The Journal of Abnormal Psychology, Vol. 10
by Unknown
Hypertext Meanings and Commentaries
from the Encyclopedia of the Self
by Mark Zimmerman
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[5] Castle and Fish, Amer. Nat., Feb., 1915.

[6] Wright, S. Amer. Nat., March, 1915.

Goddard's findings as regards feeble-mindedness fit in perfectly with this
scheme. That Goddard was unaware of it when his conclusions were reached is
all the more evidence of their soundness because it shows that they were
reached independently. Among albinos every higher grade of pigmentation
dominates all the lower grades in inheritance, and so apparently it is with
mental development; the higher grades dominate the lower. At every point
there appears to be agreement in method of inheritance between albinism and
feeble-mindedness. Each is a unit character but showing graded allelomorphic
conditions which correspond probably with different stages of arrested
development of pigmentation or mentality respectively.

The fact noted by Goddard that the feeble-minded resemble savages, that is
backward races of low mentality, has much interest to the student of
evolution. It indicates that the evolution of intelligence has occurred by
a gradual progressive advancement, stages in which reappear as the higher
grades of feeble-mindedness. Of course it is not certain that the
ontogenetic stages, at which mental development may be arrested, correspond
accurately with earlier phylogenetic stages, but the idea receives
considerable support from the observed resemblance between the mentality of
morons and that of savage peoples, if the observation may be accepted as
accurate. I do not understand however that Goddard makes any claim to
first-hand familiarity with the mental life of savages, so that no great
emphasis should be laid on the point. But the mere fact that RETROGRESSIVE
variation in mentality is GRADED favors the view that its PROGRESSIVE
evolution has been gradual, rather than the view that it has arisen by
mutation or sudden loss of inhibitors. (Bateson, Davenport).

Goddard points out that a high grade moron may be a useful and
self-supporting member of society in some environments (usually rural)
whereas he would be quite helpless in the keen competition of urban life.
This suggestion leads the reader to wonder whether many peasant and peon
populations of the old and new world represent survivals of an older and
lower grade of mental evolution than has been attained in the more advanced
nations, or whether it is merely lack of opportunity that makes these
populations backward. The fact that in every generation great men come from
the lower social levels shows that the lower classes are not entirely devoid
of capacity; nevertheless it seems probable that a low grade of intelligence
would stand a better chance of escaping elimination in the struggle for
existence when placed in a simple environment than when placed in a complex
one. Consequently, under modern conditions, we might expect a peasant or
peon population to average lower in mental capacity than a community more
advanced in civilization. Whether the peasant population would equal in
average intelligence a band of North American Indians or a tribe of native
New Zealanders is very doubtful, for in such peoples natural selection for
intelligence was undoubtedly severe because of their intense struggle with
nature and with other tribes, unaided by the accumulated knowledge and tools
of civilized communities. Among such peoples greater demands were probably
made on inborn intelligence than among modern industrial populations.

As regards the CAUSES of feeble-mindedness Goddard's findings are wholly
negative, but not less valuable on that account. His case histories
statistically studied indicate no causal relation to a number of reputed
agencies in the creation of feeble-mindedness, such as alcoholism (which he
regards as oftener a symptom than a cause), tuberculosis, sexual immorality,
insanity, syphilis, accident and consanguinity. He recognizes HEREDITY as
its principal source, i. e. he recognizes feeble-mindedness as a stage of
mentality already existing and transmissible by the ordinary mechanism of
heredity, but does not attempt further to account for it, either as a
survival or as an atavism.

That humanitarian governments by shielding and supporting the moron without
putting a limit on his naturally high reproduction will speedily increase
this class at the expense of the more intelligent classes of the community
is self-evident, if it is admitted that feeble-mindedness is hereditary, as
all who have investigated the matter carefully now declare. Goddard shows
further that a large percentage (probably more than half) of the alcoholism,
pauperism, prostitution, and crime, of the United States are directly
traceable to hereditary feeble-mindedness, another strong reason for taking
measures to reduce it.

How is this to be done? Goddard has no cure-all to offer but urges first of
all that the mental grade of each individual be accurately determined and
education and occupation be provided suited to his capacity. This will tend
to make the moron a useful and contented member of the community, not a
menace to it. Segregation is recommended so far as practicable, but in view
of the large number (estimated at 300,000 to 400,000 in the U. S.) Goddard
considers segregation of all impracticable. Nevertheless he urges further
and energetic efforts in this direction, that as many as possible may be
segregated as a safeguard against their reproduction. In individual cases
"sterilization wisely and carefully practiced" must be employed to insure
non-reproduction.

In this volume there is a pleasing absence of the rant which pervades some
eugenic literature. The author has something of importance to contribute to
science and he presents his contribution in a sober, dignified manner in
keeping with the important character of his contribution. W. E. CASTLE.

CHRISTIANITY: THE SOURCES OF ITS TEACHING AND SYMBOLISM. By J. B. Hannay.
(Francis Griffiths, London; pp. 394).

This is an attempt to expound the symbolism of the Christian religion. It is
divided into three main parts: ancient cults (phallism and sun worship);
ancient cults in the Old Testament; ancient cults in the New Testament. The
author's main thesis can be stated in a sentence: the essential constituents
of every religion, and the underlying meaning of its symbolism, are
phallicism and sun worship. Of these the former is the more important, more
primary, and more wide-spread; the latter is a superimposed layer better
adapted to more civilized and educated people, but rarely penetrating into
the hearts of the common people to the extent that the former has. "The
great branches under which all the religious systems of the past have
developed may be classed as based, on the one hand on the consideration of
our world and the continuity of life upon it, expressed in Phallic
symbolism, and on the other hand, on the Sun as the great giver and
sustainer of man, expressed in Solar symbolism." (p. 21). "As the Phallic
cult was much the older, it retained its position after the rise of the
Solar cult. It required a much higher intelligence to grasp the facts of
Solar worship, so it never entered the 'hearts' of the common people as did
the Phallic worship, but it had a much more intelligent priesthood, and was
the arbiter in all questions of dates, and regulated al) feasts; and, what
was more important to the people, fixed the time for payments of debts or
interest, and regulated the times of sowing and harvesting, so it became a
much more 'official' religion than Phallism."  In support of these
conclusions the author marshals a huge number of facts, so that the work
becomes a veritable encyclopaedia of symbolism.

Now in spite of the fact that the reviewer fully accepts the main thesis of
the book, as stated above, and therefore has no prejudice or hostility on
the score of the conclusions encunciated being distasteful, his judgment of
the book is entirely unfavourable, for the following reasons: In the first
place, any presence of the book to be a scientific, and therefore impartial,
contribution to knowledge is invalidated by the author's moral bias evident
from beginning to end, against religion in general, and Christianity in
particular, which he maintains is the most phallic of all religions. His
point of view is that of the older rationalists, to whom religion is nothing
but an unfortunate instinct for "delight in the miraculous," expressing
itself in phallic and sun worship, and fostered by the exploiting tendencies
of priests. His desire seems to be, in writing the book, to "show up"
religion and, by discrediting it, hasten its end.

In the second place, there is not a single new idea in all its closely
packed pages, and therefore no excuse for writing them, since the material
here laboriously brought together is easily accessible in other books. It
never seems to dawn on the author that pointing out the sexual basis of
religion, which countless other writers have already done, is but the
beginning of the problem, the starting-point of all sorts of complex
riddles. Having dogmatically divided all religious symbols into male and
female, he is self-satisfied enough to think that he has explained religion.
There is no inkling of the points of view suggested by such words as
determinism, significance, genesis, so familiar to the modern psychologist.

Side by side with all this goes a disorderly arrangement and very imperfect
powers of criticism. The latter feature is especially marked in the field
of etymology, where the author fairly lets himself run wild. The following
gem is a typical example (p. 110): "Bacchus became degraded into the God of
Wine, and his fetes became drunken orgies, but he was originally the
beneficent sun who ripened the fruits, and hence God of Wine, from which,
indeed, is derived the English name of all our gods, angels, prophets, or
even parsons,--"divines," "dei vini," "Gods of Wine."  Jesus was the "True
Vine."

The merits of the book are that it may direct the attention of some people
to the connection between sex and religion, if there are any who are still
unaware of this, and that it possesses a good index that may be useful to
readers with limited facilities for looking up particular symbolisms; it is
also well illustrated. ERNEST JONES.

LAUGHTER: AN ESSAY ON THE MEANING OF THE COMIC. Henri Bergson. Translated
by C. Brereton and F. Rothwell. (Macmillan, London, 1913. Pp. 200).

In this stimulating little book Professor Bergson propounds his theory of
the comic, which is shortly to the following effect. Noting first that
laughter is purely a human phenomenon, and therefore probably has a social
significance, he seeks for this by trying to define what are the essential
features of the comical. He reduces the various characteristic features in
the main to one, namely, automatism on the part of the comical person or
thing. This automatism is of a special kind; especially is it an automatism
that is out of place, that occurs at the expense of spontaneity, vitality,
and freshness. It may thus be defined as "something mechanical in something
living," "a kind of absentmindedness on the part of life."  "The comic is
that side of a person which reveals his likeness to a thing, that aspect of
human events which through its peculiar inelasticity, conveys the impression
of pure mechanism, of automatism, of movement without life."  "To imitate
anyone is to bring out the element of automatism he has allowed to creep
into his person. And as this is the very essence of the ludicrous, it is no
wonder that imitation gives rise to laughter. "This bald statement of
Bergson's conclusion is, in the reviewer's opinion, made very convincing by
the delicate analysis he proffers of numerous illustrations.

Up to this point Bergson's theory of the comic fairly well coincides with
that of Freud. The latter author, it is true, summarises his conclusions in
different language. But the meaning is not very different. For him the
feeling of comicality is an "economy of ideational expenditure," and it is
evoked by the sight of another person who in a given performance displays
either a lack of mental activity or an excess of physical, i.e., who is
either stupid or clumsy. Compare this formulation with Bergson's. The latter
says that the opposite of the comic is gracefulness, rather than beauty. "It
partakes rather of the unsprightly than of the unsightly, of rigidness
rather than of ugliness."  The replacement of mental by physical activity is
insisted on in the following passage: "Any incident is comic that calls our
attention to the physical in a person, when it is the moral (i. e. mental)
that is concerned." Again, he compares a comical person to "a person
embarrassed by his body."  His automatism is essentially a lack of mental
nimbleness, a formal lack of mental elasticity, a defective capacity for
rapid adjustment, in short, a mental laziness. And especially is this defect
one of consciousness. The failure is on the part of the higher mental
activities, which should be the most alert, and what happens is a relapse
into unconscious, automatic modes of functioning, a form of absentmindness.
"The comic is that element by which the person unwittingly betrays
himself--the involuntary gesture or the unconscious remark. Absentmindedness
is always comical. Systematic absentmindedness, like that of Don Quixote,
is the most comical thing imaginable . . . . . . . No one can be comical
unless there be some aspect of his person of which he is unaware, one side
of his nature which he overlooks; on that account alone does he make us
laugh."

In substantial agreement on this general conclusion as to mental rigidity
and bodily clumsiness, the two views diverge from here. According to
Bergson, the comic presupposes "something like a momentary anaesthesia of
the heart;" "laughter is incompatible with emotion." For Freud this absence
of emotion is much more characteristic of humour than of the comic, two
matters that Bergson quite fails to distinguish. Then, whereas Freud
explains the subjective side of the comic purely on hedonic principles,
Bergson sees in it an important social function. According to him, laughter
is one of society's weapons for dealing with tendencies that threaten to
diverge from the conventional and accepted norm. It "restrains eccentricity"
and "corrects unsociability." "Any individual is comic who automatically
goes his own way without troubling himself about getting into touch with the
rest of his fellow-beings. It is the part of laughter to reprove his
absentmindness and wake him out of his dream . . . . Each member must be
ever attentive to his social surroundings; he must model himself on his
environment; in short, he must avoid shutting himself up in his own peculiar
character as a philosopher in his ivory tower. Therefore society holds
suspended over each individual member, if not the threat of correction, at
all events the prospect of a snubbing, which, although it is slight, is none
the less dreaded. Such must be the function of laughter. . . . It represses
separatist tendencies."  "Unsociability in the performer and insensibility
in the spectator--such, in a word, are the two essential conditions." This
interesting theory leaves some questions unanswered. Why, for instance,
should onlooking society remain emotionally cold in one case, and merely
laugh, and in another case adopt much graver measures? Bergson deals with
this point rather imperfectly. It is not the seriousness of the case that
decides, for "we now see that the seriousness of the case is of no
importance either: whether serious or trifling, it is still capable of
making us laugh, provided that care be taken not to arouse our emotions."
Nor is it the immoral nature of the deviation from the normal. "The comic
character may, strictly speaking, be quite in accord with stern morality.
All it has to do is to bring itself into accord with society."  "It is the
faults of others that make us laugh, provided we add that they make us laugh
by reason of their UNSOCIABILITY rather than of their IMMORALITY."  The most
specific criterion seems, in Bergson's opinion, to be that of vanity. "It
might be said that the specific remedy for vanity is laughter, and that the
one failing that is essentially laughable is vanity."

We may briefly refer to some other matters dealt with more incidentally;
wit, and the relation of the comic to art and to dreams. The discussion of
wit is perhaps the weakest part of the book. No analysis is given of the
different forms of wit, and the important subject of what may be called its
technique is quite passed by. Wit is identified in a superficial manner with
the comic in general, the fundamental differences between the two, which
Freud has dealt so exhaustively with, being altogether ignored. Bergson
gives a more interesting and profitable study of the relation of the comic
to art; especially of the nature of comedy as distinct from other forms of
drama. According to him, comedy portrays character types rather than
individual persons. He repeatedly insists on this point, adding that "it is
the ONLY one of all the arts that aims at the general; so that once this
objective has been attributed to it, we have said all that it is and all
that the rest cannot be."  Further, "comedy lies midway between art and
life. It is not disinterested as genuine art is. By organizing laughter,
comedy accepts social life as a natural environment, it even obeys an
impulse of social life. And in this respect it turns its back upon art,
which is a breaking away from society and a return to pure nature. "The
discussion of the relation of the comic to dreams is, on the other hand,
less satisfying. Comic absurdity is stated to be of the same nature as that
of dreams. The main point of resemblance seems to be that in both cases
there occurs an absence of social contact. In both there is a mental
relaxation from the effort of "seeing nothing but what is existent and
thinking nothing but what is consistent." This really applies much more to
wit than to the comic itself.

As may be expected, the whole book is written in Professor Bergson's
pleasing style, and is full of suggestive hints and fresh points of view.
The most significant contribution, one which pervades the book throughout,
is the view of laughter as a social censor. Even if this hypothesis is
substantiated by detailed investigation, however, it cannot rank as a
complete theory of laughter, or of the comic, until it is supplemented by
some explanation, not given by the author, of the most striking feature of
laughter, its capacity for yielding pleasure.

It only remains to say that the translation is literally excellent. ERNEST
JONES.

ADDRESSES AND PAPERS AT THE OPENING OF THE PHIPPS PSYCHIATRIC CLINIC, JOHNS
HOPKINS HOSPITAL. The American Journal of Insanity, Special Number, Vol.
LXIX, No. 5. The Johns Hopkins Press, 1915.

This special number of the American Journal of Insanity contains the
exercises and papers delivered at the opening at the Phipps Psychiatric
Clinic at the Johns Hopkins Hospital, Baltimore, Md. The contents of the
entire volume should prove to be of the greatest interest to all students
and lovers of psychiatry. The volume opens with a brief but fitting
Introduction by Dr. Adolf Meyer, Director of the Clinic, a man to whom
American psychiatry owes so much for the stimulus and inspiration which he
has injected into others. This is followed by A Word of Appreciation by
Henry D. Harland, President Trustees, The Johns Hopkins Hospital, some brief
remarks on The Psychiatric Clinic and the Community by Stewart Paton, the
heart-to-heart talk on Specialism in the General Hospital by Sir William
Osler, and a short talk on The Purpose of the Psychiatric Clinic by Prof.
Adolf Meyer. There then follow a series of fascinating and inspiring
papers, as follows: The Sources and Direction of Psychophysical Energy, by
William McDougall; Autistic Thinking by E. Bleuler; Personality and
Psychosis by August Hoch; The Personal Factor in Association Reactions by
Frederic Lyman Wells; A Study of the Neuropathic Inheritance by F. W. Mott;
On the Etiology of Pellagra and its Relation to Psychiatry by O. Rossi;
Psychic Disturbances Associated with Disorders of the Ductless Glands, by
Harvey Cushing; Primitive Mechanisms of Individual Adjustment by Stewart
Paton; Demenzprobleme by K. Heilbronner; The Inter-relation of the
Biogenetic Psychoses by Ernest Jones; Prognostic Principles in the
Biogenetic Psychoses, with Special Reference to the Katatonic Syndrome by
George H. Kirby; Anatomical Borderline between the So-called Syphilitic and
Metasyphilitic Disorders in the Brain and Spinal Cord by Charles B. Dunlap;
and Mental Disorders and Cerebral Lesions Associated with Pernicious Anemia
by Albert Moore Barrett. The number is concluded by the penetrating Closing
Remarks of Prof. Adolf Meyer.

The papers by Mott, Rossi, Cushing and Heilbronner are of the greatest
interest. The discussions by McDougall and Bleuler are fascinating and
uplifting. McDougall's paper is a masterpiece. Kirby, Jones and Hoch
present us with the modern standpoints in the conception of the psychoses.
Throughout the volume one sees the adoption of the broad biological
standpoint in mental life. The adoption of the term "biogenetic psychoses"
is indicative of the general trend. The adoption of this well-chosen phrase
is, I venture to suggest, the product of Dr. Meyer.

The reviewer regrets that the papers do not very well lend themselves for
brief reviews. Furthermore, he would not attempt to briefly present the
views which have been so lucidly and succinctly expressed by the individual
writers.

Prof. Meyer is to be commended for the very splendid program presented at
the opening exercises of the Phipps Psychiatric Clinic.

May it be a lasting inspiration for those who drink at the fountain of
psychiatry and psychopathology. MEYER SOLOMON.

BOOKS RECEIVED

SLEEP AND SLEEPLESSNESS. By H. Addington Bruce. Pp. IX + 219. Little, Brown
& Co., 1915. $1.00 net.

THE MEANING OF DREAMS. By I. H. Coriat. Pp. XIII + 194. Little, Brown &
Co. $1.00 net.

THE JOURNAL OF ABNORMAL PSYCHOLOGY

A PSYCHOLOGICAL ANALYSIS OF STUTTERING[*]

[*] Paper read May 6, 1914, at Albany, New York, before the American
Psychopathological Association.

1915 by Richard G. Badger.

BY WALTER B. SWIFT, A.B., S.B., M.D.

Instructor in Neuropathology, Tufts College Medical School, In Charge Voice
Clinic, Boston State Hospital, Psychopathic Department.

THE object of this paper is to carry the analysis of stutter phenomena
deeper than before. In my last year's paper I showed that chronologically
the diagnosis of dyslalia mounted step by step from a material external
affair, up through the nerves until we came to the basal ganglia. I showed
conclusively that it was an involvement that did not exist in any of these
places. I further took steps to demonstrate and present evidence that
indicated that dyslalia was in its essence some trouble with the
personality. I mean by this: that the trouble was located in the nervous
system beyond the lower sensory areas of the sensorium; and also above the
lower motor areas on the motor side. By the broad term "personality" I mean
the total of the activities and interrelations of mental activities that
occur above our lower sensory and motor areas. The paper of last year
clearly located the trouble vaguely in this region of the personality.

Since that time I have been interested to ascertain just what the nature of
this changed personality is. In order to do so, I have carried on an
investigation that has reached interesting conclusions. To me it is new
truth. It may not be all the truth, but as far as it goes, and as for what
it is, it surely is truth and a new finding! This research is an effort to
show not only where it is but WHAT IT IS.

The method was as follows: For the purpose of finding out some of the
activities going on in the area of collaboration during speech, I asked my
stuttering patients two simple questions. I thus found that their methods of
collaboration complied to a certain mental type.

Then I carried this same method into the study of normal individuals in the
collaboration of their ideas, just before and during speech in order to
establish a norm; and to see whether or not it differed from my preliminary
test of stuttering cases just mentioned. It did, and therefore I formulated
a series of questions in order to pin the type of collaboration down to
certain fields of mental action. To make this clear, let me present an
outline of these different steps in tabular form.

     1. Orientation tests on stutterers.
     2. Orientation tests on normal individuals.
     3. The research, its objects and methods.
     4. Final detailed results.

Let us now pass to a minuter description of each of these procedures and a
tabulation of the data that resulted.

1. PSYCHOLOGICAL ORIENTATION TESTS ON STUTTERERS:

By orientation test I mean simply a vague try-out to see just where the
problem lies; an initial step to see what further steps are necessary; or in
other words enough of an investigation to know where to look next.

The orientation tests consisted in requesting a series of twenty stuttering
cases to answer two questions. Following their answers an immediate
inspection was made of the content of their consciousness before, during,
and after speech. These two questions were as follows:

     1. Where do you live?
     2. Say after me "The dog ran across the street."

After these questions I asked the patients to state whether there was any
picture in the content of consciousness and how long it lasted; also whether
that was detailed, intense or weak. I noted the presence of stuttering in
relation to the presence or absence of this mental imagery; and also made a
note of any other unusual data that happened. The results of the tests
indicated above can be summarized as follows:

Of the twenty stutterers examined, ten made no visualization of their homes,
some even after a residence of years; one of these twenty visualized home
very faintly; two others visualized home clearly but the picture vanished on
speaking; seven others visualized home clearly but these had been under
treatment.

On repeating the dog statement, ten stutterers made no visualization
whatever; one visualized faintly; four visualized well but the picture
vanished on speaking; five others reported visualization, and four of these
had been under treatment.

At first I did not know but what this was the norm of average visualization
methods; so I tried this same series upon a number of normal individuals for
comparison; by normal individuals, I mean, at this time, merely anyone who
is free from stuttering, and chosen in a haphazard way from the hospital
community; for example, one was our executive secretary, another a
typewriter, another a telephone operator and so on.

2. PSYCHOLOGICAL ORIENTATION TESTS ON NORMAL INDIVIDUALS

The results of these orientation tests upon normal individuals were as
follows:

The normal individuals examined almost without exception visualized clearly
before and during speech. Sometimes this visualization was very marked in
detail and resulted in emotional responses, such as pleasures, etc.

From the above two sets of figures were thus obtained a fair norm of
visualization for ordinary individuals; and in comparison a marked variation
from this in stutterers. This data therefore warranted the tentative
conclusion that stutterers have a loss or diminished power of visualization.
This assertion may seem a little more than is warranted by such meagre data
and perhaps would be better revised pending further data into the following:
As compared with the normal, stutterers show a weakness in visualization.

3. THE RESEARCH, ITS OBJECTS AND METHODS:

These general orientation tests for a norm and its pathological variation
were the basis upon which I proceeded on broader lines with a further and
more exhaustive investigation with the following points in view:

To what extent is visualization weak?

Is it weaker in the worst cases?

Is it less and less weak as cases appear less severe?

Is it the same for past, present and future memories?

Is visualization equally at fault in all sensory areas of the cortex?

Do cases approach normal visualization processes in proportion as they
progress in their cure? and

Lastly, numerous other minor queries presented themselves.

All these questions were answered in the following research, which after
thus much orientation found a more complete and final form.

In order to answer these questions I formulated the following series of
tests to the number of twenty-four in all, and asked them in series to
nineteen stutterers, making almost four hundred tests:

     1. Speech:
        Say, Today is sunny.
        The dog ran across the street.
        Submarines will sink all the steamers.

     2. Motor:
        Do you dance?
        Did you ever skate?
        Would you sew for a living?

     3. General Sensory:
        How does a pinch feel?
        Did you ever get hurt?
        What would you like to do if it was very hot next summer?

     4. Hearing: (Eyes closed)
        Do you hear anything?
        Did you ever hear a rooster crow?
        What sounds would you like to hear next summer?

     5. Sight: (Eyes closed)
        What do you see now?
        What did you see yesterday?
        What would you like to see next summer?

     6. Smell: (Eyes closed) (Pen to nose)
        Do you smell anything?
        What have you told by smell?
        What would you like to smell next summer?

     7. Taste: (Eyes closed)
        Do you taste anything?
        What have you been able to tell by the taste?
        What would you like to taste next summer?

     8. Muscle Sense: (Eyes closed)
        Put one arm up; the other like it.
        Put one arm up, down; the other like it.
        How would you hold a hand to read from it?

This long series of questions with careful introspection tests upon the
content of consciousness constituted then my main research in the field of
stuttering. Perhaps further details in explanation of the questions chosen
is unnecessary. Three or more questions on introspection were asked at each
test.

4. FINAL DETAILED RESULTS are found in the following conclusions as drawn
from 1440 answers.

In our average conversation a visual picture is created before we begin
utterance. Severe stutterers never visualize at all. In direct proportion
that these cases become less severe, does visualization increase in
frequency, strength and continuation in consciousness before and during
utterance.

When severe stutterers are free from spasms they visualize, and when they
stutter they do not visualize.

When mild cases are free from spasms, they visualize, and when they stutter
they fail to visualize.

In a word, when visualization is present stuttering is absent; when
visualization is absent stuttering is present.

This is true not only of EACH UTTERANCE, in most cases, but is true of
severe as well as mild forms as a whole.

Stutterers gain in visualization as they approach cure.

For past, present and future memories: visualization is slightly more
frequent for past and future.

Therefore stuttering is an indication of absent or weak visualization either
in isolated words, occasional stutterers, mild stutterers or the severest
type, either before or during speech, or both.

The slump, then, in personality which I showed last year as the main thing
in stuttering as its cause and condition, is thus found by further
psychological analysis, to be a slump in the power to consciously visualize.

By personality I mean as mentioned above the composite of collaborative
activities that lie between the low sensory repository areas and the low
motor expression areas. In other words, personality includes all those
collaborative processes that lie between the sensory intake areas and the
motor output areas; in a word, any unexpressed use the mind makes of its
intake. Conscious visualization is a part of personality processes, then. In
my last year's paper([1]) the whole matter was left vague. Here something
definite and constant is found. In other words the psychoanalytical method
revealed no conscious subconscious cause. Granted there is room here to
"interpret" (or create according to Freudian mechanisms) a definite
subconscious complex, a step which I could not feel justified in taking; I
leave this to better psychoanalysts than I. For me to twist stutter
phenomena to comply to a theoretical complex is unscientific to say the
least. But the psychological method--as represented by this paper--shows a
definite constant cause for all the phenomena of stuttering.

FAULTY VISUALIZATION EXPLAINS ALL PHENOMENA:

Upon this basis of an involved visualization all the intricate phenomena of
stuttering may be explained. Let us take some of these up in detail.

THE START. Visualization processes are a matter of growth through exercise
and development and use from the sensory area mostly of the eye. If these
processes in their early start and evolution receive a setback through the
treatment of people in the environment, such as interruptions of their early
speech efforts, constant inattention of those to whom they speak, and
persistent refusal by older people to answer questions propounded or the
allowing of the little one to ask the same question without hopes of answer
for a great number of times, these visualization processes receive a
setback. This kind of treatment in the home is one of the chief causes of
the slump of visualization processes. Another cause is hearing other
stutterers interrupt their own visualization processes as they stutter; and
still other minor causes may be almost any psychic trauma; these traumata,
such as an operation, an accident or a severe illness, are sufficient to
bring to the surface or intensify a growing lack of visualization that has
been started by bad environment long before.

THE DEVELOPMENT OF STUTTERING. When the habit of visualization is lessened,
the action upon speech is the same as the withdrawal of an inhibiting or
regulating reflex arc.

It is thus that visualization processes act like reflex inhibition. When
visualization is present a higher inhibition arc is functioning and we have
a normal speech as a consequent reflex expression. When and in proportion as
visualization is absent this higher inhibition arc is not functioning; and
the speech thus uncontrolled flies away in spasms which we call stutter. It
should be called an exaggerated or uninhibited speech reflex.

The stutter, then, is merely the externalization of an exaggerated reflex of
motor speech, exaggerated through the loss of the inhibitory action of a
more or less weakened visualization process.

Not only does this explain the phenomena at large but seems to be a
satisfactory explanation for all its intricate, minute details. Some
examples may, perhaps, be welcome at this point. I say to two stutterers:
"Tell your first name."  One of them stutters and the other one does not.
On furthering questioning, it is found that the one who did not stutter
visualized, and the one who did stutter did not visualize.

CONCRETE: These conditions are also seen when stutterers talk about
concrete and abstract matters or when they promulgate some important plea
that cannot be visualized. On concrete matters that can be easily visualized
the stuttering is gone; and on abstract matters where visualization is hard,
the stuttering again appears.

ANGER: In anger, when an intense visual picture is presented and occupies
the mind, there is then no stuttering, and also in other similar situations
there are periods when the individual is abandoned to some visual concept
which acts in the same manner.

SINGING: We all know that stutterers can sing without stuttering. The
process here is a similar one; only that there is held up over the speech
before utterance an auditory image of a melody in place of the visual image
as held in normal speech. This auditory image may be more easily applicable
as supplying the needed inhibition reflex arc than the visual because it is
nearer to the speech area.

PRAYER: For the same reason prayer is uttered without stuttering when there
is faith enough in a God to hold an image of Him during utterance. There may
also be other images held during prayer.

FAMILIAR SIGHTS: Familiar sights are less stuttered upon than the detailing
of situations that are less familiar and therefore can be less well
visualized. This is also true of sights that have been recently seen or
that have been repeatedly seen, or that in some other way have been made
intense as pictures in the visual field.

AS CURE PROCEEDS: In the process of recovery where visualization is seen to
increase as the stutter decreases, there is another illustration where this
visualization attitude explains the whole situation. I have taken a severe
stutterer and told him a story that could be well pictured, got him to work
up the pictures properly by several complicated processes (which we will not
consider now) and when he had them well in hand, I have seen him stand up
and relate the story from beginning to end with little or no stuttering If
at any point he would trip up, the inevitable confession would be that at
that point he dropped the picture, or, in other words, the visualization
could not be held over in its inhibitory action; and therefore the stutter
came. On further request to hold it over that point, the same passage would
be again expressed smoothly if he succeeded in holding the picture.

This constancy, this presence and absence of the picture, its presence to
make smooth talk and its absence to cause stuttering, is so constant at
every turn of the situation, that I would offer it as a new interpretation
of all these phenomena. I know of no other interpretation that can EXPLAIN
EVERYTHING UNDER ONE HEAD as does this absence, weakness or interruption of
visualization processes.

TERMINOLOGY. We have found in our orientation tests that in a vague way the
visualization was at fault. We have also found in normal individuals that a
marked visualization was an automatic process that preceded speech, and
lasted during utterance; and we have found in the long series of stutterers
that visualization is entirely absent in severe cases; that it is weak in
milder forms; that it is intermittent in most cases, and that on words that
are smooth it always appears, and in occasional stutter it is as
occasionally absent.

We have also found that the form of visualization common in normal speech is
the visualization of eye sensations; that in unusual situations we may have
visualizations from other sense areas, such as the ear, taste or smell, but
these are the RARE EXCEPTION.

From all this data it would naturally follow that some sort of term is
needed to designate this condition. Last year I probed to find such a term
without much success.

At present I see no reason why it should not be called an Asthenia; it is
surely the weakening of a mental process that is strong in normal
individuals. The evidence here presented shows that. I doubt whether there
is any marked pathological change, since the individual may be educated out
of it; but this does not necessarily follow as proven with my dog in
Berlin.[2] As a general designation, then, I should consider Asthenia as
apropos.

One objection to this is that the weakness is by this terminology lacking in
localization. Our data above has shown us that the location of the trouble
is visual; that is, it is situated about a centre of sensory registration
that deposits data from the eye; this must naturally then be located
somewhere in or near the cuneus. We could therefore add to the terminology
this idea of a minute localization and call it a Centre Asthenia.

Some may prefer to carry the matter one step farther and add the name of the
centre in which this weakness is located, but I fear if I take this step and
complete my terminology by the word "Visual Centre Asthenia," it will, as
such, not cover quite all the cases, for I find that sometimes the
visualization is absent in other areas as well, and also the holding of an
emotion of pleasure or pain and of other dominating mental attitudes that
are sometimes visualized would not, therefore, be included. I would
therefore retract the broader claim in order to place the term on a
conservative basis and call the essence of the lesion simply no more or less
than a Centre Asthenia. As well as visual Asthenia, the following terms
might be considered as applicable: collaborative centre asthenia;
imaginative centre asthenia; visual creative centre asthenia; picture
producing centre asthenia. We say neurasthenia when the trouble is not in
the nerves as such, so much as it is in the collaborative centres. More of
this later. Here in stuttering the trouble is also collaborative, and we
can be still more definite than that and say the trouble is with the
collaboration of visualization. So if I were forced, however, to choose one
term from all these, my choice would be "Visual Centre Asthenia."  This
indicates a new and rational treatment. But of this later.

SUMMARY: Psychoanalysis reveals stuttering as some vague trouble in the
personality[1]. Psychological Analysis shows stuttering is an absent or weak
visualization at the time of speech. This new concept of stuttering as
faulty visualization may be called Visual Centre Asthenia. This lack or
weakness in visualization accounts for all the numerous phenomena of
stuttering in severe, medium, or mild cases. A new treatment is indicated.

REFERENCES

[1] Swift: Walter B, A Psychoanalysis of the Stutter Complex with Results
of Synthesis.

[2] Swift Walter B., demonstration eines Hundes, dem beide Schafenlappen
xtirpiert worden Sind. Neurologisches Centralblatt, 1910, no 13.

THE ORIGIN OF SUPERNATURAL EXPLANATIONS[*]

[*] Read at the 7th Annual Meeting of the American Psychopathological
Association, New York, May, 1915.

BY TOM A. WILLIAMS, M. B., C. M. (EDINBURGH)

Corresponding Member Neurol. and Psychol. Societies of Paris, etc.
Neurologist to Freedmen's Hospital and Epiphany Dispensary, Lecturer on
Nervous and Mental Diseases, Howard University, Washington, D. C.

THERE is a general impression that the explanations of natural phenomena,
including human destinies, to which the term superstitious is given are
usually attributable to the vestiges of traditional cosmogonies of our
tribal ancestors handed down to children at the knees of their parents or
guardians. This explanation however, is only true of a portion of the
beliefs which we call superstitions. The demand for superstitious
explanations depends upon psychophysiological tendencies of the human
organism, the root of which is comprised in the affect which we call
craving. This theorem I have tried to develop as follows:--

I

Craving is a sign of physiological need. It is a sensory phenomenon, of
which, however, explicit awareness cannot always be discovered. It is
conspicuously noticed in cases of disturbance of the body secretions, such
as occurs in over-function of the thyroid gland. It is regarded as a crude
body-consciousness that something is the matter. In motorial organisms it
causes visible reaction: this expresses itself in what is termed
restlessness. But the unrest may show itself by a fixation more particularly
in the muscles of emotional expression, although the manifestation is not
confined to these; shallow respirations and restricted amplitude of movement
in limbs and trunk may be observed also. In cerebrate animals the reaction
of the individual is under the guidance of preceding impressions stored in
the pallium and known as memories; whereas in the animals without a pallium
all reaction is accomplished through stable mechanisms known as instincts.
Both of these types of reaction are tropisms merely; but the former are
labile, conditionable; whereas the latter cannot be modified. The science of
conditionable reactions of cerebrate animals is called psychology, and the
means by which the reactions are influenced are called psychogenetic,
whether these are healthy or diseased. It must not be forgotten, however,
that the genesis of a psychological disturbance may be purely somatic,
although the manner in which the reaction shows itself is contingent mainly
upon the features of the individual which have been derived from previous
sensory impressions and their resultant motor reactions commonly known as
experience. It is the influence of these upon the hereditary dispositions of
the individual which constitute what is known as "make-up" or character; and
it is this which determines the form which reaction to stimulus must take,
whether the stimulus is purely psychological or somatic.

Now physiological discomfort is an experience universal at one time of life
or another; but the reaction to it is infinite in variety; and while part of
it depends upon the congenital dispositions which are the common property of
humanity, a larger part is contingent upon the psychogenetic factors which
have stamped the individual.

