THE PSYCHOPATHOLOGICAL APPROACH
One of the standing obstacles in the path of personality research
is the difficulty of describing the personality as a whole at any
given cross-section of its development. In despair at the myriad
difficulties of the task, academic psychology has long evaded the
issue and concentrated its attention upon the minute exploration of
detached aspects of the individual. The manuals of physiological
psychology are full of painstaking accounts of how atomized aspects of
the individual’s environment (the “stimuli”) modify the reactions of
selected parts of the individual. What these manuals characteristically
omit is a workable set of conceptions for the classification of the
phenomena which are the objects of investigation in personality
research. It is impossible to found a science of geology without
inventing terms to distinguish plateaus, plains, mountains, and
continental blocs, even though all these phenomena possess the common
attributes of “matter.” What matters for the geologist is how the
differences and not the likenesses come to pass. Much of the academic
psychology, in its quest for precision and prestige, has quit studying
the problem with which it is ostensibly engaged, and has substituted
a minor field of physiology therefor. In so doing, it has lost any
criterion for testing the relevance of the results of particular
researches for the understanding of personality because it has no
master concepts of personality.
The psychopathologist has never been able to evade the necessity of
summing up the personality as a whole because he has been compelled
to make important decisions about the future of the personality as a
whole. The psychiatrist must continually decide whether John B and Mary
C will, if released from careful supervision, commit suicide or murder,
or whether they will be dependable members of the community. Thus the
clinician has found it imperative to search for signs which have high
predictive value in relation to the major social adjustments of the
individual.
The psychopathologist has had the great advantage of seeing many
trends of the personality which are normally subordinated to other
trends when they have escaped from control and achieved Gargantuan
proportions. The clinical caricature throws into imposing relief the
constituent tendencies which make up the functioning person, and draws
attention to their presence and their processes. “Normality” involves
a complicated integration of many tendencies, a flexible capacity to
snap from one mood, preoccupation, and overt activity to another as
the changing demands of reality require. The pathological mind, if one
may indulge in a lame analogy, is like an automobile with its control
lever stuck in one gear: the normal mind can shift. One has a queer
feeling as one passes around the wards of a hospital for the custody
of the more seriously disordered patients that if one could assemble
the scattered parts of the mind that one could create at least a single
supermind. There in one corner is a melancholic who is stuck in the
mood of despondency; in another corner is a manic who is expansive
and elated; elsewhere is a man whose self-esteem has achieved cosmic
dimensions; in the back wards is a deteriorated mind in perpetual
repose. Every conceivable nuance of preoccupation and mood with which
we are normally familiar seems to be dissatisfied with its minor rôle
in a healthy integration, and intent upon autocratic mastery of the
mind. The clinical caricature draws attention as sharply as possible
to the components of the healthy mind. So every theory of pathological
manifestations must presently become expanded or assimilated into a
comprehensive account of human psychology.
The gross clinical material reveals the intimate interrelationships
between soma and psyche. The patient who suffers from obsessive ideas
may find relief from obsession by showing hysterical symptoms; and
hysterical symptoms may clear up, only to make way for obsessive
symptoms. “Pure pictures” are almost pure theories. The patient who is
suffering from a definite organic lesion may complicate his troubles
by “worry,” and “worry” may be one of the factors in bringing about a
physical disease picture. There is evidence that psychological factors
are among those significantly operating in such diseases as common
colds, asthma, catarrh, hay fever, hyperthyroidism, gall-bladder
trouble, gastro-intestinal ulcers, irregular menstruation, and sexual
impotence.
Fresh vitality has come into modern psychology from the clinic. The
psychopathological approach has gradually vindicated itself as more
and more of its conceptions find a permanent place in the vocabulary
of psychology and social science. Modern psychopathology is itself a
recent development, and undoubtedly the most revolutionary figure is
Sigmund Freud.
The spectacular and influential nature of Freud’s work is sufficient
justification for devoting some space to a brief account of his
standpoint and his innovation in method. As we shall have occasion to
illustrate, his method is of more general application to practical
problems of political research and political practice than is usually
understood.
When Freud was a student in the University of Vienna, the triumphal
progress of microscopic methods of studying cellular structure was
sweeping all before it. Congeries of mental symptoms in the living
were frequently found to be correlated with the discovery of certain
definite cerebrospinal lesions on autopsy. The future seemed to
rest wholly in the hands of those who used the dissecting knife and
the lens. Before Freud graduated from the University, he became
demonstrator to Brücke, the eminent physiologist; and he labored in
the laboratory of Meynart, the distinguished psychiatrist of his day.
Freud’s first publication was a result of laborious laboratory work.
