X
From Dr. Jung.
March, 1913.
At various places in your letters it has struck me that the problem of "transference" seems to you particularly critical. Your feeling is entirely justified. The transference is indeed at present the central problem of analysis.
You know that Freud regards the transference as the projection of infantile phantasies upon the doctor. To this extent the transference is an infantile-erotic relationship. All the same, viewed from the outside, superficially, the thing by no means always looks like an infantile-erotic situation. As long as it is a question of the so-called "positive" transference, the infantile-erotic character can usually be recognised without difficulty. But if it is a "negative" transference, you can see nothing but violent resistances which sometimes veil themselves in seemingly critical or sceptical dress. In a certain sense the determining factor in such circumstances is the patient's relation to authority, that is, in the last resort, to the father. In both forms of transference the doctor is treated as if he were the father—according to the situation either tenderly or with hostility. In this view the transference has the force of a resistance as soon as it becomes a question of resolving the infantile attitude. But this form of transference must be destroyed, inasmuch as the object of analysis is the patient's moral autonomy. A lofty aim, you will say. Indeed lofty, and far off, but still not altogether so remote, since it actually corresponds to one of the predominating tendencies of our stage of civilisation, namely, that urge towards individualisation by which our whole epoch deserves to be characterised. (Cf. Müller-Lyer: "Die Familie.") If a man does not believe in this orientation and still bows before the scientific causal view-point, he will, of course, be disposed merely to resolve this hostility, and to let the patient remain in a positive relationship towards the father, thus expressing the ideal of an earlier epoch of civilisation. It is commonly recognised that the Catholic Church represents one of the most powerful organisations based upon this earlier tendency. I cannot venture to doubt that there are very many individuals who feel happier under compulsion from others than when forced to discipline themselves. (Cf. Shaw: "Man and Superman.") None the less, we do our neurotic patients a grievous wrong if we try to force them all into the category of the unfree. Among neurotics, there are not a few who do not require any reminders of their social duties and obligations; rather are they born or destined to become the bearers of new social ideals. They are neurotic so long as they bow down to authority and refuse the freedom to which they are destined. Whilst we look at life only retrospectively, as is the case in the Viennese psychoanalytic writings, we shall never do justice to this type of case and never bring the longed-for deliverance. For in that fashion we can only educate them to become obedient children, and thereby strengthen the very forces that have made them ill—their conservative retardation and their submissiveness to authority. Up to a certain point this is the right way to take with the infantile resistance which cannot yet reconcile itself with authority. But the power which edged them out from their retrograde dependence on the father is not at all a childish desire for insubordination, but the powerful urge towards the development of an individual personality, and this struggle is their imperative life's task. Adler's psychology does much greater justice to this situation than Freud's.
In the one case (that of infantile intractability) the positive transference signifies a highly important achievement, heralding cure; in the other (infantile submissiveness) it portends a dangerous backsliding, a convenient evasion of life's duty. The negative transference represents in the first case an increased resistance, thus a backsliding and an evasion of duty, but in the second it is an advance of healing significance. (For the two types, cf. Adler's "Trotz und Gehorsam.")
The transference then is, as you see, to be judged quite differently in different cases.
The psychological process of "transference"—be it negative or positive—consists in the libido entrenching itself, as it were, round the personality of the doctor, the doctor accordingly representing certain emotional values. (As you know, by libido I understand very much what Antiquity meant by the cosmogenic principle of Eros; in modern terminology simply "psychic energy.") The patient is bound to the doctor, be it in affection, be it in opposition, and cannot fail to follow and imitate the doctor's psychic adaptations. To this he finds himself urgently compelled. And with the best will in the world and all technical skill, the doctor cannot prevent him, for intuition works surely and instinctively, in despite of the conscious judgment, be it never so strong. Were the doctor himself neurotic, and inadequate in response to the demands of the external life, or inharmonious within, the patient would copy the defect and build it up into the fabric of his own presentations: you may imagine the result.
Accordingly I cannot regard the transference as merely the transference of infantile-erotic phantasies; no doubt that is what it is from one standpoint, but I see also in it, as I said in an earlier letter, the process of the growth of feeling and adaptation. From this standpoint the infantile erotic phantasies, in spite of their indisputable reality, appear rather as material for comparison or as analogous pictures of something not understood as yet, than as independent desires. This seems to me the real reason of their being unconscious. The patient, not knowing the right attitude, tries to grasp at a right relationship to the doctor by way of comparison and analogy with his infantile experiences. It is not surprising that he gropes back for just the most intimate relations of his childhood, to discover the appropriate formula for his attitude to the doctor, for this relationship also is very intimate, and to some extent different from the sexual relationship, just as is that of the child towards its parents. This relationship—child to parent—which Christianity has everywhere set up as the symbolic formula for human relationships, provides a way of restoring to the patient that directness of ordinary human emotion of which he had been deprived through the inroad of sexual and social values (from the standpoint of power, etc.). The purely sexual, more or less primitive and barbaric valuation, operates in far-reaching ways against a direct, simple human relationship, and thereupon a blocking of the libido occurs which easily gives rise to neurotic formations. By means of analysis of the infantile portion of the transference-phantasies, the patient is brought back to the remembrance of his childhood's relationship, and this—stripped of its infantile qualities—gives him a beautiful, clear picture of direct human intercourse as opposed to the purely sexual valuation. I cannot regard it as other than a misconception to judge the childish relationship retrospectively and therefore as exclusively a sexual one, even though a certain sexual content can in no wise be denied to it.
Recapitulating, let me say this much of the positive transference:—
The patient's libido fastens upon the person of the doctor, taking the shape of expectation, hope, interest, trust, friendship and love. Then the transference produces the projection upon the doctor of infantile phantasies, often of predominatingly erotic tinge. At this stage the transference is usually of a decidedly sexual character, in spite of the sexual component remaining relatively unconscious. But this phase of feeling serves the higher aspect of the growth of human feeling as a bridge, whereby the patient becomes conscious of the defectiveness of his own adaptation, through his recognition of the doctor's attitude, which is accepted as one suitable to life's demands, and normal in its human relationships. By help of the analysis, and the recalling of his childish relationships, the road is seen which leads right out of those exclusively sexual or "power" evaluations of social surroundings which were acquired in puberty and strongly reinforced by social prejudices. This road leads on towards a purely human relation and intimacy, not derived solely from the existence of a sexual or power-relation, but depending much more upon a regard for personality. That is the road to freedom which the doctor must show his patient.
Here indeed I must not omit to say that the obstinate clinging to the sexual valuation would not be maintained so tenaciously if it had not also a very deep significance for that period of life in which propagation is of primary importance. The discovery of the value of human personality belongs to a riper age. For young people the search for the valuable personality is very often merely a cloak for the evasion of their biological duty. On the other hand, an older person's exaggerated looking back towards the sexual valuation of youth, is an undiscerning and often cowardly and convenient retreat from a duty which demands the recognition of personal values and his own enrolment among the ranks of the priesthood of a newer civilisation. The young neurotic shrinks back in terror from the extension of his tasks in life, the old from the dwindling and shrinking of the treasures he has attained.
This conception of the transference is, you will have noted, most intimately connected with the acceptance of the idea of biological "duties." By this term you must understand those tendencies or motives in human beings giving rise to civilisation, as inevitably as in the bird they give rise to the exquisitely woven nest, and in the stag to the production of antlers. The purely causal, not to say materialistic conception of the immediately preceding decades, would conceive the organic formation as the reaction of living matter, and this doubtless provides a position heuristically useful, but, as far as any real understanding goes, leads only to a more or less ingenious and apparent reduction and postponement of the problem. Let me refer you to Bergson's excellent criticism of this conception. From external forces but half the result, at most, could ensue; the other half lies within the individual disposition of the living material, without which it is obvious the specific reaction-formation could never be achieved. This principle must be applied also in psychology. The psyche does not only react; it also gives its own individual reply to the influences at work upon it, and at least half the resulting configuration and its existing disposition is due to this. Civilisation is never, and again never, to be regarded as merely reaction to environment. That shallow explanation we may abandon peacefully to the past century. It is just these very dispositions which we must regard as imperative in the psychological sphere; it is easy to get convincing proof daily of their compulsive power. What I call "biological duty" is identical with these dispositions.
