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sensitiveness." One may hope that the "supervision" of family life which is so largely recommended will be only temporary and educational. And one might doubt the stability of a society which demands for its protection such drastic steps as the permanent incarceration of "all tramps and cranks." "All tramps," in a land where there is a whole continent to tramp in? And "all cranks"! Is there no housing shortage in the States?

LORNA YARDE-BUNYARD.

The Constitutional Factors in Dementia Praecox. By NOLAN D. C. LEWIS, M.D. Nervous and Mental Disease Publishing Company, New York and Washington, 1923. pp. 134. Price $3.00.

This work embodies the results of an extensive research into the morbid anatomy of Dementia Praecox. The author excludes Dementia Paranoides for reasons which he will explain in future publications.

From a study of over six hundred autopsies on cases of Dementia Praecox, the author shows that the heart and circulatory system are undeveloped in this disease. In 75.5 per cent. of the cases of Dementia Praecox the heart was below average weight, the nearest approach to this proportion in other insanities being 59.1 per cent. in General Paralysis; but it would appear that the heart is below average weight in all the insanities. In Dementia Praecox, however, even the lumen of the aorta is strikingly small.

The author naturally sought an explanation of his discovery by examining the endocrine glands. This he did thoroughly in 22 of his cases and he found histopathological changes (aplasias, atrophies, scleroses and patchy hyperplasias), not only in the gonads as Sir Frederick Mott has described, but also in the thyroid, adrenals and (in six of the cases) the pituitary.

These changes "are as universally present as are the characteristic mental symptoms in the clinical picture of a case." They "do not depend on age, duration of psychosis, or the association of physical disease." Dr Lewis's considered conclusion is that the function of the glands has suffered during the development of the personality. From this and other passages in the book we gather that the author is willing to accept the view that the morbid anatomical features he has discovered are not primary, but secondary to mental factors; and that dementia praecox is of purely psychical origin.

W. H. B. STODDART.

Psychoanalysis and Suggestion Therapy. By Dr W. STEKEL. Authorized translation by JAMES S. VAN TESLAAR. Kegan Paul, Trench, Trubner and Co., Ltd. Pp. xi + 155. Price 6s. 6d. net.

Fortunately the eulogistic description of the author on the jacket, which might be regarded as mere advertisement, is confirmed by a reading of the book itself. Dr Stekel leaves no doubt in the minds of his readers, through a proper reiteration of his merits and through the avowal, with the modesty of true greatness, of occasional errors in diagnosis and treatment (these generally little ones and at any rate having occurred a long while ago excuses familiar to most doctors) that he is the world's greatest psychotherapist.

In the handsomest manner Dr Stekel admits that Freud has, or rather had his value; more in sorrow than in anger he demonstrates that Freud's decline began with his refusal to accept the lightning strokes of the world's greatest, etc. Dr Stekel complains that his cured patients evince so little gratitude; he, however, insists almost to wearisomeness that whoever does not get well under treatment by Dr Stekel has only himself to blame through his "will to illness," that the cured perhaps not unfairly claims his recovery as due to his own efforts, to his "will to wellness"-alone I did it might say both the cured and uncured.

"I assumed a bellicose tone" Dr Stekel states in one case; he always seems to be assuming a bellicose tone, to be tyrannizing the unfortunate person who does not respond to treatment by making the sufferer entirely responsible for the failure. The reviewer is reminded of the insight he once obtained into the methods of a Christian Scientist who for years ministered to a man suffering from progressive muscular atrophy. When the only progress the patient made was towards a bulbar paralysis the practitioner turned round and abused, in a most unchristian way, the wife and the other members of the family. It was their want of belief, the atmosphere of evil thinking, that was killing the patient. The poor wife was distracted to frenzy by her attempts to believe that her dying husband was getting better every day; self-accusations and mental torture evoked the compassion of a non-Christian Scientist. Dr Stekel's abusive methods, though less cruel, for they are only directed towards the patient, are not dissimilar.

