THE CONTENT OF THE PSYCHOSES[194]
INTRODUCTION
My short sketch on the Content of the Psychoses which first appeared
in the series of "Schriften zur Angewandten Seelenkunde" under
Freud's editorship was designed to give the non-professional but
interested public some insight into the psychological point of view
of recent psychiatry. I chose by way of example a case of the mental
disorder known as Dementia Præcox, which Bleuler calls Schizophrenia.
Statistically this extensive group contains by far the largest number
of cases of psychosis. Many psychiatrists would prefer to limit it, and
accordingly make use of other nomenclature and classification. From the
psychological standpoint the change of name is unimportant, for it is
of less value to know what a thing is called than to know what it is.
The cases of mental disorder sketched in this essay belong to well-known
and frequently occurring types, familiar to the alienist. The facts will
not be altered if these disorders are called by some other name than
dementia præcox.
I have presented my view of the psychological basis in a work[195]
whose scientific validity has been contested upon all sorts of grounds.
For me it is sufficient justification that a psychiatrist of Bleuler's
standing has fully accepted, in his great monograph on the disease,
all the essential points in my work. The difference between us is as
to the question whether, in relation to the anatomical basis, the
psychological disorders should be regarded as primary or secondary. The
resolution of this weighty question depends upon the general problem as
to whether the prevailing dogma in psychiatry--"disorders of the mind
are disorders of the brain"--presents a final truth or not. This dogma
leads to absolute sterility as soon as universal validity is ascribed
to it. There are undoubted psychogenic mental diseases (the so-called
hysterical) which are properly regarded as _functional_ in contrast
with organic diseases which rest upon demonstrable anatomical changes.
Disorders of the brain should only be called organic when the psychic
symptoms depend upon an undoubtedly primary disease of the brain. Now
in dementia præcox this is by no means a settled question. Definite
anatomical changes are present, but we are very far from being able to
relate the psychological symptoms to these changes. We have, at least,
positive information as to the functional nature of early schizophrenic
conditions; moreover the organic character of paranoia and many paranoid
forms is still in great uncertainty. This being so it is worth while
to inquire whether manifestations of degeneration could not also be
provoked by psychological disturbance of function. Such an idea is only
incomprehensible to those who smuggle materialistic preconceptions into
their scientific theories. This question does not even rest upon some
fundamental and arbitrary spiritualism, but upon the following simple
reflection. Instead of assuming that some hereditary disposition, or a
toxæmia, gives rise directly to organic processes of disease, I incline
to the view that upon the basis of predisposition, whose nature is
at present unknown to us, there arises a non-adaptable psychological
function which can proceed to develop into manifest mental disorder;
this may secondarily determine organic degeneration with its own train
of symptoms. In favour of this conception is the fact that we have no
proof of the primary nature of the organic disorder, but overwhelming
proofs exist of a primary psychological fault in function, whose history
can be traced back to the patient's childhood. In perfect agreement
with this conception is the fact that analytic practice has given us
experience of cases where patients on the borderline of dementia præcox
have been brought back to normal life.
Even if anatomical lesions or organic symptoms were constantly present,
science ought not to imagine the psychological standpoint could
advisedly be neglected, or the undoubted psychological relationship
be given up as unimportant. If, for instance, carcinoma were to prove
an infectious disease the peculiar growth and degenerative process
of carcinomatous cells would still be a constant factor requiring
investigation on its own account. But, as I have said, the correlation
between the anatomical findings and the psychological picture of
the disease is so loose that it is extremely desirable to study the
psychological side of it thoroughly.
PART I
Psychiatry is the stepchild of medicine. All the other branches of
medicine have one great advantage over it--the scientific methods can be
applied; there are things to be seen, and felt, physical and chemical
methods of investigation to be followed: the microscope shows the
dreaded bacillus, the surgeon's knife halts at no difficulty and gives
us glimpses of most inaccessible organs of vital importance. Psychiatry,
which engages in the exploration of the mind, stands ever at the door
seeking in vain to weigh and measure as in the other departments of
science. We have long known that we have to do with a definite organ,
the brain; but only beyond the brain, beyond the morphological basis
do we reach what is important for us--the mind; as indefinable as it
ever was, still eluding any explanation, no matter how ingenious.
Former ages, endowing the mind with substance, and personifying every
incomprehensible occurrence in nature, regarded mental disorder as the
work of evil spirits; the patient was looked upon as one possessed,
and the methods of treatment were such as fitted this conception. This
mediæval conception occasionally gains credence and expression even
to-day. A classical example is the driving out of the devil which
the elder Pastor Blumhardt carried out successfully in the famous
case of Gottlieb in Deltus.[196] To the honour of the Middle Ages
let it also be said that there are to be found early evidences of a
sound rationalism. In the sixteenth century at the Julius Hospital in
Würzburg mental patients were already treated side by side with others
physically ill, and the treatment seems to have been really humane.
With the opening of the modern era, and with the dawn of the first
scientific ideas, the original barbaric personification of the unknown
Great Power gradually disappeared. A change arose in the conception of
mental disease in favour of a more philosophic moral attitude. The old
view that every misfortune was the revenge of the offended gods returned
new-clothed to fit the times. Just as physical diseases can, in many
cases, be regarded as self-inflicted on account of negligence, mental
diseases were likewise considered to be due to some moral injury, or
sin. Behind this conception the angry godhead also stood. Such views
played a great _rôle_, right up to the beginning of last century,
especially in Germany. In France, however, about the same time a new
idea was appearing, destined to sway psychiatry for a hundred years.
Pinel, whose statue fittingly stands at the gateway of the Salpetrière
in Paris, took away the chains from the insane and thus freed them from
the symbol of the criminal. In a very real way he formulated for the
world the humane and scientific conception of modern times. A little
later Esquirol and Bayle discovered that certain forms of insanity ended
in death, after a relatively short time, and that certain constant
changes in the brain could be demonstrated _post mortem_. Esquirol had
described as an entity general paralysis of the insane, or as it was
popularly called "softening of the brain," a disease which is always
bound up with chronic inflammatory degeneration of the cerebral matter.
Thus was laid the foundation of the dogma which you will find repeated
in every text-book of psychiatry, viz. "diseases of the mind are
diseases of the brain." Confirmation of this conception was added about
the same time by Gall's discoveries which traced partial or complete
loss of the power of speech--a psychical capacity--to a lesion in the
region of the left lower frontal convolution. Somewhat later this view
proved to be of general applicability. Innumerable cases of extreme
idiocy or other intense mental disorders were found to be caused by
tumours of the brain. Towards the end of the nineteenth century Wernicke
(recently deceased) localised the speech centre in the left temporal
lobe. This epoch-making discovery raised hopes to the highest pitch.
It was expected that at no distant day every characteristic and every
psychical activity would be assigned a place in the cortical grey
matter. Gradually, increased attempts were made to trace the primary
mental changes in the psychoses back to certain parallel changes in the
brain. Meynert, the famous Viennese psychiatrist, described a formal
scheme in which the alteration in blood-supply in certain regions was
to play the chief part in the origin of the psychoses. Wernicke made a
similar but far more ingenious attempt at a morphological explanation
of psychical disorders. The visible result of this tendency is seen in
the fact that even the smallest and least renowned asylum has, to-day,
its anatomical laboratory where cerebral sections are cut, stained, and
microscoped. Our numerous psychiatric journals are full of morphological
contributions, investigations into the structure and distribution of
cells in the cortex, and other varying source of disorders in the
different mental diseases.
Psychiatry has come into fame as gross materialism. And quite rightly,
for it is on the road--or rather reached it long ago--to put the organ,
the instrument, above function. Function has become the dependent
accessory of its organs, the mind the dependent accessory of the brain.
In modern mental therapy the mind has been the loser, whilst great
progress has been made in cerebral anatomy; of the mind we know less
than nothing. Current psychiatry behaves like a man who thinks he can
unriddle the meaning and importance of a building by a mineralogical
investigation of its stones. Let us attempt to realise in which mental
diseases obvious changes in the brain are found, and what is their
proportion.
In the last four years we have received 1325 patients at Burgholzi;[197]
331 a year. Of these 9 per cent. suffered from congenital psychic
anomalies. By this is understood a certain inborn defect of the psyche.
Of these 9 per cent., about a quarter were imbeciles. Here we meet
certain changes in the brain such as microcephalus, hydrocephalus,
malformations or absence of portions of the brain. The remaining
three-quarters of these congenital defects present no typical changes in
the brain.
Three per cent. of our patients suffer from epileptic mental troubles.
In the course of epilepsy there arises gradually a typical degeneration
of the brain. The degeneration is, however, only discoverable in severe
cases and when the disease has existed for some time. If the attacks
have only existed for a relatively short time, not more than a few
years, the brain as a rule shows nothing. Seventeen per cent. of our
patients suffer from progressive paralysis and senile dementia. Both
diseases present characteristic changes in the brain. In paralysis there
is most extensive shrinkage of the brain, so that the cortex is often
reduced by one half. The frontal portions of the brain more especially,
may be reduced to a third of the normal weight. There is a similar
destruction of substance in senile decay.
Fourteen per cent. of the patients annually received are cases of
poisoning, at least 13 per cent. of these being due to alcohol. As a
rule in slight cases nothing is to be found in the brain; in only a
relatively few severe cases is there shrinkage of the cortex, generally
of slight degree. The number of these severe cases amounts to less than
1 per cent. of the yearly cases of alcoholism.
Six per cent. of the patients suffer from so-called maniacal depressive
insanity which includes the maniacs and the melancholics. The essence
of this disease is readily intelligible to the public. Melancholia is
a condition of abnormal sadness without disorder of intelligence or
memory. Mania is the opposite, the rule being an abnormally excited
state with great restlessness; likewise without deep disturbance of
intelligence and memory. In this disease there are no demonstrable
morphological changes in the brain.
Forty-five per cent. of the patients suffer from the real and common
mental disease called dementia præcox. The name is a very unhappy one,
for the dementia is not always precocious, nor in all cases is there
dementia. Unfortunately the disease is too often incurable; even in the
best cases, in those that recover, where the outside public would not
observe any abnormality, there is always present some defect in the
emotional life. The picture presented by the disease is extraordinarily
diverse; generally there is some disorder of feeling, frequently
delusions and hallucinations. As a rule there is nothing to be found in
the brain. Even in cases of a most severe type, lasting for years, an
intact brain is not infrequently found _post mortem_. In a few cases
only certain slight changes are present which, however, cannot as yet be
reduced to any law.
To sum up: in round figures a quarter of our insane patients show more
or less clearly extensive changes and destruction of the brain, while
three-fourths have a brain which seems to be generally unimpaired or at
most exhibit such changes as give no explanation of the psychological
disturbance.