II

Now an influence which has been of great significance to every human being
since the traditional period, at least, has been the concept of the universe
regnant at the period of that individual's life. The insistence by its
protagonists upon this concept as the ultimate motive of human endeavour
made its acceptance almost universal at periods when it was the custom to
lean upon the dicta of authority for guidance in life even when blind
obedience was not the rule. Now in natural affairs, inconvenient
questionings and scepticisms towards dogmatisms would ultimately reach
truth. But as inaccessibleness to verification of what was called
supernatural made authority, rather than investigation, its criterion,
excommunication from the tribe would still all criticism.[1] Thus every act
of life became permeated by motives, originated in arbitrary interpretations
of a super-nature.

[1] A dramatic study of this occurrence is presented by Grant Allen in "The
Story of Why-Why" in his book "The Wrong Paradise."

These influences were specially conspicuous concerning the difficulties of
man's almost blind struggle against the uncomprehended astronomical and
geodetic phenomena marvelled at and fled from, as well as the pestilences
which ravaged him. In his sociological affairs too, every act or thought
became embued with relationship to an extraneous power.

It is by these social and physical phenomena that the greatest appeal is
made to the states of feeling termed emotions and sentiments. So that it
became the custom to invoke, concerning ill states of feeling, the reference
to a supernatural influence. Thus, from the cradle up, the ordering of
social relationships was made dependent upon the simple expedient of the
supernatural extraneous agent, rather than upon the more difficult and
elaborate analysis and synthesis which would have been required for a proper
investigation of each perturbing circumstance in its relation to life as a
whole. The power of this influence was inversely proportional to the
resiliency and tenacity as well as the general well-being of the individual.

But not only is reference to the supernatural favoured by traditional
cosmogony, but because of certain psychological features of the individual
himself there is a tendency towards supernatural explanations of the
introspective observations. The Occasions of introspection of this kind are
two, and I am not speaking of the inculcated introspection of the moralists.
One of these Occasions is the self-examination into his conduct which is a
normal character of a thinking being. This may give rise to supernatural
explanations even when the introspection is not determined by the tradition
of which I have already spoken.

The second kind of Occasion demanding introspection, is the autochthonous
emanation of feeling of unaccustomed character. Such feelings occur at the
physiological epochs;--but at these times they are readily explained in a
familiar and simple way, and hence no supernatural agency is usually
invoked. A similar explanation is made readily enough in cases of evident
bodily disease, even where mental symptoms are prominent, for it is no
longer the custom to speak of demon-possession even in the acute deliria.
But even where no physiological epoch or clearly defined physical disease
stands forth, unusual feelings are no uncommon phenomenon, and they demand
explanation. Such occur conspicuously in the psychopathological syndrome so
completely described by Janet under the term psychasthenia. Persons thus
afflicted feeling an incapacity and an impediment to their free activity and
not recognizing that they are sick, endeavour to interpret their feelings.
Of course, the interpretation varies somewhat in accordance with the nature
of the feelings, and with the person's information about the world and his
psyche. But quite apart from modifications of this type, I have found it
very common for patients to declare "I feel as if there was another person
in me," or "I feel compelled as if by another agency to act thus."  The
explanation of a supernatural agent weighing upon them becomes very easy.
For the purpose of this discussion, it is not important whether
psychasthenia arises purely from degeneration of structure, or from faults
in the chemistry of the plasma which bathes the nerve structures, or whether
it is a purely psychopathological condition to which the physical phenomena
are secondary, as some would have us believe. Our object is merely the
setting forth of the fact that it is a diseased condition which disposes its
victim towards metaphysical explanations.

It is a sort of uneasiness which prevents comfort in the feelings of
certainty, in the operations of the intellect and decision of action. The
patient finding himself abulic, and perhaps too critical minded to accept
the mundane supports in his vicinity, seeks a solace in that which to him
seems powerful because incomprehensible, that is to say in something
supernatural.

For this, it is not essential that the victim's mind be pervaded by the
infantine cosmogony which parades often as religious truth. Without anything
of the sort, there may arise naive interpretations, hardly even having
explicit reference to supernatural agents. For example, a patient may say
"If I begin on Friday, a certain undertaking will fail," "If I do not turn
my vest twice, misfortune will occur," "It is incumbent upon me to turn
round in my chair, or the negotiations will fail."  The enumeration of
expedients would be useless. The above are from three different patients,
one a boy of fourteen now completely cured; the second from the son of a
prominent public man now quite restored to health; the third from a case
still under care. In none of these was the bodily state of importance, the
psychological reactions were the sole object of therapeutic effort, and
their ordination was accomplished by purely psychological means.

DATA CONCERNING DELUSIONS OF PERSONALITY WITH NOTE ON THE ASSOCIATION OF
BRIGHT'S DISEASE AND UNPLEASANT DELUSIONS.[*]

[*] Presented in abstract at the Sixth Annual Meeting of the American
Psychopathological Association, held in New York City, May 5, 1915. Being
Contributions of the State Board of Insanity, Whole Number 47 (1915. 13).
The material was derived from the Pathological Laboratory of the Danvers
State Hospital, Hathorne, Massachusetts, and the clinical notes were
collected by Dr. A. Warren Stearns, to whom I wish to express my
indebtedness but to whom no one should ascribe the somewhat speculative
character of the present conclusions. (Bibliographical Note.--The previous
contribution was State Board of Insanity Contribution, Whole Number 46
(1915.12) by D. A. Thom and E. E. Southard entitled "An Anatomical Search
for Idiopathic Epilepsy: Being a First Note on Idiopathic Epilepsy at
Monson State Hospital, Massachusetts," accepted by Review of Neurology and
Psychiatry, 1915.)

E. E. SOUTHARD, M. D.

Pathologist, State Board of Insanity, Massachusetts; Director, Psychopathic
Hospital, Boston, Mass., and Bullard Professor of Neuropathology, Harvard
Medical School, Boston, Mass.

ABSTRACT

Previous work on somatic delusions. Suggestion that allopsychic delusions
are as a rule in some sense autopsychic. A genetic hint from general
paresis (frontal site of lesions in cases with autopsychic trend.)  Mental
symptomatology of general paresis. Work on fifth-decade psychoses.
Statistical summary. Group with pleasant (or not unpleasant) delusions.
Three cases of senile dementia, delusions of grandeur, and frontal lobe
changes. Three cases with religious delusions. Remainder of
pleasant-delusion group. Group with unpleasant delusions. Nephrogenic
group.

THE suggestions here put forward concerning personal (autopsychic) delusions
are based on material of the same sort as that previously analyzed for a
study of somatic and of environmental (allopsychic) delusions. Our
conclusions are also influenced by two analyses of the types of delusion
found in general paresis. Moreover, at a period subsequent to the analysis
presented here, some work on fifth-decade insanities had been completed, and
the delusional features constantly found in the functional cases of insanity
developing at the climacteric, entered to modify our general point of view.

The situation may be summed up as follows:

The accessibility to analysis of the clinical and anatomical data at the
Danvers State Hospital was such as to prompt the use of its card catalogues
for statistical work upon delusions. The more so, because in a period of
enthusiasm over the Wernickean trilogy (autopsyche, allopsyche,
somatopsyche) of conscious phenomena, the Danvers catalogue had attempted to
divide the delusions recorded into the three Wernickean groups. Putting
these clinical data side by side with the anatomical data, we were speedily
able to single out those cases with normal or normal-looking brains and thus
to secure a group approximately composed of functional cases of insanity.

It shortly developed, as to the CONTENT of delusions, that somatic delusions
were exceedingly prone to parallel the conditions found in the trunk-viscera
and other non-nervous tissues of the subjects at autopsy.) A subsequent
study has confirmed this conclusion for the distressing hypochondriacal
delusions found in climacteric insanities, which delusions, however
distressing, are often far less so than the true conditions found at
autopsy. And it may be generally stated that the clinician can get very
valuable points concerning the somatic interiors of his patients by
reasoning back from the contents of their somatic delusions.

But how far can we, as psychiatrists, reason back from the contents of
environmental delusions, e. g. those of persecution, to the actual
conditions of a given patient's environment? In a few cases it seemed that
something like a close correlation did exist between such allopsychic
delusions and the conditions which had surrounded the patient--the delusory
fears of insane merchants ran on commercial ruin, and certain women dealt in
their delusions largely with domestic debacles. But on the whole, we could
NOT say that, as the somatic delusions seemed to grow out of and somewhat
fairly represent the conditions of the some, so the environmental delusions
would appear to grow out of or fairly represent the environment.

Thus, however brilliant an idea was Wernicke's in constructing the
allopsyche (or, as it were, social and environmental side of the mind) for
the purpose of classification, our own analysis promised to show that for
genetic purposes the allopsyche was much less valuable. These delusions
having a social content pointed far more often inwards at the personality of
the patient than outwards at the conditions of the world. And case after
case, having apparently an almost pure display of environmental delusions,
turned out to possess most obvious defects of intellect or of temperament
which would forbid their owners to react properly to the most favourable of
environments. Hence, we believe, it may be generally stated that the
clinician is far less likely to get valuable points as to the social
exteriors of his patients from the contents of their social delusions than
he proved to be able to get when reasoning from somatic delusions to somatic
interiors. Put briefly, the deluded patient is more apt to divine correctly
the diseases of his body than his devilments by society.

Our statistical analysis, therefore, set us drifting toward disorder of
personality as the source of many delusions apparently derived ab extra and
tended to swell the group of autopsychic cases at the expense of the
allopsychic group,

In the statistical analysis of a group of cases corresponding roughly with
the so-called functional group of diseases, we find false beliefs about the
some on a somewhat different plane from those about the patient's self and
his worldly fortunes. We can even discern through the ruins of the paretic's
reaction that his false beliefs concerning the body are often not so false
after all, and that his damaged brain of itself is not so apt to return
false ideas about his somatic interior as about his worldly importance and
plight. There then seems to be more reality about somatic than about
personal delusions: the contents of somatic delusions are rather more apt to
correspond with demonstrable realities than the contents of personal
delusions. Accordingly our analysis of delusional contents includes a hint
also as to genesis. Taken naively, the facts suggest a somatic genesis for
somatic delusions exactly in proportion as these delusions are not so much
false beliefs as partially true ones.

What genetic hint have we for the delusions concerning personality? One
genetic hint was obtained from a correlation of delusions with lesions in
general paresis,[2] in which disease perhaps the most profound and
disastrous of all alterations of personality are found. Amidst the other
alterations of personality found in paresis, autopsychic delusions are
characteristic: indeed allopsychic delusions are conspicuously few in our
series. And, as above, the somatic delusions, fewer in number, can be
fairly easily correlated with somatic lesions, or else with lesions of the
receptor apparatus (thalamus) of the brain.

Now it was precisely the cases with autopsychic delusions, as well as with
profound disorder of personality in general, that showed the brunt of the
destructive paretic process in the frontal region. The other
not-so-autopsychic cases did not show this frontal brunt, but were less
markedly diseased at death and had a more diffuse process.

Our genetic hint from paresis, therefore, inclines us to the conception that
this disorder of the believing process is more frontal than parietal, more
of the anterior association area than of the posterior association area of
the brain. And if we can trust our intuitions so far, the perverted
believing process is thus more a motor than a sensory process, more a
disorder of expression than a disorder of impression, more a perversion of
the WILL TO BELIEVE than a matter of the rationality of a particular credo.

Again we may appear to burst through from an undergrowth of statistics into
the clear field of truism. False beliefs are more practical than
theoretical, more a matter of practical conduct than of passive experience,
more a change of reagent than a reaction to change. The man on the street or
even many a leading neurologist would perhaps accept this formula as his
own.

Certainly in general the least satisfactory of these chapters on the nature
of delusions was the chapter on environmental effects,[3] and this perhaps
because the results seemed so nearly negative.

A further contribution to delusions of environmental nature was somewhat
unexpectedly derived from a piece of work on the general mental
symptomatology of general paresis.[4] Dichotomizing the paretics (all
autopsied cases) into a group with substantial, i. e., encephalitic,
atrophic or sclerotic lesions of the cortex and a group without such gross
lesions or else with merely a leptomeningitis, I found the latter (or
anatomically mild) group to be characterized by a set of symptoms which were
all "contra-environmental," whereas the former (or anatomically severe) did
not thus run counter to the environment. The conclusions of that paper, so
far as they concern us now, are as follows:--

The "mild" cases showed a group of symptoms which might be termed
contra-environmental, viz. allopsychic delusions, sicchasia (refusal of
food), resistiveness, violence, destructiveness.

The "severe" cases showed a group of symptoms of a quite different order,
affecting personality either to a ruin of its mechanisms in confusion and
incoherence, or to mental quietus involved in euphoria, exaltation, or
expansiveness.

The most positive results of this orienting study appear to be the
unlikelihood of euphoria and allied symptoms in the "mild" or non-atrophic
cases and the unlikelihood of certain symptoms, here termed
contra-environmental, in the severe or atrophic cases. Perhaps these
statistical facts may lay a foundation for a study of the pathogenesis of
these symptoms. Meantime the pathogenesis of such symptoms as amnesia and
dementia cannot be said to be nearer a structural resolution, as these
symptoms appear to be approximately as common in the "mild" as in the
"severe" groups.

But in both papers dealing with paresis [2,4] we rest under the suspicion
that the delusions are possibly of cerebral manufacture. Of course, a lesion
somewhere outside the brain is not unlikely to be projected through the
diseased brain, and SOMATIC delusions in the paretic are rather likely to
represent something in the viscera.

It was desirable to get back to normal-brain material, to learn how the
INTRINSICALLY NORMAL brain[5] could perhaps produce delusions from a
particular environment. Could a particularly "bad" environment actually
PRODUCE delusions?

By chance, at about this stage in our studies of delusions, some work on
fifth-decade insanities[6] was completed. This work seemed to show that the
most characteristic (non-coarsely-organic) cases of involutional origin were
much given to delusions (each of 24 cases studied), somewhat more so than to
the hypochondria and melancholia which we commonly ascribe to the involution
period. But this result is equivocal as to the environmental (i. e.
allopsychogenic) power to produce delusions, since one could not rid oneself
of the suspicion that the delusions were due to the degenerating brain.

To return to our former results with the normal-looking brain:

Case after case of the quasi-environmental group proved to be more
essentially personal than environmental, until at last it almost seemed that
the environment could seldom be blamed for any important share in the
process of false belief. In short, we seemed to show that environment is
seldom responsible for the delusions of the insane.

Be that as it may, we secured several lines of attack on the delusions of
personality by our study of quasi-environmental delusions. First, we were
irresistibly led to a consideration of the emotional (pleasant or
unpleasant) character of the delusions. We heaped up a large number of
unpleasant delusions in that (quasi-environmental, but actually) personal
group. It is interesting to inquire, accordingly, whether our more obviously
autopsychic cases will also be possessed of an unpleasant tone. Secondly, we
came upon the curious fact that cardiac and various subdiaphragmatic
diseases were correlated with unpleasant emotion as expressed in the
delusions. It was therefore important to inquire whether similar conditions
prevailed in the new group. Thirdly, we found ourselves inquiring whether
our patients were victims of what might be termed a spreading inwards of the
delusions (egocentripetal) or a spreading outwards thereof (egocentrifugal
delusions). But this difference in trend, clear as it often is from the
patient's point of view, remains to be defined from the outsider's point of
view.

Again, it remains to determine, if possible, how far delusions are dominated
respectively by the intellect or the emotions, or even by the volitions.

As before, I begin with a brief statistical analysis.

SUMMARY

Danvers autopsy series, unselected cases 1000
Cases with little or no gross brain disease 306
Cases listed as having autopsychic delusions 106
Cases listed as having only autopsychic delusions 50
Cases for various reasons improperly classified 13
Cases of general paresis in which gross brain lesions were not observed 15
Residue of autopsychic cases 22

The group of 22 cases thus sifted out can be studied from many points of
view. We may recall that our former study of allopsychic delusions proved
that a large proportion of delusions concerning the environment were in all
probability not essentially derived from the environment. Their contents
might relate to the environment, but their genesis could better be regarded
as autopsychic (intrapersonal). In fact we really found only 6 out of 58
cases of pure allopsychic delusions, which could be safely taken as showing
so much coincidence between anamnesis and delusions that a correlation could
be risked.

Following the method of our former work on somatic and on environmental
delusions, we sought in the first instance PURE cases of autopsychic
delusion-information. For a variety of reasons, more than half of the
original list, namely, 28 cases, had to be excluded. Many of these
exclusions were due to the strong suspicion that the cases were really cases
of general paresis, despite the normality of the brains in the gross. The
residue of 22 cases include, we are confident, no instance of exudative
disease of the syphilitic group, though general syphilization cannot safely
be ruled out in all cases.

There are two groups of cases, a group of eleven cases with delusions of a
generally pleasant or not unpleasant character (in which group there is a
small sub-group of three cases of octogenarians with expansive delusions
reminding one of those of general paresis) and a group of eleven cases with
delusions of an unpleasant character.

I. CASES HAVING DELUSIONS OF A NATURE PLEASING OR NOT UNPLEASING TO THE
BELIEVER

The true emotional nature of the beliefs placed in this group cannot fairly
be stated to be pleasurable. But, if not pleasurable, they may perhaps be
stated to be complacent, expansive, or of air-castle type. The criteria of
their choice have been largely negative: the patients are not recorded as
expressing beliefs of a painful or displeasing character: in the absence of
which we may suppose the beliefs to be either indifferent or actually
pleasing in character.

Of the 11 cases whose delusions were supposedly of an agreeable nature or at
least predominantly not unpleasant, there were 3 with delusions reminding
one of general paresis. The ages of these three were 80, 84, and 87
respectively. They did not show any pathognomonic sign (e.g. plasma cells)
of general paresis. They all showed in common very marked lesions of the
cortex, including the frontal regions (in two instances the extent of the
frontal lesions was presaged by focal overlying pial changes) .999 was a
case of pseudoleukemia with marked cortical devastation but without brain
foci of lymphoid cells. Two of the cases showed cell-losses more marked in
suprastellate layers; in the third there was universal nerve cell
destruction, with active satellitosis caught in process.

Condensed notes concerning the cases with pseudoparetic delusions follow.
Two of them, it will be noticed, yielded some delusions also of an
unpleasant nature.

CASE I. (D. S. H. 10940, Path. 999) was a clever business man, Civil War
veteran, who began to lose ground at 75 and died at 84. He was given during
his disease to boasting and perpetual writing about elaborate real estate
schemes and said he owned a $100,000 concern for the purpose.

The case was clinically unusual in that the picture of a pseudoleukemia was
presented, with demonstration at autopsy of great hyperplasia of
retroperitoneal lymph nodes and grossly visible islands of lymphoid
hyperplasia in liver and spleen. The brain weighed 1390 grams and showed
little or no gross lesion, if we except a pigmentation of the right
prefrontal region under an area of old pias hemorrhage. There was also a
chronic leptomeningitis, with numerous streaks and flecks along the sulci,
especially in the frontal region. There was little or no sclerosis visible
in the secondary arterial branches and but few patches in the larger
arteries. Microscopically the cortex proved to be far from normal: every
area examined showed cell-loss, perhaps more markedly in the suprastellate
layers than below.

CASE 2. (D. S. H. 11980, Path. 1024) was a Civil War veteran who failed in
the grocery business, was alcoholic, was finally reduced to keeping a
boarding-house and grew gradually queer. Mental symptoms of a pronounced
character are said to have begun at 75. Death at 80. Delusions reminded one
of general paresis: worth $5,000,000 a month, 108 years old, was to build a
church: also, a woman was trying to poison him.

Autopsy showed caseous nodules in lung, coronary and generalized
arteriosclerosis (including moderate basal cerebral), mitral and aortic
stenosis (the aortic valve also calcified). The frontal pia mater was
greatly thickened and, although no gross lesions were noted in the cortex,
the microscope brings out marked lesions in the shape of cell losses
(especially in suprastellate layers) in all areas examined. There were no
plasma cells in any area examined.

CASE 3. (D. S. H. 12767, Path. 1185) was a widowed Irish woman, who died at
87. Previous history blank. Extravagant delusions of wealth were
associated with a fear of being killed.

The autopsy showed little save chronic myocarditis with brown atrophy,
calcification of part of thyroid, non-united fracture of neck of left femur,
moderate coronary arteriosclerosis. The brain was abnormally soft (some of
the larger intracortical vessels showed plugs of leucocytes possibly
indicating an early encephalitis--Bacillus cold and a Gram-staining bacillus
were cultivated from the cerebrospinal fluid.) Though the convolutions were
neither flattened nor atrophied and absolutely no lesion was grossly
visible, the cortex cerebri and also the cerebellum were found undergoing an
active satellitosis with nerve-cell destruction in all areas examined.

The following three cases (IV, V, VI) present a certain identity from their
delusions concerning messages from God (V thought he was God). It is very
doubtful whether VI should be placed in the present group of Pleasant or Not
Unpleasant Delusions, since the patient appears to have been "theomaniacal"
as the French say, in a rather passive and unpleasant manner (God occasioned
foolish actions!) Placed on general statistical grounds at first in the Not
Unpleasant group, Case VI should be transferred to the Unpleasant group.
Case V's delusion (identification with God, expression of atonement?) was in
any event episodic in a septicemia. Case IV ("happiest woman in the
world"), was phthisical (cf. VII) Notes follow:

CASE 4. (D. S. H. 4019, Path. 218) Housewife, 37 years always cheerful,
became the happiest woman in the world, hearing God's voice and being
specially under God's direction. "Acute mania." Death from bilateral
phthisis with numerous cavities and bilateral pleuritis. There were no
other lesions except a small sacral bed-sore, a small fibromyoma of the
uterine fundus, small slightly cystic ovaries, a slight dural thickening,
and possibly a slight general cerebral atrophy. (wt. app. 1205 grams,
marked emaciation.)

CASE V. (D. S. H. 11742, Path. 852) was a victim of streptococcus septicemia
(three weeks) who said he was God. Patient was a Protestant iron-worker of
59 years, who had lost an eye and had become unable to work about three
months before death. Aortic, cardiac, renal lesions at autopsy. Prostatic
hypertrophy. Dr. A. M. Barrett found few changes in nerve cells, except
fever changes. One area in left superior frontal gyrus showed superficial
gliosis.

CASE VI. (D. S. H. 5345, Path. 867) was a "primary delusional insanity," a
salesman of 37 years, whose beliefs concerned impressions direct from God,
in consequence of which he habitually knelt and prayed. Yet many of the
actions which he felt he must perform were foolish actions. The patient
died of pneumococcus septicemia during a lobar pneumonia. The brain showed
a few changes suggestive of fever (A. M. Barrett). There were a few flecks
of atheroma in the aorta. There was an acute parenchymatous nephritis with
focal plasma cell infiltrations suggesting acute interstitial nephritis.
This case appears to have shown one of the most nearly normal brains in the
whole Danvers series.

The remainder of the Pleasant or Not Unpleasant Group as originally
constituted consists of VII, a phthisical case (cf. IV), VIII, probably
feeble-minded romancer, not deluded in the sense of self-deception (probably
best excluded from present consideration); IX, probably not safely to be
assigned to the Pleasant or Not Unpleasant Group, feeling passive in
somewhat the same sense as Case VI (see above), suffering from auditory
hallucinosis (superior temporal atellitosis, data of the late W. L.
Worcester); X, delusion of birth to superior station, possibly the object of
mixed emotions, probably not pleasant; and XI, manic-depressive exaltation
with grandiose utterances, long prior to death (if there had been lung
tuberculosis at the basis of the ileac ulcers, it had long since healed).

Notes follow (VII-XI) and at the end a brief summary of the entire group
(I-XI).

CASE 7. (D. S. H. 8878, Path. 521) It is questionable whether the delusions
classified in this case entitle it to inclusion in the present study. e.g.
"I was baptized in the Catholic Church (patient a Protestant housewife) with
holy water, ink, and Florida water."  Patient was variously designated, as
"dementia" and as "acute confusional insanity." Death in second attack at 26
(first attack at 22). Father also insane. Death due to bilateral ptthisis
with tuberculosis of intestines and mesenteric glands, emaciation. It is
noteworthy that the brain weighed but 1038 grams. Dr. W. L. Worcester's
microscopic examination showed acute nerve cell changes probably of the type
of axonal reactions.

CASE 8 (D. S. H. 8807, Path. 556) very probably a feeble-minded subject. At
all events patient had done no work in his life, had been given to spells of
restlessness and excitement, and had talked disconnectedly. Symptoms were
thought to have dated from the tenth year. It is questionable whether a
statement that he was managing the Electric Railway and Shipbuilding Company
can be regarded as delusional, that is, as believed by the patient. Death
was due to (perhaps septicemia from one abscess of jaw and to hypostatic
penumonia), the brain appeared normal but Dr. W. L. Worcester found, besides
certain acute changes, also satellitosis. The question remains open whether
the case should be regarded as defective or as belonging to the dementia
praecox group.

CASE 9. (D. S. H. 8605, Path. 568) had an ill-defined attack of mental
disease and was in D. S. H. at 29. Thereafter, lived in Gloucester
Almshouse, but at 51 became excited and was returned to D. S. H. where she
died at 59. Possibly hallucinated: someone called her mother (single
woman). Delusion: the spirit is here (Protestant). Patient was given to a
stream of muttered, vulgar and incoherent talk. Possibly the case was
residual from hebephrenia. Dr. W. L. Worcester found cell changes in the
superior temporal gyri (finely granular stainable substance in practically
all nerve cells) and not elsewhere. The correlation is suggestive with the
probably auditory hallucinosis. The brain weighed 1190 grams. Death due to
bronchopneumonia. Heart and kidneys normal.

CASE 10. (D. S. H. 10145, Path. 928) a Danish fisherman possibly
manic-depressive, victim of three attacks at 40, 50, and 69 years. The first
attack followed loss of wife, and delusions concerning being born again
developed. The last attack showed few well-defined delusions, as patient
was in a bewildered and incoherent state. One statement is characteristic:
if patient had remained in Denmark, he might have inherited the throne. The
autopsy showed most extensive arteriosclerosis, including basal cerebral.
Death from general anasarca and jaundice. (cholelithiasis). There was some
question of an acute encephalitic lesion in the tissues lining the posterior
half of the third ventricle. Various chronic lesions (splenitis,
endocarditis, diffuse nephritis), malnutrition.

CASE 11. (D. S. H. 7767, Path. 792) was a case possibly of manic-depressive
type (previous attacks Hartford Retreat and Danvers State Hospital) who
worked as machinist between attacks and died at 70, having been in D. S. H.
8 years. Patient was greatly emaciated and anemic from chronic ulcers of
ileum. There was also cholelithiasis. There was a mild coronary atheroma
and slight mitral valve edge thickening.

The delusions expressed were those of great wealth. Patient also thought he
was a great poet. No brain changes were found (A. M. Barrett).

Having attempted on the basis of certain statistical tags to constitute a
group of cases having relatively normal brains and pleasant (or not
unpleasant) delusions, we are forced to reconstruct our group upon viewing
several cases more attentively.

Case VIII should be excluded as probably not delusional.

Case X might perhaps be transferred with propriety to the
unpleasant-delusion group.

Certain cases of felt passivity under divine influence separate themselves
out from the group; indeed VI and IX probably belong in the
unpleasant-delusion group (see below).

These subtractions leave seven cases to deal with. Three of these seven,
viz. I, II and III, are apparently best regarded as examples of frontal lobe
atrophy, and their grandiosity may resemble that of certain cases of general
paresis.

Of the remaining four, two, Cases IV and VII, are phthisical; one, Case VI,
showed an episodic identification with God (incident in fatal septicemia),
and one, Case XI, uttered manic-depressive exalted statements about wealth
and poetical power.

I turn to a consideration of the unpleasant-delusion group, which as first
constituted was to contain eleven cases (XII-XXII) but to which must be
added three more (VI, IX, X).

Case XII should be at once excluded from present consideration on account of
its microscopy.

CASE 12. (D. S. H. 12282, Path. 942) died in a second attack of depression
(manic-depressive insanity?). Catholic, always of a quiet and reserved
disposition, happy in married life. Delusional attitude concerning an
abortion which she said she had induced. "Soul lost," "I'll see hell."

Autopsy: Death from gangrene of lung and acute fibrinous pericarditis.
Erosion of cervix uteri. The edema of the brain, irregular pink mottlings
of white substance, and an exudative lesion of one focus in the pia mater of
the right side suggested an encephalitis more marked on the right side.
Microscopically a few small vessels showed plugs of polynuclear leucocytes.
The nerve cells were affected by various acute changes. The visuo-psychic
portion of an occipital section (right) showed suprastellate cell-losses of
a somewhat focal character

Of the remaining ten (XIII-XXII), one, Case XIII is another of mixed
emotions ("am Eve and have to suffer;" "in Purgatory;" etc) of a religious
type. It is the only case in the unpleasant group with phthisis pulmonalis,
(combined, however, with abdominal tuberculosis and nephritis).

CASE 13. (D. S. H. 7361, Path. 499) was a somewhat defective Catholic woman
(mother insane) always of a melancholy and reserved temperament. She had
been ill-treated by husband, child had died, another had followed soon. She
developed a belief that she was Eve and had to suffer. At hospital decided
that she was in purgatory and expressed a variety of other religious
beliefs. She also thought she was ill-treated at hospital. Her head was
asymmetrical: skull thick and eburnated. Brain (1130 grams described as
normal). Chronic interstitial nephritis. Pulmonary and mesenteric
tuberculosis.

Of the remaining nine (XIV-XXII) all had grossly evident kidney lesions
except two (XIV and XV). Of these two, XIV probably had renal
arteriosclerosis and was in any case very gravely arteriosclerotic in
general and suffered from cystitis. Case XV died apparently of starvation
with hepatic atrophy; it is a question whether "poverty" was or was not a
delusion. Notes of XIV and XV follow:

CASE 14. (D. S. H. 8741, Path. 500) was a German teacher, college-bred, of
a reserved and melancholy turn of mind (mother insane). An attack at 39,
another at 70. "Both poor wife and son will starve." "Perhaps they should
be put out of reach of poverty," later felt he "had caused death of wife and
son on account of his expensive living."  Autopsy: chronic internal
hydrocephalus, cerebral arteriosclerosis. Brain weight 1180 grams. Coronary
sclerosis with calcification throughout, aortic and pulmonary valvular
calcification hypertrophy of heart. Cystitis.

CASE 15. (D. S. H. 4454, Path. 237) was presumably a manic-depressive case,
had in all four attacks, and died in the fourth attack (66 years). The day
he arrived at the hospital, having not eaten for several days at the end of
several months of delusions of poverty the case was called "acute
melancholia," and the cause of death assigned was starvation. The liver
weighed 1102 grams and was fatty. There was a diffuse thickening and
clouding of the pia mater, and the dura was firmly adherent everywhere to
the skull.

Notes follow of seven cases (XVII-XXII) which show many lesions, are in a
number of instances cardiorenal and in all instances renal. If it is
permitted to count XIV also as renal, a list of eight cases out of the
original list of eleven unpleasant-delusion cases is obtained in which
nephritis of some type has been found. Case XIII, nephritis and phthisis,
belongs also in the renal group.

CASE 16. (D. S. H. 4168, Path. 226) feared death and refused food on the
ground that she should not eat. Patient had always been of a despondent and
reserved nature (sister also insane) and, after her husband's death, when
she was 53, grew unable to carry on her house, dwelt constantly on griefs,
entered hospital at 61, and died at 64 ("chronic melancholia"). Death from
internal hemorrhagic pachymeningitis. The liver of this case weighed 1074
grams and was fatty. There was chronic interstitial nephritis.

CASE 17. (D. S. H. 4707, Path. 498) originally cheerful and frank, lost her
situation as companion, grew despondent at failure to get employment, had a
"hysterical" attack at 52. It is doubtful whether her beliefs were
delusional: "can never be better," "will not be taken care of," "no place
for her." "Subacute melancholia. "The autopsy showed gastric dilation (over
3000 cc.), and an atrophic liver and pancreas, and slightly contracted
kidneys. The heart was normal. Death from ileocolitis. Moderate chronic
internal hydrocephalus. Dr. W. L. Worcester's microscopic examination showed
rather unusual degrees of nerve cell pigmentation (precentral and
paracentral).

CASE 18. (D. S. H. 8898, Path. 570) was an unmarried daughter of a fire
insurance company president. Both her mother and she developed mental
disease after the company failed (Boston and Chicago fires). Both mother and
father died, and patient was in several hospitals after 36, obscene,
denudative, onanist. Delusions concerning crimes committed. Satyriasis.
Could hear fire kindled to burn her. Diagnosis, "secondary dementia."

Death at 54 from bilateral bronchopneumonia. Atrophic uterus. Cystic right
ovary with twisted pedicle: atrophic left ovary: contracted kidneys. The
brain was not abnormal in the gross-- but showed (Dr. W. L. Worcester) some
acute changes (also larger cells pigmented).

CASE 19. (D. S. H. 10106, Path. 663) a cheerful Irish house-wife (mannerism
of drawling words) underwent a maniacal attack at 41, and another at 44.
Delusions: "sorry she had lived": "broken her religion" Given to self
recrimination.

Autopsy: Death from hypostatic penumonia. Healed gastric ulcer. Moderate
arteriosclerosis, slight cardial hypertrophy. Granular cystic kidneys.
Mucous polyp and subperitoneal fibromyoma of uterus. The brain was
macroscopically normal, but showed superficial gliosis (frontal and
precentral) and thinning out of medullated fibers superficially (frontal).

CASE 20. (D. S. H. 8963, Path. 679) an epileptic shoe-maker, 50 years, was
of the belief that he was sent to Hospital for hitting a boy and was to be
executed.

Autopsy: Aortic and innominate aneurysm, hypertrophy and dilatation of
heart. Interstitial nephritis. The brain, normal macroscopically, proved
microscopically to show, in all areas examined, superficial gliosis. There
was gliosis in parts of the cornu ammonis, but no demonstrable nerve cell
loss (interesting in relation to the epilepsy).

CASE 21. (D. S. H. 4584, Path. 861) cabinet-maker of melancholy
temperament, Civil War veteran. Said to have been feeble-minded after six
months in rebel prison. Violent at times for twenty years. Did no work,
thought "soul lost."

Death from pneumococcus and streptococcus septicemia. Chronic diffuse
nephritis. The brain was described grossly as normal: but microscopically
there was marked superficial gliosis in all areas examined and considerable
cell loss in suprastellate layers of precentral cortex. The calcarine
sections show little or no cell-loss. But one section from the frontal
region is available (right superior frontal). This shows little cell-loss
except in the layer of medium-sized pyramids.

CASE 22. (D. S. H. 8250, Path. 909) an unmarried woman without occupation,
two attacks of "melancholia" at 36, and 40. Always of a retiring and shy
disposition. Mental disease began after father's death. Delusions (if
such): has been selfish and wicked. Constant self condemnation. Suicidal.
Exophthalmic goiter.

Autopsy: Thyroid glandular hyperplasia. Mitral sclerosis. Aortic sclerosis
with ulceration. Chronic endocarditis. Chronic diffuse nephritis. Scars of
both apices of lungs, with small abscess of left apex. Emaciation. Brain
weight 1050 grams. No gross lesions described; microscopically profound
alterations; extreme or maximal cell-losses in small and medium-sized
pyramids in both superior frontal regions. Smaller somewhat less marked
cell-losses elsewhere.

Upon reviewing the unpleasant-delusion group, then, we exclude one (XII)
altogether. It is questionable whether XV actually exhibited delusions at
all. We then discover that eight (in all probability all) of our nine
remaining cases are renal in the sense of grossly evident lesions at
autopsy.

But it will be remembered that we transferred three cases originally thought
to entertain "not-unpleasant" delusions to the unpleasant group, because
their constraint, although conceived to be of divine origin, seemed to be
unpleasant (VI, IX, X). Of these VI and X were renal cases; but IX is
expressly stated by a reliable observer (the late Dr. W. L. Worcester) to
have had normal kidneys as well as heart. In point of fact, however, Case IV
had hallucinations and religious delusions ("spirit is here") probably
derived therefrom, and Dr. Worcester found an isolated brain lesion
correlatable with the hallucinosis; and in any event the emotional state of
the patient is in grave doubt.

Accordingly if we take the unpleasant-delusion group to be constituted of
Cases VI and X (transfers from the first group), XIII, XIV, and XIV to XXII,
that is eleven cases, we come upon the striking fact that virtually all of
them are renal cases.