In conclusion, I must deal with a matter which seems to have caused you uneasiness, namely, the moral question. Among our patients we see many so-called immoral tendencies, therefore the thought involuntarily forces itself upon the psychotherapist as to how things would go if all these desires were to be gratified. You will have discerned already from my earlier letters that these desires must not be estimated too literally. As a rule it is rather a matter of unmeasured and exaggerated demands, arising out of the patient's stored-up libido, which have usurped a prominent position, usually quite against his own wish. In most cases the canalisation of the libido for the fulfilment of life's simple duties, suffices to reduce these exaggerated desires to zero. But in some cases it must be recognised that such "immoral" tendencies are in no way removed by analysis; on the contrary, they appear more often and more clearly, hence it becomes plain that they belong to the individual's biological duties. And this is particularly true of certain sexual claims, whose aim is an individual valuation of sexuality. This is not a question for pathology, it is a social question of to-day which peremptorily demands an ethical solution. For many it is a biological duty to work for the solution of this question, to discover some sort of practical solution. (Nature, it is well known, does not content herself with theories.) To-day we have no real sexual morality, only a legal attitude towards sexuality; just as the early Middle Ages had no genuine morality for financial transactions, but only prejudices and a legal standpoint. We are not yet sufficiently advanced in the domain of free sexual activity to distinguish between a moral and an immoral relationship. We have a clear expression of this in the customary treatment, or rather ill-treatment, of unmarried motherhood. For a great deal of sickening hypocrisy, for the high tide of prostitution, and for the prevalence of sexual diseases, we may thank both our barbarous, undifferentiated legal judgments about the sexual situation, and our inability to develop a finer moral perception of the immense psychologic differences that may exist in free sexual activity.
This reference to the existence of an exceedingly complicated and significant problem may suffice to explain why we by no means seldom meet with individuals among our patients who are quite specially called, because of their spiritual and social gifts, to take an active part in the work of civilisation—for this they are biologically destined. We must never forget that what to-day is deemed a moral law will to-morrow be cast into the melting-pot and transformed, so that in the near or distant future it may serve as the basis of a new ethical structure. This much we ought to have learnt from the history of civilisation, that the forms of morality belong to the category of transitory things. The finest psychological tact is required with these critical natures, so that the dangerous corners of infantile irresponsibility, indolence and uncontrolledness may be turned, and a pure, untroubled vision of the possibility of a moral autonomous activity made possible. Five per cent. on money lent is fair interest, twenty per cent. is despicable usury. That point of view we have to apply equally to the sexual situation.
So it comes about that there are many neurotics whose innermost delicacy of feeling prevents their being at one with present-day morality, and they cannot adapt themselves to civilisation as long as their moral code has gaps in it, the filling up of which is a crying need of the age. We deceive ourselves greatly if we suppose that many married women are neurotic only because they are unsatisfied sexually or because they have not found the right man, or because they still have a fixation to their infantile sexuality. The real ground of the neurosis is, in many cases, the inability to recognise the work that is waiting for them, of helping to build up a new civilisation. We are all far too much at the standpoint of the "nothing-but" psychology; we persist in thinking we can squeeze the new future which is pressing in at the door into the framework of the old and the known. And thus the view is only of the present, never of the future. But it was of most profound psychological significance when Christianity first discovered, in the orientation towards the future, a redeeming principle for mankind. In the past nothing can be altered, and in the present little, but the future is ours and capable of raising life's intensity to its highest pitch. A little space of youth belongs to us, all the rest of life belongs to our children.
Thus does your question as to the significance of the loss of faith in authority answer itself. The neurotic is ill not because he has lost his old faith, but because he has not yet found a new form for his finest aspirations.
CHAPTER X
ON THE IMPORTANCE OF THE UNCONSCIOUS IN PSYCHOPATHOLOGY[182]
When we speak of a thing as being "unconscious" we must not forget that from the point of view of the functioning of the brain a thing may be unconscious to us in two ways—physiologically or psychologically. I shall only deal with the subject from the latter point of view. So that for our purposes we may define the unconscious as "the sum of all those psychological events which are not apperceived, and so are unconscious."
The unconscious contains all those psychic events which, because of the lack of the necessary intensity of their functioning, are unable to pass the threshold which divides the conscious from the unconscious; so that they remain in effect below the surface of the conscious, and flit by in subliminal phantom forms.
It has been known to psychologists since the time of Leibniz that the elements—that is to say, the ideas and feelings which go to make up the conscious mind, the so-called conscious content—are of a complex nature, and rest upon far simpler and altogether unconscious elements; it is the combination of these which gives the element of consciousness. Leibniz has already mentioned the perceptions insensibles—those vague perceptions which Kant called "shadowy" representations, which could only attain to consciousness in an indirect manner. Later philosophers assigned the first place to the unconscious, as the foundation upon which the conscious was built.
But this is not the place to consider the many speculative theories nor the endless philosophical discussions concerning the nature and quality of the unconscious. We must be satisfied with the definition already given, which will prove quite sufficient for our purpose, namely the conception of the unconscious as the sum of all psychical processes below the threshold of consciousness.
The question of the importance of the unconscious for psychopathology may be briefly put as follows: "In what manner may we expect to find unconscious psychic material behave in cases of psychosis and neurosis?"
In order to get a better grasp of the situation in connexion with mental disorders, we may profitably consider first how unconscious psychic material behaves in the case of normal people, especially trying to visualize what in normal men is apt to be unconscious. As a preliminary to this knowledge we must get a complete understanding of what is contained in the conscious mind; and then, by a process of elimination we may expect to find what is contained in the unconscious, for obviously—per exclusionem—what is in the conscious cannot be unconscious. For this purpose we examine all activities, interests, passions, cares, and joys, which are conscious to the individual. All that we are thus able to discover becomes, ipso facto, of no further moment as a content of the unconscious, and we may then expect to find only those things contained in the unconscious which we have not found in the conscious mind.
Let us take a concrete example: A merchant, who is happily married, father of two children, thorough and painstaking in his business affairs, and at the same time trying in a reasonable degree to improve his position in the world, carries himself with self-respect, is enlightened in religious matters, and even belongs to a society for the discussion of liberal ideas.
What can we reasonably consider to be the content of the unconscious in the case of such an individual?
Considered from the above theoretical standpoint, everything in the personality that is not contained in the conscious mind should be found in the unconscious. Let us agree, then, that this man consciously considers himself to possess all the fine attributes we have just described—no more, no less. Then it must obviously result that he is entirely unaware that a man may be not merely industrious, thorough, and painstaking, but that he may also be careless, indifferent, untrustworthy; for some of these last attributes are the common heritage of mankind and may be found to be an essential component of every character. This worthy merchant forgets that quite recently he allowed several letters to remain unanswered which he could easily have answered at once. He forgets, too, that he failed to bring a book home which his wife has asked him to get at the book-stall, where she had previously ordered it, although he might easily have made a note of her wish. But such occurrences are common with him. Therefore we are obliged to conclude that he is also lazy and untrustworthy. He is convinced that he is a thoroughly loyal subject; but for all that he failed to declare the whole of his income to the assessor, and when they raise his taxes, he votes for the Socialists.
