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The incidence of hallucinations among war neurotics is in my experience a good deal higher than it is generally supposed to be. Of the patients in my wards at present more than 25 per cent. are hallucinated and of the hallucinations from which they are suffering about a quarter are of the aural type. In the list vague hallucinations such as 'shadows are not counted nor the very frequently occurring footsteps of the pursuer and, in fact, only cases where the patient sees a distinct figure or scene or hears a voice or voices speaking are included. I have omitted, too, tactile, gustatory and olfactory hallucinations, the former being almost altogether represented by the tap on the shoulder, an occurrence of considerable frequency, and the latter by hallucination of taste and smell, these appearing in three instances only.
It will be observed that my studies among war anxiety neurotics have led me into speculations extending beyond the limits of the subject. In addition to those already advanced I would put forward a few other matters on which so far as I am aware there is at present no definite consensus of opinion-no pragmatic pronouncement. Arising out of my clinical experiences among these unfortunate men I am concerned and in some doubt on the important question as to whether or not a psychoneurotic patient as such can pass into a psychotic condition. I am inclined to believe that he can. For some of these men the struggle has been too severe and too long. They feel as Cain did when he cried out: "My punishment is greater than I can bear." The combined effects of their internal mental conflicts and (arising out of these) their inability to face reality—not from want of trying, for they have tried and been beaten back again and again—leaves them in a critically unstable condition in which it does not require much more to topple them over. Anyone who has to do with a war anxiety neurotic will find it interesting and instructive to study Macbeth. He will find in Macbeth a predisposed man exhibiting all the symptoms of a war anxiety neurotic with visual and aural hallucinations. In this instance, however, the man passes beyond the borderland-a fate from which our men, with remarkably few exceptions are spared. Their hallucinations and suspicions— the stepping-stones to delusions-tend to clear up under active, encouraging and sympathetic psychotherapy so much so that if anything has become transparently evident in the course of a long experience of these war cases it is that hallucinations by themselves and unaccompanied by signs of fixation are not to be taken as indicating a psychosis. On the other hand, if there is evidence of fixation the outlook is not so good. I have a case in point at present under my care. The circumstances are
these. The patient, a young man (of moderate intelligence) bayoneted a German and left him, as he believes, only wounded. He now sees a man, dressed as a tramp, following him. He believes that this man is the German in disguise come to England awaiting his opportunity to have his own back. The hallucination and accompanying delusion appear to be fixed. There seems good reason to think that if the case had been taken early the hallucination might have been dispelled and the delusion removed. As matters stand it would appear that a condition originally psychoneurotic may have become psychotic. Up to the present attempts to give him an insight into his condition have failed. though I am not without hope of ultimate success.
M. COUE'S THEORY AND PRACTICE
BY CAVENDISH MOXON.
THE present study is based upon the explanation of Suggestibility by Dr S. Ferenczi in terms of Freud's libido theory1. From this it is evident that suggestibility depends on the repressed libido. The affects connected with the parental complexes, being incapable of free discharge, undergo neurotic displacements until they can be transferred to a parent-substitute who shows signs of sympathy and healing power. Dr Ferenczi's paper was written before the present widespread popularity of the New Nancy School of auto-suggestion under the leadership of M. Emile Coué. At that time the method of suggestion by hypnosis prevailed, but M. Coué and his school dispense with hypnosis and claim that their method of induced auto-suggestion, being free from the objections raised against the older methods, is the best way of treating the symptoms of neurosis.
It is the purpose of the present paper (a) to state M. Coué's theory and practice of auto-suggestion in psycho-analytic terms; and (b) with an understanding of the mechanisms involved in the technique, to weigh the claims that are being made for its superiority as an almost universally applicable aid to psycho-physical health.
Mr Harry Brooks' popular manual contains a statement of the essentials of the theory and method written in a manner that M. Coué, in the Foreword, regards as "simple and clear2." The theory is based on the power of the unconscious, but the term is loosely used in a sense that seems chiefly to cover the psycho-analytic concept of the preconscious. The power of the unconscious is seen to consist in an acceptance of conscious thoughts and a consequent realization of them either in healthy or in unhealthy states of mind and body. It is significant that Prof. C. Baudouin in his more technical book on Suggestion and AutoSuggestion uses the vague term 'sub-conscious.' The acceptance of the psycho-analytic concept of the unconscious is incompatible with M. Coué's claim to heal all neurotics by a method which only attacks symptoms and pre-conscious 'outcroppings.' In harmony with the technique based on verbal formulae, M. Coué's theory makes pre-conscious products in
1 S. Ferenczi, Contributions to Psycho-Analysis, p. 30.
2 The Practice of Auto-suggestion. New York. Dodd, Mead & Co. 1922.
the form of verbal imaginations take the primary part in the causation of health and disease. What Prof. Baudouin calls the law of 'reversed effort' is thus stated by M. Coué: "When the Imagination and the Will are in conflict the Imagination invariably gains the day1."