Of course, as (with Canavan) I have been at some expense of time to prove,
virtually ALL cases of psychosis (as autopsied) are in a microscopic sense
abnormal as to kidneys.[7] But only about a third exhibit GROSS interstitial
nephritis, arguing a certain severity of process. The above cases, it will
be observed, fall into the GROSS class in respect to renal lesions.

Without laying too much stress on such results, it is worth while to say
that, whereas most workers might be willing to surmise that metabolic or
catabolic disorder must affect the sense of well-being, I must confess that
the discovery of so much gross kidney disease in a group selected on other
grounds filled me with a certain surprise.

The literature is not without suggestions as to the possible correlation of
renal and mental disorder. Ziehen,[8] for example, remarks that nephritis
brings about mental disease in two ways,--through vascular changes which
very frequently accompany chronic nephritis and other uremic changes in the
blood. Inasmuch as we know that creatin, creatinin and potassium salts
irritate the animal cortex, Ziehen notes that psychopathic phenomena may
occur in man as a result of slight uremic changes. According to Ziehen, most
of these nephritic psychoses run the course of what he calls hallucinatory
paranoia (it may be remembered that Ziehen counts among paranoias a number
of acute diseases and even so-called Meynert's amentia). Chronic nephritis,
as well as acute diabetes and Addison's disease are thought by Ziehen to
produce certain chronic forms of mental defect which he terms autotoxic
dementia, but he regards most of these cases as really cases of
arteriosclerotic dementia.

It does not appear that Wernicke[9] has considered renal correlations
systematically.

Kraepelin[10] mentions the epileptiform convulsions of uremia as well as
delirious and comatose conditions, especially those in advanced pregnancy.
These uremic conditions may be both acute and chronic. But Kraepelin has
not been able to convince himself of the existence of a clearly defined
uremic insanity unless the delirious condition just mentioned may be
regarded as such

Binswanger[11] states that the mental disorders occurring in acute and
chronic nephritis are either toxemic psychoses on uremic bases, or due to
arteriosclerosis. In the latter cases, he states that the disease pictures
are as a rule characterized by grave disturbances of emotions, chiefly of a
depressive character. He adds that these are all too frequently the
forerunners of arteriosclerotic brain degeneration.

A brief mention of renal disease in the general etiology of mental disease
is made by Ballet.[12] Ballet states that Griesinger's opinion that renal
disease had little importance in the etiology of mental disease and that no
one would count the cerebral symptoms of Bright's disease as mental is no
longer held. Ballet enumerates a number of works upon so-called folie
brightique which tend to prove that acute or chronic Bright's disease gives
rise either to melancholic disorder or alternately to maniacal and
melancholic disorder. How the mental disease is produced is doubtful.
Ballet holds that all the various psychopathic disorders resulting from
Bright's disease are autotoxic. Renal disease like heart disease is only
capable of awakening a latent predisposition or liberating a constitutional
psychosis, unless it is merely effecting a species of intoxication.

It cannot be doubted that the relation of kidney disorder to mental disorder
is worth intensive study, of which the present communication is merely a
fragment. Progress will be of course impeded by the fact that upon
microscopic examination, practically all cases of mental disease coming to
autopsy show renal disease of one or other degree; in fact, it is perhaps
possible to show a higher correlation of renal disease with mental disease
than of brain disease to mental disease. Perhaps something can be obtained
if we limit ourselves to a study of cases with pronounced somatic renal
symptoms and signs, cases with the renal facies and the like.

As to the question of phthisis and mental disease, Ziehen remarks that the
tuberculous are often observed to be optimistic but that other cases show a
hypochondriacal depression with egocentric narrowing of interests. He
speaks of a sort of rudimentary delusional disorder looking in the direction
of jealousy in certain cases. Pronounced mental disorder occurs rarely in
tuberculosis, according to Ziehen, and leads either to melancholia or to
hallucinatory states of excitement, resembling the deliria of exhaustion or
inanition. Acute miliary tuberculosis may produce the impression of a
general paresis or of an amentia in Meynert's sense. The inanition delirium
of tuberculosis resembles that of carcinosis and malaria.

Kraepelin regards tuberculosis as of very slight significance in the
causation of insanity, despite the fact that slight changes in mood and in
voluntary actions frequently accompany the course of the disease.
Irritability, depression and sensitiveness, incomprehensible confidence and
desire to undertake various tasks, pronounced selfishness, sexual excitement
and jealousy are the traits of mental disorder in tuberculosis.

Kraepelin states that many cases of tuberculosis show traits of alcoholic
disease and says that the occurrence of polyneuritic forms of alcoholic
mental disorder is favored by the association of tuberculosis with
alcoholism.

Wernicke does not systematically consider the topic.

Binswanger states that tuberculosis, aside from miliary tuberculosis or
meningitis, produces no mental disorder except phenomena of the amentia of
exhaustion.

Ballet states that there exists a peculiar mental state in the tuberculous.
It is compounded as rule of sadness, of looking on the dark side and of
profound egoism. This readily leads to mistrust and suspicion which may be
pronounced enough to constitute a sort of persecutory delusional state or a
state of melancholic depression (Clouston, Ball). More rarely there are
phenomena of excitation explained in part by fever. In its slightest degree
this phenomenon of excitation is characterized by a feeling of well-being,
of euphoria, which even at the point of death may give the patient the
illusion of a return to health, or there may be a more pronounced excitation
with impulsive sexual and alcoholic tendencies. Autointoxication may lead to
the usual train of confusional symptoms.

If we compare the accounts in the literature of the two conditions here in
question, namely, nephritis and phthisis, we must be convinced, that aside
from so-called autotoxic phenomena, renal disorder seems to be marked by a
tendency to depressive emotions but that phthisis shows not only depressive
emotion but also euphoric and hyperkinetic phenomena.

So far as these results thus hastily reviewed are concerned, they are
consistent with the appearances in the present group of cases. Both the
nephritic and phthisical groups need further intensive study.

As to the question of the spreading inwards or outwards of delusions from
the standpoint of the patient, no analysis is here attempted. It is plain,
however, that the theopaths, as James calls them, or victims of theomania,
to use the French phrase, will be of importance in this analysis because of
the equivocal character of the emotions felt in cases of religious delusion.

SUMMARY AND CONCLUSIONS

The paper deals with delusions of a personal (autopsychic) nature and is one
of a series based upon certain statistics of Danvers State Hospital cases
(previous work published on somatic, environmental (allopsychic) delusions
and those characteristic of General Paresis). The previous work had
suggested that somatic delusions are perhaps more of the nature of illusions
in the sense that somatic bases for somatic false beliefs are as a rule
found. On the other hand, delusions respecting the environment (allopsychic
delusions) had appeared to be more related to essential disorder of
personality than to actual environmental factors.

The fact that cases of paresis with delusions were found to have their
lesions in the frontal lobe, whereas non-delusional cases showed no such
marked lesions, is of interest in the light of the present paper because
three cases of senile psychosis were found to have delusions of grandeur
and, although they are demonstrably not paretic, they also show mild frontal
lobe changes supported by microscopic study.

The Danvers autopsied series, containing 1000 unselected cases, was found to
show 306 instances with little or no gross brain disease. Of these, 106 had
autopsychic delusions and of these 106, 50 cases had delusions of no other
sort. 15 of these 50 cases appeared to have been cases of General Paresis
in which gross brain lesions were not observed at autopsy, and upon
investigation 13 other cases were found to be, for various reasons,
improperly classified. The residue of 22 cases was subject to analysis and
readily divides itself into two groups of 11 cases each, or two groups of
normal-looking brain cases having autopsychic delusions and these only are
cases which may be termed the "pleasant" and "unpleasant" groups, in the
sense that the delusions in the first group were either pleasant or not
unpleasant, whereas the delusions in the second group were of clearly
unpleasant character.

Three of the "pleasant" delusion group were the three cases of grandeur and
delusions in the senium above mentioned. Three others were cases of
"theomania" in the sense that their delusions concerned messages from God.
It is not clear that these three religious cases should be regarded as
belonging in the group of "pleasant" delusions on account of the sense of
constraint felt by the patients.

The remainder of the "pleasant group," as the delusions were originally
defined, turned out for the most part to show either doubtful delusions or
delusions involving a sense of constraint rather than of pleasure.

An endeavor was made to learn the relations of pulmonary phthisis to the
emotional tone of the delusions. The few available cases in this series
seem consistent with the hypothesis of phthisical euphoria (IV, "happiest
woman in the world," hearing God's voice, VII and possibly XI).

The problems of the "pleasant" delusion group, as superficially defined,
turned out to be a. the problem of a group of senile psychoses with
grandiose delusions and frontal lobe atrophy; b. the problem of felt
passivity under divine influence; c. the problem of phthisical euphoria.

The group of "unpleasant" delusions in the normal-looking brain group should
be diminished by one on account of its positive microscopy (encephalitis).
One case (XIII) is a case of mixed emotions of religious type, showing
phthisis pulmonalis together with abdominal tuberculosis and nephritis. One
case (XV) is doubtful as to delusions; the remainder are subject to renal
disease, as a rule associated with cardiac lesions.

Two cases which were transferred from the "pleasant" to the "unpleasant"
group on account of constraint feelings, were also renal cases,--VII and IX.
The only exception to the universality of renal lesions in this group is the
case in which religious delusions were probably based upon hallucinations
for which hallucinations an isolated brain lesion was found, very probably
correlatable with the hallucinosis.

Virtually all of the eleven cases determined to belong in the "unpleasant"
group are cases with severe renal disease as studied at autopsy.

Whether the unpleasant emotional tone in these cases of delusion formation
is in any sense nephrogenic and whether particular types of renal disease
have to do with the unpleasant emotion, must remain doubtful. A still more
doubtful claim may be made concerning the relation of euphoria to phthisis.
The renal correlation is much more striking as well as statistically better
based. A further communication will attack the problem from the side of the
kidneys in a larger series of cases.

REFERENCES

[1] Southard. On the Somatic Sources of Somatic Delusions. Journal of
Abnormal Psychology, December, 1912-January, 1913.

[2] Southard and Tepper. The Possible Correlation between Delusions and
Cortex Lesions in General Paresis. Journal of Abnormal Psychology,
October-November 1913.

[3] Southard and Stearns. How far is the Environment Responsible for
Delusions? Journal of Abnormal Psychology, June-July, 1913.

[4] Southard. A Comparison of the Mental Symptoms Found in Cases of General
Paresis with and without Coarse Brain Atrophy. Submitted to Journal of
Nervous and Mental Disease, 1915.

[5] Southard. A Series of Normal-Looking Brains in Psychopathic Subjects,
American Journal of Insanity, No. 4, April 1913.

[6] Southard and Bond. Clinical and Anatomical Analysis of 25 Cases of
Mental Disease Arising in the Fifth Decade, with remarks on the Melancholia
Question and Further Observations on the Distribution of Cortical Pigments.

[7] Southard and Canavan. On the Nature and Importance of Kidney Lesions in
Psychopathic Subjects: A Study of One Hundred Cases Autopsied at the Boston
State Hospital. Journal of Medical Research, No. 2, November, 1914.

[8] Ziehen. Psychiatrie, Vierte Auflage, 1911.

[9] Wernicke. Grundriss der Psychiatrie, 2 Auflage, 1906.

[10] Kraepelin. Psychiatrie, Achte Auflage, I Band, 1909.

[11] Binswanger. Lehrbuch der Psychiatrie, Dritte Auflage, 1911.

[12] Ballet. Traite de Pathologie Mentale, 1903.

SIXTH ANNUAL MEETING OF THE AMERICAN PSYCHOPATHOLOGICAL ASSOCIATION

New York, N. Y., May 5, 1915

PROGRAM

ADDRESS BY DR. ALFRED REGINALD ALLEN, President, Philadelphia, Pa.

1. "The Necessity of Metaphysics," Dr. James J. Putnam, of Boston, Mass.

2. "Anger as a primary Emotion, and the Application of Freudian Mechanisms
to its Phenomena," President G. Stanley Hall, of Worcester, Mass.

3. "The Theory of 'Settings' and the Psychoneuroses," Dr. Morton Prince, of
Boston, Mass.

4. "The Mechanisms of Essential Epilepsy," Dr. L. Pierce Clark, of New
York, N. Y.

5. "Material Illustrative of the 'Principle of Primary Identification,' "
Dr. Trigant Burrow, of Baltimore, Md

6. "Psychoneuroses Among Primitive Tribes," Dr. Isador H. Coriat, of
Boston, Mass.

7. Data Concerning Delusions of Personality," Dr. E. E. Southard, of
Boston, Mass.

8. "Dyslalia Viewed as a Centre-Asthenia." Dr. Walter B. Swift, of Boston,
Mass.

9. "Constructive Delusions, " Dr. John T. MacCurdy and Dr. W. T. Treadway,
of New York, N. Y.

10. "Narcissism," Dr. J. S. Van Teslaar, of Boston, Mass.

11. "The Origin of Supernatural Explanations," Dr. Tom A. Williams, of
Washington, D. C.

12. "The Psychoanalytic Treatment of Hystero-Epilepsy, " L. E. Emerson, Ph.
D., of Boston, Mass.

The meeting was called to order by the President, Dr. Alfred Reginald Allen,
at 9:30 A. M., in Parlor E, Hotel McAlpin.

Dr. Allen delivered The Presidential Address.

Dr. James J. Putnam, of Boston, read a paper entitled, "The Necessity of
Metaphysics."[1]

[1] Published in the June-July number, p. 88, of this Journal.

DISCUSSION

DR. MORTON PRINCE, Boston: I sympathize with Dr. Putnam in his interest in
philosophical problems, my only conflict with his point of view being with
what I conceive to be a mixing of problems. I suppose that if we want an
explanation of the universe it must be in terms of philosophy or
metaphysics. The only alternative is to accept it as a phenomenal universe,
as it is. You will remember that when it was reported to Carlisle that
Margaret Fuller said she "accepted the universe," he replied "Gad! I think
she had better!". So we have got either to explain the universe in terms of
philosophy or accept it as it is.

I have no objection to introducing philosophical problems if we do not
confuse those problems with our psychological problems. They are entirely
distinct. This distinction between philosophy and science the physicists
and chemists clearly recognize. One of their problems is the ultimate nature
of matter, but it is not a problem of practical physics and chemistry. These
deal, let us say, with phenomenal atoms and molecules, with their
attractions and repulsions, etc. In dealing with the problem of the
ultimate nature of matter the chemist analyzes matter and finds that it can
be reduced to atoms, and then analyzes the atoms and finds them composed of
electrons flying about within the circumscribed space of an atom. Then he
analyzes the electron and reduces it to negative electricity, and when asked
what negative electricity is he says it is a form of the energy of the
universe, and stops there and says--"I don't know," when asked to explain
energy.

Here the problem of the ultimate nature of matter becomes a question of
philosophy and metaphysics. It is a field of research by itself. The
chemist never confuses that problem with the specific problems of his
particular science. These deal with empirical atoms and molecules as he
finds them. No chemist would undertake to give the chemical formula of the
union of sulphuric acid and zinc by a formula which expressed the ultimate
nature of atoms or negative electricity. If he did so he would confuse his
problems. And so I think we confuse our problems when we attempt to explain
empirical psychological phenomena in philosophical or ultimate terms. We
must treat our psychological elements--ideas, wishes, emotions, etc,--as the
chemist treats atoms and molecules. But, just as the latter may take up
ultimate problems as a special field of investigation so may we do, if we
like, but we must not treat them as psychological problems.

This confusion of problems is, I think, the fundamental error of Jung and
others in treating of the libido when he and they attempt to explain
specific phenomena as empirically observed. Jung undertakes to resolve
libido into the energy of the universe. Of course this is possible. All
forces can be ultimately so resolved, including the forces of mind and body.
Emotions such as anger and fear are forces and each of these forces, with
great probability, can be reduced in the ultimate analysis to a form of
energy. But this is not to admit that we are justified in explaining
specific concrete psychological phenomena, with which we are dealing, in
philosophical terms. We must explain them in terms of the phenomena
themselves. As a monist and pan-psychist, for example, I may believe that
conscious processes can be reduced to, or be identified with the ultimate
nature of matter, the thing-in-itself. And conversely atoms and electrons
may be reduced to a force which may be identified with psychic force, but I
would not attempt to explain psychological behaviour in terms of such a
philosophical concept but only through phenomenal psychological forces, let
us say, wishes. In other words, I would not undertake to introduce
pan-psychism into the problem at all as an explanation of a particular
phobia. I think, therefore, that when Jung and others attempt to explain
phobias and other psychological phenomena through a philosophical concept of
the libido as analyzed into an elan vitale or the energy of the universe,
they not only confuse their problems but introduce such a mixing up of terms
that the resulting explanation becomes little more than nonsense. The
libido, whatever it may be, must be treated as a psychophysiological force
just like any of the other emotions. Otherwise psychology ceases to be a
science.

Now one word about conflicts. Undoubtedly conflicts play a most important
part in such psychological disturbances as we have to deal with in the
psycho-neuroses, but I cannot agree that psychological conflicts conform
only to, or are synonymous with ethical conflicts. Undoubtedly there are a
large number of conflicts between ideas and sentiments which we have all
agreed to label as ethical, but there are also a large number of conflicts
between sentiments which cannot be pigeon-holed as ethical. For example, the
mother whose child is threatened with danger and who herself would incur
danger in rescuing her child, undergoes a conflict between her fear
instinct, on the one hand, and her love on the other, exciting also her
anger emotion. The anger and love conflict with the fear, down and repress
it. There you have a conflict but I think it could not be classed as an
ethical conflict. It is a general law, whenever one instinct antagonizes
another instinct there is a conflict. It is a conflict which has its
prototype in the lower organic processes. Thus Sherrington's spinal
reflexes, that he has worked out so beautifully, involve conflicts between
opposing organic impulses. In the scratch reflex, for instance, the impulse
which excites the flexor muscles inhibits the excitation of the extensor
muscles. I believe this principle underlies the higher processes and upon it
is built up the whole of the psycho-physiological mechanisms.

DR. TOM A. WILLIAMS, Washington, D. C.: I want Dr. Putnam to reply to two
objections to his position. One, the manifestations of functional
capacities which are themselves dependent upon structural differences. I am
not talking now of psychogenetic determinants, but alone of the trends of
which Dr. Putnam has spoken. Is he not assuming the contrary to Darwin when
he says that function precedes structure? Are not the potentials dependent
upon the variation which has determined this function? I am speaking now in
the broadest possible terms and not confining myself to the cerebrum. Do we
not find it in the tadpole who is prepared for breathing not because he
wants to breathe, but because he is going to have a new kind of breathing
apparatus and the duck who takes to the water because he has the mechanism
to swim?

Two, in regard to Hegel and the appeal to the ethical as being of a
different type from the motive of biological satisfaction. Is not that
difficulty only apparent, and is it not answered by Dr. Putnam's own appeal
that these matters should be settled independently, and is not it the case
that the average sexual man would settle it very differently from Dr. Putnam
himself and most of us; and is not it true that, though the ethical
determinants of behaviour are not auspicious for the average sexual
satisfactions of man, yet are they not themselves forms of hedonistic
satisfactions? For a man who would behave unethically would be miserable in
doing so by the loss of his own self-respect. So that he already has a
hedonistic determinant for his own conduct which is in harmony with the
biological concepts of Aristotle.

DR. JAMES J. PUTNAM, Boston: I should be very sorry to be taken as wishing
to put myself in the sort of adverse position which Dr. Prince and Dr.
Williams believe me to assume. I accept, of course, the proposition that
there are conflicts which are not ethical, and, as Dr. Williams says, the
average man would naturally come to different conclusions from those of the
trained man in ethical matters. I want to make a slight movement towards
restoring a balance which it seemed to me had become tipped too far one way.
Psychoanalysts, for example, actually deal with metaphysics and yet they do
not really study out what this involves. If we were nothing but scientific
men we could say, "very well, let metaphysics go."  But we are not. We are
dealing with individuals who are thrilling with desires, hopes and fears,
the movements of which cannot be expressed in scientific formulae. Dr.
Williams speaks of Darwin. It can be asserted with justice, however, that
the genetic method of investigation which is exemplified by Darwin's study
of evolution is an imperfect method for discovering the aims of human
beings. I refer to the interesting book of Prince Kropotkin in which he
studies mutual aid as a factor in evolution, mutual aid being something not
adequately contemplated by Darwin, who considers conflict as the essential
influence in evolution. Prof. Judd showed in a paper a few years ago the
change which has taken place in the attitude of a good many students of
economics through the introduction of human intelligence and desires as
something quite distinct from the conflicts of interests, and similar
arguments have been brought forward by students of evolution. Among others
Prof. Cope, the distinguished Zoologist of Philadelphia and Prof. Hyatt of
Boston, showed very clearly how the course of evolution becomes materially
changed when desires and will become prominent as factors. I agree that, as
a partial motive, structure does limit and determine function. There is no
question about that. I merely want to say that logically function precedes
structure, inasmuch as the wish and desire to do a thing precedes the means
by which we secure for ourselves the power to do it. But of course all
energies must work through structural media. In regard to hedonism, one must
recognize that pleasure counts as a partial motive, but when it comes to
taking it as the final motive it fails utterly. Our lives contain
determinants which we cannot range under the category of pleasure. We act in
certain ways because our structure and our functions and our wills are what
they are, and not exclusively by our temporary wishes. Our "meanings," when
thoroughly studied are found to coincide with the meaning of the universe as
a whole. It is only through getting hold of the entire scheme that you have
something that you can use as a criteria. The nearest approach to this is
obtained through the study of the most broadly developed, public spirited
men, and such men do not work in accordance with hedonistic principles.
President G. Stanley Hall, of Worcester, Mass., read a paper entitled, "The
Application of Freudian Mechanisms to Other Emotions."[*]

[*] Published in the June-July number, p. 81, of this Journal.

DISCUSSION

DR. JOHN T. MAC CURDY, New York City: I have been so interested in the
paper by Dr. Hall that I have been distinctly delighted by it and with your
permission I will refer to a point in Dr. Putnam's paper directly pertinent
to the issues raised by Dr. Hall. Dr. Putnam has spoken of the necessity
for metaphysics by which I presume he means the necessity for formulation.
Yesterday there was some antagonism in a discussion on formulation. We
cannot avoid formulating. Our advance in knowledge is purely empiric unless
it is directly dependent on formulation. We have not formulated enough. We
have stuck too much to our empiric data, have not made the necessary
deductions from it. What formulations there are have been based on
therapeutic data and explain the productions of symptoms. No attention has
been paid to the general psychoneurotic or psychotic Anlage. When this is
done I am sure that it will be found that there are just such primordial
reactions as President Hall has been talking about lying back of all the
sexual impulses. Sexual reactions have in the course of development come to
be the vehicle for more primitive ones. We know by observation that the
infant demonstrates anger in a much greater degree, and long before he gives
evidence of things sexual, in anything approaching the adult sense of that
term. The temporary formulation of psychoanalysts who attempt to explain
anger or temper by sadism are really ridiculous. President Hall rightly says
that sadism must be explained by anger. That is one of the primitive
emotions. Sex is merely a vehicle. The importance of this transference is
that the sex emotions are peculiarly adapted to repression and when once
unconscious, continue to operate all through the life of the individual.
This is less likely to occur in the sudden reaction of anger, which is much
more apt to be blown off at the time.

DR. SMITH ELY JELLIFFE, New York, N. Y: I cannot quote the line, but in
Shaw's "Doctor's Dilemma," recently presented in New York, there is an
exchange of words during which the heroine tells the surgeon that she is
tempted to pass from loving him to hating him. He replied that one is
surprised after all what an amazing little difference there is between the
two different attitudes of mind. Dr. Jelliffe said he was quite in sympathy
with what Dr. MacCurdy had been saying, with reference to the need for
formulation: We all know how these formulations have grown and how they are
utilized practically. For instance, we formulate an attitude towards space.
We wish to handle space and say 3 ft. or 7 ft. in order to handle space
relations. In other words, to handle space we utilize a formulation which
we call a measure of space. In the same manner in order to handle time we
make a hypothetical unit to be pragmatic. In handling the phenomena of
electricity, we formulate other units. In my own mind there has grown up
therefore the analogy that in order to handle psychological phenomena we
have formulated the Oedipus by hypothesis. This hypothesis I would define as
the unconscious biological directing of the energy of the child towards the
parent of the opposite sex and away from that of the same sex. This is the
unconscious basis of what in consciousness we call love and hate. The boy
is unconsciously directed away from the parent of the same sex. He develops
according to the Oedipus hypothesis the desire to get away from the father
or the father image. All other men are patterned after the father image and
if this strong biological direction fails to take place, his interest not
being directed in an opposite direction, he fails to mate and thus fails in
his reproductive function. The reproductive function cannot go on without
this biological thrust towards the proper object. By Narcissism is meant the
formulation that a new development is taking place in the infantile Oedipus
fantasy. The child cannot hold on to the mother image. He passes it to
others nearer his own age. He does it first through his own identification
with the female. His bisexuality permits this. Similarly the infantile
father protest must be supplanted by an evolved brotherly love. The
competition with the father image must take a new form. It must be a mutual
competition with mutual productivity. Any contact between man and man that
does not ensue to the value of both in some degree, therefore, registers a
failure to sublimate the unconscious gather hatred of the infantile stage of
development. Sublimated hatred of the father image is brotherly love.
Sublimated love of the mother image is taking one's place in the world as a
father for the continuance of the race. In the unconscious the formula of
direction against same sex and towards opposite sex, means therefore that in
the unconscious love and hate are the same; one cannot give them these names
however.

Thus I would enlarge the Oedipus formula and say that it is useful not only
in understanding the neurotic, but it can be used to measure up all
psychological situations.

DR. JAMES J. PUTNAM, Boston: I deeply appreciated and enjoyed what Dr. Hall
said and I have no question whatever that we all who are so interested in
psychological work profit by arguments of this sort being brought before our
notice. I think it is an unfortunate thing that Adler, who was on that line
and did such good work in it, coupled his statements with a sort of
denunciation of Freud's views. It seems to me to have been entirely
unnecessary. One of the remarkable stories of O. Henry, who was a keen
observer of human nature, deals with a frontier army officer who exposed
continually himself to danger, desiring to work out in an indirect way this
feeling of conquering one person by another, only it was himself, his own
cowardice, that he wished eventually to conquer. I would ask Dr. Hall if
the notion of which Royce has made so much, namely, the social concept, is
not one which perhaps would act as the common denominator in these cases. We
cannot assert ourselves and get angry without virtually having reference to
other persons, neither can we have sex feelings without such reference. It
seems that the social instinct or imagination which is carried around by
every individual and which determines his acts is as natural and as
invariably present as the existence of a desire to live, not to speak of the
desire to conquer.

DR. MORTON PRINCE, Boston: I feel extremely thankful to Dr. Hall for his
very interesting and satisfying presentation of the thesis which he has
given us. I remember an old gentleman once saying to me, in speaking of
another man with whom he had been conversing, "He is a very intelligent man.
He thinks just as I do." So I think Dr. Hall is a very intelligent man; he
thinks just as I do. I am entirely in accord with his views which he has so
well expressed. What he has said is in principle the basis of the paper
which I intended to present this morning but which, in view of the length of
our programme, I have decided to withdraw.

The principle underlying the large number of concrete facts which he has
given is that besides the sexual instinct there are a large number of other
instincts--one of which is anger--which have a very important place and play
important parts in personality. Some of these instincts play not only as
important a part as the sexual instinct but even a more important part.
And, as Dr. Hall has said, the Freudian mechanisms can be applied to them
just as well and just as logically. If an analysis is fully carried out
along the directions of these instincts we find, according to my
observations, the same disturbances that we find from conflicts with the
sexual instinct and effected by the same mechanisms. Amongst these instincts
besides anger there is the parental instinct, containing, if we follow Mr.
McDougall's terminology, tender feeling or love. At any rate love is an
instinct entirely distinct from the sexual instinct. There are also the
instinct of self-assertion and, fully as important as any, that of
self-abasement. This last, according to my observations and interpretations
plays a very important part in many cases of psycho-neurosis and leads
through conflicts to the same disturbances of personality that one finds
brought about by conflicts between the other instincts. That love may be
something entirely separate and distinct from the sexual instinct is a view
which is generally recognized and accepted by psychological writers but
entirely ignored, as a rule, by Freudian writers. A criticism which I would
make of the work of the Freudians is that while they recognize these
instincts they do not give them their full value nor study them as
completely and thoroughly--nor do they carry their studies to the final
logical conclusion--as they do with the sexual instinct. So far as they may
do so they subordinate these instinctive emotions entirely to the sexual
instinct so that these latter simply make use of them. When the
psycho-neuroses are completely studied we will find the same repression of
the various instinctive dispositions and impulses to which I have referred
in the one case as in the other, and of ideas organized with these
disposition. We find the same conflicts and resulting disturbances. The
sexual instinct has no hegemony. To my mind each occupies precisely the
same position and may play the same part in personality.

When you bear in mind that psychologically it is a fact, as I believe, that
sentiments are formed by the organization of emotional instincts with ideas,
with the memories of experiences, as Shand has pointed out, and when you
remember that it is through the force of emotional instincts thus organized
that an idea, i e., a sentiment, acquires its driving force which tends to
carry the idea to fulfilment, and when you bear in mind that sentiments thus
formed are derived from antecedent experiences sometimes dating back to
childhood and sometimes persisting through life, we can understand how
conflicts arise between antagonistic sentiments and the part which the
different instincts, through the force of their impulses, play in these
conflicts.

Furthermore when we bear in mind that sentiments thus originating and
organized are conserved in the subconscious forming what I call the
"setting" which gives idea meaning, the meaning being the most important
component of any idea, and when we bear in mind that this subconscious
setting is an integral part of the total mechanism of thought--each
sentiment in the setting striving to carry itself to completion, and for
this purpose repressing every conflicting sentiment--I think we find a
satisfactory explanation of the disturbances due to conflict in the
psycho-neuroses. Such a mechanism gives full value to any one and all of the
emotional instincts without giving primacy to any one.

DR. WALTER B. SWIFT, Boston: In regard to the origin of emotions: I
understood Dr. Hall to say that they were not instinct. Of late I have been
observing two young children develop certain emotions. The starting point of
that development has seemed to be in the imitation of motions seen in
others. It is plain to see that this is along the line of the James-Lange
hypothesis. So that before these motions were seen there was no emotion in
the child. If these motions were observed and imitated by the children then
the emotions developed. I would, therefore, like to ask President Hall
whether he would consider imitation of motion seen in another as the
starting point of the development of emotion.

DR. TOM WILLIAMS, Washington, D. C.: The value of formulation we know. It
has been well illustrated by Dr. Hall's paper that he has by definite
concept followed out by investigation of this. The disadvantage of
formulation is very well shown by over-formulation by the scholastics in the
Middle Ages. I think Dr. Hall's wonderful contribution to our psychological
researches should be kept in mind by those who have excessively formulated
in a certain direction in order that some of us at least may apply to some
of the other emotions what others have attempted concerning libido. Dr.
Prince has long appealed for other methods than those which have been
applied so exclusively to the sexuality. In reference to the manifestation
of the anger trend, for instance, it may be not only a definitely conscious
manifestation, but it may perhaps produce a crisis even in dream-thought. I
am speaking of a case. A young boy at boarding school who was a musical
genius had been very much bullied. He suffered a great deal from this, but
did not retaliate until one night in the dormitory with eight boys while
asleep, he being badgered by neighbors, got up while asleep and attacked
these larger boys and discomfited them. It was the subject of conversation
in the dormitory, whether he was really asleep or not. The boy became so
terrible in his anger on future occasions and so successful as a fighter
that his bullying thereafter ceased, and his status in the school thereafter
was different. Whether this really occurred in a dream state or was mere
simulation I cannot say.

DR. A. A. BRILL, New York City: I must say that the mechanisms described so
interestingly by Pres. Hall are found in our patients during analysis and I
believe that almost all of them belong to the love and hate principles. This
may not seem so on superficial examination, thus, I have on record nine
cases of women who were suffering from various forms of psychoneurosis, one
of whose symptoms was screaming. Every once in a while they had to scream.
It was an obsessive screaming. Questioning elicited that the screaming
always occurred when they were thinking of some terrible or painful thought.
For instance, one woman went through fancies of killing her husband and when
she came to the idea of shooting him, she began to scream. Here one might
think that it was an ethical struggle which had nothing to do with sex, but
if one considers that it was against her husband that her anger was
directed, that she wished to kill him because he abused her and that there
was another man in the case, it becomes quite clear that the anger had a
sexual motive.

Concerning new formulations, I feel that there is nothing against
promulgating new attitudes and theories, provided one has sufficient cause
for doing so. Formulations based on insufficient data and hastily
constructed are dangerous, to say the least. Prof. Freud is most careful in
formulating new theories. He gathers his material for years before he puts
it forth in the form of tentative theories and does not hesitate to modify
them if occasion demands. Nor is it true that the Freudians ignore the work
done by others. Freud and his followers give due credit to other observers,
but as the Freudian mechanisms have opened up so many new fields for
investigation, we naturally give most of our time to this work. That does
not at all signify that we ignore everything else, as some believe. Freud
himself continually urges that the psychoanalytic problems should be taken
up by observers in other fields than medicine and I was, therefore,
extremely pleased to hear Prof. Hall's formulations of anger. I do not
believe, however, that his paper shows that we are overestimating the sexual
impulse. Basically, all his mechanisms come under the heading of "Sex," as
we understand it.

DR. L. E. EMERSON, Boston, Mass: I wish to express my delight in President
Hall's paper. It seems to me what he has done has been to show the breadth
of the Freudian conception of sex. The word sex as the Freudians use it,
includes all personal relations and even personality; and it is apparently
in question only as to whether one is going to draw a line at one place and
say everything on this side is sex and the other side personality, or
whether one is going to enlarge the concept of sex to include personality.
That as I understand it, is what Dr. White has also said. It seems to me the
value of the sex conception lies in the fact that while it can be expanded,
and is illimitable, at the same time it focuses, it does come to a point.
Personalities as talked of ordinarily have no point, they are too vague. On
the other hand, a man who has a mind no bigger than a pinhole is too
circumscribed to be capable of understanding any very broad generalization.
If one can grasp a conception that does have a center, even though no
circumference, he has got hold of a very valuable generalization.

DR. E. E. SOUTHARD, Boston: Dr. Jelliffe has just brought into ridicule
what he terms "pinhole psychiatry;" but as I remember it, there is a
technical method in psychology whereby things may be more clearly visible
through a pin-hole!

The valuable thing about President Hall's communication is that the
fundamental distinction is brought out between two groups of workers in
psychopathology. I should be inclined to divide the people in this room
into what might be termed emotional monists and emotional pluralists. The
Freudian theory is in general a theory of emotional monism and therefore
fundamentally must satisfy a great many of the Hegelian tenets. Hence,
perhaps Dr. Putnam's adherence to both Hegel and Freud. Now as I understand
it, what Dr. Prince wants is an emotional pluralism such as might well be
founded upon the data in MacDougall's "Social Psychology" and in Shand's
work on "The Foundations of Character."  This view of emotional pluralism is
one which I should myself be compelled to hold. We must remember, however,
that the work of Cannon on various types of emotion may possibly show that
different emotions which look vastly unlike (e. g. fear and rage) may be in
some sense equivalents. Fear may be equivalent to rage much as different
types of energy in the physical universe are equivalent to one another. The
emotions may be interchangeable in some sense so that it might be possible
that sex emotion and the emotion of fear are translatable. In this way there
might be constructed a fundamental monism of emotion in the same sense that
energetics is a science which unifies electricity, heat, magnetism, etc. It
would not seem to me, however, appropriate to identify all kinds of emotion
with the sexual.

