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The mental manifestations of Multiple Sclerosis are presented in this volume by Drs Sanger Brown and Thomas K. Davis, and some emotional and psychological factors bearing upon the development of this disease are discussed by Dr Smith Ely Jelliffe.
Drs Brown and Davis think that in probably 90 per cent. of cases there are mental alterations which warrant the meaning commonly granted to the term "mental symptoms," but these are so overshadowed by the physical symptoms that they have very commonly been disregarded. The mental states enumerated here are Euphoria, Mental Depression, Mental Deterioration and Hallucinations.
Dr Jelliffe discusses the psychological symptoms from the standpoint of the offending focal lesions and examines the compensating psychological manifestations which the patient builds up in the face of the disease. He also seriously questions whether psychological factors may not be conceived as playing an important, if not determining, rôle in producing some special types of Multiple Sclerosis. He believes a study of unconscious factors in organic disease to be of paramount importance. T. W. M.
NOTES ON RECENT PERIODICALS
Internationale Zeitschrift für Psychoanalyse. 1922. Part 4.
In a paper entitled "Perversion und Neurose" Dr Otto Rank has followed up the analysis of the phantasy "Ein Kind wird geschlagen" (A child is being beaten) in which Freud showed that the phantasy is based on a phase of the Oedipus situation which has undergone repression. Those who have studied psycho-analysis are familiar with the view that neurosis may be regarded as the negative of perversion. In this paper Rank expresses the relation rather differently when he describes neurosis as a kind of half-way house on the road of development of certain libidinal tendencies the ultimate destination of which, if they pursued their way unchecked, would be perversion. The word 'tendencies' is used deliberately because, as Rank shows, a perversion is a mechanism by which satisfaction is obtained not for a single libidinal tendency only, but for several. The manifest form of the perversion, like the manifest content of the dream, may be the product of processes of condensation, displacement and secondary elaboration.
Perversion is then essentially the result of a complicated libido-development, which is best studied by means of the analysis of neurotics in whom there is no manifest perversion, the process having stopped short at symptom-formation. When the unconscious preliminary phases are thus brought to light, we see that they lie between an infantile phase of the libido and the full-blown perversion which is at once the remotest offshoot of, and a return to, the said infantile phase.
From this point of view Rank discusses the unconscious roots of exhibitionism, using the analysis of an hysterical patient to illustrate his thesis. He shows that her latent exhibitionism belonged to a repressed beating-phantasy, associated with a scene in early childhood when her elder sister was beaten by her father. This phantasy, as well as her recurrent exhibitionist dreams, expressed a conflict between narcissistic and object-libido. Analysis revealed on the one hand the wish to have a child by her father, in accordance with the infantile theories of coitus as a sadistic act and birth as taking place by the anal orifice, and on the other hand a narcissistic cathexis of the genitals with return to autoerotic satisfaction. (Anal exposure is regressively substituted for genital exposure.)
The writer points out that the definition of perversion as a form of libidinal satisfaction outside the normal sexual goal is illuminated by the understanding (which we owe to Freud) that in perversions there is regression to infantile phases of sexual development-phases in which the child neither differentiated between the sexes nor recognised the normal sexual goal, for he knew nothing of the sexual act. During the period of infantile sexual activity children of both sexes do, however, recognise a sexual goal, namely that of receiving like the mother a child from the father.
What happens then to this desire for a child, a desire which Rank says becomes a libido-symbol for the unconscious? Owing to the impossibility of realising his desire the child's tendency to identify itself with its parents is frustrated and its ego develops. The normal person defers the realisation of this wish to maturity and in the latency period substitutes for it the ego-ideal, but the pervert, while renouncing the infantile libidinal goal and avoiding the sexual act, gratifies in narcissistic fashion (fellatio, paederastia) the component instincts which originally subserved that goal. The neurotic on the other hand retains the infantile wish but connects it with the component instincts, so that the genital function is excluded. His symptoms represent fulfilment of the wish in extra-genital ways and his feeling of guilt is attached to repressed phantasies with this content.
One of the sections of the paper is devoted to a discussion of masturbation. This practice represents a compromise between autoerotic and reproductive gratifica
tion, as well as a transition to the primacy of the genitals. Premature repression of the physical autoerotic components may result in neurosis; perversion follows when they usurp the place of the reproductive libido.
