Full text of "Psychopathology"

See other formats

CORNELL

UNIVERSITY
LIBRARY

Date Due

ISSOMg

WTTf^m

^^^P^fW-T

-sriWAY

TSBOff

W/D iVl^

Ti^

Ipi-^-fefT-Tls '

PHOTO

SbH^itHV LCAN ^SILI

»!'t!T!-r^i

OES^Fi^ar

PRINTED IN

« [QT

NO. 23233

RC 454.Kgr"'""'''"''""-''"'^

Psychopathology,

3 1924 012 465 732

Cornell University
Library

The original of this book is in
the Cornell University Library.

There are no known copyright restrictions in
the United States on the use of the text.

http://www.archive.org/details/cu31924012465732

PSYGHOPATHOLOGY

Fig. L-^Hygeia, the Greek Deity of Health. Health, virility and happiness
being established when the serpent (phallus) is potent enough to feed from the' bowl
(vagina). The physician's duty being to cure debilitating diseases and promote virility
henee insuring the safety of the state and raee. (See Kg. 87.)

PSYGHOPATHOLOGY

EDWAED J. KEMPF, M.D.

Clinical Pstchiatbist to St. Elizabeths Hospital (Formerly Government

Hospital tor the Insane), Washington, D. C. ; Author op

"The Autonomic Functions and the Personality"

EIGHTY-SEVEN ILLUSTRATIONS

ST. LOUIS

C. V. MOSBY COMPANY

1920

CoPTRiGHor, 1920, B«r C. V. MoSBT Company
(All Rights Reseroei)':^^

A f9uy^

Prejs of

C. V. Moshy Company

St, Louis

DE. WILLIAM A. WHITE
Superintendent of St. Elizabeths Hospital

THIS BOOK IS DEDICATED AS AN ACKNOWLEDG-
MENT OF THE OPPORTUNITIES AND BNCOUEAGE-
MENT FOE EESEARCH WORK IN PSYCHOPATH-
OLOGY WHILE ON THE STAFF OF ST. ELIZABETHS
HOSPITAL

PREFACE

This book lias been written for the professional student of
human behavior who must have an unprejudiced insight into hu-
man nature in order to deal justly and intelligently with problems
of abnormal behavior as they are brought to the physician, rec-
tory, police courts, prisons and asylums, and the directors of
schools and colleges, and the commanders of military and naval
organizations.

In order to avoid speculation and theorizing, most of the space
is devoted to plain expositions of the actual difficulties of cases.
They are presented to speak for themselves. Naturally an enor-
mous amount of valuable data on delusions, hallucinations, sym-
bols, symptoms, defensive and compensatory methods of thinking,
different types of inferiorities and causes of inferiorities, etc., is
scattered through these cases. The most important illustrations
have been collected together in the index to be readily accessible
to the reader. For this tedious, difficult work I am especially in-
debted to Mrs. Kempf. The index has greatly increased the use-
fulness of the book.

Most of the case material has been taken from the cases ad-
mitted to St. Elizabeths Hospital, and for this privilege I am in-
debted to Dr. W. A. "White, superintendent of the institution. I am
also indebted to Prof. Adolf Meyer for the privilege of using some
case material -I worked out while assisting him at The Phipps
Psychiatric Clinic in Baltimore. The members of the staff of St.
Elizabeths Hospital assisted me materially in collecting the more
interesting cases and I wish to thank especially Drs. Mary O'Mal-
ley, Anita Wilson Harper, Helen Clarke Kempf, Lieut. Col. Paul
Freeman, U. S. A., M. C, and Dr. James C. Hassell for coUectiiig
interesting observations on the wards which would otherwise have
been lost. I Avish also to thank Miss Clara Willard and Mrs.
Kempf for correcting and editing the manuscript and Mr. Edward
Clements for his patience and kindness in typewriting it.

Edward J. Kempf.

St. Elizabeths Hospital,
Washington, D. 0.

CONTENTS

CHAPTEE I PAGE

The Physiological Foundations of the Personality 20

The Autouomie Apparatus, 21; The Projicient Apparatus, 21; Peripheral
Origin of Cravings (emotions, wishes, sentiments) in Different Segments of
the Autouomie Apparatus, 21; Mechanism of Postural Tensions, 21; The In-
fluence of the Autonomic- Affective Cravings on Postural Tensions and Kin- •
aesthetic Sensations, 22; The Mechanism of Conflict between Segmental
Cravings and between Segmental Cravings and the Bgo, 28; The Value of
the Projicient Apparatus to the Autonomic Apparatus, 29; The Nature of
Consciousness and the Content of Consciousness, 31; The Conditioning of
Autonomic- Affective Cravings, 36; Substitutions of Symbols, Fetiches, Im-
ages, Delusions, Hallucinations for Eealities Which Are Needed to Gratify
Uncontrollable Cravings or Believe Fear, 39; The Affect and the Use or Dis-
use of Organs, Anaesthesia and Hyperaesthesia of Receptors, 49; The Phys-
iological Nature of Memory, 49 ; Complex Nature of the Autonomic- Affective
Stream, 52; The Development of the Ego, 52; Mechanism of the "Trans-
ference," 56; Origin and Nature of the Will, 57; Affective Adjustments,
Suppression, Mepression, SiMnmcUion, Dissociation, Segression, Compensation,
Beadjustment, Assimilation, SublimMion, 61; Psychopathic Eliminations or
Simulations, 69; Formula of the Affective Conflict, the Environment and
Behavior, 74.

CHAPTER II

The Psychology aw the Family 76

The Conditioned Autonomic-Affective Cravings of the Individual and the In-
fluence of his Associates, 76; His Associates and Environmental Situations
as Compound Stimuli, 77; The Insidious Repressive Influence of Parents
and Associates Who tend to Repress their Own Cravings, 80; The Psychopath
aiid the Influence of Associates, 80; The Judge and His Son, 82; The Rus-
sian Peasant- <Jirl, 83; The Letter of A Business Man about His Mother's
Influence upon Himself and His Brothers and Sisters, 87; The Family's Re-
sistance and Pernicious Regression and Dissociation of the Youth's Personal-
ity, 88; Causes of Variations in Family Adjustments and Matings, 91; The
Child that Binds the Mismated, 93; The Child that is Hated Unconsciously
and the Matured, Brooding Psychopath, 93; The Wiii/'s Disgust for Sexual
Relations and Her Insidious Castration of the Husband, the Husband as a
Homosexual Regressive, 94; The Foundation of the Oedipus and Electra Love
Fixation in the Child Due to the Dissatisfied, Erotic, Clinging Parent, 102;
The Homosexual Father and Parricidal Inspirations in His Matured Son as
Biological Compulsions, 103; Competition for Social Esteem and the Serious
Influence of Flirtatious, Flattering Parents and Teachers, 104; The Insidi-

CONTENTS

PAGE

ous PatMpgieal Influenee of Dominating the Child to Strive to be "First"
and "Beat," 112; The Despair of Relative Organic Inferiority, 112; Trans-
mission of Familiar Functional Traits through the Conditioning Influence of
Associates, 117.

CHAPTER III

The Universal Struggle for Virility, Goodness and Happiness 118

Definition of ViriUty, Goodness, Happiness, 118; The Biological Laws of the
Struggle, 119; The Bisexual Attributes at Birth, 120; The Influence of As-
sociates and the Development of Aggressive and Submissive Masculine Traits
in Competition where Adequate and Inadequate Compensations Are Developed
through Training in Childhood, 122 ; The Influenee of the Unconscious Attitude
of Others toward Superior and Inferior Organic and Functional Traits, 122;
The Seven Stages of Evolution of the Sexual Functions, 123; The Precedence
of Homosexual Interests to Heterosexual Interests in Man and the Inf rahuman
Primate, 139; Marriages as Cures for Psychopathic and Painful Situations,
156; The Biological Struggles of Males and Females with Conventions and
Perverse Resistances as Portrayed in Art and Myths, 165.

CHAPTER IV

Inplxjence op Organic and Functional Inferiorities upon the Personality . 179
Competition and Contrast of Organs and Functions, 179 ; The Necessity of
Compensation for the Inferiority, 180; Fear of Failure in Sexual Selection,
181 ; Failure and Avoiding Competition and Affective Regression, 183 ; Elim-
ination of the Inferiority, 183; Castrations (Surgical and Functional) 184;
Catatonic and Hebephrenic Adaptations, 184; Simulations and Eccentric Com-
pensations (Paranoid), 184; The Influence of Hatred, 185.

CHAPTER V

Mechanistic Classification op Neuroses and Psychoses Produced by Dis-
tortion OP Autonomic-Apfective Functions 189

Necessity of Abandoning the Old Modified Kraepelinian System of Classifi-
cation, 189; Advantages of a More Adaptable Simple Method, 192; Discus-
sion'of the New Method, 193; Table, 190.

CHAPTER VI

The Mechanism of the Suppression or Anxiety Neuroses 201

Variations in Degree of Anxiety, 201; Symptoms of Anxiety and Spastic
Tensions, 202; Anxiety and Sexual Impotence, 203; The Influence of Fear
without Insight into the Cause, 203; Failures of Compensation, 205; The
Anxiety Neurosis of Charles Darwin, 208; The Conditioning Factors in His
PamUy that Determined His Professional Selections, 213; The Personal
Sources of His Theory of Evolution, 241; The Wish to Hallucinate His Fa-
ther, 244; 'The Anxiety Neurosis of a Scientist "Which Later Developed Com-
pensatory Paranoid Inspirations, 251; The Father's Repressive Rivalry and

CONTENTS XI

PAGE

the Autoerotie Mother Fixation in Youth as tlio Foundation of the Parricidal
Compulsion, or Crucifixial Psychosis, or the Sacrificial Suicide after Maturity,
285.

CHAPTER VII

Eepkession or Pstchoneuboses ; Their Mechanisms and Relation to Psy-
choses Due to Repressed Autonomic Ckavings 289

Differentiation of Anxiety or Suppression Neuroses from Repression Neu-
roses, 289; Phobias, Compulsions, Obsessions, Delusions, Hallucinations, 292;
Elimination or Castration Strivings and Simulation Strivings, 293 ; Case of
Mysophobia, 293; Case of Convulsions, Vomiting, Anesthesia, Visual Con-
striction, Erythema and Itching, 297; Case of Functional Paralysis as a Cas-
tration of Incestuous Autoeroticism, 318; Suicidal Compulsions as Castra-
tion of Incestuous Autoeroticism, 322; Perverse Sexual Cravings and Suicidal
Compulsions, 323; Case of Fear of "Dying" and Choking, and an Abdom-
inal Tic Relating to Submissive Homosexual and Impregnation Cravings, 327;
Simulations to Escape Responsibility, Case of Railroad Spine, 335; Simula-
tions of Pregnancy and Labor Produced by the Dissociated Erotic Cravings,
335; Simulation of Diseases and Functional Distortion as Defenses against
External Causes of Fear in Fearful Perverse Erotic Compulsions, 345; Rela-
tion of Repression Neuroses to Dissociations of the Personality and Affective
Regressions, 352.

CHAPTER VIII

Benign Compensation or Regression Neuroses, with or v^ithout Dissocia-
tion or Personalitv, Manic-Depressive Psychoses. Elimination or

Simulation for Wish-fulfillment in Affective Crises 353

Two General Types of Depression, With Anxiety or Without Anxiety, "353; Case
of Prudish, Intelligent Woman Trying to Eliminate Uncontrollable Eroticism,
355 ; the Autoerotic Significance of Skin and Hair or Scalp Rubbing, Picking,
Scratching, Finger Biting, Rubbing Sputum in the Skin and Hair, Clothing
or Furniture, Picking out Threads, as Extraneous Bits and Placing Them in
the Mouth, 369; Oral-Gastric Erotic Cravings and Swallowing Sticks, Glass,
Needles, Nails, Hair, etc., 377; Autoerotic Fancies and Their Fixation, 378;
Depression Without Anxiety, as an Affective Regression to an Infantile or
Intrauterine Level, 379; The Erotic Flight Followed by Renunciation of the
Love-Object and Infantile Affective Regression, 379; The Mechanism of the
Manie-Erotic Flight and the Unrestrained Incestuous Fantasy, 379; The Sub-
limated Parental Attachment, 384; Case of Unrestrained Erotic Indulgence
and Dissociation of the Personality, 385; The Ego's Gradual Reassimilation
of the "Mysterious" Hallucinations as "Imaginations" (Meaning Wish-
fulfilling Creations), 400; Case Organic Inferiorities and Erotic Fancies Re-
vealing Mechanism of Compensation, 402 ; Manic Compensatory Striving as A
Defense against Uncontrollable Eroticism, 407; The Double Value of the
Symbols used and the Behavior, 410; Anal-Erotic Compulsions and the De-
fense to Conceal Them in One Case and the Heedless Indulgence in Another,
418; Differentiation of the Attitude Toward the Erotic Compulsions by the
Dread of, or Delight in Getting into Rapport with the Physician, 419.

Xll CONTENTS

CHAPTER IX

PAGE

Pernicious Kepression Compensation Neuroses. The Pstchopathologt of

Paranoia 421

The Particular Nature of the Biological Inferiority and the Eccentric Com-
pensatory Strujggle to Develop Virility and Win Social Esteem, 421; Compe-
tition and Contrast of Inlgirior Organs and Punetions, 421; The Phylogenetic
Foundations of the Dread of being Biologically Inferior, 421; Compensations
for Sexnal Impotence and Pear of becoming Homosexually Submissive, 422;
Perpetual Motion Machines and Eccentric Inventions as CompensatioBS, 423;
Language Creations as a Defense and Self -aggrandizement, 431; The Poten-
tial Dangefousness of the Paranoiac lies in his Fear of becoming Perverted
and his Hatred of any Influence in that Direction, 435 ; The Domineering Fa-
ther and Parricidal Inspirations, 439; The Resultant Affective Compulsions
that Culminated in the Assassinations of Lincoln and Garfield, 440; The
Mechanism of Dissociation of the Personality in the Paranoiac and His De-
fense Without Deterioration, Differentiated from His Defense With Deterio-
ration, 449 ; The Enduring Nature of the Final Dissociated Adjustment When
the Individual Becomes Convinced that the Erotic Compulsions Are Caused by
Secret Plots of Other People (Case PD-1), 450; Marriage as a Defensive
Solution of Homosexual Compulsions, 457; The Parajioid Defense of Homo-
sexual Compulsions in the Female, 472; The Relation of Paranoid Compensa-
tions to Similar Compensations for Functional Inferiorities having an Organic
Foundation But a Perverse Tendency, 473.

CHAPTER X

The Pstchopathology or the Acute Homosexual Panic. Acute Pernicious

Dissociation Neuroses 477

Mechanism of the Homosexual Panic, 477; The Sensory Disturbances and
Hallucinations Caused by the Uncontrollable Erotic Cravings Which Become
Dissociated, 478 ; The Ego 's Desperate Defensive Striving and Terror of Eter-
nal Disgrace and Biological Impotence, 478; The Significance of Delusions
about "Poison" in the Food and Oral, Nursling Erotic Cravings, 480; The
Erotic Cravings Compelling Impulsive Gratification after the Ego Has Lost
Control, 480 ; Series of Cases Illustrating Homosexual Panics and Homosexual
Submissions, 480; Symbolic Manner of Describing Difficulties, 482; Symbol-
ism of the Hallucinated Snake, Poison, Dope, etc., 488; Paranoid Mechanism
in Women, 507; "Freezing" Repressive Influence of the Female upon the
Homosexual Male, 511; The Regressive (Intrauterine) Significance of Some
Suicides, 511 ; The Prognosis of Homosexual Panics, 514.

CHAPTER XI

The Pstchopathology of Chronic Perniciqus Dissociation of the Personal-
ity WITH Defensive Hatred, Eccentric Paranoid Compensations and

Pernicious Deterioration 516

The Reconstructive Influence of a Positive Transference in the Cases that
Recover, 516; Cases of so-called Paranoid Dementia Prsecox, their Behavior,
Fear, Defense, and Manners of Recovery, 518 ; The Paranoiac 's Vicious Cir-
cle because of Blaming Others for his Inferiorities When the Cause of the
Sensory Disturbances Lies in the Repressed Dissociated Cravings, 523; The
TJnadjustablfl Conflict When the Family Becomes Intimately Involved, 533;

CONTENTS Xm

PAGE

The Sexual Kxatioii of the Male Paranoiac on the Mother and the Female on
the Father, 551; The Significance of Crucifixion Tendencies in the Paranoiac
in Contrast with the Overt Crucifixion in the Catatonic, 554.

CHAPTER XII

The Pstchopathology of Chronic Pernicious Dissociation or the Personal-
ity "WITH Crucifixion and Catatonic Adaptations to the Repressed

Cravings 556

Catatonic Adaptations in Animals and Man to Causes of Fear Associated
with Sexual Excitation, 55'6; The Dissociated Sexual Cravings and the Cata-
tonic's Defensive Adjustment to Environmental Temptations but Submissive
Enjoyment of the Erotic P'ancies, Hallucinations, etc., 557; The Ego's Yield-
ing Crucifixion to the Uncontrollable Affect, 557; Impregnation and Labor
Fantasies, 563; Feelings of Dying and Rebirth, 563; The Significance of the
Catatonic Male's and Female's Feelings of Being Crucified and Being
' ' Christ, ■' ' 569 ; Christ as the Symbolization of Equally Active Bisexual Ten-
dencies, 578; Variations of Adjustment, to the Erotic Pressure to Become a.
Love-Object, from Fanatical Compensations to Utterly Heedless Resignation,
590; A Case of Spontaneous, Unreserved Confession of Erotic Perverseness
with Gradual Assimilation of the Repressed Cravings and a Practical Re-
eoustitution, 605; The Essential Differences between Catatonic and Paranoid
Adjustments to the Erotic Pressure and the Differences in the Conditioned
Nature of the Erotic Pressure, 613.

CHAPTER XIII

The Pstchopathology op Chronic Pernicious Dissociation of the Personality
WITH Hebephrenic Adaptations — Predominance op Excretory Erotic

Interests 615

Paranoid, Catatonic and Hebephrenic Adaptations to Failure Determined by
the Conditioned Nature of the Erotic Cravings, 615; Fascination for the Ex-
cretions among Primitive Peoples, the Illiterate, and the Medical Profession
of Yesterday, 615; Case of Persistent Affective Repression, Pernicious Regres-
sion to the Intrauterine Level with Dissociation of the Personality, Panic and
No Insight, Predominance of Excretory, Autoerotic Interests followed by Pro-
gressive Reconstitution of the Personality through Psychoanalysis, 617; Influ-
ence of the Positive Transference, 654; Episodic Anal Erotic Compulsions
and Episodic Confusions of the Bpileptoid Type, 661; Anal Eroticism and
Cravings to Destroy, 662; Love of Filth and Waste in Anal Erotic,. 662;
Comparison with Mysophobic Compulsions in Attempts to Eliminate Anal
Erotic Cravings, 662; Case of Insidious Development of Anal Eroticism and
the Tendency to True Epileptic Orgasms, 684; Hebephrenic Self -Cures, 690;
Hebephrenic Impregnation Fantasies, 691; An Anal Erotic Paranoiac with-
out Deterioration, 691; Summary, 693.

CHAPTER XIV

Reconsideration op the Conditioned Autonomic Affective Determinants of

Abnormal Variations of Behavior 698

The Forces of the Personality, 698; The Repressed Segmental Craving
and the Symbol, Ritual, Fetich, Fancy, Fairy Tale. Novel, Psychosis, 704;

XIV CONTENTS

,- >'A'--ii-'-V PASE

Influence of Affective di!a#|a§&: on Postural Tensions, 706; Differences in the
Mechanisms of the Neuroses and Psychoses, 710 ; Determinants of the Prog-
nosis of Affective Distortions, 715; Symptoms of 'Affective Conflicts, 720.

CHAPTER XV

PSYOHOTHBEAPEUTIC PRINCIPLES 733

The Problem of the Ego and the Segmental Craving, 733; The Suggestive
Method of Treatment, 733; The Psychoanalytic Method, 734; The Necessity of
Restoring the Vigor of the Ego before Beginning a Psychoanalysis, 737; The
Development and Control of the Transference, 738; The Ahsolute Necessity of
Freedom of Association of Thought, 742; The Use of an Assistant in Psycho-
analysis when the Transference cannot be Controlled, 742; Responsibility of
Penal Institutions and Asylums, 743; Because of the "Wholesale Erotic Per-
versities that Must Occur Where Men or Women are Isolated and Discouraged
from Again Winning Social Fitness and Freedom, 745; The Biological Cas-
tration Tendency of Present American Social Practices, 746.

ILLUSTRATIONS

FIG. PAGE

1. Hygeia Frontispiece

2. African Pliallic Wand 39

3. Aztec Phallic Ceremonial Knife 39

4. Symbols of Sexual Union 40

5. Symbols of Sexual Union

A. Winged Phallus 42

B. Phallus Grasped by Crab 43

C„ Maiden and Serpent 44

D. Copulation Design .... 45

E. Double Vase 46

F. Copulation Design 47

6. Symbolic Postures of Hands ... 48

7. Maha-Kali, Wife of the God Siva 95

8. Egyptian God Phtha 97

9. Java Temple and Legend 100

10. Costa Eiean Phallus as Diety 107

11. Pygmalion and Galatea — Eodiu 108

12. Courtesan — Eodin 114

13. Martyr— Eodin 115

14. In the Garden — Brush 116

15. Costa Eican Copulation Fetich (Prehistoric) 125

16. Mars and Venus United by Love — Veronese 126

17(a) Two Natures of Man — Barnard 137

(b) St. Michael, the Archangel — Zurbaran 137

(d) Theseus Slaying Centaur — Barye 137

18. Centaur and Cupid 138

19. Hercules and Omphale — Boulanger 142

20. Eternal Spring — Eodin 143

21. Lost Hour and Maternity — Beveridgo 146

22. Caryatid — Eodin 147

23(a) The Storm— Cot 148

(b) The Eing— Alexander 148

24. Madonna of the Eose — Dagnan-Bouveret 149

25. Mother; — ^Lewin-Funcke 150

26. Bacchante — ^MacMonnies 151

27. Der Sphinx— Von Stuck 153

28. Eequiem — from Pfister 160

29. Isle of the Dead— Boeeklin 161

30. Fetal Position of Egyptian Burial 163

31. Buddha 164

32. Ivory Coast African Copulation Fetich 167

33. Aztee God— Phallic Border of the Kobe 168

XVI rLLUSTEATIONS

PIG. PAGE

34. Aegean Goddess, with Serpent Attributes 169

35. Falling Leaves — Merle 170

36. Graziella— Lefebvre ' 171

37. Laehrymffi — Leighton 172

38. Eve— Rodin 173

39. Eve . . . ^ . 175

40. Simulation of Manhood '. r™f^ 182

41-A. Spastic Distortion as Defense against Anal Erotic Cravings , 347

41-B. Biting off Lips as Defense against Oral Erotic Cravings 351

42. Cupid and Psyche — Eodin 354

43. Posture of Begression 355

44. Mother Earth as Madonna 363

45. La Pensfie — Eodin 371

46. Centauress — ^Eodin 372

47. Captive — Michelangelo 374

48. Hand of God— Eodin 382

49. Die Hoffnung — v. Bodenhausen 406

50. Inspired, Dissociated Paranoid Type with Purified Hands 413

51. "Pirst Church — Perpetual Motion" — ^Patient 428

52. Cover of Magazine — Ert6 489

53. Desperate Striving to be Fiercely Masculine 552

54. Pieta, — Michelangelo 5^;;

55. The Resurrection or Rebirth 567

56. Seal of Lichfield Cathedral 569

57. Window of Dumblane Abbey 569

58. The Vulva and its Symbol, the Ellipse 571

59. Imitation of Christ as a Biological Type 604

60. Catatonic as God 610

61. Leda and Swan — Michelangelo 640

62. Petal Posture of Negress 642

63. Regression to Early Childhood 655

64. Costa Rican Sculpture, Fetal Position (Prehistoric) 6fl|; ;

65. Hebephrenic Fetal Postures 660

66. Hebephrenic in Primitive Posture 661

67. Crochet Work Showing Preadolescent Incest Fantasy (A and B) 694

68. Regression to Infancy 696

69. Masculine Compensation in Homosexual Female 701

70. African Fetich Tree 705

71. Omnipotence as a Compensation for Impotence 706

72. Asylum Group 707

73. Characteristic Biological Result of Dissociated Oral Eroticism 708

74. Auto- and Anal-Erotic Catatonic Showing Posture of Hands 721

75. Autoerotie Joy , 721

76. Autoerotie Terror 722

77. Prayer to be Saved from Oral Eroticism 722

78. Anal Erotic Joy 728

79. Anal Erotic Hate 723

80. Anal Erotic Terror 723

81. Oral Erotic Suppression 724

82. Adaptations to Anal Eroticism 725

ILLXTSTRATIONS XVU

FIG. PAGE

83. Adaptations to Perverse Eroticism 726

8i. Adaptations to Perverse Eroticism 727

S5. Castration of Eye as Defense against Auto Eroticism (Incestuous) .... 728

86. Contrite Virgin 728

87. Aesculapius 739

ILLUSTEATIOXS AEBANGED ACCOBDING TO TSEIE AFFECTIVE OB
SYMBOLIC SIGNIFICANCE

Fliallic

2. African Pliallic Wand . 39

3. Aztec Ceremonial Knife 39

10. Costa Bicau PhaUus as Deity 107

33. Aztec God— Phallic Border of Eobe 168

34. Aegean Goddess, with Serpent Attributes . . 169

70. African Fetich Tree 705

Vulvar

56. Seal of Lichfield Cathedral 569

57. Window of Dumblane Abbey . . ... . . • 569

5S. The Vulva and Its Symbol, the Ellipse . 571

Symhols of Sexual Union
1. Hygeia Erontispieee

4. Sexual Union ... .40

5. Sexual Union • • 42-47

6. Symbolic Postures of Hands ....... . . . 48

15. Costa Eican Copulation Fetich • 1-5

16. Mars and Venus United by Love 126

32. African Ivory Coast Copulation Fetich .... 167

51. First Church — Perpetual Motion 428

87. Aesculapius ^^^

Sexual Attachment to Parents or Children

9. Java Temple l^^O

11. Pygmalion and Galatea ■ • 1"^

27. Der Sphinx 1^^

54. Pieta ^^^

61. Leda and Swan ''^^

67. Crochet Work ^^^

Seterosexuality

12. Courtesan ^^^

13. Martyr ^^^

14. In the Garden ^^^

20. Eternal Spring ^^^

21. Lost Hour and Maternity ^^^

22. Caryatid "^^^

48. Hand of God ^®^

49. Die Hoffnung • *°^

XV] 11 ILLUSTRATIONS

FIG. PAGE

23. A. The Storm 148

B. The Eing ; 148

24. Madonna of the Rose 149

25. Mother 150

26. Bacchante . . 151

35. Falling Leaves 170

36. Grazi^Ua - . . . . 171

37. Lachrymse 172

38. Eve 173

39. Eve 175

42. Cupid and Psyche 354

44. Mother Earth as Madonna 363

Somosexuality

7. Maha-Kali 95

17. A. Two Natures of Man 137

B. St. Michael, the Archangel . 137

0. Theseus Slaying Minotaur . .- . 137

D. Theseus Slaying Centaur ... 137

18. Centaur and Cupid 138

19. Hercules and Omphale 142

52. Cover of Magazine 552

72. Aslyum Group 707

73. Dissociated Oral Erotic Personality 708

74. Catatonic 721

77. Prayer to be Saved from Homosexuality . . 722

78. Anal Erotic Joy 723

79. Anal Erotic Hate 723

SO. Anal Erotic Terror 723

81. Oral Erotic Suppression . , 724

82. Adaptations to Anal Eroticism 725

53, 84. Further Adaptations to Perverse Eroticism 726-727

Autoeroticism

8. Egyptian God Phtha! 97

3J.. Buddha 164

45. La Pensee 371

46. Centauress 372

47. Captive 374

75. Autoerotic Joy 721

76. Autoerotic Terror 722

Begressions

62. Fetal Posture of Negress 642

55. The Resurrection or Rebirth 567

63. Regression to Early Childhood 655

64. Costa Rican Sculpture, Fetal Position (Prehistoric) .... .... 659

65. Hebephrenic Fetal Postures 660

66. Hebephrenic in Primitive Posture 661

68. Regression to Infancy 696

ILLUSTRATIONS XIX

FIG. PAGE

28. Requiem 160

29. Isle of the Dead 161

30. Fetal Posture of Egyptian Burial 163

43. Posture of Kegressiou 355

Compensations and Defenses

40. Simulation of Manhood 182

41. A. Spastic Distortion . . 347

B. Destruction of Lips . 351

50. Purified Hands in Autoerotic 413

53. Desperate Striving to be Fiercely Masculine 552

59. Imitation of Christ . 604

60. Catatonic as God . . 610

69. Masculine Compensation in Homosexual Female ... .... . 701

71. Omnipotence as a Compensation for Impotence ... 706

So. Castration as a Defense Against Eroticism .... ... . 728

86. Contrite Virgin 728

LIST OF CASES

AN = Anxiety neurosis

PN = Psychoneurosis
MD := Manie depressive dissociation
• P = Paranoia

PD = Paranoid dissociation

CD = Catatonic dissociation
HD = Hebephrenic dissociation

GP ■= General paresis

AS ^= Arteriosclerotic deterioration

CASES PAGE

AN-1. Fixed grandfather attachment with hallucinations and suicidal compulsions 83
AN-2. Affective sources of Darwin's inspirations and anxiety neurosis .... 208
AN-3. Mother fixation, father domination, autoeroticism and pernicious sense of
inferiority with parricidal ilispiration in maturity, final suicide as a
sacrifice 251

PN-1. Mysophobia of young woman 293

PX-2. Convulsions, anesthesia, vomiting, erythema, itching of young woman . 297

PN-3. Functional paralysis 318

PN-4. Compulsion to smash head 322

PN-5. Compulsion to suicide 323

PN-6. Abdominal tic and laryngeal tensions ... 327

PN-7. Spastic distortion, defensive 345

MD-1. Anxiety because of eroticism aiid simulations of pregnancy 355

MD-2. Anxiety because of erotic hallucinations 364

MD-3. Anxiety because of autoerotie compulsions 372

MD-4. Anxiety because of autoerotie and oral erotic compulsions 376

MD-5. Periodic erotic flights and regressions 379

MD-6. Manic-overeompensation to be mother's hero, followed by infantile regres-
sion, later followed by paranoid brooding • . . 381

MD-". Abandonment to erotic flight with hallucinatory gratifications .... 385

MD-8. Erotic fancies, overcompensation for organic and functional inferiorities . 402

MD-9. Fear of homosexual submissive compulsions with violent, bluffing defense 407

MD-10. Wild manic compensation for fear of inferiority 409

MD-11. Wild manic compensation as defense against uncontrollable anal erotic

cravings , . 409

MD-12. Abandonment to autoerotie cravings without- fear 418

MD-13. Abandonment to autoerotie prsadolescent cravings without fear .... 516

LIST OF CASES XXI

CASES PAGE
P-1. Heterosexual impotence, fear of liomosexual submissiveness with defensive

compensations of divine omnipotence 423

P-2. Similar to P-1 in divine inspirations resulting in violent tragedy .... 434
P-3. Tear of small genitalia and sexual inferiorities with compensatory compul-
sions to invent world's most powerful cannon 436

P-4. Paternal persecution in youth with parricidal compulsions in maturity — Guiteau 440
P-5. Paternal influence in youth with parricidal inspiration in maturity — J. "Wilkes

Booth 447

PD-1. Fear of homosexual submissive compulsions, with dissociation of personal-
ity, and brilliant literary compensations 450

PD-5. Fear of homosexual submissive compulsions with marriage as a defense,

final pernicious dissociation of personality 457

PD-6. Fear of homosexual submissive compulsions with systematized delusions and

counterattack 458

PD-7. Pernicious dissociation due to homosexual submissive cravings ... .95

PD-8. Pernicious periodic dissociation with eccentric omnipotent compensatory

fancies 96

PD-9. Fear of hom'osexual cravings with defensive marriage 459

PD-10. Pernicious dissociation due to homosexual compulsions, finally suicide as

escape 462

PD-11. Fear of homosexual compulsions with violent counterattack 469

PD-12. Pernicious dissociation due to autoerotic cravings with compensatory fan-
cies of developing omnipotence 470

PD-13. Pernicious dissociation due to homosexual cravings with omnipotence defense 480
PD-14. Acute panic upon homosexual regression in male with recovery .... 484
PD-15. Acute panic upon homosexual regression in male with recovery .... 486
PD-16. Acute panic upon homosexual regression, marriage, with eventual perni-
cious dissociation 325

PD-17. Uncontrollable erotic simulations with panic at hallucinated homosexual

assault in female 335

PD-18. Panic upon homosexual regression in male with pernicious dissociation 489

PD-19. Homosexual regression without panic in male 491

PD-20. Acute panic upon homosexual regression in male, with recovery . . 493

PD-21. Acute panic upon homosexual regression in male, with recovery . . . 494

PD-22. Acute panic upon homosexual regression in male, with recovery . . . 496

PD-23. Panic upon homosexual regression in male, with recovery . . . 498

PD-24. Pernicious dissociation in negro 500

PD-2'5. Pernicious dissociation with fear of castration 501

PD-26. Pernicious dissociation with crucifixion cravings 502

PD-27. Acute pernicious dissociation with vivid wish-fulfilling hallucinations : . 502
PD-28. Pernicious dissociation in female, panic upon uncontrollable homosexual

cravings 507

PD-29. Pernicious dissociation in female with systematized paranoid delusion of

persecution due to secret autoeroticism 508

PD-30. Panic with suicidal compulsions upon heterosexual failure in an illiterate

Eussian male immigrant 511

PD-31. Panic with suicidal compulsions upon heterosexual failure in an intelligent

American 51."!

XXU LIST OF CASES

CASES PAGE

PD-32. PetJjioioiis dissociation in anal erotic female having vigorous prostitution

compulsions _ . . . 691

PD-33. Pernicious dissociation due to irrepressible ora,l homosejiual oravii^wwith '
paranoid defense, recovery '■'"w . . 517

PD-34. Pernicious dissociation due to irrepressible homosexual cravings with para-
noid defense, partial recovery 526

PD-35. Incestuous mother fixation, father-uncle hatred, homosexual fears, final per-
nicious dissociation .... 533

PD-36. Pernicious dissociation in female with homosexual cravings and heterosex-
ual aversions 547

CD-I. Homosexual regression in male with crucifixion to the father, catatonic

adaptation, impregnation, rebirth, reconstitution, manner of recovery . 557

CD-2. Cruciiixion to the father and mother, with catatonic adaptation to uncontrol-
lable erotic compulsions in female, manner of recovery 572

CD-3. Uncontrollable autoerotic compulsions with catatonic adaptation, manner of

recovery 579

CD-4. Uncontrollable homosexual orucifixial compulsions with wild compensatory

defensive strivings 590

CD-5. Self-castration compulsions as compensatory defense against uncontrollable

autoerotic and homosexual cravings .... 600

CD-6. Acute homosexual panic in male showing erotic value of hallucinated snake 603

CD-7. Orucifixial inspirations and sublimations of father attachment . . 604

CD-8. Chronic tendency to polymorphous sexual perverseness culminated by eccen-
tric fervid compensatory compulsions, crucifixion and elimination of per-
verseness 605

CD-9. Oral eroticism with panic and self-purification 601

HD-1. Chronic sexual repression, pernicious dissociation, regression, reconstitution,

manner of recovery with insight 617

HD-2. Pernicious dissociation with permanent regression to infantile level . . . 654
HD-3. Pernicious dissociation with permanent regression to infantile excretory

erotic level 656

HD-4. Pernicious dissociation due to homosexual cravings with omnipotent com-
pensatory defense . . . . 662

HD-5. Bpileptoid convulsions in dissociated personality having uncontrollable

submissive anal erotic cravings 671

HD-6. Epileptoid stupor in dissociated personality having uncontrollable submis-
sive anal erotic cravings 672

HD-7. Stuporous confusion in hebephrenic erotic state ... 678

HD-8. Submissive anal erotic compulsions 673

HD-9. Submissive anal erotic compulsions in stupid dissociated personality . . 674

Hl)-10. Violent hatred in anal erotic female 674

HD-11. Pernicious dissociation due to uncontrollable submissive anal erotic crav-
ings, impregnation and father fancies 675

HD-12. Pernicious dissociation due' to submissive anal erotic cravings, social re-
covery 680

HD-13. Pernicious dissociation due to anal and autoerotic cravings 682

LIST OF CASES XXlll

CASES PAGE

HD-14. True epilepsy of insidious development, pernicious regression in anal erotic

youth having an infantile mother attachment 684

HD-15. Pernicious dissociation with eccentric compensatory defenses against auto-
eroticism 325

HD-16. Pregnancy feelings and fancies in male 691

HD-17. Naive cures for impotence 688

OP-1. Paretic Avith fears of heterosexual impotence and compensatory euphoric

defense . . 473

<JP-2. Paretic with homosexual fears and compensatory defense 474

AS-1. Arteriosclerotic witli compensatory defense for homosexual fears . . . 475

PSYCHOPATHOLOGY

INTRODUCTION

Psychopathology treats of abnormal behavior, that is, ab-
normal thoughts and actions and their causes as they are found
in individuals. No other study must deal so intimately witli
the most tabooed and secret tendencies of human behavior. The
psychopathologist believes that the most grewsome maladjust-
ments of humanity can be understood and in many instances can
be happily corrected, and this conviction justifies his study of
phases of human behavior that are regarded by some as the most
sacred interests of humanity, -which must never be violated by
doubts or questions, and by others are believed to be the perverted
causes of most of humanity's suffering, -which must be uprooted
or suppressed at any price.

A treatise on syphilis must deal frankly with syphilis, and on
gjTiecology, -with the diseases of the organs of the pelvis, even
though the subjects are tabooed by refined society. The student
of human behavior should train himself, because he has been
educated to take quite the opposite vic-w, to appreciate the tremen-
dous behavioristic significance of the fact that Man has ascended
from some branch of the ape family. In a biological sense, Man
is a species of ape that has gradually developed an intricate social
system of laws and beliefs (methods) which direct the gratifica-
tion of the indi-vidual's affective cravings. By developing systems
of laAvs that are designed to prevent heedless excitation and grat-
ification, and systems of punishment that, make him fear uncon-
trollable or tabooed cravings within himself, forcing him to
compensate with strivings to control them, he has succeeded, upon
the one hand, in directing the forces within himself so as to build
up a civilization, but, on the other hand, he has gradually become
so constituted that, Avhen these same forces become uncontrollable
and tend to run their own biological course, they distort and
even destroy his personality. The uncontrollable, tabooed crav-

I PSYCHOPATHOLOGY

ings, and the struggle with them, constitute the functional neu-
rosis or psychosis. For these vital reasons the psychopathologist
or psychiatrist, if he is true to his duty and his cause, must learii
to think honestly and without prejudice, prudery, or mock finery
about any abnormal cravings in man, no matter where local-
ised in their physiological activities or what they tend to do. No
work can be more difficult, because we must often study abnormal
affective cravings that are naturally extremely offensive to even
think about. The reaction of disgust or aversion is of the utmost
protective value to man as well as to many other forms of animal
life, but the psychopathologist must learn to prevent such reac-
tions from becoming obvious to the patient or from diverting his
study and treatment, or misleading his prognosis and judgment,
because it is the possibility of being considered disgusting that
terrifies most psychopaths and compels them to conceal the nature
of their inferiorities. The almost universal tendency to accept the
camouflaging, complaint as the true difficulty rather than uncover
cravings that may be incomparably more offensive and distressing
is the principal factor that has retarded the insight of psychopath-
ology and, in turn, psychology and philosophy.

The reader who can not study the abnormal tendencies of
Man without prejudice is advised not to study the case histories
in this book. The student who is determined to understand the
nature of Man, in order to contribute intelligently to the improve-
ment of Man and his social systems, will surely find much valuable
material for his work and no little information that may influence
him to see Man as quite a different problem than his parents and
teachers had interpreted and taught him to believe. The averie^p
American has been taught, through the influence of his associates,
to react to most things that pertain to sex in either a prudish or
vulgar manner. My experience with classes in psychopathology
shows that it is difficult for sortie individuals to avoid becoming
prudish or vulgar when the abnormal sexual tendencies of a
patient have to be studied with the same scientific sincerity -~with
which any other biological deviations are studied.

The psychopathologist must free himself from the earlier
impressions of both influences and train himself to accept the
degrading and refining tendencies of Man for what they are worth
to the individual, on the one hand, and to society on the other,

INTRODUCTION 6

for maintaining the functional statiis of virility, goodness, and
happiness. This state is most conducive to fulfilling the biological
career of the individiial and the species. Vulgarity is as intoler-
able to the prude as prudery is to the vulgar aad both of these
tendencies are to be avoided, because one is conducive to a bio-
logical degeneration of Man and the other, to his castration ; both
eventually leading to the development of abnormal behavior and
misery. The truly normal attitude is to recognize that anything
which tends to insidiously pervert or discourage the cultivation and
enjoyment of love, has, biologically, an abnormal influence. But,
to emphasize publicly the importance of cultivating the capacity
to love to the average American, who, although he secretly knows
it to be the truth, has always been influenced to make a joke of it,
is like telling him to glorify interests that all his life he has treated
as abject "mushiness."

The biological destructiveness of the persistent tendency to
vulgarity or to prudishness becomes evident time and again in the
study of abnormal people and is typically illustrated in the des-
perate struggle of Case CD-8 to refine himself, and in the frantic
efforts of Case MD-1 to save herself from a prudish conception of
disgrace.

No one can study this collection of cases of abnormal behavior
and sexual (biological) maladjustment without realizing more
than ever that civilization is indeed a delicate structure that must
be protected and fostered with eternal vigilance and sound
msdom, in order that its growth shall be full, progressive and
healthy. Never has it been so evident that social taboos and com-
munistic sublimations must be thoroughly protected from the in-
fluence of ignorance, fanaticism, superstition, vulgarity, laziness,
envy, lust, prudishness, autoeroticism, homosexuality and per-
verse heterosexuality. It is clear that we must not accept from
religious fanatics or purveyors of sex that the body is a filthy des-
ecration of the soul. Man is a biological creation and only exists
as a healthy, happy, constructive force so long as he lives in har-
mony with the self -refining tendencies of Nature and avoids both
the castration tendencies of the prude and the degenerating ex-
ploitations of the vulgar. It is comparatively simple and very
easy to be an extremist in anything, but it requires eternal care,
sound common sense, and no little patience and endurance to main-

4 PSYCIiOPATHOLOGY

tain a progressively refining', healthfully constructive attitude to-
■vvard the fundamental needs and pleasures of hiiman nature.

The prejudiced attacks upon Freud's conception of the nature
of the influence of love and sex upon the normal and abnornial
mind, by physicians who have earned, through years of work and
study, the reputation of sincere mindedness, shows how extremely
difficult it is for many people to study the problems of love and
sex without losing control of themselves. This is largely due to
the way they haVe been trained to adjust to these vitally important .
functions.

The analytical study of a large variety of abnormal people,
of both sexes, from many nationalities and of nearly every age,
educational and mental level, has demonstrated that all peojjles
tend to suffer from similar affective difficulties and that similar
adjustments to similar cravings produce similar psychoses, no
matter what country or race they come from. That is to say, the
suppression-,. repression and dissociation of segmental cravings re-
sult from fear of the cravings, and, when the segmental cravings
are similar and the defensive compensatory strivings are similar,
the psychoses, as the symptoms, are sim,ilar. Hence, if given a
good account of the psychosis and the compensatory strivings, we
are able to diagnose and often correct the repressed cravings of
the individual, although the patient himself has not been conscious
of their existence or influence.

It is almost needless to say that this is a dynamic biological
conception of mental disease and is decidedly different from the
Kraepelinian method of classifying cases into symptomatological
groups, and, in turn, assuming these groups to be distinct t^^pes
of diseases of obscure etiology but fairly definite prognosis. The
Kraepelinian and Freudian concepts have been enthusiastically
supported and bitterly assailed, which is the common greeting of
all movements that tend to overturn old gods and older dogmas.
The discoverers of the mechanics of the circulatory system, the
process of vaccination, the bacterial cause of disease, the first
users of anesthetics, obstetrical forceps, percussion, ligatures,
rubber gloves, hypnotism as well as psychoanalysis have had to
endure bitter personal attacks; hence it is quite to be expected
that many of the cases, records, and particularly the physiological
formulation of the personality and processes which cause abnor-
mal behavior and psychoses will be inipartially criticised by some

INTRODUCTION 5

and violently attacked by others who can not avoid i)li rasing their
criticisms in a bitter personal liglit. From the first type of crit-
ical attitude much is to be expected that is constructive and woi'th
while ; from the latter type, nothing.

It seems necessary to remind the reader again that he must
never allow himself to forget that Man is by no means a perfected
species of the ape family, that he is undoubtedly in one of his most
critical periods of development and refinement, indicated by the
growing vision of an international social system to prevent war
and subjugation, and promote free social development, and by the
discovery that the most destructive forces in Nature Avhich bear
upon the individual are not external to himself but within himself
and actually constitute his personality.

The Darwinian conception that Man has ascended. from some
species of the infrahuman primate is freeing humanity from
countless confusing dogmas and fancies as to the origin and des-
tiny of Man and has enabled the student of human behavior to be-
gin to approach his problem as a biologist. Freud's discovery that
the tvish is the dyilamic factor in the personality, as one feels it in
himself, did as much for psychology and psychopathology, as Dar-
win's theory of evolution did for biology. Tlie next logical devel-
opment is to account for the physiological nature and origin of tlie
wish. James and Lange, before Freud, taught that the emotions
had their origin in the peripheral activities of the viscera, but
James seems to have had no clear idea of the existence or dynamic
influence of the repressed (forgotten) wish as later discovered l)y
Freud. On the other hand, Freud has not given us a conception of
the physiology of the repressed ivisJi and how it continues to exist
in the personality after the individual has succeeded in making
himself "forget it;" that is, has prevented the wish or affective
craving from causing him to be conscious of its influence and
needs. Freud's conception that the repressed wish (energy or
libido) becomes converted into pliysical distortions or symptoms,
a concept now freely used l)y some writers on the "conversion
mechanisms" in liysteria, is a l)i()logical riddle and utterly unin-
telligil)le. Most Freudians do not try to explain it. They simply
accept and use the explanation dogmatically as if it settled most
questions — a method of working that is similar to the method of
the pre-Darwinian biologists, who explained the origin of a spe-

PSYCHOPATHOLOGY

cies by. assuming tlie conversion of some' sort of divine energic
constituent into a type of organism. It is just this assumption of
libidinous conversions that has made it impossible for many ear-
nest neurologists and psychologists to follow Freud. Holt's timely
warning that we had best not assume a "psychic energy" to con-
stitute the wish, although we are safe in accepting that the wish is
the dynamic force in the personality, "directs our attention directly
to the physiological origin and nature of the ivish.

If the student will see the "will-to-be" or the "will-to-have"
and the wish to he or have as different ways of regarding the af-
fective cravings that are acceptable to and constitute the ego, and,
-further, recognize that all emotions and sentiments are cravings
that have their origin in the tensions and movements of different
autonomic (visceral) segments, then the dynamic forces in ab-
normal and normal personalities become relatively simple. This
conception, which is amply supported by physiological data, is
thoroughly workable and is a consistent biological conception of
the dynamic forces that make up the personality : one that is com-
prehensive enough, if fully applied, to cover all the phenomena
which are to be found in normal and abnormal behavior, and upon
minute introspective self-analysis.

The various systems of the body, if grouped according to their
functions, form two great divisions, the autonomic apparatus and
its projicient apparatus. The sensory streams flowing from the
periphery of different segments of the autonomic apparatus (de-
fined in Chaptet I) constitute the affective cravings or feelings,
and the sensory streams flowing from the projicient apparatus, as
it is compelled to work by the affective stream, constitute the kin-
esthetic stream. The kinesthetic stream and exteroceptive sensory
streams become associated in a manner that makes the organism
conscious of them as thoughts or conceptual images of past experi-
ences and present external realities. These sensory images or
mental pictures are as much of a reality as the mountains and the
ocean, and the realization of this pertinent fact is of tremendous
value in understanding the delusion, hallucination and dream, in
fact, the whole psychotic misinterpretation of the environment.

This is decidedly a monistic biological conception of the
I^ersonality and leaves no room for the notion that the mind is
one thing and the body another, and that these artificially created

INTRODUCTION 7

entities work upon each other in an intimate parallelistic manner :
hand in hand in a metaphysical romance. There have been vigor-
ous attempts to bridge the gap that is created when the old as-
sumption, that "the body" and "the mind" are distinct from on*^
another, is given a negative belief by trying to adopt an attitude
that subordinates and evades the dilemma. The older phys-
iologists worked mth physical processes without considering
what they made the individual conscious of, and the older psy-
chologists studied what the individual was conscious of without
caring what particular physiological changes occurred that de-
termined the nature of the content of consciousness; hence, the
confusion of views.

An ardent movement to avoid or bridge this chasm is being
made in some psychiatric centers by using " psych obiological"
terms and phrases on the common-sense assumption that, since
Man is after all only a biological product, his thoughts are in some
manner dependent upon physiological processes; hence, it would
be more practical for psychopathology to subordinate the mental
and physical dilemma. This casts a fog over the chasm and denies
"its presence, depending upon no one's asking for an explanation of
what has become of it or how it is to be bridged. This has one
value in that it encourages some students to work without bother-
ing about the two points of view that create the chasm, but it is
far from satisfactory, because the psychopath is incessantly
troubled by a content of consciousness that distresses him, which
can not be explained or relieved by assuming that somewhere in
the brain some neurones are out of order (such assumptions ex-
plaining anything and nothing), or that there is a constitutional
maladjustment.

Meyer's teaching that the psychiatrist, psychologist or physi-
ologist must do more than think of the isolated phenomenon which
he happens to be interested in, such as the hallucination, the con-
tent of consciousness or the physiological functions of a neurone
or segment, if he wishes to understand the entire problem and see
the phenomenon as it occurs in its relationship to the personality
or organism as a whole, has been of the utmost importance in forc-
ing many workers to take account of their attitudes. But we must
go much further than merely pointing out that the personality
must be considered to work as a unity. The very attitude forces

b PSYCHOPATHOLOGY

US to develop an explanation of hoiv the personality, as a unity,
works if we care to be understood.

The contributions of the psychoanalysts have greatly clarified
this problem. Particularly the work of Freud and Jung, and oth-
ers, on the activities of the repressed wish working against the
egoistic resistance and the use of symbols to avoid the fear of
failure or of being censured ; and Adler on the compensatory striv-
ings because of fear of being organically or functionally inferior
to the competitor for the love-object ; and Bleuler on the compensa-
tory value of autistic thinking; have been of decisive value in de-
veloping a better understanding of the personality. But none of
these contributions get us on a truly physiological basis, and no
conception of the personality or any of its attributes is sound until
it is so formulated and clarified as to be readily understandable in
terms of the integrative functions of the nervous system.

-It is almost needless to say that this could not possibly have
been brought aboiit until Sherrington gave the world his remark-
able series of studies on the integrative action of the nervous
system, on the' postural tonus of muscle and nerve, and on the
proprioceptive system especially in its reflex aspects. The"
interesting differentiations of the fimctions of cortical areas and
the localization of neurone groups that have to do with the func-
tions of some muscle group or sense organ have a definite neuro-
logical value but contribute little to the actual solution of the rid-
dle of the personality. They encouraged the conviction that there
is an intimate relationship between physiological activities and
the content of consciousness, but not until we learned to under-
stand the integrative functions of the organism were we actually
able to explain in a physiological manner such phenomena as the
adjustments of allied and antagonistic wishes and thoughts, func-
tional conflicts, inhibition or suppression, repression, summation
and dissociation of antagonistic cravings, the necessity of sym-
bolical compromises in methods of thinking, the source of the pres-
sure of the repressed craving or wish in the postural tensions of
visceral segments and its manner of causing delusions and halluci-
nations.

No explanation of the personality can be expected to be satis-
factory so long as it is not as clearly integrative in its mechanisms,
and as definable in its elements as the integrative functions of the

INTRODUCTION 9

nervous system, because the content of consciousness and beluvvior
are results of the integrative functions of the whole organism and
not the localized activities of different centers of the nervous sys-
tem. It seems to be very difficult for many of our most important
psychiatrists and psychologists to recognize this fact. I am deeply
indebted to the late Prof. J. J. Putnam for his encouragement in
this point of view, because it came at the time that a series of
dogmatic objections, that I Avas dealing in "neurologizing tautol-
ogies," greeted my efforts to show how many of the features of a
psychosis could be explained as phenomena of integrative conflicts
Avithout either assiiming lesions of the nervous system or the pres-
ence of a destructive toxin. These unintelligible resistances, which
made neither a pointed criticism nor gave a Avorkable alternative,
loomed up like foggy, mountainous obstacles that prevented the
recognition of critically important principles.

The integrative conception Avas further clarified by two most
important contributions to our knowledge of the dynamic forces
of the personality, Cannon's Avork on the bodily effects of pain,
fear, rage and hunger, and PeavIoav's and BechtereAv's on the con-
ditioned reflex. Cannon clearly shoAved that the intragastric itch-
ing, felt as hunger, Avas produced by peripheral activities in that
viscus, and that the hunger craAT.ngs compelled the projicient ap-
paratus to seek and acquire food. This Avas of the greatest signif-
icance, although he still seemed inclined to l)elieve that other emo-
tions or cravings, as such, had a cerebral origin. FoUoAving the
suggestion, I belieA-e made by Freud, that all emotions, sentiments
and hungers Avere really different types of cravings and the
James-Lange theory of the peripheral origin of the emotions, the
researches of Cannon on fear and rrifie were capable of interpre-
tation in a manner that explains, like the craving for food, the
physiological or rather autonomic sources of all the wishes, emo-
tions and sentiments of the personality.

The neutralization theoiy of the dynamic or autonomic mech-
anism of the personality is as folloAvs: The different segments of
the autonomic apparatus are stimulated to assnme different tapes
of postural tensions cuid activities, trliicli (jive rise to an affective
nervous stream, irhich, in turn, coordinates llie priijieienl appa-
ratus cmd compels it to act so as to expose the receptors of the
organ-ism so that they loill accjuire certain types of stimuli and
avoid others. The stinmli which m.ust he acquired in order to

10 PSYCHOPATflOLOGY

avoid prolonged unrest and distress, which may become decidedly
WMlnutritional in their influence, must have the capacity to coun-
ter-stimulate the autonomic segment so that it will resume a state
of comfortable tonus, We find that this occurs in hunger, fear, hate,
love, siiaiaie, jealousy, sorrow, eroticism, etc. This lalsr of com-
pulsion by the segment .to seek counter-stimulation and neutralisa-
tion of its craving seems to me to be the physiology of the wish and
the fundamental dynamic principle of all behavior; and not until
this law and its physiology are understood and applied can nor-
mal or abnormal behavior be really understood.

The segmental craving when hyperactive or hypoactive needs
certain types of stimuli to bring about a comfortable adjustment in
its postural tonus. What determines what the stimuli sha,ll be?
Is it an inherent predilection or a- matter of experience? It is
both, no doubt. We have an inherent metabolic preference for
oxygen and are compelled to acquire it as the pulmonic segment
becomes distressed. But how sjidivhere we shall seek oxygen is
a.matter of experiences conditioning the segmental craving to ac-
quire certain stimuli which are associated with the primary stim-
ulus and eventually lead to it, and to avoid the stimuli that are
associated with its loss. That the segmental cravings of different
people should have different preferences and aversions is readily
traceable to the conditioning influence of experiences with the en-
vironment and particularly the influence of other people.

The researches of Pawlow, Bechterew and Watson have given
us the mechanisms by which segments of the autonomic apparatus
and the simple projicient reflexes are conditioned. Hence, the ab-.
normal or tabooed segmental cravings of the psychopath must be
studied, particularly through the psychoanalytic method, so that
he will become aware of their influence and the experiences that
conditioned the segment to crave certain stimuli and avoid' others
that are socially important. For example, a large number of sol-
diers and sailors are received at St. Elizabeths Hospital each year
who state that they are disgusted with life and care for nothing.
They are depressed, sullen, morose, slovenly, destructive, and
often have hallucinations pertaining to pleasant anal and gluteal
stimulation — sodomistic in their general trend. They usually give
a history of having been discouraged by bullying companions and
impleasant work. In studying this peculiar segmental domination

INTRODUCTION 11

of the personality, I found that mothers often stimulate the gluteal
and anal regions of their babies to comfort them when they are
pouting and sullen. An incident may, perhaps, illustrate how this
occurs. ^^Tiile in a street-car, a young mother held an infant on her
knee as it played contentedly with a soldier's keys and chain.
When he left the car, taking his keys and chain, the child began to
fret and cry. The mother slipped her hand under the dress so as
to cover the gluteal area and began to shake the child up and
doAvn with slow rhythmical movements. The child soon stopped
fretting, having acquired a satisfactory substitute in the gluteal
stimulation. Here is a distinct illustration of the countless ex-
periences that this infant will have, which eventually, will prob-
ably detennine what stimuli are needed as a solution of its sullen,
depressed, morose states and also its most pleasing substitution for
demonstrations of love and sympathy upon its trials and losses.
(For further illustrations, see the excretory erotic fascinations
of the sullen, hebephrenic type of dissociation of the personal] tv.
Chapter XIII.)

To return to the significance of conditioned segmental crav--
ings. It is obvious that many secondary stimuli become associated
Avith primary stimuli that are pleasing to some segment and par-
ticular states of tension of this segment, but also become asso-
ciated AAT.th the primary painful or obnoxious stimuli of other
segments or states of tension, such as the color red in fruits and in
danger signals that may happen to be stationed between the hungry
stomach and the fruits. Through an endless variety of experiences
we see the principal autonomic segments eventually becoming quite
firmly conditioned to seek socially approved stimuli in a manner
that wins social esteem. Furthermore, and herein lies the crux
of the neuroses and abnormal behavior, as people become ashamed
or fearful of a segment's activities they try to disown it as a part
of their personality, as when individnals feel fearful, angry, erotic,
covetous, or embarrassed in a situation and refuse to admit it but
m-aintain that they only feel "nervous" or "worried." In every
matured personality there is something that thinlfs of itself as "I"
and the divisions and functions of the body as "mine." This
entity that constitutes the "I" or "me," or "myself" (the ego),
does not exist at birth but can be observed to develop gradually
from infancy to adolescence and reach its final integrations as a

12 PSYCHOPATHOLOGY

highly organized unity in late maturity. It is constituted oi the
inherent segmental functions that have become conditioned to seek
stimuli in" a manner that not only obtains gratification but also
wins social justification and esteem. Hence, this egoistic unity
must keep the asocial segments under control.

This conception of the personality is purely biological and be-
havioristic, and, it will be shown, fully accounts for the content of
consciousness and memory, will and choice, purpose and reason,
or that vaguely, chronically used concept, the mind in contradis-
tinction to the body, or psychological processes in contradistinc-
tion to physiological processes. The whole parallelistic issue is
completely avoided if the student will but learn to see that con-
sciousness and the content of consciousness is the reaction of the
body as a unity to the sensc^tional activity of one or several of its
parts. And when toxins, injuries, fatigue, etc., prevent the seg-
ments from integrating into a unity, consciousness of the activities
of a part disappears, as when passing under a general- anesthetic
or going to sleep.

The struggle of the egoistic unity to keep any perversely con-
ditioned segmental craving from causing us to be conscioiTS of its
needs, because we rightly fear it, becomes a psychopathic strugffe
when it forces us into an eccentric biological adaptation or asocial
position. All the abnormal variations of human behavior, as
purely behavioristic phenomena, can be explained in this manner.
Tt is the only explanation that fully covers all the issues raised in
the study of psychoses and normal minds.

This very simple conception of the personality requires the rec-
ognition of the fact that there are fundamental differences between
the ego's adaptations to an autonomic segment's craving: (1)
when it accepts it as a part of the ego, as ' ' mine, ' ' and supports or
justifies its domination of the projicient apparatus and the free
seeking of its stimuli ; or (2) when the ego prevents it from seeking
freely by suppressirig the segment so that it can only dominate the
projicient apparatus sufficiently to cause the organism to be con-
scious of its presence and needs; and (3) when it represses the
segment so that it can not even cause consciousness of its, needs;
and (4) when the segment becomes dissociated and forces the or-
ganism to become conscious of sensory images that are wishfulling
or gratifying, constituting the endogenous sensory elements of

INTRODUCTION 13

hallucinations, delusions and dreams, compulsions, obsessions,
phobias, mannerisms, persistent thoughts, etc.

The egoistic unlfij can not attach the segmentnl cravings dl-
rectlij, hut controls them throngJh controlling the, final-coninion-
motor paths of the projicient apparatus. (Some psychopaths ac-
tually attempt to destroy the segment or the functional distortions
cau,sed by the segmental cravings, as in castrations to prevent
masturbation fancies or seeking radical surgical operations that
may eliminate the source of the craving.)

The terms, suppression, repression, dissociation, summation,
readjustment, regression, progression and sublimation applied to
the affective cravings, seem to me to be as important for psycho-
pathology as any terms in physiology can be for that science. De-
spite their great value one still meets with prominent psychiatrists
who refuse to use them but persist in using whole phrases and
sentences to describe the same phenomena. It is difficult to see
common sense in such methods, and it would be well Avorth while
if they explained away their resistances in order to get within
"shouting distance of one another."

Watson's work on the behavior of animals and infants has
been of value in teaching the psychiatrist to see his cases as prob-
lems of behavior, although his explanations of abnormal behavior
are wholly inadequate. The psychiatric student must be trained
through the study of animal behavior to be able to recognize the
movements and postural tensions of fear, anger, love, shame, sor-
roiv,. jealousy, etc., because only in this manner can he learn to
study his cases from a truly biological point of view. So far,
practically nothing is taught the medical student about the prin-
ciples underlying human and animal behavior.

The student of animal behavior has not gone so far as the
psychopathologist and psychologist in his schematic reconstruc-
tion of the personality, apparently because he wishes to avoid the
use of terms or concepts that savor of purpose, although he has
a purpose in doing this ; and has so far been unwilling to consider
the phenomenon of consciousness of self, even though it is one
of the critically important factors which determine enormous
variations in the development of the personality; such as the
psychopath's eccentric compensatory defensive strivings that
are initiated by the fear of becoming conscious of or dominated

14 PSYCHOPATHOLOGY

by abnormal segmental cravings ; like the erotic perversions, bed-
wetting, kleptomaniacal or parricidal compulsions, etc., which
once dominated him in infancy and adolescence.

Sherrington and Langelaan, on the postural tonus of striped
and unstriped muscles, have given its an insight into physiological
mechanisms that may be used to explain how a repressed segmtent
ct)ntinues its pressure, like a compressed spring, through its
heightened postural tensions, causing the individual to be conscious
of a kinesthetic stream, constituting thoughts which, although un-
desirable or distressing, are means of getting gratification. The
psychiatrist must recognize that when a man spends an exhaust-
ing afternoon wandering about the market trying to purchase a
particular kind of food a segmental craving for this particular
food is compelling the complicated behavior ; and so with the un-
intelligible, confused behavior of a dissociated personality, who
spends weeks in religious incantations and prophetic exhortations
and finally eats the plants on the ward, "root and all," and then
tries to perform fellatio and be "crucified," we must recognize
that the psychosis has been largely a struggle Avith uncontrollable
oral homosexual cravings, which finally dominated the ego and
obtained free control of the projicient apparatus after perhaps
years of repression- and certainly months of suppression of the
cravings.

The behaviorist recognizes that the tensions of the sex ap-
paratus dominate the behavior of birds and animals during the
mating season and their tortuous cotirses through the environment
are due to the sexual cravings striving to acquire appropriate
stimuli. Similarly, the psychopath's struggle with the environ-
mental resistances (social taboos) and the tortuous, tangled course
of his behavior and fancies during his psychosis must be seen as
a biological struggle to obtain gratification for the cravings.

No student of human behavior, no matter what his point of
view, can^ for one moment, afford to lose sight of the fact that all
men and women are bisexual in their anatomical construction and
in their affective cravings, and that all the segmeints contribute to
the affections and wishes of the personality. The tragedy in the
struggle to fulfill the biological career occurs when the male de-
volps a preponderance of effeminate or indirectly aggressive traits
and the female a preponderance of masculine or directly aggres-

INTRODUCTION 15

sive traits. This distortion may not lead to misery if in the mating
the abnormal tendencies of the pair reciprocate well enough. The
ease histories show that certain social influences and fears often
force an individual to have a predominant craving for homosexual
interests, and later a new environmental adjustment may lead to a
return to heterosexual interests. This is shown plainly in the
maladjustments which men and women often force each other into
after marriage ; and after divorce or death removes the oppressive
influence, the repressed affections swing back to a biologically nor-
mal, more comfortable course. These profound changes in the
autonomic tensions and cravings always have a tremendous influ-
ence upon the individual's content of consciousness and his social
career (professional or vocational) even though he may have no
appreciation of what is going on within himself.

The conditioning influence upon the child's autonomic-affec-
tive cravings by the parent's autonomic attitude accounts for the
unconscious development of characteristic family functional traits
in generation after generation; and, furthermore, there can no
longer be any doubt that most infants who begin life Avitli fairly
normal equipments and end as social or biological abortions, that
is, as criminals or insane, have become asocial through the patho-
logical influence of their parents and those associates to whom they
are obligated by society. The general understanding of how these
conditioning influences work will, no doubt, lead to reforms in
education and social laws which will be of the greatest importance.

When the physician and surgeon come to realize the tremen-
dous influence of the repressed hypertense or hypotense autonomic
segment and its local circulatory system as an influence in recov-
erability from infections, diseases and surgical shock, the localiza-
tion of destructive germ colonies, and derangement of metal^-
olism, a new epoch in the progress of medicine will begin. The
psychopathologist, physiologist and clinician have enormous un-
explored fields of research open before them in this direction.
Means for training men to carry on this work should be established
by the medical schools. There is not the slightest doubt that the
termination of many infections of vital organs, such as pulmonary,
genitourinary, cardiac, gastrointestinal and cerebrospinal, are in-
fluenced by the blood supply and tonus of the segments and the
reciprocal changes in the blood supply of their nerve centers.

PSYCHOPATHOLOGY

The affective mechanisms of local vasoconstriction and vasodila-
tion and chronic spastic tensions of impor1?aait nnstriped muscles,
particularly those groups that may occlude or open ducts and
valves, are so far unknown; such ag, the largeT bile ducts' sudden
occlusion in an emotional crisis of a certain type as a possible etio-
logical factor in some cases of acute yellow atrophy of the liver.
Some forms of diabetes and hyperthyroidism are no doubt inti-
mately related to compensatory strivings against certain types of
repressed fear. The researches of Cannon on the physiological
changes in the blood stream upon fear and rage, which, in turn,
indicate marked changes in the activities of different organs, such
asthe liver, adrenals, and thyroids, certainly show that great dis-
turbances of the metabolic processes must occur during the psy-
choses, if delicate enough means of biochemical analysis can be
developed to find them, because the extremes of fear and terror,
hatred, envy, eroticism, shame and sorrow are to be found in the
psychoses. The metabolic disturhances should not he interpreted
as the primary caitses of the psychoses hut as contributing factors
to a vicious circle of adjustment.

This new understanding of the physiological functions and
the personality is becoming the foundation of a new psychopathol-
ogy and a new psychology, with sweeping changes in the interpre-
tation of normal and abnormal behavior and their causes, and,
eventually, a new classification of the so-called "mental diseases."
The author hopes that this volume may help revolutionize present
psychiatric notions, and contribute to the foundations of a truly
biological psychiatry.

Since Freud made his illuminating contribution to the study
of hysteria, despite the bitter criticism of hopelessly prejudiced
men, a legion of earnest workers in the psychoanalytic method of
studying the psychoses have followed him. Their contributions
are to be found now in almost every modern language, ranging
from shy to cautious references to the sexual difficulties of their
cases to sound, dignified, erudite studies, to unrestrained helter-
skelter speculations and fancies, i'his sort of thing always occurs
with new methods. All sorts of men become interested in new dis-
coveries, whether an arctic gold field, aviation, vaccine therapy,
salvarsan, brain surgery or what not. Out of the great herd tlie
conservative world must choose the careful, reliable student from

INTRODUCTION 17

the inefficient, the ultra-cantious, and the plunging speculator. The
soundness of a new scientific procedure is greatly increased when
large numbers of sincere students apply similar methods to similar
problems and yet maintain a constructively critical attitude toward
each other's Avork. The psyeliiatrists who avoid the sexual prob-
lems of their cases and the psychoanalytic method of studying
them are to be classed with the medical cults that avoid the study
of anatomy and physiology. Their resistance to the problems of
sex is, as rational as the medieval persecution of dissection and
the present-day hubbub by the iiltra-esthetic .about vivisection.

The analytical studies of a great variety of cases in the func-
tional neuroses and psychoses, by many different workers in
Europe and America show, on the one hand, that the symptom-
atological classification of cases is misleading and hopelessly con-
fusing, and, on the other, that a mechanistic classification is highly
necessary and practical. The analytical studies of Freud, Bleuler,
Jung, Jones, Ferenzi, Pfiester and Adler, in Europe, and Putnam,
White, Jelliffe, MacCurdy, Frink, Prince, Sidis, Clarke, Brill,
Coriat, Emerson, Campbell, Burrow, Tanneyhill, Dooley and many
others in America so consistently reveal that the neuroses and psy-
choses are produced by the autonomic-atfective cravings that the
development of a new mechanistic system of classifying cases is
necessary. Chapter V is devoted to this work. It is not expected
that the system advanced is to be accepted as thoroiighly satis-
factory but rather it is a pragmatic attempt in which simple
critical psychological, mechanistic differences are used to differ-
entiate cases into types. It has the advantage of elasticity and
adaptability, fundamental attributes of human nature, which the,
old German, static system utterly failed to recognize.

The contents of Chapter I are devoted to an abbreviated pres-
entation of the physiological foundations and mechaiiisms of the
personality Avhich 'have been more fully presented in th'te author's
monograph on ' ' The Au.tonomic Functions and the Personality. ' '
Chapter II covers the conditioning influence of the family upon
the autonomic cravings of the infant and child, and in Chapters III
and IV, the struggle to fulfill the biological career, despite func-
tional and organic inferiorities, is discussed in order to approach
the mechanisms underlying the. psychopathic deviations that con-
stitute functional neuroses and psychoses.

18 PSYCT-IOPATIIOLOGY

Chapter VI deals with the anxiety or suppression' neuroses,
anxiety due to the ego 's fear of the segmental cravings, and Chap-
ter VII deals with the repression neuroses or psychoneuroses
which are produced by the ego's attempts to make a permanent
adaptation to the segmental craving. This leads directly to the
psychoses (dissociation neuroses) of more or less benign and per-
nicious types, varying from rather brief, acute or periodic, mild to
violent dissociations of the personality, to chronic mild fixed types,
to chronic dissociations that utterly destroy the personality. This
broad group is covered in Chapters VIII to XIII. A discussion
of the factors that detennine what the psychosis will be like and
what its prognosis will be, is made in Chapter XIV, and Chapter
XV covers prophylactic measures and the essential principles of
psychotherapy.

The case records have been selected from a large variety for
the purpose of illustrating the more important mechanisms, and
to support certain facts, such as the explanation of the delusion
that secret intriguers are putting "poison" in the food. If some
of the cases seem too unpleasant to study the reader must not for^-
get that this is psychopathology and not romance or an essay on
how to sublimate and maintain the refined and beautiful.

I would like to emphasize again, as the cases are read, to al-
ways keep in mind the factor of ivish-fulfillment in the delusions
<m,d hallucinations, the physiological nature of the wish, the ex-
periences that conditioned it, the stimuli that excite it, and the
patient's manner of compensating to his fear of it. The behavior
of the cases is presented so as to be as free from speculations and
impressions as possible.

Much of the information about the patient's difficulties was
gathered through observation and asking questions. In some cases
this material was enormously enriched through the psychoanalytic
method of inducing the patient to permit a free association of
thought; that is, to allow, himself to be made conscious of what his
repressed cravings tend to seek, no matter where they would go
or how. This method is often attended by no little embarrassment
and at times by nothing less than temporary terror and suffering,
but there seems to be no alternative ; and surgery uses the principle
that, although operations may be more painful than tumors or
fractures, in the end they generally prove worth while. Some-

INTRODUCTION 19

times the ego's horror and despair at tlie repressed cravings ends
in suicide, but this is a rare adaptation and must be compared to
many fatal results of surgical and clinical therapy.

A series of illustrations from modern and prehistoric painting
and sculpture is used to emphasize the fact that symbolism is as
much used today by Man, in order to relieve his repressions, as
by his primitive fathers. "When one recalls the ridiculous tirades
some inspired psychiatrists levelled at the psychoanalysts' recog-
nition that the appearance of a knife, Avand or beast in a dream or
hallucination probably had a phallic or erotic significance, it seems
worth while to publish illustrations of such things having an actual
phallic value. These same thinkers, who would refer to the asocial
sexual cravings as "bestial," seem to be too prejudiced to recog-
nize that the bestialness might be expressed by the image of a
beast, and, conversely, the sacredness of socially approved love by
beautiful images of many varieties. Without recognizing the
stimulating value of symbols to the autonomic affective cravings
and understanding in a large degree the universal language of
normal or abnormal behavior of Man and tlie biological value of
his creations.

CHAPTEE I

THE PHYSIOLOGICAL FOUNDATIONS OF THE
PERSONALITY*

A critical review of the more prominent, current conceptions
of psychopathological processes and the nature of the personality
would require such extensive discussion to adequately treat the
works of the authors, and is itself so important for psychopathol-
ogy, that an entire monograph should be devoted to . this work.

It is justifiable, therefore, for the author to present his case
material as he understands it, without confusing it with the
injection of surmises of another psychopathologist 's impres-
sions of such processes. The controversial method never does suf-
ficient justice to the other student of huma,n behavior, beyond mak-
ing an acknowledgment of his work; hence, it is suggested that
those who are seriously interested in psychiatry will themselves
review the literature (a list is appended) and take what they can
use.

All the cases herein presented are carefully arranged on the
basis that the affective cravings or wishes resisting one another
in their struggle with the environment (emphasizing other people)
determine the nature of our behavior. Hence,. the history of the
development of the peculiar conditioning of the individual's af-
fective cravings and the nature of the environmental resistance
are elaborately presented in many cases, because, when completely
worked out, this is enough to logically explain the psychosis with-
out bringing any other complicating assumptions, such as meta-
bolic, constitutional or hereditary inferiorities, into the oase.

The results of the intensive study of a large variety of psy-
chotics of many nationalities have forced the abandonment of the
Kraepelinian symptomatological classification of psychoses, be-
cause of its futility, for the much more interesting, practical and
resourceful conception of uncontrollable autonomic affective crav-
ings originating in autonomic segments opposed by the ego.

The ivish, as we are prone to recognize it in everyday life, and

*This discussion of the physical foundations of the personality is largely taken from the
author's monograph on "The Autonomic Functions and the Personalityi" Exact references for
the data are given there.

PPIYSIOLOGICAL FOUNDATIONS OF PERSONALITY 21

no one should be misled into assuming for its source a "psychic
energy" (Holt), may be completely accounted for if it is recog-
nized to be none other than a localized autonomic-affective crav-
ing and its compelling influence on the striped muscle apparatus
of the personality. This fact can be demonstrated by using the
researches of James, Sherrington, Cannon, Mosso, Wertheimer
and a collection of psychoses and psyclioneuroses. The term "af-
fective craving," has a distinct advantage in that it can be clearly
correlated with its physiological source in the streams of craving
feelings or itching sensations that are aroused by increased ten-
sions of different segments of the autonomic apparatus.

The autonomic apparatus is constituted of all the vital organs,
including the ductless secretory glands, unstriped muscles and the
ganglionic nervous systems that have to do with the assim.ilatio}i,
conservation, distribution and expenditure of energy-giving meta-
bolic products and the elimination of the waste products. This in-
cludes the entire digestive, circulatory, respiratory and urinary
systems, sex organs, glands of internal secretion, glands of ex-
ternal secretion and the autonomic nervous system. This nervous
system includes all the ganglia outside the central nervous system
that innervate the above visceral systems and those autonomic
centers that are imbedded within the cord and brain-stem and
directly or indirectly innervate the viscera; as, for example, the
vagus centers. Also the autonomic neurones of the cord and
cerebellum that maintain the postural tonus of the striped muscle
cells (Langelaan, De Boer, Sherrington). The striped muscle
apparatus and the cerebrospinal nervous system proper consti-
tute the projicieut apparntvs which has been developed liy the
autonomic apparatus in order to master the environment.*

The Mechanism of Postural Tensions and the Peripheral Origin
of Cravings in the Autonomic Apparatus

Sherrington has shown that all the striped muscles that must
maintain a certain degree of postural tension in order to overcome
the influence of gravity, that is, practically all of the skeletal mus-
culature except perhaps the abdominal, are in a state of constant

*The term "'segmental craving" will be frequently used and by it is meant the craving that
originates in some autonomic segment, i.e., some viscus or organ such as the stomach, bladder,
throat, heart or genitalia. As physiological segments they include their nerve and circulation
divisions. As excised anatomical segments or dead organs we do not usually consider the cir-
culatory and innervating systems but in psychopathology we must deal with organs as they func-
tion in life.

22 ■:.-■'. PSYCHOPATHOLOGY-

postural contraction or tension. This may vary, in intensity for
different muscles ;aa4 organs at different times, arid the degree of
variation seems to be rather characteristically different for each
individual. Its mechanism depends upon the presence of the pro-
prioceptor, embedded within the muscle walls, tendon sheaths and
about the joints, and its afferent nerve. The proprioceptors are
stimulated by the pressure of the muscles as they contract and
pull against tha skeletal frame: or in the hollow viscera, by the
contraction in t|e form of a postural grip on the contents; as, the
heart, blood-vessels, stomach, bladder and rectum. Since the mo-
tor cell in the cord stimulates the muscle-cell and the latter in turn
stimulates the proprioceptor and its afferent impulse agairi stimu-
lates the motor neurone, it is necessary to recognize that prac-
tically all raotor functions are part of an efferent-afferent-efferent
continuous circuit. We have external stimuli, and afferent im-
pulses with efferent responses, but also afferent-efferent-g-fferent
internal circuits in both the skeletal and visceral functions to
consider. Since the rate of the impulses maintaining postural
tension varies from 40 to 90 per second (Sherrington) the con-
verging streams! must be recognized as continuous and composed
of almost innumierable minor circuits and combinations of circiTits.
-^ The postural tensions of the hollow viscera, although they
vary in degree, are also continuously active, and this gives rise to
a continuous, complex, converging affective stream- from all parts
of the-rautonorpic musculature, to which the organism as a unity
is -constantly, reciprocally adjusting itself. • Most of the 'time this
afferent affective stream from 'a visceral or axitdnomic segment
is subliminaliy active and does not cause the organism to adjust
overtly as ^ unity, that is, to become conscious of the segment's
activities. '' "VVlien, however, the tension ' of some visciis is in-
creased, the sensory stream is felt in the form of a' craving; that
is, a mo^e or less intermittent, persistent itching (which in the
stomach/ causes a craving or wish for food, or in the bladder causes
a craving or wish to urinate). This mechanism is characteristic
of pleasing as well as disagreeable (anxious) tensions. Sherring-
ton y^ays that postural tensions are relatively indefatigable and
najnes the sexual .clasp of the frog and the catatonic attitude of
patients as examples. It is, therefore, satisfactory, as an expla-
nation of the origin of persistent cravings or "wishes to recognize

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 23

that they are caused by the persistent hijpeiieiisiun and contrac-
tiiral, activities of some autonomic segment or viscus. ,

cHoV wishes come and go may be seen in the functions of the
bladder. When the intracystic pressure is over 18 centimeters of
water the craving to urinate is aroused (Mosso and Pellacini), but
in due time the desire disappears as the bladder adjusts its tension
by enlarging itself so as to accommodate' to the increasing quantity
of urine, thereby lowering the 'intracystic pressure. The desire
again returns when the pressure is again increased by the accumu-
lating urine to 18 centimeters. If, however, for some stimulating
reason, the postural tension of the bladder is greatly increased, so
that a small quantity of urine raises the pressure to 18 centimeters,
and the bladder is unable to relax its grip, the individual becomes
obsessed with the necessity for frequent micturition which may
constitute a very abnormal condition (a not uncommon feature in
the psychoneuroses).

This explanation also may be applied to the mechanism of
cardiac anxiety, respiratory or asthmatic anxiety, gastric anxiety,
rectal, intestinal, and sexual anxiety, on the basis of distressing
sensations due to a persistent hypertension that prevents a return
to normal comfortable functioning — hence, the obsession or com-
pulsion to act so as to get relief. But the relief may be unobtain-
able, because it depends upon changing the attitude of an unmodi-
fiable environmental resistance, as a hopelessly indifferent, or ta-
booed, or dead love-object, or the fear of failure when compelled to
act, asUn addressing an andrencel

'Cannon and Carlson'have shown that a definite type of" gastric
contraction precedes and' is concomitant with a "gnawing" or, bet-
ter, itching sensation in the stomach commonly spoken of as hun-
ger. This autonomic-affective craving compels the organism to
acquire such stimuli as have the especial capacity to relieve the
craving, and, as a counter-irritant, cause the gastric muscle to re-
sume comfortable tensions and movements, ' neutralizing the
craving.

These physiologists have also shown that when a potentially
painful distant stimulus or an actually painful contact stimulus is
permitted to play upon a distance or contact receptor, the stomach
particularly, (other viscera also), promptly assumes spastic or
fixed postural attitudes which are decidedly conducive to malnutri-

24 PSYCHOPATHOLOGY' ''

tion; shoAvn by the constriction of the gastric blood-vessels, de-
crease in hydrochloric acid secretion, increase in secretion of mu-
cus, and decrease in size and ability to empty the contents into the
duodenum. This status produces the disagreeable sensations or
feelings of fear or anxiety. As the autonomic compensation fol-
lows through shifting of the blood supply to the muscles and or-
gans that must remove the receptor from the dangerous stimu-
lus we feel the affect fear. As we attack or destroy the danger-
ous qualities of the stimulus, we feel the affect of anger. That is
to say, a compensatory series of autonomic tensions follows the
fear tensions and the affect flowing from them constitutes the
anger and the compulsion to attack. Similarly a reversed gastric,
esophageal and pharyngeal peristalsis gives off the feelings of
disgust and the compulsion to get away from or get rid of the
disgusting stimulus.

The autonomic-affective craving for food, which is a typical
acqmsitive-assimilative craving and the autonomic-affective crav-
ing to urinate, which is a typical emissive-avertive craving, indi- '
cate that probably all the acquisitive or avertive emotions or af-
fective cravings and the most delicate sentimentSj such as hunger,
love, fear, anger, grief, sympathy, pity, joy, can probably be best
understood as having a peripheral origin in characteristic varia-
tions of postural tension of autonomic or visceral segments. In
its essential respects this is the James-Lange theory of the
emotions.

This explanation is all that is necessary to account for the
origin of the dynamic forces of the personality. Nothing else,
such as "soul," or "will," or "psychic energy," is needed. All
such notions, being superfluous, are only confusing and have no
biological value.

All the autonomic-affectiA'e cravings, whether they compel an
acquisitive or -an avertive course of behavior or attitude toward
the environment, follow the same two laws :

1. When an autonomic-affective craving is aroused, either to
compensate for the deficiencies due to metabolism {as in Mmger)
■or through the influence of an exogenous stimulus {as. iu fear), it
compels the projicient {striped wAiscle) apparatus to shift the ex-
teroceptors about in the environment so that they will acquire
such stimuli as are necessary to counterstimulate and neutralise

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 25

the autonomic deraugemenf so that flie segment luill assume com-
fortable tensions.

2. The projicient apparatus that shifts the receptors about
SO as to expose them to appropriate stimuli is organized and co-
ordinated so as to bring a vinximuin. of affective gratification
tvitJi a minimum expenditure of energy.

When fear is aroused the distressing autonomic tensions
force the organism into flight until comfort giving stimuli are
acquired. For example, a frightened man or animal seeks the
comforting stimuli of his house or den, the bird reduces the dan-
gerous stimulus to subliminal influence by flight to or hiding in
secure places. When an adequate compensation of anger occurs,
the stimulus is attacked and its threatening qualities are destroyed
or rearranged into submissive forms. This occurs in the fight to
kill or subdue, and in polite society it is refined to demands for an
apology, or compensation, or submission.

If one will introspectively study the mechanism of his affec-
tive cravings, he will recognize the folloAving compulsions.

Fear ahvays removes the receptor from the painful contact
stimulus or the potentially dangerous distant stimulus. -

Anger is the aggressive compensatory reaction that follows,
more or less promptly and intenseh', the fear reaction, and, as a
compensatory reaction, compels the removal of the stimtdus from
the receptor. That is, it compels an attach upon the painful stim-
ulus, whereas fear compels an evasion of the stimulus.

Shame is a type of fear reaction following the misapplication
of receptor and stimidus, as in error, masturbation or stealing.

Disgust is a type of fear reaction associated with anger in
which the organism tends to emit or avoid the obnoxious stimidus,
as the nauseating, emissive peristalsis of the stomach, esophagus
and pharynx when fetid odors are associated with food ; as upon
finding a dead mouse in a tub of butter.

Grief is a fear reaction due to the loss of an energizing or
comforting stimulus and is the result of the respiratory, circula-
tory and digestive system assuming certain tensions which are
distressing and disposed to malnutrition.

Love, like the craving for food, has its origin in the metabolic
and reproductive functions forcing the seeking for, and acquiring
of, certain types of stimuli. There is unquestionably a character-

-O PSYCHOPATHOLOGY

istic tontts of the circulatory, respiratory, digestive, and repro-
ductive organs of the body when love predomin,ati|i:r There. is ^|
certain tenderness and* gentleness of reaction to the envlfomaent,
.depidedly different from the tonus when enraged, fearful or,, fam-
ished. The love status, although as yet we can give it no definite
physiological description, has a well-defined ■ influence ' upon be-
havior and what it tries to accomplish. It strives to, bring g,bout
similar autonomic-affective states in others, particularly the love-
object, in order that, it 'will obtain the stimuli associated with
caressing, reproduction, and protection, such as petting, praise,
admiration, sympathy, interest, esteem, faith, encouragement, re-
ward, justice, etc. The general trend of the love cravinps is to
create, construct, protect, and cherish that which keeps away dis-
tracting fear, shame, sorrow, rage, suffering and extermination;
these states of existence being conducive to malnutrition and jeop-
ardizing reproduction and the race. Although the love behavior
may be varied and disguised, its natural goal, if not interfered
with, would be the sexual act and reproduction. In civilized man
this trend has been directed by laws and taboos to seek a sexual
object having at least certain qualities, such as racial and intel-
lectual development, freedom from certain diseases, not too close
blqod relationship or too great disparity in ages, etc. The result
is that society makes the individual seek farther and work harder,
thereby enriching society as he tries to Ayin esteem and fitness
for the love-object. His love attachments for parents, relatives,
children, friends are directed so as to be refined from sex.

In contradistinction to fear, shame, sorrqw or hate, love cher-
ishes the stimulus and its accessibility- for the receptor. It is on
gu^rd to prevent the loss of the stimulus so as not to develop the
reactions _of'fear, or.rg^ge. Fear or rage are aroused by resist-
ances to , acquiring, the love-object. The ancient Greeks taught
that- when Love (Eros) flies away, the Mind (psyche) dies. We
find this, to be true in the ,psychopath and the uninspired. In the
latter,- the. love functions -are depressed ; in, the former, they have
been crowded out i of normal methods of seekil^g for the love-
object. !

- When an autonomic-affective craving compel^ the projicient
apparatus' (cerebrospinal) tO' make movements in order that a
certain receptor shall be so exposed as to acquire the stimulus that

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 27

is necessary to relieve the autonomic tension, the movements tend
to be coordinated so that the maximum of gratification is acquired
through a minimum expenditure of energy. Thereby, the excess
of energy is conserved to increase the extension of influence over
the environment. Man's civilization is simply the building of a
more comfortable, controllable environment within the greater
environment. He conserves his powers to extend his influence in
order that his wishes- may be more and more surely and satis-
factorily fulfilled. Civilization is to be recognized as a protective
compensation against the anxiety and autonomic unrest caused
by the unfulfilled wish and uncontrollable' environment.

'"An individual is constantly in a complex affective state
whether he is asleep or awake, in an emotional turmoil or a state
of reverie. He is never possessed by purely one affective craving
or emotion although he is often dominated by a distinct craving,
such as hunger or anger. Under such conditions one can recognize
other wishes and interests also at work in the background of con-
sciousness, all characteristically striving to overcome one another
and doniinate the final common motor path in order to acquire
gratification.

During sleep states, except during dreams, the autonomic
tensions seem to subside sufficiently so as not to cause the organ-
ism, as' a whole,' to readjust to their activities. When the activity
of any viscus increases, it affects the nature of the dream, as in
the case of thirst upon eating salty food before sleeping or the
dream of urinating. As its activity compels the organism to re-
spond more completely as a unity, the individual awakens.

To sum up the significance of the peripheral origin of the
ivish or affective craving: Hunger, fear, disgust, anger, shame,
love have their origin in the feelings aroused by the hypertensions
or hypotensions and movements of different visceral segments
and it'.is quite probable that all the viscera, including' the blood-
vessels, give rise to an. afferent or affective stream, and the nature
of the'ivishes ive are aware of at any time is determined by the
organs that happen to be hyperactive at the time and in conflict
ivith the resisting environment, as stomach-hunger for' food,
bladder-wish to urinate, etc. The complexity of the intricate auto-
nomic apparatits, arousing simultaneously more or less vigorous
manifold cravings, fidly accoilnts for the complicated- nature of

28 tSYCHOPATHODOGY -

the affections of the personality. When one hears in mind the
fact that all the cravings have hut one means of ohtaining gratifi-
cation; that is, through using the skeletal neuromu^sGular appa-
ratus, the hasis of autonomic-affective conflict for control or dom-
ination of the final common motor path hecomes ohvious. It is also
ohvious that the affections which have control of the projicient
apparatus, indirectly hut irresistihly, control the antagonistic, re-
pressed affections.

Sherrington has shown that wherever two neurones converge
iipon a third, which is efferent to them, they may oppose (antag-
onistic) or reenforce (allied) one another in their efforts to con-
trol the nature of the impulses along the efferent nerve. This
principle applies to the autonomic apparatus as well (Cannon,
Sherrington) and is very easily observed in oneself when one has
two wishes to do different things at the same time with the same
thing, as one hand or foot, or with one automobile, one dollar, etc.

It is in the mechanism of the struggle between different auto-
nomic segments to control the final common motor path for ad-
justment that the psychopathic and the well constituted person-
ality are organized. A severe anxiety would arise if compulsive
tensions in the stomach and bladder and rectum were aroused at
the same time by the presence of food. When certain foods (such
as butter, oils, cream, gelatines) tend to cause undesirable erotic
reactions in the oral erotic psychopath he becomes fearful and
often starves himself as a defense.

The cravings or aversions of some particular autonomic seg-
misnt or viscus may jeopardize the safety or comfort of the entire
organism; as, for example, the tendency of the stomach to react
with a reversed peristalsis (nausea) or a type of spastic tension
(fear) when a certain drug or food, which is vitally needed, is
presented ; or the persistent hunger cravings may force the entire
organism to jeopardize itself by stealing food. In animals and
people we may see the more severe hunger cravings (intragastric
itchings) compelling behavior that often leads to destruction or
revolution.

The mechanism by which most of the segments of the auto-
nomic apparatus become associated as a unity against the demands
of a particular visCus or segment and its cravings seems to be
largely a matter "of the segments becoming so conditioned as to

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 29

react to the same enviroHinental conditions in a similar manner
(acquisitive or avortive) requiring the same sort of overt adjust-
ments, while the particular viscus reacts in an antagonistic man-
n(>r requiring socially tabooed stimuli. The incessant compen-
satory integrations to prevent the autonomic apparatus from get-
ting into the fear state (because of the possibility of failure to
gratify the cravings or wishes) greatly contributes to the develop-
ment of the egoistic viilti/ of the autonomic segments. Man, as a
descendant of the ape-man and the ape, has inherited the polymor-
phous sexual cravings of the ape, and the greatest problem of
modern man is to establish social ideals, conventions, religions
and laws which will direct these primitive affections so that they
will have a constructive value for society and yet will not be de-
stroyed by being prudishly refined. Should they be castrated by
too fanatical asceticism disguised with "righteous wrath" the
more highly developed families of the race will be destroyed with
their parental-sexual cravings, and the race will automatically fall
back becoming constituted of lower types who do not have suffi-
cient integrative capacity to develop an ego tliat can control the
primitive cravings.

Before considering the mechanism of the development of the
ego and man's personality, the relation of the autonomic appara-
tus to the skeletal or projicient apparatus, the mechanism of con-
ditioning the affective cravings, and their influence npon each
other, as antagonistic or allied cravings, must be considered.

The Value of the Projicient Apparatus to the Autonomic

Apparatus

The autonomic apparatus is constituted of the organs that de-
termine an animal's or man's growth, and, in the lower organisms
and the embryo, the autonomic apparatus is quite well developed
long before the cerebrospinal sensory-motor apparatus (includ-
'iSig muscles and skeleton) begins to develop. Any part of the
skeletal apparatus can be sacrificed without serious danger to life,
whereas no division of the autonomic apparatus, such as circula-
tory or digestive system or adrenal glands, can be sacrificed with-
out disintegration of the organism. But an autonomic apparatus
can only continue to work comfortably and healthfully as long as
it can acquire appropriate stimuli from the environment. As the
power of the primitive autonomic apparatus to conserve energy

30 PSYCHOPATHOLOGY

increased' it developed an apparatus that could be used to shift
the entire organism about in the environment. In other words,
the autonomic apparatus developed and immersed itself in a pro-
jicient apparatus (the skeletal striped muscle-system) for the
purpose of projecting itself about in the environment in order to
be able to obtain gratification of its needs. (Because of this mech-
anism it is valuable for understanding the personality to speak of
an autonomic apparatus and its projicient apparatus.)

The relationship between their nervous systems is very inti-
mate although probably not fully understood. It seems Lange-
laan, De Boer, and others are inclined to regard the striped mus-
cle-cell to be really a dual cell; that is, a " sarcoplasmatic mass"
containing a striped apparatus. The sarcoplasmatic mass is in-
nervated by the "autonomic component" (Langelaan) and the
striped apparatus by the cerebro-spinal system.

The intimacy of dependence of postural tensions of the striped
muscles upon the autonomic apparatus may be seen in many ways
such as certain disastrous accidents due to change of postural ten-
sion and in efficiency word-association tests. For example, a man
was holding a knife in a fixed postural grip, pressing the point
against a hard surface while brooding over some personal trouble
(an autonomic disturbance which was trying to adjust itself) and
the remark of a companion, Avhich revealed that he might have
guessed the secret of the man's troubles, startled him. Instantly,
the hand's grip relaxed, and the open knife slipped through, caus-
ing a disastrous cut in the hand. The dropping of a razor or good
cigar through a sudden, reflex relaxation of the light postural grip
is in turn due to a sudden change in the autonomic-affeotive ten-
sions. The ego 's wish to hold the cigar is interfered with by being
forced to repress an embarrassing affective reaction that was sud-
denly aroused by a suggestion. One may easily collect numerous
accidents of this sort in his behavior in a few days' observation.
If he will analyze the mistakes and accidents that he creates he
will find that they are caused by sudden changes in his postural
tensions, in turn due to reflex changes in his affective or auto-
nomic tensions caused by repressing their activities.

One may also observe ill himself, and in his relatives and
friends, that the general carriage and postural tonus of the mus-
cles of the body, particularly of the hands, arms, shoulders, neck

PHYSIOLOGICAL POXTNDATIONS OF PERSONALITY 31

and head, and the style of the walk, hand-shake,' voice sounds, etc.,
reveal the characteristic affective tensions and wishes more than
what is said and done. The postural tensions of the individual
reveal the character of the "sneaking," "spineless" coward, the
bombast's strut, the confidence in movement of the victor, the sub-
missive posture of the vanquished. The postures of timidity,
anger, hatred, love, disgust, shame, deceitfulness, jealousy, joy,
guiltiness and sorrow are recognizable on sight, and cannot be
concealed from the trained observer. If the student will try to
conceal his affections from himself (that is, try to make himself
feel glad when he is sad, love when he hates, feel indifferent when
he fears, act boldly when timid, etc.), he will become distinctly
aware that vigorous postural tensions in various segments of the
body are the source of the resisting affect and he can not get him-
self to be unconscious of them without prolonged repressive mus-
cular effort and even then he does not eliminate their influence.

The Nature of Consciousness

This brings lis to the nature of consciousness and the content,
of consciousness. Because one is never conscious without being
conscious of something, and consciousness can not be separated
from its content, they are here considered as one phenomenon.*

Neuropathology and neurophysiology have not been able to
demonstrate that any cerebral center or group of centers or nerve
cells anywhere within or without the brain, has anything like the
functional capacity that may be regarded as a " center of conscious-
ness." On the other hand, apparently every living cell in the body
has the capacity to react to certain stimuli with such qualities in
the reaction that it may be regarded as a manifestation of
"awareness" or "consciousness" of the stimulus. Hence, it is
necessary to recognize that the nervous system has only the ca-
pacity of integrating and reoiforchig the activities of the periph-
eral organs.

"When we are conscious or aware of anything or any event in
the environment we are not accurately conscious of all its attri-
butes but of only a few of them, and we use these attributes to rep-
resent the whole; as, for example, when discussing England, or a

*For'a more detailed discussion of tlie mechanism of ' consciousness see "Tlie Autonomic
Functions and the Personality." By 15. J. Kempf, Nervous and Mental Disease Monograph Series,
No. 28.

62 . - PSYCHOPATHOLOGY

cannon, congress, the nation, a friend, a cigar, gold, an experience,
a book, etc.

When we are conscious of ourselves, we are not conscious of
all the attributes of ourselves, or of all of our experiences or crav-
ings but we are conscious of only that small portion of ourselves
that happens to be in the ascendency of activity at the moment, and
these few attributes represent the ivhole organism or ego. For
example, a part of our clothing (color and style) some of the af-
fei'ent currents due to our positions, a tight hat-band, a flushed
face, and the sensations of a vigorous hunger may constitute the
principal part of the content of consciousness at a certain moment.
Then we say "I am hungry" or "I feel," "I wish," as if it con-
stituted all of the ego's interests. When a lesion occurs that pre-
vents the organism from becoming integrated into a unity, con-
sciousness of self can not occur and only segmental activities go
on at a low level of integration, similar to the status at birth or
during sleep. We see this behavior in the dumb reflex adjust-
ments of the stuporous or the dissociated man or animal when
asleep.

We can only become aware of the activities of our sense or-
gans. The phenomenon of consciousness of self or of the envi-
ronment is the result of ail the segments reacting together more
or less vigorously, as a UNITY, to the sensational activity of any
one or several of its parts. The destruction of a contributing or
- an integrating mechanism like the conducting optic nerve, or
the coordinating visual centers in the cerebral occipital cortical
area prevents the organism from reacting as a unity to the activ-
ity of the visual receptors in the retina ; hence, prevents the organ-
ism from becoming conscious of their reactions. But such lesions
in the coordinating areas of the visual apparatus do not indicate
the destruction of a " center of consciousness. ' ' One may imagine
a lesion in the brain stem that will prevent the organiism or any
considerable part from reacting as a unity, thereby obliterating-
the organism's capacity to become conscious of itself. This oc-
curs particularly in some tabetic lesions in which the organism
must apply the visual receptors to the part in order to become
aware of its position ; as the man must watch his feet in order to
know where they are, or else he will stumble because the organism
can not adjust. When a drug (ether) or shock causes uncon-
sciousness it does something that reduces the integrating capacity

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY o.J

of the nervous system and perhaps the irritability of the receptors.
When we desire to become aware of the sensation of saltiness
we must apply a definite receptor to the stimulus and when that
receptor is destroyed Ave lose the capacity to become aware of the
quality of saltiness. This principle applies to other capacities for
sensations, but in selecting an example one must not overlook the
fact that we habitually apply many receptors to an object; hence,
have many impressions of it, such as visual, auditory, tactile, kin-
esthetic, etc. Crile's method of "blocking" a nerve, through the
injection of novocain along its trunk, prevents the nerve impulse
from ascending from the receptor to the brain and spreading over
the organism in a diffused wave. He has shown that, even when
the indi\T.dual is unconscious, under an anesthetic, the destruc-
tion of a peripheral nerve causes changes in many cerebral cells.
It has been demonstrated by Wertheimer (cited by Cannon) that
the stomach's tensions change when painful stimuli are applied to
the sciatic nerve while the animal is unconscious. The stomach's
reactions are very similar to the reactions that would give fear-
ful sensations if the animal were conscious. Hence, it must be
recognized that the notion of the cerebral or central origin of the
emotions, as such, or of perceptions always preceding emotional
reactions, is not acceptable. The only explanation that satisfac-
torily covers all the facts is that lue are conscious of representa-
tive parts of ourselves, or of our experiences, or the environment,
just in the degree with which the body reacts as a UNITY to the
especial or sensation producing activity of any one or several of
its various receptor fields.

The nature of the content of consciousness can be entirely
explained by the activity of our receptors. The greater part of
the active receptor field is the proprioceptive from which
arise the kinesthetic sensations of proportion and movement. The
content of consciousness may therefore be compared to a compli-
cated moving picture of vivid and dim figures which are composed
of black dots, and, as the black dots are shifted in their arrange-
ments and intensity, the picture changes. Let us assume that each
receptor in the body is represented by a dot, and the vigor of the
receptor's activity is represented by the vividness of the dot, then,
as the various receptor fields become associated together or dis-
sociated in. their converging afferent contributions, the content of
consciousness becomes changed.

34 PSYCHOPATPIOLOGY

This is virtually saying, that we think with our muscles, be-
cause the kinesthetic impulses (dots) arising from the proprio-
ceptors are much more numerous than all the others. For example,
if we' allow -ourselves to become aware of the visual image of a
moving automobile, the awareness of its movement is furnished by
the extrinsic muscles of the eyeball as they shift the image by
shifting their postural tensions. Overt movements are not neces-
sary unless we desire a very vivid image, then, also, the muscles of
the neck may contribute by moving the head. If the image of the
moving automobile is one of ourselves pushing it, then the muscles
of the body are active to furnish the images (receptor dots), and,
if it is to include pushing it through a cold, wet, muddy road, the
sensations of coldness and wetness arise fronl the tactile receptors
of the skin of our faces, hands, backs and legs. If the description
of the experience includes the reproduction of an accident (say
slipping), we feel the image of the movement of the slipping in our
legs first, and then the remainder of the body adjusting and co-
ordinating to the change of posture. (The reader must discrim-
inate between this printed word image of the automobile incident,
as he reads, and his own visual-motor image as he reproduces a
similar fantasy. If the reader will allow the wish to reproduce a
fantasy to proceed, he can feel the motor tensions slightly preced-
ing the mental picture.)

The postural motor tensions of our striped muscles contribute
the kinesthetic impulses or images of movements that reproduce
the experience. If we can not reproduce the movements of the ex-
perience we ca/n not recall it. The child, savage and illiterate can
much more easily react an experience than describe it and can only
vaguely recall the experience if not allowed to react it. Those who
have not had the experience of hearing and seeing a savage play-
ing a I'botanco" are unable to become conscious of anything more
than a vague, indefinite picture, because they can not grossly re-
produce the movenients and weird rhythms, but if some one should
speak of a small boy playing "In the Good Old Summer Time" on
his mouth harp, we quickly get a vivid visual and motor image of
it and are therefore able "to think" about it clearly.

Children, in order to recall an image of an experience, tend to
reproduce it with overt movements besides using postural ten-
sions. One may often observe adults spontaneously, assuming

PHYSIOI.OGICAL rOXJNDATIONS OF PERSONALITY 35

overt movements, as in making motions to explain tlie proportions
of an experience. While in the droAvsy state preceding sleep we
often jerk or find ourselves making reflex movements before we
become conscious of the dream-image of doing something, as mak-
ing a winning stroke with ^ tennis racket.

This integrative conception of the personality brings up the
question as to what determines, besides the stimulus, the degree of
activity of a receptor field and its association with other receptors.
It can be sho-\vn that the determining force is the autonomic need
or affective craving. That is, our wishes determine the content of
consciousness through controlling the postural tensions and overt
movements of our miiscles as well as controlling what shall be ac-
cepted from our extero-ceptors as stimuli. In this effort to con-
trol, the wish is constantly opposed by the environment, hence
the environment must be modified to suit, either by changing it,
or changing the organism's position in it; as in changing our
social positions or business in order to change our obligations so
that our affections will be more nearly satisfied.

When the hunger cravings in the stomach dominate the ac-
tivities of the projicient apparatus, they make us become aware
of suitable foods and methods and places of getting the food. In
producing this awareness, the autonomic apparatus is already on
its ivay to get the food. The overt actions that follow only com-
plete the journey. This mechanism is also true for fear, shame,
anger, grief, the desire to urinate, to copulate, etc.

When autonomic-affective tensions (anger)- are not permitted
to attack the stimulus, say, demand an apology for an insult, one
is conscious of a persistent stream of thought as the affect forces
us to be conscious of its needs, as well as persistent tensions in
the neck, arms, scalp, eyes, face and epigastric region. The af-
fective attitude, determining characteristic postural tensions of all
our muscles, explains why we think in harmony with the way we
feel, and, also, reciprocally, why often w^e are greatly relieved,
when in an affective dilenmia, by a decisive thought. This thought,
or postural attitude happens to be a suitable resultant for reliev-
ing the affective conflict ; as, when we finally assume a conclusive
attitude in a dilemma. The cause of the old belief that the mind
is in the upper front part of the head is probably due to the con-
stant postural activity of the extrinsic muscles, of the eyeballs.

36 PSYCHOPATHOLOGY

which are the niost active proprioceptor fields, perhaps, in the
body. As the source of the most active sensory stream, naturally
it is the most prolific contributor to the content of consciousness
and causes the organism to adjust more as a unity to activities
there than to the activities of any other receptor field. '

This now brings us to the significance of conditioning or spe-
cialization of our affective cravings. It is not necessary to explain
why the itching craving in the stomach (hunger) is best satisfied
by certain kinds of food, but it is valuable to understand how such
things come about, how it happens that the autonomic status of
love or hate requires for each individual quite definitely character-
istic stimuli that do not at all suit other individuals.

Conditioning of the Autonomic-Affective Functions

The researches of Pawlow, Bechterew, "Watson, Latchley, and
others indicate that most reflexes, projicient as well as autonomic,
at birth have the capacity to react to certain stimuli which may be
said to be the primary stimuli for those reflexes. All other stimuli
are, insofar as the particular reflex is concerned, then indifferent
to it. When, however, a combination of a primary and an indiffer-
ent stimulus ■^is permitted to, intentionally .or accidentally, stimu-
late the organism simultaneously for a number of times, the reflex
becomes conditioned to react to the formerly indifferent stimulus.
If this is repeated often enough, the conditioning becomes fixed,
and the associated stimulus may, in turn, become the foundation
for still further associations of stimuli, until important reflexes
may become very intricately conditioned, or, conversely, com-
pounded stimuli may cause very intricate reactions.

For example, a pain stimulus applied to the hand will arouse
a reflex retraction. A color stimulus to the eye (say, red) or a
sound stimulus to the ear (say, ringing bell), if associated simul-
taneously for a number of times with the pain stimulus, causes
the reflex to become conditioned to react when the color stimiilus
or sound stimulus is applied to the eye or ear. This conditioning
capacity also exists in the different autonomic segments; as the
parotid, or sex glands, or stomach, becoming active when certain
pietiires, sounds, odors, colors, or subjects that are associated
with previous experiences are brought to our attention. The hu-
man infant, or puppy -or kitten becomes conditioned to react pleas-

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 37

antly to the voice, personal and physical attributes of the person
who nurses, pets and comforts it. Gradually that person condi-
tions the segmental reactions of the entire infant through feeding,
bathing, cleansing, nursing, petting, Avhipping, scolding, humor-
ing and praising it.*

It requires no effort of the imagination to recall how our OAvn
anger, fear, shame, sorrow and love reactions have been conditioned
by experiences to react, despite ourselves, to stimuli that do not
affect other individuals. It is also easy to see how an individual
may become conditioned to feel anger when he sees a certain per-
son or situation and love when he sees another, and then, when
they are brought together by some coincidence, the combination
arouses bewildering activities in himself because it arouses both
vigorous acquisitive and avertive reactions toward the situation.

It is upon this mechanism that mates often develop the un-
fortunate capacity to arouse avertive reactions in one another;
through becoming associated with a disgust producing stimulus,
such as illegitimate affection for some one who is disliked by the
other person.

It is safe to assume that all organically normal individuals at
birth have the inherent capacity to react to appropriate primary
stimuli, with love, hate, fear, joy, or hunger, etc. But it is in the
conditioning of the segmental autonomic-affective cravings to react
to associated stimuli that the individual comes to develop char-
acteristic traits. These functions constitute the very foundation
of character formation and our vitally important preferences and
aversions for different social^conditions.

We understand how a child's fear, love, hate, disgust, shame,
sorrow, pride, himger, and other affections become unconsciously
conditioned by experiences and the influence of associates, par-
ticularly parents and playmates, to react to people and situations
in ways that are excusable while relatively easily compensated for
in childhood. But, furthermore, how this same conditioning, when
fixed, may cause the most serious anxiety and social criticism when
the individual matures, such as the tendency to incest, masturba-
tion, sexual perversions, coAvardice, arrogance, narcissism, thiev-
ery, lying, etc.

If one will retrospectively consider his own behavior or study

*This entire mechanism is so important that it is elaborated in the chapter on "The Psychol-
ogy, of the Family."

38 PSYCHOPATHOLOGY

the behavior of others he will find that his wishes or affections are
conditioned to do certain things in order to be gratified and that
this conditioning depends npon past experiences and adjustments,
and the things that will arouse or gratify similar wishes in others
may have an indifferent effect upon him. The affect compels us
to avoid everything in proportion as it is not pleasing to the con-
ditioned needs and also to seek the especial things that reduce the
tension, hence in the treatment of psychoses we must be constantly
on the search for the wish-fulfillment and the memories of the ex-
periences that so definitely conditioned the craving.

It is a law, common for all emotions, that no matter what the
vdsh, when it can work freely and is realizing gratification, the in-
dividual feels a pleasing sense of potency, and, when he can not
acquire the object, he feels a certain amount of discomfort, which
may "become prolonged and severe under certain conditions.
The individual -tends to feel the compensatory striving of anger
when food is withheld, or when his time or property is wasted,
reputation jeopardized or love seeking infriiiged upon. In other
words, no matter what particular autonomic-affective tensions an
object or situation relieves, whether hunger, hate, shame, grief,
love, etc., its potential loss causes a fear reaction which may or
may not be compensated for by anger reactions. The determi-
nant for the nature of the compensation lies in the submissive or
resistive qualities which the environmental situation has for the
individual. Compensation is a most fundamental attribute of
living tissue and is in principle like making a compensatory leu-
cocytosis for infections or the compensatory hypertrophy of an
organ for the painful or distressing insufficiency of another organ.

The itching autonomic segment and its affective craving are
confined by nature to obtaining relief through the successful ex-
posure of an especial receptor to an adequate stimulus. When
we study the behavior of man or animals, normal or abnormal,
this principle must be constantly borne in mind. Most of our
segmental cravings come to be so conditioned that the adequate
stimulation of any one of several different receptor fields may
gratify them.

The autonomic-affective cravings do not reason. Lilce other
physical forces they cease to strive just in proportion as they are
neutralized. Therefore, when the perfect reality can not he oh-

PflYSIOLOGIGAL FOUNDATIONS OF PERSONALITY

taiiied, a substitute is adopted or accepted, as an imar/e, delusion,
hallucination, fetich, ritual or sijmhol. The use of rituals, sym-
bols and images is adopted or substituted reflexly, and one image
is often quickly dropped for a better. On the other hand, he who
would force the abandonment of a pleasing image or fetich is at-
tacked— as the persecution of religious reformers.

For example, Frazer* reports that some African savages nail
strips of ox hide to their shields and spears to make themselves

Fig. 2. — African negro wand as a phallus. The glans penis carved as a head and face.

Fig. 3. — Early Mexican (Aztec?) ceremonial knife as the erect phallus. (By permis-
sion of the National Museum, Washington, D. C.)

feel as strong as the ox, and tie frog skins around their necks to
make themselves feel that they are elusive and difficult to hold in
combat, because this desirable quality of the frog's skin enters
their bodies. No doubt the suggestions and the reflex imitative
responses greatly compensate for the inferiorities and prevent
fear. I saw children take angle worms, cook them into a paste

*The Golden Bough.

PSYCHOPATHOLOGY

Pig. 4-A. — The black line on the vase shows masculine (M) and feminine (F)
sexual symbols. The design irst developed in a dream of an unhappy Woman suf-
fering from the unresponsiveness of her lover. While completing the design on the
vase she became conscious, of its sexual sigjaiAcance ajid its comforting influence. She
had the courage not to destroy the sublimation.

Pig. 4-B. — Symbols of sexual union; the linga-in-yoni and the arba are signs of
union; the symbol of wisdom is a male and female triangle joined by the serpent, or
passion; the systrum is a symbol of virginity..

■PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 41

and rub this into their backs, arms and legs in order to obtain the
angle Avorni's power of contorting itself. A little girl's mother
drank from a glass of water before going on a long journey. The
little girl Avas obsessed with the fear that her mother would die
and preserve'd the glass of water to keep her alive. An impotent
dementia prsecox male rubbed tallow into his abdominal skin to
restore his potency. Some savages sprinkle water on the ground
amid religious incantations to simulate rain. This is a common
practice in some present-day religions. We collect mementoes
and souvenirs, erect monuments, dedicate books, buildings, char-
ities, wear colors, styles of clothing, go to the play, attend church,
etc., all for the purpose of giving ourselves stimuli that, as sub-
stitutes, have the capactiy of relieving the affective cravings, or,
by arousing compensatory reactions, diminish the fear of failure
and loss of potency.

It would be very valuable for the physician to know some-
thing of the language of symbols which seems to be surprisingly
similar all over the world, among all peoples of every educational
level. It is the only avenue for understanding a patient's affec-
tive cravings in order to work in psychopathology.

It may be Avell to enumerate here a few of the male and female
sexual symbols to be seen used by people, many of whom are not
psychopaths :

Mate genitalia. — Key, pole, stick, gun, pistol, sworrl, knife, tower, monumejit, pillar,
post, wire, flower, fish, horse, dog, tree, stone, serew, pencil, pipe, column, snake, worms,
rat, mouse, frog, insects entering flowers, fork, spoon, ax, saw, teeth, tongue, finger,
toe, broom, leg, arm, watch, clock, stove, number 1 or 3, sheep, lamb, dove, etc.

Female genitalia. — Beetles, vase, chalice, globe, curtains, earth, flowers, fish, books,
bottles, key-holes, lock, food, mouth, hands, wound, violin (female's body), windows,
doors, halls, number 2, sheep, lamb, dove, etc.

Copulation symbols. — Putting key into a key-hole"; killing animals, birds, etc., by
shooting or stabbing, sweeping a floor, polishing a floor, cutting bread, entering a room,
ascending stairs, insects and birds and butterflies entering flowers, ploughing ground,
fires, electricity, flashing lights, injections, numbers 23 and 5, or "2 in 1," or "3 in 2,"
"3 in 1," etc.

Seminal symtols. — Almost anything thrown off, emitted or passed off by a
larger body, such as sputum, pus, perspiration, urine, feces, scabs, hair, falling leaves,
etc.

Parturition symbols. — Almost anything given off by the body, such as pus,
vomitns, feces, urine, etc.

Impregnation fantasies. — Any odd little trinket in a box, vase, jar, trunk, pack-
age, bundle, number 3 or 4, tumors, etc.

PSYCHOPATHOLOGY

To sum up : It seems that anything that may enter something
else, even as a blanket being put into an automobile, may repre-
sent the tnale genitalia (in this case, impotent phallus) and the
sexual act; anything that is cast off from- the body may represent
semen or parturition; and anything retained within something else
may represent an impregnation fantasy; anything devouring or
liilling something or stealing something may symbolise seduction
or rape.

Vulgar stories, religious rituals, and dreams, psychoses, fe-

Tt-.!

Fig. 5-A. — Winged phallus or sun disk uniting with another world creating a third.
Note. — Figs. 5-A, 5-Bj 5-0, 5-D, 5-E, 5-P are symbols of sexual union, and were
drawn by a patient of paranoid homosexual striving. (Published by courtesy of Dr.
Mildred Sheetz.)

tiches and decorations reveal the amazing extent to which symbols
are used to relieve oiir autonomic tensions.

The psychoses presented later will shoAV the use of symbols in
innumerable, odd ways, and many of the symbols are logically ex-
plained as they are presented.

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY

The presence of the image or symbol in a psychosis need not
mean that it has a sexual significaaice. It may gratify quite a
different Avish, but, as the professor of surgery advised the medi-

IHi

Fig. 5-B. — Phallus grasped by arms of crab. The crab as a devouring oauecr often
symbolizes the destrucCiveuoss of excessive eroticism.

cal student, in all lower abdominal tumors in females that have
the capacity to menstruate, rule out the possibility of pregnancy
first, also, in all obscure chronic diseases, rule out syphilis first;

PSYCHOPATHOLOGY

SO the psyohopathologist must consider the patient's sexual life
in every abnormal adjustment.

It is a psychological law, universally found active throughout

^^. 1

Fig. 5-O.^Maiden standing over cross inspired by the serpent as the phallus. The
cross symbolizes the sexual act.

the race of Man that children and adults, ivhether savage or highly
civilized, will use an image or symbol, or a suhstitute when the

PHYSIOLOGICAL FOUNDATIONS 01? PERSONALITY

reality can not he obtained in order that the affective craving, no
matter what it is, may he neutralized. In this manner, the individ-
ual gets relief from the autonomic tension, and, for this reason,
the image or symhol has a psijchotherapeutic value, in that it has

THE GtAiTtS or HO?N.

0Aid> Hilt' A^jxh-iuq-fuwii oj -/^^T^^vm.,

Fig. 5-D.^This design show§ the male above united with female below. Above is an
algebraic formula used for a similar significance.

PSYCHOPATHOLOGY

a protective influence against the loss of the true stimulus causing
the autonomic apparatus to assume fearful tensions, which are
alivays conducive to malnutrition and impotence.

Fig. 5-E. — The double vase with crossed designs symbolizing sexual union. This
design signifies homosexuality and has its origin in the crossed gluteal lines". A series
of such drawings were made by the patient while having such cravings.

If one will analyze the wish-fnlfillment in a scientist's re-
searches, an artist's paintings, a writer's characters and theme, a

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY

child's fantasies, a laborer's tools, a housekeeper's choice and ar-
rangement of furniture, colors, etc., one will find that it satisfies
certain conditioned autonqmic-affectivo cravings. The selections
appeal to the individual Avho has similarly conditioned wishes,
and, conversely, this la\\- is just as true— it is disliked by the in-
dividual who has either i-epressed intolerable wishes that crave
the object or has manifest wishes that are imposed upon by the
object.

Fig. 5-F. — Symbol of sexual union, same design as Fig. 5-E but signifying hetero-
- ■ . sexual relations.

In the gravest, most confused psychoses, whether related to
organic or metabolic disturbances, the autonomic cravings are the
dynamic factor. They determine what environmental conditions
will be accepted or rejected by the individual, the practical or
impractical nature of his stream of thought and what organs,
movements and postures of the body shall become favorites and
be cultivated assiduously or shall be avoided and allowed to atro-

4:8 PSYCI-IOPATI-IOLOGY

phy through disuse, or even be mutilated and destroyed. To il-
lustrate: Many prudish young women hold the chest as flat as
possible so that the breasts will not be.prominent. The bashful,
awkward boy or girl avoids competitions that require the dem-
onstration of physical skill because of fear of being inferior,
and through disuse- becomes more inferior. One son takes to
athletics to win pleasure and esteem and a rival brother becomes
a scholar and a third brother, a musician, or two brothers become
physicians, and both, trying to become a parent's favorite, hate
each other. One daughter physically more beautiful than her sis-
ter becomes a society belle, and her sister, desiring the same things,
but, being discouraged because her family openly favor the beauty,

Fig. 6. — Showing sexual significance of postures of fingers. Hands in blessiij^i^,^
First, male trinity; second, Hindu symbol through which worshippers gaze at saerect
objects; third, male and female symbols; fourth and fifth, sexual union.

becomes sullen, brooding and autoerotic. In a similar situation
the less beautiful sister imitates a sympathetic, "brilliant," though
ugly looking aunt. Narcissistic boys and girls make features of
any superior organ that happens to win praise, such as the hair,
eyes, hands, voice, face, the dance, etc.

The chapter on the "UniveTsal Struggle for Virility, Good-
ness and Happiness," is devoted to the behavior of males and
females, normal and abnormal, in their struggle to master the
causes of fear and compensate for inferiorities in order to win
virility and social esteem.

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 49

The Use or Disuse of Organs, The Anesthesia or Hyperesthesia!
of Receptors and the Physiological Nature of Memory

The collection of psyehoneuroses and psychoses will show how
autonomic-affective resistance to a receptor lowers its power to
produce sensational reactions in consciousness, as in visual con-
striction, regional anesthesia, functional anosmia; and, also, how
a persistent affective craving increases the receptor's capacity to
produce sensations, probably not by directly affecting the re-
ceptor, but because the affective craving, through seeking its
needs, raises or lowers its reaction threshold to the particular
receptor and its stimulus. For example, when we wish to learn
through the use of our eyes (reading), while in a noisy room, the
affect lowers its resistance to what it sees (reads), and raises its
resistance to what it hears or feels, blocking out distractions ; or,
when a mother sleeps her autonomic reactions are conditioned to
be aroused by those sounds which are characteristic of her baby
becoming restless but other sounds are resisted.

When children are forced to study, or adults are compelled to
work with things that their love cravings are conditioned to have
aversions for, their capacities for recall and associations of
thought become dull, slow and unprogressive ; whereas the same
child's learning capacity or the same laborer's or scientist's work-
ing ability is tremendously increased so soon as the love cravings
can work with a medium that pleases them. This is to be clearly
seen in the analysis of Darwin's working capacity as a child and
as a man.*

When an animal, child or adult, educated or uneducated, sane
or insane, is forced to attain affective gratification through work-
ing with a medium that it has aversions for, its constructive capac-
ity is greatly depressed.

This law should be understood by every educator and advisor,
no matter what may be his especial line of work. Darwin, like all
of us, found it difficult to learn, remember and use, or do that which
did not please his wishes. Plence, in analyzing a man's character,
it is to be remembered that he retains what pleases and tend\s to
forget what displeases; except when indirectly the displeasing may
later become a useful means.

•Chap. vi.

50 PSYCHOPATHOLOGY

This has been demonstrated in the psychological laboratory*
and verified through psychoanalysis. The content of conscions-
ness is largely composed of kinesthetic sensory streams, aroused
by the postural tensions, -vvhich please the affect, being retained.
In recalling images (memories) of past experiences or of objects,
the affect or wish so coordinates the postural tensions and move-
ments as to reconstruct a sensory-motor image of the experience.

The efficiency of the acquisitive coordinations or learning
curve when not complicated by fear and aversions may well be
represented .by the following experiments :

"When food Avas held by the hand, under carefully controlled
conditions, to a cage in which a hungry monkey was imprisoned, it
projected itself in practically a straight line to the food and seized
it. Now, when a stick was held by the hand in the same place, the
monkey projected itself in a tangled line in back of the cage, show-
ing a typical avertive-fear reaction. "When food was placed on the
end of the stick, the monkey cautiously approached in a zigzagged
line, a compromise between the straight food line of approach and
the tangled-avertive-stick line ; showing that a compound or com-
plex stimulus or situation may arouse both acquisitive (hunger)
and avertive (fear) reactions. The autonomic cravings struggle
to dominate the final common motor paths and cause the confused,
inefficient coordinations. The less fearfiil man or monkey, given
the same acquisitive cravings, therefore generally wins in compe-
tition because he coordinates more accurately and freely.

The above curves or trails of efficiency apply very well to a
child learning Avhat it has cravings for from some one it likes (the
straight line), as compared to its manner of learning what it dis-
likes from someone it dislikes (the tangled line), or learning some-
thing it likes from someone it dislikes (the zigzagged line). This
applies equally well to the adult working at what pleases his condi-
tioned cravings under an encouraging, appreciative employer or di-
rector, and the uncomfortable adult who must work at what dis-
pleases him. This principle is also shown in the marked difference
in the constructive, and destructive compulsions of the happily and
imhappily married.

The unbiased study of human behavior in males and females
sho\YS that both sexes, at all ages, must constantly strive to main-
tain a relatively high quality of virility and efficiency, and, no mat-

*I/angfeld, li. S.: Psychological Keview Publications, xvi, No. 5, 1914.

PHYSIOLOGICAL FOUNnATIONS 01? PERSONALITY 51

ter what course is pursued it must be a protection from fear of
possible failure due to the superiorities of a rival or disastrous
incidents in the environment, such as accidents, responsibilities,
failure, etc. Compensated fear causes a convergence of the l)lood
supply upon the liead, arms, and shoulders, and prevents sexual
potency by depriving the pelvic vessels of sufficient blood. Hence
the cause of fear must be counteracted by a fetich or faithful rit-
ual. This fact is not believed by many because they regard their
sexual interests as something other than admissible to a refined
state, and by keeping the sexual cravings repressed so that the
latter must use obscure symbols and disguised fantasies the indi-
vidual maintains that he has freed his ego from the influence of
the sexual autonomic segments. Only those individuals make such
repressions who dread- the peculiar requirements of their sexual
cravings and the resiiltant course of adjustment is always char-
acterized by a semifanatical or prudish castration tendency.

A large, vigorous, well-developed army officer, 48, consulted
me for relief from high blood-pressure (180-200), cardiac palpita-
tion, and the fear of dying from cerebral hemorrhage due to his
assumed "arteriosclerosis." Eepeated physical examinations by
competent men showed no physical lesions or arteriosclerosis.
(Cannon has demonstrated the compensatory value of increase of
blood-pressure and cardiac systole during fear.) The man's self-
exhibitionistic behavior, conspicuously checkered clothing, button-
hole carnation, eccentric movements that attracted attention, and
his general attitude of making himself the center of attention,
indicated that he was suffering from an unavoidable feeling of
social inferiority. Several of his family had died from heart
lesions and cerebral hemorrhage, and this suggested the specific
grounds of his fear and seemed to be sufficient cause to his phy-
sician.

' The psychoanalysis showed that he had repressed his, sexual
cravings from acquiring a heterosexual object because (1) he loved
his mother too devotedly to love smother woman, she clung to him
most persistently, and (2) woman stood, not for love, but sj'-philis,
social scandal, blackmail, or impregnation. Hence, the female's
sexual approach did' not invigorate him but aroused a sexually
depressing fear reaction. Since he could not love a female his
sexual cravings were strongly reacting to homosexual situations,
and fear of this inferiority caused his overcompensation of os-

52 PSYCHOPATHOLOGY

tentatiously assuming masciiline traits even though they became
so grotesque as to be reflexly scorned or ridiculed by other men.
His persistent fear of becoming homosexual (subconscious)
had aroused the compensatoiy autonomic striving and explained
the cause of his increased blood-pressure. When he acquired in-
sight and learned how his selfishness was ruining his heterosexual
potency, he made a quite comfortable readjustment, and his blood-
pressure soon subsided to about 160. Thq. course of his blood-
pressure must be expected to vary with the hygienic nature of his
affective adjustment.

