Hysteria was known to the ancients and in fact is as old as the
written history of mankind. Considered essentially a disease of
women, it was given its present name which is derived from
"hysteron," the Greek name for the womb. We know to-day that men
also are victims of this malady, though it arises under somewhat
different circumstances than is the case with the other sex. Men
and women, living in the same world and side by side, are placed
in greatly different positions in that world, are governed by
different traditions and are placed under the influences of
differing ambitions, expectations, hopes and fears. Hysteria
arises largely out of the emotional and volitional reactions of
life, and these reactions differ in the sexes.
It was a group of French neurologists, headed by Charcot--and
including very illustrious men, such as Janet and Marie, who paid
the first scientific attention to the disease. Under their
analyses hysteria was defined as a mental disease in which
certain symptoms appeared prominently.
1. Charcot especially paid attention to what are known as the
attacks. The hysteric patient (usually a woman, and so we shall
speak of the patient as "she") under emotional stress and strain,
following a quarrel or a disagreement or perhaps some
disagreeable, humiliating situation, shows alarming symptoms.
Perhaps she falls (never in a way to injure herself) to the floor
and apparently loses consciousness, closes her eyes, rolls her
head from side to side, moans, clenches her fists, lifts her body
from the floor so that it rests on head and heels (opisthotonic
hysteria), shrieks now and then and altogether presents a
terrifying spectacle. Or else she twitches all over, weeps,
moans, laughs and shouts, and rushes around the room, beating her
head on the walls; or she may lie or stand in a very dramatic
pose, perhaps indicating passion or fear or anger. The attacks
are characterized by a few main peculiarities, which are that the
patient usually has had an emotional upset or is in some
disagreeable situation, that she does not hurt herself by her
falls, that consciousness is never completely abolished and
fluctuates so that now she seems almost "awake" and then she
seems almost in a complete stupor, and that the expression of
emotion in the attack is often very prominent. These symptoms are
readily differentiated from what is seen in epilepsy.[1]
[1] The French writers of the school of Babinski deny that the
above symptom and even the majority of the following have a real
existence in hysteria. The English, American and German
neurologists and the rest of the French school describe hysteria
substantially as I am here describing it.
2. The hysteric paralyses which are featured in all the
literatures of the world are curious manifestations and often
very stubborn. Following an accident (especially in industry and
in war) and after some emotional difficulty there is a paralysis
of some part of the body. The arm or some particular part of the
arm cannot be moved by the will, is paralyzed; or else the
difficulty involves one or both legs. Sometimes speech is gone,
or the power of moving the head; occasionally the difficulty is
with one side of the face, etc. Usually the paralysis comes on
suddenly, but often it comes on gradually. Modern neurology soon
discovered that these paralyses were quite unlike those seen when
there is "real" injury to the brain, spinal cord or the
peripheral nerves. They corresponded to the layman's idea of a
part. Thus a paralysis of the arm ends at the shoulder, a
paralysis of the feet at the ankle, and in ways not necessary to
detail here differ from what occurs when the organic structure of
the nervous system is involved. For example, the reflexes in
hysteria are unaltered, and stiffness when it occurs is not the
stiffness of organic disease. If a neurologist were to have a
hysteric paralysis a very interesting problem in diagnosis would
be presented.
Further, the paralysis yields in spectacular fashion to various
procedures or else disappears spontaneously in remarkable fashion
overnight. Paralyses of this type have disappeared under
hypnosis, violent electric shocks, "magical" liniments, threats,
prayers, the healer's, the fakir's, the doctor's personal
influence; under circumstances of danger (a fire, a row, etc.);
by pilgrimages to Lourdes, St. Anne de Beaupre, the Temple of
Diana, the relic of a saint; by the influence of sudden joy,
fear, anger; by the work of the psychoanalyst and by that of the
osteopath! Every great religious leader and every savage medicine
man beating a tom-tom has had to, prove his pretensions to
greatness by healing the sick--so intensely practical is man--and
he has proved his divinity by curing the hysterics, so that they
threw away their crutches, or jumped blithely out of bed, or used
their arms, perhaps for the first time in years. Hysteria has
caused more talk of the influence of mind over body than all
other manifestations of mental peculiarity put together. Wherever
there is anything to be gained by hysteric paralyses, these
appear in much greater frequency than under ordinary
circumstances. Thus the possibility of recovering damages seems
to play a role in bringing about a paralysis that defies
treatment until the litigation is settled; similarly the
possibility of being removed from the fighting line played a
large part in the causation of war hysteric paralysis.