Rank emphasises the importance of the sense of guilt attached to onanism. It is upon the fate of this sense of guilt that the fate of the whole infantile libido depends. Normally, this feeling serves a useful biological and social purpose, but in neurosis there is an excessive 'free-floating' sense of guilt, and just in so far as the patient can be free from this excess is there a possibility of cure. Perverts on the other hand appear to lack the sense of guilt in gratifying the component instincts to the exclusion of the reproductive libido. On this showing masochism must be regarded as an unsuccessful perversion-formation. But Rank shows that, if analysis of a true perversion goes sufficiently deep, the sense of guilt will be reached, and that the way to cure then lies through a neurotic phase in which that sense becomes connected with libidinal and ego-tendencies.
At the conclusion of the article the writer brings the principal perversions into relation with the sense of guilt and the mechanism of defence against it, showing that in each case there is a return to infantile sexual theories. Only instead of desiring to have a child, the pervert, in respect of his perverse tendencies, is a child: the homosexual ignores the difference of sex, the exhibitionist takes an infantile delight in self-display, while the masochist places himself in the situation of being beaten like a child.
Dr Stefan Hollós contributes an article on "The time-feeling" (Das Zeitgefühl). This feeling he distinguishes from the sense of time, i.e. the capacity for estimating intervals of time, and the consciousness of time by which we orientate ourselves in time. Both these faculties belong to the conscious system. In this paper he discusses a third faculty, which is unconscious and which he calls the 'time-feeling.' He shows that it is subject to pathological disturbances, even when the conscious time-faculties are operating undisturbed. These disturbances may take the form of the complete neglect of an interval of time (as when a patient suffering from psychosis gives his age as that at which he entered an asylum), or that of the sense of having passed through many years in what is actually a short space of time.
As regards the former disturbance it might be suggested that it is an instance of wish-fulfilment, the patient translating himself to a happier period, or else that with his withdrawal of libido from the outside world he has withdrawn it from dates and the passage of time. When the disturbance in the time-feeling takes the latter form, it might be due to an increase of external perception. (Even the hallucinations of mania and delirium are apparently perceptions from without.)
Dr Hollós, however, puts forward another explanation which is briefly this: that the unconscious time-feeling is based on the rhythmic discharge of stimuli and that this rhythm is a repetition of a reaction in the protoplasm to cosmic stimuli.
Here he follows August Stärcke's description of the evolution of psychic mobility. Stärcke distinguishes certain phases in which the discharge of accumulated stimuli is successively tonic, epileptic, rhythmic, of the nature of a reaction, and finally the phase of thought in which there is deferred reaction. Hollós goes on to show that in every phase, even the highest, there is the impulse to rhythmic discharge, that like all impulses this must have been originally a reaction to some external stimulus. The stimulus here he believes to be cosmic, and especially solar, influences e.g. phases of the sun and moon, revolution of the earth on its axis and above all the succession of day and night. Even in the highest organisms certain organs, for instance the heart and lungs, reproduce this primitive rhythmic discharge of stimuli, whilst the higher discharge in thought, arrhythmic and seeming independent of cosmic influences as it is, is yet regulated by the rhythm of these organs. Morcover there is a certain rhythm in the direction of our attention, and periodically (in sleep) we withdraw our libido from the outside world.
Since, then, the time-feeling depends on this unconscious rhythm, the writer defines it as "an endo-psychic perception of the fluctuation of libido-distribution, related to somewhat analogous real cosmic changes."
Dynamically the time-feeling is conceived of thus: a stream of energy seeks
discharge by two opposing outlets, (1) at the stable, phylogenetic, rhythmic end, which is timeless and unconscious, and (2) at the labile end, which is variable and subject to time. The labile discharge may be affected by an increase in resistance, which results in an increased libidinal cathexis of the lower methods of outlet, or by a decrease in resistance, in consequence of which there is over-investment of the actual libidinal discharge and a diminution in the regulating influence from the stable end. The former disturbance would lead to narcissistic states and the latter to hallucinations.
Thus Dr Hollós arrives at the conclusion that pathological alteration in the timefeeling is due to a change in the distribution of libido in respect of its discharge in motility.
The third original article is by Dr E. Weiss on the analysis of a case of nervous asthma. He shows that the asthmatic attacks of the patient had a mechanism very similar to that of a phobia and were a reaction to separation from the mother. Besides a strong mother-fixation the castration complex and anal-erotic tendencies played their part in the neurosis.
There are four short communications in this number: (1) Notes on Dr Alexander's paper "Kastrationkomplex und Charakter" (Int. Zeitschr. 1922, 2) by Dr Wilhelm Reich. The writer discusses two contrasting narcissistic types, in the first of which there are manifest feelings of inferiority and latent narcissism, the subject deriving gratification from the ego-ideal, while in the second manifest narcissism compensates for latent feelings of inferiority, and gratification is obtained from the real ego; (2) the analysis of an obsessional symptom by Dr M. J. Eisler; (3) a paper on the spider as a dream-symbol, by Dr Karl Abraham; (4) a case, communicated by Monroe Meyer, of a dream six times repeated, illustrating Freud's statement that the form of a dream or the manner in which it is dreamt may represent part of the latent
The Journal contains reports of the 7th International Psycho-Analytical Congress held in Berlin last year and of the work and organisation of the Psycho-Analytic Clinic in Berlin.