The Complex Nature of the Autonomic-Affective Stream

Since all of the autonomic apparatus is more or less active all
the time, the stream of cravings flowing from its tensions is more
or less active; that is, all of our wishing functions whether we are
conscious of them or not are more or less active all the time. Each
moment's behavior is the resuUcmt of the Tnanner in which the
cravings, reenforcing or inhibiting one another, converge upon the
striped muscles; hence, upon the sequence of acts or stream of
activity, and the content of consciousness.

In the lower animals and children it is quite easy to arouse a
wish and see its influence upon behavior, but in the matured male
and female, civilized, the nature of the dominant wish is often
neatly disguised behind other more manifest wishes. This is due
to the necessity for each individual in civilized society to acquire
social approbation or esteem for his wishes and avoid censorship
in some direct or indirect form.

The Development of the Ego

The struggle to acquire the approbation and esteem of the
social group and, more important, of those few particular indi-
viduals whom we love, fear or hate, is a vital determinant of our
behavior. One rarely does anything without having thought, more
or less, of how some other person may censure or esteem it. Or-
dinarily, one is inclined to regard himself as an absolutely inde-
pendent personality, but, in reality, there is no such thing, except
perhaps in certain types of pernicious deterioration of the per-
sonality.

The need for social approbation begins with nursing, and has

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 53

its root, no doubt, in- the years of helpless dependence upon some
other person npon whose wishes and favor most comforts and life
itself depends. The child becomes conditioned to fear losing esteem
and favor when heedlessly indulging in segmental pleasures, such
as anal and genital sensations, slobbering, finger sucking, stealing,
asocial behavior. This dependence becomes further developed
through loneliness, illness, and the prospective dependence of old
age. Nearly all of our comforts should be and are obtained
through the direct or indirect assistance of other individuals, and
we depend upon the reactions of others to our achievements for
orientation as to our social fitness. One may observe this in the
innumerable little tricks of speech and behavior people use in
order to win a pleasing comment of esteem for some act, creation,
sacrifice, accomplishment, discovery, ideal, etc.

The most important factor in an adult's career is the measure
of security and confidence other adults have in his honesty, sin-
cerity and integrity. Hence, very rarely can an individual afford
to gratify any particular wish that may jeopardize the wish for
social esteem, unless, like the thief and prostitute, he becomes will-
ing to renounce all interest in true social esteem and regress to a
lower social or phylogenetic level where he may associate with in-
dividuals who gratify their cravings in a similar manner.

The individual's cravings for social esteem become the most
manifest and persistently active of all the compensatory auto-
nomic functions because from infancy to old age he is conditioned
to obtain his needs in a lawful, fair, equitable, justifiable manner ;
that is, in a manner that will give satisfaction to or at least will
not jeopardize others.

The herd, beginning with the parental influence in the home,
trains the infant to contribute to the general progress of the herd's
development. The infant's segmental cravings (as nursing and
defecation) are early counterbalanced by developing wishes to con-
trol them in order to please the mother and mn her favors. These
Avishes are jeopardized by heedless self-indulgence and the fear
of losing favor and esteem initiates more vigorous compensatory.
striving to prevent a recurrence of submitting to the segmental
indulgence. We see the infant defecating or crying heedlessly,
then gradually forces develop in it that try to prevent defecating
except under certain conditions. This struggle is particularly

54 PSYCHOPATHOLOGY

common in overcoming the segmental pleasures attendant upon
bedwetting, stealing and lying. At first there is but little success,
but as the act is followed by greater fear the latter initiates
stronger compensatory strivings to control the segment, which suc-
ceed in preventing the segment from controlling the striped muscle
apparatus under most conditions, and finally altogether. When
the segmental indulgence not only has the pleasant value of warm
sensations but also dominates the mother, punishes her, or wins
attention during the lonely night, or comes to have an erotic value,
as a birth fantasy to please the father, the compensatory striving
for self-control must be decidedly greater and more difficult.

Obviously what occurs is that whenever the projicient appa-
ratus is allowed to be controlled by a segmental craving and the
indulgence does not jeopardize the functions of the other segments
no compejtisatory defense occurs, as an animal or child taking food
or urinating as it pleases without fear of punishment. But when
other autonomic segments are jeopardized by yielding to' some
segmental craving they tend to keep control of the projicient appa-
ratus and thereby prevent the segmental indulgence because, al-
though, the indulgence has its pleasures, it is followed by fear of
punishment or loss of esteem. That is, the autonomic apparatus
(gastric, circulatory and respiratory segments) reflexly assumes
tensions which are anxious or fearful and which initiate a com-
pensatory striving to prevent a repetition; as in the fear and de-
pression following masturbation. Autoerotic people make the
common complaint that for several hours or days following the
indulgence they suffer from a horrible sense of inferiority, fear of
discovery and shame which is followed by firm resolutions (com-
pensations) to prevent a similar recurrence. After several days
the conditioned sex organs again tend to become congested by
certain stimuli and the sexual (segmental) cravings become more
active until they finally dominate the entire organism and the
resolutions to maintain self-control and win social esteem are
again overcome. This sort of struggle goes on incessantly with all
sorts of simple and complex segmental cravings in the child, as
oral and pharyngeal (sucking, eating, drinking), gastric (drink-
ing, eating), anal, urethral, and genital itchings, and they must be
thoroughly controlled by the time the individual becomes an adult.
Those who tend to allow themselves to become avaricious, envious,

PHYSIOLOGICAL FOUNDATIONS OP PERSONALITY 55

jealous, slothful, gluttonous, erotic under perverse conditions, or
those who can not prevent such segmental reactions are most de-
cidedly shunned, ridiculed and punished if they can not be ostra-
cized.

The innumerable compensatory strivings of the autonomic
apparatus that become conditioned to attain social esteem as well
as segmental gratification become integrated into a imity or ego
which is opposed by the segments which tend to compel actions
that may jeopardize the ego. In this manner the conflict between
the ego and the not quite socially justifiable or utterly unjustifiable
cravings becomes established and is incessantly waged even in the
normal. In the psychoses the conflict is far more severe than nor-
mal, due to the vigor of the segment or the weakness of the ego.

This peculiar striving of the autonomic apparatus to act as a
unity, in order to control an individual segment, develops gradu-
ally, and should be regarded as a compensatory reaction to di-
rectly avoid the causes of pain and fear, and, indirectly, to retain
love. When the child has developed the power to reliably control
the more simple autonomic adjustments, such as the eliminative,
it achieves its first great social triumph. When this capacity be-
comes so soundly established that no tendency to segmental indul-
gence remains, the individual's strivings change their tendencies
and, feeling its power, it begins to strive directly, more and more,
to win love and esteem, and, indirectly, to control itself. Adults
who suffer from "self -consciousness" failed to make this change
in childhood. The supreme triumph comes with the gradual com-
pensatory development of the power to control fear, self-doubt,
gluttony, envy, sloth and narcissism; usually from fourteen to
eighteen. This compensatory mechanism applies also, obviously
enough, to perverse sexual and homosexual interests, and must
not be considered in the sense of applying merely to the act of mas-
turbation, but to all the fancies, movements, interests, associa-
tions etc., that are related to autoeroticism. Most boys, when they
conquer the autoerotic cravings, develop an aversion for all the
associations that are connected with them, and compensate with
high resolutions to enrich society.

One must, therefore, see that, slowly, but incessantly, from
infancy, the autonomic apparatus develops a compensatory capac-
ity to act as a sociaUsed unity in order to control the segmental

56 PSYOHOPATHOLOGY

cravings, and these compensatory* cravings, through their condi-
tioning by associated stimuli, gradually become interwoven into a
personality as a unity of constantly active wishes. This imity re-
sponds to the mother's address of "yon," or "John." The child
begins to think of itself, as "John won over the bad little boy" or
bad impulse or spirit or devil. In this manner is slowly developed
the I, Me, Myself and the Not-I, Not-me, Not-myself. When the
personality or organism acts as a unity with the hunger cravings,
v/e say, "I am hungry." When the personality wishes to do some-
thing and hunger is disconcerting us, we say, "my hunger," or
"this hunger."

Gradually, in youth, this mechanism develops into the
"good," "conscientious" I and the evil, uncontrollable Not-I.
Many people are stillinclined to differentiate this as the "soul"
striving against the "flesh" or the "devil." In the chronic func-
tional deteriorations, the segmental cravings become dissociated
and the "I" interprets the dissociated wish and the behavior it
produces as another personality. This mechanism is of the ut-
most importance to the insight of the psychopathologist, and for
all people who wish to relieve the suffering and anxiety that is
caused by the eternal feud between the ego and the segment. It
will be discussed in detail in the chapters on the psychoses.

Any man or woman may learn to know, upon introspective
self-analysis, that anxiety is generally due to fear of the possibility
of failure to live at the level that pleases his refined wishes best.
The possibility of failure may be caused by a disease in an im-
portant organ or by the pressure of an unmodifiable, persistent
affective need that we can not or dare not permit to acquire grat-
ification.

The Mechanism of "Transference"

This is the key to successful psychoanalysis and psychother-
apy, and upon it depends the physician's ability to sincerely
appreciate the patient 's conflict. He must genuinely wish to assist
the patient for his welfare and the welfare of society and the
analysis must proceed upon a clearly defined altruistic basis. The
physician must not become a censor, moralist, or temptation. He
must remove, as soon as possible, the fear of censure in order
that the repressed functions may manifest themselves. The phy-

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 57

sician represents the highest reconstructive interests of society;
hence, so soon as the patient confidently feels that the revelation
of his repressions will not lose for him the physician's esteem, he
quickly begins to show a relief from anxiety ; that is, relief from,
fear of the affective cravings that he has repressed (that he tried
to " forget '■') because they Avere "selfish," "vulgar," "per-
verted," etc. In turn the functions to love become reestablished
and this force makes life worth living and suffering. For a time
this affection transfers or attaches itself to the physician and
works to make the personality attractive to him thereby giving up
the delusions for methods of thinking that win his confidence.
Thus is developed the bridge to normal, practical interests, new
"will power" and neAv love attachments.

Before considering the mechanisms of suppression and re-
pression of affections or cravings, the physiological nature of the
will must be considered. The riddle of the nature and origin of
the ivill, which has baffled philosophy and psychology since man be-
gan to assume its existence, may be remarkably clarified for the
student if he ynll follow Holt's suggestion to see the ivill to be or
the ivill to have as the wish to he or the trish to have.

Origin and Nature of "The Will"

When Ave will to do this or that, go here or there, rve really
WISH and compensate or strive, ivithout restraint, in order to
overcome the potential possibility of failure to obtain gratification.
This capacity should be assiduously cultivated by the individual
throughout life provided it does not make him asocially aggressive.

It should become, with reserve, a consistent attitude toward
everything in the environment. The affect craves for an event or
an object, and the likelihood of its not becoming a pleasing reality
causes a more or less vigorous fear producing reaction in the
autonomic apparatus, in proportion to the seriousness of the msh
and the likelihood of its not being gratified. The fear reaction, in
turn very quickly arouses a reflex compensatory speeding up of
the autonomic apparatus, as sho'wm by Cannon and others, in the
increased rate and strength of the heart beat, increase of adrenin
and sugar in the blood, and an appropriate shift of the blood sup-
ply to the Avorking parts.- This compensatory increase of physio-
logical power, greatly envigorating it, enables the ivish to attack

58 PSYCHOPATHOLOGY

and reconstruct the environment so that at a certain time certain
events must occur.

This mechanism Avorks incessantly in every person's daily life
in a ceaseless stream of minor events. When I wish a pencil, I
must compensate for the pencil's failure to place itself in my hand
by picking it up, an aggressive act. When I need someone's as-
sistance, I must compensate for the discomforts caused by not hav-
ing it, by expending the energy which has been aroused by the in-
conveniences of the situation, and seek it.

The man, who, after due consideration, allows himself to wish
to have an object, such as a position, factory, invention, be an hon-
ored guest, conduct a hazardous responsibility to a successful con-
clusion, or make a scientist of himself, naust not only be able to
wish for the event, but be able to freely and successfully compen-
sate for all the fears of faihore that may arise. In proportion as
his compensatory powers begin to fail, the weakness of his so-
called "will poiver" becomes manifest. When we wish for an
event, but do not act to make its fulfillment possible the wish is
only strong enough to cause awareness of its need (thought) and
not strong enough to act. Through the introspective analysis of
the occasions of what might be called increased will power in my-
self, I have been able to find a repressed, banal fear of losing the
thing I wished to acquire. For example, while working on a manu-
script, my capacity to coordinate details and to visualize the object
for which I was striving (demonstration of a theory) had greatly
subsided, and, for several days, I could get nothing done. Then,
one day, about noon, the capacity to work had become greatly ac-
celerated. This acceleration had occurred so spontaneously that
it was well under way before I realized it had occurred. At first,
I could not account for it. No one had relieved any diffident, re-
pressive tendencies in myself through an expression of esteem for
my work, but, with further recall, I became aware of the fear that
another psychopathologist, who was acquainted with my material
and theory, was finding it difficult, revealed in his manner of say-
ing what he would like to do, to refrain from usurping my rights.
The only practical defense was being reflexly made through vigo-
rous self-assertion which discouraged the other man. Within a
few minutc>s the vigorous autonomic compensation for the fear of
the possibility of losing the fulfillment of an important wish began

PHYSIOLOGICAL FOUNDATIONS OF PEBSONALITY 59

to show itself in an aggressive onslaught upon tlie environment,
my data, making it conform to please the wish by assuming the
form of a completed article.

The grand, old law, that "honesty is the best policy," has a
critical significance in the development of personal power. It
often requires the endurance of great anxiety to honestly endure
the prospect of failure, particularly when a dishonest adaptation,
as a lie, secret, or malicious advantage may give temporary relief
or advantage. But the enduring of the anxiety, in turn, gives the
individual a sublime reward, in that the autonomic apparatus is
so constituted that the situation forces it to augment its vigor and
thereby develop additional skill, endurance, insight and power.
One may see this compensatory mechanism wonderfully developed
in such remarkable characters as Charles Darwin. (An analysis
of his personality is included in the chapter on the anxiety neu-
roses.)

The failure to endure anxiety makes the vicious, secret, in-
triguer, the pathological liar, the drug liabitue, the shyster, etc.
Society can only protect itself from the destructive influence of
such dishonest adjustments ))y resolutely, promptly, severely pun-
ishing' the perpetrator of asocial acts. Because, then, the greater
fear of punishment will influence the individual to endure the
lesser fear of failure until the compensation is established. Then
the individual becomes a stronger link in the social chain.

The so-called paraphrenic .types, that is, individuals who are
"Aveak of will," fail to make socially approvable adjustments be-
cause of the poorly developed nature of the wish to be socially
esteemed. This is due, in turn, to the nature of the conditioning
of the love cravings during youth and the insidiously repressive
influence of more powerful, competing hostile associates, usually
a parent or mate.

The self -lover or autoerotic type naturally sacrifices society's
interests in the innumerable petty crises as well as in the greater
crises, in the sense that he would rather gratify his cravings with
dream images of the reality than woi'k for the reality in a manner
that has a practical social value also. This is not his conscious
choice, but, during his growth, his parents failed to give him suf-
ficient love and esteem without cost during critical tests. (This is
clearly brought out in the masturbation difficulties of Case AN-3

60 PSYCHOPATHOLOGY

and many others.) The attitude of wishing to be esteemed was
not developed sufficiently to endure the stresses of competition
when a more self-reliant older rival had to be beaten. Hence, the
timid retreat into autoeroticism where no rivals care to or can
enter.

To sum up: The "will-to-become" is the same as the wisTi-
for-esteem and the ivish-to-have. It is the autonomic apparatus'
reflex compensation to prevent fear of the estimable or justifiable
wish's failure to acquire gratification, or to prevent the asocial
wish from jeopardizing the organism as a whole that gives us the
power to endure anxiety and refine our methods.

(In the chapter on "The Universal Struggle for Virility,
Goodness and Happiness" it is necessary to give considerable im-
portance to the manner in which mortal struggles between father
and son, mother and daughter, husband and wife, may force one or
the other to abandon the struggle for virility and power unless
they develop considerable insiglit.)

This now brings us, logically, to the significance and mecha-
nism of the affective conflict between what may be designated as
the socialised wishes of the personality, which constitute the erjo,
and the perverse, segmental craving, or wish, that arises from
some individual autonomic segment, as the digestive or sexual
apparatus.

To illustrate: The hunger craving in the stomach may,
through its compulsive powder, place the entire organism and its
future in jeopardy by forcing the stealing of fdod. This compel-
ling influence occurs much more commonly in the commitment of
sexual transgressions; particularly when the compulsive craving
for autoerotic, or perverse homosexual, or incestuous indiilgence
is "insistently forcing itself upon the individual. This sort of inter-
autonomic-affective conflict, it will be shown, is the mechanism
that produces the destructive psychoses, and is to be found under-
lying every functional deterioration of the personality. Where the
sexual cravings support the ego or socialized wishes of the per-
sonality, if of a high order, the individual becomes virile, good and
happy, and a most constructive social influence.

Out of the affective conflict between the cravings of the or-
ganism as a unity, and the cravings of a segment or segments for
control of the final common motor path of adjustment, arise the

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 61

mechanisms of suppression, repression, the summation of allied
cravings, and the summation of the antagonistic cravings, disso-
ciation of the personality, or affective readjustment, with satis-
factory compromises as sublimations.

Affective Adjustments

Sherrington has shown, to repeat, and Cannon and others
maintain that the following mechanism holds for the autonomic
apparatus: Wherever two neurons simultaneously converge
upon a third that is efferent to them, in order to direct its move-
ments, the mechanism of reenforcement or of inhibition may occur,
depending upon whether or not, the impulses are allied or antago-
nistic in their tendencies.

The mechanism of affective suppression may therefore be ap-
plied to those instances, almost continuously occurring in every-
day life, when the individual must prevent a wish to act from con-
trolling his behavior, (such as to be negligent or show anger to a
superior officer w^hile, at the same time, an obedient attitude is
necessary). Under such conditions we do not "forget" the wish ;
that is, we allow it to cause us to be conscious of its needs but are
dominated by other wishes that prevent the anger from freely
dominating the projicient sensorimotor apparatus.

Affective repression occurs when we prevent the wish from
making us conscious of its needs ("forget it"). The difference
between affective suppression and repression lies in the degree
with which the wush is prevented from controlling the projicient
apparatus and arousing an appropriate kinaesthetic stream. In
all cases, the wish is inhibited because we are afraid its conse-
quences will jeopardize the whole personality if allowed free play.
An inhibited wish or affective craving, being the sensations caused
by the hypertension of an autonomic segment, persists so long as
the hypertension of the autonomic segment exists. This tension, it
seems, can not he relieved except through the acquisition of ap-
propriate stimuli. Certain stimuli come to have the capacity,
through the manner in which the segment has been cond&tioned, to
couhterstimulate a comfortahle adjustment of the viscus. The
avoiding of the stimuli that have the capacity to stimulate the
visctis to become hypertense often becomes a necessary hygienic
measure whenever the individual is unable to acquire the means

62 PSYCI-IOPATI-IOLOGY

that can give him relief. This can be seen in the careful manner in
which Darwin avoided personal conflicts because he was nnable to
control the genesis of cravings, which, in turn, tended to demand
submissions from others. All people eventually become forced to
evade many situations for which they are conditioned to have un-
comfortable reactions.

Hence, the psychopathologist must recognize that," during sup-
pression or repression of autonomic-affective cravings the indi-
vidual merely walls in the wishes but does not disintegrate them.
Moreover, although we may be no longer aware of their true na-
ture or the manner of their genesis, we, nevertheless, feel physical
disturbances, such as localized or vague tensions, inability to work
or think Avell, the tendency to make mistakes, have a poor appetite,
sleep restlessly, etc. The repressed affections are incessantly try-
ing to force us to become conscious of their needs; that is, to dom-
inate our behavior so that they can obtain gratification ; and they
may be seen to seize upon the slightest opportunity that may pos-
sibly bring relief. This is evident in our dreams, errors, selec-
tions, prejudices, the tensions we feel when we have forgotten to
do something important and the neuroses and .psychoses.

The seriousness of autonomic repression depends, largely,
upon the nature of the segment involved axid the importance to
the daily life of the circumstances attending the repression. This
may be estimated only through a study of the patient's affections
and his responsibilities.

The tendency to suppress our affections may accumiTlate ; that
is, a summation of the repressing or suppressing egoistic wishes
may occur, usually through the influence of puritanical associates.
Also, a summation of the repressed and suppressed autonomic ten-
sions may occur and they can not be prevented from showing their
influence on the postural tensions of the striped muscle apparatus,
as in the summation of fear through a series of dangerous ex-
periences. Through the summation of proprioceptive and exoge-
nous stimuli (the kinaesthetic stream of erotic imagery and the
influence of an attractive person) the repressed affect may become
so vigorous that an acute, mild or even severe, dissociation of the
personality may result. The repressing or socialized wishes for
esteem (which constitute the ego) become unable to prevent the
tense repressed autonomic segment from forcing the organism to

PHYSIOLOGICAL FOUNDATIONS OV PERSONALITY 63

be conscious of its needs. Logically, the manner in A\'}iicli the
individual becomes conscious of the needs of the dissociated seg-
mental cravings is in the form of obsessive thoughts, phobias,
compulsions to bring about a particular act, or confusing wish-
fulfilling sensations, dreams, delusions and hallucinations, and
distressing bodily sensations.

The mechanism of Avisli-fulfillment in the dream, delusion, cre-
ation, fantasy and hallucination should be thoroughly understood
by anyone professing to have a serious interest in psychology and
psychopathology.

It has been pointed out in the discussion of the peripheral or-
igin of the affective craving and its means of obtaining gratifica-
tion, that, through the tense segment striving to be restored to a
degree of comfortable tension, the autonomic apparatus has the
capacity to force the projicient or striped muscle apparatus to
la'dke such movements and assume such tensions as are appropri-
ate for so exposing the exteroceptor as to (1) avoid the unsatis-
factory stimuli in the environment, and (2) to acquire satisfactory
stimuli from the environment. But, also, through this means of
controlling the postural tensions of the striped muscles, the kin-
aesthetic stream- of sensory images is regulated. The affective
craving makes the individual aware of such kinesthetic images
of previous experiences as are suitable to gratify the craving [as
gastric (segmental) hunger and the thought of how, where, and
when to get food]. Whenever the individual has repressed crav-
ings which resist assuming a submissive attitude when dominated
by an aggressor, he finds that it is almost impossible to forget the
domination and think freety or impartially about another subject.
When the wish recalls or reconstructs an insulting experience we
actually reproduce an image of the experience liy reproducing ap-
propriate postural tensions which give us the kinesthetic images
of the experience. This can be seen in children and in ourselves
when trying to adjust an old quarrel.

We only know the ultimate nature of why, vhnt, or how an}'-
thing is by wTiy, what or hoiv it is not. That is, by comparing an
object or beha^dor of a person Avith similar objects, persons, or ex-
periences and diife-rentiating it from dissimilar objects or experi-
ences, we estimate its nature, physical qualities and affective
value to us. Our capacity to understand anything depends upon
the nature of this imitative or apperceptive capacity. As ire are

64 PSYCHOPATHOLOGY

able to accurately reproduce the factors in an environmental situa-
tion of the present moment, we are able to foresee the fivture re-
sults and, accordingly, make practical efficient adjustments. Our
apperceptive functions, however, depend, fundamentally, not only
upon tlie organic construction of the peripheral sense organs, and
the integrative capacity of the nervous system but, more so, upon
the way they are used by our affective needs, Therefore, when we
can not avoid unduly including irrelevant Avish-fulfiUing sensory
images, that is, images or fancies of past pleasing experiences, in
a present situation, our adjustment will be proportionately im-
practicable. We fail to be practical in so far as undue fancies are
injected into the situation, as the anxious lovesick girl reads wish-
fulfilling meanings in her indifferent idol's manner of accenting
words, his looks, signs, etc. Southard gave an example of an or-
ganic foundation for a delusion in a woman who repeatedly said
she had been shot in a certain spot in the thorax with a "seven
shooter. ' ' Upon autopsy, a plural adhesion was found under that
spot, which probably accounted for the local pain delusionally at-
tributed to the shot. The psychopathologist and psychologist can
not, however, accept the single fact, the adhesion, as a complete
explanation of this delusion, because it does not explain why she
said she was "shot" and why she said a "seven shooter" did it.
Why did she not say she was stabbed, etc., or according to Der-
cum's idea of the influence of suggestions accounting for delusions,
why did not the old lady accept the diagnosis of an intrathoracic
disease process?

(Throughout all the cases presented in the following chapters;
it is the endeavor to demonstrate that all creations, delusions,
dreams, hallucinations, psychoses, gratify autonomic cravings that
can not be gratified by external realities because social conventions
and obligations force the ego to prevent the autonomic cravings
from acquiring the external stimuli which they are conditioned to
need. Many psychoses will be shown in which the dream, delusion
and hallucination are so obviously produced by the same affective
need that it is not necessary to give a series of examples here.)

It is usually so easy to recognize the compelling wish in a psy^
chotic's behavior that one needs only to learn how to look for it. It
is important, however, to bear. in mind that often the Avish that
produces the behavior, say the -wish to go back to a past experience
and reconstruct it, is not the fundamental cause of the difficulty;
but is a resultant compromise between conflicting wishes. For ex-

PHYSIOLOGICAL FOUNDATIONS 03? PERSONALITY 65

ample, one of our cases lias, for six months, been screaming that
she wants to go back one year, six years, twenty years, etc., in order
to start life over again. After cantious inquiry, we found that this,
in turn was due to the conviction that she had ruined her woman-
hood through masturbation which began in childhood. This, in
turn, upon analysis, as is often shown, as in Case AN-3, is due to
the domineering resistance of some adult (parent) preventing the
love affections from frankly competing for a certain heterosexual
love-object.

Art and literature, as the illustrations show (see Mars and
Venus, etc.), are literally composed of images that allow the so-
cially tabooed or repressed affect to obtain some gratification
through the use of a symbol which is substituted for the reality.

On the other hand, the affect may not be repressed, but, be-
cause it is physically impossible to obtain the reality, it may use
an image to ol)tain gratification, as in the imitative, "make-be-
lieve," play of children or the savage's manner of substituting
an energizing image for the reality, as in imitating rain by sprin-
kling water on the parched ground, or the civilized man cherishing
a photograph, memento, autograph, memory, etc., or the delusions
of a psychopath.

."When the repressed affect can not be controlled by the social-
ized wishes, the ego becomes more and more inclined to regard its
influence as the work of another personality, and, throughout the
psychoses later presented it will be seen that the patients speak
of it as "God," "the devil," "they," "a secret society," "the
president," "bad blood," etc. Most commonly, "they" is the term
used for the dissociated affect. But, often, when the affect is de-
cidedly conditioned to react to some definite person, the patient
openly blames that person for having hypnotic powers over him,
and the "voices" heard, or the "pictures" seen, are "thrown into
the mind" by a "brain machine," etc., supposedly under that per-
son's direction.

Intoxications due to disease, exhaustion or drugs, or a serious
disappointment, depress or weaken the ego 's wishes to attain social
esteem. That is, since the latter are composed of compensatory
functional integrations of the nervous systein superimposed to con-
trol the segmental cravings from asocial influences, they tend to
weaken first, and then, the repressed affect forces the individual

66 ' PSYCHOPATHOLOGY

io become conscious of thoughts and sensations, such as tactile,
auditory or visual hallucinations, constituting the delirium or
psychosis, which in some manner gratify the affect.

As the vigor of the repressed, dissociated affect subsides, the
vividness and persistence of the hallucination subsides. As the
hallucinations weaken, grow dimmer, the socialized ego, if it be-
comes reorganized, again becomes able to direct its attention upon
subjects that gratify its practical needs for social esteem. Just in
proportion as the individual grows able to prevent himself from
becoming conscious of the sensory image, he begins to doubt its
being an external reality. We attribute the quality of reality to
the persistence and vividness of the sensations wMcJi objects in
the environment force us to become conscious of when we expose
our receptors to them; as when we can not "believe our eyes" or
"ears" we try to touch the object. This mechanism applies also
to the hallucinated image, the delusion and the dream. The dream
is often so vivid that it has the physiological effect of an actual
experience. If the reader will bear this in mind, when reading the
case records, it will become quite obvious that the mechanism of
the fading obsession or delusion is due to the assimilation of the
repressed affect as the ego becomes less fearful of it and allows it
to become a part of the ego.

Through the psychoanalytic method of studying suppression
neuroses and repression neuroses (psychoneuroses) it was first
recognized that functional derangements or symptoms disappear
after an adequate affective readjustment is made, and that, while
the affective readjustment is in progress, the individual becomes
aware of the true value of "trivial" or forgotten memories and
old desires or cravings to do certain things. Usually, the history
of the genesis of the desire is such that it conclusively, in a sense,
logically, explains the cause of the symptoms and why they should
disappear when the desire is allowed to seek gratification with
the help of the ego (assimilated into the ego). Such phenomena
are only intelligible on the assumption that the desire or affective «
compulsion, because of the persistence of the symptoms or ten-
dencies, existed somewhere; continuously, from the time of its
genesis until its readjustment. Since the .affective craving has a
remarkably persistent tendency to remain true to its original form
upon its recall, and, since it disappears or subsides after an ade-

PHYSIOLOGICAL FOUNDATIONS QP PERSONALITY 67

qnate readjustment of the conflict or gratification, it is reasonable
to conclude that the affective craving persisted after its genesis in
something like its original form, because it was not permitted to
adjust itself. Since the host has no awareness of its nature or
origin after the repression but only feels distressing symptoms of
its pressure, it is also reasonable to consider that it has continued
its repressed existence in the postural tensions of those autonomic
segments of the organism in which it had its genesis. A splendid
but too puritanical young woman, who strove assiduously to have
a "pure mind," that is, repress all the kinesthetic influences of the
sex organs, suffered from dysmenorrhea and quickly recovered
(without dilatation and curettage) upon learning to make a natural
adjustment to the hyperactive phases of the uterus. A man who
felt strong compulsions to damn his domineering father suffered
from a husky, aresonant voice for years because of the suppres-
sion of the affect of anger that would use this means of attack.
The individual is constantly seeking, though without realizing
it, an opportunity to obtain relief from the influence of the re-
pressed affect. It shows in his innumerable individualistic prefer-
ences and aversions through which relief, may possibly be obtained.
The persistence of the repressed affect may cause such disturb-
. ances of judgment and selection, or aversion, as to induce serious
faulty adjustments in mating, business and professional conduct,
whereby the man, having become his own greatest enemy, makes a
false adjustment and ruins his business or career. Not uncom-
monly, however, the individual, by changing his location, business,
or associations, greatly relieves the repressed tensions, through
avoiding the stimuli that irritate them or cause the repression.
But, the individual whose moral and economic interests are so in-
volved that a change of adjustment is not possible faces disaster,
unless he can make an adequate affective readjustment through a
psychoanalysis. It is this outwardly normal but inwardly miser-
able individual whom a psychoanalysis can help. That is, through
the controlling influence of the transference, the fear of permitting
the repressed wish to express itself is obviated. Thereby, the re-
pressed craving is gradually allowed to fully exercise itself by
making the individual conscious again of what he had forced out
of consciousness upon previous critical occasions. This is often
a most painful and embarrassing procedure, but so are many

(j8 psychopathology

surgical operations. No alternative is as practicable. The re-
pressed affect often, but not always, causes tremendous physio-
logical disturbances (such as the physiological effects of violent
rage, anxiety, shame, fear, despair, eroticism) as the individual
becomes aware of his true affective constitution and the unjusti-
fiableness of his wish. If it is justifiable, usually, vigorous in-
dignation, with an unmistakable expression of opinion about some
offensive, selfish individual who forced the repression, concludes
the recall and a splendid robust adjustment follows.

Sighs, weeping, anger, etc., followed by more or less gradual
relaxation and general physical comfort, with spontaneous ten-
dency to become generous, appreciative and playful (not witty),
show that the readjustment has been completed, and the playful-
ness shows that the autonomic tensions are again normally re-
ciprocating in their functions in order best to fulfill their biological
career.

It is as necessary as putting a roof on a house for the patient
to permit the wish to talk and say what it pleases. Merely "know-
ing" or "realizing" what the trouble is is not sufficient. All our
affections are conditioned to obtain much of their gratification
through speech. The wish must be permitted to talk and act freely
in ord\er to acquire the reality or imuge of what is needed. In this
manner the individual wish loses its obnoxious or fearfuV qualities
and becomes completely assimilated into the ego.

The affective mechanism by which the personality becomes
more and more accurate in its capacity to make constructive as
Avell as pleasing social adjustments, and its capacity to project its
influence farther into the society of the present and future, may.be
considered to be a form of affective progression. This is in direct
contradistinction to the mechanism of affective regression, where-
by the discouraged, depressed personality recedes from the higher,
more intricate and more delicate adjustments to the earlier and
more simple, childish methods of adjusting. In the hebephrenic
and catatonic dissociated types, as the cases show, the regression
may continue to the infantile or nursling level or even intrauterine
attitude. In the catatonic cases, it will be shown, the personality
passes through a "rebirth" and progressively redevelops, resum-
ing its former interests ; some stop at a childish, others at an ado-
lescent, and still others even attain a more matured, efficient level
than they had reached before. The degree of readjustment de-

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 69

pends mostly "apon the nature of the obhgations and the attitude
of certain associates (usually family) and, very important, the
physician's constructive influence through the transference and
psychoanalysis.

The psychopathologist must develop the habit of seeing any
adult person's behavior as the resultant of many wishes and never
as the adjustment of simply one wish. It requires considerable
training to develop this viewpoint, because we are educated to be-
lieve that any wish that we try to forget, or disown, is not to be
considered as a part of ourselves, but belongs to the devil, or some
organic cause or disappears entirely.

The mechanisms of compensation and sublimation now logic-
ally follow for consideration.

Compensation is one of the most fundamental attributes of
living tissue and occurs particularly where there exists some sort
of painful irritation or the tendency of the autonomic-affective ap-
paratus to be forced into the fear state. The cause of the fear state
may be due to pain from the disease or injury of some organ (as
the heart, lung, kidney, skeleton, skin) or the potential danger of
injury, failure, persecution, prosecution, loss of social esteem or
property, etc. In either case the digestive circulatory and respi-
ratory segments and the adrenal, tliyroid and hepatic glands are
forced into a state of hypertension by the potential danger and
this continues until an adequate defensive course of adjustment or
insurance of protection and safety is established by protecting or
concealing the vnlnerable part or defect, or by destroying the dan-
gerous qualities of the attacking organism or person. If the cause
of fear is a segmental compulsion within ourselves an attempt to
eliminate it, or, if regarded as a social inferiority, an attempt to
compensate by some estimable work is reflexly initiated.

The elimination process not only may lead to the most drastic
surgical procedures, justified as the last resort to relieve an ob-
scure cause of distress, but to violent self-inflicted castrations and
suicides, or the chronic disuse of organs and functions that are of
the utmost importance in the struggle for life and happiness. The
elimination method of relieving the ego from the pernicious or dis-
tressing influences of a tense, painful organ is justified by the
surgeon who desires to perform plastic operations on the stomach,
colon, rectum and particularly the female genitalia. Many sur-

70 PSYCHOPATHOLOGY

geons still reason that in order to remove the distresses of a seg-
ment the segment needs only to be excised. This procedure fails
in a most inglorious manner if the cause of the repression is not
removed; as the fear of failure in business, the tendency to per-
verseness, or secret autoerotic indulgence.

A panhysterectomy did not relieve the erotic cravings of a
woman. Although performed as a last resort the elimination of
most of the sex organs did not eliminate all the erogenous zones
which had become conditioned through fancies and masturbation to
be aroused by many forms of environmental conditions, particu-
larly the presence or thought of nearly any type of man. A bril-
liant, paranoid army surgeon amputated his penis to prevent young
women, whom he hallucinated, from using him for sexual purposes.
The erotic segments continued to exercise a pathological effect
upon the personality even though partly destroyed. He now begs
to have his testicles excised for the same purpose.

Where the cause of fear exerts a continuous, pernicious influ-
ence the defensive compensation tends to become eccentric and
eventually, like an excessive hypertrophy, defeats its purpose;
thereby establishing a vicious circle. Conversely, when a psycho-
path presents eccentric compensatory claims of power or ability
the psychopathologist should look for a repressed segmental crav-
ing that is asocially conditioned, the influence of which he fears.
Many of the paranoid psychoses which are presented reveal this
mechanism.

"When we have done something that we regret, we reflexly feel
a compulsion to compensate with restorations. When we have a
wish to do something that we regret, we also tend to compensate
with restorations in order to maintain a state of estimableness. In
both cases, the tendency is to get as far from the intolerable mem-
ory or craving as possible by tending to keep ourselves conscious
of the direct opposite. This is to be seen in the case of mysophobia
presented in the chapter on psychoneuroses. The ' ' contaminated"
girl (anal autoerotic) was compelled by the compensations to get
clean in order to save herself from the shame and fear state.

An enormous field for psychological research lies in the di-
rection of ascertaining hoAv the sexual indulgences of youth, which
later become regarded, desperately, as inferiorities, influence the
compensatory striving for self-mastery, and how this extends it-

PHYSIOLOGICAL FOUNDATIONS OP PERSONALITY 71

self in tlie direction of some vocational or professional pursuit for
society's esteem and welfare.

One patient, who was persecuted by the memory of a series of
oral erotic transgressions when a boy of eight to fourteen, passion-
ately strove to compensate by developing unusual linguistic pow-
ers. Another patient had literally every tooth in his head covered
with a gold crown. The latter did not frankly admit oral eroti-
cism, but his psychosis was such that it definitely indicated it. He
thought men regarded him as a sexual degenerate.

The most common inferiorities that are compensated for in a
manner that may become pathological are segmental cravings for
masturbation and homosexual and heterosexual perversions. This
is true for both sexes. The manner of compensating for having
inferior sexual cravings is to fancy haAdng great prowess even
without supporting facts. This demonstration of prowess must be
absolutely differentiated by the psychopathologist from the natural
demonstration of abilitj^ in order to win the esteem of a splendid
love-object, in order not to grievously offend worthy men and
women. The former is characterized by chronic sensitiveness and
irritability, a compulsion to overvalue fancies, always on the look-
out for hints of having been discovered or of being spontaneously
disliked, utter inability to be humble, inclination to domineer un-
justly, to be ostentatious, egotistical and destructively or depreci-
atively critical, but not able to be generously and constructively
critical.

One can diagnose such cases on sight, when, with meager
actual accomplishments, they come into the ward, walking stiffly,
proudly, with head erect, face staring, hair combed so as to radi-
ate (intelligence), face flushed or tense, inability to become agree-
able, and inclination to have vague physical discomforts from the
tensions of repression and overcompensation.

The general rule is that any eccentric claim having <M eccen-
tric value, which is not substantiatedi hy facts, is to he regarded as
a compensation for a personal inferiority. The mechanism of sub-
limation is directly related to the compensatory striving, and really
means the refinement of the needs of the affective craving by other
wishes which are compromising on acquiring substitutions in the
form of stimuli which are associated with the primary stimuli of
the repressed cravings. For example, an unmarried woman, who
had strong maternal cravings, derived great comfort and relaxa-

72 PSYCHOPATHOLOGY

tion throTigli creating babies in bronze, satisfying both the procrea-
tive and social cravings ; many impotent men try to build perpet-
ual motion machines.

One finds, npon analysis, that the artist creates his play, his
novel, poem or model to please his affective disposition, but this
artistic fantasy is using an image or substitute for the gross
reality. This is the mechanism of sublimation. Eeligion is man's
supreme method of sublimating the repressions of infancy and
childhood and gratifying the unfulfilled desires of maturity and
old age, through the use of sacred rituals and fancies without
which the autonomic apparatus would become depressed and
might even fall back to a lower primitive level.

A very common form of affective adjustment and sublimation
of ungratified love is devoting oneself to becoming proficient in a
field that is attractive to the love-object. This applies also to
hate, in becoming proficient in a field of work that is envied or
hated by the hate-object.

In the presentation of the cases, many data are included
to show how the unhappy men or women strove to attain certain
ends to protect themselves from unhappiness caused by physical
inferiorities and imgratified yearnings.

Whenever a sudden shift in the affective tensions occur in an
individual, say, when something reminds us of an unpleasant wish
or experience, certain symptoms of the quick, critical, subconscious
conflict always occur, and these the psychopathologist must regard
as symptoms of repression. By learning the motor symptoms
and the use of symbols, the physician becomes able to recognize
what affections are being repressed.

The symptoms may be divided into two general groups: (1)
motor incoordinations, and (2) unpleasant sensations, in turn, due
to motor tensions. (Wherever any of the following symptoms are
complained of, organic lesions must be ruled out first.)

The motor incoordinations occur in the form of slight, quick
changes in postural tensions, and the environment, which requires
exact postural tensions, shows the subtle change in the muscle ten-
sions by a great disturbance in the form of an error. For example,
the light postural grip of the hand may be deftly holding a delicate

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 73

structure when an affective repression is made. The sudden pos-
tural relaxation lets gravity pull the object from between the fin-
gers, and an accident results or reflexly, the next instant, the
fingers clutch desperately to prevent the fall and crush the object;
as a delicate bit of china. If the object is an open razor, the re-
adjustment of the fingers may come in the form of a gra]), even as
it is falling through the air.

The more common forms of motor symptoms to be met with
are tensions in the muscles of the scalp and base of the skull, or
"stiffness" of the extrinsic muscles of the eyes, due to a repressed
fear; sneezing, when not due to an actual irritant, is caused, it
seems, hj the contracting nasal muscles arousing itching sensa-
tions in the mucous membrane; biting the tongue, lips or cheek,
swallowing food or drink into the trachea; sudden loss of vocal
resonance ; coughing when not due to an irritant ; sudden nausea
or loss of appetite ; vertigo, or migraine ; cystic or rectal tenes-
mus ; stumbling or falling ; errors in mechanical adjustments ; er-
rors in speech or writing; forgetting of names of people or ob-
jects, places, dates; inability to recall and, often, losing or mis-
placing objects.

The more common unpleasant sensations complained of, that
indicate affective repressions, are the disagreeable sensations
aroused by any group of tense, striped or unstriped muscles, usu-
ally complained of as a "jerking pain," "gnawing pain," "burn-
ing pain," "tingling," "muscle spasm," "stiffness, or hardness of
the muscle ; ' ' inability to empty a viscus or to retain the usual quan-
tity for the habitual length of time; "heart burn," "tightness
around the chest, or throat," "inability to swallow," "choking
voice," "hoarseness," "stiffness of the tongue," vertigo, weak-
ness of the grip, or knees ; nausea, vomiting, diarrhea or constipa-
tion in anxiety (the nature of the peristalsis apparently depending
upon the nature of the compensatorj'' aggressive reaction to the
cause of fear) dysmenorrhea, amenorrhea, impotence, rapid pulse,
high blood-pressure, headaches, mental dullness, inability to work
or think, hypersensitiveness of a receptor field, or anesthesia of a
receptor field, an uncommon aversion for some definite color, ob-
ject, place, person, position of the body, work, event, food ; or an
eccentric fondness for some particular thing, event, posture or
form of thought.

74 PSYCHOPATHOLOGY

Conclusion

The behavior of .animals, children, most illiterate people, the
lower savages, and the mental defectives of lower grade may be
formulated as follows :

Primary Wish -j- Subsidiary Wishes X Resistance (environmental) ^Behavior-.*

But, in the more complicated civilized personality, where re-
pressions are necessarily retained, and in the psychoses, the form-
ula becomes complex.

Primary Wish + Subsidiary Wishes (manifest ego) 1 v, f> ■ 4.
Primary Wish -[- Subsidiary Wishes (repressed) j

(environmental) = Behavior.

As a personality develops and compensates for one disap-
pointment, and then meets with a second crisis and again compen-
sates or distorts itself, the complex affective makeup may be form-
ulated as :

Manifest Wishes

over
Later Eepressed Wishes

over
Adolescent Repressed Wishes

over
Preadolescent Eepressed Wishes

X' Resistance (environmental) = Behavior.

In the study of a personality, we can usually get a satisfactory
account of the behavior, such as the productions, many fancies, the
vocational pursuits, hobbies, religious and social affiliations, eco-
nomic resources, addictions, hallucinations, delusions, dreams,
methods of obtaining comfort, associates, ^tc.

Through inquiry from the relatives and the patient, we are
able to get, if great caution and persistence is used, a partly true
account of the resistance the individual had to overcome, both in
the form of the wishes and prejudices of other people (father,
mother, sister, brother, wife, husband', children, friend, employer,
etc.) as well as the material the wish had to work with — vocation,
disinterested husband, etc.

Given then the behavior and the resistance, we can infer, using
the diagnostician's method, from manifold indications, what the
wish or affective craving is that compels the pathological adjust-
ment. (We must assume, like all diagnosticians, that the patient
"has a heart.")

•In the above formula the sign x is used in the sense of opposed by.

PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 75

Given the wish and the behavior, we can infer the nature of
the resistance, as in the amorons wife, who hallucinates sexual
gratification, we know that her husband is indifferent, or, more
usually, heterosexually impotent.

When the nature of the ivish is ascertained, and the patient
himself recognizes and admits it as a part of his personality, the
psychosis changes proportionately into an anxiety neurosis, the
dissociation of the affective forces disappears through accepting
the socially inferior cravings as a part of the personality (Case
PD-33).

When this has been accomplished, the origin or the genesis of
the craving logically comes into the foreground. The analysis
leads regressively from the conditioning of one wish to the influ-
ence of an earlier Avish, and so on, back into adolescence and pre-
adolescence. This brings us to the psychology of the family which
will be covered in the next chapter.

CHAPTEE II

THE PSYCHOLOGY OF THE FAMILY

This study of the influence of members of the family upon the
affections of the individual is based upon the families that it be-
came necessary to study in order to enable the neurotic or psy-
chopathic member to attain a normal degree of independence so
that a healthy emotional life might be developed.

In the introductory chapter, wherein the physiological nature
of the emotions is presented, the mechanism was discussed by
which emotions or affective cravings become conditioned to need
certain environmental conditions. The influence of associates upon
an individual seems to be essentially the mechanism of condition-
ing his affective cravings through indifferent stimuli being asso-
ciated with primary stimuli until he also needs the formerly in-
different stimuli. The mother's voice, facial expression, color of
hair, odors, eyes, skin, the shape of her mouth and conformations
of teeth, her neck, bosom, arms and hands, touch and step, postural
tensions, irrita,bility and goodness, habits, ideals and eccentricities
are all stimuli that come to have a potent autonomic-affective in-
fluence upon the child through being frequently, simultcmeously
associated with the giving of nourishment, physical comfort and
relief from fatigue, loneliness and anxiety. This continues as an
almost incessant combination of stimuli, varying somewhat as the
mother's affections (love, anger, sorrow, shame, pride, jealousy)
determine her reactions to the infant. It persists throughout
the child's growth, and, somewhat intermingled with the condition-
ing'influence of other females, determines the value of different at-
tributes of the female to the child as a source of comfort or cause
of anxiety. Similarly, the father's physical attributes and emo-
tional traits determine the relative value of the various types of
males as comfort-giving or anxiety-producing stimuli.

It seems naive to urge that every person, friend or enemy, is
essentially a compound stimulus that varies more or less in its
gratifying or distressing influence upon an individual, but the

rfn

THE PSYCHOLOGY OF THE FAMILY 77

stupid resistance to psychoanalysis and the adjustments of repres-
sions make it necessary. The conditioning of fear, hate, love,
shame, sorrow, hunger, occurs without our conscious choice that
these affective-autonomic functions should or should not prefer to
have or to avoid certain objects, persons or situations. These
mechanisms may often be obscure, but in one respect they are
consistent. They are always determined by experiences.

There is no such thing as a definitely circumscribed experience
or one person having a fixed emotional value for another, because
the causal relations of events and the affective changes of people
are not fixed; hence the term experience is used to designate a
complex situation that has more or less graduallly assumed a
distinct affective influence or value for an individual. The psy-
chopathologist must, therefore, train himself to think of experi-
ences and personalities as complex influences which may be both
loved and hated at the same time. This is not generally recognized
and often leads to ridiculuous discussions because of the absurd
attitude: "flow can a patient hate his wife Avhen he shows that
he loves her I" The child or adult, when living in a relatively
consistent environment, as at home, in a village, in school, at work
or in an office, meets with an endless stream of complex experi-
ences, having, however, a common quality wliieh conditions tlie
affections, and, characteristically, these external and internal
forces mold the personality into the typical farmer, sailor, race-
horse man, schoolmaster, minister, lawyer. Naturally, tlie period
from infancy to adolescence is the most impressionable ; the child,
having little previous experience witli which to qualify the influ-
ence of its associates, is helpless to control the affective reactions
that others arouse in itself. In fact, the infant seems to be so con-
stituted that no socialized interests exist in its personality imtil
the compensations to prevent unpleasant social experiences begin
to develop them. The compensatory wish to remain pleasing to its
benefactors must eventually be developed and associated with any
perverse wish that might be aroused in order that its restricting
influence will regulate the influence of, the asocial, perverse wish.
For example, infants liave to be trained to control their segmental
cravings such as to eat or void promiscuously. Unless trained
through the infliience of clear-sighted, earnest parents, they are
likely to be perversely curious about anything pertaining to the
sexual or excretory functions, and this curiosity when repressed

78 PSYCHOPATHOLOGY

later becomes, during maturity, the determinant of asocial inter-
. ests, such as frigidity, peeping, lying, exhibitionism, etc.

The older children and adults exert an incessant pressure upon
the child to control its affective cravings and reward it with all
sorts of praise and tokens of esteem when it succeeds. On the
other hand, when it is indifferent to the general interests of its
group and selfishly yields to the pleasant influence of an auto-
nomic segment, such as stealing money or food for the gastric
cravings, or indulging in anal or masturbation pleasures, it is
severely punished and more or less ridiciiled and ostracized.
Through pain and the fear of arousing the disgust and dislike of
its associates a general autonomic compensatory striving is re-
flexly initiated, which, above all else, becomes devoted to control-
ing any autonomic segment that may tend to compel asocial be-
havior. This general, incessant, autonomic compensation becomes
essentially integrated into a unity to prevent any division from
jeopardizing the unity. This UNITY, having the capacity of re-
acting so as to lye conscious or aware of any segment's activities,
constitutes the ego, and learns to speak of itself, as "I," "me,"
"myself," "I am," "I wish," etc. Before this fimctional inte-
gration develops in the child it is regarded as "it," and only
gradually does it become a personality that is named. Even the
devoted mother instinctively speaks of her new-born infant as
"my child" or "the baby" or "it," and not until "it" begins to
talk does the tendency to apply its name begin in other personal-
ities. Naturally, the ego that masters itself most thoroughly and
is supported by its segmental cravings so that it can control the
environmental and social factors constitutes a potent factor in
society. In proportion as the segmental cravings are asocially
conditioned and uncontrollable we have social delinquents, crim-
inals, psychopaths, etc. The nature of the influence of associates
upon the ego also explains why people adjust differently to their
asocial cravings, as the homosexual and autoerotic.

A man of thirty-six, who had masturbated almost consist-
ently every third night for many years with no distressing feel-
ings of inferiority, although always very eccentric and effeminate,
began to grow progressively sensitive, irritable and paranoid," as
he tried to master himself and overcome his autoerotic inferiority.
His confessions emphasized the mechanism that the feeling of be-
ing an inferior developed in proportion as he strove to master him-

THE PSYCHOLOGY OF TPTE FAMILY 79

self. His adaptation became so seriously paranoid that lie had to
be advised to quit trying to readjust his affections, and, instead of
continuing to attack himself, he was urged to develop vigorous in-
terests in a hobby which might distract him from his sexual self-
love.

The most common factor that influences people to flock to-
gether into characteristic groups is the finding of associates who
will not become critics of each other's organic, functional, or seg-
mental inferiorities, and who also express some admiration for
whatever aggressive, efficient compensations one or the other might
make, whether criminal or not. Hence, when the compensatory
strivings are too eccentric and annoying, as a vocal mannerism in
an oral erotic, the individual's associates, through nagging, try to
force a change in his adjustment or force him out of the social
group as much as possible. The individual when not able to aban-
don the compensation, becatise of its value for the control of the
obsessive segmental craving, either becomes seelusive or goes
through an affective reformation, or a distortion that may even
require confinement in an institution. (See illustration of a man
with a spastic functional paralysis. Fig. 41.)

Many boys and girls suffer agony and despair from seductions
or pernicious asocial (autoerotic) habits simply because they can
not go to an adult, particularly the father or mother, and through
a confession, win assurances that they have not irretrievably dam-
aged their parent's esteem for them and may continue to feel
worthy of winning their love. Such secret shames and fears often
become the foundation of eccentric defenses and compensations,
such as deceitfulness, shyness, and seclusiveness. If the distress-
ing factor continues to be vigorous, as irrepressible masturbation,
the child may develop a very pathological trend of adjustment
which will, unless later corrected, become the foundation of a
wretched personality. (See Case AN-3, p. 251.)

It is highly important- for the psychopathologist to bear in
mind that vicious affective circles as well as benevolent affective
circles may be established between any two people or the members
tff a group of people, whether they are of the same family or not,
because we are usually misled by the evasive first story of the
family. A benevolent relationship in a group of individuals may

80 PSYCHOPATHOLOGY

become changed into a vicious one through some disturbing event,
as the death ' or marriage of one of the group.

An unhappy parent, conventional and miserable because of
his affective repressions, tends, insidiously, to make those about
him cause repressions of all affective interests that tend to arouse
the intolerable, repressed Avish in himself. In this manner, such
adults incessantly influence the defenseless child to make repres-
sions of the very affective functions whose freedom of expression
is absolutely essential to the development of a healthy, creative
personality.. In this manner also, the tendency to make psycho-
pathic repressions becomes a characteristic of a family, and may
be traced from the patient to the father's or mother's influence,
and, in turn, to grandparents, and so on, almost indefinitely. The
fact that psychopathic personalities are to be found among the
ancestors of a psychopath has been the flimsy ground upon which
the dogmatic thinkers in psychiatry have made the assumption
of "defective heredity," "hereditary taint," "constitutional in-
feriority," etc. This assumption, upon mature consideration, is
nothing less than amazing, and could hardly have been wilder or
more unproductive. That is to say, simply because two organ-
ically defective individuals beget mentally defective children it
can not safely be assumed that two organically normal but func-
tionally abnormal parents will beget functionally abnormal chil-
dren. The early school record of many children of such par-
ents indicates that they have excellent functional capacities, but
the personal influence of the aff-ectively distorted parents distorts
the affective requirements of the child, and this mechanism, plus
the insidious censorship of society, imposed upon those who have
insane relatives, may cause miserable maladjustments in post-
adolescence and maturity, particularly if other personal inferiori-
ties exist, such as autoeroticism.

A series of families is presented to show how the abnormal
affective adjustment in a parent influences a son and the son .in
turn influences the grandson; or how the unhappy grandparent
may persistently impose himself or h(?rself upon the grandchild
and ruin it. These relations are cultivated through innumerable
experiences, day after day, extending throughout the growth of
the child. I am convinced (this conviction is based upon profes-
sional experience) that no one can become a functional psycho-
path who is not greatly so influenced through the intentional or

THE PSYCHOLOGY OF THE FAMILY 81

unintentional attitude of his associates. The question as to the
moral responsibility for influenee is not to be considered by the
psychopathologist. It is far better, since it can only be a matter
of controversial estimation in each ease and has no biological
value, to leave the question of moral responsibility strictly alone,
as a matter for the judge and jury to decide.

The judge of a circuit court suffered from a severe suppres-
sion or anxiety neurosis, ^dth particularly persistent, distressing
gastric sensations, apparently due to peculiar gastric hypoten-
sions and a marked reduction of hydrochloric acid secretion. Be-
cause of these deficiencies, he had placed himself on a progress-
ively restricted diet until finally it consisted of milk. He had the
habit of massaging his stomach for relief after eating by gently
rubbing his hand over the pyloric region. This was frequently
continued until the gastric contents were regurgitated. A large,
darkly pigmented blotch over the epigastric area had developed
apparently from the persistent massaging. His general attitude
was that of covertly pleading for sympathy and attention. He
tallied almost incessantly to anyone who would listen about his
misery and goodness, incurability and expected death, in a way
which clearly indicated that he derived great relief, even pleasure,
from the manner in which he had adjiisted the secret cause of his
anxiety.

What proved to be the essential features of his life, which he
persisted in repeating to almost anyone, were that his father, who
had been an "impractical" man had been inclined to neglect the
family, and that he, even as early as six years of age, and his
mother, he being the oldest son, conducted the farm and raised the
family. It was quite evident that his father suffered from an un-
gratified affective need and tended to neglect his family while he
sought for the rainbow of his dreams. The unhappy wife, like all
such mothers when they are heterosexually conditioned and have
strong moral interests, turned to her son for what comfort and
relief from loneliness he could give her. This affective rapport
continued for years, that is, throughout the mother's life, and re-
sulted in the mother unwisely conditioning a fixed attachment for
her son, and the son for the mother. He became a successful law-
yer and judge, but did not marry until after forty. He made a
mother substitute out of his wife, and turned to her incessantly for

82 PSYCHOPATHOLOGY

sympatliy and petting. Like most cases of affective attachment
wMeli must be ungratified, he suffered from anxiety and gastric ir-
ritability.

After his mother died, the tendency to seek mothering from
his wife increased until he abandoned all other interests. Later,
when he became aware of the ruinous influence of his mother-
attachment and the depressing effect it was having on his children,
he made a determined effort to bring about a common sense ad-
justment. The fact that probably brought him to a full realization
of the seriousness of his mother-attachment was not so much the
autonomic distress as the danger of ruining his children by his
depressing manner of soliciting sympathy and his seductive, in-
sidious appeals for them to relieve his loneliness and suffering.*
The incident that made this decisively clear was the discussion of
the manner in which his eldest son had responded to him.

"While bemoaning his sad state of health, incurability and cer-
tainty of dying (following his recently dead mother), his son, an
adolescent, heroically promised not to forsake him. He said he
would lie on his father's grave, until he could join his father, be-
cause he could not bear the loneliness of being without him.

It is to be accepted that just as the lonely mother had de-
veloped a pathological attachment in her son, her son, although
now a judge who was chosen by his people for his common sense,
was, in turn, innocently cultivating an even more serious affective
attachment in his son. Such an attachment would surely make him
a passive homosexual. That is, by having been induced to sac-
rifice himself to please the unhappy father, he would become
morose from the craving to become his father's love-object. (See
Cases CD-I, CD-2. This type of attachment to the mother, when
it becomes uncontrollably incestuous, is illustrated by Von Stuck 's
Der Sphinx, Fig. 27.)

The unhappy, yearning adult, whose affective cravings have
been so conditioned in childhood as to cause a persistent longing to
return to that ancient state of rapport with his mother, even when
an old man, when permitted to associate with children, insidiously
cultivates the affections of some favorite child from whom he de-
rives a degree of comfort and sjonpathy. With this child, he is
more or less able to live over again his own childhood. This is
done, usually, without realizing its true influence on the child, who,

THE PSYCHOLOGY OF THE FAMILY 83

innocently, is induced to contribute its most sacred affections to
the welfare of the self -centered, senile adult. This -all occurs in-
nocently enough, but will result most disastrously, even if overt
sexual seductions do not occur.

The following case illustrates how the love affections, when
fixed upon an object in childhood, tend to force the individual,
when an adult, to remain conscious of the sensory images (mem-
ories) of the object upon which they are fixed. When the object
is unattainable, and the attachment too powerful to be modified by
the individual, the constantly recurring sensory images (as hal-
lucinations), if grewsome, may cause grave depression and anxiety.
Such intense fixations, in which the child becomes the innocent
slave of the transference, are usually cultivated in children by
adults who have strong yearnings to return to their own child-
hood. Children seem to be the most suitable objects to give them
comfort. Nearly all children, particularly if they are lonely, fall
easy victims to such adults.

Case AN-1. — ^A Eussian peasant girl, age thirty-seven, has
suffered since her childhood from depressing, horrifying, visual
and auditory images of her dead grandfather.

The influence of the pathological affective trend was easily
traced to the grandfather. He was a sad, lonely, religious old
man, who lived with his son, son's wife and his grandchildren on
a little farm in Russia. The son was irritable, selfish, domineer-
ing, and did not hesitate to beat his father, his wife and children.

During the patient's childhood, she says, her grandfather
cared for her "like a mother." Her mother was a tubercular
invalid. The father often starved the old man to punish him, and
the little girl stole bread from the family table to keep him from
suffering. Her love for her grandfather was stronger than the
fear of her father.

One day she found the old man's body hanging by the neck.
He had been dead for some time, and his livid, swollen face and
thick, black tongue made an indelible impression on the child.
She believed that her grandfather had taken his life because he
was sad. She had learned to recognize that he came to her for
sympathy and comfort when he felt neglected.

The child and her father washed and prepared the body for
burial. His discolored face ("black") she thought was, perhaps,
the devil's. She was seven when this experience occurred. After

84 PSYCHOPATHOLOGY

this she had a long series of night terrors with ghastly dreams.
She tried to protect herself by wearing a rosary about her neck
and praying herself to sleep. For a year she slept with her
niother to prevent being taken away by the ghastly grandfather
who would appear to her (hallucinatfed) as he looked when he
was prepared for burial. She believed that he actually eaime for
her becaiTse he was lonely. (This belief in the realness of the
vision is characteristic of savages, psychopaths, and normal peo-
ple during dreams.) A year after the grandfather's death, the
mother died following labor.

The patient could not go to school because her eyes became
"sore." The night terrors continued to occur several times a
week and during the day she was unable to forget the sadness
and longing of her grandfather. Probably, the rough, abusive
father, by depressing her, prevented her from turning, to him for
love. She derived some comfort from the petting of an aged
woman, but was unable to enjoy the company of young people.
Her menstruation began at eighteen, and, with its appearance,
she said, the night terrors tended to disappear. At twenty-two,
she had grown into a strong peasant girl and emigrated to Amer-
ica to work as a servant. The grandfather attachment, neverthe-
less, persisted more or less vigorously except for brief periods
when something occurred to make her happy. She still inter-
preted her visions as her grandfather actually visiting her in
spirit because he was longing to take her Avith him to relieve his
loneliness.

When thirty-seven years of age the patient became more de-
pressed than usual and was unable to sleep because of the feeling
that her grandfather was trying to strangle her. He reappeared
in the garb in which he was dressed for burial, and, to protect
herself, she again slept with the rosary around her neck. After
the terrifying dream, she usually prayed the remainder of the
night to prevent its return. Vomiting, dysmenorrhea and the
feelings of abdominal weakness added considerably to her dis-
tress. She broke up the heads of a box of matches in a cup of millv
and drank it, hoping that it would cause death. After she was
discharged from the hospital, she stole several sticks of dynamite
from a mine and carried them across the state line to her home.
She hoped to leave no traces of her death as her grandfather had

THE PSYCHOLOGY OF THE FAMILY 85

but was unable to explode the dynamite and her inquiries about
how it should be done led to the discovery of her plans and arrest.
Upon trial, she was sent to a federal prison for carrying dynamite
from one state to another.

During her stay in prison, she passed through two episodes
in which singing about going to heaven and terrors from the hal-
lucinations were prominent. Upon her admission to St. Eliza-
beths Hospital she was decidedly cowed, sad, depressed, felt
weak, cried, did not want to live and complained of being unable
to escape from her grandfather. The vision appeared constantly
and urged her to come with him.

She complained of dreaming about meat "all cut up," and of
two men bearing a dead woman away in a coffin. They were also
coming after her. She said that she did not want to die now, but
that when she became old she would destroy herself with fire so
that she would not leave a frightful vision of herself for some-
one else.

The autonotnic-ajf ective 7nechanism is the fixation of her love
upon the melancholy grandfather, ivho had been "like a mother"
to -the patient. This affective yearning reproduces the scene of
the grandfather's dead body. Her affections crave to have him,
but are unable to have him alive; hence, the affective craving re-
produces, in a sense, preserves, his existence in sensory images.
She claim^s that she looks very much like him. Site says she has his
facial lines and moles, etc. The affect seems to be eternally work-
ing ivith the dead man, trying, to resuscitate him..

She pleads that if she could rid herself of his depressing ap-
peals to her she could become happy because she enjoys working
and is strong enough to earn her livelihood.

The grandfather apparently Avas the only one besides her
sick mother and an old woman who had shoAvn her consistent
kindness and sympathy. The patient was assigned to work and
treated with especial care in order to make earning a living and
the value of friends attractive to her. The reaction was a gradual
but definite fading of the grandfather images or thoughts as the
transference to her physician developed. She said he had gone
away and now she was happy. Several weeks after the vision
had disappeared, the patient was unwisely treated. She became
depressed and her troubles returned (regression of the affect).
She escaped one night, wandered along the railroad, contemplat-

86 PSYCHOPATHOLOGY

ing suicide, but could not make up her mind. The next day she
was returned to the hospital in a tired, bedraggled condition. She
came into the ward sorry, crying and fearful that her physician
was going to "beat" her: This was a golden opportunity to win
an affective transference. A little reassurance that we were glad
to see her come back, a good dinner and rest in bed, won a splen-
did affective response from her. After this she took special pains
to see me when I made my morning rounds, and seemed to be de-
lighted when I stopped to talk to her. She'knew my Avish, from a
series of conferences, that the sad grandfather and the mean
father should lose their influence over her so that she could be-
come a happy woman and help us. She has now become inter-
ested in our ideals about working, being kind, saving money, being
happy, and helping everybody along. The sad, longing, tearful
facial expression has changed to one of happiness. She laughs,
heartily and works incessantly. She now has a paying position
in the domestic service of the hospital and regards it as the final
road to winning' happiness. She says that she is no longer both-
ered by the grandfather and has no interest in her father. She
is industrious and is developing into a reliable worker.

The prognosis depends upon the manner in which the trans-
ference is sustained by those who have charge over her. Should
she be treated meanly by a superior, a regression to the grand-
father attachment is expected to recur.*

It is generally recognized, although its mechanism and signif-
icance are not fully appreciated, that the father and mother, or the
adults who control the child in the development of its personality,
have a profound influence upon its affective requirements. But
what has not been recognized is that the adult unconsciously exerts
a decisive influence on the wishes of the child without the child hav-
ing the slightest comprehension of the existence of this influence..
Further, the adult unconsciously cultivates in the child attributes
that please his own wishes and tends to repress in the child the
spontaneous interests that irritate the affections which the adult
has himself repressed. In this manner, a psychopathic (homo-
sexual) teacher or parent may ruin a child's affective disposition
by insiduously repressing its most vigorous and constructive affec-
tive cravings, particularly heterosexual love.

*About slvi months after this was written, the patient again became depressed and unliappy
and eloped from the hospital.

THE PSYCHOLOGY OF THE FAMILY 87

The following extracts from the letter of a business man to
the physician in charge of his brother, who was in a serious
anxiety state (regression), shows how a mother's repressions
may cause her, in turn, to ruin her children and they, in turn, ruin
the grandchildren:

"Dear Sir:

"This is the second trip Gf has made to the hospital. I have taken

him there some years ago in a similar condition he is in now.

"I do not believe there is anyone that knows G 's condition better than I do,

being my brother. There were four children in father's family that lived to maturity,
four died in childhood. Father lived to a good old age of eighty years, and mother is
now living, having passed the 80th year. This would give the children a natural lon-
gevity, everything else being natural. Ov/r mother was a de-dowt Christian, always looked
upon conception or the act of conception as the great curse or cause of the human race's
downfall in Eden. Fo-ught marriage in the matter of her children amd advised all others
to steer dear of the pollution of marital union* Around our home fireside in youth, our
consciences were molded, and even to this day one brother 45 years old has never had
a sweetheart nor girl friend in his life. Both father and mother were powers in the
community in which they lived, but not of the leader sort, simply good citizens and re-
spected by all, living honest lives from without, but no doubt sinning in conscience all
the time if her doctrine be true.

"My sister, a beautifully sweet woman at maturity, withheld her marriage for a
number of years for mother 's consent, and finally married, mother simply not objecting,
but refused to attend the ceremony at our church. We children are all above the
average run in honesty, but lack a something that is essential in a human to fight the
world with. One would say ' ' lack of nerve, ' ' which would be right in one sense, but to
be more accurate, I would say, of a truth, we are all overconsoientious, so that what
would be passed over by a normal person, would prostrate one of us. My sister actually
lived the life of a Christian as near as her mind with God's help could guide her, but
she went down in despair and hellish torment when her daughter finally married (the
granddaughter) .

"Her daughter's marriage was excellent, and, though rough at the start, has
settled into a most contented condition now. The roughness was encountered iy Tier
not allowing her husiand to do family duty.

"She fought for her virtue, and, in several separations that occurred on this ac-
count, her mother's mind succumbed. (Sexual resistance in grandmother, mother and
daughter, through training; the conditioning influence of associates.)

"Fifteen years ago, for a period of five years, I, myself, made three trips to a
sanitarium, thought to be past hope of ever returning mentality. The cause of this I
frankly admit was from- being conscience-striclcen. A young girl, cousin to my wife,
crawled into my bed one night while wife was away from home. I quqte this truly.
She came to my bed and I also say I did not have a communication with her, but I do
say I really at the time enjoyed her company. But this could not be hid. Conscience
brewed till I was crazed to a point of confession direct to wife which she paid no at-
tention to, but to me a rip in the brain was made, and for five years I was outside of

*Italics inserted.

88 PSYCHOPATHOLOGY

God's love and care, suffering the pangs of hellish torment from nothing in the world
that would have made a normal brain even swerve to one side.

"Just this last week, the third brother, the one that never had a girl sweetheart,
entered into the same condition, dementia, or something akin to it.

' ' I returned three days ago from where I took him for rest and treatment. The
cause was most silly, from ordinary human standpoint, but to him it is as real as any-
thing can be. In a case where an inmate of a rooming house here had some girls which
she was using immorally, friction arose between them in the division of the spoils, and
the young girl preferred cha5:ge of white slavery against her housekeeper. Amongst a
number of witnesses, consisting of quite a few of our best young fellow citizens here,
bankers and lawyers, brother was summoned for the state. I thought it would kill the
boy, the shame and . disgrace he attached to the matter. He reported to the Federal
court and in the trial the woman openly acknowledged that it was her business, and she
was not ashamed of it and the act. None of the witnesses were called to testify.

' ' The states attorney, however, in examining his witnesses before the trial, aSked
if he had ever had anything to do with the girl. He said no, and his brain is now, so to
speak, broken in a conscience-stricken condition, awaiting the awful penalty of perjury,
which, like Poe's Raven, won't leave the door.

"G 's breakdown first was occasioned by his haying promised to marry an

officer's divorced wife. His courtship, we can imagine, was mingled with trespasses,
but, when I found him in her grasp at the time on a leave of absence, she had him,
body and soul. His confession to me was pathetic, I assure you. His promise was out,
but she was, he found, a pervert of the first water, and his nerve was gone. I simply

took him and entered him in the hospital at once ; and he remained there bound

to his promise, but knowing it was death to consummate the marriage. The woman

married an officer in thirty days from that time, and G went out of the institution

well."

The occasion of this letter was.G 's second anxiety and de-
pression, which was said to be dne to his wife 's approaching labor
and his work as an officer.

It is a general observation to be made, if looked for, with sur-
prising frequency, that, ivherever we have an individual, male or
female, who is^conscientiously absorbed in striving to suppress the
sexual functions from mahing him or her aivare of their condi-
tioned needs, lue have a neurotic individual as the result. This
type of neurotic sexual abstainer must be differentiated from the
healthy, happy sexual abstainer who is so keenly and vigorously
engrossed in creating the fulfillment of a wish, through profes-
sional or vocational pursuits, that the creative, reproductive func-
tions are fully satisfied through the substitution.

The above conscientious, wretchedly trained mother, who was
unable to enjoy sexual intercourse because of some repressive
tendency, almost destroyed her children and granddaughter
through the pernicious, insidious suppression of their sexual
forces. The patient G , now a fatherj has had two very seri-

THE PSYCHOLOGY OF THE FAMILY 89

ous depressions and is expected in turn, unconsciously, tlirough
his attitude, to influence his children so that their socialized
wishes will become ill adapted to meet the persistent demands of
the vigorous sex\ial cravings.

It Avill be seen, in the analysis of his life, that Darwin em-
phasized sexual selection as an important cause of variations
between individuals of the same species, because similarly
constituted males and females, struggling for the same habitat
and love-objects have the most persistent, and fiercest compe-
titions forcing the weaker to seek new objects.

The disguised competition between the males of the same fam-
ily, or the females, may be most serious, particularly if the mother
or father should be unhappily mated, and treat the child as an
obstacle, or substitute it for the mate. Many variations are possi-
ble in the father-mother or husband-wife adjustment.

The male or female child's affective cravings may become un-
knowingly conditioned by the persistent attitude of a parent,
grandparent, adult relative, brother or sister, or teacher, to re-
quire infantile, preadolescent, adolescent or post-adolescent forms
of attention from a particular person, that is, one having certain
affective and physical attributes. This depends upon the nature
of the influence and probably the child's level of development as
well as physiological condition when it has the experience of the
other person's influence. This conditioning capacity of the auto-
nomic cravings is as important for psychology and psychiatry
as the bacterial cause of disease is for medicine and science.

In Case HD-1, p. 617, the father, mother and older sister as-
siduously strove to keep the patient, a young woman, completely
dependent upon them. That is, they, with most amazing persist-
ence and selfishness, tried to keep her, the youngest child, a baby,
throughout her life. Hence, when she reached physical maturity,
she was utterly unable to compete with other males and females
for the means to gratify her cravings. Her most terrible enemies
were her father, mother and sister, who, despite my most vigorous
insistence, were unable to keep from imposing their wishes and
opinions upon her. With unerring fatality, she married the only
child of a beautiful, unhappy, neglected but self-reliant mother
who had made her son her hero and by cultivating a fixed affective
attachment in him she prevented him from being able to.love any-
one except his mother. He, in turn, horrified by incestuous.

90 PSYCHOPATHOLOGY

thoughts and dreams that developed at maturity, courted and
finally married this girl, physically and mentally almos.t the di-
rect opposite in type of his mother, '

This husband and wife, oppressed by the demands of the two
families, became incompatible, and the more infantile personality
collapsed. They were the offspring of highly intelligent people
whose heredity was apparently free from psychopathic traits and
"inherent taints."

The Crucifixion of Virility as a Wmlkj^^ Mechanism

The wise, severe, self-centered father and the religious, timid,,
obedient, mother tend to raise a son, particularly when they have
only one child, to have a profound mother-attachment from which
he becomes unable to free himself. He is completely subdued from
infancy by the father's power, and, held by the pitying mother's
love, is unable to assert his own masculine tendencies, because
they would claim the mother and compete with the father. Such
sons, despite the most desperate efforts, tend to remain miserable,
autoerotic personalities (Cases AN-3, PN-6, PD-35) or even be-
come sexually perverse because the self-sacrificial or erucificial
cravings take on the form of submissive oral eroticism for the fe-
male at first, but, usually, later, for the male (Case PD-33). When
the child's affections to be submissive are too insidiously cultivat-
ed by the mother for her own delight, since this begins at birth
mth nursing attentions and cleansing, the affections seem to over-
value the oral. and visual receptors (nursing), and olfactory and
anal receptors (tickling and cleansing). AVhen the affective crav-
ings become definitely developed in their requirements at matur-
ity, instead of converging upon muscular play and the external
organs of the pelvis and the tactile receptors there, it seems the
oral zone continues to be overvalued, producing an oral erotic
effeminate personality. (Other factors of invigoration are dis-
cussed in the chapter on "The Universal Struggle for Virility,
etc.")

This will be shomi (Cases CD-I, PD-35, PD-36, PN-6, PD-33,
and others), upon the study of the graver psychoses j to be the
fundamental determinant for the terrible fears and the dissocia-
tion of the personality in such individuals ; because the affective
cravings to win social esteem are so trained that they can not be-

THE PSYCHOLOGY OF THE FAMILY 91

come reconciled to the demands of the perverted sexiial cravings.
The repressed, perverted cravings, overcoming the resistance of
the ego, force the individual to become vividly aware of distorted
images of past experiences (hallucinations) and these sensory-
images, gratifying the craving, increase the patient's anxious
plight and fear of becoming a degenerate. The cases show that
the feeling that "poison" is in the food means that the food has
a sexual value which is probably conditioned by the affective value
of nursing in infancy, being overvalued by the affective rapport
with the mother and the mammary gland. The timid, submissive
mother's wish, that the son shall obey a domineering, jealous
father, is gratified by the homosexual submission, crucifixion or
sacrifice of his virile initiative for the sake of the potency of the
rival. Thereby, all competition, as a virile male, for the mother's
love, is renounced for the sake of her mate's potency, upon the
mother's timid influence (Case AN-3). The one avenue left to
retain the mother's demonstration of love is to regress to or remain
her dependent (nursling). The compensation for this trend, when
it becomes recognized as an inferiority, is extreme arrogance and
hatred of the parents and a feeling of being persecuted for inferi-
orities; or, if the environment is favorable, a career consecrated
to gratifying the inspirations of the mother despite the father's
resistance. (See Darwin's Life, p. 208.) The crucificial adjust-
ment to the parents is shown in Michelangelo 's Pieta, Fig. 54.

To return to the causes of variations in family adjustments
or matings and their influences on the offspring. The psychopath-
ologist must study the family as a biological problem. The osten-
sible practices of the family, that is, the "good manners," as-
sumed for the needful purpose of misleading the neighborly gos-
sips, are utterly worthless data upon which to estimate the true
character of the family situation. Experience with numerous
psychopaths and their families shows that it is almost impossible
for a member of a family to develop a psychoneurosis or functional
psychosis without the family or some member being involved di-
rectly or indirectly, consciously or unconsciously, as a repressive
influence that has combined with other causes of stress to bring
about the collapse.

The marriage obligates the male and female to depend upon
one another for such displays of affection as are necessary, in

92 PSYCHOPATHOLOGY

turn, to arouse vigorous autonomic functions in each, other. These
vigorous cravings are the forces that give the male and female
the power to enjoy creating the pleasant home and prosperous
business despite toil and worry. Wherever two people are un-
satisfactorily mated, that is, wherever one or the other, as a com-
pound stimulus, is not appropriate to arouse vigorous autonomic
affective cravings in the other, because these functions are condi-
tioned to react to quite different types of stimuli, the individuals
tend to become obsessed by compulsions that insist upon freedom
from restraint in order that the affections may attain their normal
requirements. Discontented, irritable and critical, a chronic per-
secution of the unsatisfactory mate develops until it is followed by
separation and divorce, or eccentric distortions and inefficiency
of the personalities.

In those cases where the immediate members of the two fam-
ilies or the religious convictions resist the divorce, a psychopathic
type of adjustment results, because the restless affect must be
repressed or diverted. Out of the dilemma, the natural wish spon-
taneously arises that the other might die or become sexually un-
faithful, which would then legally liberate the repressed craving
or tense aittonomie functions. When one or the other member of
this kind of marriage is stricken with a serious illness, both may be
horrified by becoming aware of the wish for death.

One occasionally 'sees such unfortunate individuals gro-
tesquely trying to conceal their pleasure at the prospect of free-
dom.

The unsuitable marriage, through forcing the affect to accept
that which it has aversions for, finally depresses the affective vigor
of the individual when it is accepted as an unchangeable obstacle
or resistance. Cynical people, including those who are married
as well as unmarried, are cynical because they have accepted the
world as containing nothing that can ever really gratify their love
cravings. Hence life becomes a bore, and spontaneous thought
drags along with only sufficient vigor to protect the honor, and the
nutritional and economic needs of the personality. For such indi-
viduals, the belief in a second life, Avhich is encouraged by religious
associates, is adopted to make life worth- living. This belief often
becomes the most important compensation of the individual and
almost a vital necessitv.

THE PSYCHOLOGY OF THE FAMILY 93

The married couple that is unable to give up the struggle to
attain happiness through becoming attached to a satisfactory love-
object, often decides that a child will give it the common bond
of interest for happiness. This plan too frequently fails when it
is hoped that the child will become a mutual inspiration. It fre-
quently happens that one or the other of the parents, depending
upon whether he or she is homosexually or heterosexually inclined,
will cultivate the affections of the child while the other tends to
persecute or neglect it. In this manner, an affective fixation will
be innocently, gradually developed in the child at the level that
pleases the affective needs of the parent who has turned to it for
love and comfort. For the other parent, the child becomes a bonds-
man, because its existence enslaves, through economic and social
obligations, the affect of this parent. The unwelcome child may or
may not become aware in the future that it is a hated obstacle but
it will surely come to feel like any other individual whose society
is not desired, that something is amiss. Uncomfortable, dissatis-
fied, irritable, lonely, neglected, and feeling inferior, it may never
find anything or any vocation to inspire it. (When influenced to
become resentful of this mistreatment he tends to become a rest-
less, wandering hero, criminal, or hobo, depending upon his cour-
age.)

A heterosexual male and a homosexual female, or the re-
verse, rarely make a comfortable marriage unless they have ade-
quate sublimations. Heterosexual males and females, or,
strangely enough, homosexual males and females, who have in-
sight and do not suppress one another, often make comfortable
marriages. Children born of mismated parents, who must live,
day after day, until maturity, under the influence of their conflicts
and ungratified yearnings, do not become conditioned to have the
well-defined interests in life that other children have whose par-
ents are so mated that they do not need the child's affective at-
tachment to satisfy old, selfish interests. When one of the mis-
mated couple resigns its wish to see the children fulfill certain
aspirations and tacitly favors the wish of the other parent, they
may be saved from developing a confusion of interests. This
seems to be the most common adjustment adopted by mismated
American families.

The fact that over 30,000 cases of so-called dementia precox,
that is, chronic regressions and dissociations of the personality,

94 PSYOHOPATHOLOGY

occur in the United States'^every year is suffieient to empiiasize ho^w
vitally necessary it is that the American family should become
organized or reconstituted on a more healthful, honest basis. The
vigorous movement for the enfranchisement of womanhood will
probably relieve one cause of adolescent fixations in the child,
because gradually the attitude will be developed of allowing the
well-conditioned affections frankly to dominate our behavior in
order that an honest source of gratification may be maintained,
if not through the husband's contribution, then through exercising;
the right to again choose freely. The succeeding mothers will
generally become progressively more resourceful and self-reliant
in their methods of attaining happiness. Out of this tendency,
however, a new, most serious difficulty is arising, if one may judge
from the actual dilemma of certain families, and that is a pro-
gressive tendency to cultivate interests which are homosexual.
This is due to the sexual resistance in the female, who, afraid of
becoming pregnant and jeopardizing her beauty and independ-
ence, refuses to take the risks of making herself the slave of a
child and becom'es frigid. She then exerts every artifice to castrate
psychically her mate (Cases PD-7 aaid PD-8).

It seems to be a strikingly consistent occurrence that when-
ever a male is unable to seek another female because of his moral
resistances, and his mate, holding him in this iron grip, discour-
ages his sexual advances through obstinate refusals, fear of pain,
or frigid disgust, he tends to lose his heterosexual potency and
often reverts to post-adolescent homosexual interests. This re-
version is irresistible and produces a family catastrophy because
the children are neglected as they become burdens when the paren-
tal affections diminish.

The principal factors that seem to influence the female to be
resistant are /ear of being dominated, the dangers of preg^^
nancy and labor, pain, inconvenience, drudgery and loss of physi-
cal beauty caused by pregnancy, and an aversion for using
contraceptives, besides the fixation upon infantile sexual substitu-
tions, as anal, oral and urethral eroticism.

When she is homosexual the sexual attentions of the male do
not give her pleasure and if aggressive may even be terrorizing
or disgusting to her. While her husband is engrossed in the eco-
nomic struggle with other men, this type of woman secretly in-

THE PSYCHOLOGY OF TIIE FAMILY 95

trigues with herself to practice a thoiTsand and one tricks by which
she can discourage his sexnal inclinations, even at the cost of his
vocational initiative. Following her secret dishonesty, she con-
stantly watches for indications of what his dissatisfied feelings
may prompt him to do in the matter of getting a new sexual ob-
ject. "With jealous petulance or the tears of invalidism, she holds
him in her remorseless grasp.

One of our patients (Case PD-7) has been fighting strong
cravings to become homo sexually submissive. He has persisted in
refusing to resume an interest in his wife. After several inter-

Fig. 7. — Maha-Kali, destroyer of men.

views with her, in which the usual stock of' lies had to be deci-
phered she finally told me the true stoiy. She maintaiiied that
Tier fear of having children and her husband's small salary made
her resistant. Her love for her physical beauty might be in-
cluded. Repeatedly, she had played with her husband until he
became sexually aroused and then refused him. He became
"hysterical," depressed and sullen and gradually passed into a
struggle against homosexual compulsions which finally caused
most distressing hallucinations of assault and delusions of being
seduced by men. Her efforts to win him back, following sincere
regret, have utterly failed to arouse any confidence in him. This
man, it must be included, had developed a weak heterosexual mar-

96 PSYCHOPATHOLOGY

gin before his marriage, but it became quite evident that his wife,
like Delilah, had deftly castra;ted him. Her sisters, both more
maternal in type, regarded her resistance as the cause of the man's
impotence.

Case PD-8. — An undersized, effeminate man, has been re-
turned to St. Elizabeths Hospital several times, with always the
same psychopathic condition — namely, a wild flight of fancies in
which he believes he exercises omnipotent powers. This is inti-
mately associated, as a compensation, with feelings of sexual in-
feriority, jealousy and convictions that his wife secretly loves
another man. The foundation for his belief in this is unshakably
based upon the fact that, although she is amorous, she refuses his
sexual advances. She has six children, and the family's income,
her husband having, had three prolonged psychoses, is too meager
to support another child. Although sexual perversions occurred as
a substitute, no solution was found. The wife now siims up the
tragedy with the conviction that they are "mismated." She said
her husband was sexually unattractive to her, but she could not
consent to his seeking another sexual object. The patient's sister,
who was present at this interview, suggested to the sister-in-law
that she should follow her adjustnient, which was to permit her
husband sexual freedom if he would consent to leave her alone.
She said the sexual act was disgusting to her. For the jealous
wife this solution was impossible.

The daughter of this man, a delicate, unhappy, brooding,
young girl, comes to visit her father with a motherly, solicitous
attitude. Her future seems destined to become a tragic psycho-
pathic struggle.

Another very serious influence in the American family, be-
cause it tends to abnormal sexual repression and distortion, hence,
prudish resistance to- really loving the mate, is the universal ten-
dency in the home, church and school to taboo any childhood in-
terest pertaining to sex. This tends on the one hand to develop
secret vulgarity and perverseness, and on the other, frigid prud-
ishness. This is gradually changing, but is still very far from
normal. It seems to be vitally necessary, for society frankly to
express its disgust for sexual perversions, but, constructively, it
must come to recognize the importance of admiration and ap-
proval, for the sake of the individual's health and happiness, of
a normal 'sexual life. The tendency to sexual castration or secret

THE PSYCHOLOGY OF THE FAMILY

autoeroticism and perverse substitutions can only he adjusted hy
aggrandising the maintenance of virility and removing fear of
normal sexual relations. Never entirely, however, will the race
be able to eUminate the traces of the phylogenetic influence of the
ape-man and his polymorphous perverse tendencies which crop
out in well-defined forms in the lower grade mental defectives and
in the preadolescent stages of childhood.

The two women who unsexed their mates, that is, through sub-
tle resistances forced a regression to adolescent homosexual meth-
ods of obtaining gratification in their husbands, are representative
of the pretty, amorous woman who loves herself more than she

Fig. 8. — The Egyptian god Phtha, adoring virginity "but masturbating and showing
oral^ eroticism. Egyptian Temple sculpture; from L'Egypte.

does her husband. She must protect herself because so soon as
she becomes affectionately demonstrative he becomes erotic and
this frightens her. When he becomes depressed and sullen and
homosexual she is safest. This type of woman is also to be con-
sidered with the opposite truly masculine type of female, who
has male features and voice, hypertrichosis, square shoulders and
smaU hips, and whose aggressiveness disposes to an uncomfort-
able tension unless she can dominate and fight for a social cause
under the pretext of liberating her sisters from the domination
of the "nasty man." She unconsciously, and often openly, com-
petes with the male for a female love-object, is a hater of virile
manhood and an "adorer" of "sweet men" and effeminate es-

98 PSYCHOPATHOLOGY

thetes. The latter, sexually inclined to seek the affections of virile
males, quite gladly substitute the protection of the aggressive
female. This type of woman is usually quite happy when mar-
ried to an effeminate, or passive male who graves to be dominated
and protected and they even raise children with little difficulty.
The virile female, who needs to dominate, can not live comfortably
with a virile male, neither caai the clinging, dependent female live
comfortably with a dependent male. G-radually, the true affective
needs will cause irritability and impatience with the imposed
love-object and the child, as the bondsman, must suffer perse-
cution.

Another relationship of affections to be met with in the family
is the virile, vulgar male and the unhappy, refined, invalided wife,
Avho, although heterosexua,!, can not love her offensive husband.
His attentions worry her and his intercourse causes pain. She
suffers, from headaches, dysmenorrhea, and abdominal distresses,
while he, vaguely aware of her general attitude, forces her into
the alternative of submitting or permitting him to seek a mis-
tress. When she is unable to endure the latter she suffers from
one sexual act to the next, not daring to become gay because he
will become sexually aroused. She usually has but one or two
children who gradually tend to support the appeals of the sufferer
and hate the aggressor.

One boy, who became an impotent, unaggressive male at ma-
turity, at twelve, violently and openly hated his father upon hear-
ing his mother's sufferings when she had to submit to sexual inter-
course. Such reactions on the part of the son often lead to a mor-
tal feud between father and son, and the mother, depending upon
whether she wishes her freedom or not, inclines to support the
son's aggressiveness or induces him to submit to the father in or-
der to have peace. The tendency of this type of father, if he has no
insight, is incessantly to force the son to give (spontaneously) evi-
dence of his submission in hesitant movements, aresonant tone of
voice, and errors of judgment which give the father the desired
opportunity to shoAv his potency, domination and wisdom by mak-
ing corrections. Out of this persistent submissiveness of the pos-
tural tensions of the body comes the inability to assume "responsi-
bility or maintain initiative. Sons of such fathers and mothers
become unable openly to contend for the love-object because the

THE PSYCHOLOGY OF THE FAMILY 99

mother has unconsciously betrayed the son's potential aggressive-
ness hy pleading that he shall submit to the rival^ (Case AN-3).
The mother wlio obtains a separation or divorce, l)y the act of re-
nouncing her interest in the father, greatly encourages the son to
feel that he is his mother's hero. He enthusiastically responds
with affection for her and prematurely seeks responsibility. This
affection, as he matures, if not effectively sublimated, will be likely
to express itself frankly, at first, in drc^aiiis and then in obsessive
cravings, in the form of sexual interests in the mother (Cases
PN-6, AN-3, and MD-6).

When this mother, however, marries again or becomes eco-
nomically independent, which means to the son that she still loves
.someone more, he tends to become a psychopath (Case MD-6) if
he is unable to find another love-object that inspires him to work
and struggle. Under such conditions he is actually functionally
inferior to other competing young men. Feeling. that all hope of
finding love is lost, he is forced liy the ungratified affect to waste
time and energy in reminiscent brooding, hence, ineffieient work.

When the mother's second marriage is also unhappy, the son
may become a bitter feudist if his mother tends in the least to
depend upon him for protection and sympathy. If she can not
quite go this far he leaves home as a wretched wandering hero or
runaway boy (in the reverse family situation the girl wanders)
and often enlists in the army or navy to fight.

The presence of the second and third son, or son and daugh-
ter, or several sons and daughters, greatly complicates the situa-
tion in a poorly balanced marriage, but by diffusing the attentions
of the parents and the child the latter is often saved. Competition
for affection may occur between the children of any intellectual
level, including twins as well. The favorite son of the virile fa-
ther becomes virile largely through the influence of the father
mshing him to propagate his name and family honor. Whereas,
the attached son of the dutiful, suffering mother becomes ef-
feminate because he is not allowed to make virile, competitive self-
assertions. When he does attempt it the affect struggles so fla-
grantly for the, mother's love that it competes with the father and
is instinctively attacked, or unjustifiable incestuousness comes into
the foreground. Often, however, religion, art, music, or science,
as the means of sublimation and contention, obscures the nature of

100

PSYOHOPATHOLOGY

THE PSYCHOLOGY OF THE FAMILY 101

the mother attachment sufficiently to make it acceptable to society.
Nature, however, can not always remain satisfied with the love
song to the subconsciously enshrined mother. Incestuous dreams,
indicating the trend of the affect, cause depression and anxiety.
The ministry is often adopted to refine the mother attachment,
and earnest prayers succeed frequently in sublimating the mother
love. This solution is more lUcely to occur when the mother, not
satisfied with her husband, because of her own childhood attach-
ment to her father, converts her son into a minister — thereby re-
storing the image of the holy father. Vigorous girls, having
strong affections for their fathers, often marry elderly men and
may or may not be persecuted by the vague awareness of their
incestuous feelings. When incestuousness frightens a woman, and
she reflexly tends to distort her affective interests in her family
in order to escape, her husband becomes dissatisfied, because she
can not hfelp but neglect him.

In one family, composed of a well-educated young man and
woman, the htisband became seriously depressed for a year fol-
lowing the birth of a son. The wife was frankly disappointed in
her husband's lack of manly self-assertiveness. He had been some-
what depressed by the dominations of an employer, and still ear-
lier, by his family's resistance to the marriage, biit when his wife

Fig. 9. — Java Temple and Legend. (Published by permission of Asia Publishing Co.)

The Java temple (Buddhist) serves as the setting for the three stone statues in
the dim half -ruined interior. The middle and larger one is remarkable for its posi-
tion. Buddha is usually represented in a kneeling or sitting posture; this image is
seated on a stool with both hands held as if in prayer. There is a popular legend
to the effect that the middle statue is Prinee Dewa Kosoumi, and the smaller statues,
his wife and daughter.

Onee in the fabled past there dwelt a great prinee, Dewa. His illustrious reign
was bright and unclouded until the pearl of his heart, his two-year-old daughter,
was stolen by a revengeful courtier., Everywhere he searched, but he could n'ot find
her. His sorrow, like all sorrows, was assuaged by time. At the end of twelve years
he fell in love with a very beautiful girl and married her and a child was born to
them. The villainous courtier now appeared and told Prince Dewa thathis wife was
no other than his kidnapped daughter. The prinee was horrified and wished to atone
for his unconscious sin. A holy man was consulted. He said that the sin would be
forgiven only on condition that the prince would construct a temple at Boro Budor in
ten days. All the artists and workmen in the country came and worked with fren-
zied enthusiasm to save their king. The great temple, with its galleries and hun-
dreds of images, was completed within ten days. But alas! One image was missing.
The gods in anger turned the prince and his wife and daughter to stone.
* The legend of this attachment of father for daughter has its counterpart _in von

Stuck 's painting of '/Der Sphinx" (See Fig. 27), showing the attachment of mother
for son. The Oedipus tragedy of Sophocles portrays the attachment of son for mother
and hatred of father, whereas the crucifixion (La Pieta) shows the attachment of
son for mother and his submission to the father.

102 PSYCHOPATHOLOGY

neglected him in her devotion to the infant son, he regressed into
a helpless, suicidal attitude. A serious affective conflict developed
between the two. Unfortunately, this became further aggravated
by the wife's mother supporting her daughter rather tactlessly,
both being disappointed because the husband was unable to wel-
come his infant son. The husband and wife were both sincere and
quickly effected a wholesome readjustment upon the development
of insight through a psychoanalytic study of the situation. The
father readjusted and became fond of his infant son, making a
fine beneficent transference to him, and returned to work with
enthusiasm and efficiency.

The foundation of the Oedipus or Electra complex, as the
psychopathologis.t meets it in his practice, may be shown to rest in
one or the other of the parents. The parent that cultivates the
affections of the child conditions it so as to please his own affective
cravings. He is often devoted to the welfare of one child and
heedless of the future of the other (Case HD-lj. This occurs be-
cause most parents have absolutely no insight into the affective
mechanisms that develop the personality, either in themselves or
the child. Parental influence becomes particularly vicious and dif-
ficult to reconstruct wherever the parents have succeeded in dis-
guising and justifying their secret pleasure with pretext and sub-
terfuge. No matter how flimsy this may be, they adhere to it most
tenaciously when it hides pride, envy, jealousy, sloth, gluttony
or dishonesty.

Case CD-2, p. 572, shows how a vigorous, affectionate girl, who
had a strong father attachment, married a divorced, middle-aged
man, an obvious father substitute, despite the objections of her
family. The marriage was a disaster and after two daughters,
had reached adolescence, a divorce was procured. This sincere,
well-intentioned mother, struggling against her sexual needs, suc-
ceeded in belittling the male as an attractive object for herself.
But, more seriously, in order that her daughters should not be
self-willed and make impulsive marriages, which she always felt
she would not have made had her father frankly objected, she as-
siduously cultivated an absolute dependence upon her advice in
both of her daughters. The oldest dau.ghter married a man who
was pleasing to her mother largely because the mother be-
lieved she could influence him. This later became unsatisfactory

THE PSYCHOLOGY OF THE FAMILY 103

because the husband began to feel the necessity of being inde-
pendent of the mother-in-law and urged his wife to assert herself
in order that she might develop the ' ' attitude of a woman. ' ' De-
spite the mother's disappointment they established themselves in a
neat secluded home which was relatively inaccessible to her sugges-
tions. Upon the daughter's third labor, because no maid could be
obtained in the emergency, the mother had to take charge of the
house. • She simply could not refrain from resuming her old dom-
ination of the family. Her daughter repressed her anger upon
her husband's influence and submitted to the mother. During
the convalescence, following a sudden conflict with her mother,
she passed into a psychosis in which she became crucified as a
hermaphroditic Christ — becoming both male and female in that
she believed she was masculine sometimes and feminine at others.
Follomng the patient's recovery this family situation was fairly
well readjusted after repeated conferences with the wife, husband
and mother.

An infantile mother, suffering neglect and yearning for a pro-
tector, may influence her daughter, if the only child, to develop
masculine traits of personality, and wlien she matures slie contin-
ues to be aggressive but homosexual. Because of her conditioned
affective cravings she in turn can only be happy when she is the
dominating member of the family. She becomes a type of per-
sonality that is unable to understand her husband if he does not
become submissive. Another type of woman unconsciously cul-
tivates submissi^'e tendencies in her son or daughter and tends
to dislike their virile affective compulsions when they begin to
show.. She excuses her selfishness with the feeling that she must
keep her child out of dirt and mischief and make it obey. She
makes "a girl" out of her son by keeping him unduly long in
dresses, keeps his hair long and curly, and adds an "ie" to his
name: as Frankie, Willie, or gives the boy a name that may have
an effeminate sound, as in Case PD-35. The mother of this pa-
tient did not love her husband and tried to develop effeminate
traits in her son, naming him "Lawrence," keeping him dressed
like a girl, hair long and curled and manners gentle and shy. Such
men tend to marry aggressive elderly, "manly" Avomen if some
influence does not give them insight and cause them to strive to
overcome the submissive affective trend. If they have some in-

104 PSYCHOPATHOLOGY

sight, they turn heaven and earth to win their manhood and hate
to the killing point the unwise mother.

The homosexual father, who is "not averse to his homosexual-
ity, tends unconsciously to cultivate such reciprocal homosexual
traits in his son as please him most. The father who is afraid of
his homosexuality and strives to compensate by developing all the
masculine traits possible, hates the parent whose influence he be-
lieves made him homosexual, hates the dissatisfied wife who, he
feels, must surely be disappointed in him, and suppresses his son's
spontaneous virile expressions because they emphasize his own in-
feriorities and influence him to resume his old submissiveness.

Frequently, a debilitating disease, such as infantile paralysis
(Case PN-6), justifies the temptation of the mother "to raise her
boy like a girl. ' ' Her tears and sympathy destroy his aggressive-
ness and self-reliance and he becomes so conditioned (pettish) as
to be unable to compete with men honestly. He either resorts to
trickery or depends upon soliciting pity.

A flirtatious father or mother may keep a family of children
in an incessant turmoil, and, wherever one suffers anxiety or jeal-
ousy because of the illegitimate fancies of the other, the children
are drawn into the miserable situation, and its effects upon their
school record can be easily seen. When a child, having an average
capacity to learn, begins to fail and no physical lesion exists, either
a sexual trauma is disturhing the thoughts of the child or a serious
affective conflict is raging between the father and mother. When
parents arrive at the admission that the only thing that prevents a
divorce or separation is the welfare of the child, the child, having
subconsciously for the parents, the value of being an imprisoner of
their affections, soon begins to feel that it is unwelcome. Parents
usually deny such feelings, but the psychopathologist, by compar-
ing the attitude of parents who are genuinely happy with their
children, with the manner in which irritable mismated parents
censure and "pick on" their children, can rest assured that the
child is being slowly, insidiously ruined, because it is the bond that
represses vital yearnings. Most of our chronic lawbreakers and
asocial adults, thieves, pimps and prostitutes, whether mental
defectives or not, are chronically asocial in their tendencies be-
cause of the pernicious influence of mismated parents or the hatred
of the adults, who raised them. It is far better for the child to be

THE PSYCHOLOGY OF THE FAMILY 105

raised under the consistent influence of one parent than to be dis-
torted in its emotional reactions by two people having conflicting
tendencies. It is not amazing that the affective needs of an
unsophisticated child should be mined by the conflicting wishes
of parents, siiice highly trained adults become confused and ineffi-
cient when their employers become incompatible and demand con-
flicting kinds of work.

The study of the sexual and social behavior of infrahuman
jy-imates shows that the male and female young, as they mature,
tend to compete with the adult males and females, including their
parents, for each other's affections. Similarly, a son of the genus
Homo will naturally compete mth his father for the affective fa-
vors of the mother, and the mother -and daughter compete for the
father's favors without being aware of its significance. The sex
regulative laws of society indicate that somewhere in the evolution
of the higher primitive man, the older males, as their physical
powers weakened, were forced to protect themselves from the in-
cestuous cravings of their more vigorous maturing offspring, for
two purposes, personal safety and control of influence in the fam-
ily alliances (as the subordination of son-in-law or daughter-
in-law) .

The resistance of the parents, forcing the young to withhold
the fulfillment of their childhood wishes, influences them to create
substitutes which are necessarily more or less beneficial to society.
These productions often constitute art, science, invention, etc.
(See Freud's Analysis of Leonardo da Vinci. Also the origin of
Darwin's inspiration, Chapter VI, and tlie perpetual motion ma-
chine of Case P-1.) Within the historic age a. growing social cen-
sorship has developed which has its formulation in the laws of the
church and state, as well as in the attitude of the family, whereby
the sexual cravings of the offspring are forced to seek a satisfac-
tory love-object outside of the family, and the youth, in turn,
jealous of his rights, insists that the parent shall not transgress
beyond the family.

The social resistance has increased since the ancient conflict
between father and son for the mother, or between two sisters
for the husband of one, or two brothers for the wife of one, or
two sons for a mother. The adult female as well as the child was
regarded by some peoples as having no rights or soul and was

106 PSYCHOPATHOLOGY

bartered by the strong. Violation of her was not a crime. Now
society maintains laws to discourage intrafamilial intrigue. This
is a frank recogniti-on that within each civilized male and female
there may possibly become active cravings that care for the sexual
object without regard for any social implications. Therefore, in
some states, it is specifically prohibited by law for a man to marry
his grandmother, grandfather's wife, wife's grandmother, fa-
ther's sister or mother's sister, mother, step-sister, A\T.fe's mother,
wife's daughter, grandson's wife, wife's son's daughter, wife's
daughter's daughter, brother's daughter or sister's daughter.

ThroiTgh forcing the affective cravings to go outside of the
family in order to exercise sexual selection, society has been enor-
mously enriched by the intermarriage of families and the contri-
b\itions for esteem made by the individual competitors. The in-
dividuals must demonstrate their initiative, charm and potency
by their creations in order to win the affections that are generally
bestowed upon the fittest. Hence, each individual's method,
through profiting by the experiences of others, tends to become
more and more efficient and intricate, and the creations that best
suit the affective needs are retained while the others tend to be
discarded.

Wherever parents are happily mated the influence of one upon '
the other arouses strong cravings to iimnortalize and perpetuate
the comfortable affective relationship by extending it through the
offspring. Hence, their consistent attitude, creating a distinct at-
mosphere in the home, unconsciously arouses and conditions
strong, consistent wishes in the child which determine its behavior
later, as an adult, if it finds that its methods bring it happiness
and esteem from its social group. If the family methods are "old
fashioned," or the religion is "unreasonable," the youth may suf-
fer and revolt. The parents who are really dissatisfied but "kejBp
up appearances" must have a confusing influence upon their chil-
dren because the affections, disguised behind the effort to keep up
"appearances," subtly influence the child so that its capacity to
socialize its affections becomes confused.

The heterosexually conditioned father or mother, who is not
satisfied by the mate and cultivates the love of one of the childrqji,
may develop vague, incestuous fantasies for this daughter or son.
This will surely arouse, reciprocally, a vigorous incestuous crav-
ing in the child. This incestuous craving in the daughter, when it

THE PSYCHOLOGY OF THE FAMILY

107

is not Avell sublimated in Avomanhood maj^ become satisfied in the
psychosis by the fantasy of being a heavenly hride and the prosti-
tuted sexual object of the onmipotent fatlier. This often l^ecomes
extended to include all men as omnipotent man (Case HD-l).
This mechanism also indicates the genetic origin of the chronic

Fig. 10. — Costa Eican prehistoric ceremonial statue of erect pliallus as a God to
popularize reproduction. (Permission of the National Museum, Washington, D. C.)

wish to be a prostitute. Prostitutes have a favorite song in which
they delight in calling their patrons "daddy," and also refer to
the penis as "daddy," a form of phallic worship. One patient
fancied the penis as a god "that stood up like a little man and

108 PSYCHOPATHOLOGY

wore a crown." See the erect Costa Eiean phallus as a sufEering
god. Fig. 10. Prostitutes often delight in being held as helpless
sexual slaves by some man who uses their money; also a very com-
mon fantasy in the erotic psychoses. Many of them are not only
seduced in fancy by a relative, as they cohabit with men who re-

Fig. 11. — "Pygmalion and Galatea," by Eodin. A subtly disguised form of
phallio worsliip which has tremendous influence in popularizing and refining the sex-
ual interests, thereby insuring the race against autoeroticism, prudishness, prostitu-
tion, perverseness, and suicide.

mind them strongly of their fathers, uncles, or brothers, but vice
investigations have shown that many prostitutes have actually
been seduced by their fathers, uncles or brothers. It also is to be
considered that the lower the mental capacity of the female, as the

THE PSYCHOLOGY OP THE FAMILY 109

imbecile, the less she is able to sublimate her attachment to the
male that clothed and fed her during the preadolescent stages if
she has not been carefully trained to make a religions conversion.
Some women have strong sexual feelings for their sons which
they are not quite able to disguise. This may be seen in the man-
ner in which they show their affections and coyly display them-
selves to their sons more or less undressed, find excuses to travel
and sleep with them, but avoid their own husbands (Case PD-36).
(xradually, a vigorous incestuous craving is developed by this play.
By an adolescent boy these privileges may be enjoyed until the
disgust of others opens his eyes to the significance of his secret
behavior and wish. Suddenly, the mother finds he has developed
an "unreasonable" impatience and hatred for her (Case PD-35).
Other boys, who have been similarly raised, may not becorde in-
fluenced to repress the incestuous craving, but use it during adoles-
cence for the masturbation fancy and later promiscuously patron-
ize houses of prostitution, seeking one type of girl, then another,
to fulfill the fancy (Case PN-6). The obese matron of the house
of prostitution is commonly addressed as "mother," and the fam-
ily circle is completed by the girl's calling the lonely boy "daddy,"
"popper," etc. The opposite solution of the incestuous attach-
ment is to be found in the hyper-conscientious neurotic and re-
ligious fanatic who strives to get everything free from sexual crav-
ings because his incestuous tendencies, dreams, etc., horrify him.
The father or mother, who has such ascetic tendencies, tends to
ruin the child by training it to feel that his sexual functions are
degrading.

It seems that parents who have incestuous interests in their
own parents, when not afraid of themselves, are inclined to have
incestuous affections for their o\Ya children. The parents who are
happily mated, having satisfactorily adjusted their preadolescent
attachments to their own parents, seem, also, by their example and
general attitude, definitely to condition their children to have
strong, well-defined affective tendencies to sublimate and mate
T/ell. Such children seem to know quite clearly what they love
most and what they can not like, and, if the children are not im-
posed upon by some domineering, well-intentioned adult, as a
homosexual or prudish teacher or relative, or are not exposed to

110 PSYCHOPATHOLOGY

pernicious companions, thoy become vigorons, ethical, constructive
membfers of sobiety.

A well-conditioned fatlier or mother, upon the death of the
mate, because of loneliness, may unconsciously cultivate the af-
fections of a daughter or son with such insidious eagerness that
the youth willingly becomes the love-object. As it matures, it
finds all its constructive dreams are centered upon ultimately giv-
ing this parent happiness. Youth often becomes blindly conse-
crated to the selfish invalid or aged parent and when the parent
dies, this son or daughter faces loneliness and anxiety with little
chance to find a love-object. If this person then seeks for sympa-
thy too persistently from a relative or neighbor, he becomes a
burden. Our asylums contain many unmarried women who be-
came incapacitated after the death of a dependent parent (Case
MD-2), as well as the more common types who give up upon losing
a fostering parent.

Some of the most serious feuds between individuals for honor,
esteem and favor occur between sons or daughters. Avoidance of
this depends entirely upon the insight of the parents into the strug-.
gles between their children to become the favorite child and the
tactful manner in which they convince each child, not only by what
they say and do, but also by the manner in which they uncon-
sciously act, that they have no favorites. The psychopathologist
must bear in mind that it will usually be claimed by a parent that
all the children are treated alike, but as an actual psychological
fact no parent is ever able to consistently treat any two children
alike, because the children themselves are not inclined to act alike,
do not have identical attitudes or social positions and do not re-
quire the same attentions under the same conditions, nor while the
parent is in the same mood. Variations iji the attitude of parents
to children. usually have a trivial beginning, such as an injury or
illness, a triumph in school, an aptitude, a physical attribute, par-
ticularly a feature, such as the eyes, hair, voice, figure, etc. One
child may result from an accidental impregnation whereas the
other was sought.

Charles Darwin derived his inspiration to study biology and
the secrets of nature from -his mother. She was, in turn, greatly
influenced by her father-in-laAv. Her grandson, Francis Darwin,
also became a biologist. Charles Darwin, in his old age, was

THE PSYCHOLOGY OF THE FAMILY 111

pleased to think that he became his father's favorite child. Most
parents are imable to avoid iiu consciously showing favoritism,
and some of the children reflexly become inspired to strive for this
favor while those in a disadvantageous position brood or become
jealous and regard themselves as relatively inferior and unwel-
come. The favored and censured children vary enormously in
their working and learning capacity, and their affective interests.
The feud of Cain and Abel is the classical fantasy of this rivalry.
We often see children suffering from fear that a brother or sister
or parent will die, be killed or kidnapped because of the uncon-
scious wish to get rid of the rival.

As a general rule, either the first, second or last child, provid-
ing none of the series of children happen to be born at an unwel-
come period or as the result of an unwelcome pregnancy, becomes
the favorite child during its infancy. The last child, like the only
child, may be seriously spoiled by the indulgent yielding of the
parents to his wishes, or may be seduced into remaining a "baby"
by the persistent " babj^f ying, " petting and general attitude of the
father or mother, brothers and sisters. An affective conditioning
results, which may seriously incapacitate the compensatory pow-
ers and social ingenuity of the babyfied or "spoiled" child.

The oldest child of happily mated parents enjoj''s a year or
two of perfect living wherein the father and mother constantly
seek for its favors. It becomes a monarch in which every wish is
satisfied, then, suddenly, its little kingdom is intruded upon by the
birth of the next child who usurps the mother's most tender sym-
pathy and her breast. Angry and jealous, it becomes irritable,
hates the baby, and fights to siibdue its parents. This is impossi-
ble and the punished child becomes a wanderer among the neigh-
bors. It may even try to injure the infant by gouging out its eyes.
If it becomes independent, the child compensa'tes for the disap-
pointment of the lost attentions, and learns through experience
that bright thoughts, funny remarks and ingenious playthings win
praise from the parents. With the advantages of a year or two
it finally outrivals the younger child and tends to keep it subdued
by beating it in games, in school, confiscating its playthings,
thoughts, creations, etc. This continues in the school and college,
and shows in the eagerness with which one child strives to beat
the record of the other.

112 PSYCHOPATHOLOGY

Parents and -teachers, who indiscreetly hold np '* first" and
"best" and "prettiest" as incentives to greater effort in children,
most cruelly subject the defeated children, of which there are-,
manyior the one triumph, to a most depressing, humiliating pres-
sure, which gradually forces them to atoid competition and sub-
mit to the superiority of the favorite. The immunizing attitude of
indifference or insincerity is finally adopted by the weaker chil-
dren. The conquering or potent child becomes independent and
aggressive, but, unfortunately, learns, with great difficulty, later
in life, to assume second place, or a subordinated position when
necessary. Its competitive, selfish spirit may cause it to become
unpopular, particularly, if badly trained and lacking in courtesy,
as in Case PD-35.

The second child may be so consistently discouraged by the
conquests of its stronger, bigger, older, brighter brother or sister
that it remains "mamma's baby." When, however, it reaches
adolescence, infantilism is not admired and it must abandon the
old attachment and behavior. It now becomes fearful and jealous
of the admiration that the rapid advance of the older child is
winning from the parents, and, with a little encouragement, enters
upon an intense struggle to beat the school record of the older
brother (Case HD-14). Illness, a combination of depressing fac-
tors, such as the loss of a postadolescent love-object, the feeling
of inferiority from the persecuting memories of an adolescent
sexual trauma or autoeroticism, the death of the mother, failure
in several courses of study, etc., may finally cause a serious de-
pression and feeling of hopelessness, with regression to an infan-
tile level and fanciful, hallucinatory compensations which are
treated as realities.

The same tragedy may result when a son tries to beat an. il-
lustrious father, or a daughter tries to outshine her accomplished
mother or older sister, in order to stand "first" in some particular
person's esteem (Cases PD-35, PN-6, MD-6).

The study of the pathological manner in which parents and
children disguise their hatred and love, shows how often the se-
lection of associates, religious interests, family routine, clothing,
favorite studies, vocations, costumes, household furnishings and
the thousand and one things that make up the "atmosphere of
the home" are determined by the suppressed affective craving,

THE PSYCHOLOGY OF THE FAMILY 113

using the qualities of the material as a vehicle for obtaining a
gratifying advantage. The tactless, domineering father or
mother, who can not direct the child to suit his or her wishes, and
sends the child to a Bible class, using the threats of hell in the
name of God to s\ibdue the child into obedience, has usually not the
slightest regard for its initiative or natural tendency to diverge
from the parent. The tragic careers of various members of a fam-
ily are often the climax of the life-long intrafamilial feud.

If it were feasible upon the declaration of a war actually to
send all men over fifty to battle first, there would be no chance
of declaring an international war. If the senile and arterio-
sclerotic males had to accept a pension and retirement from the
younger males and females when a certain statiTS of physiological
deterioration developed, there would be no need for the younger
people to struggle against the legal devices of economic oppression
in the control of the arteriosclerotic males. Then no socialistic
revolutions would be necessary. The arteriosclerotic, decadent
malcj feeling his loss of potency, compensates with those forms of
thought and unmodified convictions which are successful in keep-
ing the maturing males subdued. Their policies force the youths
to oppose one another and kill each other off in the, name of glory
for the fatherland. The general staff of the German army was
composed of men over sixty. New social or scientific innovations
are readily adopted by the growing generation while traditions
and precedents are sanctified by the arteriosclerotic.

Whenever an adult forces a child to do something or learn
something against its wishes, without justifying his demand by in-
ducing the child to wish to act, other than as a compensation for
fear, the adult, whether a sincere, devoted parent or not, dulls the
child's initiative and curiosity. Eepeated experiences of this sort
subdue the youth's aggressiveness, and opportunity is lost to his
competitor, who, although he may have less inherent capacity, wins
because he is better trained.

If the corrective infliience of our religious and social organi-
zations did not exist, it is quite probable that society would dete-
riorate into a trial and error method of seeking a satisfactory sex-
ual life. This is the secret method used by people at present, con-
sidering their illegitimate sexual practices, and is an acknowledged
cause of fear for the future of society by advocates of religious
sublimation. As in all ponderous social problems, the solution

114

PSYCHOPATHOLOGY

Fig. 12. — "The Courtesan," by Eodin. (By permission of the Metropolitan
Museum of Art, New York.) Showing anguish and regret at sexual waste. Com-
pare with "The Martyr" by Eodin, Fig. 13.

THE PSYCHOLOGY OF- THE- FAMILY 115

must come through the general ch^velopment of insight by the in-
dividuals of a series of generations. The invariable results of
promiscuous affective indulgence, -weakening the development of
the personality upon the one hand, and the rigorous imposition
of an unsatisfactory mating or sexual abstinence, retarding the
growth of the personality on the other, constitute the two great
parallel dangers that most healthy individuals must avoid in order
to make life worth living.

Fortunately, there is now developing in prudish America,
thanks to the insight deiived from the analytical study of the in-
dividual's wishes, their genesis and influence upon the personality,
a strong, common-sense tendency toward a more practical, less

^J'v '* \ ^^K|^,^^|^^fi^M

WtKr ■■ vio

"^^iflttHHuj^

XttA, y j^B^^^^^^L

^^ .^,0!^f:"..^^^^j^tk

■^1^

Fig. 13. — "The Martyr," by Eodin. (By permission of the Metropolitan
Museum of Art, New York.) Showing agony at uncontrollable, ungratifiable sexual
Rravings — a martyr to social conventions and virtuous ideals.

repressive system of education. Out of this should come a frank
recognition of what constitutes a normal constructive sexual life
and what constitutes a destructive sexual life, and how one is to
be sustained and the other avoided.

Summary

Because the autonomic-affective cravings, in the child, alivays
become conditioned through the influence of associates, particu-
larly the adults in the family, and each experience conditions the
affections so that they determine the adjustment to the next

116

PSYCI-IOPATHOLOGY

experience, it beoomes necessary to study the family wherever
a psychppathological disposition is met with in an individual.
Every personality constantly struggles to satisfy its wishes.

Fig. 14. — "In the Garden," by Brush. (By permission of the Metropolitan Museum of
Art, New York.) The contentment of a normal biologioal career.

The wishes, whether repressed or not, incessantly strive to get
from another individual such contributions of affection and ma-
terial as best satisfy their needs, and they discourage such inter-

THE PSYCHOLOGY OF THE FAMILY 117

ests in others as displease them, no matter what their nature or
origin. If "unfair" or "unjustifiable," a compensatory control-
ling wish may be developed that compromises the demands so as
to seem fair.

It must be expected that parents who take upon themselves
the work of training children, unless they have most unusual in-
sight into their own affective cravings, will train the children to
gratify their own wishes and not the natural aptitudes of the chil-
dren. It is the easiest thing under the sun for an adult to find a
disguise for his wishes and induce or force the unsophisticated
child to make affective adjustments accordingly. It may not be
until maturity, when the son or daughter is compelled to strug-
gle and compete for responsibilities, that the impracticability of
the conditioned needs of his affective cravings and his methods
of fulfilliagthem will bring on a desperate crisis and misery, or
even a psychosis.

"Whenever individuals come to the physician for advice and
relief from anxiety which is caused by the tensions of repressed
autonomic cravings, it is necessary not only to bring about an ad-
justment of the immediate difficulty, but, in order to avoid a re-
currence, the foimdation for the faulty attitude must be analyzed
out. TJiis always, it will he found, lias been established by the con-
ditioning influence of associates, through actual experiences, upon
the affective cravings of the individual.

The natural course of the individual who has an average or-
ganic constitution is to develop a functional capacity that acquires
from its world the material that gives it a state of virility, goodY-
ness and happiness.

If it can not adapt itself so as to attain this state, its affective
requirements have been unfortunately conditioned through the in-
fluence of associates, particularly the adults who raised it.

I have been able to find that the happy or unhappy experi-
ences of a great grandfather, conditioned him so that he, in turn,
unconsciously, conditioned the affections of his children, and they
conditioned their children, and so on to the fourth generation.
Plenty of evidence.can be found in almost any psychopathic family
to show that an autoerotic manic-depressive mother's condition-
ing influence is a most potent determinant of the affective adjust-
ments of her offspring during their maturity.

CHAPTER in

THE UNIVERSAL STRUGGLE FOR VIRILITY, GOODNESS

AND HAPPINESS

The, incessant pressure of social competition, as ivell as the
continuous metabolic needs and the cravings determined hy
growth, require that the capacity for virility must he consistently
maintained, if the state of goodness and happiness is to be approx-
imated for even intermittent periods*

The perfect state of existence is certainly not one of- coniplete
satiety, the very thought of which is as nauseating as overeating,
Ijut is one of freedom so that the antonomic-affective functions
can work, with some degree of certainty, for gratification as well
as the progressive refinement of their methods of working in order
to keep up with competition. The nature of the biological strug-
gle of the individual is determined by what the Avishes or auto-
nomic cravings need in the form of stimuli and what the social en-
vironment offers. The problem thus reverts to the conditioned-
qualities of the autonomic cravings, and, since this conditioning
can only occur through experiences, it emphasizes the influence of
associates (family, school, community, race).

The reading of the case histories, to be presented later, will
show essentially that the foundation of the personality is estab-
lished by the manner in which the autonomic cravings are condi-
tioned in cjiildhood. and adolescence, the nature of the autonomic
cravings (considered in a biological sense) and their manner of

*It is perhaps well to define what is meant by virility, goodness and happiness.

Virility is the capacity of the autonomic apparatus to compensate, when environmental re-
sistances tend to prevent the fulfillment of its wishes or needs, so as to overcome the resistance
and so modify the environment that it will gratify (neutralize) the autonomic cravings. True
virility applies not only to the mating competitions and overt sexual func'tidns of the individual,
but to his ability to coordinate his functional resources into a means (vocational) so as :.to win
the esteem of his love-object, overcome competition, and maintain a relatively influential social;^^
place in the community, or clan. Indiflierence, timidity and inactivity are conducive to^Joss of'
social esteem. Fear of becoming socially inferior stimulates the compensatory striving. iP^

Goodness is a state of feeling that is aroused when the act or sequence of acts gratifies
those wishes of the individual which promote his own career (egocentric) as well as the wishes
that promote the interests of the race (altruistic) ; the race containing the love-objects, gives rise
to the necessity of being esteemed by the race. In the struggle against perverse cravings, the
effort to establish the feeling of goodness is often extremely eccentric and* may even become
asocial. This idea of goodness is biological and not puritanical.

Happiness is felt as the autonomic tensions, becoming gratified, permit- the striving postural
tensions to change to comfortable tensions; as in the vigoroiis pursuit of a solution or result when
we feel confident of final success, in contradistinction to the heavy sense of depression when a
cause seems hopeless.

118

VIKILITY, GOODNESS, AND HAPPINESS 119

adjusting to one another, determining tlie individual's struggle
with the social resistances and contentions of the race.

The following biological principles may be advanced as
absolute rules of the game which the individual is predestined to
play in his struggle to develop virility.

(1) Use of organs and their functions is necessary to prevent
the atrophy of disuse and their impotence ; and regulation of use is
necessary to avoid eccentric development and social inferiority.

(2) Social opportunity for use of functions and organs must
therefore either exist or be created for the individual- by the
members of the group and the individual himself.

(3) Fear, if not compensated for, tends to prevent the use of
those functions and affections which entail responsibilities that
the individual dreads.

(4) Autonomic cravings that can not be gratified cause uncom-
fortable ^^.sceral and postural tensions (neuroses) which tend to
force the individual, in order to obtain relief, to strive to obtain
gratification. lie usually becomes forced to repress the craving if
the taboos and conventions of society are severely critical of it
or if his restraining obligations are impassable.

(5) The conventions of society are, essentially, designed by
social groups to control the affective cravings of the individual.
The individual must suffer if the autonomic cravings have been
conditioned through experiences to need that which happens to
be tabooed by his associates whose esteem he wishes to retain.

(6) When his cravings are uncontrollable and intolerable a
psychosis develops to give relief.

The demented functional psychopath is the victim of auto-
nomic cravings which have destroyed his interest in society by
overcoming and distorting the affective needs for social esteem.

The perverse cravings often run a rampant career in the
asylum and prison and it will be seen that suicide is the final sur-
render of the struggle for virility and a regression to the prenatal
affective state.

Society tends to conserve the energies and conventionalize the
■wishes of the individual in order that the interests most common
to the group will be assured of gratification. The majority regu-
lates the behavior of the minority in order that the wishes of the
majority will be served. The individual, on the other hand, strives

120 PSYCHOPATHOLOGY

to make the social group establish interests and customs -wMcli
■will permit Mm to '^i^|l|fy Ms. own autonomic cravings. Society-
is not safe (the martial history of the world shows this) when it
is forced to follow the dictations of one individual, of one auto-
nomic apparatus, no matter how splendidly and altruistically it
may be conditioned. It seems to be impossible for the indiAndi^fe;:if
to prevent the craving to aggrandize himself from worldng-'for
the personal reflections to be had from the indirect implications of
his laws and exhortations. Hence, the republican, the democratic,
and the socialistic forms of society consist of defenses or restric- ,
tions against this fatal self -aggrandizing, autonomic tendency of
the individual, which has reached its highest formalizing influence
upon society in the absolute monarchy and papacy, and the foster-
ing of autocratic exploitation.

The problem for the psychopatfeelogist is always one regard-
ing the individual's a:ffeetions versus society's welfare. The prob-
lem begins with the autonomic apparatus at its birth, the predes-^
tined nature of its biological career and the molding it tmdeijgfes
through the influence of associates, with, finally, at, maturity, the
autonomic cravings stxuggiing with social conventions. ,. .

Males and females are obviously hiseocual in their oTffMi&'JA--
and functional attributes, with, at birth, an almost equal balance
of masculine and feminine {assertive and submissive, or better,
projective and receptipe) functions. The preponderance of traits,
however, tends to shift rapidly, the social influence being equal, as
competition contrasts their organic differences; such as size and
contours of bones and muscles, the lever angles of the elbow, shoul-
der and hip-joints for fighting, grace a,nd beauty, color of eyes,
hair, skin and the pitch of voice for attraction. The organic .
basis however, does not seem to be as influential as the functional
traits which are developed through the encouraging and re-
pressive influence of associates. This fact is to be observed right
and left in any social group where one may see delicate women
who are indomitably aggressive (projective) and powerful women
who are chronically submissive and receptive. Similarly, beard-
less men are to be seen who are socially and sexually potent,
always projective; and men of ponderous masculine organic con-
struction who are as timid, submissive and receptive as the pro-
verbial girl. The general tendency, among- animals and men, it

VIKILITY, GOODNESS, AND HAPPINESS 121

seems, is for the aggressiveness or submissiveness of individuals,
who are opposing one another, to be reflexly determined in favor
of the one having the more powerful bluff or more justifiable
racial position. When the positions are quite equal, organic ad-
vantages decide.

In war, national morale is worth more than a temporary ex-
cess of cannon. The simulation of great size and power in order
to intimidate the opponent is used by animals, as the erection of
the dorsal hair, raising of the back as high as possible and making
violent, roaring sounds. This method is also used by the genus
Homo, classically portrayed in the thunders of the bully and the
irate screams of the infant. These compensations do not occur
when the individual is in terror but they occur as a defense against
fear. The organic determination of behavior may be theoretically
true for individuals having the same training, but, since individ-
uals are practically never trained in the smiie manner, although by
the same people (and outrageous intimidations and splendid com-
pensations are very commonly induced through the influence of
training or education), the influence of associates must be recog-
nized as the decisive factor that conditions the autonomic appa-
ratus to crave for, and do, the advantageous thing at the advanta-
geous time.