3. A group of sensory phenomena is conspicuous in hysteria,
sometimes combined with the paralyses and attacks but often
existing alone. A part of the body will become curiously
insensitive to stimulation. Thus one may thrust a pin into any
part without evoking any pain and APPARENTLY without being felt;
one may rub the cornea of the eye, that exquisitely sensitive
part, without arousing a reaction; one may push a throat stick
against the uvula as it hangs from the palate without arousing
the normal and very lively reflex of "gagging." These insensitive
areas, known as stigmata, played a very important role in the
epidemic of witchcraft hunting of the sixteenth and seventeenth
centuries, when the witch was so diagnosed if she felt no pain
when a needle was thrust into her. Mankind has often enough
worshiped the insane and mentally aberrant and has as often been
diabolically cruel to them.
What has been stated of the paralyses is true of the insensitive
areas; they correspond to an idea of a part and not to an
anatomical unit. Thus a loss of sensation will reach up to the
wrist (glove type) all around, front and back, or to the elbow or
the shoulder, etc. No organically caused anaesthetic area ever
does this, and so the neurologist is able, usually, to separate
the two conditions. And the anaesthesias yield as do the hysteric
paralyses to a variety of agents, from prayer and persuasion to a
bitter tonic or a blow. I confess to a weird feeling in the
presence of a hysteric whose arm can be thrust through and
through with a needle without apparently suffering any pain, and
it seems to me that this may be the explanation of the fortitude
of those martyrs who have astonished and sometimes converted
their persecutors by their sublime resistance to torture.
There has been described as part of hysteria the hysteric
temperament. The characteristics of this temperament are the
emotional instability, the strong desire for sympathy, the effort
to obtain one's desire through weakness, through the appeal to
the sympathy of others, an irritable egoism never satisfied and
without firm purpose. It is true that the majority of peace-time
hysterics show this peculiar temperament, but it is also true
that the war-time hysterics often enough were of "normal"
character, without prior evidence of weakness.
As I before mentioned, Freud became greatly interested in this
group of patients and especially in the female patients, since in
ordinary neurological practice the male hysteric is not common.
Out of his experience and effort he built up a system of beliefs
and treatment, the evolution of which is interesting, but which
is not here important.
At the present time the Freudian doctrine hangs on the following
beliefs:
1. That from the beginning to the end of life everything in the
mental activities of man has a cause and a meaning, and that
these causes and meanings may be traced back to infancy. No slip
of the tongue is accidental; it has purpose and this purpose can
be traced by psychoanalysis. So with hysteric phenomena: the
paralyses, the sensory changes, all the queer and startling
things represent something of importance and of value to the
subconscious.
2. There is in man a subconscious mentality, having wills,
purposes, strivings, desires, passions. These trends are the raw,
native, uninhibited desires of man; they are our lusts, our crude
unsocialized desires, arising out of a metaphysical,
undifferentiated yearning called libido. In the Freudian
"psychology" the libido is mainly sex desire and takes the form
of homosexual feelings, incest feelings (desire for the father or
for the mother--the oedipus complex), desire for the sister or
brother.[1] (The human being, according to Freud, goes through
three stages in his sex life: first, a sex attachment to himself
marked by thumb sucking, masturbation, etc., second, an
attachment to the same sex--homosexuality--and, finally, the
attachment or desire for the opposite sex.) In the practical
application of the Freudian psychology to the patients the sex
conflicts (of which we shall speak shortly) are all important;
the subconsciousness is largely taken up with sex and with
efforts to obtain gratification for these sex desires.
[1] The Freudians would protest against this. Libido is the life
energy,--but all the Freudian analyses of actual cases published
make libido sex, and usually "perverse." (I put the perverse in
quotations because I fear to be called prudish by Freudians.)
3. But, the theory continues, the conscious personality is the
socialized personality, having aims and ends not consistent with
desire for mother, homosexual cravings, lust for a married man or
woman. So there ensues a battle between desire and inhibition.
The inhibiting agent is a something called the censor, who pushes
back into the subconsciousness the socially tabooed, the socially
abhorrent desires; represses emotions and instincts that are
socially out of order. But there is no real victory for the
consciousness, for the complex (the name given to a desire or
wish with its attendant ideas, emotions and motor manifestations)
is still active, subconsciously changing the life of the person,
causing him to make slips in his speech, expressing itself in his
dreams and his work, and if sufficiently powerful, giving rise to
nervous or mental disease of one type or another. Nothing is ever
forgotten, according to Freud, and the reason our childhood is
not voluntarily remembered is because it is full of forbidden
desires and curiosities and the developing censor thrusts it all
into the subconsciousness, where it continues to make trouble all
the rest of the individual's life. In fact, a cardinal part of
Freudianism (which he and his followers are lately modifying) is
that it is the results of the "psychic traumata" (psychical
injuries) of infancy and childhood that cause the hysteria of the
adult; and these psychical traumata are largely (about ninety-
nine per cent.) sexual.
