stimulus of the presence of food. Realization of the range and importance of internally determined instinctual impulses, brought about the formulation of a Dynamic Psychology just as realization of the cultural modification of these impulses opened a new chapter in Genetic Psychology. And finally the conception of Conflict between impulses automatically restrained and ignored by the cultural self, and impulses which maintain that cultural self in being, provided at last a satisfactory explanation of neurotic illnesses. Armed with this new knowledge, a scientific therapy will aim at a better adjustment of internal forces in conflict, rather than at a better adjustment of reactions to environment, for neurotic illnesses are due to threatened failure of internal control of the impulse-life and not to impairment or disorder of the capacity to react suitably to external environment, which appears only in those graver developmental disorders described as Psychoses. The exaggerated and irrational fears of the neurotic are not primarily disorders of the Fear Instinct. He may be conspicuously fearless in situations which do not instigate internal conflict. They are the outcome of an unwitting attempt to deal with an internal menace as if it were external, by mobilizing in a phobia the reactive tendency of avoidance efficacious when external menaces are present. In other words reactive tendencies which, like avoidance or attack, were once appropriate to all menaces are brought into play in the 'projections' of the neurotic as a last resort against internal menaces with which he can no longer successfully cope. One of the several important reasons why rational re-assurances fail to quench a neurotic fear is the fact that his fear is a defence against something more painful. In resisting your re-assurance he is by the way of re-iterating "It's this, not that," although this is perhaps too simple a conscious analogy of the unconscious process of 'counterinvestment.'

When we realize that neurotic illnesses are the outcome of imperfect cultural modification of primary instinctual impulses directed to culturally archaic goals, and that their unrealized persistence behind the too precarious acquisitions of the cultural self, maintains a state of internal conflict which unfits the patient for adequate adaptation to his social environment, we are at last within sight of a purely scientific Psychotherapy. This state of internal stress may occasion somatic disturbances such as disorders of endocrine functioning, as well as obviously unsatisfactory environmental reactions, but at last we see why endocrine therapies and environmental re-adjustments are of necessity palliative measures. It is true that we have to thank the genius and patient

labours of Freud for this fresh standpoint, but for the moment I should like to consider it apart from his distinctive views concerning the nature and grouping of the internal forces in conflict. Although personally I regard these views as the most illuminating and practically useful yet advanced, I am at present concerned with the fundamental pre-requisites of a scientific Psychotherapy rather than with the claims of any existing system to possess them. In theory the scientific validity of this fresh standpoint would not be affected by differences of opinion as to grouping of these instinct-units or as to actual details of Psychogenesis. In the course of time the most valuable views will survive but we do not need to wait for finality in this respect, to claim that this new genetic and dynamic standpoint at last frees Psycho-Pathology from an equivocal relationship with organic medicine detrimental to its own vigorous development.

The Boundary-Concept of instinct-impulse, preserving contact with the organic on the one hand and with mental process on the other, may be described as the bridge across which the new science has reached its own independent territory.

But although here it would seem to be at last secure from attack on its physiological frontier, there still remains to be considered criticism from its metaphysical frontier. For instance, instead of being accused of being too unscientific, from this quarter it may be accused of being too scientific.

Just as those with a physiological bias tend to describe causal psychological formulations as being too unsubstantial, as having no visible means of support, so those with a metaphysical bias tend to describe them as being too materialistic, as having too vulgar means of support. With the extreme view that mental phenomena resist all formulation in terms of scientific causality we need not detain ourselves. It may be correct, but if it be correct then all Psychological research is reduced to absurdity. And no one whose psychological formulations have enabled him both to understand hitherto obscure problems and to get an effective practical grip on phenomena is likely to be seriously disturbed by this point of view.

All that may be said of it here is, that like the scepticism proceeding from a physiological bias it may easily cover an inner shrinking from a scientific investigation of Mind.

I am at present more concerned with the standpoint that a scientific Psychotherapy is not enough, that it requires to be supplemented, in this case not by drugs or extracts, but by the inculcation of philosophic

or religious doctrines. That methods apparently consisting of nothing else than procuring the emotional acceptance of philosophical, ethical or religious systems of thought or belief, may bring about amazing changes in the mental life of large numbers of individuals cannot be contested. We have only to remind ourselves of the most successful example of this form of Psychotherapy the world has ever seen which apparently owed its efficacy to acceptance of the simple maxims:

God is all-in-all

God is good, Good is mind

God, spirit being all, nothing is matter.

Now I do not propose to criticize this form of Psychotherapy when employed by itself or even in conjunction with advice as to diet, breathing and raiment. Here we are dealing with robust empirics beyond the scope of our present survey. I wish to examine rather the contention that a scientific therapy is needed but that it requires to be supplemented by e.g. what Janet has aptly termed 'medical moralization,' for it seems to me that here two quite separate issues are apt to be confused.