However, no one would wish to have a real disagreement with Dr Stekel; it is hard to conceive of a serious discussion on psychotherapy with him as it would be to have a serious discussion on, say entomology, with Morpho Adonis. The existence of that brilliant butterfly is its own justification as is the existence of Dr Stekel with his possession of the born journalist's mind: the journalist's mind is an excellent and valuable article for a journalist; for the scientist?

With most of Dr Stekel's opinions there will be substantial agreement among psychologists: they are the commonplaces of the literature.

Perhaps Dr Stekel in the book he is now publishing or writing (he seems to have discovered the secret of perpetually finding publishers to publish the same kind of thing under another title) will correct the remark about Jung's method on p. 5.

The translation is an excellent piece of English; 'facetiously' on p. 8 would be better rendered 'half humorously.'

M. D. EDER.

Dreams. By H. TASMAN LOVELL, M.A., PH.D. Published by the Australasian Association of Psychology and Philosophy, Sydney, N.S.W. pp. 74. Price 2s. 6d.

This monograph by the associate Professor of Psychology in The University of Sydney is an attempt to expound the main features of Freud's theory of dreams and to make a critical examination of some of the more important of Freud's principles.

The author does not pretend that his treatment of the subject is exhaustive and he tells us that he is conscious of the defects that are present in the critical

section of his work; but he exercises the right which, he thinks, "every psychologist may claim, of expressing his views upon principles which are the subject of controversy, and of attempting to reconcile traditional psychology with what is apparently incontrovertible in the invaluable system evolved by Freud." We may well demur to this claim on the part of "every psychologist' until he can show that he has an adequate acquaintance with the principles he is expounding or criticising.

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Dr Lovell is apparently at that stage of criticism of Freud's doctrines where judgment is influenced by the affects connected with the subject of sex. We have all probably passed through the phase in which we feel that "there is something out of focus in this psychology" and that "there is an over-emphasis put upon the sex interests which does not accord with the facts of spiritual life as many good men and women actually lead it." We have also perhaps experienced a glow of satisfaction when the happy thought has occurred to us that "perhaps this over-emphasis may be due to the fact that the great majority of the dreams upon the analysis of which the theory was founded were the dreams of neurotic patients."

For so small a book there appears to be an inordinate amount of quotation. We have here whole pages of letterpress embraced by inverted commas. The authors chiefly drawn upon are Freud, Jung, Maeder and Rivers. Such liberal use of authors' own words should tend towards accuracy of exposition; but Dr Lovell frequently goes astray when he takes his eyes off the book. He says that Freud used dreams in his analytic search of the patient's mind and that "he claims to have been so successful that he calls dreams the 'royal road' to psycho-analysis." But, alas, Freud has told us of no royal road' to psychoanalysis; what he has told us of is the 'royal road' to the Unconscious.

It seems as if Dr Lovell has not yet found this road, for he says he “has felt for some time past that it is unscientific and mystifying to regard the unconscious as an entity of diabolical cunning and intelligence, which is ever at work repressing and dissociating this, resisting the rise, disguising, or altering the emphasis of that, until the hope of explanation seems to be denied any fulfilment."

This monograph is dated 1923.

T. W. M.

Multiple Sclerosis (Disseminated Sclerosis). An Investigation by the Association for Research in Nervous and Mental Diseases. New York: Paul B. HOEBER. pp. xvi + 241. Price $3.75.

Of all organic diseases of the nervous system none is, in one sense, of greater interest to the psychotherapeutist than Multiple Sclerosis. In its early stages it is easily mistaken for hysteria and there are probably few psychotherapeutists of experience who have not been at some time asked to treat cases of this incurable disease; for even the most expert neurologists are sometimes at fault in making the differential diagnosis between the two conditions. This book should therefore be of interest to those whose work lies in the field of the functional neuroses, for an accurate knowledge of the general and special symptomatology of Multiple Sclerosis may some day save them from bringing discredit on the art of psychotherapy.

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

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