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At any rate, if we are not in a position to define neurotic character with precision, our knowledge of it is sufficient to permit of increasingly exact formulations concerning normal character processes. We might provisionally define these as a set of organized behaviour reactions founded on and tending to preserve a stable equilibrium between Id-tendencies and submission to Reality: they are characterized by more or less satisfactory adaptation along lines of displacement. Having proceeded so far with caution we may remind ourselves that at least one non-analytical formulation concerning character was not hampered by scientific timidity and yet foreshadowed a psycho-analytical discovery. What strikes every observer of character processes, is not only their almost compulsive nature but the way in which they repeat over and over again the same situation. In extreme forms where external conditions are continually turned to disadvantage the impression is created that the individual has been pursued by some inexorable Fate. In the language of metapsychology we would say that his actions are governed to a large extent by the 'compulsion to repeat' which is a characteristic of instinct and is seen in a milder form in habit. But this is only to give academic form and understanding to that more terse generalization— "Character is Destiny."
Consideration of the prognosis and treatment of neurotic character affords a welcome opportunity of emphasizing that neurotic character studies are essentially tentative and have no claims to finality. We are as yet very unsure as to mechanisms and classifications, and consequently must be even more guarded on matters of prognosis and treatment. Nevertheless observations made by various psycho-analysts permit us to formulate certain points of agreement and to indicate sharp cleavages of opinion on these matters. For example it is generally agreed that character-analyses are more difficult and prolonged than the analysis of the transference neuroses, and Ferenczi1 has added the rider that analysis of so-called 'normal' persons is for the same reason really much more difficult than has been imagined. There are many good reasons why this should be so. To take the last mentioned factor, the influence of the repetition compulsion: where this compulsion is very strong there is a greater tendency to repeat in action than to remember. Obviously then the prognosis would depend on whether the repetition compulsion can be got into the transference. For example a blind repetition in external situations provides an easy escape from recognition of repressed alloerotic tendencies in transference. Besides we have the
1 Ferenczi, loc. cit.
additional difficulty that this blindly repetitive solution can be camouflaged as a real and thoroughly rationalized actual problem, a process which is strongly reinforced by somewhat blind acceptance, an unconscious conspiracy of silence, so to speak, on the part of society in which normality of character sometimes hangs by a perilous thread of rationalization.
In any case the modification asked for in analysis is not merely recognition and tolerance of libidinal trends but a complete reorganization of Ego structure. The problem of neurotic character formation is essentially an Ego problem and to be certain about the nature of prognosis or treatment, we must have definite information concerning the strength of Super-ego formations and the efficiency of the Ego in reality proving. In fact we have to reconsider the relation of neurotic character to normal character, to neurosis and to psychosis. Now here we find a very definite cleavage in opinion. Whereas all observers seem to be agreed that there is no sharp distinction between an exaggerated character trait and neurotic character, Alexander1 holds that the latter is midway between health and neurosis, and that each neurotic character contains the germ of a neurosis. As opposed to this, Reich2 believes that the neurotic character is more serious than neurosis, and that neurosis represents a peak standing out from a mountain group of neurotic character formation. This prognosis is therefore more grave. Now, whilst Ferenczi3, as has been said, regards character abnormalities as private psychoses tolerated by the Ego, it is clear that he does so only for descriptive and not for prognostic purposes, because he advocates for character analysis a form of 'active' treatment which is contra-indicated in the psychoses. This variance amongst authorities would seem to suggest that no definite prognosis can be given in any case until a preliminary investigation of an analytical nature has been carried out. This is to some extent true and it is obviously good practice to delay opinion until one has taken measure of the patient's sense of reality proving and noted the exaggeration or otherwise of mechanisms of projection. But there is still a rough and ready method of arriving at prognosis. It is the relation of character peculiarities to symptoms and the nature of the symptoms if any. To take extreme cases, a severe neurotic character would appear to have more serious prognosis where there was neither insight nor any subjective signs of illness. Where however signs of neurotic illness were present the prospects of influencing character peculiarities would appear more favourable. Again the presence of
1 Alexander, loc. cit.
2 Reich, loc. cit.
3 Ferenczi, loc. cit.
neurotic symptoms associated with libido defect of late origin, e.g. phobias, anxieties, conversions, etc., would in many instances be regarded as a favourable factor.