The parents' or teacher's conscious efforts to train a child to
do a particiilar thing, in a certain way, under certain conditions,
have relatively less influence upon the child than the unconscious
manner in which the parent or teacher attempts to train the child.
This is merely applying the well-known truth: It is not what is
said or done that pains or pleases but the affective manner with
ivhich it is said or done. As to how much parents or teachers are
responsible for their affective tensions (attitudes) when in the
presence of a child, is questionable, but the fact remains, neverthe-
less, that the influence upon the other person, of the affective in-
terests of which we are unconscious, goes on whether it is recog-
nized and admitted by us or not. This can be demonstrated in
our selections of words, movements, attitudes, etc., while associ-
ating with other people. Some people unconsciously influence us
to use dignified words and movements and greatly encoiirage us
to build up while others depress us.

It is necessary to sketch the different stages in the growth of

122 PSYCHOPATHOLOGY

the bisexual personality and emphasize the manner in which mas-
culine, feminine, and racially perverse characteristics become dif-
ferentiated, developed and fixed, or discouraged. This process, be-
cause of its intricate variations and the manifold influences to
which the individual is subjected, is endless, but its more common
principles must be understood.

The wish or craving (no matter whether it is hunger, love,
hate, shame, grief, pity, or what not), when permitted free flay,
always strives to expose its favorite receptor to appropriate
stimuli in order to become neutralised, that is, to have its ten-
sion relieved through counter stimulation, and it alivays follows
the laiv of trying to acquire a maximum of result with a minimum
expenditure of energy. For example, when we pity the depressed
or unfortunate, we feel compelled to do things which will stimulate
a certain attitude of courage and resolution in them. This atti-
tude, in turn, as a counter stimulus acting upon us, relieves us of
feeling pitiful and enables us to become happier. This law of ad-
justment most consistently and automatically assures, for the au-
tonomic apparatus, the greatest possible use of its power for the
most diversified and secure domination of the environment. It
underlies and determines all organic evolution and functional vari-
ation. In proportion as a new coordination of functions, or an
organic structiire, can be more economically applied, the others are
abandoned. This applies not only in the evolution of structures,
such as the thumb and foot, but also to the use of vocal tones, ac-
cents, words, sentences, languages, customs, religious ritual,
machinery, theories, and scientific methods.

Families, communities, and similar social classes have many
similar traits, but the great variations that exist between individ-
uals having quite similar organic equipment are due, principally,
to differences in conditioning their autonomic functions through
experiences.

Adults, almost universally, have quite different attitudes to-
ward male and female children, and, although this may not show in
a single incident of adults associating with children, taken through-
out the day and in the innumerable, unconscious ways in which it
is demonstrated, it exerts an enormous pressure upon the child's
methods of becoming estimable in order to win love and admira-
tion. This is not only to be seen in the masculine and feminine

VIRILITY, GOODNESS, AND HAPPINESS 123

■toys and clothing nrged upon children, but in innumci-al)le pleas,
flatteries, criticisms, commands of the parents.

Society's expectations are so remorselessly rigid that the little
girl -who is raised like a boy, or the boy who is raised like a girl,
is foredoomed to live in a most uncomfortable, eccentric position
Avhich may finally amount to nothing less than a biological abor-
tion. This socializing pressure upon the individual has its begin-
ning with the infant's birth, and, by the time the child enters the
school, it has already developed definite aggressive and submissive
methods of gratifying its affections; and these, reflexly and re-
ciprocally, adjust to the affectivity of its associates. "When their
wishes conflict, individuals reflexly take advantage of each other's
inferiorities, fears and submissive tendencies, establishing affect-
ive circles that may become progressively vicious.

The growth of the personality may be divided into seven au-
tonomic-affective stages, which, in. certain respects, are profoundly
influential upon the behavior of the individual. The stages, in
regard to age, vary considerablj^ in different children, being in-
fluenced by retarding diseases, accidents, and fearful experiences,
as well as by the intimidating, fascinating or encouraging influ-
ences of associates.

The transitions from one stage to the other occur quite im-
perceptibly, but for the sake of convenience they may be differen-
tiated for Americans as follows :

Intrauterine,
Infantile, birth to 3 ;
Preadolescent, 3 to 10 ;
Adolescent, 10 to 17;
Postadolescent, 17 to 22;
Maturity, 22 to 45 ;
Decadence, 45 to — .

During the intrauterine period, the autonomic apparatus lives
an impersonal parasitic existence, probably exerting little influ-
ence upon its projicient apparatus Ijeyond a tonic effect and the
occasional compulsion of shifting of position in order to maintain
comfortable postures. Upon leaving this affective state the infant
is considered to have been "horn." The feeling of having died
or of being dead, which is so common in the psychoses, will be
shown to signify, often, a regression to the prenatal state, and the

124 PSYCHOPATHOLOGY

suicide has this affective value. (See illustrations Requiem, Egyp-.
tian burial and Isle of Death, Figs. 28, 29, 30.)

The infantile period is characterized by the utter helplessness
and innocence of the autonomic apparatus as to the nature of its
environment, and its vital dependence upon the :good will of those
who gratify its cravings. This is the stage when the autonomic
functions begin to become conditioned to react with pleasant or
painful tensions to the presence of characteristic stimuli, as the
kind mother, irritable mo'ther, sadistic or masochistic father, mas-
culine, aggressive mother, effeminate, timid father, a jealous or
cruel brother or sister, etc. Naturally, the cooing voice sounds
and gentle smiles of the mother as secondary stimuli, at first hav-
ing no influence, associated with the primary stimulus of the nipple
and food, petting and cleansing, etc., soon condition the autonomic
apparatus to react pleasantly to the presence of the secondary
stimuli, and then to react to strange people who also give off stim-
uli like the mother. Liltewise, the harsh voice sounds, rough hand-
ling, staring eyes and irritability- of people become associated to-
gether, and, through their causing painful tensions, the autonomic
apparatus tries to avoid the influence of individuals Avho possess
irritating characteristics.

During the infantile stage, the autonomic apparatus seeks its
supreme pleasure in sucldng and emitting its excreta without
self-restraint. Gradually, the wishes of those who administer to
such needs impose restrictions upon these supreme segmental
pleasures of infancy, through associating the fear of punishment
in the form of physical injury or the loss of favor (esteem) with
the indulgence. The first great tragedy is experienced when the
sucking source of the food supply is stopped,, and it is then that
the foundation of the infant's belief that it is unwelcome is so
often quite correctly fixed, or the belief that it is a foundling and
the parents are foster parents. Mothers vary .enormously, largely
according to their understanding of an infant's affective reactions,
hence, according to the degree' of their love for the infant, in their
ability to minimize the anxiety of the infant upon being weaned
from the sucking stimulus. No doubt, as in all denials of affective
needs, the gradual change is more easily accommodated to than the
abrupt.

The soothing value of the sucking stimulus in the infant (sug-

VIRILITY, GOODNESS, AND HAPPINESS

125

gested by Freud) is due to the affective value of the oral zone
as well as its association with the gratification of hunger. The in-
timacy of nutritional and sexual cravings is also illustrated by the
Costa Eican Indian's sculpture (prehistoric) and Veronese's
painting of ' ' Mars and Venus, ' ' p. 126. The fear of having a sex-
ual stimulus secretly put in the food, so often complained of by
oral erotic psychopaths, is due, apparently, to the erotogenic in-
fluence of food and sucking upon the oral zone, which must ob-
viously have some of its determinants in the conditioning influence
of nursing.

The tendency to persist in sucking in order to relax or sleep,
after hunger is gratified, and have "soothing feelings" (finger

Fig. 15. — Costa Eioan prehistoric ceremonial altar. Male figure sits between
the thighs of the reclining female who is in copulation position. She holds a large plat-
ter on her bosom and abdomen, one edge of which fuses with the mons veneris
while the mammary glands fold over the upper edge into the platter, symbolizing
the circle of life — nutrition and reproduction. The heads of the figures have been
broken off. The stone is exhibited in the National Museum, Washington, D. 0. (Eep-
roduced by courtesy of National Museum.)

sucking, pacifier, pipe, toothpick, fingernail and gum chewing),
even at the expense of causing organic deformities, supports
the conception that vigorous autonomic tension^ are relaxed by
the sucking stimulus.

The erotogenic value of some forms of kissing and the sooth-
ing value of others, as well as the fact of the unconquerable crav-
ing in the oral erotic for specific stimulation and its influence on
his autonomic tensions, in a manner that is similar to masturba-

126

-ESYCHOPATHjOLOfiy

tion and copulation, surely, fixplainslone of. the^ causes of oral per-
version as a conditioned autoiipmic .over valuation in infancy, of
this sensory., zone. This is not physiologically mystifying' if we

Fig. 16.— "Mars and Venus United by Love," by Veronese. (By permission of
the Hetropolitan Museum of Art, New York.) Showing like the prehistoric GostaRican
copulation stone (Fig. 15), an association of nutritional and sexual interests; also
the sword, horse, satyr, tree, vine, old temple, armor, cupids^ and knight as sym-
bols associated with sexual virility.

VIEILTTY, GOODNESS, AND HAPPINESS 127

consider that the sexual act is essentially a counter stinailus ap-
plied to a tactile zone to relieve general antonomic tensions.

Another source of soothing stimuli, if the behavior of the in-
fant and the pleasant reminiscences of psychopaths may be con-
sidered as indicative of its value, is the cleansing of the pelvic
skin areas after emissions of excreta. The emission of excreta,
besides its segmental pleasantness, becomes the infant's most po-
tent means of winning attention, particularly when lonely at night,
if the parent is not clever at avoiding its use for this purpose.
Many parents enjoj^ giving such attentions to infants, whereas
others detest it. (One not uncommonly meets with hebephrenic
anal erotic adult males and females who plead for cathartics and
enemas to be given in the way that the mother or grandmother
gave them.)

During the earliest infantile stage, the capacity for affective
reactions of hunger, love, rage and fear is present ("VVatson). But
a true personality does not exist. The autonomic apparatus now
begins to coordinate its projicient (skeletal) apparatus into an
instrument for dominating the environment. In this period of
training, parents vary enormously from intimidating the child into
doubting its coordinating ability, by cries of "watch out" and
"don't" to encouraging it to try courageously and persistently,
-so that it will enjoy the effort almost as much when attended by
failure as success. Disastrous intimidation may occur day after
day in innumerable forms and often with such vehement excite-
ment, upon sudden provocation, that almost at the onset of its
existence tke personality is doomed to become unable to assume
responsibilities without becoming tmduly tense where failu,re may
occur, particularly if the emotional comfort of others is dependent
upon it, not only in a business or athletic contest, but in copulation,
as ejaculatio prcecox. Upon the infant's development of sufficient-
functional skill, most parents, in order to be relieved of discom-
forts and distractions, wisely make the child take care of its- own
needs, particularly those pertaining to dressing, cleansing and
feeding. This does not always occur, however. Some mothers
strive to keep their children infantile forever and have been known
to nurse their children for over three years and babyfy and sleep
with their sons until after they had physically matured.

The enormous economizing of energy and time through the

128 PSYCHOPATHOLOGY

child's effectual use of language (affective convergence upon the
iiead segment) usually wins genuine praise. But some parents
keep their boys and girls hesitating, whining and lisping. When
failure to control the emissive impulses of the pelvic segment oc-
curs, it is punished, more or less, by loss of favor with the parent.

The fear of losing favor and praise, later of esteem and con-
fidence, and of being ridiculed and ignored, stimulates the auto-
nomic apparatus to compensate by coordinating itself into an egois-
tic unity as a means of dominating the tabooed impulses of any au-
tonomic segment, as rectal, cystic, gastric, oral, lachrymal. Up to
this stage, the child is regarded as "it," as not having a personality
until it begins to use sentences. Some children are not given a
name until this stage is. reached. This recognition is gradually
bestowed upon the child as the compensatory strivings of its
autonomic apparatus become integrated into a functional unity
which, constantly on guard against doing something which will
jeopardize its struggle for the love-object's favor, learns to use
word-sounds to influence sources of gratification: asking ques-
tions, telling fancies, etc. As the social obligations become
more involved, and necessitate the control of physical appear-
ance and emissions, of hunger, anger, love, fear, grief, etc., the
autonomic compensations that arise to prevent the fear of failure
become increasingly intricate and more highly coordinated.
Gradually the personality becomes more and more highly organ-
ized and capable, until it becomes recognized by name with the
baby's suffix "ie," as "Willie"; but, later, if it has developed the
capacity of convincing aggressiven-ess, the "ie" is dropped for
"Will" and it earns the prefix "Mister," then, perhaps, "Sir,"
or "Honorable," and, finally becomes known as "Shakespeare,"
and his followers, as Shakespearean. (The hebephrenic type of
dissociated personality, having yielded to the regressive affec-
tive cravings, often feels and complains that he has no name, no
ancestors and no personality. One boy, anal erotic, tore his name
out of his clothing and said he wasn't anybody but just a "shit
pot." Case HD-11.)

The capacity to become conscious of self as a personality be-
gins to be consistently maintained by this compensating unity (the
ego) as it becomes able to control its asocial and unfriendly imi-
pulses and the socially perverse cravings and their compulsions

VIRILITY, GOODNESS, AND HAPPINESS 129

to be gratified. The tendency of the ego to lose control of the seg-
mental cravings can be seen in the failures of the child to control
the wish to steal food, to suck its fingers, masturbate, indulge in
nocturnal enuresis, cry, scream, lie, bluff, fight, steal, etc.

The functions of self-control begin very early in the integra-
tion of the personality and are shown in the child's efforts to tell
lies in order to disguise its inferiorities and wishes. The fluctua-
tions of the ability to control dissociated impulses are still to be
seen in the painful embarrassment of children of five to seven years
who are occasionally unable to prevent the soiling of their cloth-
ing by the craving for emissions, and in the tendency to allow them-
selves segmental indulgences when the ego is depressed by illness,
loneliness, etc. Naturally this Aveakness continues during sleep for
several years after it has been mastered during consciousness and
often is the source of a persistent feeling during maturity of being
an inferior personality.*

The compensatory integrations, as they become knitted into
a unity, slowly develop the tendency to regard themselves as "I,"
"I will," "I wish," "I am," and the body as "mine," probably
imitating the examples of older people. The " I " becomes the good
boy and the perverse craving, the bad spirit, or bad boy. As the
ego, or "I," matures and tends more and more to master and
assimilate the individual cravings of different segments into its
unity, by claiming them as a part of the personality, the conception
of the bad spirit or influence, devil, etc., simplifies into a conception
of perverse cravings or impulses.

With this conception of the personality as a physiological
mechanism, it is obvious that the accumulating force of re-
pressed cravings, or the weakening of the ego, through fatigue,
insomnia, discouragement, toxemia, etc., might lead to a dissocia-
tion of the wishes or power of the integrated structure constitut-
ing the ego and, also, how the unsophisticated ego might regard
the sensory disturbances caused by the repressed, dissociated crav-
ings as being due to another personality's hypnotic influence; a
form of reasoning common in sleep, psychoses, and illiteracy.

As the stage of infancy is left behind, the impres,sions of the
omnipotent father and kind mother, and that divine, heavenly

*The psychoanalysis of tense people has shown, in a series of cases, that the tenseness is
dqe to fear of making mistakes and being considered mentally inferior. T^he dread of mental in-
feriority in turn had its foundation in having been teased for not being able to prevent bed wet-
ting and soiling clothing.

130 PSYCHOPATHOLOGY

equilibrium of the intrauterine existence, become immortalized ^g
Grod, the Holy Mother, and Heaven. The om'nipotence of infancy
is left behind to be sought for in another form during maturity.
Many of the patients who believed they were seeing "God" were
found, upon adequate examination, to be hallucinating their infan-
tile impressions of the father. The infantile stage seems to ter-
minate with the child's realization that it can no longer be a part of
the mother's personality.

The preadolescent stage of childhood (three to ten) begins as
the individual, now an embryonic personality, begins to compete
Avith all the universe for the gratification of its autonomic cravings.
Handicapped by its inferior organs and unskilled functions, it com-
pensates for the deficiency Avith day-dreams, make believe, and
magic, fairy fancies, bluffing, lying, etc., (the age of motor illu-
sions). The natural erotic curiosity of childhood, blindly censured
in almost every conceivable manner by prudish adults, is often
forced to indulge in secret play. The polymorphous, imitative cu-
riosity about the behavior of parents, animals, birds, insects, etc.,
and, particularly that which causes the most excitement, naturally,
their sexual play, no doubt is of tremendous value as a dynamic
influence for the acquisition of knowledge." It surely is necessary
for the invigoration of the personality during its growth and ma-
turity. Curiosity about the possibilities of finding pleasure in the
environment is the grand acquisitive urge of the personality to un-
derstand and master the environment and the self in order to win
and sustain the love-object and superiority. (Upon the half -rec-
ognition of the manifestations of the erotic functions in the child,
there will no doubt appear moralizing educators, who, obsessed
Avith wild fears of anything pertaining to sex, Avill advance further,
biologically disastrous, educational schemes to castrate instead of
refine the sexual curiosity of school children.)

During the preadolescent age, all children, if permitted to
pursue a natural course of development, show, frankly, curiosity
in all sorts of mechanical devices and sexually significant func-
tions ranging throughout the demonstrations of nature; and, in
this promiscuous quest, a convergence of the child's affections
tend to become fixed upon things that enchant the love-object (as
Darwin's mother's curiosity about the cause of variation, in

VIRILITY, GOODNESS^ AND HAPPINESS 131

plants). Around the solution of this riddle of the love-object will
be developed the vocational career. But woe must befall the child
who at this late age has no love-object to make it feel welcome and
inspired.

The preadolescent child's curiosity is so unsophisticated that
it is inclined to personify and consider secretly many polymorph-
ous perverse objects in an affective relationship of equality to
itself: such as animals, poultry, birds, insects, clothing, fetiches,
mechanical devices, signs, mannerisms, etc. Boys and girls of this
age amuse each other with all sorts of mechanical copulation de-
vices, such as boring, with great hilarity, into objects with sticks;
the breeding of insects and pets ; the adoption of various mechani-
cal devices and pets as the yoimg of themselves in their play fam-
ilies. Apparently, this is the trial and error method of differen-
tiating the unknown homogeneous universe into its heterogeneous
values and discriminating the actually, biologically useful from
the useless, the pleasing from the displeasing.

The convergence of interest upon the pelvis is almost infalli-
bly certain, because of its pleasing sensory cutaneous zones, which
are probably discovered throiigh the emissions and by the acci-
dents of play and clothing. (In regard to this, the early sexual
play of the infrahuman primate is characterized by its trial and
error method of experimenting, and is decidedly anal erotic and
coprophilous.) The preadolescent stage shows remarkable prog-
ress in the autonomic apparatus' control of the striped muscle
system and the development of skill in control of movement. Too
flattering admiration of adults easily stimulates in the child an
egotistical over-evaluation of the little successes and this may
later_ prevent the true comparison of its personal resources.

The stage of adolescence (ten to seventeen) may be consid-
ered to begin with the definite convergence of the affections of the
individual upon its pelvis in a manner that is associated Avith the
use of love fancies about the personality of another. (During the
preadolescent stage, experimental pelvic stimulation and rela-
tively little preliminary fancy are used.) The practice of some ex-
perimental masturbation is almost universal during this age and is
not to be considered harmful if not excessive, and if a narcissistic
fixation does not occur. That is, if the adolescent does not become
more inclined to enjoy secret sexual fancies, self-admiration and

132 PSYCHOPATHOLOGY

self -stimulation than the seeking of a playmate and winning his es-
teem.

The stage of adolescence has a most critical influence npon the
maturation of the personality. In order to pass beyond. the stage
of infancy, and know the physiological secrets of its nature,
the' child, it seems, must actually experiment with itself and learn
the truth of its powers. This can not be adequately taught by read-
ing or prevented by threats of disaster ; it must be gone througli
-wdth, and the less secretive the easier it is for the socialized ego to
assimilate, control and refine these cravings. Society must, how-
ever, uphold the ideal of refinement and maintain adequate means
for this purpose, not only in schools and churches, but in play-
grounds, athletic games, artistic sublimations, etc.

My cases indicate that the children who masturbate alone and
carefully maintain the habit as a secret have by far the most dif-
ficulty in mastering themselves. The cause is almost obvious,
mechanically, because the wish to be socially estimable tends to hide
the inestimable, particularly the socially censured craving and its
fancies. Therefore, the latter tends to remain a distinctly dis-
sociated, unmanageable segmental craving which periodically dom-
inates the ego 's wish for self-control. Any force, to be controlled,
must be intimately associated with opposing forces, and this physi-
cal law, not being followed, lays the foundation for the failure to
control the eccentric erotic craving in maturity.

It is almost a consistent feature of psychopaths who are ad-
dicted to masturbation, to complain, during the psychosis or erotic
compulsion that they have destroyed everything in the world worth
living for, particularly those they should love most. We see them
pacing the floors, weeping and groaning, wringing and scratching
their hands, pulling their hair, beating their faces, (even some-
times amputating organs, castrating themselves, or committing
suicide) as a result of the terrific anxiety they suffer from the
fact that they have ruined their feelings of worthiness for love and
esteem, and have wasted the vital forces of nature through self-
love and masturbation. (See Eodin's "Centauress" and Michel-
angelo 's ' ' Captive, "p. 372, 374. ) It is also a surprisingly consist-
ent mechanism, though probably not a universal one, that the adO-
, lescents who have mutual sexual interests .which are rather freely
discussed with adults who understand them, have far less difficulty ,

VIRILITY, GOODNESS, AND HAPPINESS 133

in finally affecting the transition (transference) from indulging in
secret fancies about the attractiveness of members of the opposite
sex to actually striving to win their esteem and affections through
overt competitive behavior. This transference of affective inter-
est is vital to the growth of the personality, for it leads directly to
projecting the energic resources so as to fashion and master the
world to suit the craving; whereas, the self -loving, fanciful auto-
erotic individual cares little for the world except to be aggran-
dized and otherwise left alone to dream and brood, even though he
later becomes eccentric and scoffed at and finally socially ostracized
or confined in an asylum. The autoerotic's fancies, as vivid, in-
expensive pleasures, are as stimulating to him as the worldly
reality is to others.

The difficulties some of my cases had in mastering the auto-
erotic tendency, and the ease with which it is mastered by healthy
individuals, strongly indicate that the vigor and persistence of the
autoerotic cravings is greatly influenced by the intimacy of the per-
son who becomes the subject of the fancies, even though that
individual does not suspect the nature of the influence. That is,
when the subject of the fancies is the mother or sister, the boy has
more difficulty in mastering the masturbation pleasure than when
it is a girl neighbor. Also, the more the autoerotic fancies are
shared with playmates (not one playmate) the more quickly they
lose their value. This is also true for other fascinations and
causes of worry.

The autoerotic difficulty has another influence besides the pei'-
nicious seductiveness of the fancies, i. e., self-love resists making
the sacrifices necessary for heterosexual love, and is, for this rea-
son, regarded by the race as an inferiority. Furthermore, when
self-love becomes too strongly fixed in adolescence, the individual
can not free himself during maturity, even after mating. The over-
development of autoeroticism usually depends upon the suppres-
sive domineering influence, during preadolescence, of the more
powerful, skillful rival, the father or older brother, and for the
daughter, the resistance is in the jealous, prudish mother, aunt or
sister. The father, especially, when he does not love the tendency
towards maturity in the son and selfishly loves to remain as nearly
omnipotent and domineering as possible, directly, indirectly, or un-
consciously, attacks and suppresses the spontaneous attempt of the
child to win the mother's admiration and esteem. Through becom-

134 PSYCHOPATHOLOGY

ing her hero in the home, at school and on the athletic field, he
tries to fascinate her if she loves him. The older rival belittles
these serious adolescent attempts and the affect becomes fixed tt'
the autoerotic level unless some other influence accidentally comes
into the life of tlie individual, as a master encouraging his ap-
prentice to become proficient and win love and win manhood.

I have never Jcnoivn an individual, who had fixed autoerotic or
perverse cravings, whose history shoived that he ivas treated in
his childhood like a true personality when conflicting with his par-
ents. Most parents seem to suffer from sexual phobia, that is,
their fear that the child might inquire about or discover their own
sexual secrets (of adolescence, particularly) unconsciously forces
them to protect themselves against the danger of embarrasses
questions l)y severely tabooing everything pertaining to sex. The
child is therefore forced to answer its curiosity by accepting the
hopelessly erroneous conceptions and wild, frivolous fancies of
other children, or rely upon its own imagination and experiments
(Case CD-3). This tendency will be seen throughout the more
intimate case histories to be given later (particularly Cases HD-1,
AN-3, CD-2).

In order to overcome the opposition of the father, boys often
elope from home to become chronic wanderers or engage in fierce
feuds with him. ( See Barye 's " Theseus and Minotaur in Battle, ' '
Fig. 17. The value of this myth is interesting when the bull
is seen to symbolize the oppressive father.)

The postadolescent stage (seventeen to twenty-two) begins to
develop as the personality predominantly seeks the realities of the
love object and converges its interest upon the sexual career of an-
other of the opposite sex in a manner that is designed ultimately
for reproduction of self. The moment that this transition begins,
boys and girls tend to become serious rivals for overt demonstra-
tions of the esteem of members of the opposite sex, particularly of
their own age.

This necessitates courageous competition, steadiness, and self-
control in trials, and willingness to suffer from defeat as well as
to enjoy the glories of victory (the heroic age of athletics and self-
conquest, and writing and reading of romantic literature). The
youth who tends to seek the esteem of a person considerably older
(teacher), or younger, or of the same sex, is usually afraid to enter

VIKILITY, GOODNESS, AND HAPPINESS 135

the general competition. My cases of anxiety at this stage quite
consistently showed that the attitude of a parent or some sponsor
was the responsible resistance that made it almost impossible for
the son to compete, because his diffident, self-conscious, self-
repressive tendencies had been already too thoroughly established.
A mother taught her son not to fight; "to fight is ahvays wrong,"
and the father had no confidence in his son's powers for competi-
tion. Fearing the reflections upon himself of the failures of his
"sissified" son, he refused to give him any support. This man,
age twenty-six, although he felt that he was practical in his social
and business impulses, however, could not proceed upon his own
initiative because he had been trained "always to ask father," or
"ask mother," etc.

In the postadolescent age, parents, having sexual phobias and
egocentric interests, actually plot and scheme to send the boy or
girl to intimidating teachers, colleges, and training schools. They
seek the advice of "authorities," priests and physicians, and actu-
ally beseech them to admonish the youth to heed the interests of
the parents at any cost to the vital yearnings of life. The fear
of pain, of being considered functionally inferior, clumsy or
stupid, the intimidation and lack of initiative and self-reliance
soon make such boys or girls unable to demonstrate their biological
fitness to the love-object and force them into progressively per-
nicious affective circles.

The inclination to exhibit through tales of prowess in all sorts
of competitions (athletic, business, scientific, professional, etc.,)
is nothing more than a refinement of the lower animals' exhibition-
istic mannerisms when trying to win the choice of a mate or a place
in the herd. This attribute may be seen among birds, insects, ani-
mals, and seems even to be present in fish.

In one instance, a splendid type of postadolescent girl was
literally in a mortal struggle with her domineering, infantile
mother and jealous father to free herself from their restrictions
in order that she might become an independent personality and
choose her school, companions and career. A young man, an only
son, having a splendid physical and educational equipment, "suf-
fered hell" because his ambitious old parents, who had risen from
the farm, would not tolerate his marriage to anyone except a
wealthy girl. Under no persuasion could the parents be brought

136 PSYCHOPATHOLOGY

to allow this son Ms emotional freedom.. The above two cases are
of the mild type.

The horrible biological distortion of splendid yonng males and
females, who must suffer most because their vital energies are
more vigorous than the average, occurs when parasitical parents
insist upon keeping them dependent, "babyfied;" "sissified," dis-
courage their initiative with incessant_ intriguing, pleading, beg-
ging, weeping, invalidism, scolding and commanding. The parents
continue this procedure until they actually crucify the youth's
vital yearnings, upon the cross of filial obedience (Cases MD-13,
CD-3, HD-1). Many parents, without realizing what they are do-
ing, will stoop to use almost any hypocritical measure, of force,
from the Bible and pulpit to threats of disowning, in order to con-
trol the son or daughter. A series of cases shows that certain
types of crucifixion psychoses have their foundation in this form
of paternal or maternal domination of the vital yearnings of
youth, which, if once discouraged, prostituted or repressed, may
never again, except perhaps under the most unusual forms of spon-
taneous encouragement, respond to the crises that beset the win-
ning of virility, self-reliance, and social esteem.

The opposition of adults to maturing youths may occur in
the individual's parents, or the parents of the mate. The principle
is the same. The unreserved love of the mate is absolutely neces-
sary for thorough development of virility, goodhiess and happi-
ness, and, without it, the struggle slowly but surely, as the age of
thirty is reached, becomes more and more of a burden. The social
responsibilities after thirty have to be met at an increasingly in-
volved" level or else' the individual suffers humiliation from the
fact that yearly he must" see the youngei", more self-reliant mem-
bers of the herd pass him by.

Most parents actually seem to be unable to forgive the inde-
pendent declarations of their offspring. This often reduces to a
principle of selfishness disguised by claims of duty.

The male youth who submits to the dominations of others
lends to remain at the autoerotic or homosexual level (adolescent)
and those who have been "sissified" by their parents and' asso-
ciates tend to become fixed homosexuals of the receptive, de-
pendent, submissive type. They seek for the protective friendship
of virile, popular males and this in its biological significance may

VIRILITY, GOODNESS, AND flAPPINESS

137

finally have the same value as the love-seeking of the dependent
female. Anyone who has had experience with trying to assist such
male youths to bring about an affective readjustment, so as to
become normal, may testify as to the humiliations they suffer from

"Two Natures in Man," by Barnard.

"St. Michael," by Zurbaran.

'Theseus Slaying Minotaur," by Barye. "Theseus Slaying Centaur," by Barye.

Fig. 17.— Different protrayals of the struggle against homosexuality in man. (By
permission of the Metropolitan Museum of Art, New York.)

138

PSYCHOPATHOLOGY

their sexual and social inferiorities, and their tendencies to make
egotistical compensations or to seclude themselves.

Virility is essentially being able, "unhesitatingly and yet with
effective self-control, to project the affect, at any cost of physical
or economic sacrifice, into the social herd and force it to reco^iC^e

]?ig. 18.-

-Tho homosexual sigiiifleance of the centaur is shown by the left hand a
turbating the eupid.

its power by spontaneous submission. This does not imply that
the virile hero needs always to win, but, to use a pregnant expres-
sion of the game, he needs aliuays to play the game to the finish,
for all he is worth, and in a manner that will win the respect of
himself and admiration of his conqueror. Never can he afford to
be petulant, timid, self-doubting, or tmfair. The defeated but
good-humored rival is never vanquished, but respected and loved.

VIRILITY, GOODNESS, AND HAPPINESS 139

As a social influence, he becomes more of a favorite the more grace-
fully he endures defeat.

Because of the tendency in both males and females of the
genus Homo to regress to the homosexual level whenever the com-
petitions and combats of heterosexual courtship or dangers of
heterosexual indulgence (venereal disease, pregnancy, rival's at-
tack or social scandal) cause fear and depression (impotence), it
has become valuable to know the phylogenetic determinant for this
universal trait.*

The behavior of infrahuman primates (Macacus rhesus, Maca-
cus cynomolgus, and a species of baboon) may be considered to be
indicative of the sexual behavior of the ape ancestors of the genus
Homo, and to indicate the phylogenetic influence that the civilized
ape (man) has still to master through the establishment of appro-
priate social relations. Hamilton's observations,* made under
practically normal environmental conditions, and my observations
made later in an abnormally close confinement, showed that there
is a persistent autonomic-affective tendency, in man and the
higher apes and monkeys, to revert bach to homosexual methods
of obtaining gratification ivhen the environmental resistances to
heteroseosual advances become too severe. The presence of per-
sistent fear producing exogenoii^s stimuli of course removes sexual
potency.

The behavior of the infrahuman primates, as well as male and
female adolescents of the genus Homo, shows that homosexual in-
terests precede and predominate the heterosexual interests. It
has been observed that matured male monkeys and apes when iso-
lated from females, or when prevented from courting a female by
a domineering male, Avill revert to homosexual play.

This reversion tendency must be seen to have its counterpart
in the behavior of men and women when isolated by religious or
social obligations or laws, as marriage to a frigid or incompatible
mate, over-conscientious self-repressive wishes, fear of venereal
diseases, scandal or prosecution, actual isolation in military camps,
prisons, asylums, monasteries. Men and women then tend to
become anxious and irritable because of the persistent autoerotic

•Kempf, E. J.: The Social and Sexual Behavior of Infrahuman Primates. The Psycho-
analytic Review, Vol. IV, No. 2.

*G. V. I-Iamilton: A Study of Sexual Tendencies in Monkeys and Baboons. Jour. Animal
l^ehavior, Vol. IV, No. 5.

140 PSYCHOPATHOLGGY

or homosexual pressure which, is usually misunderstood and may-
lead to a psychosis.

Whenever two or more men are obsessed with cravings for the
affections of a certain woman, the weaker rival, who fears defeat
or punishment, or can not endure anxiety, or justify the pursuit
of his craving, tends to revert back to homosexual interests if he
can not find a substitute. I have seen this occur in sons who rivaled
their fathers for the mother's affections, in the weaker of rival
brothers, and in a father who believed his son had replaced him
in his wife's affections. The sexual cravings of man apparently
have only comparatively recently been subjected'to censorship for
incestuous fixations. A series of pernicious psychoses, presented
later, show that sexual reversion occurs ifthe resistances to hetero-
sexuality are too severe, a fact which has been utterly disregarded
or overlooked by most educators, ultra-moralists and sociologists.

To accuse a male of being effeminate is to insult him, but to
accuse a female of "having a vigorous, aggressive (masculine)
temperament is in this day of woman's suffrage to compliment her.
The first is truB the world over among all peoples. The conquest
of, or adequate masculine compensation for, effeminate or uncon-
trollable ' submissive tendencies is the underlying theme of the
great classical fantasies about such male heroes as Hercules and
Theseus. Although Hercules performed the cycle of twelve labors
and- was the chief national hero of Hellas, upon the slaying of his
friend Iphitus, in a fit of madness, he was condemned to become the
slave 6f Queen Omphale for three years. "While in this service
the hero's. nature seemed changed. He lived effeminately, wearing
at times the dress of a woman, and spinning wool with the hand-
maidens of Omphale, while the queen wore his lion's skin."* This
myth probably had its affective origin in the fact that when a
man's heterosexual ventures cause sorrow (as from syphilis, hate,
or the loss of a friend) he tends to a homosexual regression. I have
seen two poorly developed young men in homosexual panics which
were related to fear of venereal infection which had discouraged
heterosexual responsibilities and liabilities.

Theseus, the great hero of Attic legend, son of Aegeus, king
of Athens, and Aethra, virgin daughter of Pittheus, king of
Troezen (noble parentage), when sent by his mother, on passing

♦Bulfinch, T.: The Age of Fable, vol. i, p. 147.

VIEILITY^ GOODNESS, AND HAPPINESS 141

out of adolescence, to Athens, encountered many adventures on
the way. He performed many heroic deeds, the slaying of
Periphetes, called Pine-Bender, who killed his victims by tear-
ing them asunder between two pine trees, the Crommyonian
Sinis boar, Sciron, who kicked liis guests into the sea, Cercyon,
and Procrustes, who killed all comers by stretching them or cutting
them down to fit his bed. Despite this immortal virility, as he
passed through the streets of Athens, his curls and long garments,
which reached to his ankles, dreAv on him the derision of some
masons who were putting a roof on the new temple of Apollo
Delphinius : ' ' Why, they asked, was such a pretty girl out alone ? ' '
In reply, Theseus took the bullocks out of their cart and flung them
higher than the roof of the temple, a virile, masculine compensa-
tion. [Postadolescent males tend to delight in exhibiting their
heroic deeds, sexual prowess and organic superiority (high-flung
bullocks) in the face of religious censorship and ridicule in order
to prove that they are not effeminate, as well as to win the esteem
of their male associates and the love-object. This heroic but
aborted tendency is also to be seen in the pseudo-virile demonstra-
tions of many forms of gambling, fighting, stealing, raping, seduc-
tive intrigues of males and females, the pimp's mastery of the
prostitute, and promiscuous patronage of prostitution. The pros-
titute, usually homosexual, often lives with other prostitutes to
dominate their affections.]

When Theseus undertook to free Athens of the scourge of
the Minotaur, a monster having a human body and the head of a
bull, to whom had to be sacrificed a tribute of seven Athenian
youths and seven maidens every nine years, he was guided by
Ariadne (meaning : "Very holy and the personification of Spring,"
the love of a vii'gin). She gave him a clue of thread to guide him
through the maze of the labyrinth (social intrigues) in which the
Minotaur lived. After slaying the Minotaur, he carried Ariadne
away with him. Barye's statuette of "Theseus Slaying the Mino-
taur" shows the monster attacking the pelvis of Theseus with his
pelvis (homosexual assault). (Fig. 17.) The origin of the myth
as a means of gratifying affective cravings is probably in the
struggle against suppressive, rival males, particularly the father,
in order to overcome the tendency to remain homosexual, if sub-
missive. One timid young man frequently dreamed that he was
being attacked by a charging bull whose roars grew louder as it ap-

142 PSYCHOPATHOLOGY

proaclied. The analysis brought out its origin in the snoring, dom-
ineering father with whom he had to sleep during his adolescence
and the increasing loudness of the roaring bull was the snoring
reaching a crescendo. The defeat of the father would set him free
from his domination, but the labyrinth of obligations and gratitude
bound him to his rival. The inspirations from Ariadne, lovely
maiden, freed Theseus from the old dependence upon his mother
and enabled him to free himself from the father's domination,
symbolized by the' Minotaur.

Pig. 19. — "Hercules and' Ompliale," from a painting by Boulanger. Masoulin'e
virility regresses to effeminacy and' homosexuality after slaying- a friend. Hercules
wore Oijiphale 'a. clothing for three years while she dominated him and wore his lion's
skin; the effect of shame and sorrow upon virility.

Ariadne (Spriffg) replaces the mother-attachment of ado-
lescence which, like Winter, must wane as postadolescence is re-
placed by the virility which her love stimulates. It is this inspira-
tion which, produced by the beauty of the pure love-object, who
will be the reward if he becomes a virile hero, gives him the en-
during ideal (continuous thread of thought) which guides him to
evade social intrigues and overcome opposition and inferiorities.
(See Fig. 20.) If the father is too severely domineering the
repressed affections may develop a patricidal craving. Its cul-

VIRILITY, GOODNESS, AND HAPPINESS

143

mination in the patricidal act of Guiteau has its opposite solu-
tion in the crucifixion of the son to preserve the omnipotence of
the father (Cases AN-3, CD-I, CD-2) in order to please the mother
and also avoid incest.

Pig. 20.— "Eternal Spring," by Eodin. Trom "Art," by Eodin. (Eeproduced
by courtesy of Small, Maynard & Co.) The sculpture expresses the eternal vigor
and constructive power of uneensored heterosexual love.

This same theme runs through that wonderful modern play,
"The Yellow Jacket" by Hazelton, in which the kind mother saves

144 PSYCHOPATHOLOGY

the infant from the jealousy of the father and then ascends to
heaven, becoming spiritualized npon wegling her child, which ends
its infancy. The young hero 's career then, till postadolescence, is
in the house of foster parents, a farmer, where the animals, birds,
fish, insects and flowers educate him (polymorphous interests in
nature). He emerges with an uncontrollable craving to know the
world and win love, and leaves home despite the pleas and tears
(resistance) of his parents (or foster parents).

In the world he promptly falls into the intrigues of homo-
sexuality which, symbolized, by the hunchback, tries to destroy his
virility through the seductions of a siren. When he loses her, he
becomes depressed, and enters into an infantile regression beside
the grave (memories) of his mother. While in this mental state,
he meets Plum Blossom, who like Ariadne, is a holy virgin who
loves virility, truth and heroism. Plum Blossom (Spring) now in-
spires him. Although he attempts suicide when her parents try to
keep her from him, they, upon learning of his ancestry, allow her
to present the youth with her slipper, the symbol of her love and
body, which is to become the inspiration and guide (thread), for
his conflicts and his prize if he conquers himself, his self-love and
vanity, by defeating homosexuality and evading social pitfalls.

With a mighty sword (phallus), given him by his foster father
(wish for his son's haature potency which many never receive)
and a garment, upon which is written, in her blood, his mother's
wish for his winning of virility, goodness and happiness (which
many mothers do not know enough to instill into their sons) and
Plum Blossom's love, as his inspiration, he sets forth to master
himself and the world. Gruided by a sympathetic philosopher (an
invigorating conception of his place in nature) he overcomes, in
turn, the Thunder God of fetich and tradition, the Spider and his
web-snares (labyrinth) of social intrigues and flattery, the Tiger in
the form of his jealous grandfather and jealous father (Minotaur
equivalent), and the freezing indifference of conventional society
towards the aspirations of youth. These heterosexual obstacles
become allied with Homosexuality's and Narcissus' seductive re-
sistance to the courage and self-sacrifice necessary to reach the
stage of true manhood. He finally learns to know himself, where-
upon he no longer needs the philosopher's guidance, and, entering
the temple wherein the Yellow Jacket of Virility is kept, he de-
mands it for himself from his homosexual, narcissistic brother.

VIRILITY, GOODNESS, AND HAPPINESS 145

Then calling the beautiful Plum Blossom to bring her body (phys-
ical as well as spiritual love), he places her upon his throne,
maldng her slipper his scepter. Thus, he reaches true maturity
and bestows honor upon his family, glory to the Emperor and
offspring to the race.

The heroic struggles of the male youth to develop skill and
power, the willingness to risk pain and injury in order to main-
tain courage and self-confidence are of the utmost importance for
sexual potency. Such traits of character and the postural ten-
sions of the muscles of this type of adaptation stand oiit in strik-
ing contrast to the adaptations and postures of the narcissistic
youth who loves his grace and beauty, dislikes struggle and
competition and dreads to make an error. The normal maiden
reciprocates in her development by cultivating grace and beauty
to charm and inspire the virile 3fouth. She admires power and
courage and dislikes timidity and narcissism in the opposite sex.
If, however, she herself has developed the masculine attribute to
dominate, she makes a poor mate for the virile male, and, because
of the discomforts and competition, avoids him for the effeminate
male. If one will study the postures or expressions of the fea-
tures and bodies of the illustrations "Caryatid," "Lachrymas,"
"Graziella," and "Falling Leaves," one sees a predominant
note of submissive longing for love and pregnancy, whereas in
the "Martyr" we see extreme suffering from uncontrollable
but ungratifiable eroticism depicted especially in the breasts and
pelvis. This condition is not unconamon to institutions for the
care of the insane, where the patient is sent because the family
abhors loss of self-control and the phj^sician is too stupid to un-
derstand human nature. Contrast the struggling Martyr and the
dying Psyche in "Cupid and Psyche," with the power, harmony
and virile assurance shown in "Eternal Spring."

Fear of being subjugated by the hyperactivities of an auto-
nomic segment is shown in "Maternity" and "The Lost Hour"
where the uterus is depicted as a grinding oppressive burden
that prostrates the body. The woman's sacrifice for maternity
is tremendous and requires great courage of those who fully com-
prehend its cost and suffering. The Caryatid shows the maiden's
awakening to the importance of her existence to the race and the
vigor of her maternal longing. A few years later this attitude be-
comes distorted by social intrigues, jealousies, fears and doubts.

146

PSYCHOPATHOLOGY

VIBILITY, GOODNESS, AND HAPPINESS

147

Fig. 22. — "Caryatid," "by Eodin. (By permission of the Metropolitan Museum of
Art, New York.) The vase as the burdensome uterus and longing for maternity.

148

PSYCHOPATHOLOGY

tmleBs her companions have most ■annsnal regard for what is
worth while.

In "The Storm" we see a beautiful flight of love which, how-
ever, is being pursued by the storm of social disapproval, and
the maiden, although courageous enough to follow her hero, shows
a little apprehension of what is to come. The' courage in this type
of personality contrasts with the sullen, shut-in, brooding auto-
erotic maiden who indulges in innumerable sexual fancies about
her male relatives and neighbors, but has been trained to fear and
avoid an open, frank courtship because of a withering sense of in-

Fig. 23-A.— "The Storm," by Cot.
A love fantasy ■ pursued" by censorship.
(By permission of the Metropolitan Mu-
seum of Art, New York.)

• Fig. 23-B. — "The Ring," by Alex-
ander. An uneensored love fantasy. (By
permission of the Metropolitan Museum
of Art, New York.)

feriority. "The Eing" portrays the calm, justifiable contempla-
tion of sexual love symbolized by the ring. It contrasts with the
agony of the unfortunate girl martyr and the wastage of "The
Courtesan," or the remorse and anguish of Rodin's "Eve."

The "Madonna of the Eose" illustrates the maternal adapta-
tion of the religious type in which the affect is not fully

VIRILITY, GOODNESS, AND HAPPINESS 149

satisfied by tlie birth of the infant because of the attachment to the
father, whereas the statue "Mother" shows a predominant love
for the infant, and "Bacchante" depicts robust, vigorous, graceful
joy of motherhood.

Fig. 24. — "The Madonna of the Eose, " by Dagnan-Bouveret. (By permission
of the Metropolitan. Museum of Art, New York.) This mother's posture, while con-
tented in most respects, shows some traces of longing in the features. Her costume
indicates a highly sublimated attachment to the father.

The group of young mothers, as fulfillments of the inherent
biological cravings, contrast strikingly with the ungratified long-
ings of the childless, the bitter anguish of those who fear the

150

PSYOHOPATHOLOGY

titems, the wasters of sex, and the abnormally sexed. Art'
miTseums are filled with snch portrayals of the struggle to gratify
the inherent biological cravings; and the physician, who would
understand human nature and "mental diseases," must become
able to recognize the nature of the dilemma in his patient. The
possibility of functional abortion is very great in both sexes, even
though the individuals have a splendid organic equipment through-
out life. Our social ideals and purposes in education must be re-
adjusted in a most decisive manner to correct the evil. The aver-

Fig. 25. — "Mother," by Lewin-Funoke. (By permission of the Metropolitan'
Museum of Art, New York.) Showing contented motherhood and the inspirations, of.
child worship. "■

age youth would eventually, like the animal, solve the riddle of his
place in nature if he were not misled by dogmatic ascetics and
biologically abnormal teachers into believing that the "fleshly"
cravings of his body will destroy the soul and that the "devil"
mysteriously encourages him to yield to their "filthy cravings."
Narcissistic youths are common in almost every social gather-
ing. They are characterized by their unusual admiration for their
physical and personal attributes and their inability to make the
sacrifices that are necessary to Avin the affections of others.

VIRILITY, GOODNESS, AND HAPPINESS 151

They may make desperately grotesque, even criminal, attempts
to establish their potency and attain the esteem of their asso-
ciates, such as the narcissistic seducer of girls who brags of
his conquests in order to be considered potent. Considered in
its varied phases, it seems almost miraculous, under the present

rig. 26. — "Bacchante," by MacMonnies. (By permission of the Metropolitan
Museum of Art, New York.) A modern version of joyous motherhood freed from
religious suppression and dogmatic conventions.

idea of social and educational propriety, for parents to be able to
raise children who are so wisely trained that the fullness of na-
ture's heritage will be theirs during maturity. It seems that the
conglomeration of races, languages, customs, religious dogmas and
social ideals, which have been perniciously thrown together into

152 PSYCHOPATHOLOGY

the treasure-house of primeval America has completely misled
the American people from the quest for true happiness. Only in
sporadic instances may families still be found who have not lost
their vision of man's true place in nature, families who have not
substituted economic or intellectual exhibitionism for love and
friendship.

The stage of maturity of the personality may be_ considered
to be entered upon at twenty-two, that is, about the years of com-
plete ossification of the skeletal apparatus and the development of
the ego's control of the individual autonomic segments (popularly
called self-control) for a full biological career, which includes the
capacity to derive pleasure out of the responsibilities of parent-
hood. It extends to the menopause in the female, and to the onset
of organic deterioration (sclerosis) in both sexes. During this
stage, both sexes, even though well developed as vigorous person-
alities, still retain bisexual traits and the constant possibility of re-
gressing (reflexly) to a homosexual level if the stresses of main,
taining heterosexual interests tend to cause too much anxiety and
sorrow. Regression often occurs even though the individual (male
or female) is the parent of children.

Heterosexual potency, judging from the behavior of many
psychopaths and normals of both sexes, varies in its vigor, and
is never quite secure from the possibility of disintegration in the
face of depressing influences, such as disease, a frigid, unldnd,
terrifying, neurotic or disgusting mate, hopeless economic bur-
dens, fear of pregnancy, or venereal diseases, social scandals, an
inaccessible or unresponsive love-object, death of the mate, or a
too fixed mother-attachment. The intrigues and usurpations of
power by the family of the mate, suppressing the idealized wishes
of the individual, often cause the regression to the lower level of
homosexuality, where, at least, parental sacrifices need not be
made. We have found, in the regression of many young wives
and husbands, that a domineering, jealous, scheming mother-in-
law or father-in-law played a most important part, as a cause of
the tragedy.

The disastrous influence upon heterosexual potency when the
autonomic apparatus has been conditioned (trained) to love sex-
ually the mother (her attributes, physical and personal), and can
not react so as to produce sexual potency when obligated to a

VIRILITY, GOODNESS, AND HAPPINESS

153

wife of markedly different physical and personal constitution, is
often found to be the underlying cause of the male's anxiety (Cases
riD-l, AN-3, PN-6, PD-35, MD-6).

Fig. 27. — "Der Sphinx," by Ton Stuck. The number of young men who are
destroyed by incestuous love is astounding. They form a large part of the popula-
tion of asylums and xJrisons. The incest mechanism is symbolized by the left hand
about the mother's neck while the right (moral) reaches out for help as the mother
attachment, like a cancerous, bestial influence secretly destroys his virility and love
for other women.

This tragedy of the male is wonderfully expressed in Von
Stuck 's grewsome painting, "Der Sphinx." Here, the beautiful
face of the woman, whose maternal affections are shown by the

154 PSYCHOPATHOLOGY

nursing mammary glands, is fondly kissing the helpless younj
man like a vampire. Her arms, fair to the elbows, are extended
behind him, and, becoming bestial, her talons are buried in his
back. Thereby, her selfish love, secretly ("behind his back" or
unconsciously to him), destroys the potency of his maturity. His
right (moral) hand grasps convulsively for assistance and free-
dom, but his left (incestuous) hand clings to her neck. Below the
shoulders, her body becomes bestial (incestuous) and the dark
cancerous shadow in the pedestal upon which she rests, symbol-
izes the biological disaster that threatens every man who can not
free himself from a physical mother-attachment and gratify the
needs of his affections at an esthetic level. It has been almost
consistently observed in the last five years that our male patients
who are admitted in a state of homosexual panic have profound
mother-attachments of an infantile, incestuous nature, and even
hallucinate having sexual intercourse with her during the panic
and despair (Case PD-34).

This mechanism, also, naturally, is to be found in the female,
who, because of her incestuous attachment to her father, finds all
other men sexually unattractive when she expresses her true sex-
ual interests, ■ and, when she permits her incestuous feelings free
play, she inclines to become impelled to submit herself promiscu-
ously as a prostitute to all men (Case HD-1). The report of the
Chicago Vice Commission shows that an astonishingly large per-
centage of prostitutes (over 50 per cent) were seduced by their
fathers or other adult male relatives, which indicates that overt
and secretly fancied incestuous interests have a definite relation*
ship to prostitution.

The physically matured males and females, who still have
affective attachments to homosexual experiences of adolescence
and "fond memories" of those incidents with their companions,
are not likely to become heterosexually mature. Many of them
become cynical and convinced that there is no such thing as hetero-
sexual love and never marry ; or if they do marry they find the ob-
ligations of the contract intolerably oppressive. As parents, they
have little interest in the maturation of their children and love
them in order to make a renewal of their own childhood.

An autoerotic narcissistic man or woman hates anything that
tends to .detract from personal beauty or self-indulgence, as the

VIRILITY, GOODNESS, AND HAPPINESS 155

sacrifices of parenthood. He despises the drudgery of parenthood
withont realizing that it is because of its impositions on his self-
love.

Upon marriage, a subtle, if not overt struggle occurs between
the mates for the dominant position in the contract. The big, ag-
gressive wife and timid, little husband attest to the importance of
organic superiority in the adjustment, but the average marriage
does not show such organic differences. The sadistic or masochistic
husband and masochistic or sadistic wife will certa,inly adjust to
please their reciprocating cravings, no matter what influence this
may have upon their children, and a sadistic husband and sadistic
Avife, although both are cruel in their pleasures, will divorce each
other on the charges of the other being cruel ; but it is the common-
place adjustment that interests us most, because it is most predom-
inant. Nature places an unerring punishment upon the woman
who, by incessantly using every whim, scheme and artifice, finally
succeeds in dominating her husband. By forcing him to submit to
her thousand and one demands and coercions, within a few years
he unconsciously becomes a submissive type and loses his sexual
potency with her as the love-object. If he does not have secret
love interests which stimulate him to strive for power he finally
loses his initiative and sexual potency completely and must live
always at a commonplace level, the servant of more virile men:
the counterpart of the subdued impotent males of the animal herd.
His more aggressive, selfish mate, if periodically heterosexually
erotic, will become neurotic if her moral restraints are insurpassa-
ble, or seek a new mate whom, in time she will again attempt to
subdue. Never is she able to realize that her selfishness makes
her sexually unattractive. The psychopathologist meets many
such women whose husbands have evaded domination by secretly
depending upon the affections of another more suitably adjusted
Avoman.

Men and Avomen often marry to escape from autoeroticism
or homosexuality, an incestuous attachment to a parent, to satisfy
an irrepressible, subconscious curiosity, or to escape from a pain-
ful economic or social situation. Such adjustments are rarely
happy because the individuals do not have enough of those attri-
butes, Avhich, as stimuli, are required by the conditioned autonomic
functions of the other ; hence, they do not invigorate and "inspire"
one another. This adjustment, if accepted as final, predisposes to

156 PSYCHOPATHOLOGY

loss of initiative and acceptance of the commonplace. Sncli indi-
viduals are able to get less than one-half of their working and crea-
tive capacities out of themselves and finally solve the problem
through secret attachments, remating or hopeless resignation.

Marriages, as cures for masturbation and irrepressible homo-
sexual interests, very rarely, if ever, are truly successful in either
relioAdng the autoeroticism or as a compensation for homosex-
uality. Such solutions are promiscuously advised by the ministry
and medical profession, when, at best, the maladjusted individual
is an imposition on the mate. ' Autoerotic or homosexual men and
women should always have a psychoanalysis and develop insight
before attempting to mate. Examples of the tragedies attending
such matings are collected in the chapters on the neuroses and
homosexual panics.

It is well known that excessive sexual indulgence is as perni-
cious and debilitating in its fatiguing influence upon the capacity
to win social esteem as too severe sexual restraint upon those who
have poorly developed sublimations. Copulation by no means can
be considered to be indicative of sexual virility, because it may
be entirely a defensive compensation against oral eroticism (Case
PD-10).

Throughout life each individual must maintain his virility, but
it will be consistently found that those who are persistent in dem-
onstrating their virility by "showing off," bragging with unmer-
ited bluffs and claims, and trying to evaluate their commonplace
productions above their intrinsic worth, are perniciously afraid of
their lack of virility. Five children, one six years of age, the
others about four years, were marching like soldiers. Upon asking
them, "How many children are there here?" the oldest child re-
plied "four." This compensatory attitude for organic and func-
tional inferiorities will be found throughout life, but in itself, must
not become an inferiority, like the grandiose claims of the para-
noiac.

The stage of decadence, organic and functional inferiority, be-
gins to make its appearance in the vital organs and blood-vessels at
about forty to fifty, and, the effect may be observable in the indiv-
idual's failure to compensate under stress (lack of physiological
recoverahility of the nerve, muscle and gland cell). The influence
upon the personality is to be seen in the manner in which the in-
dividual conserves his energy and economic resources. He admits

VIRILITY, GOODNESS, AND HAPPINESS 157

there are many things he does not care to know (make effort to
learn). He insists upon traditions, precedents, conventions, ances-
tral worship, and distrusts, very naturally, social and religious in-
novations, invests permanently in bonds and real estate, and be-
gins to feel an instinctive compulsion to suppress the surging pres-
sure of the younger men. Men in this stage naturally push their
class into the law-making bodies and offices of their corporations as
self-conservative measures. Biologically, it is the last struggle
of the old bull to maintain his dominant place in the herd (family,
community, nation). "When the economic, military and diplomatic
intrigues fostered by men of this stage develop international com-
plications, they summon, as feudists, their heroic youths to the
colors and hurl armies of them upon one another to further their
international schemes and the domination of their economic inter-
ests. (The leaders of the German military machine, as well as
her diplomats, were preponderantly men who had advanced far
into the stages of arteriosclerosis and organic inferiority. One
may see worthy sons, who could enormously improve the family's
business, bound hand and foot by the arteriosclerotic father. He
will not yield his grip on the dominant position in the fanlily.)

Throughout the case histories to be presented in the follow-
ing chapters, it will be seen that the psychoses are greatly deter-
mined by the individual's struggle to maintain feelings of being
virile and esteemed despite his inferiorities. The tragedy occurs
when he possesses cravings to do things and obtain things that
are not tolerated by his associates, and which he himself regards
as depraved.

Many youths are to be saved from disaster just so soon as
parents are trained to educate their children with the object of
enabling them to attain the functional state of biological virility.
Most psychopaths are, however, the offspring of loveless mar-
riages, and since few people really know whether they are happily
mated or not until some time after marriage, the necessity of trial
marriages and a revision of the social obligations pertaining to
the sexual functions is becoming imperative, or a profound refor-
mation of education must come. Many male youths only suceed in
stopping the tendency to homosexual perversions and masturbation
through heterosexual intercourse; hence, usually, patronage of
prostitutes. As grewsome as this fact is, it can not be evaded or
dispersed by scorn, but must fearlessly be given consideration by

158 PSYCHOPATHOLOGY

well-balanced sociologists and psychopatliologists, and not en-
trusted to the fanatical innovations and castrations of moralists
who are themselves suffering from sexual obsessions.

Prostitution, masturbation, homosexual and heterosexual per-
versions as a tendency to biological abortion and waste, and social
deterioration, are always to remain among the great problems of
the human race and incessantly require society's counter-efforts
to train the individual to enjoy living a socially constructive sexual
life. Society can not possibly escape the laws of nature (because of
the fatal tendency to autoerotic and homosexual reversion) by
erecting barriers against normal sexualit}^ There is but one so-
lution and that must lie in a profound revolution of social and
religious conventions and the ideals of education in order to bring
about a more healthful and happy career of sublimation of the
sex cravings with virility as the goal.

As vitally necessary as athletic and esthetic preoccupations of
interest are for the development of self-reliance and self-control
of the personality, there are many educational institutions that do
Jiot provide sufficient means and inducements to the school chil-
dren, maidens, youths, and young men and women. So far, at
best, many institutions that have gymnasiums encourage only the
more aggressive, and much smaller proportion of the pupils, to
cultivate control of their muscles and affective resources, and prac-
tically none of them give the student as much credit for developing
self-control and a splendid physique as they give for a course in
Latin.

Schools ought to be built around gymnasiums, and residential
communities around recreation grounds. The temple will event-
ually again become the sacred institution where athletic and es-
thetic refinement may meet to enchant and inspire the populace.
This aggrandized social ideal will alone be able to induce the youth
openly to cultivate the fundamental biological principles which are
most conducive to goodness, virility and happiness. Prostitution
and perverseness, alcoholism and drugs, are largely barometers
of our social system's aborting influence upon human nature. The
utterly bigoted manner in which professional, ascetic purveyors of
grace have striven to control the pressure of nature needs a sane
readjustment.

Humanity, no matter how it may be enshrined with eulogies

VIRILITY, GOODNESS, AND HAPPINESS 159

and hales of soul, is, after all, notliing more or less than a biological
product. Whoever intends to understand. the profound forces that
compose us, which, moving like the resurging tides, force us to
adopt fashions of thought to please the affections, must train him-
self to see man as a biological problem, a refined ape that has
learned to wear clothing, develop a written language and use
mechanical means for transmitting his thoughts and forces.

Anthropological history reveals that, as an animal, man has,
iiniversally, acquired a trait which is not to be found in any other
species, and that is the capacity to use symbols and images as
substitutes for realities in order to acquire stimuli which arouse
comfortable and potent autonomic tensions. The rela,tion of the
symbol to the ungratified affective craving in the child, the sav-
age, the psychopath, and in the normal, modern man, directs our
attention to the difference betAveen man's affective mechanisms
and those of the infrahuman primate. This difference is the
mechanism of the suppressed, and later of the repressed, or dis-
sociated craving or wish. The capacity to disguise the wish, while
aware of its influence upon other associates, probably had its be-
ginning, at least as far back in the phylogenetic scale as that rep-
resented by the Macacus rhesus monkey. The behavior of one of
these monkeys, who showed sig-ns of being conscious of himself or
his wish to steal his companion's food, was reported in full.*

In brief, he would approach his victim by moving backward
toward him while at the same time he pretended to be searching
for food in the sawdust before him. As he drew near the eating,
unsuspecting monkey, he slyly glanced over his shoulder, cau-
tiously extended his arm backward, and, if not being watched,
made a quick turn of his body and full extension of his arm, grab-
bing the food out of the other monkey's hands. His backward
manner of approach, apparent pretensions of being disinterested
(a behaviorism very commonly used by monkeys), his hesitation,
and his choice of conditions for grabbing, indicated, decidedly,
that he was aware of the necessity of disguising his wish ; hence,
temporary suppression of its domination of the projicient appara-
tus.

Children begin to use similar mechanisms when they become
highly enough organized as personalities to have to solve the prob-

•KemDf, E- J.: Did Consciousness of Self Play a Part in the Behavior of This Monltey?
Journal of Philosophy, Psychology and Scientific Methods, xiii, No. 15, p. 410.

160

PSYCHOPATHOLOGY

lem of satisfying their individual cravings, and yet retain the af-
fections of their masters.

The affective mechanism that would naturally follow upon the
development of the advantageous capacity of preventing a crav-
ing from jeopardizing the personality, by preventing it from con-
trolling the final common motor paths of the projicient apparatus,
would be the development of the capacity to repress it so that it
could, not cause the personality to think of it and be distracted
during a crisis.

It is this final mechanistic difference — ^namely, the capacity

. ; / ;

■- • ;.

^r^^

-^^1

■ '\ - > - — l-*"!'' "

sc^-- -

'~^

Kg. 28.— "The Eequiem." (From Pf iater-Payne : "The Psychoanalytic Method."
By courtesy of MofEat, Yard & Co.)

The fantasy, of a man -who had strong suicidal cravings and wishes to return
to the womb of his mother. The fantasy shows the mother church isolated for him-
self, the tower as the clitoris, the round window as the urethral orifice, the door-
way as the vaginal opening, the trees as the labia, and himself floating dead on the
waters of labor. The hills show the thighs parted and the mens veneris. Pfister
showed the posture of the details to be intimately related to characteristics of- vari-
ous members of the family and their cravings to possess the mother. [Compare with
Boeeklin's fantasy: "The 'Isle of the Dead" (Fig. 29)' and "The Resurrection"
(Fig. 55.).] - ■

to make affective repressions, that has probably giyen. man the
universal feeling that, in some certain profound, although un-
known, respect, he is different from lower animals. It is the re-

VIKILITY, GOODNESS, AND HAPPINESS

161

■3

-|J

' h

-4J

fcJD

^-^

• iH

-4J

-0

t«

• •\

t»

J2 eri

fcjD

bjD

'So
13

g «H ■

, CO

n ^ d)

i ^ &

j BO

03 .

' >t

) GJ O

eg ^^ cs

" ■« n CO

162 PSYCHOPATHOLOGY

pressed wish that longs to be regarded as the hopeful soul, the su-
premely beautiful and most pleasing wish of all in the personality
of man. As a solution for his repressed cravings, repressed be-
cause of the distractions, sorrow and longing they produce when
permitted freely to cause consciousness of their needs, Man's uni-
versal dream of eternal heayen is created.

In the happy, virile, normal individual, this mechanism is too
much obscured by his general obligations, immediate schemes and
ambitions to be recognized, but, in the preadolescenf, senile and
depressed individiial, the source and nature of the craving for
death and heaven is revealed in its biological values.

The wishes and fanfasies of the suicidal (Cases HD-1, AN-3),
show that the autonomic apparatus, being discouraged and de-
pressed by the hopelessness of the environment and the envy of
its associates, and still fascinated by the Avarmth and sincerity
of the mother's love, craves to return to its parasitical attachment
to her. Boecklin's "Isle of the Dead," when studied after the
print "Requiem," reveals wherein the gates to the first heaven
are located. The "Eequiem" was drawn by one of Pfister's pai-
tients,* who wished, as the patient himself repeated, to commit
suicide in order to acquire the feeling of being again with his
mother. The drawing of himself as a dead man floating on the
waters (of labor) before the Island (mother, alone) shows the
mother church between four trees. If one will see the steeple of
the church as the clitoris, the round window in the tower as the
urethra, the doorway as the vaginal inlet, and the two tall (broth-
ers) and two short trees (sisters) as the labia, then the wish ful-
fillment of the sketch and the origin of the symbols, in actual ex-
perience becomes obvious. The wish that created the symbolic
sketch must be associated with the fact that he wished to return
to the ivomb of his mother. Case HD-1, suicidal, was in a veritable
panic for several weeks from the feeling that she had to return
to the uterus, a belief compelled by the regression of the affect.
One mah (aged twenty-three) was obsessed with cravings to per-
form cunnilingus. He had a profound mother-attachment, and
several times planned to commit suicide, preparing his pistol and
secluding himself for the purpose. When he abandoned himself

•Pfister, translated by Payne: The Psychoanalytic Method, p. 394.

VIRILITY, GOODNESS, AND HAPPINESS

163

to the cunnilingus craving, he became aware of wishes to get com-
pletely inside of the female through the vagina.

If, now, we compare Boeklin's "Isles of the Dead" with Pfis-
ter's patient's "Requiem" it will l)c perceived that this profoundly
impressive painting has its potent influence upon the affections
through its symbolic value to our regressive tendencies. The isle
again symbolizes the lonely, isolated mother ; the great rock ridges
that converge behind the forest represent the flexed thighs; and the
forest, the pubic hair; the two pillars of the gate, the labial folds
about the vaginal entrance; and the entering, pure white soul in
the boat upon the waters (uterine) reveals the serious affective
origin of the unhappy Boecklin's masterpiece. The foetal posi-

Mg. 30. — The fetal position is obvious. Compare to the "Isle of the Dead"
(Fig. 29) and "The Eebirth" (Fig. 55).

ti6h of the Egyptian burial. Pig. 30, and that of the negress, who
made a series of attempts to commit suicide and wished to get out
of the world, as she has suspended, herself before the window in
the dark room, are self-explanatory. (See Fig. 62.)

If the posture of the prehistoric Costa Rican Indian's sculp-
tured figure (Fig. 64) is compared with the intrauterine position
of the hebephrenic dissociated j)ersonality, whose case is distinctly
that of an intrauterine affective regression under the pressure of
great sorrow (Fig. 65), the posture of the fetus, and the posture
of the motionless, eternal dreamer Buddha, the similarity of the
muscular tensions for their kinesthetic value is at once obvious.
The intimate dependence of postural tensions upon autonomic

164

PSYCHOPATHOLOGY

tensions and cravings has been well established (Sherrington,
Langelaan, De Boer) and must be considered as indicative of the
true affective interests of the individual.

If this tendency to infantile or intrauterine regression persist-
ently occurs when the environment is too severely depressing and

Fig. 31.— Buddha — the sublimation of autoerotie self-sufl5eiency. (Compare with
the postural attitude of the catatonic deity, Pig. 60.)

painful, then it becomes obvious that unless man is able to find a
means of keeping himself happy and virile, his biological career,
as a species, must soon find a level beyond which it will not tran-
scend, because it can not endure the depression and sorrow caused
by the ungratified cravings. This brings us back to the use of the

VIRILITY, GOODNESS, AND HAPPINESS 165

symbol and its saving, invigorating influence upon the ungratified
autonomic functions.

Anthropologists and psychologists have not adequately rec-
ognized that fetiches and idols, rituals, luck charms, and religious
systems have their origin in the compensatory strivings of the
ego to control th6 reactions of the autonomic apparatus. The
principle is simple enough. Every man must protect himself from
the incoordinations and weaknesses of muscle tone which instantly
are aroused by doubt of one's powers in a crisis. This self-doubt
or lack of self-assurance is a fear reaction. It quickly forms a
vicious circle because in an emergency or test self-doubt decreases
skill and power and this in turn, decreasing the margin of safety,
increases fear of failure. Sportsmen universally recognize this
principle. Hence the biological value of faiths, rituals, beliefs,
forms of thought, traditions, prayers, idols, fetiches, mannerisms,
which, as stimuli envigorate the man, and preventing self-doubt
or fear of "losing his nerve" are of the utmost importance. Ani-
mals, primitive man and civilized man depend enormously upon
bluffing as a means of keeping up courage and intimidating oppo-
nents. Rituals bluff the intimidations of the unknown.

Man has always had to compensate against potential defeat,
failure or danger, because no matter how remote, if the individual
is aware of it, it' remains a cause of fear and this in turn tends
to cause impotence. Hence, the creation of the symbol, ritual
and fetich as invigorating counter-stimidi which arouse com-
pensatory autonomic reactions which overcome the depressing
influence of fear and hopelessness. Man, no matter what his
intellectual rating may be, uses this psychotherapeutic trick in
some form. It is apparently necessary because, as Cannon has
shown, a fear producing stimulus causes a shifting of the blood
supply from the digestive apparatus (and the sexual organs) to
the organs (head, heart, limbs, lungs) which are used for defense
and attack. Hence, unless defensive or aggressive measures are
taken to remove the influence of the fearful stimulus, the nutri-
tional disturbances tend to become chronic, and chronic sexual
impotence results which might terminate the race. The sympa-
thetic encouragement individuals may give one another in the form
of praise, tokens of esteem, charms, fetiches, blessings, well
wishes, moral support, etc., are therefore invaluable. They be-
come particularly valuable in allaying the secret fears men and

166 PSYOHOPATHOLOGY

women have of one another because of the envy, jealousy and in^-
trigues that incessantly arise within the members of the family,
elan and community. The primitive community's ritualistic
efforts to produce rain in the time of drought or to stay rain
in time of flood, to induce the return of the sun in winter, to
bring peace in time of a losing war, or relief from the ravages
of disease, beasts, famine, to induce sexual excitement, preg-
nancy, and labor, etc., are important, in that they tend to en-
courage reciprocity with and sjmipathy for one another. Environ-
mental dangers, as winter, storms, beasts of prey, are not so con-
stant, as trials, as the feuds between individuals of the same
sex and community. It is in the effort to induce the- men and
women of a community to renounce envy and avariciousn-egsA'ha.t
the Christian formalizations of religious behavior have been
cultivated.*

Through . relieving the fear of another's political and iwjpV;
mercial intrigues and homicidal plots, the biological potency of an
individual is increased, because the pelvic converg-fttcet of the blood
supply is permitted so soon as the cephalic convergence is no
longer necessary for defense.

Among savages, the plots and selfish intrigues were so inces-
sant, the necessities of life so difficult to acquire, pregnancy so
burdensome, and infant mortality so great, that the potent phallus
and its images were, by compensation, made the supreme gods of
ancient Man. Neither is it surprising that in sjTXibolic disguise it
should still continue so today, if one considers the physical and
personal sacrifices that are necessary to maintain the parental
state and provide for the needs of a family.

Another important value of the symbol as an autonomic stim-
ulus lies in the tendency of the invigorated autonomic reactions
of one individual reflexly, more or less vigorously, to stimulate im-
itative reactions in a friendly associate. The rapidity with which
imitation occurs is to be seen in the almost simultaneous leaping of
a school of fish, of the darting of a flock of birds, the reactions of
the mob or audience. The tears of the mourner or actress start
tears in the viewer; we admit that some smiles are welcomed be-
cause they stimulate imitations in us.

It is this very mechanism that also prevents many physicians
from using the psychoanalytic method ; because, when the patient

*Wc, however, slill make a Christian's appeal to God to defeat our enemies.

VIRILITY, GOODNESS, AND HAPPINESS 167

permits the recall of his repressed emotions and memories, the
reflexly imitative reaction of the sympathetic physician, although
not usually observable in the form of overt movements, occurs in
the form of unpleasant postural tensions producing kinesthetic
images which often require considerable patience to endure. One
may observe that most people experience an activation of parotid,
lingual and labial reflexes when some one expresses a craving for
certain kinds of food. Although it is well known that such reflex
imitations occur, many psychiatrists are distressed by imitative
oral reactions when compelled to listen to the account of the crav-
ings of an oral erotic psychopath. Friends and families weep and
sing together, are afraid and courageous together, women feel
cravings to become pregnant when others are pregnant, or avoid it

i^H^Pk'.

^^^fe^* ■' ^>

- 'j'^-' '';*'■■*■'" ;*'3^

} ^Hj^i^jife

■■■■

Fig. 32. — Copulation feticli from the Ivory Coast of Africa. Undoubtedly made by

a negro savage.

in groups, boys enter similar professions, children imitate each
other's objects of play or an adult's work, etc. Hence, when the
semipotent man or woman can obtain from the more virile compan-
ion a hint of his faith in his charm, fancies or method, or of what he
loves, the general tendency is to imitate the method or steal the
object — as fashions in dress, remedies, by-words, hobbies, ideas.
That which is intensely desirable to one becomes desirable to
many, even though it is only a misleading fancy. This is probably
the fundamental factor in hypnotism and suggestion and in the
miraculous influence of the inspired mystic who, zealously using
his self -invigorating charm, arouses his clan to overcome the

168

PSYCHOPATHOLOGY

Fig. 33. — Azteo God wearing a robe showing a phallic border, probably to popularize

and stimulate reproduction.

VIRILITY, GOODNESS, AND HAPPINESS

169

causes of fear and impotence. But it is his unshakable faith that
gives the other man confidence and encouragement as the inspira-
tions of Joan of Arc, and not the amulet or fetich.

The material, word, or movement, that may be used as a sym-

Fig. 34. — Aegean Figure of Goddess, with Serpent Attributes (about 1600 Bi. C.)
showing serpentine design in the costume and serpent entwined figure with coil in the
abdomen probably signifying pregnancy. (By permission of Metropolitan Museum
of Art, New York.)

bol to express the interest in the reality is as varied as language
itself, which, after all, consists of merely sound or sign symbols.
It must be recognized that almost anything that has the slightest
similarity of appearance or action, or contiguity of relationship
may be used by the affections to express their interests in the real-

170

PSYCHOPATHOLOGY

Kg. 35. — "Falling Leaves," by, Merle. (By permission of Metropolitan Mu-
seum of Art, New York.) Fantasy of impregnation, with falling leaves symbolizing
the seed.

VIRILITY, GOODNESS, AND HAPPINESS

171

Fig. 36. — ' ' Graziella, ' ' by Lef ebore. Maiden with net longing for maternity — ■
the plan or net as the means of catching her ]over. (By permission of the Metropol-
itan Museum of Art, Now York.)

172

PSYCHOPATHOLOGY

Fig. 37. — "Lachryma-e," by Leighton. (By permission of Metropblitan Museum
of Art, New York.) Woman longing for maternity. The vase rests upon the pillar
(phallus) while the fires burn to renew life.

VIRILITY, GOODNESS, AND HAPPINESS

173

rig. 38. "Eve," by Eodin. (By permission, of tlie Metropolitan Museum of Art,

New York.) Anguish following the censored sexual act.

174 PSYCHOPATHOLOGY

ity. Many psychiatrists have professed utter intolerance of the
suggestion that a knife, spear, wand, tree or horse should be used
as the symbol of the potent phallus, and yet they probably often
speak of a man as being "green" when they mean unsophisticated.
The word "screw" is commonly used to mean copulate. (See the
Ivory Coast fetich, Fig. 32.) A series of illustrations is given to
show how symbols are used in art to express the affections. The
same symbols are often used in dreams and fairy tales. Fig. 10
shows the erect phallus as a suffering man (prehistoric Costa Ei-
can Indian) ; Fig. 3 is an Aztec ceremonial knife, the handle of
which is a male in the copulation position and the blade stands
for the extended penis; on the same page is an African negra's
wand with a face carved into the glans penis, treating the phal-
lus and its cravings as a distinct personality. (This value is
also given by psychopaths, to the penis. One patient spoke of the
penis as a god that stood up like a little man.) Fig. 33 is an
early Mexican (Aztec) statue in the border of the robe of which is
worked the penis and testicle motive, and Fig. 34 an Aegean
(1600, B.C.!) statuette with the serpent wound into the border of
the gown, along the arms, into the head-dress, and knotted into the
abdomen (pregnancy) ; also the conventionalized serpent motive is
woven into the hem of the apron. The painting by Paul Veronese
of "Mars and Venus," Fig. 16, shows Mars uncovering Venus for
the sexual act while an infant symbolizes it by binding their legs
together. About Mars are many symbols of the potent phallus,
the horse, sword, armor, trees, grape vines and satyr. Venus is
also pressing milk from the nipple and looking at the infant that
binds her to Mars. (An identification of the nutritional and sex-
ual interests in the same fancy. See the prehistoric Costa Eican
Indian's sculpture of copulation. Fig. 15.)

The tree as a phallus, and the falling leaf as the impregnating
semen, is symbolized by Merle in "Falling Leaves," Fig. 35. The
lovelorn maiden and the infant playing near her, but still oiit of
sight, reveal the affective influence that created the fantasy.

The net as a web of ideas to catch the fish (infant) and the
lover is shown in the painting of the maiden with the net. Fig. 36.

The pillar as the phallus and the vase as the uterus, and the
fire (passion) that burns as they become imited, are shown in
Leighton's painting, "Lachrymae," Fig. 37, w^hich fantasies a

VIRTLTTY, GOODNESS, AND IIAPPINESS

175

Fig. 39. — Eve. (By permission of Metropolitan Museum of Art, New York.) Eve
awaiting the rise of the serpent.

176 PSYOHOPATHOLOGY

beautiful sorrowing woman who is suffering from an ungratified
wish for motherhood. This same motive is wonderfully depicted
in Eodin's "Caryatid," a postadole'scent maiden who is bearing
the burden of an ungratified uterus. The vase or bowl, as the
uterus, and the serpent, as the phallus, and their relationship for
beauty and health are immortalized in the statue of the Greek gi^
dess of Health, Hygiea, Fig. 1. She is shown enabling the serpent
to approach the bowl. Beveridge's "Lost Hour" and "Maternity"
depict the bowl as symbolizing the agony of the uterus : one, the
imgratified uteru's, and the other, the subjugation of the woman by
the pregnant uterus. (An example of an autonomic segment over-
coming the ambitions of the ego.)

Eodin's "Martyr," Fig. 13, shows by the engorged breasts
and the muscular torsions of agony what may be suffered by a vi-
rile woman who is forced by the conventions of society to repress
the maternal cravings. On the other hand, Eodin's statue of the
wasted "Courtesan," Fig. 12, shows what may occur upon sexual
excess and sexual perversion. His " Centauress, " Fig. 46, shows
the. autoerotic female with extended hands, striving in despair
to escape the compulsions of the bestial pelvis, and his "Eve"
portrays the shame and remorse after the loveless indulgemue
whereas the statue of "Eve," Fig. 39, shows a beautifully mod-
eled and poised woman gladly awaiting the rise of the serpent
from the earth beneath her.

The religious joy that comes to the female upon conceiving
the child after a love indulgence, may be said to be portrayed by
Lewin-Funke's statue, "Mother," Fig. 25, and, similarly, though
with different sentiment, by Dagnan-Bouveret's painting, "The
Madonna of the Eose," Fig. 24. They represent two most pro-
nounced, although quite different, methods of expressing joy.
Perhaps Lewin-Funcke's statue, "Mother," may be considered to
be the more modern and expressive of a new, growing ideal of
maternity.

Eodin's statue, "Eternal Spring" (virility, goodness and hap-
piness). Fig. 20, is a marvelous portrayal of the affections, which
as a love mating, brings out in horrible contrast, as biological
abortions, modern commercialized, loveless marriages. Cot's
painting, "The Storm," shows a love flight pursued by society's
criticism. The backward glance and slight anxiety of the maiden
indicate that her love is not quite free from the censorship of her

VIRILITY, GOODNESS, AND HAPPINESS 177

associates. Alexander's painting, "The King," Fig. 23-B, con-
trasts with this, showing the maiden in her home, contrasting
with a dream common during the erotic state, showing the destruc-
tion of home and loss of friends, which occurs when the woman
abandons herself to her passions (the wish to be abducted for
prostitution). She is often helpless in the arms of one conqueror
while others are already approaching. The wish for an abandoned
liaison is often portrayed in the dream by the fire that destroys the
home and the world ; and the anxious complaint is often made by
the uncontrollably erotic patient that the world has been destroyed
by fire. Eodin's statue of "Cupid and Psyche," Fig. 42, portrays
the old Greek truth that when love is denied or lost, thought and
inspiration (Psyche) dies.

Michelangelo's statue, "The Captive," Fig. 47, shows the
dual nature of Man. The youth, bound about his chest (suffoca-
tion distresses are often complained of while eroticism is re-
strained), has his homosexual, perverse craving symbolized by the
crouching beast (ape-dog) behind him. Barnard's statue, "The
Two Natures of Man," Fig 17, shows the perverse influence as
an imp of owl-dragon combination resting upon the prostrated
half of the man. (One patient saw the infantile, perversely auto-
erotic self before her in a dream as a black little imp.) Zurbar-
an's painting, "St. Michael, the Archangel," Fig. 17, expresses
the imperative requirement that Man shall master incest and
homosexuality.

The destruction of youths and maidens by satyrs, minotaurs
and centaurs in the fantasies of the ancient Mediterranean peoples,
probably has its origin in the attempt to prevent biological de-
struction by the tendency to revert to bestial perversions. Soph-
ocles' "Oedipus" was probably a profoundly thought-out pro-
test against the incestuous tendencies of the lower Greeks and their
slaves.

In contrast to the hero's slaying of the oppressor, Michel-
angelo's statue, "La Pieta," Fig. 54, may be used to show the col-
lapse of the youth when he is forced to sacrifice his vital love
wishes because they would conflict -with the potency of his beloved
father. The most common of all psychopathic tragedies is the
crucifixion of the son's or daughter's love because they are condi-
tioned to oppose the rival father or mother. (See Chapter XI on
catatonic and crucifixion adaptations.)

178 PSYCHOPATHOLOGY

There will always be clever thinkers and zealous writers who
will not be able to tolerate the conception that the symbol is used
as a means, by the ungratified biological cravings of man, of obtain-
ing some relief, as in his fancies, dreams, writings, researches, psy-
choses, philosophies, religions, etc. But, whatever they have to
say in their attacks and counter-arguments, they must bear in
mind that often an individual reveals, by what he hates or can
not accept, what he has himself repressed and why he has re-
pressed it. This goes even deeper than conmaitting oneself to a
profession of faith which must afterwards be upheld in one's in-
terpretations of life. It goes to the bottom of the conditioned
cravings of the individual and his sublimation of them in order to
attain personal comfort and social esteem.

Virility can only be attained through the enjoyment of work,
play, study, fight, prayer and more ivorh. It must be maintained
by working for the true needs of. the autonomic apparatus as it
happens to be conditioned, despite all anxiety and suffering. If
the repressed" cravings are perversely conditioned they must be
readjusted by the psychoanalytic method, or adequately subli-
mated through striving for some scientific, artistic, religious or
altruistic ideal.

According to the conception of the development of the per-
sonality discussed in Chapters I to III, the following studies
of abnormal personalities, presented in Chapters VI to XIII are
made. Wherever the eccentric behavior can not completely be
explained by the manifest wishes, indications for the nature of the
repressed cravings have been sought. The repressed cravings,
when dissociated from the control of the manifest cravings, con-
stitute the "not me" or the foreign, "hypnotic" influence which
the ego must struggle against in order to keep control of its overt
behavior.

CIIAPTEE IV

THE INFLUENCE OF ORGANIC AND FUNCTIONAL IN-
FERIORITIES UPON TliE PERSONALITY

An organ is relatively inferior when its structure or function
is not equal to the average requirements that are fulfilled by the
same organ or function in other members of that species. The
inferiority may be due to the organ being undersized, oversized,
diseased, or deformed, or displaced from its most advantageous
position, as the horns of the stag, the upper or lower mandible of
a bird, undescended testicles, delicate hands, or hyperthyroidism;
or it may be due to the excessive or inhibited innervation, as the
anger or fear state of the stomach while competing in polite so-
ciety.

A function may be inferior to similar functions of others,
although the organs that are used to perform the functions are
quite superior to the average; as inferior skill in swimming, or
fencing, the more rapid solving of problems by enthusiastic chil-
dren as compared to brooding children, sexual impotence in the
depressed or fearful, the inability to make love in the timid.

Organs and functions in one individual may be enormously
superior to the same organs and functions in others under some
conditions and fatally inferior under others ; as Avhen an amorous
person is married to an indifferent mate ; egotism and selfishness
wins in childhood and loses in maturity.

In every instance the inferiorities of the organ or function for
the requirements of the situation become emphasized when they
tend to cause failures in competition ; and after a few distressing
experiences they cause a persistent fear of failure. The fear of
failure in turn stimulates an autonomic compensatory striving to
prevent failure, forcing the development of skill and power in
the weak organ or an associated orgctn: as the stenographer learn-
ing to write "with the left hand after the right has been injured, the
stammerer in youth becoming the writer or orator during matur-
ity. When the fear of failure can not be compensated for, we have
an anxious neurotic patient.

179

180 PSYCHOPATHOLOGY

Compensation as a physiological process is obviously a most
fundamental characteristic and requirement of living things and
is found in all living things. In fact, so soon as the powers of com-
pensation begin to fail, the organism or the personality begins to
deteriorate and finally dies. Physiological compensation to pre-
vent failure is to be seen in the storing of glycogen and fats
in the tissues to compensate for the loss of vital energies
due to metabolism, the development of immunity for infectious
bacteria, the mending of injured tissues, restoration of power and
vitality after disease, fatigue or fright, cardiac muscle compensa-
tion following valvular deficiency or hard work, the hypertrophy
of a kidney upon the excision or disease of the other kidney, the
balance of function in the endocrine glands, etc. The necessity of
compensation goes farther. We find it is the process of develop-
ing accomplishments and self-control by the personality. The
compensatory efforts to prevent the distresses caused by climatic
changes, beasts, diseases, war, hunger, social rivals, etc., developed
the skill and power to build houses, make clothing, invent and con-
struct languages, governments, machinery, create the modern
methods of medicine, surgery, etc.

Competition with the lower animals no doubt enormously
stimulated the ape-man and his offspring to develop mechanical
means of conquering and subjugating them in order that they
could not cause fear. Competition betiveen species, although often
a struggle for life, is by no means as severe and incessant as com-
petition between individuals of the same species who become con-
ditioned to require the sam,e objects to satisfy their autonomic-
affective cravings.

This fact was emphasized by Darwin as a most important
cause of evolution among higher animals.

Through sexual competition and the general tendency to favor
the fit, the less fitted or inferior are forced to diverge from the
favorite pursuits unless they can make adequate compensations;
hence most of them die or develop eccentric variations, and the
neuroses and psychoses are to be regarded as failures to make
comfortable adjustments and are eccentric biological variations.
It-is easy to see how the fine qualities of a species are maintained
through the successful natural selection of that which most thor-
oughly gratifies the autonomic needs of the individual. The func-
tionally and organically superior are so consistently favored that

ORGANIC AWD FUNCTIONAL INFERIORITIES 181

ail men and Avomen are forced to develop estimable qualities unless
well protected by the strong and rich. The principle of natural
and sexual selection which has been maintained for countless gen-
erations, and upon which much of modern, civilized man has been
developed, must be recognized as the predominant determinant
of social adaptations whether the average individual is con-
sciqjis of it or not. Therefore, the organically or functionally
inferior male or feniale, child or adult, must make an adequate
compensation that will not only win in competition but also win
some social esteem, or always feel a pernicious sense of being
biologically inferior to his associates. Most people who have
sexual inferiorities show by their behavior and sensitiveness that
they are more or less consciously, incessantly on guard at trying
to keep their inferiorities hidden or unobtrusive. This defense
must be so consistently maintained that it has a most decisive in-
fluence upon vocational selections, places of living and working,
choice. of friends, mating, prejudices, forms of thought, etc.

We find that the stupid, illiterate, unclean, indecent, awkward,
ugly, weak, unskillful, poor, cowardly, immoral, vulgar, criminal,
perverse, tend to associate together in order that their functional
inferiorities will not be emphasized by too serious contrast with
the intelligent, decent, graceful, beautiful, strong, skillful, wealthy,
courageous, moral or normal.

Alfred Adler* emphasized the importance of organic inferior-
ities as the cause of distressing compensatory strivings. The im-
portant fact is that it is the individual's fear of his organic or
functional inferiority that forces him to make compensations which
later, as eccentric claims, in turn may themselves become inferior-
ities because of the criticisms, loss of confidence and ridicule
which they arouse ; as the flaunting of heroic or sexual conquests
by the effeminate male dandy. The inferior organ, as undescended
testicles or effeminate face, voice and physique in the male, is not
the fundamental cause of the eccentric compensation, but the fear
of ridicule is the cause. We find that some men, who are decidedly
unsexed by nature, are able to live their anomalous biological and
social careers quite comfortably because they have been msely
trained from infancy to maturity to accept their organic defects
and attempt no compensations which later may become causes of

*Organ Inferiority and its Psychical Compensation, Nervous and Mental Disease Mono-
graph Series, No. 24.

182

PSYCHOPATHOLOGY

distress. On the other hand, many people are to be found who a,re
organically well constituted and, professionally, decidedly sldllfnl,
who can not escape feeling a pernicious sense of inferiority which
must be protected in every conceivable manner. This may be due

"Fig. 40. — Simulation of perfect man by undersized Russian immigrant, age 18,
illiterate. He thought the wearing of a man's suit would encourage him to grow to
fit it.

OEGANIC AND FUNCTIONAL INFERIORITIES 183

in some instances to the prejudiced training in childhood, or an
unredeemable act of perverseness or cowardice, but it is necessary
to look for a more general cause of anxiety in certain forms of
functional inferiorities. It may safely be assumed that all func-
tional inferiorities, in vocations or hobbies, as of the mediocre sur-
geon or musician, in themselves, occasionally cause anxiety, but
this occurs ouly when circumstances place too much responsibility
upon the act and arouse fear of failure. Hence a form of functional
inferiority that interferes constantly Avith the struggle for hetero-
sexual virility and biological fitness must be considered to be the
critical factor. As such, the psychopathologist finds that tvherever
men or ivomen are sexually inferior to the ideals of their associ-
ates, due either to organic vmfitness, as masculine traits in the
female or effeminate traits in the male, or functional inferiority,
as the tendency to autoeroticism or sexual perverseness in either
sex, they feel a pernicious sense of inferiority from which they are
forced to protect themselves in some manner.

• The methods of defense for inferiority vary greatly, but may
be correlated into three general types. They are either (1) avoid-
ing competition, or (2) eliminating the inferiority, or (3) develop-
^ ing a protective superiority in some other organ or function.
Either adjustment tends to become extreme and eccentric if the
fear of the consequences of the inferiority is pernicious and quite
continuous, whether the individual is conscious of it or not : then
the compensation may become so eccentric as to constitute an in-
feriority also!

Avoiding competition because the inferiority is ahvays re-
flexly contrasted with the opponent's or rival's superiority may
vary from the tactful avoidance of certain forms of competition to
the general dread of all personal contact. The latter through its^
insidious influence, within a few years develops an incurable
psychopath; as in the seclusive, suspicious, brooding, autoerotic,
postadolescent boy or girl becoming the regressive hebephrenic.

Elimination of the inferiority may be solved by a severe,, un-
conditional aversion for anything that influences the individual tO'
become aware of his inferiority or by having it excised or re-
paired; as surgical repairs, or self-inflicted castrations for haas-
turbation or perversions, and catatonic adjustments.

The tendency to prevent the inferior craving from causing the
individual to be conscious of its existence mav become Severe

184 PSYOHOPATHOLOGY

enough to be considered a psyehoneurosis, particularly when the
effort at repressing the inferior function, as masturbation crav-
ings, causes serious preoccupations of thought which interfere
with work.

Compensation, by developing a protective superiority in some
other function is, fortunately for the progress of civilization, the
most common method of adaptation and the most successful. The
successfulness of this method for the individual's needs does not,
however, always depend upon the fine qualities of the compensar
tion, as the development of literary, artistic or scientific skill, but
upon the fact that fear of the secret inferiority, as a potential
cause of failure to win social esteem, has ceased. We find men
Avho have made remarkable contributions to society's welfare who
can not even then escape from having a pernicious feeling of be-
ing biologically inferior to the ordinary, happy*go-lucky artisan.

When the fear of being inferior ceases, the tendency to com-
pensation slows up and wherever we find eccentric or unreason-
able attempts to win social esteem, as in the paranoiac 's or autistic
imbecile 's claims, we are sure to find an unavoidable fear of havi#g5
a certain functional inferiority recognized by others or by the in-
dividual himself. Inferiorities that are pernicious causes of anx-
iety initiate eccentric compensatory strivings, which in themselves
become notorious (as gaudy, loud exhibitionism, grandiloquent
manners, extravagant claims of wealth, honors, social recognitions,
unfounded claims of great inventive capacities, illegal profiteering,
bigamy, white-slave exploitation, sexual conquests, fanatical sex-
ual-religious reformations, pathological lying, stealing, etc.) The
inferiorities in such cases have been found to be almost invariably
sexual. The cases to be presented show that in every instance of
pernicious asocial behavior we find that the individual was suffer-
ing from an irrepressible tendency to crave that which was sex-
ually perverse or unjustifiable. Their eccentric strivings, while
conducive to self-control for perhaps several years, finally became
inferiorities because they ceased to win confidence and only
aroused ridicule, which soon forced the individual into a vicious,
affective circle that became progressively worse.

Vicious circles of compensation in vital organs for a diseased
or inferior organ are common enough, as in compensatory emphy-
sema but vicious circles of affective adjustments have not yet been
given their due importance.

ORGANIC AND rUNCTIONAi INFERIORITIES 185

The psychopathologist and general practitioner must there-
fore thoroughly familiarize themselves with the mechanisms of
compensation in order that, as in compensatory emphysema, a
study of the compensation will assist them in diagnosing the true
nature of the individual's inferiority and his method of adjusting
to it. So soon as Ave deprive a man of his means of compensating,
by forcing him into a vocation which he dislikes, or by preventing
him from abandoning a position that deprives him of a means of
solving his affective distress, or by discrediting his creations, he
tends to become anxious or even panicky. He now becomes a
patient, complaining of distressing cardiac, respiratory, gastric,
intestinal, rectal, or genitourinary sensations, which we must
recognize as flowing from pathological tensions of certain auto-
nomic segments.*

These tensions are conducive to iinbalancing the reciprocal re-
lations of the other autonomic segments, and by their causing a
stream of distressing sensations, the autonomic apparatus most
effectually forces the individual to make a social adjustment which
will permit it to resume its normal methods of working. When an
artisan loses his right hand in an accident and complains of in-
somnia, loss of appetite and a "sinking feeling" in his abdomen,
we know that the stomach and viscera in the epigastric region have
assumed postural tensions that are the source of a stream of fear-
ful feelings. As he compensates by developing efficient skill with
his left hand, the dangers of failure and poverty decrease and the
viscera are again enabled to work at a more comfortable tension.
But it is the uncomfortable tension of the viscera that forces him
to go through the drudgery of learning to apply his left hand.
The development of skill must be recognized as having a psycho-
therapeutic value and a most decided physiological effect upon the
autonomic apparatus through enabling it to acquire the stimuli
that it needs.

The above type of case is rather simple when compared to the
individual whose inferiority is not a lack of skill, physical means or
social opportunity, but is due to an irrepressible craving for some-
thing or to do something which is absolutely tabooed by society,
such as erotic perverseness, or an uncontrollable but unjustifiable

*Such terms as "mental," ''somatopsychic"' or "imaginary" are unsatisfactory when applied
to such conditions. They only reveal the diagnostician's loose methods of thinking about such
processes.

186 PSYCHOPATHOLOGY

love, hate or fear. A study of a large group of psychopathic per-
sonalities shows consistently that they are the victims or hosts of
persistent autonomic cravings ivhich are conditioned to seeh ivhat
they regard as perverse stimuli, such as oral or anal, incestuous,
homosexual, autoerotic stimuli, or illegitimate pregnancy, etc.
Such individuals may give up the fight for self-control and, sub-
mitting to the cravings, become social delinquents or dependents,
or hallucinate images of the necessary realities and treat them as'
realities; as the simulations in hysteria or the hallucinations in
chronic regressives and paranoics. We find many such individuals
in asylums and prisons as well as in society.

On the other hand, the man may strive desperately to master
himself and coordinate all his powers upon a compensation that
will bring him assurances of being esteemed and will prevent him
from becoming conscious of his inferiorities. It has been pointed
out before that this striving may or may not be valuable to civiliza-
tion. After some time it may tend to fail and then is pushed on
until it becomes hopelessly eccentric. Behind this compensation,
more or less subconscious and vigorous, we find the individual is
afraid, fearful, uneasy about losing control of himself and becom-
ing dominated by the dissatisfied, perversely conditioned auto-
nomic segment.

It is obvious that the individuals who have marked organic
inferiorities, (such as a girlish physique, hairless skin and soprano
voice in a male, or a mannish physique, facial hypertrichosis and
baritone voice in a female), and serious asocial cravings (for homo-
sexual submission in the male or female), have most terrific diffi-
culties in themselves and society's aversions to overcome. Their
struggles are terribly severe when compared to those of the indi-
vidual whose organic constitution is inclined to be ridiculed but
whose training has been so wisely managed that the affective com-
pensations are quite normal; or the individual who is physically
true to sex but is affectively perverse but kindly and tolerant and
does not hate his critics.

The men and women, who are constituted to be physically and
conditioned to be affectively true to the sexual requirements of the
race, have no comprehension of the anxiety their more unfortunate
brothers and sisters must suffer unless they themselves have had
experience with trying to cure them.

The normal men and women, who loved, but finally failed to

OKGANIC AND J-UNCTIONAL INFERIORITIES 187

\nn their love-objects, may have some comprehension of the sup-
pression those people must endure who are conditioned to love
perversely, but they can never comprehend the terror and panic
such people endure when they realize that their ability to control
themselves is weakening and they may be forced by their own pas-
sions into unredeemable social and biological degradation. It is
not uncommon to see such men and women desperately resisting
the perverse erotic pressure long after a dissociation of the per-
sonality has taken place and they are being forced to endure a riot
of perverse hallucinations which are produced by the erotic affect's
uncontrollable seeking for gratification. The cases of benign dis-
sociation neuroses, (the manic depressive group) and the perni-
cioiis dissociation neuroses (the paranoiacs and the paranoid, cata-
tonic and hebephrenic dissociated types), often show these causes
of fear and bewildered efforts at compensation and defense.

The cause of functional inferiorities is often due to fear of
using a function or orgaii under certain conditions ; as fear of ex-
aminations or competitions even though sufficiently learned or skill-
ful to meet the test, fear of trying because of being considered
awkward, stupid, ignorant or silly, or fear of the responsibilities
or consequences involved in the act wh^en the safety of others is
dependent upon it. In heterosexual functions fear of pregnancy,
venereal disease, social scandals, blackmail, a rival, of being
jilted, rebuked, scorned, ridiculed, or of ejaculatio prsBcox, pain,
marriage, etc., certainly makes of the opposite sex hideous mon-
sters instead of attractive lovers ; hence the erotic affect is turned
back to the more easily maintained homosexual or autoerotic ad-
justment. Inferiorities due to fear of using normal organs are
much more easily adjusted than the homosexual fascinations which
have existed since childhood.

Summary-
Only those organic inferiorities are compensated for which
tend to jeopardize the biological career of the animal by being con-
ducive to failure in the struggle for life and sexual favor — in man
the struggle for sexual favor and social esteem, social esteem be-
ing an elaboration of the sexual interests, is to be given pre-
eminence, except, perhaps, during war.

The fear of potential failure stimulates the autonomic appa-

188 PSYCfiOPATHOLOGY

ratus, the individual or organism as a unity or whole, to compen-
sate by developing, or claiming to have developed, skill and power
in some socially beneficial and estimable capacity. When the com-
pensation begins to fail as a defense, a vicious affective circle is
established which eventually destroys the personality if the causes
of fear are not rectified. This principle is the same as that death
of the orgaiaism follows when its physiological compensations fail.
In the following chapters the most prominent types of the
ego's compensation or adaptation to the causes of fear and the
various types of autonomic affective cravings that become causes
of fear, although most pleasing to the individual under certain
conditions, are illustrated by typical cases.

CHAPTER V

MECHANISTIC CLASSIFICATION OF NEUROSES AND

PSYCHOSES PRODUCED BY DISTORTION OP

AUTONOMIC-AFFECTIVE FUNCTIONS

The following system is essentially based on the integrative
functions of the nervous system, the derangements of which pro-
duce the psychoses as symptoms. The same forces that build up a
personality when harmoniously integrated cause its deterioration
when unadjustable conflicts occur. It is always necessary for the
progress of any science to be willing to abandon an old system and
adopt the new if more efficient and adaptable to facts. The old
biology died hard in opposition to DarAvin's theory of evolution,
and many scholarly old physicians found the germ theory of dis-
ease beyond comprehension and utterly intolerable, but in each
struggle the more practical and rational method eventually re-
placed the old. Modern psychiatry is certainly in need of an
elastic, adaptable hypothesis, a direct terminology and method of
classifying its cases and problems. Should a patient have a ty-
phoid infection and develop nephritis and myocarditis, the clin-
ician would certainly add the words nephritis and myocarditis to
his diagnosis and again drop them as the different organs recov-
ered. Psychiatry must find a similar method.

The modified Ki;aepelinian system of classifying personalities
and psychoses fails because it is fundamentally based on a static
neurology, emphasizing symptoms and prognosis. Syiiiptoms have
been grouped into circumscribed disease entities despite the fact
that a large proportion of cases show symptoms which are classi-
fiable into two or three, or even more, groups, such as neurasthenia,
manic-depressive types and dementia prsecox type ; or hypomanic
and paranoid. About half the cases are, at one period or other,
atypical for the Kraepelinian divisions. Most institutions easily
evade this dilemma by dogmatically forcing the most suitable
diagnostic term onto the case for statistical purposes. If each im-
portant institution could be induced to give, sealed, to a central

189

Q
O

CO
O

o
I— I

H
O

>H fJL,

I— I

H
O

CO
CO

o
o

H- (

I— (

1—1

W
Q
PJ

l-H

H
P<
O
H

2 M

O OJ

■^S ft
- aj 1)

o 5 I

P4IZ;

_i- ,,'0 aj £- o 3
•2 !>,.ti= C 3 h S

" X rt K,3 " !3

S 0.2-0

■^^ ^ p

_ oj o (

■£'3 Sf
S ->

.J3 bo ^

11°

ftJ3 flj
to •«

*-< O 1^

; 1 o +3 b -t-' I
-J3 rt ° .5

So,

'.§■5 2 o'^

: c-^^

•5 "BO'S

GO H.S

•".£

(i('

, M— v.'H hS JJ

! C ,, rt o cd £

,^.0 OJ QJ^ . O

1 at Cfe Jgl^ V "m

•u rt o ^- "u

o -," ™

stJ 13 3

t ^ c w ^ '/, li"^ n-r

_ g = "> - n-

l*ij 3 rt " m tn ^

'3 R-"" !< " .

o ^- " bfl ** - m

° S ^ "." C

° E W O ft t>- bo

"! Sill;

C.2 o-a p

■ ^ tii

§p

oT (ij m £

P^-3

" C «

J=> t4H

rt'-i^^

b ft <u 4j t;"

•- "" rtiti "J rt f^ tfi

i O rt O r- I

° ° torn'" G "i"^ B

■^ X 3 ^5 S S.g^ u

"Xt 3 ta (u rt tl.3 e. „ >, 3 qj 3
o 3 rt ^ - nj u^ b . ^. ra

B S « j; ■"

f! „ 3

" S S S c

. 2 — S ?c

'm 3."^ uj

, JJ JH " " tJ

■« 11 "So 3,0.3.10- g ,

M(o 0 o "'"«.:= h -

£ a "

■ a" £S'l3

S §.,1 S-«

■ D ^m 3.+-
' o. „ 3 -C
I f ■n.S'S ^

H M 5 o

r§ ir.2.2

1 -d Jl^ t, rt 3 5

. t^' o -S o

•S'E a

E 3 .

g s >- g-s
.swg-sSg

.2 .Sg S
o^^ . „ w

m OJ 3 +j »-;

"SE'H
»-s.2 5

4) M tj.^

l^ S O •+H

_-5 p m g 3 g

S3 Jf ..gfex
£ a ■ iS t^ 2 S

tH E ,

l^u-

u.^.2 G u
MO o !■ " >
.G » B "

!. 3 o 1
O-i'

^ o 3

4-* C •" r- to

.2 g c B -a
^Sog^E

ft ft+j nf^

OJ 6 C
Woo

-^ft^

>%3

I^S

oo^ " G
.3 y 3 OJ aj

— in UJ

g, " 3 •>

> ■? « ■

f^ CO C (u in

Si? ^ >

rt.g-a ° rt h

u -t-ii+i bo'+j

o .2

o o "
" +j tn

*" tn '-'

<u OJ 2 !

.Li

en ■)-• S

c G ft o o

I ^"^ " .

u o to ■

S IH O dJ 4J

£o.g'g.S§i

ACUTE OR PERIODIC

190

>• O 3 "
■S M R u

£■■2 3-
1 S S !^

ftO I

o rt'o O
*j ft--

o yi bo S .
-=5.^ S o "

- >.'J >» " o
m w frt — ' -rt

■g ^ e;s K

-M tn O G t

Mm OS

0Jt3

go nl aj I

.Sii'TS.;

.5 "1 5J

U 9J I rt

tn i+H

- TO,

TO -5

'Si

, ' £ g S S B

3"*^ S ® 2 -d

O .^-M- +-■.

a 11 cajs t> '
"Zl ca C m

1 c ''J — w ,T

"■S V, I'? °

boi^ h ? OJ rt

.ssss.s>-3

o ft

1-. nj

m (U i IJO*^ (Um tn" wii i:

be »^ S a.£ 3 s fe b-s I

r^ ft-r: i-" bfl o " jj ■

C o gf^ ttj g.o S „

>> E +3 cd D S " O

J3 ^ 3 ., St) y

i/j C 10 in o

M^i-cMiuboi-tJm box)

1 oj'^ d u

■t; '^ -ft

y " O. ft.O

" .2 "oV

i-s g.-

Sg'a.3^:2Be

~B ,„-

■O a-

?Cc

S .y c 2 ^. o -v t" -

,-<8 S ^-^-^'S s §■§ g i
a»2„-g .-s.Silli

E--.2'^ oj n o V a^^fi
g "3 rtii «,2 &H »

e2 c

•s5e

.SS u

fi ^ ft

3&>

ass

U nJ

~ -"+-1 M .

^rt-r-clErtiit::

l&l

^«r.5

r o I— I

) OJ - 5 lU

. C +j rt ft

; o " o

^--^i! S g o a rt-^ rt.2 ft?,

I ?! ^ <U C •

Bgoi^

3 m

d ..2i-*'^B .2

3.2£-aJ=5"-Bg
•".OTz: - u S ■"

_34Jt.M t>PC3

.c-o

U] a

r^.3." v-

^1^1

[■fctJ '+3 TJ « „

™ d S fi •"■ ^'Ti
ft.;^ ^ rt ft-t-" ft

: 'S'+j p R ;- I
-.2 o ft-'?.B fl "^

5t3 ft nJ w wM-i.i:! -^.t^

2.^:2 r ■

a-a-?.-

V ^ c

P-„B

"■" '-.S S"jS ".2

"J ^^ ij ci* ti d ^
B|ooc."ggg

2 b " bi, i- c '■&'*'

.S 5~ S n, 6

M s ill

bo £3 ^ aJ
flu "ti
.3 +j _^ fl

,nl V

■5 ^ rt ft 00

- « fl «

aj t, 4-;

ra ,, ^^ O '^

" .£ aj, aJ fl
! o rt o ^Ji

i c fl o « c S

: d.Oj:] C O fl
m 4j +j aj ■j;^

C bo ^
° C 2
ft'm'w'5
c in fl-r-

■at, 05.3

^ gj! 8 uja o

"Sit: " ,.t; rt'

>■ o S S^Sg'!

J, .— i fl s(j +j n u
"P a; p o rt .rt -^

.s'^ .S.S*j m ;
PHM^-agS-

: OJ ii a G i^ ri "^ i

S 3

•°S o-

••3VI

2 " S'S a

^ So «.-S " w !

"■« w-§ '^ "^'^ G4

aJ. K ttJ o "i ? '73 ^
a bo oi+^, w t5<B f

E^3 g s 0) '

;-;3 P .

: h ;

^-E;

•IS - p.s^

- o aJ aj o
ii ^. o M

, gT! i. (

OR CHRONIC

191

192 PSYCHOPATHOLOGY

committee, its actual working system for classifying cases m
dementia prsecox, manic-depressive, paranoia, hysteria, and neu-
rasthenia, illustrated by cases, the differences would probably be
so varied that the whole system would have to be abandoned be-
cause the faithful assumption that symptoms are similarly ap-
plied and evaluated throughout psychiatry would be brutally
discredited. The errors in medical and surgical diagnosis are the
result of the failure to discover critical symptoms or the wrong
evaluation of the symptoms found. To this difficulty is added, in
psychiatry, the fact that personalities vary greatly in their auto-
nomic activities at different times, under different conditions and
under the care of different physicians ; and the same environmen-
tal conditions may have entirely different influences upon differ-
ent people, and upon the same person at different times. Hence,
the symptoms (as irritability) that are shoAvn under certain en-
vironmental conditions may not be noticeable under others, and
uncontrollable cravings may constitute a benign difficulty in one
case and a pernicious influence in another. Many cases may be in-
fluenced to change their attitudes toward uncontrollable cravings,
so that a pernicious conflict may become quite bent§ff or the re-
verse ; as in autoerotic or perverse cravings — one case may end in
suicide and another in a wild orgy, or zealous purification. The
strongest argument against the utility of the old system is the
manner in which such terms as ' ' manic-depressive " or " dementia
prsecox" mislead psychiatric curiosity, when there is any. In-
most ins'titutions the diagnosis "manic-depressive" tacitly means
recoverable and "dementia prascox" means incurable, no matter
what is done for the ease. Hence, M^hen a case, diag-nosed "cata-
tonic dementia prsecox," recovers, the inclination is to reconsider
it as a stuporous manic-depressive. The analytical study of
large, varied groups of cases shows that nothing could be more
fallacious or misleading. Remarkable, constructive, healthful re-
adjustments can be made if the autonomic-affective conflict can be
corrected and readjusted.

It seems, therefore, much more practical to use a system of
classifying psychopaths according to the nature of their autonomic-
affective difficulties and their attitudes toward them, because this
keeps the dynamic factors directly in psychiatric attention and
permits of revision as the cases change. It is adaptable, intelligi-

MKCHANISTIC CLASSIFICATION OF NEUROSIS AND PSYCHOSES 193

ble, simple, and the nomenclature^ is directlij applicable to the
mechanisms involved. It is also comparatively easy to pick ont
the differentiating factors. We must not forget that the golden
rule in diagnosis is to htioiv what we are looking for because then
it is infinitely easier to find it. Hence the essential mechanistic
factors that make a case curable or incurable, or determine its
course and prognosis, are used for the terminology in the following
system. The psychopathologist, therefore, can only diagnose his
case in so far as he understands it. Under the old system the
promiscuous diagnosis of "dementia prsecox" is correct in over
half the cases (in obscure cases in medicine and surgery this is
fairly good practice) hence even if the physician knows little or
nothing about a case, he is reasonably safe becaiise over half the
asylum cases are "dementia prsecox types," i.e., disposed to de-
teriorate.

The descriptive terms, acute, chronic and periodic, are valu-
able for medicine and surgery and decidedly so for psychopathol-
ogy. Here the term, actde, is reserved to apply to cases of less
than one year's duration. Chronic is applied to cases having
had more than a year's duration or eases that have had an insid-
ious course for more than a year before the consultation. Periodic
is applied to cases that have periodic or intermittent episodes
or recurrences accompanying the repetition of natural phenomena
such as menstruation, pregnancy, the birth of a grandchild, mar-
riage or death of child, etc.

The most important question to be ansAvered in any case is,
"Is the illness likely to prove destructive or fatal?" In psycho-
pathology the paramount issue is, "Do we have a benign or per-
nicious process at work?" In the vast majority of cases, we may
safely hold, as an axiom, that the benign or pernicious nature of
the autonomic-affective conflict is determined by the ego 's adapta-
tion to the pathological cravings. If the ego can not accept the
cravings as a part of the personality, we have a pernicious mecha-
nism that is sure to force an eccentric, if not asocial, development
of the ego. If the intolerable cravings are inclined to increase in
vigor through natural physiological processes (gro-wi;h) and ex-
ogenous stimulation (as the sexual), we have a malignant process
that exerts an incessant pressure to influence an adjustment so
that gratification can be obtained. If the sexual cravings are
disowned by the ego and are conditioned to seek the type

194 PSYCHOPATI-IOLOGY

of stimuli which were pleasing in infancy or preadolescence,
the destructive influence upon the personality will be greater than
if the cravings are postadolescent in type or fully matured, and
the resistance is due to an excessive prudishness.

On the other hand, apparently, no matter what the segmental
cravings tend to seek, if the ego is inclined to accept them as a
part of the personality, due to natural causes, and not due to secret,
mystic. or unnatural influences, the personal conflict is not so fer-
nicious but is rather henign, because the autonomic distress is less
severe and in turn the compulsion to compensatory defenses is
less persistent ; hence the individual does not become so eccentric
and asocial. Furthermore, the benign mechanism is usually ac-
cessible to psychoanalysis and constructive readjustment, whereas
the pernicious mechanism is extremely difficult to influence. Quite
frequently, however, patients' attitudes change from pernicious
adaptations to the segmental cravings to henign attitudes; as in
Case PD-33, an oral erotic submissive homosexual, who for two
years was diagnosed a typical "paranoid dementia prsecox" be-
cause of his convictions that the cravings were caused by secret,
hypnotic influences and were not a part of his personality, — caus-
ing most eccentric defensive behavior and compensatory, grand,
omnipotent, egotistical claims and fancies. Upon the development
of a transference to me, he asked to have his "mind read," and in
due course of time the ego's fear of the segmental cravings-
changed to a frank consideration of them, the mechanism chang-
ing from an apparently hopeless pernicious type to a fairly en-
couraging benign type. As he learned to allow the repressed dis-
sociated cravings frajikly to cause him to be conscious of their
needs, the weird, hallucinated sensory images of assault, etc.,
disappeared and the case changed to a suppression (anxiety) neiT-
rosis of a benign though serious nature. As his sexual cravings
became more heterosexual and normal, and the oral eroticism
abated, the suppression neurosis and eccentric compensatory
striving decreased so far that he had to be discharged as socially
readjusted. Under the old classification he would have to be con-
sidered as a case of paranoid dementia pra^cox that had made a
social recovery. Under the following system he Avould at first
have been diagnosed as a chronic, pernicious, dissociation, compen-
sation neurosis, and, upon discharge, as a benign suppression neu-
rosis ivith a tendency to eccentric compensatory striving.

MRCI-TANTSTTC CLASSIFTOATTON OT? NETTTiOSTS AND PSYCTTOSES 195

To emphasize : the essential moohanistic difference between a
henign neurosis and pernicious neurosis lies in the ego's attitude
toward the segmental autonomic cravings. 80 long as the patient
reAains the tendency to accept the personal source of the ivishes or
cravings ivhich cause the distress or psychosis ire have a henign
type; and when the patient develops the tendency to oppose or re-
fuse to accept the personal source of the ivish or craving, to hate
those ivho woidd attrihute a personal source for the craving and
evasively to hlame an external or im-personal cause for the diffi-
culty, tre have a pernicious type. Obviously, the benign attitude
is capable of being analyzed and corrected, whereas the pernicious
attitude is most difficult to rectify and influence.

The chart shows that the terms, acute, periodic, or chronic,
are to be prefixed to the terms, henign or pernicious, and they in
turn prefixed to the different types of neuroses.

The neuroses have been differentiated into five distinct gen-
eral types, because of the five distinct differences to be found in the
autonomic-affective mechanisms. It must be borne in mind, how-
over, that an individual may have one or more mechanisms at one
period just as he may have erysipelas and nephritis or become
healthy. ^ '<-

The suppression neuroses are characterized by the individual
heing, clearly to vaguely, conscious of the nature and effect upon
himself of his ungratifiable cravings. Similar autonomic distresses
may be caused by the loss of the love-object, through its inaccessi-
bility, as death, indifference, infidelity, or the perverseness that is
craved, or through the individual's becoming disgraced and unfit
for the love-object, as imprisoned, exiled, ostracized, etc. ; or the
inability to escape from one cause of fear because of a more dan-
gerous cause, such as the battlefield versus court-martial for
desertion. For this reason it is utterly imsatisfactory to use such
terms as "situation psychoses," "war neuroses," or "shell
shock." They are no more scientific and practical than the diag-
nosis of "automobile fracture," "fall fracture," "jump dislo-
cation, " " elevator sprain, " or " railM^ay spine. ' '

The repression neuroses are characterized by the individual
trying to prevent the autonomic cravvn.gs from causing him to be
conscious of their nature or needs and influence upon his person-
ality. He succeeds by maintaining a vigorous, incessant, defen-
sive coordination (concentration of attention) of his egoistic

196 PSYCHOPATHOLOGY

■wishes upon a course that compromises, as a resultant of converg-
ing forces, with the repressed cravings. In battle the autonomic
tensions -which produce the distressing afferent sensory streaffl,
called fear, must be relieved. Flight niay mean life-long disgrace
or court-martial and shooting for desertion. Motor disability or
localized anesthesia, as blindness or deafness, results in hospital
treatment, hence the "war neurosis" is the symptom of the re-
pressive adaptation to the uncontrollable autonomic reaction.
There are certainly two distinct types of "war neuroses" — shown
in individuals who know that they are incapacitated by fear, admit
they have "lost nerve" but can not control themselves, and in-
dividuals who maintain that a bruise, wrench, fall, or explosion
caused the functional distortion that keeps them from the battle-
field, insisting on the other hand, that they are not afraid.

The psychological mechanism of suppression, wherein the
individual permits the affect to cause him to be aware of its needs
but prevents it from causing overt behavior, is decisively different
from the adaptation of repression, wherein he not only prevents it
from dominating his overt movements, but does not allow it to
make him conscious of its existence or true needs (makes himself
forget it).

The results or effects -of these two adaptations are distinctly
different, the effects being the symptoms. Their types reveal the
nature of the adaptation — ^whether suppressive or repressive. The
symptoms of suppression neuroses are mild to severe distressing
hypertension or hypotension of some autonomic segment or seg-
ments, whereas the repression neuroses show similar effects plus
distinct functional distortions of the projicient apparatus or sense
organs ; such as localized spastic or flaccid paralyses, anesthesias,
hyperesthesias, or amnesias, mannerisms, compulsions, unchange-
able preferences, persistent thoughts, etc. They are more difficult
to treat than suppression neuroses, because the patient's tendency
is to prevent the disagreeable affect from causing him to become
aware (conscious) of its existence, and^ the treatment essentially ^
requires that he should allow it to assert itself naturally and then
be assimilated or used for constructive purposes.

The compensation neuroses as a division naturally follow
next. When the individual feels that he has cravings which arc
socially inferior and detrimental, and wishes to win social esteem,

MECHANISTIC CLASSIFICATION OF NEUROSIS AND PSYCHOSES 197

the fear of losing social esteem and fear of the influence upon his
personality of' the intolerable cravings initiates a compensatory
autonomic reaction, which in turn compels a course of behavior
that is designed or adapted to acquire some form of comforting
social esteem. Obviously, when the asocial cravings cause persist-
ent, intense fear, the compensatory striving is likely to be more
vigorous, obsessive, eccentric and socially less adaptable, being
frequently designed to destroy or defeat the environmental factors
that arouse the intolerable cravings, as well as those opposing- the
compensation. Hence the eccentric compensator^^ striving is to be
regarded as protective but symptomatic of the fear of a secret
functional inferiority.

The regression neuroses are quite opposite in type to the
compensation neuroses in that the individual makes no effort or
gives up the struggle to win social esteem and biological potency,
regressing to a preceding, usually preadolescent or infantile, func-
tional level. During this sort of adaptation the asocial cravings
are acceptable to the ego and permitted to run a rampant course
of indulgences. The symptoms of the compensation neuroses are
characterized by striving, egotism, intolerance, grand claims, and
usually high tension of the striped muscles, with a general quick-
ening of the autonomic activities whereas in the regression neu-
roses we have social indifference, lethargy, apathy, slovenliness, ir-
responsibility, suicidal tendencies and a decided general, lowering
in autonomic and striped-muscle tonus. In the compensation neu-
roses distressing visceral tensions occur almost consistently and
may be serious if involving a defective vital organ, whereas in the
regression neuroses the individual is comfortable.

The dissociation neuroses, as the fifth division, follow logically
and naturally, covering that enormous group of patients who suc-
ceeded in keeping the undesirable cravings repressed until they
became dissociated and finally dominated the personality through
the increase of their vigor, because of stimulating environmental
and metabolic conditions, or the decrease of the vigor of the ego
because of depressing and exhausting environmental and meta-
bolic conditions. The dissociated segmental cravings may be
fought to a bitter finish, as in the paranoid adaptation, or yielded
to in abject fear and despair as in the catatonic, or accepted with
disgusting glee and abandon as in the hebephrenic and epileptoid.

198 SSYGHOPATHOLOGY

They may rim a consistent course or a periodic course as in the
liallucinated, regressive epileptic, who has periods characterized by
fair judgment and self-control.

The distinctive symptoms of the dissociation neuroses are:

(1) the ego is forced to be conscious of weird, distorted images
(hallucinations) of past sensations (experiences) which seem to
gratify the dissociated affect although they horrify the ego; and

(2) the ego is dominated by unacceptable, mysterious cravings
worldng as obsessions, phobias, compulsions and inspirations.
The dissociation neuroses may or may not be further characterr
ized by severe visceral distress and motor disturbances, localized
anesthesias, amnesias, etc.

The distinctive difference between the henign dissociation
neurosis (hallucinated manic or depressive) and the pernicious
dissociation neurosis (hallucinated dementia prsecox and epileptic)
exists in the fact that in the henign adaptation the ego never quite
loses the faculty of knoAving that, after all, the most important in-
fluences in the psychosis are the wishes or cravings which are
getting satisfaction (physiological neutralization). When the
formerly henign psychopath begins to lose this faculty, a perni-
cious mechanism develops Avhich, imless rectified, will seriously
abort the personality. On the other hand, most serious, perni-
cious maladaptations may be readjusted to benign mechanisms by
training the patient to accept the wish-fulfillment in the psychosis.

It is a common occurrence, under the old system of classifi-
cation, for so-called manic-depressives to change into dementia
prsBCOX types. The reverse course is more uncommon, and when
it occurs the diagnosis of "dementia praecox" is usually changed
to tentative "manic-depressive."

There is often considerable disagreement about the differen-
tiation of paranoid, catatonic and hebephrenic tyes of dementia
prjecox, Avhereas under the mechanistic diagnosis the presence
of regressive and compensatory tendencies can easily be covered
by these terms. For example, chronic, pernicious, regression,
dissociation, compensation neurosis, covers Case HD-4, an apa-
thetic, anal erotic sailor who regressed to a preadolescent, irre-
sponsible social attitude, enjoyed the hallucinated sodomistic
pleasures and compensated with claims of great inventive powers
and omnipotence.

MECHANISTIC CLASSIFICATION OF NEUROSIS AND PSYCHOSES 199

The studies of Clarke and MacCurdy and others, as well as
the cases included in Chapter XIII, show that certain types of
epileptics are really biological (erotic) abortions in which the
epileptic convulsion has nothing less tlian the value of an erotic
orgasm. These cases are characterized by regression, dissocia-
tion and compensation mechanisms shown in their infantile ir-
responsibility, hallucinations and omnipotent fancies. It is gen-
erally recognized that under the old classification, some cases,
classified as dementia prascox, develop epileptoid convulsions and
a typical epileptoid personality; hence the difference between
many epileptics and hebephrenic demeiitia prascox types is really
symptomatic and not mechanistic. Therefore, it seems quite ac-
ceptable to classify the epileptoid mechanism under the type of
functional neurosis tliat covers it; most cases, not showing symp-
toms of dissociation at first, are rather to be classified as perni-
cious repression neuroses.

In the table, under the heading common symptoms, the generic
group and the more common symptoms are detailed. The common
causes can not be fully given except in a semigeneric manner, be-
ing as endless as experience. Uuder old diagnostic terms, those
in most frequent use at present are listed.

The terms suppression, repression, compensation, refjression
and dissociation, as applied to neuroses, represent levels of de-
viation from the normal, but one or more terms may be applied to
the same case. For example, we may have a suppression neurosis
with or without the tendency to compensation or regression. The
term dissociation implies repressions that have finally overcome
the ego 's power of control ; hence repression need not be used when
dissociation is used in the diagnosis.

"When this system is fully developed the biological nature of
the cravings which are repressed or dissociated, will also be desig-
nated, as love, shame, hate, fear, sorrow, as well as the level to
which the regression has occurred, as adolescent, infantile, nurs-
ling, prenatal.

In_ conclusion the term "psychosis" is not used because, after
all, the sensory phenomena which we are conscious of as thoughts
and wishes are really integrative phj^siological processes and 'the
term "neurosis" is more consistent wth the integrative functions
of the nervous system.

200 PSYOHOPATHOLOGY

This system of differentiating and classifying psychiatric
cases is to be considered as essentially Mologicalr It is hoped
that it will be fully tested and adequately readjusted. I Wke
found it most useful for correlatiiHf . important, essential attributes
of widely scattered and apparently dissimilar cases, which could
hardly be possible under the old systems of clasifying them. Un-
fortunately, it is necessary to present Chapters VI to XIII, cov-
ering the neuroses and psychoses, according to the old' system
of classification with parallel references to. the new system bpMuse
the old system is now in general use. It is hardly necessary, to re-
mark that terms designating the hyperactive condition of some
gland of internal secretion or the presence of an infection, toxin
or drug can be used by adding. "-with" hyperthyroidism, typhoid
or morphine intoxication to the type of neurosis.

CHAPTEE VI

THE MECHANISM OF THE SUPPRESSION OR
ANXIETY NEUROSES

Anxiety may vary in degree from brief to continuous slight
visceral discomforts about the cephalic, pelvic, cardiac or epi-
gastric regions, to very severe general physical discomforts. It
may occur intermittently or endure indefinitely. These variations
are determined by the nature of the affective conflict. The more
severe forms may be characterized by vertigo, headache, a dis-
agreeable sense of "stiffness" in the extrinsic muscles of the eyes,
and at the base of the occiput and muscles of the neck, nausea,
vomiting, tremors, reduction of digestive capacity Avith eccentric
appetite, abdominal griping, diarrhea or constipation, rectal tenes-
mus, cystic tenesmus, dismenorrhea, amenorrhea, excessive mic-
turition, incontinence of feces or urine, dyspnea, tachycardia, in-
creased blood-pressure soihetimes, a disagreeable postural weak-
ness, felt particularly in the muscles of the forearm and hand
("weak grip"), and those extensor muscles of the thigh ("weak in
the knees") and the back ("spineless") which continuously
oppose gravity, restlessness and insomnia, also facial apathy or an
overcompensatory tenseness, aresonant voice sounds, persistent
thoughts, and inability to create new thoughts in order to meet
even trivial emergencies, such as keeping business schedules, etc.

