REVIEWS

THE MEANING OF DREAMS. By Isador H. Coriat. Little, Brown and Company,

Boston, 1915, Pages xiv plus 194.

This concise and well written little book hardly needs reviewing for the

readers of the Journal of Abnormal Psychology as all who have followed Dr.

Coriat's writings for the last few years will know at once the nature of the

book and what it contains. His purpose is evidently to give a simple clear

statement of the position of the Freudian school and he accomplishes this

with more than ordinary success. He is lavish in his praises of Freud and

seemingly accepts unquestionably the whole mass of Freudian doctrines. One

searches in vain for the least question or the slightest suggestion that

some of the Freudian concepts might possibly be wrong. Everywhere the words

of Freud and the beliefs of the author are given as absolute, eternal and

unquestionable. He incorporates some of the recent additions to the

Freudian teachings, such as Brill's treatment of the "artificial dream," but

concerning the fundamentals he leaves the original doctrines without

noticeable modification. In discussing the mechanisms of dreams he adds a

fifth to the original four, calling his addition "reinforcement."

Reinforcement is the mechanism by which "the prominent or primary wish of

the dream is reinforced, expressed anew for the purpose of emphasis by means

of a second dream following the first, really a dream within a dream." With

this exception he leaves the original Freudian teachings intact and

unchanged. He says that a dream is the fulfilment of a wish and no

modifications of the statement follow that could possibly make one think he

meant anything else. His definite position is stated as follows: "The term

'wish' in psycho-analysis is very comprehensive and connotes in a broad

sense all our desires, ambitions or strivings." He illustrates his points

by numerous dreams which he has himself analyzed. He will probably meet some

objection from those who are not ardent Freudians concerning some of these

dreams as the interpretation is not always "perfectly clear" as he says it

is to him. Some may say that at least a dozen other interpretations might

just as well and just as logically have been given, but this is the

objection that is raised concerning all Freudian literature. The best

characterization of the book is to say that it is typically Freudian.

(As a side issue, it is interesting to notice how many of the dreams given

relate to the European War. Some one has said that America shows her

concern over the war by the way Americans dream.)

There are two characteristics of the book which are worthy of special

mention and for which Dr. Coriat needs special praise. One of these is that

it is so simply written that the general public can read it and understand

it. No other Freudian publication which the reviewer has seen can boast of

the same simplicity. The other point is that absolutely everything

concerning sex which could possibly be objectionable has been ruled out.

There is not a word or a sentence in the book that a precise maiden lady

need hesitate to read to her Sunday School class or at a pink tea. In doing

this Dr. Coriat has indeed achieved the impossible as all will readily

agree. This book is probably too elementary for the majority of the readers

of the Journal of Abnormal Psychology but it is destined to fill a place

which no previous Freudian publication could ever fill; it is a book for the

general public and the beginner in psychology and for this purpose it is

truly a little gem. RAYMOND BELLAMY. Emory and Henry College.

THE PSYCHONEUROSES AND THEIR TREATMENT BY PSYCHOTHERAPY. By Professor J.

Dejerine and Dr. E. Gauckler. Authorized Translation by Smith Ely Jelliffe,

M.D., Ph. D. J. B. Lippincott Co., Philadelphia, Pa.

This book is another instance of the lack of a common nomenclature in

psychopathology. Psychological mechanisms are penetratingly discussed; and

important syntheses are made regarding categories which many American

psychopathologists name differently not to speak of the nomenclature of the

repressionist of Vienna. It seems to the reviewer indeed, that what the

authors call neurasthenia is merely a somewhat complex elaboration of the

psychosis by induction to which Babinski has restricted the name hysteria.

It is true that certain manifestations of this, especially a false

gastropathy, may lead to an increased fatigue, and to this the name

neurasthenic might appropriately be given. But still more often one sees the

appearance of increased fatigue on account of the patient's faulty notion;

and to this the name neurasthenic should certainly not be given.

