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the patient must not be urged to this goal any more than to any definite position or philosophy; but in deep-going analysis the genital primacy appears of itself. Orgasm is not a property of organs but an expression of the entire unchecked offering to a partner, the libido of the entire body issuing at the genital, it is not simply a genital function. Women with clitoris orgasm are inhibited in giving themselves to their partners and have a diminished capacity for orgastic discharge. Similarly those sadists whose penis is a sadistic instrument carry into the act an infantile sexuality which tends to place the genital under the sway of partial impulses instead of the other way round. The facts point clearly to the function of genital libido as a libidinal anchor in reality, as protection against relapse. The patient can overcome every pleasure but the sexual. Patients who appear on superficial examination to be cured may relapse but the author has met with no case of a person who after a phase of full orgastic potency became anaesthetic. This leads to the question of the duration of treatment: the disappearance of symptoms is no evidence of successful cure, neither is the persistence of symptoms evidence of unsuccess. The chief point to consider is the alteration of libido-structure, the passive-feminine male neurotic becomes 'upstanding,' his ego is strong enough to accept his sexual demands in part, in part to pass judgement on them as incompatible with reality.
VILMA KOVÁCS: Analysis of a case of 'tic convulsif'." HELENE Deutsch: "On the psychogenesis of a case of tic." MELANIE KLEIN: "On the Genesis
The Occult Significance of Dreams. SIGM. FREUD. Imago, 1925. Bd. xI. 234-238.
All problems of mental life are to be found in dreams, for example symbolism is no special dream-creation but belongs as much to mythology, anxiety dreams are questions of neurosis, and so on. It is the same with occult phenomena, but since dreams themselves are full of secrets people couple the two in a peculiarly close way. There are two categories of occult dreams-prophetic and telepathic, there is an unmistakable quantity of evidence for both and, on the other hand, an obstinate refusal to meet the evidence. That there are prophetic dreams in the sense that their contents represent the unfolding of the future there is no question, what remains in doubt is the degree of correspondence between the dream and the event. Freud has no experience to lead him to any conclusion. With the telepathic dream the matter is different. By telepathy he means a mental process in one person occurring in another person's mind without employing the paths of perception, and regarding this again it may be said that it is no special dream problem.
If we submit telepathic phenomena to the same criticism that one applies to other occult manifestations there yet remains some material that cannot be lightly put aside-it may be that telepathy exists and that forms a nucleus of truth for many otherwise unbelievable dispositional elements. One does well to maintain one's scepticism obstinately. The following observations are worthy of consideration, though they cannot be communicated with full details.
The person concerned was at a place strange to her and visited an unknown soothsayer who prophesied something that did not occur. The date of the prophesied occurrence had long gone by. Instead of treating the matter as a joke the person regarded the prophesy as satisfactory. The content contained definite particulars which are unintelligible when considered alone. The soothsayer said to the woman, then aged 27 (but who looked much younger), that she would marry again (she was divorced) and at the age of 32 would have two children. The patient was 43 and childless when she came to analysis severely ill and with this story to relate. We can understand the meaning of these figures if we know her private history, which certainly were unknown to the soothsayer in the hall of a Parisian hotel. She married after an unusually intense father fixation and ardently desired children in order to be able to put her husband in the place of her father. After years of disappointment, and on the brink of a neurosis she heard the prophesy that her mother's destiny was to be hers! For her mother had, at the age of 32, two children. How can we better explain the particulars of the prophecy than by assuming the strong wish of the questioner-in fact the strongest unconscious wish of her emotional life and the dynamic factor in her germinating neurosis-to have announced itself through immediate transference to the soothsayer. The author has repeatedly felt in intimate circles of acquaintance that the transference of strong affectively toned recollections occurs without difficulty, and concludes that such transfers occur particularly well at the moment when an idea emerges from the unconscious (theoretically when it passes over from the 'primary process' to the 'secondary process'). This has to do with dreams to the extent that if there is telepathic communication it may reach the sleeper and be perceived by him in dreams; analogously with other perceptual or thought-material we cannot reject telepathy which may be received in the day and elaborated in a dream in the following night. One would like with the help of psycho-analysis to have more and better established experience of telepathy. [This paper and several others on dreams will appear in the forthcoming Bd. III of Freud's Gesammelte Schriften.]
Med. Psych. v
Entwurf zu einer Psychiatrie auf psychoanalytischer Grundlage. By Dr PAUL SCHILDER. Wien, 1925. Internationale Psychoanalytische Bibliothek, No. 17. Internationaler Psychoanalytischer Verlag. Pp. 208. Price 9 Marks.
Psycho-analysts have been contributing to psychiatry for over thirty years and with increasing vigour, and some of the most important additions to psycho-analytical theory in the last decade have been the outcome of close study of the psychoses. Recently the reviewer made an attempt to collect these contributions for a paper to this Section, and found that the task involved a review of almost the whole of psychoanalytical theory. The very complexity of the subject might well frighten the beginner and dismay the textbook writer.
