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Glands in Health and Disease. By BENJAMIN HARROW. George Routledge & Sons. pp. xvi + 218. Price 8s. 6d.
An eminent physiologist has recently stated that the rapid growth of organotherapy is largely due to the appalling ignorance which exists in the minds of the laity as to their own anatomy and physiology. He was referring, no doubt, to those developments which did not meet with his approval; but he spoke disparagingly of the standard of education which exists in the average man where matters medical are concerned.
In the little book which Dr Harrow has written, presumably his object is to remedy this state of ignorance, at all events in so far as the ductless glands are concerned. He tells us in the preface "there is a crying need...of simple, yet clear statements of scientific work to which the layman can refer." This point is, at least, debatable, for it is sometimes contended that the less an individual knows about the workings of his organs the better. Certainly in so far as their pathology is concerned, there is a good deal of truth in this; for out of a little knowledge, much morbidity is capable of springing.
Dr Harrow has written a clear account of the endocrine glands, and has delivered up his message in language understandable by all. His descriptions in popular language of such differentiations as internal and external secretions; of vitamines and hormones, and his accounts of the normal and abnormal actions of such glands as the thyroid, are intelligible to all. One wonders whether, in a book such as this, which has no purpose save the enlightenment of the ignorant in such matters, there is any good purpose served by the lengthy and highly technical footnotes on physiological and chemical experi
The thyroid gland is described, and its work in health and disease discussed; a section being devoted to exophthalmic goitre. To describe the treatment of this distressing complaint in a book of this kind seems unnecessary if not undesirable.
The parathyroids and tetany are described; but the fact now widely recognised that this latter name is not a disease but merely a term to connote a state which may arise from a multiplicity of causes, is not made clear. Moroever, while the theory that tetany is due to guanidine is referred to, no mention is made of other theories, at least equally well supported, as, for example, that its symptoms are due to an alkalosis.
The footnote on page 49, in which the word 'anterior' is defined as "any part nearer the head than another part is anterior to the latter; if farther away it is posterior," leaves much to be desired in the matter of accuracy and clarity. For while anterior is used in this sense in zoology, it is not so employed in human anatomy, owing to the cogent fact that man is not a quadruped; and it should be made clear that this definition does not apply to human anatomy.
In the chapter on the Pancreas and Liver, the medical reader will be puzzled as to the reason for describing, for example, the Allen treatment for diabetes. It seems to us, that anyone desirous of obtaining such information, would best do so by consulting his physician, or alternatively a text-book on metabolism. Justice cannot be done to the value of such a therapeutic procedure in two paragraphs.
In the chapter on the nervous system and the ductless glands (which, by the way, consists of over thirty pages), a large amount of space is given up to
a consideration of the difference of opinion existing between physiologists on highly technical points, such as the action of adrenaline. It is possible that these differences will interest the lay reader, but, frankly, we doubt it.
The book contains an adequate Bibliography and a good Index. Despite the tendency to insert technical descriptions into a book not intended for the technical reader, Dr Harrow has produced a clearly written description in simple language of the endocrine glands and the utilisation of their products in the treatment of disease. For anyone desiring an introduction to more serious study, we can recommend this volume.
I. GEIKIE COBB.
NOTES ON RECENT PERIODICALS
Internationale Zeitschrift für Psycho-Analyse, Vol. VIII, part п, 1922.
In an article entitled "Castration complex and character" Dr Franz Alexander contributes a study on the so-called passagere Symptome, symptoms which make a transitory appearance during an analysis: "a kind of laboratory products of the analytic work," which are explained as manifestations of the resistance.
Alexander prefaces his detailed description of the analysis of a neurotic character' with some observations on the dynamics of the process by which, in such characters, unconscious tendencies find outlet in irrational conduct in life, rather than in symptomformation. Such conduct affords a real gratification, deprived of which the neurotic character will develop neurotic symptoms. Deprivation may result from external circumstances or, as in the case in question, may ensue upon the subject's becoming conscious during analysis of the tendencies underlying his irrational conduct. The transitory symptom then makes its appearance in what Freud calls the fresh neurosis of the transference.
There follows the account of the analysis of a patient whose neurotic character manifested itself in his conjugal and social relations. The unconscious tendency, arising out of fixation to the mother, to degrade the wife to the level of prostitute drove him to pay his wife in material gifts on each occasion of intercourse. His social relations had this peculiarity: that he was repeatedly in the situation of being cheated and robbed by his associates, while his own business dealings were marked by a scrupulous honesty.
