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When the author says that the main part of the beneficial result achieved by persuasion is due to the suggestive influence of the physician, he is not likely to meet with universal assent from those who practise this method. His enthusiasm for the elaborate methods of Freud perhaps tends to make him underestimate the extent to which non-Freudians dig below the surface in their attempt to explain conscious symptoms by reference to factors (emotional as well as intellectual) not themselves in clear consciousness. It is only when the unwarranted assumption that “the aberrant mental processes that have to be corrected are [believed by the non-Freudians to be] conscious ones” is made, that the Freudian criticism is effective. The belief in unconscious psychical process did not originate with Freud, and psychological determinism is at least as old as Spinoza. It was no doubt lack of space that prevented Dr Jones from giving a more adequate account of methods of analysis, reassociation and re-education used so successfully by many British psychotherapists during the last few years. In the short chapter (seven pages) on“ Traumatic Neuroses, including War Shock,” one finds statements that are rather surprising. For example, reference is made (p. 204) to "the small percentage of the total combatants thus affected” (with war-shock]. As a matter of fact, one-seventh of all the cases discharged from the British Army as permanently unfit, from whatever cause, were of this nature. And these were only a small proportion of the total number affected. The average returns to duty of shellshock cases in the field were 70 %, and this percentage rose as high as 90% or more at the time of a push. So that less than 30 % of all the cases reached the base, and less still reached England. Dr Jones writes: “The source of the morbid fear present in most cases of war neurosis appears to be repressed narcissism, and it is even possible to predict from this knowledge which men will be more liable to suffer from war shock or any similar trauma” (p. 207). Medical officers who saw the thousands of brave men who got over their shellshock while in the field, and never went down the line at all, will read this sentence with a smile; and when they turn the page to read that “there is little point in going over now the ways in which human material was recklessly wasted through the lack of knowledge of clinical psychology so widely displayed at that time” (p. 208) they may remark on the lack of interest shown in this book for the work done on the greatly preponderating amount of that human material, which could only be seen in the armies in the field and did not reach England at all.
There seems to be some confusion of thought in the discussion of 'transference' (Uebertragung) on pp. 136-138. Dr Jones first says (p. 136) that this affective rapport between patient and physician constitutes the essential basis of suggestion.” On p. 137 he writes: “Suggestion is thus the main hindrance to treatment by psychoanalysis, and this is one of the grounds, amongst others, why the psychoanalytic method cannot be combined with treatment by means of suggestion or hypnotism, as Forel and others have unthinkingly advocated; the two systems are fundamentally opposed in their aims.” And yet, four lines lower, he writes, “It is only via these transferences that the analysis can proceed, beyond at least the earliest stages; it is only by making the old buried motives and emotions current and actual in the transference situation that one can lead the patient to a complete realisation and assimilation of them.” So transference, or “the essential basis of suggestion," is needed for a successful analysis, after all! And if we turn to the Master, we read these words:“Wenn der Kranke den Normalkonflikt mit den
Widerständen durchzukämpfen hat, die wir ihm in der Analyse aufgedeckt haben, so bedarf er eines mächtigen Antriebes, der die Entscheidung in dem von uns gewünschten, zur Genesung führenden Sinne beeinflusst. Sonst könnte es geschehen, dass er sich für die Wiederholung des früheren Ausganges entscheidet und das ins Bewusstsein Gehobene wieder in die Verdrängung gleiten lässt. Den Ausschlag in diesem Kampfe gibt dann nicht seine intellektuelle Einsicht die ist weder stark noch frei genug für solche Leistung sondern einzig sein Verhältnis zum Arzt” (S. Freud, Vorlesungen zur Einfuhrung in die Psychoanalyse, Zweite Auflage, 1918, S. 522).
[Translation: “If the patient is to fight through the normal conflict against the resistances, which we have discovered for him in the analysis, he is in need of a powerful motive which influences the decision in the sense, wished by us, leading to recovery. Otherwise it could happen that he might decide for the repetition of the earlier result, and allow that which had been raised into consciousness to slip back again into a state of repression. The decision in this fight is given, then, not by his intellectual insight—which is neither strong enough nor free enough for such an accomplishment—but solely by his relationship to the physician.”] It is true that such transference or affective rapport has itself to be resolved' later on in the analysis, but this fact does not destroy its significance as an essential factor in cure by psychoanalysis. Indeed, Freud distinguishes the curable hysteria and obsession neurosis, which he calls Uebertragungsneurosen, from the incurable dementia praecox and paranoia, which he calls Narzisstische Neurosen or paraphrenia, with reference to this very factor of positive transference.
