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constituents, for we recognise several kinds of it-a proud, a modest, a selfconscious or a mocking reserve, and so on. It may be that in paranoiac dissimulation we have another form of this reserve.
As regards the accidental (external) influences in childhood bearing on the formation of the neurosis the following points may be noted. The patient was the eldest child of 14; his first sister was born when he was six years old. He was jealous of the pleasure her arrival caused the parents (wish to be a woman). He had been the unwitting cause of an accident by which a younger brother met his death. The grandparents, of peasant stock, lived with the family and were more significant than his own parents to his childish mind. The grandfather, whom he much admired and envied, ranked as his earliest object-love; later the grandfather played the part of 'rescuer' by saving the boy's life from a mad bull. The grandmother began his upbringing and from her emanated the first castration-threats. (It appeared that at nine months he gave up his oral-erotic pleasures-thumb-sucking-in consequence of her treading on his thumb!1)
The event which was actually of traumatic significance took place soon after he was three years old; this was a scene in which his mother threw a knife at him which cut his head open. She bathed the wound and laid him at the foot of her bed, where new-born children are laid. The effects of this were far-reaching. It seems probable for one thing that it put an end to the phase of infantile onanism, this time again by an injury inflicted by a woman. The head-injury must also undoubtedly have had the effect of activating prematurely the latent masculine narcissism, resulting in the first Libido-fixation. That there was such a fixation was proved in many ways. Sublimation of both narcissism and homosexuality was shown in the great interest the patient took in trades-union and similar movements, with the object of improving his own position along with that of other men. After his cure he became a leader in his own union where his word was respected. He showed great moderation in his views and knew how to influence others in the same direction. He showed no aesthetic tendency; Eisler points out that he belonged to the type of active thinker and was entirely lacking in the necessary self-observation and criticism which leads to appreciation of style and form.
This masculine narcissism was evident in his attitude to women, which was highly depreciatory; he objected to their emancipation, would allow them no reasoning power or educational ability (the 'castration' experiences!), though he himself had signally failed to train his youngest sister and his wife's illegitimate daughter, owing to his impatience with the sex; but he attributed this to their natural inferiority. He never allowed his wife any part or knowledge in the plans and schemes which made up his life. Jealousy of women was very marked; he could never resign himself to the fact that the forming and bearing of children had been entrusted by nature solely to the female sex. He had phantasies of being self-begotten and created, which the author compares with those of the very similar Schreber case, described by Freud, of paranoiac delusions of being a woman impregnated by divine rays. The patient's dreams were markedly egocentric and his hypochondria pointed in the same direction.
Even so, it appeared that the masculine narcissism had been forced to accommodate itself to the presence of another predominating impulse. As we
1 This is interesting as an indication of an inherent disposition to connect the two ideas of bodily pleasure and bodily loss or injury. J. R.
have seen, the strength of the anal-erotic impulse, by inborn constitution (not, like the narcissism, called forth by an external occurrence, the headinjury) was sufficient to penetrate and colour all the other impulses. One such strongly accentuated impulse can often interfere with the development to the narcissistic stage, on which all the partial-impulses are to be co-ordinated with the Self as Object, even though some event, such as the head-injury, has otherwise induced the onset of this stage. This state of things is no doubt more or less typical, since we have reason to presume a second stage (pregenital) of anal-sadistic interest between the narcissistic and the genital stages of development. From all which, we see the enormous importance of analerotism in psychical development.
Every neurosis is, in a certain sense, a subduing, auto-erotically effected, of desires which, being unrealizable, become incapable of entering consciousness. Such ideas in this case were the homosexual phantasies and we know from the symptoms that the anal-erotism here again proved stronger than the masculine narcissism, which would otherwise have mastered these phantasies. For we may assume, a priori, that the narcissism must adjust itself in some way to a passive-homosexual wish before a neurosis can result. This struggle was fought out on the field of the castration-complex. The analerotism, the interest in 'giving-up,' is transferred from the faeces on to the penis and makes the sacrifice possible. Later reinforcements come in the castration-threats and in the knowledge of the missing penis in woman. As further evidence that the neurosis-mechanism forms itself along these lines, Eisler instances two observations; first, that symbols of excreta, hair, nails, teeth, etc., are also castration-symbols, and secondly, that in all cases of unconscious passive-homosexuality the signs of any psychic defence against the castration-threat are noticeably absent. This state of things is due to the success with which the infantile psyche has adjusted itself to a traumatic experience, from which Eisler infers that the auto-erotic tendencies have not merely a preparatory, but also an adaptatory, function.
In conclusion, this case was not, as was at first supposed, a traumatic 'Accident'-neurosis (fall from the car), but arose out of a harmless experience (X-ray examination) which re-activated, by means of a strong anal-erotic impulse, passive homosexual wishes active during childhood and puberty. The hysterical attack was an imitation of a confinement, witnessed by the patient as a child, in which the exclusion of all recollections of his own mother's frequent child-bearing was reproduced. This had, however, largely contributed to the enormous development of the anal-erotic impulse in conjunction with the passive-homosexuality. (Identification with the mother.)
