A CRITICISM OF BLEULER'S "THEORY OF SCHIZOPHRENIC NEGATIVISM"[169]
Bleuler's work contains a noteworthy clinical analysis of "Negativism."
Besides giving a very precise and discerning summary of the various
manifestations of negativism, the author presents us with a new
psychological conception well worthy of attention, viz. the concept of
_ambivalency_ and of _ambitendency_, thus formulating the psychological
axiom that every tendency is balanced by its opposite tendency (to this
must be added that positive action is produced by _a comparatively small
leaning to one side of the scale_). Similarly all other tendencies,
under the stress of emotions, are balanced by their opposites--thus
giving an _ambivalent_ character to their expression. This theory rests
on clinical observation of katatonic negativism, which more than proves
the existence of contrasting tendencies and values. These facts are well
known to psychoanalysis, where they are summed up under the concept of
resistance. But this must not be taken as meaning that every positive
psychic action simply calls up its opposite. One may easily gain the
impression from Bleuler's work that his standpoint is that, _cum grano
salis_, the conception or the tendency of the Schizophrenic is always
accompanied by its opposite. For instance, Bleuler says:--
1. "Disposing causes of negativistic phenomena are: the _ambitendency_
by which every impulse is accompanied by its opposite."
2. "_Ambivalency_, which gives two opposed emotional expressions to the
same idea, and would regard that idea as positive and negative at the
same time."
3. "_The schizophrenic splitting_ of the psyche prevents any final
summing up of the conflicting and corresponding psychisms, so that the
unsuitable impulse can be realised just as much as the right one, and
the negative thought substituted for the right one." "On this theory,
negative manifestations may directly arise, since non-selected positive
and negative psychisms may stand for one another," and so on.
If we investigate psychoanalytically a case of obvious ambivalency,
_i.e._ of a more or less unexpected negative reaction instead of a
positive one, we find that there is a strict sequence of psychological
causes conditioning negative reaction. The tendency of this sequence is
to disturb the intention of the contrasting or opposite series, that is
to say, _it is resistance set up by a complex_. This fact, which has not
yet been refuted by any other observations, seems to me to contradict
the above-mentioned formulæ. (For confirmation, see my "Psychology
of Dementia Præcox," p. 103.) Psychoanalysis has proved conclusively
that a resistance always has an intention and a meaning; that there is
no such thing as a capricious playing with contrasts. The systematic
character of resistance holds good, as I believe I have proved, even in
schizophrenia. So long as this position, founded upon a great variety
of experience, is not disproved by any other observations, the theory
of negativism must adapt itself to it. Bleuler in a sense supports this
when he says: "For the most part the negative reaction does not simply
appear as accidental, _but is actually preferred to the right one_."
This is an admission that negativism is of the nature of resistance.
Once admit this, and the primary importance of ambivalency disappears
so far as negativism is concerned. The tendency to resistance remains
as the only fundamental principle. Ambivalency can in no sense be put
on all fours with the "schizophrenic splitting of the psyche," but must
be regarded as a concept which gives expression to the universal and
ever-present inner association of pairs of opposites. (One of the most
remarkable examples of this is the "contrary meaning of root-words."
See Freud's "Essay on Dreams," Jahrbuch, vol. II., p. 179.) The same
thing applies to ambitendency. Neither is specific of schizophrenia, but
applies equally to the neuroses and the normal. All that is specific to
katatonic negativism is _the intentional contrast, i.e. the resistance_.
From this explanation we see that resistance is something different
from ambivalency; it is the dynamic factor which makes manifest the
everywhere latent ambivalency. What is characteristic of the diseased
mind is not ambivalency but resistance. This implies the existence
of a conflict between two opposite tendencies which has succeeded in
raising the normally present ambivalency into a struggle of opposing
components. (Freud has very aptly called this, "The separation of pairs
of opposites.") In other words it is a conflict of wills, bringing about
the neurotic condition of "disharmony within the self." This condition
is the only "splitting of the psyche" known to us, and is not so much
to be regarded as a predisposing cause, but rather as a manifestation
resulting from the inner conflict--the "incompatibility of the complex"
(Riklin).
_Resistance_, as the fundamental fact of schizophrenic dissociation,
thus becomes something which, in contra-distinction to ambivalency, is
not _eo ipso_ identical with the concept of the state of feeling, but
is a secondary and supplementary one, with its own special and _quasi_
independent psychological development; and this is identical with the
necessary previous history of the complex in every case. It follows that
the theory of negativism coincides with the theory of the complex, as
the complex is the cause of the resistance.
Bleuler summarises the causes of negativism as follows:
(_a_) The autistic retirement of the patient into his own
phantasies.
(_b_) The existence of a life-wound (complex) which must be
protected from injury.
(_c_) The misconception of the environment and of its meaning.
(_d_) The directly hostile relation to environment.
(_e_) The pathological irritability of schizophrenics.
(_f_) The "press of ideas," and other aggravations of action and
thought.
(_g_) Sexuality with its ambivalency on the emotional plane is
often one of the roots of negative reaction.
