The Journal of Abnormal Psychology

Part 3 out of 8



the meat I had chosen and take spare-rib. This variety of meat I had neither
eaten nor thought of for months and the conclusion that the reference is to
the story of Adam and Eve is inevitable. I dream of eating at the table of
a friend. I am a little sick and cannot eat all that is given me. My friend
points smilingly to a package of stuffed dates on my plate. One date is
apart from the package. This dream relates unmistakably to a day when I had
a pressure of engagements and had not time to eat; when I did feel slightly
ill, and when one very significant engagement was made unexpectedly--a date
apart from the others. A kiss of her lover upon the lips of a young girl
becomes in my dream a piece of court plaster on her upper lip, and a woman
about whose prospective marriage some one asked, returns, in my night vision
to a university to obtain the degree of B. Ed., which in sleep I took to
indicate Bachelor of Education but which is open to a different
interpretation.

Visions of natural scenery are most remote, strange, beautiful and
delightful. They are doubtless composites of actual localities but in their
construction and use fine powers of imagination are at work and real life
seems left far behind. In my dreams of this type the ocean stands as a
symbol of Life itself, of the mighty and profound procreative force the
entrance into whose domination is the crisis of existence. For this
experience is demanded the mightiest symbol. It is evening. I am on the
seashore with my father and mother. Greatwaves are rolling in. I look
backward and see one wave break where we have passed. My mother is afraid
but we cannot turn back. I am calm. Then--this immediately follows--I am
in a kind of tunnel and fear that I shall suffocate. This and the following
might be construed as symbolising my own birth. I am in a boat on the ocean
with my mother. The waves are tremendous and as she goes out on deck to
close a great door I fear she will be washed away. But she is safe. Next
there is a violent jar and the boat is aground. Then I see down a city
street. In a particularly impressive dream I approach the sea at early
morning. I think I shall see the sun rise from the water. I go over a hill
to reach the ocean which is frozen near the shore. I go into a little house
and when I come out I can not close the door. The wind is high and the
waves enormous. Then there is calm and I see a man on horseback in the
water. Next a fog rises and out of the mist a little boat comes toward me,
the oars flashing like silver. Then a little boy comes ashore. There are
strange dreams of a frozen ocean, and of being out in a small boat with a
friend, soon to be married, with ships passing and we afraid. I am near the
ocean and longing to see it, and once trying to go with some one to see the
foundation of the sea but am hindered.

Among visions of mountains is the following.--I see high and beautiful
mountains as I stand on a bridge. I hear the squeal of a horse. Then stones
fall from a mountain-top into the stream and spirals of bright water rise to
meet them. After receiving from a man of vigorous, vital personality an
atomizer for a slight hay fever, I dream of high mountains and at the foot
of one is an irregular patch of red sunlight. Above are two houses, not
side by side. In front of them is a fine, slanting veil of rain. A dream in
which indications of the reputed "father complex" may be found is one of my
father and myself in a team at the top of a high mountain, at the end of the
road. My father wants to drive off among the peaks but I fear that we shall
be lost. I dread the night there but think I can call for help. Somewhat
similar is the following.--I am in a high, steep place with my father. I
fear. He moves a stone and in the hollow of a rock I see moss or fungus.
There are often brief, passing dreams in which no person figures. I see a
bridge across a chasm; it is long and extends beyond where a bridge is
necessary. I see two rivers join and wonder what the resulting stream is
called. I see a river from the side of which emerges a spring of water and a
new stream. A small, steep hill, snow-capped. A river with water above the
banks.

To dream of moving to an old house--what signifies this? Apparently
nothing. If one is to dream it must be of something--houses or people or
scenery. But to dream often of going to live in an ancient house,--of trying
to find in it my room; mosquito netting at the window, not quite tight; from
my room into a smaller one a door which I try to fasten but can not because
at the bottom it is a swaying curtain, the wall paper loose and a mouse hole
near the floor; a long, sunshiny room where I see what appears to be a rat
but which becomes a little kitten, weak from long confinement, that follows
me from room to room and at last through a door leading to a porch;--why all
these accessories? Once I go through many rooms--furnished but
uninhabited--and come to an upper bed chamber where, upon a couch, lies a
woman, quite dead I think; but presently she moves one hand. Again I go
through room after room until I reach one where still another woman--or is
it the same--lies dead on the bed. As I look she becomes a beautiful child
who has lain there forty years. The child stirs and opens its eyes; I think
something should be done to keep it alive but the eyes close, and sleep, or
death, reigns again. After calling upon an expectant mother who showed me
her layette, all white and blue, I dream that I go in an old house to a room
with blue papered walls, a blue and white spread on the bed and a case of
books, one of which is Dickens' Great Expectations. In one old house I find
the bulbs of some plant sprouting on a shelf; in another I open the stove
and find to my surprise that fire is still there. In still another house I
see behind the stove a closed door which I long to open. I go about the
house, up steep, worn stairs, down again and out into a garden where there
is a single strawberry and I think staminate and pistillate plants should be
set out to insure fertilization. Always I think of the closed door and
presently I return to the house and enter the room behind the stove. On the
floor is a green veil of firm texture. And at last there are cobwebs on the
ceiling of my old house and I still search for my room.

After the presentation of this array of symbolism quite spontaneously the
interpretation arose in my mind. The old house is the recurring abode of
life. I would dwell there and take my place in the line of succession.
Quite in line with this symbolism was the very beautiful dream of a young
woman not many months before her bridal which I give in her words--"With a
crowd of unknown people I was to visit and go over a haunted house. The
living room was nicely furnished in antique furniture and the whole house
was very still. We went upstairs, and it passed through my mind that people
who were dead and gone had moved through the rooms. I was coming down the
stairs when suddenly a pipe organ burst forth. That was the haunted
part--music in the air, no organ at all. We were awestricken and I awoke
with the same feeling." In dreams of this character we find it necessary to
predicate a creative, myth-making tendency in the structure of the mind by
means of which currents of life flowing beneath all thought become
articulate.

Coming now to examples of reasoning by analogy directly expressive of the
desire for maternity, I wish to make still more plain my view of the reason
for symbolism. Maternity is untold ages old; intelligent comprehension of
the function very recent. That portion of the mind functioning in
dreams--that is in the majority of dreams--is unable to picture the process
and its necessary antecedents. (Frankly sexual dreams occurred to me very
rarely.) Instinctive acts are the last to be made objects of thought; a
relatively high degree of mental development is necessary before the
requisite detachment from the process can be obtained and as we have seen
this detachment is beyond the power of the self that dreams. Hence the
recourse to analogy and symbolism.

I call upon a woman who is pregnant and whose face is slightly bloated. In
that night's dream I look in a mirror and see that my face is plump. I think
I am too old. I see on the street a young girl in short skirts wheeling a
baby carriage. My friend tells me that the girl is a mother. That night I
dream of being in a shop to buy an article which I in reality intended to
purchase and in addition looking at a dress for a girl of twelve or
fourteen. I hear of a pregnant woman who ran away and worked for a time in
a mill and a night or two after I have a dream of a devious walk with many
details which finally ends at a kind of factory. An expectant mother tells
me of her trip to a neighboring town where a friend gave her a tiny
crocheted jacket. Soon after I start in a dream for that town, afoot, in
the dark, without lantern or money, and hampered and stumbling, make the
weary journey.

A dream which upon analysis proves extremely interesting is the following:--
I come out from a house and stand looking at other houses. I am waiting for
some one, and look toward the street. In the yard I see a large elm tree
nearly sawed off but at one side the wood is continuous,--to indicate that
the tree is still alive. I look up. A bough sways and I am dizzy. I think
the bough will fall. Beneath the tree is a sick woman on a couch. Until the
clue was found this appeared a mere aimless mixture of imagery but one
circumstance makes it very clear. Shortly before I was reading a book on
biology and in the section devoted to the influence of environment on
organisms a portion of the trunk of an elm tree was shown and the influence
of various factors noted as indicated by the annual rings of growth. One
considerable variation was due to the fact that children had swung from one
limb of the tree. At the time of reading the fact made so slight an
impression that after the dream some time elapsed before I recalled it and
then so faintly that I had to refer to the book for verification. Thus we
see upon what slight and obscure basis a dream may be constructed.

That all dreams do not originate in one section or at one level of the mind
is quite evident. The range extends from those which almost merge with
waking thought to creations strangely remote and primitive. When I dream
that Goethe is a guest at my home and I am trying to ask him in regard to
Faust, Wilhelm Meister and Mignon,--when after reading of x-rays, ether
waves and electrons wake with the thought, "To solve the problem of matter
would prove materialism,"--when I dream that I am conversing with a
conservative friend who says that he does not like new religions and I reply
that Moses and Jesus were new once, it is plain that a different stratum of
mind is operative than when I dream that I am in an old fort and chased by
three rats, or that a snake is on my bed and my father kills it with a
pitchfork, or strangest of all, that I throw an egg at the plug of a sap
bucket which it hits and then flies to the left; it is rotten. Again, a
very vague dream, I, see two eggs and then am climbing inside a kind of
tower. A dream which immediately preceded the menstrual period, is as
follows:--I pass a narrow, dark canal which seems to be under cover. On the
very brink is a child and I fear it will fall in. A man is there whose
business it is to save the child but be does not. That this indicates the
impending passage from the body of the ovum can hardly be doubted. Under
like conditions--this before sleep--I see a doorway filled with flowers.

It was natural that after a time I should wonder what event of the day would
be woven into a dream; as I performed certain acts I found myself wondering,
will this appear tonight, and how? One Sunday I walked across lots to church
and on the way picked a twig of balm of Gilead poplar keeping it with me
through service for its fragrance. That night I dream that I am in a
pasture looking for fertile fronds of the cinnamon fern which I fail to
find. I see cows and am afraid.--This based on reality of a few days
before.--At length by a stone I find a fern coiled as in spring. This
becomes a squirrel, the male comes, and then they are lions. The male has a
sprig of leaves which he lays at the feet of the female and which she eats.
I want to know what the leaves are but fear to look closely because of the
lion. I found it difficult to deliberately influence dreams by suggestion.
The dream-self is not to be coerced and usually I over-did the matter. Most
of my examples deal with flowers and perhaps the most apposite is the
following:--I plucked a stem of blossoms of white everlasting and wore it
inside my waist on my bosom all day, asking as I fastened it in,--How will
this reappear in my dream? The following morning as consciousness returned,
I had a vision of a baby's bottle filled with milk and beyond it, more
faint, another similar bottle. It is fair to say that this outcome was
entirely unexpected. Another night after watching Venus, low in the
southwestern sky, I dream that I am molding a statue--strangely enough the
arms as the reference is to the Venus de' Melos--and the figure is that of a
young woman of immoral life.

My store of dreams is so great and varied that the forms of symbolism are by
no means exhausted. The reception of mail is a favorite subject and here
again one may say that this is the most natural of dreams and quite its own
excuse for being. But strange things come in the mail,--pieces of turf in
which are growing tiny plants, boxes of rice, jelly, breakfast food, cooked
fish still warm; and once a sack of mail is emptied upon my door-stone--not
by the postman but by a man who the day before drove past with a little
child. Other recurring motifs are strawberries, yeast, Bologna sausage, ice
cream-- once poured over slices of clear, transparent fruit which I eat,
this very plainly referring to the fertilization of the eggs of fish about
which I read the preceding evening:--"As soon as the female finishes
spawning the male will approach the eggs and eject a milky fluid over them
to effect fertilization. If this is successful the spawn will have a clear,
glassy appearance." The dream-self can turn anything to its use,--I read of
certain suffrage activities in England and forthwith dream that I attend a
suffrage meeting. But the house at which it is held is in reality the home
of a woman nearly my age, who is pregnant.