He believes himself to be an independent thinker, yet a little while back he undertook a big deal on the Stock Exchange, and when he came to enter the details of the transaction in his books he noticed with considerable misgivings that it fell upon a Friday, the 13th of the month. Therefore, he is also superstitious and not free in his thinking.
So here we are not at all surprised to find these compensating vices to be an essential content of the unconscious. Obviously, therefore, the reverse is true—namely, that unconscious virtues compensate for conscious deficiencies. The law which ought to follow as the result of such deductions would appear to be quite simple—to wit, the conscious spendthrift is unconsciously a miser; the philanthropist is unconsciously an egoist and misanthrope. But, unfortunately, it is not quite so easy as that, although there is a basis of truth in this simple rule. For there are essential hereditary dispositions of a latent or manifest nature which upset the simple rule of compensation, and which vary greatly in individual cases. From entirely different motives a man may, for instance, be a philanthropist, but the manner of his philanthropy depends upon his originally inherited disposition, and the way in which the philanthropic attitude is compensated depends upon his motives. It is not sufficient simply to know that a certain person is philanthropic in order to diagnose an unconscious egoism. For we must also bring to such a diagnosis a careful study of the motives involved.
In the case of normal people the principal function of the unconscious is to effect a compensation and thus produce a balance. All extreme conscious tendencies are softened and toned down through an effective opposite impulse in the unconscious. This compensating agency, as I have tried to show in the case of the merchant, maintains itself through certain unconscious, inconsequent activities, as it were, which Freud has very well described as symptomatic acts (Symptom-handlungen).
To Freud we owe thanks also for having called attention to the importance of dreams, for by means of them, also, we are able to learn much about this compensating function. There is a fine historical example of this in the well-known dream of Nebuchadnezzar in the fourth chapter of the Book of Daniel, where Nebuchadnezzar at the height of his power had a dream which foretold his downfall. He dreamed of a tree which had raised its head even up to heaven and now must be hewn down. This is a dream which is obviously a counterpoise to the exaggerated feeling of royal power.
Now considering states in which the mental balance is disturbed, we can easily see, from what has preceded, wherein lies the importance of the unconscious for psychopathology. Let us ponder the question of where and in what manner the unconscious manifests itself in abnormal mental conditions. The way in which the unconscious works is most clearly seen in disturbances of a psychogenic nature, such as hysteria, compulsion neurosis, etc.
We have known for a long time that certain symptoms of these disturbances are produced by unconscious psychic events. Just as clear, but less recognised, are the manifestations of the unconscious in actually insane patients. As the intuitive ideas of normal men do not spring from logical combinations of the conscious mind, so the hallucinations and delusions of the insane arise, not out of conscious but out of unconscious processes.
Formerly, when we held a more materialistic view of psychiatry we were inclined to believe that all delusions, hallucinations, stereotypic acts, etc., were provoked by morbid processes in the brain cells. Such a theory, however, ignores that delusions, hallucinations, etc., are also to be met with in certain functional disturbances, and not only in the case of functional disturbances, but also in the case of normal people. Primitive people may have visions and hear strange voices without having their mental processes at all disturbed. To seek to ascribe symptoms of that nature directly to a disease of the brain cells I hold to be superficial and unwarranted. Hallucinations show very plainly how a part of the unconscious content can force itself across the threshold of the conscious. The same is true of a delusion whose appearance is at once strange and unexpected by the patient.
The expression "mental balance" is no mere figure of speech, for its disturbance is a real disturbance of that equilibrium which actually exists between the unconscious and conscious content to a greater extent than has heretofore been recognised or understood. As a matter of fact, it amounts to this—that the normal functioning of the unconscious processes breaks through into the conscious mind in an abnormal manner, and thereby disturbs the adaptation of the individual to his environment.
If we study attentively the history of any such person coming under our observation, we shall often find that he has been living for a considerable time in a sort of peculiar individual isolation, more or less shut off from the world of reality. This constrained condition of aloofness may be traced back to certain innate or early acquired peculiarities, which show themselves in the events of his life. For instance, in the histories of those suffering from dementia præcox we often hear such a remark as this: "He was always of a pensive disposition, and much shut up in himself. After his mother died he cut himself off still more from the world, shunning his friends and acquaintances." Or again, we may hear, "Even as a child he devised many peculiar inventions; and later, when he became an engineer, he occupied himself with most ambitious schemes."
Without discussing the matter further it must be plain that a counterpoise is produced in the unconscious as a compensation to the one-sidedness of the conscious attitude. In the first case we may expect to find an increasing pressing forward in the unconscious, of a wish for human intercourse, a longing for mother, friends, relatives; while in the second case self-criticism will try to establish a correcting balance. Among normal people a condition never arises so one-sided that the natural corrective tendencies of the unconscious entirely lose their value in the affairs of everyday life; but in the case of abnormal people, it is eminently characteristic that the individual entirely fails to recognise the compensating influences which arise in the unconscious. He even continues to accentuate his one-sidedness; this is in accord with the well-known psychological fact that the worst enemy of the wolf is the wolf-hound, the greatest despiser of the negro is the mulatto, and that the biggest fanatic is the convert; for I should be a fanatic were I to attack a thing outwardly which inwardly I am obliged to concede as right.
The mentally unbalanced man tries to defend himself against his own unconscious, that is to say, he battles against his own compensating influences. The man already dwelling in a sort of atmosphere of isolation, continues to remove himself further and further from the world of reality, and the ambitious engineer strives by increasingly morbid exaggerations of invention to disprove the correctness of his own compensating powers of self-criticism. As a result of this a condition of excitation is produced, from which results a great lack of harmony between the conscious and unconscious attitudes. The pairs of opposites are torn asunder, the resulting division or strife leads to disaster, for the unconscious soon begins to intrude itself violently upon the conscious processes. Then odd and peculiar thoughts and moods supervene, and not infrequently incipient forms of hallucination, which clearly bear the stamp of the internal conflict.
These corrective impulses or compensations which now break through into the conscious mind, should theoretically be the beginning of the healing process, because through them the previously isolated attitude should apparently be relieved. But in reality this does not result, for the reason that the unconscious corrective impulses which thus succeed in making themselves apparent to the conscious mind, do so in a form that is altogether unacceptable to consciousness.
The isolated individual begins to hear strange voices, which accuse him of murder and all sorts of crimes. These voices drive him to desperation and in the resulting agitation he attempts to get into contact with the surrounding milieu, and does what he formerly had anxiously avoided. The compensation, to be sure, is reached, but to the detriment of the individual.
The pathological inventor, who is unable to profit by his previous failures, by refusing to recognise the value of his own self-criticism, becomes the creator of still more preposterous designs. He wishes to accomplish the impossible but falls into the absurd. After a while he notices that people talk about him, make unfavourable remarks about him, and even scoff at him. He believes a far-reaching conspiracy exists to frustrate his discoveries and render them objects of ridicule. By this means his unconscious brings about the same results that his self-criticism could have attained, but again only to the detriment of the individual, because the criticism is projected into his surroundings.
An especially typical form of unconscious compensation—to give a further example—is the paranoia of the alcoholic. The alcoholic loses his love for his wife; the unconscious compensation tries to lead him back again to his duty, but only partially succeeds, for it causes him to become jealous of his wife as if he still loved her. As we know, he may even go so far as to kill both his wife and himself, merely out of jealousy. In other words, his love for his wife has not been entirely lost, it has simply become subliminal; but from the realm of the unconscious it can now only reappear in the form of jealousy.