Analysis showed that the core of the formation of his character was the castration complex. The sense of guilt resulting from the incest-wish transformed the active desire to castrate the father into a passive castration-wish, represented by passive kleptomania and passive homosexuality, which latter tendency produced in the transference situation certain of the passagere Symptome.
The impulse to pay for sexual intercourse by gifts originated in the passive castration-wish, in the sense of "anal castration" (faeces = money). In an exceedingly interesting passage Alexander shows that the human being learns from the two primary castrations' (loss of the nipple, or oral castration; loss of the faeces or anal castration), that the price of every pleasure is the loss of the pleasure-giving bodily part. This experience produces an affective state in which the fear of castration readily attaches itself to onanistic activities. This fear therefore is not necessarily to be accounted for by an actual threat or phylogenetically.
In a concluding section the writer shows that behind these primary castrations there lies the original traumatic experience of birth, which to the Unconscious is equivalent to castration. In various hypochondriac symptoms (sense of strangulation etc.) we see a compromise between the incestuous desire to return to the mother's womb and the punishment-wish of castration.
The case of writer's cramp described by Dr Robert Hans Jokl in his article “On the psychogenesis of writer's cramp" was also found to originate in the castration complex. The symptom first made its appearance on an occasion when the patient was required to sign his name to a document, in the presence of a business-superior. The occurrence of the symptom coincided with the breaking-off of a love-relation which had gratified his homosexual tendencies, in that, although the love-object was a woman, it afforded him an opportunity for certain practices which represented homosexual activities of his early days. This deprivation of real gratification caused the libido to regress to the infantile fixations.
Analysis revealed a strong fixation to the father, characterised on the one hand by the desire to observe and to touch the penis of the latter and, on the other, by the sadistic wish to castrate the father-rival. The sense of guilt gave rise to the fear of castration, manifesting itself in later life as a sense of inferiority (with reference to
his own potency), in which he himself felt the parallel to his 'impotence,' due to writer's cramp, in the pursuit of his calling.
The castration-fear expressed itself in anxiety when he was required to write in the presence of a business-superior (= the father), the holding of the pen symbolising the forbidden homosexual desires. It is clear that the hand, the guilty member with which he had carried on auto- and homoerotic activities, thus became the object of his impulse to self-punishment.
In this paper, Dr Jokl raises several interesting considerations, supported by the findings of the analysis under discussion. These considerations, he thinks, should be borne in mind in analytic research, though he warns the reader against premature generalisations.
He is inclined to think that in certain obsessional neuroses urethral erotism may preponderate over the anal-erotic tendencies which belong to the same pregenital phase of libido development. He found, in several cases in which writer's cramp was one of the symptoms, a certain agreement, in that sadistic homosexual tendencies were based upon a marked urethral erotic disposition.
In the analysis of this particular case, the distinctive form of the transferencean excessively strong father-transference enabled him to infer the peculiarity of the libido-tendencies. But he thinks that there are not sufficient grounds for regarding this phenomenon as a universal one.
Dr Helene Deutsch contributes an article on "The pathological lie" (pseudologia phantastica), in which she institutes a comparison between pseudologia and other mental activities. Pseudologia bears a resemblance to day-dreaming, in that the content of the products of both represents the fulfilment of ambitious or erotic wishes, originating in the Unconscious, the subject being the centre of the phantasy. But an important difference between these two activities is that, whereas the daydreamer, conscious of the unreality of his phantasies, keeps them secret, the pseudologist is driven by an urgent impulse to impart them to others in the guise of reality. Poetic creation, which, as Freud has shown, is intimately related to day-dreaming, aims at aesthetic enjoyment, an element lacking in day-dreaming and pseudologia alike. From the analysis of a young girl in whom this symptom manifested itself at the time of puberty, Dr Deutsch was able to conclude that here the pseudologia represented a compromise resulting from the attempt to divert the libido from phantasy to a real object. A repressed infantile experience (which caused a fixation to the patient's brother) was reactivated in a purely imaginary relation to a youth whom she knew only by sight, the content of phantasies which she recounted as facts being thus directly derived from a repressed reality.