These few criticisms apart, the book can be strongly recommended as a really excellent introductory textbook on psychotherapy. It is clearly written, and has a consistent line of argument running through it from beginning to end which makes it very easy to read. Its scope has not admitted of inclusion of illustrative examples, and its whole-hearted adherence to one school of thought prevents it from being completely representative of modern psychotherapy. As an elementary statement of the Freudian position it is of great value.
Psychoneuroses of War and Peace. By Millais CULPIN, M.D., F.R.C.S.
Cambridge University Press.
Dr Culpin has produced a very readable and interesting book. It is perhaps most interesting in the evidence it gives of the writer's own development towards full acceptance of Freud's conception of the unconscious. Dr Culpin admits in his preface that his views have not yet reached finality, and to those who have perhaps travelled a little further along the difficult road towards psychological understanding it is evident that he has still some Rubicons to cross at which many have hesitated or still do so.
The writer has gained his experience and formulated his views under the difficult conditions of a special Neurological War Hospital, and no one who has not experienced the psychological situation in these hospitals can estimate how hard it was to appraise rightly the value of the different therapeutic procedures or the meaning of the psychological mechanisms involved. In the opinion of the present reviewer the principal limitations of Dr Culpin's theoretical exposition lies in the fact that he makes no reference to the mechanism of Transference in the Freudian sense, and it may be noted in passing that throughout the book the term “Transference of Affect' is used instead of the more usual ‘Displacement of Affect.' It is surely getting more and more certain that the most important mechanism involved in all therapeutic procedure, whether Hypnosis, or Abreaction, or Analysis, is the Transference of Affect from the fixations in the unconscious of the patient to the person of the physician. In no cases was Transference so easily obtained as in the peculiar psychological situation of a Military Hospital in war time, and, unfortunately, it was very frequently under-estimated. The under valuation of this factor has sometimes vitiated, not the value of the work done, but the subsequent estimate of the comparative value of therapeutic procedures.
In using Psychasthenia in his classification of cases as well as in his statement that some cases are better understood if pictured as due to dissociation and some as due to repression, Dr Culpin is evidently still halting a little between the conceptions of Janet and Freud, although evidently from his method of treatment and judgment of results, he is finding Janet's attractive conceptions increasingly sterile in their power to evolve a satisfactory Therapy.
In the chapter on Phobias and Obsessions, it is interesting to note that no case is mentioned that could probably be classified as a true obsessional or compulsion neurosis. Dr Culpin does not even include compulsion neurosis in bis classification of cases. This is in accordance with the experience of others that compulsion neuroses were very infrequent in War Neurological Hospitals, and were even, from their psychological make-up, not particularly unfitted for the stress of active service.
The greater part of the book is devoted to the description of cases, and although there may be much to criticise, it is evidently the work of one who has brought mature judgment and an open mind to the study of many difficult and still unsolved problems.
M. B. WRIGHT
Internationale Zeitschrift für Psycho-Analyse. 1920. Part I. The Zeitschrift is the official organ of the International Psycho-Analytical Association and was founded as such in January, 1913, by Professor Freud. It appears quarterly, and its official function will henceforth be shared by the International Journal of Psycho-Analysis, a publication in English, of which the first number appeared in July of this year.
Freud opens the first number of the Zeitschrift for 1920 with a brilliant essay “On the Psycho-Genesis of a case of Female Homosexuality.” A translation of this article will appear in the second number of the Journal just mentioned and will therefore not be noticed at great length here. It may
be said, though, that apart from the scientific value of the matter, the fascination of any work of Freud's in the original German is far greater than translations disclose. The simplicity and restraint of the style and presentment stimulate and tantalize the reader; his writings are works of art in a new field. For the manner is not to be dissociated from the matter, nor from the language; he excels in what he is, a writer on psychology, the mind and motives of humanity; his lucidity and insight are unique; but his personality and sympathy, somewhat patriarchal in their simplicity and dignity, give his writings the spirit of the best German traditions. This quality is not easily conveyed in an English rendering, where it may even appear as an inartistic peculiarity. In this essay the attraction of the exposition is added to by an unusual subject; homosexuality in women has been, as he remarks without explaining the circumstance, ignored by public opinion and the law, and even neglected by psycho-analytic writers.
