former case it is evident that factors will be present during the process of association which were not present in the determination of the dream, and these additional factors will probably be the more numerous and more influential, the greater the interval between the occurrence of the dream and the time of its analysis. If, on the other hand, self-analysis takes place in the half-waking or hypnoidal state, it becomes far more probable that there will be a relation between the thoughts reached by the process of association and those which have determined the dream, but even here we cannot be absolutely confident that the associations will retrace exactly the path which they had previously followed when, according to hypothesis, they were determining the dream. If a period of wakefulness and witting reflection has been allowed to intervene between the dream and the process of analysis, no believer in strict determinism. can arbitrarily reject this period as having played no part in the process by which the later associations have been determined, and the chance that this period has had an effect is the greater, the less free the process of analysis is left and the more the self-analyser adopts the artificial method of directing his thoughts to different elements of the manifest dream. The objection I bring against Freud's method of dream-analysis by free association is that it neglects factors which must be acknowledged to play a part if the doctrine of determinism is to hold good. The thoughts associated with a dream are the more likely to lead back to those by which the dream was determined, the more influences of other kinds can be excluded and the less the degree in which witting processes are allowed to intervene. It is for that reason that I believe the orthodox psychoanalytic method to be unsatisfactory and the method by which I have analysed my own dreams to be that best fitted to bring out the nature of the latent content. I have already mentioned that this method may fail to reach a solution and that in such case success may nevertheless be attained by the use of the method of free association starting from incidents of the dream. Moreover, analysis by another person may succeed where self-analysis has failed. I do not regard my own method as infallible or of universal application, but as one which is free from certain sources of error which must accompany the application of the orthodox psycho-analytic procedure. The assumption upon which my method depends is that the latent thoughts which have determined the nature of a dream during sleep continue to be active on awaking, especially when this waking is only partial, and that the period between sleeping and waking provides the fittest opportunity for the discovery of these thoughts.

SOME ASPECTS OF THE WAR NEUROSIS1.

BY GERALD H. FITZGERALD.

Now that three years have elapsed since the conclusion of hostilities, we are in a position to appraise with some degree of accuracy the claims of the war neurosis to be considered as a separate entity. I think that most of us would agree that in a very large number of our cases the underlying factors differ in no marked respect from those encountered in civilian life. It is obvious-leaving aside for the moment one highly important factor, the danger to life that the unrestrained expression of sadistic instincts must have produced a conflict with which the Ego, enfeebled perhaps by disease and most certainly by the strain of warfare, could scarcely deal. In ill-adapted individuals the segregation from the opposite sex resulted in a reinforcement of the homosexuality sufficient to cause a neurosis, whilst others of tougher mould resorted openly to perverted practices. The attitude to authority again is of self-evident importance. In men who broke down whilst training or after some trifling trauma, the ultimate prognosis is naturally far worse than in those whose neurosis only declared itself after a year or more of exposure to the rigours of the field.

In a different class, however, are the fortunately more numerous type where the constitutional factor is negligible and whose final breakdown is manifestly caused by the unparalleled ordeal of modern warfare.

A frequent history to be obtained is that they carried on well, although perhaps growing progressively more 'windy' and rather less inclined to take risks, until one day some relatively trifling occurrence completely upset their balance. From that moment they became helpless either to lead or to execute commands; and this, I think, is significant: they had a compelling certainty that every shell and bullet they heard was destined for them. The opposing belief in the immortality of the Ego was well expressed by the Tommy's dictum that the shell that was going to get you had your number on it.

Or perhaps a single violent shock, a shell-burst or burial alive may have precipitated the neurosis, although the man had not previously

1 Read before the Medical Section of the British Psychological Society, 14th Dec. 1921.

noticed any untoward symptoms. These alone are the cases which aetiologically are to be classified as traumatic neurosis.

Let us consider as briefly as may be the psychopathology of this condition. The possibility of an underlying sexual factor in the war neurosis has of course been vehemently denied, nor, if we limit sexuality to the sense of object love, would it be possible to demonstrate a 'denial of love,' a damming up of the libido sufficient to provoke the flight into disease. But by a quite legitimate enlargement of the libido concept so as to include not only the love-energy directed upon the outside world, but also that attached to the Ego itself, we can readily appreciate how any force tending to endanger the Ego and threaten its continued existence acts in its effects as an impediment to self love. All the libido is originally narcissistic, and it is only during cultural development that it becomes detached and capable of being utilized as object libido through transference formation. But this detachment is only partial, and the old channels exist whereby it is capable of flowing back to its original fixation point in the primitive narcissism.

The Ego senses keenly an impoverishment for which nothing can adequately compensate; the patient is again in the position of the infant dependent entirely upon the care of its mother, deriving narcissistic gratification by identification of itself with its first love object; and those whose presence tends to disturb this sense of security are regarded with bitter hostility.

