NOTES ON RECENT PERIODICALS.

Internationale Zeitschrift für Psycho-Analyse, Vol. VIII, part 1, 1922.

Dr Imre Hermann contributes an article entitled "Marginal notes on the compulsion to repetition." The compulsion to repetition, a conception first elaborated by Freud in Jenseits des Lustprinzips (1920), is treated by Dr Hermann in the following aspects:

(1) its 'meaning' in the mental structure; (2) its relation to the pleasure principle;

(3) the 'manner' of the repetition.

(1) In order to find the 'hidden meaning' of a mental phenomenon, we ask ourselves the questions: "Whence is it derived?" "What purpose does it serve?" That is to say, that the objective criteria of 'meaning' in such a phenomenon, e.g. a dream or a symptom, are the representation or reproduction of a former situation and the serving of a purpose. Now repetition and purpose secure the continuity of the single psychic individual (personality), and the most primitive method of securing this continuity is that of the compulsory repetition of previous situations. In order that this principle of continuity may be preserved in the case of the instincts with their purposive, yet irrational, character, Freud conceives of the instinct as a force within the living organism, urging it to reproduce an earlier state. This necessitates the extension of the idea of continuity from the individual to the race, and upon this phylogenetic continuity (typical symbols) depends such correctness of interpretation as is possible in the analysis, by means of the subject's own free associations, of the products of other minds.

(2) It is in relation to pleasure-pain as elements of consciousness that the writer considers the compulsion to repetition. According to the Breuer-Freud theory, the question is one of the increase or decrease of excitation in the perceptual (W.; Bw.) and object-memory (Er.) systems. The effect, painful or otherwise, is discussed of simultaneous and repeated stimuli; in the case of the latter the effect varies with the intervals between the repetitions.

(3) Dr Hermann shows that the compulsion to repetition which, as belonging to the primary process, has no regard to time or place, encounters a function of the preconscious system belonging to the secondary process, a function which he terms ‘Ordinanz' (will to order). In both the race and the individual, ‘Ordinanz' develops in the service of the reality principle and would appear to be connected with morality, being conspicuously lacking in morally defective children. He suggests that light may be thrown on this connection by a study of pathological manifestations of the primitive compulsion to repetition (faulty development, regression, morbid attraction of anal and urethral erotism).

Dr S. Feldmann's article "On Blushing" is a contribution to the psychology of shame. The first part of the paper is an account of the analysis of a young man, whom he treated for this symptom of blushing, and shows how it was successively found to be related to the patient's 'beauty-complex,' to exhibitionism with urethral erotism, and finally, to the castration-complex, accompanied in this case with repressed homosexual tendencies. Certain significant points emerged in the analysis: the symptom tended to be less troublesome or to disappear, when the patient practised onanism; when this was discontinued, the symptom again became acute. The nose was to him an erotogenous zone; moreover, he endeavoured to motivate his blushing, of which he was painfully conscious, by rubbing and vigorously blowing his nose. From dreams and other evidence it was clear that, by the mechanism of displacement, the face (nose) was standing for the genitals (penis). Deeper analysis revealed at the bottom of all the castration-complex. The patient suffered from a sense of inferiority in respect of the size of his penis and from a dread of castration. Dr Feldmann be

lieves that self-confidence "crystallises itself around the penis" and that "social shame" arises from feelings of inferiority in connection with that organ.

In the second part of the paper, he discusses certain observations of Darwin, Gerson, Havelock Ellis and others on the phenomenon of blushing and concludes that the mechanism of blushing is similar to that of conversion hysteria, that it manifests itself like a compulsion neurosis and that it is an autoerotic libidinal function of the skin. Freud has shown that one of the sources of self-confidence is the remnant of childish narcissism, and this primary narcissism is intimately connected with intactness of the genital organs. In the Unconscious the ego may be identified with the penis (in dreams, folk-lore, etc.). We know also from Ferenczi that there is a universal identification of the ego with the face. Thus blushing (= erection) is a compensation for the injury to self-confidence.

Dr Paul Schilder (Vienna) gives a detailed account of a psychosis following on an operation for cataract. The patient was a woman of fifty-three, whose naturally timid and nervous disposition was accentuated by the disturbance of her sight. Two days after a successful operation for cataract, she became greatly excited and suffered from visual and auditory hallucinations. As time went on, her delusions took two principal forms: that those around her were about to murder or mutilate her, and that birds or beasts were in the room or the bed, attacking her or soiling the bed-clothes, etc. These terrors continued for seven weeks, after which a hypomanic condition set in but gradually abated and finally disappeared. Dr Schilder shows that the operation upon the eye (a frequent symbolic representative of the genitals) roused the patient's castrationcomplex, which he believes to play an important part in post-operative psychoses. Further, he is of opinion that the resolution of a complex may lead to hypomanic states, as in the case of this patient, a view which he has elsewhere put forward. (“Preliminary studies for a psychology of Mania," Zeitschrift f. d. ges. Neur. u. Psych., 68, 1921.)

