In interpreting the phenomena it must be remembered that in such

suggestive experiments the subject after waking has complete amnesia for

the whole hypnotic experience, for all the ideas which were organized

into the complex to form the setting. And yet this viewpoint, in spite

of this amnesia, is that which was suggested, and he does not know why

his view has changed. That a large fraction of the hypnotic complex (or

setting) remains submerged in the unconscious can be readily shown. The

only question is whether it becomes an active subconscious process out

of which certain elements emerge as meaning into consciousness.

=The setting in obsessions.=—This question of the functioning of

unconscious complexes as subconscious processes is of fundamental

importance for psychology, whether normal or abnormal, and if well

established gives an entirely new aspect to its problems. We cannot

therefore be too exacting in demanding proof for the postulation of

subconscious processes as part of the mechanisms we are considering, or,

at least, requiring sufficient evidence to justify them as a _reasonable

theory_. If assumed as an hypothesis many otherwise obscure phenomena

become intelligible by one or other theory making use of them.

Let us examine for a moment the obsessions as one of the most important

problems with which abnormal psychology has to deal, and which offer

themselves as exaggerated examples of ideas with insistent meanings. The

phenomena are psychological and physical. They occur in a sporadic form,

as well as in a recurring obsessional form. Let us consider them simply

as phenomena irrespective of recurrence. They may be arranged by

gradations in types in which they appear:

A, as purely physical disturbances;

B, as physical disturbances plus conscious emotion;

C, as physical disturbances plus conscious emotion plus a specific idea

of the object of the emotion, but _without_ logical meaning;

D, as physical disturbances plus emotion plus idea plus meaning.

In the first type the physical phenomena (such as commonly attend

emotion) can be traced to a functioning subconscious emotional complex

of which the phenomena are physical manifestations; in the second to a

functioning subconscious complex ejecting its emotion into

consciousness. In the third we find by analysis an associated

unconscious complex (setting), which logically would account for the

emotion of the obsessing idea, and infer, by analogy with A and B, that

it is a dynamic factor in the psychosis. In the fourth we find a similar

complex, which logically would account for all the physical and

conscious phenomena.

_Type A_: The following observation may be cited as an example. At the

conclusion of some experiments, made on one subject in the presence of

another patient and while conversing socially at afternoon tea, I

noticed that the subject manifested marked tremor of the hands to such

an extent that the cup in her hand shook and rattled in its saucer. She

herself commented on the fact, and laughingly remarked that she did not

know what was the matter with her; at times she would “get awfully hot

all over and would break out in perspiration.” She could give no

explanation of this phenomenon which had not been present before the

experiments were begun. The subject was now put into deep hypnosis, in a

state in which communication was obtained only by writing, and thereby

the subconscious tapped. Without going into all the details, the sum and

substance of the information obtained in this hypnotic state was this:

coconscious images (pictures), of which she was not consciously aware,

kept coming and going; these were the coconscious phenomena I have

previously described (p. 169). When certain images appeared

coconsciously the tremor developed, and when others appeared the tremor

ceased; when still others appeared there were vasomotor disturbances and

perspiration as well as tremor.

The images as I interpret them were the secondary images belonging to

subconscious ideas or processes.[174] To understand the conditions in

this instance it will be necessary to explain certain antecedent facts.

I had arranged to make certain hypnotic and other experiments on two

patients in the presence of each other. The one in question, the subject

of this observation, hesitated to have them made on herself in the

presence of a second person, fearing lest the various subconscious

phenomena which she exhibited would be regarded as stigmata and she be

thought “queer.” Each, of course, wished to see the experiments on the

other. The subject in question had for a long time been rather obsessed

with the insistent foolish idea that if people knew she manifested these

phenomena they would not care to know her socially. It was a point of

view which had been more or less obstinately maintained in spite of all

contradictory arguments. The idea had specifically recurred from time to

time in particular situations, and had caused considerable emotional

disturbance. If not a true obsession it was close to one. Nevertheless

she wanted to take part both for the object of seeing the experiments

and also of meeting the second patient. Still there were anxious doubts

and scruples in her mind arising from her desire, on the one hand, and a

fear, on the other, that it was a social mistake to do so. This had been

going on during several days and had been even the subject of

correspondence, discussions, etc. It was only at the last moment that

she could screw up her courage to take part in the experiments.

Finally the experiments were made, with the result as above stated. Now

the coconscious images which were accompanied by the tremors, etc., were

pictures of herself, of the second patient, and of myself. These images

coming and going seemed, as in a pantomime, to symbolize her previous

thoughts. Sometimes the image of the second patient turned away from the

subject, sometimes the three images were present, but the one of the

subject stood apart from the others as if an outcast, and in both these

latter cases particularly she would shake with tremor, and would “get

awfully hot all over,” and break out in perspiration. Then apparently

reassuring pictures would come and the tremor would cease.

Besides these coconscious images there was a train of coconscious

thought of which she was not personally aware. There was the thought

that perhaps, after all, it was a mistake to have taken part in the

experiments, as X, the second patient, was not a physician, and her wish

to see the subject hypnotized must have been largely curiosity. Of this

train of thought the subject was not aware. _At the same time_

concurrently there was in her personal consciousness the “thought that

she liked X, that it was very good of her to have come, and awfully kind

of you to take your time to conduct the experiments.” There was also a

conscious emotion of pleasure and something akin to hope, and

nervousness at the situation. By contrast coconsciously there was a

greater feeling of nervousness and the _emotion of fear_ of which she

was not consciously aware. By a few appropriate suggestions all these

phenomena were made to disappear.

It would take us too long and be too much of a digression to go more

deeply into these subconscious phenomena. From what has been given,

which is corroborated by a large number of observations of the same

sort, it seems to me we are justified in concluding that the physical

manifestations of emotion (tremor, etc.) in the instance were determined

by subconscious processes which were the _functioning residua of

antecedent thoughts with their emotions_.

But more than this these antecedent thoughts were obsessing ideas of

self-abasement, i.e., of herself as a person who socially was stamped

with a stigma and, therefore, as a sort of outcast. These thoughts had

formed one setting to the actual situation in which she found herself.

The subconscious complex, therefore, contained a perception plus the

meaning of the situation plus emotion; in other words, the whole of the

psychosis including the affect was subconscious in that none of its

elements emerged into consciousness. Another and rival perception of the

situation was that which was actually in consciousness and which has

been described. The physical phenomena were the manifestation of the

subconscious affect and would have been equally manifested if the affect

had become conscious. In such a case, then, we may say the whole of one

setting actually functions subconsciously.

The case of H. O. is the same in principle as I interpret it, but is

distinguished by the fact that the dissociation of processes was not so

extreme. The obsessing idea was in the ultramarginal zone of

consciousness and, to this extent, subconscious. Briefly stated, H. O.

for many years was the victim of an intense obsession, in consequence of

which she had practically foregone social life, and found herself unable

to travel for fear she would be afflicted with her psychosis in trains,

etc. The physical symptom was intense nausea suddenly arising as an

attack. When attacked with this there developed also depression and a

mental state which is perhaps best described as a mood. She could give

no explanation of the attacks. On examination it developed that always

in the “background of her mind,” just preceding the attack, there came

the idea of disgust of self. At once the nausea as the physical

expression of disgust was experienced. The disgust-idea was always

excited by some associated stimulus. The meaning of this “sentiment” was

set in a large complex of past experiences. Into all this I will not go.

The point is that the only conscious elements of her obsession were in

the extreme fringe of consciousness, sufficiently dissociated to be

practically coconscious,[175] but the _physical symptoms_ were

distressingly prominent. _Relief was easily effected simply by

organizing a new complex giving a new point of view of self._

Complexes consisting entirely of the physiological manifestations of

emotion without conscious emotion undoubtedly occur. A long time ago I

described such a neurosis under the name of Fear Neurosis[176] in

distinction from psychosis. The symptom complex was interpreted as a

persisting automatism derived from antecedent fear states that had been

outgrown. From our present standpoint and fuller knowledge we must

believe that underlying this automatism is probably an unconscious

complex of these antecedent experiences including the fear which takes

part in the functioning mechanism. It may be called, then, a

subconscious psychosis.

True _hysterical laughter and crying_ are undoubtedly phenomena of this

type and due to the same mechanism. These phenomena are well known to be

purely automatic; that is to say, they are emotional manifestations

unaccompanied in consciousness by thoughts or even by emotions

corresponding to them. The subject laughs or cries without knowing why

and without even feeling merry or sad. I forbear to digress sufficiently

to present the evidence for the interpretation that the phenomena are

due to subconscious processes of the kind just described. Let me merely

say that in one instance, N. O., intensely studied, the automatic crying

was traced by experimental and clinical methods to a persisting and

often insistent subconscious childhood’s perception and meaning of

self—as a lonely, unhappy child. This perception, etc., could be

differentiated from the conscious perception belonging to adult age.