These figures offer the best possible proof that the purely
morphological view-point of modern psychiatry leads only very
indirectly, if at all, to the understanding of the mental disorder,
which is our aim. We must take into account the fact that those mental
diseases which show the most marked disturbances of the brain end in
death; for this reason the chronic inmates of the asylum form its real
population, consisting of some 70 to 80 per cent. of cases of dementia
præcox, that is, of patients in whom anatomical changes are practically
non-existent. The psychiatry of the future must come to grips with the
core of the thing; the path is thus made clear--_it can only be by way
of psychology_. Hence in our Zürich clinic we have entirely discarded
the anatomical view and turned to the psychological investigation of
insanity. As most of our patients suffer from dementia præcox we were
naturally concerned with this as our chief problem.
* * * * *
The older asylum physicians paid great attention to the psychological
precursors of mental disorder, just as the public still does, following
a true instinct. We accepted this hint and carefully investigated the
previous psychological history wherever possible. Our trouble was richly
rewarded, for we often found, to our surprise, that the disease broke
out at a moment of some great emotion which, in its turn, had arisen in
a so-called normal way. We found, moreover, that in the mental disease
which ensued a number of symptoms occurred which it was quite labour in
vain to study from the morphological standpoint. These same symptoms,
however, were comprehensible when considered from the standpoint of the
individual's previous history. Freud's fundamental investigations into
the psychology of hysteria and dreams afforded us the greatest stimulus
and help in our work.
A few instances of the latest method in psychiatry will make the
subject clearer than mere dry theory. In order to bring home to you the
difference in our conception I will first describe the medical history
in the older fashion, and subsequently give the solution characteristic
of the new departure.
The case to be considered is that of a cook aged 32; she had no
hereditary taint, was always industrious and conscientious, and had
never been noticeable for eccentric behaviour or the like. Quite
recently she became acquainted with a young man whom she wished to
marry. From that time on she began to show certain peculiarities. She
often spoke of his not liking her much, was frequently out of sorts,
ill-tempered, and sat alone brooding; once she ornamented her Sunday hat
very strikingly with red and green feathers, another day she bought a
pair of pince-nez in order to wear them when she went out walking with
her fiancé. One day the sudden idea that her teeth were rather ugly
would not let her rest, and she resolved to get a plate, although there
was no absolute need. She had all her teeth out under an anæsthetic. The
night after the operation she suddenly had a severe anxiety-attack. She
cried and moaned that she was damned for ever, for she had committed
a great sin; she should not have allowed her teeth to be extracted.
People must pray for her, that God might pardon her sin. In vain her
friends attempted to talk her out of her fears, to assure her that the
extraction of teeth was really no sin; it availed nothing. At day-break
she became somewhat quieter; she worked throughout the day. On following
nights the attacks were repeated. When consulted by the patient I found
her quiet, but she wore a rather vacant expression. I talked to her
about the operation, and she assured me it was not so dreadful to have
teeth extracted, but still it was a great sin, from which position,
despite every persuasion, she could not be moved. She continually
repeated in plaintive, pathetic tones, "I should not have allowed my
teeth to be extracted; oh yes, that was a great sin which God will never
forgive me." She gave the impression of real insanity. A few days later
her condition grew worse, and she had to be brought into the asylum. The
anxiety-attack had extended and was persistent, and the mental disorder
lasted for months.
The history shows a series of entirely unrelated symptoms. Why all the
queer story of the hat and pince-nez? Why those anxiety-attacks? Why
this delusion that the extraction of her teeth was an unpardonable
sin? Nothing here is clear. The morphologically-minded psychiatrist
would say: This is just a typical case of dementia præcox; it is the
essence of insanity, of madness, to talk of nothing but mysteries;
the standpoint of the diseased mind towards the world is displaced,
is "mad." What is no sin for the normal, the patient finds a sin.
It is a bizarre delusion characteristic of dementia præcox. The
extravagant lamentation about this supposed sin is what is known as
"inadequate"[198] emotional emphasis. The queer ornamentation of the
hat, the pince-nez, are bizarre notions such as are very common in
these patients. Somewhere in the brain certain cells have fallen into
disorder, and manufacture illogical, senseless ideas of one kind and
another which are quite without psychological meaning. The patient is
obviously a hereditary degenerate with a weak brain, having a kink
which is the origin of the disorder. For some reason or other the
disease has suddenly broken out. It could just as easily have broken
out at any other time. Perhaps we should have had to capitulate to
these arguments had real psychological analysis not come to our aid. In
filling up the certificate required for her removal to the asylum, it
transpired that many years ago she had had an affair which terminated;
her lover left her with an illegitimate child. Nobody had been told of
this. When she was again in love a dilemma arose, and she asked herself,
What will this new lover say about it? At first she postponed the
marriage, becoming more and more worried, and then the eccentricities
began. To understand these we must immerse ourselves in the psychology
of a naïve soul. If we have to disclose some painful secret to a beloved
person we try first to strengthen his love in order to obtain beforehand
a guarantee of his forgiveness. We do it by flattery or by caresses, or
we try to impress the value of our own personality in order to raise it
in the eyes of the other. Our patient decked herself out with beautiful
feathers, which to her simple taste seemed precious. The wearing of
"pince-nez" increases the respect of children even of a mature age.
And who does not know people who will have their teeth extracted, out
of pure vanity, in order that they may wear a plate to improve their
appearance?
After such an operation most people have a slight, nervous reaction, and
then everything becomes more difficult to bear. This was, as a matter
of fact, just the moment when the catastrophe did occur, in her terror
lest her fiancé should break with her when he heard of her previous
life. That was the first anxiety-attack. Just as the patient had not
acknowledged her secret in all these years, so she now sought to guard
it, and shifted the fear in her guilty conscience on to the extraction
of the teeth; she thus followed a method well known to us, for when we
dare not acknowledge some great sin we deplore some small sin with the
greater emphasis.
The problem seemed insoluble to the weak and sensitive mind of the
patient, hence the affect became insurmountably great; this is the
mental desire as presented from the psychological side. The series
of apparently meaningless events, the so-called madness, have now a
meaning; a significance appertains to the delusions, making the patient
more human to us. Here is a person like ourselves, beset by universal
human problems, no longer merely a cerebral machine thrown out of gear.
Hitherto we thought that the insane patient revealed nothing to us by
symptoms, save the senseless products of his disordered cerebral cells,
but that was academic wisdom reeking of the study. When we penetrate
into the human secrets of our patients, we recognise mental disease
to be an unusual reaction to emotional problems which are in no wise
foreign to ourselves, and the delusion discloses the psychological
system upon which it is based.
The light which shines forth from this conception seems to us so
enormously powerful because it forces us into the innermost depths
of that tremendous disorder which is most common in our asylums, and
hitherto least understood; by reason of the craziness of the symptoms it
is the type that strikes the public as madness _in excelsis_.
The case which I have just sketched is a simple one. It is transparent.
My second example is somewhat more complicated. It is the case of a man
between 30 and 40 years of age; he is a foreign archæologist of great
learning and most unusual intelligence. He was a precocious boy of quite
excellent character, great sensitiveness and rare gifts. Physically he
was small, always weakly, and a stammerer. He grew up and was educated
abroad, and afterwards studied for several terms at B----. So far there
had been no disorder of any kind. On the completion of his university
career he became zealously absorbed in his archæological work, which
gradually engulfed him to such an extent that he was dead to the world
and all its pleasures. He worked incessantly, and buried himself
entirely in his books. He became quite unsociable; before, awkward and
shy in society, he now fled from it altogether, and saw no one beyond
a few friends. He thus led the life of a hermit devoted entirely to
science. A few years later, on a holiday tour, he revisited B----,
where he remained a few days. He walked a great deal in the environs
of the town. His few acquaintances now found him somewhat strange,
taciturn, and nervous. After a somewhat protracted walk he seemed tired,
and said that he did not feel very well. He then remarked he must get
himself hypnotised, he felt his nerves unsteady. On top of this he was
attacked by physical illness, viz. inflammation of the lungs. Very
soon a peculiar state of excitement supervened which led to suicidal
ideas. He was brought to the asylum, where for weeks he remained in
an extremely excited state. He was completely deranged, and did not
know where he was; he spoke in broken sentences which no one could
understand. He was often so excited and aggressive that it took several
attendants to hold him. He gradually became quieter, and one day came to
himself, as if waking out of a long, confused dream. He soon completely
regained his health, and was discharged as cured. He returned to his
home and again immersed himself in books. In the following years he
published several remarkable works, but, as before, his life was that
of a hermit living entirely in his books and dead to the world. He then
gradually acquired the name of a dried-up misanthrope, lost to all
meaning of the beauty of life. A few years after his first illness a
brief holiday brought him again to B----. As before he took his solitary
walks in the environs. One day he was suddenly overcome by a faint
feeling, and lay down in the street. He was carried into a neighbouring
house where he immediately became extremely excited. He began to perform
gymnastics, jumped over the rails of the bed, turned somersaults in the
room, began to declaim in a loud, voice, sang his own improvisations,
etc. He was again brought to the asylum. The excitement continued. He
extolled his wonderful muscles, his beautiful figure, his enormous
strength. He believed that he had discovered a natural law by which
a wonderful voice could be developed. He regarded himself as a great
singer, and a marvellous reciter, and at the same time he was a great
inspired poet and composer to whom verse and melody came spontaneously.
All this was in pitiable and very remarkable contrast to reality. He is
a small weakly man of unimposing build, with poorly developed muscles
betraying at the first glance the atrophying effect of his studious
life. He is unmusical, his voice is weak and he sings out of tune; he is
a bad speaker, because of his stutter. For weeks he occupied himself in
the asylum with peculiar jumping, and contortions of the body which he
called gymnastics, he sang and declaimed. Then he became more quiet and
dreamy, often stared thoughtfully in front of him for a long time, now
and then sang a love song which, despite its want of musical expression,
betrayed a pretty feeling for love's aspirations. This also was in
complete contrast with the dryness and isolation of his normal life. He
gradually became accessible for lengthy conversations.
We will break off the history of the disease here, and sum up what is
furnished so far by observation of the patient.
In the first illness the delirium broke out unexpectedly, and was
followed by a mental disorder with confused ideas and violence which
lasted for several weeks. Complete recovery appeared to have taken
place. Six years later there was a sudden outbreak of mania, grandiose
delusions, bizarre actions, followed by a twilight-stage gradually
leading to recovery. Here we again see a typical case of dementia
præcox, of the katatonic variety, especially characterised by peculiar
movements and actions. In psychiatry the views obtaining at present
would regard this as localised cellular disease of some part of the
cortex, exhibiting confusional states, delusions of grandeur, peculiar
contortions of the muscles, or twilight-states, which taken all together
have as little psychological meaning as the bizarre shapes of a drop of
lead thrown into water.