I pass over all the dreams obviously of an infantile character, and likewise
those of travelling and of packing for a journey. More unusual is the dream
of a flight of birds which twice occurred under conditions which left no
doubt as to its sexual character. A house having a wet sink and a dry one is
the verdict of my dream-self regarding a home in which the woman can bear no
more children because of physical disability; and a railway station where I
go down the steps, pick from the floor a flower--wondering if it is all
right,--reach a restaurant in which seventy have that night been served and
where I lose my flower, symbolizes a house of prostitution mentioned in
Chicago's famous report where one woman served sixty men in one night and
was said to have seven thousand dollars in the bank. Beneath convention
strange unconvention lurks. A young woman of irregular life appears in my
dream as one with soiled skirts, and, very vaguely, some one's else skirts
are soiled also. After seeing a print of Tompkins' painting, Hester Prynne,
heroine of The Scarlet Letter, I dream that I go to a shop, where I have
great difficulty because of darkness, to buy some dark green silk for
embroidering a letter somewhere on my dress. Not to pander to the base in
human nature are these details given but to make known life's realities to
those who are blinded by theories. The frank and honest truth is never foul
and monstrous. Society can be renovated only when all the facts are brought
to light.

In conclusion I give the dreams of a single night:--First, a drunken man and
girl in the same team; I think they should not be there. Then I am on a
porch looking off at a headland with ice at the foot. Farther up the hill
are quantities of ice--a sheet of it over the ground and in one place it is
as if water had been poured and allowed to freeze. In the midst of this
last, which is not on the hill, is a fine and shapely tree with the ice
about it very smooth and shining and slanting somewhat. I think it is a good
place for skating. In the morning as I recalled this dream, quite abruptly
into my mind came the remark of Philina in Wilhelm Meister, after seeing a
woman "great with child," "It were prettier if we could shake children from
the trees." Next I see far off high mountains with sunlight on the summits.
Then I am in a porch enclosed by a wire screen; by me is a woman. From the
window of a building outside, which seems to be a hospital without funds, a
woman looks at me. I want to see far off and shade my eyes with my hands.
I think I must cut the screen in order to see clearly. Then I see a rampart
and beyond it is the ocean. I hear a bird, a robin, on the rampart. Near
it is another bird, large, gray and strange. Then it is a rooster. The key
to this dream lies in the fact that the day before I received an appeal for
financial aid from a hospital and the printed request showed the picture of
a row of nurses each with a tiny baby in her lap. Finally I go into a
bed-room. On the bed is a baby. I uncover it and it moves and cries. It
wants its mother and I go to find her.

That the mind which dreams is not uncognizant of the hopelessness of its
aspirations is strangely indicated by the following for which at the time I
found no direct exciting cause:-- I see two long lines of seeds planted and
at the end of the rows tiny lettuce plants. Near by are apple trees in
blossom. But it is autumn.

Bergson at the close of his essay on dreams hints that the mind may
transcend its conjectured limits and be influenced in profound slumber by
telepathy. This is but an hypothesis which must long await verification. My
own dreams which apparently forecast the future are out-numbered by
erroneous forecasts and one vivid dream of the death of a friend though
coinciding as to the day, is not of great value as evidence as I had been
expecting the news for weeks, and further, beyond the surface portent the
dream is remotely allied in certain details with more personal and vital
memories.

Though the dream process may to a certain extent be made verbally
intelligible he who studies it most best realizes the attendant mystery.
Dream-self, subconscious ideas, visual images,--these are but terms which
bridge the abyss of our ignorance. Further exploration of the mystery is of
value not only from the standpoint of pure science, to whose domain there is
no limit, but also in the interest of education, health, sanity and
morality. It is neither necessary nor wise for all persons to study their
dreams, but for those who shape the growing thought and conduct of the world
a knowledge of even the remotest outposts of human mentality is supremely
important.



REMARKS UPON DR. CORIAT'S PAPER "STAMMERING AS A PSYCHONEUROSIS"[1]

[1] Dr. Isador H. Coriat's paper with this title appeared in the Journal of
Abnormal Psychology, Volume IX, No. 6, February-March, 1915.

A CRITICISM

BY MEYER SOLOMON, M. D., CHICAGO

I have frequently wondered whether those of us who oppose the dissemination
of the Freudian theories, at least as they are being and have been applied
to the psychoneuroses and to psychopathology in general, have solved the
problem as we should have solved it or fought the fight as we should have
fought it. It has not infrequently seemed to me that our plan of battle, our
campaign, the battle we have in a way waged, was not as consistently planned
and as well organized as it should have been and as the occasion really
demanded. There were many lines of attack open for us. We could, if we so
wished, have made generalized and wholesale attacks upon all that Freudism
stood for regardless of whether, in certain principles, it was right or
wrong. This some have actually done. Although this method is not in my
opinion fair or scientific, yet, so reckless and so uncritical have been
many of the Freudians, and the foremost Freudians at that, in their
declarations and conclusions, that I can readily see how one may be prompted
to resort to unmitigated ridicule and general condemnation of the entire
system, the standpoints and the conclusions that have been made the bulwark
of the Freudian movement. Others have adopted a different method of dealing
with the situation. They have entirely ignored the Freudian school and all
that it stands for, and have permitted the members of this school to go to
ever greater and greater extremes and excesses, with the more extensive
elaboration of their system, so that eventually the error of their ways
would be apparent to all, since the final conclusions to which they would be
led would be openly fallacious and give proof positive that the foundation,
the psychology upon which as a basis the Freudian system of interpretation
and analysis has been erected, was defective to such an extent that it would
crumple into disintegrated portions under the heavy load of the unsupported
superstructure. This method has by no manner of means been unsuccessful.

A third standpoint to be assumed is that in which replies to or criticisms
of individual articles, rather than criticisms of a general nature and
applicable to the Freudian psychology or method or conclusions in toto, is
adopted as the proper method of dealing with the situation with which we
found ourselves with the advent and spread of the Freudian movement. This
last-mentioned method is probably the most desirable of the three methods
which have been here mentioned.

And it is the method which I shall follow in this criticism of Dr. Coriat's
paper, because, among other reasons, I believe it is the fairest to all
concerned.

It is not my purpose to take up for discussion the various statements, made
by Dr. Coriat, with which I disagree, but rather to consider only the
question of the correctness or incorrectness of the general thesis which he
has presented.

The reasons for my entering into a criticism of this particular article by
Dr. Coriat may be stated as follows: In the first place I am interested in
the general problems of psychopathology, and of the psychoneuroses in
particular. In the second place I am somewhat unusually interested in the
problem of stuttering.[2] This latter interest has two main sources of
origin: (1) I am deeply interested in the question of stuttering because of
my general interest in neurology and psychiatry, including the speech
disorders, under which heading stuttering finds its place; (2) I have
myself, from earliest childhood, suffered from this affection and so find
myself naturally much interested in the subject.

[2] In this paper I shall use the terms "stammering" and "stuttering"
interchangeably.

It is not out of place, it seems to me, to at once answer one of the stock
arguments which certain Freudians have been in the habit of offering as a
reply to those who criticized their theories and conclusions. I refer to the
argument or rather the insistence that those who oppose the spread of the
Freudian ideas are themselves unconscious illustrations of the truth and
accuracy and general applicability of the Freudian dicta. In this argument
they accuse their opponents of unconsciously indulging in or being victims
of a defense mechanism, as a means of self-justification and
self-rationalization, based on repression, sexuality, etc., in order that
their hidden, unconscious, repressed, forgotten desires, tendencies and
inclinations may not be brought to the surface and consciously acknowledged.
In other words, in my particular case (my present criticism of Dr. Coriat's
paper), I could, perhaps, be accused, by those Freudians who are in the
habit of resorting to this charge as their own method of self-justification
and self-rationalization, as the path of least resistance and as a loophole
through which they can escape from meeting the situation presented to them
by a frank self-examination and acknowledgment of error or by a fair and
satisfactory response--I could be accused, I repeat, of showing, by the very
fact of my criticism, that all that Dr. Coriat stated concerning the origin
and nature of stammering was true.

In replying to this oft-repeated and oft-resurrected assertion, I need not
be detained for any great length of time from proceeding to the
consideration of those facts which are the real purpose of this paper. I
need only say, in parentheses, that it does seem to me that there surely are
a few anti-Freudians (and I may here include myself) who are perhaps, who
knows, capable of that degree of unprejudiced self-criticism and intensive
self-analysis which is necessary for the purposes of making ourselves
eligible for candidacy as critics of the Freudian theories and dogmata. I
may go further and gently suggest that it even seems to me that there may be
some others of us who are capable of as great a degree of such
self-criticism and self-analysis as, and it may even be of a greater degree
than, many of those who have been making this claim. I am content to leave
this point to the sound judgment and good sense of the average reader of
these pages.

The second point that I should bring out in this connection is as follows:
That which is of fundamental importance and of basic significance in the
life of the psychoneurotic or the stutterer, that which is the fundamental
and essential motive force which controls the psychoneurotic and the
stutterer is also true, but in greater or less degree, for all of those who
are not within the confines of this group.[3] And as a further statement I
must assert that whatever is deemed to be the essential and primary cause
for stuttering must also be applicable, in the same way but in different
degree, to all the other manifestations of speech disorder such as the slips
of the tongue, and many other of the psychopathologic acts of everyday life.
Consequently, if the Freudian theories of sexuality are directly applicable
to the problem of stuttering, it follows that they must likewise be
applicable to all the other disturbances of speech just referred to. For,
if followed out to the very end, we shall find that the possible mental
content and mental mechanisms are the same for all psychopathologic acts,
whether of everyday life or distinctly abnormal and outside the pale of our
average range. If sexuality lies at the bottom of stuttering, it must be at
the root of all other psychopathologic acts, of whatever nature, of whatever
degree and wherever and whenever found. I cannot devote the time in this
place to enter into an elaborate discussion to prove the truth of this
thesis. But I can gain my point more easily and more directly in another
way. Although Freud and his followers have not stated, in just so many
words, that the psychopathologic acts of everyday life have the same hidden
mental content that the psychoneuroses have (although it is my contention
that this conclusion is but a natural extension of their sexual theories
concerning the psychoneuroses), yet we do find that Freud and the Freudian
school in general apply their sexual theories to the whole group of the
psychoneuroses. Now, since stuttering is a psychoneurotic disorder of a
certain special type, it is understood that they must believe that
stuttering, as a matter of course, comes within the rubric of their
generalization. As a matter of fact, if their sexual theories were at first
applied only to stuttering, as they were originally applied to hysteria, it
would mean that, by a process of reasoning, the Freudian school would have
to apply their dicta to all of the psychoneuroses. This was, in truth, just
what did occur, beginning with hysteria. And it is seen that the same thing
would have happened had they begun with stuttering. I contend, further, but
I shall not endeavor in this place to prove the correctness of my
contention, that what is absolutely and without exception, fundamentally and
essentially true of the psychoneuroses is likewise true, in different
degree, of the psychopathologic acts of every day life. This would be the
conclusion to which I would be forced if I started with any one of the
psychoneuroses, whether it be hysteria or stuttering. One can thus see that
my statement that if Freud's theories are true for stuttering they must of
necessity be true for all psychopathologic acts of whatever sort is quite
true.[4] I could go much further and prove that if Freud's theories were the
primary and basic explanation for stuttering they must be applicable to all
manifestations of human mental energy, which to me would mean that they are
no less true of all vital energy, human or otherwise. In other words, the
solitary application of Freud's conception to the problem of stuttering
would lead us, by logical steps, to the ultimate conclusion that the vital
energy was sexual--a conclusion with which Jung will not agree. And let us
not forget, too, that the term "sexual" would here be used in a
psychological sense, so that, in fact, Freud's theories of sexuality as the
explanation of stuttering would lead us, step by step, to a psychosexual
conception of the universe. And is this not exactly what the Freudian school
has assumed?

[3] Freud himself agrees that his sexual theories apply to all mankind and
that the psychoneurotic differs from others in not being able to
successfully and completely repress or sublimate the undesirable sexual
trends.

[4] Freud himself agrees psycho-pathologic acts of everyday life are the
formes frustes of the psychoneuroses and that this shows that we are all
slightly nervous.

I fear that I have not made myself as clear as I should and as I should like
to, but at the risk of being misunderstood, or of not carrying the reader
with me in my argument, I shall not enter into any further discussion of
this aspect-- the wider meanings of Dr. Coriat's paper.

As can be judged from the above remarks, it was no surprise to me to see
such a paper on stuttering as Dr. Coriat's. To be sure it was tacitly
understood, by those who could read between the lines, that this must be the
belief of the Freudian school, since their conclusions were said to be true
of all the psychoneuroses.