Annales Médico-psychologiques (Series XII, vol. 2).
Chronique-Le Centenaire de la Thèse de Bayle (1822-1922).
The centenary was celebrated in Paris on May 30th and 31st, 1922. The discussions were based on seven papers under the general title "La Paralysie générale (Maladie de Bayle)." Summaries of the papers and discussions are given. The papers are:
1. The forerunners of Bayle, by Laignal-Lavastine and J. Vinchon.
2. Bayle and the Work of the Charenton School, by René Semelaigne. 3. General Paralysis after the times of Bayle, by F. L. Arnaud.
4. Etiology and Pathogeny, by F. Pactet.
5. Pathological Anatomy, by Jean Lhermitte.
6. Clinical and Medico-legal Study, by R. Charpentier.
7. Treatment and Assistance, by V. Truelle.
Séquelles d'encéphalite léthargique (Drs André Collin, Tobolowska, Requin).
Particulars of three cases in which the malady seems to be an acquired state.
Un Cas d'encéphalite épidémique à évolution chronique et à forme pseudo-bulbaire (MM. Mourlon, Henri Colin and J. Lhermitte).
Report of a case. No evidence of pyramidal lesion. The suggested cause-lesion of corpus striatum. Most successful treatment-cocodylate of soda and scopolamine.
Crises d'anxiété paroxystiques chez un obsédé avec délire de doute métaphysique (Prof. Henri Claude and A. Borel).
Case of a man who had always been of an unstable, emotional, doubting disposition and suffered a severe shock at 50 years of age. He became subject to attacks of anxiety accompanied by doubt as to the reality of things which approached conviction. Mélancolie consécutive à une fracture du Crâne (MM. H. Colin, Lhermitte and G. Robin).
A man of 42 (normal and having no traceable hereditary disposition) was wounded in fronto-parietal region. Four months later he suffered from delirious melancholia and attempted suicide. Ultimately, after about six years, he scarcely moved and refused to eat except under great pressure. Post-mortem examination showed a scar in the fronto-parietal region the lesion being not of an evolutive nature.
Les séquelles psychiques de la guerre (M. Henri Colin).
A man of 49 twice wounded, the second time in the left temporal region. He became more and more apathetic and automatic as time passed.
Action de l'adrenaline sur certains états dépressifs avec hypotension artérielle (M. G. Naudoscher).
Results are always similar for any given person whether extract of or synthetic adrenalin be used and irrespective of mode of administering, provided the strength be constant. Hypodermic injection is more speedy in action. Feeble doses have no effect on dementia praecox but a rapid rise usually follows in case of melancholia and other depressed states at commencement of general paralysis. Suggestions are made as to use of this method for detecting certain disorders.
Note sur le fonctionnement du centre de psychiatrie de la 18 Région pendant la guerre (M. Molin de Teyssiew).
A tabular analysis of 4679 cases.
No. 2. July 1922.
Une question de doctrine psychiatrique; la psychose délirante dégénerative aiguë (Dr G. Halberstadt).
The classification of these cases is discussed, and the history of theories concerning them given in some detail. It is important to separate from out the chaos of psychoses, the autonomic mental diseases, of which this is one. It has nothing in common with dementia praecox, of which the early conception was too wide, and it is important to observe that many conditions wrongly called dementia are curable.
A certain relationship between all acute degenerative conditions seems undeniable. The one under consideration is an autonomic disease but its limits cannot yet be sharply defined.
Aperçu historique sur le régime des aliénés (MM. J. Raynier and H. Beaudouin).
This is an introductory chapter to a complete work on the insane and asylums for the insane from the administrative and legal point of view.
Délire systématisé et inversion sexuelle (Dr P. Quirand).
Notes on a case.
Deuxième statistique complémentaire (Dr Calixte Rougé).
Completes the record of cases admitted to the asylums at Limoux, suffering from insanity consequent on the war, 1914-1918.
Les méthodes objectives de psycho-diagnostic clinique et phrénoscopic (MM. Bonhomme and Stephanpoti).
Description of a technique for investigation of the unconscious, based on examination of the respiratory movements. Four cases are cited. Criticised adversely by MM. Toulouse, Colin, Thignard.