Although the Libido at the disposal of consciousness had sufficed to ensure a comparatively normal sexual life to the patient, the symptoms arising from the repressed wishes had become so intolerable as to enable him to go through the work of analysis to a successful end.
All those interested in the aberrations of the psyche will find this study a fascinating piece of work, most capably executed.
"Examination-fears and Examination-dreams" is the subject of a short article by Sadger (Vienna). He remarks that W. Stekel first pointed out that examinations in dreams stood for tests of sexual capacity. These dreams never refer to any real examination which has not been successfully passed, and this has led to the conclusion that they are 'consolation' or 'reassuring'-dreams.
Freud supported this view from his wide experience, but Sadger submits that more lies behind.
Analysis of a case of dementia paranoides in a young man of 25 furnished some remarkable material on the point, as often happens, the content of the Unconscious being so much more accessible than with psycho-neurotics. The patient suffered from delusions of persecution and hallucinations of ghosts and spirits, and lived an isolated life, withdrawn into himself. He had always been closely attached to his mother and the castration-complex was very marked. Until puberty he had occupied the same bedroom as his parents. After being one of the best pupils at school he suddenly acquired, at the age of 14 or 15, a terrible dread of examinations. Everything would be in his head till he was asked a question, then his mind became a blank, until he was passed over, when he again knew everything. Being asked questions was 'like receiving a blow on the head.' At the time of the analysis he became dumb with fear if asked a question, which was the reason of his isolating himself and avoiding the society of others.
The patient in the analysis spontaneously revealed the meaning of these symptoms in words which were taken down and are reproduced in the article. "I think the terrible fear that I have, which makes me incapable of concentrated thought and prevents me from answering questions according to my knowledge, is my terrific castration-fear. At bottom, though, this fear is a longing and that is why I cannot answer-I run the risk of being castrated. It is a fear and a desire at the same time I have exactly the feeling that the utter vacuity in my head is as if something had been cut away from me." In subsequent communications the patient established the identity of the teacher, and the pursuing spirits of his hallucinations, with the father, and arrived at the meaning of the unknown question which he could never answer.
From this and other cases the author believes that observation of parental coitus is one of the most frequent causes of castration-fear and of nocturnal enuresis. The patient traced back to sex-curiosity much of his interest, and his incapacity, in study. The fear of examinations is the fear of castration, and the questions which are dreaded are:-how does the father perform the act with the mother? what is the mother's organ like? and how can one find the way to it? According to Sadger, in the dreams an examination-test which has been successfully performed, in reality, replaces the coitus which in infancy had been successfully performed with the mother in phantasy.
There follow nine short notes from various sources describing incidents observed among (normal) small children, or sayings of theirs, which plainly demonstrate the truth of psycho-analytic conclusions about infantile sexual desires and emotions. All are interesting and instructive, particularly the last, which is actually a song to the beloved in lyrical prose, by a quite healthy little girl, to her rubber teat. When I went to school they would have laughed at me, they don't know how good it is to suck you....I always thought there was nothing so lovely as sucking you. And yet there is; and it is, to kiss someone whom one really truly loves.... You can't say how lovely you feel all over your body when you're sucking...you are away from the world, quite contented and happy. It is a wonderful feeling...you want nothing but peace, uninterrupted peace....It is unspeakably lovely. Some kisses are like it, and anyone who knows that can tell the joy of sucking, but if all kisses were alike, no writing could describe it."
NOTES ON RECENT PERIODICALS.
The International Journal of Psycho-Analysis, Vol. 1, part II, 1920.
This number contains a translation of Freud's paper on "The Psychogenesis of a case of Female Homosexuality," an abstract of which appeared in the October number of this Journal. It also contains Dr Ernest Jones' paper on "Recent Advances in Psycho-Analysis," which we had expected to see in part 1. Our readers are already familiar with this masterly summary of recent psycho-analytic work; and this they owe to Dr Jones' courtesy in allowing its publication in this Journal before it appeared in the International Journal of Psycho-Analysis.
Pierce Clark of New York contributes "A study of Primary Somatic Factors in Compulsive and Obsessive Neuroses"; but, as the Editor points out in a footnote, "all the symptoms mentioned by Dr Clark would be considered by other psychopathologists to belong to anxiety-hysteria." Pierce Clark's contention is that in the compulsive and obsessive neuroses we may find "somatic defects of instincts" underlying, and prior to, the introversion of libido revealed on analysis. The neurosis is a developmental unfoldment of such defects of instinct. Tone deafness, colour blindness, lack of appreciation of rhythm, and incapacity for graceful gesture or movement are instinctive defects of this kind. They are, in a sense, organic inferiorities, but unlike those postulated by Adler, they are trait or faculty inferiorities rather than inferiorities of particular organs.
Defects of this kind lead to difficulties in social adaptation, especially in the period of adolescence, and give rise to various forms of character distortion which compensate for the original inferiority. In all the cases examined, Pierce Clark found an inborn defect of the social instincts, and he advocates that in the training of children every trait of emotional expression should be cultivated to the utmost. "The child is to be given as definite a training in emotional expression as that of the discipline of nursery ethics."
