 
 " I do not love him, I love her ". This by projection becomes 
 "She loves me". 
 
 Jealous Paranoia. " I love him ", as usual, is replaced by " I 
 do not love him ; she loves him ". 
 
 The mechanism of hypochondriacal paranoia is similar to that 
 of exalted paranoia, " I love myself " becoming " I must take care 
 of myself", and querulant paranoia is only a special variety of 
 persecuted paranoia. 
 
 Although psycho-analysis has been successful in elucidating 
 the psychology of this disease, the method usually fails as a 
 mode of treatment. I understand, however, that some psycho- 
 analysts have effected a cure and many have alleviated the 
 patient sufficiently to enable him to go about his business with 
 a certain degree of mental comfort without molesting those 
 people with whom he is brought into contact. 
 
 Kecovery is said to have been effected in a few cases of fairly 
 recent origin by a method which somewhat resembles psycho- 
 analysis, but differs from it in that the physician seeks, in the 
 first instance, to obtain a positive transference before tackling 
 the disease itself. He gets the patient to give a complete history 
 of his life, endeavouring meanwhile to discover incidents and 
 characteristics which have a bearing on his delusional state and 
 to disclose them. During the whole of this process, which takes 
 twenty to thirty hours, he accepts the patient's point of view 
 throughout, until he ultimately gains his whole confidence and
 
 64 THE NEW PSYCHIATRY 
 
 convinces him of his friendship; without, however, actually 
 encouraging his delusions or agreeing with every word he says. 
 Then, when a suitable opportunity offers, he suggests that the 
 patient may have come to an erroneous conclusion about some 
 quite insignificant occurrence. After a few more sittings, as 
 opportunity offers, he points out another minor occasion when 
 the patient might have been mistaken. So he goes on until he 
 sees his chance for tackling the main delusion and pointing out 
 that even here he may also be mistaken. The physician takes 
 advantage of any attitude of doubt and completes the cure by 
 " therapeutic conversation ". The whole procedure requires an 
 enormous amount of tact, patience and skill. Moreover, the 
 physician must be familiar with those mechanisms of paranoia 
 which have been discovered by the psycho-analytic method. 
 
 The main object of these lectures has been, however, to 
 expound the principles of psycho-analysis proper, its technique, 
 the psychological mechanisms which it has disclosed and the 
 bearing of these mechanisms, not only on 70 per cent, of the 
 160,000 patients in the asylums of Great Britain, but also in an 
 enormous number of people pursuing their ordinary vocations, in 
 spite of curable mental worries, or spending an enormous pro- 
 portion of their time and income in nursing homes. Physicians 
 who will undertake the radical cure of these poor sufferers will 
 earn the gratitude of society as well as that of the patients, which 
 is always unbounded ; but he must be a man of courage, for he 
 will have to face the opposition of the " herd " for many years to 
 come. In spite of all we may say, the subject of sex will remain 
 taboo, yet no physician of experience can deny the enormous role 
 played by sexual conflicts in the genesis of the neuroses. I do 
 think that cases sometimes occur in which the psycho-genetic 
 conflict is non-sexual, but they are so rare that I can see the 
 psycho-analytic literature of the future augmented by reports of 
 such cases as curiosities. 
 
 Although I attach so much importance to psycho-analysis, I 
 hope that no words of mine will detract from the systematic 
 investigation of cases by other methods. It would be deplorable, 
 for instance, if attention to psychological investigation should 
 detract from the work of the clinical laboratory and thus allow 
 a positive Wassermann reaction, so common in dementia prsecox 
 for example, to be overlooked.
 
 CIVILISATION 65 
 
 It has often been said that the frequency of mental disease 
 is due to the effect of civilisation, to the hurry, bustle and struggle 
 for existence associated with urban life, to defective sanitation, 
 insufficient sleep, overwork, poverty, brain-fag, education, and 
 a host of other things incident on civilisation. With all our 
 modern conveniences, the poor law, hygienic surroundings, 
 hospitals, comfortable railways with restaurant cars and sleeping 
 accommodation, typewriters and telephones, such a view is 
 manifestly erroneous. 
 
 That insanity is the result of civilisation is obvious to anybody 
 who looks the facts in the face ; but psycho-analysis has revealed 
 that the essential factor is not hurry, bustle, and brain-fag, but the 
 repression of the instincts, enforced by civilisation. Kecognising 
 this fact we can now see the solution of a host of problems in 
 other domains of mental disease. General paralysis, for example, 
 has been ascribed to the effects of civilisation and syphilisation 
 because, although syphilis (an acknowledged factor in the 
 causation of general paralysis) is rife in certain uncivilised 
 communities, general paralysis is rare. The explanation is now 
 forthcoming, for we recognise that the essential difference between 
 civilised and uncivilised communities lies in the fact that the 
 instincts are much more repressed in the former. The recognition 
 of this fact has a practical bearing on both the etiology and 
 treatment of mental disorders. 
 