I had also known that a few Freudians abroad had arrived at conclusions
similar to those presented by Dr. Coriat, but since, so far as I knew, no
paper along this line had appeared in the English or American journals, I
did not give the subject any serious or special consideration and had not
the slightest idea of refuting the statements. When, however, Dr. Coriat's
paper appeared, I concluded that it was not out of place for me at this time
to enter into a criticism of these views.

I have felt on many occasions that too many of the statements made by
members of the Freudian school have been left unchallenged, with the result
that the views promulgated have received quite widespread dissemination; so
much so that many believe that the sensational and unsupported views which
have come to their ears are accepted as the untarnished truth by most or all
psychopathologists, and were a definitely proven and generally accepted part
of psychopathology. It is therefore not at all surprising to find so many
workers in other fields of medicine who believe that the terms
"psychopathology" and "Freudian psychoanalysis" are synonymous, one and the
same thing.

This also is one of the motives which prompts me to write these lines.

I am furthermore impelled by the purely scientific desire for truth and
accuracy, as applied in particular to the problem of stuttering.

And last, but by no means least, I see a serious danger to the community in
the uncritical acceptance and the widespread dissemination of the views
promulgated by the Freudian school.

Let me assure Dr. Coriat that I regret very much that I find myself
compelled to take the field against him or rather his paper in this
connection, and that no personalities enter into the question at issue, but
that it is a purely scientific problem, which demands the freest discussion,
from all sides. Each of us is entitled to his personal opinions in this
matter. The question of sincerity and honesty of purpose is not at all
breathed. It is purely a matter of "What is the truth?"

And it shall be my object in the following brief discussion not to give my
personal views upon this subject, nor even to dissect each and every
statement in Dr. Coriat's paper with which I find myself at issue, but
merely to show wherein Dr. Coriat is in most serious error.

I shall confine myself to the question of the application to stammering of
the sexual theories so rampant in Freudism. Besides, I shall avail myself
of the privilege of giving, in Dr. Coriat's own words, the gist of his
theory or concept.

"The attempt to repress from consciousness into the unconscious certain
trends of thought or emotions, usually of a sexual nature, is the chief
mechanism in stammering." This is the only place in the article where Dr.
Coriat expresses any doubt as to the universal validity of his theory for
all cases of stuttering. But I consider this merely as a slip of the tongue
or pen, because in the other portions of the paper the conclusion concerning
the sexual basis of stammering is unqualifiedly made general, and I find
that even on the very next page, at the conclusion of the paragraph of which
the sentence just quoted is the beginning, there occurs the statement that
"the fear in stammering is a deflection of the repressed sexual impulse or
wish." With this beginning Dr. Coriat proceeds to explain: "Thus the
repressed thought, because of fear of betrayal, comes in conflict with the
wish to speak and not to betray (the secret through words[5]). Hence, the
hesitation in speech arises and as the repressed thoughts gradually are
forced into the unconscious, there finally develops the defective speech
automatism, either stammering or a spastic aphonia. This arises in childhood
after the child has learned to speak."

[5] Words in parentheses mine but taken from Dr. Coriat's paper; for
explanatory purposes.

Moreover, "the hesitation of stammerers on certain words or letters is due
to disturbing complexes. The stammering does not cause the inhibition, it
is the inhibition which is at the bottom of the stammering."

"Two types of stimuli lead to stammering, either internal conflicts, or
external instigators which throw these conflicts into activity. The internal
conflicts are either conscious or unconscious fear of betrayal (and
therefore a wish to retain a secret), and this mental attitude leads to the
dread of speaking, a genuine conversion of morbid anxiety into defective
speech. . . . The external stimuli act like dream instigators, for instance
the fear of speaking to relatives or to intimate friends may be based upon
the fear that the unconscious wishes may be discovered and this stimulates
the unconscious anxiety, whereas with strangers, speech is free, because the
dread of discovery is absent."

"Thus," says Dr. Coriat, "the beginning of stammering in early childhood . .
. is caused by the action of unconscious repressed thoughts upon the speech
mechanism, the repressed thought obtruding itself in speech."

In brief it is contended by Dr. Coriat that the stammering arises as a
defense or compensation mechanism, the object of which is to keep from
consciousness certain painful memories and undesirable thoughts, in order
that they may not be betrayed in speech. In fact, as Dr. Coriat says, "all
stammering, with its hesitation, its fear, its disturbing emotions, is a
kind of an association test in everyday life and not a phonetic disturbance.
It is a situation phobia, the same as phobias of open or closed places."

Consequently, according to this view, stammering is purposeful and
intentional and not accidental. This purposiveness is psychological and
individualistic. It is resorted to by the individual for very definite,
intimate, personal reasons. It is due to unconscious, repressed hidden
complexes which crowd or press between the words of syllables, as Stekel
puts it, and which produce the inner resistance which inhibit the free flow
of speech.

It is asserted that these hidden, repressed, unconscious thoughts are
related to the sexual impulse or wish.

Dr. Coriat enumerates the types of repressed complexes in childhood which
may bring about stammering as follows:

1. Repression of sexual acts or secrets and the fear of betrayal. 2.
Typical Oedipus complexes, with a fear of betrayal of the hate for the
father and a consequent embarrassment of speech in his presence. 3.
Masochistic phantasies, wondering and imitating how it would sound to talk
with the tongue cut out. 4. The fear of pronouncing or saying certain
sexual and, therefore, tabooed words, and thus betraying what the child
thinks, his hidden thoughts.

The stammering may then arise as a wish to say or think certain tabooed
words and the wish encounters a prohibition from within. These words may
relate to certain anal, urinary or sexual functions which are recognized by
the child as unclean, and thus forbidden to pronounce. 5. As a
manifestation of anal eroticism, that is, holding the feces so that he could
talk while trying to conceal the act.

. . Talking at these times would be difficult, because talking would take
away the muscular tension for withholding the feces."

At another place Dr. Coriat assures us that "the dreams of stammerers are
interesting because these dreams reveal their wishes to talk freely, their
resistances and transferences and, also, their reversions to childhood when
the stammering arose as an embarrassment complex or as a gainer of time to
conceal their sexual thoughts or libido."

I have presented Dr. Coriat's views so fully and quoted him so much at
length in order that there may not be any question of the absolute accuracy
of my statements.

What does this mean to the one who has followed the trail of the Freudian
movement? The meaning is plain. It is like the handwriting on the wall.
Dr. Coriat has permitted himself to be deluded by the Freudian sexual
theories and their application to the psychoneuroses, and in this special
instance to stammering.

What does this imply? It implies that Dr. Coriat accepts the Freudian
theories en masse. Hence, to discuss this subject in a thorough way I
should have to take up for discussion the various aspects of Freudian
psychoanalysis. This would include a consideration of the method employed,
the psychology, the attitude or standpoint assumed, the "art of
interpretation" developed, and the real meanings, in their wider and more
extended sense, of various unsupported, unfounded, dogmatic and untrue
conclusions of a theoretical and practical nature. This cannot, it is
obvious, be expected in this place. Attempts of a certain sort in this
direction have been made by me in previous communications.[6] In the not
very distant future I shall endeavor more successfully to cope with some of
the problems mentioned.

[6] See, for example, the Psychoanalytic Review, January 1915 and the
Journal of Abnormal Psychology, June-September, 1914.

With respect to the general problem of sexuality I may say that I have
recently[7] taken up, for separate dissection, the conception of sexuality
assumed by Freud and his followers. The present paper should, I feel, be
read in connection with this particular paper, since it will, in a way,
clear the field of many of the misunderstandings in interpretation.
Everything depends upon what one means by "sexuality" or "sexual impulse" or
"sexual tendency." Unless a mutual understanding is arrived at on this
subject of sexuality, little advance toward the dissipation of conflicting
views of Freudians and anti-Freudians can ever be had. And permit me to
mention in this place that it is the Freudians themselves and not their
opponents who are most to blame. Until the Freudian school decidedly and
once for all gives up its false and distorted viewpoint of man's sexual
impulse and of human mental life, little progress of a worth-while nature
can be made by them.[8]

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

[8] Owing to the fixed, systematized theories of the Freudian school, I
believe that little co-operation can be expected from it. We can only
prevent the dissemination of their dangerous sexual theories.

Starting out, then, with certain concepts or theories which are basically
wrong and can be summed up by stating that they assume an individualisitic,
psychosexual conception of life and interpretation of vital phenomena, and
with a psychology and a sexology which is radically wrong in its sweeping
and dogmatic conclusions, Dr. Coriat, who has obviously accepted these
theories as actualities, else he could not have arrived at the ideas
concerning stammering which he presents in his paper, builds up or accepts
an imaginatively constructed theory which he applies in full force to the
problem of stuttering, and into which he crowds the phenomena of a physical
and mental order which are manifest in this intermittent, special
psychoneurotic disorder. As a natural consequence all the faults of Freudism
have been transported to the elucidation of the genesis, nature and
evolution of stammering. And this means that the theories of universally
acting psychical repression, of the unconscious, of the endopsychic censor,
of the significance of resistance and amnesia, of the employment of highly
complicated and phantastic symbolism, of the manifestations of sexuality and
so forth have been made use of in a high-handed, uncalled for, unnecessary
and unscientific manner to prove the truth of the thesis with which the
author set out upon his journey.

It is no wonder that in such a fashion and with such concepts the
conclusions above cited were arrived at. Indeed, work along this line was
unnecessary, except in a purposively corroborative way, if the theories of
Freud in the case of the whole group of psychoneuroses is once seized upon
and accepted as the basic truth. The problem for Dr. Coriat is to prove the
truth of Freud's conceptions as laid down in his psychology and sexology,
upon which his psychopathology is built.

I must stoutly protest against an evasion of the real issues by the leaders
of the Freudian movement. Let them retrace their steps and first prove the
truth, soundness and validity of their psychological and sexual theories and
cease pressing on to pastures new, as Dr. Coriat has done here in the case
of stuttering. If they are not prepared to do this, or are unwilling so to
do, I do not believe that they are entitled to continue to inflict upon
others views which have little real foundation in fact, which are unproven,
unfounded, purely speculative, imaginative, pure figments of the
imagination, a delusion and a snare. I have elsewhere[9] given credit to
Freud and his co-workers where I think they deserve it. But that should not
deter me from protesting against their evasion of the issues, their
befogging of the problems involved, their failure to prove their case or to
offer satisfactory replies to criticism which is given in a fair and frank
fashion.

[9] "A Plea for a Broader Standpoint in Psychoanalysis." Psychoanalytic
Review, January, 1915.

The method of burying one's head in sand, after the manner of the ostrich,
and the refusal to see that which is pointed out or which stares one clearly
in the face, cannot go far to establish one's case or as a method of
defense. And the same thing applies to that oft-repeated and tiresome
retort: "You do not (or perhaps you cannot) understand our theories and
viewpoints." Or that other evasive accusation, rather than reply: "Your
lack of understanding is of itself proof positive that our theories are
absolutely correct in every detail." Or "Your attack or criticism just
completely and undoubtedly proves our case. You are prompted by those very
mental mechanisms and by that self-same mental content--meaning all the time
the sexual content and sexual mechanisms--which we have been trying to
explain to you so that you might understand us."

In response to this I should like to ask the Freudian school what it means
by "censor," "wish," "unconscious," "sexual," and other similar and
constantly used terms which form the stronghold of their defenses. I have
shown,[10] at least to my own satisfaction, that the conception of sexuality
is not at all clear to any of the Freudian school, including Freud himself.
This should by no means be so. Surely the terms which are constantly used
and are the sine qua non of their theories should have a definite meaning of
some sort, at least to the Freudians themselves. Mystical and metaphysical
implications should not continue to find a sheltering place in the province
of psychopathology. They should be uprooted and driven forth from the dark
and hidden recesses into the light and open highways.

[10] Loc. cit.

These statements have a direct application to the paper which I have
undertaken to criticize. It is all very well and very commendable to come
forward with new theories. They are entertaining, interesting and make one
think, even if they are not at all true. But it should be definitely and
plainly stated that we are dealing with theories and not with facts, that
the theories will be considered theories until they are proven to be facts,
and that if they are disproven, they should be thrown into the rubbish heap
or discarded, or else they should be modified to meet with the facts and
actual conditions--as they are and not as they ought in our opinion to be or
as we should like them or as we imagine them to be. Here we are confronted
with a problem (stammering) which has been the subject of much study and
discussion by many men. Theories have been carefully and guardedly
formulated by most workers in this field. Many of them were, it is true, in
error in their conclusions or viewpoints. They were, as it were, on the
wrong trail.