PRESIDENT HALL: It would take an encylopedia and an omniscient mind. and
many hours and days to exhaust such a topic as this. Dr. Southard has said
some of the things I would have said. I supposed this society was primarily
interested in pragmatic discussions. At any rate, I left the American
Philosophical Society some years ago and entered this to get rid of
metaphysics and arid abstractions. As to what Dr. Swift says, it seems to me
imitation plays a great but is by no means the sole role. It is of course
purely instinctive, and the social instinct comes in everywhere, so much so
that discussion on almost any topic is liable to raise the question of the
individual versus the social forces in the world. As to Dr. Jelliffe's
opinion whether after all hate and love are at bottom the same, he perhaps
bottoms on the recent discussions of what I might call the expanded theory
of ambivalence, as represented by Weissfeld. But I do not interpret this to
mean that there is any sense whatever that has any pragmatic value in the
statement that love and hate are the same. If you assume this, one is dizzy
and the world seems to spin around. Hegel showed a sense in which being and
not being are the same but that is a most abstract and purely methodological
statement. What in the world is more opposite than love and hate, from every
practical and truly psychological point of view? We must not be credulous
about the unconscious and ascribe to it absurdities, nor must we lose our
orientation for surely up and down, right and left, light and dark, do
differ. If the unconscious can be used to cause a darkness in which
everything loses its identity and fuses into a general menstrum, as Hegel
said all cows were black in the dark, it seems to me we can get nowhere.
Ought we not to start by admitting that there are certain immense
differences in the emotions, whether conscious or unconscious, and that the
tendency to find a common background or identify them is a matter largely of
speculative interest?

DR. MORTON PRINCE, Boston, read by title a paper entitled "The Theory of
'Settings' and the Psychoneuroses."

DR. L. PIERCE CLARK, New York, N. Y., read a paper entitled, 'The Mechanism
of Essential Epilepsy."[*]

[*] Reserved for publication.

DISCUSSION

DR. E. E. SOUTHARD, Boston: Idiopathic epilepsy as found in Massachusetts
material and estimated from the appearances in the gross anatomy of the
brain occurs in about one of every three cases. There are accordingly more
idiopathic epilepsies than there are idiopathic or "functional" psychoses,
if the data of gross anatomy form a reliable index.

It was a somewhat curious thing that in a series of cases investigated by
Dr. Thom and myself, that the more frequent the attacks of epilepsy the less
there seemed to be to show for them in the autopsied brains. In certain
cases with daily attacks the brains were strictly normal in gross
appearances. It was the frankly organic cases with large focal lesions that
had the occasional attacks. These frankly organic cases rarely had high
frequency attacks.

DR. TOM A. WILLIAMS, Washington, D. C.: Will Dr. Clark explain the eccentric
convulsions such as when there is uraemia, on similar grounds? Also, if he
will postulate in such cases as recover with metabolic treatment. I have
published cases in which recurrent attacks of some years duration were
removed by means which considered only the metebolesia. (See Journal of
Neurology and Psychiatry, March, 1915.)

DR. JOHN T. MACCURDY, New York: I have held the opinion for some years that
the study of epilepsy was going to be of greater psychiatric moment than
that of any other condition. I feel that this promise has been very largely
fulfilled by the work Dr. Clark has been doing for the last two years. We
have found, I think, from that work that we can really shell out what we may
term an epileptic reaction, which is really the most primitive of all
psychiatric reaction. It corresponds to a flight from reality. It is a
return to the subjective phase, which, in the psychoses, is no vague but a
very real thing. In epilepsy we get it in pure culture as a lapse of
consciousness, expressed either in completeness as in a grand mal attack or
partially when consciousness is merely clouded. Sleep probably represents an
analogous condition. We go to sleep to repair the body while psychologically
we are seeking that flight from reality which we all long for. The
convulsion may be a secondary affair, and a physiological sequel to the loss
of consciousness, which is psychologically determined.

L. PIERCE CLARK: For the time being I am anxious to limit my remarks to the
mechanism of ESSENTIAL epilepsy, and, not to convulsive disorders in
general, however closely allied to idiopathic epilepsy. At some future time
I hope to take up the epileptoid convulsions and show their relationship and
variation from that of the mechanism of essential epilepsy. I may say,
however, that I have some data already at hand in which certain types of
epileptic phenomena connected with infantile cerebral hemiplegia would show
that the so-called epileptic constitution is much less marked in these
cases, but is present, however, to a certain degree. As has been well known
for a number of years and commented upon by such observers as Gowers,
Jackson and Binswanger, the so-called hemiplegic epilepsies sooner or later
develop the epileptic alteration in a character analogous to that seen in
idiopathic epilepsy. I hope to show that the main roots of the so-called
epileptic alteration in general necessarily lie in the primary make-up of
such individuals, and that the seizure phenomena of epilepsy only intensify
and make more marked the fundamental make-up when the disease has definitely
fastened itself upon the individual. My next paper on this whole subject
will attempt to show more conclusively that the epileptic seizures are but
an unfoldment of that which has already been existent in the biological
make-up of the individual epileptic.

DR. TRIGANT BURROW, Baltimore, Md., read a paper entitled "Material
Illustrative of the 'principle of Primary Identification.' "[*]

[*] Reserved for publication.

DISCUSSION

DR. JAMES J. PUTNAM, Boston: I am very much interested in Dr. Burrow's
paper and understand it as illustrating the argument brought forward by him
last night. As I remember the situation I do not quite see why this idea is
not essentially the same that has been endorsed by Freud and others. One's
interest in one's self is certainly in part the basis of homosexuality, and
this is intensified by the reflection from the mother.

DR. JOHN T. MAC CURDY, New York: When Dr. Burrow first brought up this
subject last year it struck me as being the most original theory in
psychoanalysis that had been formulated in this country and one of the most
important of all the additions to our general psychoanalytic concepts.
Personally, I found that it immediately solved certain problems which had
been in my mind for some time. I had never been able to see how it came
about that the alcoholic had a strong latent homosexuality. The ordinary
interpretations of drinking as a fellatoristic substitute has always seemed
unlikely, for, if this were so any liquid would serve the purpose, so why
alcohol? Now it is manifest that the alcoholic is an individual who is
taking a drug which dulls his sensibility. That is a way of retiring from
reality, of getting away from objectivity, retiring from what Dr. Burrow
calls the subjective phase. Now we understand why the patient in an acute
alcoholic hallucinosis almost invariably hears voices making homosexual
accusations. The unreality complex is translated into sexual terms and he is
accused of unreal love. I have been struck in dream analysis by the almost
constant coincidence in dreams of Mutterleib symbols in the same dream that
on analysis proved to be homosexual in principle. I can quote one dream
that demonstrates dramatically every point which Dr. Burrow makes in his
thesis. This patient, a man who was being treated for homosexual tendencies
which worried him a great deal, on one of the first days brought this dream.
He was a hospital interne. Someone came to him and said a nurse had cut
herself. He ran up to the surgical amphitheatre where preparations were made
to fix her wound. He suddenly discovered that his was the cut and that it
was on the ventral surface of the penis corresponding to the primitive
subincision operation. He took up a needle, sewed it up and put on a
bandage. At the end of the dream he wondered what was going to happen,
whether the bandage would come off or not. Any psychoanalyst can imagine
what the incision indicated, that it led directly to the idea of a vagina,
also to the idea of castration which is combined with that. The bandage led
to swaddling clothes. Here we have the whole situation rehearsed. The
associations went to the mother. The mother changes into himself. At the
same time he represents himself with a vagina and gives birth to a child,
his own penis which he can fondle as his mother did him.

DR. SMITH ELY JELLIFFE, New York: It seems to me the phrase identification
with the mother is very illuminating. I have no doubt that Dr. Burrow would
say that the failure to develop away from this primary identification lies
at the basis of what is called Narcissism. I have noted this identification
with the mother, i. e., with the female, in many patients. They are, in
ordinary life, after making a very hard fight with unconscious homosexual
trends and are managing themselves with great difficulty. This shows
particularly in the analysis of alcoholics especially of periodic types.
Self-fertilization is a frequent symbol in the unconscious. In males,
particularly, the identification with the mother is a frequent factor and
often explains the value of the instinctively sought relief through narcosis
and withdrawal from the conflict. Male hysterias also show it markedly. The
aggression towards the father is a frequent female symbolization in hysteria
as well.

DR. TRIGANT BURROW, Baltimore: It seems to me that the President's
reference to this heterosexual instance need not necessarily be heterosexual
in a psychological sense. It is important to recognize that though the
object of the male in a particular case be a woman, yet psychologically this
need not be a heterosexual adaptation. In the case I have cited the
relation of the patient to his wife is psychologically a homosexual one. We
have seen in this case the presence of a profound neurosis and coexistent
with it an apparently normal sexual life. This we know from the Freudian
standpoint is impossible. The heterosexual adaptation is but apparent.

DR. TRIGANT BURROW, Baltimore: In regard to Dr Putnam's comment that my
thesis contains what has been said already by Freud. Undoubtedly to a large
extent it has. There is, though, some modification here which seems to me of
importance, if only in the way of an extension of Freud's original
conception. One gets a very clear idea from Brill's excellent paper on
homosexuality of Freud's essential thesis. Here the idea of homosexuality is
that of a revulsion from the mother. The child is assumed to adapt itself
as the mother in order to get rid of the mother as object. This first
hypothesis related only to the male child. To explain homosexuality in the
female, either an analogous mechanism must be assumed, according to which
the female child adopts homosexuality to escape the father image, and
analysis does not bear out this explanation; or, assuming the same reaction
in respect to the mother in the female as in the male, the result would
entail not homosexuality but a heightened heterosexuality. I think the
formulation I have here advanced offers us a distinct advantage in placing
the causative factor in homosexuality in either sex upon an identical
genetic basis.

AFTERNOON SESSION

The meeting was called to order by the President at 2:15 P. M.

Dr. E. E. Southard, Boston, read a paper entitled, "Data Concerning
Delusions of Personality."[*]

[*] Published in this number of the Journal, p. 241.

DISCUSSION

DR. SMITH ELY JELLIFFE, New York: Dr. Southard has heretofore launched us
upon very large subjects. I can well recall in one of his previous
communications the fascinating correlations drawn between structural changes
and the character of the psychological signs. In dementia praecox
particularly, he has shown us how auditory symptoms group about temporal
atrophies and optical signs with the occipital and so forth and so on. He
now proposes to thrust us into a larger and much more intricate sphere of
activity as to the representation in the cortex of other changes which as he
has described are inframicroscopical or inframacroscopical. In other words,
there must be some type of correlation between the projection in the
cerebral structure of the organ itself which is cerebrally represented and
certain mental signs. If I see what Dr. Southard has been thinking about,
we are certainly engaged in a very fascinating topic. It is well known from
the standpoint of topographical cerebral correlation that the brain is
nothing but a series of body symbols, as it were. Adler has entered this
field and approaches the problem by saying that the inferior organ, liver,
kidney, or what not, is related to a similar defective cerebral
representation of the organ, thus introducing into the nemological mechanism
the task of compensating for the defective structure. Dr. Southard wishes to
try to map out these defects in the cerebral structures and thus reason
backwards to the somatic inferiority. I confess he lifts me into ideal
regions. Such stimuli are enjoyable and provocative of development.

DR. TOM A. WILLIAMS, Washington, D. C: I conceive Dr. Southard's purpose
somewhat differently from Dr. Jelliffe whose thought seems to be somewhat
like that of Henry Head when he published his paper in reference to
hallucinations, corresponding to various head zones in correspondence with
different visceral areas and with special sense organs, eye, ear and so on.
I have conceived Dr. Southard as being a direct chemical in line with
Folius' pathology researches. If that is the case we have a great many
clinical cases which might be underlined with his central thought.

PRESIDENT HALL: It is almost too good to be true if Dr. Southard has really
made connections between delusions of personality and the great topic of
character. It illustrates the old Hippocratic saw, "God-like is the man who
is also a philosopher." Character might almost be called a name for all the
mysteries of psychology, and from Mill's ethology and the old phrenologies
of temperament that Wundt adopts with slight modifications, we have really
made little progress. It seems to me very significant that Dr. Southard
should interest himself, as his paper leads one to judge he does, in such
problems as Shand's somewhat abstract work, and should seek correlations
with legal characterology like that of Roscoe Pound. It would be of great
interest to know whether Dr. Southard obtained his differentiations purely
from pathological cases or whether, accepting Shand or Pound or both, using
their distinctions as apperceptive organs, he unconsciously reads their
distinctions into his cases. His paper, at any rate, is a genuine
contribution as well as an encouragement to those who seek to correlate the
normal with the abnormal.

DR. JAMES J. PUTNAM, Boston: I only want to express my warm sympathy with
Dr. Southard's scheme. This careful working out of correlations one would
say is a good method of scientific research and must lead to something. I
think Dr. Southard would rather avoid the suggestion of CAUSES for the
results that he found, but the METHOD appears safe and profitable.

DR. JOHN T. MACCURDY, New York: As another psychoanalyst it gives me
pleasure to hear this paper. As a psychoanalyst, and one who has done most
of his work with the delusions. of the insane, I must say that I have felt
all along that psychoanalysis fails utterly when it tries to account for the
manifest content of a delusion. We can trace the psychological stages from
the manifest content in varying delusions back to a more or less constant
unconscious striving-- the latent content. The tendency of this latent
content to appear as delusions depends on a defect of adaptation, which must
have a physical basis probably of a general nature. The delusions, in many
cases, are symbols of the latent content. From a psycho-analytic standpoint,
the problem presented in Dr. Southard's paper is "Why is a certain symbol
chosen in one case and another in another individual?" It may well be that
specific organic factors operate here. One could imagine that the mechanism
is purely psychological. In a hepatic condition, for instance, the attention
of the patient may be directed to that part of the body which is affected by
the pathological process in the liver and that for this reason the ideas
which appear refer to generations in that region. At least we may hope for
definite and interesting results from elaboration of the method outlined by
Dr. Southard's statistics.

DR. SOUTHARD: I am rather astonished and well pleased at the cordial
reception of my little statistical work on delusions and upon the elaborate
discussion. As to Dr. Hall's question whether my data were collected to
prove the a priori contention concerning the correlation of unpleasantness
with lesions below the diaphragm, I would say that I expressed a suspicion
of this correlation in my paper on "How Far is the Environment Responsible
for Delusions," (Journal of Abnormal Psychology, June-July, 1913). I was
stimulated to finish my article by the appearance of Shand's book on "The
Foundations of Character" and the articles on "Personality" by Prof. Roscoe
Pound which have been appearing in the Harvard Law Review.

"Dyslalia Viewed as a Centre Asthenia" was the title of a paper read by Dr.
Walter B. Swift, Boston.[1]

[1] Reserved for Publication.

NO DISCUSSION

DR. JOHN T. MACCURDY, New York, read a joint paper (with DR. W. T. TREADWAY)
entitled "Constructive Delusions."[2]

[2] Published in the August-September number, p. 153, of this Journal.

DISCUSSION.

DR. WILLIAM A. WHITE, Washington, D. C., spoke of his interest in the paper
and his agreement with it. He suggested that it might be quite proper to
use the term "archaic" in speaking of this type of delusions. He also
commented on the recurrence of the excitement in the case of the last
patient quoted which, he suggested, might represent a physical periodicity
as the individual had a homosexual component in his make-up, so that it
might be reasonable to suppose that this was fundamentally sex periodicity.

PRESIDENT HALL: Sex periodicity in males is very interesting. A student of
mine many years ago kept his own record for some years and published it
anonymously in my journal, as did another some ten years ago, and the
twenty-eight day cycle seemed very marked in the first and somewhat so in
the last of these papers. They are certainly interesting to the geneticist.
We now often speak of dreams as protectors of sleep. I am inclined to think
that a good many delusions are protectors of sanity in much the same way,
and I am not at all sure that we cannot say that we shall ere long see that
this is to a great extent true for the imagination. If this patient had a
less vivid fancy perhaps his delusions would have been kept less fluid and
his sanity would have been better protected. Is there not a relation between
floridness of fancy which passes easily over to delusions (just as creative
geniuses are allied to artists), but may there not be an inverse correlation
between great liveliness and activity of fancy and liability to fixed
delusions? At any rate, from the normal standpoint we are seeing more and
more that man lives on a genetic scale. This might be illustrated by the
many cases, some of them pretty well analyzed, of cat-phobias. The greatest
enemies of mankind were once the felidae, and the theory now is that this
type is made up of very definite elements, viz., sharp claws, stealthy
tread, eyes that shine in the dark, power to leap far and suddenly, a
uniquely developed voice, etc. Now the cat-phobiacs generally focus on some
one of these traits in consciousness, but analysis seems to show that the
rest of them reinforce the one that experience happens to thrust forward
into the center of the field of consciousness. In general it seems to me
that it is a great educational advantage to keep open the experiences that
connect us with the past of the race, and it may have a psychotherapeutic
value which we do not now dream. Years ago a New York paper investigated,
with the aid of many of its reporters, and found hundreds of people fishing
off the wharves of New York on Sunday, very few of whom caught any fish, and
many who did threw them back. They were reverting to the old piscatorial
stage, feeling again the old thrill of a nibble on the hook, and went home
refreshed, even if they had not had a bite, because they had been able to
drop back into an ancient stratum of the soul which was sound, so that they
came back to the hard reality of the next day refreshed. Play in general,
too, we now regard as reversionary, and I cannot but believe that many
delusions are precisely the same.

DR. TOM A. WILLIAMS, Washington, D. C: Dr. Hall has cited the cat-phobia in
illustration that the belief that Dr. MacCurdy developed may be one in which
there may be philogenetic reasons for the phenomena. It seems to me that
before we use such data we need analyses more complete than has been given
for any of them. His citation brought to my mind a case I am working with
now, a cat-phobia. The cat does not represent sharp eyes and claws. The cat
is a definite symbol of definite sexual occurrences in childhood. I should
like to ask whether it would be here desired to draw philogenetic
conclusions. I think not without the further analysis which would be
necessary. I have a very strong distrust of the efforts which Jung and
Abrahams have made, followed by some of us, to draw analogy between the
morphological changes and the psychological experiences of the race as
reproductions in the life history of the individual.

DR. E. E. SOUTHARD: I should be inclined to feel that much of the
disturbance in the constructive delusion group would be structurally founded
upon normal or abnormal conditions in the parietal lobe. At any rate cases
with hyperphantasia in my recent Dementia Praecox series (American Journal
of Insanity, 1914-15) appear to be correlated with parietal lobe anomalies
and atrophies. It is a curious thing that such subjects with
hyperphantastic delusions are very often good institutional workers.
Although a delusion of persecution by poison is an exceedingly simple
delusion, it is in a sense far more harmful to the organism and may be often
far more productive of motor results in a patient than an elaborate
psuedo-scientific theory such as constructed by Dr. MacCurdy's patient. It
is obvious that the degree of disease does not vary directly with the
simplicity of the delusion.

It seems to me that Dr. MacCurdy's work has not only theoretical interest
but also practical importance from the standpoint of prognosis.

DR. WALTER B. SWIFT, Boston: I often wonder if we are not a little inclined
to go too far back for explanations. In football it is recognized that the
men on the field have two sets of reflexes out of which they play under
different circumstances. One is a set that they have learned in the lower
schools; and the other is the reflex circle that they use after they have
been trained differently in college. When these men get tired it is a
psychological observation that they go back to those first learned reflex
mechanisms. That is, when tired, they play the football of the secondary
schools. Something similar occurs in stammering. When a case is trained to
have a higher reflex vocalization, and they learn to vocalize spontaneously,
it inhibits their stammering. But when they get tired they revert again. In
the subject under discussion are we not reaching too far back for sources?
Should we not go to infancy or early childhood (to the old reflex circle
there) rather than to ones we suppose are inherited?

DR. TOM A. WILLIAMS, Washington, D. C.: My remarks do not apply to the
contents of the delusions, of course, but to the cerebral capacities merely
which were susceptible of the formation of such delusions.

DR. SMITH ELY JELLIFFE, New York: Dr. MacCurdy's paper fascinated me a
great deal. There is so much material that one is in a maze. I am sorry,
moreover, that he had to mutilate his conclusions by being forced by lack of
time to condense them. It strikes me he gives us a very important
contribution to the mechanism of the cure of some psychoses. That mechanism
of cure, may be stated as follows: How can one take the split off libido
which results from the analytic technique and apply it to a better
constructive synthesis? It would seem that these constructive delusions
really correspond to interpretative schemes whereby a certain amount of the
split off libido becomes synthesized. In that sense these delusions are
constructive and are, therefore, helpful to the patient. They represent
partial curative processes.

DR. JOHN T. MACCURDY, New York: I would like to refer briefly, first, to
the point made by Dr. White to the effect that these ideas were interesting
in so far as they were archaic. That is true and it is one of the
profoundest truths we have to offer. At the same time it is of psychological
and not strictly speaking of psychiatric value. The purpose of my paper was
essentially psychiatric, to point out that there is a prognostic value in
such delusion as I have tried to outline. Now one can get archaic delusions
in patients very much deteriorated. The point of this paper is rather to
show, as the discussion brought out, that it is the constructive tendency
operating in the insane as it has historically in the race. The second point
as to the cycle in his attacks, to follow the inference of Dr. White, I
presume he meant to imply that there may have been some organic swing
corresponding to the psychotic swing. That of course is quite possible. At
the same time the analysis of this case showed that purely psychic factors
had a great deal to do with it. His monthly attacks seemed to represent a
break in the balance. He was always in unstable equilibrium and the factor
that seemed to decide the issue finally between relative sanity and a
markedly deteriorated state, was a purely psychological one. When his father
died, when he was released from that bondage, the relief seemed just enough
to decide the issue. So the organic factors here seem to be the general,
underlying inability to adapt himself. One of the hardest situations to
adapt himself to was his relations with his father. If he could not free
himself he was going to be very insane. When that factor was removed he
became relatively insane.

DR. TOM A. WILLIAMS, Washington, D. C., read a paper entitled, "The origin
of Supernatural Explanations."[*]

[*] Published in this number of the Journal, p. 236.

DISCUSSION

DR. E. E. SOUTHARD, Boston: Are all these somatic explanations of
metaphysics?

DR. WILLIAMS: Largely.

DR. SMITH ELY JELLIFFE, New York: I recall a note in one of Dr. Jones'
papers in which he says "that in the future our reason will be used to
explain things. Heretofore it has been used to explain them away."

DR. TOM A. WILLIAMS, Washington, D. C.: I am not prepared to make any
predictions about a thousand years from now, that is in the air. I mention
not the levels at all, nor do I speak of "decerebrate metaphysics." Nor do I
speak of metaphysics at all unless one would imply that what I have called
supernatural explanations needs must be metaphysical. I do not speak of
cerebral functions per se. I was simply speaking of states of feelings.
The source and origin I did not go into. I simply made an attempt to imply
that such states of feeling were responsible for the discomfort and feeling
of inadequacy of the patient, and as Dr. Jelliffe has well repeated that the
victim attempts to rationalize this in supernatural fashion and that this
may be not at all dependent upon the notion of the supernatural universe he
has imbibed as a child. It is a construing of natural means for getting out
of a difficulty.

Dr. L. E. Emerson, Boston, read a paper entitled "The Psycho-Analytic
Treatment of Hystero-Epilepsy."[*]

[*] Reserved for publication.

DISCUSSION

DR. JOHN T. MACCURDY, New York: I have been very much interested in this
paper by Dr. Emerson and the part that has interested me most in it has been
the therapeutic side. I cannot feel, however, that it adds a great deal to
our knowledge of epilepsy, that is, of idiopathic epilepsy. That, of course,
is a tremendously difficult problem to tackle. If we are to regard it as a
psychosis then we expect it to show other reactions, just as dementia
praecox shows manic depressive symptoms. If we are to find out what the
epileptic reaction is, we must study it in those who are typically epileptic
and nothing else. Or else we may examine those with transitional states
grading over into hysteria, for example, excluding from our formulations
everything in them that is hysteric. This last case which Dr. Emerson
brought forward seemed to me to represent what is essentially an hysteric
reaction. The convulsive movements this man went through were symbolic. It
is difficult to regard these movements in epilepsy as symbolic because in
the true epileptic there is as typical unconsciousness as we know. How can
anything going on in almost absolute unconsciousness represent something
symbolic to the individual? This is possible however, when the condition
grades off from the hysteric side into the epileptic. The fundamental
epileptic phenomenon is the disturbance of consciousness, and that is what
must be explained.

DR. TOM A. WILLIAMS, Washington, D. C.: I don't know that we can say that
the fundamental differentiation of epilepsy is the unconsciousness. That is
a psychological division. The paper did not give any differential why they
were regarded as epileptics at all. There was no description of the
convulsion, except in so far as this formed the hysteric form of convulsion,
so I don't think we are in a position to discuss the paper without more
clear data of these instances.

DR. WALTER B. SWIFT, Boston: I was interested in hearing about the case of
stammering. That will be explained in my own paper and I have also run up
against several who have done the same. I should like to ask Dr. Emerson if
he considers stammering as an expression of an orgasm.

DR. L. E. EMERSON, Boston: Dr. MacCurdy well remarked that this adds
nothing to the understanding of epilepsy. In a certain sense this is true.
I do not feel that I could add anything to a deeper understanding of
epilepsy. The whole development of psycho-analytic theory, up to a certain
point, has been based on the actual recovery of patients, if you do not like
the use of the word cure, from particular symptoms. Then this has been
generalized. Now that has opened an enormous field for ratiocination.
Therefore, I am not at all sure that these conceptions will really apply to
essential epilepsies or to the real epilepsies. I do not know how far our
conceptions which originate in the therapeutic situation will apply to the
situation which appears to be absolutely beyond therapeutics. In regard to
what Dr. White said of starting from the known and going through
transitional stages to the unknown, you do get insight and it may be that
the condition as described in this broad way by Clark and by Stekel and
others may be true, but I am not perfectly sure. I am very grateful for Dr.
Allen's approval of this way of putting things because perhaps it is a
defence reaction on my own part that occasionally I feel it necessary to
report things I have seen with my own eyes and really experienced, instead
of following my natural tendency to go off into vague philosophizing.

REVIEWS

PSYCHOLOGY IN DAILY LIFE. By Carl Emil Seashore. 1914, XVIII plus 226 pp.,
N. Y., D. Appleton & Co.

This is the first volume of the "Conduct of Mind" series, the purpose of
which, as stated by its editor, Professor Joseph Jastrow, in his
introduction to the series, is "to provide readily intelligible surveys of
selected aspects of the study of mind and its applications."  The present
work contains seven chapters, which were originally prepared as
"semi-popular addresses." As a consequence, the book lacks somewhat in
coherence, but, except in a few places, the emphasis is practical
throughout. It is perhaps not surprising that the most subtle and modern
part of the discussion, viz. the chapter on "Mental Law" should be the
least practical in its bearing.

In the first chapter is discussed the practical importance of "Play," not
only in offering the opportunity for sensory, central, and motor development
in the child, but for releasing the broader life energies of the adult whose
mind is confined by specializing work. It is shown that the fundamental
motives of the play life are to be found in religion.

The next three chapters, on "Serviceable Memory," "Mental Efficiency," and
"Mental Health," are full of sound practical advice. The first contains a
clear and attractive presentation of the principles of remembering, so
arranged as to exemplify the rules which it inculcates. The second
emphasizes the importance of the wave form of attention in all mental work,
the superiority of efferent to afferent response as an educational process,
and the acquirement of mastery by a transfer of control from higher to lower
mental levels. There is also good counsel with regard to the best time and
manner in which to rest, although the author's deductions from the
physiological "curve of sleep" appear somewhat hasty. "Mental Health" is
defined in terms of our mental "members" in the classical way, and the "Ten
Maxims of Wise Living," which are given, are selected from the history of
moral philosophy rather than from current psychotherapeutic results.

The chapter on "Mental Law" is the most interesting one for the theoretical
psychologist, and discusses in a general but illuminating manner, principles
of perception and of perseveration which are of interest to the
psychological psychiatrist. The chapter on "Law in Illusion" seems
disproportionately long, but gives an interesting description and analysis
of three different types of illusions: those based on "units of direction,"
the over-estimation of "cylinder height," and upon the "size-weight" error.
In connection with the second, the results of original investigations in the
author's laboratory are presented. It is shown that a knowledge of the
complex but definite principles underlying illusions can be made practically
serviceable, for example, in tests of mental normality.

The final chapter deals with a specific illustrative problem in "Mental
Measurement," viz. the determination of a subject's fitness for a musical
career. A detailed analysis of the problem is offered, and it is shown that
the elemental questions involved can be answered by the methods of the
psychological laboratory, but that these answers require expert
interpretation before they can be made practically applicable.

The author's style is engaging and clear. LEONARD THOMPSON TROLAND.

AN OUTLINE OF PSYCHOBIOLOGY. By Knight Dunlap, Associate Professor of
Psychology in the Johns Hopkins University. Baltimore, The Johns Hopkins
Press, 1914. Pp. 121, octavo; illustrated.

This volume even though brief will be highly appreciated by very many
students of normal and of abnormal psychology because it is the first book
to afford them just what, in an elementary way, they need concerning the
nervous system, the essential musculatures, and the epithelia, whose
manifold activities are in some certain mode concomitant to the succession
of compound mental events. Surely, and widely, those who a few years ago
"came to scoff" at the ever-rising scientific stream of mind-protoplasm
relationship will "remain to pray" to the rising and satisfying goddess of
the new philosophy. The body with its unimagined intricacies and beauties of
still unguessed adaptation and its marvels of Someone's ingenuity is surely
now at length coming into its own. And when, after the years, it has come
into its own in a reasonable measure, "the continuity of mind-and-energy"
and "the dynamic-spiritualism of the Cosmos" when they are mentioned will no
longer draw that quasi-withering smile of toleration to the face of the
orthodox psychologist with which some of us are familiar.

This volume, happily devised by Professor Dunlap to meet this real need, at
first in his own pupils and later in a wider public, will materially help
this progress, for it has within it in fairly up-to-date and simple form
much of the structure and function, always of surpassing interest when
understood, of the human action-system. Seventy-seven excellently clear and
well-chosen illustrations make the well-printed text still more informing.
There is a good index; and short lists of books at the ends of the chapters.

The present reviewer notes only one omission of substantial importance from
the neurologic part of the book, and that is the very recent, howbeit
important, matter of the functional opposition between the sympathetic
proper and the other, the cranio-sacral, portion of "the autonomic."  The
work lacks also, in this first edition, a statement and discussion of the
important all-or-none principle which is now applicable to voluntary muscle,
probably, and to the neurones. And it is to be hoped too that the author
will take the bull by the horns and, in the next edition, show the nature of
protoplasm in general in an homologous way, as the basis, through its
uniquely complex kineticism, of the onward rush of the mental process. With
this addition the essential nature of irritability too might be set forth in
this already valuable (and inexpensive) treatise. GEORGE V. N. DEARBORN.
Sargent Normal School.

PSYCHOLOGY, GENERAL AND APPLIED. Hugo Munsterberg New York and London: D.
Appleton and Co., 1914; Pp. xiv X487 1.75.

In this volume, designed to serve the needs both of the general reader and
of the college student, Professor Munsterberg has represented in most
readable form the essentials of the entire range of his contributions to
psychology. The well-known differentiation of the "two psychologies" is the
core of the book; herewith is reintroduced the psychology of the soul, not
merely as being on a level with, but ultimately even superordinate to, the
descriptive psychology which had banished from so many systems all mention
of the soul or even of the self. For we are shown how all description and
explanation, whether of material objects or of conscious processes, is after
all but construction in the service of purposes, to apprehend, understand,
and realize which is the primary business, of life.

This exposition of purposive psychology, surely the most novel feature of
the book, is what interests us most, and we discover with disappointment
that though theoretically every conscious state is subject-matter for either
type of psychology, i.e. may be either described in its causal relationships
or immediately grasped as an act of will, still Professor Munsterberg fills
five times as many pages with the usual descriptive psychology as with this
newer departure. We willingly conceded the importance of tradition in
textbook writing, but would urge upon Professor Munsterberg the impatience
with which we await more extended treatment of this topic.

A second deviation for a book of this type,--if Professor Munsterberg may
rightly be said ever to write books typical of anything but his own
uniqueness,--is the inclusion of a section on social psychology. This too,
we are inclined to regard as in nature of a promise, representing the
germination of lines of thought which we are assured elsewhere[*] are later
to receive more elaborate formulation.

[*] Munsterburg, H. "Grundzuge der Psychotechnik."  Leipzig, 1914. Vorwort,
S. VIII.

Thirdly, one of the main divisions of the book is devoted to applied
psychology, the presentation here being essentially an abstract of the
author's previous publications in the field of his acknowledged preeminence,
psychotechnics.

Throughout the book discussion of general principles, whether of philosophy
or biology, takes precedence over the presentation of concrete facts; the
text contains no explicit references, though a brief bibliography of works
in English is appended. The consequent gain in readability is only one of
the many factors which insure this volume a very wide reading. R. M.
ELLIOTT. Harvard University.

THE JOURNAL OF ABNORMAL PSYCHOLOGY

THE SEX WORSHIP AND SYMBOLISM OF PRIMITIVE RACES

BY SANGER BROWN II., M. D.

Assistant Physician--Bloomingdale Hospital.

PSYCHIATRY, during recent years, has found it to its advantage to turn to a
number of related sciences and allied branches of study for the explanation
of a number of the peculiar symptoms of abnormal mental states. Of these
related studies, none have been of greater value than those which throw
light on the mental development of either the individual or the race. In
primitive races we discover a number of inherent motives which are of
interest from the standpoint of mental development. These motives are
expressed in a very interesting symbolism. It is the duty of the
psychiatrist to see to what extent these primitive motives operate
subconsciously in abnormal mental conditions, and also to learn whether an
insight into the symbolism of mental diseases may be gained, through
comparison, by a study of the symbolism of primitive races. In the
following communication one particular motive with its accompanying
symbolism is dealt with. The application of these findings must be left with
the psychiatrist in his clinical studies.

A great many of the institutions and usages of our present day civilization
originated at a very early period in the history of the race. Many of these
usages are carried on in modified form century after century, after they
have lost the meaning which they originally possessed; it must be
remembered, however, that in primitive races they were of importance, and
they arose because they served a useful end. From the study of these
remnants of former days, we are able to learn the trends of thought which
activated and inspired the minds of primitive people. When we clearly
understand these motives, we may then judge the extent of their influence on
our present day thought and tendencies.

Now, in our present communication, we wish to deal with a motive which we
find expressed very generally in primitive religion; this is the worship of
sex. We not only find evidences of this worship in the records and
monuments of antiquity, but our knowledge of the customs and practices of
certain tribes, studied in comparatively modern times, indicates the
presence of this same primitive religion. We feel that in sex worship we are
dealing with an important motive in racial development, and our object at
present is to give an account of its various phases.

Before we proceed, it is desirable to make reference to some of our sources
of information. There are plenty of books on the history of Egypt, the
antiquities of India or on the interpretation of Oriental customs, which
make scarcely any reference to the deification of sex. We have always been
told, for example, that Bacchus was the god of the harvest and that the
Greek Pan was the god of nature. We have not been told that these same gods
were representations of the male generative attribute, and that they were
worshipped as such; yet, anyone who has access to the statuettes or
engravings of these various deities of antiquity, whether they be of Egypt,
of India or of China, cannot fail to see that they were intended to
represent generative attributes. On account of the incompleteness of many
books which describe primitive races, a number of references are given
throughout these pages, and some Bibliographical references are added.

SIMPLE SEX WORSHIP

As will be presently shown, we have evidence from a number of sources to
show that sex was at one time frankly and openly worshipped by the primitive
races of mankind. This worship has been shown to be so general and so
widespread, that it is to be regarded as part of the general evolution of
the human mind; it seems to be indigenous with the race, rather than an
isolated or exceptional circumstance.

The American Cyclopedia, under Phallic worship, reads as follows "In early
ages the sexual emblems were adored as most sacred objects, and in the
several polytheistic systems the act or principle of which the phallus was
the type was represented by a deity to whom it was consecrated: in Egypt by
Khem, in India by Siva, in Assyria by Vul, in primitive Greece by Pan, and
later by Priapus, in Italy by Mutinus or Priapus, among the Teutonic and
Scandinavian nations by Fricco, and in Spain by Hortanes. Phallic monuments
and sculptured emblems are found in all parts of the world."

Rawlinson, in his history of Ancient Egypt, gives us the following
description of Khem: "A full Egyptian idea of Khem can scarcely be
presented to the modern reader, on account of the grossness of the forms
under which it was exhibited. Some modern Egyptologists endeavor to excuse
or palliate this grossness; but it seems scarcely possible that it should
not have been accompanied by indelicacy of thought or that it should have
failed to exercise a corrupting influence on life and morals. Khem, no
doubt, represented to the initiated merely the generative power in nature,
or that strange law by which living organisms, animal and vegetable, are
enabled to reproduce their like. But who shall say in what exact light he
presented himself to the vulgar, who had continually before their eyes the
indecent figures under which the painters and sculptors portrayed him? As
impure ideas and revolting practices clustered around the worship of Pan in
Greece and later Rome, so it is more than probable that in the worship of
Khem in Egypt were connected similar excesses. Besides his priapic or
"Ithyphallic" form, Khem's character was marked by the assignment to him of
the goat as his symbol, and by his ordinary title Ka-mutf, "The Bull of his
Mother," i.e., of nature."