Two points are specially noteworthy: first, that the patient incurred blame and punishment by telling of a relation with the hero of her phantasies, the actuality of which was not at first doubted by her relatives. This is in accordance with an observation Dr Deutsch has had opportunities of making, namely, that the pseudologist tells his 'lies,' acting on an inner compulsion and without any regard, primarily, for the effect they may produce on his audience. And secondly, the young girl, far from seeking to realise her desires, avoided all opportunities of doing so. The explanation is that the object to which her libido directed itself in puberty was identified with the incestuous object of early childhood. The incest-prohibition occasioned a flight from reality, for which the formula, as represented in the pseudologia was as follows: "Since this is already reality, there is no need for it to become such."
The writer then compares the mechanism of pseudologia to that of hysteria. In both there is the return to a repressed infantile experience and the fulfilment of a forbidden wish, and in both repression has failed. In conversion hysteria, the repressed idea is expressed in bodily symptoms, while the affect disappears; in anxiety hysteria, the repressed idea is displaced and the affect is converted into the painful one of anxiety; in pseudologia, the repressed material returns, related to a new and permissible object, to which the original affect is attached, thus securing gratification. Pseudologia then represents, in such a case as that under discussion, a compromiseformation, designed by its adaptation to reality to deliver the subject from the burden of a repressed recollection.
Med. Psych. III.
The last of the original papers in this number is by Siegfried Peine and deals with the problem of the thirst for change (especially in the sexual life), which, passing through various degrees of neurotic intensity, may end as fully developed 'Don Juanism.'
The author suggests the following root-causes of this peculiarity:
(1) The discrepancy between an abnormal 'hunger' of the libido and the amount of available gratification, giving rise to unsuccessful attempts at repression and a constant restless craving.
(2) A pseudo-infantilism,' by virtue of which the neurotic 'plays' with pleasure, manifesting a childish inconstancy and variability.
(3) The entertaining of an exaggerated ideal of the love-object. The contrast between reality and phantasy leads to perpetual disappointment and a renewed search for the unattainable.
(4) Fixation to the situation of wooing.
(5) A sadistic tendency, showing itself in the impulse to play the part of conqueror and to cause pain by the subject's lack of constancy.
(6) A lack of determination of the subject's real sexual feeling, making him incapable of a lasting relation (e.g. an oscillation between homosexual and heterosexual love).
Throughout this study the writer works out Freud's parallel between the sexual character of the individual and his general character as shown in his attitude to life as a whole.
The journal includes, besides critical notes and reviews, the following short communications:
A contribution to the problem of the act of waking, by Dr F. Künkel, a comparison of 'hynogogic' and 'hypnopompic' phenomena, with reference to Freud's hypothesis of regression and the systems1.
"The psyche as an organ of inhibition," by Dr S. Ferenczi, being notes on Dr Alexander's "Metapsychological Observations in an earlier number of the Zeitschrift.
Two papers on Freud's "Massenpsychologie und Ich-Analyse," the one by Dr Ferenczi on the advance in the psychology of the individual, and the other by Dr Róheim on that part of Freud's book which deals with the psychology of nations.
Internationale Zeitschrift für Psycho-Analyse, Vol. vII, part ш, 1922.
This number of the Zeitschrift opens with a short paper by Professor Freud on "Some neurotic mechanisms in jealousy, paranoia and homosexuality." He distinguishes three kinds or strata' of jealousy: normal or competitive jealousy, projected jealousy and delusional jealousy, and, in discussing the part played by the last in paranoia, compares it with the delusions of paranoia persecutoria and demonstrates that it is a defence-reaction against an excessive homosexual tendency.
Normal jealousy is made up of the following components: pain caused by the supposed loss of the object and the blow to the narcissism of the subject, hostile feelings towards the rival and a measure of self-criticism, which blames the ego for the loss sustained; such jealousy is ultimately derived from the Oedipus complex or the relation to brothers and sisters during the earliest period of sexual activity.
In projected jealousy an unconscious mechanism is at work by which the subject attributes his own tendencies to unfaithfulness to the other person. Such jealousy may be of an almost insane character, but the unconscious phantasies underlying it may be brought to light by analysis.
Paranoia for the most part resists such investigation, but Freud was able to gain a certain amount of fresh insight into the subject from the study of two cases. In the first, he found that the victim of delusional jealousy was concentrating an abnormally close observation upon the unconscious tendencies of others, about which he drew exaggerated conclusions. In an analogous fashion, patients suffering from delusions of persecution will seize upon the most trivial actions of others, construing in1 Traumdeutung, 4 Aufl., S. 420 ff. 2 Intern. Zeitschrift, vol. ví, p. 275.