ON THE IMPORTANCE OF THE UNCONSCIOUS IN PSYCHOPATHOLOGY[182]
When we speak of a thing as being "unconscious" we must not forget that
from the point of view of the functioning of the brain a thing may be
unconscious to us in two ways--physiologically or psychologically. I
shall only deal with the subject from the latter point of view. So that
for our purposes we may define the unconscious as "the sum of all those
psychological events which are not apperceived, and so are unconscious."
The unconscious contains all those psychic events which, because of the
lack of the necessary intensity of their functioning, are unable to pass
the threshold which divides the conscious from the unconscious; so that
they remain in effect below the surface of the conscious, and flit by in
subliminal phantom forms.
It has been known to psychologists since the time of Leibniz that the
elements--that is to say, the ideas and feelings which go to make up
the conscious mind, the so-called conscious content--are of a complex
nature, and rest upon far simpler and altogether unconscious elements;
it is the combination of these which gives the element of consciousness.
Leibniz has already mentioned the _perceptions insensibles_--those vague
perceptions which Kant called "shadowy" representations, which could
only attain to consciousness in an indirect manner. Later philosophers
assigned the first place to the unconscious, as the foundation upon
which the conscious was built.
But this is not the place to consider the many speculative theories nor
the endless philosophical discussions concerning the nature and quality
of the unconscious. We must be satisfied with the definition already
given, which will prove quite sufficient for our purpose, namely the
conception of the unconscious as the sum of all psychical processes
below the threshold of consciousness.
The question of the importance of the unconscious for psychopathology
may be briefly put as follows: "In what manner may we expect to find
unconscious psychic material behave in cases of psychosis and neurosis?"
In order to get a better grasp of the situation in connexion with
mental disorders, we may profitably consider first how unconscious
psychic material behaves in the case of normal people, especially
trying to visualize what in normal men is apt to be unconscious. As
a preliminary to this knowledge we must get a complete understanding
of what is contained in the conscious mind; and then, by a process of
elimination we may expect to find what is contained in the unconscious,
for obviously--_per exclusionem_--what is in the conscious cannot be
unconscious. For this purpose we examine all activities, interests,
passions, cares, and joys, which are conscious to the individual. All
that we are thus able to discover becomes, _ipso facto_, of no further
moment as a content of the unconscious, and we may then expect to find
only those things contained in the unconscious which we have not found
in the conscious mind.
Let us take a concrete example: A merchant, who is happily married,
father of two children, thorough and painstaking in his business
affairs, and at the same time trying in a reasonable degree to improve
his position in the world, carries himself with self-respect, is
enlightened in religious matters, and even belongs to a society for the
discussion of liberal ideas.
What can we reasonably consider to be the content of the unconscious in
the case of such an individual?
Considered from the above theoretical standpoint, everything in the
personality that is not contained in the conscious mind should be
found in the unconscious. Let us agree, then, that this man consciously
considers himself to possess all the fine attributes we have just
described--no more, no less. Then it must obviously result that he is
entirely unaware that a man may be not merely industrious, thorough,
and painstaking, but that he may also be careless, indifferent,
untrustworthy; for some of these last attributes are the common heritage
of mankind and may be found to be an essential component of every
character. This worthy merchant forgets that quite recently he allowed
several letters to remain unanswered which he could easily have answered
at once. He forgets, too, that he failed to bring a book home which his
wife has asked him to get at the book-stall, where she had previously
ordered it, although he might easily have made a note of her wish.
But such occurrences are common with him. Therefore we are obliged to
conclude that he is also lazy and untrustworthy. He is convinced that he
is a thoroughly loyal subject; but for all that he failed to declare the
whole of his income to the assessor, and when they raise his taxes, he
votes for the Socialists.
He believes himself to be an independent thinker, yet a little while
back he undertook a big deal on the Stock Exchange, and when he came
to enter the details of the transaction in his books he noticed with
considerable misgivings that it fell upon a Friday, the 13th of the
month. Therefore, he is also superstitious and not free in his thinking.
So here we are not at all surprised to find these compensating vices
to be an essential content of the unconscious. Obviously, therefore,
the reverse is true--namely, that unconscious virtues compensate for
conscious deficiencies. The law which ought to follow as the result
of such deductions would appear to be quite simple--to wit, the
conscious spendthrift is unconsciously a miser; the philanthropist is
unconsciously an egoist and misanthrope. But, unfortunately, it is
not quite so easy as that, although there is a basis of truth in this
simple rule. For there are essential hereditary dispositions of a latent
or manifest nature which upset the simple rule of compensation, and
which vary greatly in individual cases. From entirely different motives
a man may, for instance, be a philanthropist, but the manner of his
philanthropy depends upon his originally inherited disposition, and the
way in which the philanthropic attitude is compensated depends upon his
motives. It is not sufficient simply to know that a certain person is
philanthropic in order to diagnose an unconscious egoism. For we must
also bring to such a diagnosis a careful study of the motives involved.