Numerous observations of emotional phenomena similar in principle have

been recorded in the case of Miss B.[177] These observations included

automatic facial expressions of pleasure, anger, and fear. These

expressions could always be traced to subconscious processes and in this

case to actual ideas of a coconscious personality. But the principle is

the same. _Sometimes the affect linked to the process welled up into

consciousness and sometimes it did not._ When, in the case of Miss B.,

the automatic phenomena were determined by coconscious ideas it was

because the perceptions of the secondary subconscious personality had a

humorous, angry, or fear setting, as the case might be. These particular

observations are of especial interest because they allow us to clearly

distinguish _at almost one and the same moment the different

manifestations corresponding to the different settings with which the

same idea may be clustered_. While, for instance, the personal

consciousness of Miss B. perceived a person or situation with

apprehension and manifested this apprehension in her facial expression

as well as verbally, the subconscious perception of the same person or

situation was one of joy which broke through Miss B.’s apprehensive

feature in automatic smiles. In other words, two different perceptions

(with opposite meanings) of one and the same object functioned at the

same time.

These observations, as interpreted, are of wider significance in that

they allow us to understand the mechanism of many phenomena of everyday

life. For instance, the _hysteria of crowds_ may be explained on the

same principle; likewise the outbreak of emotional physical

manifestations in a person whose attention is absorbed (abstraction and

distraction) in reading or hearing something (e. g., at a play), which,

it may be inferred, touches some inner emotional experience of his life.

In the kind of instance I have in mind introspection fails to reveal the

presence of conscious thoughts or sometimes even emotions which

adequately explain the physical disturbance. When not abstracted by the

reading or play, the same ideas he was attending to a moment before fail

to excite these disturbances.

As has been said, “everyone is a little hysterical,” meaning that under

certain conditions—particularly those of stress and strain and strong

emotion—the mind becomes a bit disintegrated, and unconscious complexes

manifest themselves through what are called hysterical symptoms.

_Type B_: In this class the subject is afflicted with attacks of

_conscious emotion_, most conspicuously and commonly fear, _plus the

same physical disturbances as in type A_, but without any specific idea

in consciousness to which the emotion is related. When we examine

certain favorable subjects like Miss B., B. C. A., H. O. and O. N., in

whom memories of subconscious processes can be obtained by technical

procedures, specific coconscious ideas can be demonstrated during the

attacks of fear. These ideas are those of fear of some specific object.

The emotion pertaining to these ideas _alone_ emerges into

consciousness, the subject remaining unaware of the ideas themselves. In

the case of Miss B. numerous observations of this kind were

recorded.[178] When the obsessing fear constantly recurs it is a

so-called “_anxiety neurosis_,”[179] as I interpret the phenomena.

A typically perfect example of anxiety neurosis was the recurring

attacks of intense anxiety accompanied by a feeling of suffocation and

oppression of the chest experienced by one of my subjects. Investigation

disclosed that the first attack immediately followed a dream which was

forgotten, but recovered in hypnosis. It appeared that in the dream she

was accused by a certain person of certain delinquencies and threatened

with exposure. At this point in the dream she was overcome with fear and

anguish as in the after attacks. It also appeared that previously she

had been and still was apprehensive of this person’s loyalty. By

inference and analogy with the well-established after-phenomena of

dreams (p. 101), we must assume that the dream process still functioned

subconsciously and produced the anxiety attacks.[180]

In this connection it is well to notice that it is a common observation

that not only the affect of emotion but that of _feeling_ also may

emerge from the subconscious into consciousness and color the attitude

of the personal consciousness. This may be demonstrated by hypnotic

procedures. When in hypnosis complexes of ideas with strong feeling

tones, whether of pleasure or displeasure, of exaltation or depression,

are suggested, the subject after awakening experiences these same

feeling tones which dominate the personality. The subject then feels

pleasantly exalted or unpleasantly depressed, as the case may be,

without knowing the reason why. In alternating personalities the same

phenomena may sometimes be observed. In the case of Miss B. the feeling

tones which dominated the one personality invaded the consciousness of

the other personality, often causing considerable distress after the

alternation had occurred and although there was amnesia for all that had

gone before.[181] Thus BIV complained of the feelings of depression from

which BI shortly before had suffered, although her own ideas were far

from being of a depressing nature. This depression welled up from the

unconscious. It was in consequence of this phenomenon that BIV wrote:

“BI’s constant grieving wears on my nerves. It is harder to endure than

one would believe possible. I would rather give and take with Sally—a

thousand times rather.” Likewise when a subject has feelings of

unpleasantness and depression which he cannot explain it is easy in

certain subjects to demonstrate the concurrence of coconscious ideas

with these feeling tones. The affect in such cases emerges into

consciousness, though the subject is unaware of the coconscious ideas.

Correspondingly the feelings may be those of pleasantness and

exaltation. The demonstration of coconscious processes as the sources of

the conscious feelings of course can only be made in subjects in whom

memories of coconscious processes can be evoked. In such subjects I have

observed the phenomena on almost numberless occasions. But it can be

provoked in almost any good hypnotic subject. To awake pleasurable and

exalting feelings, to substitute them for their opposite when such are

present, belongs to therapeutic art. The skillful therapeutist endeavors

to provoke the former by the various procedures at his command. The

important principle underlying such procedures is that the feeling tones

pertaining to ideas may still invade the personal consciousness after

the ideas have become dormant in the unconscious.

This principle, it seems to me, is of far-reaching application. The

persistence of the feeling tone in a pleasant or unpleasant mental

attitude after the experience giving rise to it has become dormant is

_observed in everyday life_ and can be explained on this principle. We

have an exalting experience, engage in a spirited game of tennis, watch

an exciting football match, or take part in an exhilarating dance. For

the remainder of the day or the next day we still experience all the

stimulating pleasurable feeling, even though in the cares of our

vocation the memories of the previous experiences have remained dormant,

not having once been called to mind. The only difference between such

experiences of everyday life and those of hypnosis is that in one case

we can, if we will, recall the origin of the feeling and in the other we

cannot. In both we do not.[182]

Dormant _dream_ complexes may give rise to similar phenomena. In a minor

way everyone, probably, has experienced the persistence of the emotional

effects of a dream after waking and after the memory of the dream has

vanished. More commonly, of course, the dream is remembered, but in the

cases of people who do not remember their dreams the phenomenon is

precise. B. C. A., for example, does not as a rule remember her dreams,

but nevertheless frequently awakes in a state of anxiety or exaltation

which has considerable persistency. In hypnosis the dream which gives

rise to the emotional state is recovered.

In pathological conditions these post-hypnotic, hysterical, dream, and

other phenomena suggest, among other questions, whether in depressive

and excited psychoses the affective element is not derived from

submerged unconscious complexes. _Melancholias_, for example, may in

some cases at least derive their feeling tone from such complexes.

-----

Footnote 171:

Janet: The Mental States of Hystericals, pp. 289-290. Prince: The

Dissociation, pp. 132-5, 262, 297–8, 324-5, 497.

Footnote 172:

The Unconscious, _Journal Abnormal Psychology_, April-May, 1909.

Footnote 173:

Morton Prince: (Psychotherapeutics; A Symposium. Richard G. Badger,

Boston, 1910.) Also The Unconscious, _Journal of Abnormal Psychology_,

April-May, and June-July, 1909.

Footnote 174:

See p. 178, Lecture VI.

Footnote 175:

Memory of them could only be obtained in abstraction and hypnosis.

Footnote 176:

Fear Neurosis, _Boston Med. and Surg. Journal_, September 28, 1898.

Footnote 177:

The Dissociation, see index, “Subconscious Ideas,” and “Subconscious

Self.”

Footnote 178:

The Dissociation, loc. cit.

Footnote 179:

Ibid., p. 132.

Footnote 180:

It is worth noting that this interpretation is supported by the

therapeutic result. The attacks completely and quickly ceased after

the setting to her apprehensive idea was so altered, by one single

explanation, that she no longer feared the loyalty of her friend.

Footnote 181:

The Dissociation, pp. 262, 297, 298 and 324, 325, 497; also The

Unconscious, _Journal of Abnormal Psychology_, April-May, 1909.

Footnote 182:

Prince: The Unconscious, _Journal of Abnormal Psychology_, April-May

and June-July, 1909.

LECTURE XIII

TWO TYPES OF PHOBIA

(_Obsessions Continued_)

_Type C_: In this type _the affect is linked with an idea as its object

in consciousness but without meaning_, so that whenever this idea is

awakened it is accompanied by the affect alone. Some of the phobias are

the most common pathological exemplars. Nor is there anything in the

content of consciousness which gives meaning to the idea as something

that should occasion anxiety. The subject, in other words, does not know

why he is afraid of the given object. In such cases the restoration of

dormant memories will disclose antecedent experiences in which the idea

is set and which explains the origin and meaning of the fear. Here again

we have the principle shown in a clear cut way in conditions of

alternating personality. For instance take the case of Miss B. An

emotion, apparently paradoxical, would be aroused in BIV in connection

with a strange person or place, or in consequence of a reference by some

one to an unknown event. BIV, without apparent reason, would feel an

intense emotion in connection with something or other which she did not

remember to have ever heard or seen before. A face, a name, a particular

locality where she happened to find herself would arouse a strong

emotional effect without her knowing the reason. The memories of the

experiences to which these emotions belonged were a part of BI’s life

and could easily be recalled by her when the personalities again

alternated and BI came into existence. When BIV came again these

experiences, of course, would be forgotten and become dormant, but the

emotions associated with the visual, auditory, and other images of a

given person or place, or whatever it might be, would be liable to be

aroused in her by the perception, in spite of the amnesia, whenever the

given person or place, as it might be, came into her daily life. Here

the conscious content of the psychosis consists of perception plus

affect without meaning.