This paragraph clearly indicates that the sexual organs were worshipped
under the form of Khem by the Egyptians. The writer, however, has fallen
into a very common error in giving us to understand that this was a degraded
form of worship; from numerous other sources it is readily shown that such
is not the case.

The following lines, from "Ancient Sex Worship," substantiate the above
remarks, and at the same time, they show the incompleteness of the writings
of many antiquarians. In this book we read: "Phallic emblems abounded at
Heliopolis and Syria and many other places, even in to modern times. The
following unfolds marvelous proof to our point. A brother physician, writing
to Dr. Inman, says: 'I was in Egypt last winter (1865-66), and there
certainly are numerous figures of gods and kings on the walls of the temple
at Thebes, depicted with the male genital erect. The great temple at Karnac
is, in particular, full of such figures and the temple of Danclesa,
likewise, although that is of much later date, and built merely in imitation
of old Egyptian art.' " The writer further states that this shows how
completely English Egyptologists have suppressed a portion of the facts in
the histories which they have given to the world. With all our descriptions
of the wonderful temple of Karnac, it is remarkable that all mention of its
association with sex worship should be omitted by many writers.

A number of travellers in Africa, even in comparatively modern times, have
observed evidences of sex worship among the primitive races of that
continent. Captain Burton[1] speaks of this custom with the Dahome tribe
Small gods of clay are made in priapic attitudes before which the natives
worship. The god is often made as if contemplating its sexual organs.
Another traveler, a clergyman,[2] has described the same worship in this
tribe. He has observed idols in priapic attitudes, rudely carved in wood,
and others made of clay. On the lower Congo the same worship is described,
where both male and female figures with disproportionate genital organs are
used for purposes of worship. Phallic symbols and other offerings are made
to these simple deities.

[1] Quoted by H. M. Westropp, Primitive Symbolism

[2] J. W. Wood. The uncivilized Races.

Definite examples of the sexual act having religious significance may be
cited. Richard Payne Knight[3] quotes a passage from Captain Cook's voyages
to one of the Southern Pacific Islands. The Missionaries of the expedition
on this occasion assembled the members of the party for religious ceremonies
in which the natives joined. The primitive natives observed the ceremony
with great respect and then with due solemnity enacted their form of sacred
worship. Quite to the astonishment of the white people, this ceremony
consisted of the open performance of the sexual act by a young Indian man
and woman. This was entirely a religious ceremony, and was fittingly
respected by all the natives present.

[3] The symbolical language of ancient art and mythology.

Hargrave Jennings[4] describes the same custom in India. An Indian woman of
designated caste and vocation is selected. Many incantations and strange
rites are gone through. A circle, or "Vacant Enchanted Place" is rendered
pure by certain rites and sprinkled with wine. Then secret charms are
whispered three times in the woman's ear. The sexual act is then
consummated, and the whole procedure before the altar is distinctly a form
of sacrifice and worship.

[4] The Roseicrucians.

Hoddar M. Westropp in "Primitive Symbolism" has indicated the countries in
which sex worship has existed. He gives numerous instances in ancient
Egypt, Assyria, Greece and Rome. In India, as well as in China and Japan,
it forms the basis of early religions. This worship is described among the
early races of Greece, Italy, Spain, Scandinavia, and among the Mexicans and
Peruvians of America as well. In Borneo, Tasmania, and Australia phallic
emblems have been found. Many other localities have been mentioned by this
writer and one seems fairly justified in concluding that sex worship is
regularly found at one time in the development of primitive races. We shall
now pass to another form of this same worship, namely, sacred prostitution.

SACRED PROSTITUTION

There is abundant evidence to show that there was a time in the centuries
before Christ when prostitution was held as a most sacred vocation. We
learn of this practice from many sources. It appears that temples in a
number of ancient cities of the East, in Babylonia, Nineveh, Corinth and
throughout India, were erected for the worship of certain deities. This
worship consisted of the prostitution of women. The women were consecrated
to the support of the temple. They were chosen in much the same way as the
modern woman enters a sacred church order. The returns from their vocation
went to the support of the deity and the temple. The children born of such a
union were in no way held in disgrace, but on the contrary, they appeared to
have formed a separate and rather superior class. We are told that this
practice did not interfere with a woman's opportunities for subsequent
marriage. In India the practice was very general at one time. The women
were called the "Women of the Idol."  Richard Payne Knight speaks of a
thousand sacred prostitutes living in each of the temples at Eryx and
Corinth.

A custom which shows even more clearly that prostitution was held as a
sacred duty to women was that in Babylonia every woman, of high rank or low,
must at one time in her life prostitute herself to any stranger who offered
money. In "Ancient Sex Worship" we read: "There was a temple in Babylonia
where every female had to perform once in her life a (to us) strange act of
religion, namely, prostitution with a stranger. The name of it was
Bit-Shagatha, or 'The Temple,' the 'Place of Union.' " Moreover we learn
that once a woman entered the temple for such a sacred act she could not
leave until it was performed.

The above accounts deal exclusively in the sacrifice made by women to the
deity of sex. Men did not escape this sacrifice and it appears that some
inflicted upon themselves an even worse one. Fraser[5] tells us of this
worship which was introduced from Assyria into Rome about two hundred years
before Christ. It was the worship of Cybele and Attis. These deities were
attended by emasculated priests and the priests in oriental costume paraded
Rome in religious ceremony.

[5] Adonis, Attis and Osiris.

On one occasion, namely, "the day of blood" in the Spring, the chief
ceremony was held. This, among other things, consisted in fastening an
effigy of the god to a pine tree, which was brought to the temple of the
Goddess Cybele. A most spectacular dance about the effigy then occurred in
which the priests slashed themselves with knives, the blood being offered as
sacrifice. As the excitement increased the sexual nature of the ceremony
became evident. To quote from Fraser; "For man after man, his veins
throbbing with the music, his eyes fascinated by the sight of streaming
blood, flung his garments from him, leaped forth with a shout, and seizing
one of the swords which stood ready for the service, castrated himself on
the spot. Then he ran through the city holding the bloody parts in his hands
and threw them into one of the houses which he passed in his mad career."

We see that this act directly corresponds with the part played by the
female. The female prostituted herself, and the male presented his
generative powers to the deity. Both the sacred prostitutes and emasculated
priests were held in religious veneration.

The above references are sufficient to show that a simple form of sex
worship has been quite generally found. It becomes apparent as we proceed
that the worship of sex not only plays a part, but a very prominent part, in
the developing mind of man. In the frank and open form of this worship it is
quite clear that we are dealing with a very simple type of mind. These
primitive people exhibit many of the qualities of the child. They are quite
without sex consciousness. Their motives are at once both simple and
direct, and they are doubtless sincere. Much misunderstanding has arisen by
judging such primitive people by the standards of our present day
civilization. Sex worship, while it held sway was probably quite as
seriously entertained as many other beliefs; it only became degraded during
a decadent age, when civilization had advanced beyond such simple
conceptions of a deity, but had not evolved a satisfactory substitute.

We shall now pass to a less frank and open deification of sex, namely,
sexual symbolism.

SYMBOLISM

As civilization advanced, the deification of sex was no longer frank and
open. It came to be carried on by means of symbolism. This symbolism was an
effort on the part of its originators to express the worship of the
generative attributes under disguise, often understood only by the priests
or by those initiated into the religious mysteries. The mysteries so
frequently referred to in the religions of antiquity are often some
expression of sex worship.

Sexual symbolism was very general at one time and remains of it are found in
most of the countries where any form of sex worship has existed. Such
remains have been found in Egypt, Greece, Italy, India, China, Japan, and
indeed in most countries the early history of which is known to man.

One important kind of symbolism had to do with the FORM of the object
deified. Thus, it appears that certain objects,--particularly upright
objects,--stones, mounds, poles, trees, etc., were erected, or used as found
in nature, as typifying the male generative organ. Likewise certain round
or oval objects, discs, certain fruits and certain natural caves, were
worshipped as representing the female generative organ. (The yoni of India.)

We also find that certain QUALITIES OF ANIMAL OR VEGETABLE nature were
equally venerated, not because of their form, but because they stood for
some quality desirable in the generation of mankind. Thus we find that some
animals--the bull because of its strength and aggressive nature, the snake,
perhaps because of its form or of its tenacity of life,--were male
representatives of phallic significance. Likewise the fish, the dolphin, and
a number of other aquatic creatures came to be female representatives. This
may be shown over and over again by reference to the antique emblems, coins,
and engravings of many nations.

Another later symbolism, which was adopted by certain philosophies, was more
obscure but was none the less of distinct sexual significance. FIRE is made
to represent the male principle, and WATER, and much connected with it, the
female. Thus we have Venus, born of the Sea, and accompanied by numerous
fish representations. Fire worship was secondary to the universally found
sun worship. The sun is everywhere the male principle, standing for the
generative power in nature. At one time the symbolism is broad, and refers
to generative nature in general. At another time it refers solely to the
human generative organs. Thus, the Greek God Hermes, the God of Fecundity in
nature, is at times represented in unmistakable priapic attitudes.

Still another symbolism was often used in India. This was the addition of a
number of members to the deity, possibly a number of arms or heads. This
was in order to express a number of qualities. Thus the deity was both
generator and destroyer, one face showing benevolence and kindness, the
other violence and rage. In many of the deities both male and female
principles were represented in one,--an Androgyne deity--which was an ideal
frequently attempted. The idea that these grotesque deities were merely the
expression of eccentricity or caprice on the part of their originator is not
to be entertained. Richard Payne Knight has pointed out that they occur
almost entirely on national coins and emblems, and so were the expression of
an established belief.

We shall refer first to the simpler symbols, that is those in which an
object was deified because of its form.

THE UPRIGHT

It is perhaps not remarkable that upright objects should be selected because
of their form as the simplest expression of phallic ideas. The simple
upright for purposes of sex worship is universally found. An upright conical
stone is frequently mentioned. Many of the stone idols or pillars, the
worship of which was forbidden by the Bible, come under this group.
Likewise, the obelisk, found not only in Egypt, but in modified forms in
many other countries as well, embodies the same phallic principle. The usual
explanation of the obelisk is that it represented the rays of the sun
striking the earth: when we speak of sun worship later, we shall see that
this substantiates rather than refutes the phallic interpretation. The
mounds of religious significance, found in many countries, were associated
with sex worship. The Chinese pagodas are probably of phallic origin.
Indeed, there is evidence to show that the spires of our Churches owe their
existence to the uprights or obelisks outside the Temples of former ages. A
large volume has been written by O'Brien to show that the Round Towers of
Ireland (upright towers of pre-historic times) were erected as phallic
emblems. Higgins, in the Anacalipsis, has amassed a great wealth of
material with similar purport, and he shows that such "temples" as that of
Stonehenge and others were also phallic. The stone idols of Mexico and Peru,
the ancient pillar stones of Brittany, and in fact all similar upright
objects, erected for religious purposes the world over, are placed in this
same category. We shall presently give a number of references to show that
the May-pole was associated with phallic worship and that it originated at a
very remote period.

We shall now quote from some of the authors who have contributed to our
knowledge of this form of symbolism, as thereby a clear idea of their
meaning may be set forth. These interpretations are not generally advanced,
and therefore we have added considerable corroborative evidence which we
have been able to obtain from independent sources.

In an Essay on the Assyrian "Grove" and other Emblems, Mr. John Newton sums
up the basis of this symbolism as follows: "As civilization advanced, the
gross symbols of creative power were cast aside, and priestly ingenuity was
taxed to the utmost in inventing a crowd of less obvious emblems, which
should represent the ancient ideas in a decorous manner. The old belief was
retained, but in a mysterious or sublimated form. As symbols of the male, or
active element in creation, the sun, light, fire, a torch, the phallus or
lingam, an erect serpent, a tall straight tree, especially the palm or fir
or pine, were adapted. Equally useful for symbolism were a tall upright
stone (menhir), a cone, a pyramid, a thumb or finger pointed straight, a
mask, a rod, a trident, a narrow bottle or amphora, a bow, an arrow, a
lance, a horse, a bull, a lion, and many other animals conspicuous for
masculine power. As symbols of the female, the passive though fruitful
element in creation, the crescent moon, the earth, darkness, water, and its
emblem, a triangle with the apex downward, "the yoni"--the shallow vessel or
cup for pouring fluid into (cetera), a ring or oval, a lozenge, any narrow
cleft, either natural or artificial, an arch or doorway, were employed. In
the same category of symbols came a boat or ship, a female date palm bearing
fruit, a cow with her calf by her side, a fish, fruits having many seeds,
such as the pomegranate, a shell, (concha), a cavern, a garden, a fountain,
a bower, a rose, a fig, and other things of suggestive form, etc.

These two great classes of conventional symbols were often represented IN
CONJUNCTION with each other, and thus symbolized in the highest degree the
great source of life, ever originating, ever renewed . . . . . . . . . . "A
similar emblem is the lingam standing in the centre of the yoni, the
adoration of which is to this day characteristic of the leading dogma of
Hindu religion. There is scarcely a temple in India which has not its
lingam, and in numerous instances this symbol is the only form under which
the god Siva is worshipped."

In "Ancient Sex Worship" we read, "As the male genital organs were held in
early times to exemplify the actual male creative power, various natural
objects were seized upon to express the theistic idea and at the same time
point to those points of the human form. Hence, a similitude is recognized
in a pillar, a heap of stones, a tree between two rocks, a club between two
pine cones, a trident, a thyrsus tied around with two ribbons with the ends
pendant, a thumb and two fingers. The caduceus again the conspicuous part
of the sacred Triad Ashur is symbolized by a single stone placed
upright,--the stump of a tree, a block, a tower, a spire, minaret, pole,
pine, poplar or pine tree."

Hargrave Jennings, the author of several books on some aspects of religions
of antiquity, among them one on phallicism deals freely with the phallic
principles embodied in these religions. As do many other writers, he
identifies fire worship with sex worship, and the following short paragraph
shows his conception of their interrelationship, as well as the significance
of the upright of antiquity. In the Rosicrucians he says: "Obelisks,
spires, minarets, tall towers, upright stones, (menhirs), and architectural
perpendiculars of every description, and, generally speaking, all erections
conspicuous for height and slimness, were representations of the Sworded or
of the Pyramidal Fire. They bespoke, wherever found and in whatever age,
the idea of the First Principle or the male generative emblem."

We might readily cite passages from the writings of a number of other
authors but the above paragraphs suffice to set forth the general principle
of this symbolism. As stated above, such interpretations have not been
generally advanced to explain such objects as sacred pillar stones,
obelisks, minarets, etc. It is readily seen how fully these views are
substantiated by observations from a number of independent sources.

In a book of Travel[6] in India we are able from an independent source to
learn of the symbolism of that country. The traveller gives a description of
the caves of Elephanta, near Bombay. These are enormous caves cut in the
side of a mountain, for religious purposes to which pilgrimages are made and
where the usual festivities are held. The worship of generative attributes
is quite apparent. The numerous sculptured female figures, as remarked by
the traveller, are all represented with greatly exaggerated breasts, a
symbolism which is frequent throughout oriental countries for expressing
reproductive attributes.

[6] Rousselet, India and its native princes.

In an inner chamber is placed the symbol which is held in particular
veneration. Here is found an upright conical stone standing within a
circular one. The stone is sprinkled with water during the festival season.
The writer states that this stone, to the worshippers, represents the male
generative organ, and the worship of it is not considered an impropriety. In
this instance we feel that the symbolism is very definite, and doubtless the
stone pillars in the other temples of India and elsewhere are of the same
significance.

A clergyman in the Chinese Review of 1876, under the title "Phallic Worship
in China," gives an account of the phallicism as he observed it at that
time. He states that the male sexual organ is symbolized by a simple mound
of earth and is so worshipped. Similarly, the female organ is represented
by a mound of different form and is worshipped as the former. The writer
states that at times these mounds are built in conjunction. He states this
worship is similar to that of Baal of Chaldea, etc., and that probably all
have a common origin. It appears to be a fundamental part of the Chinese
religion and the symbolism of the Chinese pagoda expresses the same idea. He
says that Kheen or Shang-te, the Chinese deities of sex, are also worshipped
in the form of serpents, of which the dragon of the Chinese is a
modification. This furnishes a concrete instance in which the mound of
earth is of phallic significance, and substantiates an interpretation of
serpent worship to which we shall presently refer.

Hoddard M. Westropp has given us an excellent account of phallic worship and
includes in his description the observations of a traveller in Japan at as
late periods as 1864 and 1869.

A temple near the ancient capital of Japan was visited by a traveller. In
this temple the main object of worship was a large upright, standing alone,
and the resemblance to the male generative organ was so striking as to leave
no doubt as to what it represented. This upright was worshipped especially
by women, who left votive offerings, among them small phalli, elaborately
wrought out of wood or other material. The traveller remarked that the
worship was most earnest and sincere.

The same traveller observed that in some of the public roads of Japan are
small hedged recesses where similar stone pillars are found. These large
pillars unquestionably represent the male organ. The writer has observed
priests in procession carrying similar huge phalli, painted in color as
well. This procession called forth no particular comment and so was
probably not unusual. It is stated that this is a part of the ancient
"Shintoo" religion of Japan and China. There are frequent references to
certain of the gods of the Ancients being represented in priapic attitudes,
the phallus being the prominent and most important attribute. Thus Hermes,
in Greece, was placed at cross-roads, with phallus prominent. This was
comparable to the phallus on Japanese highways. In the festivals of Bacchus
high phalli were carried, the male organ being represented about the size of
the rest of the body. The Egyptians carried a gilt phallus, 150 cubits high,
at the festivals of Osiris. In Syria, at the entrance of the temple at
Hieropolis, was placed a human figure with a phallus 120 cubits high. A man
mounted this upright twice a year and remained seven days, offering prayers,
etc.

In Peru in the Temple of the Sun an upright pillar has been described
covered with gold leaf, very similar to those existing elsewhere and to
which has been ascribed similar significance.

A number of writers have expressed the belief that the May-pole is an emblem
of ancient phallic worship. We know that May-day festivals are of the most
remote antiquity. We are indebted to R. P. Knight for a description of what
May-day was like about four centuries ago in England. The festival started
the evening before. Men and women went out into the woods in search of a
tree and brought it back to the village in the early morning. The night was
spent in sexual excesses comparable to those of the Roman Bacchanalia. A
procession was formed, garlands were added to the May-pole, which was set up
in the village square. The Puritans referred to it as an idol, and they did
not approve of the festivities. Until comparatively recent years there was
a May-pole in one of the squares of London, and Samuel Pepys,[7] writing of
his time, speaks of seeing May-poles in the front yards of the prominent
citizens of Holland. A festival much the same as this was held in Ancient
Rome and also in India. The May-pole properly pierces a disc and thus
conforms with the lingam-yoni of India. We also know that the first of May
was a favorite time for all nature worship with the ancients. For a number
of interesting suggestions the reader is referred to R. P. Knight, Worship
of Priapus, and Hargrave Jennings, Indian Religions (Page 66.)

[7] Pepys Diary.

Tree worship is frequently mentioned in the religions of antiquity. We are
told that the mystic powers of the mistletoe comes from the fact that it
grows on the oak, a once sacred tree. The pine of the North, the palm and
the fig tree of the South, were sacred trees at one time. John Newton made a
study of tree worship, especially the Ancient Grove Worship of Assyria. He
shows that the object of veneration was a male date palm, which represented
the Assyrian god Baal. Sex was worshipped under this deity, and it is shown
that the tree of the Assyrian grove was a phallic symbol. Palm Sunday
appears to be a relic of this worship. In France, until comparatively
recent times, there was a festival, "La Fete des Pinnes," in which palms
were carried in procession, and with the palms were carried phalli of bread
which had been blessed by the priests.

Richard Payne Knight tells us that Pan was worshipped by the Shepherds under
the form of the tall fir, and Bacchus "by sticking up the rude trunk of a
tree."  It is shown throughout these pages that sexual attributes were
worshipped under both these deities. In reference to other symbols, the
writer continues,[8] "The spires and pinnacles with which our churches are
decorated come from these ancient symbols; and the weather cocks, with which
they are surmounted though now only employed to show the direction of the
wind, were originally emblems of the sun; for the cock is the natural herald
of the day, and therefore sacred to the fountain of light. In the
symbolical writings of the Chinese the sun is still represented by a cock in
the circle; and a modern Parsee would suffer death rather than be guilty of
the crime of killing one. It appears on many ancient coins, with some
symbol of the passive productive power on the reverse; and in other
instances it is united with priapic and other emblems and devices,
signifying other attributes combined."

[8] Symbolic language of ancient art and mythology.

Dr. Thomas Inman has made a study to show how this phallic symbolism found
its way into ancient art, and even into some designs of modern times. Thus,
many formal designs are studied in which the upright plays a part; likewise,
the oval and the circle receive a similar explanation. The architectural
ornaments spoken of as eggs and anchors, eggs and spear heads, the so-called
honey-suckle ornament of antiquity, and the origin of some church windows
and ornaments, are all studied by this writer, and his text is accompanied
by illustrations. Hargrave Jennings has also traced the origin of the
symbols of Heraldry, the emblems of Royalty and of some church orders with
similar explanations.

We may add that the crux ansata of the Egyptians, the oval standing upon the
upright, or letter Tau, may be shown to be a sex symbol, the union of the
oval with the upright being of symbolic significance. The crux ansata is
found in the hand of most of the Egyptian deities. It is found in the
Assyrian temples and throughout the temples of India as well. Prehistoric
monuments of Ireland have the same design. Priests are portrayed in
adoration of the crux ansata before phallic monuments. This symbol, from
which our modern cross is doubtless derived, originated with the religions
of antiquity. Much additional evidence could readily be given to illustrate
this prehistoric origin. The present Christian symbol affords another
example of the adoption by a new religion of the symbols of the old.

Some reflection will show that the origin of many church customs and
symbols, and indeed of a great number of obscure customs and usages, may
quite properly be traced to the religions and practices of primitive races.
Lafcadio Hearn has insisted upon this in the interpretation of the art and
customs of the Japanese. He says,[9] "Art in Japan is so intimately
associated with religion that any attempt to study it without extensive
knowledge of the beliefs which it reflects were mere waste of time. By art I
do not mean painting and sculpture but every kind of decoration, and most
kinds of pictorial representation--the image of a boy's kite or a girl's
battledore not less than the design upon a lacquered casquet or enameled
vase,--the figure upon a workman's trowel not less than the pattern of the
girdle of a princess,--the shape of the paper doll or wooden rattle bought
for a baby, not less than the forms of those colossal Ni-O who guard the
gateways of the Buddha's temples," etc.

[9] Japan, an attempt at Interpretation.

In the above pages, we have given an account of the views of a number of
writers upon certain forms and symbols, and at the same time we have offered
considerable evidence in substantiation from independent sources. These
origins, found associated especially in art and religious usages, have not
been generally understood. Yet when we reflect upon the fact that many
religious customs are of great antiquity; that when once a certain form or
custom becomes established, it is well nigh ineffaceable, although subject
to great change or disguise throughout the centuries; when we reflect upon
these conditions, and realize the fact that sex worship with its
accompanying symbolism is found throughout primitive religions, we may then
more readily appreciate the entire significance of the above
interpretations.

It must, of course, be borne in mind that no one now gives these
interpretations to spires, minarets, and to the various monumental symbols
of which we have been speaking. We are here dealing exclusively with
pre-historic origins, not with present day meanings. The antiquity of
certain symbols is truly remarkable. The star and crescent, for example, a
well known conventionalized symbol, is found on Assyrian cylinders,
doubtless devised many centuries before Christ.

The full force and meaning of these various symbols may be very readily
grasped by reference to a number of designs, ancient coins, bas-reliefs,
monuments, etc., which have been reproduced in plates and drawings by C. W.
King, Thomas Inman, R. P. Knight and others. To these we refer the reader.

(TO BE CONCLUDED)

REFERENCES.[10]

[10] For a number of additional references consult New York Library under
Phallicism.

Cox, Rev. G. W.: The Mythology of the Aryan Nations.

Deiterich, A.: Mutter Erde.

Fraser, J. G.: Adonis, Attis and Osiris; Balder, the Beautiful; Psyche's
Task.

Grosse: The Beginnings of Art.

Higgins, Godfrey: The Anacalypsis; Celtic Druids.

Harrison, Miss Jane: Ancient Art and Ritual; Themis.

Howitt, A. W.: The Native Tribes of South East Australia.

Inman, Dr. Thomas: Ancient Faiths Embodied in Ancient Names; Ancient Pagan
and Modern Christian Symbolism.

Jennings, Hargrave: The Rosicrucians; The Indian Religions.

King, C. W: The Gnostics and their Remains; Hand-book of Engraved Gems.

Knight, R. P.: The Symbolical Language of Ancient Art and Mythology; Two
Essays on the Worship of Priapus.

Layard, A.: Babylon and Nineveh; Nineveh and its Remains.

Murray, Gilbert: Hamlet and Orestes.

Newton, John: Assyrian Grove Worship.

O'Brien, Henry: The Round Towers of Ireland

Rawlinson, G.: History of Ancient Egypt; Ancient Monarchies.

Rhyn, Dr. Otto: Mysteria.

Rocco, Sha: Ancient Sex Worship

Spencer, B.: Native Tribes of the Northern Territory of Australia.

Westropp, Hodder, M.: Primitive Symbolism.

Wood, Rev. J. G.: The Uncivilized Races.

ADDITIONAL REFERENCES (Primitive customs, religious usages, etc.)

Bryant: System of Mythology.

DeGubernatis, Angelo: Zoological Mythology.

Judson: Myths and Legends of the Mississippi Valley and the Great Lakes.

Langdon, S.: Tammuz and Ishtar.

Perrot, and Chipiez: History of Art in Phrygia, Lidia, Caria and Lycia;
History of Art in Persia.

Prescott: Conquest of Peru.

Rousselet, Louis: India and Its Native Princes.

Stevens, J.: Central America, Chiapez and Yucatan.

Solas, W. J.: Ancient Hunters.

Wood-Martin: Pagan Ireland.

THE PSYCHOANALYTIC TREATMENT Of HYSTERO-EPILEPSY

BY L. E. EMERSON, PH. D.

Psychologist, Massachusetts General Hospital; Examiner in Psychotherapy,
Psychopathic Hospital, Boston, Massachusetts; Assistant in Neurology,
Graduate School of Medicine, Harvard University.

WHEN a new method of working in any field of endeavor is devised, or a new
point of view is discovered, it is natural to turn to other similar fields
to see if the method will work there. This is what is done when one
approaches the study of Epilepsy from the point of view of psychoanalysis.

It is not my purpose to undertake an exhaustive psychoanalytic study of
Epilepsy. Neither is it my purpose to enter into a discussion of the
problems of differential diagnosis. It has already been shown, in borderland
cases, that one cannot tell the difference between epilepsy and hysteria,
without a prolonged psychoanalysis, and even then one cannot be certain.
This suggests that the whole thing is more or less a matter of definition.
Into such questions I cannot enter. My aim is much more modest. The
immediate purpose of my paper is to study some of the problems of therapy,
from the psychoanalytic point of view, of that small class of patients on
the borderline between hysteria and epilepsy, or patients with epileptiform
attacks.

The first publication of studies of this general nature was made by Dr.
James J. Putnam and Dr. George A. Waterman in the Boston Medical and
Surgical Journal for May, 1905, under the title "Certain Aspects of the
differential Diagnosis between Epilepsy and Hysteria."  In this paper the
authors say, "No one, so far as we are aware, has as yet studied with
sufficient thoroughness the subconscious memories of epileptics, and for all
we now can say, closer resemblances may be found between these and the
subconscious states of the hysterics than we now imagine."  p. 513.

In this paper, however, therapy is only hinted at.

A contribution to our insight as to the epileptic state of mind is made by
Jung, under the title, "Analyse der Assoziationen eines Epileptikers," in
his, "Diagnostische Assoziationsstudien. Beitrage zur experimentellen
Psychopathologie."  p. 175 (1906).

He found an extraordinary number of emotionally toned, egocentric relations.
There were some signs to suggest that the emotional tone in the epileptic
was unusually lasting.

The first thing published on epilepsy avowedly from the psychoanalytic
view-point was by Maeder: "Sexualitat und Epilepsy."  Jahrbuch BI HI, 1909.

Maeder goes into the subject rather exhaustively, after characteristic
German fashion, but his conclusions are comparatively simple. He says, "The
sexuality of the epileptic is characterized by the prominence of auto- and
allo-erotism. It retains much of the infantile form, but has undergone,
nevertheless, a certain development, which I designate as 'sexual
polyvalence.'  For some unknown reason the libido seems to have an abnormal
intensity."  p. 154.

This is an important contribution to our knowledge of the psychic state of
epileptics but it is notable that not a word is said as to therapy.

Sadger published the same year, "Ein Fall von Pseudoepilepsia hysterica
psychoanalytisch erklart."  (Wiener klein. Rundschau, p. 212, 1909.) But
neither does he have anything to say about therapy.

Dr. Wilhelm Stekel, however, treats the problem from the therapeutic point
of view in, "Die psychische Behandlung der Epilepsie."  (Zentralblatt fur
psychoanalyse p. 220 No. 5-6, Vol. 1).

The essential kernel of Stekel's view is that the epileptic is a repressed
criminal. The convulsion is a substitute for the criminal act. He
announces categorically that pseudoepilepsy is curable by psychoanalytic
procedures. Of three cases which he completely analysed, two were cured. His
final conclusion is fourfold: (1) Epilepsy, more often than we have
hitherto thought, is of psychogenic origin. (2) In all cases there is a
strong tendency to criminality which is unbearable to consciousness. (3)
The attack is a substitute for an offense, hence, eventually a sexual
offense. (4) Pseudo-epilepsy is curable by psychoanalysis.

Spratling calls attention "to the value of an occasional convulsion in
certain cases. In some patients the fit acts as a safety valve that
unquestionably permits escape from insanity. . . In many cases the
convulsion seems t o come as the termination of an obscure (auto-toxic)
cycle which varies in duration in different individuals and bears some
relationship to the ascending period of the folie circulaire of the French.
It seems that the specific cause of the fit in these cases is something that
permeates the entire organism; something that comes and goes; that grows
rapidly in intensity, exerting a pernicious influence on the patient by
making him act out of harmony with his normal state, until the limit is
reached and the mind loses its direction and control. The power of
inhibition being finally destroyed, the nervous storm breaks with great
force and violence."  p. 361.

Although Spratling had in mind a toxic agent, one cannot but be struck with
how completely his terms describe an emotional outburst.

In a paper read in Boston last winter, Dr. L. Pierce Clark advanced the view
that the epilpetic seizure was the symbolical expression of the desire of
the patient to return to the mutterleib. The convulsive moments were such
reflect and random acts as one sees in infants or infers in the embryo.
Regard for social sanctions is lost. This, of course, suggests the first
step in criminality. Clark found that favorable cases were amenable to
psychic treatment and said that some cases had been very much helped by
psychoanalysis. I am not certain whether he claims to have cured any
particular case of pseudo-epilepsy or epileptiform attacks, by
psychoanalysis. In presenting some of my own cases let me begin with one
that certainly was not a complete success, but nevertheless was much helped
by psychoanalysis.

This case is that of a young girl, aged 14, without known inherited
tendency. Her first attacks had occurred about a year previous in the form
of fainting spells. These were afterwards followed by convulsions. In
convulsions the patient thrashed about, kicking her legs and clawing at her
chest. These convulsive movements stopped after a while and were followed
by a deep sleep, after which the patient awoke without any memory of what
had happened.

It was found that during the convulsion the patient imagined she was being
pursued by a black-faced figure with claw-like hands, of a peculiar shape
like her father's.

Further investigation showed that her father got drunk and did chase her,
sometimes kicking her out of the house. She would undress her father
sometimes and put him to bed. Once when taking off his shoes he kicked her,
as she was bending over him, in the lower part of the abdomen. This was just
before the convulsions developed. The fainting spells occurred soon after
she had first seen her father naked. The image of his nakedness so
distressed her by continually coming before her mind that she made the most
desperate efforts to repress it, finally partially succeeding. Speaking of
her father she said, "Every time I think of him I feel like taking a fit.
Oh! It makes me feel terrible."

Her father had kicked her in the chest, too, which perhaps partially
accounts for the clawing.

In the light of this knowledge the convulsive movements become a little more
comprehensible. They are futile attempts to run away. They are the partial
movements of flight.

The cries that sometimes initiated and accompanied the convulsions at first,
afterwards became sufficiently articulate to be understood as calls "Mama,
Mama, Mama."

It was found that when her father would chase her about the house, in
drunken fury, she would call for her mother in frantic fear. Here,
apparently, is a meaning of the call preceding the convulsions.

Under a very short psychoanalytic treatment the patient showed marked
improvement. Her attacks became much less violent and much farther apart.
She became able to control them to a great extent. Finally she became so
well that one might say she had practically recovered.

Apparently there is no hint here of a repressed criminal complex. But a
little deeper analysis suggests it, however. The first attack, which was in
the form of a faint, occurred under the following circumstances. The patient
was at the funeral of the father of her best girl friend. As she looked at
the dead body of her friend's father the thought flashed through her mind,
"He was so good, and now he is dead, while my father who is so bad, still
lives. I wish he were dead." Shortly after she fainted.

There were a number of reasons, seemingly adequate, for incomplete success
in this case. In the first place, the patient had been in this country only
a few years and spoke very broken English. She is a Russian Jew. Obviously
this was a very great barrier to understanding. In the next place it was
almost impossible to change conditions of home, although Social Service
worked wonders in this case. The father continued to get drunk, and one of
the last of her now infrequent attacks occurred on his return from jail. The
patient was dreadfully afraid lest her father find out that the knowledge of
his delinquency had been discovered through her.

Not the least of the reasons militating against complete success was the
short time possible for psychoanalytic treatment. The patient was seen only
three weeks. As the time needed for a psychoanalysis is variable depending
on the particular patient, it is clear that this would be too short a time
to enable a young girl, only recently here from Russia, to understand, or to
overcome resistances. That the treatment was as nearly successful as it was
is perhaps encouraging to the hope that suitable cases under favorable
conditions might be cured.

The next case is one where the diagnosis lay between hysteria and epilepsy.
The symptoms were as follows: The patient had attacks in which she became
unconscious, gasped, and spittle ran from her mouth. She also bit her
tongue. She becomes stiff, eyes stark, and is left tired and weak. These
attacks were first noticed about five years ago. Since then she has had
about five similar attacks, the last three coming within five months. The
last two were within a day of each other and frightened her so she came to
the hospital. At the age of eight or nine she said that she had flashes of
speechlessness, and a thought which she cannot define, as of a horse or a
man. She never became unconscious or bit her tongue. After her first
catamenial these flashes of speechlessness and thought came only at this
time. At the age of two the patient said that she had fallen down stairs
and hit her head. She said she was unconscious twenty-four hours.

As a result of a psychoanalysis the following facts were learned. The
patient was a very sensitive child, exceedingly responsive to her
environment. She was also stubborn and self-willed, at times. She was
reserved and capable of great repression. When she was about three or four
she remembers seeing in the Bible a picture of the Devil on a white horse.
This used to make her shudder, but it also had a sort of irresistible
fascination. Later, when she was seven or eight, it would come into her
mind in school even and make her feel so badly she would lay her head on her
arms. But she never told anybody what it was that troubled her and she
would put it out of her mind. She thoroughly believed her mother when she
told her that the Devil would come and get her if she did wrong.

At about the age of ten or eleven she began going with a girl much older
than herself. She used to visit this girl and spend the night with her, and
in turn have her at her own home. In this way they spent the night together
quite frequently. Soon the girl wanted to masturbate her and although she
repelled her advances at first she finally allowed it because she was told
she would be regarded as queer if she didn't as other girls did it and liked
it. She, however, never did get any pleasure out of the practice, and
remained perfectly passive. She thought if her friend enjoyed it and it
didn't hurt her she should let her have her pleasure. She never told of
this.