The symptoms of the traumatic neurosis,-the deep-rooted sense of injury and injustice, the desire that others should occupy themselves exclusively with their wellbeing, the intolerance of the children whose presence interferes with the wife's exclusive preoccupation with the husband,―are, as Abraham has pointed out, efforts at reassertion on the part of the injured narcissism. The extent of this regression to an earlier psychic level was well seen in many war cases soon after the traumatic event where the patient's behaviour corresponded to that of a little child, needing to be fed and tended, and showing the emotional reactions of the first years of life. The comparative frequency of cases of so-called traumatic epilepsy in which the patient develops fits of an epileptic type after some physical trauma, fits which cannot be attributed to any manifest organic lesion, with the characteristic mental traits of the civilian epileptic, selfishness, egocentricity, impulsive gratification of desires, marks, I think, a similar regressive state, though here the individual was probably before his breakdown ill-adapted to reality, and liable to violent emotional outbursts.

The regression motive is well seen in the recurring dream of a ranker officer whose breakdown developed gradually after three years of strenuous service, following on a severe conflict as to the morality of shooting a German from behind who had turned tail and was running back to his own trenches. He began to develop the feeling already described, that every shell was coming directly for him. Gradually he became less and less able to lead his men in the field, was haunted by fears of cowardice, and finally the explosion of a Jack Johnson nearly knocked the wind out of him and he developed nervous symptoms which necessitated his evacuation. After some months of psychological treatment during which he steadily improved, he dreamt of an earthquake, which at once revived the memory, hitherto repressed, of the explosion; a moderate abreaction followed. On his next visit he produced the following dream: "There seemed to be an earthquake and I saw the earth open up all around me. There were numberless corpses in their coffins, and the earthquake dislodged the lids. The coffins seemed to rise up out of the ground.”

On analysis the dream revealed obsessive fears of an earthquake, hurricane, or some such cataclysm of nature which would wipe out the town where he lived, leaving only himself alive. The primitive symbolism of the return to an intra-uterine state and subsequent rebirth is of course clear. This opened up a level of thought hitherto untouched wherein he himself was omnipotent, triumphantly directing the forces of destruction which formed the content of his phobias.

The repetition of the dream after the effect of the original event had been abreacted, and its elaboration in the services of the infantile wish mark, I think, the process of absorbtion of a traumatically effective stimulus into the general body of the unconscious. This is a point of great theoretical significance and one which, if we succeed in elucidating it further, will lead us far in our examination of the war neurosis. The tendency to recurrence of the war dream, with its culminating moment from which the sleeper awakes shaking with terror, has long been a stumbling-block to the acceptance of the Freudian theories of wish fulfilment. But, on examination, one finds that whereas some war dreams are subject to the usual laws regulating dream activity, others, though a small proportion, repeat themselves throughout long periods with apparently no change of content. These recurring dreams may be, and usually are, exact reproductions of the traumatic moment, though in a much rarer class we have dreams with an elaborate symbolism which throughout numberless repetitions never alter in any particular.

It would seem as if the unconscious were powerless to mould them

or alter their rigid character; the driving affect paralyses psychic activity, leading the dreamer night after night along the same road, repeating with monotonous certainty the well-worn paths till he awakes sweating with horror, and dreading the return of sleep. Their very rigidity of structure makes them valueless as analytic material.

From the start the dreamer can tell one everything or nothing; the dream may be, and generally is, a photographic reproduction of a traumatic event of which the dreamer is fully cognizant and of which he can speak on the reality level with no notable emotion. In other cases a puzzling symbolization has taken place which leads the dreamer back surely enough to the traumatic moment, but whose elements do not allow of fractional interpretation. The structure here, too, is fixed and unyielding. In one case I was able, under hypnosis, to convert the dream to a hysterical pain, which apparently provided a sufficient outlet, for it never returned.

If distortion occurs it is, as would be expected, in the service of the wish fulfilment and indicates a partial psychic binding of the traumatic affect. This factor is well shown in the following recurrent dream for which I am indebted to Dr Devine. "I was in the square at Cambrai, the Germans were shelling heavily, as one burst near me I awoke." This immediately recalled an incident of which the patient had a full conscious recollection, but careful cross-examination revealed the following significant dream distortion-there was glass in the windows of all the houses.

This, he agreed, was a manifest impossibility. The dream wish, therefore, had endeavoured to reassure him of his safety by placing the scene of the bombardment miles behind the line.

Let us consider a few cases in which no such alteration is perceptible. W. P., a patient of poor intelligence suffering from vague dreads, stammer, broken sleep, in which he constantly lives over a period of horror when he lay buried beneath a fall of earth in the trenches. He tells me of this without marked emotion and of the amnesia following; his next recollection is of hospital in England.

I lay him down and direct him to close his eyes and to take his thoughts back to the time in question. He does so, and in a few moments we have him reacting briskly, gasping and shuddering as the shells burst in his neighbourhood, shouting to his comrades, till finally the trench falls in, and he tells me in broken gasps of the weight pressing on his chest, his efforts to escape, and finally with a convulsive heave he frees himself and sits up. "What happened?" I ask, and he explains that he scarcely knows, he seemed to get free somehow. Thus far we have the