I formerly was inclined to interpret such paradoxical emotions on the

principle of the simple linking of an affect to a perception. But when

we consider that, on the reversion of the personality to BI the

perception, meaning, and affect still remained organized as a conscious

psychic whole, it is much more probable that the meaning took part as a

subconscious process in the mechanism of BIV’s emotional psychosis and

was responsible for the paradox. In the case of recurrent fears the

antecedent experiences which contain their meaning are conserved as

unconscious complexes. The psychosis differs clinically from types A and

B only in that another conscious element has been added,—viz.: the idea

of an object of the fear. It is consistent therefore to infer that the

unconscious complexes are a submerged part of the mechanism by which the

affect is maintained in association with the object. The conscious and

the subconscious form a psychic whole.

As an instance let us take the following case of phobia. It was

ostensibly one of church-steeples and towers of any kind. The patient, a

woman about forty years of age, dreaded and tried in consequence to

avoid the sight of one. When she passed by such a tower she was very

strongly affected emotionally, experiencing always a feeling of terror

or anguish accompanied by the usual marked physical symptoms. Sometimes

even speaking of a tower would at once awaken this emotional complex

which expressed itself outwardly in her face, as I myself observed on

several occasions. Considering the frequency with which church and

schoolhouse towers are met with in everyday life, one can easily imagine

the discomfort arising from such a phobia. Before the mystery was

unraveled she was unable to give any explanation of the origin or

meaning of this phobia, and could not connect it with any episode in her

life, or even state how far back in her life it had existed. Vaguely she

thought it existed when she was about fifteen years of age and that it

might have existed before that. Now it should be noted that an idea of a

tower with bells had in her mind no meaning whatsoever that explained

the fear. It had no more meaning than it would have in anybody’s mind.

In the content of consciousness there was only the perception plus

emotion and no corresponding meaning. Accordingly I sought to discover

the origin and meaning of the phobia by the so-called psycho-analytic

method.

When I attempted to recover the associated memories by this method, the

mere mention of bells in a tower threw her into a panic in which

anxiety, “thrills,” and perspiration were prominent. Before making the

analysis I had constructed a theory in my mind to the effect that a

phobia for bells in a tower was a sexual symbolism, being led to this

partly by the suggestiveness of the object and partly by the fact that I

had found symbolisms of a sexual kind in her dreams.[183]

Analysis was conducted at great length and memories covering a wide

field of experiences were elicited. When asked to think of bells in a

tower, or each of these objects separately, there was at first a

complete blocking of thought in that her mind became a blank. Later,

memories which to a large extent, but not wholly, played in various

relations around her mother (who is dead) as the central object came

into the field of consciousness. Nothing, however, was awakened that

gave the slightest meaning to the phobia even on the wildest

interpretation. The patient, who had been frequently hypnotized by

another physician, tended during the analysis to go into a condition of

unusually deep abstraction, to such a degree that on breaking off the

analysis she failed to remember, save very imperfectly, the memories

elicited. Such an abstraction is hypnosis.

Finally, after all endeavors to discover the genesis of the phobia by

analysis were in vain, I tried another method. While she was in hypnosis

I put a pencil in her hand with the object of obtaining the desired

information through automatic writing. _While she was narrating some

irrelevant memories of her mother_, the hand rapidly wrote as follows:

“G.... M.... church and my father took my mother to Bi.... where she

died and we went to Br.... and they cut my mother. I prayed and cried

all the time that she would live and the church bells were always

ringing and I hated them.”

When she began to write the latter part of this script she became

depressed, sad, indeed anguished; tears flowed down her cheeks and she

seemed to be almost heartbroken. In other words, it appeared as if she

were subconsciously living over again the period described in the

script. I say subconsciously for she did not know what her hand had

written or why she was anguished. During the writing of the first part

of the script she was verbally describing other memories; during the

latter part she ceased speaking.

After awakening from hypnosis and when she had become composed in her

mind she narrated, at my request, the events referred to in the script.

She remembered them clearly as they happened when she was about fifteen

years of age. It appeared that she was staying at that time in G....

M...., a town in England. Her mother, who was seriously ill, was taken

to a great surgeon to be operated upon. She herself suffered great

anxiety and anguish lest her mother should not recover. She went twice a

day to the church to pray for her mother’s recovery and in her anguish

declared that if her mother did not recover she would no longer believe

in God. The chimes in the tower of the church, which was close to her

hotel, sounded every quarter hour; they got on her nerves; she hated

them; she could not bear to hear them, and while she was praying they

added to her anguish. Ever since this time the ringing of bells has

continued to cause a feeling of anguish. This narrative was not

accompanied by emotion as was the automatic script.

It now transpired that it was the _ringing_ of the church bells, or the

_anticipated ringing_ of bells, that caused the fear, and not the

perception of a tower itself. When she saw a tower she feared lest bells

should ring. This was the object of the phobia.[184] She could not

explain why she had never before connected her phobia with the episode

she described. This failure of association as we know is not uncommon,

and in this case was apparently related to a determination to put out of

mind an unbearable episode associated with so much anguish. There had

been for years a more or less constant mental conflict with her phobia.

The subject had striven not to think of or look at belfries, churches,

schoolhouses, or any towers, or to hear the ringing of their bells, or

to talk about them. She had endeavored to protect herself by keeping

such ideas out of her mind. Before further analyzing the case there are

two points which are well worth calling attention to:

1. When the subject subconsciously described the original childhood

experience by automatic script there was intense emotion—fear—which

emerged into consciousness without her knowing the reason thereof. When,

on the other hand, she later from her conscious memories described the

same experience there was no such emotion. In other words it was only

when the conserved residua of the experience functioned consciously and

autonomously as a dissociated, independent process that emotion was

manifested. So long as the memories were described from the view-point

of the matured adult personal consciousness there was no emotion. As a

subconscious process they were unmodified by this later viewpoint. This

suggests at least that when the phobia was excited by the sight or idea

of a tower it was due likewise to a subconscious process and that this

was one and the same as that which induced the experimental phobia.

2. The phraseology of the script is noticeable. The account is just such

as a child might have written. It reads as if the conserved thoughts of

a child had awakened and functioned subconsciously.

From this history, so far as given, it is plain that the psychosis in

one sense is a recurring antecedent experience or memory, but it is only

a partial memory. The whole of the experience does not recur but only

the emotion in association with the ringing of bells. The rest of that

experience, viz., the idea of the possible death of her mother with its

attendant grief and anguish associated with the visits to the church,

the praying for recovery and finally the realization of the fatal

ending—all that which originally excited the fear and _gave the

ringing-of-bells-in-a-tower meaning_ was conserved as a setting in the

unconscious. That the rest of the experience was conserved was shown by

the fact that it could be recalled not only by automatic writing but,

although not in association with the phobia, to conscious memory. From

this point of view the fear of bells ringing may be regarded as a

recurrence of the original fear—that of her mother’s death—now derived

from a subconsciously functioning setting. The child was afraid to face

her grief and so now the matured adult was also afraid.

From another point of view the ringing of bells may be regarded as

standing for, or a symbol of, her mother’s death with which it was so

intimately associated, and this symbol awakened the same fear as did

originally the idea itself of the death. An object may still be the

symbol of another, although the association between the two cannot be

recalled. (The transference of the emotional factor of an experience to

some element in it is a common occurrence; e. g., a fear of knives in a

person who has had the fear of committing suicide.)

The discovered antecedent experiences of childhood then give a hitherto

unsuspected meaning to the ringing of bells. It is a meaning—the _mise

en scène_ of a tragedy of grief and a symbol of that tragedy. But was

that tragedy with its grief the _real_ meaning of the child’s fear or,

perhaps more correctly, the _whole_ of the meaning? And is it still the

meaning in the mind of the adult woman? Does the mere conservation of a

painful memory of grief explain its persistent recurrent subconscious

functioning during twenty-five years, well into adult life, so that the

child’s emotion shall be reawakened whenever one element (bell-tower) of

the original experience is presented to consciousness? And, still more,

can the persistence of a mere association of the affect with the object

independently of a subconscious process explain the psychosis? Either of

these two last propositions is absurd on its face as being opposed to

the experience of the great mass of mankind. The vast majority of people

have undergone disturbing, sorrowful or fear-inspiring experiences at

some time during the course of their lives and they do not find that

they cannot for years afterwards face some object or idea belonging to

that experience without being overwhelmed with the same emotion. Such

emotion in the course of time subsides and dies out. A few, relatively

speaking, do so suffer and then, because contrary to general experience,

it is called a psychosis.