This is not my view. It was certainly no accidental freak of the
brain-cells that created the dramatic contrasts shown in the second
illness. We can see that these contrasts, the so-called grandiose
delusions, were very subtly determined by the deficiencies in the
patient's personality. Without doubt, any one of us would naturally
regard these deficiencies seriously in ourselves. Who would not have
the desire to find compensation for the aridness of his profession and
of his life in the joys of poetry and music and to restore to his body
the natural power and beauty stolen from it by the study's atmosphere?
Do we not recall with envy the energy of a Demosthenes who, despite his
stammering, became a great orator? If our patient thus fulfilled the
obvious gaps in his physical and mental life by delusional wishes, the
supposition is warranted that the whispered love-song which he sang from
time to time filled up a painful blank in his being, which became more
painful the more it was concealed. The explanation is not far to seek.
It is simply the old story, born anew in every human soul, in a guise
befitting the destined creature's highest sensibilities.
When our patient was a student he learnt to know and love a
girl-student. Together they made many excursions in the environs of
the town, but his exceeding timidity and bashfulness (the lot of the
stammerer) never permitted him an opportunity of getting out the
appropriate words. Moreover, he was poor and had nothing to offer her
but hopes. The time came for the termination of his studies; she went
away, and he also, and they never saw one another again. And not long
afterwards he heard she had married some one else. Then he relinquished
his hopes, but he did not know that Eros never emancipates his slaves.
He buried himself in abstract learning, not to forget, but to work for
her in his thoughts. He wanted to keep the love in his heart quite
secret, and never to betray that secret. He would dedicate his works to
her without her ever knowing it. The compromise succeeded, but not for
long. Once he travelled through the town where he heard she lived--it
seems to have been an accident that he travelled through that town.
He did not leave the train, which only made a short halt there. From
the window he saw standing in the distance a young woman with a little
child, and thought it was she. Impossible to say whether it was really
so or not. He does not think he felt any peculiar feeling at that
moment; anyway he gave himself no trouble to ascertain whether it was
she, which makes the presumption strong that it was not really she.
The unconscious wanted to be left in peace with its illusion. Shortly
afterwards he again came to B----, the place of old memories. Then he
felt something strange stir in his soul, an uneasy feeling, akin to
Nietzsche's--
"Not for long shalt thou thirst, O burning heart!
There is promise in the air,
Winds come to me from unknown mouths--
The healing coolness comes."
Civilised man no longer believes in demons, he calls in the doctor. Our
patient wanted to be hypnotised. Then madness overcame him. What was
going on in him?
He answered this question in broken sentences, with long pauses, in that
twilight-stage that heralds convalescence. I give as faithfully as may
be his own words. When he fell ill he suddenly lost the well-regulated
world and found himself in the chaos of an overmastering dream, a sea of
blood and fire; the world was out of joint; everywhere conflagration,
volcanic outbreaks, earthquakes, mountains fell in, followed by enormous
battles where the peoples fell upon one another; he became involved more
and more in the battle of nature, he was right in the midst of those
fighting, wrestling, defending himself, enduring unutterable misery and
pain; gradually he was exalted and strengthened by a strange calming
feeling that some one was watching his struggles, that his loved one saw
all from afar. That was the time when he showed real violence to the
attendants. He felt his strength increasing and saw himself at the head
of great armies which he would lead to victory. Then more great battles
and at length victory. He would try to get his loved one as prize of
victory. As he drew near her the illness ceased, and he awoke from a
long dream.
His daily life again began to follow the regular routine. He shut
himself up in his work and forgot the abyss within himself. A few years
later he is again at B---- Demon or Destiny? Again he followed the
old trail and again was overborne by old memories. But this time he
was not immersed in the depths of confusion. He remained orientated
and _en rapport_ with his surroundings. The struggle was considerably
milder, but he did gymnastics, practised the arts, and made good his
deficiencies; then followed the dreamy stage with the love-songs,
corresponding to the period of victory in the first psychosis. In this
state, according to his own words, he had a dreamlike feeling as if he
stood upon the borders of two worlds and knew not whether truth stood on
the right or on the left. He told me, "It is said she is married, but I
believe she is not, but is still waiting for me; I feel that it must be
so. It is ever to me as if she were not married, and as if success were
yet attainable."
Our patient here portrayed but a pale copy of the scene in the first
attack of psychosis, when he, the victor, stood before his mistress.
In the course of a few weeks after this conversation the scientific
interests of the patient again began to predominate. He spoke with
obvious unwillingness about his intimate life, he repressed it more
and more, and finally turned away from it as if it did not belong to
himself. Thus gradually the gate of the under-world became closed.
There remained nothing but a certain tense expression, and a look
which, though fixed on the outer world, was turned inwards at the same
time; and this alone hinted at the silent activity of the unconscious,
preparing new solutions for his insoluble problem. This is the so-called
cure in dementia præcox.
Hitherto we psychiatrists used not to be able to suppress a laugh when
we read an artist's attempts to portray a psychosis. These attempts have
been generally regarded as quite useless, for the writer introduces
into his conception of the psychosis psychological relationships quite
foreign to the clinical picture of the disease. But the artist has not
simply proceeded to copy a case out of a psychiatric text-book; he knows
as a rule better than the psychiatrist.
The case which I have sketched is not unique, it is typical of a whole
class for which the artist Spitteler has created a model of universal
validity; the model is _Imago_. I may take for granted that you know his
book of that name. The psychological gulf, however, between the creation
of the artist and the insane person is great. The world of the artist
is one of solved problems; the world of reality, that of unsolved
problems. The mental patient is a faithful image of this reality. His
solutions are unsatisfying illusions, his cure a temporary giving up of
the problem, which yet goes on working in the depths of the unconscious,
and at the appointed time again rises to the surface and creates new
illusions with new scenery; part of the history of mankind is here seen
abridged.
Psychological analysis is far from being able to explain in complete and
illuminating fashion all cases of the disease with which we are here
concerned. On the contrary, the majority remain obscure and difficult to
understand, and chiefly because only a certain proportion of patients
recover. Our last patient is noteworthy because his return to a normal
state afforded us a survey of the period of his illness. Unfortunately
the advantage of this standpoint is not always possible to us, for a
great number of persons never find their way back from their dreams.
They are lost in the maze of a magic garden where the same old story
is repeated again and again in a timeless present. For patients the
hands of the clock of the world remain stationary; there is no time, no
further development. It makes no difference to them whether they dream
for two days or thirty years. I had a patient in my ward who was five
years without uttering a word, in bed, and entirely buried in himself.
For years I visited him twice daily, and as I reached his bedside I
could see at once that there was no change. One day I was just about to
leave the room when a voice I did not recognise called out--"Who are
you? What do you want here?" I saw with astonishment that it was the
dumb patient who had suddenly regained his voice, and obviously his
senses also. I told him I was his doctor, whereupon he asked angrily,
why was he kept a prisoner here, and why did no one ever speak to him?
He said this in an injured voice just like a normal person whom one had
neglected for a couple of days. I informed him that he had been in bed
quite speechless for five years and had responded to nothing, whereat
he looked at me fixedly and without understanding. Naturally I tried
to discover what had gone on in him during these five years, but could
learn nothing. Another patient with a similar symptom, when asked why
he had remained silent for years, maintained, "Because I wanted to
spare the German language."[199] These examples show that it is often
impossible to lift the veil of the secret, for the patients themselves
have neither interest nor pleasure in explaining their strange
experiences, in which as a rule they realise nothing peculiar.
Occasionally the symptoms themselves are a sign-post to the
understanding of the psychology of the disease.
We had a patient who was for thirty-five years an inmate at Burghölzli.
For decades she lay in bed, she never spoke or reacted to anything, her
head was always bowed, her back bent and the knees somewhat drawn up.
She was always making peculiar rubbing movements with her hands, so as
to give rise during the course of years to thick horny patches on her
hands. She kept the thumb and index finger of her right hand together
as in the movement of sewing. When she died I tried to discover what
she had been formerly. Nobody in the asylum recalled ever having seen
her out of bed. Only our chief attendant had a memory of having seen
her sitting in the same attitude as that she afterwards took up in bed,
at which time she was making rapid movements of extension of the arm
across the right knee; it was said of her that she was sewing shoes,
later that she was polishing shoes. As time went on the movements became
more limited till finally there remained but a slight rubbing movement,
and only the finger and thumb retained the sewing position. In vain
I consulted our old attendant, she knew nothing about the patient's
previous history. When the seventy-year-old brother came to the funeral
I asked him what had been the cause of his sister's illness; he told
me that she had had a love-affair, but for various reasons it had
come to nothing. The girl had taken this so to heart that she became
low-spirited. In answer to a query about her lover it was found that he
was a _shoemaker_.
Unless you see here some strange play of accident, you must agree that
the patient had kept the memory-picture of her lover unaltered in her
heart for thirty-five years.
One might easily think that these patients who give an impression of
imbecility are only burnt-out ruins of humanity. But such is probably
not the case. One can often prove directly that such patients register
everything going on around them even with a certain curiosity, and have
an excellent memory for it all. This is the reason why many patients
become for a time pretty sensible again, and develop mental powers which
one believed they had long since lost. Such intervals occur occasionally
during serious physical disease, or just before death. We had a patient
with whom it was impossible to carry on a sane conversation; he only
produced a mad medley of delusions and words. He once fell seriously
ill physically, and I expected it would be very difficult to treat him.
Not at all. He was quite changed, he became friendly and amiable, and
carried out all his doctor's orders patiently and gratefully. His eyes
lost their evil darting looks, and shone quietly and understandingly.
One morning I came to his room with the usual greeting: "Good morning.
How are you getting on?" The patient answered me in the well-known way:
"There again comes one of the dog and monkey troupe wanting to play the
Saviour." Then I knew his physical trouble was over. From that moment
the whole of his reason was as if "blown away" again.
From these observations we see that reason still survives, but is pushed
away into some corner by the complete preoccupation of the mind with
diseased thoughts.
Why is the mind compelled to exhaust itself in the elaboration of
diseased nonsense? On this difficult question our new insight throws
considerable light. To-day we can say that the pathological images
dominate the interests of the patient so completely, because they are
simply derivatives of the most important questions that used to occupy
the person when normal--what in insanity is now an incomprehensible
maze of symptoms used to be fields of vital interest to the former
personality.
I will cite as an example a patient who was twenty years in the asylum.
She was always a puzzle to the physicians, for the absurdity of her
delusions exceeded anything that the boldest imagination could create.
She was a dressmaker by trade, born in 1845, of very poor family.