4. Freudianism has borrowed the time-honored dictum that every
sensation has a natural result in action and has elaborated it
into the statement that every affective state, every desire and
craving of whatever sort, needs a motor discharge, an avenue of
outlet. If the desire or emotion is inhibited, its excitement is
transferred with it into the subconscious and that excitement may
attach itself to other excitements and break into consciousness
as a mental disturbance of one type or another. If you can get at
the complex by psychoanalysis, by dragging it to the light, by
making it conscious, you discharge the excitement and health is
restored. This originally was very important in the Freudian work
and was called by the crude term of catharsis.
5. How can one get at these subterranean cravings and strivings,
at the fact that originally one desired one's mother and was
jealous of one's father, or vice versa? Here Freud developed an
elaborate technique based on the following:
Though the censor sits on the lid of the subconsciousness, that
wily self has ways and means of expression. In dreams, in humor,
in the slip of the tongue, in forgetfulness, in myths of the
race, in the symptoms of the hysteric patient, in the creations
of writers and artists, the subconsciousness seeks to symbolize
in innocent (or acceptable) form its crude wishes. By taking a
dream, for example, and analyzing it by what is known as the free
association method, one discovers the real meaning of the terms
used, the meaning behind the symbol; and behind the apparent
dream-content one sees revealed the wishes and disorganizing
desires of the subconscious or the real person. For throughout
Freud's work, though not so definitely expressed, there is the
idea that the subconscious is by far the most important part of
the personality, and that the social purposes, the moral
injunctions and feelings are not the real purposes and real
desires of the real personality.
In analyzing dreams, the symbols become quite standardized. The
horses, dogs, beards, queer situations of the dream (falling,
walking without clothes, picking up money, etc.), the demons,
ghosts, flying, relate definitely to sex situations, sex organs,
sex desires. (The Freudians are apt to deny this theoretically,
but practically every dream of the thousands they publish is a
sex dream of crude content.) Naturally a "pure" girl is quite
shocked when told that because she dreamed she was riding a gray
horse in a green meadow that she really has bad (and still is
troubled by) incestuous desires for her father, but that is the
way to cure her of her neurasthenia or fatigue or obsession of
one kind or other.
I have not attempted a detailed account of the technique of free
association, nor the Freudian account of humor, etc. There are
plenty of books on the market written by Freud himself and his
followers. Frankly I advise the average person not to read them.
I am opposed to the Freudian account of life and character,
though recognizing that he has caused the psychologist to examine
life with more realism, to strip away pretense, to be familiar
with the crude and to examine conduct with the microscope.
I do not believe there is an ORGANIZED subconsciousness, having a
PERSONALITY. Most of the work which proves this has been done on
hysterics. Hysterics are usually proficient liars, are very
suggestible and quite apt to give the examiner what he looks for,
because they seek his friendly interest and eager study. Wherever
I have checked up the "subconscious" facts as revealed by the
patient as a result of his psychoanalysis or through hypnosis, I
have found but little truth. On the other hand, the Freudians
practically never check up the statements of their patients; if a
woman tells all sorts of tales of her husband's attitude toward
her, or of the attitude of her parents, it is taken for granted
that she tells the truth. My belief is that had the statements of
Freud's patients been carefully investigated he would probably
never have evolved his theories.
The Freudians have made no consecutive study of normal childhood,
though they lay great stress on this period of life and in fact
trace the symptoms of their patients back to "infantile trauma."
Most of Freud's ideas on sex development can be traced to, the
one four-and-a-half-years-old child he analyzed, who was as
representative of normal childhood as the little chess champion
of nine years now astounding the world is representative of the
chess ability of the average child. Moreover, the basis of the
technique is the free association, an association released from
inhibitions of all kinds. There isn't any such thing, as
Professor Woodworth has pointed out. All associations are
conditioned by the physical condition of the patient, by his
mood, by the nature of the environment he finds himself in, by
the personality of the examiner and his powers of suggesting, his
purposes and (very important) by the patient's purposes, which he
cannot bid "Disappear!" As for the results of treatment, every
neurologist meets patients again and again who have been
"psychoanalyzed" without results. Moreover, psychoneurotic
patients get well without treatment, as do all other classes of
the sick, and the Christian Scientist, the osteopath and the
chiropractic also have records of "cures."