We must, then, seek some other and adequate factor in the case under

examination. When describing the episode in the church, the subject

stated that on one occasion she omitted to go to church to pray and the

thought came to her that if her mother died it would be due to this

omission, and _it would be her fault_. The “eye of God”[185] she thought

was literally upon her in her every daily act and when her mother did

die she thought that it was God’s punishment of herself because of that

one failure. Consequently she thought _that she was to blame for her

mother’s death_; that _her mother’s death was her fault_. She feared to

face her mother’s death, not because of grief—that was a mere

subterfuge, a self-deception—but because she thought she was to blame;

and she feared to face towers with bells, or rather the ringing of

bells, because they symbolized or stood for that death (just as a

tomb-stone would stand for it), and in facing that fact she had to face

her own fancied guilt and self-reproach and this she dared not do. _This

was the real fear_, the fear of facing her own guilt. The emotion then

was not only a recurrence of the affect associated with the church

episode but a _reaction to self-reproach_. The ringing of bells,

somewhat metaphorically speaking, reproached her as Banquo’s ghost

reproached Macbeth.

All this was the child’s point of view.

But I found that the patient, an adult woman, _still believed and

obstinately maintained_ that her mother’s death was her fault. She had

never ceased to believe it. Why was this? Why had not the

unsophisticated belief of a child become modified by the maturity of

years? It did not seem to be probable that the given child’s reason was

the real adult reason for self-reproach. I did not believe it. A woman

forty years of age could not reproach herself on such grounds. And, even

if this belief had been originally the real reason, as a matter of fact

she had outgrown the child’s religious belief. She was a thorough-going

agnostic. Further probing brought out the following:

Two years before her mother’s death, the patient, then thirteen years

old, owing to her own carelessness and disobedience to her mother’s

instructions, had contracted a “cold” which had been diagnosed as

incipient phthisis. By the physician’s advice her mother took her to

Europe for a “cure” and was detained there (as she believed) for two

years, all on account of the child’s health. At the end of this period a

serious, chronic disease from which the mother had long suffered was

found to have so developed as to require an emergency operation. The

patient _still believed_ and argued that if her mother had not been

compelled to take her abroad she (the mother) would have been under

medical supervision at home, would have been operated upon long before

and in all probability would not have died. Furthermore, as the patient

had heedlessly and disobediently exposed herself to severe cold and

thereby contracted the disease compelling the sojourn in Europe, she was

to blame for the train of circumstances ending fatally.

All this was perfectly logical and true, assuming the facts as

presented. Here then was the real reason for the patient’s persistent

belief that her mother’s death was her fault and the persistent

self-reproach. _It also transpired that all this had weighed upon the

child’s mind and that the child had likewise believed it._ So the child

had two reasons for self-reproach. One was neglecting to pray and the

other was being the indirect cause of the fatal operation. Both were

intensely believed in. The first based on the “eye of God” theory she

had outgrown, but the other had persisted.

Summing up our study to this point: All these memories involving grief,

suffering, self-reproach, bells and mother formed an unconscious setting

which gave meaning to bells in towers and took part in the functioning

to form a psychic whole. The conscious psychosis was first the emergence

into consciousness of two elements only, the perception and the affect,

and the fear was a reaction to self-reproach, a fear to face self-blame.

Now even if the mother’s death were logically, by a train of fortuitous

circumstances, the patient’s fault, why did an otherwise intelligent

woman lay so much stress upon an irresponsible child’s behavior? The

child after all behaved no differently from other children. People do

not consciously blame themselves in after life for the ultimate

consequences of childhood’s heedlessness. According to common experience

such self-reproaches do not last into adult life without some

continuously acting factor.

A search in this case into the unconscious brought to light a persisting

idea that when events in her life happened unfortunately it was due to

her fault. It had cropped out again and again in connection with

inconsequential as well as consequential matters. She had, for instance,

been really unable on many occasions to leave home on pleasure trips for

fear lest some accident might happen within the home and consequently it

would be due to her fault; and if away she was in constant dread of

something happening for which she would be to blame. It was not a fear

of what might happen—an accident to the children, for example—but that

it would be her fault. I have heard her, when some matter of apparently

little concern had gone wrong, suddenly exclaim, “Was it my fault?” her

voice and features manifesting a degree of emotion almost amounting to

terror. When her brother died (still earlier, before her mother’s death)

she had blamed herself for that death, as later with her mother, on the

same religious grounds. This self-reproach for happenings, fancied as

due to her fault, has frequently appeared in her dreams. It would take

us too far afield to trace the origin and psychogenesis of this idea.

Suffice to say, it can be followed back to early childhood when she was

five or six years of age. She was a lonely, unhappy child. She thought

herself ugly and unattractive and disliked and that so it always would

be through life, and it was all her fault because she was ugly, as she

thought.[186] The instinct of self-abasement (McDougall[187]) or

negative self-feeling (Ribot) dominated the personality as the most

insistent instinct and from its intensity within the self-regarding

sentiment (McDougall) formed a sentiment of self-depreciation. She

wanted to be liked and believed it to be her own fault that, as she

fancied, she was not and never would be, and reproached herself

accordingly. This sentiment of self depreciation with its impulse to

render self-reproach has persisted, as with many people, all her life

and has been fostered by unwise and thoughtless domestic criticism. The

persistence to the present day of this impulse to self-reproach is shown

in the following observation:

Quite recently this subject began to suffer from general fatigue,

insomnia, distressing dreams, hysterical crying, indefinable anxiety and

pseudo twilight states or extreme states of abstraction. In these states

she became oblivious of her environment, did not hear the conversation

going on about her, nor answer when directly spoken to. This became so

noticeable that she became the jest of her companions. In these states

her mind was always occupied with reveries (not fantasies), though

mostly pleasant, regarding a very near relative who had died about six

months previously. Her distressing dreams also concerned this relative.

It appeared, therefore, probable, on the face of the symptoms that they

were in some way related to this relative’s death.

Now it transpired, as I already knew, that the relative had died under

somewhat tragic circumstances and that our subject’s experience during

the last illness was unusually distressing and sorrowful. _This

experience, she asserted, she could not bear to speak or even think

about and over and over again had refused to do so and put it out of her

mind. She further asserted that her reason for this attitude was the

distressing nature of the scenes in which she took part._

Now I did not believe that this was the true reason, although given in

good faith. It was improbable on its face. To say that a grown woman,

forty years of age, could not do what every woman can do, tolerate

sorrowful memories simply because they were sorrowful, and must perforce

put them out of her mind, is sheer nonsense. There must be some other

reason.

On examining a dream it was found to be peculiar in one respect: It was

not an imaginative or fantastic composition, but a detailed and precise

living over again of the scenes at the death bed: that is to say, it was

a sort of somnambulistic state. In recalling this dream[188] she could

not for some time recover the ending. Finally it “broke through,” as she

expressed it. The dream was as follows: First came many details of the

vigil of the last night of the illness; then she went to her room and to

bed to snatch a few moments’ sleep; she was waked up by the husband of

the dying relative appearing in her room. He sat on the edge of her bed

and said to her, “All is over.” Up to this point the facts of the dream

were actual representations in great detail of the actual facts as they

had occurred, but at this moment the dream presented a fact which had

not occurred in the real scene; she suddenly, in the dream, sat up in

bed and exclaimed, “My God! then I ought to have sent for the doctor!”

Here was the key to the intolerance for memories of the illness of the

relative and the death-bed scene. What had happened was this: The

question had arisen early in the illness whether or not a doctor should

be sent for from London in consultation. The expense, owing to the

distance, would have been considerable. The whole responsibility and

decision rested upon the subject. Against the opinion of other relatives

she had decided that it was inadvisable. After the fatal ending the

question had arisen again whether or not she ought to have sent for the

consultant and she had been tormented by the doubt as to whether she did

right; _was the fatal result her fault_? Although she had reasoned with

herself that her decision was good judgment and right still there had

always lurked a doubt in her mind. She was also somewhat disturbed by

the thought of what the husband’s opinion might be.

The real reason why she could not tolerate the memories of the last

illness of this relative, and the psychogenesis of the symptoms now were

plain: they were not grief but self-reproach with its instinct of

self-abasement. The memories brought to her mind that the fault was

her’s and with the thought came self-reproach. _This self-reproach she

was afraid of and unwilling to face._ This fact she recognized and

frankly confessed after the disclosures of the analysis.

Now follows the therapeutic sequel. The relative’s illness at the

beginning was in no way of a dangerous nature and the proposed

consultation had nothing to do with the question of danger to life. The

death was due to purely an accidental factor and could not have been

foreseen. When I assured her in hypnosis, with full explanation, that

her decision had been medically sound, as it was, the change in her

mental attitude was delightful to look upon. “Wasn’t it my fault! Wasn’t

it my fault!” she exclaimed in excitement. Anxiety, dread, and

depression gave way to exhilaration and joyousness. Thereupon she woke

up completely relieved in mind, and retained the same feeling of joy,

but without knowing the reason thereof. The explanation was repeated to

her in the waking state and she then fully realized (as she did also in

hypnosis) that her previous view was a pure subterfuge and fully

appreciated the truth of the discovered reason for her inability to face

her painful memories. The twilight states, the insomnia, and the

distressing dreams, the anxiety, and other symptoms ceased at once.