The anxiety is felt in the form of distressing sensations that
arise from the (anxious) postural tensions which various visceral
segments assume when the environmental situation contains the
possibility of danger or failure.

Experiments upon dogs, cats and humans by Cannon, Carlson,
Crile, Pawlow, and others show, upon causing fear or anger by
presenting a potentially harmful stimulus, reduction in the
capacity of the stomach to secrete digestive fluids both in quantity
and in digestive quality, a marked tendency to achlorhydria and
an increase of mucus, inability to macerate the food or to pass
it into the duodenum, a protective tendency to regurgitate food,

201

202 PSYCHOPATHOLOGY

and a reduction in the blood supply to the stomach, intestines,
pelvic viscera and external sexual organs, and a generally weak-
ened muscle tonus and contraetibility of the viscera. The de-
creased secretive capacity of the salivary glands and the intestines
is to be included with the general inhibition of function of the
stomach; hence, general decrease of the assimilative and elim-
inative powers of tjhe digestive, apparatus. The uncomfortable
sensations that flow from the hypertense or hypotense visceral
posture have probably become necessary to compel the animal
to remove the environmental stimulus, or escape. , Behind the
patient's complaints of "indigestion," "constipation," "heart
burn," "stomach burn," "gastric ulcer," etc., this mechanism,,
as a fear reaction, should be seen at work and the complaint never
considered to be " imaginary. ' '

A gradual- reduction in weight and general physical power, as
well as in capacity to compensate against the onslaught of disease
or the waste of fatigue, results if a solution is not found.

Obviously, it is vitally necessary for the organism to be able
to compensate when it is subjected to a painful stimulus in order
that the stimulus, as such, may be evaded or reconstructed. Com-
pensation applies to potential dangers and failures as well as in-
fections and injuries.

Cannon and others have shown that following a painful stim-
ulus, whether of a distance, or contact, or proprio-receptor, the
compensation takes place in the form of definite physiological
changes, the most important of which so far demonstrated, are the
following :

(1) Decrease in blood supply to the digestive system and
sexual organs, and a reciprocal increase of blood supply to the
organs that have to do with the defense and attack. (2) In-
crease in the sugar and adrenin content of the blood. (3) Increase
of the thyroid secretions. (4) Else of blood-pressure. (5) In-
crease in the rate and amplitude of the cardiac systole.

This physiological adaptation and compensation to sustain the
expenditure of energy is vitally necessary. Upon its immediate
and sufficient occurrence depends the organism's power to evade,
destroy or reconstruct the painful stimulus or situation so that
comfort giving stimuli may be obtained.

It should be recognized that this compensatory mechanism,
like all physiological functions, may react inadequately, sufficiently,

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 203

or excessively. Upon the degree of the reaction depends the na-
ture of the individual's adjustment, as to whether or not it is
timid, submissive and depressive in type, or admiirably ivell bal-
anced (common sense in type), or drastic and eccentric, as violent
anger at impleasant but banal situations.

Anxiety is felt when the compensation is insufficient or when
its excessiveness, being difficult to control, is also a source of
danger. The visceral muscle tensions and localized vasomotor
engorgements or anemias, that also contribute sensations which
constitute anxiety, are located mostly in the digestive system.
This may be due, phylogenetically, to the f^ct that upon the con-
sistent normality of the digestive functions depends the general
health and nutrition of the organism. The capacity to cause the
distressing sensations, it seems, has been gradually acquired
through evolution as the best means of compelling the organism to
act decisively and rearrange its environmental relations by remov-
ing the painful factors or removing itself from them, so that the
digestive functions can maintain their normal course -with as little
disturbance as possible. Then only may, eventually, the reproduc-
tive cravings accomplish the propagation of the race.

There has been considerable difficulty in applying this compen-
satory mechanism to human behavior because in most situations
the presence of the painful stimulus is not apparent to the observer
or to the individual himself, unless he has made a particular search
for it and is trained to recognize it as such, often it is a potential
or possible danger to be encountered in the future.

The influence of the mechanism of compensation is also to be
seen in the sexual functions, that is, in the potency of the indi-
vidual, because, whenever uncompensated fear comes into the
sexual situation, sexual potency becomes diminished proportion-
ately. The individual can only be considered sufficiently potent
when he has overcome such obstacles as indifference, poverty,
obscurity, ignorance, the rival's malice, expense, and social ob-
ligations and also has the capacity for confident, courageous but
refined preliminary wooing, followed by copulation with an ade-
quate affective climax upon seminal emission, which, in turn, pro-
duces relaxation. Whenever anxiety or a subtle fear reaction ac-
companies the sexual act, although the excitement and erection
may be maintained, the emission is usually precocious, and the af-

204 PSYCHOPATHOLOGY

fective adjustment is unsatisfactory. A heightened irritability
remains, and, consequently, dissatisfaction with the sexual object.
The physiologiqal cause of the impotence is probably the failure of
adequate vasomotor engorgement of the sexual organs. This ac-
companies the shift of the blood supply to the head segment and
the defensive organs, which, in turn, is dug to the presence of a
fear arousing stimulus somewhere in the implications of the sexual
indulgence. This fact is of enormous significance to health, and is
underestimated by most physicians.

It is generally recognized that flushing or pallor, trembling,
aresonance of the vofce, stuttering, fidgetiness aiid more or less
confusion, complete loss of ability to talk or think coherently, when
one is about to address an audience, are due to some form of em-
barrassment of the integiptive functions. The individual feels,
besides the above outward signs, marked increase in the rate and
strength of the heartbeat, rise in the blood-pressure, and perhaps
nausea or incontinence of the bladder or rectum. In every re-
action of this sort that I have been aBle to analyze, it has been
shown that, even though the audience was interested, the speaker
was afraid that his talk would not have the desired effect. This
was due either to the fact that he desired too much, that is, to make
a "hit" or to be recognized as "brilliant," or that some one
was present who was felt to be secretly resistant and hostile to
the speaker. Both situations are the same, in that the audience,
because it may be indifferent or bored, becomes a painful factor
and causes a fear of failure reaction which is promptly compen-
sated for by the increased rate and strength of the heart-beat, fa-
cial flushing, etc. Since this, in turn, reveals the individual's anx-
iety and deficient power, and, becoming recognized by the audience,
makes the members ill at ease, it further increases the painfulness
of the situation by establishing a vicious affective circle between
the audience and the speaker.

Most speakers overcome this by the very simple little read-
justment of not desiring to scintillate, and, resolving to say their
best, humbly accept the' acknowledgment for whatever it is worth.

This mechanism applies to all situations where the degree of
potency- of the individual's social influence depends upon the pub-
lic's, or another's, response. The individual may protect himself
by keeping in mind an imaginary, appreciative, future generation

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 205

or an absent group as a comforting factor against the indifference
of the less important, pi'esent critical group. This is usually the
dreamer's method of escaping from reality and competition.

The anxiety that follows upon the death or degradation of
someone we love, or the loss of something we like, is due to the pain
aroused by the environment when it does not contain an object
upon which Ave may depend for certain protective, invigorating
stimuli. A comfortable readjustment occurs as soon as a satis-
factory situation, substitute, symbol or image is found.

Such prolonged phenomena as men working consistently for
years at a profession, science or art, etc., often, when analyzed,
show that the driving power is the compensatory striving that re-
sults from the subconscious but continuous fear of the possibility
of failure, or of losing esteem by- deteriorating to a level rela-
tively lower than a competitor's efficiency. The profession or
vocation is the individual's means of winning esteem as well as
safety and nourishment ; hence, anything that even indirectly per-
tains to the loss of esteem, as by someone becoming relatively more
desirable, should normally arouse a compensatory "speeding up"
of the autonomic apparatus — reenforeing the wish to act or "will
to power."

Because of this, it should ahvays he recognized that tvhenever
o,ny form of anxiety is complained of, the autonomic apparatus has
not been able to com,pensate siifficiently or has had to overcd^
pensate in order to struggle ivith a hostile environment. The fail-
ure of compensation may be due to one of two general causes,
either some organic disease within the organism has prevented the
physiological compensation, or the requirement from the environ-
ment is too great, as in anxiety because of inferior skill in a seri-
ous, emergency resulting finally in surrender to avoid the emer-
gency although this entails the loss of an unreplaceable love-object
and a serious state of apathy.

We are especially concerned, in this chapter, with the failures
of compensation in individuals who are not compelled to meet an
obvious, extraordinary stress and do not have an organically de-
ficient structure; as defective adrenals, thyroid, or heart. The
failures to compensate adequately because of affective oppres-
sions are the most important for psychopathology, clinical medi-
cine and sociology, and are the most numerous. Therefore, they

2Q6 PSYCT-IOPATHOLOGY

are given the most empliasis in this chapter. The anxiety and
compensations for organ igiferiority, which have heen, hereto-
fore considered, are the same in principle as anxiety because of
fear of failure. There is much serious confusion in psychiatric
literature regarding the failures to meet stresses. We find cases
discussed pro and con under such titles as constitutional infe-
riority, psychopathic personality, constitutional psychopathy,
paraphrenia, psychasthenia, neurasthenia, chronic invalidism and
"diseases of the will." None of those symptomatological groups
are satisfactory if the discussions of various contributors to the
literature are compared. They vary more vaguely than the
recommendations for feeding diabetics have varied. Obviously,
an arbitrarily standardized set of symptoms would have no value,
except to give it a name, hence a comprehensive term having .a
physiological basis may well be used to designate the mechanism.

The .term suppression or anxiety neurosis includes the whole
group of names which have just been referred to in the sense that
they are- all failures at physiological compensation. The abnor-
mal or asocial adjustment is the individual's eccentric attempt to
retain the prospects of maintaining a comfortable physiological
state. The inability to meet many painful situations honestly
often requires the enduring of severe, prolonged anxiety. Great
men must have the coiirage and fortitude to fight for a principle
even though it cost everything ; youth should be trained- to develop
this- faculty and rather than accept a disgraceful favor prefer to
lose or continue to suffer anxiety. This anxiety can only be en-
dured because of the hope of an ultimate reward. This last point
is of critical importance to the individual and its source lies in
the family training, the family and religious traits of the people,
and the justified hope of final gratification. The great difficulty
in developing this autonomic trait of character lies in the secret
yielding to illicit temptations or accepting half justifiable solutions
of a test, as the trickery to win popularity in politics.

The failure to compensate, in the organically normal, under
stresses that are not unusually severe, is due, as will be shown, to
affective suppression -or repression and its insurmountable cause.

In any crisis, the potential threat causes a fear reaction which
normally is immediately followed by a vigorous autonomic com-
pensation. This, in turn, forces the individual to adopt measure's

MECI-TANISM OF STTPPRESSTON OR ANXIETY NETTROSKS 207

or actions so as to counteract the threat of injury or loss. If,
however, this reflex protest has, in childhood, been repeatedly pun-
ished, that is, if it only resulted in thereby acquiring more pun-
ishment, the autonomic system gradually becomes firmly condi-
tioned to make either an indirect or dishonest protest, or to sub-
mit to the threat because, from experience, punishment is then
loss severe. Thereby hangs the catastrophe. The capacity for
aggressive initiative is lost and with it goes virility.

Darwin's submission to his father, the siibmissive tendency of
Case AN-3 and Guiteau's father's fanatical determination to make
his son acknowledge submission, are simple instances of the child's
difficulties with the insurmountable parent and some of the adjust-
ments that the youth may be compelled to make.

When a father determines to "break the child's spirit," and
unjustly exercising his power, forces it to submit, either one of two
disasters results. Either the child submits and later as an adult
is never able to protest for its rights and compete successfully or
dominate in competition, can never become a leader, must always
work for someone, can hot assume serious business responsibilities
becaiTse that requires constant protesting movements against com-
petitive encroachment ; or the child develops an irrepressible ten-
dency to react with excessive hatred, that is, excessively compen-
sates, when irritated or resisted. The variations in the adjust-
ment of the struggle with an oppressive parent are largely deter-
mined by the attitude of the other parent giving one party of the
conflict moral support, hence justifying or depressing the counter-
attack by the child. In this manner the irreparable father-son or
mother-daughter feud becomes established. Sons of beautiful
indulgent mothers, when the latter tend to plead that their sons
shall submit to the all wise, irritable father, often become sexual
perverts and even go through crucifixion psychoses "to please the
father" and mother (Cases CD-I, CD-2, AN-3). Parents who do
not really love children, and, living for their own pleasure, force
the helpless child to adjust itself to unnatural interests, discour-
aging its initiative through indifference and suppressing it with
threats of punishment and moralizing opinion, gradually, insidi-
ously, deprive it of its power to protest against the encroachments
of other people upon its struggle for happiness. Hence it can not
develop the necessary aggressiveness which is vitally necessary

208 PSYCHOPATHOLOGY

for successful love making, or the courage to compete with rivals
for the love-9l)ject or social esteem. Instead of wooing and com-
peting, it wishes to be wooed and protected; instead of becoming
projective and aggressive, it becomes receptive and submissive
and seeks to attach itself to the strong at any sacrifice — too often
as a sexual pervert.

The paranoid group shows that, when these individuals be-«
come aware of the fact that the submissive feelings are decidedly
depriving them of their virility, they either pass through a bitter,
anxious struggle and gradually compensate by the most eccentric
endeavors to discover the secret of omnipotence, or become incur-
able regressives if not fortunately protected.

In the psychology of the family it has been shown that the
father or mother, through'conscious and unconscious resistances
and coercions, cultivates the child's affective cravings to assume
a characteristic attitude and seek definite objects and methods
of expression. These methods of fulfilling the wish may or may
not- cause the individual, when he or she becomes an adult, most
distressing anxiety. This depends upon the nature of the social
requirements and the resistances which have to be overcome. It
is always necessary to bear in mind the question, "Does the in-
dividual suffer from an ungratified craving for a normal but in-
accessible object, or does he suffer from a wish for an abnormal,
degrading object?" The two following cases of eminent scien-
tists are selected to show the mechanism of prolonged struggles
to sublimate affective needs in highly developed personalities,
and the chronic anxiety endured because affective suppressions had
to be made, which, in turn, were due to the unmodifiableness of
the resistance to the affect and the fixed manner in which the af-
lective-autonomic cravings had been conditioned.

Charles Darwin

The Affective Sources of His Inspiration and Anxiety Neurosis*

The psychoanalytic study of these particular attributes of
Charles Darwin's personality must necessarily be rather abruptly
circumscribed. To do thorough justice to Darwin's personality
one ought to read everything he published and all the family and

•This paper was published in The Psychoanalytic Review, Vol. V, No. 2.

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 209

personal history that can be obtained and then present the mate-
rial in an analytical biography. It is hardly necessary to eulogize
Darwin's greatness in order to make the analytical study of his in-
feriorities and compensations acceptable to the hero-worshipping
public.

Charles Darwin's contributions to the progress of civilization
and welfare of humanity stand second to no man's. He has done
more for the liberation of human thought than the combined ca-
reers of Alexander the Great, Julius Caesar, Napoleon and other
so-called liberators, and his character needs no defense. It is of
great value to know how he succeeded in refining the autoerotic
cravings inherently active in every individual, and in sublimating
the father's repressive influence, thereby making it possible for
the affective cravings to create the long series of original re-
searches into the mechanisms of nature. It is quite probable that
no individual can be capable of consistent original thinking who
has not succeeded in freeing himself from the parent's resistant
domination. As to how much Darwin's sexual life played a part
in his scientific curiosity may be estimated from the fact that he
laid great emphasis upon the mechanism of sexual selection as
a determinant for the survival of pleasing attributes; hence, for
variations in structure and movement. He says, in his "Descent
of Man," that the German naturalist and philosopher Haeckel
was the only scientist whose writing showed that he fully appre-
ciated the significance of sexual selection, to which now may be
added the new school of psychopathologists.

Another indication of Darwin 's interest in the sexual functions
is to be seen in the titles of his books, such as "The Descent of
Man and Selection in Relation to Sex," "The Effects of Cross
and Self -Fertilization in the Vegetable Kingdom, " "On the Vari-
ous Contrivances by which Orchids are Fertilized," and "On the
Origin of Species by Means of Natural Selection."

In this analytical study several discussions of Darwin's sex-
ual life ai-e, of necessity, frankly made. No one who reads Dar-
win's letters can help but duly appreciate the splendid manner in
which he sublimated his sexual cravings, keeping himself pleasant,
unirritable, appreciative and grateful, which, of course, is not
usual for the sexually discontented.

Charles Darwin's paternal grandfather, Erasmus Darwin,

210 PSYCHOPATI-IOLOGY

was a physician, poet and naturalist.* He wrote "Zoonomia, or
tlie Laws of Organic Life, ' ' (sif jis by^ which animals are known
and may be named). His feelings in regard to nature study may
be estimated from his introductory phrase, "The whole is one
family of one parent." He was a studious theorizer but not
very practical in his scientific work, and Charles Darwin, when an
elderly man, came to be disappointed in the excess of theory and
the scantiness of facts in his book. Like most men who devote
most of their love to creative thinking, he seems not to have been
a very practical father. This was due, also, perhaps, to a " certain
acerbity or severity of temper" (p. 6). His second son, Erasmus,
became a suppressed, psychopathic personality. The latter was
quiet, retiring, had eccentric, self-indulgent interests, was, in some
respects, brilliant, never married, and committed suicide at forty
while in what seems to have been a state of "incipient insanity"
(p. 8).

His third son, Eobert Waring, the father of Charles Darmn,
became a physician upon his father's command. Even though he
detested the work his father gave him no choice (p. 12) and, de-
spite his aversion for it, he developed a large country practice.
There are indications that Robert and his father, Erasmus Dar-
win, did not understand each other in the matter of profession or
finances, for his father "brought him to Shrewsbury before he
was twenty-one years of age and left him twenty pounds, saying :
' Let me know when you want more, and I '11 send it to you. ' His
uncle, the- rector of Elsten, afterwards also sent him twenty
pounds, and this was the sole pecuniary aid which he ever re-
ceived" (p. 8), which seems to imply that although he needed
money he preferred to depend upon a relative. This fact may have
had quite a genetic influence upon his attitude, later, toward his
son Charles whom he rebuked for carelessly spending money
while at college. It is worthy of consideration that Charles Dar-
win, in turn, was unusually generous with his son, Francis, about
some of his careless debts contracted while at college. Francis
Darwin says : ' ' My f atlier was wonderfully liberal and generous
to all his children in the matter of money, and I have special cause
to remember his kindness when I think of the way lie paid some
Cambridge debts of mine — making it seem almost a virtue in me

*Darwin, F. : The Life and Letters of Charles Darwin. Information in this stndy is taken
from the above work, and the numbers following quotations, as (p. 6), refer to its pages.

MECHANISM OF SUPPKESSTON OR ANXTETV NEUROSES 211

to have told him of thom." The attitude of Charles Darwin to-
ward the matter of his son's college debts stands out in striking
contrast to the attitude of his own father. Charles Darwin, in
money and business matters, was extremely careful and exact.
"He kept accounts Avith great care, classifying them, and balanc-
ing at the end of the year like a merchant. * * * His father
must have alloived him to believe that he wotald be poorer than ho
really was, for some of the diiFiculty experienced in finding a housi;
in the country nuist have arisen from the modest sum he felt pre-
pared to give. Yet, he knew, of course, that he ivould be in easy
circumstances" (p. 98). (The italics inserted.) From this state-
ment, it seems that Charles Darwin, although he knew he had suffi-
cient resources, was unable to use them more freely than he did
because he felt constrained by his father's influence to deny him-
self. An indication that his father's attitude had caused him no
little sorrow may be seen in the carefully considered manner in
which he made the debts of Francis seem ' ' almost a virtue. ' ' This
affective restraint, which Darwin imposed upon himself in order
to keep peace with his father, and which Avill be associated later
with other facts, gives us one important indication as to the mech-
anism of Darwin's chronic anxiety.

To return to Darwin's parents. His father was a man of
unusual insight into human nature, for he practiced the present
psychoanalytic principle of inducing an affective catharsis and
readjustment in his patients as a method of treating the distress
caused by affective suppression — anxiety. Charles Darwin says :
"Owing to my father's power of winning confidence, many pa-
tients, especially ladies, consulted him when suffering any misery,
as a sort of Father-Confessor. He told me that they always began
by complaining in a vague manner about their health, and by prac-
tice, he soon guessed what was really the matter. He then sug-
gested that they had been suffering in their minds and now they
would pour out their troubles, and he heard nothing more about the
body" (p. 12). Robert Darwin also found that the sexual forces
played a critical part in the attainment of happiness or misery,
as is obvious from the following statement : ' ' Owing to my father 's
skill in winning confidence, he received many strange confessions
of misery and guilt. He often remarked how many miserable
w:ives he had known" (p. 12).

21 2 PSYCHOPATHOLOGY

In further characterizing his father Charles Darwin says :
"The most remarkable power which my father possessed was
that of reading character, and even the thoughts of those whom
he saw even a short time. We had many instances of the jDower
which seemed almost stopematural (p. 12). (Italics mine.) Dar-
win follows this comment with three illustrations. The first
one was how his father never, "with but one exception," made
an unworthy friend, and, in this instance, a clergyman, who was
"little better than an habitual swindler," was soon discovered.
The second was the loaning of twenty pounds to a complete stran-
ger who had lost his purse and promptly proved reliable, and the
third was the detection in an insane young man, who accused
himself of all the crimes under heaven, that he was guilty of a
heinous crime. "His sympathy gave him unbounded poiver for
winning confidence"; he was the Tnost acute observer whom I ever
saw"; and "the wisest man whom ever I saw\" (Italics are in-
serted to emphasize the superlative use of superlatives.) In order
successfully to conceal undesirable wishes and emotions from a
father having such unusual qualities for detecting them, it would
be necessary to repress them most assiduously from conscious-
ness. It is quite probable that Darwin's interest in the expression
of the emotions in man and animals was aroused by his father's
capacity to read secrets of behavior from the manner in which
emotions are expressed.

Eobert Darwin married Susan, the favorite daughter of Josiah
Wedgwood of Etruria, a very close friend of his father's and it is
quite probable that her esteem for her father-in-law was greatly
enhanced by her own father's admiration for his intelligence. She
seems to have had, according to a miniature and an account of her
by friends, "a remarkably sweet and happy face," expressive of
a "gentle, sympathetic nature" (p. 9). She is said to have enjoyed
a most benevolent regard from her father-in-law (Bettany), and
through this affective influence probably became deeply fascinated
by his poetical, scientific curiosity, and much interested in his
theories as to the causes of variation and evolution of life; She
was very fond of flowers and pets. The tameness and beauty of
her pigeons were the admiration of her friends. (The origin and
variations of domestic pigeons form a 'most important part of the
"Origin of Species.") The sincerity and frankness of her atti-

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 213

tilde, no doubt, gave her son Charles a distinct impression about
the things in life that fascinated her. She was very sympathetic
and seems to have had a protracted, wearisome illness Avhich
caused her death when Charles was but eight years of age. Her
charming interest in nature gave him, it seems, a fixed inspiration,
a wish to solve the riddle that fascinated his lovely mother. It
must have been her romantic fondness for flowers which inspired
her son to search there for the secret of her fascination, because
when he attended Mr. Case's school at eight, he had already begun
to collect "all sorts of things" — shells, seals, franks, coins, min-
erals, and "tried to mahe out the names of plants." (Collecting
was a well-developed characteristic of several of Darwin's uncles.)

The Eeverend W. A. Leighton, who was a playmate of Charles
Darwin at this school, remembered his bringing a flower to school
and saying that "his mother had taught him how hy looldng at the
INSIDE of the blossom the NAME of the plant could he discov-
ered" (p. 26). (Names are usually given in science, and also or-
dinarily, according to the genetic origin or dynamic nature of the
object — to know the secret of the name is to know the secret of the
child's or flower's origin.) The boy, Leighton, whose childhood
curiosity and inspirations Avere later considerably gratified by
becoming a botanist of well-known reputation, tried to discover
the secret. He says: "This (secret) greatly aroused my attention
and curiosity, and I inquired of him repeatedly hoAV this could be
done, but his lesson was, naturally enough, not transmissible"
(p. 26).

Whatever was the exact source of the fantasies exchanged by
the two boys, it was certainly a budding curiosity about genesis
(sexual), because Darwin, in his autobiography, says at sixty-
seven: "One little event during this year has fixed itself very
firmly in my mind, and I hope that it has done so from my con-
science having been aftenuard sorely troubled by it; it is curious
as showing that apparently I was interested at this early age in
the variability of plants! I told another little boy (I believe it was
Leighton) that I could produce variously colored polyanthuses and
primroses by watering them Avith certain coloured fluids, which
was, of course, a monstrous fable, and had never been tried by me"
(p. 27).

Why should Darwin, fifty-nine years later, with his fine in-

21.4 PSYCHOPATHOLOGY

sight into the naturalness of immorality in children, write this
confession of an act of immorality committed at eight and apolo-
gize for it as a "monstrous fable" that simply would not fade with
time. Most unforgetable incidents of childhood which later be-
come painful memories are, in some manner, associated with a sex-
ual transgression, and it is the severity of the struggle to refine
the sexual interests that gives prominence to the transgressions of
the past, like an old scar on a highly polished surface. The self-
refinement tendency in Darwin is definitely revealed in his com-
ment, "I hope that it has done so from my conscience having been
afterwards sorely troubled." This eight-year-old boy^s fantasy,
that he could produce a variation in the colors of flowers by water-
ing them, was told at the age when children are inclined to wonder
seriously about the possible genetic qualities of their excreta, and
the painful attributes of the "monstrous fable" were not in the
story as retold at sixty-seven, but in the associations it had at
eight. It is quite probable that Darwin's fancy that he could cauP'"
variations in the colors of flowers by watering them was suggested
by the manner in which they gradually faded and died after he had
repeatedly urinated upon them (not an uncommon experiment of
boys), and the fancy was told as a child's recompensative wish.
The urinating on the flowers probably had the value of being a
fertilization curiosity. (See the fertilization curiosities in the list
of Darwin's publications to be given later.)

Whether or not Darwin's mother actiially propounded her en-
chanting riddle to her boy is not quite so important as the fact that
lie said she did, showing hoA¥ keenly his wishes relished the fancy
■that she had revealed to him the one secret of life that fascinated
her — the secret, Avhich, if read, would reveal the origin and crea-
tion of life and — himself. Children from seven to ten are usually
passionately fond of riddles. It is the trial and error method of
finding the answer to the omnipresent riddle as to their origin.
Soon after this innocent exchange of confidences with her boy,
the beautiful mother died — went on a long journey into the night.

At ten, this boy was still collecting minerals mth much zeal,
still searching for the answer to liis mother's riddle and her wish
that he could know. He says, ' ' all that I cared about was a new-
named mineral" (p. 31).

"VVe must not forget "Zoonomia."

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 215

During- the next seven years in the classical schools, he was an
indifferent student, and earned the reputation of being more diffi-
cult to teach than the average boy. The cause of this is evidently
in the fact that his sponsors persisted in trying to malte him learn
stuff for which his affective cravings had an aversion. Criticism
and rebuke seemed to fail as arousing stimuli, as did also changes
of schools and teachers. In his autobiography, Darwin estimates
the value of his schooling in the folloAving sentence (p. 40) : "Dur-
ing the three years wliicli I spent at Cambridge (studying the-
ology) my time was Avasted, as far as the academical studies were
concerned, as completely as at Edinl)uvgh (studying medicine) and
at school"

The personal history of Dar^-in shows that after his mother's
influence nothing pleased him like the study of nature and never
for a day does he seem to have abandoned his quest. No doul)t
this adolescent speculator upoii the secret of life was subtly, but
decidedly, impressed by the family's I'omantic interest in the na-
ture of the recognition the grandfather's theories of evolution
^vere winning from the great scientists of England. At the time
of the following critical incident, his enthusiasm about the merits
of his grandfather's studies was at its height. He Avas admiring
"greatly" the theories in the book, "Zoonomia," when acciden-
tally his conviction Avas fixed by the enthusiastic remarks of a hero-
friend. The remarks were made under those subtly impressive
circumstances Avhich make them irresistible because they suggest
an attractive solution for an uncomfortable affective conflict. He
and his older brother, v/pon his father's insistence, were attend-
ing Edinburgh University in preparation for the practice of medi
cine, his father's and grandfather's profession. Both boys had
insurmountable resistances to medicine, but the father persisted, it
seems, in sending them to this sort of school, because the classical
school had been a miserable failure. Charles DarAvin, though in-
spired to learn the names and secrets of biological and geological
objects, was utterly distressed by names and Avords in the form of
languages. For him, it was like marrying the wrong sister. No
little anxiety was felt by DarAvin's earnest father as to what his
son's future as a man might be, and this pressure, no doubt, made
the solution of a career most desirable for all concerned if it could
only be found. His mother had innocfintly, therefore the more

216 PSYCHOPATHOLOGY

irresistibly, named her wish, for her boy's destiny, and his father's
Avishes, that he should study some profession, only diverted him
from the quest. While in this restless affective dilemma, the solu-
tion came in a most fortunate manner for the future of civilization.

Adolescent Darwin (seventeen) was walking with maturing
Dr. Grant, several years his senior. He says, in his autobiography :
"I knew him well; he was dry and formal in manner, with much
enthusiasm beneath the outer crust. ' ' (This boy had achieved one
of the supreme delights of a boy's life; he had overcome the re-
serve of his hero and was learning, through sharing confidences,
some of his impressions on the secrets of life and what works of
men aroused his admiration. In his autobiography, Darwin ex-
presses disappointment, even when an old man, that this hero of
his youth did not 'write more and develop his interests fully.)
"He, one day, when we were walking together, burst forth in high
admiration of Lamarck and his views on evolution. I listened in
silent astonishment, and, as far as I can judge, (paradoxically)
without any effect on my mind. I had previously read the 'Zoo-
nomia' of my grandfather, in which similar views are maintained,
but ivithout producing any effect on me. Nevertheless, it is proba-
ble that the hearing rather early in life such views mAmtained\ and
praised may have favoured my upholding them under a different
form in my 'Origin of Species.' At this time I admired greatly the
' Zoonomia' — as well as Doctor Grant." (The italics and paren-
thesis are inserted.)

This confidential revelation, by his impressive hero, of a simi-
lar interest in the secrets of the evolution of life, firmly approved
the soundness of Darwin's sacred wish of childhood, to learn the
secret of nature as a geologist. Although he began his scientific
career as a geologist, we find as he grew older he reverted to hif
first wish and became more and more interested in the secrets of
fertilization and variation of plants and animals. Finally, he gave
the world the following answers to his mother's sacred riddle:

Books*

"On the Various Contrivances by Which Orchids are Fertilized by Insects," at
fifty-three.

"The Movements and Habits of Climbing Plants."

' ' The Variation of Animals and Plants under Domestication, ' ' at fifty-nine.

•This is by no means a complete list ot Darwin's publications.

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 217

"The Descent of Man and Selection hi Relation to Sex," at sixty-two.
"The Expression of the Emotions in Man and Animals," at sixty-three.
"Insectivorous Plants," at sixty-six.

"The Effects of Cross and Self -Fertilization in the Vegetable Kingdom," at
sixty -seven.

' ' The Different Forms of Flowers on Plants of the Same Species, ' ' at sixty-eight.
"The Power of Movement in Plants," at seventy-one.

Papers

"Observations on the Structure and Propagation of the Genus Sagitta," at
thirty-five.

"Vitality of Seeds," at forty-six.

"On the Action of Sea- Water on the Germination of Seeds," at fifty.

"On the Agency of Bees in the Fertilization of Papilionaceous Flowers," at
fifty-seven.

"On the Tendency of Species to Form Varieties; and on the Perpetuation of
Varieties and Species by Means of Natural Selection" (Darwin and Wallace), at forty-
nine.

"On the Agency of Bees in the Fertilization of Papilionaceous Flowers, and on
the Crossing of Kidney Beans, ' ' at forty-nine.

"Do the Tineina or other Small Moths Suck Flowers? and If So, What Flowers?"
at fifty-one.

"Fertilization of Vincas, " at fifty -two.

"On the Two Forms, or Dimorphic Condition, in the Species of Primula and on
their remarkable Sexual Eelations, ' ' at fifty-three.

' ' On the Three Eemarkable Sexual Forms of Catasetum Trideutatum, ' ' at fifty-
three.

"On the Existence of Two Forms, and on Their Reciprocal Sexual Relations, iu
Several Species of the Genus Lineum, " at fifty-five.

"On the Sexual Relations of the Three Forms of Lythrum Salicaria, " at. fifty-
five.

"On the Movements and Habits of Climbing Plants," at fifty -six.

"On the Character and Hybrid-Like Nature of the Offspring from the Illegiti-
mate Unions of Dimorphic and Trimorphic Plants, ' ' at fif ty-rine.

"Notes on the Fertilization of Orchids," at sixty.

"The Fertilization of Winter-Flowering Plants," at sixty.

' ' Pangenesis, ' ' at sixty -two.

"Fertilization of Leschenaulta, " at sixty- two.

"Fertilization of the Fumariaceae, " at sixty-five.

"Flowers of the Primrose Destroyed by Birds," at sixty-five.

' ' Sexual Selection in Relation to Monkeys, ' ' at sixty-seven.

"The Scarcity of Holly Berries and Bees," at sixty-eight.

"Notes on the Fertilization of Plants," at sixty-eight.

"A Biographical Sketch of an Infant," at sixty-eight.

"Fertility of Hybrids from the Common and Chinese Goose," at seventy-one.

"The Sexual Colors of Certain Butterflies," at seventy -two.

"Movements of Plants," at seventy-two.

"The Parasitic Habits of Molothrus, " at seventy-two.

"On the Modification of a Race of Syrian Street-Dogs by means of Sexual Selec-
tion, ' ' by Van Dyck, with a Preliminary Notice by C. Darwin.

218 PSYCHOPATHOLOGY

To "The Different Forms of Flowers on Plants of the Same
Species" he made the following significant comment: "No little
discovery of mine ever gave me so much pleasure as the making
out of the mecming of heterostyled flowers. The results of cross-
ing snch flowers in an illegitimate manner, I believe to be very im-
portant as bearing on the sterility of hybrids. ' ' (Italics inserted. )

It would be most undesirable to leave the impression that th^
affective transference to Dr. Grant, through its reenforcement of
his childhood wishes, alone made it possible for Darwin to over-
come the wishes of his father, (that he should become a physician
or a minister) and devote his life to the particular work which grat-
tified his attachment to his mother. The friendship of Prof. Hen-
slow, which, he says, "influenced my career more than any other"
(p. 44), and, of the geologists, Sedgwick and Lyell, and others,
besides the contributions to science which he read, furnished the
medium through which his inspiration could work satisfactorily.
The essential point is the fact that before he met Henslow, his
affective trends had become quite definitely fixed, and it was
now only a matter of finding the proper associations and material
with which to work.

From nineteen to twenty-two, he attended Cambridge to train
himself for the ministry, because, it seems, his father and sisters
had decided that, since he would not study medicine, there was
nothing else desirable. Fortunately, they were not too resolutely
persistent, and Darwin's yearnings were tenacious and vigorous
enough to endure the disconcertions of classical literature until
he met Prof. Henslow. Prof. Henslow, he says, was a man "whosp
knowledge was great in botany, entomology, chemistry, mineral-
ogy, and geology" (p. 44) and who later became a minister. Per-
haps this complex personali'ty, as a life-long friend, saved Darwin
from floundering under Ms father's resistance, after he had
started on his course. Henslow 's knowledge of biology gratified
the mother attachment, and his ministerial interests gratified the
father attachment. Later, Henslow 's inducement enabled Darwin
to make a neat sublimation of the father's Avishes.

At twenty-two, in Cambridge, he says : "I read with care and
profound interest Humboldt's 'Personal Narrative.' This work,
and Sir J. Herschel's 'Introduction to the Study of Natural Phi-
losophy,' stirred up in me a burning seal to add even the most hum-

MECHANISM OF SUPPRESSION" OR ANXIETY NEUROSES 219

hie contribution to the noble structure of Natural Science. No one
of a dozen other books influenced me nearly so much as these two"
(p. 47.) (His affective needs Avere ready for the books and these
men, and he assimilated the scientific knowledge that helped to
satisfy the ardent wish of his childhood with "burning zeal.")

Darwin's affective needs resisted his father's influence that
he should study medicine or theology, even though he had obe-
diently consented, upon his father 's instigation, to become a clergy-
man, but they accepted Henslow's suggestion that he should study
geology with enthusiasm. This course satisfied the fundamental
wish to knoAV the names and secrets of minerals and made life sin-
cerely Avorth while. Had it been necessary for, say psychiatric
reasons, to take Darwin's life history at this time, his father would
probably have conscientiously said that he was not a good student,
Avas indifferent to the serious interests of life, a sport, ratcatcher,
card player, drinker, and Avaster of time, more obstinate and self-
willed than his brother. His brother, whom he called "poor old
Philos" and "poor old Ras," had, by this time, completely sub-
mitted to the father's wish.

In regard to the origin of the subsidiary wish to travel, which
also urged Darwin to make the important voyage of the Beagle, he
says : "early in my schooldays a boy had a copy of the 'Wonders
of the World, ' which I often read and disputed with the boys about
the veracity of the statements ; and I believe that this book first
gave me a Avish to travel in remote countries, which Avas ultimately
fulfilled by the voyage of the Beagle" (p. 31), and the voyage was
additionally attractive because it enabled him to answer the wish
of his childhood, to knoAA"- the truth of the serious claims of his
playmates and the author. In other words, his "Journal of the
Voyage of the Beagle" improved the story of traA^els AA^hich he
read in his childhood.

When the opportunity for the voyage of the Beagle came
through the kindness of HensloAv, his master in science, he says
his father "strongly objected, adding the words, fortunate for me,
'if you can find any man of common sense who advises you to go
I Avill give my consent' " (p. 50). This vigorous protest, no doubt,
was aggravated by DarAvin's past three years of sporting indul-
gences at Cambridge, Avhich he, himself, later characterized as
"time worse than wasted. " His father had often rebuked him for

220 PSYCHOPATHOLOGY

his sporting proclivities, and plainly said he was seriously afraid
his son might become a regret to the family. Darwin's father had
probably not forgotten the tragedy of his brother's suicide, and
was at a loss to know how to influence his son. He had persisted
in sending him -to Edinburgh to study medicine and when he re-
fused to become interested he had sent him to study theology at
Cambridge, only to see him persistently waste his opportunities.

His son's method of wasting time and money, through sports,
card-playing and drinking companions, has every attribute of be-
ing his manner of protesting against the impatient attitude of his
father who was an abstainer. Their affective resistances had be-
come such a barrier that neither was able satisfactorily to in-
fluence the other. We learn that Darwin's sisters had become the
medium of exchange of certain opinions between father and son
from the fact that the father learned through his daughters that
his son Charles was not interested in medicine. After the father
had expressed his distrust of the voyage of the Beagle, Charles
wrote a letter declining the opportunity and promptly went on a
shooting trip to Maer. It was one of the interests his father ob-
jected to because he cared more for it than a profession.

The father's inability to see his son's zeal for scientific re-
search in this vitally important request, as well as in the selection
of an undesirable course of training for both of his sons, strikingly
contrasts with the persistent manner in which Charles Darwin
later attributed to his father the qualities of being "the wisest
man" he ever saw and a man having "almost supernatural"
powers of reading character. Additional facts, to be more fittingly
presented later, show decidedly that these conflicts greatly influ-
enced the pathological nature of Darwin's later submission to his
father and the over-compensation of gratitude which he developed.
The letters relative to the Beagle opportunity show how extremely
eager he was to go and how seriously he considered the oppor-
tunity but also how entirely, because of his affection for his fa-
ther, he was dominated by the latter 's opinion.

In a letter to Henslow (p. 169) he wrote, "My father, al-
though he does not decidedly refuse me, gives such strong advice
against going, that I should not be comfortable if I did not follow
it."

"My father's objections are these: the unfitting me to .settle

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 221

doAvn as a clergyman, my little habit of seafaring, the shortness
of the time, and the chance of my not suiting Captain Fitz-Eoy
* * if it had not been for my father I would have taken all
risks * * * there certainly could not have been a better op-
portunity. ' '

Tn the postscript occurs a sentence that clearly reveals Dar-
win's utter affective dependence upon his father's approbation
and pleasure: "Even if I was to go, my father, disliking, would
take away all my energy" (p. 170).

After Darwin had resigned himself to the loss of this wonder-
ful opportunity, he promptly went to the home of the Wedgwoods
— his future father-in-law's. Apparently, there, they all talked it
over, for the next day he Avrote a letter to his father. It begins
rather timidly :

' ' My dear Father — I am afraid I am going to make you again
very uncomfortable. But, upon consideration, I think you will
excuse me once again, stating my opinions on the offer of the
voyage. My excuse and reason is the different way all the Wedg-
woods view the subject from what you and my sisters do.

"I have given Uncle Joe what I fervently trust is an accu-
rate and full list of your objections, and he is kind enough to give
his opinions on all. May I beg of you one favour, it will be doing
me the greatest kindness, if you mil send me a decided answer,
yes or no 1 If the latter, I should be most ungrateful if I did not
implicitly yield to your better judgment, and to the kindest indul-
gence you have shown me all through my life ; and you may rely
upon it I will never mention the subject again" (p. 170).

One can hardly help being deeply impressed by the almost
tragic appeal that this young man (twenty- two) makes for par-
ental consent to his freedom of thought and behavior. Twice in
the same letter he refers to the delicate question of idleness.
"The time [on the voyage] I do not think, anyhoAV, would be more
thrown away than if I stayed at home, ' ' and ' ' I must again state
I can not think it would unfit me hereafter for a steady life."
(Such earnest pleas as this, although he was a "ratcatcher," show
how seriously he was interested in life, if only the controlling
powers would let him be free.)

Darwin's list of his father's objections reveals his attitude
about his inability to direct his son's career:

222 PSYCHOPATI-IOLOGY

(1) "Disreputable to my character as a clergyman hereaf-
ter."

(2) "A wild scheme."

(3) "That they miist have offered to many others before me
the place of Naturalist."

(4) "And from its not being accepted there must be some
serious objection to the vessel or expedition."

(5) "That I should never settle doAvn to a steady life here-
after."

(6) "That my accommodations shorrld be most uncomforta-
ble."

(7) "That you [father] should consider it as again changing
my profession."

(8) "That is would be a useless imdertaking" (p. 172).

The objections 1, 2, 7, and S, the most important, indicate that
the father's resistances to naturalists' wasting time were proba-
bly the result -.of his economic stresses as a student and practi-
tioner due to his own father being a rather indifferent provider,
probably because of the enormous amount of time he sacrificed in
unremunerative theorizing about nature. Charles Darwin says
that his "father's mind was not scientific, and he did not try to
generalize his Imowledge under general laws, yet he formed a
theory for almost everything which occurred, ' ' which indicates that
some resistance prevented him from grouping his theories as his
own father had.

To return to the objections. Josiah "Wedgwood replied in a
letter to Darwin's father, in Avhich he took up each point sep-
arately and siTpported the wishes of his future son-in-law. The
answer to the first objection is interesting in that it reveals what
enlightened Englishmen thought of naturalists in 1831. (1) "I
should not think that it would be in any degree disreputable to his
character as a clergyman. I should on the contrary think the offer
honorable to him; and the pursuit of Natural History, though cer-
tainly not professional, is very suitable to a clergyman."

Darwin's father, fortunately, was not so obstinately cruel and
self-centered as to resist this final plea from his son and relatives.
He consented in "the kindest manner," and the enthusiasm with
which Darwin reacted is revealed in several letters to his friends,
in which such phrases as the following are to be found: "I am

MECHANISM OF SUPPRESSTOK OR ANXIETY NEUROSES 223

sure it will be my fault if we do not suit" (in regard to his liking
liis captain). "What changes I have had. Till one [o 'clock prob-
ably] today I Avas building castles in the air about hunting foxes
in Shropshire, now llamas in South America. There is indeed a
tide in the affairs of men." "What a glorious day the fourth of
November will be to me ! Mij second life ivlll then commence, and
ii shall he as a birthday for the rest of my life" (p. 187) ; to Hens-
low, whose "protege" he liked to consider himself to be: "Gloria
in excelsis is the most moderate beginning [of the letter] I can
think of"; to his friend Fox he wrote: "Every now and then I
have moments of glorious enthusiasm, when I think of the date
and cocoa trees, the palms and ferns so lofty and beautiful, every-
thing new, everything sublime." When repressive influences are
removed the affective response immediately rises with enthusiasm
and exuberance. Smoky, noisy London became, for the first time
in his life "very pleasant," "hurry, bustle and noise are all in uni-
son with my thoughts ; ' ' and the crowded little ship became ' ' the
most perfect vessel that ever came out of the dockyard."

Darwin had a fine capacity for visualizing, which is to be seen
all through his letters, and there can be little doubt but that the
"second birth" he referred to meant that he proposed to remain
a naturalist, marry Emma Wedgwood and devote himself se-
riously to his work.

The vigor of Darwin's interest in science, as a young man,
certainly varied as his father's wishes forced him from the studies
that gratified his affective attachment to his mother, and it was
fortunate that his uncle was quite well aware of the family situa-
tion.

DarAvin writes in his autobiography : ' ' The voyage of the Bea-
gle has been by far the most important event in my life and has
determined my whole career; yet, it depended on so small a cir-
cumstance as my uncle (future father-in-law) offering to drive me
thirty miles to ShrcAvsbury, which few uncles would have done,
and on such a trifle as the shape of my nose" (p. 51). The captain
of the Beagle disliked the shape of Darwin's nose, believing that
it indicated weakness of purpose and energy. He, however, was
persuaded to accept the offer for service because of his zeal. This,
his father had failed to appreciate. (This complicated, decisive
incident is comparable to an accidental association of mechanical

224

PSYCHOPATI-IOLOGY

or ehemieal devices that sometimes saves a man from a life of
fruitless, painful striving after an inaccessible object by giving
him a practical medium through which the wish may, at last,
struggle freely for gratification.)

Darwin, as a psychological problem, would be only half eonsid-
orod, if we did not include an analysis of his chronic anxiety neu-
rosis, which lasted over forty years, and attempt to estimate the
nature of his affective suppressions and his manner of dealing with
them, because, in many respects, Darwin's difficulties were of
a type that often becomes extremely destructive to the personality.
It is quite probable that, had his father suppressed the voyage of
the Beagle, it would have ruined his son (like Erasmus) because
the submission would have prevented the frank sublimation of his
mother-attachment. This mechanism, in more active form, is fre-
quently the most prominent factor in many dementia precox cases.

The first indications that Darwin had a psychoneurotic tend-
ency came out, as would be expected, upon the first strenuous de-
mands for adaptation when accompanied by home or love-sickness,
which bothered him greatly. Such symptoms as the following,;
occurring in a student, would lead one strongly to suspect an auto-
erotic difficulty that had not been completely mastered. Besides
cardiac palpitation and anxiety he had other neurotic symptoms.

In a letter (p. 180) written September 6, 1821, to his sister,
Susan, is the first significant reference to his personal difficulties.
The unconscious manner in which the thoughts are associated to-
gether is quite important. He begins with a series of requests
for wearing apparel, and then, when he makes the request for a
little book, " If I have got it in my bedroom — ' Taxidermy, ' he adds,
"Ask my father if he thinks there would be any objection to my
taking arsenic for a little time, as my hands are not quite well, and
I have always observed that if I once get them well, and change
my manner of living about the same time, they will generally re-
main well. What is the dose? Tell Edward my gun is dirty.
What is Erasmus' direction?" (Italics inserted.)

The arsenic tonic for the neurotic hands, of which he is un-
duly conscious while trying to make a demonstration of his best
qualities in order to be accepted for the voyage, is interestingly
associated with the queer observation, which is given so much
importance by the * ' always, ' ' that if he once got them well, that is,

MECHANISM OF SUPPRESSION OR, ANXIETY NEUKOSES ii-!.)

under control, and changed his manner of living about the same
time, they generally remained -well. This sort of phrase is enig-
matical in almost any sense unless it reveals the manner in which
lie had mastered the natural onanistie curiosities of youth. The
associations — taxidermy, arsenic, hands, show how frankly Dar-
win permitted his thoughts to associate. Tonic — defective hands
— defective gun and Erasmus should be considered to have been
written in the same trend of thought. Erasmus was biologically
not a well-developed heterosexual type, was not creative, retired
while a youngs man and never married.

It is very interesting, in this connection, that, three days
later, Darwin again wrote to the same sister (p. 182) : "Captain
Fitz-Eoy first wished a naturalist, and then he seems to have taken
a sudden horror of the chances of having somebody he should
not lilie on board the vessel." In the previously quoted letter in.
the paragraph following the arsenic request, he says "from Cap-
tain Fitz-Roy wishing me so much to go, and, from his kindness,
I feel a predestination I shall start." (Pitz-Roy seems to have
been about twenty-three at this time, and the two were to share
quarters together. While at sea, Fitz-Roy developed a negativistic
, attitude toward Dar■\^^.n which almost disrupted the voyage. At
sixty-seven, Darwin said he "was a man very difficult to live with
on the intimate terms which foUoAved our messing by ourselves
in the same cabin" (p. 51). (This indicates that Fitz-Roy was in-
clined to become irritable under the strain of sexual suppression.)
From his autobiographic comments, Darwin apparently misunder-
stood Fitz-Roy 's reference to his sensuous nose as his true reason
for hesitating to take him on the journey. It is quite probable that
the astute Dr. Darwin was well aware of his son's personal diffi-
culties, if we consider the manner in which he read the sexual
difficulties of his patients, which Darwin characterized as "super-
natural. ' ' This may have been the true basis for the fear that it
might ruin him for the ministry. Homosexuality is a serious
problem among seameii. In the same letter, Darwin shows that ho
met the emergency and mastered himself completely, for he says,
following his comments on his successful bargain for new pistols
and a gun, and Fitz-Roy 's fine guns, that he would not need to take
arsenic. The final arrangements had then been made and the
slightly regressive tendency was relieved. According to some
psychiatric notions the neurotic and cardiac symptoms, plus a

226 PSYCPIOPATHOLOGY

suicidal uncle, would have branded Darwin as a constitutional in-
ferior failing? to accommodate under stress.

It was not until five weelfs after his letter, in which he men-
tioned Fitz-Roy's uneasiness, that he bared the yearnings of his
soul to this stranger, instinctively assuring him that all was well
by the splendid sublimation that, on the day of sailing "my second
life will then commence, and it shall be as a birthday for the rest
of my life. " The nature of the fifty-two years of married life that
followed the voyage shows clearly how well Darwin meant exactly
what he said. *

No doubt Fitz-Roy and Darwin had no occasion to lose their
esteem for one another. The voyage lasted five, instead of three,
years, during which time Darwin suffered severely from seasick-
ness, nausea, vomiting and dizziness, but the enormous amount of
work he did, and the accuracy of his journal, which has been in-
corporated in the Harvard Classics, show how splendidly he sub-
limated his affective cravings.

While on the voyage he had a serious illness which his father
was unable to diagnose from a description of the symptoms, biit
it can hardly be assumed to have left a debilitating effect, because,
after the voyage, while working at his specimens, he wrote of his ■
good health and spirits.

Dr. "W. W. Johnson,* in his article on "The 111 Health of
Charles Darwin: Its Nature and Relation to His Work," in which
he covers the symptoms and the physical stresses of the voyEg^feS'
and his intense method of work, concludes that the illness "was
"chronic neurasthenia."

Dr. G. M. Gould, in his "Biographic Clinics," reviews the case
of Charles Darwin, and, after discussing Dr. Johnson's diagnosis,
concludes that the ill health was due to "eye-strain." Both men
seem to have overlooked or given little importance to the anxiety
about his hands that Darwin complained of before the voyage or to
the affective suppressions that distressed him.

The indications, many of which have been collected in the fol-
lowing discussion, are that, 'if we will consider the nature of Dar- *
win's work, its affective value to him, what he anticipated it would
mean to civilization and the excited criticisms it would aroiise,
the attitude of his father, and his manner of working, it is quite

•American Anthropologist, Vol. Ill, 1901.

MECHANISM OF SUPPKESSION OR ANXIETY NEUKOSES 2^7

probable that he suffered from an anxiety neiirosis due to con-
sistent affective suppression. The nature of the affective sup-
pression will be discussed after other important personal traits
of Darwin and the symptoms of his illness have been fully covered.

About two years after his return from the voyage of the
Beagle, he began to be troubled by becoming occasionally "un-
well." I could find no definite account of an organic disease until
he was an old man, and none of his physicians, including his
father, seemed to consider an organic lesion as the cause of his
illness. Many hints as to the symptoms and nature of his anxiety
neurosis may be found scattered throughout the biography pub-
lished by his son, Francis, and in his letters and autobiography.
Some of the more definite remarks are here collected because they
indicate the nature of the anxiety neurosis, and, from an analysis
of his compensations and methods of obtaining relief from anxiety,
we are enabled to acquire an insight into the nature of his affective
struggle and the determinants of his final course of living.

In the critical years between his return from the voyage of the
Beagle (twenty-seven) and his marriage (thirty) Darwin passed
through his final affective readjustment. He was inclined to re-
flect deeply on the subject of religion, read books oh metaphysics,
which indicates that he still conscientiously considered the minis-
try and "the subject was much before my mind" (p. 274), but he
says "disbelief crept over me at a very slow rate, but was at last
comj)lete. The rate was so slow that I felt no distress." During
these years the first important experience of becoming "unwell"
is recorded, and the later course of his anxiety indicates that it
was a reaction to his efforts to adjust himself for his career, his
father, and his mating. (It is important to recognize the fact that
individuals having too strong an affective attachment to one of
their parents, often experience an unfathomable anxiety when they
attempt to mate, because in the mating the individual tends to re-
press the affective interests that do not idealize the love-object,
and this repressed affect produces anxiety through its struggles
to break through the resistance so as to find its own love-object.)

He married at thirty, and lived in London, but at thirty-three
he retired to the restful seclusion of Down. As he grew older,, he
isolated himself more and more from social intercourse. Before
his retreat to Down he went alone on one more geologizing tour

228 PSYCHOPATH OLOGY

to North "Wales, and this was the last time he tried to climb a
mountain. What final resolutions and emotional changes Darwin
experienced on this trip are not recorded by him, but shortly after
this he retired to Down where he became a chronic invalid and his
wife-mother became his devoted nurse. Francis Darwin fittingly
says : " N.o one, indeed, except my mother, knows the full amount
of suffering he endured, or the full amount of his wonderful pa-
tience. For all the latter years of his life she never left him for
a night and her days were so planned that all his resting hours
might be shared with her. She shielded him from every avoidable
annoyance, and omitted nothing that might save him trouble, or
prevent him becoming overtired, or that might alleviate the many
discomforts of his ill health. For nearly forty years [almost
throughout his marriage] he never knew one day of health like
the ordinary man, and thus his life was one long struggle against
the weariness and strain of sickness. And this can not be told
without speaking of one condition {ivife) which enabled Mm to
hear the strain and fight out the struggle to the end." (Italics
inserted.)

Another most important fact must be added because it ena-
bled him to play in nature study according to his wishes. His
economic independence was established through his father's good
will. It must be recognized that his wife-mother and his economic
independence, as a secure source of protection for his family and
himself, made it possible for him to endure his chronic affective
conflict because he could thereby avoid the aggra;vations that usu-
ally arise when an individual, having serious affective suppres-
sions, is required to adapt himself to the demands of a self-indill-
gent mate or the stresses of competitive business. These two facts
probably saved Darwin from utter ruin long before the "Origin
of Species" could have been published.

During the critical period of affective renunciation of ortho-
dox mysticism for the more serious and more sacred truths of
Nature, from twenty-seven to thirty, Darwin's interest changed
in other important respects. He discovered "imconsciously and
insensibly, that the pleasure of observing and reasoning was a
much higher one than that of skill and sport" (p. 53). He also
became definitely convinced of his own place innature and the sig-
nificance of his theory of evolution. He says (pp. 75, 76), "As

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 229

soon as I had become, in 1837 or 1838 [age twenty-eight or twenty-
nine], convinced that species Avere mutable productions, I could
not avoid the belief that man must come under the same law. Ac-
cordingly I collected all notes on the subject for my OAvn satisfac-
tion, and for a long time without any intention of publishing."
His cautiousness shows how clearly he foresaw the criticisms that
would be hurled at him because of the pain his theories would
arouse in others. His ability to recognize this, of course, could
only have come from the pain he himself experienced when he
quietly renounced his orthodox wishes as to the future of man.
His next sentence shows how clearly he apprehended the nature
of the illegitimate , claims orthodox minds are tempted to make
in the name of religious righteousness. He says, "Although in
the ' Origin of Species ' the derivation of any particular species is
never discussed, yet I thought it best, in order that no honorable
man should accuse me of concealing my views, to add that by the
work 'light would be thrown on the origin of man and his his-
tory.' " (p. 761).

His first child was born when he was thirty, and he says. "I
at once commenced to make notes on the first dawn of the various
expressions which he exhibited, for I felt convinced, even at this
early period, that the most complex and fine shades of expression
must all have had a gradual and natural origin." (In this re-
spect Freud's contribiition, that the sexual functions evolve grad-
ually as a variation from nutritional functions, is neither a new nor
a radical departure.)

It is Avorthy of consideration that Dai-Avin's father, although
he hated medicine, submitted and, from having "no choice," fol-
lowed Ms own father's profession but was unable to accept the im-
plications as to the origin of man that were taught by his theories
in "Zoonomia" (that all forms of life AA^ere "one family of one
parent"). Besides this resistance, he strongly wished that his
son Charles, after he had refused to become a physician, should
accept, en masse, the dogmas of the Church of England and be-
come a country clergyman. (This seems to have been an expres-
sion of opposition to "Zoonomia.") These factors indicate that
the father's resistance to his son's yearnings to work on the same
problem that had interested his grandfather had a far deeper
emotional determination than probably any of the family allowed

230 PSYCHOPATHOLOGY

themselves to consider. That Charles Darwin's consecration of
himself to science was . a most sacred resolution is firmly sup-
ported by the zeal, patience, and care with which he worked, as
well as by such statements as this, in his autobiography: "I re-
member Avhen in Good Success Bay, in Tierra del Fuego, thinking
(and I believe, that I wrote home to that effect) that I could not
employ my life better than in adding a little to Natural Science.
This I have done to the best of my ability and critics may say
what they like, but they can not destroy this conviction" (p. 73).
The delicate manner in which father and son had to adjust their
wishes is indicated by the statement regarding the intention that
he should become a clergyman: "Nor was this intention and my
father's wish ever formally given up, but died a natural death,
when, on leaving Cambridge, I joined the Beagle as naturalist."

It is permissible to infer, therefore, that Darwin's consecra-
tion of himself as a naturalist for the welfare of humanity, besides
gratifying and beautifully sublimating his mother-attachment, also
gratified his father's desire that he should religiously consecrate
himself to the welfare of humanity, which is remarkably like the
mechanism of the sacrifice of the devoted Son Christ if we con-
sider certain other facts.

At thirty-three, (incidentally the year of the Crucifixion) he
retired from London to seclude himself for the remainder of his
life in the isolated, rural home of Down. That he literally wrote
his studies of nature with consecrated devotion is obvious from
his life of self-denial, the careful exactness with which he main-
tained his working schedule, Sundays, as well as week-days, the
enormous output of material, some 7,000 pages of scientific re-
search, the "sacredness" with which he regarded the objects of
his study,his humility, and the anxiety he endured lest he should
make a mistake or offend some one.

Probably the same biological cravings that dominate us all
and have insisted upon cherishing the fantasies about renuncia-
tion of envy by Christ in the Garden of Gethsemane, the Cruci-
fixion and Burial of all selfish, worldly (sporting) interests, and
the conversion and ascension in life through seeking truth and
generously tolerating censure, urged Darwin, irresistibly, onward.
For the sake of Maii, he endured the taunts and ridicule and curses
of the orthodox thinkers of his time, as Christ endured the perse-
cutions of the orthodox Jews nineteen hundred years ago.

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 231

It is a very serious undertaking for' a man to consecrate him-
self too severely to his inspirations. Comparatively rugged vul-
garity and mischievousness are emotional exercises that, have an
important balancing influence and prevent 'too consistent repres-
sions of affective interests of an important type as 'well as dis-
tressing atrophy in others. The personality tends to become psy-
chopathic, not unlike the seclusive, shut-in, fanciful hero Christs,
and many of our paranoid psychopaths, who heedlessly accept
their inspirations without controlling them. Observations of Dar-
Avin's behavior frota thirty-three until after seventy show the na-
ture of his anxiety. Until after his marriage, Darwin was very
vigorous, fond of sports, and endured physical hardships on his
explorations with little distress.

At forty, he wrote to Dr. Hooker, presumably his physician :
"Everyone tells me that I look quite blooming and beautiful and
most think I am shamming, but you have never been one of those."
And it must be remembered that at this time he was miserably ill,
far worse than in later years (p. 90). We are told that "his ex-
pression showed no signs of the continued discomfort he suffered,"
even though, "when he was excited with pleasant talk his whole
manner was wonderfully bright and animated and his face shared
to the full in the general animation."

"Like most delicate people, he suffered from heat as well as
from chilliness ; it was as if he could not hit the balance between
too hot and too cold; often a mental cause Avould make him too
hot, so that he would take off his coat if anything went wrong
in the course of his work." (Italics inserted.) This observation
gives at least some insight into the delicate affective balance on
which Darwin's self-control swung and how quickly he overcom-
pensated for the fear of making a mistake or doing something he
might regret. He was pathologically conscientious, exceeding by
far the limitations of common sense. Another example of his
hyperconscientiousness is to be seen in his letter writing. "He
received many letters from foolish, unscrupulous people, and all
of these received replies. He used to say that if he did not an-
swer them he had it on his conscience afterwards. He had a
printed form to be used in replying to troublesome correspond-
ents, but he hardly ever used it" (p. 98).

Darwin's kindness and appreciation of the interests of others
was so remarJcably developed that it must be considered to be more

232 PSYCHOPATHOLOGY

than a grateful compensation for Ms bnrdensomeness to others,
for we find it to have been a consistent reaction, even with un-
known, "nnscrnpuloiis correspondents," and his publisher, who
had never met him, said, "Everything I did [for Darwin] was
right, and everything was properly thanked for." "We also find
that in conversation he Avas peculiarly anxious not to become bur-
densome by repeating a story twice or by talking when others
showed impulses to do so.

The spontaneous development of such traits of hyper-appre-
c'iativeness may have, as a compensatory growth, a logical incit-
ing cause in the fear of being offensive, ungrateful and inappre-
ciative. The cause of this fear, however, since the soothing nature
of his OMU family life was almost perfect, must he looked for in
suppressed emotions that he had to be incessantly on guard
against, and which, perhaps, contributed to wearying him into in-
validism.

A further indication of his emotional difficulties is to be seen
in his habits. "After dinner he never stayed in the room, and
used to apologize by saying he was an old woman who must be al-
lowed to leave with the ladies. This was one of the many signs and
results of his constant weakness and ill health. Half an hour, more
or less, of conversation would make the loss perhaps of half the
next day's work. He became much fatigued in the evenings, es-
pecially of late years, when he left the drawing-room about ten,
going to bed at half -past ten. His nights were generally bad, and
he often lay awake or sat up in bed for hours,' suffering much
discomfort. He was troubled at night by the activity of his
thoughts, and would become exhausted by his mind working at
some problem which he would willingly have dismissed. At night,
too, anything ivliich had vexed or troitblcd him in the day would
haunt him, and I thinli it was then that he suffered if he had not
answered some troublesome person's letter" (p. 101). (Italics
inserted.)

This duly confirms the impression that Darwin's careful
gratefulness and conscientiousness were also a necessary compen-
sation to protect himself from anxiety and the horrors of sleepless
nights and uncontrollable thoughts. He dared not become conten-
tious or critical, because, if he did, even in little conversations, as-
sume the postural attitude necessary for tlie suecessfiil criticism of
another, the suppressed affect literally overwhelmed, his self -con-

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 233

trol and could not be checked even in the late hours of night. This
unfortunate man must have suffered excruciating distress in his
later years as his resistance weakened, but, sitting up in bed, a de-
fense against anxiety and fear, with his wife, who dared not leave
him alone at night, they shared the distress together.

That this disturbance of function had an affective basis and
not an organic one is indicated, not only by the fine old age he
reached, but by the fact that most people regarded him to be in
good health and shamming, and no organic lesion was found by
his ph^'-sicians until his last years.

"Any public appearance, even of the most modest kind, was
an effort for him," the marriage of his oldest daughter caused
undue fatigue and he was unable to attend the funeral of his
father. He rarely traveled and, even if he were leaving home for
a week, the packing had to be commenced early on the previous day
and the chief part of it he would do himself. "The discomfort of
a journey to him was, at least, latterly, chielfly in the anticipatioi},
and in the miserable feeling from which he suffered immediately
before the start, even a fairly long journey, such as that to Conis-
ton, tired him wonderfully little, considering liow much of an in-
valid he was" (p. 107).

This sort of fatigue and weakness, due to ant'icipation, re-
minds one of the fatigue that is so disastrous to athletes when
they become overly anxious before a race or game. The extent
to which his anxiety might affect him when in society may be
gathered from this comment in his autobiography: "My health
almost always suffered from the excitement, violent shivering and
vomiting attacks being thus brought on. I have therefore been
compelled for many years to give up all dinner-parties ; and this
has been somewhat of a deprivation to me, as such parties always
put me into high spirits. From the same cause I have been able to
invite here very few scientific acquaintances." So methodically
did he have to live that his schedule could not be comfortably
varied from week-day to Sunday.

It is quite evident that DarAvin's constant problem was to
protect himself from anticipations and conflicts because his auto-
nomic-affective reactions caused severe anxiety and insomnia. It
is to be regretted, because of its great importance to psychology,
that the nature of his thoughts and dreams under such conditions
were not recorded.

234 PSYCHOPATHOLOGY

A contributory cause of Darwin's tendency to anxiety and ex-
citement must be recognized in the important fact that he was a
sincere man and his discoveries of the laws of nature, destined
subtly to produce a serious change in religious practices, were se-
verely criticised by the rampant orthodox with probably as much
vindictive unreasonableness as psychoanalysis is enduring today.

The isolation of himself from the public greatly protected
him, but this would hardly be sufficient to insure him from the
fear of making a mistake or of wasting time or of offending his
father.

The most disastrous affects of chronic anxiety are of course
digestive and nutritional, and Darwin's digestive functions were
seriously affected. His long, thin legs showed the meagerness of
his powers to assiiiiilate nourishment. It seems that the most sat-
isfactory treatment he found was "hydropathic," and his biogra-
phy indicates that he must have tried many forms of treatment.

Darwin's interests in life were most decidedly eccentric if
compared to the interests of the average healthy scientific re-
searcher. He exercised little interest in business and read little
current literature besides his newspaper unless associated with
scientific work. He was very fond of novels, but his serious inter-
ests were devoted entirely to certain genetic problems in biology
and geology. He says : "My chief enjoyment and sole employment
throughout life has been scientific ivorTc; and the excitement from
such work makes me for the time forget or drives away my daily
discomfort" (p. 65).

His manner of working in regard to saving time also shows
how intensely he had compensated for the charge of being a waster
of time in his youth. Francis Darwin says (p. 121), as to his
manner of working: "One characteristic of it was his respect for
time ; he never forgot how precious it was. This was shown, for
instance, in the way in which he tried to curtail his holidays ; also,
and, more clearly, with respect to shorter periods. He would often
say that saving the minutes was the way to get work done; he^
showed his love of saving the minutes in the difference he felt
between a quarter of an hour and ten minutes' work; he never
wasted a few spare minutes from thinhing that it was not worth
while to set to work. I was often struck by his way of working up
to the very limit of his strength so that he suddenly stopped in

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 235

dictating, with the words, 'I believe I mustn't do any more.' The
same eager desire not to lose time was seen in his quick move-
ments when at work."

"He saved a great deal of time through not having to do any-
thing twice. Although he would patiently go on repeating ex-
periments where there was any good to be gained, he could not
endure having to repeat an experiment which ought, if complete
care had been taken, to have succeeded the first time— and this
gave him a continual anxiety that the experiment should not be
Avasted; he felt the experiment to be sacred, however slight a one
it was" (p. 122).

"In the literary part of his work he had the same horror of
losing time, and the same zeal in what he was doing at the moment,
and this made him careful not to be obliged, unnecessarily, to read
anything a second time" (p. 122).

In regard to saving, he is said also to have used the backs of
his note-sheets in order not to waste paper and, because of this,
many historically interesting sheets were destroyed.

The above noted characteristic of saving time, energy, op-
portunity and material was decidedly more developed than is
usual for the average biological researcher. Why? What strange
influence could have determined this trait of character?

As a schoolboy, preceding^ during and after adolescence, his
father, besides others, regarded him to be more stupid and lazy
than the average boy and his father was honestly afraid he would
become a source of regret to his family. "V^Hien he came to his
father for consent and encouragement to make the cherished voy-
age of the Beagle, he was derided for utterly lacking common
sense; and, when he returned home, the "sensitive" father did
not frankly acknowledge his interest as a naturalist or his intel-
lectual improvement, and admit that he had been mistaken in his
judgment, but, compromisingly, turned to one of his daughters
and remarked, "Why! the shape of his head is quite altered!"
(p. 53). This was a phrenological observation which approved of
the signs of intellectual improvement in his son, but did not offer
a frank retraction of his former impression and create an oppor-
tunity for honest emotional readjustment. Darwin precedes this
comment in his autobiography with the significant statement, in
the same paragraph, "I discovered, though unconsciously and in-

236 PSYCHOPATHOLOGY

sensibly, that the pleasure of observing and reasoning was a much
liigher one than that of skill and sport. That my mind ^§^^ de-
veloped through my pursuits during the voyage is rendered prob-
able by a remark [quoted above] made by my father, who was the
most acute observer whom ever I saw, of a skeptical disposition,
and far from being a believer in phrenology. ' '

This revelation, an additional reason for Darwin's change of
interest from sports to intellectual pursuits, becomes duly si^lfi-
cant when we associate with it the fact that his father, when fie
heard from his daughters that Charles did not like the thought of
becoming a physician, proposed that he should become a clergyman.
"He was very properly vehement against my turning into an idle
sporting man, which he considered my probable destination. " His
father regarded a voyage with the Beagle as a "wild scheme" and
an idle, sporting adventure. The romantic circumstance in wMch
Darwdn's uncle testified for Darwin's sincerity of purpose, no
doubt, put it up to his honor not to betray his uncle's confidence,
and, moreover, to win his father 's approbation lest he should later
regret having given his consent ; hence, the gradual change of in:^|.
terest from worldly sports' to higher interests of reasoning as a
v/ish-fulfillment.

The enormous collection of observations that Darwin made
on this voyage verified his sincerity and diligence, but it did not
win frank approbation, as the father's behavior showed in the
first critical moment of meeting the returning prodigal, but self-
respecting, son.

His father, though deeply sympathetic, was too sensitive to
malse the complete admission that the voyage had proved to be
a common-sense proposition, and that he had been mistaken in
his judgment. Darwin 's regard for his father prevented him from
showing any disappointment at the evasive greetiaig upon his re-
turn home after five years of adventure in the obscure quarters
of the earth ; but, in Ms later years, his ' ' peculiar ' ' use of admir-
ing superlatives in regard to his father's wisdom and sympathy
indicate that it was probably at that time that all feelings of dis- 1
appointment in his father's attitude were resolutely suppressed
and the father was accepted as utterly unable to do a wrong. The
disappointment in his father's judgment was kept suppressed by
over- evaluating his Avisdom. Francis Darwin makes the signifi-
cant comment: "Charles Darwin's recollection of everything that

MECHANISM OF SXIPPRESSTON OR ANXIETY NEUROSES 237

■\vas connected Avith his father was peculiarly distinct and he spoke
of him frequently, generally prefacing an anecdote ivifh some
phrase as 'My father, who iras the ivisest man I ever knew,' "
(p. 10). (Italics inserted.) "His reverence for him was bound-
less and most touching. He would have wished to judge every-
thing else in the world dispassionately, taut anything his father had
said was received with implicit faith" (p. 10). In contrast to this
significant, complete acceptance of his father's word (whereby, of
course, all possibility of conflict of opinion or expression of doubt
and displeasure was removed), we find that Darwin said to his
daughter, as she writes it, that "he hoped none of his sons would
ever believe anything because he said it, unless they were them-
selves convinced of its truth — a feeling in striking contrast with
his own manner of faith" (p. 10), and a direct admission that his
attitude toward his father was not a healthy one, but the best ad-
justment that he could make under the circumstances of (1) his af-
fective attachment to his father, whereby he was the victim of his
transference, and his love for his mother and her interest, (2) his
economic dependence, and (3) the necessity of avoiding conflicts in
order that he would not be distracted from his researches.

The carefulness with which Darwin adjusted is to be seen in
his ' ' peculiarly distinct ' ' recollection of ' ' everything that was con-
nected Avitli his father," and his secret difficulties, which passed
unobserved by most people, may be estimated by the. following im-
pressions he had of his father. He was "very sensitive, so that
many small events annoyed and pained him much. He was easily
made angry, but his kindness was unbounded" (p. 18). (If not
made angry, is to be presumed.) Darwin's father seemed to have
an unforgetable memory for painful events becausCj when he be-
came older and unable to practice, he refused to go driving foi-
the reason that every road was associated with painful memories.
It may be repeated here that he also characterized his father thus,
"his chief mental characteristics were his powers of observation
and his sympathy, neither of which I have ever seen surpassed
or even equalled" (p. 11), and "the most remarkable power whicli
my father possessed was that of reading characters and even the
thoughts of those whom he saw even for a short time; some in-
stances of his power almost seemed supernatural" (p. 12). This
gives us an idea of the difiiculties Darwin must have had in main-

238 PSYCHOPATHOLOGY

taining a submissive posture or attitude that kept his father com-
fortable, whereby he renounced all independence of thought in re-
lation to his father, submissively accepting his every opinion or
statement without reserve and as not to be questioned.

This probably explains the cause of "a fatality" of reasoning
which Darwin had to struggle with. When anyone makes a new
deduction or an original statement or theory, if it is correct, it
more or less reflects an atmosphere of superiority of thought upon
himself and, logically, an implication of inferiority of thought
upon other people. This is probably why lawyers, ministers,
scientists, artists, actors, physicians, mechanics, psychoanalysts,
ball-players, debutantes, cooks, i.e. established individuals who
compete for recognition by displaying the same powers or inter-
ests, have difficulty in recognizing the superiority of the new ri-
val's qualifications. The recognition usually comes from those
who are not rivals. Darwin's theories were more generally ac-
cepted by the younger naturalists who were training for competi-
tion with the established naturalists ; and the older men, who could
not reconstruct their work, were unable to accept the theory, pre-
ferring their "standing" rather than the actual truth. The feud
between Freud, Jung, and Adler has a similar mechanism.

With this mechanism in mind a determinant is to be seen for
the variation in asserting potency displayed by Erasmus Darwin,
grandfather, poet-naturalist and physician, and Robert Darwin,
physician, with theorizing capacities highly developed but not fin-
ished, and Charles Darwin, son, who refused to be a physician but
resumed his grandfather's work on the origin of species, and re-
wrote the theory in an improved but decidedly individualistic form.

Darwin, by his refusal to become a clergyman, had formally
given his father to understand that he could not accept the Church
of England's and his father's impressions as to man's place in
nature, and the expression of his views had to be most consider-
ately made so as not to assert himself heedlessly upon his father's
wisdom. Like all such adjustments between superior officers and
subordinates, the subordinate usually suffers from a retarding
tendency to misexpress himself whereby he leaves an opening'for
the superior to display the fact that his position is still one of
dominant potency. Darwin complains, "I have as much difficulty
as ever in expressing mypelf clearly and concisely; and this diffi-

MECHANISM OF SUPPRESSION OU ANXIETY NEUROSES 239

culty has caused me a great loss of time * * * There seems to
be a sort of fatality in my mind leading me to put at first my
statement in a -wrong or awkward form" (p. 80). The wrong
form invites a self-assertion from another as does also the awk-
ward form offer a chance for more graceful display of self by
another.

There is considerable evidence to show that this person who
was always more or less in mind was none other than his father.
Darwin was completely independent of all other people. This
"fatal" tendency might have deprived humanity of his theory of
evolution because, although Darwin had quite clearly formulated
it at thirty, he did not present it until fifty-six. His father died
when Darwin was thirty-nine, but the death of the suppressive
influence does not relieve the suppressed affect so long as the mem-
ory is revered and cherished. It was only upon the ' ' strong advice
of Lyell and Hooker" (p. 70) that Darwin accumulated enough ini-
tiative to prepare a volume on the transmutation of species. The
moral support of Henslow, whose protege Darwin liked to con-
sider himself, and Lyell and Hooker, fortunately counteracted the
affective resistance to free self-expression as a naturalist, which
is clearly traceable to the revered father's painful manner of yield-
ing to the voyage of the Beagle.

Darwin compensated for the persistent paining of his father
by elevating him to the revered, immortal height of godliness as
the wisest, most sympathetic, most observing of all men. Such
affective attitudes toward the father, during a psychosis, are al-
ways indicative of renunciation of all affective competitiveness
with the father in order to keep peace while love is secretly claim-
ing for itself the mother's supreme interest.

I have seen this, frequently, distinctly illustrated in young
men. In a typical instance, the only son of a devoted, beautiful
mother was in constant anxiety lest he should suddenly die from
cardiac failure or strangulation. In a confidential moment, with
unmistakable pleasure, he said that his mother had often told him
that "she loved him more than she did his father. He was dis-
tressed -by incestuous dreams and the fact that he and his father
were always hostile and unable to understand one another. He
could 'not admit that they hated one another, and though he wished
to love his father he could not give up stealing his mother's af

240 PSYCHOPATHOLOGY

fections for himself.' Such secret intrigue was punished by the
fear that he must (ought to) die and renounce his enmity. The
crucifixion or dying of patients, who feel that they are Christs, is
always attended by severe anxiety. This mechanism has been
observed in many of our cases.

It is evident that the affective relationship between father
and son had a most signi-ficant direct influence on the theory of
evolution which will be still further shown later.

As to the suppressed affect that distressed Darwin and added
considerably to his invalidism, we are given an indication of its
nature by his methods of obtaining relaxation ; that is, relief from
its pressure.

He says : ' ' Novels,- which are works of the imagination, though
not of a very high order, have been for years a wonderful delight
and pleasure to me, and I often bless all novelists. A surprising
number have been read aloud to me, and I like all, if moderately
good, and if they do not end unhappily — against which a law ought
to be passed. A novel, according to my taste, does not come into
the first class unless it contains some person whoyn one can thor-
oughly love, and if a pretty woman, all the better." In this tend-
ency to become unduly distressed by a novel in which hate and
misfortune triumph over love and, on the other hand, of almost
requiring a diet of novels in which some character won the reader's
love, is a strong indication that Darwin suffered from suppressions
of affect which, if allowed free play, might have pained him in
his devotion for his dominating father. This would have shattered
his own peace infinitely worse than slighting the letter of an un-
scrupulous correspondent. Rather than permit the recalcitrant
competitive craving free play, he incessantly suppressed it and
never relaxed his vigil. This was not only to keep from paining
those he loved, but also to protect his powers for research by
avoiding tbe distractions that attend arguments and dissensions.
He regarded himself as being "not quick enough to hold an ar-
gument with any one." "Unless it was a subject on which he ^sf&%
just then at work he could not get the train of argument ' into
working order quickly enough" (p. 117), which shows how deeply
he became concentrated on the problem that he worked on. We
must recognize that his self-isolation, in Down, from nearly all
social contact, onabled.him the more to enjoy the free play of his

MECI-J^VNTSM OF SUPPRESSION OR ANXIETY NEUROSES 241

love for biological research, but the eccentric nature of the self-
isolation was made necessary by the ease with which he lost control
of himself in a conflict. This, in turn, must be recognized as being
largely due to the nature of the suppressed affective tendencies.
"When he felt strongly about * * * a question, he could hardly
trust himself to speak, as he then easily became angry, a thing
wliich he disliked exceedingly. ITe Avas conscious that his anger
had a tendency to m.uUij)ly itself in the utterance, and for this rea-
son dreaded (for example) having to scold a servant" (p. 118).

The above characteristics indicate that Darwin could not trust
himself to conflict with others or protest with anger because the
suppressed affect, that was being held back like an uncoiled spring,
tended to become associated with the anger of the moment and it
multiplied too rapidly to be controlled. In this light we can under-
stand why he accepted everything that his father said as final.

It is quite reasonable to give considerable value also to the
fact that, although Darwin had to resist his father's wishes until
after the voyage of the Beagle in order to gratify the affective
attachment to his mother, after he had fairly clearly formulated
his theory of evolution at thirty, about the time of his marriage,
it became obvious to him that the successful proving of his theory
lay in his finding a means for devoting all his life to study, and this
his father could easily give him if he were so disposed. This fact,
making him the source of nourishment and physical comfort, em-
phasized the father's omnipotence and, in his resignation to it,
Darwin further renounced independence of affective expressio]].
In one sense this was fortunate for science and civilization, be-
cause it gave him more freedom for affective gratification in the
one direction that alone could fascinate him, but, in another sense,
it ruined his health and almost spoiled his theory of evolution.

The influence of this affective conflict upon his conception of
the origin of species and his formulation of the theory of evolu-
tion, which Avas to free science of many suppressive influences, is
most interesting. At twenty-nine Avhen he happened to read for
amusement Malthus' "Essay on Population," (p. 68), he promptly
appreciated the significance of the universal struggle for existence
and the survival of the fittest, not only because he had enormous
collections of biological data in mind Avhich Avere readily corre-
lated with the law, but because it was his personal experience.

242 PSYOHOPATHOLOGY

This evidently was exactly the mechanism of his own triumphant
emotional struggle with his father's wish.* He was experiencing
perhaps from obscure emotional sources the enthusiasm of the
survival of the fittest, because his older brother, whom he affection-
ately called "poor old Philos" (philosopher), had yielded to his
father's domination and studied medicine, even though he dis-
liked it and retired soon after graduating, whereas he himself,
through his persistence and courage, had triumphed.

Most significantly, Darwin comments (p. 68): "It at once
struck me * * * favourable variations (mother's favorite)
Avould tend to be preserved and unfavourable ones to be destroyed.
The result would be the formation of new species." (Parenthesis
inserted.) "Poor old Philos" never married and in that word
"poor" was unconsciously expressed Darwin's appreciation of his
brother's silent tragedy. He continues further: "Here then, I
had at last got a theory by which to work, but I was so anxious to
avoid prejudice, that I determined not for some time to write even
the briefest sketch of it." As to how much excitement the reading'
of Malthus' "Essay on I'opulation" caused Darwin can only be
conjectured, but he at least felt the necessity of guarding himself
against "prejudice."

This cautiousness of Darwin contrasts strikingly with the im-
pulsiveness of Wallace, although both men, when they realized the
biological significance of the survival of the fittest, were decidedly
aided by their own personal experiences. According to the "En-
cyclopedia Britannica, " Wallace, "Avhile lying muffled in blankets
struggling in the cold fit of a severe attack of intermittent fever"
fin the isolated tropical Moluccas], began to thinli of Malthus'
"Essay on Population" [which he had read several years pre-
viously] and, to use his OAvn words, ' ' there suddenly flashed upon
me the idea of the siirvival of the fittest. ' ' The theory was thought
out during the rest of the ague fit, drafted the same evening, writ-
ten out in full in the two succeeding evenings, and sent to Darwin,
by the next post. (This inspiration saved his name and brought
him his greatest honor. It was clearly an effort to save something
of himself from the onslaught of disease.)

Darwin and Wallace differed in their valuation of certain
factors in evolution, and this can be traced to personal experience
and wish- fulfillment. In their joint essay, "On the Tendency of

MECHANISM OP SUPPRESSION OR ANXIETY NEUROSES 243

Species to Form Varieties; and on the Perpetuation of Varieties
and Species by Means of Natural Selection" Darwin used the
phrases, "natural selection * * * Avhich selects exclusively for
the good of each organic being" and "sexual selection," whereas,
Wallace emphasized "the struggle for existence."

Even more astonishing is the fact that Darwin, before he had
read "Wallace, while contemplating marrying his cousin, his moth-
er's niece, made the scientific conclusion, which he entered in his
diary, that "selection loas the keystone of man's success. But lioio
selection could he applied to orgcmisms living in a state of nature
remained a mystery to me," showing clearly that this man, as well
as Wallace, whose scientific formulations are molding the course
of modern civilization, even though rigorously trying to follow
pure reason, were unable to avoid unconsciously founding their sin-
cerest conclusions upon their own most personal emotional striv-
ings.

Three years after his marriage, at thirty-three, he first wrote
a brief abstract of his theory, and at sixty-seven he made this
significant comment (p. 68). "At the time I overlooked one prob-
lem of great importance; and it is astonishing to me, on the prin-
ciple of Columbus and the egg, how I could have overlooked it and
its solution. This problem is the tendency in organic beings de-
scended from the same stock to diverge in character as they be-
come modified. That they diverged greatly is obvious from the
manner in which spficies of all kinds can be classed as genera,
genera under families, families under suborders, and so forth ; and
/ can remember- the very spot in the road, whilst in miy carriage,
when to my joy (symptoms of relieved repressions) the solution
occurred to me; and this was long after I had. come to Down. The
solution, as I believe, is that the modified offspring of all dominant
and increasing forms tend to become adapted to many and highly-
diversified places in the economy of nature." (Parenthesis and
italics mine') What affective resistances prevented him from see-
ing a principle which he himself characterized as being as simple
as Columbus and the egg? The source of resistance may.be quite
surely inferred when we consider that the principle means that
progressive divergence is an advantage in itself, because the com-
petition is most severe hetiveen organisms most closely related,
since they require the same food and love-object, hence it could

244 PSYCnOPATHOLOGY

not help hut he associated loitli the old delicate competition he-
tween himself and his father for his mother's affections and his
dependence upon the father for food, etc. The phrase about modi-
fied, offspring tending to become adapted to diversified places in
nature has an interesting example in his marriage to an obvious
mother-image, mother's niece, and their retirement from the Avorld
to the seclusion of Down, of which he says, "Few persons could
have Uved a more retired life than we have. Besides short visits
to the houses of relations, and occasionally to the seaside or else-
where, we have gone nowhere. ' ' It seems not even to the continent.
For over forty years she was his wife-mother-nurse.

In 1869, at the age of sixty, Charles Darwin, accompanied
by his daughter, visited the home of his childhood, years after his
father's death. The tenant showed them over the place and with
mistaken hospitality did not leave the party. As they were leav-
ing, Darwin said, with a pathetic look of regret, "If I could have
been left alone in that greenhouse for five minutes, I know I should
have been able to see my father in his wheel-chair as vividly as
if he had been there before me. ' ' (The greenhouse as nature study
is the point at which the father and son began a progressive di--
vergence.)

"Perhaps this incident shows Avhat I think is the truth, that
the memory of his father he loved the best, was that of him as an
old man." Mrs. Litchfield, Darwin's daughter, describes hica as
saying with the most tender respect, "I thinlc my father was a
little unjust to me when I Avas young, but afterwards I am thankful
to think I became a prime favorite with him. ' '

It is interesting that the wish to visualize his father so vividly,
"as if he had been there," was naturally inclined to recall the
image of him as a dependent, helpless old man, and no longer the
father with "the art of making one obey him to the letter" (p. 18).
This illustrates again the universal struggle for power that causes
so much pain when not handled with insight. Darwin's father
was actually a very sincere, kindly, sympathetic man, as his large
practice and the affection of his patients showed, and it was not
in injustice and severity that he was dominating ; that attitude usu-
ally justifies an open revolt on the part of the son if the mother
does not interfere, but it was in his conscientiousness and sincer-
ity of wishing that he almost ruined his son. This is the type of

MECHANISM OF STJPPKBSSION OR ANXIETY NEUEOSES 245

affective bond that holds the object in the severest grip when it
naturally needs to break away. Like the lovely daughter who must
sacrifice her love for children to a dependent, defective old mother
and finds to her horror that she has spontaneous wishes for her
mother to release her by dying.

Darwin's method of working showed how keenly he humored
his inspirations and nursed his strength in his ascent as a man
of intellectual attainments. His study chair was higher than the
average — he had long legs — but upon the top of this he placed
"footstools" so as to elevate himself considerably and then neu-
tralized the additional height by resting his feet on another chair,
much to the mirth of the family. The elevated seat of learning
surely had a genetic influence in his work through its reenforce-
ment of the compensator}^ striving Avhich he had to assume in order
to overcome his humility and deference and the "fatality" of
reasoning which had become an attribute of his attitude of mind.

When his margin of energy M^as too meagre to work consist-
ently on other scientific problems, he could still collect facts bear-
ing on the origin of species. "I could sometimes do this when I
could do nothing else," shoAving which wish in his personality was
the strongest and could continue to work after the others had to
yield to fatigue. He says he never stopped collecting facts on the
origin of species.

Never for a moment after clearly conceiving his inspiration
did he abandon the creation of it. The excitement and difficulties
he experienced in controlling the affective reactions that were
aroused, as the secrets of nature Avere revealed to him, may be es-
timated by the following comment : When twenty-nine, upon read-
ing Malthus' "Essay on Population," in Avhich the struggle for
existence is emphasized, "it at once struck me that under these
circiimstances favourable A^ariations would tend, to be preserved
and unfavourable ones to be destroyed. The result of this would
be the formation of neAV species. Here then I had at last got a
theory by which to Avork ; but I Avas so anxious to avoid prejudice
that I determined not for some time to write even the briefest
sketch of it." Four years later he aloAved liintself to Avrite, in pen-
cil, a tliirty-five page abstract of his theory. This Avas enlarged
two years later into 230 pages, and his completed theory was not
published until some twenty-nine years after the first general
■ formulation of his idea of CA^olution.

246 PSYCHOPATHOLOGY

Some other peculiarities in Darwin's methods of workiii^"
are important for the psychologist to recognize. He says : "When-
ever a published fact, a new observation or thought, came across
me, which was opposed to my general results, it was my practice
to make a memorandum of it without fail at once ; for I had found
by experience' that such facts and thoughts were far more apt to
escape from the memory than favourable ones" (p. 71) (forgetting
as a wish-fulfillment). His watch for exceptional phenomena was
keen; and "my love of natural science [the medium for gratifi-
cation of his childhood's wish] has been steady and ardent * * *
This pure love had, hoAvever, been much aided by the ambition
to be esteemed (italics inserted) by fellow naturalists." (Reen-
f orcing postadolescent wishes produced by the influence of Grant,
Henslow, Lyell, and others.) "From my early youth, I have had
the. strongest desire to understand or explain whatever I observed
[this originated in his mother's curiosity], that is, to group all
facts under some general laws. These causes combined, have given
me the patience to reflect or ponder for any number of years over
any unexplained problem." (This mechanism of freely grouping
facts under general laws- permits the affective cravings full spon-
taneity of function and they are not then subdued or depressed by
inhibiting fears of being unwise or mistaken. The capacity for
spontaneous discriminations and comparisons is tremendously
greater than when shut in by don'ts. "I have steadily endeavored
to keep my mind free so as to give up any hypothesis; however
much beloved (and I can not resist forming one on every subject)
as soon as facts are shown to be opposed to it. He says that every
single first formed hypothesis except the one on coral reefs had to
be modified after a time or given up.

Darwin's magnificent courage fo think persistently and hon-
estly and the results of his method, as the mechanism of personal
improvement, is a splendid example that our American scientists,
holding influential chairs in research and education, should con-
sider. The minds of many American academic scientists seem
to be subtly subdued by the fear of making a mistake or of even
considering an hypothesis that possibly may have to be modified
or abandoned. This is particularly true for psychiatry and psy-
chology.

Darwin's attitude toward the objects of his inquiry, especially

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 247

flowers, also reveals the affect that forced the inquiry, which was
love. He seems to have shown no narcissistic cravings to scintil-
late, or hatred, prompting him to acquire a triumph in order to
have a potent tool for conflict, or a desire to be admired or to es-
tablish priority. His love for flowers led him to treat them al-
most as personalities. His son says: "I used to like to hear him
admire the beauty of a flower; it was a kind of gratitude to the
flower itself, and a personal love for its delicate form and colour.
I seem to remember him gently touching a flower he delighted in ;
it was the simple admiration that a child might have. He could
not help personifying natural things. ' ' His theory made him their
coequal. The actual experiences in his life in which flowers were
so associated as to arouse such tender affections, he practically
tells us, occurred in his early childhood when his lovely, gracious
mother revealed her curiosity about the secret of nature which
might be answered by looking "inside" of the flower.

Darwin, as a father and creative thinker, was a inost unu-
sual exception to the rule in that he proved to be a successful
father ; whereas, most intensive thinkers make poor fathers. The
career deprives the child of much needed attention. The "Ency-
clopedia Britannica" says four of his five sons became prominent
in the scientific Avorld. The honor for this, hoAvever, probably is
due Emma Wedgwood, Mrs. Darwin, whose Avonderful personality
made it possible for Darwin himself to become the creator of his
work.

Darwin's attitude toward his children as an educating influ-
ence was radically different from his father 's controlling methods
in that he permitted his children to develop as freely as possible,
thereby permitting the affective forces to exercise their fullest
powers. He treated his children with "unbounded patience" and
never "spoke an angry word to them in his life," but it "never"
entered their heads to disobey him. This was not their fault but
due to the fact that he always "respected" their "liberty" and
"personality."

Conclusion

The principal characteristics of Darwin that made him one of
the great constructive thinkers of all time are: (1) the loyalty
with which he cherished his mother's wish (fortunately it was
practical as well as ideal, which can not be said of the wishes of

248 PSYCHOPATHOLOGY

most mothers). lie had to struggle with influences that ■would
divert him from his love-object at ten to seventeen in the classical
schools, at seventeen in the medical school, at twenty in a theo-
logical school, at twenty-two to make the voyage of the Beagle, and
at twenty-seven to thirty when he finally renounced all interest in
the last remaining restraints, orthodox Christianity, btcoming, as
he considered himself, an "agnostic."

As a school-boy and a student he became depressed and dis-
interested when he was forced by the stupidity of academic edu-
cators to acquire in learning what his emotions had aversions for,
and yet he literally glowed with enthusiasm when permitted to
make his own free selections of friends and literature in biology
and geology. His own experience demonstrated that depression
of compensatory adaptive capacities follovjed when an environ-
ment luas persistently tmfavorable to the affective needs.

In this respect the educator "s crime of forcing children into
prescribed courses deserves the most remorseless criticism, be-
cause it is still practiced today in our public schools and universi-
ties.

(2) The second attribute that contributed to his success was
the absolute freedom of his thinking and theorizing about ' ' every-
thing" and his humble ^^allingness to abandon any theory, no mat-
ter how much beloved it might be, when exceptions disproved it.
(When the dominant craving that the theory satisfies is not love
but hate, it seems to be much more difficult to admit error or to
risk an error.)

"He often said that no one could lie a good observer unless ho
was an active theorizer" (p. 126), which decidedly means that
since our spontaneous observations and ability to react to sublim-
inal stimuli, that is delicate or slight variations in the environ-
ment, depends upon the freedom with AvTiich the aff ective-autonomie
cravings may work, no one, Avho must work with material that he
hates, can become a good observer. This is the most common cause
of the tendency to dullness of thinking in most matured males and
females. Economic and moral obligations force the individual to
continue with the unpleasant work.

(3) His inherent perseverance and humility and sincerity.

(4) His patience, which was probably due to the fact that Mrs.
DarAvin was a perfect mother-image by birth and temperament.

(5) Freedom from economic distractions and family conflicts.

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 249

(6) The suggestions from his grandfather's theory and the
influence of Grant, Henslow, Sedgwick, Lyell and Hooker, that
counteracted his father's resistance to his becoming a naturalist.

(7) The sacredness with which he regarded his objects of re-
search and the religious manner in which he consecrated himself
to the study of nature.

The influences that conditioned Charles Darwin's affective
cravings so that the only thing he could satisfactorily do in life
was to write theories of evolution and study the secrets of nature
were (1) the peculiarly influential personality of his mother, due to
her (a) love, (&) beaiity, (c) sweetness, (d) fascination for her
father-in-law's work, and (e) her intuitive recognition that he Avas
not through with his task; (2) his grandfather's quest and theory;
(3) the personal influence of his postadolescent hero. Dr. Grant,
to which was largely contributory Darwin's affective dileimna
with his father, the confidential nature of the talk, his "silent as-
tonishment" whereby he did not lose the tension of the affective
reaction through talking it off; (4) Prof. Henslow's ministerial
and scientific interests, in Avhich personal combination of the wish
to please his mother as well as the conflicting wish to please his
father, both found a medium for gratification; (5) his uncle's in-
sight into the father-son conflict; (6) the voyage of the Beagle;
(7) the father's sensitive half -acknowledgment of pleasure in his
son's change of interest from sports to intellectual work; (8) his
father's forbearance from further conflict; (9) economic inde-
pendence; and (10) the unreserA^ed devotion and heroic patience of
his wife. When Ave think of how she deA^oted her life to his com-
fort and shared every one of the miserable nights Avith him dur-
ing his last years, the only song that DarAvin ever sang correctly
has a distinct interest.

AE HYD Y NOS (Welsh)

(All Through the Night.)
Ah! my love, how sad and dreary,

All through the night,
Is my heart with sighing weary,

All through the night.
Dearest love, couldst thou but hear me,
Sjirely thou wouldst, hasting, cheer me,
And remain forever near me,

All through the night.

250 PSYCHOPATPIOLOGY

Sweetly sang beside a fountain,
Mona's maiden on a mountain,
When wilt thou from war returning,
In whose breast true love is burning,
Come and change to love my yearning,
By day and night?

The causes of Darwin's anxiety neurosis may be attributed
to Ms complete submission to his father whereby he deprived him-
self of all channels of self-assertion in his relations with his
father or anything that pertained to him. Free assertions for his
rights might have led to a mortal father-son conflict, because
both had irrepressible affective cravings that contended for the
idealization of the same love-object. This would, perhaps, as it
so often does, have terminated in Darwin becoming a paranoiac, if
not an invalid. His search for the secrets of nature and his
mother's love would then have become hopelessly aborted by hate.
Through the renunciation of all envy and all competitive interests
in life, such as ambition for priority, and the unreserved accept-
ance of his father 's word and wisdom, Darwin, by adroitly select-
ing diversions, succeeded in keeping suppressed all disconcerting
affective reactions, with no more inconvenience than that of pro-
ducing nutritional disturbances, uncomfortable cardiac and vaso-
motor reactions, vertigo and insomnia.

The more one analyzes personalities, the origin of their
wishes, their wish-fulfiUing-striving and the accidents that exert
a definite influence upon their successes and failures, the more one
realizes that many men and women are potentially, finely creative,
but few are fortunate enough to become associated with factors
that enable them, to overcome or -evade resistance.

Darwin's forty years of serious anxiety neurosis, when asso-
ciated with the father's brother's "incipient" insanity and suicide,
may invite the impression of his being a constitutional inferior
with hereditary psychopathic traits that forced him to devote his
entire time to what was then regarded as useless theorizing in
order that he might "grasp this sorry scheme of things entire."

I believe that Darwin's psychopathic traits were entirely due
to the persistence ivith which he suppressed certain autonomic
functions, affective cravings, in order to gratify other cravings.

The seriousness of his regret for having conflicted with his
father may be seen in the strange paragraph which Francis Dar-

mechanism: of suppression or anxiety neuroses 251

win uses in concluding the biography of his father's life: "As
for myself, I believe I have acted rightly in steadily following,
and devoting my life to science. I feel no remorse from having
committed any great siii, but have often and often regretted that
I have not done more direct good to my fellow creatures" (p.
530). One can not help but think in this connection, of the un-
happy father who wanted a son to practice medicine with him.

Darwin's anxiety neurosis, to repeat, was characterized by
inability to adjust to excitement, anticipations, changes of heat
or cold, cardiac palpitation and vasomotor flushing, indigestion,
nausea, vomiting, violent tremors, insomnia, persistent thoughts,
inability to criticize, or to endure social contact or worry.

This anxiety continued active almost daily throughout forty
years, but at times his, distress became so severe that he was un-
able to work for several months at a time. Many forms of treat-
ment and a series of physicians were tried, but the most restful
and efficacious were hydrotherapeutic treatment and the personal
influence of Dr. Bence Jones, and later of Sir Andrew Clark.

AN-3

The following case, (AN-3), a well-known scientist whose dif-
ficulties were studied by the psychoanalytic method, Avas similar in
many respects ; particularly as to the influence of the lovely mother
and domineering, impatient, but sincere father, the necessity for
encouragement through becoming an esteemed man's protege, a
very serious emotional crisis at thirty-three, attended by most in-
tense resolutions for self-refinement, splendid scientific achieve-
ments, compensatory wish to devote all w'ork to "pure science"
and a persistent tendency to anxiety. Ineradicable feelings of
having weakened his mental powers through adolescent mastur-
bation were not so pronounced in Darwin. In two vital respects
this case was different. He was always in financially more or
less pressing circumstances, and though he loved a beautiful, moth-
ering type ,of girl, he was. unable to marry her because of the per-
nicious anxiety that was aroused by her approach after the crisis
at thirty-three. His life ended most tragically because of the un-
happy, unsolvable situation that finally wrapped itself irresisti-
bly about him.

His case is presented as a suppression neurosis, because that
was what he suffered from until his final crisis when he developed

252 PSYCHOPATHOLOGY

a paranoid compensation. As a paranoid character with parricid-
al inspirations, his oase bridges over to the pernieions repression
compensation neurosis and in turn to chronic pernicious dissocia-
tion of the personality. Hence, his case, though not recapitulated
with the paranoia group will, however, frequently be referred to
in that chapter.

This man's life shows §,lso, like Darwin's, that the adult, ca-
reer of the individual is fundamentally determined by the family
situation molding the affections of youth, unless tremendous af-
fective adjustments are later successfully made. The patient's
impressions of his parents are herein used entirely, becSust^ in so
far as he is concerned, they reveal the nature of his adaptation to
them. Naturally, other people, friends and relatives, had very
different impressions of them.

His father, he said, was a man of "strong character," and
prided himself particularly on his efficiency. At eighty-one he was
in "full working strength." He was seemingly "never sick, nor
worried. * * * jje was scornful of ailments, yet full of ten-
derest sympathy toward acute suffering. I seem to have been
the one great trial to him in the family. He was genuinely con-
cerned about my mysterious, yet obvious, nervous disabilities;
though in my presence he seemed to feel only irritability, and in-
variably inquired, 'Well, where 's the pain?' He seemed to enjoy
my irritation over this." (This spontaneous association of sen-
tences by the patient, it will be seen later, reveals the cause of
his invalid adaptation to his domineering father.) "He was
deeply religious, always just (in intention) yet arbitrary and over-
bearing. * * * Never reasoned with his children or explained
his attitude." The patient further described his father's attitude
as "illogical" and "impulsive," ruling his family with puritani-
cal sternness and maintaining that Avhatever the situation or dis-
agreement "nevertheless the fact remains" that the "father"
should be obeyed.

"My mother seemed to be none of these things, and for this,
at an early age, I thanked God devoutly. I worshipped my mother.
But I thought she took a Avrong attitude. She would do nothing,
nor permit us to do anything 'to annoy your father.' " The pa-
tient's affective reactions to the suppressive father, if they had
been allowed to be frankly asserted, would probably have enabled
him to attain his affective independence and maturity. They were

MECPIANISM OF STJPPRESSION OR ANXIETY NEUROSES 253

normally enough aroused, but the seductive attitude of his mother,
whom he could not pain by conflicting with his father, subtly dis-
armed and crucified him. (See Michelangelo's "Pieta," Fig. 54.)
The nature of the parental combination distorted his attitude and
definitely turned him upon an eccentric emotional adjustment.
(All the children in this family except the patient finally openly
revolted against the father domination and demanded the right of
equal and spontaneous expression of opinion and feeling. The
patient's brothers and sisters urged him, after he became a man,
to correct his father's attitude of domination and to insist upon
equal rights. This, the patient was never able to do, even though
it occupied his most serious contemplation.) He could not over-
come the resistance except through an uncontrollable outburst
due to the siunmaiion of a long series of insults, and he dared not
trust himself in this.

The patient's mother, according to his impressions, was a
beautiful, modest, retiring, girlish woman, who tended to suffer
silently if wronged and adjusted herself to her husband's inter-
ests, believing that the father's word should be law. He should
be master of his household, even though she could hardly endure
some of his selfish domineering methods.

The patient said, "At the table Ave were not to speak unless
spoken to, or, if we asked for anything, it miTst be done in a low
deferential tone. At other times when a request was made, and
only reasonable requests were likely to be made, it was always
met at first by a refusal. Later, without explanation, and after a
delay calculated to discipline the spirit, the reqiTest would be
granted." (This procedure, no doubt, greatly contributed to the
suppression of spontaneous emotional adjustment.)

The patient was the oldest son, and the following bitter inci-
dent reveals the chronically suppressive attitude of the father to
his first son, and the extreme steps he would take in order to hu-
miliate (crucify) him before the household. (It can not be as-
sumed that the father had any insight into the influence of his
suppressive attitude. His reasons were, no doubt, disguised under
the belief of necessary, disciplinary measures, in order that the
son should submit to and have respect for the word of the father.)
To illustrate with an incident. One day at the dining table the
patient, then a boy of about ten, persisted in maintaining a rebel-

254 PSYGIiOPATI-IOLOGY

lious attitude about sometliing that displeased tlie father. He
ordered the boy's submission, and the youngster arose from the
table with obvious display of resistance. Thereupon, the father
threatened to use force, reverting to the principle of might shall
rule, and demanded that his son should stand with his back to the
table and prfess "his nose against a flower on the wall paper."

The boy now became openly defiant and refused point blank,
but, before he could vent his righteous indignation, his mother
rushed to his side and anxiously pleaded that he must "please"
not answer back to his father. His moral support thus gone, the
crisis was lost, and his anger, for the sake of his mother, had to
be suppressed. He submitted to the mother and, for her sake, Ms
personality was sacrificed to the father. The crucifixion of his
.affective independence seems to have been gradually completed by
the long pressure of this combination of influences. This is but
one incident illustrative of a chronic parental attitude. (At fifty-
seven, when the -patient reviewed this experience, he was utterly
unable to control his affective reactions, which were mingled with
violent anger, weeping and shame. He expressed astonishment
that, this ancient injustice should cause so much "unmanly" dis-
tress forty-seven years later. It certainly revealed one great
source of his affective tension.)

Although the above incident occurred when the patient was
about ten, it should be seen as illustrative of the nature of the pa-
ternal and maternal pressure and the reflex adaptation tendency.
This affective triangle, of course, had its beginning- in the early
childhood of the patient and, although no single truly disastrous
episode occurred, the continuity of the situation had its irremedi-
able conditioning effect.

When he was eight, the patient was sent into the country to
recover from depression. He was, however, unable to meet the
expectations of his more self-reliant cousins, and they were char-
acteristically disappointed in his timidity and unwillingness to ad-
mit his inferiority to their prowess. The situation increased his
depression and he was returned to his home in a condition that
greatly alarmed his parents. His father's "tenderness" upon
his return was surprising and made a distinct impression upon
him. In due course of time he recovered from homesickness and
developed "what the women of the .household called a 'lovable

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 255

disposition.' " The father recognized this cliaracteristic as that
of "a sissy boy," and the "lovable disposition" as "girlishness."
lie criticized this and objected, but the mother (as is characteristic
for this type of mother) defended her son "with spirit," and the
father "Avas silenced for a period." This encouraged the youth
to assert himself by criticizing his father, but the mother soundly
admonished him of the wrongfulness of it. He said (at fifty-seven)
"I think I was neither timid nor shy by nature, but I learned
to be silent under injustice. Later, when I should have reasoned
myself out of this state of mind, it had become second nature —
I now react to personalities of a certain type — my father's type —
as I have always reacted to his, from the time he took me in hand
for training, and I, out of consideration for my mother's feelings,
yielded up my independence." (This illustrates the fatal condi-
tioning of his power to protect himself from injustice and the
growth of the fatal tendency to homosexual self-sacrifice.

"The way out is simple," he commented, during the psycho-
analysis, "I believe — simple in method, but difficult to practice
because I have to deal with a long-established habit. It will be nec-
essary to get up a counter habit. It is necessary merely to stop
and think, and re-establish the independent attitude. The oppor-
tunity for practice is afforded many times a day, wherever I may
be. That is, I cringe no more, and with no more serious affect,
before, say, the chief of my office (if it happens to be domineering
in the peculiar sense I mean) than before any chance associate,
about whose opinion of me I really care, or should care, nothing.

"I have expierimented, and with illuminating results. Quite
naturally, I began wrong. The blustering manner is wrong; the
mollifying, conciliatory manner is wrong. Both are harmful, even
though they succeed. What I have really to deal with is not the
manner of the other fellow, which seems so terrifying, but my own
reaction to it. The trouble is si(,bjective. li is merely necessary
to have the courage of my coivardice — not try to hide it; hut to stop
and think. The result of this self-examination is that I get back
immediately to the self-possessed, critical attitude which I used to
assume with my father when I began to be disillusioned and be-
fore I had learned to fear him. I then feel at ease and good na-
tured. And, if a smile, or a laugh, follows, it is disarming because
if it obviously sincere." (The unconscious substitution of "if it"

256 PSYCHOPATHOLOGY

for "it is" indicates the subconscious doubt he felt as to his ability
to master himself.)

The patient was inclined to teel that another reason for his
pathological self-conscioiisness and feelings of inferiority upon
his visit to his cousins and, later, their visits to his home, was his
inability to stop day-dreaming aiid masturbating. (Because of
his unusually accurate habits of thinking as a scientist, and his
keen analytic insight, his contribution to the psychology of auto-
eroticism and homosexual crucifixion is of great value.) The on-
set of the masturbation interests, he felt, upon long, careful retro-
spective consideration, to have been a logical outgrowth of the
suppression of love and anger. He was a very affectionate child,
and very demonstrative, until the unresponsive attitude of his
parents, which he thinks was in some respects assumed in order to
control him, taught him to regard "the open expression of feeling
as bad form— the possession of feeling, even, a weakness to be
covered up."

"Toward the end of this period [aged eight] I formed the
secret habit of inventing, in fancy, situations in which my longing
for affection from others, as demonstrative in its expression as
my own was naturally, was satisfied; and out of excessive indul-
gence of such fancies, the practice of masturbation developed spon-
taneously." The one person of all others for whom the patient
had an insatiable craving for demonstrations of affection was his
mother. This was the price she had to pay for begging him to
sacrifice his masculine protests against the father's suppressions.
Had the father not been so unfortunately disposed as to suppress
those interests, but rather to look for them as signs of vi|j,0rou§?a'^
growth, the boy's affections would naturally have extended them-' '
selves in the masculine manner of openly working to win esteem
and fighting for their rights instead of covertly pleading for and
fancying them.

The early vaguely defined fantasies of girls making love to
him gradually crystallized into well-defined masturbation fanta-
sies which Avere carefully recorded at the time of this discussion.
He said he would become sexually excited (this was after puberty)
by a certain type of modest, retiring, pretty, serious, but not deep,
type of slender girl, and fancy himself having a love scene. Dur-
ing this fantasy he would masturbate. This was followed by de-
spair and resolutions which, however, soon weakened as his eroti-

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSKS 257

cism became active again. At nineteen, it may be included liero,
when .he attempted actual sexual relations, he found that all women
were disgusting, and could only get satisfaction through visual-
izing his ideal feminine type, while the real woman became "a
lump of clay" that he had "fooled." After he became an adult,
upon one occasion, his paramour reprimanded him when she no-
ticed his distracted state of mind. She said: " 'I don't believe
you know I am here ' " ; and ' ' she was right about it. " (In follow-
ing this patient's biological career, I hope the reader will recognize
that as an.adult male he was only capable of a form of masturba-
tion per vagina and, what is most important, that his fancied sex-
ual object had, without his realizing it, all the charming attributes
of his mother. The mechanism of this unfortunate evolution of his
sexual affections has been well enough explained by the patient to
permit us now to study his intellectual career and his final dis-
astrous ending. It is of the utmost importance to appreciate that
the sexual functions are not merely confined to the sexual act.)

To return to the struggles of his childhood, from eight to nine
his health improved (father's tenderness) and his teacher credited
him with having "promise" and "alert intelligence." His family
regarded him as having a "delicate constitution" (failing to un-
derstand the chronic anxiety and brooding of the boy.)

At the age of nine, he was turned over to his grandmother to
be trained with particular attention to his undesirable timidity
and "girlishness." This grandmother was the "most masculine"
woman the patient said he ever learned to know. ' ' She derided mo
for my girlish sensitiveness, for my delicate coloring; that didn't
belong to a boy, and for certain sweet (celestial) notes in my sing-
ing voice that my mother, who was an expert in music, particularly
admired." The grandmother was proud of the fact that all her'
girls had been like boys, but her attitude, "although it did.no
harm," he said, failed to correct his shyness. "Her desire, though
unacknowledged, was to protect me from a harsh world," was the
boy's impression of her methods and she brought out no responses
of latent manliness.

At eleven, he was sent to a boy's boarding school, and re-
sponded with interest in athletics and led his class- as a student.
From eleven to twelve, he succeeded in distracting himself from his
masturbation difficulties, but at- twelve he relapsed again, so seri-
ously, because of suppressive influences among his playmates, that'

258 PSYCHOPATHOLOGY

he despaired of ever beiiigable to master himself. (The result of
being completely suppressed by the first rival. His athletic inter-
ests and studies were seriously neglected, and he became morose,
sensitive, timid and decidedly shut-in.)

"The thing I was morbidly emotional about was my secret
habit. I was at school five years, and during the latter half of
this period failure to overcome it made me completely miserable.
An aunt — a younger sister of my mother — to whom I was de-
voutly attached, died during my third year at school ; and, though
I had by now completely rid myself of religious belief, I, never-
theless, suffered acutely from the mere possibility that I was mis-
taken, and that my blasting shame would now be made clear to
her.

"The longing* of the average normal man to be a boy again is
to me incomprehensible; the decade of youth through which I
passed at this time was unmitigated hell. The feeling of degrada-
tion, which never left me, mounted at times to a distraught con-
dition. During the last year in school, a stroll in the hills alone
on several occasions was given over to continuous prayer, to the
possible God, for miraculous relief." (The agonizing aftermath
of secret autoeroticism.)

At seventeen, he entered a university. At nineteen, an un-
expected crisis solved his masturbation problem for him. He of-
ten.regretted that he himself had been unable to master this ten-
dency. (Unlike the average youth he had retained the habit as a
secret, that is the ego had had no opportunity to assimilate the
'periodic segmental domination by confessing it, that is, allowing
it to become directly associated mth his striving for social esteem
by openly discussing it, which is the mechanism most boys use to
overcome their old mutual masturbation interests.)

The crisis occurred at dinner in a boarding house. The good-
natured matron wanted to reprimand the boys for eating too hur-
riedly. She wanted them to follow the example of our patient,
who ate slowly and masticated thoroughly. She, however, said,
"Boys, why don't you do like Mr. • — . He masturbates (for mas-
ticates) thoroughly." The patient's extreme embarrassment and
general disposition left no doubt that he was addicted to mastur-
bation. That night the patient's room-mate advised him to use
his method of self cure, namely sexual intercourse. The patient

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 259

consented, and, upon his room-mate's arrangement, began the un-
satisfactory sexual career of masturbation per vagina already
referred to. (The nature of the masturbation fancies, that is,
whether or not they are shared with a companion, or are secretly
fixed upon someone Avhose personality finally becomes offensive,
probably determines the outcome of the autoerotic trend. If the
transference, hence the fancy, is fixed upon some one who, although
he or she is not aware of this erotic use, persists in maintaining a
devoted attachment, like a mother, sister, or friend, the individual
will probably not be able to break up the habit until the transfer-
ence is greatly mitigated. ) His own comments on the masturbation
mechanism are so valuable that they should be recorded at the ex-
pense of some repetition. "The temptation to enter upon this
course — and the support in it, at the onset — for I doubt if I could
have accomplished it unaided — came at a time when I had about
abandoned hope of overcoming the masturbation habit. In earlier
years, I had looked forward to self-mastery, eventually; and to
marriage, as a matter of course. But I had now made marriage
impossible. So far as I can see, I had lost nothing of early ideals
and illusions. Though affecting a cynical view of life, moral con-
siderations Aveighed heavily still.

"In the practice of masturbation I^had employed a mental de-
vice, to which was due, I think, the strength of its hold upon me.
Masturbation itself, as I have said, had developed spontaneously
out of an earlier habit of creating fancies, in which an old persist-
ent craving for demonstrative love from others was satisfied.
[The "suppressed wish" had been prevented from seeking for the
love of another by the father's censorship.] I visualized my fem-
inine ideal — never quite any actual person. But these seductive
fancies were not deliberately created, except at the onset. I came
to realize that they led inevitably to masturbation. They were re-
sisted, sometimes for weeks. During these exceptionally long pe-
riods, mental dullness grew upon me ; yet failure came in the end,
not so much because the powers of resistance had weakened, as
because the increasing phantasm had become convincing, and the
physical act to which it led no longer appeared repulsive. The idea
of sexual intercourse with women, though, for a different reason,
was no less repugnant to me ; in the performance of the act I was
self-conscious and critical. But this was only for a time, until the
novelty of the new relation wore off. During the act, creations of

260 ■ PSYCHOPATH OLOGY

fancy, coming unbidden, and more vividly real than before, eif aced
all. ftonacionsness of its unpleasant realities. Thus, without effort
on my part, the habit of masturbation was displaced. Even in
periods of enforced continence, there was no temptation to retiirn
to it. I Avas indifferent to it as a means of sexual gratification."

Before completing his studies he came under the influence of
a certain well-known scientist, who, although only a middle-aged
man then, had already made an international reputation. (I have
met this man, now a venerable looking gentleman, and found him
to have very well-developed paternal traits. The patient virtually
attached himself as to a foster-father, although ostensibly they
were just good friends.) Through the influence of their mutual
transference he adopted this man's science for his own career and
determined to devote himself to intellectual refinement and scien-
tific contributions.

It is probable from what has been demonstrated by young men
having similar difficulties, and what happened later in the pa-
tient's career, that this transference, or, as popularly considered,
this friendship, saved the patient from an early collapse mth, per-
haps, paranoid mental deterioration. It is worth noting, with this
possibility in mind, what actually happened Avhenever the trans-
ference was broken and the final disaster that resulted.

The patient said their friendship continued from the time he
was a student when "we used to live together. I mean [correcting
himself] I lived across the street." Then he added that he had
often hoped he might live with Mr. T — , and was disappointed
when not invited to do so, ' ' Since all his children are dead. ' ' This
last quotation he promptly corrected. (They are not all dead.)
Mr. T — had said upon one occasion that he wished his son had
the superfluous energy the patient had. The interest of Mr. T —
was truly paternal in that he not only took the patient in hand, .
but furnished him with funds, advised him, nursed him and bol^
stored up his scientific researches with his own productions.

(Like the patient's own father, Mr. T — Avas incompatible
with his OAvn son, bjit adopted another "convalescent" (crucified) «
ypiith and made a career for him. Similar in its mechanism, the
patient was unable to endure his father's suggestions, but had to
have another matured male to advise and encourage him. These
characteristic tendencies of personalities to make positive and. neg-
ative, transferences unconsciously, reminds one of the positive and

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 261

negative valency that complex chemical molecules have for one an-
other. Mr. T — and the patient adopted each other in order to
gratify the needs for the devotions of father for son and son for
father. (This is a common relationship between master and ap-
prentice.)

His career as a scientist, which covered abont thirty-six years,
from twenty-one to fifty-seven, may, for the sake of brevity, be
sunmied up in a paragraph. Despite a long series of neurotic
episodes, he made several very valuable contributions to science,
but his supreme achievement, toward which all his scientific inter-
ests converged, was never completed. Even though he had col-
lected practically all the necessary data and formulated his hy-
potheses, he was never able to complete the work. The tragic
causes of this will be presented in their chronological order.

At twenty-two, he had his "first nervous breakdo"WTi. " This
was the first one of a series, all of which were essentially similar
in type and so characteristic that the underlying cause should have
been recognized by his physicians. The attacks were diagnosed as
"neurasthenia," because they developed gradually, usually fol-
lowing periods of so-called "overwork" or "malaria," and were
characterized by "dullness," "weakness," "irrital)ility" and ob-
sessive "cravings for sympathy." Gradually the craving for
sympathy would work into a dramatic ' ' climax ' ' and then, to the
surprise of all his friends, within a few days, he would return to
work with a rebound, as if completely refreshed and invigorated.
(This neurotic mechanism is, in its characteristics, decidedly an
aborted autoerotic mechanism.) It is also important to note that
he had no "neurasthenic" episode following a severe siege of
typhoid.

The second attack (at twenty-five) was diagnosed as "a touch
of locomotor ataxia" (occurred in 1881). The patient describes
the mechanism of the attack in the following words (it should be
noted that he submits to his father and makes him pay with sym-
pathy for the submission) : "I had a touch of locomotor ataxia. I
don't know that the offhand diagnosis was^ correct; I never had
anything like it again. I had been having malaria — well-marked
chills and fever. I was falling behind in my work. On good days
I overworked, often returning to the office at night and working
late. I foolishly resisted appeals from my mother to go slow^ ; I
went faster instead. My father tried to exercise authority and

262 PSYCHOPATHOLOGY

I left home. I packed up and went to a boarding-house and sent
for my trunk. In my relations with my father — who had no sym-
pathy for my iveahness and declared that I had never grown up — I
always acted pettishly. We were friends only in our correspond-
ence— ^neither of us could stand the strain of personal contact. No
attention was paid to my absence, and in a few days I returned
home. I called for my father at his office and walked home with
him. I was contrite and sought to get on a footing of frank under-
standing. My father met me half way ; but the interview lasted too
long. As we entered the house and met others of the family, he
explained to them, laughingly, that the heat had developed in me a
latent hysteria; and, turning to me in sudden exasperation, he
advised that / learn dignity of bearing from my sisters. [The
son's inability to openly respond almost violently to and discharge
the affect of hate at this insult was years later to contribute to a
parricidal inspiration.] The next morning on the way to my office,
I found myself walking dizzily and unable to lift my feet properly.
[See the feet in Michelangelo's "Pieta" and Case CD-I.] I turned
into a barbershop and, in the chair, recovered. Later, in the office,
standing before one of my superiors (father image), the dizziness
returned. This I deliberately exaggerated, pretending to faint,
and, falling heavily, permitted my head to strike the floor violently.
My friend at once ordered a carriage and drove me home. As the
door closed behind me, and my mother and one of my sisters came
hurrying downstairs, I baAvled like a baby. At the same time I
pretended to be ' out of my head. ' I was helped to bed. Back of
this foolishness was so much real illness, I suppose, that it deceived
everyone. Mj father was sent for, and came immediately, bring-
ing with him my uncle, a physician. Both were genuinely con-
cerned. A sea trip, on a light house inspector's vessel was at
once arranged for; and, after a two weeks' rough outing, I re-
turned, in huoyani spirits. I continued in good health and fairly
good spirits for three years. Marked improvement in health,
after crises, characteristic. The inseparable obstacle in my Avay
was my own weakness of will— my yielding to domination by the
'base animal passions.' "

He consulted the author of "Brain Exhaustion" and ven-
tured the notion that he had weakened his nervous energy through
adolescent abuses. This author, a physician whose. opinion carried

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 263

great Aveight with the patient, fully agreed with him and pre-
dicted that an insidious debilitation would result. He recom-
mended circumcision and a prolonged rest with elaborate rehabili-
tating treatment. The patient was convinced that he must never
marry. Before seeking relief from his depression and fatigue, he
had handed in his resignation in a rather petulant manner. The
resignations were always referred, as he knew, to Mr. T — (his
kind foster-father) who always tolerated the younger man's
moodiness, sympathized with his ill health and encouraged him
to recover and then return to work. The patient invariably
reacted in a uniform way. During the previous "hysterical" epi-
sode he also consulted his uncle, a physician, who without asking
him if he had any such difficulties, informed him that no member
of their family ever disgraced it by masturbation. The patient
surmised that the author of "Brain Exhaustion" had conferred
with him and he reacted with increasing tenseness and sensitive-
ness about this old inferiority.

During the next seven years he accomplished considerable
scientific work, despite his general sensitiveness. lie solved his
sexual problem with a series of attachments to women who had
heen married. The lesser degree of risk influenced him in his
affairs, he thought. (The married woman is the most usual
substitution for a certain type of mother attachment.)

From thirty-two to thirty-four, he reached the high mark of
his career and succeeded in working into "pure science." His
health now was excellent ; he was vigorous, had far-reaching plans,
organized his work well, had splendid associations, and felt con-
fident that at last his personal problems were solved for all time.
His scientific contributions at this time were excellent and unu-
sually promising. His associates, who had continued to bolster
him up through his past crises, were well pleased mth him.

The sexual life he practiced at this time is illuminating. He
was stationed in a delightful university city and did much of his
work in the university laboratories. He lived with an elderly
woman and her widowed .daughter and her children.

The young widow, who had literary aspirations, became the
patient 's mistress, with her mother 's encouragement. On the other
hand, an associate in science had introduced the patient into a
refined, wealthy family and a warm friendship had developed be-

264 PSYCHOPATHOLOGY

tween himself and Miss Y — (nineteen years of age). Her refine-
ment, restrained exuberance, enthusiasm and loveliness, and her
devotion to the success of his career, had, withont his clear real-
ization, attracted him seriously. (The account of this tragic situa-
tion is too important not to be given fully in the patient's own
words. It is essential to recognize that Miss Y — had all the attrac-
tive attributes of his mother. Furthermore, through Miss Y — 's
sympathetic influence he had "grown up," attained his place as
a man in science and entered upon his great life work in "pure
science." It is not pleasant, but extremely important, that the
reader should also recognize that Miss Y — , like his mother, was
the living embodiment of his life-long autoerotic fantasies. This
fact, associated with the dogmatic prediction of progressive de-
bilitation, is probably what made it, later, impossible for him to
marry. The associations of thought persisted in defiling her and
this he could not endure. A dream at fifty-seven, to be given later,
illustrates this mechanism.)

"I was able to drop much of my troublesome- burden of pre-
tensions, and found myself most at ease and least a conscious
fraud, in the home life of two or three families of cultivation and
refinement to which I was admitted in the university town of A —
where most of my activities were centered. Here, the attitude
toward me was so genuinely friendly, I could not very well help
becoming a frequent visitor. Miss Y — , nineteen years old at the

time of my arrival in A , took an enthusiastic interest in my

plans.' In addition to certain scientific work which was itself rap-
idly extended, with an increased force, toward what her father
characterized as broad- visioned development, I launched into, four
considerable projects, all calculated indirectly to advertise the re-
search in this comparatively new field. One of these called for a
bill before the State Legislature, and for active support on the
part of the university, the several scientific and technical societies

in and individuals of prominence and political influence. For

this undertaking, in particular, social backing was almost indis-
pensable. From the outset, Miss Y — became the most important
figure in the "audience" to which I looked for sustaining inspira-
tion. But I received from her more than approval. She took de-
light in what her mother called 'shameless scheming,' in 'which,
Avith her mother's tactful cooperation, nevertheless, the social posi-

MECHANISM OP SUPPRESSION OE ANXIETY NEUROSES 265

tion of lier family was used to advance my aims. By tlie end of
the second year, Avheii the sudden nervous breakdown occurred [at
thirty-four] I had begun to find indispensalile also, not only her
siire intuitions as to the right course always, but her bright and
stimulating companionship — a new thing in my experience.

"The two years, up to this point, had been years of all-round
mental development. During no other period of sustained effort,
as I now clearly see, liave all my faculties been so variously and
healthfully exercised. In the recognition of this single fact, the
time and thought given to this circumstantial history is amply
justified to myself. The general verdict at the time, which it has
never before occurred to me to question (until the psychoanalysis),
that I hroJce down at last from overwork, I now believe to be mis-
taken. Nor do I think the collapse came because I had morbidly
regarded it as inevitable. Morbidness in large part had disap-
peared. It resulted from the concurrence of new worries that had
nothing to do with my work.