For instance, it is possible to question the scientific validity of this standpoint, without questioning the possibility that certain philosophical, ethical or religious beliefs may sustain a man through severe mental stresses. Conversely the value of these cultural acquisitions does not establish the scientific validity of their exploitation in the cure of the Psycho-neuroses. Before this can be established we have to demonstrate that the absence of or defective strength of these acquisitions plays an important part in determining these illnesses. Our therapy then would at least be as scientific as the administration of Insulin to make good a defect in an internal secretion. But immediately we are confronted with certain facts difficult to reconcile with this view. In the first place a man may hold any religious or philosophical belief under the sun, or none at all, and yet be free from neurosis. Again his ethical standards may be obviously defective yet he may escape neurosis. On the other hand, we know that the most profound capacity for philosophic thought, the most saint-like ethical standards, the most earnest and assured religious beliefs have not saved innumerable people from the most torturing neurotic illnesses.

It might be urged that I am making a fetish of scientific method in Psychotherapy and that no means of ameliorating human suffering should be rejected merely because it is not consistent with the requirements of a rational and radical therapy.

I am however dealing here with broader issues than the practical

merits or demerits of any particular methods and am considering various tendencies in their bearings on the development of Psychotherapy as a whole. But even from the point of view of practical value the employment of medical moralization' calls for passing comment.

We have seen that the neurotic's struggle to subjugate certain mpulses, remaining in an arrested or infantile state of development, nobilizes against them all the resources of his cultural self. In other words his powers of sublimation are already strained to breaking point. Again it must be remembered that he is waging internal war, not with the ordinary temptations of the World, the Flesh and the Devil, but with the inner urgency of his arrested infantile cravings. We have here a situation in which 'medical moralization' may not only leave the real sources of guilt and self-reproach untouched, but may dangerously increase the already too strenuous activities of what we call the Superego, the deep-seated source of what is called conscience.

Sometimes an attempt is made to defend the scientific validity of the employment of such psychological adjuvants on the grounds that they promote what is called mental synthesis, a process supposedly rendered all the more necessary by a previous mental process called analysis. This view is the outcome of a superficial analogy, according to which in a mental analysis we take the mind to pieces and in a mental synthesis put it together again and build it up.

This analogy ignores the most fundamental implication of the doctrine of mental conflict according to which forces, which in favourable circumstances should be harmoniously integrated are disintegrated and kept asunder by the dynamic demarcation of Repression. By dissolving this sundering barrier and thus promoting the assimilation of the repressed into the main personality what is called analysis automatically achieves synthesis. Any other forms of so-called synthesis are more correctly described under the categories of side-tracking, re-education, moralization, etc., and however successful they may appear to be leave untouched the most fundamental distribution of dynamic forces in the patient's mind.

It has however been contended that the two processes can and should be combined and here we come to what I have ventured to call the crucial dilemma of Psychotherapy.

Nowadays practically all Psychotherapists are agreed that whatever the actual technique employed, the agency on which we depend for its success, is the affective relationship existing, or brought into existence between the physician and his patient, what used to be called the state

of rapport between them, and is now designated the 'Transference.' While it lasts this affective relationship invests the physician with quite special significance in the patient's mental life, and entrusts him with an authority which can be exploited along one of two directions, butand here is the crucial point-not along both of these divergent directions. The physician has to decide from the first which direction to take and he must stick to his decision, or he runs the risk of falling between two stools.

Now the choice he has to make is between using the Transference to influence the patient directly and using it as a technical means of bringing into consciousness his forgotten infantile past, and the dilemma arises from the fact that in order to achieve this second technical result he must scrupulously refrain from the first.

The point cannot be made clear without some reference to the role of the Transference in a classical Psycho-Analysis.

Here the physician reduces to a minimum all personal contacts with his patient. During the analytical hour he sits out of his patient's sight, and when he speaks it is only to give an impersonal explanation of some point which he considers the patient is ready to appreciate. He does not argue or persuade, he does not praise or condemn. He does not advise. His sole exercise of authority is to enforce the fundamental rule of free association. Now when this procedure is consistently carried out two phenomena are observed to occur, both of which play an important part in the cure. His influence in maintaining the patient's adherence to the difficult task of free association brings about the admission into consciousness of trains of thoughts that otherwise would have been automatically censored, and the overcoming by means of explanation of resistance to these unwelcome intruders is facilitated by the fact that the analyst never appraises but only explains. Each successful explanation facilitates the production of more repressed mental content and the path is opened to memories which gives this repressed mental content a historical setting. The relief which follows this process of integration enhances the affective bond between analyst and patient. The energies released by the cessation of conflict attach themselves to the concealed figure of the analyst and presently a new situation arises in which the patient no longer remembers his infantile past but repeats it in fantasies concerning this impersonal figure about whose actual personality and views of life he knows nothing save a readiness to face and explain unpleasant facts. In producing these Transference fantasies, the patient has an opportunity of reliving and revising his infantile past.