ePub 版

from the neurosis but everything to gain from recovery, then treatment, otherwise ineffectual, might succeed; but to stop a pension does not give us this possibility.

Yet there are, I believe, some cases, chiefly those showing a certain type of hysteria, in which the cessation of the pension would remove the symptom. They are few, and few psychotherapists would like to diagnose them.

In regard to railway injuries it is now a truism of the text-books that when the claim is settled the patient often makes a speedy recovery, though this is not invariable as the case of Mr Page's, quoted previously, illustrates. At one time the plan of giving gratuities was tried with men suffering from shell-shock but proved a complete failure and has been abandoned for two or three years; the men returned later with their symptoms unchanged or, to speak more correctly, unimproved. I saw two such cases where the men had re-enlisted. One, who proved a most satisfactory patient, had re-enlisted as a last resort when he had spent his gratuity and found himself unable to work and support his family: the other, when I questioned him as to his reasons for re-enlisting when he knew he was unfit, answered: "Well, the army made me like this and I reckoned it was their job to cure me."

In both cases the usual war repressions were found and unaided recovery was hardly to be expected.

There exists a definite state of mind which the French call la psychose de revendication and the Germans die Rentengier. It is not merely a desire to obtain a pension but its predominant affect is rather a sense of irreparable injury at the hand of society, for which the fullest compensation can never suffice. Dr Karl Abraham of Berlin regards it as favoured by state pension but only possible in those patients who already had a tendency to react in a narcissistic manner to assaults upon their self-feeling. Roussy and Lhermitte also dwell upon the importance of the previous temperament of the man.

One meets with this Rentengier sometimes in association with a pathological irritability which is not recognised by the patient. It occurs most often and most significantly in men who broke down early and shows itself in such phrases as "I was an Al man when I joined the army and look at me now, and I know I shall never get any better," together with an aggrieved and truculent manner. I regard the condition as pathological, and in some cases the question of paranoia has arisen.

Quite different is that frank statement often heard from a reasonable man, who has helped in his own treatment, that he is afraid for the future or even finds his present troubles are hindering his recovery.

When we consider the influence that a current trouble has in provoking

nervous break-down in civil life we must admit that the war neurasthenic is adversely influenced by his difficulties, whether financial or domestic. However much effort he makes he finds adjustment no easy matter and in many cases gives way to the strain. He finds extra difficulty in obtaining employment, for his disability affects him more disadvantageously than a bodily injury. The employer knows where he stands, for example, in regard to a one-armed man and can estimate precisely what are his capabilities. But we must realise that the neurasthenics are peculiarly unreliable; in some of them the deterioration has affected their social sense to such an extent that they are definitely dishonest and I must confess that I have often looked at a patient and thought that I should not care to employ him myself. One frequently hears the complaint that an old employer has found it impossible to reinstate the man, and one agrees that this action was inevitable.

I know an ex-officer who before the war held a responsible position abroad at £500 a year; he did good war service before a severe break-down, which came on after the armistice, but the medical officer of his old firm refuses to pass him as fit to go abroad again—and I think he is right; the Ministry has provided him with proper treatment, the alternative pension scheme has been to his advantage, and he receives a grant for his children's education. But he is now a clerk at £3. 10s. a week and the housing trouble makes him keep his family in the country whilst he lives in uncongenial lodgings in London. One can appreciate the effort necessary for the man to find his way back to health under these conditions, though he had enough stamina to take him through three years of campaigning and is now keen on doing the best for himself and his family.

We have to face the fact that economic conditions at the present moment, affecting as they do the well-being of the whole country, more particularly affect the neurasthenic pensioner. He is in the vicious circle of economic stress and his own disability; each reacts upon the other and increases its evil effect. Thus the man is led to rely more and more upon his pension.

We can now sum up the chief elements in the problem:

1. The deterioration that takes place in the power of the pensioner to face the realities of life.

2. The administrative loss of control over the individual, whose outlook may be distorted and whose neurosis is master of the situation. 3. The need for a pension and at the same time the need for a stimulus to recovery.

4. The special difficulty of the pensioner in facing the economic struggle.



IN psychology, as in every-day speech, the terms conscious and unconscious, consciousness and unconsciousness, are often used ambiguously. To be conscious implies, or ought to imply, present awareness; and consciousness should refer only to the 'field of consciousness' at any moment. But very often consciousness is used as a collective concept to denote the totality of mental processes, and by the older psychologists it was commonly used as the antithesis of 'matter,' very much as we now use the word 'mind.'

Even up to the present time some people think that consciousness and mind are synonymous terms. There are two senses in which this opinion may be held. It has been maintained by some writers that only what is in the field of consciousness at any present moment is truly mental, and that when a presentation passes out of the field of consciousness it passes literally 'out of mind.' By these writers the problem of mental retention is solved by supposing that the 'memory-traces,' whose existence we must assume in order to account for conscious recollection, persist in the form of 'brain-traces' which have no mental counterpart until they are again roused to functional activity accompanied by consciousness.