"In my sexual life in A — , I had been cool and sure of myself.
I was conscious of a growing force of character that was new in
kind. Under the stimulus of almost uniform success in projects
undertaken now solely on my own initiative, I became more and
more fixed in the determination to let no sentimental weakness
stand in my way. By the end of the first year, at a considerable
cost in time and money, I had provided securely, as I supposed,
against the calamitous possibility of being "found out." It would
seem that this particular fear had been pretty well allayed, and
that I was in a fair way to become emancipated from all of my ob-
sessions (sexual). Yet, in view of what actually happened they
appear to have been as strong as ever.

"Mrs. X — , with whom I had made this secure arrangement,
as I supposed, was a minister's daughter, with an ambition for
the stage, who had married a dramatic critic, and then given up
her stage ambition. For several years her husband had been a
consumptive, and a few months before I met her, he had died, and,
instead of returning to her home in the East, she had moved to A —
to live. Here she was joined by her mother. The mother and
daughter together had a small income — just about sufficient to
live on comfortably ; and at the time I met them, they were looking
for a house in — .

266 PSTCHOPATHOLOGY

"It was the mother's idea that they should forego society^
save rather than spend, and for a time make expenses by taking
two or three boarders from among the unmarried instructor class
in the university faculty. My rapidly developed intimacy with
the daughter modified this plan. I assisted in finding a house, and
became their only boarder, paying $100 a month. I had a 'frank
understanding' with both mother and daughter. It was the moth-
er's view that the daughter's artistic temperament demanded that
there should be no interruption of her sexual life. Furthermore,
her sexual life had been imperfect; the husband had been compara-
tively old as well as physically feeble. In the understanding! I
had been insistent on only one point ; there must never come up any
question of love and its obligations. I invented a girl-wife, who
had died in childbirth, and in whose grave love lay buried. (Ap-
parently this fancy about a dead girl-wife was also an unconscious
protective wish-fulfillment that the autoerotic fantasy should die
through the influence of Mrs. X — .) Mrs. X — 's mother could be
sentimental as well as "sensible." She called me her "poor boy"
and was very tender toward this affliction. Fortunately, as she
pointed out, her daughter, though of a warmly affectionate dispo-
sition, was wholly wedded to her art. We would all need to ob-
serve the conventions carefully. There was no occasion for social
attentions on my part. Then, too, the whole famtly — the children
as well — were in fresh mourning. Even, as the event proved, she
was perfectly sincere ; I had to modify my first impression that she
was a moral monstrosity.

"I filled the spare room in the house (by day) with a clerical
assistant. I was the only boarder. The older of the two children
in the family was under four years of age. The arrangemeutt
seemed ideal. Yet, within a year, my discreet household suddenly
revealed itself as a volcano, and blew up.

"During this year I had received an occasional rather formal
note of invitation from Miss Y— no intimate letters. Doubtless
Mrs. X had seen these notes. She had seemed intentionally to
avoid reference to my social engagements. They were in fact not
numerous. The annual foot-ball game between M — and the Uni-
versity of — is one of the social events in A — . Some time in ad-
vance of its announced date Mrs. X — asked me to take her to this
game. It was her first request of the kind. Her period of mourn-

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 267

ing was over. She wanted to see something again of real life. It
would do no harm, as she said, for me to show her now some atten-
tion occasionally. Her request Avas natural enough, but she showed
a tensity of feeling that was disquieting, even to her mother ; and
her manner indicated that she expected to be refused. I replied
that I had already engaged to take someone else.

"This was hardly true. At one time, I had planned to ask Miss
Y — and her mother. It seemed well, however, now to settle the
matter. They were out of town and I mailed my invitation. Im-
mediately afterward, ahead of my working program, I left town
myself for a routine tour of inspection. A note of acceptance from
Miss Y — addressed to my house as usual, was forwarded to me
by Mrs. X. She had opened it, without apology for doing this;
she had written across the top: 'I knew you were lying to me.'
Such action was wholly out of keeping with her ordinary behavior.

"I returned, the day of the game, on an early morning train.
I found Mrs. X — in her room dressing her little girl for break-
fast. She appeared suddenly half-demented. Her mother was
unable to quiet her. She picked up the child and thrust her into
my arms, telling her to kiss her new papa — that I was to be her
new papa. She derided me for 'that precious bit of fiction,' the
child- wife story, over which 'I, poor fool,' she said, 'have wasted
tears of sympathy. ' I finally announced that I should give up my
rooms immediately.

"I wrote out a check for an extra month's rent. TMs was
dramatically crumpled and throAvn at my feet, declaring I should
soon discover that 'hell holds no fury like a woman scorned.' She
sobbed hysterically in her mother's room for an hour or more
while I was packing up. (The behavior of Mrs. X — illustrates the
effects of a positive transference with its sacrifices and offerings
shifting to a negative transference with impulse to destroy the
object in order to get free from it.)

"My assistant had arrived, meantime, and I made arrange-
ment for immediate shifting of the work to an office. I wanted
him, with his gossip about a family row, to be as far away as
possible. I could trust Mrs. X — 's mother to do her best to avoid
a scandal, but was not sure that she would be successful. I left
a hotel address on my personal baggage (for Mrs. X — to see) ;
and then waylaid the expressman and changed it to another hotel.
It seemed not impossible that Mrs. X — might follow me.

268 PSYCHOPATHOLOGY

"On my arrival at the house in the morning, I had been pre-
pared for trouble. I had hoped, by concessions for the future, to
get back to a fairer understanding. But the life I wais leading,
suddenly presented to me in this sordid aspect, appeared no lOTger
possible. I had carried off the scene with an air of righteous in-
dignation, which, for the moment, I had thought I actually felt;
but the underlying conviction was that I must prevent the possi-
bility of a recurrence of such scenes. / must again change my
mode of life radically. I was baffled, for there were other convic-
tions with which this was in conflict. In addition, I felt remorse.
After I had begun packing, the little girl had come to me with a
message: 'Grandma says, please don't go.' I had gone without
a word; and this memory rankled. It is possible, though it is a
mere guess, that the unconsidered act of cruelty of the gopher
dream, with its remonstrating children's voices (which I wrote
out for you some months ago)* reflects this old incident.

"I remember, as I hurried to keep the appointment for the
afternoon football game, I was halted suddenly by an overwhelm-
ing sense of panic. It was related to nothing clear, though it was
so sharp, like an electric .flash illuminating the whole mind, that
it is still clearly recalled. It had no relation, for instance, to the
situation immediately ahead; to that, I was looking forward for
relief from my repression. On the other hand, I was beginning
to see that in all probability the situation from which I had just
escaped had been brought to an absolute finish ; and in the only way
possible, as the event proved. The panic feeling was due, I thinl?,
to something old. I had been let doivn, for a time, to the level of
the old nervo^os instability, with its familiar perils (autoerotic).
It passed, however, and I regained full confidence. Strength for
resistance had been acquired in the vigorous and successful ex-
periences of the past two years. It would take a much heavier
blow than that of the morning to floor me now. This resilience
and feeling of relief I recall distinctly. It was the old rebound,
characteristic of my temperament. I can hereby say that I have
not felt any such elastic recovery of spirits on like occasions since.

"At the game, I was conscious only of exhilaration [tempo-
rary autonomic compensation] . I knew the coach of the University
team (a C — man, as I was also), had followed the training records

*The gopher dream occurred during the psychoanalysis and will be given later. ^^

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 269

of his stars, and was well up in football strategy. I was delighted
to tind my companion not mif amiliar with its principles, and show-
ing restrained enthusiasm over the good points of play. I was in
a mood to note and appraise highly this versatility and strength.
These qualities, in a mere girl, had been of inestimable service to
me already ; and they were at my service further. I carried away
from this last meeting an abiding impression, too, of her quiet
joyousness and unconscious air of cultivation. Certain details of
sentiment here seem to he essential to this record, since they ex-
plain the lasting emotions. During the game, which had aroused
strong partisan feeling, I felt, nevertheless, that her eyes were on
me often, not in coquetry, nor boldly, but in kindness. Shortly be-
fore I had called at her house, by appointment, to take her some-
where ; and, while waiting for her, discovered a book with her card
lying on it, addressed to me. It was Barrie's "Little Minister"
then just out. I had taken the book with me on the trip I had jiist
completed. This sentence had impressed me : 'Knou-lng what he is,
the pride that shines in his mother's eyes, as she looks at him, is
about the most pathetic thing a m,an has to face, hut he would he a
devil altogether if it did not hum some of the sin out of him.'
[An interesting incident showing the significance of favorite quo-
tations as a means of solving great affective conflicts.] I thought
of this iioiv. In spite of my long course in which love had heen
dehased and simulated, my early illusions had remained; and if a
resolution can he formed suhconscioiosly , I' helieve I determined
there that this sin of disloyalty to ideals should he burned' out of
me. I could give up my sexual life. It had relieved me of stresses
and strains of a kind, but' it had set up others, no less unnerving.
In view of the contrasting experiences this one day had presented,
the memory of the morning' s- experience was searing. My stdind-
ards, or principles, had become confused^ I was glad, by this easy
renunciation now, to he able to pay my tribute to the sanctity of
women. It required no act of will, and I have used none since to
resist temptation; there have been no temptations. I have led a
wholly continent, life for twenty-three years. [The solution and
fixation of the sexual struggle upon a chronic course of anxiety.]
"At the close of the day, as the immense audience rose to
watch the thousands of students of the winning side pouring into
the field for the 'serpentine' of- victory — the supreme spectacle — ■
she detained me in the seat. (Her mother, on my other side, who

270 PSYCHOPATHOLOGY

had risen, paid us, seemingly, no attention.) She wanted to know
what was 'the trouble.' It was a surprise — an attack. Evidently
I had been showing traces of worry. It seemed the natural thing
to be entirely frank. However, I replied merely that I had given
up my home quarters that morning and had moved to a hotel over
in the city. She watched the expression of my face intently for a
moment, her hand on my arm. Then she started abruptly to rise,
turning toward her mother. As I sought to restrain her, she seized
my hand impulsively, pressing it against her breast. As we rose
together, she said, close to my ear, as if the uproar about us made
that necessary: 'I think I shall have to take care of you, sir.'

"Mrs. Y — could not have heard this, yet she leaned toward
me remarking: 'I see we shall have to make Anna your general
manager, Mr. — . ' It had the effect of a prepared speech. I could
see that she intended I should so understand it. But I had no
self-conscious feeling: I was watching the daughter, who was
blushing. She turned resolutely toward me, though answering her
mother: 'He has heard that already. Mamma.' And she laughed :
'I have told him so. He knows it.'

" (This is punishing work, though I am glad to do it. These
pictures are like an artist's incomplete sketches, whicli be had
turned to the wall as dreams that were too ambitious. I can re-
member them, but they seem to have meant more than I can ever
discover. So, with the fragments of speech, I am not trying to
record here what may have been implied ; yet it is these IMPLICA-
TIONS, which I have endlpssJy debated in mii mind, that make it
a sore subject).

"Miss Y — at once addressed herself with animation, and re-
called our attention to the brilliant scene on the football field. But
I was not to be diverted. It was an afternoon for light wraps, and
I readjusted hers about her shoulders ; then found her gloved hand
and tucked it into my overcoat pocket. Almost immediately, how-
ever, she freed it ; and leaned forward, nodding smilingly past me
to someone at a distance in the same tier, lightly clapping her
hands and pointing to the colors she was wearing — ^the colors of
the victors. Evidently I had startled her ; also /' felt rebuked. I
had been guilty of the commonplace. Yet, I persisted and sought
to recover her hand. In this she avoided me — and of her own ac-
cord replaced it securely in my pocket.

"Her father, by prearrangement, met us at the exit. He Avas

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 271

taking the ladies somewhere to a later engagement. On the short
return trip, we encountered acquaintances, a lively group. "We
drove away from the station, a party of four, and presently they
set me down at my hotel. I was leaving town that evening to re-
turn to my unfinished work. I was to be away only a few days.
Miss Y — stepped out with me ' to say good-bye better. ' She gave
me both hands gaily, swinging them apart as children do, which
brought us nearer. She dared this, as her father was commenting
on the sudden intimacy ; otherwise, I should have kissed her. As
I handed her into the carriage, to her parents, she turned an arch
look back at me over her shoulder. I was hardly responsive to
this gay mood. The carriage started and she smilingly raised an
admonishing finger, which left me thinking of her question as to
my 'trouble.'

"In the course followed during the next few weeks, I acted
on no conscious plan. Certainly I had no such craven course in
mind, as I made the short run that night by train to the little to-wm
in the foothills, which I had left in the early morning. For the
developments of the afternoon I had been wholly unprepared, in-
credible, as it now seems to me that this could be so. But I had
responded to them on the whole naturally ; and, on the surface of
my mind, at least, it was clear that I would WMrry Miss Y — . For
the time I could think of nothing but her loveliness. I was exult-
ant ; at the same time I was wondering why I Avas not really exult-
ing. In earher pages I have recounted the series of circumstances
of physical illness which brought me to a coast town Avithout reach-
ing a voluntary decision. [He never saw Miss Y — again. De-
spite repeated arrangements to do so he was unable to overcome
the repressions which forced him from her. The struggle is given
later.]

"When I set out to write this simple history, it appeared con-
fused and difficult. It proved to be difficult. I had to do a little
psychoanalysis myself. It was not sufficient to say merely that I
got mad and hit the other boy, though this records a physical act
and an emotion. It must be perceived that it is important to add
that he was the bigger boy, and that therefore the emotion was one
of reckless anger ; that I became thus violently incensed upon ap-
parently slight grounds; he had merely called me a "sissy;" but
this was a grave offense, because I felt that it was true ; and that I
must employ some retrospection to see why I felt it to be true.

272 PSYCHOPATHOLOGY

(This example was in its essentials a true experience.) Yet it (the
history) has been deeply interesting; for me, emotionally, it has
cleared the air somewhat, I think. The incident last recorded, I
recognized as its climax; and I have worked np to that with in-
creasing reluctance, though with a growing fascination of inter-
est. Now that it has been told — completely, yet with compres-
sion— ■ I feel that all is over but the misery. In what follows, with
the exception of the next paragraph, there is not the same antici-
pation of revelations to myself. I haven't the same interest.
There is a succession of salient facts like milestones ahead, how-
ever; my uncertainty will be as to the detail required for their
explanation. I haven't the same sure sense as to the signifiicance
of detail that I have felt up to this point.

"This lack of interest, not only in detail, but in the whole
business [his science] , from now on, had its beginning back in the

late fall of '94, at , the sunny, lotus-eating winter resort on

the coast of Southern Florida where I had hidden myself. In sim-
ple English, life was not worth living. I had no thought of suicide.
I didn't seem to feel the situation very acutely. It was too clearly
settled, cut and dried and finished. There was acute feeling relat-
ing to the past, however. That was a dull agony that I couldn't
think of. It was not a sense of my own loss. That was calamitous
to be sure. It was remorse for what I had done to the only lovely
girl who had ever stooped to help me. I had not meant the cruelty.
I had left — after the football game, expecting, of course, to marry
her. I had delayed my return because of unreadiness to meet her
— because of the u/naccountable growing nervous debility. When
I finally started to return and was met with exclamations of "hag-
gard," etc., by my men friends, I postponed it again and made an
additional trip into the mountains. Here, mountain fever, mala-
rial fever, every physical illness that could fasten into a pretty
sound constitution, got me. I was crazed. I have related how I
finally, came to rest, like a boulder on a ragged course downhill;
with everyone irritably shaken off, and alone. I hadn't meant it,
but, I had done it. And the worst was that after all, I had meant
it. The situation was not-really bad at all. She had heard of all
the- circumstances, of course. It was merely necessary to get well,
go back — and explanations would not even be listened to. 'Poor
boy,' etc., 'I had overworked outrageously.' 'Had not everyone

MECHANISM OP SUPPRESSION OR ANXIETY NEUROSES 273

said SO?' The worst tons, I didn't want to go haclc; must not. I
am clear now as to the meaning of my dream in rhyme in reply
to my mother's urging that I marry (which occurred shortly after
this episode) :

'You tell me I now may no longer delay,

But must lead some fair maid to the altar.
Ye Gods ! to the Anchorite Hills, I'm away.

I'll abode on some desert Gibraltar!
There, the far siren voices shall nothing avail,

There, indifferent to good and to evil,
I'll but swing by the tip of a prehensile tail

From a bough of the forest primeval.' "

The patient never saw Miss Y — again. Each time that he
made arrangements to meet her, the anxiety which was aroused
by the prospective situation was so severe that he was compelled
to avoid her. Another remarkable autonomic adjustment to the
situation was the fact that in the next twenty-three years he did
not have a seminal emission from any cause. This astonishing
adaptation and consecration of all his physiological resources to
the. sacred memory of his mother and Miss Y — (for both now be-
came memories), as suggested by the above quoted lines from Bar-
rie's "Little Minister," burned out the sin and atoned for his past
sexual profligacy.

To all his friends and the physicians whom he consulted, he
was stupidly considered to be suffering from nervous exhaustion
due to "overwork" and "malaria." The rest-cure was always
discreetly recommended as treatment. It is also important to in-
clude that the patient himself accepted the nervous exhaustion
explanation, being more considerate of his actual deficiencies,
and not until the psychoanalysis called for an unreserved consid-
eration of all the possible causes of his debility, did he actually
recognize that the nature of his love and his sexual life had been
fatal. He then dropped the "overwork" and "malaria" excuses
and faced his issue as squarely as its hopeless nature would per-
mit. This clear realization, however, came at fifty-seven, and the
twenty-three years from thirty-four to fifty-seven were charac-
terized by a blind anxious struggle with himself.

After his recovery from the distressing experience at thirty-
four, he resumed his scientific work despite his tendency to be-

274 PSYCHOPATHOLOGY

come despondent -under stress. At foxirty-fotir, fifty-one, fifty-two,
fifty-five and fifty-eight he was completely disabled for work.
His miserable condition was diagnosed as "neurasthenia." The
despondent episodes lasted from several months to two years.
During this long period he made several scientific contributions
and accumulated an enormous amount of data for his chief con-
tribution to science, but was without the necessary inspiration to
synthesize his work. In following him through his positions and
places of work, it is worth stating that again and again he tried
to replace himself in the attention of Miss Y — , using many clever
plans. He even succeeded in having himself sent back to work
in the University city in which she lived (sixteen years after the
football game) and was invited to dinner by her brother-in4aw,
but unable to endure the anxiety, he broke the engagement.

At forty-four, he undertook a piece of work with his foster fa-
ther of science, Mr. T — , and on the last day of their work to-
gether he had an attack of anxiety, playing dramatically for sym-
pathy. He was sent to a sanitarium to recuperate and ended up
with a dramatic plan of committing suicide in which he went into
the country, taking with him some of their finest instruments,
which he destroyed in a log fire. He was unable, however, to de-
stroy himself although he had made special preparations. Then
he explained his behavior and offered to resign. This was not
accepted, but, instead, a sympathetic response was elicited from
his superior in charge, Mr. T — , and the patient rebounded from
his depression to buoyancy and hopefulness. Within a surpris-
ingly short time he presented a splendid scientific paper with an
acceptable original hypothesis, which latter may be considered to
be. the most difficult of all scientific achievements, and reveals the
influence upon initiative of a positive transference.

From fifty-one to fifty-three "general debility" from physical
weakness and ulcerated teeth, punctuated with brief periods of
"exalted" feeling, forced him into a sanitarium near Miss Y — 's
city. After this episode, he was unable to master himself suffi-
ciently to do any prolonged work.

At fifty-three, a most significant termination of an episode
occurred while he was convalescing at his brother-in-law's home.
He lived alone in the house while his brother-in-law and sis-
ter were away for the summer, occupying their bedroom. One

mechanism: of suppression or anxiety neuroses 275

day he received a telegram which announced the unexpected re-
turn of his brother-in-law. (Naturally they would occupy the
house together that night.) The patient insists that he did not
think oi: this, but the situation precipitated a strange anxiety con-
dition with no apparent cause, and rather bewildered and excited,
he finally proceeded to mow the lawn "in order to be busy." He
soon developed a "heat stroke" and had to be sent to the hospital.
When his brother-in-law arrived, a day late, the patient was safe
from the embarrassment that might have arisen from too intimate
personal contact. In view of the fact that the patient and his
brother-in-law were congenial, this panic may be regarded as due
to the patient's homosexual reactions. The patient said he recog-
nized that he was misleading everyone, but the situation would
permit of no other solution, although he could not quite under-
stand why. While still in the hospital in a "confused" state, he
received an urgent letter to ' ' come at once ' ' to give an impromptu
lecture of scientific interest. Despite his physician's and his fam-
ily's protests, he left his bed and went to work.

Because he was not equal to doing exhaustive scientific work
he was transferred (at fifty-four) from his department of "pure
science" into one of considerably easier but less attractive work.
This transfer, to which he consented under pressure, meant the
ending of his dream of working in "pure science" for Miss Y — 's
esteem as his inspiration. His life was now clearly a failure and
the loss of his old position proved fatal to his sublimations and his
scientific career.

At fifty-five, a year after the transfer, he had another episode
of despondency and staged two dramatic bluffs at suicide, clearly
calculated to arouse sympathy. This he fully recognized at the
time. After several months he "recovered" and confidently
announced this to his aged father, but recognizedT in himself a per-
nicious tendency to "nervous tension." He also came to the real-
ization that his shamming might become uncontrollable. (He had
not learned to realize that the tende,ncy to sham had, since youth,
been ineradicable.)

Four months after he returned to work the climax of his neu-
rotic career developed, characterized by a clearly defined paranoid
inspiration to kill the man who was responsible for forcing him
out of "pure science." (This man had cut off, innocently, the

276 PSYCH0PATH0L06Y

patient's hope of reaching Miss Y — , f^d his adjustment was so
similar to his old father-mother conflict that the earlier experi-
ences clearly conditioned the reactions to the lateB.)

The mechanism hy which this inspiration came upon him is
reported in some detail, hecause it is characteristic of the divine
inspirations of prophets, deliverers, cranhs, paranoiacs, and par-
ricidal inspirations.

Certain of his suppressive tendencies need to be reemphasized
here. The patient always had difficulty in spontaneously express-
ing himself when it involved any degree of anger, having been so
trained by his father's suppressive attitude. He always lost his
capacity to retaliate "under injustice" at the time of its occurs
rence. In his preadolescent years he had had a pleasing singing
voice, but it later came to lack resonance and showed very
plainly that chronic vocal muscle tensions had deprived his voice
of practically all resonant qualities, so that, although his vocal
sounds were clear enough, they were rather unpleasant to listen
to for any length of time. This, no doubt, was due to the fixed
postural tensions of the vocal apparatus in turn so maintained by
his efforts to keep the repressed affect of hate under control.

Upon formal occasions, such as scientific meetings, when he
was assured by the formal nature of the situation that he would
not be interrupted, he was able to speak with ' ' zest and freedom. ' '
In informal situations where he might be suddenly interrupted,
this had almost always been impossible since his youth, because of
his father's suppressive attitude.

When the patient was offered an opportunity to accept a
change of work, ostensibly for the betterment of his health, in a
manner that he could not refuse, he recognized the undercurrent
intention of his director (not Mr. T — ) to get rid of him, but he
was unable to bring himself to speak of it. lie said he was rather
inclined to the temptation to ' ' sacrifice ' ' himself. After the action
was officially completed, the patient recognized, with no little de-
spair, that the great hope of his life was gone unless he could
transcend to heroic endeavors. He felt heeuly offended, hut did
not admit it to anyone. Severe economic pressure pinned his im-
agination to the immediate requirements of earning a livelihood.
To his coworkers and this chief, according to a written comment of
this chief, he had become "the sad case of our friend — ." It re-

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 277

quired some time for him fully to appreciate this, and the revela-
tion as to his social position, as such things usually develop, came
Avith the insignificant remark of an innocent bystander. One day,
in the laboratory, a young man sympathetically remarked to a com-
panion, not intending to be overheard, something about "the old
man losing his grip. ' ' The patient was unable to free himself from
the ringing impression it made. While brooding over this, being
profoundly self-conscious, he felt a distinct affective pressure to
have that opinion spontaneously reversed. Like a flash out of a
clear sky came the solution.

His department was unable to undertake an important piece
of work, which the patient was to direct, because the department
from which he had been transferred would not cooperate. (He
knew that his former director had lost confidence in him, hence the
loss of the prospects of successful cooperation.) There was con-
siderable general comment in the laboratories on the matter of the
friction between the departments, and the men in general believed
that this friction hindered the work. The patient's heroic inspi-
ration was that "the source of friction must he removed." Many
of the other workers had the same opinion, but, in the patient only,
was crystallized the inspiration that the thing to do was to kill the
director. (The man who had forced him out of "pure science.")

Psychoanalysis demands to know why one man, in a situation
common to many other men, reacts in a radically different man-
ner. There are logical affective determinants for this. To sum up,
the man he would kill was the (1) head of the service; (2) had
prevented him from the possibility of winning his crown as a
scientist, and, hence, the one chance of still attaining the final
realization of his biological development — Miss Y — 's love and es-
teem: she impersonated the ideals of his youth; (3) the head of
the department occupies the same psychological position to the
employee that the father, as a ruler, occupies in the individual's
youth. The father had prevented his son from "growing up,"
from developing his virility and winning a love-object, through
oppressively forcing himself upon his son, as his rival. The
mother, had effectually blocked all his capacities to resist or over-
come his domineering father, because under no circumstances
could he pain her. Hence, at fifty-seven, when the affective ten-
dencies coordinated upon a course of action, it came from the
depths of his "soul" as an "inspiration"; clearly for him it was

278 PSYCHOPATHOLOGY

his "duty" to remove the cause of friction in his struggle to
become a man. Logically, he must kill this director. The posi-
tion of his director in his emotions made him a perfect imago of
the hateful father, whereas Mr. T — was the imago of the kind
father.

The logical necessity of removing "the cause of the friction"
was so convincing that it never occurred to him to consider the re-
vengefulness of his motive. He was absolutely sure nothing in-
dicative of revenge or hatred was felt. The director had to be
sacrificed, and he felt he must do it. The patient felt that a deep,
calm, righteous sense of duty alone directed him in his steps. The
"inspiration" was nothing less than divine in its quality. With
surprising cunning he planned the details of the execution, and,
although he carried with him selected papers and letters to ex-
plain and justify his act, he insisted that it never occurred to him
that his act would arouse horror and relentless criticism of him-
self. Without going into the details of his method, it is sufficient
to say that the period of the formulation of his plans occupied
about two weeks of very clear thinking, and during this period he
felt himself to be very well and clear-headed (a symptomatic in-
dication that the conflicting affections had found a common path
for gratification). The affective turmoil had cleared up by coor-
dinating upon a simple procedure. Just preceding the crystalliza=
tion of his purpose he wrote a note to his father stating that he
was reorganizing Ms ivorh along the lines of his years from thirty-
two to thirty-four, which was distinctly a reference to Miss Y —
and a qualitative resumption of his old attitude to her.

He said: "I awoke with a full solution of the difficulty. It was
so entirely satisfactory that I gave it no elaborate consideration.
I would lay the matter before director — and ask him to cooperate
with me [italics patient's] in putting it through. In case he re-
fused to accept me as an intermediary, it would be necessary to
'remove' him. I could then take the matter ivholly in my own
hands. It would he necessary, because any lach of confidence on
his part ivould paralyse my own. I could do nothing tvith that load
on my shoulders. I wanted his approval as I had had it formerly,
tut it wasn't essential. His active disapproval, however, would
be blighting to my spirit." (Italics inserted.)

lie said, in retrospective consideration, that he was afraid the

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 279

director would talk to him the waj his father did and turn him off
without considering him seriously. The father ■usually remarked
about his never having grown up, and one of his greatest difficul-
ties was that his father never expected him to "grow up." (Fa-
ther's wish for son's virility was not given.) He felt compelled to
kill, because he must remove "the source of the trouble," the
source of the "friction," Avhich he allowed himself to believe was
the director, even though as an actual fact he knew definitely that
this man had himself worked conscientiously to remove the fric-
tion between the departments. With the readjustment of his
hatred he would become "free," and, as an actual physiological
mechanism, would no longer suffer from the affective conflict.

"I didn't dwell upon the method I should employ for his re-
moval. It was to be simple and effective. I should go armed, and,
if necessary, shoot him. It was an unpleasant alternative to think
of, but it seemed necessary." (See the parricidal inspiration of
Guiteau.)

In his fancy, after the consummation of the act, he believed
he would be hailed as a deliverer and a hero. With considerable
reluctance, and no little embarrassment, he confessed that his in-
spiration encouraged him to feel that his act of removing the direc-
tor would arouse a tremendous emotional wave throughout the
country, and, when he explained his deed, it would meet with vig-
orous approval. He would he hailed as a hero, placed in a position
of power, and, with the enthusiasm of the people running high, he
would perform great feats of national conservation which might
even sweep him into the presidency. He regarded this as a ridicu-
lous sequel, upon sober thought, but its logical growth was spon-
taneous. (In its essentials his inspiration was not different from
Gruiteau's, to be referred to later. Both would win the presidency
and an heiress. In both cases it was the hectic compensatory flush
of a losing fight to win biological potency and transcend the tyrant
of his youth. (See the crucifixion and Oedipus tragedies.)

He crossed the continent to carry out his plans, but fortu-
nately his previous nervous instability and secret departure had
aroused the suspicion of his friends. He was met en route by his
brother-in-law, to whom he confessed his plans, and, frightened
at himself, he re(juested to be taken to St. Elizabeths Hospital for
treatment.

280 PSYCHOPATHOLOGY

Upon Ms admission, he was somewhat depressed, genuinely
alarmed at himself, and sincerely eager to get insight into his diffi-
culties. His refined manner and bearing were genuine character-
istics of the highly intelligent man. There was no mental impair-
ment other than the weakness and sense of impotence which usu-
ally follows a disastrous emotional crisis. Much of tlie material
elicited by the psychoanalytic method has already been included iv
the case record.

When his fairly well concealed hatred of his former chief was
brought to recognition, the patient was astonished at the hideous
trends that his personality had assumed. The inspired assault now
assumed all the attributes of a diabolically conceived murder, for
revenge as well as for freedom. The patient faced his guilt
squarely, but, as the analysis proceeded, he came more and more to
feel that something else had crowded him into a sordid state of
mind. He inclined to reiterate that his old masturbation excesses
had undermined his mental reserve and self-control, and that the
opinion of the author of "Brain Exhaustion'' was finally being sub-
stantiated. The pernicious belief that this debility must be his
ending was so persistent that it had to be anah^zed.

This necessitated a review of his sexual life and his masturba-
tion fantasies. Plis case was unique in that a man of his scientific
learning and general knowledge had had so little insight into the
sexual life of the male. It developed that never before had he
been able to discuss the subject, and, Avhen he learned-that auto-
eroticism had its place in the normal evolution of the personality,
he reacted with sorrow and regret that fortune had not saved him
from a life of despair and harassment by faA^oiing him A^'ith a
kindly bit of advice in his youth.

His hatred for his father was brought out with a review of
many incidents of unjust domination during the patient's youth.
He was unable to control his grief Avhile revicAving the father-
mother-self triangle and the tragic emasculation of his youth. He
Avas also unable to shake himself free from the fifty odd years of
submission. Perhaps the age of his father and economic depend-
ence upon him interfered considerably Avith this. The aresonant
condition of his voice was not permanently relieved, although he
recalled the father's suppressive remarlxs about liis singing; his
mother had delighted in accompanying his songs Avhen a boy; and

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 281

he appreciated the influence upon the vocal tones of the forbidding
of his spontaneous replies.

It may be summed up that despite six months of intelligent
effort to throAv off the father domination, he did not succeed. He
did, however, arrive at the conviction that the effects of his fa-
ther's disastrous domination had been unintentional and that no
one had regretted his "childish," "girlish" attributes more than
his virile father. He also learned to know that for him there were
two kinds of people — those whose attitude permitted him to ex-
press himself freely and those who were suppressive.

The affective dependence of the patient upon his grand, old,
genial master in science (Mr. T — ), and his long series of dra-
matic, semi-crucifixion- suicidal attempts, were so clearly alike, in
purpose and method, to his methods of winning expressions of
"tender" concern from his father, that he recognized the signifi-
cance of it at once.

The "heat-stroke" episode at his brothei'-in-law's house pro-
duced, upon its analysis, no little discomfort and complaints of a
"sinking feeling" when his effeminate dependence upon virile
males became clear. His father hated his "girlishness" and his
family had striven (blindly) to educate him out of it although
actually forcing him into the submission. It had never occurred
to the selfish father that he should back down, unselfishly, in
order to let his son occupy the throne of virility with him. The
patient insisted that he had "feminine" qualities, but, sponta-
neously, with undue earnestness and repeated efforts, he tried to
establish that he was not "effeminate." No homosexual relations
had ever occurred, and no perversions.

He dreamed of a knight in beautiful armor who appeared be-
fore an audience, and a penetrating light was thrown upon his
pelvis which revealed the genitalia of a female. He recognized
himself as this knight. This was a reaction to the light of psycho-
analysis. He also dreamed of a man singing to an appreciative
audience. The man had a baritone voice, but it chailged to con-
tralto and then to soprano. The hair became long, although the
mustache remained; the breast was a man's but the manners were
a woman's. The singer showed embarrassment, then distress, and,
finally broke down in tears. The audience sympathized with him.
The patient awakened "in strong agitation," and recognized the
singer as himself. At one time he had had a pleasing baritone

282 PSYOHOPATHOLOGY

voice. He never shaved Ms mustaclie in order not to look effem-
inate.

Two insurmoimtable obstacles finally stopped the psycho-
analysis, in that it seemed profitless to continue it. (In the light
of further experience with this type of case this must be regarded
as a mistake.) One was his love for Miss Y — and the other was his
well-founded uneasiness lest he should become a public dependent,
because, at fifty-seven, he was losing ability and had no economic
resources.

,Miss T — appeared in many of his dreams and always urged
him that the past "makes no difference," but that he should re-
turn to work and succeed. Miss Y — still appeared to him as she
was at nineteen, although now she was over forty. She had never
married, and lived a comfortable but lonely life (probably still
hoping for his return, judging from her expression of interest in
the patient through her brother-in-law, sixteen years after he had
disappeared). Tier ivealth and lils poverty, he felt, made a union
impossible.

The cause of his inability to return to Miss Y — , after the foot-
ball game, was explained b}' a dream. He had been reading
Bank's "Myth of the Birth of the Hero," and previously ana-
lyzed out the origin of his masturbation fantasies in his mother,
but, strangely enough, he was unable to appreciate that Miss Y —
had the physical and personal features attributed to his mother
and the girl of his autoerotic fancies and heterosexual rela-
tions when the woman accused him of thinking of some other
person. He dreamed, "the unfriendly part of myself was throw-
ing lantern-slide illustrations on a screen and lecturing that 'all
women are the same' (meaning voluptuous). He showed a skele-
ton, obviously feminine, and superimposed a series, 'startlingly
familiar to me,' of feminine figures of 'all the women I have
known.' The figures, nude and Avith living flesh tint, were super-
imposed almost exactly, illustrating the point. Then the speaker
triumphantly excl aimed 'the composite,' and tiie audience stirred
as if with pity or indignation as he showed a figure appealingly
beautiful, composed of a thousand figures, dream conceptions that
I thought of during sexual intercourse. The figure turned to mar-
ble, and the audience recognized that it was unreal and the lectur-
er's purpose was defeated. Then, to convince the audience, the
light was made softer, and a single figure began to appear, and

MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 283

it was tmmistakably living. As the illumination grew stronger,
and glowed, I recognized it, my bonds were broken, and I smashed
the instrument."

This dream reveals its true significance when we recall that,
for him, all women, except one type, were essentially the same in
their sexual unattractiveness, unless he enriched them with fancies
about a certain type. The similarity of this girl of his sexual fan-
tasies to Miss Y — tended to associate them together in his mind,
but he was saved from the vulgar desecration by having her turned
into marble. When he was about to ask Miss Y — to marry, the
"commonplace" associations of thought, the result of his past in-
dulgences, so horrified him that he was unable to approach her as a
lover. Even twenty- three years of bitterness and sexual absti-
nence did not "burn" out the fixed mental tendencies as Barrie's
phrase suggested they would.

The psychoanalysis stopped at about the point where, figura-
tively, he smashed the source of light in the dream, in that he could
not face the last fact and consider why he remained attached to
Miss Y — but would always have to avoid her. The solution of his
problems came, arousing genuine enthusiasm, through a dream
in which he made a financial success by commercializing his scien-
tific knowledge. He now laid his plans upon a practical basis, and
urged that his freedom be restored with such common sense and
judgment that he was permitted to perfect his plans for earning
a livelihood. If successful, he might then approach Miss Y — , he
fondly hoped.

In the meanwhile he had more than recovered his physical
strength and weight, general bearing and emotional resources for
work. He and the chief, whom he had planned to assassinate, had
become very friendly. All of his friends in science, to whom he
submitted his plans, more than approved of their value and prac-
ticability, so that the patient was discharged as socially recovered
eight months after his admission. His old master in science again
responded with encouragement and financial support.

For seven months he worked on his business project and de-
pended upon Mr. T — for encouragement and financial support.
It finally became evident that the project would fail, and, because
of family obligations, his patron was forced to intimate that fur-
ther loans would be unfair to his heirs. This, of course, plainly

284 PSYCHOPATHOLOGY

said that, after all, blood relatives are to be given preference and
he must stand alone (breaking the transference).

This preference and his poverty, in addition to his inability to
get employment in the service in which he had previously Avorked,
finally precipitated a catastrophe. Under conditions that indicated
premeditation he shot himself in the head in one of the laboratory
rooms which was under the charge of the man he had once been in-
spired to ' ' remove. ' ' He left the following significant note :

"Apologies are due, but the Director knows that some sacri-
fice is necessary, somewhere, sometime, to make the connection."
(Italics inserted.)

As enigmatical as this seems to be, it is quite transparent if it
is recalled that he was inspired to remove this man in order to
"remove friction," and also in order that he might have a fair
chance of still winning Miss Y — . His life-long worry about ado-
lescent masturbation, his bitter resolutions to purify himself and
make himself worthy, the loss of the encouraging influence of his
master in science, who counteracted the depressing influence of his
skeptical father and director, the hopeless attachment to Miss
T — , his economic poverty, even though relatives were willing to
give him a home, and his mother's persistent influence establish-
ing the pernicious tendency to sacrifice himself when his affec-
tions were opposed to authority, probably were the principal de-
terminants that converged upon the sacrificial suicide, a renuncia-
tion of all competitive interests, and an eternal regression to his
mother. True to his childhood inspiration, of which he often de-
voutly told his mother, that nothing could ever separate him from
her, he finally had to give up the struggle to establish his own
biological integrity and independence.

Had the patient fulfilled his impulse to kill the director, he
Avould probably have fortified his position with all the logic, fan-
cies and inspirations of the true paranoiac and suffered as a mar-
tyr. He had brought his old correspondence for this purpose.
The jury would probably have given the verdict of insanity, be-
cause of his long series of neurotic episodes and acquitted him of
a very intelligently planned crime, and an inspired act, that was
committed in order, to "remove friction." This homicide would
have been due to a desperate effort of the repressed and misdi-
rected affect to break throiigh the insurmountable resistance and

MECHANISM 01? SUPp-RESSION OR ANXIETY NEUROSES 285

save the personality. This is essentially the mechanism of all
inspired and compelled acts: to break away from the repressing
influences and attain affective freedom.

The causes of this man's svppression or anxiety neurosis (di-
agnosed as "locomotor ataxia," "malaria," "neurasthenia,"
"delicate constitution," etc.) wore obviously the inability to com-
pensate and remove the repressive influences in the persons of his
father and others which were preventing him from developing
virility and escaping from autoeroticism and feminine submissive-
ness. The manner in which the repressed affect finally converged
upon a desperate, eccentric inspiration in order to win freedom
and attain potency will be seen, in the chapter on the paranoiac, to
be the mechanism of pernicious repression and compensation.

This parricidal compulsion is the opposite of the crucifixion
and sacrifice to the rival father. Both acts are founded upon the
suffering another's love, but become differentiated into parricidal
or sacrificial solutions by the hatred or love of the father for the
rival infant and later for the adolescent. This in turn depends
upon whether or not the father himself has difficulty with the ten-
dency to homosexual reversion or is a well-established beneficent,
virile, heterosexual type and does not mind the aggressions and
claims of his son becaiise he will "grow up" and perpetuate the
father to the third generation.

Suppression Neuroses in War

The manifold problems besetting the army surgeon, under the
caption "shell shock," arising from the stresses of a military cam-
paign, and the shocking powers of modern artillery, have produced
an enormous number of maladaptatiohs which are to be correlated
into two fundamental groups: {a.) the cases attending organic
injury and (&) the cases of affective suppression or repression.
Either type may occur with or without predominant symptoms of
autonomic distress.

The cases of organic injury include both the gross hemor-
rhages and thrombi, as well as the molecular intraneuron dis-
turbances due to violent cephalic auditory concussions. Probably
most cases of internal organic molecular injury Avhich cause ab-
normal variations of behavior are to be easily differentiated from
the affective derangements, because they belong to the cerebellar
ataxic, cerebral anmesic and aphasic types. The treatment in

2S6 PSYCHOPATHOLOGY

such cases is essentially rest, physical recoiistT-uction, and reedu-
cation.

The affectively distoited, howc'voi-, Ix'cause of their irrespon-
sibility and pernicious influence upon the morale of their com-
rades, form a more serious problem for the medical officers. The
essential factor is that the terrified autonomic apparatus reflexly
forces the individual into a useless adaptation in order to es-
cape from pain and danger. These adaptations consist usually
of the disuse of motor or sensory functions (as motor paral-
yses of limbs or larynx; hyperesthesias or anesthesias, as irrita-
bility, blindness, deafness, anosmia) or the distortion of motor
functions, as in spastic contractions and imitative postures.

This group of functional cases, complicated and highly indi-
vidualistic in their personal qualities, is best treated by giving
each patient sufficient personal attention to establish a transfer-
ence from the patient. Then the physician is able to influence him
with suggestions. The hypnotic type of suggestion can only be
made after an affective transference has been established, other-
wise no state of rapport exists. Suggestions under light ether an-
esthesia, no doul)t, must have a similar affective foundation and
the transference determines, by its vigor, the posthypnotic degree
of successfulness of the suggestion.

The soldier who generally suffers least from battle is the man
whose affect craves most to fight for the cause of his people. This,
however, is determined by the nature of his love for his people and
their principles. His sacrifice to save them is rewarded by propa-
gating their cause and winning their love and social esteem. In
the following repression neuroses it will be shown that the indi-
vidual who is subconsciously autoerotic or sexually indifferent
to the future Avelfare of his race, as the indulgent homosexual (not
the sublimated), has usually the least capacity to make severe
sacrifices for the cause of his people.

MacCurdy's studies of shell shock, as an analytical con-
tribution to our taiowledge of the individual character in rela-
tion to shell shock, establish the prevalence of abnormal biological
(sexual) types among these cases. It has repeatedly been stated
by French, English and German writers that psychoneuroses aris-
ing in a military campaign contain nothing new in principle from
the cases found in civil life, which is essentiallv true.

MECHANISM OF SXJPPRESSTOK OK ANXIETY NEUROSES 287

My impression, based upon a review of the literature collected
by F. E. Williams in "Neuropsychiatry and the War," and four
years of analyzing psychoses in soldiers and sailors in St. Eliza-
beths (Government Hospital for the Insane), is that the functional
maladaptation that renders an individual useless for a military
campaign is a profound biological adjustment to avoid the causes
of fear. The causes of fear are usually (1) potential death and
physical injury, or (2) an uncontrollable subconscious craving to
commit submissive homosexual perversions because of the sexual
isolation.

The autonomic state of fear is in itself extremely distressing
and a grave test of the compensatory capacities of the autonomic
apparatus (adrenal, thyroid, hepatic, respiratory, cardiac, vaso-
motor, renal, digestive). A disease process in any of the divisions
of the autonomic apparatus or undue fatigue from exertion and
insomnia predisposes to a failure of compensation and the mainte-
nance of aggressive resistance to the hostile or seductive environ-
ment. The individual who has undergone an eccentric deviation of
the psychopathic type, in order to avoid being forced by military
command or social obligations to compete with the causes of fear,
usually is unable ever again to meet those stresses Avith sufficient
confidence to make him feel reasonably sure of compensating suc-
cessfully, unless protected by a profound transference or love for
his people or some one representing them.

The psychopathologist must therefore make a neat discrimina-
tion between ordering the soldier, after his readjustment, into a less
dangerous environment, in order to save him from breaking
down again, or returning him to the^ battle to sustain and
propagate, eventually, the ideals of his people. It is needless
to emphasize that the acquirement of most unusual insight into,
human nature is absolutely essential for the successful practice
of psychotherapy. In this respect the medical profession has ut-
terly failed to encourage its better equipped members to give psy-
chopathology serious attention and understand the significance of
anxiety and its ranges from a mild malaise to terrific panic.

Restatement

The two foregoing cases of chronic anxiety are, after all, not
unusual types of cases. They were differentiated principally, in

288 PSYCHOPATHOLOGY

Darwin's case, by an n.nqnalified submission which, is rarely snc-
cessfnl (his adjustment conld only have been successful because
of his' economic independence and his wife's marvelous devotion),
and, in Case AN-3, by the severity and remarkable perseverance of
the struggle against hopeless odds for an impossible goal. The
psyehopathologist meets with almost innumerably varied causes
of anxiety, but, in one factor, they are all the same — the anxiety
is due to the suppressed or repressed affect trying to force its
way through the egoistic resistance in order to ohtain relief or
gratification. Hence, whenever a patient describes his physical
symptoms and the latter indicate undue tension, both the nature
and the cause of the suppressing and suppressed affect must be
sought. The cause of the suppression is egoistic and environ-
mental, that is, due to the obligations required by the individual's
associates, as the wife, children, employer, commander, or priest,
as the initiator of a conflicting fear and wish for esteem. Although
the suppressed affect may be love, fear, hate, shame or grief, the
anxiety is due to the inability to get relief and get rid of the affect.
The most common forms of affective craving which society
requires the individual to suppress, and which constitute the most
serious personal conflict, are autoerotic or homosexual love, incest,
hatred and fear. They are all rather easily recognized and ad-
mitted when the physician has the confidence (transference) of the
patient and the patient has not made a complete repression and
affective convergence upon a functional defence or sublimation,
physical or ideational. The physical distortions constitute the
solution, and like the fancies or ideas, are the product of a per-
sistent kinesthetic sensory stream which is sustained by the con-
verging affect (repressed and repressing) becoming fixed in the
adjustment of the conflict. Such maladjustments may in turn be-
come the foundations of further distortions, thereby enormously
complicating the personality. The mechanism of the repression
neuroses will be presented in the next chapter, and the manner in
which the psychoses are elaborations of the psychoneurotic ad-
justment is given considerable attention in order that the discus-
sion of the latter may logically follow.

CHAPTER VII

REPRESSION OR PSYCIiO-NEUROSES

Their Mechanisms and Relation to Psychoses Due to Repressed

Autonomic Cravings

The true repression neuroses, which exist in the form of spe-
cial phohias and definite compulsions, which are not common to the
individuaPs social group, and the eliminations of the use of special
functions or organs (as anesthesias and paralyses), contain a dis-
tinct, additional mechanism from that which is found in the pure
suppression or anxiety neuroses. In the latter, distressing tensions
of different segments of the autonomic apparatus occur (chiefly
gastrointestinal and cardiorespiratory) Avhich, in turn, disturb the
reciprocal adjustments of the other important segments, such as
the sexual or renal functions. These disagreeable tensions are
always due to threatening factors within the personality or in the
environment which cause fear reactions (such as shame, grief, dis-
gust, fear of censure, persecution, injury or failure, etc.). Dis-
tressing hypotensions of viscera (sinking feelings) are due to the
failure of the autonomic apparatus to compensate. (In many in-
stances, defensive compensation tends to increase the punishment
or threat, as when a parent, teacher, mate, or an employer demands
abject submission.*) When the autonomic apparatus tends to
overcompensate in a painful situation, the individual is distressed
by the hypertensions of visceral segments. The individual, in the
anxiety neuroses, becoming afraid of his ability to control him-
self, tends to avoid the situation, as in Darwin's seclusiveness be-
cause of the tendency to become unduly distressed by social gath-
erings, but he does not obscure its true nature from himself by
fooling himself into believing that the distress is caused by an
extraneous influence.

So soon as the individual, in order to avoid recognizing the
painful factor in the situation, attempts to give it a pleasing, fic-

*Aninials and birds often use the meciianisin of complete submission in order to avoid the
punishment that may come if anger is shown; as the puppy lies on its back exposing its throat and
abdomen to the other dog's domination.

289

290 PSYCHOPATHOLOGY

titious value, then what "usTially proves to be an impractical dis-
tortion occiirs ; as the devoted mother, who, refusing to recognize
the lies in her son's explanations of his misbehavior because that
would be too painful, overcompensates with some foolish' indul-
gence. Such adjustments eventually place the individual at a pro-
gressively increasing disadvantage if he must struggle with com-
petitors in order to retain his social and economic position.

In the repression neuroses, the indiAddual suffers from a func- .
tional distortion bepause the autonomic segment, giving rise to
affections which would claim a hazardous object or course of be-
havior, is kept repressed by a vigorous compensatory coordina-
tion of the remainder of the organism (the ego) upon some asso-
ciated interest or function. This adjustment controls the activities
of the final common motor paths (Sherrington) ; as in the case of
mysophobia-, or in the functional disuse of a limb (paralysis) or
sense organ (anesthesia).

Obviously, any defective adaptation of this nature to an emer-
gency more or less reduces the individual's capacity to master the
environment, hence, to compete for social influence and esteem. If
the adaptation involves the aggressive self-assertions that are
necessary for effective competition, such as taUdng in a resonant
voice directly to the point, and makes it impossible to functionate
with due impressiveness and Avithout posing, the individual's effi-
ciency is enormously reduced. One finds that very capable men,
who are too timid, must accept subsidiary positions because they
can not endure the embarrassment that is aroused by the possibil-
ity of failure in competition.

Such adjustments and repressions do not necessarily in them-
selves make an individual unhappy. They may, however, make it
impossible for him to compete for a mate or a responsibility. One
finds everywhere worthy men and women, who desire nothing so
much as parenthood, chronically avoiding everything pertaining
to sex ; hence, whenever the sex interest begins to assert itself, the
subject is avoided, and not even the preliminary stages of "making
love" are attempted. The scene that promised much is tactlessly
ended, and for months the memory of it is cherished and wondered
at because of what might have been. But no further progress is
made.

Individuals, who grow into this biological type, are incapaci-

REPRESSION OR PSYCIiONEUROSES 291

fated by sexual repressions and absurd compensations. Tliey are
usually started in childhood through the influence of some prudish
adult who labors under the mission of eliminating everything that
pertains to or stimulates a sexual interest.

The concentration upon a substituted interest, by which the
intolerable wish is kept repressed and the compensatory trend is
also gratified, may assiime the constructive course of making some
particular creation or investigation, or the destructive course of
merely eliminating some vitally necessary function or affection. A
great deal is being said about hysterical conversions and conver-
sion mechanisms. The term conversion was adopted by Freud (see
case of Miss Lucy E — ). lie confusingly assumed that "psychic
energy," without explaining what is meant by it, becomes con-
verted into a physical distortion or functional derangement such
as a paralysis. This conception, so generally used in articles on
psychoanalytic studies of neuroses, seems to be, upon careful con-
sideration, incomprehensible as a biological phenomenon. It is
not only confusing but imnecessary. There surely can be no dif-
ference in principle between the making of different overt move-
ments, say in making sounds and signs with the hand or vocal
organs, and preventing their being made. The innervations neces-
sary to maintain postures and functional paralysis require auto-
nomic reenforcement just as m^uch as skillful movements require
it. Functional anesthesia, or hyperesthesia of any receptor field,
is in principle the same as the commonplace phenomenon of direct-
ing attention. It is entirely a matter of affective, or rather auto-
nomic resistance to, or craving for, the stimuli ivhich are received
hy the particular sense organ. It is nothing less than a reductio ad
absurdum to assume that repressed anger can be "converted" into
a physical distortion. The repressed affect, or rather the hyper-
tense repressed autonomic segment, simply forces the assumption
and maintenance of a fixed attitude, stereotyped function or an
idea, which requires as constant innervation and affective reen-
forcement as the performance of countless movements to attain an
end ; as in the handwashing of the following case of mysophobia, or
the case of functional paralysis of the leg, or Darwin's life long
compulsion to solve the riddle of the evolution of life and the origin
of species. The functional variations in the innumerable psycho-
paths to be met with in the practice of medicine are determined by

292 PSYCHOPATHOLOGY

the manner in.wMcli the affect has been conditioned and repressed
and has compensated and its stimuli have been associated with
avoidable or unavoidable factors in the environment.

Compidsions and obsessions are the same in principle, in that
behind the compulsion to perform a certain act, or the obsession
that something might occur, when performing a certain act, is the
fear of the possible conseqiiences if such acts are not always per-
formed. The difference between compulsions and phobias usually
lies in the manner in Avhieh the patient or physician regards the
difficulty. For example, in the case of mysophobia the compulsion
to wash the hands was a compensation for the fear of being ' ' con-
taminated" by dirt, germs, feces, etc. The fear of fecal contami-
nation, however, was based upon the craving or love for anal-
autoerotic fancies and sensations. The compiilsion or phobia was
always emphasized by the patient. The erotic craving, however,
was always concealed with the utmost determination. The delusion
and hallucination as the result of vivid sensations caused by the
persistent struggle of the repressed affect to get gratification, are
actually the result of the obsessive craving compelling the individ-
ual to be conscious of the specific sensations because they are, in
some manner, associated with the stimuli that might gratify the
affect. Phobias are usually due to fea/rs of having tabooed crav-
ings : therefore, what is the repressed wish or craving and the
secret experience in which some such indulgence actually occuredf

A dependent old mother is obsessed with the fear that her
daughter wishes her to die. This gives rise to compensatory
behavior which is designed to make the daughter wish that she
should live. The foundation of the fear about the daughter 's wish
is the fact that she prevents the daughter from marrying and
usurps her affections for herself. The daughter, being forced to
repress her wishes for maternity, which naturally tend to remove
the obstruction, the dependent mother, compensates with feelings
which compel her to renounce all social engagements that may give
rise to the possibility of an offer of marriage.

Behind compulsions or obsessions is the fear of yielding to a
repressed, intolerable, secret v)ish of which the individual has suc-
ceeded in keeping himself unconscious by concentrating. on a sub-
stitute. This substitution usually becomes very much involved,
be'cause of its eccentric nature, with the adaptations that are

EEPRESSION OR PSYCHONEUROSES 293

necessarily required in the day's -work. The patient never comes
for relief from the repressed wish, but desires to be relieved
of the \exhaiisti-ng--dj;ains necessary to maintain the substitution.
The medical profession, until Freud worked out the mechanism of
the compulsion, was as helpless in the solution of the mechanism
of compulsions as academic psychology.

Simple phohins, such as fear of Avater, fire, automobiles, bee-
tles, spiders, foods, strangers, etc., are often conditioned auto-
nomic reactions due to the accidental association of the object, as
the mouse, with a primary fear producing stimulus. The primary
cause, say the frightful story of a sadistic nurse told in childhood
is no longer recalled by the patient, but the presence of a mouse
still causes a repetition of the panic of childhood.

All cases in ivhich the repressed affect is resisted by the per-
sonality, causing a functional distortion, should he considered as
repression neuroses. The individual who has repressed the affect
and refuses to regard it as a part of his personality, is logically
subjected to a mysterious, persistent, pernicious influence from
which he can never escape, and this force is potentially liable
through a summation of repressions or exhaustion of the ego to
produce a serious dissociation of the personality. Undue stresses
(diseases, exhaustion, insomnia, failures) Aveaken the controlling
AAdshes which are striving to retain social esteem.

The following patients, Avho illustrate these mechanisms, are
divided into two groups. Those who striA'e persistently to elimi-
nate or castrate the functional or organic inferiority in order to
get rid of a craAang, and those AA^ho strive to simidnte a function or
condition which pleases the otherAvise ungratifiable craving. The
elimination types of psychoses and neuroses seem to be more
malignant than the simple simulation, types, because in the latter
the affect often obtains gratification, that is, is neutralized and
the craving ceases.

There is a distinct functional difference betAA^een the repres-
sion neuroses and acute dissociations of the personality marked
by hallucinations. The degree and persistence of the dissociation
process varies enormously.

In the following Case' PN-1, the patient was compelled to
wash herself almost incessantly in order to obtain relief from the
fear and shame of being "contaminated" by feces. The feeling

294 PSYCPIOPATHOLOGY

that she was contaminated had its origin in an anal anto erotic
catastrophe of which, because of the embarrassment it caused, she
had to keep herself unconscious ("forget it").

Case PN-1 was a young woman, unmarried, with a high school
education and considered to be a likable, capable girl by her
friends. She was Avell able to earn a living, and apparently suc-
cessful, when there developed quite suddenly an intense mysopho-
bia, (fear of being "contaminated by dirt").

The history of the onset showed that she had been inclined to
conceal her emotions, and was, secretly, very erotic. The im-
portant feature in her case was the incessant compulsion to wash
her face, hair, hands and body, but chiefly her hands, because she
believed she was "contaminated." All her interests in her family
and friends were completely subordinated to this craving to get
clean.

She had to quit work and spent practically all her time wash-
ing and drying herself. When the distracted parents and sisters
tried to stop her, she became "wild," pleaded, begged, cried,
fought, and became panicky until they permitted her to resume
the washing. A few minutes after she felt herself to be clean,
she would again be compelled to use soap and water and would
consume an entire bar of soap at a washing if permitted. She
finally had to be sent to the state hospital in order to protect her
from the obsessive craving.

The sole topic of interest to her was that she had been ' ' con-
taminated" by filth and could never get clean. Her conversation
showed that there was no intellectual impairment. She would
give no explanations about when or how she had become "con-
taminated. ' '

Wlien washing herself, she rubbed the skin surface with highly
rapid, short, brisk strokes. Her almost breathless eagerness and
the flushed, excited face, and expression of rapturous delight sug-
gested a strangely erotic excitement in the contamination. She
sought no relief from the compulsion to wash and would gladly
have devoted her life to this obsession — an interesting form of
biological .abortion. (Her behavior, or affective state, was not
characterized by the disgust that one would expect when removing
filth from the skin.)

Her compulsion, after more than a year's duration, was con-
sidered incurable by the physicians she consulted. Almost daily

REPKESSION OR PSYCHONEUROSBS 295

brief talks and earnest suggestions about her welfare had no mit-
igating effect upon the craving to remove the "contamination."
Without my realization, however, of what was transpiring^ this
young woman, about my age, Avas responding to my interest in her
welfare by making a transference to me. (This case was worked
out in 1911 after reading Freud's Studies of Hysteria. I now
feel sure that only the development of this transference made the
later grewsome analysis possible.)

The transference developed to a state that made her feel an in-
terest in other possibilities of living. I was then learning the
technique of psychoanalysis, and success with another case was
creating an interest among the patients. This led Case PN-1 to
seek the intimate conversations of a psychoanalysis.

The essential points of the origin of the feeling of having
been contaminated, were easily uncovered, but, as she broiTght
them out, she vigorously denounced me for "putting the thoughts
into her mind." (I was extremely careful to avoid making any
other suggestion than that whatever we were considering at the
time would surely remind her of more details. In this sense I did
suggest that she would recall the memories of a painful experience,
but in no sense did I suggest what it would be.)

She uncovered her secret autoerotic fancies with considerable
resistance and embarrassment, but her confidence in the sincerity
of the procedure enabled her to recall the delicate secret of her
love fancies about her cousin and a playful scene with him.

This led, in turn to the critical scene in the kitchen. She vis-
ualized herself washing dishes, and her sister working near by.
She was having difficulty in washing some object and her fancies
indicated that she was in a decidedly erotic mood. Despite the em-
barrassment, she honestly revealed that she was menstruating at
the time and was wearing a cloth made from her father's under-
wear. Then she added the significant fact that the thoughts of
this cloth had aroused more pleasure than she had realized, and
in her erotic mood she felt a desire to allow her bowels to evacuate.

Despite her sister's presence, before she realized the preca-
riousness of her state of mind, she yielded to the erotic pleasure,
beca,use, as she said, the passing of the feces would "feel good"
(substitution for phallus).

Immediately following the evacuation, which she was inclined

296 PSYOHOPATHOLOGY

to urge was mfluenced by diarrhea, slie fotind herself in an ex-
tremely embarrassing situation. She fled to the toilet and in un-
dressing her hands became contaminated with feces. ;

Her guilt and shame were greatly aggravated by the dre|d
that her sister might guess the truth of the incest. The sister
seemed to accept the affair as an accident, but the mortified Sri
could not be convinced. The shame from the erotic fancies about
the father and the cloth could not be completely repressed from
consciousness, and the struggle to get clean by washing, which she
was doing at the time, persisted as a defensive, persistent, obses-
sion.

With the recall of the semirepressed material, her mortifica-
tion and anxiety became serious. She upbraided me for havinf^;
brought the thoughts to her mind and had to be placed in bed
because of becoming suicidal. "Whenever she saw me, her anxiety
waxed into a crescendo. This continued for several weeks and
I now feel its long duration was due to my inexperience Avith the
transference under such conditions and my inability to advise her
properly.

Unfortunately, I was unable to complete the analysis and help
her to free herself from the secret father attachment because of
leaving the hospital service. Several months later, however, I re-
ceived a letter from her that explained the outcome. In it she ex-
pressed gratitude for having been cured. She had returned to work
and was enjoying excellent health.

The incessant compulsion to remove every possible trace of
"contamination" was obviously a desperate effort to wash the
erotic guilt away. This sense of guiltiness was persistently forced
into consciousness by the repressed erotic cravings for the father,
which had suddenly been transformed from a secret pleasure
into a terrible burden, because the whole truth might be sur-
mised by the sister, who probably vaguely knew more than she
would allow herself to realize.

This type of anal autoerotic personality, with the father as
the affective object, will probably develop into a gravely psycho-
pathic personality having terrific affective difficulties and distress-
ing feelings of being socially inferior unless she is helped to estab-
lish an adequate affective readjustment. The cleansing obsession
in her case might be compared with the behavior of a young homo-

REPRESSION OR PSYCHONEUROSBS 297

sexual soldier, very tense, inaccessible, and hostile, who would
stand for hoiirs before the window with his month wide open to let
the sun shine into it.

The above case was essentially due to a persistent attempt to
eliminate an intolerable affective craving and the sensory im-
pressions (memories) aroused by it. The following case was also
characterized by a series of elimination procedures in which the
patient used the mechanism of repressing (forgetting) the affec-
tions and memory impressions that pertained to a painful expe-
rience, because it was her only means of escape from a distressing
situation. The extent to Avhich the elimination of inferiorities
may be developed is astonishing. It often includes the most radi-
cal of major operations if an unsophisticated surgeon can be
found, who sluggishly conceives the personality to be an organic
mass whereby his scalpel becomes the supreme truncheon of the
universe and he its irrepressible wielder. Panhysterectomies,
ciirettages, circumcisions, thyroidectomies and gastroplastic oper-
ations are not uncommon sequelae of the patient's effort to refuse
to recognize the repressed affective cravings, particularly hate,
envy, jealousy and love.

Case PN-2* was a slender, dark-complexioned girlish look-
ing woman, of medium height, twenty-one years of age, who was
admitted to a state hospital for the insane because she could not
control her "hatrish feelings" and "jerking spells."

During the admission proceedings, she sat quietly in an incon-
spicuous chair, her head lowered so that the brim of her hat con-
cealed most of her features. When she looked up, she timidly
lifted the hat just high enough to permit her eyes to peer beneath
the edge. She smiled at almost every remark addressed to her, con-
trasting strangely with the uncontrollable feelings of hatred of
which she complained and indicating compensatory efforts to hide
those feelings. Her husband gave the usual brief account of her
illness, but carefully hid his feelings of personal responsibility,
displaying no intimation of insight into her condition. However,
he was very solicitous of her welfare.

The patient's life on the ward for the first few days was un-
eventful. She adjusted herself fairly well to the companionship
and society of other patients, accepting the routine requirements

*This case was reported in the Journal of Abnormal Psychology, April, 1917, as: "A Study
of the Anesthesia, Convulsions, Vomiting, Visual Constriction, IJrythema and Itching of Mrs. V. G."

298 PSYCHOPATPIOLOGY

and finding some light work to perform to curtail the periods of
idleness.

"When her ear was pricked, in order that a blood specimen
might be taken, she submitted to the ordeal without any signs of
uneasiness until the blood was being cleaned off. Then, suddenly,
she became embarrassed, and seemed to be very uncomfortable,
but said nothing to the physician (conditioned repressed affect).

One morning, after this incident, when I made my ward
rounds, I found her. standing before a window, seemingly very
much embarrassed. The muscles of her body were jerking vigor-
ously and she explained when I approached that she hated ' ' that
man more than any one in the world." (She referred to the phy-
sician who made the ear puncture and whom she had just seen
pass the building.) She could not explain why she hated him;
he had not hurt her but had been kind and careful, she said ; but,
nevertheless, when she saw him, she felt an intense hatred.

Within a few days after her admission, the "jerking spells"
or "hatrish feelings" recurred so frequently that she was seldom
without them. She complained, pitifully, that, despite her efforts
to control herself, even the slightest commands of the nurses af-
fected her. Such impersonal orders as the call of the patients to
attend dinner caused her to feel intensely embarrassed and resis-
tant, even though, as she expressed herself, she knew better.

She told me of one of her reactions when she was in the grove
with her ward. "She [the nurse] called us .in a very pleasant
voice [to come to the ward] , but it affected me so deeply that in a
second, my thoughts Avere in a whirl. I came in, and went to my
room and cried. All those bitter thoughts back in my childhood,
rushed through my mind. I could see them all, like a flash, pass
in a string, and it made me feel so bitter I cried, and then went to
sleep. But today I feel better."

It was observed that practically all of the muscles of her body
"jerked," that is, became involved in convulsive movements dur-
ing many of these episodes. The recti abdominis were included
in the large group of muscles which were involved, but not until
later was it ascertained that their activity was conditioned by a
distinct experience. With the attacks, there would often be inter-
vals when she would beat herself and dig her nails into her palms.
She was afraid that she might injure herself or others. She did
not hallucinate or lose consciousness.

KEPRESSION OR PSYCUIONEUROSES 299

Upon examination, without a perimeter, it was found that her
visual field for colors was marliedly constricted for the right eye
and practically normal for the left.

The patient did not react to heat, cold, touch, or pain, except
sometimes when it was strongly suggested that she could feel the
stimulus, over the right side of the face and neck, right shoulder,
arm, trunk, and leg. She also practically gave no response to
.stimuli over the posterior surfaces beloAV the waist. The left side
varied considerably at different times, but, on the whole, the sen-
sations were normal over the left half of the face, shoulder and
arm, except over the hand and a narrow strip which ran down
the left side of the body and leg to the ankle. Stimulation of the
hands and feet yielded no response. She had never complained of
loss of sensation, had no idea of its duration, and seemed to be
surprised at the discovery.

On the extensor surface of each forearm, about midway be-
tween the elbow and wrist, was an irregular, blotchy, slightly
raised erythematous surface. Each area was about as large as the
finger surface of a woman's hand. These areas itched consider-
ably at times, and she insisted that it was a skin disease which she
had had for more than a year and did not worry about, and which
bad nothing to do with her illness.

Her subjective complaint consisted of "hatrish feelings,"
"jerking spells," and nausea, caused by red fruits and vegetables.
This nausea became so intense that she vomited when she ate red
fruits or vegetables (conditioned affective reaction).

To sum up her symptoms, she had (1) uncontrollable periods
of intense hatred and jealousy, for, principally, her husband,
mother-in-law and her grandmother; (2) periods of jerking of
practically all her voluntary muscles; and (3) an independent
jerking of her abdominal muscles; (4) anesthesia for her right
face, chest, arm, side of body and leg, and back below the waist,
with later hyperesthesia of the right upper face; (6) constriction
of the field for color vision in the right eye, pai"ticularly red; (7)
nausea and vomiting caused by red fruits and vegetables; (8)
erythematous blotches on the extensor surface of each forearm,
and (9) periods of intense itching over these surfaces.

Her parents died when she was two years old. She was
adopted by a neighbor whom she was very fond of and always

oOO PSYCHOPATHOLOGY

regarded as her mother. This woman taught her the Catholic
faith, gave her a comfortable home, and provided for the usual
childhood education. She was probably an excessively petted
child. She was taught by her foster-mother to fear and avoid a
certain "mean" old lady. Unfortunately, this old lady, who was
her grandmother, caught her on the street when she was about ten
years old and kidnapped her despite her cries and protests. From
that day on, she lived very unhappily with this grandmother.

The patient always believed that the shock of the kidnapping,
her great fear and hatred of her grandmother, reenforced by the
long years of unhappiness, caused her to become abnormal. As a
child of her foster-mother she had been petted, spoiled and given
every comfort and attention. After she was kidnapped, she was
always miserable; scolded, whipped, lonely and unhappy. She
had to sleep alone upstairs, and frequently, terrified, she sneaked
to the head of the stairs where she cried herself to sleep. She was
often punished for this, but the punishment did not stop the fear.
After her grandfather died, \er night terrors left her.

Other than the constant exposure to the unintelligent domina-
tion by a much older, unsympathetic personality, her life was un-,
eventful until the period of her engagement and marriage.

The grandmother was an earnest Catholic, but the patient,
as she said, felt very little interest in that faith. The persistent
old lady had no patience for such girlish irresponsibility and
planned out the young woman's course in life without considering
her wishes. She selected a young Catholic man to be her grand-
daughter's husband and, at what seemed to be the propitious time,
announced her engagement to him through the medium of the news-
papers. But this selection, like most of her grandmother's ideas,
was quite different from what the young woman desired. This
young man, she said was a flirt, and was known in the neighbor-
hood as an immoral man. For some reason that she did not quite
understand, she liked him, and often fancied herself the object
of his flirtations, but she was never able to love him.

She was in love, she thought, with a young Protestant and,
despite her religion and her grandmother's horror, determined to
niarff him. The grandmother was not sure of their intention, but
suspected it, and determined to forestall their purpose by an-
nouncing her engagement to the Catholic and this precipitated a

REPRESSION OR PSYCHONEUROSES 301

crisis. The next day the patient denied the engagement and a
furious debate between the two women resulted. The grandmother
would not permit her fiance to see her, but kept her in the house
and sent for the parish priest. She said the two people tried to
convince her that she would make a mistake if she should marry
the Protestant. In the afternoon, the patient was locked in her
bedroom by the grandmother and informed that she would be kept
there until she promised to marry the Catholic. (The remaining
details of the scene which developed while she was in the room
were forgotten by the patient and will be described later as part
of the psychoanalysis.)

Later in the afternoon, the patient managed to escape from
the house and stayed with her future sister-in-law. A few days
later she married the Protestant. (It may be best to note here
that this sister-in-law had been subject to violent "jerking spells"
since the birth of her first child. The muscles involved were
principally the abdominal, according to our patient's statement.)

Soon after this a neurosis became apparent and developed
rapidly. A sequence of unhappy experiences in an environment
that was peculiarly suited to expose her to a series of most un-
pleasant conflicts, soon proved too much for the patient.

Her husband's parents lived alone on a farm which they had
occupied for years and the young couple Avere to take complete
charge of all its details and live with the old people. This proved
unfortunate, because the mother-in-law could not give up her
dictatorship of a household that she had dominated for years.
The young wife was in perpetual conflict with her. She was, in
reality, exposed again to her perplexing grandmother problem in
the person of the mother-in-law. The long needed freedom from
restraints and criticism was not to be her good fortune.

She soon became convinced that she was not regarded Avith
much favor by the older woman, and believed that her husband
favored his mother in their conflicts, which he actually did.

The psychoanalysis, that is, the recall in detail of the sensory
images (memories) of the experiences that determined her patho-
logical condition required about eight weeks of almost daily con-
ferences averaging more than an hour to an interview. The recall
was like unraveling a tangled skein of yarn. Part of the details
of one experience, then part of another were recalled until most of
the unpleasant experiences and their influences were readjusted.

302 PSYCHOPATHOLOGY

The "jerking spells" and "hatrisli feelings" bothered her
most, and naturally, her discussion of her troubles, at first, cen-
tered about their description and onset. She attributed much
of her trouble to the fact that several months after her marriage
she was badly frightened by a report from the neighbors that an
insane man was coming through the woods towards their house.
The next day their barn caught fire. Although she was men-
struating, she ' ' ran about a mile ' ' to call some neighbors and while
on her way, it occurred to her that her mother-in-law might enter
the barn to liberate the horses and be burned up. She at once ran
back to the house and found that an excited crowd of neighbors
had gathered and the barn was in ruins. She recalled how she
cried when she saw the remains of a pet colt and also how she
and her sister-in-law prepared dinner for the neighbors. When
they entered the kitchen, her "head flew back" and her "jaw set."
For several weeks, she seemed to be unable to recall any other de-
tails of this scene. Later, when the house caught fire, and when
the wheat field burned, she again had unusually severe convul-
sions.

Details of more trivial conflicts about the condiiet of the farm,
etc., seemed to force themselves into the foreground and neces-
sarily had to be readjusted. Her jealousy of the mother-in-law
became very evident, and her incapacity to meet this condition
troubled her greatly. Gradually, she developed a determination
to meet her family problems on another basis than hatred. This,
of course, she was unable to carrj'' out, but her attitude had the ef*
feet of enabling her to study her troubles more intimately, and she
no longer evaded her own responsibilities in the psychoanalysis.

Then, quite unexpectedly, memory details or images of a for-
gotten traumatic experience came to the surface and proved to
contain the conditioning stimuli of her very distressing gastric
sensorimotor reactions to feel nauseated when red fruits or vege-
tables were placed on the table for the meal. When she ate the
re"d fruits or vegetables they were quickly emitted again. The
traumatic incident amounted to the following:

In June, a few months after her marriage, she found her
mother-in-law on the porch before breakfast, seeding cherries for
canning. The patient, who was trying to take charge of the house-
hold, made preparations to help seed the fruit. The mother-in-law
refused her assistance. The yoimg woman persisted, venturing

REPRESSION OR PSYCHONEUROSES 303

the information that she was not unwell because her mother-in-
law believed that when fruit was canned by a menstruating woman
it Avould spoil. Although her menstrual period was due, she did
not realize, until later, that the cause of its delay was pregnancy.

For several minutes she was unable to recall anything further.
Finally, she added, "Then I went in to breakfast with my hus-
band and tried to take my anger out on him, but I got no satisfac-
tion." Here, another break in the recall occurred. "Then," she
resumed, "I ate a little breakfast and my mother-in-law brought
in some cherries. I gave my husband mine, with the remark that
I guessed they were all right since he picked them. I left the table
and vomited up the food. I did this for everything I ate after
that, until my baby was born. The reason I was so angry was be-
cause we had contracted to run the farm for half, and I thought
I should have something to say." (She discussed this scene with a
free adjustment of anger for the mistreatment.)

(Cannon has shown that anger or fear arousing stimuli cause
a marked disturbance of the gastric sensorimotor and secretory
functions ; and the sensation or feelings produced by the reaction
constitute, in large part, the emotion of anger, a mechanism anal-
ogous to the peripheral origin of hunger. The anger and fear re-
actions of the stomach, both seem to be unsuitable for the recep-
tion of food.) When the patient was still further aggravated by
the triumphant mother-in-law (primary stimulus) offering the
cherries (conditioning stimulus,) and her husband supported his
mother, the patient was left no outlet through which to express her
anger and make a comfortable readjustment. She had to control
herself, that is, suppress the affect. Anger tends to remove the
stimulus from the receptor and not to accept it, m.uch less to swal-
low it as food. She succeeded in rejecting the cherries, which had
become part of the mother-in-law's interests, but the rage status of
the stomach was unlit to retain the breakfast, and caused feelings
of nausea. The stomach emitted the food, and it seems that so long
as she was unable to make a normal affective adjustment to either
the conditioning or the primary stimuli, they both tended to arouse
reactions of hatred and gastric aversion. When she did make an
affective readjustment to the experience, it seems that, concomi-
tantly, the gastric reflexes were no longer conditioned to react
with aversion to the red food. The readjustment seems to have
been in the lowering of the postural hypertension of the stomach

304

PSYCHOPATI-IOLOGY

and its tendency to emissive, reversed peristalsis when certain
foods -were being forced upon it.

The continuation of the vomiting was probably later reen-
forced by the aversions to food which occur frequently as a psycho-
genetic phenomenon in pregnancy (perhaps nourish|g(|*an unwel-
come fetus), because throughout her pregnancy the patient said
she vomited nearly all the food she ate, and merely the sight of
red fruit on the table caused vomiting ; whereas, after her labor,
the red fruits only caused nausea, unless they were eaten. She
became so emaciated that later she was unable to nurse her infant.

The tendency to react with aversion to all red fruits and veg-
etables, besides cherries, was probably reenforced by a traumatic
experience of several months previous, because, when she had
made an emotional adjustment to the cherry incident and allowed
the hatred freely to attack the unjust husband and mother-in-law,
she, much to my surprise, included the pathologist. She could
not explain why she included him, until it occurred to her that she
felt her first hatred for him Avhen he removed the blood-stained
(red) cloth from her ear after making a puncture to take a blood
specimen. To this she added: "I thought he did just as he
pleased," which seemed to be an insignificant phrase, but later
proved to be an important lead.

Her agitation and hatred continued for the next twenty-four
hours and was, later in the day, accompanied by a general con-
vulsive jerking of her muscles which continued throughout the
night.

The episode of the cherries occurred after the barn fire, and
the vividness of its affective impressions had probably covered
up the details of the more important barn fire episode. Now the
fire episode bothered her again, and she made considerable prog-
ress in the recall of its details, but could not quite get all of it —
the most pertinent fact in the scene.

She visualized the fire scene in greater detail. She recounted
how the excited crowd and the women, particularly the mother-in-^
law, noticed her excitement and trembling, and told her to keep
quiet or she would have "spells" like her sister-in-law (sugges-
tion). She could not recall what happened next, but she was able
to recall from the time her head "flew back," etc., when the men
entered the kitchen. One of the men was Mr. li — -. He was pres-

REPRESSION OR PSYCHONEUROSES 305

ident of a home insurance company that had insured the bam. Al-
though she seemed to be unable, with persistent effort, to recall
what transpired between the suggestions of the women and the en-
trance of Mr. li — , she was able to develop the scene from the time
of his entrance until her convulsions. She could see herself trying
to pour the coffee, but her hands trembled so violently that her sis-
ter-in-law took the pot, and " I broke down. ' ' She fell back into a
chair. The men seized her arms, to keep them from jerking, and
then her face began to jerk and her jaws set. Then, her entire
body became involved in a conviilsion from which she did not re-
cover until the next day. She had been apprehensive lest she
should be like this sister-in-law (as suggested) and now she had
her malady.

Her husband paid her a visit at this stage of the analysis,
and both were delighted with the improvement. She said her
''mind felt free and open," and she now understood why she had
attacks in the presence of a croivd or a fire (conditioning of the
convulsions). But, it soon became evident that she was not so well
aff she thought. The fire scene was again studied and she recalled,
more elaborately, the details of the excited crowd running about
with water, and that Mr. H — wanted to know who was the last
person in the barn, and that she thought the people believed that
the son of the insane man, who had been in the w^oods the night
before, had set fire to the barn, because the children reported hav-
ing seen him running away from the fire. The patient heard Mr.
H — ■ telephone for the sheriff, supposedly to arrest the suspected
man. The recall of these impressions worried her, and she ex-
pressed herself to the effect that "yesterday I felt so good and
now I feel as if something wants to come out and can't."

She seemed unable to recall anything further and was very
m.uch agitated. With suggestions that she would see more details
of the tire, gradually other fragments of the scene were recalled.
She now saw the excited Mr. H — with two cups of water trying
to throw them on the fire, and when he entered the kitchen door-
way she started to tease him about it, but something changed her
mind. After several minutes another fragment was added,. She
saw her husband's brother, J., walking behind Mr. H — . They
were having an earnest conversation, and then she remembered
that she was afraid J. was talking about her husband. That
morning, she heard J. say that he had always expected a fire be-

306 PSYCPIOPATHOLOGY

cause her husband would not stop carrying matches when in the
barn. "Mr. H — had a mean look in his eye, and I thought J.
had told him about my husband. This is what changed my mind,
and I stopped him to see what 'he was going to do,"

No further recall was effected although we tried hard for
fifteen minutes. Then came this "strange thought." Airs. T — ,
an old lady, set fire to her barn when she smoked in it, and j\Ir.
H — • refused to pay her the insurance."

With this fragment, it seemed obvious that the patient held
a secret which Mr. H — should knoAv, and was afraid that the in-
surance would be lost if he knew it. I insisted that she knew
something that no one else knew, but she seemed to be unable to
recall anything, and was obviously feeling very uncomfortable.
She seemed to be lost in study; then, suddenly, an expression of
decided pleasure swept over her features. "I knew that my hus-
band watered the colt after everybody left the barn that morning,
and 1 thought he might have fed it some hay and dropped some
matches. This, 1 was afraid Mr. H — would find out." She seemed
to feel relieved and said that a weight had passed from her.

The tendency to liave "jerking spells," seemed entirely to
disappear now and she regarded herself as cured. Several days
later, however, she complained of back pains, and, when the ex-
amination was made, much to my surprise, she developed strong
rhythmical jerks of the recti muscles of the abdomen which easily
could be seen through her clothing. Two days later, a jealous pa-
tient made offensive statements about her and her physician, and,
following this conflict, the recti muscles resumed a rhythmical jerk-
ing whicli lasted about thiity-six hours. Several hours of inter-
views did not yield the slightest information relative to its re-
pressed cause. Her difficulties Avitli the patient had to be dealt
with before further progress was possible. The incident empha-
sized the importance of keojiing patients who are to be psycho-
analyzed in a congenial environment and free from inquisitive
or critical people.

The remainder of the psychoanalysis will be given as com-
pactly as possiltle l)ecause of the limited space, and the traumatic
experiences will be related in brief instead of in the fragmentary
manner of the recall. She was finally able to place the first attack
of abdominal jerking as having occurred about two weeks after

REPRESSION OR PSYCHONEUROSES 307

her marriage, and, later, she recalled that it was two days after
her marriage instead of two weeks.

The difficulty developed as follows : The night following her
marriage was spent in revelry. The next night, the boys carried
her husband away, and the following afternoon, her husband and
his mother paid a visit to her grandmother, despite the patient's
objections. She refused to accompany them and this disregard
for her feelings associated the grandmother and mother-in-law
and husband against her. This disappointed her greatly, and she
was left alone in a very miserable state of mind. Her state of
feeling was probably that of intense indignation and hatred for
the grandmother. She said she was lonely and cried. She had
no friend and no one to depend upon. She knew nothing about
the sexual life of woman, and was afraid of becoming pregnant
without someone to take care of her. Her sister-in-law's attacks
of "jerking" followed the birth of her first child and the patient
believed it was the result of poor treatment. This reenforced
her fears of pregnancy. In the recall she visualized herself lying
on the bed in a very morose frame of mind. She had started to
menstruate that day and that night she expected to sleep with her
husband. She was disgusted with her condition, and felt deeply
disappointed in her husband's and his mother's attitude toward
her grandmother. She had expected them to take up her quarrel.
She even regretted her marriage, and thought that perhaps she had
made a mistake. She recalled her resolution to depend upon her
sister-in-law and that when she arose from the bed she felt better
but her abdomen jerked. (It always seemed to me that a critical
incident was overlooked here, unless the following sextial trans-
gression occurred in the afternoon and that night, also.) That
night, she said, her husband "did just as he pleased" despite her
unhappy mental state and resistance. The recall of this imposi-
tion seemed to complete the details of the repressed traumatic
experience. Her anger at the pathologist who "did just as he
pleased," when he removed the blood-stained cloth, seemed also
to be explained. Later on, she met the pathologist again and said
that she no longer hated him, although this conditioned reaction
had persisted for weeks. The final explanation which she was
able to give for the abdominal jerks did not seem definitely sat-
isfactory as a traumatic episode, although feelings of shame and

308 PSYCHOPATHOLOGY

hatred were given free play. It must be included that because
of her disappointment in her hnsband's loyalty to her, she was in
no mood to make love to him. Whatever details were missing
seemed to be unimportant, because the convulsions entirely disap-
peared, including the tendency to squint her eyelids closely to-
gether and avoid looking at anyone frankly. Her husband had
noticed this shifting glance on a previous visit and had asked her
about it.

It is perhaps necessary to repeat that she recognized heat,
cold, touch and. pain stimuli over the left |.||,lf of her face, left
breast and arm, upper back and posterior arm surfaces, and a
narrow strip along her left side and left leg. The right side of
the face and body was almost completely anesthetic, except that,
sometimes, upon strong reenforcing suggestions that she could
feel the stimulus, she reacted. The face and breast lines of demar-
cation were definite, but the other borders varied several inches at
different times. It is rather striking that she never complained of
areas of anesthesia, and maintained that she had never known of
their existence until I discovered them in the routine physical ex-
amination.

The time and manner of the onset of the anesthesia was quite
a dilemma. The anesthesia seemed to be a discovery for her, and
she did not seem to have the slightest idea how it might have oc-
curred.

In a sense, the associations of thought that led up to the re-
call of the painful experience were influenced by me in that I in-
sisted that through the areas of skin which she avoided the recog-
nition of, she had met with an unpleasant experience. But, the
actual details of the recall, I am sure, were not changed by sug-
gestions, because, when in our groping for the experience, I told
her that I believed it must have occurred as a result of her hus-
band's impositions, she maintained that she did not believe it had
any relation to that experience, and gave it little consideration.

After a great deal of searching, I rather vigorously insisted «
that she would recall some things that Avould lead us back to the
time of the experience. After considerable wandering of the vis-
ual images, which she recalled, the scene of the engagement con-
flict with the grandmother came into the foreground. She ex-
hausted the details of the unpleasant announcement of her en-

REPRESSION OR PSYCHONEXJROSES 309

gagement, and the scene shifted to her imprisonment in her bed-
room. Here, a^ gap in her ability to remember occurred, and she
was not able to recall, for some time, the slightest detail of herself
in the room. Then she added the fragment that she dressed pre-
paratory to .eloping from the house. After some time, she added
further that she changed from winter to spring underwear. Here,
the resistance became so strong that she was unable to make fur-
ther progress.

I had devoted so much time to the analysis of the repressed
causes of the anesthesia that I again felt constrained to make a
suggestion, in order to hasten the recall of the details of the ex-
perience. Obviously, the traumatic experience occurred when she
was nude, and, since the door was locked and she was alone in the
room, and the odd distribution of the anesthesia roughly included
about all of that surface of the body which one would see while
standing in a three-quarters pose before a mirror, I suggested that
something happened while she was posing before the mirror.
Had this anesthesia been merely a wish-fulfillment of the malinger-
ing type to gain an object, as is still ordinarily believed to be the
case in hysteria by many plwsicians, this patient could have es-
caped further analysis and all personal responsibility simply In^
accepting my suggestion. But it Avas not correct. It was not in
her power to change her functions by merely wishing. She replied
that although she did not know what was the true explanation of
the anesthesia, the suggestion I made did not seem to be right.

The psychoanalysis now was interrupted for a week by other
obligations. When she entered the room to resimne the analysis,
she announced rather triumphantly that her sensation had re-
turned without the analysis. Much surprised, I asked why she
thought this. She said she could no longer wash the dishes. (Be-
cause she did not mind hot water, having been able to endure hotter
water than the other patients, she had been delegated to wash the
dishes, but now the water burned her hands.) I tested her with a
pin and found her to be very sensitive where previously she had
been anesthetic. The hypersensitiveness seemed to be as patho-
logical as the anesthesia had been, and it soon proved that she had
recalled most of the traumatic experience which was incident to the
anesthesia, but had not adjusted to it. She had been ashamed of
the' experience and had repressed the affect. •

In brief, while locked in the bedroom, she had had a good cry

310 PSYCHOPATHOLOGY

and time to think things over. She must either marry the grand-
mother's choice (Mr. A — ) or escape. She was facing the crisis
of her life under most confusing circumstances. She was not ab-
solutely sure she loved the Protestant (Mr. G — ) but she had more
confidence in him than in A — . She was inclined to elope and
marry Gr — , and, while in this vacillating frame of mind, she
changed clothing. She recalled that while she was undressed, the
postman whistled his announcement of having mail for the house.
She was expecting a letter from A — in which he would declare his
feelings about the marriage. She liked him because he was bold
with women and knew more about the world than Gf — who was
quiet and more retiring. Then she recalled that she parted the
curtains slightly and looked out of the window to see whether or
not the postman was coming into their yard. She watched him
go around the house and remained at the Avindow for some time
lost in sexual fancies about A — , and whether or not to elope with
G — . She did not hear the grandmother come upstairs, and sud-
denly was aroused from her sensuous day dream by the grand-
mother pushing a letter under the door. She was startled and
deeply embarrassed because of her guilt, her nakedness, sensuous
(autoerotic) fancies, and secret planning to elope. She thoteglit
her grandmother was opening the door, but the old woman went
away without doing so or saying anything. (The recall of the
surprise came only after great resistance and mortification.)

The patient explained that she was nude when she was sur-
prised, except for the curtain that she was peeping through. It
covered one side of her face, shoulder, breast and arm, and a strip
along the side of her body to the ankles. Anesthesia for the rest
of the body seems to have resulted from a pathological effort not
to be conscious of the nudeness. When I asked why her back was
not affectM, she replied that, perhaps it was because she Avas not
ashamed of her back. (Naked backs are permitted on the stage
and in society.)

Her reactions to heat, cold, touch and pain stimuli now be-
came normal, except for a small area of anesthesia involving the
upper right face about the eye, cheek and upper lip. As an ex-
planation for this, she comparatively easily recalled a scene in
which A — caught and kiss.ed her despite her resistance. The anes-
thetic area was where he kissed her. The repressed affect was
shame and indignation.

KEPRBSSIOJSr OR PSYCHONETJKOSES 311

Up to this time, the patient consistently maintained that the
two similar blotches of erythema on the extensor surfaces of each
forearm resulted from an incurable skin disease that she had had
for a year or more. Although she had excellent insight into her
neurosis, she would not consider the blotches on her arms as any-
thing but a skin disease. She had gained in Aveight, and was now
in excellent physical condition. Hours of exposure to the sun in
the park had tanned her forearms a very noticeable brown, but the
areas of capillary dilatation did not tan, remaining decidedly paler.

She was now compelled to scratch her forearms; at times
she almost scarified her skin. The itching now occupied most
of her attention and she complained that she could not go into
the park because the grass caused her arms to itch. This feature
influenced her to study the difficulty. I thought the itching and
capillary dilatation were determined by one experience, since it
seemed part of the same skin area, although she scratched more of
the arm than the surface of the blotches.

Her associations, suggested by the symptoms, brought up a
visual picture of herself working in the garden Avith her mother-
in-laAv. It was very hot and, because of her poorly nourished con-
dition and pregnancy, the mother-in-law ordered her to go into the
house. They had been pulling a weed that had caused her skin to
itch. She felt that the mother-in-law Avas trying to command her,
and she refused and retired to the shade of an apple tree. She
visiialized herself standing there, rubbing her itching arms and
feeling very angry. The mother-in-law persisted, and she finally
submitted and retired to the house. She hated the mother-in-law
for bossing her, but repressed her feelings. She now made
a comfortable, affective readjustment to this experience by a frank
discussion of her mother-in-law, and the itching disappeared, but
the blotches of skin did not tan.

The queer distribution of the blotches of erythema suggested
the grip of someone's hands to me, which I discussed when I
showed them to another physician, and the patient probably re-
membered this, although, at the time, she did not agree Avith me.

The associations of thought may possibly have been influenced
by that conference, but I believe it is impossible for a patient to
relieve a repression symptom by telling a lie or substituting an
irrelevant experience. She visualized herself in a room with her
mother-in-law, announcing that she was going to harness the horse

312 PSYCHOPATHOLOGY

and drive to town. The domineering mother-in-law opposed this,
and a conflict resulted. The patient started to leave the house, and
her mother-in-law grabbed her by the forearms. The patient
jerked loose, and the tightly compressed fingers slipped off, leav-
ing the dilated capillary blotches where the fingers had compressed
the skin. The recall of this experience was accompanied with its
repressed affect of hatred, and she expressed herself freely about
the forgotten experience. In each of the instances of repressing
her hatred, she gave as her reason her utter dependence upon
the mother-in-law and her fear of offending her.

Unfortimately, the patient was discharged about a week later,
and I was unable to observe that the pale blotches tanned as much
as the remainder of the arm, although they were quite brown in
comparison to their former condition and had practically disap-
peared. The erythema and itching had completely disappeared. -

It was necessary for the patient to get some insight into her
serious tendency to repress her strong affective reactions of ha-
tred and grave persistent feelings of inferiority. She was decid-
edly immature in her self-reliance. She believed her grandmother
had ruined her life by the kidnapping and mistreatment, and in-
sisted that she had never had a childhood sexual trauma. (At the
time of this psychoanalysis, the psychogenetic importance of the
autoerotic and homosexual strivings was not realized and so they
were overlooked. I would now regard her as a seriously sup-
pressed, jealou.s, autoerotic girl.)

She recalled that she did not like a certain girl and her
brother, after she had grown up, although they were her play-
mates when children. She finally associated with this dislUie a
scene of her childhood, Avhen an attempt was made by this boy
to perform sexual intercourse with her and his sister. He was
considerably older and he, with his sister, who was abou.t her age,
enticed her to submit to the play. While they were in the act,
her foster-mother surprised them and whipped her. More serious
than the whipping, she caused the child to feel that she had lost all
respect for her.

This sexual trauma can not be considered the foundation of her
neurosis, but it probably played a part as a determinant of her
tendency to react in a repressive manner to her conflicts, and
tremendously accelerated the tendency to be timid and react with
shame for even trivial mistakes. The long years of domination

REPKESSION OR PSYCPIONEUROSES 313

by an unsympathetic grandmother, following ten years of petting
by her foster-mother, her tendency to nurse her hatred and even
enjoy it, associated with her serious ignorance of the sexual life
of woman, were probably more influential. She married to escape
a domineering grandmother who never permitted her to assert
herself and, most unfortunately, became associated with a still
more domineering mother-in-law and an immature husband who
could not give up his mother. The psychoanalysis of the ease can
not be considered finished nor the patient cured of her psycho-
pathic tendencies.

Three years after the psychoanalysis, she wrote in reply to
an inquiry, that none of the symptoms which were analyzed, re-
turned, but she had had a- psychotic episode since her discharge,
the details of which were not learned. She had to return to the
household of her mother-in-law and from what has since been
learned from such cases (Cases HD-1, CD-2, HD-3) the situation
is not encouraging.

Probably this patient's tendency to make one affective re-
pression after another and, in nearly every instance, that of lia-
tred, was largely the result of her affective isolation in her grand-
mother 's house. Her ' ' hatrish feelings ' ' often caused her to enter-
tain revengeful fancies, which, undoubtedly, she really enjoyed and
then regretted. (These fancies Avere her only avenue of escape
from the unusually inflexible, painfiil environment. )

That her personality never developed beyond the autoerotic
level was probably due to the consistent repressive influence of
the dominating grandmother, who assiduously imposed a censor-
ship upon most of her spontaneous, girlish, social interests, and
forced the child, with threats of punishment, to suppress her emo-
tions.

She really married to escape from her grandmother, and, un-
fortunately, moved into the house of her mother-in-law. Because
of her long training to repress her affections, to be economically
dependent, to have a grossly apprehensive misunderstanding of
the sexual life of woman, her inferiorities became the instruments
that bouud her to the older woman. She dared not retaliate and
offend her mother-in-law, for fear of being neglected in her preg-
nancy and labor.

In this case, in each instance of affective repression that left
objective, functional derangements, the affect was the natural re-

314 , PSYCHOPATHOLOGY

sponse to an irritating situation ; that is, a healthy response to the
situation, but was repressed because of some form of fear of the
consequences if she should permit her feelings free play. In each
instance, the initial affective reaction, whether shame or hatred,
may be looked upon as a normal reflex response to certain fea-
tures in a definite situation, and these features may he regarded as
the primary stimulus of the affective reaction. Associated simul-
taneously with the primary stimulus, were stimuli (secondary fea-
tures) that had previously been indifferent, in so far as affective
reactions were concerned. To illustrate this, let us take the itching
or erythema symptoms.

The dominating mother-in-law, with her affective attitude and
Avords, was the primary stimulus of the natural reaction of hatred
in the patient. The itching of the skin from an irritating weed
which was occurring at the time, or the capillary dilatation of the
skin from compression and friction of the fingers, was a normal
reaction to stimuli which were heretofore indifferent to causing
reactions of hatred. Through the accidental association, as siWiul-
taneous stimuli, of the primary affective stimuli and the indiffer-
ent secondary stimidi, {the latter were causing the next most
vigorourS, disagreeable sensations at the time), the affective re-
actions of hate became conditioned to react to these secondary
{skin irritating) stimuli. Therefore, whenever the autonomic ap-
paratus was stimulated by things that had similar qualities to the
secondary (grass) stimuli, they aroused the repressed hypertonic
aiTtonomic-affeetive reactions (hate) to greater activity. This
continued so long as the affective tensions were repressed and un-
adjusted. In turn, the repressed hate affect increased and reen-
forced the normal skin reactions to the associated stimuli, maki:&g
the reactions persist for undue periods of time. The memories of
the experience were repressed (forgotten), and the individual re-
acted with hatred and itching when in the grass, without knowing
that it was caused by the grass. Later, when she recognized that
the grass aroused the itching, it did not enable her to stop the re-
actions.' In each instance, after the repressed affect was allowed
to have free play and an adequate affective readjustment to the sit-
uation AA^as made, the pathological influence of the secondary or in-
different stimuli, as well as the objective symptoms, disappeared.

Bechterew first pointed out, and has been supported by the
studies of Watson and Lashley, that, Avhen the primary stimulus

REPRESSION OR PSYCHONEUROSES 315

of a motor or secretion reflex is associated simultaneously for a
number of times Avitli an indifferent stimulus, then the reflex will
become conditioned to react to the indifferent stimulus. This
seems to be the mechanism of the conditioned repressed affect ex-
cept that when the affective reenf orcement is vigorous enough, one
simultaneous association may be sufficient.

Bechterew further pointed out that, Avhen reflexes become
thoroughly conditioned to certain stimuli, this conditioning, simi-
lar to the reactions to primary stimuli, may be the basis for asso-
ciating other secondary stimuli so that the reflex will be condi-
tioned by them also ; thus its reactive capacity spreads.

The affective reactions of hatred and their tendency to injure
the cause of the hatred were repressed by the fear of doing some-
thing which would be regretted. The conflicts were always in-
tense and acute, necessitating vigorous efforts to repress from con-
sciousness the memories that aroused the hatred or shame. The
successful repression depended upon the patient's ability to force
immediately the conflicting cravings to converge Urpon a compro-
mise {coordinate all her attention upon a sid)stitute), and this
substitute ivas, very naturally, that content of consciousness ivhich
was next in vividness at the moment of the affective conflict.

This case seems to offer an explanation of the phenomenon of
so-called visual constriction; namely, because of the affective re-
sistance only the more sensitive receptors which lie nearest the
macula transmit sensory reactions of sufficient intensity to over-
come the affective (autonomic postural) resistance and cause con-
sciousness of their activity.

The stimuli that arise from objects in the peripheral field, as-
suming the intensity of the light waves to be equal, since they must
play upon the less sensitive receptors, cause subliminal reactions
and do not overcome the affective resistance. Therefore, only the
colors directly before the eye are seen. The affective resistance
may become so vigorous that complete anesthesia or blindness may
result, and ordinary color stimuli may not be able to break through
the resistance. Postures increase or decrease the reactivity to
stimuli', the reactivity being determined, it seems, hy luhether or not
the exogenous stimuli are allied or are antagonistic to the proprio-
ceptive activities aroused through the posture.

In the case of Miss Lucy R — , Freud says: "The hysterical
form of defense, for ivhich a special adaptation is required, con-

316 PSYCHOPATHOLOGY

sists in converting the excitement into physical innervation. The
gain brought about by this process is the crowding out of the un-
bearable presentation from the ego consciousness, which, then con-
tains, instead, the physical reminiscences produced by the conver-
sion, in our case, the subjective sense of smell, and suffers from
the effect which is more or less distinctly adherent to these rem-
iniscences. ' '

It is necessary to briefly restate the manner in which Miss
Lucy E — developed the persistent olfactory image of cigar smoke
which annoyed her almost incessantly.

She loved her master's children, and having encouraged her-
self to expect the love of her widowed master, she was shocked,
when, one day, he unjustly threatened to discharge her if stran-
gers were again permitted to kiss his children. A few months
later, when she was coincidently suffering from an ulceration of
the ethmoid, after dinner an elderly guest attempted to kiss the
children. The impetuous master shouted, "Don't kiss the chil-
dren!" and she "experienced a stitch in the heart, and, as the
gentlemen were smoking, the odor remained in my memory. ' '

The violent words of the master were sufficient as a primary
stimulus of reactions of fear, because of the previously threatened
discharge, to force a repression of her affections for the children
and master, since it was not possible in the situation for a gover-
ness to permit the naturally anxious expression of her injured
affections for the children and her master. Because of her af-
fective attachment, her position had a vital value for her. She
held the attachment by a slender thread in the hands of an impetu-
ous master who had already threatened to break it if a certain al-
most unavoidable trivial incident should occur again. In his dis-
cussion, Freud does not seem to think that the fear of the dis-
charge was a justifiable cause for the affective repression, but'
that a degree of moral courage was lacking in his patient. I can
not at all agree with Freud's feelings. It seems to me that the
patient's affective attachment (maternal) to the children made her,
unfortunately, but normally, a weakling in the face of a discharge
and their loss.

Now, to return to the "conversion" mechanism. It seems to
me that the conception of conversion is not satisfactory as an ex-
planation of the biological process, and the "special" defensive

REPKESSION OR PSYCHONEUEOSES 317

adaptation of "converting the excitement into physical innerva-
tion" is a biological riddle. Jnst how Freud understands that
excitement may be converted into a physical innervation is not
comprehensible to me. Furthermore, it seems that this conversion
conception is the keystone of Freud's important, but not satis-
factory libido concept. It seems that the persistent olfactory
image of tobacco smoke, complained of by Miss Lucy R — ■, was an
example of the repressed affections becoming conditioned to react
to an ordinary painful stimulus — the irritating cigar smoke, and
this sensory image was made to persist by the repressed affections
trying to force a recognition of their needs. They had been of-
fended by the impulsive master and wanted him to become solicit-
ous, and thereby renew the transference.

In the instant of that conflict, the love for the children and
the master was repressed because of fear of appearing indecent,
and the repressions continued until Freud released them by analyz-
ing away the cause of the fear. In order to make the repression,
and avoid showing anxiety about losing the objects of the affection,
jeopardizing them still further, the autonomic-affective ap-
paratus reflexly coordinated all its available forces upon the con-
trol of the final common path of adaptation. This was associated
with the next most vivid, similarly painful, sensory reaction of that
.moment — ^namely, the cigar fumes which were coiricidently ir-
ritating the diseased nasal membranes and causing discomfort.

The reflex adaptations to the nasal irritation, because of their
simultaneous activity, became associated with the normal affective
reactions to the primary stimulus of anxiety — namely, impulsive
master. When Freud analyzed away the fear and permitted the
repressed affections to make an adequate readjustment to the atti-
tude of the master, then the olfactory sensory images lost their
vividness and took their normal place in the sensory experiences
of the personality, because the repressed affect no longer existed
to force them into consciousness.

The persistence of the abnormal conditioning of the reflex is
due to the reenforcement by repressed affections, and the reen-
forcement disappears so soon as an adequate affective readjust-
■ ment is made.

Fear of allowing the primary affections, whether of shame,
fear, hatred, grief or love, to malce adequate adjustments, tends to
make a psychopath of any individual; that is to say, when the affec-.

318 PSYCHOPATHOLOGY

tions of a personality are repressed, their functions are abnormal,
because they are prevented from acquiring a natural adjustment.
In their struggle to acquire gratification they persist in causin|-.:
awareness of thoughts or images of past experiences which happen
to be associated with what they need. Using this fact the psycho-
therapist is able to bring about the recall of the repressed affect.

The effort to eliminate from the personality an affective crav-
ing that caiises embarrassment or sorrow is usually performed by
"forgetting it"; that is, keeping it repressed so that it can not
cause one to become conscious of it. This does not actually elim-
inate it from the personality, as man, until very recently, so
naively believed it did. It merely forces the repressed affect to
work its way into consciousness through a compromising disguise.
Often this substitute is anything but pleasant to the ego, but the
repressed affect being too vigorous to be further repressed or de-
nied, the individual may become desperate and attempt to have
the difficulty excised by the surgeon or do it himself. The indi-
vidual becomes inclined to do this, particularly if the repressed
affect causes a functional distortion of some sort and a plausible
excuse can be found for the operation. For example, a girl, who
can not control her masturbation cravings and has dysmenorrhea,
frequently consents to a series of uterine rectifications such as
curettages and replacements, and, logically, winds up with a hys-
terectomy if the surgeon is suggestible and without insight.

All such repressions of functions are, more or less, forms of
abortion or castration by which the personality tries to make itself
estimable, and the castration, in turn, may be regarded as a form
of crucifixion, or sacrifice of a part of the personality for the best
interests of society.

The castration or elimination of the disagreeable tendency
may be so neatly disguised that the martyr feels himself to be
divinely sanctified thereby and enjoys the fruits thereof indefi-
nitely. The following case* illustrates the manifold values of such
an act to the patient :

Case PN-3. — Patient, aged twenty-seven, was admitted to the
Johns Hopkins Hospital to be treated for a "sore knee." For the
past fourteen months, he had been walking with crutches which
he made for himself. At the age of tAventy-three, he had the first

*This case was reported in The Psychqanalytic Review, 1915, Vol. II, No. 2.

EEPRESSION OR PSYCHONEUROSES 319

period of soreness of the knee, lasting tliree months, and a second
period lasting three weeks. At twenty-six, the present difficulty
began. On inspection, both knees appeared to be the same except
for a general atrophy of the soft parts of the left knee as well as
a very marked atrophy of the muscles above and below the knee.
The patient wallied with crutches and made no attempt to bear
weight on the left leg. This seemed to be merely on account
of fear of using the knee, and not because it was painful. As the
patient flexed or extended the leg, nothing abnormal Avas felt in the
joints. There was no tenderness on palpation, and sensation was
normal. X-ray examination was negative. The physical status,
otherwise, was also negative, except for some constriction of the
visual fields. He had the usual diseases of childhood, with no af-
ter effects and attended school successfully until seventeen, then
Avorked in his father's workshop for two years. He had always
been very religious. At twenty, he entered college. At twenty-
one, he developed a facial paralysis of an apparently functional
type.

At that time the patient was a student at college and while on
police duty at one of the football games he became involved in a
clash of words with a trespasser and seemed to have suffered some
humiliation. A review of the emotional conflict is given almost as
the patient discussed it.

The quarrel, he says, made him compare himself with his an-
tagonist. He felt spiritually superior to the man, but thoiight that
his masturbation had weakened him physically, and that the man
showed his inferiority openly while he kept his own, personal weak-
ness concealed. He had been struggling to overcome the auto-
erotic tendency by making a confession, but had been afraid to eon-
fide in others because he might lose their respect. The conflict
emphasized the debilitating influence of his secret self-love and
aroused a strong compulsion to expose his sins. During the game,
and during this state of emotional conflict, one of the players was
knocked unconscious. The patient was impressed by the open, up-
turned eyes and expressionless face, which, to him, meant honora-
ble defeat.

That evening, he could not close his eyes. He recalled rubbing
his face, but could not tell whether it was paralyzed or not. The
next morning, he noticed that ho could not laugh with the stu-
dents in the classroom, and thinking that his face was SAVoUen he

320

PSYCHOPATHOLOGY

consulted a physician. He was advised to r,emain in school and
subjected to a course of electrical treatment. ' The right side of
the face began improving in a week or so, but the left side re-
quired about eight weeks for recovery. The patient interpreted
his conflict, as follows-:

In the patient's terminology, his "second mind" wished to lay
open his weakness as an explanation for his defeat, but his "outer
mind" would not permit this because of fear of ridicule, so his
two minds compromised on the way of showing the defeat as ex-
emplified by the expression of the unconscious football player.
The neurosis was a timid method of exposing and controlling the
autoerotie cravings and the adjustment was influenced by shame
because of his masturbation and defeat which was compelling a
radical adjustment, and fear of losing social esteem if he betrayed
liimself.

In Januaiy, his father injured his knee and had to be confined
in a hospital for seven weeks. In August (at twenty-three) the
]iatient's first knee episode occitrred. He had been working in a
kneeling position, laying flooring. For a day or two, he had been
afraid that he might get a sore loiee like his father's. Then his
knee developed peculiar feelings and "wanted to stay in a bent
position," and, finally, could not be used. For ten weeks, his
physician treated the Imee vdth iodine. He gradually became able
to walk, then used a cane. The knee became quite normal until
the foll()\\ing June wlion he bent it, accidentally, "farther than it
had over been liont since the previous illness." This second pe-
riod of soreness lasted three weeks.

He then improved and had no further difficulty until at twenty-
six, when he dropped a piece of iron on his knee. He felt some
pain which, however, disappeared after a brief period. A few days
later tlic knee again felt sore and, after that, for the next four-
i^'vu months, lie had either been in bed or used crutches.

The patient characteristically maintained a most striking men-
tal attitude of serene, sanctified composure while enduring the sup-
posed suffering. He gave one the impression of being deeply
pleased with his solution, saying that he felt God wanted him to
suffer for his sins (crucifixion for mother attachment).

He had been in the surgical service of the hospital for three
weeks and had, no doubt, been impressed by the thorough physical
examinations and negative diagnosis. Eepeated and enforced sug-

REPRESSION OR PSYCHONEUROSES 321

gestions that lie could walk were responded to with but little effort
and much complaint of the great difficulty. After a second com-
plete mental and physical examination had been made, the case
was discussed with the patient. Great emphasis was placed on his
negative physical state. I insisted that the cause was emotional,
and advised him to talk frankly and restrain no feelings about
the matter. He replied, mth little hesitation, that he was worried
about masturbation, which had continued since he was eleven or
twelve years of age. With more resistance and circumlocution,
he told that the objects of his erotic fancies were his neighbors,
his sisters and, finally, after some hesitation, Ms mother. He
said his affections were "filthy" because they were so associated
with his mother. He had been impressed by his mother's care of
his father during his illness, and now, during his own illness, she
had been unusually solicitous for him. Because of his incestuous-
ness he must suffer for his sins, either in this world or in the next.
When asked if he cared to explain why the left knee had been
affected instead of the right, he replied that he believed it might
be because his heart was the seat of his affections and it was on
the left side, and that he had a left-sided varicocele which he be-
lieved was caused by masturbation.

The "sore knee" formed an adequate castration as an ex-
piation for incestuous masturbation, but it was also a means of
religious compensation and simulation of his father's illness.
Further, he successfully solicited his mother's affections in an-
other way. After the analysis the patient walked back to his bed
without crutches, something he had not done for fourteen months.
His attempt, however, was accompanied with loud breathing and
facial distortion as if he were in tremendous pain. He afterwards
stated that he felt no pain at the time, but could not prevent mani-
festing outward indications of his struggle. With encouragement,
he rapidly recovered the use of his leg without any special treat-
ment, despite the marked muscular atrophy and plantar sensitive-
ness from disuse.

A few weeks after his discharge, he returned, bringing a
friend who was also depressed and anxious because of autoerot-
icism. This man responded promptly after a full discussion and
adequate affective readjustment. Within a few days he changed
from a morose, brooding, timid individual into a happy, grateful,
earnest fellow with considerably more confidence in himself.

322 PSYCHOPATHOLOGY

The following cases further illustrate the mechanism of elim-
ination or castration of perverse erotic cravings.

Case PN-i was a sailor, twenty-four years of age, who for
six weeks had almost incessant compulsive feelings inciting him
to smash his head into a wall or dive from a height.

His receding chin, high palate, irregular teeth, deficient en-
amel and facial development indicated some mental inferiority.
He gave an indefinite account of having had fits in childhood. At
nineteen, he enlisted in the Navy and served almost four years.
After 'a visit to his home, his difficulties began. He had always
been seclusive, shut-in, inclined to brood, indulge in alcoholics,
and was disposed to respond sullenly to the social advances of his
mates. They called him ' ' punk. ' '

Soon after his admission to the hospital he complained of hav-
ing an intense dull, persistent pressure in his head, which com-
pelled him to strike his head against objects and even to plunge
head foremost into the wall. In his desperation, his record states,
he plunged from the second story, cut his throat, and made nu-
merous efforts to pound his head. When he was admitted, he had
two deep scalp wounds, several minor facial bruises, and a scar
over his throat. He had to be watched constantly, and for several
days had to be tied in bed. Despite these precautions, he con-
tinued his vicious attempts to kill himself and succeeded in bat-
tering his head and face on the bed.

When I addressed him as Mr. — , he looked surprised, and,
after several repetitions of his name, gruffly demanded to know
whom I was calling "Mister." When I replied that I had ad-
dressed him, he showed unmistakable scorn for himself. After
a little persuasion, he said he was not fit to be called "Mister,"
and was not fit to be talked to. He reluctantly gave the informa-
tion that the pressure in his head was caused by worry and he
felt he deserved it for his wrongs, for which he was punishing
himself. After several brief visits, he was finally induced to
confide his difficulties. Eecent masturbation, and his seclusive-
ness, contributed to his feelings of being "not fit to live." But the
reason he "must die," etc., was due to his having masturbated his
young sister, a child, while on a recent visit to his home. The
details of the occurrence were such that its reality was hardly to
be doubted. When he talked of it, it drove him into a state of ut-
most desperation, and little hope "w^as entertained for a solution.

REPRESSION OR PSYCHONEUROSES 323

Several days later, in talking it over, he said that the whole
affair was so unnatural that he wondered if it were not a dream
or imagination. Within a few days, his suicidal compulsion dis-
appeared, and he rapidly readjusted to a more comfortable state.
About two months later, when I questioned him to learn his method
of adjustment, he reluctantly discussed his difficulties and said he
thought (doubtfully) that probably it was a dream. It was con-
sidered advisable to stop questioning him, because of the ominous
uneasiness he commenced to show when we started into the details.

Since then, he made an attempt to drown himself and has be-
come very sullen, irritable and inaccessible. His behavior is es-
sentially that of a most desperate elimination or castration com-
pulsion to escape from the perverse cravings.

Case PN-5 was a sailor aged nineteen. Shortly after hi^ en-
listment, he developed a grave self -mutilation and suicide compul-
sion.

He had always been unduly protected by his mother, and Avas
inclined to be timid and seclusive. He had a very odd face, al-
most ludicrous because of his very long chin which extended down
in front of his throat instead of forward like the usual prognathous
jaw. This deformity made him the "goat" of all his companions'
wit, driving him into seclusion.

He had been addicted to secret masturbation from adolescence
until after he entered the Naw. This vice greatly increased his
feelings of inferiority but was unkno-wni to others before the psy-
chosis. He resented the nagging of his mates, which began with
his first day, and, finally, they "stampeded him." His mother
had always prevented him from fighting, but the unbearable tor-
menting compelled him to protect himself. He unwisely posted
a challenge which was taken up by a man selected by the crowd.
Before a jeering crowd of boys, he was soon knocked down by his
opponent, and then held there by the crowd while they pummeled
him. His social standing was, of course, hopelessly lost, and a
tremendous regression with suicidal compulsion developed. He
felt that he had ruined himself and was obsessed with a violent
hatred for his physical inferiorities. He cut veins in his wrists
and leg that day and later made a series of attempts to strangle
himself by hanging, and by twisting a towel around his neck. This
behavior continued for three weeks.

324 PSYCHOPATHOLOGY

Upon Ms admission, it was necessary to watch him constantly
because of his self -mutilation compulsions.

When I saw the patient, the day following his arrival, he was
lying in bed with his face buried in a pillow. The nurse reported
that he had just tried to strangle himself. Unlike the previous
case, he responded almost immediately to a friendly advance, and
rolled over to answer a question, showing an earnest desire to be
helped. Gradually, after cautious inquiry, he was able to give an
account of his troubles. He began with his feelings of being unfit
to live, stating that he had ruined himself because of his ' ' selfish-
ness" and " seclusiveness. " (Complaints nearly always charac-
teristic of the autoerotic.) He then cautiously complained of hav-
ing had a series of horrible dreams; such as sliding across the
floor of a great hall, a feeling that he could not stop and was 'tigte;
ing to hell;" noises, sudden sounds, such as slamming of doors,
bugles, bands, etc., made him feel "dizzy," and have "sinking feel-
ings in the abdomen." He could not explain why sudden sounds
should affect him unless it were that they had some relation to the
bugle call (to face roll call).

The wrist scars, which were small, indicated rather timid ef-
forts to commit suicide. Something about his manner suggested
that he was pleased to have me notice the wrist scars and, with a
little encouragement, he, described his effort to hang himself, ad-
ding that he was sure one of the efforts, which he described in de-
tail, would have been successful had he not fainted just as he was
going to jump from the bed after tying the noose. (Having
"fainted," he fell upon the bed.)

He gave the impression of desiring to punish himself for
something, but not really to commit suicide. After some hesita-
tion he brought out the obvious cause, masturbation. In detail,
he discussed his autoerotic interests and selfishness. He gave, as
his opinion, expression to the belief that he would have cured
himself if he had followed the methods of other boys, but his "re-
spect for girls" prevented him.

"When he confessed his masturbation tendencies, he showed
intense affect and seemed to be grateful for the opportunity to
' ' talk it over. ' ' He believed that it had caused his weakness, short-
ness of breath, and feelings of inferiority.

The next day, he made another attempt to strangle himself,
but, on the whole was much more quiet. We talked over the im-

REPRESSION OR PSYCHONEUROSES 325

pression his odd features made on his friends and the inability
of his friends to keep from laughing at him. We concluded that,
under all conditions, it was disastrous for him to take offense when
people laughed at him because their retaliations were nearly al-
ways focused on his facial inferiority. Only one solution was pos-
sible. We agreed that his face was certainly odd and, naturally,
the cause of mirth ; so why should he not become a humorist and
enjoy the fun? It was strongly emphasized that he could turn his
deformity into a valuable asset if he became tolerant and good
natured. Several days later, he was found copying cartoons. He
showed considerable interest in the idea of developing a sense of
humor and became interested in studying the value of Mark
Twain's humorous methods to make things easier.

During his self -mutilation period, he had no hallucinations.
When discharged, he was much more congenial and apparently
normal, but his dear mother had again enveloped him in her shield-
ing arms, and his self-consciousness showed that he had yielded
to her petting and solicitations.

Case HD-15 was a Russian soldier, aged twenty-four, single,
uneducated and, apparently, a mental defective. At venereal in-
spection this patient Avas found to have inserted a safety pin
through the corpus spongiosum of his penis for the purpose of
"curing wet dreams," as he expressed himself. He also said,
several times, that he would amputate his penis to cure himself.
When admitted to St. Elizabeth's, he gave the impression of un-
dergoing a marked deterioration of the personality.

The following case is typical of the castration which is usually
characteristic of a pernicious dissociation of the personality.

Case PD-16 was a soldier who had given fourteen years of
"excellent" service. He had lived what he regarded as a normal
sexual life for a soldier. For years he had been a periodic alco-
holic.

At thirty-two, he decided to get married to a divorcee twelve
years his junior. One night, a few weeks previous to his marriage,
he became intoxicated with another soldier, and went to the latter 's
home, going to bed with him ' ' to sleep it off. ' ' (During his psycho-
sis he was obsessed with feelings that homosexual relations of
some sort may have been perpetrated upon him that night. He
also felt that he was accused of having seduced the man's young
daughter. )

326 PSYCHOPATHOLOGY

A few nights after this episode, he left for a distant city to
get married. He was still intoxicated and having dangerous audi-
tory hallucinations when he started. Voices said, "We'll get him
sure this time" and threatened to cut his throat, etc. While en
route, he became panicl?y, and jumped through the window of the
moving train. Other than some contusions, he escaped injury
and borrowed a pocket knife, with which he cut his wrists and
throat and stabbed himself over the heart. None of the wounds
were severe. (They were not unlike the wounds of the crucifixion
and are to be regarded as compulsions to self -purification.)

After two weeks in a hospital he resumed his journey and
married. He had always entertained fears that his fiancee would
"not be straight and decent," and, on one occasion, criticized her
for permitting the attentions of a superior officer.

About a month after the marriage, he began to show irri-
tability and have suspicions of his wife. This tendency gradually
developed and, about a year after marriage, he began to complain
of enemies. He now openly condemned his wife for infidelity and
restricted her freedom.

Then followed a series of changes to different cities to avoid
his enemies, who his wife (a very suspicious individual) believed
were trying to "break us up." He reverted to alcoholism, and
developed persistent, vigorous self -denunciatory hallucinations of
an auditory nature which included charges of homosexual degen-
eracy, seduction of a little girl, and the murder of a woman. He
had some insight, attributing the hallucinations to "imagination,"
but he could not avoid reacting to them for several years.

During his marriage, he was virtually impotent, and only at
times was he able to perform as much as ejaculatio prsecox. His
general attitude during his hospital confinement Avas one of con-
tinuous brooding and denial of the hallucinated charges. Four
years after the onset of the psychosis, the hallucinations had sub-
sided sufficiently to render the discharge of the patient feasible.

In this case, the cutting of the wrists (like the hands in
others), in order to shed blood, "to let out the bad blood," has a
castration (Case PN-5) and crucifixion significance. Christ's
hands and feet were punished by nailing them to a cross. The
repressed affect was accusing the ego of being a pervert and his
desperate efforts to eliminate it were the violent castration efforts.

REPRESSION OR PSYCHONEUEOSES 327

In the following case of intense struggle to prevent the oral
erotic homosexual cravings from forcing the heterosexual emascu-
lation, the patient will be seen to be continually tottering on the
verge of yielding to the crucifixion and dying, to attain the rebirth
as the best possible solution for his distress.

Case PN-6 was a male clerk, aged twenty-four, unmarried, who
had persistent feelings of ' ' dying, ' ' accompanied by choking, gasp-
ing, sniffling, and an abdominal tic. The symptoms were about
three years old.

The patient's father was a stern old soldier, a firm believer
in discipline, systematic work and fortitude.

The mother, about twelve years younger than her husband,
was a quiet, pretty, affectionate little woman, rather timid, sug-
gestible, and decidedly lacking in firmness. They had two chil-
dren. The daughter, a good-looking, aggressive girl, with con-
siderable business capacity, was about four years older than the
patient.

The patient was the only son. At four, his legs were badly
paralyzed by anterior poliomyelitis. At six, he was able to walk,
and at seven, started school. Because of his disabilities, he
had only finished the second year of high school at nineteen. He
quit in order to earn money but could not be considered an in-
tellectual defective.

His mother said she "raised him like a girl," always gave
him everything he wanted, and could not resist his pleas, because
of her pity for his deformity. His behavior was that of a very
badly petted, spoiled child who realized that under almost any
circumstances he could do as he pleased. Throiigh his infirmities,
he held his affectionate little mother as his confirmed slave. (For
more than a year, I tried every persuasion and argument to con-
vince the mother that she must allow her son to become independ-
ent of her, but marble would have been more plastic.) The stern,
gruff father tried to coimterinfluence this effect eariy in the boy's
life, but succeeded only in increasing the son's triumphant attach-
ment to his mother. The daughter usually supported the son in
his clashes with his father.

The boy was unreliable, did not hesitate to lie, or take any
advantage of a situation to satisfy his self-indulgent whims. De-
spite his deformities, he was very narcissistic. He always de-

328 . PSYCIIOPATHOLOGY

pended upon his sister to secure positions for Mm, and, because
of his unreliabihty, she finally found it necessary to have him work
in the same office with her in order to keep him out of trouble.

This patient was peculiarly erotic and it seems that all his
sincere interests were sexual and self-indulgent. As a boy, he had
almost unrestrained access to the privacy of his mother and sister,
and secretly utilized their attractions in his autoerotic fantasies.
They never discussed the sexual problem Mith him. His masturba-
tion was unusually excessive until nineteen, when he went to work
so that he could have a "good time." At six, he had a fellatio
experience with a boy playmate, and was severely punished for
this by both of his parents. Other sexual experiences occurred
with children of both sexes, and at nineteen, he had his first actual
heterosexual experience, after which, until his panic, he spent
nearly all his earnings on prostitutes. He considered himself to
have unusual sexual powers because of his chronic eroticism.

At nineteen, he also had a homosexual experience with a boy of
his age, Avhile traveling with him. Both anal and oral perversions
occurred.

At twenty, when his family was absent from the house; he
abandoned himself to his eroticism in a most unusual and sig-
nificant manner.

He described himself in the episode as having casually strayed ■
into the kitchen (where his mother prepared the food) during an
erotic mood, when it occurred to him that he might perform fel-
latio on himself. One suggestion for this was traced back to a
companion's remark aboiit a contortionist while at a circus. With
considerable effort, he succeeded. He states that he never made
a second attempt, but this does not minimize the high proportions
to which he had developed his autoeroticism. The accessibility of
his mother and sister for the stimulation of his secret fantasies
tended unduly to cultivate his eroticism, as will be seen later.

No immediate psychotic effects resulted from this behavior,
biTt it surely must have contributed to his secret feelings of in-
feriority, for, when he became twenty-one, he complained to his
mother of being unlike other young men and that he would never
be able to become "a man."

He proposed marriage to a girl of his age, for the sole purpose
of learning how girls regarded him. He was much encouraged
Avhen she was inclined to accept his proposal.

REPRESSION OR PSYCHONEUROSES 329

He was deeply attached to his sister, and seemed to regard
her as a life-long protector. lier engagement caused considerable
anxiety, but at her marriage he was, in his own words, "at my
best."

Almost six months after her marriage, his psychoneurotic dif-
ficulties began. Significantly, he could never give a clear account
of the time of the onset or what his personal difficulties were at the
time. (This extremely important part of the case history was
never cleared up, although appeals were made to his parents for
accurate data.)

The parents were both inclined to feel that the throat diffi-
culties began at nineteen, and were first noticed after a vacation.
He had visited a prostitute who had "choking spells," but he
maintained that no perversions occurred. The choking began sud-
denly, while drinking water. He felt that he was dying from
strangulation, and that evening complained to his mother, "I can't
keep my mouth open. I'm afraid I can't drink water." The pa-
tient created so much excitement that several physicians Avere
called by the distracted mother. He describes his behavior at the
time as "very nervous, could not read, had to be alone or would
just go wild. Could not talk to anyone or read sister's letters."

Several months later, one positive blood "Wassermann reac-
tion was obtained, otherwise no physical signs were found that
might have a relation to the choking and fears of "dying." The
diagnosis of his phj^sicians was "hysteria."

A series of intravenous salvarsan injections was given for
the positive Wassermann reaction, and with the third injection (so
the patient said three years later) his abdomen began to jerk vio-
lently, and an attack of vomiting followed, which latter is not un-
common after salvarsan injections. This jerking stopped suddenly
with the next injection, just as his physician "said it would."
For two years, the abdominal symptoms did not return, but the
choking and fear of "dying" persisted. The patient developed
the habit of pulling at his larynx, and persistently massaged his
throat to stop the sensations of strangling. Almost two and one-
half years after the onset (age twenty- three), the patient had most
of his thyroid excised, because the x-ray showed an enlargement
that indicated compression of the larynx.