E. R. Mason-Thompson gives a condensed report of a case of simple phobia and obsession in which the symptoms were interpreted as 'an unconscious infliction of self-punishment for the wish of her father's death." The elder sister had taken the place of the mother in the father's affections, and the jealousy and revenge of the patient were directed against the sister rather than against the mother. The idea of taking the sister's place (and hence the mother's place) with the father was superseded by the idea of revenge on the sister; and this could best be accomplished by removing the father.
"A Note on William Blake's Lyrics" by Dr J. W. Preger of Hilversum, Holland, is an example of the psycho-analytic interpretation of works of poetic genius—a mode of interpretation which, in some minds, arouses more resistance than any other application of psycho-analysis.
A few notes on points arising in actual analyses are contributed by Mrs Riviere, Dr Ernest Jones, and C. P. Oberndorf of New York. “Reviews of Recent Expository Books on Psycho-Analysis," and "Reports of the International Psycho-Analytical Association," complete the contents of this number.
The Journal of Neurology and Psychopathology, Vol. 1, No. 2, 1920. William Brown writes on "Some Factors in Psychotherapy." The factors which he enumerates are re-association or psychosynthesis, psychocatharsis or abreaction, autognosis (self-knowledge), regression, transference, and suggestion. Dr Brown found, in dealing with his 'shell-shock' cases, that the beneficial effects of re-association were augmented if, at the same time, the accompanying emotion (fear) could be recalled in all its original vividness. "The continuation of the symptoms was incompatible with the reinstatement of the original fear which had been their apparent
cause." So long as it was 'bottled up' the fear could show itself only indirectly in the form of symptoms. Dr Brown thinks the facts point to "an actual persistence of a past emotion in the unconscious, under certain conditions of conflict and repression." His results were obtained by means of light hypnosis. It would be interesting to know what he means by light hypnosis, for he draws a distinction between hypnosis and suggestion. He seems to accept Janet's view of hypnotism, namely, that it is the reproduction of a hysterical somnambulism in a hysterical subject. Hypnosis, he thinks, implies a definite break in the memory continuum -a definite dissociation. He implies that increased suggestibility can be obtained without dissociation.
The practise of autognosis seems to correspond to the methods of Dubois and Déjerine, and “differs from psycho-analysis in all its forms." The value of autognosis as a factor in psychotherapy will probably be found to depend on the answer to the question, How far is autognosis-true self-knowledge-possible without psycho-analysis? In a certain class of cases Dr Brown says autognosis "may give findings that correspond with the theories of psycho-analysis. In such cases it should, of course, be called psycho-analysis." There are many objections, however, to calling any method psycho-analysis which is not psycho-analysis. The technique of psycho-analysis and the technique of autognosis are not at all the same, and, on the practical side, at least, what is and what is not psycho-analysis may be known by its technique.
Of the factors of regression and transference Dr Brown here says little, but he promises a further discussion of transference in another place.
"The Acute Confusional States in the Psychoneuroses," by W. Johnson, is a paper on states of confusion observed in an Army centre for psychoneuroses. The cases are divided into the mildly confused group and the severely confused group. In those belonging to the latter group the confused state was profound, and usually persisted from seven to ten days. Emotional disturbance was found to be the main aetiological factor in the cases observed, not more than 5 per cent. showing any clinical evidence of concussion of the central nervous system. The cases observed ranged from those of simple type, with a short confusional period, to those of definite mental disorder-acute confusional insanity.'
"The Nature of Insomnia in the Psychoneuroses" is discussed by R. G. Gordon. The deflection of attention from the stream of consciousness is recognized as the main psychological factor in the onset of normal sleep. In the neurotic, owing to mental conflict, and the need for keeping painful memories out of consciousness, complete relaxation or deflection of the attention, conscious or unconscious, is impossible. An effort of attention, conscious or unconscious, is needed to keep the painful thought out of consciousness. The fatigue induced by this effort may cause fatigue sleep,' but as soon as this occurs the barrier which has been set up between consciousness and the painful thought breaks down, and if the painful complex can find expression in consciousness in the form of a terrifying dream the patient may awake. He then immediately reimposes the barrier, and sleep is impossible until fatigue again comes into play, and so the process goes on all through the night.
Dr Aldren Turner reviews the work of Redlich and Pierce Clark on Epilepsy. He is favourably disposed towards Pierce Clark's work of which he gives a précis, but he is of opinion that a "much fuller understanding of the mechanism of epilepsy and of its root causes is necessary before the purely psychogenic causation of this disease can be accepted, and its treatment by psychotherapy regarded with
The Journal of Neurology and Psychopathology, Vol. 1, No. 3, 1920.
The third number opens with an interesting and timely article by Professor C. Lloyd Morgan on "Psychology and the Medical Curriculum." He pleads for the introduction of psychology into the curriculum of our medical schools for some students, if not all. It should be officially taught by those who have made a special study of this department of scientific knowledge and know, and can show, at least