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This is by way of apology for my inability to exhibit the physiological neuroses as deviations from various particular standards of viable equilibrium, as I could do with the psychological neuroses. The physiological neuroses are simply departures from the type. For any fertilized ovum the attainment of physiological viable equilibrium is the attainment of the normal maturity of its type; it is a repetition of its parents. And for the mature organism, physiological viable equilibrium is normal working.
It may be said that I myself have not got outside the circle of material conditions, since I refer the physiological neuroses to physiological abnormality in the germ-cell. The objection would show a misunderstanding of my position (and incidentally a poor opinion of my intelligence, but to this I am accustomed). I have no ambition to explain material phenomena as the effects of immaterial causes. I can meet the objection equally well on the ground of normal living processes, developmental or otherwise, for in these also the notion of viable equilibrium (or some such notion) is essential to our understanding of them. Given a fertilized ovum and a suitable environment, something else is still required, or why should one ovum become a fig-tree and another a thistle? A definite tendency towards a goal is required, a tendency, I say, towards viable equilibrium, determined by the past history of the life in question. (Action tends to be repeated in similar circumstances.) It is in recognizing this tendency, this "law" of life, that I get outside the circle of present material conditions. But the living-process is unthinkable without its material conditions, just as is physical activity. I have no wish to divorce life-activity in any of its manifestations from its material conditions. A "law of Nature" is the way things happen. Apart from the happenings, it is nothing.
So with the phenomenon of acclimatization, which is acquired "degeneracy" or change of standard of viable equilibrium. I have no wish at all to deny that, in the case of the organisms A, B and C aforementioned, a super-physiologist would be able to find physiological conditions in B and C different from those of A and from those of one another. What I deny is that such physiological abnormality is the cause of the degeneracy.
The same applies, of course, to the psychological neuroses. The superphysiologist would be able to detect the physiological conditions of hysteria.
The manifestations of psychological tendency (= the "self") occur only in respect of physiological change, not in respect of the changes and situations of the external physical world. The individual is not in direct contact with the world. His body is interpolated. Of any given change we cannot know whether it is in the world or in ourselves. The world is grey." "No; you are growing old." Hence the illusion of the laudator temporis acti.
This fact gives rise to ambiguity as to the "site" of the disturbance in certain functional disorders. For they may arise either in the relation, psychological reaction-physiological conditions, or in the relation, physiological reaction-conditions.
Take, for instance, hypochondriasis. In the former case it is properly described, in subjective terms, as "the arrest of attention on the bodily sensations" (H. Rayner). But it is also possible that the individual's bodily changes are actually of such abnormal intensity that, occurring in any of us, even the most normal (psychologically), they would compel our attention to them. The visceral neurasthenic has a right to be hypochondriac.
Take the individual whose physiological processes find eggs unviable. How many of these unfortunates have been bullied by well-meaning people who have regarded the affair as psychological, as a case for having the nonsense knocked out of them"? And again, this may be the right diagnosis sometimes. (I say nothing as to the treatment.)
So with neurasthenia, as I pointed out in discussing it. The physiological machine may be working so badly that any of us would quickly tire of driving it. We are all neurasthenics by bedtime. Or the machine may be well enough, originally at least, but the driver too easily tired.
Organs and systems have their neuroses also, their hyper-aesthesia to such bodily changes as those occasioned by emotional conditions. When a wife can tell "how business is" by the history of her husband's heart or stomach, the physician labels these organs "neurotic."
In the relation of the individual to his external environment, no ambiguity as to the "locality" of the neurosis can arise. The observer simply notes the intensity of the physical change or of the emotional situation and judges whether or not it is sufficient to occasion a reaction in a normal person. And his measure is himself. The phlegmatic thinks a great many people hysterical.
Neuroses, whether physiological or psychological, and in the latter case, whether extrinsic or intrinsic, if I may so distinguish the hysteriatype from the neurasthenia-type, are not necessarily innate. The abnormality of the conditions which determines the abnormality of the individual manifestation of life may either have been in the past history of the race or it may occur in the history of the individual born, or, to be more accurate, conceived, normal.
The innate origin of neuroses I need not linger over. It presents no difficulty to thought. It would be stranger that the child of degenerate parents should be normal than that it is, in fact, abnormal, physiologically or psychologically.
The broad type of acquired degeneracy has already been exhibited in the case of our organisms A, B and C. I say the "broad" type, because in this particular instance, the "degeneracy" of B and C as compared with A, is degeneracy only in a logical sense. The adaptation of B and C to their altered conditions is effected perfectly, because the change of conditions is not actually unviable, prejudicial to life, but only unviable in the sense that any act of "attention," any "perception," is the effect of an "unviable" change, a disturbance of viable equilibrium.
