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of its material conditions. My case is that however useful such more minute knowledge of material conditions may be, for instance, with a view to curative measures, it is logically impossible to arrive in this way at the cause of the neurosis. The pathologist I have supposed is still taking life for granted, never asking if it itself can be normal and abnormal, as though even in the most degenerate organism he ever saw, the life-principle could be doing no wrong, but in the nature of things must itself be perfect and the degeneracy the effect of abnormal material conditions, as though "form" were necessarily perfect, however imperfect its "matter." But the principle of life is merely "the way that living-process works," and the process proceeds aberrantly, badly, in bad, i.e. actually unviable conditions. Nothing less, therefore, than a theory of life is adequate to explain the functional derangements of life, a theory according to which these will be manifestations of less perfect life, or as I say, of diminished "viability."

I would again emphasize, however, that no hard and fast line can be drawn between functional and organic derangement. This dualism, the medical analogue of that of mind and body, disappears in my theory along with the latter. In organic derangement the pathologist never demonstrates anything but the occasion of physiological abnormality. And for a super-pathologist, who should be able to demonstrate the abnormal physiology of a hysteric, the distinction of "functional" and "organic" would cease to exist. But as long as he remained mere pathologist, concerning himself only with the material, physiological conditions of life, he would fail to understand the true nature of a neurosis, however exactly he might be able to demonstrate its physiological conditions. In the same way a physiologist deeply misunderstands life, if he thinks he can explain it in terms of physiological conditions alone, as bio-chemistry. He requires more than physico-chemical activity to animate his clay; he must invoke other laws than those of physics and chemistry to explain his animation, normal or abnormal.


Summary. Life is a continuing physico-chemical activity whose manifestations cannot be described in terms of physics and chemistry only. The equilibrium towards which it tends, the adaptation to change of conditions which it exhibits, is not merely that of physical or chemical activity. It tends towards viable equilibrium, and this equilibrium must clearly vary in individuals according to the conditions in which their lot is cast.

Normal individuals are such as are of normal stock and have lived under normal external conditions, intra-uterine and extra-uterine, physical, emotional and social. They react normally, physiologically and psychologically, to physical changes, emotional situations, suggestions and bodily changes. Their standard of viable equilibrium, in respect to all possible relevant conditions, is the normal one for the species. In neuroses the standard of viable equilibrium is altered from the normal.


Med. Psych. IV



THE subject of this study, whom I will call D, was a well-educated single man aged 38, the only son of conventional middle-class parents. Ever since his university days he had been addicted to alcohol, taking this drug regularly rather to excess with occasional dipsomanic orgies of about a week's duration. It was on account of the loss of various positions as a result of this failing that he was persuaded by friends to submit to psychoanalysis.

At the first interview D stated that he took alcohol deliberately to drown pessimistic thoughts and to overthrow something that prevented him from mixing happily with his fellows. The orgies were however followed by a profound sense of inferiority and self-loathing. He had also cultivated a mystical pantheism which enabled him at times to feel in harmony with nature, which he personified as "The Earth Angel."

The history which unfolded itself during analysis was as follows. As an infant D had been weak, sickly and backward and on this account. was unduly coddled and fussed over. Though he had certain vague memories or rather feelings regarding this period his earliest definite recollection was the birth of a sister when he was nearly three. He regarded the new-comer with mixed interest and resentment, but she only survived a few days so that D was not troubled by her. His mother was ill for some while after the event and D one day entering the room suddenly surprised his father drawing off her milk with a breast-pump. This sight seems somehow to have disgusted D yet it stimulated his curiosity, for from that time he began to interest himself in secondary sex characters and differences in dress between men and women. He noticed disapprovingly the various artifices, pads, corsets, etc., of which his mother made lavish use to enhance her secondary sex characters. Once, about a year later, he was in his mother's bedroom when she was going to take a bath there. She enjoined upon him not to look. Naturally he made the most of the opportunity, but what he saw again only disgusted him. He got the impression of "a skinny uncomely form, flaccid breasts and red inflamed nipples." His mother's over-solicitousness for him, which as an infant had been acceptable became as he grew older hampering 1 Read at a meeting of The Birmingham Medical Psychological Society 14th Feb. 1924.