Returning to the phobia for bells, in the light of all these facts, the

patient’s belief that her mother’s death was her fault and the

consequent self-reproach were obviously only a particular concrete

example of a lifelong emotional tendency originating in the experiences

of childhood to blame herself; and this tendency was the striving to

express itself of the instinct of self-abasement (with the emotion of

self-subjection) which, incorporated within “the self-regarding

sentiment” (McDougall), was so intensely cultivated and had played so

large a part in her life. Indeed this instinct had almost dominated her

self-regarding sentiment and had given rise time and again to

self-reproach for accidental happenings. It now specifically determined

her attitude of mind toward the series of events which led up to the

fatal climax and determined her judgment of self-condemnation and

self-reproach. These last most probably received increased emotional

force from the large number of roots in painful associations of

antecedent experiences (particularly of childhood) in which the

self-regarding sentiment, self-debasement, and self-reproaches were

incorporated.[189] _Nevertheless the fear was of a particular concrete

self-reproach._ The general tendency was of practical consequence only

so far as it explained the particular point of view and might induce

other self-reproaches.

As a general summary of this study it would appear that we can postulate

a larger setting to the phobia than the grief inspiring experiences

attending her mother’s death. The unconscious complex included the

belief that she was to blame and the sentiment of self-reproach, and the

whole gave a fuller meaning to the ringing of bells in a tower. The fear

besides being a recurring association was also a reaction to the

subconsciously excited setting of a fancied truth or self-accusation.

Although excited by towers and steeples the fear was really of

self-reproach. Towers, steeples, and bells not only in a sense

symbolized her mother’s death, but her own fancied fault. It was in this

sense and for this reason that she dared not face such objects. The

conscious and the unconscious formed a psychic whole.[190]

Now in reaching these conclusions see how far we have traveled: Starting

with an ostensible phobia for towers, we find it is more correctly one

of ringing-of-bells, but without conscious association; then we reach a

childhood’s tragedy; then a self-reproach on religious grounds; then a

belief in a fault of childhood’s behavior culminating in a lifelong

self-reproach—the causal factor and psychologically the true object of

the phobia: and between this last self-reproach and the phobia no

conscious association.

The _therapeutic_ procedure and results are instructive. As the fear was

induced by a belief in a fancied fault exciting a self-reproach,

obviously if this belief should be destroyed the self-reproach must

cease and the fear must disappear. Now when all the facts were brought

to light, the patient, as is usual, recognized the truth of them. She

also recognized fully and completely the real nature of the fear, of the

self-blame and of the self-reproach. There remained no lingering doubt

in her mind, nevertheless the bringing to “the full light of day” of all

this did not cure the phobia. As the first procedure in the therapeusis

it was pointed out that it was contrary to common sense to blame herself

for the heedlessness of a child; that all children were disobedient;

that she would have been a little prig if she had been the sort of a

child that never disobeyed, and that she would not have blamed any other

child who had behaved in a similar way under similar circumstances, and

so on. She simply said that she recognized all this intellectually as

true and yet, although it was the point of view which she would take

with another person in the same situation, it did not in any way alter

her attitude toward herself. In other words the bringing to the full

light of day of the facts did not cure the phobia. It was necessary to

change the setting of her belief. _To do this either the alleged facts

had to be shown to be not true or else new facts had to be introduced

which would give them a new meaning._ This, briefly told, was done in

the following way:

She was put into light hypnosis in order that exact and detailed

memories of her childhood might be brought out. Then, through her own

memories, it was demonstrated, that is to say, the _patient herself

demonstrated_, that there was considerable doubt about her having had

phthisis at all; that she was not taken to the usual places of “cures”

for phthisis but sojourned in the gay and pleasant cities and watering

places of Europe; that her mother really staid in Europe because she

enjoyed it and made an excuse of her daughter’s health not to come home;

that she might have returned at any time but did not want to do so; and

that the fault lay, if anywhere, with her physician at home. When this

was brought out the patient remarked, “Why, of course, I see it now! My

mother did not stay in Europe on account of my health but because she

enjoyed it, and might have returned if she had wanted to. I never

thought of that before! It was not my fault at all!” After coming out of

hypnosis the facts as elicited were laid before the patient; she again

said that she saw it all clearly, as she had done in hypnosis, and her

whole point of view was changed.

The therapeutics, then, consisted in showing that the alleged facts upon

which the patient’s logical conclusions had been based were false. The

setting thereby was altered, and a new and true meaning given to the

real facts. The result was towers and steeples no longer excited fears,

the phobia ceased at once—an immediate cure.[191]

_Type D._ In this type _the conscious psychosis consists of idea,

meaning, affect, and physical disturbance_. F. E. suffered from attacks

of so-called “unreality” accompanied with intense fear. She was unable

to give an intelligent explanation as to why she was afraid of the

attacks—harmless in themselves—until it was brought out that there was

in the _background of her mind_ the thought that the attacks spelled

insanity (or that she was likely to go insane) and also death. Following

the attacks there was amnesia for these thoughts. Her fear really, then,

was of insanity and death. The content of consciousness in the attacks

contained the perception of herself as an insane person, thoughts which

expressed the meaning of her attacks, and fear. (The usual physical

disturbances of course accompanied the fear.) No amount of explanation

of the harmlessness of the unreality syndrome sufficed to change her

point of view, i.e., its meaning to her. But going further it was

discovered that her self-regarding sentiment and her ideas of insanity

and death were organized with a large number of fear-inspiring

antecedent experiences which explained why she regarded the attacks as

dangerous to her mentality and life; and why the biological instinct of

fear was incorporated with the self-regarding sentiment. These

experiences had long passed out of mind and there was no conscious

association between them and her phobia, but they could be recalled as

associative memories.[192] The unreality attacks had for her two

meanings which were within the content of consciousness, viz., 1,

insanity, and 2, death. The first was derived from (a) antecedent

girlhood and later experiences which had engendered the unsophisticated

belief that having the mind fixed on one subject, as was obtrusively and

painfully the case at one time, meant insanity: and (b), from the fact

that the bewildering, irreconcilable, absurd thoughts, conflicts, and

emotions in which the unreality attacks culminated meant insanity.

The second meaning (death) was derived from (a) the previous fixed idea

(just referred to), organized with that of insanity—namely, an

unsophisticated medieval idea of hell which was conceived of as the

equivalent of death and which had excited an intense horror of both; and

(b) from the fact that in the unreality attacks there was a _struggling_

for air; struggling was in her mind, the equivalent of convulsions;[193]

convulsions of unconsciousness; and unconsciousness of death. All these

various ideas and the intense fears which each gave rise to had become

organized into a complex, and, in consequence of these antecedent

experiences in which self took a prominent part, the instinct of fear—as

I conceive the matter—became incorporated within the self-regarding

sentiment. (Anything that aroused this sentiment tended to arouse the

emotion of fear, as in another person it would tend to arouse the

emotion of pride, or self-abasement.) At any rate this organized complex

was the setting which gave the meaning to her phobia. There can be, I

think, no manner of doubt about this. The patient herself explained her

viewpoint through these ideas here briefly summarized. The only question

is as to the mechanism of the phobia. Now as Type D, of which these

cases are examples, differs clinically from the preceding three types

only in the addition of one more element—meaning—to the conscious

psychic whole, a consistent interpretation would seem to compel us to

postulate also a functioning subconscious complex or setting and in this

case of the antecedent experiences disclosed as a factor in the

mechanism and a part of the psychic whole. Out of this complex emerged

into consciousness the idea of insanity and death and fear as the

meaning of the unreality syndrome, the whole constituting the phobia

psychosis.

That there was in fact a subconsciously functioning process derived from

this complex would seem to be almost conclusively shown by another

phenomenon manifested. I refer to the vivid _visualization of herself in

a convulsion, struggling for air and manifesting fright_, which she

experienced in each attack. We have seen that such a visualization

(i.e., a modified vision) is the expression (secondary images?) of a

subconscious process (co-conscious ideas?). As a matter of fact this

particular visualization was a pictorial representation of antecedent

thoughts organized with thoughts of death and insanity and still

conserved in the unconscious. We must believe, then, that it was these

antecedent thoughts (in the first place her apprehension of inheriting

Bright’s disease and convulsions from her father, and in the second

place her conception of the unreality syndrome as a state which might

possibly end in convulsions) which, functioning subconsciously, induced

the quasi hallucinatory expression of themselves.[194] It is difficult

to get away from the conclusion that the remainder of the setting from

which the ideas of insanity and death were derived also functioned as a

subconscious process. Whether this process was conscious or unconscious

is a secondary question which we need not consider.

In weighing the probabilities of this interpretation we should bear in

mind that there were two conscious beliefs of which the patient was

fully aware and which were very real to her; namely, the liability of

becoming insane and to convulsions and death. The conative force of the

instinct of fear linked to such ideas is quite sufficient to drive them

to expression when out of mind and subconscious. Or expressed

differently we may say that the fear was a reaction to these ideas which

the patient dared not face.

We ought not, however, to be too sweeping in our generalizations and go

further than the facts warrant. We are not justified in concluding that

the linking of an affect to an idea always includes a subconscious

mechanism. On the contrary, as I have previously said, probably in the

great majority of such experiences, aside from obsessions, no such

mechanism is required to explain the facts.