Since the conflict here described is waged between pre-conscious or conscious verbal images and the repressive forces of the moral consciousness, M. Coué is satisfied when he has replaced a pre-conscious morbific thought by its opposite. Because M. Coué regards a good verbal autosuggestion as a cure for morbific thoughts, it seems possible for him to believe in a bad verbal auto-suggestion as their source, and to ignore the unconscious source of neurotic symptoms. In harmony with M. Coué's emphasis on words, Mr Brooks has much to say about the power of thought to modify the unconscious, and thereby the bodily health. The only obstacles to this exercise of verbal imagination appear to be the conscious attention and will, which cause doubts and fears that counteract the power of thought.
Mr Brooks sums up M. Coué's theory of suggestion in these words: "The whole process of Auto-suggestion consists of two steps: (a) The acceptation of an idea; (b) Its transformation into a reality. Both these operations are performed by the Unconscious. Whether the idea is originated in the mind of the subject or is presented from without by the agency of another person is a matter of indifference. In both cases it undergoes the same process: it is submitted to the Unconscious, accepted or rejected, and so either realized or ignored. Thus the distinction between Auto-suggestion and Hetero-suggestion is seen to be both arbitrary and superficial. In essentials all suggestion is auto-suggestion. The only distinction we need make is between spontaneous autosuggestion, which takes place independently of our will and choice, and induced auto-suggestion, in which we consciously select the ideas we wish to realize and purposely convey them to the Unconscious?."
This explanation is in harmony with Psycho-Analysis in so far as it asserts that, in Dr Ferenczi's words, "in hypnosis and suggestion the chief work is performed not by the hypnotist and suggestor, but by the person himself," who was looked on by previous theorists as merely the object of the intrusive activity. While not denying the part in his method played by hetero-suggestion, M. Coué nevertheless seems to minimize unduly its importance. In his reaction against the old view of the hypnotist as the active agent in causing a dissociation without which the
2 Ibid. p. 55.
1 Quoted by Harry Brooks. Ibid. p. 63.
3 Ferenczi. Ibid. p. 50
suggestion is impossible, M. Coué writes at times as if the method can wholly dispense with the transference of libido to an authority. In the Foreword to Mr Brooks' Manual M. Coué maintains that "the instructions given are amply sufficient to enable any one to practise auto-suggestion for him or herself, without seeking the help of any other person1." There is probably no auto-suggestion free from all hetero-suggestion, because no one can be wholly removed from the influence of the parents and their suggestive substitutes. It is at any rate clear that hetero-suggestion plays an essential part in M. Coué's method. Every person who uses his formulae must have some knowledge of the ability of M. Coué or his followers to remove the symptoms of ill-health. Both in the clinic at Nancy, in M. Coué's own manual and Mr Brooks' book, the personality of M. Coué and his healing powers are impressively manifest. The ignorant regard M. Coué as a worker of miracles: and Mr Brooks makes clear the resemblance to Christ when he writes of M. Coué's "great goodness of heart" that caused him to place his whole life at the service of others at any time, and to refuse any fee for his treatments (p. 41). Mr Brooks declares that this is a method demanding faith; and faith in the method cannot be had without faith in the authority who spreads the good news. There is clearly a transference of libido to a parentsubstitute as well as a verbal formula.
The two factors in the removal of symptoms are paralleled by the two factors at work in their production.
(1) Hetero-suggestibility or the capacity for transference. Dr Ferenczi thinks this varies in proportion to the libido fixation upon the parents. The neurotic is therefore extremely sensitive to all authorities, human and divine, and in his loneliness he is ready to accept a new sympathetic parent-substitute to satisfy his hunger for love.
(2) Auto-suggestibility or the discovery by the repressed libido (connected with the parental and other complexes) of the maximum outlet compatible with conscious renunciation. These two factors-the search for parent-substitutes and the creation of neurotic outlets for unsatisfied impulses are powerfully stimulated by the environment in the most highly civilized nations at the present time.
Among the strongest stimuli to fear may be mentioned:
(a) the economic dependence of a large majority of the people upon the will of a powerful minority, and
(b) the disintegration of the traditional creeds.
1 The Practice of Auto-suggestion, p. 7.
2 Cf. E. Jones. Papers on Psycho-Analysis, p. 325.