Yet the example is a perfectly good illustration of acquired degeneracy. It exhibits a change of standard of viable equilibrium as a result of an enduring change of conditions. We have only to make the change a really unviable one in order to have a case of acquired degeneracy. When conditions are really unviable, though short of being fatal, it is clear that perfect adaptation is incompatible with normality of life. If we use the word "viability" for the perfectness of normality of livingprocess, we may say, and it is obviously a truism, that in really unviable conditions the viability of the organism is diminished. We cannot, for instance, adapt ourselves perfectly, without loss of viability, to halfrations. The horse whose owner tried to adapt it to living on nothing a day could adapt itself to the altered conditions only by dying, the last "adaptation" possible. Similarly, we cannot be subjected to long-continued or often recurrent emotional strain without loss of viability, without suffering a change in our standard of emotionality. In this connection it is important to notice that "emotions" may be divided into two kinds, those in which the disturbance of viable equilibrium is only relative, and those in which it is actual, the same distinction as that which we made in regard to "perception" and "pain." Thus the emotion
of a lover is not actually unviable; it is natural and appropriate in the circumstances, and the circumstances are not unviable actually. From our point of view there is only one really unviable "emotion," as pain is the one really unviable "feeling," namely, fear. These two are the subjective aspects of real unviability of conditions, the former of physical conditions, the latter of particular (dangerous) situations. When we speak of "emotional strain" it is of "fear" we are speaking. Among humanity, of course, fears are multiplied a hundred fold; though we no longer, for the most part, go in fear of our lives, we pay dearly for the immunity. Nietzsche has probably said that we are afraid to live.
For cases of physiological acquired degeneracy I need only refer the reader to the text-books of pathology, which is the study of physiological reactions to abnormal conditions. Here also within certain limits physiological adaptation implies no loss of viabilty. The organism of the manual worker differs obviously from that of the mental worker, yet both may be healthy, viable organisms. But if an organism is subjected to a really unviable condition, say, for instance, alcoholic toxaemia, its viability is to some extent diminished, however healthy it may appear to be, as mortality statistics show.
.Am I bound to try to apply my theory of the neuroses to particular clinical signs and symptoms?
In respect to hysteria, I submit, I am not. For the same reason that science (psychology) declines to discuss the alleged phenomena of "psychical research"; it is not worth while, as long as the objectivity of the phenomena remains in doubt. A hysterical fit is perhaps more than an "alleged phenomenon," but it is not a purely objective phenomenon. There is a person" in the case, by general admission an abnormal person, and "persons" are not objective. Usually a woman, too.
As to neurasthenia, there does seem to be more justification for the demand-I feel the demand-to come down to cases. Here the "person" is not so clearly abnormal as in hysteria. It seems that we are dealing with physiological abnormalities of the organism, which, however recondite, are capable of discussion, if not, in time, of discovery.
Certainly, but when these abnormal physiological conditions shall have been described with the utmost exactitude, we shall still be as far as ever from the cause of neurasthenia. We shall then still be discussing the physiological effects of neurasthenia, in no better case in fact than when we were discussing its very grossest, most palpable effects. And
the demand to come down to cases is a demand to show how my theory is causally related to particular clinically-observed phenomena.
An experimental pathologist introduces abnormality into the conditions of a living-process, and observes what happens. From his, quite legitimately, restricted point of view the abnormal condition is the cause of what happens. This is the very type of the aetiology that satisfies medical men in regard to what are called organic derangements. But in functional derangements the method is simply not applicable. The abnormal condition in the above case is simply the occasion of the happening; we are entitled to ask why it happens thus and not in some other way. Upon which the pathologist tells us not to be silly; all his concern is to observe what happens.
This is precisely my case in regard to functional derangements. They happen, in the abnormal conditions of the particular individual manifestation of life. They are the effect of this and of nothing less—an aetiology too large to be satisfactory to the pure scientist-in this instance, as pathologist or physician.
But if our aetiology is unsatisfactorily large, so is his clinical picture. I say, roughly, that "neurosis" is "anything going naturally wrong." Anyone who feels this to be unsatisfactory and goes to a text-book of medicine for something more definite will find that anything going wrong without an "organic cause" is "neurosis." This is a perfectly fair epitome of the picture given in medical text-books. We find cerebral, spinal, cardio-vascular, visceral and uro-genital forms of neurasthenia, and the only interest such a very inclusive description-as a description of "neurasthenia"-leaves us is the question why there is no respiratory neurasthenia. Probably because the simplicity of structure of the respiratory system, reminiscent as it is of the Irishman's description of a net as "holes tied together with string," leaves little scope for functional derangement, while its one very definite functional disorder, asthma, has long had a name and a place of its own in text-books of medicine.
The loss of muscular tone in both voluntary and involuntary muscle, to which the name "neurasthenia" more especially applies, is the bad working of those organs-the bad working natural in the circumstances. Normal tone is not a material, physiological condition. It is a function. It is the way a normal muscle works, or let us say, to avoid ambiguity, the way a normal muscle exists-lives and has its being.
I do not suggest that the most naïve pathologist is content to regard neurasthenia as the effect of loss of tone. I do suspect him of hoping to find the cause of the loss of tone by a more and more minute investigation