Here is a problem of the greatest interest and of the greatest importance--
one which should demand the most careful research and the most positive
deliberation and consideration, with prolonged and intensive study and
observation of cases, combined with self-scrutiny and self-analysis and
self-knowledge (which means a keen insight into human nature and the human
mind in its manifold workings). Here is a serious, concrete problem of great
practical importance. Its solution and elucidation means much. And he who
comes forward with an explanation of this problem should be expected to give
conclusive proof of his conception and for his conclusion. And we should,
justly and as a matter of course, expect and demand it.

And what proof has Dr. Coriat given us for his conclusions? Here and there
scattered through his paper one finds a few conclusions or explanations of a
concrete nature, but they are his interpretations of the facts and not the
facts. No real, in fact not a vestige of proof is offered. The few dreams
which he presents do not, to the inquiring and demanding reader, show
anything which permit of the conclusions which Dr. Coriat draws with
reference to their meaning or significance. He seems to have interpretated
(rather than analyzed) them in typical Freudian fashion. And, furthermore,
even if his interpretations of the few dreams which he presents and which
were taken from different cases were true, of what significance would that
be? What right would we thus have of drawing conclusions which apply to all
cases of stuttering (and, as mentioned earlier in this paper, to many other
related states of a normal and abnormal nature)? Not the slightest.

Not a single case has been presented in proof of the conclusions drawn in
the paper. Surely this is not what we have been accustomed to expect in
other fields of medicine, especially when the conception newly put forth is
entirely novel, sensational, revolutionary, contrary to all former beliefs,
and based on theories and conclusions which have been for some time and
still are a centre of storm, of wordy argumentation, and even of insult and
abuse--at any rate sub judice,

Has the science and practice of psychopathology come to the stage when
theories of any sort can be given to the reading public as fact, and no
actual proof therefor presented?

I venture to say that in no other department of medicine or in fact in no
other aspect of life would scientific men tolerate such presentation and
promulgation, despite opposition and disproof and with no tangible or
definite evidence or proof. Nor would men come forward to offer
revolutionary, let alone dangerous theories, for general consumption, with
so little proof, as is being laid on the platter for psychopathologists.

I find no evidence offered by Dr. Coriat to bolster up the conclusions of
his paper.

In response to a question asked by one of those who discussed his paper in
which he was requested to explain how he knew that stammering begins by
concealing something, Dr. Coriat stated: "I have had an opportunity of
examining a number of stammerers and subjecting them to a complete
psychoanalysis, studying all the paradoxical mental reactions and in nearly
every case this concealment of some sexual secret of childhood came up. It
is easy to establish a certain relationship between the speech embarrassment
and the concealed sexuality."

There is, as is seen, no other proof for this theory (that is all that one
call it) of Dr. Coriat and the Freudian school in general, than his or their
say-so. Those who are acquainted with the method of arriving at conclusions
adopted by the Freudian school will demand more than this as proof of either
the "concealment" of some "sexual secret" of childhood (and where lives
there a man or woman that has not sexual memories, not necessarily secrets,
of some sort or other, related to the period of puberty or antedating it by
a certain varying period?) or the establishment of a relationship other than
co-existence or coincidence, between the speech embarrassment and the
"concealed sexuality" (just as if even proof of the existence of this
relationship was sufficient testimony of the causative operating influence
of the latter).

I could discuss Dr. Coriat's paper from many angles, and in each case show
that its conclusions were not only unsupported but impossible.[11] But in
the above remarks I have presented sufficient evidence, I believe, to carry
out the objects of this criticism.

[11] The ideas in the paper are, in fact, absurd. If definite, practical,
clinical issues were not involved matters might be different. But the
situation is serious yes, dangerously antisocial, since the practical
application of these theories to human beings is the point of greatest
interest.

The reader should not lose sight of the cold but important fact that the
application of Freud's sexual theories to stammering in children is, in my
humble opinion, fraught with the greatest danger. I cannot do otherwise
than look upon this as positively anti-social. It would, it is my belief, be
a glaring and rife source of danger to the community and to society in
general for these ideas to be spread broadcast. Freud himself has shown that
the child, before puberty, with his more or less undifferentiated sexual
impulse, may be swept along into any one or more of the sexual aberrations
or to intrafamilial sexuality. These goals exist only as POSSIBILITIES and
should not, I contend, be referred to as predispositions or tendencies
(almost as if they were instincts). The direction of the child's thought
along this line before or at or after puberty may prove disastrous in one or
more of many different ways.

Think of hinting at or talking about or harping upon matters of this sort to
children, let alone to adults of the usual sort! It would be nothing less
than a crime to society, to the family and to the growing child. In this
respect I look upon the application of the Freudian theories as a distinct
and glaring danger to the individual, to the family and to the community.

Efforts to stem the tide from flowing in this direction should be
unfettered. It means much for humanity.

Even hinting (to the children) in a remote way about the various aspects of
sexuality described by the Freudian school should not find its place and has
no place in treating stammering per se in children.

Think of the effect of continual conversation and thinking of this sort upon
a child at or before puberty, or at adolescence, or even upon an individual
in adult life! His thoughts are continually drifted to his urogenital organs
and the sexual possibilities of all sorts of human relationships,
intrafamilial as well as extrafamilial.

The Freudians may object to any statements to the effect that they tell
their patients about these sexual theories. I find Jones,[12] for instance,
declares that Freud "deliberately withholds from his patients all knowledge
of psychoanalyses except what they discover for themselves." Even granting
this, the patient doesn't have to wait long or think much before he does
discover for himself just what the Freudians mean.

[12] Ernest Jones: Professor Janet on Psychoanalysis; A Rejoinder. Journal
of Abnormal Psychology, Feb.-Mar., 1915, p. 407.

But Freud[13] himself contradicts this statement by Jones when he says: "If
with my patients I emphasize the frequency of the Oedipus dream--of having
sexual intercourse with one's own mother--I get the answer: 'I cannot
remember such a dream.' Immediately afterwards, however, there arises
recollection of another disguised and indifferent dream, which has been
dreamed repeatedly by the patient, and the analysis shows it to be a dream
of this same content--that is, another Oedipus dream."

[13] Brill's translation of Freud's Interpretation, p. 242. Italics mine.

Then again, listen to Brill:[14] "With reference to the question of
determining that a person is homosexual.

[14] The Conception of Homosexuality, Journal of American Medical
Association, August 2, 1913. See Brill's discussion on pages 339-340.

"A patient came to me who was said to have nothing the matter with his
sexual life, but who had convulsions. I had seen him not more than three
times when I said to him: 'You are homosexual,' and I explained what I
meant. He told me that while at college he never indulged in sexual acts,
and that for this reason he used to wrestle, during which he would have
ejaculation, and he selected his partners. Unquestionably from the beginning
of his existence he was homosexual, although he was able to have sexual
intercourse with his wife, but he was compelled to marry when quite young;
he was 'prodded into it,' as he said. He came to me to be treated for
neurosis, but the neurosis was simply the result of homosexual lack of
gratification.

"We should be particularly careful not to suggest anything. I never tell a
patient that he is homosexual. Be reasonably sure that he is homosexual and
you need not hesitate to tell him so."

It all depends on what one means by "reasonably sure" or what kind of and
how much evidence one requires or demands to be "reasonably sure."

Furthermore the mass of popular Freudian literature is not by any means
hidden from the patient.

In conclusion I may remind the members of the Freudian school that it
behooves them to undergo that same self-analysis and self-scrutiny which
they justly advise others to have. If they do this in a truly critical and
impartial way they will find that the opposition which they have met has not
been without foundation. They will find that there are serious and
all-pervading flaws in their psychology and sexology, and that this is
responsible for their one-sided and distorted analyses and interpretations.
Most of the trouble will be found in the method of interpretation, flowing
out of their attitude. They will find that they have been advocating a
system of theories and conclusions which have been followed as a religion, a
cult, a creed. And they will correct the errors which are so patent to so
many of the rest of us.

It is or should be evident to him who reads between the lines and surveys
this question as from a mountain top, that there is not the slightest proof,
not one jot of testimony in support of the ideas which Dr. Coriat has given
us in his paper.

As a final word I cannot refrain from remarking that it will be a sad day
for humanity and for society when psychoneurotics of whatever sort,
stammerers, normal individuals with their psychopathologic acts of everyday
life, and all the rest of us, particularly children, shall be subjected to
Freudian psychoanalyses, with the numerous sexual theories and sexual
implications with regard to everything of vital or human concern, as seen
especially in family and social relations. A study of the origin, nature and
evolution of these is not only not out of place, but on the other hand finds
a distinct place of honor for purely scientific purposes. Theories, however
unfounded and untrue, may, not inappropriately, be offered for this purpose.
But we come upon a decidedly different situation when we have to deal in a
practical sort of way with individuals, particularly children, who are the
objects of the experimental application of full-blown theories. Especially
is this so in the case of sexual theories.

Propagation of such views concerning the origin and nature of stammering as
are presented to us in Dr. Coriat's paper should be sternly discountenanced.
Nay more, they should be unflinchingly denied and even severely condemned.
I, for one, protest vigorously against the propagation of such views,
especially when they represent nothing more than an inflated theory.

The writer wishes to assure Dr. Coriat and the reader that his remarks are
intended in a thoroughly impersonal sort of way. He is concerned only with
the problems involved. Personalities do not at all enter into the
proposition. He hopes that his criticism will be accepted in the same spirit
in which it is given. If, to the reader, it may seem at times that the
writer has spoken too strongly, he can only say in defense that he has
seized upon this occasion as the time and the place to so express himself
briefly, frankly but without malice. The situation more than demands such
outspoken expression of opinion.



ABSTRACTS

THE PSYCHIC FACTORS IN MENTAL DISORDER. Milton A. Harrington, Am. Jour. of
Insanity. Vol. LXXI, No. 4, p. 691.

The writer has taken the scheme of the instincts which William McDougall has
given in his book, entitled "An Introduction to Social Psychology" and has
attempted to show how it may be used in studying the problems of mental
disorder. The paper falls into three parts. In the first part McDougall's
conception is presented, modified, however, so that it may be better fitted
to the needs of the psychiatrist. Briefly it is as follows:

Man has instincts as well as the animals and all his mental activity is due
to impulses coming from these instincts. An instinct may be defined as an
innate specific tendency of the mind which is common to all members of any
one species and which impels the individual to react to certain definite
kinds of stimuli with certain definite types of conduct, without having
first learned from experience the need of such conduct. For example, there
is an instinct of pugnacity which impels us to attack that which injures us
or interferes in any way with the attainment of our desires, an instinct of
flight which impels us to seek escape from danger, a parental instinct from
which come the impulses that lead us to protect and care for our young.
But, beside impelling the individual to react to certain definite kinds of
stimuli with certain definite types of conduct, an instinct, when
stimulated, gives rise in every case to an emotion which is characteristic
of it. For example, with the instinct of pugnacity, we have the emotion of
anger; with that of flight, the emotion of fear; with the parental instinct,
the emotion of love or tender feeling. An instinct, therefore, is regarded
as a mechanism made up of three parts:

First, an afferent or cognitive part, through which it is stimulated.

Second, an affective part through which it gives rise to the emotion which
is characteristic of it.

Third, an efferent or conative part through which it gives rise to a
characteristic type of conduct.

McDougall gives a list of about twelve instincts, each with its accompanying
emotion. These he regards as primary and the source of all thought and
action.

Considering the instincts from the standpoint of evolution, one may assume
that they first developed in extremely low forms of life in order to produce
the few and simple reactions of which animals low in the scale are capable.
One might almost say in regard to such primitive organisms, that for each
situation an instinct is provided and the situation calls forth its
appropriate reaction almost as automatically as the pressing of an electric
button causes the ringing of a bell. But, as animals rise higher in the
scale, the kinds of conduct required become more varied and complex. For
example, an impulse from the flight or fear instinct, in the lower animals,
will always produce some simple reaction such as flight or concealment.
But, in man, the forms of conduct, to which it gives rise, may be extremely
varied. Thus in one case a man may be impelled to run away, in another to
work hard at some disagreeable task in order to escape the harm which might
result if he failed to do so. This capacity to direct the instinctive forces
into various forms of activity, we call the capacity for adjustment and we
may assume that it depends upon the operation of certain mechanisms which we
may call the mechanisms of adjustment. The mind may, therefore, be regarded
as made up of certain instincts from which come the impulses that give rise
to all our mental reactions and certain mechanisms of adjustment by which
these impulses are directed into the most useful forms of activity.