The patient now began having what she called staring spells. These never
lasted more than a second or so and they were never observed. She carefully
concealed them. Just before the patient began to menstruate which was when
she was about fourteen, she noticed that the day after she had been with the
girl who masturbated her she had a terrific headache. Then she remembered
that for a long time it had been so though she had never connected the
headaches before with the masturbation. She stopped the practice immediately
and never allowed it to be resumed.

After menstruation began the staring spells became grouped and came only
during her periods. But they were more numerous. She would have a number in
one day. They were not yet sufficiently observable to be noticed. At about
this time she had a terrible fright. She was kneeling at her mother's side
listening to a story when she thought she saw a woman's face looking at her
over her mother's shoulder. She was speechless with terror. This was not
noticed and she did not tell. Around this time too she had another fright.
She was studying one evening at the dining-room table when she saw a face
looking in at the window. She screamed, and kept on screaming, but finally
was able to tell that she had seen someone looking in at the window. Her
father took her out and showed that it couldn't be so because there were no
tracks in the snow which was on the ground. She wouldn't or couldn't stop
crying, however, and kept it up all night, she said. Just before
menstruation she did some sleep-walking. She got up one night and went to
her mother and said she had something to tell her. Her mother tried to get
her to say what it was but could not, and saw that her daughter was asleep.
She kept saying, "you know what it is." The mother did not dare to waken her
and finally got her quietly back into bed. The next morning she remembered
nothing of what had happened.

When the patient was about sixteen she married. Her husband did not want
any children and practiced coitus interruptus, but she became pregnant
nevertheless and had an abortion performed. Although c.i. continued to be
practiced she became pregnant again and this time she had a daughter. Four
more years of c. i. followed. During all this time the patient had the
staring spells, but they were never noticed and she never told, not even her
mother. Then, like a thunder bolt out of a clear sky, came a tragedy.

She was pregnant again, and visiting her mother, expecting her husband for
over Sunday, when she received a letter saying he had left her and had gone
off with another woman. When she read the letter she lost consciousness.

Then followed a terrible time. In hate of her husband and on account of
fear lest she be unable to care for her baby she had another abortion
performed. This time she nearly died through not having proper medical
attendance afterwards, but she finally recovered and lived a life of
feverish activity and hate.

During her marriage she had been entirely frigid with respect to the sexual
act. A friend told her she had been missing an essential experience of
marriage. About a year after her husband left her she met a man who
thrilled her through and through, and thought, "this is what my friend
meant."  This man showed her some attention and she set out consciously to
seduce him. She soon succeeded and though he was wildly in love with her and
wanted to marry her, she steadfastly refused on the score of not loving him,
but was his mistress for two or three years. During this time her staring
spells seem to have been at a minimum, but I cannot assert that they
disappeared.

Then she met the man who became her second husband. She had refused to marry
her lover because she did not "love" him. She now dropped him completely,
and getting a divorce from her husband on the ground of desertion, married.

She was happy about a year and a half when her husband moved to a country
cross-road near a "hotel" (bar-room). Here he began drinking badly, and
consorting with prostitutes. For three years she fought her husband off, in
fear of infection. During this time she had no intercourse. At this time
began the attacks of unconsciousness. She was alone one night, while her
husband was off carousing, when she had a terrible fright on seeing a man
trying to get in at the window. This was probably hallucinatory as nothing
came of it. But from this time forth she was subject to attacks, in which
she lost consciousness, had convulsions, frothed at the mouth, and bit her
tongue badly.

At the end of about three years, however, her patience broke, and she told
her husband that if he did not stop she should leave him. This threat
brought him to his senses apparently, and he completely reformed. But her
love for him was dead. And though she now permitted marital relations to be
resumed, she remained from this time on absolutely frigid. Her husband too,
now suffered from premature ejaculation. Thus from the point of view both
of "passion" and of "love" the patient was not satisfied. Her attacks
increased in number and violence, coming now at any time, not being confined
to the menstrual period as at first, and coming days as well as nights.

In this patient we have represented the points of view both of Stekel and of
Clark. The patient showed conclusively her capacity for criminal action.
She also illustrates the craving for a return to the mother. The morning of
the day on which she had the first attack in which she bit her tongue, she
passed through the town where her mother was living and thought, "Oh, if I
could only go to my mother."  But remembering she had promised her lawyer to
live a year with her husband, she went on. Of the sexual character of her
conflicts no further comment is necessary.

Here then we have the natural history of what? Hysteria? or Epilepsy? This
question I shall not attempt to answer. But what has been the therapeutic
result of psychoanalysis? This question I can answer.

In the six months during which the analysis has been in progress the patient
has had no attacks in which she has had convulsions, frothed at the mouth,
or bitten her tongue. She has had only three spells in which consciousness
was lost and these were mild. The last one was described by the daughter.
She said it was like a faint; that her mother was in it only a short time;
that she had none of the symptoms she used to have; and was all right soon
afterwards with no bad after-effects. She added that since her mother had
been coming to the hospital she had improved so much they never thought of
her now as being sick. The bad feelings have diminished so much in number
and intensity as to be almost negligible. Family relations have so improved
husband and wife are practically at one in their purposes. Social relations
have also improved to such an extent that the patient has been able to
prevent the wreck of the home of a friend, and in her church is an active
worker on a number of committees. She is now doing her best to get her
daughter started right in life. The patient regards herself as having
practically recovered.

The next case I wish to present for your consideration is that of a young
man twenty-six years old. He was brought into the accident-room of the
hospital one night last Summer suffering from convulsions. He continued to
have convulsions throughout the night, and as many as five interns were
required to hold him quiet. These convulsions seemed to have enough purpose
in them to warrant the diagnosis of hysteria, so the next morning he was
referred to me.

"Last Wednesday night," he said, "I was having dinner with a customer at the
Hotel Thorndike. I began to feel sick and went to the toilet and vomited.
Then I went back and got my friend and started for a drug store in Park
Square to get some quinine. But before I got very far I began to shiver and
shake and I knew that it took quinine two or three hours to work so I
started back to the hotel to get a room. No rooms were to be had, so I said
'get a taxi and take me to the hospital.' I lost the use of my legs on the
steps and they had to carry me. In this attack I was more or less conscious
all through it." What were you thinking of in the taxi, I asked. "I don't
know. I felt as if I wanted to jump at something and grab something." Can
you not remember what was in your mind, I continued. "Only what I've told
you," he answered. Will you lie down and close your eyes and imagine
yourself back in the taxi, I asked. Now tell me what you see. After a
moment he said, "I see flames." What else do you see? "Nothing, only
flames. I feel as if I wanted to jump into the fire."  Did you see flames
in the taxi, I asked. "Yes, that was what I wanted to jump at." At this
moment the patient gave a start. What did you see then, I asked. "There is
something in the flames, an object, I don't know what it is. It might be a
thing or a person. I feel as if I wanted to grab the object."  At this
instant the patient gave a violent jump into the air and then sank back
relaxed. What did you see, I asked. "This object. It seemed to be
attracting me."  Can't you tell what it is, I said. "No. But it seems almost
like a person. It seems as if I could see an arm."  What else do you see?
"The arms seem beckoning me." It is a person then? Is it a man or a woman?
"I don't know. I can't make out."  Look. "It is a woman. I can see now."
Is it anybody you know? "No, I can't see any face." What do you see? "Just
a woman, standing in the flames, with outstretched arms, as if imploring me
to come. I feel a yearning, as if I must jump and grab her." The patient
stiffened slightly and gave a sort of spring up from the couch and then sank
back, breathing a little heavier. What did you see, I asked. "I thought she
beckoned me to come." Can you see who it is now? "No The face is blank."
Look again and see if you can't tell who it is. What do you see? "I can't
tell. I see several faces come and go." Do you recognize them? "Yes. The
first is my little girl's; then I see a former sweetheart of mine; then I
see my wife's face."

Gradually the following story was elicited from the patient. His mother died
when he was seven and his father married again in less than a year. The
former sweetheart was his step-mother's half-sister who came to live at
their house because the schools were better. He became infatuated with this
girl and his step-mother did everything she could to encourage his feeling
as she thought it would be a good match. The vision of his sweetheart in the
flames was based on an actual occurrence. She was sitting in front of a
fireplace once when a log of burning wood fell out and he jumped to pull her
away and held her close in his arms for a moment.

Finally, however, he broke off absolutely all relations with the girl. The
reason seems quite adequate. Why didn't you marry, I asked. He answered,
"we quarrelled and I left her. I didn't like her morals. She went with
other men and had connection with them. I saw her go into the woods one
night with another fellow, and once at Salisbury Beach I saw her go into a
hotel with a man and register as his wife."

About a year after this the patient began going with another girl more in an
attempt to crowd the image of his former first love out of his mind than
because he had fallen in love again. A year later they married. From the
first his married life was not entirely happy. More or less unconsciously he
began to regret lost opportunities. He was a travelling man and soon after
marriage his route was enlarged necessitating his being away from home a
month at a time. On these trips he used to get exceedingly lonesome
especially as he steadily refused going with other travelling men and making
a night of it as they often did. One of his routes took him to Virginia and
he said that he had returned from New York on the way there just for the
sake of spending a night with his wife. Once, in New York, he was
unfaithful to his wife and on that occasion contracted gonorrhea. This,
however, was the only time he has ever had extra-marital sexual relations,
he said.

Just before his attacks began, which was about four years ago, he was told
by his wife's doctor that it would be impossible for her to have any more
children as she was suffering from heart disease. To his mind this meant
giving up coitus. Then, unconsciously, he began to dream of Anna, his first
love. He regretted more than ever not taking advantage of his former
opportunities, and unconsciously dallied with the thought of deserting his
wife. Just at this time his attacks began.

As the analysis progressed his attacks diminished and shortly disappeared.
Gradually the image of his wife took full possession of his mind and the
image of Anna disappeared. Towards the end of the analysis as he was lying
on the couch with his eyes shut, he saw Anna in the flames and felt the
yearning but not so strongly as to lead to any impulsive movements. What do
you think all this might mean, I asked. "I don't know," he answered, "it
might mean I still cared for Anna and that if I let myself go it would break
up my home." With his full realization of the meaning of this symbolization,
it was assumed that he was cured.

Seven months later, in company with a colleague, I visited my former patient
and he told me that he had not had a moment's illness since I last saw him.
He told me that while occasionally the thought of Anna would come to his
mind, it never disturbed him, and never distracted his attention from other
things. He has prospered in his business, and I saw every evidence of a
happy home.

This case merits consideration for a number of reasons. In the first place
the attacks were cured by psychoanalysis. No one who saw the association of
the symbolical imagery and the convulsive movements could fail to see that
there was a causal connection between them. The subsidence in violence and
frequency of the convulsive movements as the conscious grasp of the meaning
of the mental symbolical imagery increased was also completely convincing of
the therapeutic value of the analysis. The question of the permanence of the
recovery is of course open, because seven months is far too short a time to
carry complete conviction.

The comparison of this case with the one immediately preceding raises a very
interesting question. Why is this patient apparently completely cured and
the other one not? Several reasons may be noted. The patient is much
younger. He had never been through anything like the same mental strains.
His trouble was of short duration. But above all as he was successful in
his business he was successful in his sublimation. Here is a sine qua non of
a successful psychoanalysis: the capacity and the opportunity for successful
sublimation. If these are present the prognosis is good.

It is interesting also to compare this case in its results with the
contentions of Clark and of Stekel. It is hard to see any signs of a
definite criminal tendency. Inasmuch as the temptation to go back to his
early love is a sign of a tendency towards regression and erotism generally
the patient shows what Clark has spoken of as a desire to return to the
mother-body. This case is not very important, however, to the views of
either Clark or Stekel as the analysis is relatively superficial, and there
is no knowing what a more thorough analysis might reveal. From the point of
view of superficiality, however, the case is important as it emphasizes
Taylor's view of the value of a modified analysis. The patient was seen only
five times.

On the basis of these, and a number of other similar cases, I should like to
suggest, from a descriptive point of view, that the epileptiform seizure is
of the nature of an orgasm. An orgasm is a sudden, explosive, discharge of
nervous energy, raised to the breaking point of nervous tension. I should
like to generalize the idea of orgasm. Ordinarily, of course, it is confined
to the sexual sphere. In the last case I reported it seems to me fairly
clear that the explosive actions, convulsive-like impulses, were closely
associated in the mind of the patient with sexual ideas. That they were
substitutes for the normal relief of sexual tension, seems to me also clear.
This idea is perhaps more convincing if I add the fact, as stated by the
patient, that his last attack started when he saw an attractive girl sitting
at a nearby table in the Thorndike Hotel, and who started him dreaming about
Anna, because she looked so much like her.

The second case I reported seems also easily brought under this conception.
Here we know more about the earliest childhood of the patient and we can
easily imagine that there was an especial predisposition for the form the
symptoms took. This, however, does not militate against the descriptive
value of the above conception. That the epileptiform attacks did not take
place until after actual sexual orgasms had been experienced, lends weight
to the conception I am presenting here. The first case is not so clear.
This is partly due to the fact that it was impossible to make anything like
a complete analysis. But it shows nothing contradictory to the conception,
and indeed has some slight value as added evidence in favor of the
conception, in as much as the original trauma consisted of a kick in the
genitals, by her father.

This conception does not contradict either Stekel's or Clark's ideas, but
rather supplements them. The essence of the criminal act lies in its
unrestrained aggressive character. From this point of view anything getting
in the way of the libido discharge has to take the consequences. This also
agrees with Clark, only his idea seems to me perhaps a little too passive to
describe fully the dynamic quality of the attack.

Here, as in Hysteria, the therapeutic effect of an analysis depends on the
possibility of sublimation. The three cases I have given in some detail may
easily be arranged in order. The last case having the best chances for
sublimation shows the best results.

ON THE GENESIS AND THE MEANING OF TICS

BY MEYER SOLOMON, M. D.

Associate in Neurology, Maimonides Hospital, Chicago

THE problem of the genesis and meaning of the strange manifestations which
we find in that peculiar disorder which goes by the accepted name of tics is
indeed difficult of solution. The analytic and genetic standpoint only
comparatively recently assumed in the domain of neurology and psychiatry is
having an ever wider and wider application. The problems in neurology and
psychiatry which still cry loudly for solution and rational explanation are
indeed numerous. Some of these questions are so baffling that at times they
seem almost beyond the ken of the human mind. Nevertheless, with
persistence and the "Don't give up the ship" spirit keenly imbued into us,
and with that irrepressible spirit of investigation and of research born of
optimism and of curiosity, we may expect to see many of these problems which
now seem to us so hopelessly unsolvable gradually rescued from the uncertain
waters of speculation and theorization and brought to the more sound shores
and land of the knowable and the known. If our theories be but tinctured
with due admixture of that sound self-criticism that comes of prolonged and
serious reflection and deliberation, and if the results of observation and
investigation be brought forth in support of these theories, then we need
have no hesitancy in permitting freedom in theorization and speculation. Let
us also remember that unsound theories or standpoints do not come to stay,
but, after surviving for a certain time, give way before that which is more
sound, more tangible, more near the truth, which, to be sure, is always but
approximately attained. If, therefore, the theory which I intend to set
before you for consideration may seem on first thought far-fetched and
unsupported, I beg you to remember that in a field where but comparatively
little is known with absolute certainty, it behooves us to take notice of
all theories or conclusions which may be propounded, since, even though they
may not contain the whole truth, they may, perhaps, contain certain germs of
truth, which may contribute, in some measure, however slight, toward the
ultimate solution of the problem under consideration.

With these brief prefatory remarks, I shall forthwith enter into the
discussion of the genesis and meaning of the tics.

I may say at once that this is not merely a theoretical and purely academic
proposition which has no practical bearings in the way of prognosis and
treatment. On the other hand, a real understanding of the nature, origin,
and significance of the tics is of decided value in giving us proper
standpoints and orientation with respect to the prevention, prognosis and
cure of the condition.

I need not enter into a description of the characteristics of tics in this
place. I may merely mention that tics have two aspects--a psychic and a
physical. It is, in other words, a psychoneurosis. The characteristic
mental state is one of doubt, of indecision, of inadequacy, of restlessness,
of tension, of discomfort and of dissatisfaction, which is more or less
unappeasable and irrepressible and uncontrollable until it finds vent in a
rather explosive series of motor expressions which, as it were, are the
safety valve for the peculiar feeling of tension and discomfort which the
individual has been experiencing and which is accompanied by a sense of
relief, satisfaction and a relative degree of comfort and mental rest. The
mental imperfection (Charcot) of the ticquer is a polymorphic psychic defect
(Brissaud, Meige and Feindel) characterized by mental infantilism; for
ticquers, like other psychoneurotics, are like big children. They have the
mind of children, in respect to the emotional make-up.

The mental condition of ticquers is especially characterized by the
imperfection or weakness of volition, by a certain degree of mental
instability and lack of inhibitory control of the desires, tendencies,
activities and motor expressions of the individual, this defect laying the
groundwork for the impulsions and obsessions, as also for hysterical,
so-called neurasthenic, hypochondriacal, depressive and so-called dementia
praecox reactions. The tic movement is the symbol of the psychic defect or
degeneration or instability.

The earlier investigators were responsible for the differentiation of the
tics from such other conditions as Sydenham's chorea, Huntington's chorea,
the spasms, the stereotypies, the habit movements, the myoclonias, and other
allied conditions. It is due to their pioneer work that tics were
recognized as a definite and distinct clinical entity. The process of
disintegration of these various movements and their differentiation one from
the other cannot be overvalued. Among those who have contributed most to
this subject may be mentioned Magnan and his pupils, especially Saury and
Legrain, Gilles de la Tourette, Letulle, Guinon Noir, Pitres, Cruchet,
Grasset, Trousseau, Charcot, Brissaud Meige and Feindel. Although Trousseau
recognized the the ticquer was mentally abnormal, it was Charcot who first
called definite attention to the psychic origin of the condition and to the
fact that tic was indeed a mental disorder, a psychoneurosis, a psychomotor
reaction. His lead was subsequently followed up by Brissaud, and by the
latter's pupils Meige and Feindel, the latter two authors giving us a
comprehensive discussion of the subject in their well-known classic. [1]More
recently the Freudian school has attempted to dig down into the roots of the
tree which ultimately sends forth its branches in the guise of tics.

[1] Tics and their treatment. English translation by S. A. K. Wilson. New
York, 1907. This book contains an extended bibliography.

VIEWS OF THE FRENCH SCHOOL

The usual conception of tics, as laid down by Brissaud, Meige and
Feindel,[1] may be stated as follows: Tic movements are physiological acts
which were originally functional and purposeful in character, but which have
become habits, apparently purposeless and meaningless. The motor reaction is
the result of some external stimulus or idea (normal or abnormal) or both,
which originally was necessary for the production of the tic movement, which
latter eventually became habitual and automatic, and, owing to repetition,
was executed, even in the absence of the external stimulus or idea, without
apparent purpose or meaning. At first but little more than purposive habit
movements, they finally became irrepressible acts which sought for
expression, which were but little under the control of the will, which
occurred in attacks varying in frequency, duration and severity, which
decreased under distraction and generally ceased during sleep, which were
increased in frequency and duration and severity by fatigue, emotional
upset, mental unrest, conflict and strain, while the lack of inhibition and
will power, the lack of self-control was the dominant mental state, leading
to feelings of insufficiency, doubt, indecision and incapacity, and making
the ground work for the psychasthenic reactions in the form of morbid
impulses and obsessions, and for the hysterical, so-called neurasthenic and
other morbid psychic trends.

The inherent or acquired neuropathic and psychopathic state is the basic
condition which prepares the subsoil.

From a consideration of the motor symptom we may say that it is but a
pathological habit, which, however, is apt to lead to the tendency toward or
generation of an increasing number of such pathological habits.

Characteristic of tics we may mention their being conscious before and after
but not during their execution, their being disordered functional acts,
their impetuous, irresistible demand for execution, the antecedent desire,
and the subsequent satisfaction.

The etiology of tics, as laid down by Meige and Feindel, may be summed up by
stating that they occur most frequently in young subjects, less frequently
in savages and animals than in the civilized, there is a psychic
predisposition based on heredity (of a similar or dissimilar neuropathy or
psychopathy) upon which Charcot laid great stress, imitation (especially in
the young) plays a role, as also brain fatigue (emotion, mental upset and
worry) and indolence, with the frequent exciting cause of an external or
internal stimulus or an idea, which is the explanation of the origin,
source, situation and form of the tic or tics present in any particular
case.

Scattered references to emotional shock acting as a possible exciting cause
of tics, as at times of obsessions, can be found in the literature. Dupre[2]
has made such reference. Meige and. Feindel[3] themselves make the
statement that "Fear may elicit a movement of defense, to persist as a tic
after the exciting cause has vanished." They also state that "in ticquers
the impulse to seek a sensation is common and also to repeat to excess a
functional act."

[2] Soc. de Neur. de Paris, April 18, 1901, quoted by Meige and Feindel,
page 54, of the English translation (reference 1).

[3] Loc. cit., p. 62.

Bresler[4] has called attention to the fact that the movements are in the
nature of defensive and protective movements of expression and mimicry and
originally in reaction to some external irritant or as the result of some
idea, and he proposed the name "mimische Krampfneurose" for them. This is
somewhat allied to Breuer and Freud's theory of hysteria.

[4] Quoted by Meige and Feindel, Loc. cit., p. 267.

The object of tic is some imaginary end, the influence of the will always
being present in the beginning, although later it may be absent. Tics are of
cortical origin, being coordinated and synergic, clonic or at times tonic[*]
muscular movements, physiologically and not anatomically grouped,
premeditated, purposive, of abnormal intensity, apparently causeless and
inopportune.

[*] Cruchet objects to calling these tonic reactions tics.

Insufficiency of inhibition is the cause of the beginning and of the
persistence of bad habits and of tics.

Tic is a sign of degeneration, in the biological and evolutionary sense, a
degenerative neuropathic and psychopathic basis, as mentioned previously,
being present, although often latent.

The maladie des tics is but the extreme form.

The onset is as a rule insidious, with a tendency to spread.

Spontaneous cures may occur, while Gilles de la Tourette's disease is but
the extreme form of a condition in which antagonistic gestures are
frequently adopted by the patient to adapt himself and to get to a state of
rest.

This, as I see the situation, is as far as the French students of this
subject (including Brissaud, Meige and Feindel, and even Janet) have
permitted themselves to go. And, in my opinion, their observations and
conclusions seem to be quite accurate.

VIEWS OF THE FREUDIAN SCHOOL

Recently the Freudian school has endeavored to penetrate more deeply to the
nucleus of the problem and to solve it. Freud has delimited what he calls
obsessional or compulsion neurosis (Zwangsneurosis), which is classed under
psychasthenia by the French and under neurasthenia by others. The Freudians
regard this as a distinct neurosis, sometimes complicated by neurasthenic or
hysterical symptoms. The characteristic symptom is a feeling of compulsion.
The symptoms may be motor (obsessional acts, impulsions), sensory
(obsessional hallucinations or sensations), ideational (obsessions), and
affective (obsessive emotions, particularly doubt and fear). In this
condition we find that there is an excessive psychical significance attached
to certain thoughts. Obsessions are characterized by dissociations from the
main personality. They thus exist in the unconsciousness. The original
unconscious mental processes have brought about, by displacement, an excess
of psychical significance to these thoughts. Ernest Jones[5] states that
Freud found, by his work in psychoanalysis, that obsessions represented,
symbolically, the return of self-reproaches of ancient, infantile and early
childhood origin, which had been repressed and buried until the obsession
made its appearance. "They always refer to active sexual performances or
tendencies;" and, as Jones further explains, "there occurs early in life an
exaggerated divorce between the instincts of hate and love, and the conflict
and antagonism between the two dominate the most important reactions of the
person. A fundamental state of doubt, an incapacity for decision, results
from this paralyzing doubt. The patient oscillates between the two
conditions of not being able to act (when he wants to), and of being obliged
to act (when he doesn't want to). The symptom symbolizes the conflicting
forces. These are not, as in hysteria, fused into a compromise-formation,
but come to separate and alternating expression; one set of manifestations,
therefore, symbolizes the repressed forces, another the repressing."

[5] See his article on "The Treatment of the Psychoneuroses," White and
Jelliffe's Modern Treatment of Nervous and Mental Diseases, Vol I, pp.
408-409.

To put the matter plainly, the Freudians contend that obsessions are
symbolical representations of the repressed sexual activities and tendencies
of infantile and early childhood origin. It must be remembered that the
Freudians employ the term sexual in a very broad sense, including under it
the most indirect and distant physical, mental and moral reverbations.
conscious or "unconscious," of the relations between the sexes. The sexual
impulse is here conceived of as having incestuous, bisexual and polymorphous
perverse sexual tendencies. The word sexual is not only used as synonymous
with love, but practically all emotional surgings, all feelings, all
affectivity, all sense-cravings and bodily heavings are classed by certain
members of the Freudian school as sexual. This latter interpretation and
extension of the connotation generally accorded by us to the term sexual we
surely have no right to give it.

Clark, of New York City, is the author who has carried out the Freudian idea
to its ultimate conclusion. I refer to his series of three papers[6] in the
Medical Record, and call particular attention to his last (third) paper in
which he has fully elaborated his theory of the meaning of tics.[*]

[6] His three papers, which appeared in the Medical Record, New York, in the
issues of February 7 and 8, and March 8 1914, are entitled: (1) "Some
Observations upon the Etiology of Mental Torticollis," (2) "A Further Study
upon Mental Torticollis as a Psychoneurosis," and (3) "Remarks upon Mental
Infantilism in the Tic Neurosis."  A fourth paper by Clark on tics appeared
in the Medical Record of January 30, 1915.

[*] J. Sadger has also come to similar conclusions.

Clark's conception of the meaning of tic movements and of the mental state
characteristic of ticquers must be here given. Although not denying the
basic neurotic constitution present in ticquers, Clark sums up by giving the
following definite and fully developed theory:

"The ticquer has a strong sexual attachment; this is so strong that the love
instinct ineffectually sublimates the hate instinct and in the warring
conflict doubt and physical and psychic inadequacy arise. The situation
continues and generates mental, and physical infantilism, which in turn make
for increased feelings of tension. Motor and psychic restlessness succeed.
The motor expression manifests itself most often in habit movements of
disguised sexual significance (autoerogenous pleasures) a form of physical
stereotypy, in its broadest psychophysical meaning. The mental state often
pari passu takes up obsessive thinking and various physical acts and
thoughts are formed as defense mechanisms, born of conscious guilt. The
motor habits are usually inhibited or displaced in part, and the tic remains
as a motor symbol, usually in itself non-sexual, as a fragment of the former
complete habit movement. The mechanism of the completely evolved tic is
either a conversion (hysteric) or substitution (obsessive) mechanism or
both."

By these who have studied Freudism this will, in a way, be understood. For
these who have not it may be more difficult of understanding without
somewhat further elaboration or explanation. In this connection I must again
mention that the Freudians include tics under their obsessive (obsessional)
neuroses. The theory of the mental mechanisms and evolution of these states
is given in the attached quotation, which is taken verbatim from Clark's
paper.

"The affect of the painful idea does not become transformed into physical
symptoms, as in the conversion mechanism of hysteria, but affixes itself to
other ideas not in themselves unbearable, thus producing by this false
relationship a substitutive symptom or obsession.

" . . . In all such obsessive neurotics the transformed reproaches which
have escaped repressions are always connected with some pleasurably
accomplished sexual act of childhood but may be almost entirely lost. The
obsessive acts really represent the conflict between impulses of opposite
instincts, love and hate, which are usually of equal value. The warring
conflict engendered makes for a curiosity to discover the meaning of life
forces (sexual largely) and the desire to know the end thereof. The
nuclear-complex of all this is a precociousness of emotional life and an
intensive fixation on one or the other parent or brother or sister. The
intensive love fixation waxes the stronger as the unconscious hate requires
increased barriers against its breaking through into the main or everyday
personality. As a result of these conflicts the will is partially weakened,
there is an incapacity for resolution, first in the realm of love alone;
then later succeeds a diffusion or displacement of the mechanism all over
the field of activity. A series of secondary defense mechanisms are now
brought in and these may enable the obsessive person to get square in a
limited way (as religious practices enable many to do). Some special
adaptation is required sooner or later, and the individual, having used up
all the helps, then falls back upon the different forms of obsessive acts
and thinking. Thus the obsessive neurosis is generated."

Clark then proceeds to explain:

"If one is not permitted to draw deductions from a few data as to the
further genesis of the tic disorders, we may still hold out a tentative
hypothesis, pieced together from many sources that a certain type of nervous
make-up is inherited. In such the emotional life is precocious much beyond
the intellectual faculties. The ticquer in infancy has the emotional
feelings of love and hate of an adult. Their very precociousness aids the
parental fixation and adhesion, and makes it the more difficult for the
libido to detach itself at the proper age. One should bear in mind that the
parental fixation in itself does not directly produce the mishaps of adult
life but this small fault in infancy generates wider and wider
maladaptations as development progresses. It is these latter glaring faults
and trends that make for the character defects, and these really break down
the final effort at adaptations and adjustments producing the tic or
obsessive disorder. But the essential nucleus of the defect is lack of
balance, precocious parental fixation, and continued attachment to the
parent-stem, that makes the adult defect possible. The very infantile
precociousness of the emotions argues for the hereditary transmission of
destructive temperamental qualities. Here, as elsewhere in tracing
hereditariness in so-called functional nervosities, one should take as the
unit character for study the mental traits or trends and exclude definite
disease entities applied to ancestral disorders. I believe it is not too
suppositious to think that many of these variant individuals are really
atavistic in makeup and have continued from one generation to another
special defective traits of emotional makeup which are fortunately denied
the average individual."

The writer cannot understand how the theory which he has taken the trouble
to so fully present in the above quotations can be maintained. Jones and
Clark both assert that the tics or habit spasms as probably of the same
nature as the obsessions in general. Moreover, Jones agrees that "familiar
examples of compulsion in a slight degree are the obsessive impulses to
touch every other rail of an iron fence as one walks past, to step on the
cracks between the flagstones of the pavement, or not to step on them, and
so on." A little reflection will show us the impossibility and illogicality
of viewing all these conditions as being fundamentally of sexual origin. Let
us follow the argument. If tics are of sexual derivation, as the Freudians
here openly maintain, then it must follow that those familiar examples of
compulsion, such as the obsessive impulse to touch every other post, etc.,
are likewise of sexual origin. This conclusion is forced upon us, since,
even according to Jones, the only difference between the marked tics and the
lesser manifestations is one of degree.[*] Now, these slighter impulsive
tendencies to which we have here referred are very frequent in all children
and by no means infrequent in grown-ups. They are habitual movements, which
may be of transient duration only or may, by repeated performance, develop
into more or less fixed habits. If, then, these habits are of sexual
significance, it must follow that all other habits, especially if associated
with a certain degree of consciousness or awareness, are in like manner
symbolical of the past infantile and early childhood sexual activities and
tendencies. This conclusion is, as is seen, inevitable, if we believe in
the Freudian theory of the pathogenesis of the tics. However, since this
leads us to a reductio ad absurdum, we must, of course, reject the
explanation which has been offered by the Freudian school.

[*] The accompanying mental state characteristic of ticquers is absent in
habits. We can stop doing the latter when our attention is directed to
them; not so in tics Meige and Feindel have discussed these and other
differences.

Perhaps I should also mention the fact that all of these symptoms or
tendencies which one finds in ticquers occur in other individuals who do not
present tics; and, furthermore, that all normal individuals possess these
qualities or tendencies in varying degrees of intensity and in varying
combinations, and that this applies to adults as well as to children,
although, of course, they are seen most characteristically in children. I
may further add that the difference between the mental infantilism which we
find present in the tic psychoneurosis and that which we observe in other
(normal and abnormal) conditions is one of degree rather than of kind.
Therefore, the most we can say of the mental condition in ticquers is that
there is an exaggeration of the mental infantilism or a fixation at or
tendency toward regression to this type of thinking or of reaction. And this
leads us to the further conclusion--and it is this point which I desire to
bring out in this connection--namely, that since the difference between the
mental infantilism in all of these conditions is relative, being one of
degree and of proportionate relationship or at any rate of genesis,
evolution and meaning, it naturally follows that what is in the conclusions
of Clark, as mentioned above, asserted to be an absolute and basic principle
or truth applicable to the tics, must consequently be true, but in different
degree, of all the other conditions of a similar or allied nature. Surely
the motive source is fundamentally the same in all of these conditions.

Furthermore, tics occur in animals, especially in horses; and the whole
picture, physical and mental, of tics in horses resembles that which we find
in human beings, particularly idiots and imbeciles, with tics. And the
ultimate, fundamental meaning and motive source of tics in man is and must
be the same as that of tics in horses.

To put Clark's idea in a nut-shell, it may be said that he believes that the
primary purpose of tics is not that of a protective, defense mechanism
against unpleasant situations in life but that of obtaining really
pleasurable gratifications to the psyche, these autopleasurable acts being
based on inherent defects and having a sexual significance in the sense in
which sexuality is conceived by Freud. The protective, defense mechanism
is, according to this view, but secondary to the primary and

fundamental purpose of obtaining the autopleasurable gratifications to the
psyche.

Although approving of the analytic and genetic tendency displayed by Freud,
Clark and the Freudian school in general, it is regrettable to me that the
analytic tendency and reconstructive efforts of the Freudians in the field
of neurology and psychopathology have been seriously marred by their
insistence on forcing all observed physical and psychical phenomena and
reactions into line with their fixed sexual theories and their special
psychology, which is basically wrong in many fundamental and important
standpoints.

The writer will agree with the Freudians that there must be a cause for the
appearance of these tics. This cause existed in the past. It has in the
course of time been forgotten, but still exists somewhere in the
subconsciousness or memory. This forgetting has been brought about by a
process of dissociation from the original exciting cause. But the writer
will not agree that this dissociation has been, of necessity, brought about
by psychic repression on the part of the individual, that by psychoanalysis
the condition can be traced back to the sexual activities or tendencies of
infantile or early childhood origin, or that the condition may be cured when
the original cause is made known to the patient through psychoanalysis,
without the training of the will so necessary in this condition.

Thus the analytic tendency of the Freudian school is to be highly commended.
But this analysis should not be limited to sexual analysis, but should
include a consideration of all of man's instincts. Nor should the analysis
be limited to present-life psychic factors alone, but should be viewed from
a psychobiological standpoint. In this way only will all antecedent
causative factors--physical and mental--be included in our analytic
observation and speculation.

To fully discuss or to prove the error of Clark in his conclusions would
necessarily lead me into a general discussion of Freudism, which I cannot do
in this place, since the ramifications are too numerous and the problems
involved would lead to lengthy and tiresome discussion, pro and con. I must,
however, mention the exclusively sexual standpoint assumed by the Freudian
school in their interpretations of physical and psychical activities, their
classifying of all activities characterized by a certain rhythmicity and
periodicity, and accompanied by a certain degree of satisfaction-- in other
words of all autopleasurable activities--as sexual (in the Freudian sense),
and the neglect of comparative and behavioristic psychology with proper
consideration for man's phylogeny and ontogeny or of his true genetic
history, from the racial and world history and not alone from the
individualistic psychological standpoint. As a matter of fact the
conception of sexuality assumed by Freud and his followers has undergone
many changes and is by no means definite and clean cut in its outlines. A
criticism of the conception of sexuality cannot be entered upon here. I may
merely state that what is an absolute and fixed law for the tics, what is
the fundamental and basic explanation or theory of the genesis and meaning
of the tics must apply also to all habit movements wherever and whenever
they occur, and, in like manner, to all habit formations of whatever nature.
And since our habits are but the prolongations of our instincts, the latter
also would be included within the purview of the same generalization. In
other words, if all tics have a sexual meaning, then all instincts, which
means the vital energy of man, has the same meaning. This question I have
discussed in another place[7] and cannot enter upon here.

[7] A Critical Review of the Conception of Sexuality Assumed by the Freudian
School. Medical Record, March 27, 1915.

Without furthur elaboration or discussion I am content to give the Freudian
conception to you as I have outlined it above and to let it stand for what
it is worth.

I may say that in the physical aspect of tics we have a specific somatic
manifestation which, if explained, should, in a way, be the gateway toward
the understanding of the many somatic symptoms which we find in the
psychoneuroses and psychoses.