_The Inability to Voluntarily Modify Obsessions._—We are now in a

position on this theory to look a little more deeply into the structure

and mechanism of an obsession and thereby realize why it is that the

unfortunate victims are so helpless to modify or control them. Indeed

this behavior of the setting could be cited as another piece of

circumstantial evidence for the theory that the setting is largely

unconscious and that only a few elements of it enter the field of

consciousness. If we simply explain to a person who has a true

obsession, i.e., an insistent idea with a strong feeling tone, the

falsity of the point of view, the explanation in many cases at least has

no or little effect in changing the viewpoint, though the patient admits

the correctness of the explanation. The patient cannot modify his idea

even if he will. But if the original complex, which is hidden in the

unconscious and which gives rise to the meaning of the idea, is

discovered, and so altered that it takes on a new meaning and different

feeling tones, the patient’s conscious idea becomes modified and ceases

to be insistent. This would imply that the insistent idea is only an

element in a larger unconscious complex which is the setting and

unconsciously determines the viewpoint. The reason why the patient

cannot voluntarily alter his viewpoint becomes intelligible by this

theory, because that which determines it is unconscious and unknown. He

may not even know what his point of view is, owing to the meaning being

in the fringe of consciousness.

If this theory of the mechanism is soundly established the difficulty of

correcting obsessions becomes obvious and intelligible. It is also

obvious that there are theoretically two ways in which an obsession

might be corrected.

1. A new setting with strong affects may be artificially created so that

the perception acquires another equally strong meaning and interest.

2. The second way theoretically would be to bring into consciousness the

setting and the past experiences of which the setting is a _sifted_

residuum, and reform it by introducing new elements, including new

emotions and feelings. In this way the old setting and point of view

would become transformed and a new point of view substituted which would

give a new meaning to the perception.

Now in practice both these theoretical methods of destroying an

obsession are found to work, although both are not always equally

efficacious in the same case. In less intense obsessions where the

complex composing the setting is only partially and inconsequently

submerged, and to a slight degree differentiated from the mass of

conscious experiences, the first and simpler method practically is amply

sufficient. We might say that the greater the degree to which the

setting is conscious and the less the degree to which it has acquired,

as an unconscious process, independent autonomous activity the more

readily it may be transformed by this method.

On the other hand in the more intense obsessions, where a greater part

of the setting is unconscious, has wide ramifications and has become

differentiated as an independent autonomous process, the more difficult

it is to suppress it and prevent its springing into activity whenever

excited by some stimulus (such as an associated idea). In such instances

the second method is more efficacious. It is obvious that, so long as

the setting to a central idea remains organized and conserved in the

unconscious, the corresponding perception and meaning are always liable

under favoring conditions (such as fatigue, ill health, etc.) to be

switched into consciousness and replace the new formed perception. This

means of course a recurrence. Nevertheless medical experience from the

beginning of time has shown that this is not necessarily or always the

case. The technique, therefore, of the treatment of obsessions will vary

from “simple explanations” (Taylor) without preliminary analysis to the

more complicated and varying procedures of analysis and re-education in

its many forms.

_Affects._—Here a word of caution in the interpretation of emotional

reactions is necessary. In the building of complexes, as we have seen,

an affect becomes linked to an idea through an emotional experience. The

recurrence of that idea always involves the recurrence of the affect. It

is not a logical necessity that the original experience which occasioned

the affect should always be postulated as a continuing subconscious

process to account for the affect in association with the idea. It is

quite possible, if not extremely probable, that in the simpler types, at

least, of the emotional complexes, the association between the idea and

affect becomes so firmly established that the conscious idea alone,

without the coöperation of a subconscious process, is sufficient to

awake the emotion; just as in Pawlow’s dogs the artificially formed

association between a tactile stimulus and the salivary glands is

sufficient to excite the glands to activity, or as in human beings the

idea of a ship by pure association may determine fear and nausea, the

sound of running water by the force of association may excite the

bladder reflex, or an ocular stimulus the so-called hay fever complex.

So in word-association reactions, when a word is accompanied by an

affect-reaction the word itself may be sufficient to excite the reaction

without assuming that an “unconscious complex has been struck.” The

total mechanism of the process we are investigating must be determined

in each case for itself.

In the study and formulation of psychological phenomena there is one

common tendency and danger, and that is of making the phenomena too

schematic and sharply defined, as if we were dealing with material

objects. Mental processes are not only plastic but shifting, varying,

unstable, and undergo modifications of structure almost from moment to

moment. We describe a complex schematically as if it had a fixed,

immutable, and well-defined structure. This is far from being the case.

Although there may be a fairly fixed nucleus, the cluster, as a whole,

is ill defined and undergoes considerable modification from moment to

moment. New elements enter the cluster and replace or are added to those

which previously took part in the composition. An analogy might be made

with a large cluster of electric lights arranged about a central

predominant light, but so arranged that individual lights could be

switched in and cut out of the cluster at any moment and different

colored lights substituted. The composition and structure of the

cluster, and the intensity and color of the light, could be varied from

moment to moment, yet the cluster as a cluster maintained. We might

carry the analogy farther and imagine the cluster to be an advertising

sign which had a meaning—the advertisement. This meaning might or might

not be altered by the changes in the individual lamps.

The same indefiniteness pertains to the demarcation between the

conscious and the subconscious. What was conscious at one moment may be

subconscious the next and _vice versa_. Under _normal_ conditions there

is a continual shifting between the conscious and subconscious. I have

made numerous investigations to determine this point, and the evidence

is fairly precise, and to me convincing, that this shifting continually

occurs,[195] as might well be inferred on theoretical grounds. Nor,

excepting in special pathological and artificial dissociated conditions,

is the distinction between the conscious and subconscious at any moment

always sharp and precise; it is often rather a matter of vividness and

shading, and whether a conscious state is in the focus of attention or

in the fringe. Experimental observation confirms introspection in this

respect.

In view of the foregoing we can now appreciate a fallacy which has been

too commonly accepted in the interpretation of therapeutic facts. It is

quite generally held that it is a necessity that the underlying

unconscious complexes cannot be modified without bringing them to the

“full light of day” by analysis. The facts of everyday observation do

not justify this conclusion. The awakening of dormant memories of past

experiences is mainly of importance for the purpose of giving us exact

information of _what_ we need to modify, not necessarily for the purpose

of effecting the modification. Owing to the fluidity of complexes,

whether unconscious or conscious, our conscious ideas can become

incorporated in unconscious complexes. This means that any new setting

in which we may incorporate our conscious ideas to give them a new

meaning becomes effective in the associations which these ideas have as

a dormant complex. The latter is able to assimilate from the conscious

any new material offered to it. Practical therapeutics and everyday

experience abundantly have shown this. I have accomplished this, and I

believe every therapeutist has done the same time and again. We should

be cautious not to overlook common experience in the enthusiasm for new

theories and dramatic observations. The difficulty is in knowing what we

want to modify, and for this purpose analytical investigations of one

sort or another are of the highest assistance, because they furnish us

with the required information. If we recover the memories of the

unconscious complex our task is easier, as we can apply our art with the

greater skill.

When we speak of a setting to an idea we are not entitled to think of it

as a sharply defined group of ideas, or sharply limited subconscious

process. When we identify it with the residua of past experiences we are

not entitled, on the basis of exact knowledge, to arbitrarily make up a

selected cluster of residua which shall exclude those and include these

residual elements of antecedent associated experiences, and dogmatically

postulate the composition of the complex which we call the setting.

Analysis by the very limitations of the method fails to permit of such

arbitrary selection, and synthetic methods are not sufficiently exact

for the purpose. All we can say is that from the residua of various past

experiences a complex is sifted out to become the setting. And even then

no process is entirely autonomous and entirely removed from the

interfering, directing, and coöperative influence of other processes.

Even with simple and purely physiological processes, such as the knee

jerk, this is true. Although the knee jerk may be schematically

conceived as a simple reflex arc involving the peripheral nerves and the

spinal cord, nevertheless other parts of the nervous system—the brain

and the spinal cord—provide coöperative processes which take part, and

under special conditions take a very active part, in modifying the

phenomenon. While we are justified, for the clarifying purposes of

exposition, in schematizing the phenomenon by selecting the spinal

reflex as the predominant process, yet we do not overlook the

coöperative processes which may control and modify the spinal reflex. If

this is true of purely physiological processes, it is still more true of

the enormously more complex processes of human intelligence.

We may say, then, not only that with our present knowledge and our

present methods we are not able to precisely differentiate the settings

of ideas, but that it is highly improbable that settings as complexes of

residua are with any preciseness functionally entirely autonomous and

removed from the influence of other associative processes.

We need further investigations into the psychology and processes of

settings, and until we have wider and more exact knowledge it is well

not to theorize and still more not to dogmatize. It is an inviting field

which awaits the psychologist.

-----

Footnote 183:

In making the analysis, therefore, I was in no way antagonistic in my

mind to the Freudian hypothesis.

Footnote 184:

I want to emphasize this point, because certain students, assuming the

well-known alleged sexual symbolism as the meaning of steeples and

towers, will read and have read such an interpretation into this

phobia. As a matter of fact, although these objects had been

originally alleged by the subject herself to be the object of the fear

it was done thoughtlessly as the result of careless introspection.

Later she clearly distinguished the true object. They were no more the

object than the churches and schoolhouses themselves. They bore an

incidental association only, and only indicated where the ringing of

bells might be expected to be heard, having been an element in the

original episode. Nor were bells, qua bells, the object of the phobia,

but the ringing-of-bells of the kind that recalled the mother’s death.