This conception of the human mind enables us to form some idea of how a
mental disorder may arise from purely mental causes; for it is obvious that
conditions may sometimes arise when the mechanisms of adjustment will prove
inadequate to the demands made upon them, when they will be unable to
control the instinctive forces or find for them satisfactory outlet and, as
a result, these impulses will escape by undesirable channels, giving rise to
forms of thought and action which we recognize to be abnormal. To show that
this theory may be successfully applied to explain the facts of abnormal
psychology, the analysis of an illustrative case is presented. This case,
which is worked out in considerable detail, forms the second section of the
paper. It is the case of a young man who, partly owing to inherited
tendencies and partly to environment, developed during early life certain
habits and characteristics which, when he approached maturity and the sexual
instinct awoke to its full activity, caused the impulses from this instinct
to be directed into wrong channels, giving rise to a psychosis which took
the form of a catatonic stupor.

The conception of mental disorder here presented inevitably leads to certain
views regarding the causes which give rise to it. Since mental health is
dependent on capacity for adjustment being equal to the demands made upon
it, mental disorder must always be due to failure to maintain this
relationship between capacity and needs. The causes of insanity must
therefore be of two kinds:

First, those which make the task of adjustment so difficult as to overtax
the capacity.

Second, those which lessen the capacity so that it is unequal to the demands
made upon it.

The third section of the paper is a brief discussion of what these causes
are and how we should deal with them. Author's Abstract.



A STUDY OF SEXUAL TENDENCIES IN MONKEYS AND BABOONS. By G. V. Hamilton.
Journal of Animal Behavior, September-October, 1914, vol. 4, No. 5, pp.
295-318.

The writer asserts that the work and problems in sexuality in human beings
place upon the animal behaviorist an obligation to lay the necessary
foundations for a scientific and thoroughly comprehensive investigation of
sexual life. This has led him to formulate the following two problems in
animal behavior: (1) Are there any types of infra-human primate behavior
which cannot be regarded as expressions of a tendency to seek sexual
satisfaction, but which have the essential objective characteristics of
sexual activity? (2) Do such sexual reaction-types as homosexual
intercourse, efforts to copulate with non-primate animals and masturbation
normally occur among any of the primates, and if so, what is their
biological significance?

The author presents a list of the subjects (monkeys and baboons) employed in
his study; gives a description of the environmental conditions in his
laboratory which is in the midst of a live oak woods In Montecito,
California, about five miles from Santa Barbara; gives a list of the types
of situations that were arranged by the observer or encountered by the
subjects in consequence of their spontaneous activities, and under each
description of a typical situation one or more detailed descriptions of
typical responses thereto; and finally offers the classification of sexual
tendencies as expressions of reactive tendencies observed.

The author then enters into a discussion of the use of the term reactive
tendency, and explains that this term, according to his definition, is meant
to explain something more specific than an inclination to direct activity
toward one of a limited number of general ends, and to include both the
innate and the acquired features of an individual's reactive mechanism.

He then presents his conclusions which I shall here include in full and
verbatim, because of the fact that these findings should prove of great
importance, especially in the light of Freud's theories of infantile
sexuality. The author states that "At least two, and possibly three,
different kinds of hunger, or needs of individual satisfaction, normally
impel the macaque toward the manifestation of sexual behavior, viz., hunger
for sexual satisfaction, hunger for escape from danger and, possibly, hunger
for access to an enemy.

"Homosexual behavior is normally an expression of tendencies which come to
expression even when opportunities for heterosexual intercourse are present.
Sexually immature male monkeys appear to be normally impelled toward
homosexual behavior by sexual hunger. The fact that homosexual tendencies
come to less frequent expression in the mature than in the immature male
suggests the possibility that in their native habitat these animals may
wholly abandon homosexual behavior (except as a defensive measure), on
arriving at sexual maturity.

"Homosexual behavior is of relatively frequent occurrence in the female when
she is threatened by another female, but it is rarely manifested in response
to sexual hunger.

"Masturbation does not seem to occur under normal conditions.

"The macaque of both sexes is apt to display sexual excitement in the
presence of friendly or harmless non-primates.

"It is possible that the homosexual behavior of young males is of the same
biological significance as their mock combats. It is clearly of value as a
defensive measure in both sexes. Homosexual alliances between mature and
immature males may possess a defensive value for immature males, since it
insures the assistance of an adult defender in the event of an attack."
MEYER SOLOMON.


AN EXPERIMENTAL STUDY OF STUTTERING. By John Madison Fletcher. American
Journal of Psychology, April, 1914; Vol. XXV, pp. 201-255.

This paper is a dissertation submitted to the faculty of Clark University,
Worcester, Mass., in partial fulfilment of the requirements for the degree
of Doctor of Philosophy. It is thus from the Psychological Laboratory of
Clark University.

This interesting study of Fletcher includes some general remarks in the
introduction, the question of differentiation and definition, the
physiological aspects (including breathing, vocalization, articulation and
accessory movements), psychophysical changes (including volumetric changes,
changes in heart rate and galvanic changes), a consideration of the
interpretation of the results, the psychological relations (including
emotions, attitudes, imagery, responsibility for Aufgabe, psychoanalysis,
and association), heredity and conclusions. A valuable bibliography is
added, and seven illustrative plates complete the paper.

Fletcher would reserve the word "stammering" for mispronunciation or
incorrect speech, this stutter being anatomical (due to malformation of one
or more organs of articulation) or developmental (due to incorrect
functioning of the organs of articulation resulting in certain cases of
immaturity, such as lisping). Stammering, in this sense, is of no
psychological interest. The reviewer is in favor of employing the terms
"stammering" and "stuttering" synonymously, as is the practice in England
and America. The writer (Fletcher) finds that he cannot accept the Freudian
interpretation of stuttering which has been offered by a number of different
members of that school.

Although the entire paper is of interest and of value to the student of
psychopathology, the purposes of this review can best be served by citing
the following conclusions of the author: The motor manifestations of
stuttering are found to consist of asynergies in the three musculatures of
speech--breathing, vocalization and articulation. Certain accessory
movements, which tend to become stereotyped in each individual and which
consist of tonic and clonic conditions of other muscles not involved in
normal speech, accompany these asynergies. The type of asynergy and more
particularly of accessory movements differ so widely that it is impossible
to state that any special form of breathing, or articulation, or of
vocalization is the fundamental factor in stuttering. Disturbances of pulse
rate, of blood distribution and in psychogalvanic variations, appearing
before, during and after the speaking interval, and the intensity of which
varies approximately with the severity of the stuttering, accompany the
motor manifestations of stuttering. The essential condition in stuttering is
the complex state of mind, the quality rather than the intensity of these
feeling states governing the rise of stuttering. Such feeling states as
fear, anxiety, dread, shame, embarrassment, in fact, those feelings that
tend toward inhibition and repression, are most likely to precede
stuttering, and probably operate in a vicious circle as both cause and
effect. The permanent condition of nervousness thought to be characteristic
of stutterers should be regarded as effect rather than cause. The states of
feeling that have to do with the production of stuttering vary in degree
from strong emotions to mere attitudes or moods, the latter being often so
slight in degree that it is difficult for the subject to report their
presence. Stuttering also seems to be affected by the quality of mental
imagery, by attention and by association. The affective and emotional
experiences associated with the pronunciation of sounds rather than the
nature of the sounds themselves determine the rise of stuttering. The
author's final remarks are: "Stuttering, therefore, seems to be essentially
a mental phenomenon in the sense that it is due to and dependent upon
certain variations in mental state. Hence the study of stuttering becomes a
specifically psychological problem; and it seems evident that a detailed
analysis of all the various aspects of the phenomena of stuttering will
furnish important contributions to general psychology." MEYER SOLOMON.



REVIEWS

THE FOUNDATIONS OF CHARACTER. By A. F. Shand. Macmillan and Company,
London, 1914. Pp. xxx, 532.

In his preface the author says: "A great difficulty which I have found in
the course of my work has been to collect the facts or observations of
character on which I had to rely. Such material as I have obtained has been
drawn much more from literature than from any other source; and this was
inevitable, because psychology has hardly begun to concern itself with these
questions." This reproach levelled against psychology rebounds on the
author, for throughout the book he shows himself evidently unacquainted with
those branches of psychology, notably the medical ones, that have
contributed so brilliantly and extensively to the science of characterology.
It need hardly be pointed out, further, that to rely on second-hand
material, which cannot be checked, analysed, or immediately studied, as the
living facts can is a procedure that is open to insuperable objections.

The author repudiates any analytical approach to his problems, preferring
what he terms "a concrete and synthetic conception of character," and so
"avoids breaking up the forces of character into their elements, and being
driven to consider the abstract problem of their mutual relation." His
method consists in assuming the existence of these forces, as part of his
working hypothesis, and in formulating general laws based on a study of
them. As he himself puts it, "It is in the first place a method of
discovery rather than of proof;--a method reaching no further than a
tentative formulation of laws; for organising the more particular under the
more general; for interpreting the generalised observations which every
great observer of human nature forms for himself, and by this interpretation
making some advance towards their organization. "It follows from this that
the book is predominantly descriptive in nature, and in this field it must
be said that the author has accomplished great work, one that will be of
almost indispensable value to future students of the various emotions.

The book is really a study of the emotions rather than of character, and so
we have to pay special attention to what the author has to say concerning
them. As is well known, he formulated some years ago a special
conception--it can hardly be called a theory--of the emotions, and the most
novel part of the present work is the way in which this conception is
expounded and elaborated in detail. He rejects the usual sense of the term
in which it is taken to express a certain degree of elaboration of the
affective aspect of the mind, and adopts a much wider definition in which
the conative, affective, and cognitive aspects are all represented.
"'Emotion' for us will connote not feeling abstracted from impulse, but
feeling with its impulse, and feeling which has essentially a cognitive
attitude, however vague, and frequently definite thoughts about its object."
He distinguishes, none the less, between an emotion and the entire system to
which it belongs. It is the part of the system that is present in
consciousness, there being two other parts that are not; namely, the
processes connected with it in the body, and the executive part concerned
with its outward expression and modes of behaviour. The three main primary
emotions are fear, anger, and disgust; other are curiosity, joy, sorrow,
self-display, and self-abasement. The four emotional systems of anger, fear,
joy and sorrow have an innate connection not only with one another, but also
with every other primary system. Most of the book is taken up with a very
detailed study of the emotions just enumerated, and in this study the author
insists on the functional point of view, constantly enquiring into the
dynamic aspects and tendencies of the emotion under consideration. This is
perhaps the only respect in which it could be seen that the book was written
within the last forty years.

Mr. Shand's view of the relation between the emotions and the instincts has
led to an animated controversy with Dr. McDougall, published in the
Proceedings of the Aristotelian Society for 1914-1915. According to the
latter writer, every emotion has a corresponding instinct, and is merely the
affective aspect of this instinct. Mr. Shand, on the contrary, holds that
there are vastly more instincts than emotions, that a given instinct may
enter into several different emotional systems, and that each emotional
system may at various times, and according to its needs, make use of almost
any number of different instincts. The reviewer is unable to determine
whether these different points of view have any further implications than a
difference in the definitions adopted by the two writers. McDougall
obviously employs the term instinct in a much more comprehensive and
inclusive sense than Shand does.

In the discussion of this interrelation there occurs, by the way, the
following suggestive passage: "There are no fears so intense as those which
arise in situations from which we cannot escape, where we are forced to
remain in contemplation of the threatening events. There is no anger so
intense as when the blood boils and all the sudden energy that comes to us
cannot vent itself on our antagonist. The arrest of an instinct is that
which most frequently excites the emotion connected with it; and therefore
we feel the emotion so often before (or after: Reviewer) the instinctive
behaviour takes place, rather than along with it." This seems to
after-shadow the modern views on intrapsychical conflict and abreaction.