Her sister early went wrong and was finally lost in the swamp of
prostitution. The patient herself led an industrious, respectable,
reserved life. She fell ill in 1886 in her 39th year--at the threshold
of the age when so many a dream is brought to naught. Her illness
consisted in delusions and hallucinations which increased rapidly,
and soon became so absurd that no one could understand her wishes and
complaints. In 1887 she came to the asylum. In 1888 her statements,
so far as the delusions were concerned, were not intelligible. She
maintained such monstrous things as that: "At night her spinal marrow
had been torn out; pains in the back had been caused by substances that
went through the walls and were covered with magnetism." "The monopoly
fixed the sorrows which are not in the body and do not fly about in the
air." "Excursions are made by breathing in chemistry, and by suffocation
regions are destroyed."
In 1892 the patient styled herself the "Bank Note Monopoly, Queen of the
Orphans, Proprietress of the Burghölzli Asylum;" she said: "Naples and I
must provide the world with macaroni" (Nudel).
In 1896 she became "Germania and Helvetia from exclusively pure butter";
she also said, "I am Noah's Ark, the boat of salvation and respect."
Since then the disease has greatly increased; her last creation is the
delusion that she is the "lily red sea monster and the blue one."
These instances will show you how far the incomprehensibility of such
pathological formations go. Our patient was for years the classic
example of meaningless delusional ideas in dementia præcox; and many
hundreds of medical students have received from the demonstration of
this case a permanent impression of the sinister power of insanity. But
even this case has not withstood the newer technique of psychoanalysis.
What the patient says is not at all meaningless; it is full of
significance, so that he who has the key can understand without overmuch
difficulty.
Time does not allow me to describe the technique by means of which I
succeeded in lifting the veil of her secret. I must content myself by
giving a few examples to make the strange changes of thought and of
speech in this patient clear to you.
She said of herself that _she was Socrates_. The analysis of this
delusion presented the following ideas: Socrates was the wisest man,
the man of greatest learning; he was infamously accused, and had to die
in prison at the hands of strange men. She was the best dressmaker, but
"never unnecessarily cut a thread, and never allowed a piece of material
to lie about on the floor." She worked ceaselessly, and now she has been
falsely accused, wicked men have shut her up, and she will have to die
in the asylum.
Therefore she is Socrates; this is, as you see, simple metaphor, based
upon obvious analogy. Take another example: "_I am the finest professor
and the finest artist in the world._"
The analysis furnishes the remarks that she is the best dressmaker and
chooses the most beautiful models which show up well and waste little
material; she puts on the trimming only where it can be seen. She is a
professor, and an artist in her work. She makes the best clothes and
calls them absurdly "The Schnecke Museum-clothes." Her customers are
only such persons as frequent the Schnecke House and the Museum (the
Schnecke House is the aristocratic club. It is near the Museum and the
Library, another rendezvous of the aristocratic set of Zürich), for she
is the best dressmaker and makes only Schnecke Museum[200] clothing.
The patient also _calls herself Mary Stuart_. Analysis showed the same
analogy as with Socrates: innocent suffering and death of a heroine.
"_I am the Lorelei._" Analysis: This is an old and well-known song: "I
know not what it means," etc. Whenever she wants to speak about her
affairs people do not understand her, and say they don't know what it
means; hence she is the Lorelei.
"_I am Switzerland._" Analysis: Switzerland is free, no one can rob
Switzerland of her freedom. The patient does not belong to the asylum,
she would be free like Switzerland, hence she is Switzerland.
"_I am a crane._" Analysis: In the "Cranes of Ibykus" it is said:
"Whosoever is free of sin and fault shall preserve the pure soul of
a child." She has been brought innocent to the asylum and has never
committed a crime--hence she is a crane.
"_I am Schiller's Bell._" Analysis: Schiller's Bell is the greatest work
of the great master. She is the best and most industrious dressmaker,
and has achieved the highest rung in the art of dressmaking--hence she
is Schiller's Bell.
"_I am Hufeland._" Analysis: Hufeland was the best doctor. She suffers
intolerably in the asylum and is moreover treated by the worst doctors.
She is, however, so prominent a personality that she had a claim to the
best doctors, that is to a doctor like Hufeland--hence she is Hufeland.
The patient used the expression "I am" in a very arbitrary way.
Sometimes it meant "it belongs to me" or "it is proper for me";
sometimes it means "I should have." This is seen from the following
analysis:
"_I am the master-key._" Analysis: The master-key is the key that opens
all the doors of the asylum. Properly, according to all rights, the
patient should long since have obtained this key for she has been for
many years "the proprietress of the Burghölzli Asylum." She expresses
this reflection very much simplified in the sentence, "I am the
master-key."
The chief content of her delusions is concentrated in the following
words:--
"_I am the monopoly._" Analysis: The patient means the banknote
monopoly, which has belonged to her for some time. She believes that
she possesses the monopoly of the entire bank notes of the world, thus
creating enormous riches for herself, in compensation for the poverty
and lowliness of her lot. Her parents died early; hence she is the
Queen of the Orphans. Her parents lived and died in great poverty. Her
blessings are extended to them also, the dreamlike delusions of the
patient benefit them in many ways. She says textually: "My parents are
clothed by me, my sorely-tried mother, full of sorrow--I sat with her at
table--covered in white with superfluity."
This is another of these malleable hallucinations which the patient had
daily. It is one of those scenes of wish-fulfilment, with poverty on
one side and riches on the other, recalling Hauptmann's Hannele; more
especially that scene where Gottwald says: "She was clothed in rags--now
she is bedeckt in silken robes; and she ran about barefoot--now she has
shoes of glass to her feet. Soon she will live in a golden castle and
eat each day of baked meats. Here has she lived on cold potatoes...."
The wish-fulfilments of our patient go even further. Switzerland has
to furnish her with an income of 150,000 francs. The Director of the
Burghölzli owes her 80,000 francs damages for wrongful incarceration.
She is the proprietress of a distant island with silver mines, the
"mightiest silver island in the world." Therefore she is also the
greatest orator, possesses the most wonderful eloquence, for, as she
says, "Speech is _silver_, silence gold." To her all the beautiful
landed estates belong--all the rich quarters, towns and lands, she
is the proprietress of a world, even a "threefold proprietress of
the world." Whilst poor Hannele was only elevated to the side of the
Heavenly Bridegroom, our patient has the "Key of Heaven," she is not
only the honoured earthly queens Mary Stuart and Queen Louise of
Prussia, but she is also the Queen of Heaven, the Mother of God as well
as the Godhead. Even in this earthly world where she was but a poor,
ill-regarded homely dressmaker she attained fulfilments of her human
wishes, for she had taken three husbands from the best families in
the town and her fourth was the Emperor Francis. From these marriages
there were two phantom children--a little boy and a little girl. Just
as she clothed, fed and feasted her parents, so she provided for the
future of her children. To her son she bequeathed the great bazaar of
Zürich, therefore her son is a "Zur," for the proprietor of a _Bazaar_
is a "Zur." The daughter resembles her mother; hence she becomes the
proprietress of the asylum and takes her mother's place so that the
mother is released from captivity. The daughter therefore receives the
title of "Agency of Socrates," for she replaces Socrates in captivity.
These instances by no means exhaust the delusional fancies of the
patient. But they will give you some idea, I hope, of the richness
of her inner life although she was apparently so dull and apathetic,
or, as was said _imbecile_, and sat for twenty years in her workroom,
where she mechanically repaired her linen, occasionally uttering a
complex of meaningless fragments which no one had hitherto been able to
understand. Her odd lack of words can now be seen in another light; they
are fragments of enigmatical inscriptions, of fairy-story phantasies,
which have escaped from the hard world to found a world of their own.
Here the tables are ever laden, and a thousand feasts are celebrated in
golden palaces. The patient can only spare a few mysterious symbols for
the gloomy dim shores of reality; they need not be understood, for our
understanding has not been necessary for her for this long time.
Nor is this patient at all unique. She is one of a type. Similar
phantasies are always found in patients of this kind, though not always
in such profusion.
The parallels with Hauptmann's Hannele show that here likewise the
artist has shown us the way with the free creation of his own phantasy.
From this coincidence, which is not accidental, we may conclude that
there is something common both to the artist and the insane and not to
them alone. Every human being has also within himself that restless
creative phantasy which is ever engaged in assuaging the harshness
of reality. Whoever gives himself unsparingly and carefully to
self-observation, will realise that there dwells within him something
which would gladly hide and cover up all that is difficult and
questionable in life, and thus procure an easy and free path. Insanity
grants the upper hand to this something. When once it is uppermost,
reality is more or less quickly driven out. It becomes a distant dream,
and the dream which enchains the patient wholly or in part, and often
for life, has now the attributes of reality. We normal persons, who have
to do entirely with reality, see only the products of disordered fancy,
but not the wealth of that side of the mind which is turned away from
us. Unfortunately only too often no further knowledge reaches us of the
things which are transpiring on that other side, because all the bridges
are broken down which unite this side with that.
We do not know to-day whether these new views are of universal or only
of limited validity; the more carefully and perseveringly we examine our
patients, the more we shall meet cases, which, despite apparent total
imbecility, will yet afford us at least some fragmentary insight into
the obscurities of the psychical life. This life is far removed from
that mental poverty which the prevailing theories were compelled to
accept.
However far we are from being able to understand fully the
concatenations of that obscure world, at least we may maintain, with
complete assurance, that in dementia præcox there is no symptom which
can be described as psychologically baseless and meaningless. The
most absurd things are in reality symbols of ideas which are not
only generally understandable, but also universally operative in the
human heart. In insanity we do not discover anything new and unknown,
but we look at the foundation of our own being, the source of those
life-problems in which we are all engaged.
PART II.[201]
The number of psychoanalytic investigations into the psychology of
dementia præcox has considerably increased since the publication of my
book upon the subject.[202] When, in 1903, I made the first analysis
of a case of dementia præcox, there dawned on me a premonition of the
possibilities of future discoveries in this sphere. This has been
confirmed.
Freud first submitted a case of paranoid dementia to closer
psychological investigation.[203] This he was enabled to do by means
of an analytic technique perfected through his rich experiences with
neurotics. He selected the famous autobiography of P. Schreber,
"Denkwürdigkeiten eines Nervenkranken." The patient could not be
analysed personally, but having published his most interesting
autobiography all the material wanted for an analysis was to be found in
it.