He was terrified by the ether and complained of dying while
passing under its influence. He later stated that the vision of a

330 PSYCHOPATHOLOGY

devil trying to jab Ms harpoon into him terrified him, but, finally,
he submitted to the devil. The physician who was present said the
patient had to be prevented from masturbating when 'he became
delirious. The strangling symptoms were not materially relieved,
and, within a few months, became more severe than before. As
the patient recovered from the ether, the abd-eminal "jerldngs"
returned with the vomiting. The abdominal tic has persisted more
or less vigorously to the present writing. The contractions were
clonic in type, and occurred at the rate of 15 to 20 a minute. The
rate was, at times, almost rhythmical, but, on the whole, arhythmi-
cal, and the contractions varied greatly in vigor, according to his
emotional state. To control the abdomen, he developed the habit
of pulling on his belt, and was rarely seen without his hand on his
belt. The abdominal tic and the strangulation feeling accompanied
one another.

Then followed a long series of panics and consultations with
numerous physicians. He could never rest assured that there was
no serious danger of "dying," and, in all the interviews, he often
repeated the same inquiries, despite tiresome insistence that noth-
ing could be found to justify such suspicions. The patient most
persistently tried to find physical causes for his troubles so that
he might also have them removed (castration compulsion) by a
surgeon. He wrote: "When I wake in the morning after a rest-
less sleep, the- first thought that enters my mind is, whether I
"will live to see the day out. My breath becomes short as soon
as I get on my feet, and my abdomen starts jumping. The only
way I can manage to get a satisfactory breath is to open my
mouth as wide as possible and gap it in. I yawn continually,
all day. When these spells come on, it is almost impossible to
be still. I waU?: the floor until some relief comes. When I have
these nervous spells, the hardest part to bear is the awful smoth-
ering sensation in the throat. The nerves seem to bunch all to-
gether in the throat, causing same to feel like something is press-
ing the windpipe closed. I become very much alarmed and think
sure that every breath is the last. Then, all of a sudden, a calm
will come over me, and the throat will sort of relax, and the breath
will come natural again. I notice the most discomfort at meal
time. It is very difficult to swallow my food on account of the
jumping and smothering sensation which, if not already taking

EEPEBSSION OR PSYOHONEXJROSES 331

place, will commence inmiediately after being seated at the table. ' '

He usually ate from his plate placed on the top of the icebox
in the kitchen. Because of his discomforts when seated, a very
definite tendency to go into a panic at meal time existed, and,
when later he became a patient on the Avard, he usually attracted
considerable attention by excitedly jumping up from the table to
keep from choking.

He was admitted to St. Elizabeths Hospital for treatment at
twenty-four years of age. From the outset, he was dishonest and
could not quite be depended upon. He came voluntarily for a
psychoanalysis, but the benefits he derived could not be considered
of much value. He always maintained a bluff about his case, and
had an irrepressible craving for sympathy. He was virtually an
affective parasite. He had no delusions or feelings of being per-
secuted, and no hallucinations, although he frequently showed con-
siderable fear of insanity. His mental capacity, other than the
distractions of anxiety, showed no impairment. He was always
neat, and inclined to -be stylish. He could not be induced to work,
would mingle with the patients, was unduly curious about the
affairs of other people, inclined to be petulant and quarrelsome,
and easily dissatisfied unless he received special attention. His
associates quickly learned to doubt his statements. At night, he
bolstered himself up so as to go to sleep in a sitting position, but,
in the morning, he always found himself lying flat in bed. During
sleep, all symptoms and discomfort disappeared.

His general attitude toward his abdominal difficulties is ap-
parent in his discussions : "I am convinced in my conscious mind
that this jerking is caused by the '606' being too strong. I did
not have syphilis, so this medicine had nothing to fight and af-
fected my nerves. My father was unable to trace syphilis in our
family. ' ' (His parents were horrified when the physician advised
treatment for syphilis, and his fattier severely rebuked him for
disgracing the family. The value of the above reasoning, to shift
the responsibility upon the physician, is apparent.)

Another determinant for his abdominal troubles was revealed
in the teasing of his sister and brother-in-law. They called the
cause of the "jumping" abdomen, " Yosabel," and playfully teased
him about being pregnant.

The mother wanted a grandchild, but the daughter was "too
selfish" to have children, the patient believed. When his ab-

332 PSYCHOPATHOLOGY

dominal trouble first began he complained that "something was
kicking in there to come out." In discussing the pregnancy value
of the difficulty, the patient wittily remarked, "Four injections
ought to be enough to cause pregnancy." It should be noted hero
that at the time of the injections, the patient had developed quite
an attachment for the physician.

Previous to the strangulation crisis, a homosexual seducer of
boys paid frequent visits to the patient's office in order to per-
suade the patient to live with him. He represented himself as hav-
ing plenty of money, but Avas lonely and felt sympathetic because
of the patient ^s deformity. He said he wanted to give the boy a
home where he would not have to work. The patient stoutly main-
tained that no relations occurred, although he regarded the situa-
tion as tempting.

The strangulation and "dying" feelings at times caused
panics and the abdominal jerks often became so violent that he
had to keep his belt pulled tight. Several times in these "dying"
states, I urged him to lie on a couch, and encouraged him to let
himself go. During such states, he had to hold tight to some ob-
ject to counteract the feeling of "falling" and "dying." He was
never able to let himself go. He usiially rolled and writhed about
on the couch, suffering constantly, making sucking movements with
his lips, complaining of choking and having violent abdominal
movements. Twice, he described himself as having violent com-
pulsive homosexual fet^lings during these tantrimis. A little ward
incident spoke vokimes. An older, very active, red-headed soldier,
of decidedly scrappy appearance, was inclined to pity the patient.
This, man was also a patient because of his anxiety and jealousy
about his wife. One evening, he took the patient on his lap and
called him "honey," etc. To this, the patient commented, "I felt
so peaceful and contented it frightened me. I felt like a girl
would, and I jumped up. That Avorried me awful. ' ' The effect on
the older man ma^- be guessed from his behavior, when a little
later he made frank, but playful, homosexual advances to another
patient.

The patient gradiially l)ecame aware of his homosexual sub-
missiveness and himself found evidences of it in his jokes and the
selection of companions, etc. "The feelings (repressed) say, 'let
yourself go, you '11 be happy if you '11 die. ' They say, I am ' scared, '
and I say, 'liar, it is not so.' There is too much manhood in me

REPRESSION OR PSYCHONEUROSES 333

to give up to being a fruiter." At other times his feelings would
tell him that he would not actu.ally die, but would pass through
a climax. His manhood only would die and his mother and sister
would lose their love for him. "If I could just throw myself on
the floor and die, I believe I would feel better." (This method
of "dying," etc., is a very conunon phenomenon in the graver
psychoses.)

He was very much inclined to treat "Yosabel" as another
personality within himself that was trying to destroy his manhood.
When talking of it, he said, ""When we are by ourselves." The
case could not be psychoanalyzed satisfactorily, because of his con-
stant bluffing. After he told me of his sexual career and his self-
indulgent fellatio, he, with pseudo boldness, declared he was not
homosexual, because if he had such inclinations, he would go
right ahead since it was his OAvn business. Later, he was con-
stantly worrying lest he should become homosexual. When in a
panic he had dilated pupils, staring eyes, dyspnea, tachycardia,
insomnia, and fear of death. He would gasp and cry and beg for
help and encouragement, etc. During these states, he grasped his
belt or clothing like a drowning man and clung desperately. (The
fear of the heterosexual ego being overcome by or yielding to the
homosexual cravings.)

Behind all this symptomatic difficulty and distress was the
feeling that his father wanted him to die (crucifixion) so that
he could have his wife for himself. He tallied of his father's
jealousy, denunciations and violently expressed wishes that his
son should die because of his worthlessness. The mother usually
counteracted this by saying that her love for her son was greater
than that for her husband, but that she had to take care of the fa-
ther. (Back of this mortal feud between father and son was a timid
little wife-mother who weakly tried to keep things smoothed over
between husband and son. See Michelangelo's Pieta.)

During one of his more severe "dying" episodes, he reviewed
his difficulties with his father, permitting his anger free play,
finishing with his father's denunciations about the syphilis. The
intensity of the compulsion "to die" seemed to be greatly relieved
by a series of protests against the domineering attitude of his
father. A reaction of regret followed in which he mourned the
fact that he should have such violent hatred for his father.

His almost unrestrained attachment for his mother and sister

334 PSYCHOPATHOLOGY

was evident in a long series of dreams about light-haired girls
and women (mother and sister were light-haired) and several
rather romantic sexual dreams in which his mother or sister made
love to him. He commented that it was strange that when he was
awake he should be attracted by dark-haired girls and in his sleep
nearly always dream of light-haired women.

He developed a "funny little habit" of drinldng out of his
hands because it tasted better than the cup and relieved his tend-
ency to become strangled.

The intensity of the symptoms gradually became lessened, and
he made a fairly consistent transference to me, but would not give
up his mother attachment. This Avas expected, because his mother
could not give up her unhappy, crippled boy.

His sexual interests in his mother were never analyzed. To
this he stoutly refused to give any consideration even though he
came to an interview much embarrassed by a frank, vivid sexual
dream about her.

In due time, he was discharged as improved. He had re-
gained considerable confidence in himself, and was determined to
become a man and "make good" despite his difficulties. For
several months, he occasionally came to see me to show how well
he was succeeding. He was always well dressed and made a goodf
appearance, but was still uneasy.

"Every time I try to appear at my best, this thing comes up
in my throat. 'Tosabel' gets after me whenever I try to do my
best, but I am putting up a fight, all right, but it has not won
yet." The striving and bluff were still obvious. He was having
"a good 'time to forget his troubles" and saying nothing. Before
long, a panic developed. He had been discharged from a series of
jobs for insubordination. For three weeks, he said, he loafed.
His mother said he could not get work. Finally, his father or-
dered him to leave home and refused to give him a loan to start on.

He came to me discouraged, depressed, with all his symptoms
reaggravated. (The repressed cravings become dominant when
the ego is discouraged.) He hoped I would find him an easy road
to travel. He was advised to go it alone, and, half-heartedly,
promised to do so. A few days later, the mother informed me that
he had bravely started out (with her strings tied to him), and that
if he did not get along well she had assured him he would always
be welcome in her home. Within a few weeks, he was back. He

eepkessiojst or psycitoneueoses 335

still calls me up to be reassured that he will not die from the
throat sensations.*

This man has, obviously, very grave oral erotic affective re-
pressions, and trudges along on the precipitous edge of dementia
prsecox, that is, profound dissociation of the personality.

The struggle to become virile, good and happy through the
elimination of the distressing cause or the deficiency (the perverse
affect and its interests), has its corollary in another type of strug-
gle—namely, to compensate for the deficiency through the simula-
tion of a compensatory state Avhich atones for the deficiency. It
is important to recognize the difference for the psychotherapeutic
procedure and the prognosis, because the elimination or castration
type of mechanism, unless the tendency becomes checked, may
develop into a pernicious type of dissociation with progressive
deterioration. The preceding cases illustrate this feature.

In the shmdation type, the affect creates the postural and sen-
sory image of what it needs in order to attain comfort because the
reality is unattainable, as in the simulation of pregnancy, or of
paralysis (Case PN-3). In the latter, the suppressed affect will
often permit the free use of the inhibited or misused part so soon
as a monetary compensation for the injury is made by the of-
fender, as a railroad company. In one case, the simulation was so
transparent that after handsome damages were collected a lamin-
ectomy had to be performed despite a normal spinal column and
spinal cord. This, apparently, socially justified the recovery
which promptly followed. The neurologist and surgeon permitted
the patient to evade the responsibility for the* simulation of
paralysis.

The following case of simulation is presented as typical of
the rather startling behavior of such cases, which, however, usually
have an excellent prognosis, unless the deficiency which is compen-
sated for is utterly intolerable, as in Case PN-7, who protected
himself from fear through the defensive use of his foot.

Case PD-17 was a white, married woman, aged thirty-four,
who passed through a sexual panic with simulation of labor, and
also hallucinated sexual assaults by two female relatives.

Her father- was "dull" and her mother, "nervous" and
"eccentric." They lived unhappily together, and the patient, as
a child, suffered from their quarrels. A paternal uncle was in-

*Two years after this was written I received a letter from him stating that he had recovered
because he had learned to be a man.

336 PSYCHOPATHOLOGY

sane. A brother had three manic-depressive episodes, presuma-
bly related to his wife's alcoholism; and two other brothers sepa-
rated f-rom their wives because of infidelity.

The patient had jaundice, spasms, mumps and "kidney trou-
ble" when a child, but seemed to be a healthy woman.

Although she learned very well in school, she had to quit at
eleven because her parents refused to supply her with clothing.
As a child, she persistently tried to become a Catholic in order
to go to confession with her playmates.

Her skin was darkly pigmented, and the mother obtained much
of her revenge through calling her a "nigrified bitch," "black
bitch," and "black nigger." Her playmates often provoked her
into fights by calling her "Jew," "Italian," and "crazy Susie."
(These names were hallucinated in the psychosis.)

(The sister-in-law, who was supposed to be immoral, and who
called her "Indian," appeared in the psychosis as a sexual as-
sailant. )

The' patient began to menstruate at eleven, and early developed
maternal interests. At fifteen, she "fell in love," donned long
dresses, and eloped to get married, but the impulsive plan mis-
carried. . ,

At twenty -two, she married an artisan of twenty "for a
home," to evade her abusive mother. Her married life was not
happy. Her first child was healthy, but the second pregnancy was
aborted and this resulted in a separation. Family relations were
finally resumed, whereupon she became infected with gonorrhea.
This increased her sexual indifference for her husband. Her hus-
band, soon after, lost one of his legs in an accident and her house-
hold attentions became drudgery.

Her husband's mother and she were bitter enemies, and this
added considerably to the incessant family turmoil. Eestless and
amorous, she was forced to find an affective solution.

At thirty-four, about one year before the psychosis began, she
affiliated with a Baptist congregation. She became an ardent
worker, but was infatuated with the minister. "When he failed to
make satisfactory responses, the dissatisfied affect caused her to
suspect that he was making sarcastic references to her in his ser-
mons and the congregation was gossiping about her. Six months
previous to the crisis, her. physician noted "some mental disturb-

REPKESSION on PSYCHONEUROSES 337

The excitement began suddenly, apparently after a conflict in
which her mother-in-law figured prominently with accusations
about her character. She believed that her own mother had poi-
soned her, her husband's breath poisoned her, and that the medi-
cine for her pharyngitis was poison. She rapidly developed fan-
cies of being a little girl (regression) and refused to listen to her
friends. Although she wore her house dress she fancied it to be
an Indian costume, fixed her hair to hang unbraided and tied a
handkerchief around her neck.

She went to a Catholic hospital for help, and then became
"unconscious" from a "shock." A nun, she said, tried to calm
her and, upon hearing her story, said something about having a
baby, which, the patient thinks, influenced her, but was only an
excuse for what was inevitably coming. Because she was unable
to control herself or attend to her household duties, and was re-
sponding to hallucinations with weeping and singing, she was
brought to St. Elizabeths Hospital.

Upon her admission, aged, thirty-five, she was very much con-
fused and excited by the hallucinations and erotic cravings. Her
wide-open, appealing eyes and submissive, yearning facial expres-
sion were classical of the Madonna, although she was short, obese
and darkly pigmented. No important physical lesions were found.

Within a few hours after admission, she attacked several
women and charged them with trying to "cast influences" over
her. For several days, she retained her excreta. Although very
apprehensive in the presence of women she seemed to be relieved
from fear in the presence of a man.

(I believe that the unrestrained nature of her transference
and confession was an important influence in preventing a pro-
longed psychosis. The reasons for this impression will become
more obvious as the material of the confession and the patient's
faith in its therapeutic value becomes manifest.)

She persisted in getting under thehed, removed her clothing,
and kept the ward in confusion. She was secluded, and continued
her general erotic behavior for the next seven days. Then she
seemed to gain considerable control of herself after several frank
discussions of her wishes, which are recorded because of their im-
portance.

During the period of greatest confusion and activity, she
pleaded frequently that she wanted "to die." "I have been poi-

338 PSYOHOPATHOLOGY

soned," she would say. "I have been tortured and tortured every
night. I know I have never had nothing like this before. My
whole body was to be cut up and wrapped in some filth and thrown
into a slop-cart. I will be glad to die to get out of my trouble.
This morning, -when I sent for you, I didn't knf)w what was the
trouble. Feels lUce labor pains."

Examiner: "Why do you have feelings of labor pains?"

Patient: "I couldn't tell. I can't remember. My mind was
upset when I came here. It's drawing — some kinds of drawing
pains, just like it 's pulling your heart-strings down. I haven't had
any movement of the Ijowels — I am full of food. I don't know
when I was sick last. I don't know how long I have been here
[six days]. I don't know wliether I have been here a month. I
know some of the girls have been acting so funny, and everything
has been going wrong, and I do not know what the cause is. I
have just been poisoned today A^ith something put in the soup, so
they told me [hallucinated] . That gets me giddy in the head, and
then I feel like I am thick around the neck, get stiff, a pulling on
the nerves. I don't feel it is ni}- husband's cause [fault]. They
all say that I am going to have a baby. They said I was going to
have a baby today [hallucinated].

' ' They shut me up like a maniac. There are no conveniences,
no vessels, or no drinking water. I feel like I am not treated right
[contracts her muscles]. I feel like they are poisoning me.
[Trembles all over and writhes in bed, saying: "Oh, my!" Her
body was badly beaten and bruised from throwing herself about
in the bed.] I liave stood that poison so long. ' '

She placed her hands on her abdomen, and said: "It feels
like those drawing labor pains. It might be some convulsion pains
from poisons. AVe had soup today, and some of the people were
sick. There is food in my stomach for many days, and I don't
think the child would be healtliy if it were a child."

She asked me, with great anxiety, to close the door, because
she was afraid a "grey-haired Avoman'' might enter her room.
She said she could hear her voice. "They might cut me up," she
said. "They might throw me through the window and put me in
the slop-cart. [Smiles.] That [the voices] makes me go just like
that. [She made her arms tremble.] She is downstairs now.
They are just having a picnic out of me, and I "will do anything

EEPRESSTOK OB PSYOHONEUROSES 339

they tell me. [Refers to her autosuggestibility.J I smell the odor
of some kind of disinfectant. ' '

That morning, she complained, with anxiety, about a "woman
downstairs" who was terrifying her. She said: "She has called
me everything — ^bitch, black bitch, and names that meant I was
low." (The reader must always bear in mind the fact that the
hallucinated voice is produced by the dissociated cravings.)

I asked her if " doi^mstairs " had another meaning, and she
replied: "Below and Hell, torment, murder, death, everything
ugly and danger to me," revealing the moral direction the per-
verse dissociated affect was forcing the ego.

She complained that she could not understand why she should
have labor pains when she really could not be pregnant, and, at
times, she spoke of her pregnancy as "imagination," but she
seemed unable to stop it, and would quickly slip back into accept-
ing the feelings to mean a real labor. This indicated that at times
she was able to almost control the dissociated aifect.

The necessity of holding to her admission that her troubles
were imaginary was earnestly maintained, but all criticisms were
carefully avoided, and in her replies she made the following state-
ments :

Examiner: "What can a Avoman do Avhen she is having such
imaginary labors ? ' '

Patient: "She will never get Avell of the insane."

Examiner: "What else will she do?"

Patient: "She will die."

Examiner : "Is there anything else ? "

Patient: "If she tries to stop it [hesitates, but acts as if go-
ing to continue] . . . ."

Examiner: "How do you think she can stop it?"

Patient : " I don 't knoAA^ ' '

Examiner : ' ' How do you stop anything like that ? ' '

Patient : ' ' Trying. ' '

Examiner : ' ' When are you going to try ? ' '

Patient: "When I get out of this — ^unhappiness — trouble."

Examiner: "Tell me all about it."

Patient : "It seems just like someone had me on their mind —
minister — ^I don't know. I was going to church, and I tried hard
to believe and be right, and it seemed like this party would just

340 PSYCHOPATIIOLOGY

look at me sideways and talk directly to me. He was minister of
— it just struck me to the heart. I admired him iirst as a minister,
and thought he was a nice man. I used to like his virtue, but after
he commenced to be sarcastic I kind of didn't care for his sermon.
I thought I must be guilty of sin" (secret orotic wishes).

She confessed to having had "drawing feelings of love" for
him, and now was suffering froui "disappointment and sin," and
she admitted that her troul)les may lie "imagination." (Here she
began to writhe and groan.) "Oh, my! I don't know what I am
going to do! These girls are ah\'ays plotting and thoy are making
fun of me ! ' '

Her labor pains aud general lichavior wore evidently a com-
pensatory simulation J relieving the "disappointment" of the sex-
ual cravings for the minister.

She said: "I tried hard not to think of it [lovo]. I thought
I was wrong. I had to drive the feelings away." She followed
with tlie complaint that it had been "a week" since she had def-
ecated and "everything is mixed up in me." This retention of
her urine and faeces made her "get big," and it was "something
like labor, ' ' and made her think " of a child. ' '

"When she was not tossing, and contracting her abdominal mus-
cles, and groaning, she smiled pleasantly and tried to lie agreeable.
After her confidence was won, she became quite inclined to assume
the responsibility for lier condition, which was the encouraging
sign of a health^" solution, and I asked hor what she was going to
do about it. She replied: "I don't know. If I could just get out
of this placo. [She was afraid of being considered insane.] This
misery just started a little last night. For two or three nights I
have not had a passage of urine I held it so long. I could not
got anybody to como to the door. Last night they let me out but
I could not do it, and this morning — Oh, doctor! Please see if
you can't get mo somotliing for this. [She seemed to be in great
pain, and tossed about in the Itod.] I feel like I am just clogged
up inside by keeping my urine and passage back. I don't know
what it is. I believe I could get relief if I had a passage. I don't
know what it is. Maybe somebody has poisoned me. I don't
know — imagination or what." The transference to me was mak-
ing it possible for her to see the wish-fulfillment.

The next day she removed all her clothing and stood nude

KEPRESSION OR PSYCHONEUROSES 341

before the window. She pounded on the screen, and tried to force
an opening. She said she saw a light in a nearby building and was
trying to reach it becaixse "it meant passion." The nurse put her
to bed and, when I entered the room, she was lying quietly,
stretched out on her back, eyes closed, trying to appear as though
she. had not noticed me. With a little persuasion, she opened her
eyes and began to talk. She repeatedly protruded her tongue,
covered with foamy saliva, during the conversation and, in reply
to my questions, she explained that this meant "passion." She
continued to groan, and to contract her limbs and abdominal mus-
cles the way she did the day before. She complained that she could
not "make water flow." At first, she seemed to mean urine. To
make certain, I asked to what water she was referring, and she
explained that she meant the waters of labor, and again spoke of
her "imagination," about having to have a child by the minister.

She complained bitterly of having "impure thoughts," and
that she was unable to control herself. She said her thoughts were
"degrading" and "wrong." She was fighting against them be-
cause something was pulling her away from her husband. "It
grips my wrists," she said. [Rubs her Avrists.J "I can feel it —
feels like electricity drawing me to some other person. ' '

From the time of her admission, she had complained of being
afraid of an " old grey-haired Avoman ' ' who looked like ' ' a witch. ' '
She heard and saw this woman, described her as naked, trying to
get into her bed to perform sexual acts on her with "her mouth."
For this reason she was afraid of the women when they entered
the room and attacked them.

While speaking of the woman calling her "black bitch, negro,
foreigner," she complained that her mother never wanted her,
and, accused her of being a "nigrified bitch." She believed she
was "marked" because of this.

What she called "impure" and "degrading" thoughts, she
said, were influenced by an alcoholic, immoral sister-in-law, "be-
cause if you sympathize too much with a person it will make you
like them." (Quite a profound psychological observation.) This
sister-in-law, she hallucinated, was also trying to make a homo-
sexual assault on her like the old woman.

The patient was now extremely erotic and vividly hallucinated.
The sputum on her tongue was shown repeatedly, and she pleaded

342 PSYCHOPATHOLOGY

pitifully that she was unable to control herself. She explained
that her husband had repeatedly practiced eunnilingus on her and
induced her to practice fellatio on him. She said that is what
she meant by " It is all mixed up inside [placing her hands on her
abdomen] and the phlegm comes from down here."

The patient's anxiety about her perverse eroticism was un-
questionable. She was terrified and begged to be saved from in-
sanity.

The next day she was not quite so confused. She said: "I
think my mind is purer and I feel better." She wept bitterly, and
felt ashamed, because "I did not act right here. I took my cloth-
ing off and was so stupid. ' ' Her eroticism had greatly subsided,
and, although she still had hallucinations, they were not vivid
enough to cause her to yield to them, except to cry and plead for
help.

She now wanted to tell me about her sexual difficulties, in
order to get control of herself, because a confession, she ,|h#i.fpt,
would help her. (See Case CD-8.) She said she had loved a man
of her age and allowed him sexual privileges, then she married
her present husband to save her honor. This distorted her entire
life, and explained the origin of the dissatisfaction with her hus-
band and her cravings for the minister.

Five days later, she had improved sufficiently to review her
psychosis. It was deemed advisable so that she would understand
herself. (Some of her explanations of the impulses to conmiit per-
versions were extremely pertinent.) Eelative to the "phlegm" on
her tongue, she said: "They (voices) accused me of drawing
phlegm, like passion [placed hand on abdomen] lihe a hahy taking
nourishment from the breast."

These hallucinations indicated that the origin of the affective
craving of "drawing phlegm" (like a baby taking nourishment
from. the breast) and sucking to satisfy "passion" or sexual
hunger was actually related to a nursing craving hence the
struggle to resist the degrading sexual qualities of poison in
the food. When patients fear there is poison in the food, they
usually mean a sexual ingredient, and this feeling about its pres-
ence in the food tends to satisfy the orally conditioned sexual
craving which is associated with the food hunger, perhaps, because
practically the same physiological functions were used to satisfy
both cravings in infancy. Both cravings seem to have a common

EEPRESSION OR PSYCHONEUEOSES

343

root in the infant's affections when food is taken from the breast
(Case PD-13 and Costa Riean Indian sculpture of copulation).

She said, retrospectively: "I heard voices around me say
I was going to have a baby. I seemed to be in a dream, and I
forgot all about my husband. It seemed I was going to marry
Dr. V — . When the girls put me in a continuous tub I heard voices
say: 'You can't tell me she isn't a Southern water nymph.' I
thought a crowd of actresses were coming up from the South. I
was preparing for the stage. It seemed that after I came here,
there was a lady, Avho was built like my brother's wife, came near
me, and it frightened me. I said I would strike her, and once I
got her by force. [She attacked several women.] I thought she
was going to use her mouth on me. [Groaned, and appeared very
anxious.] I am hearing voices now call me a bitch, a dirty dis-
eased somebody. I am rotten. I must dirty the bed. Believe I
did once." The psychopathologist must see behind this talk the
erotic craving to be "rotten" and "dirty."

The patient told another physician, who was not familiar with
my notes, that she felt an old woman would come in the night and
put something into her rectum. She heard the woman's voice tell
her to put her finger into her rectum and she would see her picture,
so she covered her finger with a sheet, and, after inserting it, saw
' ' a picture of a nigger on it. ' ' She said that a voice told her she
would see Christ and that she herself was the Christ Child Jesus.
Someone cut up the bodies of her people, and she was blamed for
the crime.

"I got to da,ncing and hollering out of the window like an
Indian. Hollered for people in Baltimore. Thought the Washing-
ton people thought I was colored and were all against me. These
Protestants and Catholics were fighting. Whenever I do wrong,"
I feel better when I can confess it, and the sisters (nuns) are so
nice tome."

She continued to be distressed and anxious because the crav-
ings to perform sexual perversions could not be subdued. During
this conference, she was inclined to lapse into a distracted state,
but would respond promptly to questions.

Two weeks after her admission, she commented : "I thinli my
mind is purer and I feel better." She adapted herself well, was
not so distressed about her former behavior, and asked for work.

344 PSYGHOPATHOLOGY

She pleaded to be permitted to return to her husband, and made
profuse promises about never leaving him again.

Her dreams, during the acutely erotic period of her psychosis,
were quite in harmony with the hallucinatory trend, such as dreana-
ing about marrying her physician, and of being in bed with a man ;
that someone telephoned to her that she did not have a husband ;
and that she was going to be married to the husband of another
woman. Another time she dreamed she was nude before him, and
he was studying art, etc.

During the acute stages of her psychosis, she yielded to the
erotic cravings and interpreted the environment largely to satisfy
them. She would laugh, cry, groan, fight, pray, plead, sing, dance
or be silent for periods or talk freely. Her conversation was not
coherent, and there was a little distractibility, referring to things
in the environment. It showed in the promiscuous subjects of
her eroticism.

During the acute stages of her psychosis she also seemed to
be disoriented for time, place and person, but when her attention
was held, she proved to be quite oriented, althoTaglt she frequently
made mistakes before she arrived at the correct date, etc. Her
memory for remote and recent events was accurate, biit the special
memory tests were not so well done, and the calculations were in-
accurate. About two weeks after admission, she was able to per-
form the usual tests well enough.

Unfortunately, she was discharged by the court twenty-five
days after her admission, before she had completely recovered.
Her insight was good, and she understood the wish-fulfillment in
her behavior. She was inclined to feel that in some respects the
psychosis did her good.

During the past two years, the patient has conducted herself
quite efficiently, with, perhaps, a better appreciation of her hus-
band.

In the above case, the simulation of pregnancy and labor was
brought about by the dissatisfied affect which, obviously, craved
a definite relationship with the minister (father). On the whole
she was not desperately averse to the repetition of perversions,
but was terrified by the hallucinations of the mother.

In some cases, the simulation of an attitude or state may be
made at the sacrifice of an important organic function or personal
interest, and the sacrificed function may mislead the observer to

REPRESSION OR PSYCHONEUROSES 345

consider this in itself to be an elimination process, when, in reality,
it is decidedly a simulation process made necessary in order to
eliminate a far more grave, although more obscure affective crav-
ing.

In the following case (PN-7) the soldier simulated a disease,
"the bends," and crippled his leg in order to protect himself from
the terrifying effect his anal erotic cravings had upon him.

That one individual should become terrified when he becomes
erotic, whether perversely or not, and another elated, seems to be
decidedly a result of the influence of associates, particiilarly the
esteemed associates who create in the individual through endless
suggestions and pleas, from infancy to senility, a conscientious re-
gard for what is estimable and justifiable.

Case PN-7 shows the marked distortions an individual will as-
sume to escape the causes of fear when due to uncontrollable per-
verse eroticism.

The patient was a tall, broad shouldered, lanky soldier and
coal miner who was sent to St. Elizabeths Hospital for dementia
prsecox and a hysterical contracture of the right leg. He had also
been diagnosed as having cerebral syphilis. He was tAventy-six
years of age, unmarried, and had spent most of his life in the
coal mines and on the Ohio Eiver as a roustabout. He believed
that he was the only child of his parents, but did not remember
them and could give no information about his early childhood. His
education was extremely meagre, and he gave the impression of
being a high-grade moron. When asked to give the difference be-
tween water and ice, he said: "One is water and the other ice."

He denied having had any diseases. His blood M^as double
plus for one Wassermann test and negative for another. His
spinal fluid was negative for one examination and showed 14 cells,
double-plus protein, negative Wassermann and negative Lange
tests upon another examination. A neurological examination was
negative for all signs of any form of cerebrospinal syphilis. He
had indulged freely in alcoholic beverages for years, but did not
show physical signs of their excessive use. '

He quit the coal fields for reasons that he would not discuss,
and enlisted in the army in January, 1915. Six months later, ac-
cording to the Army Medical Eeport, while in the Hawaiian Is-
lands, he returned to the post and claimed that he had been struck

346 PSYCHOPATHOLOGY

from behind and knocked unconscions. He was put nnder arrest
for being drunk and carrying a revolver. Following the alleged:;
attack, the patient went on sick report complaining of pains in
the right testicle, right thigh and abdomen. Upon examinait,
tion, no evidence of tranma could be found. (The reports are con-
fusing on this point. The first report says the patient suffered
from a severe contusion sustained in a fight. Then the diagnosis
was changed to cerebral syphilis, and later, to dementia praseox.
The patient's stories were also contradictory and confusing.) He
waUced with the thigh in an abducted position for several days,
and his physicians expressed the belief |^t his symptoms were af-
fected. He was observed to walk across the room in a normal man-
ner, but within a few days the right knee was raised almost to the
level of the hip-joint and extended before him, while the li^^Jwas
flexed closely upon the thigh and the foot carried below the left
buttock so that the foot practically covered the anal region. (See
Fig. 41-A.) The muscles were held fixed, except upon defecation
and sleep, when the foot was let down to rest behind the left
loiee. He usually walked by shifting sideways on the left leg,
twisting the foot from heel to toe over the floor. Later, he walked
with crutches. An x-ray pictiire of the hip showed the joint to be
normal; at least, no signs of necrosis or infection could be made
out by the x-ray examiner. No trophic disturbances were found,
and no changes for sensation or tenderness could be elicited.

Unfortunately, a description of his behavior and mental status
•during the acute stages of the illness were not given in the report.
The medical officer said that he showed "mental deterioration"
within a short time after his admission. A true deterioration, how-
ever, had not occurred. The patient was only panic-stricken and
was unable to cooperate; also being illiterate, his state of mind
was misunderstood.

In the beginning of his illness he had been assigned to an
open ward, but became morose, suspicious and surly. Although
no one in authority advised a surgical operation, he became ex-
cited, threatening, abusive and profane, in order to keep the physi-
cians and nurses away from him. He could not be reassured, and
had to be assigned to a private room. (Such behavior always sug-
gests a homosexual panic.) He closed the Avindows, covered his
head with a sheet and leaned against the door to keep it closed.
He refused to eat and would not explain why.

KEPRRSSION OR PSYCHONEUROSES

347

He was not accessible and never admitted that he had hal-
lucinations, but replied to questions concerning them with, "They
don 't bother me any more. ' '

Mg. 41-A. — Spastic distortion as a defense against anal erotic cravings.

Ten months after the onset, he was admitted to St. Elizabeths
Hospital. Certain characteristics of the patient's attitude were

348 PSYOHOPATHOLOGY

very striking. He trusted no one, and always watched everybody,
particularly when they approached him from behind. He would
not make friends, tended to isolate himself, had a perplexed, anx-
ious facial expression, and did not want to be cured. He said
if his leg should be brought down, "I'll go mad." He was very
anxious to be discliarged "not in line of duty" and avoid any
form of treatment. (When a soldier is discharged for an illness
or injury which is not in line of duty he is not entitled to a pen-
sion.) Throughout his stay, he asked this monotonous, stereotyped
question: "When can I get my discharge, sir? I am all right.
It's not in line of duty, sir. They read it [record] to me that way."
If he had the opportunity he never failed to add, with anxiety, "I
do not want a pension, and since this happened out of line of
duty and I was not in the service very long and I am an expense
here, I want to be discharged, and you can put it on the records
that I do not want to claim a pension — if I could have been cured,
the doctors in Honolulu would a done it, sir." It should be re-
called that he resisted the doctors in Honolulu.

His story of the injury Avas as follows : "I was in town drink-
ing a few glasses of beer with some friends and was going along
the street (in a park) wlien I heard someone come up behind me
with a police officer on horseback. From what the police said they
knocked me unconscious and boat me up. Tlioy hurt my left ear
[while in the hospital he had otitis media] and side and my right
hip. My leg dragged afterwards and it was in the Avay, so it
drawod up this way. I couldn't iTse it while it dragged. If it
comes down (now) it would be in the way.

"My trouble's Avith my right hip. Came from my right tes-
ticle. It hung doAvn and it affected mo all through here [places
hand on right inguinal area] and my leg draAved up."

When the testicles, Avhich appeared to be normal, Avore pal-
pated the man Avas decidedly emltarrassod and uneasy. He feigned
great tendoriiess and resisted the examination.

No A^aricocole or hernia on oitlior side Avas found, although
he insisted that ho had a riglit A'aricocole. Physical examinations
of the abdomen and sci-otum av(m-o found to be negative.

Wliy this able-bodied man should light against being treated
for so serious a deformity as ho had, seems inexplicable upon any
other ground than that it Avas a necessary, desperate solution of
a graA'o affectiA^e difficulty. He had carried his leg in this position

REPRESSION OR PSYCHONEUROSES 349

for ten months, but repeated, emphatic warnings of possible, in-
curable changes in his hip and knee-joint did not influence him
to seek treatment. He would not consider it under any circum-
stances.

He worked indiistriously, was well oriented, and interested in
most things, and tried to find favor with the physician-in-charge
so that he would be given a parole. He was consistently inacces-
sible and elusive so that only fragments of information could be
gathered. He admitted to Dr. D. C. Kalloch that he had heard
unnatural voices calling him vile names, and said that he may have
been thinking of someone committing a sexual assault upon him on
the night of the supposed injury, but did not want to talk about it.

During a later interview, he thought that ' ' may be the police-
man affected my hip with compressed air." This statement fol-
lowed his explanation that he had never had relatives who had a
similar affliction, but he had seen several men Avho had had "the
bends" from compressed air. This was while he worked on the
coffer-dams in the Ohio Kiver.

The fancy that the policeman had caused "the bends" with
compressed air was significant. But, what did the policeman on
horseback and the compressed air sj^mbolize? And why did "the
bends ' ' take on this convenient form which he would not allow to
be treated! The answer is possibly to be found in the use of sim-
ilar symbols by other cases, and in his general personal makeup.
The policeman on the horse symbolized the centaur that had as-
saulted Mm, and the compressed air that he injected was a seminal
equivalent. Case HD-1 described a horse on which a policeman
rode as being "nearly all penis," and Case PD-32 often sits on
her foot to protect her amis from a secret underground device
that sends shochs into her anus, and is operated by her sister and
brother-in-law.

The patient said he had never masturbated at any period of
life. For a boy, carelessly raised in the coal-mining towns of
West Virginia, this is so improbable that it must be considered a
defensive misrepresentation of his sexual life. Since he told read-
ily about his experiences in houses of prostitution, the impression
was given that he had the usual pride about heterosexual ex-
periences, but was very uneasy about his homosexual life.

When the universality of masturbation was explained, and its
usual harmlessness emphasized, he replied, "If you can't get me

350 PSYCHOPATHOLOGY

one way you'll get me another." But lie did. not trust nie far
enough to disclose the true causes of his anxiety.

He would not relate his dreams, so this avenue to his fears was
not open.

The foot was carried over the anus and he so consistently
watched for suspicious signs of approaching danger and was so
easily startled, that the defensive value of the foot attracted at-
tention. His panicky resistance to treatment, the hallucinations
that had accused him of being a degenerate, and the fear that he
would "go mad" if the foot was displaced, indicate that he was
protecting himself from anal erotic, homosexual cravings. His
explanation that he had been ''knocked unconscious" by the as-
sault is a phrase typical of anal erotic submissions, as Cases
PD-34, PD-33 shoAv. '

One other feature of the case must be given consideration, and
that is tlie pain he endured wlien he so severely flexed his knee.
He explained it was done because "the leg_ dragged from the hip
and was in the Avay. ' ' The pain was endured in order to escape
more terrible panic. The consistent maintenance of its position
gives a measure of the persistence and gravity of the fear. Sug-
gestions that Ave Avould correct the leg after giving ether caused
him to become decidedty anxious.

His sensitiveness and embarrassment upon digital examina-
tion of his scrotum was unquestionably a homosexual reaction, as
was his tendency to isolate himself from other men. The sugges-
tion of so using the foot for a defense probably had, for one de-
terminant, its origin in the cases of "bends" he had seen from
compressed air.

The possibility of error in the diagnosis that the position of
the foot was a defense against an anal erotic predisposition must
be admitted, but the more important fact, for AA-hich the case is
presented — ^namelj^, that tJie extensive serious physical distortion
was reflexly assumed by the man and maintained indefinitely in
order to escape the affective state of fear, is definitely established.
It is probable that so soon as he escapes from the causes of fear,
he will gradual^ resume the use of his leg.

Sixteen months after the onset, he eloped in an unimproved
condition. The trend of tlie psychosis seemed to have become fixed
upon the physical distortion he had maintained, and this in itself
was the reason for not pushing his case. To have deprived him

REPRESSION OR PSYCHONEUROSES 351

of Ms "defense," without having his confidence, ■would probably
have thrown him into a more serious panic.

The peculiar phrases about being "made unconscious," or
"knocked unconscioiis," or "temporarily senses taken away"
(Case PD-34), are strikingly used by patients to describe their
experiences when passing through a sodomistic experience. It
stands out in quite marked contradistinction in my cases to the
oral erotic complaint of being ' ' crucified, " or " dying. " I do not
believe that it is distinctly pathognomonic of the type of erotic
panic, but I am sure that in my study of erotic panics the anal
erotic and oral erotic individuals have quite different ways of

A. B. c.

Fig. 41-B. Tensions of facial muscles to control eroticism.

A. Shows tensions of facial muscles at 16. No conflict apparent. Narcissism
highly developed.

B. Shows strong incessant tensions of facial muscles indicating great difficulty
in keeping himself unconscious of his sensuous lips. Age 23.

C. Two years later. Obsessed with oral eroticism he bit out the parts of his lips
that had a sensuous significance. The biting occupied several days and occurred while
in a desperate panic trying to get pure thoughts and eliminate the eroticism.

meeting their difficulties, and these methods, as symptoms, have a
diagnostic value. "When both forms of eroticism are present the
distinction is not so clear.

Attention to this variation was first directed by Case PD-34,
so-called paranoid dementia prjecox, who repeatedly described
his experiences of being made "unconscious" by secret powers,
and then subjected to sodomy. During these states, his behavior,
according to his history, was not unlike that of some epileptics
when they become erotic.

Summary

The elimination of an organ or function, or a craving, and the
memories aroused by it, is always made in order to escape from
a situation which is made intolerable by the existence of the crav-
ing. This craving, in itself, may be pleasant or unpleasant, as an

352 PSYCHOPATHOLOGY

illegitimate love or hatred. A true eliinination naturally can not
be made. The individual only, represses (forgets) the wish so that
it can not maJje him conscious of its needs.

The simulation of an organ, function or object is made in
order to gratify an irrepressible affective craving. It is usually
not so malignant as the elimination mechanism, although, because
of its eccentric nature, it may lead to the social ostracism of the
individual; as the claims of undue prophetic powers or the simu-
lation of pregnancy.

Because either mechanism may become the foundation of ec-
centric adjustments and ridicule, they are to be regarded seriously,
and the individual needs assistance in order to make the necessary
affective readjustment and obtain insight.

The surgeon, in particular, should train himself so as to have
at least sufficient insight into these mechanisms to prevent being
used for the castration of some repressed affective craving through
the excision of some important organ. Many a surgeon has had
to close a distended abdomen, which was complained of in a man-
ner that indicated a distressing fibromatous uterus, but was in
fact distended as a simulation of pregnancy.

The repression of an affective craving is aluays due to the
fear of the social consequences of permitting the craving to seek
gratification. The repression is made by coordinating all the
jeopardized cravings of the ego for social esteem upon some sub-
stituted line of behavior in order to keep the repressed affect from
causing the individual to become conscious of its needs. The sub-
stitution, for this reason, is usually seized upon reflexly and is
largely made up of those things of which the individual was quite
vividly and coineidentally conscious at the time the crisis occurred.
For this reason an overemphasized physical lesion, such as an
ulcer, a fracture or an organic inferiority, should be suspected by
the psychopathologist to be the means of maintaining the repres-
sion of some unjustifiable affective craving such as love, fear, hate,
shanie, envy, avariciousness, etc.

Since there is no line of demarcation between the psycho-
neuroses, compulsions and obsessions, and the graver psychoses
and dissociations of the personality, we may now consider the in-
fluence of repressed affections with elimination and simulation
tendencies in the dissociations and regressions and eccentric com-
pensations (psychoses).

CHAPTER VIII

MANIC-DEPEESSIVE PSYCHOSES AS BENIGN COMPEN-
SATION OR REGRESSION NEUROSES, WITH OR
"WITHOUT DISSOCIATION OF
PERSONALITY

Elimination or Simulation for Wish-FulflUment in Affective

Crises

Two general types of elimination mechanisms in the benign
regression neuroses (depression psychoses) are to be recognized:
those complicated with anxiety and those ivitlvout anxiety.

The depressed individual suffers from inhibition of the auto-
nomic-affective sources of energy, particularly love, so that his
powers for work are reduced more or less beloAV his usual capacity.
This inhibition procedure, it seems, may be due (1) to ceaseless
preoccupation of thought in order to control a perverse or asocial
affective craving, or (2) to a subtle, regressive affective tendency
toward the nursling's heaven, in which the covetous and com-
petitive interests of the individual are renounced because of the
hopeless nature of his conditioned infantile love cravings. This
renunciation or abandonment of the struggle for virility must not
be regarded as being due to sopie obscure inferiority or weakness,
but rather to the inaccessible nature of the loye-object for which
the affective craving must struggle if it is to struggle at all ; as, for
example, an unresponsive or unfaithful love-object to discourage
maturing and an infantile fixation upon the mother to pull back.

In both types, the resources of personal energy for earning a
livelihood are much reduced. In anxious depressions, where the
individual has plenty of energy, usually more than normal, the
ability to do an ordinary day's work is reduced because the affect
is striving for a fixed, decidedly different object, and the striving
is very distressing in itself, because of its uncontrollableness.

The nature of these dissatisfied affections is extremely im-
portant. It may be a disguised craving for masturbation or un-
justifiable sexual indulgence.

353

354 PSYCHOPATH OLOGY

The anxious struggle for self-control is essentially e^mwa-
tive in the sense that the individual strives to castrate or eliminate
the persecutory affective craving from the personality. In the
type -without anxiety, by giving up the object, the genetic stimulant
of potency is lost, and, according to the Ancient Greeks, when
Cupid or Eros (Love) flies away, Psyche dies.

Fig. 42. — "Cupid and Psyche," by Eodin. (By permission of Metropolitan
Museum of Art, New York.) When love flies away the mind, that is, inspiration,
dies. (Compare with "Eternal Spring," Fig. 20.)

In the following case, it will be seen that the woman strove
desperately to avoid becoming pregnant, because she thought a plot
to impregnate her had been organized. It is hardly necessary to in-
sist that no such absurd plot existed, or that she was not being mis-
treated. What then was the foundation for her belief that a plot
to impregnate her existed? Her case shows that her sexual crav-

MANIC-DEPRESSIVE PSYCHOSES

355

ings were demanding impreg-nation and, because the reality was
unattainable, they created bodily sensations of such vividness that
the patient felt and believed she was pregnant. Like Eodin's
"Centauress," the prudish ego strove desperately to escape from
the horrifying machinations of the erotic pelvis and eliminate its
cravings from the personality.

Case MD-1 was a tall, slender, rather delicate, refined but
prudish woman of fifty-two when she developed a, grave anxiety
state with obsessive feelings of being pregnant, destitute, and the
subject of world-wide gossip. For years she had been a teacher

Fig. 43. — Posture of regression to intrauterine attitude, love is gone and life is not

worth the struggle.

of physiology and nature study. Her menopause had occurred at
fifty.

Two aunts, two first cousins and the son of a cousin were pa-
tients in an institution. Two sisters were neurotic, one finally com-
mitting suicide. The son of the latter is considered to be unre-
liable and had a "nervous breakdown."

The parents taught their children to religiously avoid every-
thing pertaining to sex. Hence, the sexual interests of everyday
life of other people were always horrifying to these gentle ladies.
The atmosphere of their home was always very puritanical and
everything was sacrificed for family pride, even though the family
was at times almost destitute.

35G PSYCHOPATHOLOGY

All the children had delicate physiques and little endurance.
They ^vere well educated and two of the three daughters taught
school. The third daughter became the secretary of a business
man.

AVhen the patient was twenty-five she became engaged, al-
though she was not strongly attached to the man. AVhile the en-
gagement was dragging along her younger sister returned home
after a miserable year of married life. This sister's husband was
known to have interests in other women, and she left him although
she was six months pregnant.

The tragic situation of this "beautiful'' younger sister was

such that the patient broke her engagement and resolved to pro-
tect the unhappy girl and never marry. After the child was born,
the sister obtained a divorce. She would accept no alimony and
would not permit the father to contribute to the support of the
child. They were living with the mother at the time, and the aver-
sion of the three women for the child's father was very intense.
The court unfortunately permitted him to see his son. To pre-
vent him from touching the child, the grandmother always held
him on her lap, and to make the situation doubly secure, they are
said to have taught the child not to walk on the floor barefooted
so that when his father called, the boy obediently sat on his grand-
mother's lap in his bare feet and would not go to the father.

The two sisters taught school and raised the boy according to
their puritanical conceptions of propriety, with emphatic aver-
sions for those fundamental cravings of nature, which had be-
come grossly emphasiiied by the sister's misfortune. Affairs
moved quite smoothly until the boy was about sixteen when the
irrepressible father, Avho seems to have entertained no little aver-
sion for his son's associations, threw the women into a panic by
offering the boy a large sum in cash, a liberal education and an
automobile if he would leave his mother. The temptation at-
tracted the boy and in order to avoid it, the women took him into
a distant state, where they sent him to college. The father fol-
lowed the boy and the mother again changed his school. He failed
as a student and developed a depression. His mother took him to
a summer resort to hide him from the father and she herself de-
veloped a serious anxiety state. During her confusion she is re-
ported to have misidentified her son as her husband. The attitude

MANIC-DEPRESSIVE PSYCHOSES 357

of the son made it appear that he was inclined to accept his fa-
ther's offers as soon as he became twenty-one. No inducement,
moral suasion, or affective attachment of the two women, who had
virtually sacrificed their lives for him, seemed to counterbalance
his father's temptations. The mother solved the anxious situa-
tion for herself ten months after the depression, by taking gas.

The patient, who was at work and suddenly called home in
the emergency, entered the room first and removed all direct evi-
dence of suicide. The coroner's verdict of suicide was made de-
spite her denial of any interference. She always maintained that
she had not perjured her testimony, but probably the affair con-
tributed quite an element to her obsessive feelings during the psy-
chosis of having "told a lie."

A year later, the patient's nephew went into his father's office
but continued to live with his two old maiden aunts. His tendency
to return home at all hours of the night indicated an estrangement
from puritanical morals. The patient, now a woman of fifty-two,
persisted in her hope of holding him and never retired at night
until the boy had gone to bed. Thus she made her silent prayer
and protest night after night, but in vain.

The increasing anxiety, loss of sleep, decreasing efficiency as
a teacher, and almost total lack of funds, finally produced a col-
lapse a few months before the nephew became twenty-one. It was
expected at the time that he would abandon his aunts when he
became of age.

The patient's psychosis now developed rapidly. After a brief
period of restlessness, insomnia and inability to teach, she seemed
to become obsessed with the feeling that everything was lost, be-
cause her inability to think in the schoolroom would necessitate
her resignation and her meagre funds would soon be exhausted.
She asked to be sent to St. Elizabeths Hospital for treatment,
but before she was removed from the home she made two attempts
that indicated strong suicidal impulses. She had tried for several
weeks to induce sleep by a large variety of old home methods, but
without relief.

During the greater part of the stay at St. Elizabeths she was
in a continuous anxiety state, the affective causes of which she
succeeded in concealing for some time. She irritably complained
of insomnia, restlessness, "brain-fag," "my head doesn't work,"
etc.

358 psychopathOlogy

Her description of the onset of the psychosis revealed consid-
erable insight. "I had not slept much and was walking around the
house restlessly. All of a sudden there was a swish, as though a
lot of people were rushing toward me, gathering' in around me try-
ing to cover me. I said, 'I have no clothes on.' I Avas frightened
and resisted. This confusion of my mind began the evening before
when I asked for something sharp. It is all rather hazy in my
mind, but I remember repeating over and over : ' Scissors are not
very sharp.' I was in that state of mind that I wouldn't get well,
that I could never sleep, that I could never work again. Nothing
hut had thoughts came to me, and scissors was all that was near
me." She complained of a temporary "change of speech" and in-
ability to address her pupils which, however, was probably a func-
tional disturbance, since no organie lesions were ever manifested.

She gave the examining physician no insight into the "bad
thoughts," and cleverly evaded giving any other information than
that she was destitute and her life seemed hopeless. Her irritable
resistance was quite typical of the anxious, self -critical individual.
When a physician asked if anything worried her, she answered,
"Yes, madame," and irritably added, "ask me what it is, please."
Then she answered her own question with: "Lack' of money."
(This, obviously, was true in so far as it went, but was wholly in-
sufficient, although she persisted in trying to make it the sole
cause of worry.)

She said she had always been a "practical woman," "a good
mixer," fond of people, and made friends with her sex freely, but
encouraged no attentions from men. In the past ten years, besides
her work as an advanced high school teacher of nature study and
physiology, she taught a Simday school class. In discussing her
engagement, with a woman physician, she exhibited unusual em-
barrassment for a spinster of fifty- two. After her sister's mis-
fortune, she literally mothered the unhappy girl and her child.
Her description of this unfortunate sister revealed a deep sympa-
thy for her.

Throughout the psychosis, when her attention could be held,
she showed fair ability to perform intelligence tests, was always
well oriented and had an excellent memory. Later, when she com-
plained of confusion and inability to think, it was found to be
relative to her failure, to build up a defense for herself, to hide
from herself her sexual cravings. She said, in answer to a ques-

MANIC-DEPRESSIVE PSYCI-IOSES 359

tion about her failure to marry : "MmsU tell jon that? I know
in work of this kind [psychiatric] it is necessary for you to ask
such questions and there is often a physiological reason for a
woman breaking as I did last Sunday morning, because she should
have been married."

After she was admitted to St. Elizabeths Hospital she was
agitated, anxious, wrung her hands, picked at the bed clothes, and
held on to other people desperately. Her facial expression showed
grave anxiety, as if she were under terrific tension, and her
breathing was rapid and heavy. She said, spontaneously, "Oh!
why did you do it? No one can help me. I must work it out,
work it out — work it out — ^work it out — I must work out my own
salvation. I've got to do something. I must work. Everyone is
talking about me. There is nothing for me. My body is full of
poison. I've got to get it out — soak it out."

She almost incessantly sought water "to soak" herself in,
and cathartics to remove this "poison." When in the tub she
made frantic efforts to get her hgad under the ivater. For several
weeks, she also tried numerous schemes to escape, and her beha-
vior suggested that something in her surrov/ndmgs terrified her.
The night following her admission, she dashed to a window and
screamed to the physicians, ' ' Everybody is dying, the whole world
is poisoned." In her efforts to escape, she made numerous as-
saults upon nurses and patients.

Her intense anxiety increased until it became most grave, and
her constant restlessness, general weakness, and great fear looked
ominous. She Seemed to feel that all conversation of the patients,
every word and movement, had a secret meaning which was di-
rected at her. "What do all these people mean?" — ^I don't know
what things mean," etc., were phrases she anxiously repeated to
everyone around her.

She refused to sleep alone in a room because she believed a
man visited it at night, and to protect herself she tried innumera-
ble ways of keeping awake.

She was literally swept off her feet by the sexual upheaval.
This poor, dignified, puritanical lady stood aghast with anxiety
and astonishment at herself. She could not reconcile herself to
accept an attitude of irresponsibility for the strivings of nature,
even though she was a teacher of nature study and physiology.

360 PSYCHOPATHOLOGY

It was not difficult to understand why she thought everybody
was talking about her and the people considered her to be an "im-
moral" woman. Nature did not stop here. Before long, she was
observed to study her abdomen and complain of getting large.
Then came the desperate appeal for help because she felt con-
vinced that she was pregnant. She said she could feel it. (The
erotic cravings were forcing a simulation or imitation of what was
denied them, although at the same time she strove desperately to
eliminate them from being a part of herself.)

For several weeks, she carried about with her sheets of paper
covered with disconnected worda and pencil drawings collected to
prove that she had never had sexual intercourse, and that she
could not be held responsible for her pregnancy, which she now
regarded as absolutely real.

Her behavior was typical of the individual who is desperately
trying to hide a secret. Daily, she anxiously asked the nurses and
physicians if she had talked in her sleep, or if she had said any-
thing that she should not have said. If anyone happened to open
a letter nearby, she begged to know its contents to make sure it was
not about her.

At almost every interview, she consumed a great amount of
time demanding assurances that a woman who had passed her
menopause and had never had sexual relations could not be preg-
nant. "With it would come her insistence, however, that she must
be pregnant, because of the peculiar abdominal sensations. She
was sure she had been made the victim of an " experiment. ' ' Her
fantasies about the nature of the experiment were varied, but the
most persistent were those of "poisons" in the food and the "con-
tinuous bath."

At times, she asked: "What makes me have such fancies?"
but no explanation was convincing. Neither could she understand
the significance of her compulsion to make amorous advances to
the physician, such as trying to touch his hands, get her cheek
against his hand as it lay on the table, slap her abdomen, shift
her body restlessly, smile, make flirtatious glances, etc. Althougfiv
she tried to control herself by holding her hands behind her back
and keeping herself in a rigid position in her chair, within a few
moments she unconsciously would be making advances. The pa-
pers she carried contained numerous coitus and phallic symbols,
such as little half-circles Avith arrowheads entering the convex

MANIC-DEPRESSIVE PSYCHOSES 361

surface, and squares pierced by long, pointed cigar-shaped figures
that originated from two circles, representing the testicles and
penis. Under no circumstances would she discuss the general sub-
ject of the sexual life of woman, and stoutly maintained that, even
though she was a teacher of physiology and nature study, she
laiew nothing of the sexual life "of woman or anytMng!"

I thought an opportunity had arisen when she referred to a
"horrible woman" who had been admitted in a confused state a
day or so after labor. But I was not ingenious enough to influence
her resistance, perhaps because the erotic pressure was too severe.
She usually said: "I don't care what they say, I have never had
an experience, but I think I might have * * * The continuous
bath equalizes blood; there are two kinds of blood, long tedious
wait, birth of a child and rearing of a child." Continuous meant
"on and on and ON!"

The shghtest variation in her clothing, food, walks, nurses,
etc., were suspected of being signs of a plot.

Although brief periods of relaxation and playfulness oc-
curred, the patient's anxiety about gossip and her pregnancy per-
sisted with the same monotonous expressions. Two months after
her admission, during an interview in which we were trying to
unravel the causes of her persistent feelings of having told a "lie"
and having had an "experience," she suddenly wanted to know
whether or not her nephew was suspected of having had improper
relations with her. Without waiting for an answer, she became
frantic at the thought. This association increased her futile, in-
numerable efforts to gather facts to prove that she had never had
a sexual experience. No persuasion or reason could shake the
obsessive fears.

A most unfortunate but unavoidable situation now arose. She
was summoned to court for the crime of being insane and the pros-
pect of a legal inquiry into her sanity (moral record) drove the
patient into a panic. Her persistent sensations of being pregnant
were too real to permit her to consider the sensations and images
as gratifying a wish. She had no way of proving that she had
never had sexual intercourse and in despair she repeated to herself
as she tried to study out a defense : "I don't think the person was
in the room. There is where I got in the lie part. I can never prove
it. I can never prove it. I don't want to go to court--I Avill have
to go tomorrow and I can never prove it. ' '

362 PSYCHOPATHOLOGY

She "would not permit me to see her notes because she was
' ' trying to laake things come out right. ' ' The effort to prove her
morality now became tAvisted into tryingHo prove that she never
said she had had sexual relations with her nephew, fi^^^obsessed
with the feeling that she had admitted such interests! ''"'"^

She became very negativistic and resisted being fed, dressed
or undressed, bathed or entertained, and yet begged for help to
remove the "poison." Her attitude toward the patients and nurses
gradually changed from that of a refined, polite woman to a
combative Amazon who went about pulling women's hair, striking
them in the face and spitting on them. Sometimes she would be
sorry for her behavior and apologize because she could not control
herself.

It was absolutely impossible, it may be repeated, because of
her lifelong prudery, to persuade her to accept the sexual pressure
as a natural part of herself. "Never!" was her answer. This
was not a part of herself. It must be caused by poisons, experi-
ments, etc. She found numerous plots being woven about her
which, however, she never systemMised (hence she is not to be re-
garded as a paranoiac). She seemed to lose her identity, asking,
"Wlio am I? What do all these people mean? What do all these*
signs mean?" (like putting fingers to the nose, rubbing hands, etc.).
She asked in anxious astonishment if now she had to be "every-
body," because she was two or three people. When she struck
and spit on women, it made her feel that she was a man. (The
spitting on women was associated with her striking them and
probably symbolized the male's emission. (This bisexual state
probably was also expressed in the feeling that she was "every-
body.")

About the sixth month after the onset of the illness, she tried
to "represent" everybody and everything as if she were responsi-
ble for the universe. She retained enough judgment to realize the
absurdity of this, but affective cravings compelled her to go on,
and she often became aware of herself trying to "represent" peo-
ple, colors, objects, etc., and work out "meanings" of everything
she heard or saw. She fairly shouted, "I can't explain two peo-
ple coming in at once [as two people passed her in the hall] and
you think I know those things and I don't, because I have had no
experience in that line. [Sexual significance of two people passing
through a doorway.] I never could do anything with numbers.

MANIC-DEPEESSIVB PSYCHOSES

363

Nobody wants mimbers and numbers and NUMBERS! Go on,
forever and ever, continuous bath!"

She had now become God of everything. With horror, she
said: "They say I said I had fifty babies, and [indignantly] I
never had one. I don't represent the loorld! If I could just get
that out of my head. One of these people said that I had to be
every animal in the Avorld." (The fantasy of being every animal,
then going a step further and acting it out, is due to the vigor of
the erotic wish and its polymorphotis striving for gratification.)
She frequently and spontaneously tried to disprove that she
"knew" everybody, or was "greater than God." (The conflict

Pig. 44. — Mother earth as Madonna; goat nursing Hercules; and she-wolf nursing
Eemus and Komulus. (From "Ancient Pharmacy," by Hermann Peters.)

between the ego, the socialized cravings to be estimable, and the
perverse segmental pelvic compulsion is well illustrated by her
attitude.)

By the eighth month, this tendency had changed into quite a
manic type of craving for unlimited potency, and yet she wept at
her impulsive vulgarity and profanity— an interesting contrast to
the perfect manic who abandons herself to the erotic flight with
pleasure. The fifty years of puritanical training and refinement
could not yield so lightly to the erotic flight (showing the influence
of associates in the conflict).

She rubbed and picked her skin like the autoerotic patient, but
denied masturbation. During the erotic period I observed her to

364 PSYCHOPATHOLOGY

grab her finger and, unmistakably, make the mastnrbatory move-
ments of the male, without apparently being aware of it. At the
time, she was talking to me about her inability to understand the
meaning of things. (The resistance to understanding; "the m^^^*x.
ing" always indicates a defense to keep from recognizing certain
attributes of the repressed wishes.)

The tenth month after her admission, she was discharged upon
the request of her sister, and, several months later, was reported
to have recovered and resumed her Avork. She never gained suffi-
cient insight into her condition, but apparently adjusted, as such
cases usually do, upon the subsidence of the erotic pressure.

The sexual upheaval seems to have developed as a desperate
affective struggle to keep her own and her sister's life work intact.
The fancied pregnancy with "long, tedious wait, birth of a child
and rearing of a child" was, it seems, a compensating measure for
the restoration of the deserting boy for which the family had been
sacrificed. During the latter part of her psychosis, the nephew
became twenty-one and joined his father but retained considerable
interest in his aunts, and this enabled the patient to become recon-
ciled to his necessities. Some information was obtained about a
year after she had resumed her work as a teacher, which indicated
that the sexual pressure had not completely subsided and her abil-
ity to work was not up to the old standard.

This refined, prudish woman's frantic anxiety was due to her
compulsion to escape the influence of her sexual cravings which
had become highly aroused at fifty-two. Her psychosis was de-
cidedly characterized by efforts to eliminate the affective cravmg;,
This type of case contrasts definitely Avith that manic type which
has similar affective (sexual) cravings, but abandons itself to the
glories of the erotic flight. A series of these cases is presented
later.

The symptoms of the anxious erotic state, such as scratching,
piclcing, rubbing shin areas, pulling out threads, hair and hits of
skin, rubbing sputum into the skin, hair, clothing or furniture, and
sometimes eating it again, seem to he caused by autoerotic self-
impregnation cravings as is demonstrated by the following cases.

Case MD-2 was a slender, delicate little woman of forty-two,
admitted because of anxiety and depression intensified by hallu-
cinations.

MANIC-DEPRESSIVE PSYCHOSES 365

Her father's sister was "nervous," and her married brother
committed suicide after years of alcoholism and brooding. His
wife was insane.

The patient was a timid, shy, undersized child. She learned
easily at school and later became a capable dressmaker.

She had scarlet fever and typhoid without apparent compli-
cations. Upon her admission she had a rectovaginal fistula.

When three years old, she reacted with undue terror to a
small boy who teased her with a mask. She was found several
hours later asleep behind a barrel where she had hidden.

Because of her smallness and timidity people humored and
petted her, and according to her estimation of herself she became
whimsical and selfish. After several years as a stenographer she
became a dressmaker, which was her occupation until her illness.
As a young woman, she was pretty and enjoyed the admiration of
men, but she was too timid. She was not asked to marry until
thirty-six, and this offer came from an intimate friend of her
brother. The friendliness of her brother for the man apparently
gave her enough assurance to make love.

During the engagement, she was induced to visit an assigna-
tion house several times. Later, her fiance abruptly broke the en-
gagement, left the community, and married. The patient appar-
ently adjusted to this distressing shock, but became very seclusive,
rarely indulging in social functions, and devoted most of her time
to sewing and supporting her mother. The mother became a bur-
den; suffered from a malignant condition of the lungs which fi-
nally terminated in a fatal hemorrhage. The patient was present
at the time, and the experience contributed materially to her psy-
chosis. Because of her mother's age and feebleness, the patient
was forced to devote herself to her care and repress her own crav-
ings for masculine affection and maternity.

After her mother's death, she gave up housekeeping and be-
came an itinerant dressmaker. Her friends regarded her as
"neurasthenic" and "nervous." She complained freely of nu-
merous bodily discomforts, and finally resorted to "electrical
treatment." About this time, she happened to see her old fiance
and talked about his coming back to induce her to renew the en-
gagement.

Her moroseness, brooding and anxiety gradually increased

366 PSYCHOPATHOLOGY

after this, ■until the mood seemed to reach a climax two years later
in a well-defined struggle against strong erotic cravings. Most
of the period of anxiety w^as spent in St. Elizabeths Hospital.

She was sent here because she cried and worried about her-
self, complained of "burning up inside," (a common expression of
feeling erotic), and being choked by accumulations of froth in her
throat. At the time of her admission, menstruation occurred every
two or three weeks, lasting four to five days, accompanied by
slight pelvic pains.

When admitted, she was in accurate touch with everything,
and had considerable insight into her condition. Later, she became
suspicious of certain women, but was never confused or stupid.
Her hallucinations became so vivid that she treated them with the
utmost seriousness as reality.

She complained that her "nerves were all to pieces," and, al-
though she could think clearlj^, she was under a continuous
"strain." "I just imagine someone was after me, but it is only
my imagination. ' ' She complained of numerous disagreeable sen-
sations; such as impleasaut odors, taste of carbolic acid in her
mouth, electricity passing through her body, "qiiivering sensa-
tions" and feelings of "breaking apart," burning up inside, feel-
ings of undue weakness, and stiffness in the back of the head and
neck, sour stomach, etc.

She made friends readily and, because of her coyness, became
a pet on the wards. Her behavior, in a general sense, for the
three years following her admission, was a continuous anxious
struggle with the erotic cravings.

Soon after she was admitted, she was obsessed with the de-
sire to make a confession and, indiscriminately, asked people to
listen to her because she wanted to convince them that she was
"not bad." The pressure of persistent sexual cravings became
apparent soon after her arrival, and her method of adjustment
was an uncompromising battle to free herself from them.

' ' I have a secret to tell you. I know it mil mal?:e me feel bet-
ter to tell someone," she anxiously pleaded. "I have always been
virtuous and have done much church work, so don't think I am
bad. At the sanatorium, they treated me as though I wasn't
moral, and this present trouble is the reaction to that treatment.
[Here she confessed the nature of her relations with her fiance.]
Frequently, I have been under a terrible nervous tension, and.

MANIC-DEPRESSIVE PSYCHOSES 367

when I was thirty-eight, it seemed unbearable, although I am in-
nocent and good, I felt that [sexual cravings] had something to do
with it, and I quit using a syringe." (Here was an indication of
an autoerotie secret trend.)

Such confessions were made promiscuously with apparently
no relief from the obsessive feelings that people considered her
to be immoral. It became clear later that- the cause of such per-
sistent suspicion was due to her irrepressible eroticism. The
desire to make confessions soon changed to reticence and a tend-
ency to be seclusive and resistant. When taken to the dining
room, she would become "too weak" and complain that she could
not eat. She swallowed a portion of her dental plate in order "to
die." Her facial muscles were tensely contracted and she seemed
to be afraid of everybody. For weeks, she secluded herself in bed,
and turned her face to the wall. Here, she would moan and mum-
ble self -denunciations to herself. She passed through a tube-feed-
ing stage at this time and, later, begged to be fed with a spoon, be-
cause she was too weak to feed herself. (Infantile regression.)

She sought attentions, and then became resistant when her re-
quests were about to be attended to, as if she were afraid of her-
self or some ulterior motive. Occasionally, she surprised us by
a queer, timid interest in the dresses of the women, usually saying
something pleasant about them. Several months later, she com-
plained that she had to wear the old clothing of the people and they
wore her good dresses. About a year after her admission, audi-
tory hallucinations became so vivid and persistent that they almost
completely dominated her behavior (a complete dissociation of the
personality had developed). She would never frankly discuss her
hallucinations, but their significance may be inferred from the
answers she would make to them. "You did not, you did not
see me in there. [Eeplying to auditory hallucinations accusing
her of having been somewhere.] I did, I did [shouts], I did not
see the paper. [Groans.] They are trying to make me say [looks
at me and groans] I was not any such thing. You know I was not.
I was not a colored woman, I was not. ' '

"Dr. Kempf, when did I ever meet you?" she begged pitifully.
(Voices accused her of having had clandestine meetings with me
as well as negroes, foreigners, etc., etc. When she was admitted
to my office she resisted because she did not want to be alone in

368 PSYCHOPATI-IOLOGY

a room with, a man. Such attitudes alvays reveal the nature of
the struggling repressed affect.)

"Wliat are they trying to malie me believe? What are they
trying to make me do? I wasn't [gasps ^nth astonishment and
replies to the hallucinations angiily], I wasn't a spy. I was no
such thing. I did no such thing, stop snoring. Oh, Grod ! My con-
science! They are trying to make me say I have been to places
where I have not been." (Later, she said these "places" meant
clandestine meetings with negroes, and living in negro houses.)

At this time, she was too much preoccupied ■\^ith her halluci-
nations to pay attention to my questions. ' ' Oh ! If I could only
prove — [Avails] * * * Three million people are saying [hesi-
tates], they say I am doing wicked things. [Grits her teeth.] My
father knows I am not doing — [does not finish]. This habit of
not saying the last word was a characteristic persistently exhibited
in her statements, showing a striking, perhaps prognostically sig-
nificant, hesitancy aboiTt absolutely giving credence to the halluci-
nations.

Su.ch little remarks as the following, occurring in an attitilde
of extreme anxiety, we thought, were flashes of insight, indicating
that despite the long persistence of the eroticism, and its hallucina-
tory gratification, she would ultimately make, a good recovery.
She ceased wailing and groaning for a moment, and, looking up
A^ith a pleasant little smile, she said, "They say I am talking to the
Devil." (Kef erring to me.)

She continued quiet for a moment, then suddenly again she
began, "Oh! Oh! Tliey are trying to make me say awful things.
Oh — h ! Colored people are trying to make me. Oh ! Doctor ! Hoav
can people throw the voice into me like that and make me say
such things? Don't! Don't! Don't! let me say such things!"
(Begging pitifulh'.) For hours at a time she Avould hold her lips
together to keep from saving this something. (One woman pa-
tient on the ward has frequently tlirust wire through her lips to
join them together so that she could not be made to say things by
"the voices." Another woman on one of my wards bit a hole
through her lip by continually grasping and holding the lip with
her teeth for several months in order to prevent the voices from
making her speak. The latter Avoman made a social recovery.)

At times, the patient had brief rests from hallucinations and

MANIC-DEPRESSIVE PSYCHOSES 369

usually would, quickly become interested in lier surroundings, ask
intelligent questions and then, suddenly, again burst into crying
and protesting about the voices. This condition has coi;tinued for
a period of over four years and varied little, except in intensity, ,
from one day to another.

Details of her complaint are included here to illustrate that,
in her case, the chronic piching of the shin was, in reality, an
aborted form of mastu,rbation, and the picking up of tiny hits of
material and eating them was accompanied hy impregnation fan-
tasies. She picked the skin and scales from her face, neck and
scalp, arms, and hands, and continued this despite all efforts to
prevent it, or to control herself, for over two years. " If I pick this
ear [left], they say I will tell one story, and if I pick this ear
[right], I tell another. Now [seriously], I am not such a fool.
They say, 'Don't pick your ear with your left hand.' Why do they
tell me it is wrong to pick my earl Everybody does such things.
I am not wicked. Do you see what they are saying now? They
say I am in a room behind closed doors. [She was in the office
with me. She almost continually picked at her ear, and fre-
quently picked up little flakes, specks and threads and put them
into her mouth. At times, the picking of threads became so
persistent that she gradually destroyed her clothing.] They
say T did these things. I did not do any such thing. I never
touch myself [masturbation]. Oh, God! I did no such thing."
(Cried.) It should be recalled that she quit using a syringe be-
cause it might have meant something sexual, even though it was
necessary because of the fistula.

In reference to the flakes of skin and small bits of clothing,
etc., she asked the following question: "Why do they say that
these are prizes? You know Avhen I leave here those voices will
say those flakes on the floor come off me. Everything in this
building comes off me. ' ' The voices spoke of the little crusts from
her scalp as being "alive." She would constantly eat them, and
the relationship of the living specks probably had an intimate
association with the talk she heard about having "1,000 children"
and being "1,000 mothers," and "love caused all the troubles."

"Someone says they are going to put flint in what I eat. Gets
you afire [passion]. I wish I could go where it is a cold climate
for this kind of trouble. I don't think you ought to have heat for
this kind of trouble." She often refused to sit on the chair be-
cause it passed "electricity" into her.

370 PSYCHOPATHOLOGY

The. heat of sexual passion, the burning of the body or of the
ear,' the picking of the ear and the eating of the living flakes were
all intimately associated with her intense eroticism and.impir%=-:
nation cra-vings. '

"Oh, God! What do they make me say? [Wept bitterly.] They
say I am colored and am like colored people." A negro did some
janitor work about the house, and she hallucinated accusations of
admitting him to her room. "They" called her "black," "col-
ored," "nigger." "They" took her out of her room at night and
exposed her to. sexual indignities and "put a gown on me and made
me into' ah east." (Cehtauress.) She was fearful of the colored
patients who worked on the ward, and avoided them whenever pos-
sible.

She shouted a reply to the hallucinations: "No, I am not
going into the tombs!" And then to me, wailing, and wringing
her hands in. despair : ' ' They say I am going into the tombs ! I
never had such thoughts lintil that man came into my life. Every-
body has' come to him and put a claim onto me. God knows I am
not a character like that." (Prostituted to every man, to become
the mother of every thing.)

Two and one-half years after admission, she became wretched
because the voices accused her of having caused (wished) the death
of her mother becausje, at the time of her fatal hemorrhage, she
did hot try to save her, although she had removed the blood-clot
from her mother's mouth in order to prevent strangulation.

Bier resistance was usually given expression in the following
manner :

"I never had such thoughts, and can not understand why I
must say them now." Gradually, however, she was induced to
say them despite the horror and anxiety they caused, arid this
seemed toJessen the tension (Cases HD-1, CD-8, CD-9). When
she began to improve, she was given some old clothes to mend.
Three years after admission, she objected, saying that she should
not be given dirty old clothing to mend when they were trying to
get her skin "nice and clean with the baths." (Her skin had grad-
ually been permitted to heal, which was an indication of slowly
waning autoeroticism.)

■ As the pressure of the eroticism decreases, her self-control
increases, and at present (four years after her admission) she is
decidedly more comfortable, neat, industrious, and often cheerful,

MANIC-DEPRESSIVE PSYCHOSES 371

but not altogether free from the hallucinations. Her prognosis
might be excellent if she were economically independent. Her

rig. 45. — "La Pensfee," by Eodin. (By courtesy of Small, Maynard & Co.)
This symbolizes t.lie purity of the soul imprisoned in the body as the rock. (Compare
with "The Centauress," by Eodin, Fig. 46.)

psychosis may be regarded as an erotic gratification, with the
erotic craving dissociated and disowned by the ego.

372

PSYCHOPATHOLOGY

The autoerotic significance of the chronic, coinpulsive skin
picldng and ruhbinrj is even more definitely shorvn in the following
case.

Case MD-3 was an unmarried woman, thirty-six years of age,
who was never able to devote hersolf seriously to any endeavor
because of her unhappy family relations. She has been in an ex-

Pig. 46. — "The t'rutaurosti, " by Bodin. Showing the personality struggling
in despair to escape from the bestial sexuality of the pelvis. This anguish is typical
of unpreventable masturbation in growing and adult males and females. (The pelyis is
also shown as bestial in von Stuck 's "Der Sphinx," Pig. 27.)

trenie state of anxiety, and has, for several months, because of her
eroticism, been wailing and screaming for help, begging piteously
to be saved from hemg locked in a room, or' shut within a (fancied)
stone wall. She tried incessantly to run away, and often smashed

MANIC-DEPRESSIVE PSYCHOSES 373

the windows to malce openings "in the walls" in order to feel more
free. She would stand upon her toes and make rapid jumps into
the air, trying to escape from the rising forces that she felt were
engulfing her. She begged to be transferred to the second floor
"because it was higher up" (again the striving "centauress").
See Fig. 46.

Throughout the first year, she bored holes into her scalp with
her finger. At times, in erotic desperation, she used the rounded
ends of hair pins, etc. Her facial expression, because of the pecu-
liarly contracted miiscles reminded one of the contortions aroused
by the strong scratching or rubbing of an intensely itching patch
of skin. On one occasion, when this boring of holes into her scalp,
with a rotary motion of her finger, became so intense that she had
to be put to bed to control her, she became frenzied "with eroticism.

Another woman, who had rubbed all the hair from her scalp
so that she was perfectly bald, occupied a bed in the same ward.
The patient forced herself into this woman's bed calling her a
"man," and it was with difficiilty that she Avas removed. Then
she began an unusually unbridled, vicious attack upon her own
genitalia, masturbating without restraint and regardless of all the
women on the ward ; stuffing pieces of cloth, and other things, into
her vagina.

The association of skin picking and masturbation cravings
was here clearly shown and we have come, upon further investiga-
tion, to regard undue skin or scalp rubbing and picking as symp-
tomatic of auto eroticism.

The erotic beast that was pulling her down to the perdition
of the fiery pelvis ("the bowl of hell") has incessantly clung to
her for two years. Her strivings to get above it probably deter-
mined the scratching (masturbation) to become shifted as high as
possible (the top of the head), a compromise between the erotic
craving and the desperate compensatory defense to be saved by
the transfer upward.

In her compensatory fancies now, she is "the purest girl in
the world," and says she lives in heaven among the clouds, far
above the "wicked world," and is "destined for brighter skies."

The impulsive smashing out of windows was a wild effort to
free herself from suffocating, restricting sensations as she became
engulfed by the rising tide of eroticism. (See Michelangelo's

374

PSYCHOPATHOLOGY

"Captive" and Eodin's "Centauress.") She pleaded to be saved
from the walls that were closing in upon her, and smashing the
window was an impulsive effort to break through those walls.

Fig. 47. — "A Captive," by Michelangelo. (By courtesy of Small, Maynard &
Co.) Similar in theme to "The Centauress" (Fig. 46) and "La Pens6e" (Fig. 45),
by Eodin. This theme portrays humanity as hopelessly captive to the primitive and
infrahuman ancestry from which it has arisen.

MANIC-DEPRESSIVE PSYCHOSES 375

ig«iu s 'Captive," Fig. 47, is bound tightly about the
chest, and behind him, at his feet, crouches a hideous dog-ape,
his erotic self. Eodin's "Centauress" tries to free herself from
the pelvis like the "purest girl in the world" who can not actually
get free from her autoeroticism.

The significance of rubbing the sputum in the hair, which is
a common compulsion associated with anxiety, was definitely il-
lustrated by an erotic young woman who grabbed at a physician's
genitalia, then spit into her hand and rubbed it into her hair in
almost one movement ; also by many oral erotic men who spit in-
cessantly about the wards, feeling that the mouth contains semen
from a secret assault. (See also Case PD-17 using the sputum
as semen.)

The persistence of the auto erotic tendency after maturity
seems to be caused largely by the sitppressive influence of another
personality who, as the resistance, prevents the love-dffect from
asserting itself freely in corn-petition for the affections of a love
object while the personality is growing up.

Case MD-1 became greatly relieved from the autoerotic pres-
sure of her love as soon as her nephew's attitude assured her that
he, her love-object, was not going to forsake her entirely. It is a
common experience in psychoanalysis that as an altruistic trans-
ference becomes established the patient's erotic affect becomes
diverted to winning the esteem of the analyst — the love object —
through creative work, thereby escaping masturbation. Cases
AN-3 and HD-1 show more distinctly the mechanism of the affect-
ive cravings following an autoerotic course in which the exogenous
resistances to winning a love-object are accepted as insurmount-
able, and yet, also show how the affect tends to abandon th-e auto-
erotic course so soon as an encouraging avenue for heterosexual
striving becomes again apparent through the establishment of a
heterosexual transference.

Case MD-4 is presented because it illustrates how the exog-
enous resistances may become permanently insurmountable. The
world offers not the slightest enticement for this patient to strug-
gle with it again ; hence the affective craving reverts to the auto-
erotic course in which she becomes her owm love-object and remains
fixed, showing no perceptible change in its activity for an indefi-
nite period. (Now nine years.)

376 PSYGHOPATIiOLOGY

Case MD-4 is that of a patient characterized by a chronic
state of anxiety because of auto- and oral-eroticism.

This patient's paternal grandmother was considered to be in-
sane becatise of her temper. Her maternal grandmother's half-
sister was insane; her mother's second cousin killed himself, '^ild
his wife and her mother had "suicidal melancholia." The patient
had one sister who was an opium habitue, a brother who was an
alcoholic, and another brother who was very "nervous."

The patient learned to give herself sexual pleasure when
nine years of age by sitting on the edge of the chair in school.
She was considered to be a bright, affectionate girl by her friends.
At twenty, she became engaged, her engagement lasting five years,
during which time she yielded to her fiance's sexual advances. She
earned a living by doing office and house work. For social and
religious pleasure she sang in a church choir. She said she never
married biit lived a "double life." She did not consider herself
to be a prostitute, but was unable to resist the temptations^of men.

At thirty-nine, she was sent to St. Elizabeths Hospital be-
cause of an anxiety state. Upon admission, her symptoms con-
vinced her physicians that she was pregnant, and full preparations
were made for the labor. In due course of time, the symptoms of
pregnancy proved to be Avish-fulfilling simulations. After a year
or so of anxiety and sexual worries she was . discharged as re-
covered.

At fifty-three, she was readmitted, because of a chronic anxi-
ety state. Her mental capacities were never impaired except for
prolonged, consistent coordinations of attention. She was unable
to keep quiet or relax, and usually paced the floor, wrung her
hands, and bemoaned her troubles as follows : " Oh ! Fate ! Fate !
0, God ! Take me ! This isn't making me any better ! I have ,§0%-:
to go back to the same old thing ! — walking up and down the ward ! '
I can't sit here any longer! I'd like to have the courage to Idll
myself! — ^biit I haven't! I'd rather get well than die! But if I
can't get well, I can't stand this misery! I have been begging
and pleading with them to explain what has happened to me ! And
why this trouble came over me ! Oh, Grod ! I am the sickest pa-
tient in the world ! I am the worst patient in the world ! ' '

She "worried because her salivary secretions were "dried up"
and her menstrual functions had ceased, which, she insisted, was
caused by the mercury she had taken in the form of calomel. She

MANIC-DEPRESSIVE PSYCHOSES 377

complained of not being able to taste food or drink, and that she
had an indescribable sensation in her throat which made her des-
perate and could not be relieved. She shouted profane and obscene
phrases at the top of her voice to get relief, she said, from this
sensation.

About eight months after her admission, she complained bit-
terly of having huo balls of hair in her throat. She said she rolled
up strands of her o^ra hair and swallowed the balls in order to
kill herself, but they would not go down. She insists that they are
sticking in her throat and must be removed even though it neces-
sitates cutting her throat. Careful laryngeal examinations did
not change her complaint, and. she could not be dissuaded from
this conviction.

This incessant anxiety, including the biting of her finger nails,
restless pacing, profanity, and chronic complaints about her miser-
ableness, the dried up secretions and itching throat have continued
for nine years, up to the present time.

When fifty-seven, I made the following observations: She
complained almost constantly about the two balls of hair in her
throat, frequently palpated an enlarged submaxillary gland, which,
she said, was one of the balls, and wanted to have her throat cut
or an operation performed to remove it. She begged to be relieved
of the distressing: sensations in her throat, and seemed to think
that it had something to do with the dual life she had lived. She
spontaneously added that she was sure her troubles could not be
caused by sexual cravings, because she had passed her menopause.
Then she further added that she was in the habit of masturbating
twice nightly ' ' to let the nervousness out ' ' so that she could sleep.

She also brought up her past sexual life and her inability to
resist the temptations of men, adding that, when her menses
stopped (menopause), she felt certain that she was pregnant and
made elaborate preparations for a child (simulation).

The discussion of the above experience, including her regard
for herself as a dual personality, was followed by explanations
of the throat trouble. She said she couldn't control herself and
felt compelled to scream her denunciations of God, and wanted to
know why she shouted : "If I had it I would bite it off !" In the
same hoarse, wailing tone of voice, she followed by saying that she
swallowed pins, nails, glass, sticks, hair, ' ' anything ! ' ' The morn-
ing of the interview, she swallowed a large screw and broke up

378 PSYCHOPATHOLOGY

curtain sticks swallowing the splinters. She did these things,
she said, in order to kill herself ; and tried to make herself ' ' crazy, ' '
since, "Crazy people are happy because they do not know any-
thing. ' '

Her chronic masturbation is utterly uncontrollable, and the
degree of anxiety gives some measure of her inability to- cope with
the situation. The oral cravings are clearly explained in the
phrase: "If I had it I would bite it off," and the swallowing of
hair-balls, sticks, pins, screws, and many other things are com-
pulsions to satisfy the craving with substitutes ; the two hair-balls,
having an oral self -impregnation value.

A similar mechanism of oral impregnation is shown by the
case of a man about thirty-five years of age who had a historj'^
that very strongly indicated oral erotic homosexual practices in
the past and complained that a swollen submaxillary gland was a
testicle put into his throat by the secret religious societies that
persecuted him.

Discussion

In the states of anxiety presented above the individuals of
both sexes tried to eliminate the erotic affective cravings, which,
despite their desperate struggles to control them, produced sen-
sory disturbances that sim/idated the desired object and tended to
satisfy the craving. That this mechanism of simulation occurs in
the dream, delusion, hallucination and fantasy will become evident
as other cases are presented.

The prognosis of anxiety states, due to repressed autoerotic
cravings, is very good as a rule, if the individual's personal in-
terests and economic resources are sufficient to assiire him of a
reasonably attractive living, otherwise the resistances may be too
great for the autoerotic personality to overcome, as in the pro-
tracted case, MD-4.

The autoerotic cravings seem to be enormously reduced when
an altruistic transference is established between the patient and
someone who represents a high degree of social-moral integrity,
particularly a physician or minister.

In the treatment of such cases, the individual's previous rec-
ord as a worker or day-dreamer should be clearly estimated, be-
cause, in proportion as he was previously inclined to obtain hap-
piness throu.gh work, the prognosis is good.

MANIC-DBPEESSIVE PSYCHOSES 379

The nature of the resistance and the isroticism is to be given
the utmost importance in estimating the degree of malignancy of
the affective craving. The more it is bound up with other affective
ties, such as esthetic and nutritional interests (beautiful mother),
the more difficult it becomes for the individual to free himself.
When the object of the autoerotic fancies is the father or mother,
they are, as a rule, much more difficult to readjust than when they
are attached to a sister or brother, and are still easier to readjust
if the fixation is upon a stranger or friend. The patient always
suffers pain when the love-object has to be unconditionally aban-
doned, and quite serious depressions may follow until an adequate
altruistic and esthetic, as well as attractive creative interest, is
established. The degree of shock to be expected from abandoning
the love-object is to be measured by its value to the personality,
i. e., Avhether it is perverse in its attributes or not. It seems that
a sexual object that deserves a halo because of its exquisite, in-
trinsic worth, is far easier to sublimate than one that is associated
with grewsome, disquieting memories, because an inherently beau-
tiful sexual object contains inherently also the wish that the win-
ner of its affections shall become beautiful. Therefore, the lover,
rather than endure the pain of unconditional resignation of his
interests, willingly strives to live so as to become superior in a
field of work which may yet be conducive to mnning the esteem of
the love-object.

Depression Without Anxiety

Another entirely different type of depression occurs, often
as the sequel to the abandoned, erotic flight. These cases are es-
sentially different from the restless, anxious, agitated, striving
types in the attributes of being almost motionless, mute, retarded,
indifferent, dreamy; they must be clothed, nursed, cleansed and
fed. This' is essentially a more or less complete affective regres-
sion to the intrauterine level, in that the affective cravings of the
individual have lost all acquisitive interests in the affairs of every-
day life. Such conditions can be diagnosed almost on sight. The
degree of regression may vary to any infantile level in the same
individual, at different times.

Case MD-5, that of a kindergarten teacher, was an excellent
example of affective regression follo-wdng an erotic flight with
fancies about her father and brother.

380 PSYCHOPATHOLOGY

Her father and an annt were insane.

She was a badly spoiled, willful, stubborn child, and had
many of the self-secluding attributes of the secretly auioerotic
personality. At eighteen, she had a "love affair," and reacted to
its disappointments with a psychosis that lasted six months
(manic-depressive) .

At twenty-three, the second psychosis occurred, lasting nine
months (manic-depressive).

At twenty-eight, the third psychosis lasted one year (manic-
depressive).

At thirty-three, the fourth psychosis lasted two years and six
months (manic-depressive).

At thirty-nine, the fifth psychosis lasted three years and six
months (manic-depressive).

At forty-six, the sixth psychosis lasted two years. During this
psychosis I observed her behavior throughout the erotic striving
(manic phase) and the affective regression to an infantile state
(depressed phase). That she was in an extremely erotic state dur-
ing the first seven months was very obvious from her behavior.
She was incessantly active, trying to bring some event about, •
dressed and undressed herself repeatedly, and was fond of exhib-
iting herself. She talked a great deal aboiit love, heard "false
voices" call her "baby dear," and suddenly attacked a male phy-
sician to show him that she was "innocent." She said his eyes
made her feel excited. She misidentified the woman physician as a
man when she examined the patient's heart, and accused the
woman physician of making her feel "passionate." Masons tried
to initiate her into a secret. She insisted that she Avas "innocent
and pure minded" and ignorant of all sexual things. (Secrets. of
the initiation.) '

.Her father, she said, was the "holiest man on earth" (God),
although he had been "very passionate and cruel" to her mother.
"I never look into the eyes of a man; but a woman, that is differ-
ent." She claimed that she was her brother's wife and the mother
of his child, and denounced her sister-in-law for being a usurper.

After seven months, she became depressed, retarded in
thought, disinterested, mute, had to be clothed and fed, and usu-
ally sat on a radiator cover in the toilet, where, with her head to
one side, she would Avhisper incessantly to herself but would an-

MANIC-DEPRESSIVE PSYCHOSES 381

swer no questions. Quite characteristically, she held some little
object in her hand and sat, mute, dreaming, indifferent. We
seemed unable to change this affective state for eleven months.
Then she developed pneumonia, and following the crisis, began to
show an interest in her treatment. She recovered rapidly and
after a week or so of rather hyperactive interests became "nor-
mal," making her usual adjustment. She would not discuss her
persona! problems and was discharged as "recovered." No doubt
she will again have periods of uncontrollable eroticism.*

During the depressed state, she decidedly renounced all but
the most infantile interests in life, and seems to have made a com-
plete submission to the mother, becoming wholly dependent (in-
fantile) upon her; whereas, during the erotic state, her behavior
and stream of tallc showed that her fantastic amours were woven
about her "holy" father and brother, becoming her mother's rival.
The persistent craving to hold some little object in the hand, such
as food, bread (bread of life), a box, ad infinitum, usually mieans
that the hand symbolises the uterus. (See Rodin's "Hand of
God," as the power that makes the world and life; and also Case
P-1 — perpetual motion machine.)

In order to emphasize that this type of depression, which is
simply and essentially an affective regression, and is not at all
like the anxiety-depression which is due to intolerable eroticism,
the following case is included.

Case MD-6 was a bright, interesting, impulsive sailor of
seventeen who was admitted to St. Elizabeths Hospital three
weeks after his enlistment in the navy.

His mother, an unusually beautiful, girlish, animated woman,
married at eighteen, a man twenty years older. The patient was
her only son, and early showed his heroic attachment to his
beautiful, unhappy mother. His father was lethargic, submis-
sive, impotent, unambitious and, after several years of indiffer-
ence and neglect, the boy's parents separated. In school he was
an indifferent pupil because of the distractions caused by his
discontented parents. Soon after adolescence he insisted upon
leaving school and earning a livelihood for his mother. As a child
he strove to relieve the distresses of his mother by immediately
becoming a man without waiting for the training and growth neces-

*One year later this patient was readmitted in a very erotic condition.

382

PSYGHOPATHOLOGY

sary to make manhood possible. Because of Ms premature manly
attitude and "big" claims, his lack of preparation (inferiorities)
exposed him to merciless teasing from his playmates.

He had all the acquisitive interests of the average healthy

Fig. 48. — "The Hand of God," by Rodin. Insert at top of picture shows "The
Birth of the Greek Vase," by Eodin. (By permission of the Metropolitan Museum
of Art, New York.) Both themes use other parts of the body to symbolize the uterus
and uterine labor. (Compare to "Perpetual Motion," ITig. 51.)

boy, but was decidedly overburdened with his aspiration to be-
come his mother's hero and protector.

The first quite serious depression followed the defeat of an

MANIC-DEPRESSIVE PSYCIIOSES 383

athletic team for -whicli he was manager. He soon readjusted
and enlisted in the navy. His illy substantiated braggadocio,
which compensated for the inferior attributes that retarded the
realization of his heroic ambition, exposed him to numerous chal-
lenges from the other young aspiring heroes and, instead of ad-
mitting his deficiencies, he battled stoutly for all his claims until a
dramatic climax occurred. About a week after his enlistment his
mother happened to step into the training quarters while he was
being surrounded for a hazing. He broke down for a moment and,
like the fable of the Libyan Antaeus in the grasp of Hercules,
sought his mother's support. She, however, chided him to take
his defeat like a man. He seemed to react with keen disappoint-
ment in himself. Within a few days he overcompensated and
claimed to be the most expert fighter, sailor, tree-surgeon, organ-
izer, and champion in the world, challenging everybody to contests.
He rapidly developed and expanded into a hero of unlimited ac-
complishments, sought fights, destroyed things in order to remake
them {a confused effort to overcome a r:esistance) , became an in-
ventor, was noisy, incessantly active and difficult to control. In
this compensatory striving he elevated his family to distinguished
social heights, his father significantly becoming Jesse James, the
robber, and he becoming the pugilists, Jeffries and Jack Johnson.
He damned and challenged eVerybodj'" in his overly compensated
struggle against his inferiorities. During this period he* mastur-
bated heedlessly and was inclined to expose himself. He did not,
however, pass into the extreme manic state.

This compensatory striving lasted about six months. Grad-
ually he quieted down and, by the eighth month, had subsided
into a retarded, disinterested attitude, feeling "sad" and regard-
ing himself to be friendless and neglected (the renunciation of
becoming his mother's hero had begun).

He secluded himself, showed no interest in anyone, and was
utterly indifferent to his mother's visits and conciliatory appeal
to make a man of himself. He became very fat, slept most of the
time and could not be induced to talk. He, however, attended to
his personal needs.

By the twelfth month he began slowly to resume some interest
in the world, and by the fourteenth month had again developed a
"normal" interest. His discharge as "recovered" occurred dur-

384 PSYCHOPATHOLOGY

ing the sixteenth montli. lie never lost contact with his environ-
ment and apparently never was hallucinated.

One year later (age nineteen) he was readmitted because he
was unable to work, felt dull, had headaches and felt no love for
anything. He had tried several positions but was unable to be-
come interested in any of them. When readmitted he explained
that his grandmother could not take care of him and his mother
had to be away from home because of her work. For three months
he remained indifferent, seclusive, unresponsive, and spent most
of his time lying about on settees. This time he was more sullen
and inclined to brood, whereas in his previous depression he was
decidedly sad. His attitude indicated that he was suspicious and
perhaps had auditory, accusatory hallucinations.

By the fourth month he was more willing to work and his af-
fective readjustment progressed without intermission. One year
after his readmission he was again discharged because his work
and general attitude seemed to warrant giving him serious respon-
sibilities.

This boy's acquisitive interests and ambitions are decidedly
guided by the "love" attachment to his mother. She has become
an efficient, independent business woman, and tries to make him
realize that his place in nature is to take care of himself and not
his mother. He, however, is unable to free himself from the crav-
ing to become either his mother's hero and protector, or her nurs-
ling. His inaccessibility and tendency to keep his longing a secret
make his affective difficulties very serious.

The Mechanism of the Manic-Erotic Flight

It seems, and this conception is very helpful in understanding
the behavior of the liappy type of manic adjustment, that in the
manic (erotic) flight the individual enjoys the unrestrained de-
lights of a divine amour with the heavenly love-object of infancy.
(Daughter-father and son-mother.) Wlien the wish for this love-
object is renounced as shameful and incestuous, the individual
deprives himself of the chief source of stimulating energy and in-
spiration for sublimation. The affective attachment to the mother,
ivhen suhlimated, drives him on to become virile and good in
order to create in maturity situations and images which will gratify
the childhood love. When this wisli is renounced or betrayed, life

MANIC-DEPRESSIVE PSYCHOSES 385

becoming an onerous burden, the affections tend to regress to the
state of dependence upon the mother which existed before the
weaning or even before the parturition.

The following cases of divine rapport and erotic flight with
the father's image are presented to illustrate this mechanism more
definitely. The symptoms of this affective state are typical.

The affective craving (erotic) often transcends all resistances,
in a sudden manic flight, when some failure that discourages the
struggle for social esteem occurs and weakens the restraining
Avishes of the personality. The individual quits the struggle of
refining the erotic cravings and, with unrestrained expressions
of delight, abandons himself to the affective flood and the orgy of
fancies and wild, weird self-indulgence.

Case MD-7 was a patient who, during the first three months of
her psychosis, abandoned herself to an almost continuous stream
of vivid auditory, visual, olfactory, tactile, and kinesthetic sen-
sory disturbances Avhich were so vivid as to be accepted as reality
(commonly called hallucinations). Her delusions, hallucinations
and dreams, because of their content, were evidently produced by
the same affective cravings. She was unable to resist a compul-
sion to be incessantly active in her talk and movements, doing in-
numerable things in rapid succession. She was married, twenty-
eight years of age, large, well developed, and in excellent physical
condition. Other than her lactating breasts from nursing a four-
teen-months' old child, her physical examination was negative.

Her family history indicates probable neuropathic deter-
minants. Her paternal grandmother died at forty with convul-
sions during labor. Her sister had convulsions during her last
period of childbirth. Her father was inclined to alcoholism.

The patient is the oldest of six children. She enjoyed ex-
cellent health during her childhood, entered school at six, learned
easily, and finished the eighth grade with her class. She was
bright, and apparently always happy, with the exception of times
when she worried about her father's alcoholism and tried to re-
form him. She always delighted in considering herself to be her
father's favorite, even preceding her mother.

After her school years she worked as a clerk, spending most
of this money for clothes and amusements. She says she had many
"sweethearts," which is probably true, because of her loquacious
personality and good appearance.

386 PSYCHOPATHOLOGY

At nineteen, she married, an unskilled workman of twenty-
five. Despite the fact that she had a quite comfortable home, was
very fond of her social life, desired good clothes, entertainment,
and a married life that would enable her to continue her habits
of living, she married a man whom, for a long period, she did not
admire and was never quite sure that she loved. Her mother
discouraged the marriage because the man was an unambitious, un-
skilled workman. The patient said she realized this and hesitated
for some time, but finally her desires became too strong and she
preferred to overlook his deficiencies. She thought perhaps she
loved him a-njwaj ' ' and would help him to succeed. ' ' Also : "He
was a man who would not become interested in other women," and
one whom she "could control." The latter wishes were probably,
unconsciously, very important determinants of her selection, re-
flecting her difficulties with her own sexual tendencies.

The first two pregnancies resulted in miscarriages. Five
years after marriage, her first child was born. The second child,
which she nursed for fourteen months, until her psychosis, was
born three years later.

Unfortunately, both husband and wife were uninstructed in
sex hygiene. Their sexual desires were uncontrolled and, after the
first two years of nightly intercourse, her husband's powers failed.
This occurred gradually and insidiously. The first two congenial
years were succeeded by disappointment, irritability and unrest.
The patient could not be satisfied with the houses she lived in,
and moved frequently, trying one type of house after- another to
find a comfortable home (symptomatic. of the unsatisfactory hus-
band). She finally openly expressed suspicion of her husband's
fidelity, because of his impotence which she attributed to indif-
ference. She tried to obtain evidence of his infidelity, but could
not. Frequent quarrels occurred and she reacted with repugnance
and hatred for him. She became proud, and sighed for "high
ideals." The husband, she thought, recognized that she had "finer
feelings" than he had. She talked about her sexual difficulties
with her intimate friends who, she thought, encouraged her to
find another man. She said that her "stfong character pre-
vented her from turning out bad"; besides, she "was afraid
of venereal diseases." She felt that her husband was not good
enough for her; that he was a failure, unambitious, lazy. She
took a non-alcoholic proprietary remedy for ' ' female trouble, ' ' but,

-MANIC-UEPIIKSSIVE rSVCIfOSES 387

tlie day before her psychosis began, she took several doses oi' an
alcoholic proprietary remedy.

This craving for sexual gratilieation, and her irritability and
discontent with the now socially imposed unsatisfactory sexual
object, increased, and not knowing how to prevent the excessive
genesis of sexual cravings, her difficulties became serious.

During this period she frequently dreamed of being divorced.
(That this wish prompted her reasoning and acts and much of the
psychosis can be seen throughout her behavior.)

Four years before the psychosis she unknowingly moved next
door to Mr. L — who had been a girlhood "sweetheart." "He
married after I married," she often repeated to assure herself
that he once wished to marry her. She looked for and found many
"signs" that indicated a return of his old love for her. She
convinced herself that his wife was weak like her husband, and
that this man was discontented and desired a separation.

She found many trivial reasons for having him in her house.
He was a plumber. She thought the stove was not suitably placed
in the kitchen and unshed to have it transferred into the dining-
room. Although her husband had previously set up the stove,
she wished to have it done better. She wished Mr. Ij — to set it up.
It is also interesting that she encouraged Mr. L — to visit her,
and, upon one occasion, gave him some lilg bulbs (pure love). She
foun'd many excuses for calling at his store, but, just previous to
the psychosis, he renounced all interest in her.*

The affective craving now quickly overcame the controlling
ego. She charged her husband with infidelity, and wishing to kill
her because of her secret guilt (projection as a defense). She ac-
cused him of openly being negligent, a poor provider, not bath-
ing often enough, of not consulting a physician for his impotence,
etc. She was convinced that she made a mistake when she mar-
ried, just as Mr. L — had made one. She thought a satisfactory
solution could be obtained through tAvo divorces and a remarriage.

Several days before the onset of her psychosis, she told her
mother that Mr. L — ' ' has conquered everything. ' ' A day or so
later, she showed her brother the meager food supply for the table
and complained of starving. That afternoon, while she was play-
ing the piano, she noticed a hearse and funeral passing the house

*Twci years later she admitted that L was the father of her second child.

388 PSYCHOPATHOLOGY

She exclaimed : "Oh, look! Jack [her husband] is dead!" Her
brother stated that previous to this he thought her behavior nor-
mal. Following this incident she became very talkative and dif-
ficult to influence. That night, she lighted up the entire house
and raised all the blinds so "everybody could look in." She
wanted "everybody to see that nothing wrong was going on in her
house." (That she had no secret wishes.)

Within a few hours she was in a tremendous erotic flight.
The next day she was committed to the hospital,

A personality of this type may be thought of by some in a
moralizing sense, but one does not see how it can be understood
from any other than a biological viewpoint. The patient had an
uncontrollable tendency to erotic fancies and erotic cravings which
she did not realize the significance of nor understand how to
control. Because of her inadequate outlet, she became the host
of intense sexual cravings constantly tending to place her in an
environmental situation which might permit tjlaeir gratification.
This was shown, (positively) both by wishing prostitution and
finding the "signs" of discontent and desire in Mr. L — , remar-
riage, etc., and (negatively) by getting rid of the restricting, in-
hibiting influences, through the delusion of her husband's death,
the divorce, and the dreams, and later the hallucination.

The same day that she was admitted to the hospital, she stood
in the street and shouted to the neighbors that L — was her.hus-
b'and and the father of her second child. The reality of this father-
hood was later verified. Her ideas about the pseudo-marriage
were wish-fulfilling.

When brought to the hospital, her sexual cravings dominated
the personality. She was very talkative and happy, rejecting the
unsatisfactory husband as "untrue," "a thief,'' "a tramp," "no
good," "unclean," etc. She had learned this in the past seven
(impotent) years, and now had to leave home "to please God,"
and the hpspital was like "heaven." The positive expressions of
the sexual cravings revealed themselves in the delusion or fantasy
that she "was a bride because everybody treated her so nicely."
"It is God's Will, and God's Will must he done." She frequently
shouted L— 's name, wanting him brought to her because he was
the father of her child and her husband, etc. She persistently
maintained that she would' not remain in the hospital. If the
nurse barred the windows, "Love will find a way." ■

MANIC-DEPRESSIVE PSYCHOSES 389

For the next two montlis, she was unable to accommodate Jier-
self to her surroundings. She had great difficulty in following
out the simple routine of the ward, could not endure the slightest
inhibitions, and her threshold of consciousness for all the extero-
ceptors was so lowered that she constantly reacted to everything
in her environment. She was subjected to an almost continuous
stream of wish-fulfilling, vivid, olfactory, auditory, visual, tactile
and kinesthetic sensory images (hallucinations), and compulsions
to do what the voices said. "What makes this magnetism in my
throat? It feels like it makes my lips move. I don't know what
compels me to say things. It must be Satan. I say it must be
witchcraft — my lips move and speak words that I do not think —
are not — not — what I want to say. Now, that — that fullness comes
in my throat. [Places fingers over larynx.] It wants to say things
I don't mean." (Benign dissociation of the personality.)

She explained many of her sensations, muscular spasms of
the throat and pains in the scalp, through claiming that magnetism,
hypnotism and x-rays were tearing her brains out. "If they have
me strung up on some mechanical thing that makes that — my
father was a good mechanic — he was a good man. * * * There
are two sides to everything. There is a right side and a wrong."
She referred to the persecutory, sexual, or wrong side as "they,"
and the right, defensive side as "my," "myself," the social self,
which wished to do "right," "be honorable," "virtuous," as her
pastor, religion, parents, friends, taiight her to be. At times,
she referred to the persecutions and compulsions as "they," or
as her "inward emotions. ' ' (This case lirought out the mechanism
of the struggle of the ego with the uncontrollable cravings. )

The ego was in constant conflict with the deeper, more unmodi-
fied sexual cravings. The latter were continually forcing her to
be conscious of sensory images which she tried to suppress, dis-
own, or segregate as impersonal, etc. l^Haenever the patient and
physician became en rapport, that is, when the physician was no
longer an exogenous stimulus of the repressive social-moral crav-
ings, the sexual cravings were permitted to seek satisfaction
through the use of very transparent symbolism, and even this
disguise would be flung aside before the patient seemed to be con-
scious of it. Then she usually reacted Math embarrassment, apol-
ogies and pleas for assistance and self-understanding.

390 PSYCHOPATHOLOGY

Because of her numerous psychomotor expressions duriag this
period, only a brief review can be given here. Judging from the
material which was analyzed, every act, phrase of speech and
dream during the entire feriod had a predetermim,ed\ influence.
Such cases convince one that there is no such thing as an unde-
termined, ahsurd, or nonsense expression in a psychosis.

As the patient expressed herself, "I remember all that has
happened since I came here in this building : Visions, dreams, pic-
tures, love, sweethearts of the past, politics, religion, fraternities,
health subjects, opinions of cleanliness, schooldays, music, studies
of people, nations, United States, the government and its di:fferent
branches, inventions, infringements, occupations, growth of chil-
dren, etc."

"I feel as though I am writing for the motion picture authori-
ties or theater managers. [Exhibition cravings. The biological
value of exhibitionism during the mating season in animals is ob-
vious.] I can not understand why this thought appears to me as if
by some unknown source. Politics, faith, organizations, fraternal
orders, music, pictures, beautiful scenery and lovely visions are
continually coming before me." She frequently complained of
posing for the "movies," and being on the stage. She said the
Knights of Columbus — her former physician was a member — and
the Masons showed her their secrets. She said that her father
was a Mason, and seemed to have some very intimate relation with
her. The secrets of the Knights of Columbus were about the birth
of a child, and they would teach her "to get into a corner on the
floor and put her head down like a child coming into the world."
At the same time, she thought she was posing for a moving pic-
ture show. {A secret society's persecutions or influences, when
analysed, seem, invariably, to mean ungratifled cravings for ex-
hibitionism, and the acquisition of sexual experiences.)

Her visions, "moving pictures," were seen on the nearby
buildings. Besides others, slie saw a wedding ceremony visualiz-
ing herself being married to L — . Her husband was seen standing
near, but he seemed to have been divorced. At other times, she
saw herself being married to her physician, pastor, and "many
old sweethearts. ' ' She often saw the images of the pastor, physi-
cian, President, father, brother, and others, in the form of por-
traits. They "smiled very sweetly" and she seemed to be mar^

MANIC-DEPRESSIVE PSYCPIOSES 391

ried to them. She said she had "visions of every young man I
ever kept company with," and usually added, "They can not say
I am not a virtuous girl." The pastor appeared to her and
seemed to be proud of her goodness. She traveled in strange
lands, Alaska, Australia, England, Germany, and others. The
electric lights in the ceiling seemed to be the source of pictures
and magnetic influences. She saw people in the light having sex-
ual intercourse, and hid her head under the mattress. It made her
angry and she scolded and fought at the visions, but could not
avoid them. Shafts of light descended from the electric light and
passed into her. She was sure that it was a form of sexual in-
tercourse. One night "they produced an abortion" and she saw
the "afterbirth in five pieces." She said that her mother had
five girls and one boy. At another time, she gave birth to ten
children.

Voices of "foreigners" shouted at her from the street. They
called her "Violet," and threw white love powders through the
window (vaginal symbol). "They had wonderful odors like the
pines of Australia, menthol, chloroform, or olive oil" (common
semen symbols), which made her sleepy. The voices would say:
"Violet does not love me. Whom does she love? She has beautiful
breasts. I said: 'Go away from me,' and would fight back at
them." Her boy friends, she explained with pleasure, used to
tell her that she had violet-blue eyes. "They" would hang up red
lights on the building (sexual wishes), which made her angry and
she would shout at them to take down the red lights, because they
meant immorality, and hang up blue lights and white lights —
blue for the truth and white for morality (social wishes), or,
at least, hang up blue and white lights with the red (the com-
promise). Throughout the psychosis, its content was the product
of the conflicting sexual cravings and socially conditioned control-
ling compensations.

She frequently remained nude, and was so destructive that
nothing could be kept in her room except a mattress. Everything
else she tore up and tried to remake into something. The mat-
tress, she, at times, thought was a man to have sexual relations
with. At other times, she called it a Masonic chart and, while
lying on it, would have love dreams about her father. She shaped
the "chart" into a bell, and called it the "Liberty BelL" She -
also tried to adjust it in the "tomb of the room," and "pushed

392 PSYCHOPATHOLOGY

it up the hole," the register. Everything she could obtain she
would push into the register, such as blankets, books, papers, etc.,
so that the people upstairs would get them. She complained that
she had to work with great speed. This register she associated
with her lover's work, and laughed explosively when she spoke
of the register as a grave. This tomb (womb) was a symbol in
her fancies like the window. She formed stars with the sheets
and blankets, and "matched and compared blankets." Her fa-
ther often called his children "his stars." She compared herself
with her sisters — as her father's favorite.

During the period of eroticism her psychomotor expressions
through speech, writing, and actions were extremely disconnected,
and followed each other rapidly, showing symbolical, similarity,
contiguity, and sound .associations. She hoarded, with purpose,
numbers of papers and debris "to remake," "create." She read
religious magazines and the Bible, played hymns on the piano
and sang, when permitted. She wrote numerous essays about
"Barrooms and Red-light Districts," "The Struggle Between Vir-
tue and Vice, " " Right and Wrong and Their Victims, ' ' etc. Her
efforts at writing essays illustrated the psychotic' s abortive at-
tempts to keep suppressed the sexual cravings, keeping conscious-
ness free of them through the process of projecting an attack
upon the exogenous temptations of the -sexual cravings, such as
barrooms, red lights, prostitution, etc.

Despite the confusing flood of irrelevant sensory images which
the patient was conscious of, she was oriented, for time, place and
person, and seemed to realize that she was in an abnormal mental
state (benign dissociation neiirosis). Her memory for remote and
recent events was excellent, and she was able to do the intelligence
tests well. When she tried to calculate she had to take consider-
able time, and explained that it was due to her confusion.

A fragment of her stream of talk, which was taken by Dr.
Anita Wihon, is presented, because what at first glance seems a
senseless confiision of phrases, upon analysis reveals all the mo-
tives which caused the dissociation of the personality. The phrases
which a;re -particularly indicative are printed in italics.

Q. "What year is this?"

A. "This is leap year. Everything has a lovg tail irith a
comet to it. I have everything here and they belong to Dr. — . All
those keys, they are all maniacs together. Your hair may be curly,

MANIC-DEPRESSIVE PSYCHOSES 393

but it will he stiff ivhen my fattier gets on the stand. The fathers
and mothers will show the little kids something. Now don't leave
my pastor out." (Parental secrets, childhood sexual curiosity.)

Q. "What month is it?"

^. "I think it is October. [Correct.] I don't know. I only
knoiv the sun, moon and stars. I never saw a calendar. I never
saw the time. Keep them all. I don't care.

' ' My saviour comes to me through my dreams. King George
gives them to me. I went up in a flying machine. He smiles at his
girls. I can see him night and day. That's my husband, George."

Q. What is the day of the month?"

^. "I don't know. Black lip, black tip, any old way. This is
all a silly mess."

Q. "^Vhat place is this?"

A. "I don't know. It is my husband's hospital or it will be.
Someone pulled my hair. I could feel it. [Hallucinates. Looks
at nurse.] Did you do it? Kill me if you want to. He'll send a
light doivn to the grave to warm me from that light over there.
(Probably referred to an electric light from which, at night, beams
entered her body in simulation of sexual intercourse.)

"He loves me. There is my son, my man in the moon, he loves
me. I am not a criminal. You are my sister, one of the sweetest
I ever had. What I have done, I have done for love. I don't ex-
pect it in return. They will have to give it to me if theA' have to
go to hell for it. Red lights, bhie lights, any old lights."

Q. "Are you happy or sad?"

A. "I am happy and sad. A combination. I am happier now
that I have done my duty. I'll live forever and turn into a ivhet-
sfone. Then I'll be crucified and the man will save me because he
loves me. I am not ashamed. ' '

Q. "Why were you brought here?"

A. "To be a monkey, a baboon, anything you choose."

Q. "Were you ever like this before?"

A. "Oh, yes! Many times. They have tried to come between
me and my luck and the right hand and the left' hand, above and
behind. It did make me worried before. I dealt with them ac-
cording to law.* You are one of them [laughs]. Preach for the
war!"

Q. "Is there anything the matter with your mind?"

394 PSYCHOPATHOLOGY

A. "No, my mind is as clear as crystal. They never thougiit-
I acted crazy. I noticed my husband acted queer. I tried to hide
his misdemeanors and wrong acts. I don't like to betray Ms se-
crets. I expected to redeem him. [His impotence.] The pastor
and the President are all my sweethearts [father-image], but my
husband is not to go to Alaska, clothes, furs, wraps, money, right,
right, left, left, between, between, travel, travel, follow, follow, fol-
low."

Q. "Do you sleep well?"

A. "When I feel like it I sleep and when I wake I carry on
hell ! Everything belongs to me, this building and my room. He
just keeps me here for himself " * * * [Prostitution fantasy.]

"I never have a good sleep for I dream all the time. Last
night I sat up all the night looking out of the window watching
moving pictures. They sent Dr. — to purgatory. You are trying
to get my Dr. ■ — away from me, but it'll take more than keys or
string hea/ns.

"There was no vulgarity in any letters that were written to
me. Everyone knows my history. There is nothing crooked about
me, hut they picture all sorts of things [sexual] about me in
these moving pictures. They had me doing acrobatic [sexual]
stunts at the Bureau of Engraving [where her father works] . He
and George too were shooting them for ine. Both of them are
BuSdMsts trying to i/nfringe on other people's patents * * * ."

Q. "Does everyone treat you well?"

A. "No, they treat me like the devil. The nightfall girls, they
steal money at the Bureau. Agnes, who lived with me. They got
me drunk and brought me into the streets. I wasn't happy with my
husband, but I was with someone else."

"I had lots of enemies. I don't know why. Lots of girls were
after George — ^but he loved me best and his ivife couldn't help her-
self * * * .

"They take away my bed and give me a Masonic chart to
sleep on. I have prayed all the time to help them. They are all in
love Avith me * * * Everyone is my sweetheart. ' '

If we analyze the already transparent phrases in italics we
find that the sexual cravings utilize sensory images of her sweet-
hearts, father, and pastor with xmrestrainod promiscuity.

For example :

MANIC-DEPRESSIVE PSYCHOSES 395

"This is leap year," the year in ^vhich women are popularly
said to have the privilege of proposing, or offering themselves as
love-objects; "Everything has a long tail with a comet to it,"
she later said, meant the male genitalia; "I have- everything here
and they belong to Dr. — , all those keys; "Everything" meant
sexual desire and the female genitalia, "Those keys" meant male
genitalia, and "all" expressed her excessive eroticism; "Your
hair may be curly, but it. will be stiff when my father gets on the
stand : " It -will be stiff, etc., has an obvious meaning.

"The fathers and mothers will show the little kids some-
thing," expressed her childhood sexual inquisitiveness. "I only
know the sun, moon and stars," meaning her father, mother, and
their children; a "calendar" and "time" (piece) are sexual sym-
bols. Associated with her sexual desires for her father, she says :
"My Saviour comes to me in my dreams. King George gives them
to me. I went up in a flying machine." Her "Saviour," who
saves her from her erotic discomfort, is King G-eorge. "King"
means ' ' father, ' ' and ' ' George ' ' is the name of the man she wishes
to marry, and who, she insists, is the father of her child.

"They had me doing acrobatic stunts at the Bureau of En-
graving [where her father works]. He and George, too, were
shooting them for me." Here "shooting" is an intercourse sym-
bol. ' ' Both of them are Buddhists, " " Buddhists ' ' being evidently
subconsciously derived by her from "Buddy," her pet name for
her brother, who was also one of her sacred "lovers" contending
for her charms.

"I'll give my brother to his sweetheart." She often asso-
ciated her brother's first name with her lover's last name. She
was also her brother's sweetheart in dreams and in childhood.

"He wants me to put that pencil there for him, too [taking
pencil and putting it on a I'ackJ. He tells me what to do." Such
spontaneous acts are oxpi'ossions of the same motives. From the
context, the pencil and rack have value as sexual symbols (one
object being mechanically the receiver of another is all that seems
to be necessary for such symbolic use when people are erotic).

"Safety-pins and white-ways." Her pastor talked to her
about the safety of leading a white life, and said that she was in
safe hands. "There shall be no patents infringed upon." Her
father had lieen cheated out of a patent. "When asked what she

396 PSYCHOPATHOLOGY

meant by the phrase "keys or string-beans," she langhed and
said she had not been married for nothing, she conld not tell, she
was "too modest." She talked considerably about "Buddhists,"
.although she knew nothing about them. Her associations to
"Buddhists" later were "Buddy," "Brother," "Wilfred,"
"Bud," "Love," "Great Love," * * *

She talked a great deal about a "conflict over religion and
politics," and associated Protestant, Catholic, and Republican to-
gether, explaining the meaning as herself, Protestant; physician.
Catholic; father, Eepublican. With religion and white-ways, she
assaciated politics, red lights, immorality, etc.

She spoke of "nightfall girls" who live crooked lives, prefer
night to day, etc. G. H. was stamped on her bedding. She read
it " C. H. " and said it meant ' ' Charley J — , ' ' her teacher while in
the sixth grade.

Prostitution was shown in the phrases: "To be a monkey, a
baboon, anything you choose," "I'd go anywhere for Jesus," "He
just keeps me here for himself." [She often said that her lover
sent her here.] "I have lots of company and fellows," "I don't
know what they are trying to keep me here for, unless they are
making money on me," and, "The nightfall girls * * * got
me drunk and brought me into the streets. ' '

The desires for exhibitionism were expressed in such phrases
as, "They had me doing acrobatic stunts" and "they picture all
sorts of things about me in the moving pictures."

There was some tendency towards homosexual expression in
her dream of seeing a nurse trying to influence her "to do wrong"
while she was nude.

During the erotic flight, masturbation occurred with little ef-
fort at concealment and, without restraint or shame, she indulged
in unbridled sexual fancies about her father, pastor, brother and
physician, she became, in fancy the "Bride of Christ," married
to "God," and seemed to be wonderfully happy. She luore her
hair long, had a classical "Madonna" countenance, and felt herself
to he a "Heavenly Bride."

During the first three months, she believed that her hallucina-
tions were actual experiences caused by other people and that she
had been "hypnotized," "electrified," "experimented upon," etc.
The persistence and intensity of such sensory images, and their lia-

MANIC-DEPRESSIVE PSYCHOSES 397

hility to recur, diminished iritli the subsiding eroticism.- Gradu-
ally, she learned to doubt their reality, and her sensory disturb-
ances were rather regarded as a "mystery."

During this period she Avas somewhat sad and complained that
the other patients talked about her, persecuted her, and caused her
to have the mysterious feelings. She wished to know if it was pos-
sible to have telepathic communications, etc.

As the activity of the sexual cravings further subsided, she
no longer thought of Mr. L — as her husband but as a lover to be
met in heaven, and again recognized her real husband but dis-
liked him.

Her dreams, she said, were ahvays very beautiful and pleas-
ing. They bore an intimate and striking relation to the hallucina^
tory content. 7/ one studies her dreams as lialhtcinatory sensory
disturbances occurring during sleep, or dormant periods, we may
understand hoiv the same conflicting ^vishes produce halhwina-
tions, delusions and dreams. (This is true for many of the other
cases and a general principle of human behavior.) She dreamed
about her father, that he loved her and would help her. She had
some papers in her hand, and he said: "Don't worry, little daugh-
ter, I will try to get these papers pushed through as quickly as I
can." Upon another occasion, she similarly dreamed that her
physician stood by her bed and talked to her, saying, "Don't
worry, little girl, I'll take care of you." When relating this cir-
cumstance, she further said: " Then I felt a liking for him. Then
I had a feeling for him. ' '

She also dreamed that one of the nurses was trying to in-
fluence her for sexual purposes. At another time, several weeks
after her dissociated state had almost disappeared, she dreamed
that a white hand, a wax figure, like a man whom she did not
know, approached her bed and said, "Peace, little one!" The
person then told her to make the bed. Still later, she dreamed
about her lover but would not tell it because her conscience both-
ered her.

"I dreamed last night that my brother was kissing and caress-
ing me and then led me to meet and be introduced to a gentleman
by the name of Andrews. I also felt the clasp of his hand as he
shook hands with me upon introduction. This was only a dream,
but, upon one occasion, 7 had the pleasure of seeing the vision
of a man with an artificial wax hand, who held a dove in one hand

398 PSYCHOPATHOLOGY

and clasped my hand Avith the other, telling me to go and make
up his bed in a joking, jolly way, then disappearing. When asked
to associate with the wax figure, she replied: "I could not tell
that. It is too ernbarrassing. I might later on. I never did any-
thing wrong [masturbation] . I always assured myself that it was
necessary" [laughing boisterously]. Because the hand was so
frequently associated with the father, and "Peace, little one,"
etc., the masturbation and its fancies were justified as a necessity
and evidently were associated with the "father" fancies.

Her struggles to control herself showed, as she became less
erotic, in her essays, songs and religious-moralizing and attempts
to eradicate sexual temptations. Eeligious music and literature
(working for God and Christianity) seemed to effect the most
adequate affective sublimation through their social-moral satis-
f actoriness as well as constituting an indirect sexual outlet through
striving to please a distant lover, as God, the Heavenly Father of
infancy. Later, she inckided her children in this sublimation, and
dedicated them to the "Glory of the Heavenly Father." This
concentration of the autonomic-affective cravings upon a eertlfel
course of behavior and content of consciousness has also the emo-
tional economy of preventing direct sexual excitation.

This patient made a transference to me and from that time it
was comparatively easy to control her. She rapidly gained in-
sight. "The mystery" of "the experiments" that she had under-
gone (the sensory images forced into consciousness by the af-
fective needs, despite her efforts to inhibit, "block" them out)
rapidly cleared up.

When analyzing some of her visions, the patient asked if I
were a law^'er or congressman, and then added that she believed
I was a lawyer and not a doctor. When asked why she thought
this, she replied that I must be a lawyer gathering evidence to
help her obtain a divorce.

In the above phenomenon, the very active sexual cravings,
striving to acquire an adequate love-object, distorted her concep-
tions of the environment through forcing her to become conscious
of additional sensory images which caused her to perceive her
physician as a lawyer. Through him, the affect could realize an
opportunity for gratification, through divorce and remarriage.

Another example of this mechanism occurred when, during
the analysis, the patient clearly recognized that her difficulty was

MANIC-DEPRESSIVK PSYCHOHKS 399

sexual: her love for Mr. L — , and tlie fact that he was unattainable.
She became very anxious, complained of cardiac pains, and then
hallucinated, visually Mr. L — standing by her. She claimed that
she could see him and said she was relieved to feel that he was so
near. She refused, at this time, to give him up.

When her love was about to he deprived of its object, the
cardiac anxiety, as part of the fear reaction, resulted and had to
he relieved by vivid sensory images of her lover, in which she saiv
and felt his presence, and which she gladly accepted as realities.
{This instance first showed, the value of the hallucination for keep-
ing autonomic segments comfortable.)

We maj^ apply this same interpretation to the psychosis as
a whole. In brief, the sex cravings discarded the unsatisfactory,
Impotent husband. Sensory images ("imaginations") were sup-
plied by the sex cravings to compensate for the acts and words
which Mr. L — would not actually administer. "When, through Mr.
L— 's personal objections to her attentions, he became unattain-
able, a tremendous, uncontrollable, compensatory flight of fancies
occurred which prevented distressing teusions of the autonomic
apparatus. The conflicting cravings caused an acute dissociation
of the personality and the consciousness of a vast stream of sen-
sory images and delusional concepts. These sensory images
seemed to involve all the recent to the remote sensory impressions
of extero- and proprioceptors which, at one time or another, had
played a direct or indirect paft in gratifying her love cravings.

