Collected Papers on Analytical Psychology

by C. G. Jung

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.