In this study Freud shows out of what infantile forms of thought and
instincts the delusional system was built up. The peculiar delusions
which the patient had about his doctor whom he identified with God
or with a god-like being, and certain other surprising and really
blasphemous ideas, Freud was able to reduce most ingeniously to his
infantile relationship to his father. This case also presented similar
bizarre and grotesque concatenations of ideas to the one I have
described. As the author himself says, his work confines itself to the
task of pointing out those universally existent and undifferentiated
foundations out of which we may say every psychological formation is
historically developed.[204] This reductive analytical process did not,
however, furnish such enlightening results in regard to the rich and
surprising symbolism in patients of this kind as we had been accustomed
to expect from the same method in the realm of the psychology of
hysteria. In reading certain works of the Zürich school, for example,
Maeder,[205] Spielrein,[206] Nelken,[207] Grebelskaja,[208] Itten,[209]
one is powerfully impressed by the enormous symbol-formation in dementia
præcox.
Some of the authors still proceed essentially by the method of analytic
reduction, tracing back the complicated delusional formation into its
simpler and more universal components, as I have done in the preceding
pages. One cannot, however, resist the feeling that this method hardly
does justice to the fulness and the almost overpowering wealth of
phantastic symbol-formation, although it does undoubtedly throw a light
upon the subject in certain directions.
Let me illustrate with an example. We should be thankful for a
commentary upon "Faust" which traced back all the diverse material of
Part II. to its historical sources, or for a psychological analysis
of Part I. which pointed out how the dramatic conflict corresponds to
a personal conflict in the soul of the poet; we should be glad of an
exposition which pointed out how this subjective conflict is itself
based upon those ultimate and universal human things which are nowise
foreign to us since we all carry the seeds of them in our hearts.
Nevertheless we should be a little disappointed. We do not read "Faust"
just in order to discover that also we are, in all things, "human, all
too human." Alas, we know that but too well already. Let any one who
has not yet learnt it go for a little while out into the world and look
at it without preconceptions and with open eyes. He will turn back from
the might and power of the "too human," hungrily he will pick up his
"Faust," not to find again what he has just left, but to learn how a man
like Goethe shakes off these elemental human things and finds freedom
for his soul. When we once know who was the "Proktophantasmist," to what
chronological events the mass of symbols in Part II. relates, how it is
all intimately bound up with the poet's own soul and conditioned by it,
we come to regard this determination as less important than the problem
itself--what does the poet mean by his symbolic creation? Proceeding
purely reductively, one discovers the final meaning in these universal
human things; and demands nothing further from an explanation than that
the unknown and complicated shall be reduced to the known and simple. I
should like to designate this kind of understanding as _retrospective
understanding_. But there is another kind of understanding, which is not
analytic reduction, but is of a _synthetic_ or _constructive_ nature. I
would designate this _prospective understanding_, and the corresponding
method as the _Constructive method_.
It is common knowledge that present-day scientific explanation rests
upon the basis of the causal principle. Scientific explanation is
causal explanation. We are therefore naturally inclined, whenever we
think scientifically, to explain causally, to understand a thing and
to regard it as explained whenever it is reduced analytically to its
cause and general principle. In so far Freud's psychological method of
interpretation is strictly scientific.
If we apply this method to "Faust" it must become clear that something
more is required for a true understanding. It will even seem to us
that we have not gathered the poet's deepest meaning if we only see in
it universal foregone human conclusions. What we really want to find
out is how this man has redeemed himself as an individual, and when we
arrive at this comprehension then we shall also understand the symbol
given by Goethe. It is true we may then fall into the error that we
understand Goethe himself. But let us be cautious and modest, simply
saying we have thereby arrived at an understanding of ourselves. I am
thinking here of Kant's thought-compelling definition of comprehension,
as "the realisation of a thing to the extent which is sufficient for our
purpose."
This understanding is, it is true, subjective, and therefore not
scientific for those to whom science and explanation by the causal
principle are identical. But the validity of this identification is open
to question. In the sphere of psychology I must emphasise my doubt on
this point.
We speak of "objective" understanding when we have given a causal
explanation. But at bottom, understanding is a subjective process upon
which we confer the quality "objective" really only to differentiate it
from another kind of understanding which is also a psychological and
subjective process, but upon which, without further ado, we bestow the
quality "subjective." The attitude of to-day only grants scientific
value to "objective" understanding on account of its universal
validity. This standpoint is incontestably correct wherever it is not a
question of the psychological process itself, and hence it is valid in
all sciences apart from pure psychology.
To interpret Faust objectively, _i.e._ from the causal standpoint, is as
though a man were to consider a sculpture from the historical, technical
and--last but not least--from the mineralogical standpoint. But where
lurks the _real meaning_ of the wondrous work? Where is the answer to
that most important question: what aim had the artist in mind, and how
are we ourselves to understand his work subjectively? To the scientific
spirit this seems an idle question which anyhow has nothing to do with
science. It comes furthermore into collision with the causal principle,
for it is a purely speculative constructive view. And the modern world
has overthrown this spirit of scholasticism.
But if we would approach to an understanding of psychological things we
must remember the fact of the subjective conditioning of all knowledge.
The world is _as we see it_ and not simply objective; this holds true
even more of the mind. Of course it is possible to look at the mind
objectively, just as at Faust, or a Gothic Cathedral. In this objective
conception there is comprised the whole worth and worthlessness of
current experimental psychology and psychoanalysis. The scientific mind,
thinking causally, is incapable of understanding what is ahead; it only
understands what is past, that is, retrospective. Like Ahriman, the
Persian devil, it has the gift of After-Knowledge. But this spirit is
only one half of a complete comprehension. The other more important half
is prospective or constructive; if we are not able to understand what
lies ahead, then nothing is understood. If psychoanalysis, following
Freud's orientation, should succeed in presenting an uninterrupted and
conclusive connection between Goethe's infantile sexual development and
his work, or, following Adler, between the infantile struggle for power
and the adult Goethe and his work, an interesting proposition would have
been solved--we should have learnt how a masterpiece can be reduced to
the simplest thinkable elements, which are universal, and to be found
working within the depths of everything and everybody. But did Goethe
construct his work to _this_ end? Was it his intention that it should be
thus conceived?
It must be sufficiently clear that such an understanding, though
undoubtedly scientific, would be entirely, utterly, beside the mark.
This statement is valid for psychology in general. To understand
the psyche causally, means to understand but half of it. The causal
understanding of Faust enlightens us as to how it became a finished work
of art, but reveals nothing of the living meaning of the poet. That
meaning only lives if we experience it, in and through ourselves. In so
far as our actual present life is for us something essentially new and
not a repetition of all that has gone before, the great value of such
a work is to be seen, not in its causal development, but in its living
reality for our own lives. We should be indeed depreciating a work like
Faust if we were only to regard it as something that has been perfected
and finished; it is only understood when conceived as a becoming and as
an ever new-experiencing.
Thus we must regard the human psyche. Only on one side is the mind a
Has Been, and as such subordinate to the causal principle. On the other
side the mind is a Becoming that can only be grasped synthetically or
constructively. The causal standpoint asks how it is this actual mind
has become what it appears to-day? The constructive standpoint asks how
a bridge can be built from this actual psyche to its own future?
Just as the causal method finally reaches the general principles of
human psychology by the analysis and reduction of individual events,
so does the constructive standpoint reach aims that are general by the
synthesis of individual tendencies. The mind is a point of passage and
thus necessarily determined from two sides. On the one side it offers a
picture of the precipitate of the past, and on the other side a picture
of the germinating knowledge of all that is to come, in so far as the
psyche creates its own future.
What has been is, on the one hand, the result and apex of all that
was--as such it appears to the causal standpoint; on the other hand, it
is an expression of all that is to be. The future is only _apparently_
like the past, but in its essence always new and unique, (the causal
standpoint would like to invert this sentence) thus the actual formula
is incomplete, germlike so to say, in relation to what is to be.
To get any conception of this expression of what is to be we are forced
to apply a constructive interest to it. I almost felt myself tempted
to say, "a scientific interest." But modern science is identical with
the causal principle. So long as we consider the actual mind causally,
that is scientifically, we elude the mind as a Becoming. This other side
of the psyche can never be grasped by the exclusive use of the causal
principle, but only by means of the constructive standpoint. The causal
standpoint reduces things to their elements, the constructive standpoint
elaborates them into something higher and more complicated. This latter
standpoint is necessarily a speculative one.
Constructive understanding is, however, differentiated from scholastic
speculation because it imposes no general validity, but only subjective
validity. When the speculative philosopher believes he has comprehended
the world once for all by his System, he deceives himself; he has only
comprehended himself and then naïvely projected that view upon the
world. In reaction against this, the scientific method of the modern
world has almost put an end to speculation and gone to the other
extreme. It would create an "objective" psychology. In opposition
to such efforts, the stress which Freud has placed upon individual
psychology is of immortal merit. The extraordinary importance of the
subjective in the development of the objective mental process was thus
first brought adequately into prominence.
Subjective speculation lays no claim to universal validity, it is
identical with constructive understanding. It is a subjective creation,
which, looked at externally, easily seems to be a so-called infantile
phantasy, or at least an unmistakable derivative of it; from an
objective standpoint it must be judged as such, in so far as objective
is regarded as identical with scientific or causal. Looked at from
within, however, constructive understanding means redemption.
"Creation--that is the great redemption from suffering and easiness of
living."[210]
* * * * *
Starting from these considerations as to the psychology of those
mental patients to whom the Schreber case belongs, we must, from the
"objective-scientific" standpoint, reduce the structural phantasy of the
patient to its simple and most generally valid elements. This Freud had
done. But that is only half of the work to be done. The other half is
the constructive understanding of Schreber's system. The question is:
What end, what freedom, did the patient hope to achieve by the creation
of his system?
The scientific thinker of to-day will regard this question as
inappropriate. The psychiatrist will certainly smile at it, for he is
thoroughly assured of the universal validity of his causalism, he knows
the psyche merely as something that is made, descendent, reactive. Not
uncommonly there lurks the unconscious prejudice that the psyche is a
brain-secretion.
Looking at such a morbid system without preconception, and asking
ourselves what goal this delusional system is aiming at, we see, in
fact, firstly, that it _is_ endeavouring to get at something, and
secondly, that the patient also devotes all his will-power to the
service of the system. There are patients who develop their delusions
with scientific thoroughness, often dragging in an immense material of
comparison and proof. Schreber certainly belongs to this class. Others
do not proceed so thoroughly and learnedly, but content themselves with
heaping up synonymous expressions for that at which they are aiming. The
case of the patient I have described, who assumes all kinds of titles,
is a good instance of this.
The patient's unmistakable striving to express something through and
by means of his delusion Freud conceives retrospectively, as the
satisfaction of his infantile wishes by means of imagination. Adler
reduces it to the desire for power.