We see something of a similar nature in the case of religious converts. One who turns from protestantism to catholicism has, as is well known, the tendency to be somewhat fanatical. His protestantism is not entirely relinquished, but has merely disappeared into the unconscious, where it is constantly at work as a counter-argument against the newly acquired catholicism. Therefore the new convert feels himself constrained to defend the faith he has adopted in a more or less fanatical way. It is exactly the same in the case of the paranoiac, who feels himself constantly constrained to defend himself against all external criticism, because his delusional system is too much threatened from within.
The strange manner in which these compensating influences break through into the conscious mind derives its peculiarities from the fact that they have to struggle against the resistances already existing in the conscious mind, and therefore present themselves to the patient's mind in a thoroughly distorted manner. And secondly, these compensating equivalents are obliged necessarily to present themselves in the language of the unconscious—that is, in material of a heterogeneous and subliminal nature. For all the material of the conscious mind which is of no further value, and can find no suitable employment, becomes subliminal, such as all those forgotten infantile and phantastic creations that have ever entered the heads of men, of which only the legends and myths still remain. For certain reasons which I cannot discuss further here, this latter material is frequently found in dementia præcox.
I hope I may have been able to give in this brief contribution, which I feel to be unfortunately incomplete, a glimpse of the situation as it presents itself to me of the importance of the unconscious in psychopathology. It would be impossible in a short discourse to give an adequate idea of all the work that has already been done in this field.
To sum up, I may say that the function of the unconscious in conditions of mental disturbance is essentially a compensation of the content of the conscious mind. But because of the characteristic condition of one-sidedness of the conscious striving in all such cases, the compensating correctives are rendered useless. It is, however, inevitable that these unconscious tendencies break through into the conscious mind, but in adapting themselves to the character of the one-sided conscious aims, it is only possible for them to appear in a distorted and unacceptable form.
CHAPTER XI
A CONTRIBUTION TO THE STUDY OF PSYCHOLOGICAL TYPES[183]
It is well known that in their general physiognomy hysteria and dementia præcox present a striking contrast, which is seen particularly in the attitude of the sufferers towards the external world. The reactions provoked in the hysteric surpass the normal level of intensity of feeling, whilst this level is not reached at all by the precocious dement. The picture presented by these contrasted illnesses is one of exaggerated emotivity in the one, and extreme apathy in the other, with regard to the environment. In their personal relations this difference is very marked. Abstraction creates some exceptions here, for we remain in affective rapport with our hysterical patients, which is not the case in dementia præcox.
The opposition between these two nosological types is also seen in the rest of their symptomatology. From the intellectual point of view the products of hysterical imagination may be accounted for in a very natural and human way in each individual case by the antecedents and individual history of the patient; while the inventions of the precocious dement, on the contrary, are more nearly related to dreams than to normal consciousness, and they display moreover an incontestably archaic tendency, wherein mythological creations of primitive imagination are more in evidence than the personal memories of the patient. From the physical point of view we do not find in dementia præcox those symptoms so common in the hysteric, which simulate well known or severe organic affections.
All this clearly indicates that hysteria is characterised by a centrifugal tendency of the libido,[184] whilst in dementia præcox its tendency is centripetal. The reverse occurs, however, where the illness has fully established its compensatory effects. In the hysteric the libido is always hampered in its movements of expansion and forced to regress upon itself; one observes that such individuals cease to partake in the common life, are wrapped up in their phantasies, keep their beds, or are unable to live outside their sick-rooms, etc. The precocious dement, on the contrary, during the incubation of his illness turns away from the outer world in order to withdraw into himself; but when the period of morbid compensation arrives, he seems constrained to draw attention to himself, and to force himself upon the notice of those around him, by his extravagant, insupportable, or directly aggressive conduct.
I propose to use the terms "extroversion" and "introversion" to describe these two opposite directions of the libido, further qualifying them, however, as "regressive" in morbid cases where phantasies, fictions, or phantastic interpretations, inspired by emotivity, falsify the perceptions of the subject about things, or about himself. We say that he is extroverted when he gives his fundamental interest to the outer or objective world, and attributes an all-important and essential value to it: he is introverted, on the contrary, when the objective world suffers a sort of depreciation, or want of consideration, for the sake of the exaltation of the individual himself, who then monopolising all the interest, grows to believe no one but himself worthy of consideration. I will call "regressive extroversion" the phenomenon which Freud calls "transference" (Übertragung), by which the hysteric projects into the objective world the illusions, or subjective values of his feelings. In the same way I shall call "regressive introversion," the opposite pathological phenomenon which we find in dementia præcox, where the subject himself suffers these phantastical transfigurations.
It is obvious that these two contrary movements of the libido, as simple psychic mechanisms, may play a part alternately in the same individual, since after all they serve the same purpose by different methods—namely, to minister to his well-being. Freud has taught us that in the mechanism of hysterical transference the individual aims at getting rid of disagreeable memories or impressions, in order to free himself from painful complexes, by a process of "repression." Conversely in the mechanism of introversion, the personality tends to concentrate itself upon its complexes, and with them, to isolate itself from external reality, by a process which is not properly speaking "repression," but which would be better rendered perhaps by the term "depreciation" (Entwertung) of the objective world.
The existence of two mental affections so opposite in character as hysteria and dementia præcox, in which the contrast rests on the almost exclusive supremacy of extroversion or introversion, suggests that these two psychological types may exist equally well in normal persons, who may be characterised by the relative predominance of one or other of the two mechanisms. Psychiatrists know very well that before either illness is fully declared, patients already present the characteristic type, traces of which are to be found from the earliest years of life. As Binet pointed out so well, the neurotic only accentuates and shews in relief the characteristic traits of his personality. One knows, of course, that the hysterical character is not simply the product of the illness, but pre-existed it in a measure. And Hoch has shown by his researches into the histories of his dementia præcox patients, that this is also the case with them; dissociations or eccentricities were present before the onset of the illness. If this is so, one may certainly expect to meet the same contrast between psychological temperaments outside the sphere of pathology. It is moreover easy to cull from literature numerous examples which bear witness to the actual existence of these two opposite types of mentality. Without pretending to exhaust the subject, I will give a few striking examples.
In my opinion, we owe the best observations on this subject to the philosophy of William James.[185] He lays down the principle that no matter what may be the temperament of a "professional philosopher," it is this temperament which he feels himself forced to express and to justify in his philosophy. And starting from this idea, which is altogether in accord with the spirit of psychoanalysis, divides philosophers into two classes: the "tender-minded," who are only interested in the inner life and spiritual things; and the "tough-minded," who lay most stress on material things and objective reality. We see that these two classes are actuated by exactly opposite tendencies of the libido: the "tender-minded" represent introversion, the "tough-minded" extroversion.
James says that the tender-minded are characterised by rationalism; they are men of principles and of systems, they aspire to dominate experience and to transcend it by abstract reasoning, by their logical deductions, and purely rational conceptions. They care little for facts, and the multiplicity of phenomena hardly embarrasses them at all: they forcibly fit data into their ideal constructions, and reduce everything to their a priori premises. This was the method of Hegel in settling beforehand the number of the planets. In the domain of mental pathology we again meet this kind of philosopher in paranoiacs, who, without being disquieted by the flat contradictions presented by experience, impose their delirious conceptions on the universe, and find means of interpreting everything, and according to Adler "arranging" everything, in conformity with their morbidly preconceived system.
The other traits which James depicts in this type follow naturally from its fundamental character. The tender-minded man, he says, is intellectual, idealist, optimist, religious, partisan of free-will, a monist, and a dogmatist. All these qualities betray the almost exclusive concentration of the libido upon the intellectual life. This concentration upon the inner world of thought is nothing else than introversion. In so far as experience plays a rôle with these philosophers, it serves only as an allurement or fillip to abstraction, in response to the imperative need to fit forcibly all the chaos of the universe within well-defined limits, which are, in the last resort, the creation of a spirit obedient to its subjective values.