* * * * *
(_a_) Autistic withdrawal into one's own phantasies[170] is what I
formerly designated as the obvious overgrowth of the phantasies of
the complex. The strengthening of the complex is coincident with the
increase of the resistance.
(_b_) The life-wound (_Lebenswund_) is the complex which, as a matter
of course, is present in every case of schizophrenia, and of necessity
always carries with it the phenomena of autism or auto-erotism
(introversion), for complexes and involuntary egocentricity are
inseparable reciprocities. Points (_a_) and (_b_) are therefore
identical. (_Cf._ "Psychology of Dementia Præcox," chapters ii. and iii.)
(_c_) It is proved that the misconception of environment is an
assimilation of the complex.
(_d_) The hostile relation to environment is the maximum of resistance
as psychoanalysis clearly shows. (_d_) goes with (_a_).
(_e_) "Irritability" proves itself psychoanalytically to be one of the
commonest results of the complex. I designated it _complex-sensibility_.
Its generalised form (if one may use such an expression) manifests
itself as a damming up of the affect (= damming of the _libido_),
consequent on increased resistance. So-called neurasthenia is a
classical example of this.
(_f_) Under the term "press of ideas," and similar intellectual
troubles, may be classified the "want of clearness and logic of the
schizophrenic thinking," which Bleuler considers a predisposing
cause. I have, as I may presume is known, expressed myself with much
reserve on what he regards as the premeditation of the schizophrenic
adjustment. Further and wider experience has taught me that the laws
of the Freudian psychology of dreams and the theory of the neuroses
must be turned towards the obscurities of schizophrenic thinking. _The
painfulness of the elaborated complex necessitates a censorship of its
expression._[171] This principle has to be applied to schizophrenic
disturbance in thinking; and until it has been proved that this
principle is not applicable to schizophrenia, there is no justification
for setting up a new principle; _i.e._ to postulate that schizophrenic
disturbance of ideas is something primary. Investigations of hypnagogic
activity, as well as association reactions in states of concentrated
attention, give psychical results which up to now are indistinguishable
from the mental conditions in schizophrenia. For example excessive
relaxation of attention suffices to conjure up images as like as two
peas to the phantasies and expressions of schizophrenia. It will
be remembered that I have attributed the notorious disturbances of
attention in schizophrenia to the special character of the complex; an
idea which my experience since 1906 have further confirmed. There are
good reasons for believing specific schizophrenic thought-disturbance to
be the _result of a complex_.
Now as regards the symptoms of thought-pressure, it is first and
foremost a thought-compulsion, which, as Freud has shown, is first a
thought-complex and secondly a _sexualisation of the thought_. Then
to the symptom of thought-pressure there is superadded at least a
_demoniac_ impulse such as _may be observed in every vigorous release or
production of libido_.
Thought-pressure, on closer examination, is seen to be a result of
schizophrenic introversion, which necessarily leads to a sexualisation
of the thought; _i.e._ to an autonomy of the complex.[172]
(_g_) _The transition to sexuality_ appears from the psychoanalytical
standpoint difficult to understand. If we consider that the development
of resistance coincides in every case with the history of the
complex we must ask ourselves: Is the complex sexual or not? (It
goes without saying that we must understand sexuality in its proper
sense of psycho-sexuality.) To this question psychoanalysis gives the
invariable answer: _Resistance always springs from a peculiar sexual
development_. The latter leads in the well-known manner to conflict,
_i.e._ to the complex. Every case of schizophrenia which has so far
been analysed confirms this. It can therefore claim at least to be a
working hypothesis, and one to be followed up. In the present state
of our knowledge, it is therefore not easy to see why Bleuler only
allows to sexuality a _quasi_-determining influence on the phenomena of
negativism; for psychoanalysis demonstrates that the cause of negativism
is resistance; and that with schizophrenia, as with all other neuroses,
this arises from the peculiar sexual development.
It can scarcely be doubted to-day that schizophrenia, with its
preponderance of the mechanisms of introversion, possesses the same
mechanism as any other "psycho-neurosis." In my opinion, at any
rate, its peculiar symptoms (apart from the clinical and anatomical
standpoints) are only to be studied by psychoanalysis, _i.e._ when
the investigation is mainly directed to the genetic impetus. I have,
therefore, endeavoured to indicate how Bleuler's hypothesis stands in
the light of the theory of complexes; I feel myself bound to emphasise
the complex-theory in this relation, and am not disposed to surrender
this conception, which is as illuminating as it was difficult to evolve.
FOOTNOTES:
[Footnote 169: "Jahrbuch für psychoanalytische und psychopathologische
Forschungen," vol. III. 1912. Translator, Dr. M. D. Eder.]
[Footnote 170: Autism (Bleuler) = Auto-erotism (Freud). For some time I
have employed the concept of _introversion_ for this condition.]
[Footnote 171: Hence the replacing of the complex by its corresponding
symbol.]
[Footnote 172: See "Psychology of Dementia Præcox," chapters iv. and v.]