For him the delusion-formation is a "manly protest," a means of
gaining security for himself against his menaced superiority. Thus
characterised, this struggle is likewise infantile and the means
employed--the delusional creation--is infantile because insufficient
for its purpose; one can therefore understand why Freud declines to
accept Adler's point of view. Freud, rightly on the whole, subsumes this
infantile struggle for power under the concept of the infantile wish.
The constructive standpoint is different. Here the delusional system
is neither infantile nor, upon the whole, _eo ipso_ pathological but
_subjective_, and hence justified within the scope of the subjective.
The constructive standpoint absolutely denies the conception that the
subjective phantasy-creation is merely an infantile wish, symbolically
veiled; or that it is merely that in a higher degree; it denies that
it is a convulsive and egoistic adhesion to the fiction of its own
superiority, in so far as these are to be regarded as finalistic
explanations. The subjective activity of the mind can be judged from
without, just as one can, in the end, so judge everything. But this
judgment is inadequate, because it is the very essence of the subjective
that it cannot be judged objectively. We cannot measure distance in
pints. The subjective can be only understood and judged subjectively,
that is, constructively. Any other judgment is unfair and does not meet
the question.
The absolute credit which the constructive standpoint confers upon the
subjective, naturally seems to the "scientific" spirit as an utter
violation of reason. But this scientific spirit can only take up arms
against it so long as the constructive is not avowedly _subjective_. The
constructive comprehension also _analyses_, but it does not _reduce_.
It decomposes the delusion into _typical_ components. What is to be
regarded as the type at a given time is shown from the attainment of
experience and knowledge reached at that time.
Even the most individual delusional systems are not absolutely unique,
occurring only once, for they offer striking and obvious analogies
with other systems. From the comparative analysis of many systems
the typical formations are drawn. If one can speak of reduction at
all, it is only a question of reduction to general type, but not to
some universal principle obtained inductively or deductively, such
as "Sexuality" or "Struggle for Power." This paralleling with other
typical formations only serves for a widening of the basis upon which
the construction is to be built. If one were to proceed entirely
subjectively one would go on constructing in the language of the patient
and in his mental range. One would arrive at some structure which was
illuminating to the patient and to the investigator of the case but not
to the outer scientific public. The public would be unable to enter into
the peculiarities of the speech and thought of the individual case in
question without further help.
The works of the Zürich school referred to contain careful and detailed
expositions of individual material. In these materials there are
very many typical formations which are unmistakably _analogies_ with
_mythological formations_[211]. There arose from the perception of
this relationship a new and valuable source for comparative study.
The acceptance of the possibility of such a comparison will not be
granted immediately, but the question is only whether the materials
to be compared really are similar or not. It will also be contended
that pathological and mythological formations are not immediately
comparable. But this objection must not be raised _a priori_, for only
a conscientious comparison can determine whether any true parallelism
exists or not. At the present moment all we know is that they are both
structures of the imagination which, like all such products, rest
essentially upon the activity of the unconscious. Experience must teach
us whether such a comparison is valid. The results hitherto obtained
are so encouraging that further work along these lines seems to me most
hopeful and important. I made practical use of the constructive method
in a case which Flournoy published in the _Archives de Psychologie_,
although he offered no opinion as to its nature at that time.
The case dealt with a rather neurotic young lady who, in Flournoy's
publication, described how surprised she was at the connected
phantasy-formations which penetrated from the unconscious into the
conscious. I subjected these phantasies, which the lady herself
reproduced in some detail, to my constructive methods and gave the
results of these investigations in my book, "The Psychology of the
Unconscious."
This book has, I regret to say, met with many perhaps inevitable
misunderstandings. But I have had one precious consolation, for my book
received the approval of Flournoy himself, who published the original
case which he knew personally. It is to be hoped that later works will
make the standpoint of the Zürich school intelligible to a wider public.
Whoever, by the help of this work, has taken the trouble to grasp the
essence of the constructive method, will readily imagine how great are
the difficulties of investigation, and how much greater still are the
difficulties of objective presentation of such investigations.
Among the many difficulties and opportunities for misunderstanding I
should like to adduce one difficulty which is especially characteristic.
In an intensive study of Schreber's or any similar case, it will be
discovered that these patients are consumed by the desire for a new
world-philosophy which may be of the most bizarre kind. Their aim is
obviously to create a system such as will help them in the assimilation
of unknown psychical phenomena, _i.e._ enable them to adapt their
own unconscious to the world. This arrangement produces a subjective
system which must be considered as a necessary transition-stage on the
path to the adaptation of their personality in regard to the world in
general. But the patient remains stationary at this transitory stage
and assumes his subjective view is the world's, hence he remains ill.
He cannot free himself from his subjectivism and does not find the link
to objective thinking, _i.e._ to society. He does not reach the real
summit of self-understanding, for he remains with a merely subjective
understanding of himself. But a _mere_ subjective understanding is not
real and adequate. As Feuerbach says: _Understanding is only real
when it is in accord with that of some other rational beings_. Then it
becomes objective[212] and the link with life is reached.
I am convinced that not a few will raise the objection that in the first
place the psychological process of adaptation does not proceed by the
method of first creating a world-philosophy; secondly, that it is in
itself a sign of unhealthy mental disposition even to make the attempt
to adapt oneself by way of a "world-philosophy."
Undoubtedly there are innumerable persons who are capable of adaptation
without creating any preliminary philosophy. If they ever arrive at any
general theory of the world it is always subsequently. But, on the other
hand, there are just as many who are only able to adapt themselves by
means of a preliminary intellectual formulation. To everything which
they do not understand they are unable to adapt themselves. Generally
it comes about that they do adapt themselves just in so far as they can
grasp the situation intellectually. To this latter group seem to belong
all those patients to whom we have been giving our consideration.
Medical experience has taught us that there are two large groups of
functional nervous disorders. The one embraces all those forms of
disease which are designated _hysterical_, the other all those forms
which the French school has designated _psychasthenic_. Although
the line of demarcation is rather uncertain, one can mark off two
psychological types which are obviously different; their psychology
is diametrically opposed. I have called these--the _Introverted_ and
_Extroverted_ types. The hysteric belongs to the type of _Extroversion_,
the psychasthenic to the type of _Introversion_, as does dementia
præcox, in so far as we know it to-day. This terminology, _Introversion_
and _Extroversion_, is bound up with my way of regarding mental
phenomena as forms of energy. I postulate a hypothetical fundamental
striving which I designate _libido_.[213] In the classical use of the
word, _libido_ never had an exclusively sexual connotation as it has in
medicine. The word _interest_, as Claparède once suggested to me, could
be used in this special sense, if this expression had to-day a less
extensive application. Bergson's concept, _élan vital_, would also serve
if this expression were less biological and more psychological. Libido
is intended to be an energising expression for _psychological values_.
The psychological value is something active and determining; hence it
can be regarded from the energic standpoint without any pretence of
exact measurement.
The introverted type is characterised by the fact that his libido
is turned towards his own personality to a certain extent--he finds
within himself the unconditioned value. The extroverted type has his
libido to a certain extent externally; he finds the unconditioned value
outside himself. The introvert regards everything from the aspect of
his own personality; the extrovert is dependent upon the value of his
object. I must emphasise the statement that this question of types is
_the_ question of our psychology, and that every further advance must
probably proceed by way of this question. The difference between these
types is almost alarming in extent. So far there is only one small
preliminary communication by myself[214] on this theory of type, which
is particularly important for the conception of dementia præcox. On the
psychiatric side Gross[215] has called attention to the existence of two
psychological types. His two types are (1) those with limited but deep
consciousness, and (2) those with broad but superficial consciousness.
The former correspond to my introverted and the latter to my extroverted
type. In my article I have collected some other instances among which
I would especially call attention to the striking description of the
two types given by William James in his book on "Pragmatism." Fr. Th.
Vischer has differentiated the two types very wittily by her division of
the learned into "reason-mongers," and "matter-mongers." In the sphere
of psychoanalysis Freud follows the psychology of Extraversion, Adler
that of Introversion. The irreconcilable opposition between the views
of Freud and those of Adler (see especially his book "Über den nervösen
Charakter") is readily explained by the existence of two diametrically
opposed psychological types which view the same things from entirely
different aspects. An Extrovert can hardly, or only with great
difficulty, come to any understanding with an Introvert, on any delicate
psychological question.
An Extrovert can hardly conceive the necessity which compels the
Introvert to conquer the world by means of a system. And yet this
necessity exists, otherwise we should have no philosophical systems
and dogmas, presumed to be universally valid. Civilised humanity
would be only empiricists and the sciences only the experimental
sciences. Causalism and empiricism are undoubtedly mighty forces in our
present-day mental life but it may come to be otherwise.
This difference in type is the first great obstacle which stands in
the way of an understanding concerning fundamental conceptions of our
psychology. A second objection arises from the circumstance that the
constructive method, faithful to itself, must adapt itself to the
lines of the delusion. The direction along which the patient develops
his morbid thoughts has to be accepted seriously, and followed out
to its end; the investigator thus places himself at the standpoint
of the psychosis. This procedure may expose him to the suspicion
of being deranged himself; or at least risks a misunderstanding
which is considered terribly disgraceful--he may himself have some
world-philosophy! The confirmation of such a possibility is as bad
as being "unscientific." But every one has a world-philosophy though
not every one knows he has. And those who do not know it have simply
an unconscious and therefore inadequate and archaic philosophy. But
everything psychological that is allowed to remain in the mind neglected
and not developed, remains in a primitive state. A striking instance of
how universal theories are influenced by unconscious archaic points of
view has been furnished by a famous German historian whose name matters
to us not at all. This historian took it for granted that once upon
a time people propagated themselves through incest, for in the first
human families the brother was assigned to the sister. This theory is
wholly based upon his still unconscious belief in Adam and Eve as the
first and only parents of mankind. It is on the whole better to discover
for oneself a modern world-philosophy, or at least to make use of some
decent system which will prevent any errors of that kind.
One could put up with being despised as the possessor of a
world-philosophy; but there is a greater danger. The public may come to
believe the philosophy, beaten out by the constructive method, is to be
regarded as a theoretical and objectively valid insight into the meaning
of the world in general.
I must now again point out that it is an obstinate, scholastic
misunderstanding not to be able to distinguish between a
world-philosophy which is only psychological, and an extra-psychological
theory, which concerns the objective thing. It is absolutely essential
that the student of the results of the constructive method should be
able to draw this distinction. In its first results the constructive
method does not produce anything that could be called a scientific
theory; it furnishes the _psychological lines of development_, a _path_
so to say. I must here refer the reader to my book, "Psychology of the
Unconscious."