In a paper on the psycho-analysis of a case of homosexuality, Dr M. Nachmansohn (Königsberg, Pr.) traces the influence of the innate and the acquired factors in a severe case, the analysis of which (lasting in all over 24 years) was conducted in three separate periods, in which it went through three distinct phases. In the first phase, the development of the perversion was traced, its innate character being given special prominence. In the second phase, the incest-complex was revealed as the root of the disease and manifested itself with great force. In the third phase, by means of 'active' therapy, the completion of the cure was effected.

Besides these original articles, this number of the Zeitschrift contains the following communications:

"The Oedipus-dream of a schizophrenic," by Dr Arnold Stocker. 'Father-rescue and father-murder in neurotic phantasies," by Dr Karl Abraham. "Bridge symbolism and the Don Juan legend," by Dr S. Ferenczi.

CECIL M. BAINES

EDITORIAL.

THIS Journal will appear henceforth under the title of The British Journal of Medical Psychology. The change of name has been forced upon us by various circumstances. The old title has been found too cumbersome for purposes of reference, and a failure by authors to distinguish clearly between the General Section and the Medical Section of The British Journal of Psychology has sometimes led to doubt in the minds of their readers concerning the place where certain contributions to our pages may be found. It has further proved difficult to convince some publishers that the General Section and the Medical Section of the Journal are two separate publications and these publishers have consequently been reluctant to send two copies of a book for review to what they considered to be one journal. It has been and will continue to be our custom to review in the Medical Section many books which are noticed, from a different standpoint, in the General Section of this Journal; and it is hoped that the change of title of the Medical Section will obviate the need for repeated assurance to publishers and others that the General Section and the Medical Section of The British Journal of Psychology, although both organs of the British Psychological Society, are nevertheless two entirely separate and independent publications.

THE "REALITY-FEELING" IN PHANTASIES
OF THE INSANE

BY HENRY DEVINE.

I.

AMONGST chronic asylum cases are always to be found a number of those who believe themselves to be of exalted or royal birth. In cases of acute confusion or general paralysis in which the higher psychic functions are involved the occurrence of such delusions is readily explicable. In those patients, however, in which no defect of judgment or intelligence on ordinary matters is manifest, and the memory is intact, it is difficult to understand how delusions so manifestly absurd and so devoid of any foundation in fact could be seriously maintained. From the knowledge we have of our mental states it is more or less possible to enter into the feelings of a melancholic. Everyone is apt to feel inadequate, retarded, unworthy or vaguely apprehensive at times; but though it is easy to over-estimate our own importance, it is hard to actually feel the attitude of a person of humble birth and position who believes himself to be (say) the Shah of Persia. The attitude of a patient with a belief of this kind is so inconsistent. His behaviour in the asylum may be that of a normal person; he is quite aware of the actual facts of his past life; he adjusts happily to his environment; employs himself usefully in the garden or elsewhere; exhibits pleasure with little gifts or vexation at some real or imaginary slight-and yet holds tenaciously to fantastic views of his own personality which are contrary to that common-sense which he is quite able to apply to any subject but his delusions. Unfortunately most paraphrenic patients are unable or unwilling to give any information to enable us to understand how they could have acquired such strange beliefs about themselves; they content themselves with mere assertions as to their imagined position in life and tend to resent any form of question which seems to cast any doubt on the correctness of their statements. I have recently had under my care, however, a case in which it was possible to observe the development of delusions in their earlier stages; and as the whole subject of insane beliefs is so obscure and difficult, I thought it might be of some value to give a brief outline of Med. Psych. III

6

this case, and to suggest in what respects it seems to afford us some insight into the processes of delusional formation as a whole, and to indicate some reasons why patients believe in the reality of their phantasies.

II.

The history of the case is briefly as follows: Mr J. is a married man, aged 38. He was the youngest child in a large family and his mother's favourite. The parents belonged to the artisan class and lived in one of the poorer London districts. The father was somewhat addicted to alcohol, but the home was respectable and the children brought up as well as the means of the parents would permit. Mr J. grew up a shy, seclusive, dreamy and clever boy. His studious tendencies enabled him to acquire a good secondary education, and he eventually gained a position in the Civil Service. His industry has enabled him to raise himself above the station in which he was born, and he has achieved a position of moderate comfort. He is happily married and has two nice children.

The first signs of mental disturbance occurred in 1915 when he developed 'neurasthenia' attributable to worry and over-work. Some time later he created a good deal of friction in the family by making ridiculous assertions in regard to the morals of his mother-in-law, and subsequently a paranoid attitude developed. As Mr J. himself describes it, "I gained a general impression that people were against me; a kind of excitement was stirred up against me; nasty insinuations, suggestions and remarks were made; there was a sort of under-current when I appeared." All this time he kept on with his work, but after some trouble with a friend whom he imagined had made reflections of the morals of his (the patient's) mother, he broke down for a time and was sent to hospital. He appeared to recover, however, and resumed his work until shortly before coming under my care. He had then been sleeping badly, had alarmed his wife by muttering to himself and gazing strangely about him, had been sitting about for hours with a vacant expression, and had complained of going into trances and having visions.

The patient was an intelligent and pleasant man who talked freely of his case, but he tended to be solitary and seemed more interested in his own thoughts than anything else. And this was actually the case; he explained that he was constantly disturbed by visions of his past life and he could not concentrate on reading or the ordinary affairs of life because these experiences were so compelling. He did not merely think