In other words, the fear was of bells with a particular meaning. Nor

was the fear absolutely limited to tower-bells, for it transpired that

the subject had refrained from having, as she desired, an alarm bell

arranged in her house in the country (in case of fire, etc.), because

of her phobia. (This note is perhaps made necessary by the violent

shaking of the heads of my Freudian friends that I noticed at this

point during the presentation of this case before the American

Psychopathological Association.) See _Jour. Abn. Psychol._, Oct.-Nov.,

1913.

Footnote 185:

This idea had its origin in a child’s fairy tale, and had been

fostered by the governess as a useful expedient in enforcing good

behavior. The child accepting the fairy legend believed the Eye of God

was always on her and every one in the world, and observed all that

each did or omitted to do. The legend excited her imagination, and she

used to think about it and wonder how God could keep His eye on so

many people as there were in the world. At a still earlier age, when

she was about eight, she had thought her little brother’s death was

also her fault, because she had neglected one night, at the time of

his illness, God’s eye being upon her, to say her prayers. For a long

time afterward she suffered similarly from self-reproach. It is

interesting to compare the outgrowing with maturity of this

self-reproach with the persistence of the later one, evidently owing

to the reasons given in the text.

Footnote 186:

Another example of this idea and of the way it induced a psychosis is

the following: She had an intense dislike to hearing the sound of

running water. This sound induced an intense feeling of _unhappiness

and loneliness_. This feeling was so intense that whenever she heard

the sound of running water she endeavored to get away from it. The

sound of a fountain or rainwater running from a roof, for example,

would cause such unpleasant feelings that she would change her

sleeping room to avoid them. Likewise drawing water to fill the

bathtub was so unpleasant that she would insist upon the door being

closed to exclude the sound. She could give no explanation of this

psychosis. It was discovered in the following way: She had been

desirous of finding out the cause, and we had discussed the subject. I

had promised that I would unravel the matter in due time, after the

other phobia had been cured. I then hypnotized her and, while she was

in hypnosis and just after we had completed the other problem, she

remarked that a memory of the running water association was on the

verge of emerging into her mind. She could not get it for some time,

and then, after some effort, it suddenly emerged. She described it as

follows: “It was at Bar Harbor. She was about eight years of age.

There was a brook there called Duck Brook. The older girls used to go

up there on Sundays for a walk with the boys. I went with them one

Sunday, accompanied by the governess, and was standing by the brook

with a boy. It was a very noisy brook, the water running down from the

hillside. While I was standing by the brook, watching the running

water, the boy left me to join the other girls, who had gone off. I

thought that was the way it would always be in life; that I was ugly,

and that they would never stay with me. I felt lonely and unhappy.

During that summer I would not join parties of the same kind, fearing

or feeling that the same thing would happen. I stayed at home by

myself, and when I refused to go it was attributed to sullenness. They

did not know my real reasons. Ever since I have been unable to bear

the sound of running water, which produces the feeling of unhappiness

and loneliness, the same feeling that I had at that time. I thought

then that it was all my fault, because I was ugly.” It was then

tentatively pointed out at some length to the subject that as she now

knew all the facts which had been brought to the “full light of day,”

etc., she, of course, would no longer have her former unpleasant

emotions from the sound of running water. Hereupon, to put the

question to the test, I reached out my hand and poured some water from

a caraffe, by chance standing by, into a tumbler, letting the water

fall from a height to make a sound. At once she manifested discomfort,

and sought to restrain me with her hand. Plainly the setting had to be

changed. This was easily done by leading her to see that her

childhood’s ideas had been proven by life’s experiences to be false.

When this became apparent she laughed at herself, and the psychosis

ceased at once.

Footnote 187:

Social Psychology.

Footnote 188:

This was done in hypnosis, the dream being forgotten when awake.

Footnote 189:

For instance, when I came to the therapeutics I found in abstraction

that the patient did not want to give up her point of view “because,”

as she said, “it forms an excuse so that when I feel lonely, if there

is nothing else to be lonely about, I have that memory and point of

view to fall back upon as something to justify my crying and feeling

lonely and blue.”

When she now feels blue and cries, as happens occasionally, and she

asks herself Why? then she drifts back in her mind to childhood and

remembers she was lonely and then cries the harder. Then she vaguely

thinks of her mother’s death being her fault. She likes therefore to

hold on to this as a peg on which to hang any present feeling of

blueness and loneliness.

Footnote 190:

Some, I have no doubt, will insist upon seeing in towers with bells a

sexual symbol, and in the self-reproach a reaction to a repressed

infantile or other sexual wish. But I cannot accede to this view

first, because a tower was not only not the real object of the phobia,

but not even the alleged object, which was the ringing of bells;

secondly, because it is an unnecessary postulate unsupported by

evidence, and, thirdly, because in fact, the associative memories of

early life were conspicuously free from sex knowledge, wishes,

curiosity, episodes and imaginings, nor was there any evidence of the

so-called “mother complex” or “father-complex,” or any other sexual

complex that I could find after a most exhaustive probing. The

impulses of instincts other than sexual are sufficient to induce

psychical trauma, insistent ideas, and emotion. To hold otherwise is

to substitute dogma for the evidence of experience.

Footnote 191:

It is worth noting that between the bringing to the “full light of

day” the facts furnished by the analysis and the cure a full year and

a half elapsed, during which the phobia continued. The “cure” was

effected at one sitting. The original study was undertaken on purely

psychological grounds; the cure for the purpose of completing the

study.

Footnote 192:

This account will be clearer if read in connection with the full

analysis (“A Clinical Study of a Case of Phobia”), published in the

_Jour, of Abn. Psychol._, October-November, 1912.

Footnote 193:

She was apprehensive of having inherited Bright’s disease from her

father, who had convulsions.

Footnote 194:

It is quite possible that this subconscious process induced the

unreality syndrome in which struggling for air was the salient

symptom.

Footnote 195:

I am excluding conditions like split personalities, automatic writing,

etc., and refer rather to normal mental processes.

LECTURE XIV

THE PHYSIOLOGICAL MANIFESTATIONS OF EMOTION

Emotion,[196] more particularly fear, plays so large a part in the

psychogenesis and symptomatology of the psychoses that it is desirable

to have a clear realization of its physiological and psychological

manifestations and of the disturbances of the organism which it can

induce. It is not necessary for our purpose to discuss the various

theories of the nature of emotion that have been propounded; we need

deal only with the _manifestations_ of emotion and its effect upon the

organism.[197] We will consider the physiological manifestations first.

When a strong emotion is awakened in consciousness there are a large

number of physiological reactions, for the most part visceral, which can

be noted. Some of these may be graphically recorded and measured by

means of instruments of precision. These physiological reactions are

numerous and have been extensively described by Féré[198] among others.

The earlier work of Mosso upon the disturbances of the respiration and

vasomotor apparatus induced by sensory stimulation is well known.

More recently considerable experimental work has been done, particularly

by German investigators, to determine the influence of affective states

upon the circulation and respiration.

Modifications of the _peripheral circulation_, manifested through pallor

or turgescence of the skin and measured by changes recorded by the

plethismograph in the volume of the limbs; modifications of the volume

of the _heart_ and of the rhythm and force of the beats recorded by the

sphygmograph, and of arterial tension measured by the sphygmomonometer

are common phenomena. (Fear is more particularly accompanied by pallor,

and shame by turgescence—blushing. Anger in some is manifested by pallor

and in others by turgescence, and so on.) Changes in rate of the

heart-beats belong to popular knowledge. It is not so well known, even

to physiologists that the volume of the heart may be affected by

emotion. In several series of observations made under conditions of

emotional excitement upon a large number of healthy men, candidates for

civil service appointments, I recorded in a high percentage not only

alterations in the rate and rhythm and force of the heart-beat, but

temporary dilatation of the heart lasting during the period of

excitement.[199] This dilatation in some cases was sufficient to lead to

insufficiency of the mitral valve and to give rise to murmurs. The

examination was purposely conducted so as to induce a high degree of

emotional excitement, at least in many men. In another series of

observations (not published) the arterial tension was measured, and it

was found, as would be expected, that an increase of tension accompanied

the cardiac excitation under emotion.[200]

[Illustration:

Fig. 2. J., acute katatonic stupor. b is a wave selected from the

series in which 6 is sudden call by name. The galvanometer curve (a)

is slight, but the change in the pneumograph curve is notable.

(Peterson and Jung.[201])

]

As to the _respiratory apparatus_ the effect of emotion in altering the

rate and depth of respiration may be shown by the pneumograph; by this

method the effects of slight emotion that otherwise would escape

observation may be detected. Such a disturbance of respiration is shown

in the tracing, Fig. 2.

That emotion will profoundly affect the respiration has of course been

common knowledge from time immemorial, and has been made use of by

writers of fiction and actors for dramatic effect. The same may be said

of modifications of the functioning of the whole respiratory apparatus,

including the nostrils and the mouth; and likewise of the decrease or

increase of secretions (dryness of the mouth from fear, and “foaming”

from anger). These are among the well known physiological effects of

emotions.

Increase of _sweat_ sometimes amounting to an outpour, and alterations

in the amount of the various _glandular secretions_ (_salivary_,

_gastric_, etc.), and _rigor_ are important phenomena.