In the case of normal people the principal function of the unconscious
is to effect a compensation and thus produce a balance. All extreme
conscious tendencies are softened and toned down through an effective
opposite impulse in the unconscious. This compensating agency, as I have
tried to show in the case of the merchant, maintains itself through
certain unconscious, inconsequent activities, as it were, which Freud
has very well described as symptomatic acts (_Symptom-handlungen_).
To Freud we owe thanks also for having called attention to the
importance of dreams, for by means of them, also, we are able to learn
much about this compensating function. There is a fine historical
example of this in the well-known dream of Nebuchadnezzar in the fourth
chapter of the Book of Daniel, where Nebuchadnezzar at the height of
his power had a dream which foretold his downfall. He dreamed of a tree
which had raised its head even up to heaven and now must be hewn down.
This is a dream which is obviously a counterpoise to the exaggerated
feeling of royal power.
Now considering states in which the mental balance is disturbed, we can
easily see, from what has preceded, wherein lies the importance of the
unconscious for psychopathology. Let us ponder the question of where
and in what manner the unconscious manifests itself in abnormal mental
conditions. The way in which the unconscious works is most clearly seen
in disturbances of a psychogenic nature, such as hysteria, compulsion
neurosis, etc.
We have known for a long time that certain symptoms of these
disturbances are produced by unconscious psychic events. Just as
clear, but less recognised, are the manifestations of the unconscious
in actually insane patients. As the intuitive ideas of normal men do
not spring from logical combinations of the conscious mind, so the
hallucinations and delusions of the insane arise, not out of conscious
but out of unconscious processes.
Formerly, when we held a more materialistic view of psychiatry we were
inclined to believe that all delusions, hallucinations, stereotypic
acts, etc., were provoked by morbid processes in the brain cells. Such a
theory, however, ignores that delusions, hallucinations, etc., are also
to be met with in certain functional disturbances, and not only in the
case of functional disturbances, but also in the case of normal people.
Primitive people may have visions and hear strange voices without having
their mental processes at all disturbed. To seek to ascribe symptoms
of that nature directly to a disease of the brain cells I hold to be
superficial and unwarranted. Hallucinations show very plainly how a part
of the unconscious content can force itself across the threshold of the
conscious. The same is true of a delusion whose appearance is at once
strange and unexpected by the patient.
The expression "mental balance" is no mere figure of speech, for its
disturbance is a real disturbance of that equilibrium which actually
exists between the unconscious and conscious content to a greater extent
than has heretofore been recognised or understood. As a matter of fact,
it amounts to this--that the normal functioning of the unconscious
processes breaks through into the conscious mind in an abnormal manner,
and thereby disturbs the adaptation of the individual to his environment.
If we study attentively the history of any such person coming under
our observation, we shall often find that he has been living for a
considerable time in a sort of peculiar individual isolation, more or
less shut off from the world of reality. This constrained condition
of aloofness may be traced back to certain innate or early acquired
peculiarities, which show themselves in the events of his life. For
instance, in the histories of those suffering from dementia præcox
we often hear such a remark as this: "He was always of a pensive
disposition, and much shut up in himself. After his mother died he
cut himself off still more from the world, shunning his friends and
acquaintances." Or again, we may hear, "Even as a child he devised many
peculiar inventions; and later, when he became an engineer, he occupied
himself with most ambitious schemes."
Without discussing the matter further it must be plain that a
counterpoise is produced in the unconscious as a compensation to the
one-sidedness of the conscious attitude. In the first case we may expect
to find an increasing pressing forward in the unconscious, of a wish
for human intercourse, a longing for mother, friends, relatives; while
in the second case self-criticism will try to establish a correcting
balance. Among normal people a condition never arises so one-sided
that the natural corrective tendencies of the unconscious entirely
lose their value in the affairs of everyday life; but in the case of
abnormal people, it is eminently characteristic that the individual
entirely fails to recognise the compensating influences which arise in
the unconscious. He even continues to accentuate his one-sidedness; this
is in accord with the well-known psychological fact that the worst enemy
of the wolf is the wolf-hound, the greatest despiser of the negro is the
mulatto, and that the biggest fanatic is the convert; for I should be a
fanatic were I to attack a thing outwardly which inwardly I am obliged
to concede as right.