The tough-minded man is positivist and empiricist. He regards only matters of fact. Experience is his master, his exclusive guide and inspiration. It is only empirical phenomena demonstrable in the outside world which count. Thought is merely a reaction to external experience. In the eyes of these philosophers principles are never of such value as facts; they can only reflect and describe the sequence of phenomena and cannot construct a system. Thus their theories are exposed to contradiction under the overwhelming accumulation of empirical material. Psychic reality for the positivist limits itself to the observation and experience of pleasure and pain; he does not go beyond that, nor does he recognise the rights of philosophical thought. Remaining on the ever-changing surface of the phenomenal world, he partakes himself of its instability; carried away in the chaotic tumult of the universe, he sees all its aspects, all its theoretical and practical possibilities, but he never arrives at the unity or the fixity of a settled system, which alone could satisfy the idealist or tender-minded. The positivist depreciates all values in reducing them to elements lower than themselves; he explains the higher by the lower, and dethrones it, by showing that it is "nothing but such another thing," which has no value in itself.
From these general characteristics, the others which James points out logically follow. The positivist is a sensualist, giving greater value to the specific realm of the senses than to reflection which transcends it. He is a materialist and a pessimist, for he knows only too well the hopeless uncertainty of the course of things. He is irreligious, not being in a state to hold firmly to the realities of the inner world as opposed to the pressure of external facts; he is a determinist and fatalist, only able to show resignation; a pluralist, incapable of all synthesis; and finally a sceptic, as a last and inevitable consequence of all the rest.
The expressions, therefore, used by James, show clearly that the diversity of types is the result of a different localisation of the libido; this libido is the magic power in the depth of our being, which, following the personality, carries it sometimes towards internal life, and sometimes towards the objective world. James compares, for example, the religious subjectivism of the idealist, and the quasi-religious attitude of the contemporary empiricist: "Our esteem for facts has not neutralised in us all religiousness. It is itself almost religious. Our scientific temper is devout."[186]
A second parallel is furnished by Wilhelm Ostwald,[187] who divides "savants" and men of genius into classics and romantics. The latter are distinguished by their rapid reactions, their extremely prompt and abundant production of ideas and projects, some of which are badly digested and of doubtful value. They are admirable and brilliant masters, loving to teach, of a contagious ardour and enthusiasm, which attracts many pupils, and makes them founders of schools, exercising great personal influence. Herein our type of extroversion is easily recognised. The classics of Ostwald are, on the contrary, slow to react; they produce with much difficulty, are little capable of teaching or of exercising direct personal influence, and lacking enthusiasm are paralysed by their own severe criticism, living apart and absorbed in themselves, making scarcely any disciples, but producing works of finished perfection which often bring them posthumous fame. All these characteristics correspond to introversion.
We find a further very valuable example in the æsthetic theory of Warringer. Borrowing from A. Riegl his expression "Volonté d'art absolue" to express the internal force which inspires the artist, he distinguishes two forms, viz. sympathy (Einfühlung) and abstraction; and the term which he employs indicates that here, too, we witness the activity of the push of the libido, the stirring of the élan vital. "In the same way," says Warringer, "as the sympathetic impulse finds its satisfaction in organic beauty, so abstract impulse discovers beauty in the inorganic, which is the negation of all life, in crystallised forms, and in a general manner wherever the severity of abstract law reigns." Whilst sympathy represents the warmth of passion which carries it into the presence of the object in order to assimilate it and penetrate it with emotional values; abstraction, on the other hand, despoils the object of all that could recall life, and grasps it by purely intellectual thought, crystallised and fixed into the rigid forms of law,—the universal, the typical. Bergson also makes use of these images of crystallisation, solidification, etc., to illustrate the essence of intellectual abstraction.
Warringer's "abstraction" represents the process which I have already remarked as a consequence of introversion, namely, the exaltation of the intellect, in the place of the depreciated reality of the external world. "Sympathy" corresponds in fact to extroversion, for, as Lipps has pointed out, "What I perceive sympathetically in an object is, in a general manner life, and life is power, internal work, effort, and execution. To live, in a word, is to act, and to act is to experience intimately the force which we give out; experience creates activity, which is essentially of a spontaneous character." "Æsthetic enjoyment," said Warringer, "is the enjoyment of one's own self projected into the "object," a formula which corresponds absolutely with our definition of transference. This æsthetic conception does not refer to the positivist in James's sense; it is rather the attitude of the idealist for whom psychological reality only is interesting, and worthy of consideration." Warringer adds, "what is essential lies not in the gradation of the feeling, but pre-eminently in the feeling itself; that is to say, the inner movement, the intimate life, the unfolding of the subject's own activity; the value of a line or of a form, depends in our eyes on the biological value it holds for us; that which gives beauty is solely our own vital feeling, which we unconsciously project into it." This view corresponds exactly with my own way of understanding the theory of the libido, in attempting to keep the true balance between the two psychological opposites of introversion and extroversion.
The polar opposite of sympathy is abstraction. The impulse of abstraction is conceived by Warringer "as the result of a great internal conflict of the human soul in the presence of the external world, and from the religious standpoint, it corresponds to a strong transcendental colouring of all the representations man has made to himself of reality." We recognise clearly in this definition the primordial tendency to introversion. To the introverted type the universe does not appear beautiful and desirable, but disquieting, and even dangerous; it is a manifestation against which the subject puts himself on the defensive; he entrenches himself in his inner fastness, and fortifies himself therein by the invention of geometrical figures, full of repose, perfectly clear even in their minutest details, the primitive magic power of which assures him of domination over the surrounding world.
"The need of abstraction is the origin of all art," says Warringer. Here is a great principle, which gains weighty confirmation from the fact that precocious dements reproduce forms and figures which present the closest analogy to those of primitive humanity, not only in their thoughts but also in their drawings.
We should recall that Schiller had already tried to formulate the same presentation in what he calls the naïve and sentimental types. The latter is in quest of nature, whilst the former is itself "all nature." Schiller also saw that these two types result from the predominance of psychological mechanisms which might be met with in one and the same individual. "It is not only in the same poet," he said, "but even in the same work that these two types of mentality are found united.... The naïve poet pursues only nature and feeling in their simplicity, and all his effort is limited to the imitation and reproduction of reality. The sentimental poet, on the contrary, reflects the impression he receives from objects. The object here is allied to an idea, and the poetic power of the work depends on this alliance." These quotations shew what types Schiller had in view, and one recognises their fundamental identity with those with which we are here dealing.
We find another instance in Nietzsche's contrast between the minds of Apollo and of Dionysus. The example which Nietzsche uses to illustrate this contrast is instructive—namely, that between a dream and intoxication. In a dream the individual is shut up in himself, in intoxication, on the contrary, he forgets himself to the highest degree, and, set free from his self-consciousness, plunges into the multiplicity of the objective world. To depict Apollo, Nietzsche borrows the words of Schopenhauer, "As upon a tumultuous sea, which disgorges and swallows by turns, lost to view in the mountains of foaming waves, the mariner remains seated tranquilly on his plank, full of confidence in his frail barque; so individual man, in a world of troubles, lives passive and serene, relying with confidence on the principle of 'individuation.'" "Yes," continues Nietzsche, "we might say that the unshakeable confidence in this principle, and the calm security of those whom it has inspired, have found in Apollo their most sublime expression, and we may always recognise in him the most splendid and divine personification of the principle of making an individual." The Apollien state, as Nietzsche conceives it, is consequently the withdrawal into oneself, that is, introversion. Conversely in the Dionysian state, psychic intoxication, indicates in his view the unloosening of a torrent of libido which expends itself upon things. "This is not only," says Nietzsche, "the alliance of man with man, which finds itself confirmed afresh under the Dionysian enchantment; it is alienated Nature, hostile or enslaved, which also celebrates her reconciliation with her prodigal child,—man. Spontaneously Earth offers her gifts and the wild beasts from rock and desert draw near peacefully. The car of Dionysus is lost under flowers and garlands; panthers and tigers approach under his yoke."