Another conception peculiar to the author, first propounded in 1896, is that
regarding the sentiments. Sentiments, in the author's sense, are "those
greater systems of the character the function of which is to organize
certain of the lesser systems of emotions by imposing on them a common end
and subjecting them to a common cause." A constant conflict seems to go on
between the organizing tendency of these sentiments and the tendency of the
constituent emotions to achieve freedom and autonomous action, a conception
quite in harmony with the modern views of "complex-action," although Shand's
"sentiments" are far from being synonymous with either "complexes" or
"constellations" in our sense. The implications that follow from his
conception of the sentiments, and the importance he attaches to it, are well
shown by the following interesting passages. "The result of the modification
which the systems of the emotions undergo in man, and especially the
multiplication of the causes which excite and sustain them, is (1) to make
man the most emotional of animals, and (2) to render possible the debasement
of his character. For that which is a condition of his progress is also a
condition of his decline,--the acquired power of ideas over emotions, and
the subsequent power of each indefinitely to sustain the other. Hence the
existence of the emotions constitutes a serious danger for him though not
for the animals, and the balance which is lost when the emotions are no
longer exclusively under the control of those causes which originally excite
them can only be replaced by the higher control of the sentiments. There are
then three stages in the evolution of emotional systems; the first and
primitive, in which they are under the control of the stimuli innately
connected with their excitement, undergoing a certain change through
individual experience, but not radically altered; the second, in which they
become dangerous and independent systems; the third, in which they are
organized under the control of the new systems which they are instrumental
in developing." "There are three principal stages in the development of
character. Its foundations are those primary emotional systems, in which the
instincts play at first a more important part than the emotions; in them,
and as instrumental to their ends, are found the powers of intelligence and
will to which the animal attains. But even in animals there is found, some
inter-organization of these systems, or, at least, some balance of their
instincts, by which these are fitted to work together as a system for the
preservation of their offspring and of themselves. This inter-organization
is the basis of those higher and more complex systems which, if not peculiar
to man, chiefly characterize him, and which we have called the sentiments,
and this is the second stage. But character, if more or less rigid in the
animals, is plastic in man: and thus the sentiments come to develop, for
their own more perfect organization, systems of self-control, in which the
intellect and will rise to a higher level than is possible at the emotional
stage, and give rise to those great qualities of character that we name
"fortitude," "patience," "steadfastness," "loyalty," and many others, and a
relative ethics that is in constant interaction with the ethics of the
conscience, which is chiefly imposed upon us through social influences. And
this is the third and highest stage in the development of character, and the
most plastic, so that it is in constant flux in each of us; and the worth
that we ascribe to men in review of their lives, deeper than their outward
success or failure, is determined by what they have here accomplished."

We have given some indication of the positive side of the book, one which
deserves great praise for both its matter and style. On the negative side we
have to remark on the following important omissions. As was mentioned to
start with, no acquaintance whatever is shown with either the methods or
findings of what may broadly be called medical psychology, the only
psychology that has at its disposal the material on which a science of
character could be founded. That the important work of Klarges on
characterology is not considered may be accounted for by the fact that there
is not a single German reference given in the whole book. In the second
place, the genetic point of view is almost completely overlooked, one of
cardinal importance in such a field. Thirdly, the whole subject of the
unconscious is treated as non-existent. It is a complete misnomer to entitle
a book on descriptive psychology "The Foundations of Character" when no
notice whatever is taken of that region of the mind where the very springs
of character take their source, and where the most fundamental features of
character are to be found. Last, but not least, is the absence of any study
of the sexual instinct and emotions, surely of cardinal importance for any
investigation of character. Apart from the general contributions made by
this instinct to character, one thinks of such clearly-cut pictures as the
masochistic, voyeur, and anal types of character.

An inadequate index closes an unsatisfactory, though in many respects
valuable, book. We note no fewer than twelve references to "Seneca," but
none to "sex" or "shame;" sixteen to Hudson, but none to Freud, Janet,
Prince, Adler, or Klarges. ERNEST JONES.



AN INTRODUCTION TO SOCIAL PSYCHOLOGY. By William McDougall. Published by
John W. Luce & Co., Boston, 1910.

Although this book was published a few years ago, nevertheless it seems
sufficiently important to the reviewer to have it brought prominently before
psychopathologists.

In the introduction McDougall reminds us that the instincts are the prime
movers, the mental forces, the sources of energy, the springs of human
action, the impulses and motives which determine the goals and course of all
human activity, mental and physical. These instincts, being the fundamental
elements of our constitution, must be clearly defined, and their history in
the individual and the race determined. For this purpose, comparative and
evolutionary psychology is necessary, for the life of the emotions and the
play of motives in mental life are the least susceptible of introspective
observation and description. "The old psychologising," says McDougall, "was
like playing 'Hamlet' with the Prince of Denmark left out, or like
describing steam-engines while ignoring the fact of the presence and
fundamental role of the fire or other sources of heat." A knowledge of the
constitution of the mind of man is a prerequisite for any understanding of
the life of society in any or all of its many aspects. And this applies to
psychopathology. I venture to assert that had certain individuals read and
digested a book of this sort it might have been a prophylactic against an
exclusively sexual conception of human conduct.

The work is divided into two sections. Section one deals with the mental
characteristics of man of primary importance for his life in society, while
section two is concerned with the operation of the primary tendencies of the
human mind in the life of societies. The successive chapters of the first
section take up in order the following questions: the nature of instincts
and their place in the constitution of the mind, the principal instincts and
the primary emotions of man; some general or non-specific innate tendencies,
the nature of the sentiments and the constitution of some of the complex
emotions; the development of the sentiments; the growth of
self-consciousness and of the self regarding sentiment; the advance to the
higher plane of social conduct; and volition. In the second section the
author considers the reproductive and the parental instincts, the instinct
of pugnacity, the gregarious instinct, the instincts through which religious
conceptions affect social life, the instincts of acquisition and
construction, and there is a final chapter on imitation, play and habit.

McDougall dividends the instincts into specific tendencies or instincts and
general or non-specific tendencies. He calls attention to the abuse of the
term "instincts" and himself defines an instinct as an inherited or innate
psychophysical disposition which has the three aspects of all mental
processes: the cognitive, the affective and the conative--or a knowing of
some object or thing, a feeling in regard to it, and a striving towards or
away from that object. "The continued obstruction of instinctive striving
is always accompanied by painful feeling, its successful progress towards
its end by pleasurable feeling, and the achievement of its end by a
pleasurable sense of satisfaction." He reminds us that "the emotional
excitement, with the accompanying nervous activities of the central part of
the disposition, is the only part of the total instinctive process that
retains its specific character and remains common to all individuals and all
situations in which the instinct is excited." We may experience the
emotional excitement and the impulse to the appropriate movements of an
instinct or the re-excitement of an instinctive reaction in its affective
and conative aspects without the reproduction of the original idea which led
to its excitation. Pleasure and pain but serve to guide these impulses or
instincts in their choice of means towards these ends.

One of McDougall's important conclusions is that "each of the principal
instincts conditions some one kind of emotional excitement whose quality is
specific or peculiar to it, and the emotional excitement of specific quality
that is the affective aspect of the operation of any one of the principal
instincts may be called a primary emotion." This is McDougall's definition
of emotion.

McDougall then takes up for discussion and analysis the principal instincts
and the primary emotions of man which include the following: the instinct of
flight and the emotion of fear; the instinct of repulsion and the emotion of
disgust; the instinct of curiosity and the emotion of wonder; the instinct
of pugnacity and the emotion of anger; the instincts of self-abasement (or
subjection) and of self-assertion (or self-display) and the emotions of
subjection and elation (or negative and positive self-feeling); the parental
instinct and the tender emotion, and such other instincts of less
well-defined emotional tendencies as the instinct of reproduction (with
sexual jealousy and female coyness), the gregarious instinct, the instincts
of acquisition and construction; and the minor instincts of crawling,
walking, rest and sleep. McDougall denies the existence of such instincts as
those of religion, imitation, sympathy and play.

There then follows a consideration of some general or nonspecific innate
tendencies or pseudo-instincts which are not specific instincts with special
accompanying emotions, and this leads to the analysis of sympathy or the
sympathetic induction of emotion, suggestion and suggestibility, imitation,
play, habit, disposition and temperament.

The sentiments are now taken up for analysis and definition. A sentiment,
according to McDougall, who accepts Shand's definition, is an organized
system of emotional tendencies or dispositions centred about the idea of
some object. Among the complex emotions not necessarily implying the
existence of sentiments McDougall includes admiration, awe and reverence,
gratitude, scorn, contempt and loathing, and envy. Among the complex
emotions implying the existence of sentiments he considers reproach,
anxiety, jealousy, vengeful emotion, resentment, shame, joy, sorrow and
pity, happiness, surprise. The nature and the constitution of the sentiments
and the complex emotions comes in for very illuminating analysis. The
chapters on the growth of self-consciousness and of the self-regarding
sentiment, the advance to the higher plane of social conduct, and volition
are to be considered among the best chapters of this very excellent work.
The discussion and analysis is very penetrating and clear. It is well worth
while presenting the following abstract of the chapter on volition: All
impulses, desires and aversions, motives or conations are of one of two
classes: (1) from the excitement of some innate disposition or instinct; and
(2) from excitement of dispositions acquired during the life of the
individual by differentiation from the innate dispositions, under the
guidance of pleasure and pain. When in the conflict of two motives the will
is thrown on the side of one of them and we make a volitional decision, we
in some way add to the energy with which the idea of the one desired end
maintains itself in opposition to its rival. The idea of the self, or
self-consciousness, is able to play its great role in volition only in
virtue of the self-regarding sentiment. The conations, the desires and
aversions, arising within this self-regarding sentiment are the motive
forces which, adding themselves to the weaker ideal motive in the case of
moral effort, enable it to win the mastery over some stronger, coarser
desire of our primitive animal nature and to banish from consciousness the
idea of the end of this desire.

Volition, therefore, following McDougall, may be defined as the supporting
or re-enforcing of a desire or conation by the cooperation of an impulse
excited within the system of the self-regarding sentiment. The sentiment of
self-control is the master sentiment for volition and especially for
resolution. It is a special development of the self-regarding sentiment. The
source of the additional motive power, which in the moral effort of volition
is thrown upon the side of the weaker, more ideal impulse, is ultimately to
be found in that instinct of self-display or self-assertion whose affective
aspect is the emotion of positive self-feeling. These remarks are given more
or less verbatim.

McDougall next analyzes strength of character which he differentiates from
disposition and temperament which are innate. In section two, as stated
previously, the author takes up for separate and more minute analysis the
family (the reproductive and the parental) instincts, the instinct of
pugnacity, the gregarious instinct, the instinctive bases of religion, and
the instincts of acquisition and construction. Imitation, play and habit
receive separate treatment in the final chapter.

The reviewer can freely recommend this book as one of the best, if not the
best book of this sort that has come into his hands. His personal opinion is
that it is the best. McDougall presents us with an acceptable and clean-cut
classification of the instincts, emotions and sentiments, he accurately
defines these terms, he gives the analysis and constitution of these
instincts, emotions and sentiments, and develops the motive sources of human
conduct. He adopts many original and novel standpoints. He is an
independent thinker. He has here presented us with a book which, because of
its clearness and its frank meeting of the problems, is of the utmost value
to the psychopathologist and the psychiatrist. In fact the contents of just
such a work as this should be the first lesson of every worker in this
field. In this way only can he really begin to understand human conduct.

This work should find its place in the forefront of those books which should
be read and digested by all workers in any of the social sciences.

For the reviewer it has been a genuine pleasure to read and to review this
book and he most heartily recommends it to the reader of these pages. MEYER
SOLOMON.



BOOKS RECEIVED

THE THEORY OF PSYCHOANALYSIS. By C. G. Jung. Pp. 133 and Index. Nervous
and Mental Diseases Monograph Series, No. 19, 1915, $1.50.

PSYCHOLOGY AND PARENTHOOD. By H. Addington Bruce. Pp. IX plus 293. Dodd,
Mead & Co., 1915. $1.25 net.