While materialism reigned, psychological phenomena were degraded to
the status of trivial epiphenomena. But at this very time a revival
of psychogeneticism arose in French psychiatry under the impetus of
Charcot. Charcot had achieved eminence in pathological anatomy before
he turned in middle life to the study of mental maladies. By 1883 he
had demonstrated the possibility of producing hysterical symptoms
by means of ideas (verbal stimuli). Time and again he hypnotized
individuals and produced muscular contractures, hypersensitivity, and
hyposensitivity, together with allied symptoms of hysteria.
Breaking away from the laboratories of Vienna, Freud journeyed to the
Salpêtrière Hospital in Paris to work with Charcot, where he stayed
from the autumn of 1886 to the spring of 1887. Here he was thrown in
touch with the current of ideas which was giving concrete content to
the notion of the “out of conscious” and its dynamic consequences for
human behavior. Pierre Janet was busily accumulating the observations
which were published to the world in 1889 under the title,
_L’automatisme psychologique_. Early chapters appeared in the _Revue
philosophique_ as early as 1886.
Freud had just missed a spectacular rise to fame when he failed to
recognize the anaesthetic possibilities of cocaine in surgery. He
published a review of the literature on cocoa; and a young Vienna
colleague, Koller, struck by some of the data which Freud had
assembled, announced the discovery in 1884 which immortalized his name
in medical history. Freud pondered for many years on why the idea
should have eluded him, and perhaps his desertion of the laboratory was
due to his sense of partial failure.
In Paris he acquired a point of view which was bound to bring him into
conflict with the materialistic pundits of Vienna. Hypnotism was itself
looked upon as an artifice of charlatans. Wagner-Jauregg reflected the
ruling tradition when, only a few years ago, he said, “The trouble
with hypnotism is that you never know who is pulling the other
fellow’s leg.” Freud was met by derisive laughter when he announced
at the Medical Society of Vienna that male hysterics were to be found
in Paris. For hysteria, as one of the pedants reminded him, was
philologically derived from “hysteron,” meaning uterus, and therefore
couldn’t possibly occur in males. This was an echo of the days when
hysteria was supposed to be due to a migratory uterus and women were
turned upside down to bring it back in place.
In 1881 and 1882 Breuer had treated a girl suffering from hysteria,
and his interest was renewed in the case in conversation with Freud.
Breuer remembered that when he treated the patient under hypnosis, she
recalled the first episode in which a symptom had appeared, related
it with every evidence of excitement, and discovered on waking that
the symptom had disappeared. Breuer and Freud began to study hysteria
from this point of view and published their results. Charcot had
demonstrated that ideas could cause hysteria; Breuer had found that the
discovery of pathogenic ideas could cure hysteria.
In 1889 Freud returned to France, this time to the other center of
hypnotic research, Nancy, where Liébeault and Bernheim were doing
remarkable things. Freud here saw something the full significance of
which did not at once dawn upon him.
A subject was hypnotized and given a “post-hypnotic suggestion” to
raise an umbrella at a certain signal after coming out of hypnosis.
The subject was then awakened from hypnosis, and presently, when the
stipulated signal was given, obediently raised the umbrella, although
still inside the room. When asked why he raised the umbrella, _he
said that he wanted to see whether it was his or not_. Thus did he
rationalize (a concept later developed) the gratification of an impulse
_which he did not himself at first recognize_. When challenged to
explain himself, he merely produced a plausible interpretation of his
own conduct.
The immense significance of this train of events is great enough. It at
once raises the searching question: To what extent are we in ignorance
of our own motives and accustomed to improvise merely plausible
explanations of and to ourselves? But an even more notable phenomenon
occurred. _If the subject was asked again and again to try to remember
why he raised the umbrella, he sooner or later recalled (to his own
surprise) that he had been commanded to do it._
The full import of this observation did not instantly dawn on Freud.
But he continued to have difficulties with the patients whom he sought
to hypnotize. They sometimes held out against his suggestions, even
though they had accepted them many times before, and seriously impeded
the progress of the search for the traumatic episode. He gradually
abandoned hypnosis, leaving the patient in a waking state in a relaxed
position with instructions to report every incident connected with the
early appearance of the symptom under investigation. Vestiges of the
hypnotic technique remained as late as 1895, when he would still lay
his hand on the patient’s forehead as a stimulus to recollection.
This method also encountered crippling difficulties. A patient would
sometimes lie for hours without saying a word, totally unable to
recover a relevant reminiscence. To meet this obstacle, Freud presently
hit upon the simple expedient upon which he thenceforth relied. He
instructed the patient to say anything and everything that popped in
his head, regardless of its propriety, logic, or triviality.