If we change Beethoven's "Hymn of Praise" into a picture, and giving rein to our imagination, contemplate the millions of beings prostrated and trembling in the dust, at such a moment the Dionysian intoxication will be near at hand. Then is the slave free; then all the rigid and hostile barriers which poverty and arbitrary or insolent custom have established between man and man are broken down. Now, by means of this gospel of universal harmony, each feels himself not only reunited, reconciled, fused with his neighbour, but actually identified with him, as if the veil of "Maïa was torn away, nothing remaining of it but a few shreds floating before the mystery of the Primordial Unity."[188] It would be superfluous to add comment to these quotations.
In concluding this series of examples culled outside my own special domain, I will quote the linguistic hypothesis of Finck,[189] where we also see the duality in question. The structure of language, according to Finck, presents two principal types: in one the subject is generally conceived as active: "I see him," "I strike him down;" in the other the subject experiences and feels, and it is the object which acts: "He appears to me," "He succumbs to me." The first type clearly shews the libido as going out of the subject,—this is a centrifugal movement; the second as coming out of the object,—this movement is centripetal. We meet with this latter introverted type especially in the primitive languages of the Esquimaux.
In the domain of psychiatry also these two types have been described by Otto Gross,[190] who distinguishes two forms of mental debility: the one a diffuse and shallow consciousness, the other a concentrated and deep consciousness. The first is characterised by weakness of the consecutive function, the second by its excessive reinforcement. Gross has recognised that the consecutive function is in intimate relation with affectivity, from which we might infer that he is dealing once more with our two psychological types. The relation he establishes between maniac depressive insanity and the state of diffuse or extended and shallow mental disease shows that the latter represents the extroverted type; and the relation between the psychology of the paranoiac and repressed mentality, indicates the identity of the former with the introverted type.
After the foregoing considerations no one will be astonished to find that in the domain of psychoanalysis we also have to reckon with the existence of these two psychological types.
On the one side we meet with a theory which is essentially reductive, pluralist, causal and sensualist; this is Freud's standpoint. This theory limits itself rigidly to empirical facts, and traces back complexes to their antecedents and their elemental factors. It regards the psychological life as being only an effect, a reaction to the environment, and accords the greatest rôle and the largest place to sensation. On the other side we have the diametrically opposed theory of Adler[191] which is an entirely philosophical and finalistic one. In it phenomena are not reducible to earlier and very primitive factors, but are conceived as "arrangements," the outcome of intentions and of ends of an extremely complex nature. It is no longer the view of causality but of finality which dominates researches: the history of the patient and the concrete influences of the environment are of much less importance than the dominating principles, the "fictions directrices," of the individual. It is not essential for him to depend upon the object, and to find in it his fill of subjective enjoyment, but to protect his own individuality and to guarantee it against the hostile influences of the environment.
Whilst Freud's psychology has for its predominant note the centrifugal tendency, which demands its happiness and satisfaction in the objective world, in that of Adler the chief rôle belongs to the centripetal movement, which tends to the supremacy of the subject, to his triumph and his liberty, as opposed to the overwhelming forces of existence. The expedient to which the type described by Freud has recourse is "infantile transference," by means of which he projects phantasy into the object and finds a compensation for the difficulties of life in this transfiguration. In the type described by Adler what is characteristic is, on the contrary, the "virile protest," personal resistance, the efficacious safeguard which the individual provides for himself, in affirming and stubbornly enclosing himself in his dominating ideas.
The difficult task of elaborating a psychology which should pay equal attention to the two types of mentality belongs to the future.
CHAPTER XII
THE PSYCHOLOGY OF DREAMS[192]
A dream is a psychic structure which at first sight appears to be in striking contrast with conscious thought, because judging by its form and substance it apparently does not lie within the continuity of development of the conscious contents, it is not integral to it, but is a mere external and apparently accidental occurrence. Its mode of genesis is in itself sufficient to isolate a dream from the other contents of the conscious, for it is a survival of a peculiar psychic activity which takes place during sleep, and does not originate in the manifest and clearly logical and emotional continuity of the event experienced.
But a careful observer should have no difficulty in discovering that a dream is not entirely severed from the continuity of the conscious, for in almost every dream certain details are found which have their origin in the impressions, thoughts, or states of mind of one of the preceding days. In so far a certain continuity does exist, albeit a retrograde one. But any one keenly interested in the dream problem cannot have failed to observe that a dream has also a progressive continuity—if such an expression be permitted—since dreams occasionally exert a remarkable influence upon the conscious mental life, even of persons who cannot be considered superstitious or particularly abnormal. These occasional after-effects are usually seen in a more or less distinct change in the dreamer's frame of mind.
It is probably in consequence of this loose connection with the other conscious contents, that the recollected dream is so extremely unstable. Many dreams baffle all attempts at reproduction, even immediately after waking; others can only be remembered with doubtful accuracy, and comparatively few can be termed really distinct and clearly reproduceable. This peculiar reaction with regard to recollection may be understood by considering the characteristics of the various elements combined in a dream. The combination of ideas in dreams is essentially phantastic; they are linked together in a sequence which, as a rule, is quite foreign to our current way of thinking, and in striking contrast to the logical sequence of ideas which we consider to be a special characteristic of conscious mental processes.
It is to this characteristic that dreams owe the common epithet of "meaningless." Before pronouncing this verdict, we must reflect that dreams and their chains of ideas are something that we do not understand. Such a verdict would therefore be merely a projection of our non-comprehension upon its object. But that would not prevent its own peculiar meaning being inherent in a dream.
In spite of the fact that for centuries endeavours have been made to extract a prophetic meaning from dreams, Freud's discovery is practically the first successful attempt to find their real significance. His work merits the term "scientific," because he has evolved a technique which, not only he, but many other investigators also assert achieves its object, namely, the understanding of the meaning of the dream. This meaning is not identical with the one which the manifest dream content seems to indicate.
This is not the place for a critical discussion of Freud's psychology of dreams. But I will try to give a brief summary of what may be regarded as more or less established facts of dream psychology to-day.
The first question we must discuss is, whence do we deduce the justification for attributing to dreams any other significance than the one indicated in the unsatisfying fragmentary meaning of the manifest dream content?
As regards this point a particularly weighty argument is the fact that Freud discovered the hidden meaning of dreams by empiric and not deductive methods. A further argument in favour of a possible hidden, as opposed to the manifest meaning of dreams, is obtained by comparing dream-phantasies with other phantasies (day-dreams and the like) in one and the same individual. It is not difficult to conceive that such day-phantasies have not merely a superficial, concrete meaning, but also a deeper psychological meaning. It is solely on account of the brevity that I must impose upon myself, that I do not submit materials in proof of this. But I should like to point out that what may be said about the meaning of phantasies, is well illustrated by an old and widely diffused type of imaginative story, of which Æsop's Fables are typical examples, wherein, for instance, the story is some objectively impossible phantasy about the deeds of a lion and an ass. The concrete superficial meaning of the fable is an impossible phantasm, but the hidden moral meaning is plain upon reflection. It is characteristic that children are pleased and satisfied with the exoteric meaning of the story. However, the best argument for the existence of a hidden meaning in dreams is provided by conscientious application of the technical procedure to solve the manifest dream content.
This brings us to our second main point, viz.—the question of analytic procedure. Here again I desire neither to defend nor to criticise Freud's views and discoveries, but rather to confine myself to what seem to me to be firmly established facts.
