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repression typically occurring, as a general condition; and with the castration-complex as a specific determinant.

In concluding, we may give a moment's attention to practical considerations, particularly as regards the educational bearing of sex differences. It is hardly possible for the psycho-analyst to subscribe to the view taken by some psychologists that because intellectual differences between the sexes, as tested by laboratory experiments, are practically negligible in degree, educationists need take no account of sex differences as such, but need only insist on ample individual opportunity irrespective of sex. We must agree with this latter; but the problem does not, on the findings of the psycho-analytic method, cease there. We should rather agree with those who hold that the emotional and temperamental differences between the sexes, and the long-run effect of these upon the mental life as a whole are of considerable educational and social importance. The educational problem for both boy and girl is that of reaching the goal of normal sexuality in a balanced relation with the individualised ego; but the emphasis is different in each case.

A word needs to be said as to what is meant by normality of development, since we have used this concept here, and in speaking of the reconciliation of the ego trends with the female sexual impulse and biological functions. It is clear that our conception of normality must itself be governed by the 'reality principle,' and have reference to the actual social and economic conditions of the world in which we live. The population problem is perhaps more relevant to the question of what is the desirable balance of individuality and biological function in women, than any male infantile fantasy of the all-perfect mother. Nor, it must be further said, is the castration-fear of the male, when it impels him to deny intellectual power and personal independence to the woman, any more trustworthy guide than that of the woman herself, when it drives her to the refusal of her feminine functions. External conditions in an industrial and highly individualistic civilisation demand the most delicate adjustment; and we might well have added to our enumeration of the predisposing factors to the castration-complex in the woman, the changing and conflicting demands of modern life. Like any other neurosis, it is largely a function of the discrepancy between the demands of our top-heavy civilisation, and our native resources; and relief does not come by way of turning from the reality of those demands to a woman-imago.

We may perhaps end on a note of paradox, and say that, from the psycho-analytic point of view, neurosis occurs because sex differences are so deep-and yet is only possible because they are not deep enough.

THE WAR ANXIETY NEUROTIC OF THE
PRESENT DAY: HIS 'DIZZY BOUTS'
AND HALLUCINATIONS

BY H. SOMERVILLE.

In a previous contribution to this subject1 it was stated that the principal mental symptoms of a war anxiety neurotic were exhibited in 'dizzy bouts' or attacks of vertigo with their accompaniments, in a chronic condition of poorly suppressed fear accentuated and defined in the dark, terrifying dreams in which the patient is being attacked or killed and, in a smaller number of cases, in hallucinations. An attempt was made to explain this fear in the dark of being pounced upon by an enemy by tracing it back to fear of the father resuscitated owing to the regressive effect of terrifying war experiences-the fear taking on a childhood form or rather associating itself with the fears of childhood.

Concerning dizzy bouts anyone seeing a man in a dizzy bout or even reading a description thereof is immediately struck by the similarity between one of these seizures and an acute attack of extreme fear. The correspondence is complete, and so we feel inclined to say that a dizzy bout is an acute attack of extreme fear, the cause of which, however, in the absence of any obvious external danger, is not at once apparent.

In a good many cases I have been able to trace the stimulus occasioning a dizzy bout to a transference of the affect from a previous occasion on which a similar feeling of fear was experienced. It often happens that patients on being questioned as to what they were doing at the moment when an attack came on are able to help one out a bit by almost at once realising a superficial, apparently trivial, connection between a present and a previous occasion. Thus for example a patient told me that he generally got a dizzy bout when squatting on his hunkers in the mine getting coal out. A single question elicited the information that this was an attitude he often perforce adopted in the trenches when taking shelter. Several men got dizzy bouts when stooping, much in the same way as they had to stoop in France taking cover from shells. Drinking a cup of tea was often the occasion of a dizzy bout with another man. He had 1 Journal of Mental Science, April, 1923.

been disturbed by shells or raids several times when he was having tea in the trenches. A good many of my patients got dizzy bouts when in the act of turning round to look-a movement of frequent occurrence not only in war time but now at home-to see if there is anyone there. Sudden happenings, especially sounds, are a very common cause. In all these cases it is reasonable to suppose that the starting of a dizzy bout is due to the transference of the affect of fear from a previous alarming war experience to the present occasion. It is well to note that the memory of the experience itself is not necessarily brought into consciousness— hardly ever in fact-but only the affect and this fact accounts for the man's inability to divine the cause of his dizzy bout.

That a transference of the affect from a previous traumatic to a present innocent occasion is a factor in the causation of a dizzy bout may, I think, be accepted as a fact. It is in accordance with all our experience of the passing on of an emotional tone from one occasion or incident to another which in any way arouses feelings similar to those attached to the previous situation. But that this transference is the complete cause of such an extreme attack of terror as that characteristic of a dizzy bout is exceedingly unlikely and in fact hardly credible considering the severity of these attacks. What I think really happens is that the affect of the transferred fear is added to that of a more deeply seated and long repressed similar affect attached to a complex the like of which is to be found in the unconscious of everyone. It must be remembered that dizzy bouts are practically of universal occurrence in anxiety war neurotics and it is difficult if not impossible to explain how it comes to pass that different traumatic incidents can give rise to exactly similar symptoms in different persons without hypothesising a similarity in the mental make-up of these persons. These dizzy bouts then I take to be sudden attacks of extreme fear originating in an affective transference from a war incident or war incidents to a present occasion, amplified by a fusing of this affect with that attached to a deeper strongly repressed complex the like of which is present in the unconscious of everyone-a complex in which the father is the central figure.

