Many children show obsessional tendencies during the latent period; they are over-conscientious, set themselves tasks and punishments, and feel obliged to confess the most trivial offences. At this stage of development the super-ego is especially dominant and these children do not necessarily develop a compulsion neurosis. An obsessional patient from eight to ten years of age felt compelled to spend half an hour over her prayers, which must take a certain form and order. These prayers were spontaneous and had nothing to do with formal religion, in which she had had no teaching at all. After puberty these habits passed off and she was healthy and happy. In adult life, after a number of external disasters beginning with the death of her mother and father, and culminating in the abandonment of an illegitimate child on her marriage, she developed an acute obsessional neurosis. She expressed great faith in the efficacy of confession although she had never practised it, and it was clear from the beginning of the treatment that the expression of her conflict which, as we so often find, relieved the tension of her guilt immediately, corresponded to a tendency which had been intuitively recognized. As I have already pointed out Reik would say it gratified the universal instinct to confess, which relieved the need for punishment.

In these cases the treatment temporarily becomes a compulsion, and is thus obviously partially taking the place of previous compulsive actions which have the dual determination from the unconscious already referred to. Verbal expression apparently gives a modified and limited gratification of the repressed desire when the transference situation has been established. It may be the intuitive recognition of this fact that causes some people to condemn the reproduction and verbal expression of these infantile sexual and aggressive wishes even as a means to an end, that end being the restoration of health. Thus we have in the technique of treatment, as I have pointed out in the case of the neurotic symptom, a dual gratification of instinct impulse, the difference being that the dynamic changes brought about by the confession and the transference situation are stepping-stones to further changes which make mental adjustment feasible.

The second group of cases in which the aggression of the super-ego is especially dominant is that of certain forms of melancholia and depressed states. The state of melancholia has many features in common with that of grief experienced by a normal person after the loss of a loved one1. In both states we have dejection, loss of interest in the surroundings, loss of capacity to love, and loss of activity. In melancholia we have in 1 Freud, Collected Papers, vol. IV, p. 152.

addition a profound loss of self-esteem, an overwhelming sense of guilt and failure, self-criticisms, reproaches and the expectation of punishment. The self-criticism is the work of the super-ego which appears to have mastered all the available aggression and directed it on the ego, which accepts the criticisms as merited and makes no attempt at selfprotection as in the case of the obsessional. The explanation of this behaviour rests on Freud's theories concerning the psychological reaction of these people to the withdrawal of their love from a person who has failed, hurt, or in some way thwarted them.

The withdrawal of the libidinal cathexis is followed by a psychological regression to the oral stage, in which the loved object is made part of the self by incorporation (eating) and is thus also destroyed; psychologically the lost love-object is introjected into the ego, and there experiences the reproaches and criticisms which have been withheld from the originally loved external object. The predetermination of this regression must rest on a development fixation at this early point, the oral stage, which according to the work of Abraham is characterized by the first signs of ambivalence and sadism. In this case as in that of the obsessional the overwhelming concentration of aggressive impulses in the super-ego is due to the defusion of instincts accompanying regression, resulting in as Freud says, "a pure culture" of the death-instinct taking possession of conscience and attempting to drive the ego to destruction.

Clinically it is not hard to prove the truth of this hypothesis, apart from the use of the technique of psycho-analysis. Careful observation and attention to the reproaches and criticisms of the patient, combined with a history of the case, will enable the doctor to recognize the person who plays the leading part in the drama, and has been instrumental in exciting the attack, according to the psycho-analytical view.

4. In the fourth group of cases the early formation of the super-ego has been interfered with or appears to be isolated and shut off. Reich has described this formation in connection with a class of cases for which he uses the term 'instinct-ridden.' The cases he describes under this heading include a criminal type; broadly speaking they suffer from an ineffective critical faculty, they have practically no conscience, their sexuality is manifest and uncontrolled, the guilt, if present, is anchored in neurotic symptoms or repressed.

This group is a contrast to the last owing to the fact that the prohibiting oppressing activities of the super-ego are absent or ineffective, whilst in the preceding group they constitute the main mental occupation. Cases of this type are more frequently seen by the criminologist than by the doctor and are not often presented for analysis.

Another variety of the same type of case is represented by one in which the super-ego formation is interfered with by the behaviour of the parents. It is remarkable, from superficial observation only, how frequently the history of asocial behaviour of one or other parent, or of differences between them, is found to form part of the story of the patient's illness. A deeper investigation reveals the difficulties caused to egodevelopment. There is much work to be done here of a precise and detailed nature, and I will only indicate that the traumatic disturbance of a parental identification through the child's discovery of a parent's gross failure to fulfil the ideal, may be a factor in instigating mental regression and the onset of neurosis.

