committed in its name, it would be a mistake to be merely amused at
Doctor Beard for the pretentiousness of his concept or to criticize
him too severely for being too much of a medical popularizer. His
insight was, after all, of considerable value. For he realized, however
imperfectly, that the neuroses as a class are cultural diseases and
that they cannot be properly understood without taking into account the
background of modern civilization. This is a rare virtue in American
medicine where the specialist is constantly in danger of isolating
himself, a tendency which is particularly harmful in the study of the
mental sciences. Unfortunately Doctor Beard did not follow through. He
seems to have become frightened at his own diagnosis. For no sooner
had he drawn the worst possible picture of American civilization as
a breeder of neurasthenia than he turned around and assured the
public that things were not so bad after all. He accomplished this by
enriching his sociology with a philosophy which is a prodigy in itself.
This philosophy of his he called the “omnistic philosophy” and claimed
for it the peculiar virtue of being able to include “optimism on the
one hand and pessimism on the other and make the best of both,” which
is undoubtedly as uplifting a piece of American metaphysics as one is
likely to find on the whole Chautauqua circuit. In criticizing the slow
advance of American medicine as a whole it is always well to remember
the atmosphere of intellectual quackery in which our physicians no less
than our early metaphysicians so confidently moved.
By the end of the 19th century the study of functional nervous
disorders in America was, as I have said, pretty well strewn with the
_disjecta membra_ of neurasthenia which still breathed slightly under
the stimulus of electro- and hydrotherapeutics and of the “health
foods” industry. Meanwhile hypnotism also had come to do its turn upon
the American medical stage, where it ran through a swift cycle of use
and abuse. Neurology as a special department, like the rest of American
medicine, had been greatly enriched by contact with continental
medicine, and the works of Kraepelin had come into honour among the
psychiatrists. Dr. Morton Prince had begun to publish some interesting
studies of double personalities, and a number of tentative systems of
psycho-therapy based on a rather mixed procedure had been set up only
to be knocked down again as a beneficial exercise for the critical
faculty.
But now the stage was set for the appearance of the two modern theories
of the neuroses as presented in Europe by Janet and Freud. In the
rivalry that immediately ensued between these two opposing theories
that of Janet was soon outdistanced. His fundamental conception of
hysteria as a form of degeneration was in a way quite as repugnant
to American optimism as the sexual interpretation of Freud was to
American prudery. Janet had indeed been of invaluable help to the
hysteric by taking him seriously, but his presentation of the subject
was so narrow and his theory in the end proved so static that his views
have made little headway. Janet was also under the disadvantage of
working as an isolated figure in a prescribed field and did not come
into any revolutionary relation to psychology as a whole or find those
immensely suggestive analogies in the field of psychiatry, especially
in dementia præcox and paranoia, which have given the work of Freud
such a wide range. He had, besides, the defects common to so much of
French medicine which is often so peculiarly insular and, so to speak,
not made for export. His contribution more or less began and ended
with the theory of the dissociation of the personality which is not
characteristic of hysteria alone and could not successfully be grafted
upon the old psychology to which Janet clung.
On the other hand, Freud after an initial resistance rapidly became
epidemic in America. As was the case in Europe, he enjoyed considerable
vogue among the lay public while still violently opposed in medical
circles. His visit to America, however, in 1909, on the occasion
of the twentieth anniversary of Clark University, created a very
favourable impression and brought him to the attention of such American
psychologists as William James, Edwin B. Holt, Adolf Meyer, and others.
His works appeared in this country in translations by Doctor A. A.
Brill, and in a short while Freud was “taken up” with a vengeance.
He has had both the advantages and the handicaps of a boom. His
admirers have obscured or exaggerated him and his enemies have derided
his popularity as proof of a reputation based upon sensationalism. In
fact, Freud met with three fates: he was either wildly embraced, or
rejected in toto with an appropriate academic lynching, or else he was
accepted with “improvements.”
He was fortified by previous experience against the second alternative
and probably resigned to the third: it was the embrace that most nearly
proved fatal to him. For America was to see the most extravagant
development of the so-called “wild” psychoanalysis, a danger against
which Freud himself had issued a warning. In 1916, for instance, an
informal canvas revealed that approximately five hundred individuals
were quite willing to psychoanalyze patients in the city of New
York alone, whereas there were probably not more than six properly
qualified medical practitioners in the whole State. Advertisements
offered to teach the psychoanalytic technique by mail and instructors
in chiropractic included it in their curriculum. This gross abuse was
due to the general laxness of medical law in this country which still
remains to be remedied. It was not only the amateurs that offended;
doctors themselves were often at fault. For it cannot be too often
emphasized that a psychoanalyst must have something more than the
conceit of psychological subtlety common to most of us; he must be
a trained neurologist and must have had considerable experience
in psychiatry if he would escape the pitfalls of differential
diagnosis--a case of hysteria can be dangerously like an incipient
tumour of the brain and a compulsion-neurosis may simulate a paranoid
condition. These abuses are, of course, no criticism of the intrinsic
value of psychoanalysis. It has been the history of so many medical
discoveries that they are recommended as a cure-all; we need but
recall vaccination, or the present vitamine craze. On the other hand,
it is regrettable that the direct attack upon Freud in this country
has rarely risen above the level of denunciation. Quite recently, for
instance, one of our socially eminent neurologists allowed himself
to indulge in the teleological, or rather disguised theological,
argument that if the unconscious is really so full of dreadful things
as Freud says, they should be left there. And yet it is just serious
and sympathetic criticism of which the science of psychoanalysis stands
most in need.