Another and very useful view to take of a dizzy bout is to look upon it as an exacerbation of the patient's general condition of chronic poorly suppressed fear. Our justification for taking this view lies in the fact that by psychotherapy we are very often successful in alleviating the condition of chronic fear and when this happens the frequency and severity of the dizzy bout become diminished at the same time. The facts would appear to be that in the general condition the fear of something

dreadful happening and the expectation that it may happen at any moment are always present either consciously or unconsciously. In the dizzy bout it (as a mental process) has happened. The dreaded occurrence has come to pass and at the same time there is a sudden sharp discharge of pent-up affect the old affect attached to the deep complex plus the new affect floating about the more recently acquired superficial complex. The mode of production of a visual hallucination is somewhat similar to that of a dizzy bout, though the manifestations are quite different in the two cases. In these visual hallucinations there is also a sudden sharp discharge of affect attached to a complex or complexes and the mental conflict is one of terrible intensity. There is an effort-a supreme effort of an exacting conscience to keep back or repress a memory whose recollection causes intolerable pain-a pain the intensity of which probably no one can realise except the subject of it. It was the kind of pain that Macbeth felt when he cried out in his agony:

Canst thou not minister to a mind diseased,
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain,
And with some sweet oblivious antidote

best

In default of our being able to realise this pain subjectively the next way to get a clear notion of it is to study the mind of a man experiencing a hallucination, observe him while he is actively hallucinated

and

get his confessions on the subject afterwards. I do not consciously as a rule hypnotise my patients but many of them when I get their whole interest engaged are in a condition allied to the hypnotic. At any rate they become dissociated and in this state exhibit their hallucinations. give a few examples in illustration.

I

The patient had been a sergeant. He had a peculiarly mild or gentle *pression and his eyes were eyes of fear. During the sitting while I reviving memories suddenly his gaze became fixed and the look of

Was

fear in his eyes became profound. When I spoke to him he took no notice.

He

ex

Cleanse the stuffed bosom of that perilous stuff
Which weighs upon the heart?

was evidently dissociated. All the while he was trembling and in a state of terror. The incident that originated the hallucination was this. was in charge of a number of men-a raiding party. Returning from raid they heard cries for help coming from a small shell-hole that

He

the

they were passing at the time. On looking they saw a wounded soldier in the shell-hole. His leg was nearly off. He appealed to them for help. Their orders were not to stop to pick up wounded but to leave them for

the stretcher-bearers, so they left him with a scornful look on his face and bitter words on his lips. The impression left on the patient's mind was that he thought them cowards. That was the scene my patient was looking at. He was no longer in my consulting-room but was back again in France looking at the wounded man sneering at him. He had been seeing that hallucination often two or three times a day for the previous two years and had never told anyone about it before. After a few sittings the man began to lose his hallucination and has now been free from it for four months. It will be well to examine this hallucination a little more closely. In the first place it is clear that it arose out of a mental conflict. A memory complex of the incident was formed in the mind of the patient. Attached to this memory complex was a charge of affect at varying potential to borrow a well-known term from the science of electricity. The psychic energy of this affect represents its tendency to discharge. Opposing this discharge is the force of repression closely associated with the man's conscience. Tendency to discharge may be supposed to increase by an accumulation or rise in potential of the affective charge on the one hand or by any weakening of the repressive forces on the other. Some stimulus happens-some associative idea appearing suddenly in consciousness, some excitement increasing the potential of the charge or some depression relaxing, may we say, the watchfulness of the censor, causing a weakening of the repressive forces. There is a sudden violent discharge of psychic energy and out comes the hallucination as a substitute formation of the conflict-a visual representation in consciousness of the memory images of the complex.

It may be supposed that the whole of the energy of the discharge is not used up in the visual appearance but that in some way some of it is responsible for the trembling and other bodily manifestations which appear throughout the hallucination and continue for some time after the vision has gone (compare the residual charge in a Leyden jar).

The fear exhibited by the patient during the hallucination is, in a way, neither more or less difficult to understand than any other fear but its intensity was probably greatly increased owing to a deeper psychic traumatic cause frequently found in war neurotics suffering from visual hallucinations. It arises out of the fact that the patient unconsciously identifies himself with the subject of the hallucination. The process is a very simple one. When a soldier witnesses the death of anyone close to him on the battlefield or sees anyone in a desperate situation like that of the poor fellow in the shell-hole the first hardly conscious thought that flashes through his mind is: "It might have been

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