 Our personal impulses tell us to eat, drink and be merry, and 
 to gratify our predatory and sexual instinct, but the herd instinct 
 tells us to be above all such animal passions. The Church, as the 
 highest authority of the herd, says that there must be many days 
 of abstinence and fasting throughout the year in order to subdue 
 the flesh ; the Church again and many physicians advocate total 
 abstinence from alcohol ; instead of being merry, society dictates 
 that we should be sedate. Our predatory instincts are often 
 stigmatised as cruel, and the openly avowed and ostensible 
 attitude of the populace toward sexual matters is restriction, 
 if possible, to abolition and extinction. 
 
 Such limitations imposed by society upon the mighty impulses 
 of the sexual instinct cannot be tolerated with impunity by any 
 normal individual; for a man's sexual activity serves as his 
 standard for all his other activities and, if it is unnaturally 
 repressed, he becomes just as reconciled and submissive in his 
 
 5
 
 66 CONCLUSION 
 
 whole career ; while a person who is so venturesome as to 
 gratify his instincts exhibits the same bold enterprise and 
 energy in overcoming the difficulties of everyday life. 
 
 Much less can one who possesses a hereditary predisposition 
 to neurosis or psychosis endure such restraint of his animal 
 instincts, for in such a person it must inevitably lead to mental 
 disorder. 
 
 It is not to be supposed that the prophylaxis of insanity lies 
 in letting loose the reins of licentiousness and depravity. The 
 problem is far more intricate than this and it is not likely that 
 it will be solved in the present century, much less in our own 
 time. The mystery at present surrounding sex and birth problems 
 must be removed by systematic education of the young in such 
 matters, early marriage must be made more possible than existing 
 circumstances will permit, and old men and parents will have 
 to remember the days of their own youth when they enact the 
 laws which are to govern society. Moreover, the whole populace 
 will have to be educated in such matters before any serious 
 change can be accomplished. 
 
 The idea seems Utopian, and I cannot refrain in this connection 
 from divulging a remark made to me in private conversation many 
 years ago with one of the greatest geniuses that ever lived, Dr 
 Hughlings Jackson. I forget what was the exact topic under 
 discussion, but he said, " I suppose, Stoddart, that the end of 
 the human race will arrive by over-development of the brain at 
 the expense of the testicles ". You must remember that he was 
 primarily a neurologist and, as such, a materialist. Translated into 
 psychological language, that remark means " The end of the human 
 race will arrive by the development of culture at the expense of 
 animal passions". Let us hope that such a calamity may be 
 averted
 
 INDEX. 
 
 ABRBACTION, 8 
 Anal eroticism, 14, 58 
 Anxiety neurosis, 47 
 Association test, 27 
 Autism, 61 
 
 CENSOR, censure, 12 
 Cinderella, 49 
 Civilisation, 65 
 Classification, 23 
 Complex, 7 
 indicators, 29 
 Compulsion neurosis, 55 
 Condensation, 34 
 Conflict, 5, 8 
 Conversion hysteria, 54 
 Cover-memories, 12 
 Crystal-gazing, 41 
 
 DAY-DREAMS, 51 
 Dementia proecox, 60 
 Determinism, 6 
 Displacement, 34 
 Dissociation, 10, 56 
 Distortion in dreams, 34 
 Dramatisation, 36 
 Dreams, 32 
 
 ECCENTRICS, 61 
 Electra complex, 18 
 Erogenous zones, 14 
 
 FEARS, 51, 55 
 
 Foreconscious, 6 
 
 Forgetting names and resolutions, 
 
 40 
 Free association, 30 
 
 GREGARIOUSNESS, 2 
 
 HERD instinct, 1 
 Homosexuality, 16 
 Horme, 4 
 Hypnoid states, 51 
 Hypnotism, 42, 54 
 Hysteria, 51 
 
 INFANTILE memories, 53 
 Instinct, 1 
 Inversion, 16 
 
 LAPSUS linguae et calami, 40 
 
 MANIACAL-DEPRESSIVE insanity, 59 
 Mattoids, 61 
 Mislaying objects, 40 
 Morality, 3 
 Mythology, 22 
 
 NEURASTHENIA, 45 
 (EDIPUS complex, 18 
 
 PARANOIA, 61 
 Phobias, 51, 55 
 Preconscious, 6 
 Projection, 41 
 Psychical determinism, 6 
 Psychoanalysis, 21 
 Psycholeptic crises, 56 
 
 RATIONALISATION, 3, 5, 9 
 Re-education, 59 
 Repression, 11 
 Resistances, 29-31 
 Resynthesis, 59 
 
 SEXUAL instinct, 65 
 (development of), 13 
 Side-tracking, 59 
 Somatic displacement, 35, 54 
 Splitting of consciousness, 10, 56 
 Sublimation, 10, 12, 59 
 Suitable cases, 22 
 Symbolic actions, 38 
 Symbolisation, 35, 54, 67 
 
 Tics, 56 
 
 Transference, 43 
 Transmutation, 59 
 Transvaluation, 59 
 
 UNCONSCIOUS, 6 
 
 VORBEIREDEN, 31
 
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