The analytic reductive method has the advantage of being much simpler
than the constructive method. The former reduces to well-known universal
elements of an extremely simple nature. The latter has, with extremely
complicated material, to construct the further path to some often
unknown end. This obliges the psychologist to take full account of
all those forces which are at work in the human mind. The reductive
method strives to replace the religious and philosophical needs of man,
by their more elementary components, following the principle of the
"nothing but," as James so aptly calls it. But to _construct_ aright,
we must accept the developed aspirations as indispensable components,
essential elements, of spiritual growth. Such work extends far beyond
empirical concepts but that is in accordance with the nature of the
human soul which has never hitherto rested content with experience
alone. Everything new in the human mind proceeds from speculation.
Mental development proceeds by way of speculation, never by way of
limitation to mere experience. I realise that my views are parallel
with those of Bergson, and that in my book the concept of the libido
which I have given, is a concept parallel to that of "élan vital"; my
constructive method corresponds to Bergson's "intuitive method." I,
however, confine myself to the psychological side and to practical work.
When I first read Bergson a year and a half ago I discovered to my great
pleasure everything which I had worked out practically, but expressed by
him in consummate language and in a wonderfully clear philosophic style.
Working speculatively with psychological material there is a risk of
being sacrificed to the general misunderstanding which bestows the
value of an objective theory upon the line of psychological evolution
thus elaborated. So many people feel themselves in this way at pains
to find grounds whether such a theory is correct or not. Those who are
particularly brilliant even discover that the fundamental concepts can
be traced back to Heraclitus or some one even earlier. Let me confide
to these knowing folk that the fundamental ideas employed in the
constructive method stretch back even beyond any historical philosophy,
viz. to the dynamic "views" of primitive peoples. If the result of the
constructive method were scientific theory, it would go very ill with
it, for then it would be a falling back to the deepest superstition.
But since the constructive method results in something far removed from
scientific theory the great antiquity of the basic concepts therein must
speak in favour of its extreme correctness. Not until the constructive
method has presented us with much practical experience can we come to
the construction of a _scientific theory, a theory of the psychological
lines of development_. But we must first of all content ourselves with
confirming these lines individually.
FOREWORD TO CHAPTER XIV
This essay was originally written in 1913, when I limited myself
entirely to presenting an essential part of the psychological point
of view inaugurated by _Freud_. A few months ago my Swiss publisher
asked for a second and revised edition. The many and great changes
which the last few years have brought about in our understanding of the
psychology of the unconscious necessitated a substantial enlargement
of my essay. In this new edition some expositions about _Freud's_
theories are shortened, whilst _Adler's_ psychological views are more
fully considered, and--so far as the scope of this paper permits--a
general outline of my own views are given. I must at the outset draw
the reader's attention to the fact that this is no longer an easy
"popular" scientific paper, but a presentation making great demands upon
the patience and attention of the reader. The material is extremely
complicated and difficult. I do not for a moment deceive myself into
thinking this contribution is in any way conclusive or adequately
convincing. Only detailed scientific treatises about the various
problems touched upon in these pages could really do justice to the
subject. Any one who wishes to go deeply into the questions that are
raised here must be referred to the special literature of the subject.
My attention is solely to give the orientation in regard to the newest
concepts of the inner nature of unconscious psychology. I consider the
subject of the unconscious to be specially important and opportune at
this moment. In my opinion, it would be a great loss if this problem,
concerning every one so closely as it does, were to disappear from
the horizon of the educated lay public, by being interned in some
inaccessible specialised scientific journal. The psychological events
that accompany the present war--the incredible brutalisation of public
opinion, the epidemic of mutual calumnies, the unsuspected mania for
destruction, the unexampled flood of mendacity, and man's incapacity
to arrest the bloody demon--are they not, one and all, better adapted
than anything else, to force obtrusively the problem of the chaotic
unconscious--which slumbers uneasily beneath the ordered world of
consciousness,--before the eyes of every thinking individual? This
war has inexorably shown to the man of culture that he is still a
barbarian. It testifies also what an iron scourge awaits him, if ever
again it should occur to him to make his neighbour responsible for his
own bad qualities. The psychology of the individual corresponds to the
psychology of nations. What nations do, each individual does also,
and as long as the individual does it, the nation will do it too. A
metamorphosis in the attitude of the individual is the only possible
beginning of a transformation in the psychology of the nation. The
great problems of humanity have never been solved by universal laws,
but always and only by a remodelling of the attitude of the individual.
If ever there was a time when self-examination was the absolutely
indispensable and the only right thing, it is now, in the present
catastrophic epoch. But he who bethinks himself about his own being
strikes against the confines of the unconscious, which indeed contains
precisely that which it is most needful for him to know.
C. G. JUNG.
KÜSNACHT-ZÜRICH,
_March, 1917_.
FOOTNOTES:
[Footnote 194: First Edition, 1908 = Part I. (unaltered); Second
Edition, 1914 = Part II. Translator, M. D. Eder.]
[Footnote 195: "The Psychology of Dementia Præcox," translated by Brill
and Peterson, _Monograph Series of the Journal of Nervous and Mental
Diseases_, New York.]
[Footnote 196: Bresler, "Kulturhistorischer Beitrag zur Hysterie."
_Allg. Zeitschrift für Psychiatrie_, Bd. LIII., p. 333. Zündel,
"Biographie Blumhardts."]
[Footnote 197: Central Asylum and University Psychiatric Clinic in
Zürich.]
[Footnote 198: In psychiatry "inadequate" is employed to denote
disproportion between feeling and idea whether in excess or the reverse.]
[Footnote 199: I am indebted for this example to my colleague Dr.
Abraham of Berlin.]
[Footnote 200: As one might say in England, "a Bond Street dressmaker."]
[Footnote 201: This is an addition to the second edition, 1914.]
[Footnote 202: "The Psychology of Dementia Præcox."]
[Footnote 203: _Jahrbuch für psychoanalytische Forschung_, vol. III. pp.
9 and 558.]
[Footnote 204: Comp. also Ferenczi: "Über die Rolle der Homosexualität
in der Pathogenese der Paranoia," _Jahrb._, III., p. 101.]
[Footnote 205: Maeder: "Psychologische Untersuchungen an Dementia præcox
Kranken," _Jahrbuch f. psychoanalyt. Forsch._, II., p. 185.]
[Footnote 206: Spielrein: "Über den psychologischen Inhalt eines Falles
von Schizophrene," _l.c._, III., p. 329 ff.]
[Footnote 207: Nelken: "Analytische Beobachtungen über Phantasien eines
Schizophrenen," _l.c._, IV., p. 505 ff.]
[Footnote 208: Grebelskaja: "Psychologische Analyse eines Paranoiden,"
_l.c._, IV., p. 116 ff.]
[Footnote 209: Itten: "Beiträge zur Psychologie der Dementia præcox,"
_l.c._, p. V., 1 ff.]
[Footnote 210: Nietzsche, "Thus spake Zarathustra."]
[Footnote 211: "Quelques faits d'imagination créatrice subconsciente,"
Miss Miller, vol. V., p. 36.]
[Footnote 212: Here "objective" understanding is not identical with
causal understanding.]
[Footnote 213: This energy may also be designated as hormé. Hormé is a
Greek word [Greek: hormê]--force, attack, press, impetuosity, violence,
urgency, zeal. It is related to Bergson's "élan vital." The concept
hormé is an energic expression for psychological values.]
[Footnote 214: See p. 287.]
[Footnote 215: "Die zerebrale Sekundärfunktion." Leipzig, 1902.]
CHAPTER XIV
THE PSYCHOLOGY OF THE UNCONSCIOUS PROCESSES[216]
_Being a Survey of the Modern Theory and Method of Analytical Psychology_
I.--THE BEGINNINGS OF PSYCHOANALYSIS
In common with other sciences, psychology had to go through its
scholastic-philosophic stage, and to some extent this has lasted on
into the present time. This philosophic psychology has incurred our
condemnation in that it decides _ex cathedra_ what is the nature of the
soul, and whence and how it derives its attributes. The spirit of modern
scientific investigation has summarily disposed of all these phantasies
and in their place has established an exact empiric method. We owe to
this our present-day experimental psychology or "_psychophysiology_,"
as the French call it. This new direction originated with Fechner,
that Janus-minded spirit, who in his remarkable _Psychophysik_ (1860)
embarked on the mighty enterprise of introducing the physical standpoint
into the conception of psychical phenomena. The whole idea of this
work--and not least its astonishing mistakes--proved most fruitful in
results. For Wundt, Fechner's young contemporary, carried on his work,
and it is Wundt's great erudition, enormous power of work and genius for
elaborating methods of experimental research, which have given to modern
psychology its prevailing direction.
Until quite recently experimental psychology remained essentially
academic. The first notable attempt to utilise some few at any rate
of its innumerable experimental methods in the service of practical
psychology came from the psychiatrists of the former Heidelberg school
(Kræpelin, Aschaffenburg, etc.); it is quite intelligible that the
psychotherapists should be the first to feel the urgent need for more
exact knowledge of psychic processes.
Next came pedagogy, making its own demands upon psychology. Out of this
has recently grown up an "experimental pedagogy," and in this field
Neumann in Germany and Binet in France have rendered signal services.
The physician, the so-called "nerve-specialist," has the most urgent
need of psychological knowledge if he would really help his patients,
for neurotic disturbances, such as hysteria, and all things classed as
"nervousness," are of psychic origin, and necessarily demand psychic
treatment. Cold water, light, air, electricity, magnetism, etc., are
only effective temporarily, and quite often are of no use at all. They
are frequently introduced into treatment in a not very commendable
fashion, simply because reliance is placed upon their suggestive effect.
But it is in his soul that the patient is really sick; in those most
complicated and lofty functions which we scarcely dare to include in
the province of medicine. The doctor must needs, in such a case, be a
psychologist, must needs understand the human soul. He cannot evade the
urgent demand upon him. So he naturally turns for help to psychology,
since his psychiatry text-books have nothing to offer him. But modern
experimental psychology is very far from being able to afford him any
connected insight into the most vital psychic processes, that is not
its aim. As far as possible it tries to isolate those simple elementary
phenomena which border on the physiological, and then study them in an
isolated state. It quite ignores the infinite variation and movement of
the mental life of the individual, and accordingly, its knowledge and
its facts are so many isolated details, uninspired by any comprehensive
idea capable of bringing them into co-ordination. Hence it comes about
that the inquirer after the secrets of the human soul, learns rather
less than nothing from experimental psychology. He would be better
advised to abandon exact science, take off his scholar's gown, say
farewell to his study, and then, strong in manly courage, set out to
wander through the world; alike through the horrors of prisons, lunatic
asylums and hospitals, through dreary outlying taverns, through
brothels and gambling-halls, into elegant drawing-rooms, the Stock
Exchanges, socialist meetings, churches, revival gatherings of strange
religious sects, experiencing in his own person love and hate and every
kind of suffering. He would return laden with richer knowledge than his
yard-long text-books could ever have given him, and thus equipped, he
can indeed be a physician to his patients, for he understands the soul
of man. He may be pardoned if his respect for the "corner-stones" of
experimental psychology is no longer very considerable. There is a great
gulf fixed between what science calls "psychology," on the one hand, and
what the practice of everyday life expects from psychology on the other.