Freud found that all ramblings of his patient could furnish him with
clues to the underlying and unavowed impulses of the sufferer. He
became able to guess the nature of the buried episode in which the
impulse had received its present type of manifestation. Thus the
patient might begin by saying that she had seen a red-headed man in the
street and that she always despised red-headed men--except of course
her dear brother. Day after day apparently random allusions would build
out the picture of her great interest in anything reminiscent of her
brother’s looks and acts, all of which would be bitterly condemned. But
if she were asked directly, she would maintain that her brother was a
fine, upstanding man, and a credit to the family.
The analyst, after listening to the eddies of talk, and noting the
patterns along which they seemed to whirl, would presently locate
a hidden rock beneath the innocent surface of the stream--in this
case, an unacknowledged load of hatred against her brother. Bit by
bit, stories of real or fancied childhood tyranny would come floating
along the stream. Then suddenly, amid tears and violent gestures,
might come the story of a long-forgotten incident which involved an
intimate aggression on the part of the brother. The patient, manifestly
relieved, might speedily recover from her hysterical disabilities and
return to the active responsibilities of life.
Freud’s theory of what he saw began modestly enough, leaned heavily
upon Charcot, Bernheim, and Breuer, and was mostly founded upon
observations made upon patients who were handled by hypnosis and not by
the new procedure which later was called psychoanalysis. He published a
contribution to the theory of the psychoneuroses in which he laid down
the proposition that a distinction could be drawn between one group,
the anxiety neuroses, which depended on mental conflict, and the actual
neuroses, which were not due to mental conflict but to masturbation and
coitus interruptus. In the first case, mental energy was converted into
bodily symptoms, and in the latter case bodily energy was supposed to
be converted into bodily symptoms. In Freud’s early articles there is
little to forecast the course which he was to follow as his brilliant
imagination viewed the behavior of the individual from the new vantage
ground which he had discovered.[5]
Whether his particular theories survive or fall, the standpoint which
he achieved by ruthlessly applying his method is of the greatest
value. His method, which grew from the necessities of an exasperated
physician, led him _systematically to treat every manifestation of
the individual as part of a related whole_. Freud’s mental set had
been furnished by the data of hypnosis, which seemed to show that
patients suffer from reminiscences. When he dropped hypnosis and tried
to force recollections, his mental set had not altered, for he was
still in search of the original, the traumatic episode. When he asked
his patients to say anything that came into their heads, he was still
hunting the elusive memory of a definite early experience. But quite
without realizing it, his original mental set had widened, and with
momentous consequences for his own subsequent development. If one were
given to exaggerations, one could say that the world of psychological
investigation had suddenly begun to turn on a new axis.
What was the nature of this new mental set? Intently watching his
patients, not for word for word accounts of what had happened, and
looking upon everything else as “irrelevant,” Freud learned to look
for meanings and not for reports. Every dream, every phrase, every
hesitation, every gesture, every intonation, every outburst began
to take on significance as possible allusions to the “traumatic”
episode. Allusions to hated objects, reminiscent of a brother, failure
to mention a hated sister until days had passed, although other
members of the family had been passed in review--every deviation from
comprehensiveness--was eagerly scrutinized for the clue it might afford.
The technique of therapy consisted in using clues to facilitate the
patient’s search for relief. The problem was to discover the nature
of the patient’s conflict and to volunteer interpretations for the
sake of helping the patient to dare to bring into full consciousness
the unavowed impulse which had once frightened his socially adjusted
self into frantic repression. This involved the interpretation of the
symptom as a compromise product of the patient’s ideal of conduct; and
the out-of-conscious impulse, which, though denied access to the full
consciousness of the sufferer, possessed enough strength to procure
partial gratification. The symptom was thus a symptom of conflict
between the socially adapted portion of the self and the unadapted
impulses of the personality, and the symptom was a compromise between
partial gratification of the illicit and partial punishment by the
conscience. The particular form of the “conflict” depended upon the
traumatic experience and the antecedent history of the individual.
Far more important than these therapeutic elaborations is the shift
in standpoint which made them possible. Since Freud was on the search
for the literal by way of the symbolic, he raised hitherto neglected
manifestations of human behavior to the dignity of significant symbols,
wrote them out, and introduced them into the literature of human
behavior. There could be no sharper illustration of the prepotency of
“mental set” for the seeing of “facts” than the difference between
the clinical reports of Freud and Janet. Freud, convinced that the
eluctable energies of the organism could betray themselves in every
image and in every gesture, painstakingly recorded the dreams and
day-fantasies of his patients. Janet, who continued to assume that
dreams were nonsensical confusions attributable to the diminished
tension of the sleeping organism, seldom made any allusion to dreams.