and unwelcome. Instead of showing him encouragement she continued. to treat him as a baby and to thwart his childish impulses on the pretext of his delicacy; but more than this she behaved as though everything he did was naughty. D early resented her interference with his excretory functions, particularly her practice of dragging him from bed to make him urinate. She tried to overcome his obstinacy by squirting water from a little syringe into the commode as a suggestion, but even so the child was not to be cajoled. Feeling himself persecuted by his mother's efforts to educate him D sought to escape from the sphere of her influence to the kitchen where the environment was more propitious. Hunted from this refuge, however, he was thrown back upon himself.

D was early the subject of night terrors, which according to his recollection took two main recurring forms. In one an old hag, or witch, seemed to be bending over him with intent to harm him. A variant of this theme was that a large spider hung over his cot ready to devour him. In the other nightmare the ceiling of his bedroom became crowded with black shadowy hands clutching and crawling as though to inflict some awful doom upon him. In addition to fear the latter nightmare was associated with a worked-up sensation; his whole body becoming stiff as though something queer were about to happen within him. D's method of escape from these unwelcome disturbers of his peace was to snuggle up in the bed and completely to bury himself under the clothes. Once he ventured to speak of them, but was so discouraged by the reception he met with that he thereafter kept them to himself.

Already, at the age of 4 to 5, D gained a certain pleasure from putting a strap tightly round his waist when in bed. His mother discovered this and tried to break him of it, but he persisted in the habit until years later, his mother intuitively perceiving that he got some sort of autoerotic pleasure from it warned him against masturbation, saying that such practices led to madness. As years went on D's conscious dislike for his mother steadily increased. He sensed in her not only lack of understanding and hypocrisy, but actual enmity. It is not easy to be sure how far this estimate by D corresponded to anything actually present in his mother, but we must note that his parents had married late in life (over 40) and many things suggest that his mother did not wish to be burdened with children but to devote herself exclusively and platonically to her husband, who was already failing in health. Her gush over and excessive fondling of her baby may have been compensatory to a lack of real love for him. Perhaps also she later realised his auto-erotism and was by harsh behaviour attempting to put a stop to it. In any case

her early exaggerated solicitude and her later detachment from D's real interests, while at the same time keeping a strict restraint upon him, were objective phenomena.

D hardly ever saw his father, who was absent all day and engaged in literary work upon his return home. Only six times in his life does D remember his father taking any notice of him. Once he promised to take him fishing when D was as high as the mantlepiece, but this promise was never fulfilled. Altogether D's father ignored him and did nothing to develop his virility either directly or even by way of stimulating rebellion. The father thus stood for a dull if lofty intellectualism, which D vaguely admired but disdained as being too remote.

When D was 8 his father's health so far failed that a move from the suburbs to a country place became necessary. For D this meant leaving the dame school at which he held the record for absences and the gaining for the first time a certain amount of freedom from home restrictions as he was allowed to wander off and play in the country, a thing which previously had been prohibited. His attention now turned to natural history and in spite of his mother's objections he managed to spend a good deal of time by the river. Here he found companions of his own age but with very few of them did he become at all intimate. He delighted in everything connected with water, and became passionately fond of swimming, although this, the only form of sport he ever attempted, was forbidden by his mother as dangerous. He also made a little aquarium and studied with deep interest the habits and movements of fish and water-beetles; so things went better for a time.

At age 13 his father's health broke down completely and the family moved to an inland spa. D was "overwhelmed with desolation"; his outlets were again closed. He was sent to a local school where from the first he mistrusted and feared his school-fellows. His feeling of inferiority became more noticeable and his only method of defence was a refusal to enter into competition. During his first term he obtained a medical certificate excusing him from playing games and contrived to make it last out all his school days without getting it renewed. His mother's attention was now absorbed by the father and D was almost completely ignored by both parents. Only on Sundays did his mother interfere with him by driving him, against his will, to attend church. D, who had always considered his mother's religion as hypocritical, now came to regard it as a cloak for cruelty. The only means of escape from the hated school and domestic situation was solitary rambles in the country during which he began seriously to interest himself in entomology. He studied par

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