THE INDIVIDUAL DELINQUENT. By William Healy. Pp. XV plus 830. Little,
Brown & Co., 1915. $5.00 net.

HUMAN MOTIVES. By J. J. Putnam. Pp. XVII plus 179. Little, Brown & Co.,
1915. $1.00 net.



THE JOURNAL OF ABNORMAL PSYCHOLOGY

CONSTRUCTIVE DELUSIONS[*]

[*] Read at the sixth annual meeting of the American Psychopathological
Association, May 5, 1915, New York City.

JOHN T. MACCURDY, M. D. Psychiatric Institute, Ward's Island

and

WALTER L. TREADWAY, M. D. Assistant Surgeon, U. S. Public Health Service

MOST psychiatrists state or tacitly assume that dementia praecox is a
disease of a steadily progressive nature, where the first symptom of
dementia is a signal for relentless degradation of the patient's mental
capacity except in the sphere of the more mechanical, intellectual
functions. Yet the experience of every institutional physician denies the
universality of this deterioration, and the statistics in any good text book
demonstrate that many cases are "chronic" rather than "deteriorating."
Woodman[1] has made a careful study of 144 such chronic cases, and shows
what a surprisingly large proportion of these develop a good adaptation to
the artificial environment of the institution. So far as we know, however,
no one has attempted to formulate any definite features of onset which could
be taken as a guide in determining the gravity of the mental derangement.
In fact Bleuler states categorically that "up to the present no correlation
has been discovered between the symptoms of onset and the gravity of the
outcome." Kraepelin has split off from dementia praecox a separate
psychosis--Paraphrenia systematica--which he timidly defends as a clinical
entity apparently because the course is a long one and the deterioration
less marked than in dementia praecox. But he gives us no concise prognostic
data; in fact one feels on reading his paper that the diagnosis must be made
post hoc. This problem is manifestly of equal importance from the social
and the scientific standpoint: until we can predict the outcome our
treatment must be empiric and palliative; we confess ourselves ignorant of
the disease process if we cannot make a prognosis.

[1] R. C. Woodman, N. Y. State Hospital Bulletin, Vol. II, No. 2, 1909.

It is possible to make certain a priori speculations as to prognostic
criteria based on classification and what that implies. We know that pure
paranoia is not a deteriorating psychosis--that it does not necessarily
preclude the possibility of considerable social usefulness--and that it
grades off almost imperceptibly into dementia praecox. The features
differentiating these two diseases should therefore supply us with data for
determining the prognosis. A case undoubtedly, praecox, which shows markedly
the differential features of paranoia, should have a proportionately better
outlook. In a vague way our common sense uses this standard when it makes us
"feel" that the case will have a long course which shows a relatively well
retained personality in conjunction with praecox symptoms. But "feelings"
are hardly objective criteria. What symptoms may we make use of? We may
say that the praecox patient as opposed to the paranoia has a poverty or
inappropriateness of affect, a scattering of thought and a lack of
systematization in his delusions. The weakness of will on which Kraepelin
lays so much stress may be included, though that can probably be derived
from the scattering of thought. What of these symptoms may be analyzed for
our purpose? Affect changes and dissociation in the stream of thought are
themselves signs of the deterioration we wish to predict; to make use of
them we should have at hand some theory as to the relation between their
quality and quantity, and that we have not. There remains the content of
the psychosis, a definitely objective material with which to work. This is
naturally a big problem--almost as wide as insanity itself--and one brief
communication cannot pretend to solve it. What we wish to do is merely to
put forward tentatively the claim of one type of delusion formation to
prognostic value.

Now if delusions are to be an index to deterioration they must in some way
hold a mirror to the changes in the personality, repeat them or prefigure
them. If we generalize our conception of functional dementia, we can say
that one of its most striking features is a destruction of the faculty of
appropriate reaction, a loss of what one may term the sense of reality. The
patient in direct proportion to the degree of his dementia loses his
capacity to recognize the reality of his environment or his relationship to
it, and builds up more and more a world of his own in which he lives
untroubled by the demands of adaptation. No one who has ever argued with a
paranoic will forget how keen a sense of reality he may retain, how logical
his arguments are, and how reasonable his delusions appear, if only some one
point be granted. With the praecox, however, the opposite impression may be
quite as striking. His delusions are bizarre, inconsistent, kaleidoscopic;
he has no logical explanation and cannot even state them consecutively. And
all gradations from pure paranoia to dementia praecox seem to have
corresponding losses in the sense of reality as embodied in delusions.

May we not hope to find in the content of the psychosis some objective
criterion as to the degree in which the sense of reality is lost, with all
that it implies?

But what takes the place of the sense of reality or what causes it to go?
With what tendency of the psychotic individual is it in conflict? The answer
is a psychological truism--the indulgence in fancies. Imagination, of
course, is essential to every human being, no purposeful action can be
instituted without its first being carried out in imagination. Phantastic
thinking begins when the subject fails to apply the test of reality to his
mental image and exclude it if it be not adapted to realization. If
environment or internal inhibitions prevent this realization, however, the
craving: lying back of the fancy must be diverted to a more practical
channel--the normal solution--or the fancy must persist in spite of its
impracticability. This latter process is the germ of the psychosis. But not
its development. A certain compromise may be reached--he who digs for gold
in his back-yard is not so crazy as he who reaches out his hand for the
moon. Nor is the paranoic who chooses to put his interpretation on the
surliness of his employer as far estranged from reality as the praecox who
recognizes his employer in the person of the physician. The content of the
psychosis may then express the relative strength of the two antagonistic
factors, sense of reality and fancy, the two factors whose relative
importance decide the issue for sanity or insanity.

It is easier to imagine than to act, so no human being is free of this
tendency. But what does the normal man do? He diverts these thoughts into
channels where fancy has a legitimate place--he writes romances; he imagines
himself using an instrument to talk with his friend miles away and invents
the telephone; he imagines a better society than the one which galls him,
and writes a "Utopia"; above all he theorizes and speculates. According to
his age or ability these speculations give us alchemy or chemistry,
astrology or astronomy, magic or religion, spiritism or psychology, the
were-wolf or psycho-analysis, phrenology or psychiatry, and so on. Now
three generalizations can be made about these primitive or elaborated
philosophizings: first, they all represent a constructive tendency; second,
the degree to which this constructive tendency is exhibited is historically
a measure of the cultural development of any age, an index of the
development of the sense of reality of the time, that is, the particular
speculation is not only accepted as reasonable but has its practical
application for the period; and third, the more primitive forms of these
speculations are represented in the delusions of insane, particularly
dementia praecox, patients. Following a suggestion of Dr. Hoch we have
termed these ideas "constructive delusions." As they correspond to what was
historically a compromise between reality and phantasy, they should
represent a corresponding mildness or severity in the psychosis where they
appear. Our observations--far from being extensive--have so far demonstrated
this that we feel justified in offering the hypothesis that when such
delusions are present one can base a mild prognosis on their presence with a
rather specific relationship between the crudity of construction and the
degree of deterioration. It must be borne in mind, however, that we make no
claim as to the invariable presence of such delusions when marked
deterioration does not take place. We hope only to show that when present
this particular form of content may constitute a valuable prognostic guide,
as it represents the degree to which the patient has gone in recapitulating
the history of his civilization.

It should be understood that we are not describing highly unusual cases;
many such have been published. A highly typical one is given by Freud in
his analysis of the Schreber case.[2] In this extremely stimulating paper
Freud puts forward the claim that all delusions are an attempt at regaining
health on the part of the psyche. From a broad psychological standpoint,
this is undoubtedly true but the generalization is too wide to be of any
practical psychiatric value. Moreover, by choosing for analysis a case
which was neither dementia praecox nor paranoia but a combination of the
two, he reaches conclusions which are valuable additions to our knowledge of
psychotic processes but merely confuse the issue as to the specific
mechanisms of paranoia and dementia praecox. In Schreber a profound
psychotic reaction corresponded to crude formulations of his fancies,
whereas, when he built these ideas into constructive speculations, he became
relatively sane and an efficient citizen. If Freud had emphasized the point
that this later formulation was more than a vehicle for the cruder thoughts,
that it contained components which were potentially of social value, which
implied a broader contact with the world--had he done this--then the present
paper would be superfluous.

[2] Psychoanalytische Bemerkungen uber einen autobiographischen beschrieben
Fall von Paranoia (Dementia paranoides). Jahrb. f. psychoanalyt. u.
psychopath. Forschungen, Jahrg. III.



The first case we wish to present, John McM., is at present thirty-six years
of age, unmarried, a Catholic. For at least nine years he has been
objectively psychotic, though, according to his own account his delusional
habit of thought began seventeen years ago. He had little education but made
the most of it and has read widely (for one of his station) on such topics
as socialism. He was always somewhat distant and did not make friends
easily. From early childhood he was antagonistic towards his father and
brother and, since his mother's death six years ago, to whom he was strongly
attached, towards an aunt as well. He has struck both his father and his
aunt. His antagonism towards his father is of great importance as a
determinant for his later symptoms. When young he feared him, as he grew
older disputed his authority and, according to the father, always disobeyed
him. He was always shy with women and, as we shall see, his first conflict
in the sexual sphere was solved by a psychotic reaction. Once an efficient
salesman, for the past nine years he has drifted from one position to
another. As he says himself, he lost ambition after he decided not to get
married, and concluded he would not attempt to gain worldly possessions, but
merely enough to subsist on. His early life showed not so much tendency
towards elation and depression as towards imaginative thinking with a
leaning towards day-dreaming and "mysteries." Of late years his reading has
been confined to sexual topics, as discussed by various quacks, astrology,
phrenology, Christian Science, and religion. Although he said he discovered
God for himself he never gave up the Catholic religion. Gradually his energy
has been so engrossed by these interests that he lost position after
position as a result of continually talking of his ideas to his fellow
workers or employers. This tendency eventually led to his commitment, but as
long ago as 1906 a physician said he was insane. For the past six years he
has been cross, stubborn and self-willed so that none of family dared to
speak to him. He even left home and took a furnished room by himself. In
spite of this evident anti-social tendency he speaks of himself as having
been filled during this period with a great hope; he has been looking into
the future and content that he will reach the goal and sees happiness in the
future. For some months he had talked much of the world coming to an end
and said that those who had money should spend it as it would soon do them
no good. He wanted every one to divide his money with him as, he said,
everything belonged to God. Many people were against him and he wrote
letters about this to various officers. It was when he showed some of these
to an assemblyman that he was advised to go to Observation Pavilion.

When he arrived at Manhattan State Hospital he was quiet and agreeable,
cooperated readily with his examination and seemed to take his incarceration
as a matter of course, though he has always had mild arguments to prove that
he should be allowed parole. A certain degree of deterioration is evidenced
by his failure to make much of an effort in this direction, although such
effort would be immediately successful. In his manner he was quiet,
occasionally somewhat affected and when talking of his ideas was apt to
assume an expression bordering on ecstasy. At no time did he show an
inappropriate affect or any evidence of scattering or flight. He could talk
quite objectively of his idea. He had had only one halucinatory experience
and even it should, perhaps, be called merely an illusion. "On the 14th of
March, 1912," he said "I came face to face with God Almighty. He spoke in a
Jewish dialect and was dressed as a carpenter." The patient was in the
Cathedral at the time and that night he had a vision of this man, though
this may have been just a dream. He also heard Bishop H. speak of the man
who had come to prepare the world for the second coming of Christ. The
bishop looked at this patient which meant that he, the patient, was the man.

Before detailing his ideas it may be well to outline their general tendency.
In his psychosis he succeeded in fulfilling the wish of the Persian enemy of
reality:

"Ah, Love, could you and I with Him conspire
To grasp this sorry scheme of things entire,
Would we not shatter it to bits and then
Remould it nearer to the heart's desire."