As is usual in such cases, the cravings forced, in more or less
retrogressive order, the recall of all the retained sensory inmges
of the . experiences that might be adequate until the most impres-
sive and fundamental, accessible for reproduction, were reached.
Hence, the array of former lovers and marriages, her ' ' beautiful ' '
love visions and dreams on "the chart," the voice, "Peace, little
one, I will protect you," etc., all associated with the "Heavenly
Father," "minister," "physicians," "President," and "king";
all men as one in that the supreme qualities of one man are always
-sought for in all the men she meets. Thiis is the dominating wish
of the prostitute" s trial and retrial method of seeking for him.

It is a' moral imposition, and biologicaly wrong, to say
that fundamentally we have an "incest complex" determining this
psychosis. The problem of acquiring an adequate stimulus for the
gratification of the sex cravings luas most important. The sensory

400 PSYCHOPATHOLOGY

images and delusional concepts, -which principally made up the
content of consciousness during the dissociated state, Avere forced
into consciousness despite all resistance of the socialized wishes
which are habitually active at the level producing the conscious
reactions of the ego.

The nature of these sensory images showed several interesting
characteristics :

1. That they all, at one time or another, seem to have stim-
ulated sexual cravings or reactions which later became associated
with sexual cravings; in other words, the sexual cravings were
conditioned by definite experiences.

2. The images of sensations, which had been experienced
throughout the developrtient of the personality, were subject to
re-presentation in consciousness, and were utilized by the sexual
cravings to obtain neutralization.

3. The re-presentation seems to have been effected in a more
or less retrogressive order xmtil the sensory images of the early
childhood and infantile period were utilized, which, at one time,
probably caused the most intensive pleasure reactions of the or-
ganism— namely, sensations from the father. (His favorite;
hence, her favorite.)

4. The sense of REALITY of the visions (hcdlucinations) de-
peiided.upon the persistence and intensity of these sensory images.
They were so persistent and intense that the ego could not dif-
ferentiate their reality from the new sensations of the environment
until they could be suppressed from consciousness for periods of
time which were long enough to enable the patient to react to the
functional difference of persistence and vividness between sensory
images and actual sensations of external objects. Then her "vi-
sions," "experiences," etc., became a "mystery" to her, and this
mystery disappeared as she became able to recall the origin of the
sensory images and their cravings through a psychoanalysis.

She was discharged as recovered after four months, the
autonomic-affective cravings having completely resumed their
habitual systems of adjusting themselves and reacting to the en-
vironment. She fully appreciated, accepted in consciousness, her
sexual striving, and has concentrated all her efforts upon religion
and raising her children. It is, however, too much to expect a
personality, biologically so constituted, to endure the meager grati-
fication of her excessive needs as provided Ijy an impotent hus-

MANIC-DEPRESSIVE PSYCHOSES 401

band. She still frankly entertains wishes to discard her obliga-,
tions. Four years since her discharge the family problem remains
unsolved and now she desires a divorce.

This case is typical of a common type of acute benign dissocia-
tion of the personality. The patient's psychosis showed clearly
that hallucinations and dreams are alike in that they both are con-
stituted of sensory images forced into consciousness by the same
suppressed cravings which are striving for gratification. The dif-
ference seems to be entirely one of intensity and duration of oc-
currence. Patients often speak of the varying . intensity of their
hallucinations. This is well known to be characteristic of dreams,
and patients often refer to their hallucinatory states as dream
states. Delitrsions are concepts caused hy the association of wish-
fulfilling though misleading sensory images with new sensations.
Such associations of sensory images and sensations, producing
concepts, are utilised by unshcs to give them a means to attain an
object for gratification. The associated sensory images, in pro-
portion as they are utilized by the cravings or wishes, indicate the
personality's tendency to avoid the realities of its environment.
Cravings strive to discard from the environment, from conscious-
ness, and from the personality all sensations and sensory images
that are not needed to neutralize their uncomfortable tensions;
as in irritability at distractions and controversies, speech de-
fenses, diversions, etc.

The ego succeeds in controlling its undesirable cravings, and
suppressing them from consciousness, by coordinating itself upon
certain common paths of behavior. Such interests only are main-
tained as tend to gratify hy compromise, as a resultant, both the
socialized and sexual cravings of the personality.

"Worries about secret societies, mysterious influences, religious
societies, personal influences, hypnotism, etc., mean that the ego
can not entirely free itself of the influence of undesirable crav-
ings of a sexual nature. Either such undesirable cravings must
find another object or the patient must become conscious of them
through psychoanalysis in order to get rid of the delusion, hal-
lucination, etc. No amount of reasoning or argument, reeducation
or habit formation has the slightest effect upon the struggle of the
repressed affect.

In this erotic (manic) flight, the patient enjoyed, without re-
straint, all the repressed sexual interests of her life, including a

402 PSYCHOPATHOLOGV

divine liaison with.- her "Heavenly Father." She had no difficulty
in finding an excuse for yielding to the "father," whereas the
more catatonic patient (Case CD-2, to be presented later) had
considerable difficulty. Although the latter case ^Iso submitted to
the "father," it was not so glorious a flight, being more of a
crucifixion, with anguish, pain and joy.

This form of psychosis, in which the images of the loved and
hated objects are simulated without restraint, thereby -enabling
the repressed affections to attain thorough gratification, always
has an excellent prognosis for that episode.

As to whether or not another psychosis will follow, depends
largely upon good fortune in acquiring a satisfactory sexual
solution.

The above case (MD-7). consulted me two years after her dis-
charge. She said she had had excellent health, enjoyed work, but
was dissatisfied and needed advice. Her husband continued to de-
liver milk at night, and slept during most of the day. She had no
companionship. He was always tired out, was impotent and indif-
ferent. She .felt incessant cravings for pregnancy and was in-
clined to claim the right of free love. She wanted only the slight-
est justification from a physician for this adjustment and then she
could happily go her way. Such advice, of course, the physician
can not give. He must 'not say "iio" or "yes," because, as a re-
pressive influence, he maij cause a disaster, such as a psychosis or
suicide, and, as an immoral encouragement, he ivould betray the
social obligations -of his profession. It is not an uncommon expe-
rience to have patients, who desire but a hint of medical appro-
bation, bluff and darnn the physician violently for his silence. It
is probable more exasperating to these imfortunate people, be-
cause they feel certain the physician knows what release from
inhibitions they need.

Case MD-8 showed an interestirtg- manic (compensatory) type
of wish-fulfillment which subsided when thie 'love-object Avas re-
acquired.

She was a frail little woman, twenty-nine years of age, 5 ft.
tall and weighed only 81 lbs. Her father was, from her descrip-
tion, a man of great fancies, but provided a meager home. To her,
he was a "man among men" [Godliness].

As a child she was small and delicate, and had only advanced
to the seventh grade when she quit school at seventeen.

She was her father's "pet," and her attachment to him Avas

iMAA'K'-UKPHK^iSIVK I'SVCI lOSIOS 40.'!

probably increased by liis habit of taking lier to bed with him on
"cold" nights. He died when she was fourteen, but she felt no
anxiety because she believed that he had only gone on a journey.
She Avas always addicted to day-dreaming, and colored her
meager comforts Avith rich fantasies of love and happiness. At
twenty, she married. Her husband's name was George Washing-
ton J — .

Her first two children lived, but the next three pregnancies
ended in miscarriages, Avhich probably were largely the result of
her frail physique. Witli the second miscarriage, she was re-
ported to have been "hysterical" for several weeks, in which state
she thought her sister's child was her own. Upon the occasion of
the third miscarriage, she developed a more pronounced psychosis,
in whicli her Avishes Avere better gratified. Her husband had be-
come an alcoholic in the preceding four years. She believed that
he was losing interest in her and secretly freqiienting the "red-
light district." This added consideralily to her anxiety about her
physical Aveakness and greatly influenced the compensation.

She felt that her last infant was not dead, and again tried
to claim her sister's infant as. her oaa'u. She accused her sister
of stealing her infant and, although it Avas tAvo months old, main-
tained that it was but twelve days old and too small for its cloth-
ing. She played that she was a certain famous divorce, a charmer
of men, and dressed in her nine-year-old daughter's clothing. She
said her children had been taken from her by "conjury," other-
wise, the last child would have l^een born on Christmas Day.
Therefore, she was "The Divine Virgin Mary, Mother of the
Christ. Child. " When she opened the Christmas turkey, the intes-
tines looked like snakes, and she cast them out of her house as a
sign that she Avould cast Avickedness out of the Avorld. The day
before Christmas, she saAv a picture of a red devil on the door of
a "Jew store," probably an adA^ertisement, and entering the store
she gave the proprietor a lecture. She said it seemed that she
Avas unable to get away from that store (the devil). The police
sent her to the city hospital. The acute stages of her psy-
chosis lasted about six weeks, during which she liA^ed the char-
acter of "The Virgin Mary" and became the "Queen of Wash-
ington." She carried herself with- ludicrous dignity and compo-
sure for a frail, little, ignorant woman, and with remarkable self-
assurance talked like a ruler of the Avorld. She let her hair hang

404 PSYCHOPATHOLOGY

loose, characteristic of the "Heavenly Bride," sang songs of in-
spiration, such as "Lead Kindly Light," and danced about the
ward, threw open the windows and talked to people (halluci-
nated). She picked out patients on the ward, and gave them
her sisters' names, said her father had destined her to become
the Virgin Mary, recalling that upon his death she felt something
great was in store for her.

While lying in bed, she said five small lights, like "little
wings," (she had five pregnancies) flew around her head, and
the room became brightly illuhiinated. She then felt a "great
change" and thought of the Virgin Mary and her halo. When the
light entered her eyes, she had feelings described as "inspiration
and knowledge," remarking that she had never had a college edu-
cation. It also meant her sins had been forgiven. She spoke of
herself as Mary Magdalene, because of her sexual relations before
her marriage, and named her five children, assuming that all were
alive, after five saints. She was called "The Blessed Mother,"
"Queen of Angels," "Queen of Saints," "Gate of Heaven,"
"Morning Star," "Help of the Wealf," "Eefuge of Sinners," and
was ' ' The Head and Euler of the Universe. ' '

She maintained that she was to be married to "The Presi-
dent" and the King of England. She reasoned it out with great
conviction, as follows: She was to be married to George Wash-
ington (her husband's name was George" Washington J — ), who
was the Father of the Country and the first president, so that
might mean "The President" or it might mean King George of
England. Her next son was to be named George Washington.
She would rule Washington, and therefore desired to be boss of
her ward, starting many fights with the nurses to establish her
position.

The fact that her name was Mary, and her child would have
been born on Christmas Day, was her strongest reason for the
wish-fulfilling conviction that she was "The Divine Mary." Her
husband was not divine, but she had the power to make him divine.
She frequently substituted the word father for husband.

Her fantasies were almost unlimited, as is characteristic of
such compensatory strivings to prevent the anxiety that is caused
by the reality of her inferiority and cravings. An extract from her
essay on flowers illustrates, a strikingly symbolic method of com-
pensating for a distressing physiological inferiority. For some

MANIC-DEPRESSIVE PSYCHOSES 405

time, she felt that "something was ahead" of her and prevented
her husband from being affectionate. She said she vv^anted more
affection than he could give her.

Her fantasy is entitled ' ' The Imaginary Dream of Dreams to
be Outclassed by the Song of Songs. ' ' The synopsis given by her
is as follows: "First of all, I imagine myself among the tall
stately wall flowers. [She was 5 ft. high and weighed 81 lbs.,
and wall flowers, are the neglected girls at the dances.] They
prove a success in some instances. Then, I am attracted by the
buttercup and the daisy, but, almost too quick to realize it, I am
entirely overwhelmed by the forget-me-not [she repeatedly used
the expression 'father-'forgot-me-not'] which shows itself in many
ways: First of all, as it appears in the garden of my dreams,
as two tiny, yet dazzling, young flowers. [She had two stillbirths.
The third fetus was eight months and developed, living for twenty-
three days.] Next, I see it in a vision as a kiss-me-at-the-garden-
gate. It has changed somewhat, but in my dream it is as a lilac
which of tentimes I tries to bud and blossom ahead of Jack Frost.
(Her physical debility thrice wilted her budding flowers, produc-
ing, she thought a consequent indifference in her husband which
rendered her desolate;)

"Now, I am almost awake [reconstituted]. I have June roses
placed before me in many bright colors, but the one I love best
is the pink bud .of the daily rose. The storms of the summer only
fade her to blossom again and again till she is at last a calm,
grand beauty." (Despite the storms that tend to rob her of her
womanhood, she has become the calm, grand beauty that she im-
personates on the wards.) She has effected a satisfactory adjust-
ment, and says: "Now, I fall back and find myself among the
brightest flowers, the gayest, gladdest, the best of all. In my
lonesome pathway are three bright red poppies. They each lift
their bright heads in contrast, but the center poppy, all at once,
takes a notion to leave his brother poppies and flourishes wonder-
fully in the sunlight [the erection of the phallus] till father-fox-
glove [her father attachment] overtakes him in his desperate
struggle to leave his own beautiful garden.

"With all the earnestness of her desire, mother-lily was al-
most too worn out by the chilly blast to welcome her own red poppy
back again. But, as she always trusted father-forget-me-not with
all her treasures, she was quite sure he had some object in trans-

406

PSYCHOPATHOLOGY

planting liis own bright poppy again. So, little by little, mother-
lily opened her petals' until she was almost as bright as ever,"
(With the failure of her husband's affections, she had regressed
to her memories of her dead father for comfort, See Fig. 49, of

Fig. 49. — "Die Hoffnung, " by G. v. Bodenhanseii. Hope as a young woman
standing in the graveyard of buried wishes and memories reaches out for the revival of
life, symbolized by the spring flowers. Compare themes of Aesculapius (Fig. 87) and
Hygeia (Pig. 1).

MANIC-DEPEESSn'E PSYCHOSES 407

Hope in the graveyard yearning for the return of the flowers
and life.

With the onset of her fantastic psychosis, her husband became
very repentant and, literally, he wept and sang Avith her. He was
genuinely sorry for his negligence, and his clumsy, but earnest at-
tentions seemed to induce her to abandon the heavenly compensa-
tion for his neglect and be satisfied again with reality.

She was discharged, apparently, making a satisfactory re-
covery eight weeks after her admission.

In this case the fantasies aaid hallucinations decidedly com-
pensated for her physical defects as well as for the unsatisfactory
mate. In the preceding case (MD-7), of a woman who had all the
physical attributes necessary for a virile maternity, no compen-
satory fantasies for personal physical defects were noted in her
psychosis.

Manic Compensation for Inferior (Perverted) Eroticism

There is another type of manic compensation for eroticism
that is not a simple, pleasing orgy of wish-fulfilling fantasies, but
is decidedly more complex and is a hostile compensation for the
fears caused by tahooed erotic cravings. These cases affect bold-
ness and bluff so vigorously that the physician usually becomes
intimidated and does not recognize the patient's underlying fear.

Case MD-9 is an unmarried woman of sixty, who has for three
years been trying to dominate her environment by claiming to be
"the Lord," "God Almighty," the "King," "President," "Sec-
retary of the Navy," and so on. She proclaims that she is the
maker of a cannon that shoots 6,000 cannon balls which will de-
stroy everything and shoot into the uterus of her physician, who is
a "she devil." She threatens to cut off. anyone's head who comes
near her, damns everybody, and does it with such vicious emphasis
that she makes one feel decidedly like leaving her alone.

With hair flowing, gowa often exhibitionistically adjusted, ex-
ophthalmic stare, stern masculine countenance, mannish voice, and
hypertrichosis, she makes a formidable impression.

At about thirty-four, she -had a serious depression, lasting
seventeen months, following the death of a sister.

At fifty, she had a manic attack, lasting a year. During this
attack, she claimed to be a divine healer, "God," and her own

408 PSYCHOPATHOLOGY

healer, thereby not needing a physician to treat her. She talked
in similar, threatening, monotonous phrases, nsnally repeatiitg
each one six times. She was very suspicions, afraid of poison,
would not bathe herself, and allowed no one to approach or touch
her, or to turn the lights off, etc.

At fifty-four, she had a similar psychosis which lasted about
eight months.

At sixty, she had the fourth attack, and her behavior was de-
cidedly like that of the other manic episodes. During this last
attack, she began as a manic, then she became somewhat depressed,
and then again resumed a manic compensation.

During the manic states, her stern countenance, threatening
demeanor, exophthalmic stare and fear of disrobing or bathing,
betrayed the fact that her erotic cravings were not to be the homo-
sexual aggressor as her behavior on incomplete observation had
suggested. She really wanted to be just the opposite, even though
she talked of performing most gruesome sexual assaults, such as
shooting into the womb of her physician with a cannon and similar
devices. "When her sister or friends visited her, she drove them
from the room because they made her fearful. She said, sternly,
that those who came to her room were Roman Catholics who had;,
come to torture her.

During the erotic state, she was not happy and elated, hut,
fearful of herself, was compensating and combative. When the
truly aggressive homosexual female becomes erotic, she tries to get
in touch with women and endeavors to exhibit herself, and must
therefore be closely guarded and watched to prevent her from
making sexual assaults, like one case, who, while in an erotic aban-
donment, tried to rape her woman-physician. Another homosex-
ually aggressive woman who confessed to having repeatedly "made
love" to a married woman, performing cunnilingus, when admit-
ted to the hospital, because of a state of helpless apathy follow-
ing the death of her paramour, was quite willing to be examined
and had to be watched constantly to prevent her from establishing
herself with the younger women.

The^ fearful patient never shows happiness and joy, and the
happy patient is never fearful The physician must learn to dif-
ferentiate the pseudo-happy, who betray themselves by their tense-
ness and the ease unth which they are offended, from the truly
happy, who are delightful patients even though mischievous.

MANIC-DEPRESSIVE PSYCHOSES 409

The following stern type of threatening pronunciamento is-
sued to the world always means a counter attack to protect the self
from a repressed fear, which, in turn, subsides as the erotic crav-
ings for perverse submissions subside :

"September, October, November, 1915.

"I am the Acknowledged Lord God Almighty, The Supreme
Ruler of the Universe. I am The First Attending Physician of"
* * * * [her name] . This was followed by a long series of re-
peated claims of power and conjugal relations Avith kings and
other prominent men to keep from recognizing her affections for
women. By being her own "attending physician" she could re-
fuse the examinations of the women physicians.

This mechanism of manic compensatory striving is also found
in men.

Case MD-10 was a passenger steamship captain who failed as
a skipper soon after changing command from a freighter to a pas-
senger boat. He was forced to resign, and promptly developed
a compensatory manic psychosis in which he finally transcended
to grandly potent heights, became God, tried to produce and quiet
storms, was a king and made dukes and princes out of his at-
tendants and a castle out of his hospital. He constantly displayed
his physical power and tried to bluff everybody. He became de-
structive, uncontrollable, noisy, had flight of ideas, and was filthy
and erotic. After several months, he became fixed upon a grand
attitude, and since then, for four years, has poured out, in a clas-
sical flight of ideas, an almost incessant pronunciamento to God
and the people.

With hoarse voice, bedraggled appearance and haggard coun-
tenance, he looks upward, towards the right, and talks almost in-
cessantly. This man's behavior was distinctly a compensation
for fear of his cravings, and, thoiigh witty and inclined to laugh,
he was not truly happy, but was trying to hide a disappointment.
He does not like to be touched by men.

The following case (MD-11) thoroughly demonstrated the com-
pensatory value of uncontrolled (manic) religious striving in its
relation to the inferior, homosexual erotic craving. His behavior
also showed the influence of the two great, constant, affective
trends of the personality, the sexual and social, as they struggled
with each other to control the man's behavior. His reaction to

410 PSYCHOPATHOLOGY

men, {fear), was considerably less than in the sea paptain and yet
it Avas quite an evident influence in his behavior. His joy was not
unrestrained, as in the case following this one, and it was evident
that he could not freely associate with men because of the fear
of becoming overtly erotic when too closely approached by them.

No little controversy has arisen since Bleuler's article on
Schizophrenia over the ambivalent value of an individual's fancies.
It seems that they are the accepted resultant of opposing wishes
ajid must, .more or less, satisfy both of the antagonistic cravings ;
as -the. relative vigor of different affective cravings changes, the
fancies and symbols are changed by the affect.

This patient (CaseMD-11) shows the ambivalent value of
symbols and the value of the religious method in combating eroti-
cism. His eroticism seemed to have acquisitive interests in an
enormous variety of objects, and, to protect himself, he cultivated
interests in a large variety of oppo sites.

His personal history up to the time of his psychosis shows
an inability to control his affective cravings. He had one sister
who was "hysterical at times." His parents said he was a
"bright," "good" boy and learned very well in school although
he quit at fifteen because of a conflict with his teacher. He worked
at numerous jobs and finally ran away from home, wandering
through the West doing odd jobs:

At nineteen, he enlisted in the U. S.' Army and eventually was
courtmartialed for selling two rented "Royal" typewriters. He
seemed to fancy the name "Royal." After two years in prison he
was discharged.

While he lived in California, and during his stay in a Cali-
fornia prison, he was considerably influenced by an itinerant mis-
sionary and his wife, who, judging from their letters, were inclined
to fanatical flights of evangelism. ' The patient was very suggesti-
ble, self satisfied, easily excited and' inclined to be seclusive.

A few months after his discharge (at twenty-four) he enlisted
in the Marine Corps and four months later was sent to St. Eliza-
beths Hospital.

His psychosis began rather suddenly and its general nature
continued while in this hospital. He had some feelings of being
persecuted by a corporal. Soon after his admission he had to be
isolated because of his tendency to interfere with everyone and

MANIC-DEPRESSIVE PSYCHOSES 411

upset the routine of the Avard service, furniture, etc. He was vir-
tually in a chronic state of ecstasy which lasted about four months
and gradually shaded off into an attitude of ecstatic letter writing
and mischievousness. About the tenth or eleventh month he
quieted down sufficiently to be paroled.

Unfortunately he could not be induced to review the material
of his psychosis and was inclined to excuse himself Avitli the admis-
sion that he had been "very lively." Mentally, he was quite clear
and capable of doing the intelligence tests whenever he tried.

The preeminent traits of his psychosis are given in the follow-
ing rather detailed account to illustrate the strong autoerotic and
anal erotic cravings which the patient had, and the numerous de-
tails in which they were showm.

In the room in which he was isolated was a dark grey woolen
blanket and a sheet. He tore the dark blanket into shreds, saying
all dark or black things belonged to the devil. He pointed to the
shreds Avith triumphant glee. Although it was rather cold and
snowing, he had destroyed the warm blanket and wrapped himself
up in the sheet. He wore white underwear, and the sheet as a cas-
sock. When I entered he was pounding on the window guard and
shouting something about the "beautiful white snoir."

(From the start he classified almost everything on either the
deA''il's side or God's side and counted the devil's things with his
left hand and God's with his right. Only a few examples can be
given here. White objects belonged to God and black things be-
longed to the devil, and his incessant industry in gathering and
classifjdng such things throughout his excitement indicated the
vigor of the affective forces that he was trying to control.)

God was "first and last and last and first." With this he
pounded on the shutters and stepped from one side of the windows
to the other and explained that there were two parts to the window
and two parts to the first and last. He noticed m}^ head and play-
fully^ shouted: "You have a bald place on one side of your head
and one on the other, that is two." "There are tiro, North Amer-
ica and South America, wliich haA-e ])ocn cut in tAvo. There are
three countries in North America, Canada, United States and
Mexico, but the United States is in betAveen, so there are two
not three." He told of stealing two "gold" dragons and the tA\^o
"Royal" typeAvriters. The gold dragons, he said, lie took home

412 PSYCHOPATHOLOGY

to look at because they represented the devil and he wanted to
show that he was not ashamed to look them in the face. (This
occurred when he was abont nineteen or twenty.) When younger
he wrote "two black hand" letters to "millionaires" to get
money. He spoke repeatedly of "two not three" and always tried
to change things like the three countries in North America to two
in order to get "two not three." The reason for this he explained
in the interview.

The wonders of two were further elaborated in the Son and
Holy Ghost, two testicles, man and woman; and "three" often
was associated Avith "three in one," "God the Father, God the Son
and God the Holy Ghost," "three in one oil," "two testicles and
one made three in one, and if that was piit into a man it made
three in one."

He related a parable. "God sent down the rain to make the
grass green and the cattle ate the grass. This was converted into
beautiful, ivTute milk and people drank the milk. But why do they
raise hlach umbrellas when it rains, isn't that funny? Can you
explain it? The people drink this nice, white milk [spoken with
great ecstacy] and kill the cattle and eat them. Then God turns
this into semen and man puts this semen into woman and they bear
children. Man and womaii, that is two. But the devil tried to
make the man put the semen into another man's mouth or his —
[would not say anus]. That is three in one." (When I entered
the room I noticed a cluster of fecal spots on the corner of the
sheet. They had been made bv the patient covering his finger Avith
the sheet and thrusting the finsrer into his anus. There were no
feces in the room. He slyly tried to hide this sign of his anal
eroticism shortly after I entered.)

The above parable, which this ecstatic prophet related, proved
to contain the secret of his behavior. He was extremely anal erotic
— and autoerotie, and was "fighting the devil," his eroticism.

(Why he wanted everything white and not black (pure and
not erotic) and "two not three" (female and not male) was now
obviously because his anal erotic cravings were forcing him to seek
submission to pederasty. The above data were gained by taking
the trouble to spend an hour or so with him and encouraging him
to talk about whatever he pleased in order to get at his own story
of his troubles.)

A few days later, he demanded a Bible with a "Avhite cover"

MANIC-DEPRESSIVE PSYCHOSES

413

and a "white sailor's suit." He would not wear the black stock-
ings or black slippers and iisnally tried to put both hlacJc slippers
on his left foot. He usually sat with his right leg crossed over his
left and\ said he kept "the devil" under his left foot.

His stories of his struggles with the devil included several
experiences in childhood. When he was a boy he saw the devil wha

Fig. 50. — This man struggled for years witli an uncontrollable eroticism and
finally effected this solution. Dressed in white (purity) with his hands gloved in
white, he is a prophet of the Lord and talks his new religious system to all who will
listen.

was a "great black man," (probably a negro), and frightened, he
ran to his mother for protection. She told him to raise his right
hand to God and God protected him. "Whenever he raised his
right hand the devil could not harm him. The devil had followed
him all his life. When at home "a little nigger, who was a slick,
little devil, just worshipped me and followed me everyv\^here. He

414 rs Y C HOPATHOI.OGY

used to slap me on the back and ask me when I was going to give
him some." (EeferrM to perversions.)

"Black cats and black dogs often ran in front of or behind
me and were devils in disguise * * * The North fought the
South to get rid ol the black, ' ' and when he was stationed in Nor-
folk he was harassed liy negi'oes. With unrestricted expres-
sions of glee he told of how he beat the brains out of a bla,ck snake
when he was a boy. For some time he would go through mystic
movements to keep the crows from coming to the ground. Later
on he spent hours wa-tching the crows and blackbirds and tried
to remove a woman's black furs. He explained that if the devil
got him he would be ruined, but he had saved himself by his un-
bounded religious zeal. This sort of behavior continued for about
four months.

Another physician relates the following experiences with the
patient. The patient stated that during his boyhood days there
was a colored (black) boy who had a rather bad reputation for
engaging in fights and he tried to stab the patient in the back, and
while in California, a colored (black) boy tried to get the patient
to commit sodomistic acts ("stab in back" and sodomy are often
equivalent). When questioned about having done this, the patient
inunediately opened the Bible, which he always carried with him,
and started reading. He refused to discuss the subject directly,
but began a detailed account of the destruction of Sodom and the
transformation of Lot's wife into a pillar of salt.

He said that he came from God and was speaking the voice
of God, and later in the psychosis he became the Christ and his
family became a "wonderful" family.

fie had to be watched constantly to keep from removing his
clothing and running nude aboiat the ward. He spelled most of
the words he used by counting each letter 9f the word with a
touch of the finger to the thumb and numbered each letter accord-
ing to its respective place in the alphabet, such as A-1, B-2, M-13,
X-24, etc. (He had started his letter coimting interests before his
admission and later was considerably influenced but outdone by
Case CD-8.

Two days before I saw the patient he told another physician
(counting the letters on his right hand) that "smart, white and
angel" (five letters each) were God's words and (counting the
five letters on the left hand) that "crazy, black and devil" were the

JIAN'IC-DKPKKSSIVK I'SVCM I ( )SI':S 41')

devil's words. "Wondering'' had nine letters, "three three's,"
the first three were God the Father, Son and Holy Ghost, and the
second three meant ' ' a quail and two cuckoos, ' ' Avhich means ' ' the
penis and two testicles." This shoM^ed that God made man and
breathed the breath of life into him and the l)reath of life was the
semen. The third three were the red, Avhite and blue of the IT. S.
flag. (At this point in his ecstatic explanations he began to re-
move his clothing in his erotic excitement. )

The following are abstracts of a stenogram taken one week af-
ter his admission: "There's God — three little simple letters — ■
that's G-O-D [ecstatically counts letters on right hand]. The
devil says if you have your J-E-S-U-S, I will have my D-E-V-I-L.
And God loves the beautiful birds in the Heavens that fly above.
There's Q-U-A-I-L [counts on the right hand]. Well — the devil
says, if you have your quail that whistles [whistled Bob White four
times] in the lone, beautiful woods of nature, I Avill have my quail
too — that's Q-U-A-I-L [counts on the left hand] — that's sodomy,
sodomy, sodomy. [He often referred to the penis as "quail"].
You remember when Sodom was destroyed 1 Sodom was destroyed
by fire and Lot and his wife and two daughters, three of them al-
together, were fleeing. God said : ' When you flee from that city, '
he said, 'don't look back,' [back, anal interests]. Lot's wife looked
back and she became a pillar of salt, she became white, w-h-i-t-e,
and salt, s-a-l-t. That 2-2 is what f And the devil says if you have
your sugar, s-u-g-a-r, which is w-h-i-t-e, I will have my side, which
is b-1-a-c-k. The devil fights against the white before every side
you take. If you have your little red bird, he says I will have my
red birds too. The red birds means whores — red-light district.
li-E-D and I will ha^'e a b-a-t. ' '

His fascination in counting letters had no limit and the lively
persistence of the tendency, like all such compulsive activities,
showed the tremendous affective pressure behind it.

Upon one occasion he started an interview with a brief dis-
cussion of hands and later returned to it throwing considerable
light on the compulsion to associate his left hand with the devil
and eroticism, and his right hand with God and religion.

"Does God give us these hands for nothing? God gave us
these hands. You see it takes these hands to do the work of the
brain. It takes these haiids to build buildings. It takes these
hands to put on our clothes. Isn't that right? Everything comes

416- PSYCHOPATHOLOGY

right through my hcmds. If my hands were cut off I don't know
wiiat I could do * * * You can't make no children throughly our
hands; you have to [hesitates] that one has to go into one."

(A similar interest in counting was complained of by another
patient who said that he was compelled to count everything,- such
as houses, windows^ trees, words on a page, periods on a page, pic-
tures on the wall, etc., and this followed his fascihatidhfor count-
ing the movements of his hand when masturbating. The palielrt'
(MD-11 ) found an A in the lines of his hands which meant A stood
for Almighty. (The negro (P-1) heterosexually impotent, made
a perpetual motion machine and suspended the apparatus from
a wooden hand, which, he said, created everytfeliig. This might
be equivalent to saying, everything runs through the hands.)

The association of "everything comes right through my
hands" and "you can't make no children through your hands"
indicates the erotic fascination for his hands which he had to
struggle with. Like the "three in one" interests and the promis-
cuous numbering, all go back to autoerotic interests in the male
genitalia, masturbation, and anal eroticism. Oral erotic inter-
ests were shown in the phrase the ^ ' semen is the breath of life ' '
fa phrase used by several patients who swallowed their semen to
restore "the breath of life" while in that peculiar state of erotic
"dying" (Case PN-6).

As to whether this man hallucinated or not is questionable.
He never formed systematic delusions about anyone, but frequently
attacked men whom he felt to have carnal influences over him.

He reconstructed his family into a holy family, his father be-
came God, and he and his brother became Jesus and the Savior.
He wrote numerous letters about this and drew fanciful signs of
crosses, with the word God and his name together. His fancies
about being with God ran as follows :

He said he had been downstairs and picked up two pieces of
ice. He put one down the back of his neck and dropped the other
on the floor. This piece broke into four pieces. The fourth piece
meant "the coming forth of Christ." The piece put down the back
of his neck meant that Christ carried the Cross on his back.

His divine potency was often revealed in fancies like the fol-
lowing: His father used to cut switches from a peach tree and
whip him. He laughingly said this tree died. Then his father
cut switches from a little pear tree and this tree also died. "Then

MAjSriC-DEPKESSIVK J'SVCIIOSHS 417

lie cut switches from a large pear tree and I cut the top out of this
tree and it became loaded with pears." (Laughed.)

Last year there was a great drought. "I went to tlie Pacific
Coast and when I returned to the ^Middle AVest the rain just poui'ed
down. [Laughed.] And this rain produced much gi-ain and
fruit."

"j\[y brother jumped off a hmiber pile which i-epresented a
tree top, and hurt his left foot. Now he steps over his left foot
with his right A\hen he walks. He is a tailor now and an awful
good seAver." He explains this story as follows: "God is repre-
sented by a tree — is a tree — makes the trees. My brother steps
over the left foot with his right. The left is evil, the right means
good. My brother is a fine sewer. Did not Grod 'seAv' the grain?"
The experiences Avith his brother's foot probably cnndilioved the
mannerism of placing the right foot on the left when sitting.

Several Aveeks later, Avhen he attended the clinic,- he stepped
upon the stage, and, picking up a glass of Avater, drank some and
then poured a few drops on the center, large chair, then a fcAv
drops on the right chair, and last, a fcAv on the left. He then
pinned a "gold" (brass) pin on the right side of the middle chair.

He looked into the Bible for tlie "second chapter of the Acts,"
in Avhich he said reference Avas mado to the second coming of
Christ (himself).

To prove that he Avas the Son of God, he asked the people to
let him shoAv hoAv he could "driA-e steel through flesh Avithont
hurt." To demonstrate this, he Avould permit needles to be jabbed
into his tongue or skin Avithout Avincing. "Christ made the Ncav
Testament, the Son. I am the brother to the Christ. Christ is
brother to me — tAvo in one, and three in tAvo, and one in three."
He and his crippled brother, to Avhom he Avas deeply attached,
were Jesus and SaA^or together.

He was the "Star of the East" and fondly signed his aggran-
dized Christian name as folloAvs :

N 0 E LI A N
NaAw-Prison-Royal-]\Iarines-^\.]raighty-Xavy

(No pris-) Armies

(on. )

The first letters of tlie Avords spell XPRMAN and refer to
important experiences decreed liy divine fate.

418 PSYCHOPATHOLOGY

He was never, in a true panic, but inclined to iight and dom-
ineer. He expressed no delusions about his food and gained
■weight. Gradually, after the fourth month, his ecstasy abated,
and he swung back to his normal interests, but was not inclinepl to
discuss them. After sixteen months, he was discharged as recov-
ered sufficiently to take care of himself. Although he was very ap-
preciative for his recovery, his refusal to study his sexual life and
the psychosis, and the fact that it had no reconstructive value, in-
clined us to expect that similar episodes would recur.

The large number of symbols for the erotic cravings asso-
ciated with symbols for the religious social interests are so simple
they need no discussion.

Since this case record was prepared for publication, this pa-
tient has been readmitted (thirty-one months- after discharge).
His general attitude of suspiciousness and smiling, egotistical self-
confidence, and his eccentric convictions, are unchanged. While
serving with the American Expeditionary Forces in France, he
was arrested for refusal to salute when the casket bearing a line
officer passed in funeral procession. Confinement in a guard house
was followed by an erratic counter attack upon military authority,
and desertion. His arrest was followed by a manic episode which
lasted about three months.

Because of the tenseness and combativeness of the above pa-
tient, besides his sensitiveness and inaccessibility, further com-
pensatory erotic strivings are to be expected.

In his autoanal eroticism he did not renounce all self-control
with quite the abandon of the follomng case.

Case MD-12, a Costa Rican boy, eighteen years of age, also
claimed to be God, and tried to destroy everything and remake
it into something more pleasing, as a compensatory reaction to his
eroticism and the additional stress of making himself comfortable
in a strange land. He was never threatening, did not avoid touch-
ing men, but rather persisted in having his arms affectionately
about someone, laughed rapturously, and claimed the whole world
was his.

For two months, he abandoned himself to an analerotic and
masturbation orgy. Nude, he laughed, sang, shouted, destroyed
everything in his room, beckoned for homosexual play to the male
nurses and physicians, dressed himself in shreds of blankets like
a savage, painted the walls, floor, his face, and body with excreta.

MANIC-DEPRESSIVE PSYCHOSES 419

ate his excreta, and with his thumb in his rectum he shouted with
glee that he was God and the whole world. When asked who his
father was,- he shouted, laughing at his wit, ' ' I am no father, I am
everything!" With his finger in his rectum, like the serpent swal-
lowing its tail, he became a complete biological universe in him-
self.

Incessantly active, going at a terrific rate, he lost weight de-'
spite a ravenous appetite — the appetite is an indication that fear
is not active in the psychosis.

By the fourth month, the eroticism had subsided and he made
an excellent recovery without signs of depression. This : boy was
allowed to go the limit, and quickly recovered, whereas, had he
been moralized, bound down, scolded and hampered, he might
never have been able to regain control of himself.

The importance of fear of the influence of the erotic cravings
as the cause of the manic compensation must be recognized, be-
cause such cases are to be quite differently treated. Intelligent
efforts have to be. made to win the patient's confidence in order
that he will recognize what he is fearful of, whereas the happy, in-
dulgent erotic is best semi-isolated and left to do as he pleases.

A man of refinement and extensive business experience, who
was in a wild, combative, noisy (manic) state, naked in his room,
with a"'^'dead line" drawn on the floor, defied all his attendants
and physicians to. approach. They were trying to induce him to
submit to a hypodermic injection. Cursing and raging and sweat-
ing, he paced the floor like a raving tiger at bay. The physician
in charge of the case considered it to be a manic excitement; think-
ing of the patient in Kraepelinian terms he scoffed at the idea that
the man was fearful of an assault.

This attitude continued more or less vigorously for several
days, until a little common sense and patience won the man's confi-
dence, whereupon his attention was successfully directed to the
fact that he had been in a rage because he was frightened, and then
to what was causing his fear.

It seemed that the mere recognition of the fact that the cause
of his fear was within himself, besides the transference to the
physician, helped him to adjust himself within a few days. He
soon showed confidence in his treatment.

The happy, elated, erotic flight gives far better results ivhen
the patient is alloived absolutely free play in order that all his af-

420 PSVCirOPAT]IOLOGY

fective cravings may satisfy themselves, even at any cost to Man-
kets and extra cleaning of floors and walls.

In business, nothing can be done with a man until you allay
his foars and -win his confidence. The same applies to the psycho-
path.

Restatement

There are two distinct types of regression or depression psy-
choses, and tivo distitict types of conipeusation or manic psy-
choses. The distinctive difference in the mechanisms is the affec-
tive complication of fear which is absent in one type and an
important factor in the other type. The type of psycliosis which
is free from fear usually runs the shortest course, is less severe in
its physiological stresses, is less complicated, and, since it does
not distort the affective functions, it offers a better prognosis.

The complication of fear, when it occurs in the manic state,
is shown by the patient's distrust of the treatment, aloofness to
personal contact, eccentric or diminished appetite, and extrava-
gant claims and demonstrations of power (for defense) ; whereas
in the depressed, -anxious patient, almost every unknown thing' in
the environment causes fear of inquiry or seduction. On the other
hand, the psychotic who is not afraid, delights in being touched,
loves attention, has a good appetite, and A\'ill recover from the af-
fective dissociation so soon as the uncontrollable craving is satis-
fied and temptations to live a constructive social life are sufficient
to induce sublimating.

Throughout the cases to be presented one consistent fact is
present: the individual resorts to almost any limit of behavior or
self -mutilation to control the content of consciousness. The des-
perate extent to which such struggles may be carried will be seen
to be the most stril^ing feature of the paranoid type.

In the preceding group of cases the patients were quite well
aware of the wishfulfiUing value of the psychosis and as such the
cases were benign in type.

CHAPTER IX

THE psvchopath:ology of paranoia

As Pernicious Repression Compensation Neurosis; the Particular
Nature of Its Biological Inferiority and the Eccentric Com-
pensatory Struggle to Develop Virility and Win Social
Esteem.

In the chapter on the struggle for viriUti/, (/oodiiess and hap-
piness, the tendency to consider sexual siibmissiveness and de-
pendence as an inferiority A\'as shown to have its origin as far back
in the phylogenetic scale as the higher monkeys. This indicates
hoAv, long ago, the ancestors of the genus Hudio fought and strove
to develop the state of virility. In man the feeling that sexual
perverseness is an intolerable functional inferiority is more or less
prevalent throughout the world but most so among' the Caucasians.

Whenever two individuals compete for social influence, the
superior organs and functions of one individual emphasize the in-
ferior attributes of the other. The sjiecies, race, or clan tends to
support the organically and functionally superior individual, and
tends to neglect the inferior rival because tlic superior, most
often, promises the gratification of society's needs. This is prob-
ably due to the reproductive interests of the species, because only
through maintaining to the utmost the biological potency of Iwtli
sexes is its future secure. It is obvious that this attribute is per-
petuated through inherent transmission liy the individuals of the
species which best meet the struggle. This tendency to conserva-
tion of useful attributes is expressed in the form of dread and
liafred, among the. more civilized peoples, for all tendencies to
incest, masturbation, perversion or biological waste. Therefore,
the individual 'who, liecause of the ]^eculiar nature of bis organic
constitution or the conditionutg of his affective cravings, can
only obtain autonomic-affective potency and comfort through
some perverse indulgence, or who is only potent when invigor-
ated l)y some pervei-se stimulus, is sti-ongly, unshakably felt to be

421

422 PSYCHOPATHOLOGY

inferior, and he himself can not escape the feeling of being racially-
inferior.

The feeling of being inferior seems to be ineradicable so long
as a potentially uncontrollable tendency to vary from the biolog-
ical demands of the race exists within the personality. The psy-
chosis varies according to the manner of the individual's efforts,
to free himself or herself of the inferiority, and the manner in
which he strives to compensate in order to attain sexual potency
and social esteem. The efforts to compensate vary according to
the life long influence of the individual's associates. Many sexu-
ally abnormal and organically inferior individuals are quite com-
fortable so long as they associate Avith similar types of people and
avoid competing with sexually normal people.

The painful influence of organic inferiorities, such as being
hairless, effeminate, soprano voiced, sexually undersized in males,
in the struggle for social esteem and personal influence is obvious
to any sophisticated adult. In this chapter organically normal
but affectively inferior types will be given most consideration, be-
cause it is obvious that the organically inferior, if also affectively
inferior, must have a more severe struggle.

The nature of the sexual inferiority and mechanism of com-
pensation is brought out in each case. It may be" well to add that
the convictions expressed herein are not based solely upon the
cases which are presented, but upon the examination and intimate
study of nearly two thousand males and females, of nearly every
educational level and vocational interest, and from most of the
races that immigrate to this country. The nature of the individ-
ual's inferiority and manner of compensating has also been inves-
tigated in the various developmental stages from infancy to senil-
ity, under quite an extensive variety of social influences.

The paranoiac, who crystallized the converging data which
were rapidly accumulating, will be presented ' first, because his
"perpetual motion" machine symbolizes and reveals' his functional
inferiority and the protective compensation in one creation. To
this case are added the remarkably similar, but more tragic, strug-
gle of another ignorant negro, and the strivings of an American
college graduate, and an American sailor.

Because of the variations this inferiority may assume, it is
necessary to follow these cases with a comprehensive variety of
cases so that the physician and psychologist may learn to know

PSYCHOPATHOLOGY OF PAKANOIA 423

what the eccentric variations may mean after he has learned to
recognize them in his practice.

This patient (P-1), noAv in St. Elizabeths Hospital, is a tall,
slender, rather clever, bnt imedncated, light skinned negro, abont
forty-one years of age. He has an effeminate, conciliatory man-
ner of speaking. There is no history of insanity in his ances-
try. His education consisted of sfeveral years, each of a few
months, in a country school, and what information he was able
to acquire from newspapers, current magazines, the Bible and a
few books.

Gonorrhea was the only serious disease he acquired after he
became an adult.

"When the patient was twenty, his father, Avho was a minister,
died, and it devolved upon him to raise his 3''ounger sisters with
his mother. He talked of this work with considerable pride, and its
influence formed an important part of the material of his psycho-
sis. (He believed that he had successfully raised his father's
children, that they had married happily, and in his psychosis he
felt that he could elevate the negro race out of its lowly social
position.)

At the age of twenty-five he married a very light mulatto of
nineteen. The negro traits Avere so little in evidence that she
could have easily passed as a Caucasian. She was a bright, ener-
getic woman, inclined to accommodate herself to all of her hus-
band's dominations. "I had to obey him as if I was a child," she
said. She had two miscarriages during the early years of their
marriage. Aside from this, she never Avas pregnant.

His work, after his marriage, was mostly that of doing odd
jobs until several years ago when he became the janitor of a thea-
tre. His employer, who Avas a Jcav, became an important figure in
his psychosis.

He only occasionally drank liquors until about one year before
his first, admission. During this last year, he drank excessively,
and, because of his inefficiency, lost his position as janitor.

As a personality, during the early years of his marriage, he
was kindly disposed and rather suggestible, but suspicious and
inclined to be jealous. He was a good provider, but a poor saver.
He had no close friends of his OAvn sex. His wife said "he Avould
turn on the men" when they came to Adsit him in his home. When
drinking, he associated with men. He was always jealous of his

424 PSYCHOPATH OLOGY

Avife, and objected to the least attention she gave men. Years
after the incident occurred, he denounced her for giving his
brother a kiss of welcome Avhen he came to their house for a visit.
This jealousy became more marked in the last two years, and fre-
quently Avhile drunk he abused and struck his wife.

During the years in Avhich he so jealously watched his wife
to prevent her from being unfaithful, he secretly visited other
Avomen.

The onset of his troubles, the patient says, occurred suddenly.
But, this complaint dates about a Aveek after he had completed his
"tabernacle." lie says it began Avhile he Avas trying to have in-
tercourse Avith his Avife; lie felt a "live substance" Avithin his
Avife. It AA^as "a man child" and "snatched" his penis and "bent
it" and took his "poAver" from him; but the latter was due, ho
added, to his "run-doA\m condition." A feAV minutes later, "vi-
sions came." He saAv that his Avife had been AA-ith a man, his former
employer (the JeAv), and he accused her of it. Because of his ex-
citement at this time he had to be sent to a city hospital.

Among his visions, about Avhich he AA-as at first extremely cau-
tious, he saAv a snake on a square rock aiid killed it l:)y throwdng
a stone at it, and (Avith emphasis) he "cut its head clean off."
(Destruction of sexual temptation.) Then smoke and fire came
out of it and the smoke frightened him as it floated upAvard around
him.

Unfortunately, an account of his behaAdor Avhile in the hos-
pital on this occasion is not obtainable, except that he was diffi-
cult to manage, had seA^eral fights, and resisted AA^hen baths Avere
administered to him. He Avas discharged after eight days upon his
promise of good behaAdor. He gradually became more egotistical
and dignified in manner, dressed in a ministerial garb, and
wore a broad black felt hat. He carried himself Avith an atti-
tude of exaggerated self-importance, was overbearing in contro-
versies, defiant, sensitive and dictatorial. He eanphasized his
discussions with quotations from the Bible and later developed
the habit of giving numerous references to books, chapters,
and verses of the Bible Avith an atmosphere of authority and
benevolent tolerance for anyone Avho appeared to be ignorant of
the meaning of his references. He impressed one as being ex-
tremely sensitive about something and yet Avell pleased Avith his
superiority and the grand compensation he had effected.

PSYCHOPATHOLOGY OF PATtANOIA 42.")

lit' accused his ^vil'o of liavin"' soci-etly liad two illcf^itimatc
children while he was confined in the hospital the first time. One
child was black and he was the father of it, but the other was white
and the son of his Hebrew employer. These children Avere dis-
posed of secretly, but one Avas to become Jesus Christ. He kept
a record of his wife's time Avhile at work away from the house.
When she failed to return from her Avork at a certain hour, he ac-
cused her of infidelity and later he accused her of keeping secret
relations Avith her landlord, the President, etc. He often blamed
her for his oayu difficulties and repeated tliat she had taken all Ms-
powers from him by taking "the blood" out of him. This com-
plaint, at times, he Avordcd differently, stating that AA'hen he had
intercourse Avith her he came in contact A\'ith "something alive "
and that he "found strange blood" and this took his power. (For
a year or so before the sloAvly develoiiing paranoid attitude had
reached an asocial degree, he had become impotent — that is, could
not perform the sexual act satisfactorily to himself, and most of
the time not at all. This developed gradually and seemed to be
closely related to his irritability and increasing haughtiness.) His
wife states that he had ahvays been "very ciuick." She has main-
tained that no abnormal practices occurred. The history of the
patient's impotence Avas not obtained until the second admission.
He had completely coAved her into secrecy and made her promise
to reveal nothing about their sexual difficulties.

As a patient, he was defiant, arrogant and sensitive about dis-
cussing his personal difficulties, but upon encouragement he re-
vealed that he considered himself to 1)e a prophet, directed by God,
to teach the Gospel and build a model of the "tabernacle" Avhich
Avas also "perpetual motion." He intrenched himself in the Bible
and projected a chronic attaclf upon the immorality of the Gen-
tiles. The feAv ideas that he confided to us indicated that he had
elaborately systematized delusions about the practice of circum-
cision by the JeAA^s, Avhich seemed to have a profound significance
to him, and in the interim l)etween liis first and second admissions
he had himself circumcised.

He arrogantly insisted that no one had the right to ask him
about his affairs, and warned the examiner about the danger of
asking too many questions.

Like all paranoiacs, he consistently liated anyone Avho at-

426 PSYGHOPATHOLOGY

tempted to question him about anything that might lead to infor-
mation about his deficiencies or errors, but promptly became fond
of anyone who would listen to his fancies about his potential deeds
of the future. For such unhappy, tense, striving individuals,
every hint of giving esteem or recognition of their efforts as a
social necessity to the herd is ravenously accepted. It seems to
relieve that profoundly fixed, unmodifiable feeling that they are
inferior to their fello~WTnen.

The only hallucinatory experiences admitted by the patient
were always consistently limited to that of having had a vision of
a serpent on a rock which he killed and which appeared again, and
the auditory experience of hearing God's voice tell him to build
"the first tabernacle."

He never expressed ideas of being hypnotized or under the
influence of anyone. He was, however, inclined to be uneasy at
night, but adroitly concealed this. He did not seem to worry
about having his food poisoned. While in the hospital, he tended
to isolate himself, and complained of being annoyed by the attend-
ants. He always carried his Bible and enjoyed being seen with
it. On the whole, he was easily managed if his wisdom and pro-
phetic knowledge were not questioned.

His fancies about being the prophet of a new religion, and
probably being a second Christ or Father of Christ were highly
elahorated and almost inexhaustible. Some of his arguments to
prove this were like the following: When he became guardian of
his father's minors he lost his father's pension certificate, and the
new pension certificate had for its last three numbers "666."
"This number can l^e found in the Bible, Revelations, 13th chapter,
18th verse." ("Here is msdom. Let him that understand et^i
count the number of the beast : for it is the number of the man ;
and his number is Six hundred threescore and six.")

He claimed the distinction of being the only man that had built
a correct model of the tabernacle, and that its dimensions had been
revealed to him by a young priest. He said his revelations were
inspirations to him, and he absolutely pinned his faith on God's
wisdom which was "different than man's wisdom."

This "tabernacle" was "the first church, perpetual motion,"
which is "the force" that makes the world move, that mingles
the blood of the races, and referred to the mingling of the blood of
the white and black races. (One of his grandfathers was white.

PSYCHOPATHOLOGY OF PARANOIA 427

his wife had well-marked Caucasian traits, and he believed" that a
Jew was the father of an illegitimate child by her.) His discus-
sions of this ^"sp-called tabernacle were difficult to follow. He
strongly maintained that he had no preconceived idea of what he
was doing, but was compelled to- build it according to ' ' revela-
tions." When he discussed this creation, he used the following
phrases: "Wisdom has built her foundations. She has builded
her seven pillars. She has mingled her urine. She has killed her
beasts — my father said, 'My son, I can not do that without re-
course to my mother.' " "My" was a misplacement for "your"
mother, and in this instance indicated Ms incestuous attachment.

During an examination, he showed a photograph of this ' ' tab-
ernacle," which he had taken for publication. The model is. shown
standing in a room, and on the Avail on the right side was hung a
large picture of his mother, and on the left, a similar type of pic-
ture of himself. (It should be noted that his "perpetual motion"
was placed between himself and his mother, and one should recall
the above error of "recourse to my mother.")

A detailed description of the machine which I had the oppor-
tunity to examine would be tedious, but the principal features of
its mechanism will be described here, because they revealed the
man's affective difficulties, what he unconsciously strived to at-
tain, and the machine's biological significance. In building what
was "revealed" to him, he unconsciously constructed and substi-
tuted an image of the very biological qualities that he had func-
tionally failed to develop.

In other words, this creation or "model," and his psychosis
was the goal of an aborted biological career, some of the deter-
minants of which had their sources in his early life, far deeper
than the levels of activity of which he would ever again likely be-
come aware.

The "model" (see Fig. 51) about 5 ft. high is constructed of
pine boards, pieces of boxes, cast-off spiral springs, a lamp oil
container, and other like material which he had gathered from va-
cant lots and alleys. It consists of two large compartments — name-
ly, a large square frame (A) upon which is erected a pyramidal
frame (B). From the apex of the interior of this pyramid is sus-
pended a "hand" or "arm" (1) which he whittled out of pine. To
this "hand" is attached a long, coiled spring (2) which holds up a
vessel (3) which was at one time the oil container of a lamp. The

428

PSYCHOPATI-IOLOGY

Fig. 51. — Copulation, f eticli by impotent negro paranoiac. He said lie was in-
Kpired by God to build "the flrst church" -or "perpetual motion." A, pyramidal
frame; ,B, square frame; 1, hand; 2, long, coiled spring; 3, oil lamp; 4, sand bags;
5, horizontal board ; 6, bed spring; 7, lever; S, wlu-el; 9, "chorubs. "

rSYC'Il()l'ATll()I.()(iV Ob' I'AIIANOIA 42!)

lower end of this y('ss(4 is attached to a horizontal lioard (5) and
this board rests upon two old l)ed springs (6). AVhen this board
(5) is pressed doAvn it stretohos the long spring alcove and com-
presses the l)ed springs underneatli ; lience it is bobbed u]) and down
for a short while from one jmsli oC the hand. To keep tiie inachiiie
at rest, he fancies that it is necessary to weight the board (5) with
two liags of sand (4) wliich he removes in order to operate the ma-
chine.

Several other springs are fastened to various parts of the
rcpiare frame, and they ccmtribute to tlie "perpetual motion." Two
other features of interest are the "four cherubs" (9) and the four
"wheels within wheels" (8) which are inside the square frame.
A cherub Avas made out of a broomstick with a hole bored through
the upper end. A piece of rope was passed through the hole and
both ends wound once in the same direction around the stick, and
then tied to th(> opposite ends of a horizontal board. The broom-
stick ran through a hole in the center of this board, and the board
itself is made to slide up and clown the stick liy the springs. Eais-
ing and lowering tlie board would slightly wind and unwind tlie
rope and cause the stick to bore slightly. The winding of the rope
was not mechanically correct to make tlie stick revolve, but the
attempt had the same value. He said he obtained the idea of the
"cherubs" when he was sixteen years old. A cousin taught him
how to bore holes in bricks. He commented : "I made up my mind
then that if perpetual motion ever came, it was to come that way."
He would give no inkling- of whei-c he had obtained the name
"cherub," but tried to give the impression that it was a revela-
tion (heavenly infant).

The mysterious "wheels within wheels" were solid, clumsy
structures of wood. The tA\o inner wheels were cross sections of a
barber's pole and still showed red and aluminum stripes. He
called these the "American Glory." The wheels were revolved
slightly by large levers (7) that were attached to the horizontal
board (5).

He pointed to the interior of the scpiare frame and remarked
that here "the blood of the world is mixed." When I asked to
be shoA\Ti more definitely where it occurred, he avoided an answei'
and smiled at my stupidity.

To return to the significant oil can suspended from the long
spring, he said that it was "the manna — it came to me to put sand

430 PSYCHOPATI-IOLOGY

into it, ' ' and he told of his pleasure in watching the sand ran out
as the "perpetual motion" made the "manna" move up and doAvn.
He also spoke of the sand as the "manna."

When the picture of this "perpetual motion" machine with
the pictures of himself and mother was shown and described by
him, the diagnosis of heterosexual impotence with striving to com-
pensate was made, although the foregoing information about his
sexual life had not yet been, obtained because of his resistance.
Later the diagnosis proved to be correct. It was based upon the
following interpretation of the behavioristic symptoms which were
"inspired," that is, compelled by the affections in their struggle
to find a solution of their needs.

The "manna," which is a divinely given food in the Bible, he
made to pour out of the can as it moved up and doAvn, on the end
of the long spring, inside of the pyramidal space. This is sym-
bolic of the semen emitting from the glang penis while in the mo-
tions of copulation. He called the emission "manna" (holy or
divinely bestowed food), which reveals the unconscious pleasure
he derived from the crude symbolization of his nursling oral erotic
hunger. Several of iny cases treated their oral eroticism with
most fervent religious ecstasy. This is the grand compensation
for, a most serious biological inferiority. The constant pressure
of his homosexual cravings are the cause of a constant fear that
he might be considered a degenerate; hence, the eccentric striv-
ing to be acclaimed as great. The pyramidal frame in which the
"manna" etc. (penis) moves is the vagina, and the large square
frame beneath it, in which the "cherubs" and "wheels within
wheels" work and the "blood of the world is mingled," is the
uterus. The hand, which he spoke of as the power that made every-
thing, significantly holds the spring and the emitting can which sug-
gestively associates with masturbation. The "manna" and oral
erotic cravings recall Freud's grouping of the food hunger and the
earliest and most important zones for the soothing of love cravings
of the infant to be in the mouth.

The two bags of sand, which he placed on the machine as
weights to keep it quiet and removed in order that the machine
might run, were made with extra labor. When I asked why he
did not use bricks or stones as weights, he replied that he had to
make it as it was "revealed" to him. If one follows the lead from
sand in the container, then the sand in the bag becomes manna, or

PSYCHOPATHOLOGY OF PARANOIA 431

semen, and the substitution value of two bags of sand as testicles
completes the generic significance of the "first tabernacle."

The patient would not accept this archaic model of his own
sexual functions in this light, because that would destroy his ritual
and compensation. He has enshrouded it with an atmosphere of
sanctified mystery. To remove this archaic mystery would deprive
him of all his means of defense, evasion and compensation.- So
long as the paranoiac deals with his sexual troubles in religious
terms, he may talk freely ; he may even, with the ignorant, develop
in them an attitude of awe which gives him at least a social sense
of potency as a personal influence. His wife believed in his pro-
phetic powers and the wonderful machine for some time. He hates
me for pointing out its sexual significance.

The defensive value of the paranoiac 's grand fancies may be
further illustrated in the case of a well-trained physician, who,
after several periods of excitement and panic, finally distorted,
in his effort to establish himself comfortably, everything he
heard or saw, in order to place himself in an awe-inspiring, om-
nipotent light. He called all the people about him Caesars, Cic-
eros, kings, philosophers, etc., and addressed them as such with
most gracious, princely bows and greetings to express his admira-
tion. But, in turn, he demanded to be recognized as Napoleon, and
dressed accordingly. He wrote a language, at immense cost of
time and labor, which he would have the world adopt. This lan-
guage would malie him the premier thinker of his time. He ac-
quired several magnets and induction coils with which he worked
by the hour to send telepathic messages and direct the affairs
of the world. These most extravagant efforts at establishing his
place in the sun really isolated him, because no one could se-
riously consider his fancies. To this he accommodated by simply
maintaining that his associates were too stupid to understand him.
Nevertheless, so long as he could keep himself believing that what
he upheld was reality, he was safe from his homosexual submission
cravings.

The above negro maintained that there were "two kinds of
wisdom," God's and Man's. The wisdom of Man was worldly
and did not understand the revelations. His wisdom was Ood's,
therefore, sv/perior to Man's.

That he was afraid of homosexual cravings is indicated by his
effeminate traits, and is supported by the fact that he had culti-

432 rSYCTTOPATirOLOGY

vated no male friends, but rather, as his ^vif e put it, would turn
on a man so soon as they became friendly. His responses to his
male associates could not be endured when friendliness was too
freely shown. Always in tlie background of his mind lurked a
fear, a distrust of men, a subconscious fear of his own weakness.
The mental dissociation (hallucinations) and tendency to panic
depended upon the intenseness of the homosexual cravings.

When I saw "the model,''' he had it covered with, a white
(purity) cloth, and on it were tacked several large pieces of card-
board. One piece was the discarded cover of a writing pad on
which was printed in large type the words, "LEGAL CAP — EX-
TEA FINE." A newspaper abstract of Lincoln's Gettysburg
address and a long sheet of legal cap covered with written
quotations from the Bible were also tacked on the model. He dis-
played it with great pride, and explained its nature with consid-
erable tremor of the facial muscles (symptomatic of great affec-
tive pressure).

The air of profound religious mystery with which he on-
shrouded the whole effort had quite convinced his wife that her
Imsband had performed a wonderful deed. The great, amount of
noise and motion from so little effort was sufficient to itJiake her
believe in "the perpetual motion." But the religious fervor of
her husband was beyond her understanding, and she was inclined
to warn him against his overenthusiastic demonstrations. His
sincerity decidedly contradicted malingeriitg' or affectation. He
was desperately sincere in his efforts to become potent.

It is not surprising that his wife should have believed in his
sanity and the perpetual motion machine. After he had created
it and taken photographs to a newspaper, got an editorial on per-
petual motion, tried to have his machine patented, written numer-
ous wild letters to government officials, full of vulgar, perverse
phrases purporting to be religious, dressed like a minister, and
claimed himself to be a prophet inspired by God, a jury, in a trial
as to Ms sanity, gave as their verdict, that he ivas sane.

He believes that the last days of the Gentiles have come and
liis people are to be led into their rightful dues by him.

The perverse nature of his letters is best illustrated by one
which he wrote to the President denoimcing the American flag.,
saying that it should be destroyed and the flag of a menstruating

PSYCHOPATHOLOGY OP PARANOIA 433

woman substituted. (Since that letter, lie lias had no chance witli
a jury.)

Almost daily, he writes letters Avhich are filled with an inco-
herent collection of biblical references and phrases. He clips head-
lines of murders, scandals, abortions, thefts, embezzlements, etc.,
from the ncAvspapers and marks them Avith biblical references
which, he seems to feel, prophesied the event. He adjusts to the
fact that he is not believed, by pointing out a biblical phrase about
the prophet not being heeded at first. His voluminous output of let-
ters and arguments serves one valuable purpose, in that, by con-
trolling the content of conscionsness Avitli such interests he does
not feel his sexual difficulties. He often Avrites on his letters:
"Were it not for the pleasant fields of Holy AVrit, I might de-
spair." His invention of "perpetual motion," he says, is finished,
and he refers to it as a final achievement, a goal which he has
reached.

Argmxient, persuasion, and reasoning have no influence with
him. He can not and Avill not forsake his fancies. He promptly
damned me when I advised him that work would be good for him.

This man became heterosexually impotent at a period closely
related to his systematization of delusions about his wife's infi-
delity. He has never been satisfactorily potent in the sense of hav-
ing the power to perform sexual intercourse Avith due affective
gratification, being capable only of ejaculatio prsecox. He is so
constituted in the reactions of his sexual reflexes as to feel vaguely
Avhat the normal biological goal should be, and his striAdngs to
reach this level are ceaseless.

Upon the other hand, his feminine manners of self-expression,
the shunning of friendly^ masculine associations, the tendency to
guard his room at night, the conviction that a "man child" in the
uterus of his wife destroyed his potency, and his thoroughgoing
pleasure in the disguised "manna" sjonbol, indicate a fairly well-
covered but pressing tendency to drop back to the biologically
more easily maintained submissive homosexual level. His hetero-
sexual possibilities are surely seriously inhibited because of their
conditioned specific requirements — namely, the mother. In pro-
portion to the limitations imposed by this fixed conditioning, the
possibilities for ever making a biologically satisfactory mating are
reduced to the barest possible accident. There are many colored

434 PSYCHOPATHOLOGY

wpmen seeking mates, but very few are likely to meet the require-
ments of the necessary and too strictly limited prototype. The af-
fective determinants for this fixed condition of his reflex systems
can only he worked out through an analysis of his experiences with
his associates.

At present, he claims that he has become an apostle, must
gather about him 'tnany wives, establish a religion, and guide his
heavenly flock.

This negro's "perpetual motion" is only complete when pla-
carded with prophecies and religions writings and intimately
placed between himself and his mother. In its energizing, inspir-
ing effect upon him, it should be recognized as having the same
affective valne that the painting of Mona Lisa and her smile had
for Leonardo da Vinci. Freud's anafysis of da; Vinci's personal-
ity, showing that the yearning and mother fixation were consider-
ably gratified by the inspired painting of a certain type of smile,
clearly brought ont its significance to the creator.

That the inspired ' ' first tabernacle ' ' in which ' ' the blood of the
world is mixed," and whence all men and women are creatsd,
should be suspended from a hand,' is as poetical and remarkable
in its conception as Rodin's "Hand of God." A comparison of
the two figures shows the refinement in symbolic expression that
training, education and social influence exert iipon the creative
yearnings.

The inspirations of this negro, as striving to compensate for
grave biological malfunctions, lead directly into another group of
cases, who, as individuals compelled to make consecrated striv-
ings, feel themselves directed to come to the Nation's Capital.

A Chicago negro* (Case P-2), who had been arraigned before
the police court for carrying a dangerous knife and being "qneer"
and a "little off," was discharged by the conrt after a careless
mental examination. His neighbors recognized that he was a " re-
ligious fanatic," but regarded him as harmless. In January, 1915,
he mailed a letter io a " Prince Johannes L. Menelik, Adis abbeba
Abyssinia," which was returned unopened. It was an appeal that
Prince Menelik should recall the African people and teach them his
(this prophet's) religion. He said : "The traitors and betrayers of
the black race are black men and white wpmen." (A mixed pair

*This case is taken from a Chicago newspaper, in which the crime was featured in bljainug
headlines.

PSYCHOPATHOLOGY OF PAEANOIA 435

lived next door to him.) He wrote numerous religious messages
on the walls and curtains of his house, such as "The Lord has
made me the Saviour of all Africans in America, and now I shall
recommend all that are worthy imto my Heavenly Father, the
Great God of all Creation. The Lord has given me the spirit to
judge the quick and the dead.

"I must die in this land, that I may carry my reports unto
Almighty God concerning the land of the United States. I am
the spirit of the Almighty God. ' '

For about two years, the negro had been seclusive and deeply
interested in his religious strivings. He built a crude, wooden
model of nn electric generator and designed other contraptions,
such as switchboards, etc., which probably had a similar value to
Case P-l's perpetual motion machine.

The reference to the pernicious mixture of black men and
white women is also similar to the "place where the blood of the
world is mixed" and also the suspicions about the relations of his
wife and his employer. Both were religious prophets and deliver-
ers of their people. The electric generator, like the perpetual
motion machine, indicates that the cause of impotence which he
vras trying to overcome was also causing great anxiety. He col-
lected a rifle, shotgun, loaded mimerous shells with vicious slugs
and armed himself for an assault, Avhich indicates that the erotic
pressure of the repressed affect and his fears Avere influencing a
desperate compensation (See Case PD-11).

One morning (June, 1916), this dangerous fanatic ran amuck
and killed four people, and wounded five others, and not until his
house, which he had barricaded, was blown up with dynamite, were
he and his wife finally shot by the police.

The tragic sequel of suppressed erotic attachments between
females is illustrated by the following instance:

Two well-educated, wealthy young women, who had developed
an unusual intimacy, registered under assumed names in a hotel.
They retired to a booth in the restaurant where they dined. Late
that evening they simultaneously shot each other in the head. Ac-
cording to the Press, a note was left saying, "We have experienced
perfect love for each other and can not bear the thought of separa-
tion. So we will end it all." In such instances as this, the act
can hardly be regarded as any other than the expression of an
aborted erotic climax.

436 PS\'( : I H) PAT 1-IOLOG V

An eccentric compensation of tlie paranoid type that may be-
come disastrous is illustrated by the following case:

This man (Case P-3) was sent to St. Elizabeths Hospital by
the police department because he was acting suspiciously. He had
complained to the police that people on the street and at his board-
ing house were making "threatening remarks" al)ont him. These
suspected remarks were related in some manner to the fact that
the War Department had discouraged him in his ambition to per-
fect a great cannon which would have more power than any other
because the rifling would lie abolished, thereby decreasing the
friction to the shell.

He was unmarried, tliii-ty-two years of ago, a graduate of a
polytechnical school and a designer of tools for a large manufac-
turing company. In this work, ho had been A^ery successful and
drew the highest salary in his department.

His coworkers, like his classmates, considered him to be ec-
centric because he applied himself too severely to his work and
never encouraged friendly advances from anyone. As a student, he
had striven constantly to be the foremost in his class. Shortly
after beginning work, he said, an elderly man in his office took a
"fatherly" interest in him. This man, who was notorious for his
vulgar stories, urged him to live a more active sexual life on the
grounds that it would do him good. He thought the old man had
noticed his irritability, tenseness and asocial tendencies, and sin-
cerely tried to help him.

The patient was neat, efficient and conscientious, and a capable
tool designer. He was, hoAvover, inclined to assume an attitude of
superior knowledge, was dissatisfied, unduly self-aggrandizing,
and morose. TTe was openly proud, and usually talked, even in
ordinary conversation with one person, in a loud, deliberate tone
of voice, which, with the studied enunciation of unusual words,
sounded strikingh' as if lie were speaking formally to an audience.
The large number of unique words which he used to express a sim-
ple thought was unusually impressive.

His opinions nearly ah^-ays contained an egocentric turn, and
distinctly indicated that he obsessively felt the necessity of ad-
vancing his self-importance. He enjoyed arguments, he said, but
tried to do all the talking.

For several years he had been interested in designing an enor-
mous cannon upon the principle of using a smooth bore in order

PSYOHOPATHOLOGY 03? PARANOIA 437

to reduce the resistance to the discharge caused by the rifling
which is used in modern artillery. He hoped to obtain the neces-
sary rotation of the projectile through a new means of producing
the explosion. This, he thought, he had theoretically demon-
strated and, at his own expense, he spent three months review-
ing the files in the patent office in order to secure a patent for his
design.

He secured an interview at the War Department, where he
was discouraged and, at the same time, flattered, on the grounds
that such an instrument would be too expensive to be practical.
This, he repeatedly said, "brought me to earth." For several
days he seemed to be unable to adjust himself to the disappoint-
ment and, without insight (until later), he unconsciously compen-
sated for his loss by developing feelings that roomers in the house
were planning to raid his trunk in order to steal the plans for an-
other government. He also heard "remarks" about himself, such
as "there lie goes" (as if he were important), and "something
was said" about the progressiveness of the German Army and
that he was suspected of furnishing the Germans with plans of his
gun. This compliment to his mighty gun was obviously restoring
the fulfillment of the wish that the War Department had so pain-
fully disappointed.

Fortunately, he was intelligent enough to become suspicious
of himself and not assume the absolute certainty of "the re-
marks." He realized that his long hours of Avorry, poor appetite
and loss of weight might have fatigued his powers of self-control.
To make sure of himself, he talked it over with a policeman who
induced him to accept hospital treatment.

Upon his admission, he was appreciative, accessible and pleas-
antly accepted advice about rest and hygienic living. He told the
impersonal side of his interest in a powerful cannon with so much
detail that he eonfiised himself as well as the physicians Avith his
abstract mathematical theories.

His proud carriage, cultiA^ated grandiloquence, tendency to re-
vert to a fixed subject, rather slight figure, sparse facial hair,
strained sobriety, undernourished condition (indicating the sever-
ity of his striving) and the obvious wish-fulfillment in the delusions
all coincided with the significance of the long-continued effort
to create an instrument of great potency.

The diagnosis on the above information was ventured that the,

438 PSYCHOPATHOLOGY

man was anxious about his heterosexual potency and was striving
to establish it. {TJie term, sexual potency, is used in a broader
sense than merely potency for mechanical intercourse, for it also
includes estahlishing the capacity to obtain affective gratification.)

Several days later he was led to discuss his sexual life freely.
He denied having masturbated at any time, and was, I am quite
sure, ignorant of the practices of homosexuals. He stated that
he had occasionally had sexual intercourse with prostitutes upon
the advice of a physician, but, finding it an unsatisfactory ex-
perience, made strong efforts to repress any sexual inclinations.
Then, he elaborated further and explained that one reason he had
had for visiting prostitutes was that he felt encouraged when they
(in answcn- to his questions) told him that his penis was as large
as that of the averas'o man. He said he Jiad been afraid since
his adolescence thatlie was sexually undersized.

The symbolic value of the mighty cannon as a compensation
for his undersized penis and impotence was immediately grasped
by tlio patient. The grandiloquent style, which worked havoc in
its tendency to isolate him from friendly associations, was de-
fended as an "old habit." That he used it as an instrument for
social domination he admitted. Interwoven with this confession
of the tendency to sexual compensation, he confided his story of
disappointment in love as an explanation of why he had never
married. The girl's father had at one time discouraged the match
because of his salary, and, irritated by her attitude, he had proudly
determined to make a great success for himself.

The permanent value of this insight into his struggles can
not be estimated here, but an indication of what it might be worth
was shown by his rapid readjustment to a sociable, more unselfish
attitude, with a genuine, unforced tendency to be amused at him-
self for his absurd striving. He frankly rebuked himself for his
stilted pride about his love affair. Before he was discharged he
intimated that he intended to apologize to the girl for his attitude.
He abandoned the big cannon fancies and considered the "suspi-
cious remarks ' ' to have been imaginary.

This patient may be regarded as typical of the so-called
"cranks" who feel compelled to come to Washington and present
the nation with "inspired" advice or a discovery having great
potential possibilities. The uniform revelation of sexual inferi-
ority in the accessible cases of this type, which we have received at

PSYCHOPATHOLOGY OF PARANOIA 439

St. Elizabeths Hospital, strongly reenforces the impression that
probably most individuals of this type are striving to overcome
definite pernicions sexual inferiorities of which they are fearful.

Throughout the above three cases runs the well-defined inflii-
ence of both the sexual inferiority and the eccentric compensatory
striving for potency and social esteem. The foundation of the lat-
ter exists in the repressed affections, and finally succeeds in direct-
ing itself by an "inspiration," Avhich, although radical and
destructive, may be irresistible. The actual mechanism ' of the
"inspiration" is most clearly demonstrated by the repressions
and inspirations of Case AN-3, which is worth reviewing in this
connection. The extent to which such cravings may influence the
individual is brought out in the cases of J. Wilkes Booth and
Gtiiteau.

It seems highly desirable, with the knowledge of the parricidal
type of inspiration of Case AN-3, to review the personalities and
acts of Booth and Guiteau. An unprejudiced account of Czolgosz's
personality, unfortunately, is not accessible.

In Case AN'-3 many facts show that the man became "in-
spired" to kill his director because the latter, through transfer-
ring him from working in "pure science," prevented him from
ever possibly solving his biological obsessions thereby compensat-
ing for the inferiorities of masturbation and the sexual affairs
that caused the loss of his love-object, who was a mother image.
The director, by his act, unconsciously became the equivalent or
image of the domineering, hateful father who had disastrously sup-
pressed the patient's youthful, vital, spontaneous aspirations,
Avhich necessarily needed encouragement and freedom of function-
ing in order that the personality should later develop to a com-
fortable, healthful maturity, and overcome its homosexual and
autoerotic tendencies. This case is of the utmost value, in that it
explains the origin of the inspiration that the suppressive superior
must be killed in order that the freedom of manhood might be
realized; hence, the reader should be familiar with it.

The cases of Booth, the assassin of Lincoln ; Guiteau, the as-
sassin of Gdrfield ; and Czolgosz, Avho shot McKinley, were not
considered from this point of view by the psychiatrists who ad-
vised the court; hence, essential details arje lacking which would
convincingly fix the impression that these "men were all obsessed
with inspirational compulsions to "remove" the suppressive fac-

440 PSYCHOPATHOLOGY

tor, father-image. There is sufHcient reliable data, however, to be
had in W. W. G-odding's "Two Strange Cases" and A. M. Hamil-
ton's " Eecollections of An Alienist," to make it worth while to
reconsider these crimes from this new point of view — ^namely,
that the preadolescent affective repressions finally tried to destroy
the repressing influences in order to attain freedom from sexual
inferiority and acquire the functions of maturity.

In the following brief reconsideration of these parricidal acts,
the limitations of space make it possible to bring out only those
points which support the impression that probably most parricidal
and treasonable acts are the result of preadolescent repressions
of primary emotions'. They were repressed by the doniineeri^g
attitude of someone who, through the powers inherent in their con-
trolling position, as father, mother, guardian, teacher, older,
brother or sister, aborted or distorted the affective career of the
individual. The history of Case AN-3 shows that affective re-
pressions may be so constituted that the individual will never be
able to achieve a comfortable solution during maturity, unless he
obtains insight. He is doomed to become noted for his eccen-
tricities, irritability, neurotic episodes and paranoid struggles.

Guiteau (Case P-4), according to Godding,* came from a very-
pathological family. His paternal grandparents had eleven chil-
dren, of whom one died of cancer and perhaps six died of pul-
monary diseases, probably "consumption." Two other children
were insane at one time, and a third was considered to be insane
by her acquaintances.

The paternal grandfather was thought to believe that one
might attain a mental state of such purity that it Avould immor-
talize the body, and this conception was apparently a conviction of
Guiteau 's father.

Guiteau 's father was knowii to be an imusually persistent, in-
tensely religious type of man, and "intensely honest and sincere"
as a business man. "In his ecstasy he believed that by prayer and
the laying on of hands lie could himself raise the sick to health,
and that he might attain, yea, had already attainecj,. to a union
with Christ, in whicli he should live forever on earth" in his
natural bodily state. He became an ardent member of J. H. Noyes '
Oneida Community. He believed insanity was caused by a dia-

*"Two Strange Cases."

PSYCHOPATHOLOGY 01? PARANOIA 441

bolical possession and that superior virtue could cast it oixt. Ac-
cording to his daughter, who described his methods of domination
over his son, his father "would whip him, and after he had
punished him would say, 'Now say pail': and he Avould say
'quail' every time" (Godding). Such sitaations between the fa-
ther and son are never anything but hopeless hatred in which the
father is determined to force the son into abject submission; and
the son, physically inferior, must endure the punishment, but con-
quers through his contradictory " wilfuUness. " The boy's grand-
father, Howe, said he was the smartest Guiteau he knew of (God-
ding) and bequeathed him $1,000 for his education. Guiteau 's fa-
ther, however, regarded him as a worthless, disobedient "devil's
seed."

AVhen liis father married the second time, like many unhappy,
brooding children, Guiteau ran away from home at the age of thir-
teen. After his crime at forty he said he never knew amotlua-'s
love, his mother having died from a protracted illness when he was
a child.

It seems that the youth and father were so deeply incompatible
that they were rarely able to approve of one another's work. "It
would seem that his father neglected and flogged him by turns,"
and the following quotation from a letter of the father to his son
reveals his utterly uncompromising attitude toward his son.
(Such an attitude between any two people who are unable to avoid
one another must almost inevitably lead to a disastrous climax.)

The letter read : ' ' Soon after your mother 's death our family
became somewhat scattered. I was much away from home, and
gradually for the want of fidelity on my part, you became more
and more insubordinate, for the want of proper discipline and re-
straint, until I lost all, or nearly all, the control of you, which
I had the right, and ought to have exercised as your father. In-
deed, my discipline Avas absolutely loose, etc." (Thus, the father
had to justify his abnormal domination of his son.)

As a youth, Guiteau was considered to be egotistical, un-
friendly, restless, brooding, irritable, cowardly, and, according to
North, upon one occasion, attacked his father from behind ivhile he.
was seated at the table.

Judge Porter, in closing the argument for the prosecution of
Guiteau for Garfield's murder, spoke a deeper truth than he per-

442 PSYCHOPATHOLOGY

haps realized when he said: "The spirit in which at forty he
fired at Garfield [from behind] loas the spirit in ivhich at eighteen
he struck his father from behind."

There is no doubt that the father was absolutely obsessed with
a bitter hatred for his son, which worked under the ethical disguise
of driving the devil out of him and only resulted in hopelessly con-
fusing the son's affective interests in life.

At eighteen, he entered a school at Ann Arbor, but as usual,
Avas unable to obtain his father's approbation for this preparatory
interest in life. He seemed unable to become attached to anythin^|!|i'
definite, probably because of his father's persistent negation and
resistance. He was unable, on the other hand, to leave his father
alone or his father, to leave him alone. While his son was at
Ann Arbor, the father, who had joined the Oneida religio-
socialistic community, sent him their literature, which resulted in
the son finally abandoning college to devote his life "to Christ"
and this community, being, as he wrote, "attracted here by an
irresistible power, which I was not at liberty to disobey."

After five stormy years in the communitjr, he abandoned it
"to give Jesus Christ a daily paper, 'The Theocrat.' "_ While
in the community, Guiteau's eroticism and egotism caused his fa-
ther and Mr. Noyes no little anxiety to prevent him from cor-
rupting their teachings with licentious interpretations. From
what followed later, it is apparent that "The Theocrat" was an
attempt to supercede his father and the founder of the community.
Because he had, no funds or preparation upon which to base or sup-
port his newspaper project it seems to have been nothing more
than a wild self-aggrandizing fancy. His uncle Maynard thought
"he was going as crazy on religion as ever his father was."- The
newspaper project fizzled out and he returned meekly to the com-
munity only to leave in a few months, now openly hating his father
and Noyes, the leader, and writing vindictive open letters about the
licentious practices of the community.

From this time, in 1866 (aged twenty-four), until the shoot-
ing of Garfield, he worked as a newspaper reporter, studied law,
lectured on theological subjects, and wrote a book on "the second-
coming of Christ." The book shows that he had strong affective
repressions that were interested in a rebirth, a second coming forth
of Christ, which was himself.

PSYCHOPATHOLOGY OF PARANOIA 443

As a lawyer, he never won a case, and as a theologian and
politician he scarcely made a living. He was immoral, a plagiarist,
dishonest, bigoted, unfriendly, crooked and a dead beat. He
tried to blackmail the Oneida Community and boosted numerous
wild business projects with no success. He was utterly unable
to control his impulsive cravings and reach a comfortable, efficient
affective state. He was divorced for adultery by his own procure-
ment, dismissed from the Chiirch on charges of gross immorality,
and "his life pleaded guilty to all the sins of the Decalogue except
profanity, smoking and drinking" (Godding).

Evidence was given at his trial (1881) that at thirty (1872) he
had said in a discussion that he would someday gain notoriety, if
not by good then by evil, and shoot some public man as Wilkes
Booth had. (Guiteau was twenty-three when Booth shot Lincoln.)
The statement at the time M^as regarded as a bit of nonsensical
braggadocio, but was damaging evidence nine years later.

From thirty-five to thirty-seven he entered the lecture field
of theology and left behind a trail of board bills and incoherent
harangues on the second coming of Christ, quitting finally after
he "had worked the inspiration out of him."

In 1880 (aged thirty-eight), he attached himself to a Ee-
publican campaign committee in New York, wrote an inconsequen-
tial speech on "Garfield against Hancock" and gave one or two
addresses to negro meetings. During the campaign, he remained
a faithful hanger-on at the Republican campaign headquarters.

Even before Garfield Avas elected, he wrote about marrying an
Austrian heiress and asked to be sent to the Austrian mission,
basing his claim for consideration "on the principle of first come,
first served." After the election, he repeated the request, and,
on the day after Garfield's inauguration, he arrived in Washing-
ton. His method of forcing himself upon the attention of Presi-
derit Garfield by pressing' his way into his private office during a
conference, handing him a printed copy of his speech -with his
name and request written on it, should at once have called atten-
tion to the eccentric, persistent, egotistical attitude of the man.

Godding 's review of the behavior and character of this man
up to this time leaves lio doubt but that the man was probably
sexually petverse and certainly 'inclined to wild' flights of unrea-
sonable' conduct due to his obsessive inspirations and unbounded

444 PSYCHOPATHOLOGY

paranoid egotism. Godding appeared for the defense and testi-
fied belief in Ms insanity, and later wrote a review of the case
of Guiteau in which he justified his opinion. A. "W. Hamilton tes-
tified that Guitean Avas a malingerer and, half a century later,
in his " KecoUections of an Alieniest," he repeated his opinion.
"Without entering into a controversy as to whether or not he
malingered, Guiteau 's history shows that something prevented him
from becoming a reliable, constructive member of society, and tjxai
he had wild religious inspirations, M^as extremely selfish, egotis-
tical and dishonest, and was sexually a very inferior type of man.
For the psychopathologist, this is sufficient evidence to show that
the man was a psychopath because of affective repressions and not
because he planned to be so.

His book on the second coming of Christ indicates his in'-
terest in a future happier rebirth. The heiress, whom he wrote
President Garfield about, was a Sunday-school teacher whom he
had seen but never spoken to. However, true to the paranoiac 's
estimation of his love-object, he believed she would marry him if
he was appointed. This belief, of course, held the President not
only responsible for Guiteau 's honors and economic position, but,
also, in so far as Guiteau seemed to feel, for his marriage to an
heiress and the rehabilitation to a happy state of his heretofore
misguided, wretched life through the "second coming" of himself
as a Redeemer.

Similar to Case AN-3, the pressure of poverty was forcing
him to a desperate solution. In March, 1881, he wore the last
year's summer clothing and appeared in a Senator's office in san-
dal rubbers, without stockings. This may also have had a re-
ligious significance.

A few weeks later, Secretary Blaine sharply told Guiteau
"never speak to me again on the subject of the Paris consulship."
This attitude placed a hopeless barrier between him and the Aus-
trian mission or the Paris consulship. While brooding over this,
the rupture occurred lietwoon Garfield and the New Yoi'k "stal-
warts." Garfield had appointed Blaine and Avas responsible
through other appointments for wliat the New York Eepublicau
stalwarts claimed was the ruin of the party, the empowering of
the Democrats, and the ruin of the country. Garfield, and not
Blaine, Guiteau seemed to feel, Avas responsible for the refusal ;
and Arthur, the Vice-President, he thought, Avould treat him AAdth

PSYCH OPATllOLOCn- Ol-' TAIIANOIA 441)

more consideration. Tlie logical solution would be the "removal"
of President Garfield and the placing of Vice-President Arthur,
"a friend," in power, the liberation of the Republican party from
betrayal, and the saving of the country from the Southern Demo-
crats. This removal of Garfield Avould, therefore, arouse the grati-
tude of the American people. He A\'ould be liandsomely rewarded
and the spirit of the Hood-tide might even sireep him transcen-
dentalli/ into the presidency. By a miraculous turn of events he
would attain the fittest place in tlic social herd and his struggles
would be eternally solved.

No evidence is to be had that, in this hour of fancied triumph,
he thought of the damnatory repressions and prophecies of his
father. Other men in their hour of triumph are often briefly con-
scious of their old, hateful enemies, of old deficiencies and strug-
gles, and w^eep with joy. The conception that the "removal" of
Garfield Avas the thing to do was significantly clarifying in its affec-
tive value, feeling it to be an "inspiration from God," that is, from
the deepest levels of the unconscious. In a psychological sense,
it relieved the affectiA'c repressions of his youth just as Case
AN-3's inspiration did, by destroying the cause of the repressions.

There is no doubt that at this time there were many disap-
pointed politicians who were hoping that something "legitimate"
Avould interfere Avith Garfield's career. The point I A\dsh to em-
phasize is that Guiteau's aborted affections, due primarily to
the repressive influences of his tyrannical father, combined with
liis destitute economic and political position, which did not give
enough material AA'ith Avhich the old repressed craA'ings might
Avork, his sexual perverseness, and the half-suppressed animosity
in certain quarters against Garfield, the ruler (father eqiiiva-
lent), determined and inspired the nature of his act. Guiteau's
affective constitution made the act of shooting Garfield prob-
able when he was forced into a submissive position by Secre-
tary Blaine's attitude. The soundness of Blaine's attitude, and
ihe utter irresponsibility of Guiteau for the position he demanded.
Lad no special significance for the repressed affections.

About the first of June, Guiteau's conflicts and struggles Avere
solved by the "inspired" idea — "the remoA^al" of Garfield. His
manner of carrying out the scheme of the assassination may be
abbreviated. He planned it for several weeks and, on one occasion,
succeeded in getting near Garfield Avith a loaded pistol, but the

446 PSYCHOPATHOLOGY

helpless dependence of Garfield's invalid wife clinging to his arm
influenced him to postpone his act. Mrs. Garfield, "the first lady
of the land," probably aroused to an influential extent the old im-
pressions of his invalid mother. He could not destroy this re-
sistance to his wishes (father eqiaivalent) in her presence.
: In July, 1881 (aged thirty-nine), he approached his unsuspect-
idg- victim from behind and fired two bullets into his back. He
had made careful preparations to protect himself from the mob,
and had prepared an heroic appeal "To the American People"
to explain his act and win their approval. His stupid selfishness
and litter lack of insight into the true value of his act convinced
Godding that he never expected to be tried. He only prepared for
flight to the jail to escape the mob.

His "Address to the American People," dated June 16, 1881,
nearly three weeks before the assassination, says: "I conceived
the idea myself and kept it to myself. I read the newspapers care-
fully for and against the administration, and gradually the con-
viction settled on me that the President's removal was a political
necessity, because he proved a traitor to the men that made him,
and thereby imperiled the life of the Eepublic. [Guiteau believed
he had helped to make Garfield president.] In the President's
madness he has wrecked the once grand old Republican party, and
for this he dies." (Similarly, Case AN-S felt that his former di-
rector was causing the ruin of his department.)

Two days after the above address, he wrote in a letter :

"The President's nomination was an act of God.

"His election was an act of God.

"His removal is an act of God's.

"(These three specific acts of the Deity may furnish the
clergy with a text).

"I am clear in my purpose to remove the President. Two
points will be accomplished. It will save the Republic and create
a demand for my book, 'The Truth.' (On the second coming of
Christ, the Redeemer. — See page 10. ) This book was not written
to make money, but to save souls. In order to attract public at-
tention, the book needs the notice the President's removal Avill
give it."

Had these letters and the man's ideas become known before
the act, he would surely have been sent as insane to the Govern-

PSYCHOPATHOLOGY OF PARANOIA 447

ment liospital for the Insane. At present, he would be classified
as a paranoiac.

After the assassination, the man elaborated his defense and,
characteristic of the egotistical paranoiac, he maintained that
"Grod and one man are a majority," he being God's inspired man.

The fact that Guiteau sincerely believed his assassination of
the President would make him a popular hero also showed his utter
lack of judgment and insight, and his insanity. His feelings told
him that if he removed the oppressing influence in his life he would
attain his biological potency. In a man whose altruistic and
egocentric interests balance well, this is a truth. "Ye shall know
the truth, and the truth shall make you free. ' ' But, in a patholog-
ically distorted personality, the struggle for truth and freedom
and its inspiration are liable to have disastrous consequences.

It is probable enough to deserve consideration that Guiteau's
"inspired" destruction of an innocent man, who had become
through his office and political relations a father equivalent, would
never have occurred had Guiteau's affective functions, in his
youth, not been so pathologically abused and repressed by a sin-
cere, but unnatural father. He was never able to attain a state
of comfortable affective composure and maturity. The affective
value of his crime to him is to be measured hy his dreams of what
it would bring — a consulship in Paris (his ancestors were French
Huguenots), an heiress and, perhaps, the Presidency. This would
be a complete domination of the social herd and give him its
approbation of his fitness, which would rectify his ineradicablp
sense of biological inferiority as a " devil 's seed, ' ' which had been
present since his youth. The second coming of Christ as a com-
pensation for his sexual perversions needs no further comment.

The case of J. Wilkes Booth (Case P-5), who assassinated
President Lincoln, can only be briefly. discussed to show that the
sincere, but tyrannical, oppressive attitude of the father, Junius
Brutus, was one of the important determinants of the act, and
"Sic Semper Tyrannus" had a deeper significance than a refer-
ence to the most democratic and fair minded Lincoln.

Booth's father, according to A. W. Hamilton* was excitable,
licentious, unbalanced and cruel. In his acting, when he played
the character of an assailant, he did it with such sadistic delight

•"Recollections of An Alienist."

448 PSYCIIOPATHOLOGY

that lie was often cruel and cut his adversaries upon the stage "in
sheer wantonness and bloodthirstiness." He surely had a re-
pressed hatred for some oppressor in his youth, for as an adul^
he had an uncompromising hatred for oppression and, yet, he
himself did not hesitate to take a brutal advantaige^. of others.
The youngest son, J. Wilkes, was named after an English agitator,
and the oldest son, Junius Brutus, was named after his father and
the deluded Roman liberator, an assassin.

As a boy, J. Wilkes Booth was unstable, suspicious, morose,
had fits of melancholy, was waj'ward, and one time ran away
from home (a protest against its tyraimy) and joined the pirate
oystennen of Chesapeake Bay. At other times, he was gentle,
winning and lovable. In school, he learned with, difficulty, and
later doted on sentimental verses, Avhich he was fond of recit-
ing. His morbid, brooding periods, as in most young men, were
probably due to sexual difficulties which are usually later com-
pensated for as inferiorities.

He compensated by being vain and grandiose. He was in-
clined to be dissolute and dissipated. At times, he had a speech
impediment that may, possibly, have been pathognomonic of the
nature of his personal deficiencies.

After he shot President Lincoln, he is reported ,to have leaped
upon the stage with a bowie-knife in one hand and a smoking pis-
tol in the other shouting: "Sic Semper Tyrannus — ^Virginia is
avenged ! ' ' This dramatic manner displayed his grandiose, self-
exhibitionistic cravings. There is more than a coincidence in the
father's selection of names for his sons and the assassination of
Lincoln. The name Brutus always suggests the assassination of
CsBsar, and the father's sadistic bloodthirstiness on the stage was
caused by the craving to attack some person superior to him. The
morose J. Wilkes, oppressed by the father, unconsciously became
fertile soil for this suggestion. It is believed that a gang of an-
archistic plotters iTsed him for tbeir tool, but his affective repres-
sions made their suggestions acceptable and pleasing.

(The writer does not hold that every case of severe affective
repression in youth, due to the father's hatred or a father equiv-
alent's, will lead finally to a parricidal or treasonable compulsion.
It is only held that such affective repressions produce a revolu-
tionary character, which, if given an appropriate repressive set-
ting during maturity, will then converge upon the parricidal act.

PSYCHOPATHOLOGY OF PARANOIA 449

Without the rather specific type of affective repression in his
youth, he would be invulnerable to parricidal suggestions later on.)

The sexual inferiority may not become plainly evident, the in-
dividual indulging in a series of wild heterosexual experiences,
until the social or vocational obligations or a failure in a mating
attempt emphasizes its presence. There may follow then a des-
perate effort to compensate in some particular manner which is
designed to attain social esteem. The repressed affect, as in the
following Case PD-1 may finally become dissociated from the ego
and be considered by the individual as a foreign power or person-
ality which is trying to coerce him into most perverse forms of be-
havior. This dissociation may become chronic and endure for
many years, in the following case, over fifty, without causing an
otherwise marked deterioration of the personality. The compen-
sating fancies may also become very eccentric and, in turn, arouse
society's suspicions and ostracism, or they may win unusual hon-
ors, but fail to relieve the repressed perverse craving.

In Chapter I it was emphasized that for the psychopathologist
the individual case is always a problem of repressed or suppressed,
and suppressing autonomic cravings. The repressed craving per-
sists in its efforts to solve the resistance. The nature and inten-
sity of the two opposing forces determine, as a resultant, the
behavior of the individual and caiise the symptoms or distress.
The repressed affective cravings and the resistance are al-
Avays complicated and can not be summed up in a word, but in
their persistence, intensity and requirements, they have well-
defined characteristics that enable the psychopathologist to clas-
, sify them.

When the affective cravings require acts and objects that
would irrevocably stamp the individual as being perverse or de-
graded, and they are intolerable to him, the individual makes in-
tense efforts to repress the cravings and compensate for them so
as to attain biological fitness and win social esteem. The repres-
sive-compensatory striving is necessarily intimately associated
with the repressed craving Avhich remains active although sub-
merged. The intensity and nature of the affective cravings, there-
fore, determine, fundamentally, the intensity and nature of the
compensatory strivings. Since both forces must be satisfied
through the individual's behavior, symbols are often substituted
for reality, as a compromise. The compensatory achievements, as

450 PSYCHOPATHOLOGY

one would expect, are Tisually all the patient cares to tell the phy-
sician. The rest he wishes to remain nnconscions of and hates to
have recognized.

When the repressed cravings become too vigoroiis to be con-
trolled, the conflict often results in a serious dissociation of the
personality. In the completely dissociated pernicious sta:tes, the
individual maintains that the hallucinations and other sensory
disturbances are caused by some personal influence that is wholly
foreign to his own personality. The physician must be constantly
on his guard so as not to accept this explanation by the patient.
The point may well be emphasized here that, the degree of convic-
tion with Avhich the patient maintains that sensory disturbances
are produced by some foreign, mystic, or personal influence, and
the degree of systematization of his compensatory defense, indi-
cate the degree of dissociation and its destructive prognosis.

The repressed cravings ihay become continuously very active,
forcing a constant problem for control upon the patient, or they
may be intermittently active, depending largely upon the environ-
ment, forcing an intermittent volcanic type of psychosis.

The following Case PD-1 shows clearly the nature of the- af-
fective craving he had to struggle against, its surprising persist-
ence, and a most remarkable compensatory striving and castration
defense.

Captain • Avas born in 1834, in Ceylon, India. His parents

were missionaries with strong religious convictions. The mother
died when the patient was six, and, at fourteen, he was brought
to America to be educated. (He said, when an old man, the wild,
naked children of Ceylon made a vivid impression on his mind as
a child.)

He had no other serious diseases than septicemia and typhoid
at twenty-eight, from which he made a good recovery.

At twenty-nine, he graduated from Yale Medical School, and
entered the Army at the close of the Civil War. He had, up to
this time, shown excellent capacities as a student and physician,
and for his services during a cholera epidemic on Governor 's Is-
land, New York Harbor, he was brevetted by the Government.

At thirty-two, while at Governor's Island, he began to carry
a revolver, which seems to have been the first overt indication of
uneasiness. He was engaged to a New York girl at this time,

rSYCTIOPATllOLOGY 01'" PATIANOTA 451

and her mother strongly opposed the marriage, fmally causing the
engagement to be broken. (He would make little comment on this
affair except that he did not really love the girl because a man who
had had "forty or fifty" sexual affairs with women could not feel
love. He considers himself -to have l^een extremely licentious iTp
to this time, and is inclined to be pleased to exaggerate the sexual
activities of his twenties.)

Later, he Avas stationed in an army post where he devoted
considerable time to painting A\'ater-colors, but lost interest in
his work as a surgeon. The course of his behavior in the years
immediately foUomng his unhappy engagement gives the impres-
sion that he passed through serious emotional disturbances. He
became more and more irritable and suspicious. Then he had a
"severe sunstroke" attended by "some mental disturbances."

He finally challenged an officer to a duel because he believed
the man was the leader of a movement to persecute him.

At thirty-five (1869), he was ordered to St. Elizabeths Hospi-
tal for observation and treatment. The meagre records of that
period give the diagnosis of ' ' homicidal and suicidal mania, ' ' but
include no account of his behavior or the content of his psychosis.
From later evidence, it is certain that he was struggling to repress
homosexual cravings.

He has always been reluctant about discussing this period of
his psychosis, but, recently (1917), he gave the information that
he felt himself to have been persecuted by secret societies who
exposed him to sexual indignities at night. Because of this, he
violently protested, and tended to attack anyone Avho had a sinis-
ter effect upon him. This desperate state of mind lasted about
one year, when gradually, he changed his attitude about the offi-
cer he had challenged to a duel and admitted he had been wrong.
He studied everybody at this time to understand his own perse-
cutions, and finally concluded that "they" (not referred to any
one in particular) had some secret power with which "they" were
tiying to force him to submit to licentious practices. He was dis-
charged after eighteen months, as a social recovery. This action,
however, proved to be a mistake.

At thirty-seven, he left America for England to escape the
persecutions, spending most of this time "sight seeing" in Lon-
don, He had entirely lost interest in his medical work. In Eng-

452 PSYCHOPATHOLOGY

land, the persecutory cravings grew worse, and he developed the
conviction that while asleep he was often taken from his room
and later returned after being subjected to sexual indecencies.
He believed that many young women used him for sexual purposes
and among them were "some of the first ladies of England's no-,
bility. ' ' He fondly, blindly aggrandized himself with these dreams
and fancies and cherished the names of many prominent English
people as having been attracted to him sexually.

He firmly believed that he heard "remarks" and read articles
which "proved" that women spoke of his penisi as being the "big-
gest thing in the world." He received several pamphlets with
some such title, which, although they were not on a sexual subject,
he insisted, subtly referred to him in that light.

The nature of such cherished fancies as a compensation for
the terrifying homosexual undercurrent, which he was struggling
against, is so obvious it needs no discussion. The important fea^
ture in this case is the extraordinary nature the compensatory
fancies finally assumed and how they themselves became an ad-
ditional pathological influence in his life.

The seductive dreams were as vivid as the real experience
could have been, and the patient suffered keenly from them. He
tried to obtain passports for France to escape the persecutions.
At night, he guarded his rooms, or often wandered the streets
to keep from sleeping, always carrying a loaded revolver. The
inevitable disaster finally came, as is usual under such conditions,
by merely the addition of a suitable, though innocent factor.

One night, before a passport was secured (aged thirty-eight),
he shot an innocent man. The following account of the episode
was received many years later from the criminal asylum in which
he was confined after his trial. It can be accepted as reliable in
its essentiar points.

"He had been tried at K — , shortly before his admission, on
a charge of murder, and acquitted on the ground of insanity. His
offense consisted of shooting Avith a revolver and killing a man
in the Belvedere Road about 2 :30 a.m. The man was on his way
to work at the time when he was shot. Captain—; labored under
the delusions that persons, who were unknown to him, entered his
bedroom during the night, for the purpose of annoying him ; and,
in order to punish his supposed tormentors, and, also, for the pur-
pose of proving to ' his friends that he was right in saying that

PSYCnOPATHOLOGY OF PARANOIA 453

persons did really enter his room, he took a loaded revolver to
bed with him, intending to shoot one of his tormentors in his bed-
room. ' '

' ' One night, he awoke with a start, and fancied he saw a man
at the foot of his bed. He took the revolver from under his pillow,
intending to shoot the man, but, he says, the man was too quick
for him, and ran out of the house. Captain — followed, and, think-
ing that a man whom he saw in the street was the man who had
been in his bedroom, he fired at him repeatedly, and killed him.
Captain — is still insane, and still has the same delusions respect-
ing persons coming into his sleeping room at night. His bodily
health is moderately good. " (Dated April 25, 1910.)

After his commitment to the English Asylum (1872, aged
thirty-eight), his case did not materially change.

The almost nightly hallucinatory experiences continued
throughout the next thirty-eight years in that asylum. Visual,
auditory, gustatorj'', and other sensory disturbances tended to con-
firm his beliefs in the persecution. "Remarks" by the people
around him convinced him that they were familiar with his ex-
periences.

He fought against the homosexual dreams, but enjoyed the
heterosexual dreams, and considered both forms to be real ex-
periences, not dreams. At sixty-five or so, he began to seek relief
from the visitations of the women, and finally, passed through a
religious conversion in which he "accepted Christianity." He
tried every possible means, as he sincerely thought, to save the
young women, and, finally, "conscientiously" amputated his penis
(aged sixty-eight.) He secretly performed the act with a pocket-
knife after taking due surgical precautions. (This defensive elim-
ination gave him no relief from the erotic cravings.)

At^ghty-threp, in discussing the act, he said, earnesth^: "I
cut it off because of the enormous size of it. I cut it off for a real,
considerate reason, because it was so attractive to others. It was
not a haphazard sort of thing, but seriously considered to protect
young women." He explicitly added that it was not done to pre-
vent masturbation.

During this (forty years) period of almost nightly hallucina-
tory experiences of a type that certainly results from serious erotic
cravings which work independently of the ego, and into which
he had no insight, he made a long series of brilliant contribu-

454 PSYCIIOPATIIOLOGY

tions to the Oxford Dictionary, Ijecoming recognized by the
■university as a lexicographer of most unusnal ability. He was ac-
corded, under dramatic circumstances, an honorary visit by the
editor, and received complimentary mention from newspapers and
magazines. Besides his literary interests he painted and learned
to play the flute.

At seventy-seven, he was transferred to the United States and
admitted to St. Elizabeths Hospital. Upon admission, his phj's-
ical condition was excellent, and his mental integrity surprising.
At eighty-four, he is still an ardeiit reader and a serious thinker.
His tall, slender, stooped figure, his keen eyes, finely cut features
and white lieard distinguish him as a scholar.

Upon several occasions (aged eighty-two, eighty-three and
eighty-four), he told me of his experiences and his life history.
Each time, the story was about the same as the above in its essen-
tials and corresponded with the hospital records.

At present, he barricades his door each night, to prevent the
entrance of abductors, by leaning chairs upside down against it,
so that if it should be opened their fall would awaken him. He
says his experiences usually follow a deep sleep. He may or may
not be awakened by his abductors, but finds himself in some un-
usual place, such as a strange house, on a boat, in a carriage, etc.,
where he is forced to submit to the sexual play of women, mostly
young, and even of little girls. He carefully avoids including men,
but admits that men also visit him. (It is noteworthy that he will
not permit men to enter his room at any time, and rarely speaks
to the men on his ward, but is ahvays pleasant to women.) He
speaks of his experiences as occurring "like a dream," but makes
the firm insistence that they are real, and ventures proofs that he
hears "remarks" made on the ward about hoAv his keepers mahe
moneij out of him. He has noticed that the bottoms of his pajamas
have been soiled, whieli pTf)vos that he has been led through the
grounds. At times, ho becomes agitated abo;it his tormentors, and
complains bitterly. Ui)<)ii sudi occasions he has threatened to com-
mit suicide if not relieved. He says they have a metal funnel A\'hich
they use to poiir food down his throat and engorge him until hir
stomach overflows. They also "peck at my eyes" and "hammer
my finger-nails." At times, his delusions become quite fantastic.
Upon one occasion, he described his tormentors as pir/mips Avho
hide in the ceiling and cracks in the floors to acts as scouts for

PSYCHOPATHOLOGY OF PARANOIA 45.5

the people of the underworld. Sometimes at night he runs panic-
stricken and yelling ont of his room, because "they" are trying
to carry him away. He particularly emphasizes the food which
he says is often pumped into him in great quantities and is often
contaminated with excreta to punish him. He can taste the ex-
creta the next morning, and tends to attribute all spontaneous or
unpleasant physical sensations, such as inflammatory conditions
of his larynx or nasal passages, to the practices of his enemies.
When he had a mild otitis media he attributed it to the "scoun-
drels ' ' using an electric battery on him.

He does not fancy that he is a Christ or an apostle, but be-
lieves that Chapter II, Book of Mark, refers especially to his case,
and Christ "must have foreseen" his trials, which indicates feel-
ings of an unusual relationship between himself and Christ.

(When I explained to him that cases having similar hallu-
cinatory experiences were quite common, but that the younger men
usually became so severely disturbed by the experiences that they
were unable to adjust themselves, he gave the opinion that he had
been saved through a deep acceptance of Christianity. "Book of
Mark, Chapter II," he says, "was Avritten as though Christ had
foreseen all this abominable stuff which I have been receiving"
(referred to excreta in his mouth). With solemn conviction he
said the chapter meant "nothing can enter into them from without
to defile the body. It must start from Avithin and it always seemed
to meet my case. I'll say it was a great consolation to know that
there was nothing in the world could enter man except that which
came out from him. They are angr}- with me because I would not
lie down with them. I endure it for Christ's sake."

He discusses his experiences with striking conviction and firm-
ness, and his reasons are expressed in scholarly English. He feels
that he has given the subject of his persecutions years of careful
study and has concluded that a secret society abducts him bodily
Avhen he is in a profound sleep. This subject, he treats as if it were
a scientific problem.

He frequently comments that it is strange that attractive
Avomen should continue to pursue him since he has grown old
(eighty-four) and has amputated his penis. This amputation does
not stop them, and this, he reluctantly, solemnh^ confides, is prob-
fihly due to the "persistance of the priapism" though his penis is
"only one- third of its former gize,"

456 PSYCHOPATHOLOGY

At present (eighty-five), he is more inclined to dwell on the
persecutions of men than women, and frequently he comes to nay
office for assistance. Recently, he has begged to be castrated so as
to prevent women and men from abusing him. He often directs me
how to make investigations for him, and slyly adds that I should
notice the "manner of the reply more them what is said." He
feels at present he is being prostituted by the ward attendant, and
often threatens to assault patients for their supposed persecutions.

To sum up, he was raised, until fourteen, among the savages
of Ceylon by a very religious father. From about twenty to thirty-
two, he was promiscuously erotic, and, upon the failure of his
engagement, become impotent, irritable, asocial and suspicious,
and finally, passed through a homosexual panic. Although he ap-
parently recovered and was discharged from an asylum, the hallu-
cinatory sexual difficulties persisted, and, to escape their supposed
causes, he traveled about the United States and England. Finally,
in a nocturnal panic, at thirty-eight, he shot an innocent passer-by.
From thirty-eight to eighty-five, he has lived in asylums and con-
tinued to experience the hallucinatory sensory disturbances of
homosexual and heterosexual form, but predominantly the former.
The man was probably heterosexually impotent, of undersized sex-
ual development, and suffered from ejaculatio prsecox. He com-
pensated with fancies about being sexually, unusuallj^ potent. De-
spite these hallucinatory and persecutory difficulties he became a
world-famous lexicographer.

At sixty-eight, he amputated his penis to save the (halluci-
nated) women and children, and, at eighty-five, he begs to have his
testicles excised for the same purpose. He believes he is intimately
associated with Christ and is religious, but has no mission.

His most annoying sensory disturbances, due to excreta in his
mouth, definitely indicate the oral eroticism he has struggled
against. As an interesting sublimation he made a wonderfully re-
fined contribution to the origin and'use of words.

His attitude, at eighty-five, to control his eroticism, is similar
to his attitude at thirty-two. Probably the congenial nature of the
asylum in which he lived made his classical sublimation possible,
because his superintendent (father-equivalent) turned over a well-
equipped library to him and had a personal pride in his pr'oduc-
tions.

No skeptic, no matter how orthodox and conservative, can read

PSYCHOPATHOLOGY OF PARANOIA 457

the above cases witliotit feeling some respect for the seriousness
of the struggle which males and females are forced to undergo
when their sexual affections become fixed upon homosexual objects
and perverse mannerisms. The decisiveness and chronic persist-
ence of the dissociation of the personality of this brilliant philol-
ogist is unquestionable. His homosexual and perversely oral
erotic cravings, Avhich obtain gratification through hallucinated
forms of sensory disturbances are unquestionable, and his anxiety
and tragic struggle, ending with self -castration, must be accepted
as a biological (sexual) struggle to save himself.

Before pursuing the mechanism of the acute panic with acute
dissociation of the personality, which, in turn, leads directly into
the nature of the biological struggle of the so-called dementia prse-
cox group, it is probably worth while to illustrate with further
cases other ways in which men and women struggle against the
homosexual cravings, and desperately strive to establish comfort-
able heterosexual powers.

Some men fight for years against homosexual tendencies, and
finally marry, in an effort to save themselves. Such marriages,
as a rule, end disastrously upon the patient's experience showing
that he is heterosexually impotent. He may develop feelings of
having been betrayed by his A^dfe, and justly or unjustly blame
her for having caused his impotence through the infidelity of her
"wishes. The usual cause, which he refuses to recognize, is, how-
ever, his self-love and homosexuality. It is certain that men are
often psychically castrated by frigid, homosexual women (Cases
PD-7, PD-8) and, though ''impotent with one mate, may enjoy a
comfortable potency Avith an appropriatelv constituted mate. Tn
such cases, it goes without saying that a remarriage is almost
necessary. Such cases should be differentiated from fixed homo-
sexuality.

Some males, who have a very small margin of heterosexual
potency, and lose it soon after the novelties of the marriage be-
come commonplace, secretly try almost every conceivalile expe-
dient to reach the coveted biological goal. Many are doomed, how-
ever, because of the conditioned nature of their autonomic func-
tions and lack of insight, never to quite reach a comfortable po-
tency, and, if hatred for their more potent rivals should develop,
the individuals become incurable.

A salesman (Case PD-5), about thirty-five, who had kept him-

458 PSYCHOPATHOLOGY

self popular with a certain "buncli of sports," not realizing, it
seems, that he was living a crudely sublimated homosexual exist-
ence, finally married an attractive young and inexperienced
woman. His behavior immediately following this marriage showed
that it was hastily consummated to ward off a possible disaster
from the cumulative effects of whiskey and his perverse eroticism.
The plan failed.

Within a few months, the man began stimulating himself to re-
tain his potency, taking whiskey to bed with him. Upon several
occasions, he attempted sexual perversions (this tendency is char-
acteristic of apes when sexually fatigued), and, finally, he ex-
ploded with an outburst of jealous invectives a,bout his Avife's
betrayal of his affections, although he had no justifiable grounds
for the suspicion. He became dangerous, but, before a tragedy
occurred, he was sent to a hospital. He rapidly developed a homo-
sexual panic in which he hallucinated homosexual assaults and
thought himself a sort of ' ' white slave " in a house of homosexual
prostitution.

After several months of anxiety and hallucinations, he began
most intense efforts to control the homosexual compxilsions, devel-
oping a compensatory system of telepathic communications and an
omnipotent social-reform scheme that would be backed up by a
wealthy aristocracy. He made strenuous efforts to regain his
health, and, finally, emerged a very tense, sullen, suspicious, de-
lusional man, decidedly dangerous. His wife had to seek a di-
vorce, and he, after the eccentric attempt to master himself, has
regressed to a mother dependence, where he apathetically dreams
but Avill not work. (His marriage was a desperate attempt to
save himself from disaster.)

The following cases illustrate variations of the marriage at-
tempt to escape from homosexual tendencies. A college professor
(Case PD-6), aboiit thirty-five years of age, had to leave his uni-
versity because of unfounded feelings of being persecuted by the
college president. He felt the president had evidence about his
practices of heterosexual perversions. To escape "persecution,"
he went to a foreign country to study, but only brooded over his
wretched condition.

An inspirational type of solution began upon seeing an at-
tractive, refined young foreign woman in a cafe. Without intro-
duction, he proposed to her through letters to her parents, and,

PSYCHOPATHOLOGY 01*' PARANOIA 459

after a series of letters they actually became engaged, even though
by the time the engagement was consummated he had returned to
America, had passed through a homosexual panic, and attempted
suicide. At the time of the acceptance of his proposal, he was
being treated in a hospital for an elaborate system of paranoid
delusions of persecution centered about his former president. The
feelings that he should be persecuted were intimately attached to
the feeling of being sexually perverse. The impulsive engagement
was a desperate attempt to solve his dilemma through marriage.

The following cases illustrate the same mechanism :

Case PD-9 was a tall, strong, wiry man about forty-four years
of age. He had served since his eighteenth year in the army and,
through efficiency, attained the rank of sergeant major. He also
received an honor from Congress for conspicuous bravery during
an engagement in the Spanish-American War. As a soldier his
record was "excellent."

The patient's father was a chronic alcoholic, and one brother,
he said, had "mental trouble."

Dissatisfied with his home and school, he settled his troubles
by eloping at fifteen. He maintained himself quite well by work-
ing at odd jobs until eighteen, when he enlisted in the U. S. Army.

He had several gonorrheal infections, and, at thirty-two, had
a chancre followed by skin eruption Avhich was diagnosed as syph-
ilitic and treated as such. He maintained that because of syphilis
he had postponed his marriage.

He thought people had imagined him to be a "moral pervert"
since his twenty-fifth year. When about thirty-two, he had a homo-
sexual experience and an anxiety type of psychosis, the nature
of which he would not disclose, although it was serious. He read-
justed well enough to keep his difficulties concealed, although the
course of events indicates that at no time was he really ever free
from homosexual cravings. Like many such men, he was an al-
coholic.

At forty-four, he mai'ried a Avoinan -whom he had known casu-
ally for several years. This was a sudden change in his course
of living, and it surprised those who knew him.

Just previous to his marriage, he had complained of feeling
weak, tired and forgetful. He went to a Western city on a fur-
lough, evidently to recuperate, and married, hoping to solve his
sexual i^roblem. He felt that he was being "hypnotized" by some

460 PSYCHOPATHOLOGY

people while in this city, but would not explain what their in-
fluence was. When he returned to his company, a friend, he said,
informed him that the woman he married had a questionable repu-
tation. The charge, he said, became "fixed" in Ms mind. He be-
came morose, seclusive, and constcmtly brooded about Ms sexual
difficulties. Impulsive feelings developed, accompanied by voices
which prompted him to commit murder and suicide. The murder
probably meant that of his wife. He shunned and accused her
of immorality without facts to substantiate his beliefs. Auditory
and visual hallucinations bothered him in the form of what he
called "telepathic communications" and "dreams." He was not
absolutely sure of their reality, and dragged out a long period of
indeciision as to whether or not he should obey the voices.

He slept insufficiently because of his anxiety and dreams, one
of which is quite typical. He dreamed of a death-chamber in
which he saAV his wife in a red dress, and on the wall Avas written :
"This is the life."

When he was admitted to the hosp'ital, his homosexual eroti-
cism had become so active that he believed poison was administered
in Ms food, and electricity was forced into his body from batteries
in the wall. He spit almost continuously in order to keep his
mouth purged, because, he said, it was the only way he had of
clearing himself of sexual perverseness. (He was experiencing
vivid gustatory sensory disturbances. )

He became retarded, suspicious, and very cautious about his
answers, and decidedly fixed in Ms emotional reactions. He had
no sense of humor, never smiled, and talked in a low, serious, omi-
nous tone of voice. His features were tensely set, lips compressed,
and his eyes stared into space. Frequently, the upper eyelid be-
came so much retracted as to expose the sclera above the iris,
decidedly the exophthalmic stare. He was inaccessible, on the
defensive, had no insight, and was inclined to feel that the homo-
sexual struggle was forced upon him by others. He gave the gen-
eral impression of being a desperate man. Pertinent questions
were met Avith a sullen, threatening stare, and he usually walked
away or refused to answer.

He'said that his Avife tried to poison him with strychnine, and
her kisses turned his lips "to ice." He Avas reserved and very
formal in his behavior Avhen she visited him.

He was always neat, seclusive, and wanted special privileges

PSYCHOPATHOLOGY OP PARANOIA 461

in order that he might treat his illness in his own way. He com-
plained that some force was making him think of his "whole past
life" (Regression of the love affect after mismating). The
thoughts w^ere unpleasant, and, by frequently jerking his head, he
found he could get relief and think of something else. He said:
"I can think of you or any person and it seems to stop it."

He felt a force "drawing at the heart" as if something
' ' pulled on it. " Then he added, " I feel drawn toward you. ' ' ( Dur-
ing another interview, he spontaneously left' his chair and lay
down on a bed. He seemed to expect some procedure to follow
this. He did this, he said, because he felt that it was wanted of
him. ) He gave every evidence of having to make a desperate ef-
fort to control poAverful submissive homosexual cravings.

He indifferently performed the intelligence tests with many
mistakes of memory, indicating marked preoccupation. He was
accurately oriented for time. Later, he performed the intelligence
tests very well, apparently being better able to coordinate his in-
terests better.

His general attitude was characterized by sullen indifference
to advice. He tried to smooth over his difficulties with his wife,
and refused to discuss his past suspicions about her infidelity,
but stubbornly maintained that he believed she ^vas faithful. He
usually seemed willing, and at times glad, to see her, but his pre-
occupied manner of staring at her indicated that all Avas not going
as smoothly as he tried to make the physicians believe. His be-
havior varied from fairly efficient cooperation with the ward-work
to periods of anxiety, resistance and refusal to cooperate and to
eat.

He complained bitterly of the electrolier and batteries in the
wall shooting electric currents through him and burning his skin.
He persistently asked for medicine to cure a weakness caused
by dreams — namely, frequent nocturnal emissions without an
erection.

This erotic difficulty and defensive tension subsided after sev-
eral months. Later, he explained the cause of his behavior, as
follows: "I was considerably mixed up. I imagined that little
pieces of stone and plastering which I -saw near the baseboard on
the wall were electric magnets, and that these had an influence on
me and kept charging me with electricity." During this period of
"electric shocks," etc., he frequently had nocturnal emissions, but

462 PSYCHOPATI-IOLOCiY

was not observed, to masturbate. He said, further, tvith convic-
tion, that he noAV regarded, the voices he had. heard and his ideas
about his wife as "imaginary" and due to a "mental derange-
ment." He was given a parole and permission to direct his af-
fairs to soine extent, but not allowed to visit the city with his wife.
He promptly eloped, but returned two days later of his own ac-
cord. His brooding continued, and again he eloped several weeks
later, returning again because he had become confused. He re-
fused to cooperate, and tried to convince us that he loved his wife.

At no time ivere we able to persuade him to talk over his per-
sonal problems. Fourteen months after he was admitted, he made
a final elopement, and persuaded his former commander to give
him some occupation. Because he threatened to, commit suicide
if forced to return to the hospital, and upon the assumption of"
responsibility by his commander, he was discharged. He refused
to live with his wife, convinced of her infidelity and sent her back
to her family. (He impressed his commander as being "normal"
despite this knowledge of his grave homosexual difficulties. Be-
cause of the secret nature of his struggle, the tendency to become
confused by hallucinations, and his desperate efforts to fight off
his homosexual cravings, we felt that the prognosis was bad.

His wife was a quiet, patient, healthy woman, submissive to
his demands and eccentricities, and wholly without insight into
the nature of his struggle. She reported that he had always been
potent,' and he claimed as much, but the content of the psychosis
and his behavior make their statements unacceptable. (It has
been a general experience that the statements of men and women
under such conditions are usually not reliable.)

The tragic ending of such desperate struggles is well illus-
trated by the following case :

Case PD-10 was a man twenty-three years of age, married,
rather iTuder sized, but well muscled, very active, had a well-formed
head and face, and liked to be considered handsome. He Avas fond
of displaying his cleverness and worldly knowledge, and made a
determined effort to be considered a man of the world by his asso-
ciates. He looked very much of a " dandy. '.'

His family history contained no indications of an inherent
psychopathic taint. He was a healthy, active- boy, learned well
at school, and was fond of sports, but girls made him "nervous."
As a student, he was indifferent, and left high school to work as

PSYCHOPATPIOLOGY OF PAHANOIA 463

a stenographer. At twenty, he attended night school, but aban-
doned this at the end of a year with an indifferent record. He
spent all his earnings as a sport and frequenter of the red-light
district and certain saloons. He considered himself to be a hard
worker, which was not substantiated by actual endeavors, but, be-
cause he was always on the lookout for a scheme to get rich quick,
he felt himself to be superior to the other clerks. (A not uncom-
mon method of overcoming the inferiorities of poor ability is to
be extravagant. This is the most usual compensatory mechanism
of the rich inferior male or female.)

As a clerk in a government department, he was inclined to be
inconsistent and suspicious of the other employees. He dressed
in advanced styles of clothing and lived what he considered to be
an "active life."

When twenty-one, he, secretly, without a license, married a
girl of seventeen. During his psychosis he boasted that his mar-
riage was the result of his seduction of the girl on a picnic. This
affair he dangled like a scalp on his belt as a token of his virility.
"A girl has no chance Avhen a good man is at the helm," was his
comment on the affair. She was an unusually pretty, stylish, but
simple, maiden Avho had been infatuated with the dashing brag-
gadocio of the man. She mistook his ready wit and boastfulness
for promising ability. About six months after the unlawful mar-
riage, he corrected his crime by marrying the girl according to the
requirements of the law. (This should be regarded as a reaction
of fear, although he -made the plea of having done this out of pity
for her.) From this time on, he fared badly, drank excessively,
and insulted and abused her shamefully. He often abandoned
his wife on the street to "pick up" a street- walker. He w^as ut-
terly unable to endure the restrictions of this marriage.

Their sexual - relations were excessive, practically daily, de-
spite the resistance and distress of his wife. He stated that it
was not an unusual thing for him to have sexual intercourse and
then masturbate "to get. relief," or to patronize several houses
of prostitution, have intercourse with several women and then re-
turn to his Avif e. His boast was that he had ' ' so much power "that
he could "not get enough." He held this up as a flaunting proof
of his heterosexual virility at the time that he was in a panic about
. becoming a sexual pervert.

He had been drinking excessively since seventeen, and once

464 PSYCHOPATHOLOGY

"swore off" because of a tendency to deliritim. Despite the dan-
ger and entreaties of his wife, however, he returned to his old
haunts. One night, he was accosted by a homosexual prostitute,
and permitted him to practice fellatio upon the payment of a
dollar. Later, he boasted of this to his companions and made it
a point to prove that he himself was not homosexual. From his
quotations of their comments, he seems to have been recognized
by his companions as homosexually inclined and defensively trying
to establish a recognition of his manhood. A strange man in a
hotel one day complimented him on being a "handsome boy," and
this suggested that he ought to have his nose operated on to im-
prove his looks. Just before the onset of the psychosis he had his
teeth treated by a dentist, and later the electrically operated drill
played a prolific part in his hallucinations. Also, the dentist him-
self became an hallucinated figure in his struggle and worked on
his mouth. He had delusions of his wife's infidelity practically
from the time of his marriage, and accused her of having had sex-
ual relations with her uncle. He abused her violently, and de-
nounced her with most unbridled profanity.

About three weeks before his admission to St. Elizabeths
Hospital, he visited a friend's house and there acted "queerly."
He familiarly looked over the house and went into the bathroom,
while the guests were chatting in a nearby room, and removed his
clothing. He made homosexual advances to his host and believed
that his host wanted him to have sexual intercourse with the host-
ess. His insane state was recognized, and his friend* put him
to bed, but later allowed him to return home. Several days la1;er
he "felt mean" while in a cafe and smashed up furniture, raised
a row, and tried to fight. He was then in a homosexual panic,
and hallucinated several of the men planning an assault upon him.
He was sent to a receiving hospital, and for several weeks con-
tinued in an uncontrollable jampage similar to that which followed
when admitted to St. Elizabeths Hospital.

Upon admission, he refused to give any history of himself or
to discuss his mental state. Any questions were answered with,
"It is none of your damned business. If you want to know about
that you can find out the best way you can. You are not going to
learn it from me." Direct questions were. resented, and he fre-
quently threatened to assault the examiner. He was well oriented,
said he was happy, and refused to consider thathe was mentally

PSYCHOPATHOLOGY OF PABANOIA 465

deranged. Although he was experiencing prolific, unpleasant hal-
lucinations, he refused to admit them for several months. He
would not relate his dreams. The simple intelligence tests were
performed quite acciTrately, and several times he asked for some-
thing more difficult in order to show his mental efficiency. He
elaborated the memory test story and, throughout the examina-
tion, made many plays of wit and showed considerable tendency
to a flight of ideas not unlike the classical manic stream of talk.
He strove constantly, desperately, to convince everyone that he
was a strong man.