The attempts to assimilate Freud were of two kinds. The first of these,
like Professor Holt’s book on “The Freudian Wish” or Doctor Edward J.
Kempf’s “The Autonomic Functions and the Personality,” were sincere
attempts of critical dignity to relate psychoanalysis to American
behaviouristic psychology on the part of men who are not altogether
professed Freudians. The second were more in the nature of somewhat
pompous criticisms which attempted to reconcile and soften what seemed
to be the more repellent features of the Freudian theories. There is a
prevalent tendency among medical men in America to indulge in criticism
without any due regard to the proportions between the magnitude of a
subject and their familiarity with it, somewhat after the manner of the
green theological student who is confident of his ability to subvert
the theory of evolution in a casual thesis of his own. The scientist in
many fields is constantly facing this debasement of standards, making
science not too scientific or logic not too logical lest it should
be misunderstood; it is certainly a commentary that the majority of
Americans, for instance, look upon Edison as our greatest scientist.
The tendency to sweeten and refine Freud has taken some peculiar forms,
due, in great part, to Doctor Jung who, on having re-introduced the
libido theory to American audiences with a number of philosophical
and mystical trimmings of his own, felt that he had made Freud more
palatable over here.
Ironically enough, it would have been a very simple matter to “put
over” Freud in this country with all the éclat of the Bergsonian
craze which just preceded him. It was merely a question of the right
kind of publicity, for the problem of how to handle sex in America
has been solved long ago. The way to do it is to sentimentalize it.
If Freud, instead of saying that the incestuous longing of the child
for the parent of opposite sex is a natural impulse, though normally
sublimated during the period of adolescence, had put the same idea into
the phraseology of so many of our popular songs which reiterate the
theme about mother being her boy’s first and last and truest love, he
would have encountered no opposition. And if he had given his theory
of the unconscious a slightly religious setting by emphasizing the
fact that the unconscious has no sense of the passage of time and
cannot conceive its own annihilation, he would have been hailed as the
latest demonstrator of the immortality of the soul. A little personal
press-agenting to the effect that he led a chaste life and was the
father of a flourishing family would have completed the prescription.
He would have gone over with a bang, though he probably would have been
quite as amiably misunderstood as he is now viciously misunderstood.
Freud, however, presented his case at its own value and, aside from
informing an astonished American audience that Doctor Sanford Bell had
preceded him in announcing the preadolescent sexuality of children,
shouldered the responsibility for his theories. What he has said,
carefully and repeatedly, is that ever since, for a long period in our
development, the difficulties of satisfying the hunger impulse have
been overcome in so far as civilized man has pretty well solved the
problem of nutrition; it is the sex impulse to which the individual
has the greatest difficulty in adjusting himself. This difficulty
increases rather than decreases with the advance of culture and at
certain stages leads to the group of diseases known as the neuroses. In
a normal sexual life there is no neurosis. But our civilization has in
many ways become so perverse that we find something akin to an official
preference for a neurosis rather than a normal sexual life, in spite
of the fact that the neurosis ultimately will destroy civilization.
This is the vicious circle which Freud attacked. In doing so he
had first to enlarge the concept of sexuality and show its complex
relation to our whole culture. In studying civilization at its breaking
point he naturally had to study what was breaking it up, namely, the
individual’s maladjustment to his sexual impulses. But he has never
attempted to sexualize the universe, as has been claimed, nor has he
ever lost sight of the fact that while man as an egocentric being must
put the self-regarding instincts first, man regarded as one of the
processes of nature remains to be studied in terms of his reproductive
instincts. Freud has been persistently oversexualized both by his
admirers and his opponents, and the degree to which this has been done
in America is at least some indication of how close he has come home to
conditions here.
