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.