THE EVOLUTIONARY, PHYLOGENETIC STANDPOINT

A year or more before Clark's paper appeared, I had arrived at certain
general conclusions regarding the subject of tics.

G. Stanley Hall has arrived at similar conclusions in his inspiring
Synthetic Genetic Study of Fear[8] and I wish here to acknowledge my
indebtedness to his paper for making my own ideas clearer to me, for having
given me broader standpoints and for clearly presenting a theory which shall
form the basis of the remainder of this paper.

[8] In the American Journal of Psychology, Vol. XXV, in the July issue et
seq.

Let us first take up the tic movements and see whether we can arrive at a
rational explanation for their appearance.

The different varieties of tic movements embrace the entire field or range
of systematic, physiologically coordinated voluntary muscular activities.

The main types of tics may be enumerated at this point: facial tics, which
are the most frequent and which may be tonic or clonic, are tics of mimicry
and express emotions; tics of the ear or auditory tics; nictitation and
vision tics, particularly of the eyelids; tics of sniffing; tics of sucking;
tics of licking; tics of biting and of mastication, and mental trismus; tics
of nodding, tossing, affirmation, negation, salutation and mental
torticollis; trunk, arm and shoulder tics; snatching tics; the professional
or occupational spasms, which are really a special atypical form of tics;
walking and leaping tics; tics of spitting, swallowing, vomiting, eructation
and wind sucking (aerophagia); tics of snoring, sniffing, blowing,
whistling, coughing, sobbing, hiccoughing; tics of speech, including all
sorts of sounds, stammering (in some cases), habit expressions, echolalia
and echopraxia.

It is thus seen that we have here physiological and biological acts of
different manifestations and purposes.

The tic movements have a certain significance at the time of their
performance. The physiological functions are definite.

The Magnan school insisted that tics are not morbid entities but episodic
syndromes of mental degeneration. Charcot referred to tic as a sort of
hereditary aberration, which, I may add, is surely true when we view it from
the phylogenetic standpoint, as representing a resurrection of what was at
one time a normal tendency or reaction. Noir has called attention to the
fact that the movements found in the tics correspond to the infant's
spontaneous muscular play, which means the muscular play of all mankind.

These authors were directing their efforts in the right direction. To
appreciate this we need but remember that the mechanisms or the
potentialities for the movements are inherited and have a phylogenetic
significance. At a lower psychic level, far back in our phylogenetic racial
history, all of these movements, perhaps then in a rudimentary form, had a
single, original meaning. This meaning was self-preservation, and it was
because of its value as a means of adaptation or reaction to the
environment, with the consequent maintenance of self-preservation; that the
movements or the mechanisms of the movements were selected for survival and
for hereditary transmission as inherent, unconscious, organic mechanisms,
processes or engrams. The original, phylogenetic significance attained at a
low cultural or psychic level, relatively unconscious, may or may not later
be consciously associated or dominate its subsequent functioning. But its
primary, biological significance, its real raison d'etre is to be found in
the phylogenetic, racial history of man. The present life history with its
varied experiences do but act as stimuli or as exciting factors to bring
once more into activity functions which have been preserved in the organic
structure of the nervous system.

In our return to phylogenetic, ontogenetic, rudimentary, unconscious,
organic reactions, to atavistic, prehistoric, performed, embryonic, immature
methods of response, the vestigial remnants, revivals of long ago, which
have been submerged but which now reappear due to our reversionary
tendencies--uprooted by dissociation, disintegration or regression, with its
lapse or descent to low cultural or psychic levels--these old components
which reappear or rather fall apart and appear as independent activities,
are exaggerated, inflated, caricatured or excessively performed. In our
devolutionary tendency toward ancestral methods of reaction, the individual,
resolved, so to speak, into his proximate elements, permits or is compelled
by biological determinism to permit these split off tendencies to break
forth once more, albeit in exaggerated fashion, as if let loose from the
leash of control by the higher nervous centres, and reanimified,
intensified, and magnified, our infantile, archaic, instinctive, inherited,
hidden, phylogenetic tendencies or activities held sway.

It seems to me that it is well worth while to quote at some length from G.
Stanley Hall, that great exponent of genetic psychology and all that it
stands for. His very stimulating and inspiring paper on fear, to which I
have already referred, is freely quoted in the following paragraphs.

According to geneticism, Stanley Hall tells us, all responses to shock are
vestiges of once useful reactions. In fact, the shock neuroses and shock
psychoses, if analyzable psychogenetically, "would be found to be reversions
to, and also perhaps more often than we suspect, magnifications of acts and
psychic states that were at one time the fittest of which our forebears were
capable.[9] However, all the pathological phenomena of today are not mere
revivals of the acts and states of primitive man and his ancestors, but
"they are often, on the other hand, grotesque variants and intensifications
of phylogenetic originals that were more sane and simple if also more
generic. Shock symptoms may thus be symbols of long past racial experiences
which when we have learned to interpret them more fully will tell us much of
the early history of our phylum."[10] It is the outbreaks of emotion which
"mark the incursions of the race into the narrow life of the
individual."[11]

[9] Loc. cit., pp. 178-179.

[10] Loc. cit., p. 179.

[11] Loc. cit., p. 183.

Furthermore, "the central nervous system differs from all others in that it
is par excellence the organ of registration and of physiological memory. It
is there that the traces of ancestral experience are stored so that almost
nothing that was ever essential in the development of the phylum is ever
entirely lost. Hence suggestive as are many physical traits of our racial
history, the intangible psychophysic traits must be assumed to be both far
more numerous and more indelible.

"While these faint tendencies often crop out in a behavioristic way, by far
the most of them need some stimulus of individual experiences to awaken
them, and still more exist only in the slight facilitization of impulses or
permeability of nervous centres, lability of molecular or neural tensions,
or as preferential re-enforcements, in one rather than in another direction
or manner."[12]

[12] Loc. cit., p. 351-352.

It is obvious that motor expressions of shock or motor methods of adaptation
or reaction are much older and far more prominent than psychic. But although
a changed environment made the old types of defense obsolete, they still
persist, "in a sthenic if somewhat now inco-ordinated way, and when they are
called into action now they evoke a faint phosphorescence of the old
primordial feeling."[13]

[13] Loc. cit., p. 197.

In brief it should be said that no matter how refined and how highly
cultured we are, we still fear and react to emotions "in the same terms of
the same old gross organs and functions as do the brutes."[14]

[14] Loc. cit., p. 197.

REGRESSION

As I have stated in a previous paper,[15] the pathogenesis of tics and
allied conditions can best be appreciated by viewing the subject from an
evolutionary standpoint. In our reactions and adaptations to the varying
experiences with which we meet we respond by one or more of several methods
of motor reaction. These motor expressions are of increasing complexity as
we ascend the scale of evolution and development. One of the simplest kinds
of adaptation is by simple, reflex muscular action, the response being
anatomical and not physiological in its extent. Then come our simple
physiological reactions. A more complex reaction is by those
physiologically co-ordinated motor reactions or movements which go to
comprise our pantomimic movements. This is seen most characteristically in
our facial expressions, gestures, mimicry and dancing. Still higher up in
the scale we find our conduct and feelings as exemplified in our speech. And
finally, highest of all, we must place our conduct as shown in written or
printed language. This is a brief outline of our evolutionary and
developmental ascent and of the increasing complexity and refinement of our
social conduct.

[15] Tics. Interstate Medical Journal, January and February, 1915.

In our motor adaptations we respond in one or more of these ways. When for
some reason or another one outlet us denied us, we find avenues of
expression through one or more of the other paths. Now, the manner and
degree of our response is dependent on our stage in evolution and
development, on the development of our senses, on our instincts, feelings
and emotions, on our intellect and experiences. Unable to find expression by
means of writing or speech, we instinctively fall back upon and seek
expression by a less refined method, one earlier acquired and thus lower in
the scale of evolution. This has a more or less general application
throughout the scale of human (individual and social) conduct. It is an
application of the universal law of adaptation to existing conditions in the
best manner possible under the circumstances. We may thus lay down in a
general sort of way a conception which I like to call the theory of
psychophysical progression, fixation and regression along evolutionary and
developmental lines. In the case of tics the regressive or devolutionary
aspect comes in for special consideration. We may react mainly physically,
or mainly psychically. But as a rule we react by both physical and psychic
means, the manner and degree of our conduct being determined, as above
mentioned, by our stage in evolution and development.

How does all this preliminary and general discussion apply to the problem of
the tics? The relation seems to me to be most intimate and most important.
The tics are methods of response or reaction to certain external irritations
or ideas, this response being the manner of adaptation. The response may be
mainly motor or mainly psychic, most frequently psychomotor. When the source
of irritation and the cause for action is known, our conduct is more
specific and is apt to be less diffuse, less inadequate, less indefinite.
In our reactive adaptations, which, as explained above, are greatly
dependent upon our psychophysical make-up or constitution, we protect
ourselves consciously or more or less unconsciously against disagreeable,
inimicable, unpleasant or irritating environmental factors, physical or
psychical, by bringing into activity certain psychical or physical or
psychophysical reactions or processes. The special defense reactions
brought into the foreground are those which follow the line of least
resistance, due to hereditary or environmental construction, or are those
which were most intensely stimulated or irritated and the most biologically
useful and adaptive at the particular moment or under the special
circumstances. The young child's reactions are preponderately motor, or at
any rate psychomotor and not purely psychic. When there are sources of
irritation or bodily or mental discomfort, there is a more or less general
bodily reaction, psychophysical in nature. When the irritation is definite
and clearly recognized by the child, the local motor response is also apt to
be definite. When, on the other hand, the irritation is but vaguely
perceived and not clearly appreciated or localized, we find that the child
may show a general diffuse reaction, or even, in some cases, a reaction
limited to certain regions as determined by the reaction taking place along
the line of least resistance. This is plainly seen in the conduct of the
physically sick child. Every pediatrician will find ample proof in support
of this statement in his observations of the defensive reactions of the ill
child.

When this irritation along a certain nerve path is oft repeated or quite
constant, we have a consequent repetition of the defensive reaction,
whatever it may be. This performance may be so frequently repeated that the
idea of irritation or mental conflict or the anticipation or the expectation
of a repetition of same may be quite sufficient in itself to arouse this
reaction. It may become so habitual that, even though no such idea be in
the mind, there may be a repetition of the movement whenever the individual
is nervously excited or upset, whenever there is any mental stress, strain
or discomfort. And we may go even further and say that as a result of some
unusual mental struggle, some excessive mental strain, defense or adaptation
is brought about by regression or resort to a tic, this being conditioned by
the fact that for the particular individual under discussion this is the
easiest, most convenient or most immediate form of reactive response. The
discharge is, as is seen, along the line of least resistance. This line of
least resistance is determined by the organic nervous constitution and by
certain life-experiences or habit-formation factors. In some cases the
movement, once initiated, may be continued long after the disappearance or
cessation of the external irritation, because of the sense of relief or
satisfaction or pleasure[*] which is obtained by the performance of the tic.
In many instances the habit has become rather fixed, and, as a relief from
the struggle to do or not to do the movement, and because of fatigue in the
effort to inhibit or control the movement, the individual adopts the path of
least resistance, best for immediate relief from mental struggle; and as a
psychobiological effort at self-preservation and self-gratification, as
immediately as possible and at any cost to be paid in the future, he gives
vent, as it were, to the movement.

[*] This is not, of course, of a sexual nature the Freudian school
notwithstanding.

The psychic symptoms may come on at a later date than the motor symptoms or
simultaneously, although, of course, the early life history, in childhood
and puberty, for example, if we are dealing with an adult, may show, at
least in a certain proportion of cases, that the individual was of a
psychopathic type, perhaps somewhat shut-in or asocial. If the appearance of
the psychical symptoms be simultaneous with that of the physical symptoms,
we can understand at once how, like the motor symptoms, they may be repeated
time and again. In many instances, at least, the psychic symptoms arise
later, being added to the motor symptoms. These later psychic symptoms may
be a direct reaction to the source of irritation, or may be occasioned by
the dissatisfaction at being unable to control the movement in question.

The degree of reaction, its duration and severity, depend upon the
hereditary and developmental make-up of the individual and the severity,
frequency and duration of the irritation, physical or psychical. The psychic
element is particularly apt to vary. The more neuropathic and psychopathic
the make-up the greater is the reaction.

Where mental enfeeblement or mental disorder exist, the severity and
chronicity are apt to be still greater.

There is thus a fixation, or rather a regression or reversion, oft repeated,
to a type of reaction of a very infantile, primitive sort, farther down in
the scale of evolution and development.

This picture may be further complicated by so-called neurasthenic,
psychasthenic, hysterical or other reactions. Naturally one would expect to
find these conditions, especially the more aggravated forms, in individuals
of a neuropathic and psychopathic family strain, and who themselves are
neuropathic or psychopathic or both.

It may be mentioned here, as is clearly appreciated from what has been said
before, that there is an interrelationship between the tics on the one hand
and the symptoms which we discover in the psychoneuroses, psychoses and the
mentally unstable on the other.

In all of these conditions we find a cortical origin for the disturbance,
there is a lack of will power, of inhibition and of control of the lower
centres, there is a nervous and mental instability with a tendency toward
regression or dissociation, and the assumption of more or less independent,
almost automatic activity, this activity being characterized by its almost
(relatively) infantile, primitive, archaic makeup.

Were I to take up any one of the tics as an illustration, this general idea
could be applied very nicely. But I shall not present any illustrative cases
in this paper. I shall leave it to the reader, however, to explain the
genesis and evolution of, for example, facial tics (which are so common)
from this standpoint.

In passing I may say that the tic movements may have a special, individual,
psychological significance. But this is by no means necessarily so.
Frequently, I am inclined to believe usually, these movements result rather
merely because there has been effected a psychobiological reaction,
following the theory of psychophysical-progression, fixation and regression
with involvement of the nervous paths most seriously affected or most easily
disturbed.

In the case of the tics, therefore, it is as if the various tic movements
are being used in reaction to or in adaptation to sources of internal or
external, physical or mental irritation, for the protection, defense or
self-preservation of this or that particular part of the nervous system--as
if the movements which we find in the tics and which are the expressions of
certain engrams, neurograms, mnemes or organic memories, are existing in and
for themselves, except that, in the tics, they are reacting with and for the
psychophysical organism, the organic make-up or personality.

The individual, as a biological unit, is reacting to the particular
situation which presents itself by the tic mechanism.

By granting the phylogenetic, racial significance we also give the basic,
psychophysical meaning of tics in all ticquers.

EXCITING FACTORS

How is it that these activities may come into play again? What brings them
to the surface once more?

There are many factors which come in for consideration in this connection.
In the first place the basic cause is the instinctive, organic,
psychophysical make-up of the individual. Whether and which functions
re-exist as of old and respond as means of adaptation and self-preservation,
depends on the stability and the weaknesses or defects of the nervous
mechanism or system with its various parts, systems, functions or inherent
psychophysical dispositions on the one hand, and the life-experiences and
the immediate inciting factor on the other hand.

A neuropathic or psychopathic or neuropsychopathic constitution with its
usual causes (germinal, intrauterine or extrauterine, usually of a toxic,
infectious or disturbed metabolic nature, and including particularly
alcohol, syphilis and nutritional disorders) may form the ground work. This
predisposition may be congenital--that is, present from the date of birth,
although not necessarily germinal in origin, or it may be acquired at some
period in life from physical or psychic causes. In this connection the
infantile and early childhood history are very important. Consequently the
diseases, training, example, education and opportunities in childhood and
infancy are of very great significance, the parental training and example
and the home conditions having a most intimate relationship to the
development of many of these tics. Imitation and mimicry here play a decided
role. Spoiled children, too quickly satisfied or over repressed, are apt to
develop tics. External somatic irritations may be the starting point in some
(not in all) cases. At other times an idea (normal or abnormal) may incite
the tic movements. Auto and hetero-suggestion, hypochondriacal ideas,
hysterical symptoms and obsessions may, particularly in adults, initiate
tics. Obsessions are especially apt to produce habits or tics, if they
produce any motor reaction. Tics may develop into obsessions and vice versa;
or both may co-exist simultaneously and be unrelated. The original ideas
which led to the movements vanish while the movements survive. In the insane
various sorts of delusions may be the groundwork on which a tic may later
develop. Habit movements, which represent purposive physiological acts
which have become automatic and not inhibited (hence showing weak will
power) and which seek strongly for expression, which the individual
struggles against and endeavors consciously to inhibit and overcome after
the tendency is fairly well developed, may eventually become impulsive and
irresistible with the ultimate evolution of the psychic state which is
characteristic of ticquers. Automatic habits and mannerisms or stereotyped
acts are of course not tics but the latter are but caricatures of the former
with an added characteristic mental state. Tics, as mentioned earlier in
this paper, are thus pathological habits.

Tics may also be but the symbol for a vague feeling of tension, irritation
or stimulation, which seeks relief or expression by the performance of the
tic.

Emotional stress and strain, fright, fear, excitement and mental shock can
arouse a tic. Mental conflict and unrest has not received that degree of
attention which it surely deserves. Clark and the Freudian school have
definitely called our attention to this aspect. Bresler refers to tic as a
motor reaction to original mental shock, so that it is in fact a psychic
defense reaction of expression. Dupre has stated that emotional shock may
act as a possible exciting cause of tics, as at times of obsessions. Meige
and Feindel have asserted that fear may excite a movement of defense, and
although the exciting cause has vanished, this movement may continue to
persist as a tic. They also mention that in ticquers we frequently find the
impulse to seek a sensation and to repeat to excess a functional act.

That there is a weakness of will power in the ticquer, with a lack of
control or inhibition over the lower neurones normally regulated by the
higher co-ordinating centres, so that certain automatic activities become
dissociated and exist more or less independently, is generally acknowledged.

In fact it must be said that tics are reactions of the organism, of the
organic make-up, the psychophysical personality, as a response to
irritation, excitation or stimulation, sensory, nervous or psychic! It is a
means of relief of tension, of organic reaction or adaptation, not
necessarily conscious but frequently unconscious and automatic, as in fear.
Starting in this way it may persist. In the tic we see a method by which
the individual or organic personality has met a certain difficult or
undesirable or disturbing situation. It is thus a constitutional, biological
defense reaction, psychophysical in nature, with a reversionary tendency
(when viewed from the evolutionary standpoint), and hence is indicative of
degeneration, this term being used in the racial, biological, phylogenetic
and ontogenetic sense.

There is not such a far cry from the simplest tic to Gilles de la Tourette's
disease or maladie des tics with its more pronounced signs of psychophysical
deterioration and dissociation. The tendency is a degenerative one-- a
prolapse to ancestral methods of reaction, a dissociation or disintegration
of the personality, a lack of control over more elementary activities. We
should therefore appreciate the need of early recognition and treatment of
tics and fixed habit movements, especially since there is a tendency to
spread, for the tics to multiply, and for mental symptoms and reactions of a
hysterical and psychasthenic nature to appear, if they do not already exist
or have not existed before the onset of the tic.

In brief, then, tics represent the emotional reactions and feelings of the
individual--the loves and the hates, the likes and the dislikes, the wishes
and the fears, the cravings and the dissatisfactions, the bodily and mental
tension, unrest, excitement, discomfort and disequilibration. In other words
the ticquer feels and speaks and acts by the tic. He lives by, in and for
his tic. He is attempting to meet certain situations of a disturbing nature
and to obtain equilibrium and equipoise by compensating for his feelings of
inefficiency and unrest by the tics. It is an organic, constitutional,
psychophysical, biological means of adaptation.

PROGRESSIVE EVOLUTION OF THE CONDITION

We now come to the progressive evolution of the motor manifestations and to
the mental aspect of this condition.

Concerning the mental state characteristic of the ticquer it is generally
agreed that there is a polymorphic psychic defect or disorder which shows
itself particularly in a precocious or hyperemotional condition, in a lack
of will power and of inhibitory control, leading to a state and feeling of
doubt, indecision, incapacity, insufficiency and unreality, of inferiority
and self-depreciation, with a tendency towards morbid self-absorption,
egocentricity, self-observation, auto-and hetero-suggestion, with the
consequent development in many instances of so-called neurasthenic,
psychasthenic, hysteric and various psychotic reactions. I am not prepared
to say definitely how frequently the mental state, in lessened degree,
precedes the outbreak of the tic movements. This may be present in a certain
proportion of cases, but is by no means always present and it is even
questionable whether the predispositional mental condition is the ground
work in the majority of patients.

Tics, it is true, are especially apt to develop in individuals with a
neuropathic or psychopathic history or heredity. In other cases this
history is not obtainable, the individual having been apparently perfectly
normal up to the time of the outcropping of the tic. In these cases shock
is apt to bring on the outbreaks and so one may say that the instability had
been latent and that a severe shock was sufficient to bring it to the
surface. We must remember, in all these cases, that the mental state which
we see in the ticquer is but an exaggeration of that which appears in many
children, and is similar to that which appears also in other psychoneurotic
states, and in fact the germs of this condition may occur transiently in any
of us. This psychic condition may frequently but does not always precede the
appearance of the tic movement. But it is only after the appearance of the
motor manifestations of tic that the mental state becomes prominent or
develops where it was not noticeable if not absent before.

Be that as it may, or even granting that in most patients the characteristic
mental state or the neuropathic or psychopathic make-up exists in some
measure to an abnormal extent, we do know that once the tic movements have
made their appearance and begin to spread, so that the individual is thrown
into the struggle to perform or not to perform the movement, the development
of the psychic state which we find so patent in the more pronounced forms of
tic, thereafter more or less rapidly occurs, no matter what the mental
condition of the ticquer may have been previously. I am also not prepared to
discuss here at any length the phylogenetic or ontogenetic significance and
the biological genesis and meaning of the various mental trends of the
ticquer, but I may say that they too have been acquired in the course of
evolution, for certain very definite reasons which need not concern us here,
although it can be appreciated that the biological motive of
self-preservation played a most important role in their genesis and
fixation.

APPLICATION OF ADLER'S THEORY OF THE NEUROTIC TO TICS

The progressive spreading of the tic movement which so commonly occurs, as
well as the evolution of the mental aspect which develops subsequent to the
appearance of the tic movement, may be very nicely understood if we adopt,
for our present purposes the recent theories of Alfred Adler,[16] of Vienna,
concerning the makeup and development of the neurotic. This we may do
without committing ourselves, at this moment, one way or the other, with
regard to the correctness or incorrectness of Adler's views as applied in
toto to the neurotic.

[16] Ueber den Nervosen Charakter, 1912. See also Adler's Studie uber
Minderwertigkeit von Organen, 1907.

One should note that Meige and Feindel were, in a way, on the threshold of
this theory when they said that tic, like the other psychoneuroses, is due
to some congenital anomaly, an arrest or defect in the development of
cortical or subcortical association paths--unrecognized teratological
malformations.

In a very few words Adler's theory may be given as follows: Adler assumes
that there is definite somatic inferiority (based on anatomical and
physiological changes) as the basis or foundation for the neurotic soil.
The neurotic consciously comes to realize the unconscious, organic, somatic
inferiority, and the endeavor to effect a psychic compensation or to make up
for these organic deficiencies by certain definite mechanisms, frequently
results in an overreaction or over-compensation. He thus overdoes himself in
efforts to make up for his inferiority, and in these endeavors he
necessarily makes use of unusual means and devices. It is this effort which
is the great motive force which dominates the life activities of the
individual and which compels him to seek as his ultimate object or final
goal a state which is best described as one of complete masculinity, of full
manhood, of self-maximization, of the will to live, to become powerful and
to seek supremacy or "the will to power" (Nietzsche). In following this goal
he goes to extremes and employs peculiar methods and devices, most of which
have for their object the concealment of his defects, and it is these
overcompensatory efforts and these peculiar devices resorted to, which go to
form the peculiarities or traits of the neurotic. According to Adler's
theory, the conscious efforts of the individual for psychic compensation or
overcompensation (for the unconscious, organic deficiencies) leads to a
resulting feeling of insufficiency, of incompleteness, of inferiority, of
unreality, of anxiety, of inability to face reality. Thus the mental
symptoms or characteristic mental state, being but the conscious recognition
of the unconscious inferiority, become especially pronounced when there is a
failure of compensation, or, in other words, when the individual is unable
to meet with or adapt to the situation which at the moment presents itself.
In these forced efforts at defense and compensation there is a resort or
regression to older, infantile, child-like, archaic types of reaction, of a
physical or mental nature, which are thus the protective defense mechanisms
or symbols. The struggle of the neurotic consists particularly in the
conscious appreciation of his goal and of his deficiencies of makeup and in
the attempt to reach his goal of full manhood and self-maximization in spite
of his handicapping deficiencies.

Without discussing the exact status of this theory in the case of the
psychoneuroses and their related conditions in general, we may, as mentioned
previously, very conveniently use this theory in the elucidation and
understanding of the further development of the tic condition.

Let us first consider the spreading of the tic movements. We know how in the
ticquer one tic movement may disappear only to give way to another, or one
after the other an increased number of tic movements and also of definite
compensatory movements not of a tic nature but of the nature of antagonistic
gestures and stratagems may make their appearance. The latter may in certain
instances become habit movements and eventually real tic movements. One
movement after the other may be resorted to, some perfectly consciously,
others more or less unconsciously, as reactions of the personality, of the
organic makeup or psychophysical constitution. These movements are adopted
by the patient, frequently more or less unconsciously, in order to attain a
state of equilibrium and rest, and in order to hide and make up for the
defect (the tic movements) of which he is aware. In these efforts he
overdoes himself and instead of hiding the movement he exaggerates it and
even resorts to further movements in his struggles to compensate, to adapt,
to conceal, and to flee from a state of mental disarrangement to a state of
psychophysical equilibrium.

Now, most of our gross reactions are of a psychophysical nature, so that we
find that when the old types of defense or of activity are called forth (as
they are in the tics, as explained earlier in this paper, from the
evolutionary and phylogenetic standpoint), the resulting actions, now
reanimified, appear in exaggerated form, and also tend to "evoke a faint
phosphorescence of the old primordial feeling." This probably results in the
outcropping of the various psychic trends which appear in the ticquer and
which increase in degree and in number. The most common of the resurrected
psychic trends is the general tendency to dissociation or disruption of the
personality with the reanimification, in varying degrees, of certain mental
deficiencies and inferior types of reaction which are indicative of the
relative failure of the patient to measure up to and efficiently deal with
and adapt to the struggles of life as he must face and meet them. And so,
many undesirable and inferior kinds of mental trends come forth and hold
sway. The basis of their appearance is the lack of will power and of control
over these various trends which were previously more or less completely held
under control but which are now impulsively forcing their way to the surface
and being unravelled. These trends are characterized by their relative
immaturity, their infantile-like and archaic type. And so we have the states
of indecision, of doubt, of uncertainty, of inferiority, of depression, of
unrest, of self-depreciation, of self-observation, of auto and
heterosuggestion, of egocentricity, of self-criticism, of inhibition of the
expression of the personality along the broader, social lines of effort.
The groundwork for added states (hysteric, psychasthenic, and others) is
here very fertile.

The law of psychic ambivalence and ambitendency, as so nicely developed by
Bleuler,[17] here shows itself in marked degree. There is both the positive
and the negative tendency toward the performance and execution of these
activities and reactions which are necessary for the living of a life of a
high or low degree of efficiency, so that the ticquer is obsessed by the
problem of "to do or not to do." This added factor leads to an exaggeration
of all the unfavorable psychic tendencies which have made their appearance,
and the intrapsychic struggle goes on with increased vigor.

[17] The Theory of Schizophrenic Negativism. Translated by William A.
White. Nervous and Mental Disease. Monograph Series, No. II.

The entire mental picture which we find in the most extreme forms of tic
could be beautifully elaborated along these general lines. For example, the
ticquer becomes asocial, seclusive and shuns society because of the
consciousness of the condition and the exaggerated sensitiveness. This
represents compensatory, defensive methods of concealment. Absentmindedness
and the inability to concentrate the attention are conditioned by the great
degree of attention devoted to the tic. The mental dissociation or
disintegration leads to an inflating of the emotional aspect of the
patient's mental life with a resulting increased nervous irritability and
reaction and a heightened degree of susceptibility to emotional
disequilibration and fatiguability of the mental faculties. The lack of
self-assertion, of confidence in himself, and the feeling of inferiority and
insufficiency are natural consequences of the general picture. The
inhibition of even, unhampered self-expression is always observed.

In tics, it must be noted, there is regression to more inefficient and
inferior methods of response and adaptation, the types of activity being of
a somatic and psychic nature. Following the regression and owing to constant
repetition and habit formation there is a gradual fixation to certain
methods of response which become the lines of least resistance and this is
followed by progression and development of the general picture to other tics
and psychic symptoms.

In general we note that the psychophysical reaction which we come upon in
the tics leads to the unearthing of various psychophysical types of
reaction, this unearthing consisting of disintegration or regression or
dissociation, the repressed, hidden, unconscious, phylo and ontogenetic,
archaic and relatively infantile-like activities, tendencies and
possibilities coming to the fore and unfolding themselves.

It is here seen that this broad genetic standpoint is one of the greatest
contributions to psychopathology and is of infinite aid to us in the
understanding of the problems which confront us in the domain of
psychopathology and psychiatry.

Comparative and animal psychology and the study of the reactions of
children, of primitive races, and of the mentally disordered give us a
splendid opportunity for studying it and unravelling the meaning of the many
somatic and psychic manifestations which are exhibited to us in the
psychoneuroses and psychoses and in tracing out the racial history of man.
Is it not plain that an understanding of the genesis and meaning of tics
opens the gateway to the elucidation of the origin and significance of the
psychoneuroses and functional psychoses--of reaction types of various kinds?

REVIEWS

THE INDIVIDUAL DELINQUENT. By William Healy, A. B., M. D. (Little, Brown &
Co., Boston, 1915.)

It is a rare and pleasant experience to meet a book on such a general topic
as delinquency, which has not as its raison d'etre the exploitation of some
over-worked hypothesis. The Director of the Psychopathic Institute of the
Juvenile Court in Chicago has, however, not only avoided this danger but has
given psychologists, jurists, and penologists such a report of his five
years work as not one of them can afford to overlook. As the title of the
work implies, the material is drawn from the individual study of the
delinquent. He presents the results of the unbiased investigation of the
discoverable factors in the production of criminality in 1000 recidivists,
who were mostly, though far from exclusively, adolescents-- the period when
factors, both internal and external, are most easily determined and
modified.

A careful perusal of the introductory chapter on methods reveals both the
thoroughness and open-mindedness of the author. He demonstrates that no
satisfaction was gained by the finding of any special mental or physical
abnormality, unless a more direct relation could be shown with the crime
committed than is established by mere coincidence. It is particularly
satisfying to note the precautions taken in the application of set tests,
how careful Dr. Healy and his assistants have been to determine the
completeness of cooperation on the part of the subject and to weigh this
factor in evaluating the results. One soon reaches the conclusion that the
author's own series of tests are much more likely to lead to reliable
diagnosis than the series of Binet, which demands so much of the rather
specialized capacity of abstract formulation. Healy's tests, on the other
hand, deal fairly with the primitive, untaught mind and that which has an
unequal and deceptive development of language ability. In connection with
these tests, it is interesting to note, by the way, that he finds
irregularity in results (or cooperation) to be so often associated with
epilepsy and depletion from sex over-indulgence that it may be taken as a
suggestive diagnostic feature.

The value for the reader in discovering the eclectic view-point and critical
conservatism of an investigator lies in the confidence which these qualities
beget in the reliability of results. One can read most of "The Individual
Delinquent" to learn facts without the distraction of critical uncertainty.
With this in mind, therefore, a few of his conclusions, picked mostly at
random, may be quoted. An important factor in the production of delinquency
he finds to lie in the premature appearance of adult sex development--a
precocity which he regards as dangerous because it seems to be correlated
with a stimulation of sex instinct before adult inhibitions appear. In girls
(not in boys) he finds a distinct tendency to general physical
over-development as compared with the norm of the same age. In this
connection it is striking to find how many of his cases, which seem to
exhibit ingrained criminal tendencies, are delinquents only during the
period of adolescent instability. The various statistics are naturally also
of extreme interest, particularly since they are the result of examination
of 1,000 cases, chosen for this purpose only when there were sufficient data
secured to make the individual study relatively complete, and since they are
so at variance with the publications of others who have approached criminal
statistics to prove a theory rather than to learn facts. He finds alcoholism
in one or both parents in 311 cases. He cannot determine any direct
inheritance of criminal tendencies as such, but regards them as indirectly
of great importance as there were 61% who showed distinct defects in the
family antecedents. He thinks that stigmata of degeneration are probably
better correlated with mental defect and also with nutritional or
environmental conditions than with criminalism as such. Followers of
Lombroso will be disappointed to read that he found only 83 epileptics, or
possible epileptics, among his 1,000 cases. A full two-thirds of the cases
presented no symptoms of mental abnormality while only one tenth were
definitely feeble-minded. These are but scattered data; no digest, which
might be taken as substitute for the book itself, would be advisable.

It is to be expected, of course, that psychologists (and particularly those
interested in dynamic psychology) will find mixed pleasure in reading this
work. The section on "Mental Conflicts" must appeal to all with its
practical demonstration of what can be done by psychological analysis to
abolish anti-social tendencies in many puzzling cases. There will
undoubtedly be disappointment in his failure to make general psychological
formulations, but, as the critics would differ amongst themselves as to what
these formulations should be, Dr. Healy's silence is here probably a wise
conservatism. At the same time there is certainly exhibited a tendency to be
rather too individual and give too few generalizations. This is evidenced by
his failure to regard as a factor in one case what has been admitted as such
in a slightly more obvious instance. To cite one example: On page 192, he
speaks of the inheritance of hypersexual tendencies; on page 166, we find:
". . . immodest behavior and use of obscene language on the part of a
parent, which we have so frequently found to be one of the main causes of a
girl going wrong . . . " Somewhat similar results are thus ascribed once to
heredity and again to environment. At this stage of our knowledge it would,
of course, be foolish to eliminate any specific inheritance as a factor, but
it is surprising that in the former case he does not consider environment as
a factor, although he elsewhere gives striking evidence of unconscious
influence proceeding from one individual to another via sex initiation.

It is possible that this lack of a broad psychological view point-- this
example chosen is far from isolated--is connected with a specific, and most
definitely serious, defect in the book. The treatment of the psychoses is
distinctly unsatisfactory. Apparently the author has had to rely on the
literature for his preparatory experience and has been fortunate only in
some cases, if we may judge by his references. The most satisfactory group
he describes is that of the traumatic psychoses and there he follows Meyer's
admirable study. On the other hand, in introducing the Dementia praecox
group, he makes no specific mention of any one of the cardinal symptoms of
disassociation or shallowness of affect, scattering of thought, and
delusions or hallucinations. His nearest approach is when he says:
"Variations in the way of excitement, with dullness and paranoidal
excitement are seen during the course of the disease." This is followed by
the description of a case which he says contains the symptoms typical of the
psychosis but in which no pathognomic abnormality is mentioned except
negativism-- a vague term whose meaning varies with the observer.

Not unnaturally with such unfamiliarity, the psychosis is a "dispensation of
Providence."  There is no evidence that to him psychiatry is as much a
problem of every day life as it is of institutional care of the insane. We
can, therefore, find such a statement as this:

"The mental findings and the conduct determined the fact of aberration and
that is all that should be necessary for immediate court purposes. Further
business of diagnosis should be left to a psychopathic hospital."

It is true that responsibility may and should be evaded when the psychosis
is full-blown; but how about the innumerable cases of incipient psychotic
disturbance which grade over into the "mental conflicts?"

In harmony with this diffidence is the repeated hope for aid from the
Abderhalden. or some similar reaction. For instance:

"The newer methods of diagnosis of Dementia praecox we look forward to for
help in one place where discrimination is important."

But surely a psychologist cannot hope to predict conduct by physical
findings! If Dementia praecox postulated criminality, the situation might
be different, but, as it stands, the reaction would only be of value in the
doubtful cases-- cases which are so many of them non-institutional.

With this vague conception of the psychoses it is not surprising to find
that diagnosis used faute de mieux. For instance, in describing Case 169,
of "pathological lying," he says:

"We could not in any way find evidence of mental peculiarity but we did
question his story because of intrinsic improbability." Rather conflicting
statements! Later on, he explains, the case was diagnosed as one of
"epileptic psychosis" because the subject developed convulsions, although
there is no evidence, or even claim, presented that the lying was an
equivalent, or in any way correlated with the epilepsy except as a
coincidence!