This need became the starting-point of a new psychology whose inception
we owe first and foremost to the genius of Sigmund Freud, of Vienna,
to his researches into functional nervous disease. The new type of
psychology might be described as "analytical psychology." Professor
Bleuler has coined the name "Deep Psychology,"[217] to indicate that
the Freudian psychology takes as its province the deeper regions, the
"hinterland" of the soul, the "unconscious." Freud names his method of
investigation "psychoanalysis."
Before we approach the matter more closely, we must first consider the
relationship of the new psychology to the earlier science. Here we
encounter a singular little farce which once again proves the truth of
Anatole France's apothegm: "Les savants ne sont pas curieux."
The first important piece of work[218] in this new field awakened
only the faintest echo, in spite of the fact that it offered a new
and fundamental conception of the neuroses. Certain writers expressed
their approbation, and then, on the next page, proceeded to explain
their cases of hysteria in the good old way. It was much as if a man
should subscribe fully to the idea of the earth's being spherical, and
yet continue to represent it as flat. Freud's next publications[219]
were practically unnoticed, although they contributed findings of
immeasurable importance to the domain of psychiatry. When in 1900 he
produced the first real psychological elucidation of the dream[220]
(previously there had reigned over this territory a suitable nocturnal
darkness), he was ridiculed; and when in the middle of the last decade
he began to illumine the psychology of sexuality itself,[221] and at
the same time the "Zürich school" decided to range itself on his side,
a storm of abuse, sometimes of the coarsest kind, burst upon him, nor
has it yet ceased to rage. At the last South-West German Congress of
alienists in Baden-Baden, the adherents of the new psychology had
the pleasure of hearing Hoche, University Professor of Psychiatry at
Freiburg in Breisgau, describe the movement in a long and much-applauded
address, as an outbreak of mental aberration _among doctors_. The old
proverb: "Medicus medicum non decimat" was here quite put to shame. How
carefully the question had been studied was shewn by the naïve remark
of one of the most distinguished neurologists of Paris, which I myself
heard at the International Congress in 1907: "It is true I have not
read Freud's works (he did not happen to know any German!), but as for
his theories, they are nothing but a "mauvaise plaisanterie." Freud,
dignified, masterly, once said to me, I first became clearly conscious
of the value of my discoveries when they were met everywhere with
resistance and anger; since that time I have judged the value of my work
according to the degree of opposition provoked. It is against my sexual
theory that the greatest indignation is felt, so it would seem therein
lies my best work. Perhaps after all the real benefactors of mankind
are its false teachers, for opposition to the false doctrine pushes men
willy nilly into truth. Your truth-teller is a pernicious fellow, he
drives men into error."
The reader must now calmly accept the idea that in this psychology
he is dealing with something quite unique, if not indeed with some
altogether irrational, sectarian, or occult wisdom; for what else could
possibly provoke all the scientific authorities to turn away on the very
threshold and utterly refuse to cross it?
Accordingly, we must look more closely into this psychology. As long
ago as Charcot's time it was recognised that neurotic symptoms are
"psychogenic," that is, that they have their origin in the psyche.
It was also known, thanks mainly to the work of the Nancy School,
that every hysterical symptom can be exactly reproduced by means of
suggestion. But _how_ a hysterical system arises, and its relationship
to psychic causes, were altogether unknown. In the beginning of the
eighties Dr. Breuer, an old Viennese doctor, made a discovery[222]
which was really the true starting-point of the new psychology.
He had a very intelligent young patient (a woman) suffering from
hysteria, who exhibited the following symptoms among others: A spastic
paralysis of the right arm, occasional disturbances of consciousness
or twilight-states, and loss of the power of speech in so far as she
no longer retained any knowledge of her mother-tongue, and could only
express herself in English (so-called systematic aphasia). They sought
at that time, and still seek, in such a case to establish some theory of
anatomical disturbance, although there was just as little disturbance
in the arm-centre in the brain as in that of any normal man who boxes
another's ears. The symptomatology of hysteria is full of anatomical
impossibilities; such as the case of the lady who had lost her hearing
completely through some hysterical malady. None the less she often used
to sing, and once when she was singing her doctor sat down at the piano
unnoticed by her and softly accompanied her. Passing from one strophe
to another he suddenly altered the key, and she, quite unconscious of
what she was doing, sang on in the altered key. Thus she heard--yet did
not hear. The various forms of systematic blindness present similar
phenomena. We have the case of a man suffering from complete hysterical
blindness. In the course of the treatment he recovers his sight, but at
first, and for some long time, only partially: he could see everything
with one exception--people's heads. He saw all the people around him
without heads. Thus he saw--yet did not see. From a large number of like
experiences it has long been concluded that it is only the patient's
consciousness which does not see, does not hear, but the sense-function
has nothing at all the matter with it. This state of affairs is directly
contradictory to the essence of an organic disturbance, which always
materially involves the function.
After this digression let us return to Breuer's case. Since there was no
organic cause for the disturbance, the case was clearly to be regarded
as hysterical, that is, psychogenic. Dr. Breuer had noticed that if
during her twilight-states (whether spontaneous or artificially induced)
he let the patient freely express the reminiscences and phantasies that
thronged in upon her, her condition was afterwards much improved for
some hours. He made systematic use of this observation in her further
treatment. The patient herself invented the appropriate name for it of
"talking cure" or, in jest, "chimney sweeping."
Her illness began whilst she was nursing her dying father. It is
easy to understand that her phantasies busied themselves mainly with
this disturbing time. In the twilight-states memories of this period
reappeared with photographic fidelity, distinct in every detail: no
waking recollection is ever so plastically and exactly reproduced.
The term hypermnesia is applied to this heightening of the power of
memory, which occurs without difficulty in certain states of contracted
consciousness. Remarkable things now came to light. Out of the many
things told, one ran somewhat as follows.[223]
On a certain night she was in a state of great anxiety about her
father's high temperature. She sat by his bed, waiting for the surgeon
who was coming from Vienna to perform an operation. Her mother had gone
out of the room for a little while, and Anna (the patient) sat by the
bed, with her right arm hanging over the back of her chair. She fell
into a kind of waking-dream in which she saw a black snake come out
from the wall and approach the sick man, prepared to bite. (It is very
probable that some real snakes had been seen in the fields behind the
house, and that she had been frightened by them; this would furnish the
material for her hallucination.) She wanted to drive the creature away,
but felt paralysed; her right arm, hanging over the chair, had "gone to
sleep," was anæsthetic and paretic, and as she looked her fingers turned
into little snakes with death's heads (the nails). Probably she tried
to drive the snake away with her paralysed right hand, and thereby the
anæsthesia and paralysis became associated with the snake-hallucination.
Even after the snake had disappeared, her terror remained great. She
tried to pray, but found she had no words in any language, until at
length she managed to remember some English nursery rhymes, and then she
could go on thinking and praying in that language.
This was the actual scene in which the paralysis and speech-disturbance
arose; the describing it served to remove the speech-trouble, and in
this same fashion the case was finally completely cured.
I must restrict myself to this one instance. In Breuer and Freud's book
there is a wealth of similar examples. It is easy to understand that
scenes such as these make a very strong impression, and accordingly
there is an inclination to attribute a causal significance to them in
the genesis of the symptoms. The then current conception of hysteria,
arising from the English "nervous shock" theory, which Charcot strongly
supported, came in conveniently to elucidate Breuer's discovery,
hence arose the _trauma-theory_ maintaining that the hysterical
symptom and in so far as the symptoms comprise the disease, hysteria
itself, arises from some _psychic injury_ (or _trauma_), the effect
of which is retained in the unconscious indefinitely. Freud, working
as Breuer's colleague, amply confirmed this discovery. It was fully
demonstrated that not one out of the many hundred hysterical symptoms
came down ready made from heaven; they had already been conditioned
by past psychic experiences. To some extent, therefore, this new
conception opened up a field of very important empirical work. But
Freud's tireless spirit of inquiry could not long rest content at
this superficial layer, since already there obtruded deeper and more
difficult problems. It is obvious enough that moments of great fear
and anxiety, such as Breuer's patient went through, would leave behind
a lasting effect, but how is it that these happenings are themselves
already deeply stamped with the mark of morbidity? Must we suppose
that the trying sick-nursing in itself produce such a result? If
so, such effects should occur much more frequently, for there are,
unfortunately, many trying cases of sick-nursing, and the nurse's
nervous constitution is by no means always of the soundest. To this
problem medicine gives its admirable answer; the "x" in the calculation
is _predisposition_; there is a tendency to these things. But for Freud
the problem was, what exactly constitutes this predisposition? This
question led logically to an investigation of all that had preceded the
psychic trauma. It is a matter of common observation that distressing
scenes have markedly different effects upon the different participants,
and that things which to some are quite indifferent or even pleasant,
such as frogs, mice, snakes, cats, excite the greatest aversion in
others. There are the cases of women who can calmly be present at a
very bad operation, but who tremble all over with horror and nausea
at the touch of a cat. By way of illustration let me give the case
of a young lady suffering from severe hysteria following a sudden
fright.[224] She had been at a social gathering, and was on her way
home at midnight accompanied by several acquaintances, when a carriage
came up behind them at full speed. All the others moved out of the way,
but she, beside herself with fright, ran down the middle of the road
just in front of the horses. The coachman cracked his whip and cursed
and swore in vain. She ran down the whole length of the street till
a bridge was reached. There her strength failed her, and to escape
the horses' feet in her despair she would have jumped into the water
had not passers-by prevented her. This same lady happened to be in
Petrograd during that sanguinary Revolution of the 22nd of January, and
saw a street cleared by the volleys of soldiers. All around her people
were dropping down dead or wounded, but she retained her calmness and
self-possession, and caught sight of a door which gave her escape into
another street. These terrible moments agitated her neither at the time
nor later on. She was quite well afterwards, indeed felt better than
usual.
Essentially similar reactions can quite often be observed. Hence
it follows that the intensity of the trauma is of small pathogenic
importance; the peculiar circumstances determine its pathogenic effect.
Here, then, we have the key which enables us to unlock at least one of
the anterooms to an understanding of predisposition. We must now ask
what were the unusual circumstances in this carriage scene? The terror
and apprehension began as soon as the lady heard the trampling horses.
For a moment she thought this portended some terrible fate, her death,
or something equally frightful; the next, she lost all sense of what she
was doing.