On the other hand, when consciousness is used to include the whole mass of psychical manifestations, the totality of the mental processes of the individual, it is implied that there is much in the mind that is not in the conscious field of the moment, but nothing which is not now, or has not at some time been, in consciousness in this strict sense of the word. On this view memory-traces exist as mental traces or dispositions, and in their latent state as well as in their active state form part of the mind.

In these two senses, then, it has been held that consciousness and mind are equivalent. The former view is very commonly held by physiologists. The latter is that which has been held by the majority of psychologists up to recent times.

When those who believe that the passing wave of consciousness

1 Read before the Medical Section of the British Psychological Society, Dec. 22, 1920.

alone is truly mental speak of an idea becoming unconscious, they mean that it has no longer any existence except in the form of some physical trace left in the brain. And the brain, as material substance, is unconscious in the same sense as inanimate objects are said to be unconscious. If, however, we believe that when an idea passes out of the conscious field it leaves behind a trace or disposition in the mind, the total sum of such mental dispositions, so long as they are latent, may be said to form an unconscious part of the mind. And this is a use of the word unconscious which is very commonly made.

So long as cerebral traces or mental dispositions give no evidence of activity it may be convenient to speak of them as unconscious, if we suppose that so soon as they become active they will manifest in consciousness again. But when evidence is found of the occurrence of mental activity which does not appear in consciousness and cannot be discerned on introspection, the inadequacy of this distinction between conscious and unconscious becomes apparent. The static physical view of unconsciousness-the hypothesis of brain-traces, has to be supplemented by some sort of 'unconscious cerebration' which is capable of doing mental work without any mental accompaniment; and, in the alternative hypothesis, the mental dispositions must be accredited with activity and consciousness in some degree, though not in a degree sufficient to attract the attention and be discerned on introspection. This latter supposition is the hypothesis of subconsciousness as this was first formulated by writers on general psychology.

We know that the field of consciousness has always a focus which is the centre of attention, and that outside this focus there is a margin in which discrimination becomes less and less exact as we recede from the focus; and the principle of continuity compels us to believe that beyond the margin, also, something of the nature of consciousness exists. This possibility is commonly described in terms of a psycho-physical threshold which can be overstepped only by such feelings or thoughts as attain a certain degree of intensity; and such thoughts or feelings as do not attain the necessary intensity are described as subconscious.

The need for postulating any subconsciousness beyond the margin discernible on introspection was not very keenly felt by psychologists so long as they confined themselves to the study of the normal mind; but when such facts as those revealed in Janet's investigations of hysteria came to light, it became urgently necessary to find some term by which to describe them. The dissociated sensations and movements of hysteria were called subconscious by Janet, and it was very commonly

supposed that the subconsciousness of such hysterical manifestations was the same kind of subconsciousness as that which has been postulated by some psychologists as existing in every normal mind. Yet Janet himself has clearly shown that the hysteric's failure to perceive sensory impressions applied to an anaesthetic area is not due to lack of intensity of the modifications of consciousness so produced, but to a dissociation whereby these modifications fail to be assimilated to the 'personal consciousness.' For it is obvious, in his experiments, that there was some sort of awareness of the impressions which was not dim or confused, but was clear and discriminative. The most striking feature of this awareness is that it was an awareness concomitant, though not compresent, with the awareness of impressions received through other senseorgans which were not anaesthetic. There was a kind of consciousness which is best described by Dr Morton Prince's term 'co-consciousness.' The implication of diminished intensity contained in the term subconscious makes the use of this word inadvisable when we wish to refer to such mental activities as those revealed in hysteria and multiple personality. Moreover, by using Dr Morton Prince's term 'co-conscious,' we emphasise the important fact that in these dissociations we have an actual splitting of consciousness, not merely a splitting of the mind. For we may have dissociation of the mind in which the split-off portion shows no evidence of being accompanied by awareness, and seems to be truly unconscious.

It would thus seem useful to have some other term to describe all that exists or takes place below the threshold of consciousness, whether it be subconscious or co-conscious or unconscious. The word 'subliminal' was used by Frederic Myers just in this way, and it would perhaps be convenient if we could still use it in the sense defined by him. He said: "The idea of a threshold (limen, Schwelle), of consciousness; of a level above which sensation or thought must rise before it can enter into our conscious life;-is a simple and familiar one. The word subliminal-meaning 'beneath that threshold,'-has already been used to define those sensations which are too feeble to be individually recognised. I propose to extend the meaning of the term, so as to make it cover all that takes place beneath the ordinary threshold, or say, if preferred, outside the ordinary margin of consciousness; not only those faint stimulations whose very faintness keeps them submerged, but much else which psychology as yet scarcely recognises; sensations, thoughts, emotions, which may be strong, definite and independent, but which by the original constitution of our being, seldom emerge into

« 上一頁繼續 »