In conclusion I would remind you that the organization of the superego corresponds in its functions to the herd instinct which has been formulated by many psychologists; primarily, in early life, it represents an attempt at adaptation to family life, secondarily, in adult life, the mode of its development is a measure of social adaptability. A failure of adaptation to family life, when the environment is favourable, is a precursor of failure in group life. This is obvious enough to be a platitude.

Again every psychologist recognizes the neurotic as an individual who cannot adapt himself to community life, whose attempt at adaptation has partially failed and who must be content with a compromise, a symptom which is dynamically determined not only by repressed instinct impulse of the id, but also by the unconscious demand for punishment involving suffering because of the asocial impulse.

Alexander has made an interesting suggestion concerning the relation of social service to guilt-feeling. When dealing with unsublimated libidinal impulses we are familiar with the fact that genital primacy and a satisfactory relationship ensures the resolution of guilt-feeling and the satisfaction of libidinal desires. The question arises why there is no guilt reaction in connection with sublimations and social relationships in spite of the fact that their libidinal origin cannot be undetected by the unconscious critical faculty. Alexander reminds us that in the sphere of literature Sachs has already suggested that it is the social factor which distinguishes writing from phantasy making, and it is the fact of the presentation to others which dissipates the sense of guilt. Alexander would give this idea a wider application. He says,

A social act silences the feelings of guilt; it has in the normal man an economic function similar to that of suffering in the neurotically sick. But the neurotic pays with a coin of narcissistic value, he is able to draw from his suffering masochistic

pleasure, whilst an act that is socially directed is an active performance that can be of use to others1.

A well recognized form of treatment for neurotics which, though not curative in the true sense of the word, may relieve symptoms and enable the patient to carry on, is the setting of useful tasks or making the patient take up definite work, preferably of a social nature. The benefit which results must have relation to the gratification of conscious and unconscious wishes. Super-ego demands, and the unconscious need for punishment, are satisfied by the work, and the other determinant of the symptom of a libidinal nature, is satisfied through the transference to the doctor controlling the treatment. The work of course may satisfy other demands as well as those indicated.

It is obvious that the presence of an unconscious moral factor in the mind is important not only to mental therapeutics but to a wider circle of knowledge which includes sociology, criminology, religion and education, spheres which have already benefited by the researches of psycho-analysis, and are likely to continue to do so as the science advances.

1 International Journal of Psycho-Analysis, vol. vi, p. 352.

CRITICAL NOTICE

Psychological Healing. By PIERRE JANET. 2 vols. Allen and Unwin. pp. 1265.

42s.

To those who take a serious interest in psychological medicine the views of Pierre Janet must always command attention. There are, we believe, distinct defects in his theories from the point of view of modern psychotherapeutic principles, but the extent of his clinical experience and the detailed accuracy of his observations remain unrivalled.

In these two volumes he gives a systematic survey of all the various systems of psychological healing, from miraculous healing, philosophic and moral methods, through methods which utilize the patient's automatism, particularly suggestion and hypnotism, to psychological economies like those of rest, isolation and mental liquidation, under the last of which he includes psycho-analysis.

In the second volume he deals with psychological acquisitions such as educational methods and treatment by excitation, psychological and moral guidance.

A glance at this list will convince the reader of the value of this book if only as a historical digest of the various systems of healing: to acquire the same information elsewhere would take a vast amount of reading.

We are familiar with Janet's theories previously published with regard to these psychopathological states. Briefly stated, they are that the mind is a synthesis, built up of the varied and innumerable mental experiences, sensations, etc., which come to us daily. This synthesis is maintained by 'psychological tension.' At any particular moment we possess a certain quantity of psychological energy which enables us to reach a certain level of psychological achievement. If our energy is at its highest we are capable of reasoning, reflection and the organization of facts. If the level of energy is lowered the synthesis of our personality becomes weakened and we fall into a state of psychasthenia, characterized by the feeling of incompleteness, and states of hysteria, fugue states or dual personality, due to dissociation and splitting of the personality. The factors which determine this 'depression' or lowering of our mental energy are partly hereditary, partly the result of toxaemic states, fatigue, shocks, or persistent emotion. In this way Janet links up the psychoneuroses with physiological states. He quotes, for instance (p. 399), Tissie, who observed that upon a six days' bicycle race the competitors suffered from loss of will, obsessions, phobias and delusions of perse

cutions.

Emotion and fatigue are according to Janet almost identical; "both these phenomena are psychological states of depression in which there are inadequacies and agitations." The difference between them is that emotion is prior to action and appears to inhibit action, whilst fatigue follows repeated action or even inaction. Elsewhere he describes emotion as 'surplus behaviour,' and any form of surplus behaviour is an extravagance which leads to fatigue.

Whenever, therefore, an individual is faced with a task or situation in