To place in the same rubric a simple somatic hysteria like a paralysis and

the complications of what are comprised in psychological neurasthenia as so

lucidly described in this book, seems at first sight irrational; but so at

first appeared the placing together of clinical pictures as unlike as

cervical struma, phthisis pulmonalis and ossious caries under the rubric of

tuberculosis, and in a nearer field the synthesis of catatonia, hebephrenia

and cementing paranoia into the rubric of dementia precox. So, recognizing

the accuracy of the beautiful analysis of Professor Dejerine of what he

calls neurasthenia, we venture to assimilate it with the equally true

analysis which Babinski has made of the immediate mechanism of what he

wishes to call pithiatism. It is the condition which we personally term

hysteria, and the mechanism of which we have more especially studied in the

traumatic neuroses and the occupational dyskinesias and some other disorders

incident to the exercise of trade or profession. Indeed, the authors

say:--"One can see that the helmet headache, the pain in the nape of the

neck, and the pain in the spine are frequent among cultivated people and

educated neurasthenics, but much rarer among the others" and he explains

this by saying that these disturbances "are due to the diffusion of the

attention towards obsessions or preoccupations;" and he gives as an example

the reply of a patient "I think of my illness or such vicissitude by which

it was brought about." Indeed, in one place, Professor Dejerine goes so far

as to permit himself to say that the hypochondriac preoccupation itself

constitutes originally a purely intellectual conception, a propos of which,

but secondarily to it the patient really may work up an emotion, but which

is really NOT OF EMOTIONAL ORIGIN, a position first taken and long insisted

upon by the reviewer.

What is this when traced to its source but the mechanism of suggestion? The

portion of the book describing the functional manifestations of the

digestive system is charged with most illuminating instances of

associational mechanism typifying the induction of morbid reactions by

suggestion. No one perusing them can fail to perceive that the psychological

process at work does not differ in principle from that found in the somatic

hysterias, from which therefore their separation seems unjustifiable, and at

the hands of so eminent an author is likely to maintain rather than diminish

present psychological misunderstanding.

The dissimilarity of terms and resemblances of ideas has another

illustration in the reference to energy and the will; here it is clearly

pointed out that the apparent aboulia of the "neurasthenic" is not a lack,

but an unfruitful directing of the will while the Viennese school imply the

same idea in their doctrine of sublimation.

The authors believe that neurasthenia differs from the psychasthenia of

Janet in that the latter is constitutional, and that the obsessions are

secondary, when analysed profoundly, to some pain-bearing contingency which

by the mechanism of association has pervaded the mind and which henceforth

distorts it with subsequent realities. And yet when Dejerine lays stress

upon the fact that badly organized moral hygiene conduces to the emotional

preoccupations which lead to obsessions and which he regards as the

essential characteristics of the neurasthenic constitution, he leaves no

apparent distinction from the psychasthenia of Janet.

"The fundamental distinction of neurasthenia is causation by emotion," but

the authors have not extricated this factor from the role played by

induction either of idea or its secondary emotion. In such a fundamental

matter as anaesthesia for instance, they say: "In our opinion there exist

three classes of hysterical anesthesia. In the first series of facts one may

place the cases due to simulation. In the second group of cases we shall

range the patients in whom the disturbances of sensibility are directly due

to suggestion. Finally there remains a third class of patients in whom the

disturbances of sensibility seem to us to be residual emotional phenomena."

"Emotion is able to suppress sensibility entirely by producing absolute

side-tracking, and that under such circumstances it was really a question of

total anesthesia and not purely psychoanesthesia. When the state has passed

and the emotional cause has disappeared the sensibility may return, but

anesthesia which is preserved may also persist, either by auto-suggestion or

as in the case of the individual who remarks that he felt none of the

various injuries which he has experienced, or it is a question of simple

residual phenomenon independent of all suggestion." And yet, further on, the

authors say that the phenomena of auto-suggestion cannot be separated from

the emotion. All this lacks clarity; and except in the instances of failure

of perception or of auto-suggestion, the mechanism is not intelligibly set

forth.

The authors, however, although under the deplorable classification of

neurasthenia or hysteria, depart from the usual therapeutic methods and seek

the cause of the patient's disease outside of the objective symptoms and

declare that the "element of diagnosis lies chiefly in the origin of the

symptoms."

They make much of the assertion that Dr. Weir Mitchell's method of treatment

is based practically upon isolation, rest in bed, over-feeding, douches,

massage and electricity, in fact on purely physical measures and Professor

Dejerine adds: "I was not long in discovering that unless the patient's

state of mind improved, the therapeutic results were far from satisfactory;"

and he gives examples.

But in spite of the objections to the nosology and psychopathological theory

of the authors, there remains nothing but the highest praise for the

presentation of the clinical facts and of the sound advice regarding the

therapy of various functional manifestations, and concerning the role of the

physician in the prophylaxis of the psychogenic neuroses. It is most

desirable that every physician should be aware of the clinical facts which

Professor Dejerine has accumulated in his vast experience. In gynaecology,

gastroenterology, cardiology. and genitounary disease the psychogenetic

affections are ignored by most physicians.

This book will give a better understanding of what every practitioner of

those specialities should be familiar with. TOM A. WILLIAMS.