The fact that a dream is a psychic structure, does not give us the slightest ground for assuming that it obeys laws and designs other than those applicable to any other psychic structure. According to the maxim: principia explicandi prœter necessitatem non sunt multiplicanda, we have to treat dreams, in analysis, just as any other psychic structure, until experience teaches us some better way.
We know that every psychic construction considered from the standpoint of causality, is the resultant of previous psychic contents. Moreover, we know also that every psychic structure, considered from the standpoint of finality, has its own peculiar meaning and purpose in the actual psychic process. This standard must also be applied to dreams. When, therefore, we seek a psychological explanation of a dream, we must first know what were the preceding experiences out of which it is combined. We must trace the antecedents of every element in the dream picture. For example: some one dreams "that he is walking in a street, a child is running in front of him, who is suddenly run over by a motor-car." We will trace the antecedents of this dream-picture, with the aid of the dreamer's recollections.
He recognises the street as one down which he had walked on the previous day. The child he acknowledges as his brother's child, whom he had seen on the previous evening when visiting his brother. The motor accident reminds him of an accident that had actually occurred a few days before, but of which he had only read an account in a newspaper. Popular opinion is known to be satisfied with this kind of explanation. People say: "Oh, that is why I dreamt such and such a thing!"
Obviously this explanation is absolutely unsatisfactory from a scientific standpoint. The dreamer walked down many streets on the previous day; why was this particular one selected? He had read about several accidents; why did he select just this one? The mere disclosure of an antecedent is by no means sufficient; for a plausible determination of the dream presentation can only be obtained from the competition of various determinants. The collection of additional material proceeds, according to the principle of recollection that has been called the Association Method. The result, as will easily be understood, is the admission of a mass of multifarious and quite heterogeneous material, having apparently nothing in common but the fact of its evident associative connection with the dream contents, since it has been reproduced by means of this content.
How far the collection of such material should go, is an important question from the technical point of view. Since the entire psychic content of a life may be ultimately disclosed from any single starting point, theoretically the whole previous life-experience might be found in every dream. But we only need to assemble just so much material as is absolutely necessary in order to comprehend the dream's meaning. The limitation of the material is obviously an arbitrary proceeding, according to that principle of Kant's whereby to comprehend is "to perceive to the extent necessary for our purpose." For instance, when undertaking a survey of the causes of the French Revolution, we could, in amassing our material, include not only the history of medieval France but also that of Rome and Greece, which certainly would not be "necessary for our purpose," since we can comprehend the historical genesis of the Revolution from much more limited material.
Except for the aforesaid arbitrary limitation, the collecting of material lies outside the investigator's discretion. The material gathered must now be sifted and examined, according to principles which are always applied to the examination of historical or any empirical scientific material. The method is an essentially comparative one, that obviously cannot be applied automatically, but is largely dependent upon the skill and aim of the investigator.
When a psychological fact has to be explained, it must be remembered that psychological data necessitate a twofold point of view, namely, that of causality and that of finality. I use the word finality intentionally, in order to avoid confusion with the idea of "teleology." I use finality to denote immanent psychological teleology. In so far as we apply the view point of causality to the material that has been associated with the dream, we reduce the manifest dream content to certain fundamental tendencies or ideas. These, as one would expect, are elementary and universal in character.
For instance, a young patient dreams as follows: "I am standing in a strange garden, and pluck an apple from a tree. I look about cautiously, to make sure no one sees me."
The associated dream material is a memory of having once, when a boy, plucked a couple of pears surreptitiously from another person's garden.
The feeling of having a bad conscience, which is a prominent feature in the dream, reminds him of a situation he experienced on the previous day. He met a young lady in the street—a casual acquaintance—and exchanged a few words with her. At that moment a gentleman passed whom he knew, whereupon our patient was suddenly seized with a curious feeling of embarrassment, as if he had done something wrong. He associated the apple with the scene in Paradise, together with the fact that he had never really understood why the eating of the forbidden fruit should have been fraught with such dire consequences for our first parents. This had always made him feel angry; it seemed to him an unjust act of God, for God had made men as they were, with all their curiosity and greed.
Another association was, that sometimes his father had punished him for certain things in a way that seemed to him incomprehensible. The worst punishment had been bestowed after he had secretly watched girls bathing.
That led up to the confession that he had recently begun a love affair with a housemaid, but had not yet carried it through to a conclusion. On the day before the dream he had had a rendezvous with her.
Upon reviewing this material we see that the dream contains a very transparent reference to the last-named incident. The connecting associative material shows that the apple episode is palpably meant for an erotic scene. For various other reasons, too, it may be considered extremely probable that this experience of the previous day is operative even in this dream. In the dream the young man plucks the apple of Paradise, which in reality he has not yet plucked. The remainder of the material associated with the dream is concerned with another experience of the previous day, namely, with the peculiar feeling of a bad conscience, which seized the dreamer when he was talking to his casual lady acquaintance; this, again, was connected with the fall of man in Paradise, and finally with an erotic misdemeanour of his childhood, for which his father had punished him severely. All these associations are linked together by the idea of guilt.
In the first place we will consider this material from Freud's view-point of causality; in other words, we will "interpret" it, to use Freud's expression. A wish has been left unfulfilled from the day before the dream. In the dream this wish is realised in the symbolical apple scene. But why is this realisation disguised and hidden under a symbolic image instead of being expressed in a distinctly sexual thought? Freud would refer to the unmistakable sense of guilt shown up by the material, and say the morality that has been inculcated in the young man from childhood is bent on repressing such wishes, and to that end brands the natural craving as immoral and reprehensible. The suppressed immoral thought can therefore only achieve expression by means of a symbol. As these thoughts are incompatible with the moral content of the conscious ego, a psychic factor adopted by Freud called the Censor, prevents this wish from passing undisguised into consciousness.
Reviewing the dream from the standpoint of finality, which I contrast with that of Freud, does not—as I wish to establish explicitly—involve a denial of the dream's causæ, but rather a different interpretation of the associative material collected around the dream. The material facts remain the same, but the standard by which they are measured is altered. The question may be formulated simply as follows: What is this dream's purpose? What should it effect? These questions are not arbitrary, in as much as they may be applied to every psychic activity. Everywhere the question of the "why" and "wherefore" may be raised.
It is clear that the material added by the dream to the previous day's erotic experience, chiefly emphasises the sense of guilt in the erotic act. The same association has already been shown to be operative in another experience of the previous day, in the meeting with his casual lady acquaintance, when the feeling of a bad conscience was automatically and inexplicably aroused, as if, in that instance, too, the young man had done something wrong. This experience also plays a part in the dream, which is even intensified by the association of additional, appropriate material; the erotic experience of the day before, being depicted by the story of the Fall which was followed by such a severe punishment.
I maintain that there exists in the dreamer an unconscious propensity or tendency to conceive his erotic experiences as guilty. It is most characteristic that the association with the Fall of Man should ensue, the young man having never really grasped why the punishment should have been so drastic. This association throws light upon the reasons why the dreamer did not think simply, "I am doing what is not right." Obviously he does not know that he might condemn his own conduct as morally wrong. This is actually the case. His conscious belief is that his conduct does not matter in the least morally, as all his friends were acting in the same way; besides, for other reasons too, is unable to understand why a fuss should be made about it.