This is not the place to discuss in further detail the Freudian
ideas (the wish, the symbol, the jargon of transference, etc).
The leading follower of Freud, Jung, has already broken away from
the parent church, and there is an amusing cry of heresy raised.
Soon the eminent Austrian will have the pleasure of seeing a
half-dozen schools that have split off from his own,--followers
of Bleuler, Jung, Adler and others.
There IS a subconsciousness in that much of the nervous activity
of the organism has but little or no relation to consciousness.
There are mechanisms laid down by heredity and by the racial
structure that accomplish great functions without any but the
most indirect effect on consciousness and without any control by
the conscious personality. We are spurred on to sex life, to
marriage, to the care of our children by instinct; but the
instinct is not a personality any more than the automatic
heartbeat is. We repress a forbidden desire; if we are successful
and really overcome the desire by setting up new desires or in
some other way, the inhibited desire is not locked up in a
subterranean limbo. There is nothing pathological about
inhibition, for inhibition is as normal a part of character as
desire, and the social instinct which bids us inhibit is as
fundamental as the sex instinct. Most conflicts are on a
conscious plane, but most people will not admit to any one else
their deeply abhorrent desires. To all of us, or nearly all, come
desires and temptations that we would not acknowledge for the
world. If a wise examiner succeeds in getting us to admit them,
it is very agreeable to find a scapegoat in the form of the
subconsciousness. I have often said this to students: if all our
thoughts and conscious desires could be exposed, the most of us
would almost die of shame. True, we do not clearly understand
ourselves and our conflicts and explanation is often necessary,
but that is not equivalent to the subconsciousness; it merely
means that introspection is not sagacious.
Nor is it true, in my belief, that dreams are important psychical
events, nor that the subconsciousness evades a censor in
elaborating them. To what end would that be done? What would be
the use of it? Suppose that Freud and his school had never been;
then dreams would always be useless, for they would have no
interpreter. Men have dreamed in the countless ages before Freud
was born,--in vain. Think how the poor, misguided
subconsciousness has labored for nothing,--and how grateful it
should be to Freud! Dreams are results and have the same kind of
function that a stomach-ache has.
Things, experiences are forgotten, and whether they are
remembered or not depends upon the number of times they are
experienced, the attention they are given, the use they are put
to and the quality of the brain experiencing them. Disease and
old age may lower the recording power of the brain so that
experiences and sensations do not stick, and now and then the
brain is hypermnesic so that things are remembered with
surprising ease.
The conflicts of life are generally conscious conflicts, in my
experience. Desires and lusts that one does not know of do no
harm; it is the conflict which we cannot settle, the choice we
cannot make, the doubt we cannot resolve, that injures. It is not
those who find it easy to inhibit a desire or any impulse that
are troubled, though they may and do grow narrow. It is those
whose unlawful or discordant desires are not easily inhibited who
find themselves the theater of a constant struggle that breaks
them down. The uneasiness of a desire that arises from the
activity of the sex organs is not a manifestation of a
subconscious personality, unless we include in our personality
our livers, spleen and internal organs of all kinds. Such an
uneasiness may not be clearly understood by the individual merely
because the uneasiness is diffuse and not localized. But there is
no personality, Do will, wish or desire in that uneasiness; it
may and does cause to arise in the conscious personality wills
and wishes and desires against which there is rebellion and
because of which there is conflict.
Upon the issue of the conflicts within the personality hangs the
fate of the individual. Race-old lines of conduct are inhibited
by custom, tradition, teaching, conformity and the social
instinct and its allies. Here is a subject worthy of extended
consideration.
Freud has done the thought of our times a great service in
emphasizing conflict. From the earliest restriction laid by men
on his own conduct, wrestling with desire and temptation has been
the greatest of man's struggles. Internal warfare between
opposing purposes and desires may proceed to a disruption of the
personality, to failure and unhappiness, or else to a solidified
personality, efficient, single-minded and successful. Freud's
work has directed our attention to the thousand and one aberrant
desires that we will hardly acknowledge to ourselves, and he has
forced the professional worker in abnormal and normal mental life
to disregard his own prejudices, to strip away the camouflage
that we put over our motives and our struggles. Together with
Jung and Bleuler, he has helped our science of character a great
deal through no other method than by arousing it to action
against him. In order to fight him, our thought has been forced
to arm itself with the weapons that he has used.