Psychoneuroses

PSYCHONEUROSES At this point we may cast back to pre-analytical days and con sider, in as condensed a way as possible, the vast problem of the neuroses as a whole. Two contrasting views have always ob tained on this matter, the popular and the medical respectively. According to the former, neurotic ailments are purposive; they are more or less deliberately produced by the patient's imagina tion for various motives, e.g., securing sympathy, self-indulgence, etc. Medical practice has always been strongly influenced by the same attitude, and the corresponding treatment meted out has often been extremely drastic. Officially, however, the medical view has been that such disorders are proper diseases, for which the victims were, of course, in no way responsible. In practice a compromise was generally reached, typified by the attitude called "kind but firm." The difficulty was to ascertain the nature of the "disease," which was so plainly out of ordinary medical experience. The fiction was desperately invented that there must be some such disease but that unfortunately its traces in the brain were invisible, and so the term "functional disease of the brain" was coined. Janet's researches lent colour to the medical view by demonstrating that in many hysterical manifestations the patient was really unaware of the dissociated mental processes, so that he could hardly be held responsible for them. On the aeti ological side, however, he contributed little beyond confirming Charcot's opinion that shock, both physical and mental, could play a part in addition to an hereditary disposition. Janet's work was mostly carried out in respect of the signs of hysteria rather than the symptoms. He proved, for instance, that a patient suf fering from blindness or numbness could really see or feel, though with a part of the mind dissociated from consciousness. But, strictly speaking, this had little to do with the question of whether causative mental processes lay concealed behind the symptoms.

It was Freud who first demonstrated that hysterical and other neurotic symptoms have a meaning and in so doing he was also able to reconcile what we have called the popular and the med ical views on the subject. On the one hand there turned out to be this much truth in the popular view, that neurotic symptoms are purposely brought about and that their function is to serve some quite personal interest of the patient; but this purpose is en tirely unknown to the patient, for what had been regarded as a conscious process proved to be an unconscious one. On the other hand, the medical view was true in so far as such events can be regarded as something happening to the patient without his knowing why, or, therefore, being responsible for it ; but it was nevertheless something purposely brought about by a part of his personality and not a disease in the sense of an external accident.

One further point in this connection. After the symptom has been in this way created it can be put to further secondary uses in the interest of the patient (to secure sympathy, escape dis agreeable tasks, etc.), but only the smaller part of even these secondary uses is as a rule conscious.

The unravelling of the genesis of neurotic symptoms is an ex tremely complicated affair and has taught us much about the finer mechanisms of unconscious mental processes in general. In re gard to the problem of the neuroses themselves, the outstanding conclusions that have emerged are that they result from uncon scious conflict and represent a compromise between the two com ponents of this conflict, and that the essential source of them invariably lies in the sexual sphere, though other adjuvant fac tors may also be present. The symptoms represent a disguised form of sexual gratification, but this statement has to be supple mented by two others to give it its proper meaning. In the first place, the symptoms also represent an expression of the forces opposed to the forbidden sexual impulses ; it is from this that the suffering of the neuroses proceeds, the suffering, what ever form it may assume, thus signifying fear and guilt. In the second place, the impulses that obtain gratification are not sex ual in the ordinary adult sense, but only the infantile compo vents which, as was described earlier, are destined to build up the adult instinct. What actually happens is that the subject of the future neuroses meets with some situation in life which, for reasons connected with errors in his early development, is difficult to cope with ; the situation may be a really difficult one or one that would present no difficulty whatever to other people who did not possess the particular disposition. He then withdraws into phantasy in which the external difficulties are overcome in his imagination; the phantasies become more and more "introverted," more and more connected with older unconscious ones which they revive, and they ultimately re-animate the oldest, most uncon scious, i.e., most repressed of all, those concerning infantile sex uality. The imagined and consoling gratification of these is op posed by the ego, the energy accompanying them displaced on to associated ideas, and a compromise formation built up in which both of the opposing factors in the conflict come to expression. The structure of any neurotic symptom is thus very elaborate and the genesis of it more complex than might have been supposed. The essential point is the flight into consoling phantasy as an ostrich-like means of dealing with the real exigencies of life.