The remarkable researches of Pawlow[202] and his co-workers in Russia on

the _work of the digestive glands_, and those of Cannon[203] in America

on the _movements of the stomach and intestines_ have revealed that

these functions are influenced in an astonishing degree by psychical

factors.

Although it has long been known that the sight of food under certain

conditions would call forth a secretion of gastric juice in a hungry dog

(Bidder and Smith, 1852), and common observation has told us that

emotion strongly affects the gastrointestinal functions, increasing or

diminishing the secretions of saliva and gastric juice, and even

producing dyspeptic disturbances and diarrhœa, it has remained for

Pawlow and his co-workers to demonstrate the important part which the

“appetite,” as a psychical state, plays in the process of digestion. In

hungry dogs a large quantity of gastric juice, rich in ferment, is

poured out when food is swallowed, and even at the sight of food, and it

was proved that this outpouring was due to psychical influences. Simply

teasing and tempting the animal with food cause secretions, and food

associations in the environment may have the same effect. “If the dog

has not eaten for a long time every movement, the going out of the room,

the appearance of the attendant who ordinarily feeds the animal—in a

word, every triviality—may give rise to excitation of the gastric

glands.” (Pawlow, p. 73.) This first secreted juice is called “appetite

juice,” and is an important factor in the complicated process of

digestion. “The appetite is the first and mightiest exciter of the

secretory nerves of the stomach.” (Pawlow, p. 75.) Pawlow’s results have

been confirmed in man by Hornborg, Umber, Bickel, and Cade and Latarjet.

The mere chewing of appetizing food, for instance, is followed by a

copious discharge of gastric juice, while chewing of rubber and

distasteful substances has a negative result. Depressing emotions

inhibit the secretion of juice (Bickel). More than this, Cannon,[204] in

his very remarkable experiments on the movements of the stomach and

intestines, found that in animals (cat, rabbit, dog, etc.), gastric

peristalsis is stopped whenever the animal manifests signs of rage,

distress, or even anxiety. “Any signs of emotional disturbance, even the

restlessness and continual mewing which may be taken to indicate

uneasiness and discomfort, were accompanied in the cat by total

cessation of the segmentation movements of the small intestines, and of

antiperistalsis in the proximal colon.” Bickel and Sasaki have confirmed

in dogs these emotional effects obtained by Pawlow and Cannon.

The effect of the emotions on the digestive processes is so important

from the standpoint of clinical medicine that I quote the following

summary of published observations from Cannon: "Hornborg found that when

the boy whom he studied chewed agreeable food a more or less active

secretion of the gastric juice was started, whereas the chewing of

indifferent material was without influence.

"Not only is it true that normal secretion is favored by pleasurable

sensations during mastication, but also that unpleasant feelings, such

as vexation and some of the major emotions, are accompanied by a failure

of secretion. Thus Hornborg was unable to confirm in his patient the

observation of Pawlow that mere sight of food to a hungry subject causes

the flow of gastric juice. Hornborg explains the difference between his

and Pawlow’s results by the difference in the reaction of the subjects

to the situation. When food was shown, but withheld, Pawlow’s hungry

dogs were all eagerness to secure it, and the juice at once began to

flow. Hornborg’s little boy, on the contrary, became vexed when he could

not eat at once, and began to cry; then no secretion appeared. Bogen

also reports that his patient, a child, aged three and a half years,

sometimes fell into such a passion in consequence of vain hoping for

food, that the giving of the food, after calming the child, was not

followed by any secretion of the gastric juice.

"The observations of Bickel and Sasaki confirm and define more precisely

the inhibitory effects of violent emotion on _gastric secretion_. They

studied these effects on a dog with an œsophageal fistula, and with a

side pouch of the stomach which, according to Pawlow’s method, opened

only to the exterior. If the animal was permitted to eat while the

œsophageal fistula was open the food passed out through the fistula and

did not go to the stomach. Bickel and Sasaki confirmed the observation

of Pawlow that this sham feeding is attended by a copious flow of

gastric juice, a true ‘psychic secretion,’ resulting from the

pleasurable taste of the food. In a typical instance the sham feeding

lasted five minutes, and the secretion continued for twenty minutes,

during which time 66.7 c. c. of pure gastric juice was produced.

"On another day a cat was brought into the presence of the dog,

whereupon the dog flew into a great fury. The cat was soon removed, and

the dog pacified. Now the dog was again given the sham feeding for five

minutes. In spite of the fact that the animal was hungry and ate

eagerly, there was no secretion worthy of mention. During a period of

twenty minutes, corresponding to the previous observation, only 9 c. c.

of acid fluid was produced, and this was rich in mucus. It is evident

that in the dog, as in the boy observed by Bogen, strong emotions can so

profoundly disarrange the mechanisms of secretion that the natural

nervous excitation accompanying the taking of food cannot cause the

normal flow.

"On another occasion Bickel and Sasaki started gastric secretion in the

dog by sham feeding, and when the flow of gastric juice had reached a

certain height the dog was infuriated for five minutes by the presence

of the cat. During the next fifteen minutes there appeared only a few

drops of a very mucous secretion. Evidently in this instance a

physiological process, started as an accompaniment of a psychic state

quietly pleasurable in character, was almost entirely stopped by another

psychic state violent in character.

"It is noteworthy that in both the positive and negative results of the

emotional excitement illustrated in Bickel and Sasaki’s dog the effects

persisted long after the removal of the exciting condition. This fact

Bickel was able to confirm in a girl with œsophageal and gastric

fistulas; the gastric secretion long outlasted the period of eating,

although no food entered the stomach. The importance of these

observations to personal economics is too obvious to require

elaboration.

“Not only are the secretory activities of the stomach unfavorably

affected by strong emotions; the movements of the stomach as well, and,

indeed, the movements of almost the entire alimentary canal, are wholly

stopped during excitement.”[205]

So you see that the proverb, “Better a dinner of herbs where love is

than a stalled ox and hatred therewith,” has a physiological as well as

a moral basis.

Nearly any sensory or psychical stimulus can be artificially made to

excite the _secretion of saliva_ as determined by experimentation on

animals by Pawlow.

It is probable that all the _ductless glands_ (thyroid, suprarenal,

etc.), are likewise under the influence of the emotions. The suprarenal

glands secrete a substance which in almost infinitesimal doses has a

powerful effect upon the heart and blood vessels, increasing the force

of the former and contracting the peripheral arterioles. The recent

observations of Cannon and de la Paz have demonstrated in the cat that

under the influence of fear or anger an increase of this substance is

poured into the circulation.[206] Cannon, Shohl and Wright have also

demonstrated that the glycosuria which was known to occur in animals

experimented upon in the laboratory is due (in cats) to the influence of

the emotions, very probably discharging through the sympathetic system

on the adrenal glands and increasing their secretion.[207] The

glycosuria is undoubtedly due to an increase of sugar in the blood. It

is interesting to note, in this connection, that there is considerable

clinical evidence that indicates that some cases of diabetes and

glycosuria have an emotional origin. The same is true of disease of the

thyroid gland (exophthalmic goiter).

Most of the viscera are innervated by the sympathetic system, and the

visceral manifestations of emotion indicate the dominance of sympathetic

impulses. “When, for example, a cat becomes frightened, the pupils

dilate, the stomach and intestines are inhibited, the heart beats

rapidly, the hairs of the back and tail stand erect—all signs of nervous

discharge along sympathetic paths” (Cannon). Cannon and his co-workers

have further made the acute suggestion that, as adrenalin itself is

capable of working the effects evoked by sympathetic stimulation, “the

persistence of the emotional state, after the exciting object has

disappeared, can be explained” by the persistence of the adrenalin in

the blood. There is reason to believe that some of the adrenal secretion

set free by nervous stimulation returning in the blood stream to the

glands stimulates them to further activity, and this would tend to

continue the emotional effect after the emotion has subsided. “Indeed it

was the lasting effect of excitement in digestive processes which

suggested” to Cannon his investigations.[208]

According to Féré[209] the _pupils_ may dilate under the influence of

asthenic emotions and contract with sthenic emotions. However that may

be, the dilatation of the pupils during states of fear may be

demonstrated in animals.

exert force of which he is ordinarily incapable. Or this energy, instead

of being discharged into the channels being made use of by the will, and

so augmenting its effects, may be so discharged as to inhibit the will,

and produce paralysis of the will and muscular action.

These muscular vasomotor and secretory changes need not surprise us, as

indeed they have a biological meaning. As Sherrington[210] has pointed

out, “there is a strong bond between emotion and muscular action.

Emotion ‘moves’ us, hence the word itself. If developed in intensity, it

impels toward vigorous movement. Every vigorous movement of the body ...

involves also the less noticeable co-operation of the viscera,

especially of the circulatory and respiratory [and, I would add, the

secretory glands of the skin]. The extra demand made upon the muscles

that move the frame involves a heightened action of the nutrient organs

which supply to the muscles the material for their energy”; and also

involves a heightened action of the sweat glands to maintain the thermic

equilibrium. “We should expect,” Sherrington remarks, “visceral action

to occur along with the muscular expression of emotion,” and we should

expect, it may be added, that through this mechanism emotion should

become integrated with vasomotor, secretory, and other visceral

functions.