The patient in the case was a well-bred girl of 18, brought to Freud by her parents on account of her infatuated pursuit of a woman of doubtful reputation, which no efforts of theirs were able to cure or prevent. There were no neurotic symptoms; it was a case of perversion; the girl had evolved an attitude to life in which all feminine interests (such as men and children) were regarded with indifference or contempt; in the passion for the loved woman which absorbed her she herself played the part of an adoring man. Such was the superficial aspect of things: Freud's account of the analysis, undertaken experimentally by him for reasons which he gives, unfolds an extraordinary tale, which on close attention is found to have no link missing in its logical sequence. The main psychological motive behind the abnormal state of mind turns out to be the girl's unconscious desire for revenge on her father, closely connected with unconscious envy of a child which was born to her mother in the first year or so after the girl had reached puberty. Underneath the homosexuality lay the buried heterosexuality. The connection and inter-relation between the wish to become a mother herself (her feminine sexuality), love and hate of the father, and hate and love of the mother, are traced with absorbing clearness to their final development-a revulsion from them all and an exclusive concentration of all sexual feeling into a masculine form, latent in the inborn bisexuality. Such a conclusion is undeniably startling; that beneath the surface the adored woman should be comparatively unimportant, that the unsatisfied desire for a child and love of the father should be the main cause of an attitude excluding men and children are contradictions which only psycho-analysis could have revealed. Yet here is an explanation so intelligible, so characteristic of human behaviour, that, beside it, shadowy conceptions like the third sex'theory fade into meaningless insignificance. “The grapes are sour" is one of the oldest cris du caur, one of the commonest and simplest reactions. The vehement rejection and repudiation of the unattainable, of femininity and the mother-rôle, is a consequence and a measure of the original longing for just that form of sexual satisfaction. Revenge follows upon disappointment-men shall be hated and ignored; more, their rights shall be taken from them, their place shall be usurped, women shall love women, and a world without men or children shall exist. Here are the mainsprings of female homosexuality, reversing the same order of things, the same cry as in the male. As psycho-analysis has found in the case of men, sexual inversion rests on the basis of a strong infantile Oedipuscomplex, a fixation on the parent of the opposite sex and subsequent identification with that parent; whether the parallelism between the mechanisms in the two sexes goes further than the starting-point is not yet clear.
Freud's doubts as to the success of analysis in this case on general grounds were the more justified owing to the particular unconscious forces at work beneath the surface; for, in the course of the analysis, he naturally became a father-substitute, so that the transference took a purely negative form, supplying less than no incentive to aid in overcoming resistances. For this reason he broke off the attempt and advised that the case should be handed over to a woman analyst.
Freud takes the opportunity provided by this case of discussing the general problem of homosexuality, referring to current and popular theories as to its nature and origin, and the question of its constitutional or acquired character; he points out the important distinction between the inverted choice of object and an inverted attitude in the subject, and the relation between the two. He goes on to deal with the problem of physical hermaphroditism and the presence of secondary sexual characteristics of the opposite sex and the relation of this to psychical inversion; finally pointing out that psychoanalysis is not qualified to solve the problem of homosexuality, which in the last resort depends upon a biological definition of the terms masculine' and 'feminine.' He concludes by alluding to operative experiments on the genital organs by Steinach, of Vienna.
In this essay Freud deals with several points of great psycho-analytical interest; referring particularly to the mechanism of identification of the self with the loved object after repression, a most important matter, responsible for much of the complicated inconsistency of human behaviour; he mentions also the extremely common mechanism of backing-out,' by which a final and life-long abnegation of a particular interest or rôle in life (for example, an interest in music) may be due to an early, and subsequently repressed, rivalry with another in regard to it, the repression taking the form of yielding to the rival, with a total renunciation of the role or interest thenceforth. The subject of the essay shows this trait, the girl having renounced a feminine rôle for ever in consequence of the repression of the wish to supplant her mother in that capacity. He also throws light on a practical point in analytic treatment, arising in the phenomenon of ‘propitiatory' dreams (produced in order to propitiate the analyst and deceive him as to the resistances),