The famous psycho-analytic treatment with which the conclu sions just indicated are bound up, is designed to remedy the state of affairs by introducing the unconscious part of the mind into con sciousness. It recognizes that the natural method of dealing with forbidden impulses has failed; it has proved to be beyond the patient's power to repress them satisfactorily, i.e., in a way that their energy can find adequate expression through various sub limations and the socially permissible amount of direct gratifica tion. It has proved impossible to find a solution automatically and unconsciously, so the analyst decides to call in the assistance of consciousness. The process of revising the ancient infantile conflicts in the light of adult knowledge, and with the help of an ego that no longer has reason to fear the temptations of child hood, holds out every prospect of the patient finding more har monious solutions than he previously could. The essence of it is the transferring of the decisions, judgments, condemnations, and so on, from the old irrational unconscious super-ego, with its out-of-date nursery outlook, to the conscious self, fortified as it is with all the strength of the conscious personality and the knowl edge of reason. The patient is thus freed from the old tyranny and acquires a control over his full self never before possible.

When the super-ego has been built up in childhood through the imprint of disharmonious influences, there is always the latent possibility of the remarkable occurrence known as multiple per sonality. This condition may take various forms. The simplest is a mere loss of memory for a section of past life, occasionally for the whole past life and personal identity ; such cases are com mon in the police reports. More complicated is the condition when the consciousness remaining develops attributes at variance with what was known to characterize the previous personality. If such cases are investigated by means of hypnotism, but prob ably not otherwise, two or more definite personalities may be de veloped. The relation they have to consciousness varies. They may become conscious in turns, one at a time, or there may be two consciousnesses, one being aware of the second, but not the second of the first. The splitting takes place typically in the region of the preconscious mind, and probably in the super-ego.

Adler and

leaving the subject of the neuroses, mention should be made of two alternative views to those of Freud put forward by Adler and Jung respectively, workers who were for a short time colleagues of his. There is much in common between their two views, especially in their negative aspects of denying the conclusions Freud reached about the deeper strata of the mind. Adler put forward the suggestion that in the neurotic mind all attributes and feeling of inferiority tend to become identified with the idea of femininity, so that the motive of the neurotic trends is to secure in an infinite number of ways a "masculine position." It can be shown that, though this view corresponds with a certain number of observations in neurotic symptomatology, it is descriptive rather than explanatory, since the formula in question is a composite product which can be analysed into a number of constituent elements. Jung's view is harder to present, for it avowedly passes beyond the canons of science and enters the realms of both philosophy and mysticism. Essentially it consists in the reinterpretations of psycho-analytic findings into extremely abstract terms for which there is very doubtful warrant in the evidence to hand.

Insanity.

This is not the place for consideration of the very complex problems of insanity, but it must be pointed out that medical psychology, and especially psycho-analysis, has been able to throw a great deal of light on many aspects of them. The psychology of certain forms of insanity, notably paranoia (delu sional insanity), manic-depressive insanity (mania and melan cholia), and to some extent dementia praecox, has been elucidated in a very satisfactory degree, and even with those forms of insan ity, e.g., general paralysis, that depend on structural changes in the brain, the purely mental manifestations can be brought into line with our other knowledge of unconscious mental processes.

Borderline of the Normal.

To pass to the other extreme, to the borderline of normal mental functioning. There is a large class of phenomena which indubitably indicate erroneous mental functioning and therefore come under the heading of abnormal psychology, but which nevertheless are, by what might be called a general conspiracy, regarded as well within the realm of the nor mal. This latter feat is accomplished by removing the phenom ena from the sphere of psychological determinism and agreeing to ascribe them to vague processes such as "chance," "inattention," "accident," and so on. We refer to the everyday occurrence of such errors as slips of the tongue and pen, forgetting of familiar facts (names, etc.), mislaying of objects, forgetfully omitting to carry out quite definite intentions, and a large number of similar phenomena. Freud has shown by a detailed analysis of numerous examples that these phenomena have a certain amount in common with neurotic mechanisms. It is true that their origin is not sex ual (though of course it may on occasion be so), and that the source is only at times to be sought in the unconscious proper, but it can be demonstrated that they nearly all have a definite meaning and they arise from conflicts between opposing inten tions which are not both clearly present in consciousness.