Such faults in a book of this sort are serious but only in so far as the
work is theoretical. The main object of the book is to present facts in an
unbiased way and for the first time we have them in anything like
completeness. The importance of Dr. Healy's labors cannot, then, be
overestimated. His publication will be eagerly welcomed by the army of
workers who see a few cases at various stages of delinquency and who long to
know authoritatively what the types are, how they develop, what the outlook
is, and how that may be modified by appropriate treatment. We owe him much.
JOHN T. MACCURDY.

HUMAN MOTIVES. By James Jackson Putnam, M. D. Professor Emeritus, Diseases
of the Nervous System, Harvard University. Boston. Little, Brown & Co.,
1915; 12mo. Price $1.

According to the publishers' announcement this is a study in the psychology
and philosophy of human conduct, based largely on the author's use of the
Freudian psychoanalytic method of mental diagnosis. The editorial
introduction by Dr. Bruce consists in a brief outline of the subconscious
mind. The author's preface, aside from anticipating the main features of the
book, makes the announcement that the latter is based very largely on the
personal experience of the last two years. The author gives one the
impression that this period represents to him one in which he has to his own
satisfaction mastered the relationship between psychoanalysis on the one
hand and our current conception of moral philosophy, ethics and religion on
the other. During this period he has "studied motives at close range."

The work consists of six chapters and of these the first two deal with the
philosophic method of viewing man, while the others are devoted to
psychoanalysis. In the last chapter the author makes suggestions as to the
possibility of synthesizing the two methods.

Human motives are either constructive or adaptive. The former are
associated with conscious reasoning and will, the latter with emotional
repressions. The former represent aspirations and are much higher than they
seem, since every man has an ideal--"getting out the best that is in
himself." He is a "lover of the best" and will die for and live for mere
ideas and abstractions like patriotism. He is assumed to be free because he
voluntarily creates, and is as free as anything in the Universe; and he is
free because he can choose. But where there is freedom there must be
clashing and compromise and repression. Among repressed subjects are
prejudices and superstitions, which, while irrational, unconsciously affect
our conscious motives.

Man has feelings of humanity and brotherhood but has also the feeling of
separate individuality which comes from the egoism of the young child. The
instincts also come into play in the conflict between duty to others and
love of self. No one, however good, can escape this conflict.

The old teaching as exemplified in philosophy and religion is based on a
study of man at his best, man in the abstract. This is incomplete because it
cannot promote such feelings as sympathy and understanding among men.
Something has always been needed to supplement it and this is found in
psychoanalysis in which conditions are reversed.

Religion the author regards as an existence which is in harmony with that of
the "universe-personality." If we have the attributes we give to the Deity
as reason, love (disinterested) and will, we should seek this harmony. The
"world of sense" is antagonistic to this conception, in that it leads us to
reject all other than sense knowledge. Our notions of love, honor, power,
justice cannot spring from the sense-world. We must look beyond the
latter--a mere illusion--to find the true, immutable. Mind cannot be
evolved from life but must pre-exist. God and man must be conceived in the
same way--both represent a totality of expressions of world will, both
create and persist in their creations. Man must be regarded as creating his
thoughts and acts, even his own body. Every portion of the universe is
responsible for every other portion. Man, though ever changing, represents a
"self consciously unified person" and therefore feels responsible for all he
has ever done or ever will do. Freud himself, as the author states, never
cared to generalize on the subject of psychoanalysis.

The book proceeds with a general outline of psychoanalysis which need not be
reproduced here. The subject of sexual repression, so far from being
exaggerated by Freud, is completely borne out by centuries of teaching by
the Church that all sexual matters must be repressed, because they proceed
solely from the flesh, the material world. As we have seen, however, the
author with others--both Freudians and non-Freudians--makes the libido a
form of creative energy, which attitude lifts it above the purely material
plane. Complete suppression of anything which will not down is regarded as
unwise hygiene of the soul, and the results of psychoanalysis, both as to
cause and cure of neurotic disturbances, amply sustain this view. A man's
unbidden thoughts are part of him and must be acknowledged.

Psychoanalysis cannot be employed upon a number of subjects at once. It lies
between physician and patient, teacher and pupil. The unconscious but active
motive must be brought under the conscious will. The fantastic world of
childhood must be re-created. The teacher, dealing with childhood has an
advantage over the physician who applies his analysis to adults.

The child should be encouraged to show all that is in him, and at the same
time must learn to regard himself less as an individual and more as a social
unit. He should do things which divert him from himself.

In psychoanalysis an act is nothing, a tendency everything. The latter must
be changed. In analysis of one's self one must avoid all tendency to self
depreciation, since all must make mistakes. One should also distrust in
himself whatever savors of emotional excess.

There is no radical difference between the neurotic and sound subject in
respect to the presence of unreasonable fears, compulsions and obsessions.
Stress of circumstances causes even the normal man to show objectionable
traits. Mental disease-phenomena, like physical, indicate natural
reactions, or "attempts at repair" such as are found in the organic and even
inorganic worlds.

Treatment by psychoanalysis represents an education--the removal of
inhibitions which are fixations or arrests.

The fifth chapter is in a way a resume of what the author had previously
said. He also seeks to reduce his teachings to a tabulation. The
rationalisation or adaptation of life progresses in proportion as the
individual is mature, but here maturity is by no means equivalent to age.
The process also is active in the immature child.

A subject is usually quite unaware of his fixations and explains the results
of his internal conflicts by false reasoning. Rationalisation in this
connection becomes a bad habit.

All motives are creative. The act is not the result of the immediate motive
but of all those which preceded it. The final act throws no light on the
original motives.

In speaking of certain adults as children who never grew up, we are
referring to a much larger class than is commonly understood. All who attain
mature years with fixations are to be regarded as children. All
individualists belong here unless their individualism is merely a stepping
stone to altruism. Indeed, we see in all men a desire to place themselves
on a pinnacle. This craving seeks expression in a thousand acts. Even if
outgrown it may assert itself in times of stress. It is of benefit at times
when individuals espouse just but unpopular causes. What we ordinarily call
courage involves self assertion but a higher courage is involved in
refraining from certain things.

All individuals also have occasional cravings to get away from
responsibility and back to rest and pleasure. We long to get back to a
theoretical state of childhood, as the infant longs to return to his
mother's body.

For a number of reasons this not a work to be criticized. The author does
not mean to be dogmatic. His dicta, while they may have the ipse dixit
flavor, are not meant to be axioms. The creative energy of the mind can
formulate these dicta and they must clash with the convictions of others. It
is easy to deride the method as a method, but we must judge it by its
results. In Emerson's hands it became a profound stimulus to thought to
people of quite dissimilar mental makeup. In like manner the author's work
will prove of the highest suggestive value to the reader, and especially the
materialistic reader. But aside from the general character of the book we
must not forget that it has a very definite object, to wit, to elevate
psychoanalysis to the highest planes of philosophical speculation and to
remove the prejudices of those who profess to go to the other extreme and
see in it only the slime of the pit. The author's attempt to bring it in
unison with the eternal verities is deserving of the highest commendation
and illustrates his deep faith in the nobility of this new resource for
understanding the spiritual side of man. L. PIERCE CLARK, M. D.

EDUCATIONAL PSYCHOLOGY: VOL. I, THE ORIGINAL NATURE OF MAN VOL. II, THE
PSYCHOLOGY OF LEARNING. By Edward L. Thorndike. Published by Teachers
College, Columbia University, New York, 1913.

In the first three chapters of Vol. I Professor Thorndike introduces what he
calls the 'original tendencies' of man. These are the simpler and what have
often been called the 'instinctive', or 'innate' forms of behaviour. And
they are here taken as innate, in contradistinction to learned; as the
inherited dispositions on which the character of the adult is built. In
Chapters IV to X, inclusive, these original tendencies are enumerated and
described. This is a valuable, although somewhat unordered, inventory of
the more elementary human activities. A wholesome step is taken in
replacing the terms 'pleasure' and 'pain' (subjective categories supposed
from time immemorial to account for many sorts of reaction and to be the
basis of the learning process) by the more objective terms 'satisfiers' and
'annoyers'. The author inclines away from the common idea that very young
individuals exhibit random or diffuse activities

A curiously baffling and admirably sceptical chapter on the Emotions (XI) is
followed by a largely destructive chapter on Consciousness, Learning, and
Remembering, in which Prof. Thorndike is in point of literary style almost
at his worst; and in some cases incoherent (e.g. p. 185, middle). The
chapters on the Anatomy and Physiology, on the Source, on the Order and
Dates of Appearance and Disappearance, and on the Value and Use of Original
Tendencies seem to the reviewer inconclusive and uninspired. There are
shrewd and interesting remarks here and there, particularly those of a
destructive intent, which the older reader will appreciate; while on the
whole he will wonder whether the author has, in these last four chapters,
any other than the whimsical aim of producing bedlam in the minds of his
younger readers.

Vol. II is a long treatise of 452 pages on the faculty of Learning. The
author would probably reject the suggestion that he is dealing with his
subject in the spirit of the faculty psychology. Learning, he would say, is
an empirical fact, which he is simply describing. So also, however, the
'faculties' are empirical phenomena--attention, memory, and all the rest.
The question is, do Prof. Thorndike and others like minded analyze the
phenomena in a way that reveals their mechanism, or in the unfruitful manner
of the faculty psychology? Is, for instance, the mind an aggregate of the
following "functions that have been, or might be, studied:--Ability to spell
cat, ability to spell, knowledge that Rt 289 equals 17, ability to read
English, knowledge of telegraphy,. . . . ability to give the opposites of
good, up, day, and night, . . . . fear and avoidance of snakes, misery at
being scorned," etc., etc. (p. 59)? To the reviewer it appears that these
'functions' are cross-sections of the mental life which reveal NOTHING of
the mind's real mechanism. This way, surely, lie the maximum of pedantry
and the minimum of scientific insight. The volume as a whole may be
recommended to those who wish to ascertain to what extent academic
psychology of to-day is still dominated by the spirit of faculty psychology.
E. B. HOLT.

SLEEP AND SLEEPLESSNESS. By H. Addington Bruce. Little, Brown & Co.
Boston, 1915. Pp. vii, 219.

This book constitutes the third volume of the "Mind and Health" Series. In
it the author has given an admirable and clear summary of the recent
psycho-pathological work on sleep and sleeplessness. He begins by a
discussion of the nature of sleep and considering the difficulties involved
in making such a discussion clear to the average reader, the author has done
remarkably well in summarizing the technical work along this line. He then
passes to the problem of dreams and the part played by the unconscious
mechanism involved in dreaming, laying particular and justifiable stress
upon the point, that when problems are solved or adjusted in dreams, they
have always been previously solved by a kind of unconscious incubation
during the waking moments. The chapters on the disorders of sleep and the
causes of sleeplessness are brief but comprehensive, while in the discussion
of sleeplessness important stress is laid on the mental elements involved in
every case of insomnia. A strong plea is made for the psycho-therapeutic
rather than the pharmacologica, treatment of the disorders of sleep. On the
whole the book is clearly written and can be recommended to those who wish a
brief and at the same time comprehensive account of the modern theories of
sleep and its disorders. ISADOR H. CORIAT.

A CORRECTION.
To the Editor of the Journal of Abnormal Psychology.

I wish to call your attention to the fact that the quotation attributed to
me on p. 135 in the June-July issue of your Journal is a misrepresentation
of what I actually said. Due to an oversight on the part of the publishers
of the A. M. A. Journal, the stenographer's notes of the A. M. A. meeting
were not submitted to the members of the Section for examination and
correction. The Editor of the A. M. A Journal regretted this fact and the
discussion of my paper "The Conception of Homosexuality," from which this
quotation was taken, was published in corrected form in the Transactions of
the Section of Nervous and Mental Diseases (1913) of the A. M. A. A. A.
BRILL

BOOKS RECEIVED

PATHOLOGICAL LYING, ACCUSATION AND SWINDLING. By William Healy and Mary
Tenney Healy. Pp. 278 Plus x and Indexes. Little, Brown & Co., 1915.

THE CRIMINAL IMBECILE. By Henry Herbert Goddard. Pp. 154 Plus vii & Index.
The MacMillan Co., 1915. $1.50.

CHARACTER AND TEMPERAMENT. By Joseph Jastrow. Pp. 596 Plus xviii. D.
Appleton & Co., 1915. $2.50 net.

A SURGEON'S PHILOSOPHY. By Robert T. Morris, M. D. Pp. 575 Doubleday, Page
& Co. $2.00 net.

BACKWARD CHILDREN. By Arthur Holmes. Pp. 247. Bobbs, Merrill. $1.00 net.

A MECHANISTIC VIEW OF WAR AND PEACE. By George W. Crile. Pp. 105 Plus xii.
The MacMillan Co. $1.25.

THE JOURNAL OF ABNORMAL PSYCHOLOGY

SCIENTIFIC METHOD IN THE INTERPRETATION OF DREAMS[*]

WITH A THEORY TO EXPLAIN THE DREAM-PROCESS AS APPERCEPTIVE TRIAL-AND-ERROR.

[*] A paper read at Columbia University, April 19, 1915, at a Joint Meeting
of the New York Branch of the American Psychological Association and the New
York Academy of Sciences, Section of Anthropology and Psychology.

1916, by Richard G. Badger.

LYDIARD H. HORTON

HISTORICALLY speaking, dreams have always been credited with meanings; but,
in a given case, the psychologist must ask, how far does the accredited
meaning represent the mere fancy of the interpreted and how far does it
mirror actual conditions in the dreamer's mind. To seek aught beyond these
is but idle divination. For of all dreams it is true, in the words of Ralph
Waldo Emerson, "that the reason for them is always latent in the
individual." "Things are significant enough, Heaven knows;" he exclaims,
"but the seer of the sign,--where is he?"[1]

Not till the last year of the nineteenth century, did an answer come; it was
Sigmund Freud's work, "The Interpretation of Dreams," which said, in effect,
"Here am I, in Vienna."[2]

THE FREUDIAN PRETENSIONS

"In the following pages," he begins, "I shall prove that there exists a
psychological technique by which dreams may be interpreted and that upon the
application of this method every dream will show itself to be a senseful
psychological structure which may be introduced into an assignable place in
the psychic activities of the waking state."

The sweeping character of this pretension has not been justified. The
demonstration has succeeded only with that large class of dreams in which
there happens to be a trend of infantile reminiscence and of disguised
sexual phantasy. It fails to reveal the inner nature of other kinds of
dreams or the modus operandi of dreaming as a process of thinking. And while
it is asserted by the publishers of the English[3] edition that the main
contentions of his book have never been refuted, the fact is that his thesis
has not been accepted by the representatives of scientific psychology, as a
solution of the problem.

The exponents of Freudian interpretations today are medical men associated
with the practice of so-called "Psychoanalysis;" which means that they are
more concerned to apply Freud's ideas for the treatment of nervous ailments
than to cultivate pure psychology. An examination of the methods they
exemplify in individual practice and in the large literature of the
psycho-analytic movement shows sufficient reason, in my view, why the
psycho-analytic theory of dreams should still be greeted with skepticism.
Psycho-analysts tell us that repugnance for the subject-matter has delayed
acceptance of their essentially sexual interpretations. But there is also a
resistance based on sound logical criticism. Judged by this standard,
Freud's theory appears dangerously inaccurate and needs revision.

THE TWO SCHOOLS OF PSYCHO-ANALYSIS

Dr. C. G. Jung, formerly a pupil and literal follower of Freud, is
attempting to reform psycho-analytic doctrine from within the fold.[4]
Incidentally, he tells us that there is nothing essentially novel about the
technique of investigating the dream in Psycho-analysis. It copies the
methods of historical and literary criticism and consists in collecting all
the data possible about each item of the dream. These are then called the
dream material. What seems to me novel and characteristic is the
psycho-analytic method of working up this material into an interpretation by
a process of inference. Freud and Jung are today no longer in agreement as
to the details of this process.[6] Speaking of the interpretations of these
authorities, on the basis of extended investigations of dreams on my own
part, I must say that their methods do not seem to be as rigorous, as is
required today in the investigation of literary and historical problems, nor
capable of bearing comparison with experimental psychology.

It must be acknowledged, however, that Freud has infinitely refined the
guesses of earlier generations of thinkers as to the relationship of
sleep-fancies to the waking life. He has conferred startling precision upon
the general proposition of Goethe "that these whimsical pictures, inasmuch
as they originate from us, may well have an analogy with our whole life and
fate." And he has certainly vindicated in practice that dictum of Emerson:
"A skilful man reads dreams for his self-knowledge."[1] But he has
formulated no open-sesame, as psycho-analysts proclaim.

When it comes to the use of symbols, the Viennese professor parts company
with the Concord philosopher. The latter, as we know, decried the mystical
conception of fixed symbolism in any domain. But Freud, although
theoretically agreed, falls victim in practice to the fascinations of the
dream-book cipher method which he has condemned. The adjective Freudian is
now justly a by-word, among psychopathologists, for a stereotyped habit of
reducing each item of a dream to some cryptic allusion or roundabout
reference to the primitive demands of the infantile and sexual life. Freud's
fertility in such interpretations has led one of our best-known experimental
psychologists to say, in mingled admiration and impatience: "His utterances
are those of a poet, not of a scientist."

JUNG'S COURAGEOUS RECANTATION

As spokesman of the Zurich group of psycho-analysts, Dr. Jung has lately
protested against these arbitrary translations, which he calls Freud's
"reductive method."[6] In formulating a more scientific method of his own,
which he calls the "constructive method," Jung reveals a change of views so
extensive as to suggest, on several points, almost a conversion to the ideas
that Dr. Morton Prince expressed in 1910, as to the insecurity of the
psycho-analytic ideas of symbolism.[7] At that time, Jung valiantly defended
the Freudian preference for stereotyped meanings as against the Principian
idea of highly variable meanings.[8] Now, in going to the other extreme from
Freud's cipher-like method, Jung has succumbed to the attractions of that
other popular method, equally decried by his former master: the symbolical
method of Joseph and Daniel.[9] But at least he has bravely called in
question views which he once espoused with exaggerated positiveness.

Jung's principal amendment to the Freudian dream-analysis consists in
subjecting the literal implications of the established Freudian symbols,
such as snakes and staircases, to a further, more allegorical mode of
treatment in which the sexual meaning is greatly altered. The evidence,
which Freudians continually find in dreams, for a pre-occupation concerning
infantile and sexual needs[10] is explained away, as merely incidental
reviewing of past experiences, in the attempt to solve problems of the
future by analogy with the past. In other ways also Jung alters his views,
notably by following Prince in explaining the dream on a broad biological
foundation, viewing it as part and parcel of the individual's life-struggle.
Yet it is difficult to see wherein the so-called constructive method really
applies, to the concrete dream, those biological conceptions of which it
makes ostentation. The practical consideration of telling the patient what
is good for him, and of keeping sexuality in the background seems to
dominate the technique.[6] The interpretations are no more accurate than
before. There is not much to choose between the reductive and the
constructive method from the standpoint of the application of logic.

THE SUPPOSED LANGUAGE OF DREAMS

These reductions and constructions of the psychoanalytic schools appear to
be rather favorite ways of guessing than rival scientific methods.
Unquestionably, they must achieve a gratifying number of hits under the
easygoing conditions of the psycho-analytic seance. This is obviously
satisfactory to medical practice; but the danger to psychological theory
lies in the temptation to overvalue the particular technique that seems to
bring about such successes. For instance, Freud and Jung, finding it
convenient to assume that the dreamer is attempting to express his latent
thoughts by the use of metaphors and figures of speech, have unfortunately
come to regard the behavior of the Unconscious Mind as if it were employing
a secret archaic code or language of dreams. According to Freud, its symbols
have very concrete meanings; Jung, more liberal, says they are only very
general. But both authors seem to abuse the language-analogy as a guidance
in dream interpretation. That is why psycho-analytic method today suggests
not only the free play of poetic invention, but the license of mystical
speculation.

If there is any present point in Emerson's remark that "Mysticism consists
in the mistake of an accidental and occasional symbol for an universal one,"
then, in speaking to the psycho-analyst, the psychologist should echo
Emerson further, and say: "Let us have a little algebra instead of this
trite rhetoric-- universal signs instead of these village symbols--and we
shall both be gainers."[11]

The reason we shall need a little algebra, as it were, is that many
psycho-analysts have fallen into confused ways of regarding their signs and
significations.

Consider, for example, the reputed signs of the birth-phantasy, as listed by
Freud:[12]

"A large number of dreams, often full of fear, which are concerned with
passing through narrow spaces or with staying in the water, are based upon
fancies about the embryonic life, about the sojourn in the mother's womb and
about the act of birth." . . . Again, "There are dreams about landscapes and
localities in which the emphasis is laid upon the assurance, 'I have been
there before.' In this case the locality is always the genital organ of the
mother; it can be asserted with such certainty of no other locality that one
has 'been there before.'  "

(What we should infer from the waking illusion of familiarity, which,
Emerson said "almost every person confesses"--on this basis--is too absurd
to contemplate.)

Statements like these, though far from syllogistic in form, are virtually
general propositions or laws to the effect that all dreams having the
designated earmarks or manifest content, possess additionally and
necessarily certain specified qualities in the latent content--in this case,
the meaning of birth-phantasy.[13]

Freud and Jung have stood sponsors for many such seemingly far-fetched
interpretations. How do they come to be so sure of their ground?

EXAMINATION OF THE LANGUAGE-ANALOGY[14]

Let A represent the idea in the latent content and C the corresponding
"symbol" in the manifest content. Suppose that in a number of cases a
correlation is observed between A, the antecedent latent idea, and C, its
consequent or sequential manifestation in the dream-consciousness.
Thereafter, the observer comes to interpret the re-appearance of C in a
dream narrative as a sign of the presence of the affiliated idea A, in the
latent content. And, as Thomas Hobbes phrased the matter in 1651, the
oftener they have been observed in like connection, the less uncertain is
the sign.[15] Now this is precisely the way we come to recognize the verbal
signs of our mother-tongue. And our confidence that a given speech C' is
significant of a meaning A', in the speaker's intent, is arrived at by
relying upon, if not consciously formulating, just such a causal connection.
Where an existing language is concerned, this is a perfectly legitimate
tooling of thought. But in applying such inferences to a supposititious
language of dreams, psycho-analysts are begging the question, as well as
running into other kinds of fallacy as to the powers of the Unconscious.

The meanings and significations of dream-items are not so simply made out as
in language. For one cannot readily make sure that the relationship or
affiliation between A and C has been observed in its purity; there is an
uncertainty coming from the possible interposition of a variable factor,
which may have vitiated the observation, as Alfred Sidgwick points out in
his "Application of Logic."[10] So let us well consider the basis of any
inference of meaning in dreams, and how far the language-analogy applies.

THE SOURCES OF MEANING

Fundamentally, every dream, yours or mine, consists of certain more or less
clearly remembered images or ideas; and these are secondarily derived from
some mental disposition previously or coetaneously acting in the background,
as it were: i. e., persisting through its residual subliminal nervous
dispositions. This anterior phenomenon is properly called the primary idea
or image; the other, which appears (supraliminally) in the dream is called
the secondary image or idea. The dream is thus made up of collocations and
combinations of secondary images, to which is usually added a filling-in of
fancy which may be called tertiary ideas: required, to find the primary
ideas and so, the relation of one idea to another--which is the measure of
"meaning."

Each secondary or tertiary image, in the absence of any immediate stimulus
to account for it, may usually be traced back into a primary train of
thought left unfinished during the day. This is the conception of the
perseveration of the unadjusted, stated in 1891 by Delage, in giving his
theory of dreams.[17] Its history runs back to Thomas Hobbes; and it has
been amplified lately by Professor Woodworth, to whom I am indebted for
unusually clean-cut illustrations of the applicability of the theory to
dream-life. The principle is a most important contribution to the study of
meaning in dreams.

More specifically, Prince, through his text-book on "The Unconscious," is
the exponent of the idea that the elements of meaning reside in the primary
ideas and must be sought there by highly specific investigations in the
given case: "the meaning is in the fringe of thought."  The meaning of a
supraliminal image must be discovered in its relation to the subliminal
ideas clustering around it. This implies studying by association-tests what
James called the psychic overtones, and what Prince has, in his teaching,
called the unconscious settings-of-ideas, which determine meaning.[18] Care
must be taken to find the real determinants, and to set aside spurious dream
material--which is not always facilitated by the psycho-analytic methods.

In order to show that one should not assume meanings by rule of thumb,
without investigations of this kind, Prince has demonstrated a case in which
typical phallic symbols, in a phobia of bells and towers, had acquired their
emotional meanings, not through sexual analogies, as Freudians would
suppose, but through actual contiguity-experience with church bells and
belfry, quite apart from sexual matters.[18] Similarly, snakes, sticks,
circles do not necessarily carry the sexual meanings assumed by
psycho-analysts, who are over-influenced by the language-analogy.

DECISIVE VALUE OF CONTEXT AND APPERCEPTION MASS

To Freudians such statements seem paradoxical, to say the least; but the
simple fact is that never is it correct to assume, as they do, a
transcendental connection between a symbol C and a signification A, as if
the Unconscious Mind disposed of ready-made symbols of its own. Barring
words used in their proper sense, and similar borrowings from waking habit,
the so-called symbols in dreams are essentially impromptu fabrications, in
which the association is not a direct causal connection between A and C, but
a mediate association involving a third element, which psycho-analysts
usually leave out of account.

An element of this kind, overlooked in the formulation of a supposedly
simple connection between cause A and effect C, is labeled Hidden Z, by
Alfred Sedgwick. The Hidden Z in this case is what James calls the
topic-of-thought, Ebbinghaus the set-of-the-mind, and others
apperception-mass. In rhetoric it is familiar as context. It has an
important place in thought and speech. For example, when I utter the
phrase--Pas de lieu Rhone qne nous--the idea obtained is different according
to whether your language apperception-mass is set for French or for English.
It may have happened that while I was uttering the French nonsense phrase
you were hearing it as the English saying. Similarly, the traveler in Egypt
may correctly apperceive the meaning of architectural forms of temples as
phallic; whereas it would be manifestly out of context to do so in
connection with churchly edifices of the Gothic type, which do not represent
the generative powers of nature, as do the former.

Conversely, the Freudian disciple may apperceive, in error, a sexual meaning
in a dream, when the dreamer's mind contained no reference to this topic.
Hence, the interpreter must make sure that his own apperception-mass is
attuned to that of the dreamer in the given case. That is, one must be free
from apperceptive bias. One must reject all hastily formed causal laws to
the effect that C is the sign of A in every case. Otherwise absurd
conclusions must result, as in Freud's theory of the birth-phantasies. For
the same "symbol" may proceed from entirely different significations
according to the set-of-the-mind or apperception-mass. The following analogy
of Ebbinghaus puts the matter clearly: "When a train enters a large station
there are many paths over which it might pass; but its actual path depends
on the position which was given to the switches immediately before the
train's arrival."[19] That is why one needs to detect, experimentally, the
dream material that really represents the set-of-the-mind, and thence the
significant relations called MEANING.

In this connection, I published a year ago the dream of a child of six,
containing seemingly typical phallic symbols.[20] Not one of them could be
correlated with a sexual context; but every one was concretely shown to have
reached its position in the dream through the influence of an entirely
different set-of-the-mind. It is, therefore, not safe to assume stereotyped
meanings in dreams.

METAPHYSICAL CONCEPTIONS IN PSYCHO-ANALYSIS

There are three reasons why psycho-analysts do not more often encounter this
variable element, this Hidden Z. First, such dreams as they elect to deal
with, are mostly sexual. Second, they do not apply the methods of
individual differences which have been made so familiar and so useful by
Professor Cattell in this country.[*] Thirdly, their type of culture leads
them to study the dream extensively rather than intensively and all the
while in apparent disregard of those conceptions of physiological psychology
which we now associate with the work of Wundt, of Ladd and of Woodworth, and
with the psychopathology of Prince.

[*] The writer's present psychophysiological theory of dreams was first
broached in public, at a series of meetings on the subject of Individual
Differences, held in honor of Professor Cattell, at Columbia University, in
the Department of Psychology, in April, 1914.

To be sure, Jung's recent utterances before the Psycho-Medical Society of
London, demonstrate his dissatisfaction with the Freudian conception of the
dream; but he is still far from those studies of specific mental and nervous
dispositions to which psychology has slowly come, and for which we now have
a tool in the shape of Prince's conception of the neurogram. In
psycho-analytic work a more vague use of "dream material" is preferred and
it is only by good luck that the real settings-of-ideas come into account.
Jung, no less than Freud, has forgotten that philosophy has become
mechanistic since Descartes'[21] famous year of 1637, and Jung would throw
us back to the early seventeenth century, with his energic conception of the
Libido, or the Ur-libido, now called Horme and sometimes merely elan vital.
And this, fifty years after Herbert Spencer's tremendous emphasis on
specific studies in reflex-action![22]

Fontenelle, the wittiest of Cartesians, writing in 1686, gives us a classic
tableau of this sort of speculative temper. [23] He pictures worthies like
Pythagoras, Heraclitus; Empedocles, as being invited to witness Lulli's
opera "Phaeton," at the Paris Odeon. In characteristic fashion, each in
turn tries to explain the spectacular aerial flight of the actor in the
title-role, from the floor of the stage to the ceiling. One says, that
Phaeton is able to fly by the potency of certain numbers of which he is
composed; another, that a secret virtue carries him aloft; still another,
that Phaeton travels through the air because he abhors to leave a vacuum in
the upper corner of the stage; and so on, with a hundred and one
speculations which, as Fontenelle remarks, should have ruined the reputation
of antiquity. Finally, he pictures Descartes coming along and saying: "This
actor is able to rise from the floor because he hangs by a cord, at the
other end of which is a counterpoise, heavier than he, which is descending."
This is mechanistic . . . If Freud and Jung had been of the party, can it be
doubted that the one would have ascribed Phaeton's aviation to a
wish-fulfilment of the flying-dream type, derived from a reminiscence of
erotic motion-pleasure[24] in childhood, or that Jung, for his part, would
have said Phaeton was levitated by the energic force of a sublimation of the
Ur-Libido, alias elan vital, alias Horme!

* * *

VARIETIES OF DREAM INTERPRETATIONS

Let me illustrate these points of criticism of the psychoanalytic methods,
by the analysis of a sample dream; speaking first as the dreamer giving the
simple narrative; next as Freud applying the reductive method; then as Jung
employing the constructive method; and finally explaining the dream, as I
would myself prefer, by the use of what I may call the reconstitutive
method. The dream itself, for reasons, that will be obvious, I call the
"Scratch-Reflex Dream."

"I was looking down upon a microscope from the right side of the lens-tube,
and could see, laid upon the stage, a glass slide. Under the cover-glass, in
place of an ordinary specimen, there was supposed to be a new reflex,--one
of those discovered by my friend the neurologist, Dr. X., whose scrawly
handwriting I recognized on the label. I was anxiously trying to decipher
what he had written, and was having the same trouble with it that I had
experienced in real life with the record of some of his dreams, which I had
interpreted successfully. The handwriting on the label, as I gazed, appeared
less and less like script and more like disconnected, scratchy lines or
hachures, owing to the formation of lacunae in the inky traces. It became
scratchier and scratchier as I wakened. On coming to my senses . . . "

"That is enough," we hear Dr. Freud saying, "It is obvious what kind of
reflex-action you have in mind! The word 'slide' is of a punning nature,
and in conjunction with the easy moveability of the microscope-barrel
suggests a meaning akin to that of dreams of skating and sliding, which are
usually sexual. From the standpoint of symbolics, the geometric forms and
relative positions of cover-glass and microscope suggest allusions to the
generative powers of nature--like the phallicism of the ancient Egyptian
religion, whose sacred emblems of sexual objects still confront the explorer
and the tourist. Here, the 'stage' of the microscope refers obviously to
the theatre, so often the scene of exhibitionistic activities. Your dream
represents the male and the female principles in such a manner that it must
mean a survival of infantile curiosity related to the mystery of parenthood.
Sir, this proves your Libido to have been fixated at the 'voyeur'
level."[25]

"Not so fast," says Dr. Jung, while the dreamer remains nonplussed at the
foregoing example of the reductive method. "It is not good for the health
to overvalue the past, as my colleague does. Nous avons change tout cela,
in Zurich. Your curiosity, according to the constructive method, is a
demand for satisfaction in new and better ways than those of infancy. I will
prove this to be so, by an investigation of the dream material. This Dr. X.,
what of him and his handwriting?"

The dreamer then explains that Dr. X. had consented to have his dreams
analyzed, and that the outcome had been the uncovering of his secret
intention to be married; the dreamer also states that Dr. X. had written
some very original papers on periosteal reflexes.

"Ah," says Dr. Jung, as it were, making quotations from his own writings,
(as indicated in italics) "one has only to hear this dream material in order
to understand at once that the dream is not so much the fulfilment of
infantile desires as it is the expression of biological duties hitherto
neglected because of . . . infantilism.([6]) To be sure these are sexual
objects that you are looking at in the dream, as Freud would have it. But
your interest in them is not so primitive as it would seem. For do you not,
symbolically speaking, 'look down upon' them in your fancy. And moreover,
since you are looking at these emblems of parental union 'from the right
side,' does it not therefore mean that you are contemplating something
legitimate; namely, marriage on your own account-- not exhibitionism on the
part of others. One infers you wish to put away childish sex-curiosity and
fulfil your destiny as a parent. In this case symbolical value, not concrete
value must be attached to the sexual phantasy."

At this point, the dreamer makes free to admit that he is a bachelor, and
that he would not be averse to marriage if he could manage to take a wife
and at the same time keep up his research work.

"Precisely," Dr. Jung might say, rapidly turning these clues to account,
"your interest in future advancement is clearly reflected in your anxiety to
decipher the handwriting of Dr. X., with whom you have identified yourself.
You desire to emulate his scientific achievements; his published work on
reflexes excites your ambition. The handwriting on the label, which
perplexes you, is an allusion not only to his authorship but to the
difficulties in the way of your own contribution to the science of dream
interpretation. By imitating Dr. X's triumph you wish to make your marriage
possible. Your Horme or elan vital is pushing you to evolve new and higher
forms of the Libido. You are sublimating!"[26]

THE RECONSTITUTIVE METHOD

"No, gentlemen," the dreamer replies at last, "your reductions and your
constructions are too easy-going, too conjectural, too much dominated by
prepossessions and the 'will to interpret.' The alleged sources or
determinants for this dream may or may not have played the parts you assign
to them; the mystery of the matter must remain inscrutable. But what your
methods, so plausible in effect, certainly do show is how easy it may be to
confabulate an explanation that goes no deeper than a phrenological reading
of cranial bumps or than a seance in the cabinet of a palmist. Let us turn
away from all this and consider what really happened, as by the grace of
luck I can bear witness. Permit me to reconstitute the dream as an actual
event, by the employment of certain clues which I was about to give when the
ready-made symbolism of Dr. Freud was interposed."

OUTLINE OF THE RECONSTITUTION

Inasmuch as the dream is one of my own, I may be permitted to testify that
it was unmistakably connected with a scratching sensation at my ear, as I
distinctly perceived on awaking. This stimulation proceeded obviously from a
mouse, which I had time to observe in close proximity, as it remained
perched on the bedclothes, until my own startled movements put it to flight.
Tracing the stimulation from this external source, I shall try to maintain
the following interpretation:--

First, that the dream is an associative reaction to the sensation of
scratching, in the form of evocations of imagery related in experience to
this sensory element; and that the dream-process was a part of the
perception, or recognition or apperception of the stimulus.

Second, that this reaction--let us name it apperception of the stimulus--
took place slowly and imperfectly, owing to the state of sleep, so that the
reaction was, to begin with, only remotely relevant to the stimulus, but
improved in relevancy with successive evocations, until the mental
representation closely approximated the character of the stimulus.

Third, that in and among the secondary images[27] so evoked, incidental
processes of thought, tertiary compoundings of these images, were
immediately set up; the selection and re-arrangement of these secondary and
tertiary features, constituting the revelation of a significant state of
mind which had preceded the dream.

Specifically, in addition to the mental response to the external stimulus,
there was a phantasy representing an imaginary wish-fulfilment: namely the
desire to forsake the study of histology, with the eye-straining search