Various textbooks of psychiatry have been written with a paragraph at the end of each chapter on what the psycho-analyst has to say about the various diseases. This method only bewilders students. A book on psycho-analytical psychiatry should lay stress on five points in psycho-analytical theory: (1) the development of the libido; (2) regression and fixation; (3) the three elements in metapsychology, (a) dynamic factors (repression), (b) economic factors, (c) topographical (whether an idea is conscious or is in the unconscious); (4) Ego-development; and (5) the most important feature of the individual's psychic life-the rise and the decline of the Oedipus Complex. There would also have to be chapters on the disintegration of the Super-ego, on sublimation, on character formation and what not. Such a book might be called an attempt to base a psychiatry on psycho-analysis.
The volume before us does not justify its title. The enormous influence and the central position of Freud's "Three Contributions" in psycho-analytical theory is disregarded. Dr Schilder could cut out the meagre references to the pregenital fixations without affecting his main theme, and without most readers noticing the omission if they re-read it in the amended version. Neither is the notion of the unconscious utilized, though it is mentioned. He should have remedied the second omission by the inclusion of his "Spherical Theory," though then he might have forfeited the right to use the label 'psycho-analytical.' It remains to say what he does chiefly deal with. It can be put in a word: Identification. The baby identifies itself with the nipple, when it sees a bright object it identifies itself with that object and stretching out its hand tries to 'master' it, to incorporate it into its grasp (action of Ego-instinct). In similar fashion the child identifies itself with its parents and incorporates them into its psyche. There are two kinds of identification and two kinds of Ideal-ego formation, according to the author, peripheral or impersonal and central or nuclear, which is more personal. To the former belong the identifications with objects, to the latter those more important relations to the parents. Peripheral and central Ideal-egos struggle for the central position in the psyche, for control of action. The most important Ideal-ego formations are due to central-identifications. There are therefore many 'Ideal-egos' in a single person, because there are many persons and things introjected into the Ego.
This view of the formation of the Super-ego differs from Freud's in two important respects: it disregards first, the most important factor in the genesis of the differential grades in the Ego, namely, a frustration. According to Freud, when there is frustration (Versagung) the cathexis is not annihilated but shifts on to another idea (Vorstellung), or else the energy of the cathexis is employed to make a change in the Ego1 and then is attached to an idea (Object-presentation) in the Ego. Dr Schilder, by omitting the invaluable concept of Frustration as the cause of psychical change loses one of the most useful of psycho-analytical notions; and secondly, by omitting the Oedipus Complex, he loses its most valuable discovery, for it is just because the parents are the objects of the sexual desire of the child and yet are unattainable
1 Cf. Kapp, "Sensation and Narcissism," Intnl. Jnl. of P.-A. 1925, VI. 292.
sexually that the child has to do something' with the cathexis of the parent image, the cathexis cannot remain indefinitely suspended and inactive in its mind. What it does is well known: it renounces the parents as sexual objects by introjecting them into the Ego, the energy of the cathexis, on being drawn into the Ego, does not produce megalomania, because there has not been a detachment of the cathexis from the object, but produces a change in the Ego, in the quality of a part of the Ego, we might say, in contrast to a change in the size of the Ego which we can picture as a description of megalomania. This change in quality of a part of the Ego is the process by which the Super-ego is formed. Dr Schilder does not avail himself of this explanation because presumably he has not grasped the importance of the Oedipus Complex in individual development.
The author regards the Ideal-egos as multiple psychical structures having a 'vertical' distribution in the Ego, so that repression can issue from one Ideal-ego division and not from others; and as a consequence of this vertical arrangement the Ego easily 'falls to bits.' He gives a case of a woman with schizophrenia who identified herself with her sister, her father, her grandmother, etc.; in this way by dividing her Ego she was able to avoid conflict. She had destroyed the Ideal-egos in the process as well and had regressed to a number of ego-identifications, so now her conduct had no relation to reality, the barriers between her Ego and the outer world were destroyed, the process of 'depersonalization' had set in.
When there is a splitting of the Ego he finds an observing and an observed Ego face to face. Self-observation (proceeding from an Ideal-ego) is perception with a new and egocentric orientation and is normal in conditions of bodily disturbance; the observing Ego, when it is attracted to the organ which has an over-great libidinal cathexis, treats it as if it were external because it is painful. In similar fashion he regards a disagreeable thought as being ‘objectified,' “though the proof in this case is more difficult," which is a process akin to repression. In schizophrenia a high degree of self-observation is found and a large amount of deep material brought up that others keep repressed; it therefore looks to him as if in this disease repression can be removed from the material coming from the deeper strata of the mind while the higher strata are functioning, for he regards self-observation as standing in close relation to the perceptual Ego and an Ideal-ego. Attention is directed for the most part to the self and the bodily organs at the expense of the outer world so that we should expect and indeed find that depersonalization and hypochondria are clinically very closely related. He brings out the contrast between hysterical hypochondria in which objectlibidinal relations are clearly seen behind the hypochondriacal complaining and the true kind in which there is no trace of this object relation. In true hypochondria the disturbance is in the distribution and amount of narcissistic libido-the fixation is in the narcissistic phase. In another place (p. 78) he finds 'unending difficulty' in settling the question where the fixation point in schizophrenia lies. There is one in the domain of magical experience, one in narcissism, where body and world are not sharply distinguished. He wavers between the foetal stage, birth and the suckling period.
