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

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

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 ex-

best

periencing 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. I give a few examples in illustration.

The patient had been a sergeant. He had a peculiarly mild or gentle expression and his eyes were eyes of fear. During the sitting while I was reviving memories suddenly his gaze became fixed and the look of fear in his eyes became profound. When I spoke to him he took no notice.

He

was evidently dissociated. All the while he was trembling and in a

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

me," or my turn next." In this way he is mentally identifying himself with the person killed or in dire straits. This repressed thought gives rise to another complex, an ego complex and so the total affect is an accumulated one, viz. that attached to the wounded man complex plus that attached to the ego or self-preservation complex. It may be supposed, too, that the greater part of the fear arises out of the ego complex.

Visual hallucinations appear to be always started by some association in consciousness acting as a stimulus and bringing out the affect attached to the unconscious conflict. Thus in the case just described the recall of memories during my examination brought on the hallucinatory attacks. In other cases the association is accidental and not noticed by the patient as having any connection with the attack. A striking example of this is the following. The scene was in the trenches. Patient with several unarmed comrades was having tea. There was an unexpected raid by the enemy. Cups were dropped and there was a general stampede. Patient jumped into a sap just in time to miss the blow of a descending weapon and so escaped. Subsequently he hallucinated the whole scene frequently. He could see himself running and the big German after him. When telling me the story he remarked: “It is very curious how often this comes to me when I am having a cup of tea." How important it is for the patient to get him to understand the connection between the association and the attack can be readily appreciated. Another good example may serve to emphasise the point. A patient saw his dearest friend blown to pieces and subsequently hallucinated the scene. Every time he did so he fell down in a 'fit.' When I asked him to tell me what he was doing on the occasion of his last attack he replied: "I was having a lark with a friend in the day-room." I said, "Does this remind you of anything?" Whereupon he immediately replied: "Yes, it makes me think of the larks I used to have with Jack"-the man who was blown to pieces. And so it always happens that a hallucinatory attack is started by some association generally of the most trivial nature and practically always unnoticed by the patient.

A curious fact I observed in a few visually hallucinated patients was that they seemed, after they had been hallucinating for some time (perhaps two years or more), to acquire a facility for hallucinating.

What I mean is best illustrated by an example. The case is far too long to describe in detail so I give an abstract only. The patient was having several visual war hallucinations, the principal one being that of a death-scene in which his dearest friend, mortally wounded, died in his arms. Besides this he hallucinated two other war scenes, saw two faces

those of a man and a woman looking in at night at the window. He hallucinated his mother, and later on his wife having connection with a man whose face he could not see but whom he associated with a suspected person. During treatment progress was slow and he contemplated suicide by cutting his throat with a razor. Accordingly he began to hallucinate the razor. Several times in my consulting-room he saw the razor flash in front of his face. After six months' treatment his hallucination disappeared. Three months later he returned to work at his own request but took to drink, began to hallucinate again and was returned to hospital, this time with fresh hallucinations. His war complexes seemed to have disappeared and with them his war hallucinations. One of his new hallucinations was interesting but awkward. He saw himself with a razor in his hand chasing me along the corridor with murderous intent. (incidentally an excellent example of a negative transference, though I stood for the father also. He had an exceptionally strong mother complex). He got well again and during the second course of treatment towards the end had a hallucination of a quite trivial kind. One day he was playing cards in the day-room. The game I do not know but it was essential in order that he should win that someone should play the seven of Clubs. No one played it and he lost the game. That night while lying awake in bed he saw the wanted card in front of him (wish-fulfilment in hallucination). He was rather amused than frightened by the hallucinated card.

In two other instances patients showed a progressive tendency to hallucinate or rather a progressive facility for hallucinating, but I cannot give any better example than that described.

In this and the two other cases the Oedipus complex was very strongly marked. Mere statements, however, are not always convincing, and so I give a dream of one of these patients which for simplicity and useful illustration can hardly be excelled. The dream was:

"I was going to work and there was a nurse dressed in black. She stopped me. There were two men with the nurse. Each man had a lighted candle in his hand. I thought the nurse gave me a candle. I went to light it from another fellow's candle but it wouldn't light. The candle just melted in my hand and wouldn't burn. The nurse said to me, 'If your candle won't light you must dig a grave."

On going over the dream with the patient it came out that the nurse was his sister with his (deceased) mother's face. The grave was his own. The man was single and was suffering from psychosexual impotency. A masturbation complex was clearly present. Furthermore it came out