Dreams.—Similar remarks apply to dreams, for many of these are situate on the same borderline. The older views about dreams have been entirely superseded by the penetrating study Freud has made of them by application of his psycho-analytic method. The latent meaning behind dreams has been laid bare, the mechan isms whereby this becomes distorted into the fantastic imagery of most dreams have been elucidated, the reasons for this distortion are known, and the function itself of dreaming has been as certained. Dreams are devices, which may or may not be success ful, for allaying stimuli that would disturb sleep. They achieve this by a special mechanism which shows much in common with that of the neuroses. Thus there is an introverting regression towards unconscious, and usually infantile, material, the forging of associations with a repressed wish in this sphere, and the disguise of the imaginary fulfilment of this wish, which has, so to speak, in a consoling fashion replaced the disturbing stimulus. The detailed investigation of dream life affords one of the readiest means of access to the unconscious.

Phantasy Life.

Other products of the life of phantasy have also been extensively investigated by the methods mentioned above. We can here only enumerate a few of the fields where this work has proved fruitful; the mechanisms and functions of wit, the meaning of humour, the explanation of such opposite phenom ena as uncanniness (sense of awesome strangeness in a familiar situation) and what is known by the name of déjà vu (sense of familiarity in a new situation), the sources of the imagination employed in such activities as art and literature, the signification of superstitions, folk-lore and mythological beliefs, and last but not least—the significance of religious emotions, beliefs and ritual.

Super-normal Phenomena.

Finally a word must be said about the vexed question of so-called super-normal phenomena, in cluding telepathy and spiritism. In the eighties of the last century many interesting investigations of these phenomena were car ried out on the lines of medical psychology by various English observers, notably Gurney and Myers. They made a number of discoveries in the field of automatic writing, etc., which were in close agreement with the work then being done by Janet and others on subconscious processes in a state of dissociation. Un fortunately the researches soon left these lines and they have not been seriously resumed since then by medical psychologists. The chief reason for this is, obviously, lack of opportunity, for interest in psychology and in super-normal possibilities re spectively has not yet proved mutually compatible ; in other words, mediums appear to guard themselves solicitously against the chance of submitting to a psycho-analysis. The matter there f ore remains in an atmosphere of general scepticism. It is evident that a knowledge of the unconscious must inevitably be capable of throwing much light on many of the happenings recorded in this sphere, but how much ground the conclusions thus reached would cover it is impossible to say without actual experience.

Bibliography (A) General: The best historical accounts are given in Bernard Hart, The Psychology of Insanity (1912) and Psycho pathology (5927) ; Ernest Jones, The Treatment of the Neuroses (1920) ; T. W. Mitchell, The Psychology of Medicine (1921) and Prob lems in Psychopathology (1927). For A. Adler's work see The Neurotic den nervosen charakter, trans. B. Glueck and J. E. Lund (1921) ; • and for C. G. Jung, The Psychology of the Unconscious, trans. B. M. Hinkle (1921). (B) Pre-analytical: Morton Prince, The Dissociation of a Personality (1906) and P. Janet's works, most of which have been translated, are indispensable; the best of the latter is The Mental State of Hystericals (1921). Milne Bramwell, Hypno tism (1913) is an excellent text-book. (C) Analytical: Sigmund Freud has published some 20 volumes, all of which have been translated. A bibliography will be found in his Collected Papers (1924, etc.). The best volume to begin with is his Introductory Lectures on Psycho-Analysis (1926). In addition the following may be consulted with advantage: K. Abraham, Selected Papers (1927) ; S. Ferenczi, Contributions to Psycho-Analysis, vol. i. (1916), vol. ii. (1926) ; J. C. Fliigel, Psycho-Analytical Study of the Family (1921) ; Ernest Jones, Papers on Psycho-Analysis (1923), and Essays in Applied Psycho-Analysis (1923). (E. J.)