It was indeed this relation between symptom formation and character alterations which drew increasing attention to the possibility of treating character peculiarities by psycho-analysis. Four definite observations have been made in this direction; first, that deliberate analysis of character peculiarities arouses not only vigorous transference resistances but is associated with transitory symptom formation; second, that the analysis of neuroses is sometimes accompanied by temporary regressions of character to more primitive levels; third, that reduction of neurotic symptoms is frequently associated with improvement in character abnormalities; and fourth, that improvement in cases of manic-depressive insanity has been observed by Abraham1 to coincide with the appearance of obsessional characteristics, implying advance from a primitive oral fixation to the anal-sadistic level. This would seem to suggest that as in the milder psychoses (Abraham) and in the curable perversions (Sachs) a middle stage may be necessary for the alteration of neurotic character, viz. the transformation of alloerotic impulses into neurotic symptoms and the uncovering of primitive forms of guilt and anxiety.
It is a commonplace of analytic practice to say that character analysis is often refractory and always difficult, and it is not surprising that various suggestions have been made concerning the employment of auxiliary devices. Two of these seem to be in direct opposition to one another yet have this in common that they represent purposive attempts to modify the structure of the Ego ideal or Super-ego. The first is the so-called 'active' method of Ferenczi, which is intended to produce increased libido tension by the imposition of various libido frustrations. They are directed mainly against certain set habits and concealed gratifications and are imposed under transference authority in order to force repressed material to the surface. The second, suggested by Reich for his 'instinctive' character cases, consists of a preliminary educational phase for the purpose of stabilizing the unbalanced Super-ego, to be followed by the usual analysis. A third method is suggested by the work of Wälder2 on psychotics and of Aichhorn on reformatory cases, the
1 Abraham, "Versuch einer Entwicklungsgeschichte der Libido," Internationaler Psychoanalytischer Verlag, 1924.
2 Wälder, "The Psychoses: their Mechanisms and Accessibility to Influence," International Psycho-Analytical Journal, vol. v1, 3, 1925.
3 Aichhorn, "Über die Erziehung in Besserungsanstalten," Imago, vol. IX, 2, 1923.
judicious encouragement of sublimatory activities during analysis. All of these methods are in the experimental stage and do not as yet justify definite conclusions. Nevertheless we can say definitely concerning the treatment of neurotic character that the ultimate success of any treatment depends on classical psycho-analytic methods which do not shrink from subjecting the seemingly banal routine of everyday life to detailed. scrutiny.
PSYCHIATRY AS AN OBJECTIVE SCIENCE1
BY TRIGANT BURROW
WITHIN the accustomed sphere of our observation, that which we call our actual experience is often flatly contradicted by the facts of science. If one sets a match to a piece of paper, his experience tells him that he has "burnt it up" or destroyed it. But chemical experiment plainly demonstrates that his experience is wholly fallacious, that what he has actually done is merely to cause a re-arrangement of the parts or atoms composing the original substance. Likewise, conventional experience wholly repudiates the dicta of the astronomers when they postulate a universe revolving in space. We do not even experience by direct evidence the fact that our own earth is round in contour. We know very well that according to personal experience we may at any moment look out upon the horizon and point to the "dropping off place." The usage of language constantly justifies this casual mode of experience in violation of demonstrable scientific deduction. We do not hesitate to say that the sun 'rises' or 'sets' when we know perfectly well that it does nothing of the kind. We say that sound travels, as from place to place. But sound, as we know, is an attribute of matter, and an attribute cannot travel. We speak of day and night as though such planetary phases were localized conditions when we are quite aware that these phenomena are but the conditions of our own localization.
It is clear then that we are accustomed to employ two quite different modes of evaluation. The one we live by; the other we reason from. The one is subjective, immediate and internal to our habitual feeling; the other is objective, perceptual and external to us. Within the objective sphere that man reasons from he reaches out far beyond his localized and habitual inferences, and within this realm he makes contact with observable phenomena that are dependent upon widely remote but logically correlated data of judgment. Yet side by side with this more encompassing reach of man's reason there remains the phase of his experience that is personal, habitual and uncodified. We permit ourselves trivial, unscientific and inaccurate statements because there exists close at hand the scientific and stabilized principle to which we may return at a
1 Read at the Fifteenth Annual Meeting of the American Psycho-pathological Association, Washington, D.C., May 7, 1925.