His pellucid description of grimaces, gestures, sentiments, and
theories of his patients led back to relatively recent moments when the
patient failed of adjustment. This failure of the patient to mobilize
his energies in smooth adaptation to the exigencies of social reality
was then imputed to a defective biopsychical mechanism, to a lowered
“psychological tension,” due to a miscellany of possible causes, among
which was mentioned “the exhaustive effects of emotional excitement.”
Therapy consisted in restoring the capacity of the individual to
mobilize and deploy his energies at the highest “levels” of adjustment.
This was to be achieved by a variety of means--by hypnotic suggestion,
rest in a simplified environment, and the usual repertory of the
psychotherapist.
But the golden flash of psychological insight eluded Janet. At bottom
he had little respect for the concrete reality of the mental life of
his patients. Although he talked the language of psychogeneticism, it
had a poor and not a rich connotation in his mind. I think this is
due to his too exclusive reliance upon hypnotism, for the mental set
of the hypnotist is derogatory to most of the concrete productions
of the patient. The patient, one feels with a shrug, will presently
come to the important experience; why take the superimposed material
too seriously? Then, too, the patient may be put in order by direct
command. Janet relates with some pride how people in the waiting-room
of his office would marvel when a woman, bent nearly double, would be
admitted into his sanctum, presently to emerge, erect and cured--until
the effect wore off.
Freud learned a new respect for the concrete reality of mental life in
his concentrated effort to divine the hidden conflict without resorting
to hypnosis. His weakness as a hypnotist was in a sense the beginning
of wisdom. A patient who is deeply hypnotized is but infrahuman.
Barring commands which do violence to the moral code of the individual,
the subject will passively execute the commands of the hypnotist. The
patient descends from a complicated “nearly normal” person to a waxy
caricature of a human being. The unhypnotized patient of Freud is in
relatively full possession of all the resources of the ordinary waking
self, and must be dealt with as a complex human being.
The widest gateway to psychoanalytic development became the study
of dreams. And here again we are dealing with something which came,
not from laborious reflection upon underlying concepts, but from the
urgencies of the clinical situation. Just as we found that Freud had
taken up a new post of observation in practice before he discovered
its implications in theory, we find that in such a detail as the
investigation of dreams, his theoretical preoccupations contributed
less than his everyday necessities. Freud’s patients continually thrust
their dreams upon him; and he, now in pursuit of clues to what lay
behind, presently took them seriously, and found in them many helpful
indications of unspoken things. He would assist the free-fantasies of
the patient by asking what came into his mind about any detail of the
dream, and he attentively followed the long chains of superficially
meaningless associations.
It began to appear that Freud had stumbled upon, and then brilliantly
elaborated the possibilities inherent in, a new way of using the mind.
He trained his patients in a technique of free-fantasy which they
could subsequently use for themselves as a supplement to the logical
technique which society ostensibly tries to foster. It at once appeared
that he had discovered a method of thinking which was applicable far
beyond the confines of the clinic and which could be added to the
repertory of the mind.
The interpretation of dreams was the bridge which brought Freud from
the confines of the clinic to the analysis of the whole psychology
of individual development. The dreams of patients and the dreams of
non-pathological persons showed such homogeneity of symbolism that
the gap between the “normal” and the “sick” seemed to close. Popular
lore already furnished a clue to dreams as wish-fulfilments, whether
found in the “well” or “ill,” but popular lore also treated them as
reminiscences, prophecies, and omens, or as confusions, depending on
the transitory context of the moment. Freud had a double orientation
in dealing with the individual. He regarded him as motivated in the
present by impulses which eluded his own consciousness. He regarded
these motivations as having achieved their present form in concrete
historical events in the life of the individual. The nature of the
present could be made clear to the conscious mind if the organizing
episode could be recalled. This recall could be greatly facilitated by
paying special attention to the “irrational” or non-adjustive aspects
of the person’s present conduct. The “irrational” would seem rational
enough if the unacknowledged motives were made manifest, and if the
historical as well as the contemporary allusions were sought after.
Sooner or later the unrecognized motives would disclose themselves in
consciousness, if the individual waited attentively; but the process
could be greatly helped by using a different style of thinking than the
logical.
No one has more dramatically and repeatedly shown the limitations (as
well as the advantages) of logical procedures of thought than Freud.
No one has made a more important contribution to the technique of
supplementing logical thought by other methods of thought than Freud.
This is the aspect of Freud’s work which has immediate and constant
relevance to political as to every other sort of thinking, and to which
it is important to devote more extended consideration.