By the simple expedient of translating his interest from this world to that
of spirits he built up a new Heaven and a new Earth, where he was supreme
and his chief enemy, his father, was subject to him. Beginning with
astrology he found that his father's sign and his showed different
characters, the father's strong in earthly affairs, while the patient's
showed preeminence in spiritual qualities. Passing from astrology to the
Heavens, he discovered that his father had been Jehovah, while he had been
Christ. There had been a struggle between them in which the father had been
temporarily successful. But when his father's spirit had entered into a
body, he had become subject to Christ. In the Heaven to come, Jehovah was
to give way to precedence to Christ, was to enjoy with the Virgin Mary, his
mother, a union of love, as much more fervid as it was to be free from
carnal features. In extolling this life of the spirit the patient excluded
that physical problem which had caused him so much trouble-- the adult
sexual demand which, in the form of marriage he could not agree to meet nor
yet to put out of his mind. At the same time this religious formulation
gave him a comfortable ascendancy over his hated rival, his father. But it
gives him more than this: he has a mission, he says, he must prepare the way
for the new world, the new heaven. This is an objective interest and it is
that, we think, which has a causal connexion with his mild degree of
deterioration-- for he has been what we must regard as a praecox for many
years and yet has lost so little of his personality that to a layman he
would certainly be regarded as little more than a crank. Where his system
fails of having a sane outlet it is of course in the fact that his prophecy
has little to do with anything of advantage to others. It is merely a cover
for self-glorification.

At nineteen he talked to his friend W. of sexual matters, and, being
troubled with constipation and "rheumatism" at the time, he asked the
physician who was treating him as to whether he should indulge himself
sexually. The physician told him to, but he worried over this advice and
went to a priest, who said for him to get married. This he did not wish to
do, and so turned his attention to astrology and phrenology, the other
subjects which his friend talked of. That this was only a cover for his
original sex problem is shown by his conclusions: that he had a weakness in
amativeness--"the faculty of sexual power," his "concentration" on sexual
matters was poor. "If I had more amativeness there would be trouble; I am
glad I haven't so much. I was always more of a companion to my mother, and
when I wasn't with her I went to the theatre with W." He and his father, he
learned, had strong faculties of destructiveness; the patient, however,
could control his by reasoning; his reasoning was so strong that he could
even control his father and settle disputes between father and mother.
Phrenology also taught him his intellectual superiority to his father in
other ways.

From phrenology he learned there was a time to be born; from this he passed
to astrology. His father had arranged that he should be born in the sign of
Virgo, which guaranteed his truthfulness and obedience to his father. He
explained this by speaking of Adam and Eve disobeying God, from whose sexual
intercourse all evils sprang. Manifestly, then, it was his father's
arrangement that he should have to abstain from sexual intercourse.

His father was born in the sign Gemini; this is a fighting sign; the father
selected this sign himself, by his great fighting power; the sign is not a
spiritual one but a worldly one, and shows avarice in great grasping of
worldly things. He never thought that his father was so great, until three
or four years ago. He wrote a minister, asking him what became of God the
Father; he asked another man about religion, and was told how obedient
Christ was to his foster-father Joseph. He thought of how disobedient he
was to his father, and then decided that his father was the God, the Father,
and in the Kingdom of Heaven he was called Jehovah. (Here he identifies
himself with Christ). He says about this "I tried to reason myself away from
it many times, but was finally convinced"--The father came to this world as
John; Jehovah was the patient's father in the other world. In the other
world he had a falling out with the father, and now the father has that
revenge in his soul. He had some kind of a falling out, a fight; his father,
then Jehovah, ruled the third Heaven; one of the twelve, which he says is
about the earth, the earth making the thirteenth; this formulation he
derived from astrology: the first Heaven Aries, the second Taurus, and the
third Gemini, etc.

His father was born in the sign of Gemini, whose symbol is the twins, which
means a duel; and people born in this sign have a dual nature; the father
had a dual nature; and when the father ruled in the third Heaven as Jehovah,
a duel took place between the patient and the father, and the son's spirit
was separated from a body and roamed about. After a time the patient's
spirit got back into the Kingdom by worrying the father, but he was never
admitted in the form of a body. The father and son while still in a body
could both create man and woman; the patient then knew all about creation,
and was endowed with all the powers the father possessed, and helped the
father to build up that kingdom; but when the patient's spirit was separated
from the body his powers became less, so that he could not create a human
being. His physical personality was weakened by this, but the spirit of love
was increased; the father had carried revenge in his soul since then. The
patient was never a ruler of a Heaven, but "I was my father's son--I was
next to him--the sons never become rulers unless they win out;" the
patient's spirit remained out of his body until he was born into this world;
the patient's father came to this world as John, and married Mary McE.; when
the father came on earth he placed himself under the jurisdiction of Christ
this came about automatically when the father was born.

In the next Heaven the patient will be on the same plane as Christ, but
perhaps in a lesser degree. There can be only one father, and he will be
under Christ's jurisdiction. Christ will be supreme. He is part of the
Trinity; there is one God as three united persons; they agree on everything;
Father, Son, and Holy Ghost. These will be possessed of equal powers, but
one will be looked upon as the father, and another Son, and another the Holy
Ghost. In the new Heaven he will have equal rights and powers with the
father.

After the father married two children were born, brothers, the younger being
the patient. He says about this that he was born in the usual way, "The
spirit entered the womb of the mother from outside, and from the seed of the
father, and I was born by the will of the father." Christ was born of Mary
through the will of Jehovah--simply the spirit entered the womb and the word
was made flesh. When the father lived as Jehovah he created Adam and Eve, "I
was simply my father's son and son of Jehovah--perhaps my name was John,
which had some great meaning"--Jehovah was the greatest spirit in the
universe, but is not now, for when he was born he placed himself under the
jurisdiction of Christ; his name is now John, the patient's father. Christ
was selected to be the son of Jehovah; he was selected by Jehovah because
Jehovah had a great personality; his father arranged all of this, and he
even selected the sign that the patient was to be born in. When asked who he
is, he said, "I am who I am--When I was positive that I am who I claim to
be."

When the patient's spirit was thrown out of the body, it caused Adam and Eve
to be created--Eve was a great spirit in the third heaven--the father
thought that if he could create two persons, and they were congenial to each
other, that Adam's soul would be increased or developed by being in company
with Eve. When Adam and Eve were created they were not to have sexual
intercourse; they were merely to come in contact by spoken words--love could
exist without intercourse; it started all the trouble. To Adam and Eve two
sons were born, and the brotherly love that existed turned to fire and
hatred. They probably became jealous of each other, and so one deceived the
other. At one time he said that perhaps the mother made more over one than
she did the other; again, perhaps father and mother might have favored one
more than the other; hence jealousy arose; his brother was born in the sign
of Capricorn, which ordinarily is a sign which is congenial to Virgo; his
brother, however, is a crank and not congenial; the brother is jealous of
the patient, because the mother favored the patient.

He did not take his mother's death to heart, as he had expected for two
years that she would die. His aunt said that he told her it was a good
thing the mother was dead. He says that in the other heaven, Jehovah's wife
was Martha, a sister of the Virgin Mary. In this life she was Mary; the
father may have had many wives in the third heaven; perhaps his mother's
sisters were his wives, as they seem attracted to him. His mother's soul
existed before birth, lived in Jerusalem in the time of Christ, and was
Mary's sister. His mother was born in the eighth sign and could be trusted
with great secrets; his mother kept things to herself. She was both feminine
and masculine; that is, she was strong and sociable. In the sign in which
he was born they have great spiritual conception, keen, searching and
penetrating vision; The symbol is the Virgin, and pride makes them more
feminine than masculine, and they are sensitive; he at one time was more
feminine than now, which was due to his sensitiveness. The sign of Virgo is
the mid-heaven, where love is more intent; there they understand each other,
and there is no disagreement. "The magnet of the male and the magnet of the
female are attracted, and they agree with each other in words spoken; this
is true love, like that which existed between Christ and the Virgin Mother;
the Virgin Mother was born in that sign--there's where she got her name."

When he dies the soul of his mother will enter heaven.

In heaven Christ is to raise his mother's soul from purgatory, and she will
become the Virgin Mary. A spirit rapping in the house, which began shortly
after his mother's death, is her spirit and his guardian angel.

Jehovah was jealous of Christ as a greater spirit, so had him crucified.
Joseph was also jealous of Christ because Mary loved him more.

Further ramifications of his ideas are the cruder conceptions that semen is
the equivalent of thought, and that thoughts of women cause him to have
nocturnal emissions. Semen comes from food; to the sacrament he gives a
definitely sexual significance, and it was following communion that he
realized that he was Christ.

At one time he thought he could live, and that he could marry a girl and not
have sexual intercourse; because if he got married and had sexual love
trouble would arise. He was convinced by what he saw of his friends and
every one else he knew, his aunt, his mother and father, that they did not
get along well. The Divine Power knowing that this could not be in this
world, broke the affections he had for this girl; and he concluded he would
never get married. From a worldly point of view he knew that he was a
failure; he had failed in all his business. But he did not care for worldly
things. When he reached this point he knew that he had a mission to
perform, and began to write and preach religion to people who were qualified
to understand. He wrote many letters, all dealing with religion, saying that
he had to get things ready for the second coming of Christ; that he was the
successor of Christ; and that he was to get things in readiness for the
union of religion; when there should be one Shepherd and one Fold.

Case 2. The next case differs from the first in that the emphasis in the
ideas was laid more on spiritistic and astrological than on religious lines.
Another difference in the problems solved by the psychosis is that the
personality of the patient was not incompatible with an outlet to the adult
sexual demand through the channel of prostitution but a basic similarity
lies in the fact that the delusions center around attachment to her father,
again a family situation. The patient is an unmarried woman now forty-seven
years of age, of whose early life we know nothing. She had applied for aid
to a charity organization who, becoming suspicious on the report of a police
captain that the woman was a street walker, sent her to the Cornell
Psychopathological Clinic for mental examination. She had some petty
complaints of not being fed properly where she lived, of things not being
clean there and of the women around her being queer. Then she launched
spontaneously into her delusional story, needing very few questions to
stimulate a fairly complete recital. Throughout an her talk she showed no
abnormalities in her train of thought. She talked in a quiet way of her
"knowledge" but with enthusiasm, smiling frequently but more in a satisfied
or sociable way than with any silly expression. There was not a trace of
ecstasy in her expression. It would have been hard to say definitely that
she had any inappropriate affect. At a later interview, however, she
admitted recent acts of prostitution with no embarrassment whatever.

Her psychotic experiences began some ten years ago when she entered into
illicit relations with an elderly married man R., in the South. A year
before she had met a "mastermind" who told her that she would never be seen
in the right light. Everything came as he predicted. Her lover soon lost
his sexual capacity and so began to show his power by keeping her under his
control but still at arm's length. But she has fooled him for now she has
his power. This power was in the form of "influences." When they worked on
her she would have a throbbing like a typewriter in her head, and would then
be forced to some act. Such acts included affairs with various men and
through R.'s influences she also lost many positions. For some time she
tried to get him to support her, as it was his "influences" that had ruined
her, but he merely called her a blackmailer and had her put out of his
office. Soon, however, as the result of visions she learned that her father
(who is dead) had become Christ in the other world. It was all his influence
that had been acting on her through the medium of R. From Astrology she
learned that she had been born under two planets--Jupiter, Influence; and
Neptune, Spiritual. Her father's sign was Neptune and he was therefore a
spiritual man. Shortly after his death, she had a vision of him floating up
towards the moon and then she knew that he was joining her ethereally. She
had visions of this Father-Christ.

When we turn to the constructive side of these delusions we find that she
regards all her experiences as having been designed by the Father-Christ to
give her training, training that would increase her psychic powers. For
instance, she said part of her training had been frequent accusations of
dishonor with men she never knew. She had to acquit herself of these
charges; thus she gained power. Then she found that she did not even need to
expostulate. She could defy them, defy the whole world. As soon as she knew
she was not guilty she felt power. Things she WAS guilty of, she knew were
right for her, because she gained power by these experiences. This was
because through them she learned spiritistic facts and knowledge is power.
According to her system one mind acts over another by greater penetrating
power, though the recipient must be powerful too. Sometimes she found that
she had to be reduced by lack of food or other privation to receive
influence. Naturally, too, she could communicate with the dead and had many
examples of this power to offer. She had learned, also, about the influence
of the planets over the human brain and how to learn of conditions which
exist for any person--what he should avoid and what to accept. As the
patient was only seen for little over an hour the details of her system of
ideas could not be obtained but she assured the examiner that she never
could tell all she knows about the spirit world. In general, however, she
said that all her knowledge was useful to her and she could give it to
others individually without effort to herself but that she had no way of


 


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