The Journal of Abnormal Psychology

Part 6 out of 8

convulsion may be a secondary affair, and a physiological sequel to the loss
of consciousness, which is psychologically determined.

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

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

[*] Reserved for publication.

DISCUSSION

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

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

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

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

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

AFTERNOON SESSION

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

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

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

DISCUSSION

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

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

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

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

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

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

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

[1] Reserved for Publication.

NO DISCUSSION

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

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

DISCUSSION.

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

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

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

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

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

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

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

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

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

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

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

DISCUSSION

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

DR. WILLIAMS: Largely.

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

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

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

[*] Reserved for publication.

DISCUSSION

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

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

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

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

REVIEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

THE JOURNAL OF ABNORMAL PSYCHOLOGY

THE SEX WORSHIP AND SYMBOLISM OF PRIMITIVE RACES

BY SANGER BROWN II., M. D.

Assistant Physician--Bloomingdale Hospital.

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

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

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

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

SIMPLE SEX WORSHIP

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

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

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

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

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

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

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

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

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

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

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

[4] The Roseicrucians.

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

SACRED PROSTITUTION

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

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

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

[5] Adonis, Attis and Osiris.

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

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

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

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

SYMBOLISM

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

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

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

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

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

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

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

THE UPRIGHT

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

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

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

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

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

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

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

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

[6] Rousselet, India and its native princes.

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

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

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

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

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

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

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

[7] Pepys Diary.

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

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

[8] Symbolic language of ancient art and mythology.

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

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

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

[9] Japan, an attempt at Interpretation.

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

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

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

(TO BE CONCLUDED)

REFERENCES.[10]

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

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

Deiterich, A.: Mutter Erde.

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

Grosse: The Beginnings of Art.

Higgins, Godfrey: The Anacalypsis; Celtic Druids.

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

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

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

Jennings, Hargrave: The Rosicrucians; The Indian Religions.

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

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

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

Murray, Gilbert: Hamlet and Orestes.

Newton, John: Assyrian Grove Worship.

O'Brien, Henry: The Round Towers of Ireland

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

Rhyn, Dr. Otto: Mysteria.

Rocco, Sha: Ancient Sex Worship

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

Westropp, Hodder, M.: Primitive Symbolism.

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

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

Bryant: System of Mythology.

DeGubernatis, Angelo: Zoological Mythology.

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

Langdon, S.: Tammuz and Ishtar.

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

Prescott: Conquest of Peru.

Rousselet, Louis: India and Its Native Princes.

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

Solas, W. J.: Ancient Hunters.

Wood-Martin: Pagan Ireland.

THE PSYCHOANALYTIC TREATMENT Of HYSTERO-EPILEPSY

BY L. E. EMERSON, PH. D.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ON THE GENESIS AND THE MEANING OF TICS

BY MEYER SOLOMON, M. D.

Associate in Neurology, Maimonides Hospital, Chicago

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

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

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

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

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

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

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

VIEWS OF THE FRENCH SCHOOL

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The maladie des tics is but the extreme form.

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

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

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

VIEWS OF THE FREUDIAN SCHOOL

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

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

To put the matter plainly, the Freudians contend that obsessions are
symbolical representations of the repressed sexual activities and tendencies
of infantile and early childhood origin. It must be remembered that the
Freudians employ the term sexual in a very broad sense, including under it
the most indirect and distant physical, mental and moral reverbations.
conscious or "unconscious," of the relations between the sexes. The sexual
impulse is here conceived of as having incestuous, bisexual and polymorphous
perverse sexual tendencies. The word sexual is not only used as synonymous
with love, but practically all emotional surgings, all feelings, all
affectivity, all sense-cravings and bodily heavings are classed by certain

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