Freudian research in this country has been limited almost entirely
to cases. Our physicians who practise psychoanalysis have lacked
either the leisure or the culture to apply their science to wider
cultural questions to which the Freudian psychology applies, and
among the lay scholars using the psychoanalytic technique there has
been no outstanding figure like that of Otto Rank who has done such
notable work in Vienna. But the study of specific cases of hysteria
and neurosis as they occur in America already permit of some general
conclusions as to the character of the national matrix from which they
spring. One of the most striking features of our emotional life is
the exaggerated mother-love so frequently displayed by Americans. The
average American, whether drunk or sober, can grow maudlin about his
mother’s perfections and his devotion to her in a way that must shock
the European observer. Not that the European loves his mother less:
it is simply that he is more reticent about expressing an emotion
which he feels has a certain private sanctity; he would experience
a decided constraint or αἰδώς in boasting about it, just as a woman
of breeding would not parade her virtue. The American adult knows no
such restraint; he will “tell the world” how much he loves his mother,
will sing sentimental songs about her and cheerfully subscribe to the
advice to “choose a girl like your mother if you want to be happily
married,” and then grows violent when the incest-complex is mentioned.
This excessive mother worship has reached almost cultic proportions. It
is reflected in our fiction, in our motion-pictures, in the inferior
position of the American husband, and in such purely matriarchal
religions as Christian Science where a form of healing is practised
which is not very far removed from a mother’s consolation to her boy
when he has bruised his knees. All this points to a persistent sexual
infantilism and an incomplete sublimation, which are such fertile
breeders of hysteria. One is involuntarily reminded of Doctor Beard’s
rather enigmatic statement that the extraordinary beauty of our women
is one of the causes of nervousness in America. In so far as they
offer a maximum of enticement with a minimum of conjugal satisfaction
the charge is certainly justified. It is as if they did not even know
their own business in terms of their sexual function of weaning their
husbands from their mothers and thus completing the necessary exogamic
process. We thus have the condition where the husband, in further
seeking to overcome his incest-complex, becomes everything in his
business and nothing in his home, with an ultimate neurotic breakdown
or a belated plunge into promiscuity. The wife, on her part, either
becomes hysterical or falls a victim to religious or reformatory
charlatanism.
The study of compulsion-neuroses and allied paranoid states which are
so prevalent among us has given us further insights into the neurotic
character of the American temperament. One of the most valuable of
these is the recognition of the compulsive nature of so much of our
thinking. This has also been well observed by a foreign critic like
Santayana who says of America, “Though it calls itself the land of
freedom, it is really the land of compulsions, and one of the greatest
compulsions is that we must think and feel alike.” This is a rather
fatal indictment of our boasted individualism, which is, as a matter of
fact, an individualism born of fear and distrust such as already marked
our early pioneers. We are indeed ultra-conformists, and our fear of
other-mindedness amounts almost to a phobia. But such an atmosphere
constitutes a paradise for the compulsion-neurotic because he finds
it easy to impose his compulsions upon the rest of society. The fact
that compulsion-neurotics are constantly indulging in neo-religious
formations through which they are enabled temporarily to accommodate
their taboos and phobias in religious ceremonials, enables them to make
use of the general religious sanctions of society in order to impose
their compulsions upon their fellow-beings.
Herein probably lies a better explanation of American intolerance
than in the indictment of Puritanism which furnishes such a favourite
invective for our iconoclasts. Puritanism has become a literary
catchword and by no means covers the case. For it must be remembered
that we are dealing with offshoots of deteriorated religions which
spring from a very wide range of individuals. Religion, having been
cut off from direct interference with the State, and having gradually
lost its primitive anthropomorphism which really was one of its sources
of strength, proceeded to project itself more and more outwardly upon
social questions. As the personality of God grew dim the figure of the
Devil also lost its vividness and the problem between good and evil
could not longer be fought out entirely in the individual’s own bosom;
he was no longer tempted by the figure of the Devil appearing to him
in person. Christian religion in its prime saw very clearly that the
soul must put its own salvation to the fore, and constantly used many
apt similes, such as the beam in our own eye, to remind us that while
our neighbour might also have his hands full in fighting the Devil, he
probably was capable of taking care of himself. Our modern reformer
has no use for any such simile; he would have to go out of business
if he could not keep picking at the mote in his neighbour’s eye. He
finds the equivalent of the Devil in our social vices, in alcohol, in
tobacco, in tea and coffee, in practically all forms of amusements. He
preaches a crusade which no longer has an ideal object, and enlists
a vague religious emotion which is inaccessible to reason and mocks
intellectual criticism. The device of using religious associations as
carriers of propaganda has often been used for political purposes with
consummate skill. Bryan’s famous Cross of Gold speech and Roosevelt’s
Armageddon appeal are excellent examples of it.