He gives the term 'depersonalization' a wide meaning, it is a state in which the world feels strange, uncanny, dreamlike, and objects seem at times small or flat, the patients do not complain of an alteration in perceptual function but of a change of their ideas. Emotional feelings change greatly, they feel no pleasure or pain, neither love nor hate. In some cases the personality changes so much that affects show themselves by mimicry. Now the orthodox psycho-analytical view of the cause of this condition is a withdrawal of libido from the objects, but to this Dr Schilder objects that the patients observe their experiences quite well. He offers another theory: in depersonalization there are two tendencies to be found, one which tries to get experiences of the outer world correctly and in spite of the estrangement of the outer world not to renounce the experiences, the other tendency seeks to withdraw cathexis from the outer world. His theory is a development of the psycho-analytical one. He is led to the conclusion that depersonalization is a preliminary stage to withdrawal of libido from the outer world, it precedes the 'Weltuntergang' which denotes complete libidinal withdrawal. A part of the perceptual Ego and Ego-ideal remains in reality, that is
to say, these retain a part of their cathexis. He carries the notion however further than most people would care to follow him, saying that every neurosis begins and ends with a phase of depersonalization (p. 41). He uses the term not only in the sense of a diffuse withdrawal of libido, but of a localized disturbance, thus he speaks of a singer who specialized in coloratura who on feeling ill could no longer sing-the depersonalization was in the oral and vocal sphere, i.e. those organs which she had strongly cathected narcissistically, were most depersonalized.
Dr Schilder does not emphasize what causes the patient to withdraw libido from the outer world, and yet this is one of the most important features of psycho-analytical contributions to psychiatry. Let us examine a few well-known cases to see if some hints can be gained for the cause of withdrawal of libido. In the Schreber case we recollect that his marriage had not been blessed with children and he had no son on to whom he could turn the warm affections he felt for his father: there was a damming up of homosexual libido. In Nunberg's case1 the outbreak and the certification occurred shortly after he had returned from manœuvres and had taken up his residence with his sister. It will be remembered that he entertained thoughts of a special kind of holy but incestuous matrimony. The cases could be multiplied, but what must be mentioned here is the fact that there were internal and external frustrations playing an integral part in the aetiology of the diseases (paranoia and schizophrenia respectively), and on failure to obtain gratification of these impulses-conscious in both cases as it happens the patient's libido-organization regressed to pregenital fixations. Freud and Nunberg in the long case histories quoted then trace the next stage in the disease when restitution occurs. Dr Schilder, by avoiding a detailed examination of his cases from the aspect of libido-organization, weakens the book and makes it far less convincing both to psycho-analysts and to psychiatrists. I do not wish to imply that Schilder does not mention the libido theories; he does, but they are not worked into the warp and weft of his subject. His views on the aetiology of schizophrenia deserve special attention. He points out that researches on the shape of the body, Abderhalden's reaction, on the gonads and other organs indicate that there is a disturbance in the internal secretion in schizophrenia, particularly respecting the gonadal secretions, which play a significant part in the establishment of the disease. This illness, conditioned by physical change, affects the psyche, and does so in a different way from gross organic brain lesions. In schizophrenia the physical change produces a change in the position of the libido. He rejects the view that the disease is primarily psychical-a primary tendency to narcissistic regression-but is due to a fixation of a particular physical constellation. The essential causative factor is an 'endogenous component' which acts like a toxin. He compares the clinical picture of the schizophrenic with that of meskaline and cannabis indica poisoning, and suggests that every poison has an affinity for a definite system, and all of them produce a change-about of libido disposition. The intoxicants (alcohol and cocaine) affect the homosexual component of the libido, the hypnotics affect the psychical system which functions in sleep and hypnosis....This is characteristic of his method: a condensation of several theories and none of them worked out. But though not to be recommended as a textbook, it is stimulating reading for the student who is keen enough to be stirred by his brilliance and shrewd enough to be not more than stirred.
An Introduction to the Study of the Mind. By Wм. A. WHITE, M.D. Washington, D.C., 1924. Mental and Nervous Monograph Series, No. 38. Pp. iii + 111. Price $2.00.
Dr White presents an interesting and popular account of general psychology from the point of view of a psychiatrist. After discussing 'what is the mind,' and 'what does the mind do'-its function being to adapt the individual to his environment— he applies the term 'mental' to all total reactions of an organism, and therefore to all
1 Internationale Zeitschrift für Psychoanalyse, Bd. VI and VII.