Whether this dream should be considered full or void of meaning depends upon a very important question, viz. whether the standpoint of morality, handed down to us through the ages by our forefathers is held to be full or void of meaning. I do not wish to wander off into a philosophical discussion of this question, but would merely observe that mankind must obviously have had very strong reasons for devising this morality, otherwise it would be truly incomprehensible why such restraints should be imposed upon one of man's strongest cravings. If we attach due value to this fact, we are bound to pronounce this dream to be full of meaning, for it reveals to the young man the necessity of facing his erotic conduct boldly from the view point of morality. Primitive races have in some respects extremely strict legislation concerning sexuality. This fact proves that sexual morality is a not-to-be-neglected factor in the soul's higher functions, but deserves to be taken fully into account. In the case in question it should be added, that the young man—influenced by his friends' example—somewhat thoughtlessly let himself be guided exclusively by his erotic cravings, unmindful of the fact that man is a morally responsible being and must perforce submit—voluntarily or involuntarily—to a morality that he himself has created.
In this dream we can discern a compensating function of the unconscious, consisting in the fact that those thoughts, propensities, and tendencies of a human personality, which in conscious life are too seldom recognised, come spontaneously into action in the sleeping state, when to a large extent the conscious process is disconnected.
The question might certainly be raised, of what use is this to the dreamer if he does not understand the dream?
To this I must remark that to understand is not an exclusively intellectual process, for—as experience proves—man may be influenced—nay, even very effectually convinced—by innumerable things, of which he has no intellectual understanding. I will merely remind my readers of the efficacy of religious symbols.
The example given above might suggest the thought that the function of dreams is a distinctly "moral" one. Such it appears to be in this case, but if we recall the formula according to which dreams contain the subliminal materials of a given moment, we cannot speak simply of a "moral" function. For it is worthy of note that the dreams of those persons whose actions are morally unexceptionable, bring materials to light that might well be characterised as "immoral" in the current meaning of that term. Thus it is significant that St. Augustine was glad that God did not hold him responsible for his dreams. The unconscious is the unknown of a given moment, therefore it is not surprising that all those aspects that are essential for a totally different point of view should be added by dreams to the conscious psychological factors of a given moment. It is evident that this function of dreams signifies a psychological adjustment, a compensation essential for properly balanced action. In the conscious process of reflection it is indispensable that, so far as possible, we should realise all the aspects and consequences of a problem, in order to find the right solution. This process is continued automatically in the more or less unconscious state of sleep, wherever—as our previous experience seems to show—all those other points of view occur to the dreamer (at least by way of allusion) that during the day were underestimated or even totally ignored; in other words, were comparatively unconscious.
As regards the much-discussed symbolism of dreams, the value attached to it varies according to whether the standpoint of causality or of finality is adopted. According to Freud's causal view point it proceeds from a craving, viz. from the suppressed dream-wish. This craving is always somewhat simple and primitive, and is able to disguise itself under manifold forms. For instance, the young man in question might just as well have dreamt that he had to open a door with a key, or that he had to travel by aeroplane, or that he was kissing his mother, etc. From this standpoint all those things would have had the same meaning. In this way, the typical adherents of Freud's school have come to the point of interpreting—to give a gross instance—almost all long objects in dreams as phallic symbols.
From the view-point of finality, the various dream pictures have each their own peculiar value. For instance, if the young man, instead of dreaming of the apple scene, had dreamt he had to open a door with a key, the altered dream picture would have furnished associative material of an essentially different character; that, again, would have resulted in the conscious situation being supplemented by associations of a totally different kind from those connected with the apple scene. From this point of view, it is the diversity of the dream's mode of expression that is full of meaning, and not the uniformity in its significance. The causal view-point tends by its very nature towards uniformity of meaning, that is, towards a fixed significance of symbols. On the other hand, the final view-point perceives in an altered dream picture, the expression of an altered psychological situation. It recognises no fixed meaning of symbols. From this standpoint all the dream pictures are important in themselves, each one having a special significance of its own, to which it owes its inclusion in the dream. Keeping to our previous example, we see that from the standpoint of finality the symbol in this dream is approximately equivalent to a parable; it does not conceal, but it teaches. The apple scene recalls vividly the sense of guilt, at the same time disguising the real deed of our first parents.
It is obvious we reach very dissimilar interpretations of the meaning of the dream, according to the point of view adopted. The question now arises, which is the better or truer version? After all, for us therapeuts it is a practical and not a merely theoretical necessity that leads us to seek for some comprehension of the meaning of dreams. In treating our patients we must for practical reasons endeavour to lay hold of any means that will enable us to train them effectually. It should be quite evident from the foregoing example, that the material associated with the dream has opened up a question calculated to make many matters clear to the young man, which, hitherto, he has heedlessly overlooked. But by disregarding these things he was really overlooking something in himself, for he possesses a moral standard and a moral need just like any other man. By trying to live without taking this fact into consideration, his life is one-sided and incomplete, so to say inco-ordinate; with the same consequences for the psychological life as a one-sided and incomplete diet would have for the physical. In order to develop a person's individuality and independence to the uttermost, we need to bring to fruition all those functions that have hitherto attained but little conscious development or none at all. In order to achieve this aim, we must for therapeutic reasons enter into all those unconscious aspects of things brought forward by the dream material. This makes it abundantly clear that the view-point of finality is singularly important as an aid to the practical development of the individual.
The view-point of causality is obviously more in accord with the scientific spirit of our time, with its strictly causalistic reasoning. Much may be said for Freud's view as a scientific explanation of dream psychology. But I must dispute its completeness, for the psyche cannot be conceived merely from the causal aspect, but necessitates also a final view-point. Only a combination of both points of view—which has not yet been attained to the satisfaction of the scientific mind, owing to great difficulties both of a practical and theoretical nature—can give us a more complete conception of the essence of dreams.
I would like to treat briefly of some further problems of dream psychology, that border on the general discussion of dreams. Firstly, as to the classification of dreams; I do not wish to overestimate either the practical or theoretical significance of this question. I investigate yearly some 1500-2000 dreams, and this experience enables me to state that typical dreams actually do exist. But they are not very frequent, and from the view-point of finality they lose much of the importance which attaches to them as a result of the fixed significance of symbols according to the causal view-point. It seems to me that the typical themes of dreams are of far greater importance, for they permit of a comparison with the themes of mythology. Many of these mythological themes—in the study of which Frobenius has rendered notable service—are also found in dreams, often with precisely the same significance. Unfortunately the limited time at my disposal, does not permit me to lay detailed materials before you: this has been done elsewhere.[193] But I desire to emphasise the fact that the comparison of the typical themes of dreams with those of mythology obviously suggests the idea (already put forward by Nietzsche) that from a phylogenetic point of view dream-thought should be conceived as an older form of thought. Instead of multiplying examples in explanation of my meaning, I will briefly refer you to our specimen dream. As you remember, that dream introduced the apple scene as a typical representation of erotic guilt. The gist of its purport is: "I am doing wrong in acting like this." But it is characteristic that a dream never expresses itself in a logically abstract way, but always in the language of parable or simile. This peculiarity is also a characteristic feature of primitive languages, whose flowery idioms always strike us. If you call to mind the writings of ancient literature—e.g. the language of simile in the Bible—you will find that what nowadays is expressed by means of abstract expressions, could then only be expressed by means of simile. Even such a philosopher as Plato did not disdain to express certain fundamental ideas by means of concrete simile.
Just as the body bears traces of its phylogenetic development, so also does the human mind. There is therefore nothing surprising in the possibility of the allegories of our dreams being a survival of archaic modes of thought.
The theft of the apple in our example is a typical theme of dreams, often recurring with various modifications. It is also a well-known theme in mythology, and is found not only in the story of the Garden of Eden, but in numerous myths and fables of all ages and climes. It is one of those universally human symbols, which can reappear in any one, at any time. Thus, dream psychology opens up a way to a general comparative psychology, from which we hope to attain the same sort of understanding of the development and structure of the human soul, as comparative anatomy has given us concerning the human body.
CHAPTER XIII
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.