The question has often arisen why the fanatical reformer is so
omnipotent in America. Why does he succeed so well in imposing his
compulsions upon others? Why are we so defenceless against his
blackmail? Why, in plain language, do we stand for him? Foreign
observers have frequently commented upon the enormous docility of the
American public. And it is all the more curious because ordinarily
the average American prides himself upon his assertiveness and his
quickness in detecting false pretensions. Yet it is a common occurrence
to meet people with valid claims to hard-headedness who nevertheless
submit to every form of compulsion. They do not believe in prohibition
but vote for it, they smoke but think smoking ought to be stopped, they
admit the fanatical nature of reform movements and yet continue their
subscriptions.
In giving what can at best be only a partial answer to this national
enigma, we may briefly consider two types which profoundly contribute
to our atmosphere of compulsion: our immigrant and our native
aristocrat. The first, from the very nature of the case, becomes the
victim of compulsion, while the second imposes the compulsion and then
in turn, however unwillingly, succumbs to it himself. Our society,
with its kaleidoscopic changes of fortune and its unchannelled social
distinctions, presents a problem of adjustment with which even those
who are at home in America find it difficult to cope. People on the
make, people who are not sure of themselves on a new social ladder, are
likely to conform: we find an astonishing amount of social imitation,
in its milder and more ludicrous form, in all our pioneer communities.
The immigrant faces the same problem to an intensified degree. He
comes to us in an uprooted state of mind, with many of his emotional
allegiances still lingering in his native country, and often with an
entirely alien tradition. His mind is set to conform, to obey at first
without much asking. He is like a traveller arriving in a strange
town who follows the new traffic directions even though he does not
understand their purpose. But even with the best of will he cannot
entirely conform. He finds himself in a new world where what formerly
seemed right to him is now considered wrong, his household gods have
lost their power, his conscience is no longer an infallible guide.
It is a sign of character in him to resist, to refuse to sink his
individuality entirely, to struggle somewhat against the democratic
degradation which threatens to engulf him too suddenly. But his
struggle leads to a neurotic conflict which is often not resolved
until the third generation. It is thus quite permissible to talk of an
immigrant’s neurosis, which has considerable sociological importance
even though it does not present an integral clinical picture. It leads
either to the formation of large segments of undigested foreigners
in American society who sullenly accept the forms we impose upon
them while remaining comparatively inarticulate in our cultural and
political life, or else it produces a type of whom our melting-pot
romanticists are foolishly proud, the pseudo-American who has sunk from
individualism to the level of the mob, where he conforms to excess in
order to cover his antecedents and becomes intolerant in order that he
may be tolerated.
Ordinarily, the mob tyranny which has become such an alarming feature
of our public life would be checked by the aristocratic element in
society. It is part of the aristocratic function to foster cultural
tolerance and to resist herd suggestion: the aristocratic or dominant
type, in enjoying the most privileges, is normally least subject to
compulsions and taboos. With us that is not the case. The Southerner,
for instance, our most traditional aristocrat, finds himself paralyzed
by the consciousness of a black shadow behind him who constantly
threatens both his political and his sexual superiority. He moves in
an atmosphere of taboos from which he himself cannot escape, for it
is an established fact that interdiction in one line of thought has
a crippling effect upon a man’s intellectual activity as a whole.
Elsewhere our native aristocrat frequently finds himself in the
position of a lonely outpost of a thin Anglo-Saxon tradition which he
must defend against the constant onslaughts of alien civilizations, in
the desperate attempt to uphold the fiction that spiritually, at least,
we are still an English colony. He is in a state of tension where he
himself cannot move with any of the freedom which he vaunts as one of
the outstanding characteristics of the country of his fathers. In his
hands his own latest hope, our war-born Americanization programme,
which should really be an initiation into freedom, has quickly become
little more than a forced observance of sterile rites with which to
impress the alien. He already sees its failure, and, like a general who
is afraid of his own army, he does not sleep very well.
ALFRED B. KUTTNER
MEDICINE
From time immemorial the doctor has been the object of respect and awe
by the generality of mankind. It is true that he has occasionally been
made the butt of the satirical humour of such dramatists as Molière and
Shaw, but the majority of people have regarded these jests as amiable
buffooneries, and not as penetrating criticisms. In ancient days the
veneration of the medico was based upon his supposed association with
gods and devils, and upon the belief that he could cure disease by
wheedling propitiation of _deus_, or by the exorcism of _diabolus_. In
modern times he holds sway by his supposed possession of the secrets of
science.
In spite of his pretension to scientific attainment, many vestiges
of his former priesthood remain, and this _mélange_ of scientist and
priest has produced curious contradictions and absurdities. But these
absurdities must by an inexorable law remain concealed from all save
a few, and the general failure to recognize them has led to a great
increase in the importance and prosperity of the medical cult. In
America, of all civilized nations, medical magnificence has reached its
most formidable proportions. This exaggeration, characteristic of all
social phenomena in the new world, makes the real importance of the
doctor to society easy to inspect and to analyze.