The mentally unbalanced man tries to defend himself against his own
unconscious, that is to say, he battles against his own compensating
influences. The man already dwelling in a sort of atmosphere of
isolation, continues to remove himself further and further from the
world of reality, and the ambitious engineer strives by increasingly
morbid exaggerations of invention to disprove the correctness of his own
compensating powers of self-criticism. As a result of this a condition
of excitation is produced, from which results a great lack of harmony
between the conscious and unconscious attitudes. The pairs of opposites
are torn asunder, the resulting division or strife leads to disaster,
for the unconscious soon begins to intrude itself violently upon the
conscious processes. Then odd and peculiar thoughts and moods supervene,
and not infrequently incipient forms of hallucination, which clearly
bear the stamp of the internal conflict.
These corrective impulses or compensations which now break through into
the conscious mind, should theoretically be the beginning of the healing
process, because through them the previously isolated attitude should
apparently be relieved. But in reality this does not result, for the
reason that the unconscious corrective impulses which thus succeed in
making themselves apparent to the conscious mind, do so in a form that
is altogether unacceptable to consciousness.
The isolated individual begins to hear strange voices, which accuse him
of murder and all sorts of crimes. These voices drive him to desperation
and in the resulting agitation he attempts to get into contact with the
surrounding _milieu_, and does what he formerly had anxiously avoided.
The compensation, to be sure, is reached, but to the detriment of the
individual.
The pathological inventor, who is unable to profit by his previous
failures, by refusing to recognise the value of his own self-criticism,
becomes the creator of still more preposterous designs. He wishes to
accomplish the impossible but falls into the absurd. After a while he
notices that people talk about him, make unfavourable remarks about him,
and even scoff at him. He believes a far-reaching conspiracy exists
to frustrate his discoveries and render them objects of ridicule. By
this means his unconscious brings about the same results that his
self-criticism could have attained, but again only to the detriment of
the individual, because the criticism is projected into his surroundings.
An especially typical form of unconscious compensation--to give a
further example--is the paranoia of the alcoholic. The alcoholic loses
his love for his wife; the unconscious compensation tries to lead him
back again to his duty, but only partially succeeds, for it causes him
to become jealous of his wife as if he still loved her. As we know, he
may even go so far as to kill both his wife and himself, merely out of
jealousy. In other words, his love for his wife has not been entirely
lost, it has simply become subliminal; but from the realm of the
unconscious it can now only reappear in the form of jealousy.
We see something of a similar nature in the case of religious converts.
One who turns from protestantism to catholicism has, as is well known,
the tendency to be somewhat fanatical. His protestantism is not entirely
relinquished, but has merely disappeared into the unconscious, where it
is constantly at work as a counter-argument against the newly acquired
catholicism. Therefore the new convert feels himself constrained to
defend the faith he has adopted in a more or less fanatical way. It
is exactly the same in the case of the paranoiac, who feels himself
constantly constrained to defend himself against all external criticism,
because his delusional system is too much threatened from within.
The strange manner in which these compensating influences break through
into the conscious mind derives its peculiarities from the fact that
they have to struggle against the resistances already existing in the
conscious mind, and therefore present themselves to the patient's mind
in a thoroughly distorted manner. And secondly, these compensating
equivalents are obliged necessarily to present themselves in the
language of the unconscious--that is, in material of a heterogeneous
and subliminal nature. For all the material of the conscious mind which
is of no further value, and can find no suitable employment, becomes
subliminal, such as all those forgotten infantile and phantastic
creations that have ever entered the heads of men, of which only the
legends and myths still remain. For certain reasons which I cannot
discuss further here, this latter material is frequently found in
dementia præcox.
I hope I may have been able to give in this brief contribution, which
I feel to be unfortunately incomplete, a glimpse of the situation
as it presents itself to me of the importance of the unconscious in
psychopathology. It would be impossible in a short discourse to give an
adequate idea of all the work that has already been done in this field.
To sum up, I may say that the function of the unconscious in conditions
of mental disturbance is essentially a compensation of the content
of the conscious mind. But because of the characteristic condition
of one-sidedness of the conscious striving in all such cases, the
compensating correctives are rendered useless. It is, however,
inevitable that these unconscious tendencies break through into the
conscious mind, but in adapting themselves to the character of the
one-sided conscious aims, it is only possible for them to appear in a
distorted and unacceptable form.
FOOTNOTES:
[Footnote 182: Paper given before the Section of Neurology and
Psychological Medicine, Aberdeen, 1914. Reprinted from the _British
Medical Journal_, by kind permission of the Editor, Dr. Dawson Williams.]