On the whole, he was inaccessible, and would not reveal his
troubles. Unlike the typical manic, however, he had hallucina-
tions and reacted to them, investigating them as realities. He
grimaced, and displayed his square jaw by thrusting his lower
teeth beyond the upper. He stared defiantly into the faces of the
physicians, and smashed his fist into his palm (same as Case
PD-34) to emphasize what he had to say. This behavior was con-
sidered to be a desperate effort to convince the men about him
that he was not a weakling: Later, this proved to be true. The
desperate necessity was probably not caused by a threatening or
hostile attitude of the hospital attendants, but it was caused
by a terrible fear of being considered inferior. He could not dis-
tinguish the sensory disturbances (hallucinations) from external
reality, and this caused his fear. He felt some secret power was
exerted over him by the men about him which was pressing him to
commit oral erotic perversions ; and this power (which, of course,
was within himself) he fought to a desperate finish. So vivid were
the hallucinations this caused (visual, auditory, gustatory, tactile
and kinesthetic) that he was unable to recognize the causes as a
part of his personality. In fact, the sexual cravings had become
dissociated from the social self and Avere pursuing their own
course.

Within a few days, he fixed the whole cause of his cravings
iipon a certain patient, and assaulted him at every opportunity.
He tried to dominate the ward with his displays of power and ag-
gressiveness, which, in a certain measure, intimidated the other
patients, and must have relieved his fears to an extent. He de-
stroyed property wantonly, and his clothing became disheveled
and untidy. His language was extremely vile, even for his envi-
ronment.

463 PSY.CHOPATPIOLOGY

When his pretty, timid, young wife visited him, he made her
sit on a bench in one end of the hall while he placed himself
squarely before her and glared down upon her. He tried to intim-
idate her, and would not allow her to look anywhere except directly
at him. The passers-by, he said, came near them because they
kneAV that she wanted to flirt. He was determined to stop it, and,
upon several occasions, struck her, accusing her of lying to Mm
when she denied his accusations. He did not seem to feel the
slightest sympathy or sorrow for her when she cried and pleaded,
but, charged her, again and again, with being prostituted to her
uncle.

For four months, he maintained a general attitude of univer-
sal distrust and hatred, upon the one hand, and fear of plots and
assaults, upon the other. The following pathetic letter by his wife,
written to him at this time, shows the nature of the mating and
how he projected his infidelity upon her.

"Dearest Boy:

"Your letter received this morning, but, dear, you know very
well that I will not be able to do what you ask me in your letter.
In the first place you have not asked Mr. — about the rent coming
to you, and in the second place I would not know how to go about
taking this matter to court. I tell you what you do, you write me
a letter and enclose a note addressed to Mr. — , telling him to let
me have the rent money due you, and sign your name to it, then
I will take the note up to him and see what he will do about it.
You can tell him that I am in need of the money, but, dear, write
him a nice note, because you will gain more by being nice than by
being so mean.

' ' Sweetheart, you certainly do say mean things in your letters
to me. Now I guess you think that I would sue my aunt for open-
ing my letter ; my how foolish you are to talk that way. Do you
think for one minute that I would sue my aunt for opening that
letter? Why you must think I am crazy. Then you are always
talking about who I am living with, you speak of my uncle as
though he was an awful person. Instead of do-wning my people
as you do, you ought to uphold them and thank them for the kind-
ness they have shown toward us, since we have had this trouble.
They are good people and they treat me very nice, and you know
they are good, but I do not know and can not understand why you
say such mean "things about them, that are not the truth. Now,

PSYCHOPATHOLOGY OF PAEANOIA 467

darling, try to speak more kind of people than you do, and you will

find out that it will pay in the end. Now do what I told you about

the note to Mv. — , dear. I have some cigarettes for you, and if I

see — I will send them oiit by him, because you know they will not

allow me to come out to see you on account of Avhat happened the

other day, and it's all your fault too, dear; now I will not be able

to see you for about a month, or until the doctor lets me know

when I can come over. Why don't you be good, dear, for I am

sure (by the way the doctor talked) that if you behave yourself,

you will get out in a short time, but you are everlastingly getting

into fights. Now try to be good dear, and try to believe more in

God, for I am sure this will help you along a great deal. I hope

you are well, sweetheart, and try to be as happy as possible, and

I will tell you again to he good. With lots of love and kisses, I

remain, ^^ ^ . -r. ,,

' Your lovmg wife.

For four months he was openly hostile to everyone.
Gradually, his eroticism subsided sufficiently for him to feel more
kindly towards the physicians, and he made advances to obtain
privileges. It was for privileges only that he discussed his case.
He only admitted having hallucinations in order to gain the favor
of the physicians and not to obtain insight, and was surprised to
learn that the hallucinations he heard could not be heard by the
physician. For several Aveeks, he could not believe this, and asked
innumerable questions and cross-questions about their electrical
machines. He became curious about the hallucinations, as such,
and began to look for explanations of them. The electrical ma-
chine, he believed, was the dentist's instrument boring the steel
burr into his teeth. His attitude towards his wife also changed,
and he became lavishly affectionate in order to coerce her into
pleading for a parole for him. He tried to keep her from becoming
aware of his true difficulties and the fact that he had been insane.
He never fully trusted anyone, and gave his confidence guardedly.
The incentive for this was his wish for discharge, his general mis-
information about the rules of the hospital, and his shame. He
thought patients were discharged only when the physicians be-
lieved they were able to control themselves.

He at first made most persistent demands for a parole, and
backed it up with threats and profanity. Later, he adopted the
method of incessant begging, a decidedly common attribute of the

468 PSYCHOPATHOLOGY

spoiled child. It was surprising to see his astqnishment when he
first learned that his auditory hallu^cim-ations were not heard\ hy
others. It seems probable that this revelation was largely due to
his general ability to grasp things quickly and the unusual rapid-
ity with which the hallucinations waned, perhaps largely the result
of the alcoholics.

The electric machine that had tortured him so persistently,
he decided, was an "imagination" that he had carried over from
his experiences with the dentist a short time before the onset of
his psychosis. The fact that he could place all the blame for his
psychosis on alcohol was very valuable to him,, and he seized this
opportunity for shifting the responsibility. . But, when it came to
explaining why his hallucinations and difficulties were so thor-^
oughly sexual, why he was afraid of being hypnotized and forced
to commit oral perversions, he had some difficulty. (Alcoholics, as
a rule, will not admit the homosexual fears after the hallucina-
tions have stopped.)

When he learned that homosexuality and oral erotic cravings
were considered to be the probable difficulties that caused his fears,
etc., he advanced his sexual history to prove that it could not be
true. One experience that he laid great emphasis upon was the
recorded experience with the homosexual prostitute. (See also
Case PD-33.) The fact that the man had practiced fellatio upon
him, he believed, was evidence of his masculine superiority and
virility. He included an accoimt of how he had told this ex-
perience to his friends, and how they had considered it a great
joke. However, he was not satisfied with' his insight, and
persistently sought to learn more about himself. He seemed in-
clined to believe that perhaps he was homosexual, relating how
strangers in hotels had accosted him. He thought it was strange
that men whom he did not know should compliment him upon his
good looks and try to entertain him. The significance of this im-
pressed him, and he finally wanted to know if an act of eunnilingus
upon his wife meant that he was oral erotic. Later, he admitted
that he repeatedly did this, and yet maintained that he was not oral
erotic, although, when he spoke of his cravings, he performed most
flagrant impulsive movements with his lips and tongue. At this
time, he threatened to assault a patient whom, he insisted, talked
about him and his wife. This seemed to indicate Jiow much he

PSYOHOPATHOLOGY OF PARANOIA 469

"was occupied with a solution of his oral erotic inferiorities and
the memories of it. (People, as a rule, feel, when ideas can not be
repressed from consciousness, that observers can read their minds
by the effects emotions have on features, etc.) As his eroticism
subsided, he talked more freely, and no longer seemed to be
afraid. He had fair insight, but often asked for assurances that
he would not have another similar experience. He seemed to
be ominously desperate about tliis, but his behavior on parole
and his attitude toward his wife was such that the physicians ' con-
ference of the hospital yielded to their entreaties for a. month's
leave (five months after admission). {A series of these cases have
demonstrated thoroughly that vie)!, ivtio are oral erotic, who are
inclined to feel that their wives are unfaithful, and cure themselves
anxious about their abilitij to copulate with due affective relief,
are most unreliable men. When they also have fears of homosex-
ual reversion, they must be consideredi as potentially suicidal and
homicidal.)

This young man was strongly homosexual and oral erotic, as
well as autoerotic. Through the influence of associates, he learned
that these ' ' unmanly ' ' traits were easily hidden by demonstrations
of sexual prowess with prostitutes and young girls. Seductions
indicated that ' ' a good man was at the helm. ' ' (One wonders how
many girls are seduced by young men homosexually inclined,
who make conquests merely to boast of them.) His unusually fre-
quent acts of intercourse were the expressions of most desperate
compensations to become heterosexual and overcome the fears at-
tending homosexual reversion. Highly narcissistic, he could not
love his wife, or any other woman. Novel forms of excitation
probably made it possible for him to copulate, but sooner or later
he would have to face the true nature of his biological constitution.

Several weeks after he left the hospital, he was found lying in
a park, dying from a very large dose of bichloride of mercury. A
note in a pocket contained the following to his wife: "I have
stood the suffering as long as I could. Goodbye."

Case PD-11, a soldier, aged thirty-seven, unmarried, had been
tense and uncomfortable since he was twenty-nine. He drank ex-
cessively, and was unable to solve his affective conflicts. For sev-
eral years, he felt convinced that his comrades thought he was a
sexual pervert. "Signs" and "remarks," which he interpreted

470 PSYCHOPATHOLOGY

as having a secret reference to Ms troubles, goaded him into des-
peration. He felt that certain men were persecuting him, and
planned to kill "four or five" of them. One morning he entered
the squad room with a loaded rifle and killed two men before he
could be stopped.

During his stay in this hospital,, he has felt that his attendants
and physicians persecute him for having secret sexual inclinations,
and has repeatedly assaulted attendants and nurses for having
such influences upon him.

The desperate mental straits that men and women get into
when the primary affective cravings, pertaining to nutrition or
sex, are resisted, hardly needs further elaborate illustration. ..On
the other hand, the nature of the underlying affective cra^Mg^;
that cause the desperate act are worthy of further analysis, be-
cause the variations of behavior must be understood so that the
underlying difficulty will become apparent to the psychopathol-
ogist.

Throughout the above group of cases an immodifiable, hio-
logically inferior, terrifying, sexual craving is evident, and the ec-
centric striving, as a compensation, made in order to win social
esteem, as ivell as to insure the feelwig of biological fitness, is cer-
tainly obvious. In the above group, homosexual inferiorities were
predominant. In the following case, the autoerotic source of wild
compensatory fancies is quite definite.

The following patient's (Case PD-12) account of the develop-
ment of wild compensatory fancies about studying " electrons, "
"molecules," etc., to solve the great riddle of the universe, and of
himself, in order to develop potency, shows that compensatory
striving is also typical of the autoerotic. It protects him from the
fears of social persecution so often arising from such wastage:

"Began the act of masturbation at thirteen, which continued
until seventeen, when I sought a room in my mother's house, and
in which I stayed until eighteen. During the period of confine-
ment I was beset with the delusions that everyone I heard speaking
was deriding me. Not only did I think this of my own relations,
but of everyone I heard speaking. My resentment finally centered
on the "Odd Fellows" who had forcibly ejected me from their
hall one afternoon. I thought that I would find great satisfaction
in destroying their property, so attempted to burn down their hall,
and on being examined by physicians was sent to the Matteawan

PSYCI-IOPATHOLOGY OF PAKANOTA 471

State Hospital where I was confined nntil twenty-one, wlien I was
discharged as cured. During the first part of my confinement
there I was troubled mth the same delusions. On leaving that
institution my mind acted in a weak and wandering state which I
could not control. I had numerous positions, but tlie condition of
my mind prevented me from holding any of them but for a short
time. But I found that I was gradually becoming stronger, and
could better concentrate my mind as the years went by. I enlisted
in the army, where, having access to the library, I became inter-
ested in scientific ideas. I spent all my wages for books on the sub-
jects of Chemistry, Astronomy, Morphology, Electrons, Atoms and
Molecules, which I shidied\ for three years luith the idea in mind
that I tvoidd discover some ivovderfid facts imlinown to the other
men ivho did not use Electrons, Atoms and Molecules for a base to
start from. During this period, I was masturbating about twice
a week. When I was discharged, I soon became convinced that I
was mentally living in a world of theory, but decided to finish my
books so I reenlisted in the army. I studied for eight months, when
becoming startled at unknown fears and intense pains in the head,
accompanied by fiutterings in the back part of the head when evac-
uating the bowels, I became frightened. I commenced to study my
mental condition. I looked back over the years of masturbation ac-
companied by intense study, so became convinced that my mind
Avould shortly fail me. I determined that my only relief was to
seek the noise of the city streets, so I deserted. For three days I
was intoxicated, which helped me to completely forget my troubles.
But I found that I was still possessed of a Avandering mind and a
peculiar quick temper. I would hold a position for a short time
only. I commenced to experience pains in the head when it seemed
to me that the sidewalk was moving sideAvise. I consulted one old
soldier friend who advised me to surrender myself to the military
authorities, which I did. My friend stipulated that I should behave
as a prisoner and that if found being afflicted with lung trouble I
would be sent to Fort Baird, New Mexico. But as three examina-
tions showed no signs of lung trouble, I determined to secure a
medical discharge from the army by shamming insanity which I
did successfully. I told the doctor I was possessed of a knowledge
concerning electrons, atoms and molecules as would enable me to
change the present existing conditions and bring on the millemiium.
I accompanied these verbal assertions by exaggerated nervous

472 PSYCHOPATHOLOGY

stimulations which completely fooled the doctor, as expressed by
his eyes. This continued for two months, when to my surprise,
I was brought to "Washington under the impression that I was com-
ing to the Walter Reed General Hospital for observation."

When this patient was brought to St. Elizabeths hospital he
soon claimed that he had malingered insanity in order to escape a
prison sentence. He made the confession of malingering, saying
he would rather go to prison than to remain here, because he was
afraid the associations with patients would again make him insane.
He had very little confidence in his mental stability, and begged to
be sent to prison.

He declared the material he had used to give the impression
of insanity had been picked up at Matteawan from other patients
and from his own experience there. It consisted mostly of claims
of auditory hallucinations, fear and very grandiose fancies about
omnipotent, heroic deeds -wdth electrons and molecules, and the
destructions of an enemy's, fleet, etc.

While he was a patient here he was sociable, helpful, clean and
generally well behaved. The intelligence tests indicated consid-
rable inability to concentrate on facts and think accurately.

The Paranoid Mechanism of Compensation in the Female

The paranoid mechanism of compensation in the female seems
to be similar to the male in that fundamentally there is an overde-
veloped homosexual craving that has existed since adolescence,
which, however, has often not been truly appreciated by the indi-
vidual. Through the influence of some experience or overt auto-
erotic and homosexual play, the woman becomes fearful of her
inability to control herself and tries to show that she is not auto-
erotic or homosexual, but is fond of men and very attractive to
them. Within due time the fear of being recognized as homosex-
ual becomes covered over by the obsession, a wish-fulfilling con-
viction, that men are passionately fond of her and resort to every
means to seduce her.

These patients, as a rule are remarkably clever and tell an
astonishingly logical story built up of deductions from, however,
the wish-fulfilling "meanings" in the suspected person's "re-
marks" and "manners."

My experience with a series of such women, several of whom-
are reported (Cases PD-28, PD-36), is that if the male physi-

PSYCHOPATHOLOGY OF PARANOIA 473

cian is not critical and carefully refrains from expressing any
donbt about the defensive delusional system, which is not often
easy to do, he will soon find that the woman will strive to force
herself to establish a transference to him which in a short time will
be difficult to control (contrasting with the truly heterosexual type
who make a natural transference). He will also find that these
Avomen usually are much more inclined to trust men physicians
and will not, if possible, allow a woman physician to examine or
prescribe for them.

Their records also show, if married, that they have been
frigid, vain, self-indulgent, and often secretly autoerotic, and not
until they become fearful of their affections for other women do
they plunge into a system of heterosexual fancies. In this respect
they strive to compensate like the homosexual man.

It seems to he a consistent fact, remarkable if so, that the con-
slstently aggressive homosexual male and female, iieither one, are
inclined to become paranoiacs and panic-strickeu , developing
m-erely anxiety neuroses and periodic manic flights of abandon-
ment, but those ivho can not control cravings to submit to sexual
assa^dts, develop a delusional system in ivliich everytliing in the en-
vironment that tends to stimulate the compulsion to be submissive
is resented and attacked.

The mechanism of compensating for an inferiority, l^eing
characteristic for all forms of animal life and probably every cel-
lular division of each animal, not only shows in the psychoses when
a functional inferiority causing fear is present, but also when the
individual has a functional inferiority due to disease. The fol-
lowing cases of paresis and an arteriosclerotic old man show how
the compensatory claims a]:ise as a defense against fear. When
this inferiority is increased by disease, reducing the margin of
reserve power, the compensation may become more eccentric. It
is quite probable that only those paretics compensate who become
afraid when they begin to feel their potency diminishing.

Case GP-1 was a government clerk, aged twenty-seven,
recently married, who had all the clinical and laboratory findings
of paresis. He acquired syphilis seven ^^ears before his admission,
and received vigorous an ti syphilitic treatment. His physician con-
sented to his marrying, although a few weeks previous to giving
this advice the patient developed a slight ptosis of one eyelid.

474 PSYCHOPATflOLOGY

Soon after his marriage he complained, after copulating, of
having to work unduly long in order to have seminal emissions,
and worried about the cause of this weakness. Three weeks after
his marriage he became depressed, felt that he was going blind,
and reacted to auditory hallucinations that were trying to make
him commit sexual perversions. They also told him he was goii^
blind in one eyes

He developed a classical compensation type of psychosis with
a grand euphoria and a consistent goodhumored, halfserious hy-
peractivity, colored with chronic plays of wit. He constantly built
great electrical machines in his fancy, with which he could explode,
magazines of powder at great distances by mere turn of the hand.
These fancies gave him great pleasure. He told of a fight he had
with an attendant, in which, by the power of his mind he took hold
of the man's little finger and threw him.

He fancied that he could hypnotize any girl by looking at her,
and, with his eyes, make her fall in love with him. This was a dis-
tinct compensation for distressing sexual impotence, although the
impotence was probably caused by cerebral syphilis ; and the hyp-
notic power of the wonderful eyes replaced the ptosis.

Case GP-2 was a sailor, aged twenty-nine, divorced, who
had many clinical and all the laboratory findings of paresis.
Pie was hyperactive, made numerous incoherent productions,
Avrote many unintelligible letters and constantly tried to establish
his potency as an inventor. He believed that syphilis of the brain
was the cause of his incoherent speech, feelings of weakness and
tremors. Through exercise and incessant work, he tried to repair
his loss of skill and strength. One morning, while confused and
stuporous, following a convulsion, he rushed up to me from his
bed, crying and begging for protection^froni men who, he explained
unmistakably, were trying to subject him to an oral sexual assault.
From the facts, that he was isolated in a room, had been muttering
and cursing the assailants, and later treated the affair as an " im-
agination," and that he was recovering from a stupor following
convulsions, we regarded the panic as the result of vivid halluci-
nations, in which oral erotic cravings played a predominant part.
The tendency to homosexual regression caused fear which was com-
pensated for by the vigorous, wild striving to be potent.

Case AS-1 was a man over seventy years of age, who had
many signs of a cerebral arteriosclerotic deterioration process. He

PSYCHOPATHOLOGY 01? PARANOIA 475

always persisted in demonstrating Ms fancied great strength and
inventive ingenuity, and described, with indefatigable detail, the
wonders of a powerful drill for "boring into rock," which he was
going to build.

The rock suggested the resistance to sexual potency, and the
drill Avas the all potent phallus, which brought up the question:
Why should an old man, on the verge of his grave, persist in this
striving? What was he afraid of? He answered this question as
soon as we inquired about his comforts and safety, not about his
sexual difficulties.

He immediately begged for protection from a young man who
slept near him. He described the man 's behavior in a manner that
convincingly showed that he himself had submissive erotic inclina-
tion toward his neighbor and was blaming the young man for the
difficulty. The old man was afraid of himself and so was recon-
structing his potency in fancy as a defense. His hyperactivity and
demonstrations of power were compensations.

Case MD-8 illustrates a compensatory mechanism in the fe-
male due to organic inferiority.

Summary

It is apparently a sound principle in psychopathology that,
whenever an individual presents an eccentric claim for prowess,
inventive power, creativeness, or undue potency in some artistic,
professional, social or mechanical field, without reasonable foun-
dation in reality, he is overcompensating for inferiorities of which
he is fearful.

Organic and functional inf erioritieis that do not cause anxiety
("sensitiveness") or fear are not compensated for.

Conversely, when an individual wishes to acquire or avoid the
attentions of someone, or develop some project, he compensates
with work, the endeavor relieving the fear of possibility of failure
to gratify the wish.

The paranoiacs and paranoid types arc, always individuals
who are biologically inferior to the requirements of the race.
They are not able to establish a comfortable heterosexual potency
and are constantly forced to struggle in order to control homo-

476 PSYCHOPATHOLOGY

sexual perverse cravings of which they are fearful, and which they
usually refuse to recognize as a part of themselves.

My experience with these unhappy people is that the prognosis
depends upon the development of insight, and this, in turn, de-
pends upon the absence of hatred and the ability to avoid system-
atizing an attack upon those who make them conscious of their un-
desirable cravings.

The paranoiac is functionally so conditioned and his cravings
are so repressed that he can almost but not quite reach hetero-
sexual virility. The near approach to potency compels him to
strive incessantly to reach it.

CHAPTER X
THE PSYCHOLOGY OF THE ACUTE HOMOSEXUAL PANIC

Acute Pernicious Dissociation Neuroses

The confirmed paranoiac avIio systematizes delusions of per-
secution and the paranoid individual who does not systematize
his delusions of persecution, the individual who passes through an
acute homosexual panic and recovers, and the homosexual individ-
ual who becomes dissociated and deteriorates, are dissimilar,
largely because some make fortunate positive transferences which
ameliorate the fear of inferiority and stop the tendency to erotic
deterioration, whereas the others, who make negative (hatred)
transferences, drive themselves into a progressively eccentric
social position which establishes a vicious affective circle and a
pernicious dissociation of the affective forces which constitute the
personality. Chapters IX, X, XI, XII and XIII contain studies
of these different types of adjustment.

The mechanism of the homosexual panic (panic due to the
pressure of uncontrollable perverse sexual cravings) is of the ut-
most importance in psychopathology, because of the frequency
of its occurrence wherever men or women must be grouped alone
for prolonged periods, as in army camps, aboard ships, on explor-
ing expeditions, in prisons, monasteries, schools and asylums.

The perverse sexual craving threatens to overcome the ego,
the individual's self-control, because the affections for winning
social esteem have been pushed into an eccentric adjustment. The
weakness of the ego is usually due to fatigue, debilitating fevers,
loss of a love-object, misfortunes, homesickness, the sediTctive
pressure of some superior, or erotic companions. As the individ-
ual tends to become eccentric and irritable he is teased and goaded
by his associates. He then loses his social influence and develops
a feeling of being inferior and disrespected. The goading is the
reflex reaction of the herd to get the individual into line with the
needs of the herd. The herd can not afford to be biologically
misled.

477

478 PSYCHOPATHOLOGY

The fear of inferiority arouses a more intense compensatory-
striving, wMch, because of its eccentric nature, further increases
the nagging. The vicious affective circle gradually becomes a per-
secution and the erotic individual, as the perverse sexual cravi^^|
tend to force him into further jeopardy, becomes panic-stricken.

The perverse affective craving causes delusions about, and
hallucinations of, situations, objects and people which tend to
gratify the craving. The pressure of the perverse craving occurs
despite the social honor and social future of the individual. Hor-
rified, he is swept off his feet into a hell of hallucinated tempta-
tions and demons of destruction.

The physiological reactions of fear to a painful contact stimu-
lus are quite like the fear reactions to horrible, painful hallucinated
stimuli. The mechanism of the terrifying dream, like the halluci-
nation, is first an affective disturbance due to the repressed auto-
nomic tensions becoming released by the relaxation of self -con-
trol, as in sleep. During sleep, indigestible food would cause
increased gastrointestinal striving. This produces consciousness
of distressing sensory images which may coalesce into a horrible
perception, like the black dots forming a picture (to^ repeat the
simile used in Chapter I), and this horrible visual or kinesthetic
image, in turn, cati^s the fear reaction. The next stage would
be to compensate by awakening, by flight or counter-attack. When
the erotic.hallucination is felt to be an external reality and no de-
fense is found, pamic ensues.

The panic may be more or less serious, lasting from a few
hours to several months, and the metabolic disturbances attend-
ing such dissociations of the personality, because of the autonomic
reactions due to fear may be very serious.

The autonomic reactions to fear, whether endogenous (as car-
diac incompensation) or exogenous in, origin, are, ivhen the com-
pensatory striving can he made, increase of blood-pressure and
pulse rate, increase of adrenin and thyroid secretions, increase of
blood sugar and decrease of the digestive and assimilative capa-
cities of the digestive apparatus, decrease of heterosexual potency,
and marked increase of trial and error movements of the skeletal
apparatus for the purpose of escape — ^heiice, restlessness, irrita-
bility, insomnia, etc.

When the compensatory striving to retaliate or escape in-
creases the liability to punishment, a tendency to loivering of

ACUTE HOMOSEXXJAL PANIC 479

blood-pressure, irregularliy of pulse, difficulty in respiration cmd
a tendency to assume the catatonic attitude seems to follow; as in
young monkeys, puppies, terrified soldiers, niid catatonic patients.

Obviously, since work and play are necessary to prevent the
atrophy of disuse of tissues and functions in the normal, long per-
sistence of panic or anxiety, besides the tendency to abnormal
endocrinous functions, may be expected to cause marked physio-
logical and, later, permanent structural changes. Gradually, a
deteriorating or destructive autonomic-affective vicious circle is
established, which, because the powers of adaptation and social
competition are greatly reduced, deprives the individual of the
capacity to regain self control, social esteem, reassurance and bio-
logical fitness. Intercurrent diseases and seclusion in asylums
further reduce the compensatory capacities of the dissociated per-
sonality. This is not dissimilar to the Aricious circle of disease and
inactivity upon the normal. "What normally active individual
would dare to endure the deteriorating, monotonous type of activ-
ity forced upon the individuals incarcerated in prisons and asy-
lums?

A series of cases is here presented to show that the cause of
the anxiety and panic is the uncontrollable, perverted segmental
craving struggling with the socialized affective cravings, the ego,
in the same personality. The latter can only acquire gratification
by doing the things that win social esteem. They constitute the
ego and are spoken of as "I," "me," "myself." Naturally, when
the sexual cravings can not be controlled they become disowned
by the ego as a foreign influence, and the ideas and visions, or
sensations they cause, are treated as being due to a foreign influ-
ence. Hence, when another individual, whose characteristics hap-
pen to coincide with the conditioned needs of the dissociated sexual
cravings, thereby stimulating them, comes into the patient's en-
vironment, the patient feels he is being "hypnotized." Often
such men and women attack the innocent person or yield to the
hallucinated assault; or even do both. When the patient says
someone is "throwing voices" into his head, making him hear
voices or have visions, making him have a peculiar taste in his
mouth, putting poison in his food, shooting electricity into his
body, hypnotizing him, going to kill, crucif}^, initiate him, or make
him join a society or religion, or steal his manhood, etc., it has
been found that the patient is telling the physician that he has lost

480 PSYCHOPATHOLOGY

control of Ms sexual cravings ivhich are forcing him to offer him-
self as a sexual oiject. When the patient insists that a certain
person is performing this mysterious ritual or power over him,
it may be accepted that in some manner this particular person is
either sexually attractive to him or is very intimately associated
with someone who is sexually attractive.

The prognosis of such cases, it seems, depends largely upon
the extent of the defensive systematization of the delusions, and
whether or not the patient is reacting with hatred. The presence
of hatred should always he considered as dangerous under such
conditions and almost sure to prevent the develop'inent of insight.

The true significance of "poison" in the food was a riddle
until the following patient showed us that it probably, usually,
meant semen. A further careful investigation of the meaning of
"poison," "filth," "dope," "drugs," "stuff," "something in the
food," "cream," "powder," "saltpeter," in a series of over 200
cases, established the probability that in every instance in which
a patient seriously complains that food has a mysterioiTS, or hyp-
notic, or erotic influence upon him, it is due to the fact that the
food acts as the stimulus of pernicious oral erotic cravings. This
insight naturally has led us through a simple approach to the very
foundations of the patient 's emotional cravings and the heretofore
obscure causes of this type of psychosis.

We have found that the patients who can be influenced to quit
fighting the recognition of oral erotic cravings — this does not mean
submission to them — fare better than the patients who struggle
desperately to eliminate them and attack everything that arouses
the craving.

In order to make it unnecessary to refer again to the facts
that explain the meaning of "poison," etc., in the food, or of im-
pulsive suicidal assaults upon the head, mouth and throat, or swal-
lowing extraneous material, the reader is asked to note -partic-
ularly the factor of oral, homosexual eroticism and the delusions
about being persecuted for having such perverse cravings in the
following series of cases.

Case PD-13 was an egotistical, taciturn, rather well-built, but
undersized, German, with small features, and lips which were
tightly compressed into a cynical, indulgent smile. He was twenty-
eight and unmarried when admitted to the hospital. He had never
been able to adapt himself comfortably to any society and had at-

ACUTE HOMOSEXUAL PANIC 481

tended school irregiilaiiy, liad a poor education, was fond of play-
ing truant, and frequently was arrested for vagrancy, serving two
sentences of thirty days and one oL' six months. lie Avorked in
bicycle-repair shops, and at similar odd jobs, until he was twenty-
four, but was unable to submit to the dictations of an employer,
feeling that it referred to some inferiority.

At twenty -four, he drifted into the army and earned a fair
record during his first enlistment. There, he was operated on for
appendicitis, and later for hernia. Neither experience seriously
disturbed him. He denied venereal infections and was not inclined
to be alcoholic. He saved no money, giving some aM'ay to men who
Avere "down and out" and patronized prostitutes when "nature,
called for it." Otherwise, he cared very little for women.

He was inclined to brood, made no friends, was very seclusive
and sullen. He felt that his companions talked about him and
avoided him because they thought he was "a silent worker." (He
meant homosexually, oral-erotic.)

At twenty-eight, his feelings of persecution due to the re-
pressed eroticism assumed the proportions of a fernicious repres-
sion compensation neurosis or paranoid psychosis. He became
more seclusive and would talk to no one, feeling himself to be re-
garded as "no good in the army." He fancied that "broken
pills" had been put into his pudding and coffee, and complained of
this as mistreatment. He said that at one time he acted as if he
was asleep and heard his companions make such remarks about
him as "fluter," "silent worker," "start him working," "he will
be in Washington in the insane hospital soon."

He was finally confined in the Post hospital because he was
suspected of taking money from a store-till. A fcAv weeks later,
he was sent to St. Elizabeths Hospital at "Washington, D. C.

The mental examination showed no actual impairment. He
was well oriented, understood his environment, his memory was
accurate, and he easily passed the special intelligence tests. The
physical examination revealed no organic inferiorities.

His psychosis seemed entirely to be constituted of a struggle,
with intense homosexual cravings. He believed that he had been
sent to this hospital as a punishment and that the men here re-
garded him to be a sexual pervert. His auditory hallucinations,
accusing him of homosexual desires, worried him continually. He
believed the accusations were made by other patients and isolated-

482 PSYCHOPATHOLOGY

himself accordingly. He was depressed and at times wept bitterly.
At other times he was quite indignant and threatening. He walked
erectly, held his head up, and looked defiantly at his physicians and
associates. He usually smiled in a very tolerant, superior, self-
satisfied manner, as if he knew something that made him superior
to most men.

He complained mostly about the food, and was fed with diffi-
culty. ' ' They ' ' put pills and powder in his coffee ; it was ' ' ground
up so that it would dissolve. ' ' He said the milk in the coffee was
"too thick." "It ivas not cream, it ivas too fat." His ideas
about the coffee were very similar to the ideas he entertained
at the army post. A few days later he cautiously revealed his true
feelings about the pills in his coffee at the army post. This was
told with mingled embarrassment, weeping and affectionate smil-
ing. .The questions had to be guardedly phrased so as not to of-
fend him or lose his confidence. He finally revealed his craving
for the ingredients and that it made him "feel better," relieving
his depression. He said the coffee and pudding contained some-
thing "richer than cream, richer than milk,." It would make him
"feel hot" when he ate it, and he had to open "two windows" to
"cool off." He added, in his discussion of this, that later he had
to go to the toilet but could not pass feces because "it was too
hard." (Two windoAvs evidently referred to two orifices ; in order
"to cool off," to be relieved — namely, oral or anal. An erotic
woman begged for cold water because she was "hot.")

He would not say definitely what this coffee contained, but
felt sure it made him "dream off." His smiles and tendency to
become affectionate when he described the "richer than cream"
were unmistakably characteristic of the homosexual advance.
(Such men can not be held morally responsible for having such
autonomic cravings, but they are responsible for their adjust-
ments to them.)

He said he would like some more of it because it did him
"more good than anything else," and made him "feel much bet-
ter."

During this renunciation to his sexual feelings for men, he
wept bitterly, and showed how easily he might lose control of his
cravings. He said : "Somebody might make me do something, biit
I would not do it if I knew it. ' ' He continued to mal?:e homosexual
advances with this statement and talked of his inability to control

ACUTE HOMOSEXUAL PANIC 483

himself. When he realized that he was making advances unre-
servedly, he cried and tried to assert some self-control, with the
statement, "I am not so low as that." I was careful to ask only
simple questions, basing each one on the content of his preceding
statement so as not to suggest an opening to him, but it seemed
that my insight into his struggle was sufficient for him to make
a frank exposure of his difficulties. After he expressed his resist-
ance to his sexual cravings in the phrase, "I am not so low as
that," he followed it up with another advance and then with agita-
tion, ' ' If you want to, take me out and shoot me and be done with
it." After this conversation he frequently sought further inter-
views and regarded me with affection and as a protector. This
soon changed to peevishness Avhen- 1 was unable to give him fur-
ther attention.

In the meantime he was neat and seclusive, spent most of
his time in day-dreams, often laughing heartily to himself. He
was paroled several times, and did some indifferent work in the
laundry, but, because of his egotism and sensitiveness, he had to
be removed.

For several months he compensated for his feelings of infe-
riority and unpleasant hallucinations by most extravagant claims
of being "God" and very powerful (potent). Otherwise, he could
not be induced to discuss his troubles Avith anyone, but prophesied
that we would soon know all about him. He became very arrogant,
and often demanded his discharge. He Avrote numerous letters
containing incoherent phrases referring to his omnipotence and
self-importance. Unfortunately (sixteenth month) he eloped from
the hospital. The following letter was received from him about
a month later: "Sii* — Am writing in regard to clothes and rest
of funds, $5900 due to me while I been in U. S. Army from 5th
December 1914, discharged 13th July 1915. Hoping to hear from
you soon." (Signed.) «

Other sensory disturbances than auditory and gustatory were
never complained of or indicated.

When he eloped, he had no insight into the hallucinated sen-
sory gratification of his affective cravings, but believed other peo-
ple were responsible for them. He was regarded as a paranoid
type of pernicious dissociation of the personality.

After this patient's revelation of the significance of "poison"
and "dope" in the food, and the cravings.it satisfied, an entirely

484 PSYCHOPATHOLOGY

new interpretation of the resistance to food, which is common in
many psychotics, became necessary. We now were able to under-
stand why many panic-stricken patients had to be tube-fed. The
food and month were intimately associated Avlth the erotic crav-
ings and the forced feeding constituted an assault : to some, pleas-
ant, to others, horrible. Some resist the feeding desperately
whereas one woman starves herself in order to be tube-fed and
reacts to the tubing as a sexual orgy in which she masturbates if
not restrained.

Case PD-14 had an alcoholic father; his mother had had
"fainting spells." Because of his limited mental capacities, he
attended the ungraded schools until twelve years of age, then
worked as a helper in many different trades, and enlisted in the
navy at seventeen.

About fifteen months after his enlistment, his psychosis began.
The interesting feature in his psychosis was the panic, because of
inability to control himself. He suddenly submitted to the homo-
sexual cravings, and put white paste into his m,outh, insisting that
some person's hypnotic influence forced him to do this.

When he was admitted to St. Elizabeths Hospital, having
practically readjusted, he discussed the panic with great reluc-
tance. When he spoke of the details of his experience, he again
became agitated, and only controlled himself with the greatest
effort. He insisted he had been "doped" and a scheme had been
"framed up," on board ship, which he resented bitterly.

He was well oriented upon admission, his memory was accu-
rate, and he performed the intelligence tests quite well, althoiagtv'
his answers were frequently rather simple and insufficient.

At the time of his psychosis, he was in love with a girl and
planning to marry. He naively displayed the girl's picture to his
companions and promptly became the butt of unpleasant "kid-
ding ' ' which, on one occasion, resulted in a fight.

His fair, pink, girlish complexion, scanty facial hair and shy
manner of expressing himself were effeminate attributes. Several
times, some of his shipmates made homosexual advances to him,
and he probably felt uncomfortable about their impressions af his
masculinity. For several weeks before the acute panic, he worried
about his health (anxiety) and tried to get into "the sick bay" be-
cause of feelings of dizziness, weakness, fear of falling, and a tend-
ency to become confused (common symptoms of failure to con-

ACUTE HOxMOSEXUAL PANIC 485

trol the erotic affect). The first tune he went to the sick bay, he
said, a "red-headed" attendant told him that if be didn't quit
' ' pulling his penis something would go wrong with him. ' ' He said :
"I let this sink deep into my mind; I had been dreaming a lot
about my girl and may have masturbated while in my sleep." He
had tied his hands at night to preA'ent himself from masturbating.
(Fear of the segmental craving.)

During this episode he complained of the usual anxiety symp-
toms: Pain in the stomach, vomiting, depression, weakness and
crying. Despite this, he was sent back to duty in two days. The
physician made a diagnosis of "hysteria." About three weeks
later, a serious panic developed. He remembered the following
' ' remarks, ' ' which had something to do with the ' ' frame up. ' '

He said the day he drew his pay he was feeling uncomfortable.
One of the sailors, he thought, significantly remarked : " ' Sign it
for all you're worth ! ' The pay check said 18, and I told him to look
again and he found it was $27!" That afternoon, they stored
"brightening paste" (a white metal polish) in a storeroom and it
made him feel sick, but he could not explain why brightening paste
should sicken him. (His later impulse explains this.) He said he
felt "so dizzy" he could hardly take a bath. (Fear of sexual
temptation.) That evening, he joined some sailors in a game of
poker, during which his "queer feelings" made him sure that
"something" was going to happen to him. He gave his money to
a companion for safe-keeping and then sought help from an officer,
who, it seems, passed him up. He retired to his hammock, but
could not sleep. Finally, he went to the toilet "to get relief," and
on the way he passed a bulletin-board on which he saw the names
of all the men with Avhom he had previously played poker. Their
names were posted to receive ' ' registered mail, ' ' and his name was
not on the list. (He was not a truly registered, thoroughbred
male. ) This convinced him that a ' ' frame up ' ' was being planned
against him and caused his "queer" (sexual) feelings. He tore
the names off the board, and. the officer sent him to the sick bay.
Here he felt that "odors, like ammonia, were blown into the room
by a fan. ' ' He became panic-stricken, was afraid they were plan-
ning to kill him or put him through a series of initiations. He
cried, resisted all attention, talked confusedly, and could not be
controlled. He was finally put to bed, but insisted upon examining
everything in the room. He tried to find the cause of the odors, and

486 PSYCHOPATHOLOGY

found a box of brightening paste. He sKonted, "This is the
stuff ! ' ' and bit into it. The taste was unpleasant, and he scattered
the remainder over the ward. He was caught and put into the
' ' strong room, ' ' where he now cried, shouted, cursed and called for
the "red-headed attendant." When the man came, he threw his
arms around him and begged for protection. He said he thought
his penis was all" shrivelled up" {castration) , and that they were
trying to do "something, pull something over his eyes." He con-
tinued to be excited, incoherent, confused, and was unable to be-
come reconciled to his confinement. After he readjusted he al-
,ways became agitated and wept when he discussed this experi-
ence, and is still firmly convinced that he was " doped "^and
subjected to a sexual assault of some sort. The panic and depres-
sion lasted about a week.

He never gained insight, but explained the eating of the
paste as an impulse. Physically, he was a well-developed young
man, but the scarcity of his facial hair, his transverse pubic hair
and soft voice indicated his effeminate make-up. He M^as fond
of other male patients, and was observed to sit on the bed with
another man and kiss him.

His panic was clearly terror at his own homosexual eroti-
cism which he could no longer control or understand.

While in this hospital he was neat, well-behaved, sociable, and
worked on the ward. He was discharged at the end of the third
month as a social recovery with partial insight. He declared he
was going to marry and make a man of himself. The prognosis is
considered poor.

Case PP-15 was an illiterate Eussian Jew, aged thirty, mar-
ried, who served in the U. S. army one and one-half years as a pri-
vate.

He said his father was ' ' crazy. ' '

This man was well developed, physically, but gave a history
of syphilis, had a positive blood reaction (Wassermann), but nega-
tive spinal fluid and no neurological symptoms of intracranial
syphilis.

He was sent to St. Elizabeths Hospital as a case of ' ' catatonic
dementia prsecox." His psychosis was a classical homosexual
panic.

At twenty-six, several years after his marriage, he began to

ACUTE HOMOSEXUAL PANIC 487

practice cunniliBgus, and there is some indication that homosexual
perversions may also have been practiced.

The onset of the psychosis, according to the army medical re-
port, was "snb-acnte with insomnia, confnsion and depression."
This was followed by a state of panic, hallucinations and a "hys-
teria form of attack. ' '

During the panic, he knew he was in the army hospital and
could give the time of day, but not the day of the week. His mem-
ory for most past experiences was quite detailed and accurate.
He calculated fairly well.

He made numeroiTS efforts to strangle himself and to take
poison (emphasizing the throat and moiTth). He was afraid of
being killed, and believed that poison was put in the food. He
resisted the food for three days, and could be fed only after
considerable persuasion.

V'oices called him a Eussian spy, and hallucinations convinced
him that his death was being planned. When a blood specimen
was taken he fought fiercely and had to be anesthetized in order
that the spinal puncture might be made. He resisted all the rou-
tine ward measu.res, and was afraid of the approach of men pa-
tients, male nurses and physicians. He was constantly trying to
escape from his "tormentors" and impending "death."

On one occasion, during an interview, he threw himself about
in his chair, and finally, allowed himself to slide to the floor with
his muscles rigid. He remained there stretched out, eyes closed,
and mute, for several minutes, simulating "d3ang." (This usu-
ally means an offer of sexual submission.)

He repeated questions four or five times, and whispered to
himself but gave few, irrelevant answers. After several weeks
of panic, he lapsed into a mute state and became indifferent to
everything, had hallucinations, whispered, and responded with
mysterious signals to the dissociated affect.

He was in this inaccessible state wlien admitted to St. Eliza-
beth's three months after the onset. He was apprehensive, very
much afraid of everyone, and would stand about or hide in the
corner of a dark room. He seemed to be disoriented, repeated
questions, rubbed his hands, said he was sick, and suspiciously
resisted all efforts to take care of him.

He gradually improved, liecame more accessible, and showed
considerable insight, denied hallucinations, but complained of

488 PSYCHOPATHOLOGY

"bad dreams." About tbe sixth month of his psychosis, he went
through another panic which lasted about four weeks. It, for-
tunately, was more accurately observed. It seemed to have been
initiated by an erotic dream; because, about three o'clock one
morning, the patient awakened everyone on his ward with shouts
of terror and pleas for help. When the physician entered the
room, he jumped from the bed, fell on his knees and begged to be
saved. He shouted something about being killed, but was too ex-
cited to give any information. Finally he succeeded in telling Dr.
James Hassell that, for several nights, he had been unable to sleep,
and on this occasion, as the clock struck three, he began to shout;
"I am a fool!" (in Polish) and to count: "One, two, three," re-
peatedly. Snakes appeared all about him, and he became panic-
stricken. (He said he had always been very much afraid of
snakes, rats, rabbits and toads, and later attributed it to older
children frightening him with such things when he Avas a child.
He had had similar nightmares when on board ship.)

On the i?,ight of the panic, a snake approached with its head
raised, "about six inches," with mouth open, making hissing
noises. It jumpe_d at him and bit him in the chest. His brother
and sister also appeared in the hallucinations.

The panic gradually subsided and he resumed an interest in
work, recovering his composure after four weeks.

A young man, very well versed in abnormal psychology, was
afraid that he might develop dementia prsecox because of his oral
homosexual compulsions. He related a dream in which a snake
bit him inside of the mouth, causing considerable anxiety (fea,r of
an oral infection). Another young man who incessantly boasted
of his physical powers, his dangerousness, love for blood and mur-
der, and tried to keep the other patients bluffed to protect himself
from his homosexual cravings, dreamed, with anxiety, that a snake
coiled around his neck and strangled him. (See p. 603.)

In the fable about Man's Fall from Paradise, a snake was the
seducer, and, in religious writings and sexual stories snakes, bats,
dragons, rats and. owls are often used to symbolize sin, death and
sexuality. (See Fig. 52.)

The feelings, of inferiority in this man were due to oral-erotic
homosexuaLcrayings, and the anxiety and panics were due to th6
cravings becoming uncontrollable. When the Eussian recovered,
he worshipped his imif orm and s'trutted about the hospital grounds

ACUTE HOMOSEXUAL PANIC

489

like a "dandy," making a classical compensation of egotistical
self -admiration.

Case PD-18 was a soldier, twenty-eight years of age, unmar-
ried. He had served five years in the U. S. army.

Abont six months before his admission, he made the rounds
of gastroenterologists to be ti'oated for "catarrhal gastritis" and

Fig. 52. — Cover of magazine, by Erte. Sexual fantasy showing the phallus symbolized
by great birds, bunches of grapes and a serpent; with passionate submission.

490 PSYCHOPATHOLOGY

"acute duodenal ulcer," because of abdominal pains and a "turn-
ing stomach." He also complained of "gonorrhea of the rectum,"
and that the soldiers were calling him a "masturbator," "bas-
tard" and "degenerate" (referring, as usual, to submissive oral
and anal eroticism).

He was held in an army hospital for observation to determine
whether or not he was "a malingerer, hysterical, or really ill."

About three weeks before his admission to St. Elizabeths
Hospital he escaped from the hospital in his gown and bathrobe,
and was later found in a state of panic. He complained that his
"stomach and bowels are on fire," drank large quantities of warm
water to induce vomiting, was inaccessible and very difficult to
control. He was sent to St. Elizabeths Hospital about six months
after his first complaints began.

Upon his admission, he went to bed, covered himself com^
pletely with blankets and turned his face to the wall. When ques-
tioned, he at first refused to answer but later accompanied his re-
plies with violent motions of his body. Pounding the wall with his
hands, he shouted, "they call me a dope, a thick-headed Irishman,
and this and that ! ' ' When he talked of his ' ' terrible pains ' ' in the
abdomen, he viciously jabbed his fingers into his abdomen, grabbed
his tongue with his fingers as if to pull it out, and tried to seize the
physician's stethoscope. His voice was sharp, high-pitched and
whining..

Later, when he talked to me, he said : ' ' Somebody chokes me ;
they do everything in the little room ; they throw me away ; words
come out of my mouth; I can't help it, and people tell me lots of
things, and I have to tell it over again; nobody likes me. I feel
queer ever since I have been in a warm climate, have feelings that
cause my troubles and can't help it. The troubles are in my head
and I can 't help it. [Shook his head vigorously.] They say I killed
Major — and Captain — and could not help it. I ran out into the
snow. [Referred to his elopement from the hospital.} They were
after me — I was calling them names — they forced me — pulled me
out, said T did this and that ; [cried] said I had all kinds of dis-
eases, venereal diseases, said I done everything — one fellow told
all aroimd the company that I had a venereal disease of the rec-
tum, and he said that I said things about the Major — said the
Major was giving me salt enemas and eggnogs."

He frequently asked for a priest, because he had "to die,"

ACUTE HOMOSEXUAL PANIC 491

and when the priest arrived, he insisted the man was not a priest.

His behavior indicated auditory, visual, gustatory, and other
hallucinatory disturbance of sensation. He wa§ disoriented and
misinterpreted almost everything to be related to his erotic crav-
ings.

When patients approached him, he made noises, grimaces,
manneristic movements, threatened or attacked- them or secluded
himself. He complained of being afraid, and often resorted to
making as much noise as possible to intimidate his environment.
(A method common to birds and animals.) He Avas very untidy
and destructive, and, occasionally, drew his finger across his throat
as if he meant to cut it, saying, "Cut it off!"

He would often lie on the floor half-clad and beat his head and
face with his fists, expectorate and repeat that there was some-
thing in his head, and that he could not control his thoughts.

The eroticism of the patient was clear enough. The fear of
gonorrhea -of the rectum fromanal eroticism and gastric disease
from oral eroticism, his attachment to the officers and fancies
about the Major giving him salt enemas and eggnogs (seminal
equivalents) are distinctly symptomatic of his cravings. His
method of beating his head, because of inability to control his
thoughts, shows the desperate manner in A\'hich he was fighting to
control himself.

Suicides in such conditions, usually by cutting the throat,
hanging, or plunging on the head, are quite common. I know of
two young men who killed themselves by several days of terrific
pounding of their heads and bodies ; another by plunging from an
elevation onto his head, fracturing a spinal vertebra; another by
shooting himself; and another, by taking bichloride of mercury.
These men seemed to reach a stage in the affective struggle when
intolerable sensory disturbances about the erotic region coinpelled
an annihilation at the cost of everything. ( Such cases, demanding
castration of the erotic zone, under pretext of distressing pain-
fulness, often gravitate to a surgeon.)

Case PD-19 was a rather slender man of medium height,
twenty-four years of age, and unmarried. He enlisted in the navy
with the ostensible intention of improving his knowledge of certain
kinds of machinery. His physical condition showed certain in-
feriorities. His facial hair was very scanty, and the bones of his

492 PSYCHOPATHOLOGY

face, while not small enotigB. to be distinctly effeminate, were not
as heavy as the average male's of his age.

He had never shown a social interest in girls. Several times
he had patronized prostitntes when on shore duty.

Several months after his enlistment, he suspected' that some-
one was putting different "chemicals" and "medicine" in his
beer. This "dope" or "jnnk" made him feel "dopey" and have
"swimming in the head." He heard whisperings on the streets
"like anybody would," such as, "He is not guilty! Don't believe
it!" He did not get excited about the names he heard "those peo-
ple" use, such as s. b., c. s., etc., because he "did not know who they
meant."

Whieh he had tonsillitis, the doctor, he said, swabbed out his
throat with "margarine oil" and whispering voices said: "He
wouldn't have anything to do with it," etc.

Later, the food became "rotten." Someone "put filth in it."
He could see "white stuif " in the bread. This filth he smilingly
described as "come" (semen), when he was asked more definitely-
concerning it. This "stuff" made him sick at the stomach, caused
vomiting, anxiety, and inability to worJc.

About this time, he noticed that his "tools" had been tam-
pered with. ' ' The ripper " (a type of chisel for cutting tubes) had
its edges turned and instead of cutting into the tube would "slip
off."

"The expander" (a cluster of three rollers to be inserted into
a tube so that when a cone-shaped pin is driven between the rollers
they spread apart and expand the tube) was also "tampered with"
and would not work. ' ' The tools would kink over every time you'd
go to use them. ' '

After his admission he adapted himself to the" ward routine,
was neat, not worried, sociable, and gave the impression of rather
enjoying the auditory hallucinations and his perverse sexual in-
clinations. The trouble with his tools symbolized his actual hetero-
sexual impotence. The fancies about the treatment of his throat
with "margarine oil" and the "come" in his food gratified his
oral erotic homosexual cravings.

He discussed these things with sm,iles and laughs, showed no
embarrassment, and seemed to make no effort to compensate for
feelings of defieienc}^ which was in striking contrast to the des-
perate compensations of other men.

ACUTE llOMOSEXUAI. PANIC 493

Impregnation fancies were not obtainable at the time of the
examination, bnt were rather to be expected.

Case PD-20 was an illiterate, irresponsible soldier, aged
twenty-four.

The patient's father was a chronic alcoholic and psychopathic
personality. Twice, he suddenly disappeared, deserting his chil-
dren.

The patient said he was not able to learn very well, and only
reached the sixth grade in school. He was a shiftless worker and
never earnestly tried to develop skill in any mechanical art. He
wasted all his earnings in carousals and alcoholics, Avas seclusive in
his social tendencies and at times lived the hobo 's life.

He never shoAved an interest in women for social purposes.
His sexual career included perversions when he was about six
years of age, and numerous anal perversions with adult males in
the last few years. He also patronized prostitutes and practiced
sexual perversions. He contracted gonorrhea, but not syphilis.

The present psychosis began two years after his first enlist-
ment in the U. S. Army. His indifference and "queer, silly" be-
havior caused him to be confined in the Post hospital. The report
of his behavior at the Post hospital says that when he tried to
think, he wrinkled his forehead, said he felt happy sometimes
but usually had ' ' the blues ' ' and felt ' ' homesick. ' '

He complained of restlessness and insomnia, had auditory,
visual and olfactory hallucinations, and other distressing sensory
disturbances. The voices called him a sexual pervert, etc., and the
auditory image of the voice of a man named M — , saying "I'll
shoot that s. b.," frightened him. He believed he had been given
a "hypodermic injection," which made him feel "dead." (Possi-
ble reaction to a hypodermic.) When, however, the spinal punc-
ture was made, he said with anxiety, "It is all off," he was going
to die. "They accused me of going doAvn on different fellows — of
having improper intercourse with women and by rectum with
men." He admitted sodomy and masturbation but denied oral-
erotic acts. He believed his sins were unpardonable and that he had
to suffer accordingly. He had sensations of choking that made
him very uncomfortable, and during these states he sometimes saw
"flashes of light in the sky."

He smelled "drugs" on the bed-linen and, believing that "poi-
son" had been placed in the food, refused to eat. Feeling that he

494 PSYCHOPATHOLOGY

ought to be shot or hanged, he regarded everyone with suspicion
and dread.

His insight was not encouraging. He maintained that there
was nothing wrong with his mind and the other patients were
all sane. He would not discuss the symptoms of his cravings and
their influence on his thoughts.

His memory for remote and recent events was reliable. He
was well oriented and passed most of the intelligence tests when
lack of knowledge did not make it impossible, but he showed very
little interest in current events, being absorbed in his feelings of
persecution ■ and degeneracy. He apparently made little or no
effort at a religious or social compensation. His general knowl-
edge was very meagre. Seven months after the onset of his con-
fused meutal state, his eroticism subsided and he was dischargeii
as socially recovered, having become able to work when not too
erotic.

His physical status showed no stigmata of degeneracy and his
hair distribution and general physical make-up was masculine in
type.

Case PD-21 was a soldier, twenty-three years of age, unmar-
ried, who enlisted at seventeen and served five years when he be-
came panic-stricken.

His maternal grandmother was insane, probably cerebral ar-
teriosclerosis. One maternal uncle was "thought to be insane,"
and his father was a chronic alcoholic.

Although he attended school from six to fourteen, he advanced
only to the fourth grade, about the ten-year level. He said he
learned with great difficulty.

At twelve, he left home because of his alcoholic father's abuse.
His father caught him in the act of masturbating, which increased -
their animosity. Besides this, he said, he stole $13.00 from his
father and denied it under oath in court, which denial, later, greatly
worried him.

At seventeen, after several years of crude labor, he enlisted in
the army and served as a private until the onset of his psychosis.

In the army, he indulged in alcoholic debauches and became
infected with syphilis from a prostitute. The psychosis appar-
ently developed some time after this, but was probably related to
his worries about it. One day, he was observed to be talking to
himself in a curious manner. He complained that one of the ser-

ACUTE HOMOSEXUAL PANIC 495

geants intended to "blow np the stables" in which he had been
sleeping and, with manifest anxiety, said the sergeant worried
him by his frequent inqiiiries about the locks on the doors of the
stable, commenting in a confused way "this got on my mind and
I thought he was crazy. ' '

The earliest hallucinatory experience which referred to feel-
ings of homosexual assault was probably his statement that "the
horses got loose" and he heard "chains rattling." The psychosis
soon developed more frankly. He complained at the hospital that
he had a cough and, in a few days, that he had a ' ' sticky substance
in the mouth between the teeth" Avhich he removed with his fin-
gers. He could ' ' smell ether, ' ' which doped him, and thought that
"my manhood had been taken from me." "They would cut my
testicles out to stop my masturbation [and] prevent me from hav-
ing intercourse with women. I tried to stop it but did not have
quite enough will power to stop altogether — ^I was afraid it would
make me crazy."

Coincident mth his delusions and hallucinations, he became
confused, depressed, retarded and mumbled continimlly to himself.
He would stand in one position for hours and repeat his mumbled
phrases about the sergeant, horses, blowing up stables, etc. "The
voices reminded me of my step-brother and my stealing money."
Later, the voices said : ' ' Give him all he wants. ' ' He refused to
eat (probably because of poison — semen symbol— in the food) and
was afraid to sleep because of his feelings of impending sexual as-
sault. He frequently examined his genitalia to find the place of
a supposed operation and seemed to be puzzled by the absence of
signs. He asked the examining physicians at St. Elizabeths and
at Fort Oglethorpe about the operation on his testicles. (Castra-
tion.) He complained that "the voices" (hallucinations) called
him "everything except a man."

His general behavior was that of a depressed, confused man
who was in profound state of fear and tended to make a catatonic
adaptation to the hallucinated assault. He understood the other
patients to be "posing" and doing "queer things on purpose." He
had no insight for several months, and for some time was dis-
oriented for time, place and person. Upon admission, he per-
formed simple intelligence tests poorly, but, several weeks later,
the intelligence tests were better performed and his recall for re-
mote and recent experiences was accurate and fully detailed. (In-

496 PSYCHOPATHOLOGY

telligence tests are only valuable for showing how mneh the ego is
preoccupied with the irrepressible erotic affect.)

He gradually adjusted himself to the hospital environment
and assisted in the ward work. After several brief relapses he
was finally given duty in the dining-room and later a parole of the
grounds.

The patient was a tall, slender, pale man with no physical
defects. His thin, firmly compressed lips, and his brief, staring
looks, indicated his tension and fear.

His blood reacted positively to the Wassermann test, but two
spinal fluid examinations and all physical signs were negative.

Probably because of his mental development he never attained
satisfactory insight into his condition other than that he had ' ' im-
agined" his troubles and had worried about his masturbation. He
showed no aggressive tendencies to a grand potential compensa-
tion or social-religious censorship of immorality. He was dis-
charged as a social recovery seventeen months after his admission.

The prognosis apparently depends upon a fortunate location
in a community of simple requirements, avoidance of serious re- ,
sponsibilities and the control of his autoerotic tendencies. Be-
cause this depends so largely upon other sources than himself, the
prognosis is poor.

Case PD-22 was a patient who had enlisted in the navy at
twenty-one, after he had been unable to find other satisfactory
employment. After three years of "good" service he apparently
quite suddenly developed a psychosis. He had had several infec-
tious diseases, but had not been excessively alcoholic. Like most
sailors he had patronized prostitutes and had had an "affair"
with a married woman.

A classical panic began one morning after a "shore leave"
with a companion. He had several times taken shore leave mth
this man and, on this particular night, they had taken "several
drinks together" and spent the night in a boarding house, occu-
pying the same bed.

(The medical certificate, which accompanied the patient,
stated that he had a record of sodomistic relations which, later,
the patient stoutly denied.)

The patient said that he and his companion returned to the
ship the next day and after they were on board he noticed an aver-
sion in his companion's attitude toward him. He overheard him

ACUTE HOMOSEXUAL PANIC 497

make remarks about "the blond queen of the deck" and having
been ashore with the blond queen (the patient was the only blond
in that part of the ship) and that "she was on the stuff." That
morning when he attempted to urinate, he said, "I could not do it
because it ran backward into my stomach." He believed that his
companion had "doped" him and performed some sexual act upon
him which had destroyed his sexual powers. He reasoned that
he must have been doped because he could not remember anything
of a sexual nature that might have transpired but was certain
that a sodotnistic assault had been attempted because of his de-
ranged sexual powers and the talk that he overheard.

He said that he challenged his companion to a fight to show
how much of a man he was, but the sailor avoided a conflict
by declaring that his remarks about the blond queen referred to
the Jew plumber. Later in the day, he became panicky when he
found that his testicles were "all shrunken up" and his "penis
looked small and drawn up." That night, while in his hammock,
he thought he overheard several sailors plotting against him, and
one of them said : ' ' Give him a couple of shots of dope. ' '

The fear of "lost manhood" was decidedly increased by the
belief that he would now become a sexual pervert (oral erotic).
He said his companion boasted freely that he had caused two
other men to leave the navy "by putting up jobs on them." One
of them deserted and the other fellow bought himself out.

The period of worry and panic was comparatively brief, which
may have been due to the frankness mth which he confessed his
troubles to the ship's medical officer. About two weeks later, he
had a sexual dream which he could not recall, except that it was
accompanied by a nocturnal emission. This dream and the tend-
ency to have spontaneous erections seemed to have been a most
important basis for the return of his self-confidence.

After several weeks of confinement in a naval hospital, he was
admitted to St. Elizabeths Hospital, but was no longer worried
about his heterosexual powers. He never developed insight into
the episode and always maintained that he probably had been the
victim of "a job," which he disciissed with grief and anger (sim-
ilar to Case PD-14).

Physically, the patient was a rather slender man, about 5 feet
9 inches tall, weighing about 140 lbs., with blond hair, fair skin and

498 . PSYCHOPATHOLOGY

scanty facial hair. His sexual organs appeared to be well devel-
oped.

Five months after his admission, he was disehaygeii because he
was apparently able to take care of himself.

This man gave one the impression of being a rather simple
type of personality, in the -sense- that -he expressed his wishes
bluntly, was sincere, and had a limited capacity for sublimation
and adaptation. He said: "I would rather die than become a
c. s.," and this probably expresses the prognosis best if his hetero-
sexual margin is as limited as the homosexual psychotic episode
indicates. Either attempts at suicide, or, as he expressed himself
before his discharge, "I'd rather go crazy before I'd become a
e. s.," indicate his probable final .adjustment. The fear of the
shrinking penis becoming invaginated into the abdomen was ap-
parently due to an uncontrollable effeminate . attachment to his
companion.

Case PD-23 was an unmarried soldier, twenty-six years of
age, whose psychosis began rapidly after his second enlistment.

At thirteen, he left school to earn money, because the curric-
ulum was uninteresting to him. He stammered seriously. At
twenty-three, he enlisted in the army and was discharged at the
expiration of his service with the character "good." Duriiig the
last few months of this service he was court martialed for alcohol-
ism.

He worked at a soda fountain for a short time, but was unable
to keep his position After several months of loafing and quarrel-
ing with his father, he reenlisted in the army at the age of twenty-
six.

His sexual history began mth unsatisfactory heterosexual re-
lations at fourteen, which continued more or less. frequently until
a few months before his psychosis. He contracted gonorrhea twice,
but never acquired syphilis. His alcoholic indulgence, could not
be considered excessive, and he was not a drug habitue. He
smoked cigarettes excessively and wasted his money.

Soon after his reenlistment, he became irritable and apprehen-
sive. His bed was in the barracks and he had to retire in company
with other soldiers. This environment, associated with his homo-
sexual cravings, made sleep impossible and he soon became panic-
stricken. He blamed the catise of his fears upon his associates,
which, though probably unknown to the associates, was partly

ACUTE HOMOSEXUAL PANIC 499

true. The fear increased quite rapidly. A few days later, he de-
clared that someone was trying to get into bed with him. He after-
wards stated that this followed an evening of listening to tales
of sexual prowess by the older veterans. He tried another bar-
racks, with no relief, and several nights later insisted that someone
tried to inject cocaine or morphine into his arms, legs, or penis
(castration fears), and tried to get into bed with him. "Thought
it was the doctors or something. Must have been dreaming or
something. Thought it was somebody one minute and then knew
no one was there the next minute." The next night he took his
bayonet to bed with him with the intention of "getting" anyone
who bothered him. He now believed that he was not wanted in
the company, that the men called him "c. s.," cursed him, "pulled
their noses" and made other signs of disgust at him. He tried to
escape from the island with the intention of deserting but was
transferred to the hospital ward, and after one night, the homo-
sexual obsessions became more serious.

He believed he had "killed the captain" and wanted to see
the chaplain, believing that he Avas to be shot. Many of the simple
things in his environment began to act mysteriously, such as the
clock, etc. He. talked of committing suicide, and would frequently
kneel and pray. Later, he referred to himself as Jesus Christ;
said that he was to be killed by God ; that he had killed his father
and the captain, and often referred to a murder that he had com-
mitted.

"When admitted to St. Elizabeths Hospital, though in excel-
lent physical condition, he had visual, auditory, cutaneous, olfac-
tory and gustatory sensory disturbances of the hallucinatory
type, Avith the usual supplement of delusions. He thought he
had been sent to the hospital by God, and pointed out a pa-
tient as God and an attendant as his brother. He felt "sad"
and "everything" worried him. "I want to do the right thing,
but I can't. When I try to do the right thing I am doing wrong,
and everything I should do." (He frequently added unqualified
words to his sentences.)

He heard bells ringing, people shouting, steam blowing, tasted
poison in his food, smelled "all kinds of odors," saw people whom
he knew to be dead and was sure they had come to life, particularly
his grandparents and mother (ancestors). Thought that he, Jesus
Christ, had killed his father, who reappeared in a hat and cape

500 PSYCHOPATHOLOGY

looking like a priest (See Case PD-27). He contimied to feel that
lie was being stuck with needles, that cocaine, a "green fluid,"
and morphine, were injected into him, and a "brain machine" was
turned on his head.

His dreams were terrifying and very similar to his hallucina-
tory experiences. "I dreamed I was going down, was burned out,
grabbed an electric light, thrown in water, was walking, running,
I don't know what else I didn't do." .

During this period he was suicidal, depressed, apprehensive,
seclusive and careless with his clothing. He performed the usual
intelligence tests with some difficulty. This markedly dissociated
mental state continued for about six months, after which a gradual
affective readjustment began. He never became entirely con-
vinced that his strange experiences were not real, as they dimin-
ished in intensity, his doubt increased. He finally made a com-
plete readjustment and social recovery with fortunately no mani-
fested tendencies to project a social or religious reform move-
ment. No obsessive counter-attack upon the environmental temp-
tations of the now fairly well repressed homosexual cravings was
projected. He remained, however, very sensitive, tense, refused
to discuss his difficulties, and s'eemed to be extremely determined
to maintain his level of social fitness.

The prognosis is apparently poor just in so far as his homo-
-sexual cravings tend to break through his concerted efforts to
control them. That he will be able to maintain a biologically sat-
isfactory heterosexual adjustment is very unlil?:ely, and his homo-
sexual cravings being intolerable, a later sustained chronic disso-
ciation of the personality with consequent deterioration, because
of the future hallucinatory gratification of his homosexual needs,
will probably be the ultimate course of his biological career.

Case PD-24 was a well-developed, ignorant male negro, about
thirty-nine years of age, married twenty years, who became panicky
because of his homosexual eroticism. He had no insight, and ex-
citedly complained of his difficulties as follows :

"My time was up some time for some two years to have me
on exhibition before Congress 304 years ago for real delegatesi —
for reputation as well as for anything else — they did not Avant me
to drink at the bar. They put things in my food and made me
feel bad at the stomach. It smelled like something that had been
in the ground — smelled like guano fertilizer. They tell me it came

ACUTE HOMOSEXUAL PANIC 501

from animals — sometimes they shoot stuff into yonr ears and make
yon dumbfounded, and they pull it out; sometimes they put pic-
tures on your eyes and change them, pull them back. [Pushes
his eyes hard with his fingers and says it takes the pictures away. J

"The electricity runs from the shoulder and arm and feels
like pins in you ; they are trying to break me down and are forcing
me to have friction.

"Through sleight-of-hand they touch it [penis] and draw your
breath. They play it and said I played it with racehorses and
children, boys and girls ; they take your nerve from you and you
naturally fall. [Fail, when he tries to perform the sexual act.]
I thinlc they have lots of luck, interfering with a man and
his wife, but I don 't do anything about it. ' ' They make him feel
weak and "faintified like." "It seems as if somebody throws this
at you with a sling-shot and put so many horse-power into you.
[They pump him full of air.] This cold air pressure and warm
air pressure fills your stomach, and I have to belch it and it has
to go away. They would learn me how to bend over and it would
go away. They move you from one side to another [bends from
left to right] and this takes the blood. It would drop from up here
[places hand on chest] to do^wTi there [places hand on buttock] and
it would make you cold and weak. ' '

He spoke of his auditory hallucinations as having a "tele-
phone" in his ears and his visual hallucinations as "pictures."

Almost daily, when he could reach a physician, he complained
of aches and pains and tried to show the scars from the tortures of
the night before.

Often at night, he pounded on the door and called for help.
He would usually be in a panic because of his terrifying sensory
hallucinations, such as having holes pounded into his abdomen,
dramng sensations at his heart and umbilicus, and pounding elec-
tricity into his head. Sometimes he tied a handkerchief about his
head because of head pains, and another time he pasted a piece of
paper over his abdomen and asked for treatment for a hole there.

The voices talked of making a "hermaphrodite" out of him.

He was quite frank about his hallucinations, but had no in-
sight into his eroticism. His efficiency for simple manual labor
was not impaired, and he worked very well. Alcoholism as an ad-
ditional exciting factor was excluded.

Case PD-25, a marine having about two years service, un-

502 - PSYCHOPATHOLOGY

married, about twenty-three years of age, was in a constant anxi-
■ety state because "voices in the walls" told him that they were
going "to operate" on him and remove his "kidneys" so that he
could not have children.

Case PD-26 was the only son of an overworked, uneducated
mother who suffered from neglect and the need of the simple com-
forts necessary to make life worth living. He was a typical "mam-
ma's boy," seriously pampered, effeminate, dainty in manners,
tenor voice, and generally submissive in his make-up.

He was an ordinary seaman in the navy when a typical homo-
sexual panic developed in which he was obsessed with fears that
men plotted to sexually assault him. He had to be tube-fed, and
when he resisted, and his arms were forcibly drawn beTiind him,
he had a "vision of Jesus Christ and the Thieves on the Cross,"
feeling that he was being crucified as one of the thieves. Later,
he realized that it was ' ' imagination. ' '

The following patient (Case PD-27) was a white sailor, single,
aged twenty-seven, medium sized, earnest in disposition, but very
naive and simple in his general attitude. His mother 's father was
a cocaine habitue and his father was an alcoholic. Upon his ad-
mission, he was very repentant and somewhat depressed. He
wrote the following story of his life, which contains an excellent
description of the causes of his anxiety, the repressed cravings,
the psychosis and the reconstructive tendency. (Following the
letter is appended some information about his boyhood which
explains his difficulties more completely.)

"I was always aloude to race and play with everybody, and
would prefer larger boy's work, but didn't know at the time, hav-
ing jest come from the country. The first two years of my- city
life taught me how to masturbate, and smoke cigaretts and chew
tobacco. I went to School steady, and got along fine in the lower
grades, but, as I grew older, kept slipping behind, umtil finally,
after reaching my fifteen year, I got discouraged and hounded my
mother and father to let me go to work. And I did, at the same
time, I was given permission to smoke in the house. So between
Master Bation and cigaretts, my school life was ruined. I worked *
in the shop two years, enlisting in the Navy at eighteen as an Ap-
printise Seaman, changing my rateing to that of coal-passer, and
made the cruise around the world with the Atlantic fleet. I was
discharged ordinary, as I had a bad record from overstaying leave

ACUTE HOMOSEXUAL PANIC 503

and didn't save any money. My dowTifall was bad women. I am
not, never was, and never will be a drnnkard. I have been drunk,
but never took any pleasure in it. I Avent home and went to work,
with intentions of staying out of the service, but through women,
I lost my job and was told by my father I had better go back to the
Navy, and I went.

"While at the Norfolk Navy Yard, I was going to see a bad
woman, and got in with her very thick. This company run along for
over two years, and I tried to stay away from her at times, but she
seemed to call me back. While on my thirty-day furlough, I took
her out of the hoiise she was living in, and lived with her for a few
days before going to Guantanamo. I Avorried right from the time
we left the Navy Yard, for I was afraid she would do wrong before
I could get back ; also I had lied terrible, about being married, and
she was with very nice people. Then I remembered, too, that her
husband was to be let out of jail. And she had two suits of clothes,
liiy watch and chain, Honorable Discharge button, and I liked to
worried myself to death. And then I received a letter from the
man that rented the rooms we had, telling me that she had gone
and owing him a bill of $8.70, and took everything with her.

"Well, I just went to pieces altogether. I prayed to God to
put me in touch with her some way or another. I sent telegrams
and asked God to connect us up some way, so I could find out where
she was and everything. ^[This is a good account of a dissatisfied,
affective craving and the hallucinated gratification which it pro-
duced.] Then I got to thinking more and more about her husband,
and finally got to hearing her talk and also hearing her husband
talk and that he was with her. And some nights, she would get
beat to death, and other nights she would get cut to pieces. I
imagined everything horrible that could happen to her at the hands
of that husband. And I told the Hospital Apprintice about it and
he took me to the Hospital and on the 24th of Dec. I was put on
board the Jupiter. She left on the 29th, and I went to the Hospital
again. Now, it was coming up on the Jupiter I got to thinking of
home and I got a letter from home right after gifting to Norfolk.
And then it seemed that the woman was killed by her husband for
the last time and that he also killed himself and went to heaven and
hell, coming to the Norfolk Hospital to kill me by cutting my heart
out. He also brought the God of Hell with him. I had to go to Hell
for being a ma'sturbator, murderer, never told God the truth. *

504 PSYCHOPATHOLOGY

"And, then there was an angel came to me and told me that
'I conld go to Heaven if * * * .' Then my little sister #3111
Jesus Christ came to save me. The dog is dead, so its spirit came
along with my sister. There was something strange about that.
The girl's [his mistress] right name was May White, and m. a
prostitute she went under the name of "Eose Brown." The dog
was a bitch, and she was brown and white, the brown hair was
very rough and coarse and unnatural, but the white hair was as
soft as silk. [May White was beautiful to him and he loved her,
but Eose Brown was coarse and a prostitute.]

"One day [when a boy] when I first got; the dog, I put my
finger in her womb, thinking of trying to do her wrong, but
couldn't, so I masturbated myself instead. Now, by wronging my
dog, I wronged this girl, and was the cause of her bfefomi^ a
prostitute. I can't say just how this happened, but will say this
much [similar affective attachment for his dog and mistress and
association of the two together in the hallucination] — 'Grod's
Will will be done on earth as it is in Heaven. ' I am writing things
as they came to me, as near right as possible. I was told [auditory
hallucination] that whenever I smoked a cigarette, I was burning
up my little sister, for I had said I wouldn't smoke them any more.
It seemed to me that they had a certain way of doing things and
saying things to bring about every move, like a good lawyer fi^Bt-
ing a case before a judge and jury, and I do honestly believe that
the powers of the Holy Ghost were working on me.

"I also received some knowledge about going to New York to
a Mission House run by the Salvation Army. Also to go to the
Brooklyn Bridge, Brooklyn Side, to the President's Office, and
ask for a pocket-book containing $10,000, to be used for mission
purposes on the Bowery of New York City. This mission is the
one I went into drunk one night and was taken sick, leaving a ter-
rible mess behind me for some poor soul to clean up. As near
as I can understand it I am on trial for my life, and this is where
I think it comes in [the reconstruction, but very pathological.]
That I will go to Heaven if 'I do as I'm told, and obey the Lord
our God.' As I have been letting the Devil lead me instead, and
now it has come to a show down, and I feel that I have been put
threw this thing for a purpose. It seems like a 3rd degree to me,
and I think I have a hiffh duhf to perform before I' leave this earth.
' "I saw one vision at the Norfolk Hospital. It was a very big

ACUTE flOMOSBXUAL PANIC 505

Tabernacle at Chicago, and it was full of people. They were seated
like people at a circus, and I saw myself in the center standing
in my shirt sleeves with my fists doubled up, and the spirit of
Our Savior was behind me. I don't know what I was saying, biit
I think those things Avill be put in my head as I go along. I'm
reading the bible and learning things that I never dreamed of be-
fore, for us children at home were not brought up by Church par-
ents. I also have a letter to prove that my sick sister has felt
this same Heavenly Power. And I also say, truthfully, that I
was taught the Lord's Prayer, and also this one: 'The Lord is
my Shepherd, I shall not want. lie leadeth me threw green
marshes. He is the story of my soul.' I never remember of hear-
ing it before. And the other, I couldn't find my way. threw it
before I went to the Norfolk Hospital if I tryed.

"The $10,000 is another strange thing. When I was about
Fourteen years old and carrying newspapers, I found an old
cigarette button with the picture of a very pretty young lady on
it, Avhich, of course, must have been an actress, and I thought a
good deal of it, and carried it in mj coat pocket for a long time.
And, as near as I could understand, that money was lost by her
at the time of her death. It was in a Pocket Book, and the money
is in cash, and is being held by the President of the Brooklyn
Bridge. Now, doctor, I've told you about all there is, and I hope
it will be the last time, for I wish to be done with it.

"I also wish to go home, and then I will be contented and
happy once more. I would never be happy again, with all this on
my mind. I wish to unload it on my mother and father. I also in-
tend to go to a Priest and confess my sins, to be reconciled with
God, and then threw the help of the Church, I will know just what
to do. I have told the truth as near as I can judge, and I hope that
you doctors won 't hold me here very long, for I am anxious to find
out if there really is any truth in this matter or not. Perhaps I
have been chosen by Our Lord to perform a Cirtain duty, and I
Avish to go and find out. ' '

The affective reconstruction after his panic and collapse has
many elements of efficiency, willingness to work and endure fail-
ures, but he finishes mth an admission that he feels that he is
called upon to be a disciple of Christ, and, as an absolution for his
sinfulness, God will direct him ; meaning, of' course, complete sub-

506 PSYCHOPATHOLOGY

mission to the obsessive compensation for inferiority, but on
probably pathological lines.

During his psychosis, he wonld stand immovable for long
periods and look at the wall while he was having hallucinations
pertaining to Jesus, his little sister, a dog, Grod, etc.

Several times during one panic, he dived head first into fur-
niture and was restrained "vvith considerable difficulty. (Unfortu-
nately, the history sent with the patient did not record the details
of this excitement.) While in the Naval Hospital he heard his
mistress' voice calling, "Come back!", gratifying the affective
attachment to her.

His discussion of himself reveals the origin, in past experi-
ences of many distinctive wish-fulfilling sensory disturbances of
Avhich he complained. This woman looked "something like my
little sister." "Jesus Christ looked like a man -with a hood on,
and it came tight across his chin." "The little girl was supposed
to be the little sister that was born when I was seven or eight years
old. She only lived two weeks. All I remember of that baby
sister is my brother had her wrapped up in blankets before the
fire. The dog was like a big mastiff. I had a dog on my mind, sir.
I thought the world of that dog. There was a family moved in
next door to us. They were from the West and they had two dogs.
One was a martin pointer. She was given to me. [His descrip-
tions of his relations with the dog showed his erotic adolescent
affection for her. J My father got disgusted and gave her to the
dog-catcher one day while I was in school. Of course, I was cut
up by it. At G — Hospital I asked several times for the dog's
picture. That (God) was my own father. I believed my Father
in Heaven sent me here for that purpose to keep me from destruc-
tion, because he was God to me. ' '

He gradually became clearly oriented, sociable and indus-
trious, but somewhat depressed and very repentant. He was dis-
charged in excellent physical condition and appeared to be quite a
comfortable personality, with, however, a dangerous tendency to
cultivate moralizing inspirations in order to become fit for social

esteem and complptely repress his erotic cravings.

* * * *

It is hardly necessary to include additional cases of homo-
sexual panic that originated in prisons, monasteries and colleges.
The case of the physician (Case PD-1) who later became a bril-

ACUTE HOMOSEXUAL PANIC 507

liant philologist and the panic of a university professor (Case
PD-6) show that irrepressible homosexual cravings are not charac-
teristic of the ignorant or mentally defective. Under appropriate
sentimental conditions, homosexual cravings probably may become
aroused in most males and cause very serious disturbances of self-
control, developing at times into nothing less than a psychosis.

In women, anxiety and even panic, with a well-fixed feeling
of inferiority and delusions of persecution systematized about
other women, show that the same mechanism of irrepressible
erotic cravings may also occur in the female when she has sub-
missive cravings for assault. I have never seen an aggressive
homosexual female or male in a panic. The anxious homosexual
female usually feels safer when her physician is a male.

Case PD-28 was a young unmarried white woman of twenty-
five, who was struggling to pull herself together after a grave
long continued dissociation of the personality. She related the
following dream and impressions of her physical examination.

She dreamed: "I think I was dying and something with
wings stood over the bed. It was black and I heard the noise. I
said go away, go away. Somebody had me by the hair and said :
' I '11 make a cripple out of you like Mrs. L. ' I yelled and twisted
and it seemed as if somebody was holding me." (The patient had
an obsessive tendency to pull the hair of old Avomen patients.)

She discussed the dream and finally began to tell with marked
affect and weeping, her misinterpretations of the work' of the
woman physician who made her physical examination. ' ' She did
something to me Hke Mrs. L. — she stuck me in the thigh. She said
I want to show you a little invention of my OAvn. She put a towel
over my face and asked me what she had in her hand. I said it
was a bottle of perfume. ' ' ( The wish-fulfillment in these peculiar
delusions becomes transparent when we see that "the bottle of
perfume" here symbolizes a fragrant narcotic and "the little
invention" in her hand becomes the desired phallus which, how-
ever, would cripple her womanliness. The symbolic value is more
evident in the following.)

The patient said her left leg then became paralyzed and she
protested, "You destroyed something you can't replace [virgin-
ity]. You can't try that holy mother business on me." * * *
"She drove something into me with a tadk hammer. I nqver
wanted a girl. ' ' She said she never wished for sexual love from a

508 PSYCHOPATHOLOGY

girl and then drifted immediately into the subject of her great love
for her sister Ann. She said she cried every night and complained
that she had no one to sleep with.

She believed she gave birth to a child by the twilight sleep
method (narcotic), and insisted that the people found a dead
child in the house.

This patient, while she was afraid of women, trie.d to misiden-
tify a male physician as her lover and made many flirtations ad-
vances to him.

Case PD-29 was an intelligent, married woman, forty-three
years of age, who gradually elaborated a system of persecutory
delusions which she centralized about her neighbors and a neigh-
bor's wife in particular.

At thirty-four, she married a man of seventy. She had known
him since her childhood, when he was a man of fifty with children
considerably older than herself. When she was ten, her father was
killed by the husband of his paramour and probably a compensa-
tory association between her future husband and her father became
established.

The patient was very religious, conscientious, friendly, and
satisfied with her home. She felt that her married life was satis-
factory until about three years ago (aged forty) when she noticed
that the neighbors made "remarks" about her and seemed to
laugh rudely whenever she appeared. This feeling, that common
gossip was made about some secret relating to her life, grew into
a firm conviction, and for three years she gathered an enormous
collection of incidents where "looks," "remarks," "laughs,"
"signs," etc.,, proved it. For about tAvo years she secretly nursed
her suspicions, but finally, unable to further restrain herself, she
confronted her husband with a surprising but convincing arrayal
of incidents to prove that her neighbors were slandering her and
making charges that she was a "bad woman."

Without going into her characteristic paranoid story of elec-
tric currents, searchlights, ridicule, plots, gossip, mind-reading,
suggestion, etc., the case may be abbreviated to a record of a year
of anxious consultations with physicians and a few months in a
sanitarium. Her behavior was characterized by weeping and fear
of persecution but no anger and no retardation of thought or
ability to work.

She showed, symptomatically, every indication of being an

ACUTE HOMOSEXUAL PANIC 509

amorous woman who was making a desperate effort to suppress
her eroticism. She had spontaneously confessed to her husband,
with great anguish and embarrassment, her masturbation prac-
tices during the past few years, but this was not sufficient to re-
move the feelings that she ought to be punished and that the
woman neighbor was to instigate the punishment.

Upon her admission, although she was at first rather reticent,
her mental integrity was found to be excellent, and, gradually, as
her confidence in the physician became established, she told most
but not all the history.

Her difficulties, on the whole, seemed to be, at first, natural
for an amorous woman at forty, being persistently sexually ex-
cited by an equally erotic but impotent man of eighty.

After a few conferences, she, apparently without reservation,
told the details of difficulties which contained facts that made
it possible but not probable for the neighbors to learn of her mas-
turbation, through hearing certain characteristic noises through
an open window, and her confession to her husband, which was
made in a very loud voice because of his deafness.

Following a common sense, frank discussion of how such prac-
tices might be gossiped about by herself if she discovered another
woman doing the same, she admitted that she had been too quich
and severe in blaming her neighbor for her troubles and not hold-
ing herself to an honest account. (This method of adjusting the
attitude of a paranoid state never works, unless the physician
has the thoroughgoing confidence and transference of his patient
and is able to induce his patient to see the reversed side of her
belief that she is hated — the fact that she despises herself for hav-
ing abnormal sexual cravings.)

Later, a more complete confession of her autoerotic difficulties
and a readjustment of her interests along socially wholesome lines
removed all traces of anxiety, and she seemed to become a very
much relieved, grateful woman. Her most distressing fear, that
neighbors were planning to have her arrested and punished by
the police seemed to become adjusted when she no longer felt a
sense of secret guiltiness. Previous to this time she wept bitterly
and complained with great fear that the police were going to arrest
her. As is usual in such cases, arguments and persuasion had not
been sufficient to shake the apprehension. Not until she related
how the woman who lived on the other side of a thin partition

510 PSYCHOPATHOLOGY

had followed her about from room to room, "keeping opposite to.
her," and made remarks to others, when the patient turned on the
water or scrubbed the floor, that she was going to masturbate, did
the patient succeed in seeing the mechanism of her cravings. This
revealed the disguised interest of her eroticism, a masturbatory
sexual interest in the woman neighbor and its attending feeling, of
being inferior to her.

The case assumed an encouraging turn after several very free
discussions of this wish and of her methods of disguising her
wishes. Her transference to me after I had been made aware
of her worst traits, no doubt gave her firm feelings that she still
must have some goodness in herself. Fortunately, while becom-
ing aware of the fact that she was accusing the woman neighbor
of being guilty ,of what she herself wished her to do, which caused
her to feel no little shame at her hyprocrisy, this woman paid her
a friendly visit at the hospital.

This spontaneous visit helped to satisfy the patient that her
suspicions had been entirely due to her own misbehavior. She-
made an excellent adjustment and openly showed her penitence
and gratitude. Here was a very serious case of paranoia of over
three year's duration that apparently made a comfortable adjust-
ment through a psychoanalysis.

The patient was carefully forewarned that she must not con-
sider her sexual problem at an end. It was difficult to foresee
how a woman of such amorous disposition, with a strong resistance
to illicit sexuality and an impotent, erotic, aged husband, would
succeed in keeping herself comfortable.

About nine months after her discharge, following her hus-
band's dangerous illness, which implied the possibility of free-
dom she again became erotic. Although she succeeded in pre-
venting masturbation, she could not avoid the belief that her
neighbors suspected her of such misbehavior. This soon became
elaborated again into fears of persecution and secret influences.

She voluntarily returned to the hospital, depressed, anxious,
erotic, and preoccupied with a stereotyped stream of thought. Al-
though she had had insight into the wish-fulfilling mechanism of
her fancies, such as being considered a "whore," she was now
too erotic to understand herself. ' She however, had confidence in
our insight, saying she believed she was understood.

She refused all personal attention, and food, had to be con-

ACUTE HOMOSEXUAL PANIC 511

fined to bed, given general hygienic attention and reassured re-
peatedly that she was safe. Within a month the erotic tensions
and cravings again subsided and the tendency to become appre-
hensive at sudden sounds (electric elevator, locking doors, rat-
tling carriages, etc.) disappeared.

Ten weeks after her admission she became accessible and
confessed that the fear of her neighbors was due to her uncon-
trollable sexual desires. She now became pleasant, confiding,
wanted to work, was no longer suspicious and resumed her general
social interests. In the twelfth week she had insight and claimed
to have recovered. She seemed to be "normal" and did not re-
lapse. Eighteen months later she was still in excellent health and
quite happy.

This patient is nnliJce the usual anxious depressive in that she
systematized her delusions of persecution and is unlihe the usual
paranoiac in the absence of hatred and haugJitiness as a defense
for her inferiorities.

The tendency to homosexuality surely in males has a dual de-
termination. Not only are homosexual associations attractive, but
there is an insurmountable affective (fear) resistance to hetero-
sexual potency which becomes aroused by the amorous approach of
the female. Through some affective mechanism, she, like the ser-
pent-headed Medusa, freezes his soul. Her sexuality horrifies
instead of fascinates.

Anxiety and depression may develop rapidly after a hetero-
sexual failure in this type of male. Such reactions are often
characterized by suicidal impulses due apparently to an irresisti-
ble regression to the mother. The patient feels that she can not
give him up, and he, being unable to free himself, in order to be-
come devoted to another woman, finds life is not worth living.

Case PD-30 was a soldier, unmarried, aged twenty-seven. He
had a meagre education and came from the poor peasant class of
Eussian Poland.

He emigrated to America at seventeen, and Avorked in coal
mines for five years. At twenty-two, he enlisted in the U. S. Army,
because the mine had closed. His army record was free from mis-
demeanors except alcoholism. He was a tall, dull, sluggish fellow,
slow to comprehend, and gave the general impression of not hav-
ing the mental capacity of the average man.

512 PSYOHOPATHOLOGY

lie had become interested in the adopted daughter of a board-
ing-house keeper, and had been inclined to spend much of, his time
in their house. She was a rather pretty, delicate little girl, -with
small symmetrical features and blue eyes, but decidedly inferior
mentally. She had been unable to attend school regularly, g,nd
had such stigmata as very defective, poorly aligned teeth. In her
general attitude toward the patient, she was very erotic, and
openly made sexual advances to him. She considered herself to
be engaged and, later, despite his defects and the gravity of his
psychosis, she was determined to marry him.

For several months previous to his psychosis, the patient had
been depressed" by the misfortunes of his mother. She lived in
the Polish war area, and nothing could be learned about her fate.

Four weeks before his attempt to commit suicide, he was fur-
ther depressed by influenza. One day, he left the hospital mthout
permission and went to his girl's home. Here he solicited petting
for several hours, and she occupied a bed with him, she said,
only to comfort him. He believed, however, she had other in-
terests. He became very erotic, but, as he expressed it, "didn't
have the nerve." He said these temptations had been offered
frequently, and he had never been able to go ahead because he
lost courage. On this particular occasion, he left the house about
1:00 a.m., and procured a pint of whiskey. He felt, he said,
"knocked crazy," and went to a hotel. There, he drank the whis-
key, turned on the gas and went to bed with the intention of dying
because he was "no good." He was found by an hotel employe
almost asphyxiated, but recovered later without any serious phys-
ical effects.

At the hospital, he became very erotic and masturbated openly.
He talked incessantly about being "rotten inside," and "knocked
crazy, ' ' would not rest in bed, pounded his head against the wall,
rolled around on the bed and floor. He heard his mother's voice,
a,nd dreamed of her calling him. He believed that in some man-
ner his mother called him, and he often repeated: "My mother ^
wants me to come back home." (Regression to the mother be-
cause of inability to surmount the obstacles to his potency.)

During his excitement, he was confused, and muttered to him-
self frequently, but was generally oriented, and rememb^ered most
things, although he was unable to hold his attention on any sub-

A.CUTR HOMOSEXUAL PANIC 513

ject. His stream of talk Avas diseonnocted and could not be fol-
lowed.

He passed into a depression after a few days, and complained
that he Avas burned up inside, had no blood, was "rotten," "no
good," "nerves were bad," and people called him "crazy," and
"weak." He had headaches and could not walk or do any work.
He tried to control himself but rather periodically masturbated
and then declared that he wanted to die, because he could not con-
trol himself. He had completely given up, and was a very de-
jected, wretched man.

He considered his whole life to have been a failure and fre-
quently talked to himself and to us about his girl, saying he wished
to marry her, but could not make himself consent, masturbating
instead.

He was kindly disposed toward the other patients, but re-
garded himself as hopelessly unfit. His depression continued for
three months, after which he gradually extended his interests to
the games, ward work, and finally worked on the grounds.

His heterosexual failure may be summed up as largely due to
his attachment to his suffering mother, and the imfitness of the
"sexual object, as well as autoeroticism. "At the hospital, I wor-
ried myself nearly dead so I could come back to my mother. ' ' His
attempt to suffocate himself Avith gas in the closed room Avas, it
seems, the' regression to the uterus. This man had never had sex-
ual intercourse Avith women and could not establish his biological
potency, but this is not to be attributed to his mental deficiency.

Case PD-31, a A'ory Avell-trained, efficient laA^^^er, a descendant
of a proud old New England family, reacted in a manner very sim-
ilar to this ignorant Eussian peasant, to a Avoman^s sexual ad-
A^ances. True to the teachings of the NeAv England conscience, he
had been trained drastically to suppress any interests that per-
tained to sex.

He had never married, and had never shoA^m an overt sexual
interest in women. While visiting at the home of an old friend,
this man's Avife made unmistakable sexual advances to him. They
had been "Platonic friends" for years. The act, he said, so em-
barrassed and "disgusted" him that he tried to commit suicide,
locking himself in a room and turning on the gas. He Avas found
unconscious. Confusion and disgust were the only explanations
he offered for his act. He related this experience to me at the

514 PSYCHOPATHOLOGY

time when he was obsessed with his sexual difficulties. He gave
the history while seeking relief from an anxiety that made it
reliable. The obsessive persistence of the sexual cravings had
forced him to stop his work. Although over forty, he derived
most unusual pleasure from any sort of conversation about the
sexual question, and must be regarded as sexually undeveloped,
because of his inability to perform the sexual functions of the
mature male. This fiact he attributed to puritanical moraliz-
ing on the part of his parents and relatives. His attempt to die,
like the Eussian peasant's, was the equivalent of an. intrauterine
regression to the mother. (These two cases become strikingly
interesting when associated with Boecklin's fantasy, "The Isle of
Death," Fig. 29, and the "Eequiem," Fig. 28, as a regression, a
suicidal fantasy.)

The acute dissociation of the personality, in both sexes, may
become chronic and run a protracted course, varying from several
weeks to many years, with final recovery, or may become perma-
nent without further deterioration, as in Case PD-1, or pursue a
course of progressive deterioration depending upon the negative
nature of the transference and adjustment to the erotic pressure.

It seems that a persistent vigorous, pernicious counter-attack
of hatred becomes directed against the conventions of society
and particularly against those to whom social obligations bind the
patient (parent, offspring, mate, employer), because they are re-
pressing influences. This finally results in loss of social adapta-
bility. '

Summary

The acute homosexual panic may well be considered a distinct
stage in the psychoses. It may be diagnosed as readily as paresis
by certain cardinal symptoms: (1) panic and the autonomic reac-
tions which accompany grave fear; (2) the defensive compensation
against the compulsioit to seek or submit to assault; (3) the sym-
bols used by the erotic affect and the disturbances of sensation
it causes. The latter are complained of as visions, voices, electric
injections, "dopy" feelings, "poison" and "filth" in the food,
seductive and hypnotic influences, irresistible trance states, cruci-
fixion, etc. It is necessary to estimate the significance of the symp-
toms of panic in a neutral environment and the significance of the
various symbols used.

ACUTE I-IOMOSBXUAL PANIC 515

The prognosis of a homosexual panic in a soldier or sailor
is usually favorable for that episode, but the future of that in-
dividual is most insecure unless he obtains insight and a fortunate
sexual adjustment. In a series of several hundred cases which
have been recognized in the past six years, most of the cases
recovered. The recurrence of panic, later, among men who se-
cretly reenlisted in some branch of the government's service and
were returned to St. Elizabeths Hospital, as well as the return,
several years later, of men who had profoundly deteriorated after
having been discharged as social recoveries, shows that the recur-
rence of panic results from inability to control the tendency to be-
come perverse, i. e., biologically abnormal. This abortive tend-
ency seems eventually to become dominant and incurable and the
chapters on the causes of variations in chronic pernicious dissocia-
tion neuroses or dementia prascox are composed of cases that are
selected to show why one type becomes paranoid (compensates),
another, catatonic or submits, and another, hebephrenic, or an-
other case may show attributes that indicate a tendency to cover
the whole regressive cycle and not be distinctive of any of these
classical divisions.

CHAPTER XI

THE PSYCHOPATHOLOGY OF CHRONIC PERNICIOUS
DISSOCIATION OF THE PERSONALITY WITH DE-
FENSIVE liATRED, ECCENTRIC PARANOID
COMPENSATIONS AND DETERIORATION

(Paranoid Dementia Prseeox) — Clironic, Pernicious, Dissociation,
Compensation Neuroses

Why should one man or- woman who suffers from an acute
dissociation of the personality make a relatively rapid recovery
and another case run a protracted chronic course without de-
terioration, and still another individual deteriorate? To assume
that the variation is due to differences in the social stresses the
individuals had to meet, and to greater so-called constitutional
or nervous instability, is about as accurate and satisfactory as to
tell a scientific engineer that a hoiTse was blown over becaiise its
foundation was unstable. The answer can hardly be based upon
one factor or attribute, but must consider the nature of the re-
pressed affective cravings, the nature of the compensatory striv-
ing, as to how eccentric, systematic and persistent it is, how much
hatred there is in it, and how persistent are the resisting social
obligations that force the repressions to be continued and prevent
a transference from being established.

In those cases where an affective readjustment occurs quickly,
we often fiind that the patient has been greatly assisted by the
friendly affection (positive transference) for some other person,
a relative, friend, patient, nurse or physician. Attention was di-
rected to the influence of the transference of affection to another
person, which, in turn, stimulates a desire to work so as to retain
the person's esteem, by several of our cases, particularly HD-1,
PD-33, CD-3 and a seriously depressed young male Hebrew whose'
psychosis began upon the suicide of a boyhood friend and whose
recovery began, he said, when he "found a friend."

Case MD-13 reported in full by Dr. Dooley,* definitely crystal-

*The Psychoanalytic Review, Vol. V, No. 1.

516

CHRONIC PARANOID DISSOCIATION 517

lized the realization of tlie importance of affective transference
for recovery from dissociation of the personality. This attractive
young Avonian had been unable to control or to sublimate her
vigorous sexual cravings. Secret masturliation and the repressing
influence of a pernicious, infantile mother who, obsessed with the
tendency to obsti-uct the maturation of her daughter by suggesting
all sorts of fears about the uterine pains and trials of maternity,
gradually forced her to divert her sexual cravings from refining
themselves for a mate to substituting autoerotic fetiches, etc.

She repeatedly submitted to Avild, erotic, infantile, self-indul-
gent flights of behavior only to emerge discouraged and feeling
hopelessly inferior and unfit to win social esteem. Quite trans-
parent advances made spontaneously to me on my ward rounds,
indicated that probably a carefully directed influence might greatly
help her to master her eroticism and influence her to turn it into
constructive channels to win my interest. She reacted splendidly
to a suggestion made while she was depressed, after an erotic
flight, that I was sure she could take up the "responsibilities of
womanhood. ' ' The next day she wrote me a letter containing a
most sincere appreciation of my interest and encouragement. The
existence of a vigorous transference between us soon became no-
ticeable to those who were familiar with the case. Fortunately,
through Miss Dooley, the patient found a medium of reaching me
(my esteem). She made an excellent recovery after an elaborate,
skillful psychoanalysis by' Miss Dooley, and when she returned
to the hospital for her discharge, now a student in a university,
she asked to see me. "With splendid womanly reserve, and yet a
pleasing expression of gratitude, she said slie wished to thank me
for the interest I had taken in her, and for the "transference"
that had been established between us while she was ill, making the
psychoanalysis possible. She said it had enabled her to make an
analysis of her difficulties, through associating her transference
to me with the work of my assistant.

Case PD-33, presented below, further illustrates the influence
of a transference upon recovery from chronic dissociation of the
personality. The dissociations of the personality that run brief
courses when the repressed affect overcomes the controlling ego-
istic affect, the latter having been weakened and depressed by
disease or a hostile environment, are usually brief, due to the suc-
cessful evasion of the depressing influence in the environment.

518 PSYCHOPATHOLOGY

This occurs when the panicky, homesick soldier is sent to the
hospitalas a preliminary step for discharge. He escapes danger
and the nagging , of his companions, and the friendly nursing
encourages or stimulates the depressed socialized wishes to assert
themselves and regain control of the content of consciousness.
The patient, feeling more hopeful, recovers through the influence
of the prospective discharge and the prospect of winning his love-
object.

The following case (PD-33) ran a chronic pernicious course
and, although the patient strove desperately to understand him-
self, he was unable to understand the influence of his homosexual
cravings. The psj'^choanalysis brought about considerable insight,
promising recovery in this case of so-called "paranoid dementia
prsecox. ' '

He had been diagnosed as a case of paranoid dementia prsecox
and generally regarded by his physicians as utterly hopeless be-
cause of his systematized delusions of persecution, auditory hal-
lucinations and oral sensory disturbances, his arrogance, danger-
ous assaults, and persistent masturbation. Aboiit six months after
his admission, he begged to have his "mind read" so as to learn
whether or not he was "crazy" or actually being "hypnotized" for
sexual purposes.

He was an uneducated Russian -peasant of German parentage.
His mother was "peculiar," and had been confined" in an institu-
tion for the insane. His sister was also insane. He had no dis-
eases that left injurious effects. He attended the Russian schools
from six to twelve and advanced with his classes, althoiigh he
felt little interest in his studies. He considers himself to have
been a "wild boy" and difficult to control.

He ran away from home to work as an apprentice, and had
to be persuaded to return. (This type of impulsive solution of
an unpleasant environment was later frequently repeated by the
patient.)

At seventeen, he emigrated alone to the United States despite
the wishes of his parents. Until twenty-three, he maintained him-
self fairly comfortably in New York and other cities by working
as a general utility man in stores, and as a plumber's apprentice.
He was very restless, and Wandered from one job to another. He
said: "I used to work in a place; all of a sudden get tired of
work there and leave it for another place. / seemed all at once

CHRONIC PARANOID DISSOCIATION 519

to take a dislijc^^ to the people and quit." {This characteristic
fickleness is significant of inability to find a satisfactory love-
object, and later showed that homosexual fears determined the
shifting about as a defense.)

At twenty-three, he enlisted in the U. S. army, and served for
about two years. Then he impulsively purchased his discharge
and visited his mother in Europe. After a few months he became
restless and returned to the United States. He reenlisted in the
army and was sent to the Philippines. After twenty months of
service (aged twenty-six) he again bought his discharge and re-
turned to the United States. The second time, as he explained with
great detail to justify Ms actions, Avas the result of "unfair"
work imposed upon him by his captain. (The charge, unsupported
by facts, of being discriminated against is often significant of wn,-
due affections that are not being recognised by the persecutor.)
After several months of restless work at odd jobs, he enlisted as
a federal prison guard. His struggle to control himself became
intense, and he persisted in blaming others for Ms emotional diffi-
culties.

A few weeks after he began his duties as a federal prison
guard, the loss of self-control reached the proportions of a grave
dissociation of the personality. He said he "got into the habit
of being mad all the time." He objected to being imposed upon
and placed on duty in the "worst cell house." Other men, he
thought, began calhng him "bad names," and he frequently ob-
served them talking about him. He tried to escape this unpleasant
situation by asking for a transfer, but the affective storm broke
before this could be arranged. Distressing auditory hallucinations
accused him of being a ' ' pervert, ""c.s.,""s.b.," etc. One night,
he hallucinated an assault in which ' ' someone was cutting me, ' ' and
this precipitated a panic. He attempted suicide by drinking sul-
phuric acid, because men considered him to be an oral sexual per-
vert. {The analysis of a series of such impulsive acts shows that,
■unconsciously , the act often satisfies the repressed cravings.) Af-
ter a period of treatment in a hospital he became more self-com-
posed, and was considered to be fit for duty. (His physicians evi-
dently had no insight.) Several months of duty with depression
and worr3^ followed, but his anxiety and tenseness becoming per-
sistent, because "men looked at me in a peculiar way" and "dis-
liked me," he was sent to St. Elizabeths Hospital.

520 PSYCHOPATHOLOGY

Before discussing Ms psychosis as it developed further, it
will be of interest to bring the history of his sexual life up to the
same chronological period. He avoided, with denials and refusals,
a frank confession of his sexual life until nearly six months after
his admission to St. Elizabeths Hospital, although persistent at-
tempts were made to obtain the history. Without it, his difficulties
in the prison and the army Avould be wholly unintelligible. Not
until he had repeatedly consulted me about his difficiTlties, after
begging for a psychoanalysis, did he finally venture to tell the
true story of his sexual experiences. It was imniediately obvious
that this had a most important bearing upon his distress and feel-
ings of being persecuted.

(In all such cases, the only physicians who are at all likely to
obtain a true history of the sexual career of the patient, are those
who convince the patient by their personal attitudes, not words,
that they appreciate the nature of his struggles. )

He gave his history of masturbation, including an account of
the usual struggle to overcome the tendency, -with little embar-
rassment. This was consistent with the facit that he had been
masturbating freely during the psychosis and excused it as "a
necessity." His sexual history also inchided numerous hetero-
sexual experiences, attachments to several mistresses and an in-
fection of syphilis at twenty-seven, for which he received some
treatment. His debauches were visually accompanied by alcoholic
indulgence. Finally, with great embarrassment^ he confessed the
nature of his relations with his mistress AA'hile he was employed at
the federal prison. During an alcoholic ( ?) debauch he performed
cunnilingus.

He insisted that she must have drugged him and deprived
him of self-control. After this act, which he said occurred only
once, he became more sensitive and worried. He lost his potency,
Avhich seems to be a common sequel in these cases, and this gravely
depressed him. He believed that his associates had caught on to
his perversions. This partly explained his notions that they were
maldng remarks about him, in that he regarded himself to be
sexually abnormal.

About two weeks after his admission to St. Elizabeths liospi-
tal, he discussed the anxiety period at the prison, stating that he
thought it had been caused by "imaginations," showing some in-
sight; but at the same- time, he insisted that the men in St.

CHRONIC PARANOID DISSOCIATION 521

Elizabeths Hospital were voir talking about him, considering him
to be a pervert, and were making sexual advances to him. Prac-
tically the same difficulties which he now said were "imaginarji"
at the federal prison, he insisted were a reality here. The reader
should bear in niind that during the following six months he would
give no account of his past sexual behavior.

He had a slight gonorrheal discharge and his blood Wasser-
mann reaction was plus-minus. His physical condition was other-
wise negative except that he complained of being "cold,"
"drowsy," "dizzy," "doped," and was afraid he would "die in
a funny way." He was a man of medium height, square-shoul-
dered, and very well developed. He had a large head, good fea-
tures, a heavy distribution of hair and well-developed masculine
physical traits. He held his head up stiffly, was proud, rather
defiant in his stare, inclined to be arrogant and combative, and
never showed a friendly disposition to nien.

He Avas decidedly depressed, sullen, worried, apprehensive
and suicidal. At every opportunity, he stopped the physicians and
nurses to say, "I want a chance to go back to my outfit and prove
to them that I am all right." He persistently told his troubles
with great detail, and tried to jiistifi/ his reasons for believing
that he was being persecuted. He often added that, because he
could not see why he should live, he would kill himself.

When he talked to the physicians or nurses he Avas extremely
arrogant, and aUvays wanted them "to understand" that he Avas
as good as they were. He "impulsively" attacked other patients,
and, one time, while lying sullen and brooding on a couch, and a
physician bent over him to ask hoAv he felt, he struck the physi-
cian in the face, shattering his glasses. He Avould giA^e no ex-
planation for this act. It looked "impulsive," but later he ex-
plained that he thought homosexual insinuations AA^ere meant by
the question of "hoAV he felt."

During this period he Avas disoriented for time and person,
and answered the intelligence tests poorly. Ho ]5aid no atten-
tion to questions or eA^cnts in his environment tliat did not touch
his personal difficulties.

He said: "lani not happy oi' sad, but just mad, because of
the dirty tricks they haA-e plaA'ed on me. I imagine everybody is
looidng at me. I am supposed to be sometliing I am not."

His delusions of persecution Avere mostly clal)orati()iis of lial-

522 PSYCHOPATHOLOGY

lucinatory experiences wMcli consisted of auditory, olfactory,
visual, gustatory and cutaneous sensory disturbances.

He felt that "dope" was being used upon him, which made
him do "funny things" (oral erotic acts). Sometimes when he
closed his eyes he saw "stars" and "angels." At times he heard
"beautiful music" and had a "queer taste" in his mouth. He
heard voices accuse him of being a c. s., s. b., etc.

His dreams, he said, were "funny ones." "Sometimes I
dream I am flying from one roof to another, and sometimes I
dream my tongue is as big as an elephant's and my body is all
dried up." His sleep, he believed, was disturbed by someone giv-
ing him "dope," and he felt like fighting everybody.

His insight was interesting, in that, despite his confusion and
panic, he said, "I imagine all the time that people are talking
about me." (His use of the doubting word, "imagine," indicated
that he was still conscious of sensory images which were the
foundation of perceptions that so qualified the hallucinated sen-
sory disturbances as to cause some doubt about their reality and
influenced him to admit that perhaps he himself created many of
his troubles.) Sometimes. he said, "I am a little off in my mind."

His judgment, however, about his difficulties and their solu-
tion was very poor, and followed purely reflex lines of defense.
He wanted the doctors to "look up my past," to "let me go back
there and prove I am all right." Attempts at explaining the
necessity of his being treated in the hospital only aroused the per-
sistent question: "Why should I be locked up?" He paid no
attention to persuasion and advice.

The progress of the case was slow and changed but little dur-
ing the first month. He continued to be sullen and extremely
tense, becoming startled at the slightest sound. He was, however,
not agitated, and did not complain of having committed sins, so
typical of the more simple depression.

The first suicidal attempt was made about two Aveeks after
his admission. He tried to strangle himself with his belt but,
fortunately, it broke. His explanation was that people would not
let him alone and he wanted to die.

After the second month he became more sociable and in-
terested, and was assigned to work in the douche room. Although
he still had the same hallticinations, he was not "so panicky, but
more combative. About the fifth month, his work had to be stopped

CHEONIC PABANOm DISSOCIATION 523

because he began openly to accuse different men of making sexual
advances to him.

At this time he was very erotic, and one morning he in-
dignantly demanded the protection of his physician. With great
bitterness, he insisted that while asleep some men had forced him
to submit to an oral sexual assault. Despite the most earnest
persuasions, he could not be made to doubt the reality of this
vivid dream experience. Fear of sexual assault by men continued
almost nightly for the next two months. During this time, he slept
very little and used many precautions to protect himself from the
(hallucinated) assaults. He barricaded the door of his room with
all the furniture available, and kept chewed paper in his mouth,
Avhich, he thought, would catch the semen and prove that he had
been mistreated while asleep. Unfortunately, one morning, he
found a hair in the paper, and this firmly convinced him that his
hallucinations were realities. Conversations or questions had
"double meanings." One night, the attendant legitimately asked
him if he wished to have a sheet. The patient interpreted it to
mean something "to spit in," and promptly assaulted the attend-
ant. He Avas sure he heard the attendant saj'^ he had chancres in
his throat. [Numerous incidrnis of this tupe might be included
in this case record to ilhtstrafc hoiv persistently the individital in-
sists that the cause of his distressing, irrepressible sensations is
someone in the enviroiim.ent, in order to avoid becoming conscious
of the true nature of his segmental cravings. However, in the
sense that the autonomic functions (homosexual cravings) re-
spond to the seductive stimuli (a certain type of man) despite his
efforts to prevent it, the patient is perfectly right in his statement
that he is persecuted by the man, although the latter is unaware
of it. J

During this period of homosexual eroticism he masturbated
several times a week, because, as he reasoned, he "felt passionate
and it had to have an outlet. ' '

Despite these difficulties, he was given work in the laundry.
He insisted that people there also talked about his sexual behavior,
and soon he decided a certain woman employee was making over-
tures to him to perform cunnilingus. Although he would fight and
threatened to kill a man when he suspected homosexual advances
were being made, he was willing to indulge in heterosexual per-

§24 PSYCHOPATHOLOGY

versions, lie tried to induce the woman to go into a nearby closet
for that purpose. He again had to be confined.

Then he was 'employed in the green-house, but was quite .use-
less because of his arrogance. He constantly tried to demon-
strate his superiority, did little work, argued incessantly, and an-
noyed the employees.

He accused attendants of smacking their lips as an invitation
to "go do-wm," and often threatened an attack. Any smacking of
lips, smile or inquiring look at the patient was resented as a refer-
ence to his sexual difficulties.

During the latter part of this period of eroticism, the patient
asked for the ' ' mental treatment. ' ' He naively wanted to be " hyp-
notized so the bad thoughts could be stopped." He reasoned, plac-
ing the cause characteristically in an impersonal light, that it was
due to "bad blood." He also begged for Avork "to keep my mind
imder control." This was his own solution and, being excellent
mental hygiene, had to be given every consideration despite his
perverseness. He became determined to get his discharge, the need
for which was surely biological, being created by the redevelopment
of heterosexual cravings which now began to remanifest them-
selves.

Although he was disappointed because he could not be hypno-
tized, he decided he wanted to have his ' ' mind read. ' ' He now, for
the first time, told the important details of his sexual life and the
act of cunnilingus. Because of his vocal difficulties and illiteracy
the remainder of the time Avas devoted to helping him to understand
that he thought men had homosexual thoughts about him, because
he had homosexual cravings for them and was trying to hide
them. At first, this was met with considerable indignation, but
his transference was well enough established to permit me to talk
plainly. He soon substituted me for the physician in charge of
his ward and the superintendent (father equivalent), Avhom he had
previously insisted used him for sexual purposes. He learned
to recognize the element of irresponsibility^ for homosexual feel-
ings (feelings should not lie mistaken for overt conduct), and
naively learned to talk of this as his "bad blood."

He discussed his sexual feelings at first in the following man-
ner. "I feel as if a girl was like a piece of cake — it is my imagina-
tion, but mv character Avotild not alloAV it. I Avas that Avay Avhen
I was a little kid."

CITRONTC PAKANOin DTSSOCTATTON iy2.)

He maintained that eunnilingais was not so depraved as fel-
latio, but not until later was it possible for him to discuss his
reasons for this belief. "If I would allow myself to do that [fel-
latio] to cure myself [it is surprising how often the belief is ox-
pressed by patients that l)y allowing the cravings to commit the
act, a cessation of the craving would result], it Avould not cure me
— [because] — my character will not let me go so low. I would
jump out of the window or down a stairs afterwards. It looks like
the harder I try the more it is against me. I feel dizzy and chills
in me and it makes me drowsy. When a person feels that way he
does not care to live. — Now, if I must die, for God's sake make
Drs. "W. and H. not do these things when I am asleep." (He was
in earnest.)

He gradually became aware that he was afraid to sleep be-
cause of his erotic feelings and dreams, and this led to his ex-
planation that he really lost control of himself in 1912 while in
the Philippines when he complained of the captain's mistreatment.
He said, with insight, "I had the feelings for years, bvf did not
knoiv luhat it ivas." (This explains the whole trend of his be-
havior, irritability and repeated elopements, and sudden change
of associates.)

As the analysis and insight progressed, this uneducated man
began to feel that he Avas no longer homosexual, and had as much
interest for normal sexual relations with women ' ' as anyone. ' ' At
the time of the onset of the psychosis, he said, he was able to per-
form the act, but had no desire. He now disappeared from the
hospital. Two days later he returned with the explanation that
he eloped to see if he could make a "good enough impression" to
get employment, and also test his sexual powers with women. He
insisted that he had enjoyed sexual relations, and his affective
tone showed considerably less tension. He was still sensitive,
however, walked stiffly, Avith head and shoulders back, held his
chin high, and pursed his lips, but not so intensely as formerly.

Eepeated studies of his social difficulties as they occurred, and
their relation to his eroticism, enabled him to improve his insight.
He felt proud of his conquest of masturbation, and considered his
homosexual feelings as only a "small part" of himself which he
no longer heeded to worry about.

His homosexual cravings had considerably subsided, and with
them, as always happens, the sensitiveness and compensatory ec-

526 PSYCHOPATHOLOGY

centric strivings disappeared. The arrogant posture was not so
evident. He no longer complained of persecutions, and tried to
make friends. He talked about his future prospects, and deter-
mined to get married and "ijiake a man of himself." The patient
■was discharged as a social recovery ten months after his admis-
sion— now adjusted as a benign suppression neurosis.

It was highly necessary to forewarn him of a possible return
of his homosexual feelings if his wife should prove to be an un-
satisfactory mate. (He seemed to appreciate this, and declared
he would not make accusations should it occur. This, however,
would be too much to hope for, should the homosexual regression
recur. The prognosis depends, it seems, entirely on his capacity
to make an adequate heterosexual transference.)

Unfortunately, at present, there is no means of preventing
such eases from marrying, or of knowing whether or not the diffi-
culties will return with the stresses attending marriage. This
man's anxiety, compensatory arrogance and feelings of persecu-
tion had increased as his sexual cravings turned to homosexual
interests and decreased as they turned to heterosexual interests.
Should he marry, and his mate become a heterosexual obstacle,
instead of an attraction, he mil probably again have feelings, of
persecution as his repressed affections turn back to the easier
outlet of homosexual submission (See Case PD-9).

The following case (PD-34) ran a more protracted course.
His compensatory strivings were more eccentric and violent, but
he finally adjusted sufficiently to permit discharging him as having
made an affective readjustment sufficient to control himself and
earn a living. In his case, an important variation from the pre-
ceding case occurred, in which, he at times submitted with con-
siderable pleasure to the dissociated perverse affect.

His father died at sixty -three of a cerebral hemorrhage (?),
and his mother, who "was out of her head at times," died at forty-
seven of carcinoma of the uterus. The patient was born in Con-
stantinople, in 1887. He was the second child, and had most of
the diseases of childhood with no serious effects. His blood (Was-
sermann) reaction was positive for syphilis to several tests, but
no signs of a cerebral form of syphilis could be found. He also
had had gonorrhea. He was educated in several mission schools
in Turkey, and learned to speak English fairly well. He emi-
grated to the United States at seventeen, and worked at numerous

CHRONIC PARANOID DISSOCIATION 527

jobs until twenty-one, when \w enlisted in the army. His reasons
of "unfair treatment" for leaving many of his positions indicated
that his general suspiciousness and irritability were due to a dis-
satisfied affective craving.

His sexual experiences during childhood were very promis-
cuous, including masturbation and considerable overt curiosity
about his mother. He never felt moral resistances to heterosexual
indulgence. His career as a soldier lasted two years. He had
several courtmartials and was difficult to control. When brought
to St. Elizabeths Hospital (at twenty-three) he was very hyperac-
tive, with flight of ideas, Jiallucinations, marked suggestibility,
fairh' clear orientation, memory accurate, mental faculties well
controlled for brief periods, but no insight. He was proud, ar-
rogant, suspicious, loud, domineering and yet afraid. He was al-
ways very hypochondriacal and wanted treatment for cancer of
the brain, (condensation of father's and mother's diseases), weak
alrteries, weak muscles, floating kidney, tobacco heart, appendicitis,
syphilis of the larynx and inability to see with his right eye when
he used his left eye (to see good because of evil). His complaints
indicate that he had vivid auditory, visual, olfactory and other
sensory disturbances of the hallucinatory type, into which he had
no insight. He complained of seeing "parts of the body, as a lung,
a leg, a foot, etc.," but added: "You know they are not there,
don 't you ? They are only thoughts, maybe. ' '

When asked if he heard voices, upon admission, he said :
"Certainly, it is my mother talking to me. Yes, mother. About
nine — 2 C. C. " Voices accused him of sexual perversions and,
particularly, of oral erotic homosexual cravings. To protect him-
self from the homosexual cravings, he constantly moved about the
ward, talked loudly, accused others of following him, and had
numerous fights to protect himself from the "hypnotic influence"
of others.

During the first few months, because of his activity, com-
bativeness and inaccessibility, little could be learned about his hal-
lucinations, except through his letters and spontaneous discus-
sions which showed that his difficulties were very similar to those
he complained of throughout the following four years.

During the acute stage of his illness "all" his "relatives"
appeared to him (visions). His mother appeared as a "consoler
and adviser." He had sexual relations with her, "as natural

528 PSYCHOPATHOLOGY

intercourse." • She "felt affectionate, loving one like I would
when I was a child, but when it was all over it seemed like a
dream." To this he spontaneously added, if his mother now tried
to coerce him into a sexual act he would resist it. He commented
further : ' ' My mother has suggested to me to know what it is to
feel gorgeously, in the gorge [placed hand on larynx], to have
sexual intercourse in this manner" (oral). He said all' his life
he had to struggle against such compelling- feelings in order to
retain his "manhood."

About the sixtli month he began to describe his hallucinations,
and within the next four years he developed an elaborate system
of explanations for them to which he persistently adhered until
the sixth year of the psychosis.

: He usually wandered about the ward talking to himself, mak-
ing many gesticulations and mystic movements with his hands and
eyes to communicate with and control the telepathic messagfes he
was receiving. He had numerous fights to stop patients and at-
tendants from "working on" him, and wrote a series of pitiful
letters to the superintendent. They characteristically Show the
nature of his homosexual struggle and the transference to the
father image.

The following abstracts from a letter written by the patient
to the superintendent about four years after bis admission shoAv
the chronic persistence and the nature of his affective struggle:
' ' Am dropping you a few lines to let you knoAV that I am awfully
displeased about your actions as you are constantly tormenting
me by giving me surplus pains all .over my body. [In the light
of present psychiatric knowledge, the foregoing sentence ivoiold be
sufficient to make- a diagnosis of repressed submissive homosexual
cravings.]

"1 have written you particular letters about infidelism, ma-
sonic secrecies and all that. Am positive of everything and not a
bit scared to tell you that you are the cause of my surplus worry,
tormentations and sorroAV.

"You are the Masons that's augmenting the pain of these
sores [ulcers] and my appendices as well, for you are constantly
keeping after them and you are irritating them all the time. I
have pleaded and am pleading again and again, telepathically and
correspondingly, to stop all this foolishness as I have enough of
it, for I can stand it no longer. I am a hitman being lilte your-

CHRONIC PARANOID DISSOCIATION 529

selves and have feelings like yourselves. So please consider a lit-
tle about what you are doing to a person who has never bothered,
hunted or harmed you in any way.

"I have been considering this for the past two years and four
months — I have done my utmost to have you stop the frequency
of the 'nightly emissions' but haven't succeeded yet. What on
earth is the matter with you? Are you after my life pretty bad?
I have used six bottles of medicine for such 'nightly emissions'
but to no avail. Do you mean to tell me that I am so weak as all
that? You are the 'Masons' that's halhicinating us in my dreams
and deceive me while helpless and make me dream off. I feel so
weak at the present from the consequences that I can not sit down
and write a letter without feeling pains in my back, kidneys and
along the spine. [Nocturnal and precocious emissions are often
the cause of worries about having a weak brain and spine.]

" It is a dirty shame. Only twenty-four years old. One thing
that I have noticed and it has been exercised on me for a long
while, it's the wish of some of your employees that has a lot to
do with my sufferings. [Herein are revealed the feelings that lead
to fights, delusions of persecutions and defensive murder. This
patient, however, was passive enough in his reactions to make him
fairly safe if treated pleasantly, as the following quotations show.]

"If you wish to let me know your presence at any time or any-
where give me some secret signs of the harmless hind, to make a
poor v/nfortunate lad lihe me happy." (Willingness if pleasantly
treated.)

On the basis of his somatic disturbances he wrote many
characteristic essays about such subjects as: "Immigration,"
"Darwin and His Theories of Evolution," "Christianity and In-
fidelism," "Masonry and Its Deeds" or "Freemasonry and Rosi-
cVucianism, ' ' and a series of erotic love letters to girls.

(All psychotics are exceedingly introspective and inclined to
note their trivial, odd, sensory disturbances as well as the more
persistent, unpleasant tensions like the scalp tensions, spastic and
griping alimentary conditions, etc. Such normal incidents as in-
crease in rate and strength of the cardiac systole, when the patient
has to appear before a conference of physicians, are often attrib-
uted to the annoying "wireless influences" of the Masons, etc.)

In an essay on Masonry he pinned a newspaper clipping
about the training of Jesuit priests, identifying the two as similar

; J

530 PSYCHOPATHOLOGY

mysterious bodies. For him the Masons were "The ranking,
highest order and founded by "Solomon the King," "The Wise
(paternal attributes). He commented: "Through some mysteri-
ous way, like the inventions of the present day, the secrecies of
Masonry were discovered or founded by the f orementioned King,
which it undoubtedly shows the supreme mentality possessed [by]
him, as the secrecy of life and its particulars." {The secret so-
cieties are Relieved to hnoiv the secrets of life and logically are sus-
pected hy the patient of Imowing the secret ivish in his difficulties.)

Since the erotic feelings and hallucinatory experiences', are
compulsive and force themselves on the individual, he feels him-
self to be held as "a victim for sexual purposes, a white slave, or
a novice before the shrine, to be initiated into'the mysteries of sex
and life.

Four years after his admission he gave the following inter-
view. (He was extremely tense and emphatic. He shouted his
statements and often smashed his fist into the palm of his hand
to derhonstrate, he said, his vigor and manhood, and indicated what
he would do if "foul play" was contemplated. His personal style
was stilted and arrogant, and he used numerous polysyllabic words
with little regard to their meaning.) In the interview, he said:

' 'T was temporarily insane when I first came here. I saAV many
pictures of ianatoiny, such as hands, feet, heads, different kings,
angels, -the. German Emperor, the Sultaii of Turkey, etc. My idea
has been' that secret lodges could interfere with a man's career.
It may be my imagination, hallucinations caused by mental strain.
I had'false hearing. I was called unpleasant and insulting names.
People said they would "pump me out," told me I was immoral,
a pervert and associated with prostitutes. I have no tendencies
that way. [He was, however, very immoral.] I have seen it when
a soldier and outside of the service. People have tried to seduce
me and when they would not get me to concentrate my rtiind on
these things they called me bad names. I have had to struggle
against these things and at times it has been hard to control my
thoughts. "

With intense feeling, he shouted, as T sat at the desk: "I see
you are trying to get at Masonic secrets and by coercing my mind
you think to impress those feelings on me hut it can not he done
unless I am fouled."

The patient then continued as follows :

CHRONIC PARANOro DTSSOCTATTOW 531

"I might, however, be led into a trap and tlie object accom-
plished through love. This can be done. For example: If a
mother, sister or sweetheart were to concentrate sufficiently on
one's mind and thus produce the desire — I never had the love for
man that a woman has. I have had men practice immoral rela-
tions with me, but I have given the part up, and, although it gives
me feelings of love, I can control myself except when I am fouled.
I have worried and fought against it for I know it is against my
manhood. I can demolish [smashes his fist into his palm] the feel-
ing [in himself] if there is no dodge in it. They will have to fight
it [demonstrates his willingness to fight], but as I said before it
can be done if two or three people concentrate on me. [This was
a frank admission of his submissive homosexual make-up and he
identified it in nature to be like the love of a woman for a man.]

"They say once a pervert, always a pervert now. If I as a
child did it, yoti fouling me, do you mean I would do it now? But,
if I did it after a certain age, then I say, once a pervert, always a
pervert. This feeling is an instinct. It belongs to a woman, but
I have to fight against it. If this feeling were transferred to me I
must resist it. If not, I lose my manhood. ' ' (This man had iror'ked
out this mechanism of the repressed wisli himself and his case is
used here because of this.)

A few days later he wrote a letter under the caption : ' ' FOUL
PLAY— MASONIC SECRET ORDER— CONTINUED SODOMI-
ZATION," in which he tried to explain how an individual could
be influenced into sexual perversions against his will and why he
feels that secret societies are responsible for this. The following
is an extract:

"I shall remind you of the present 'Masonic order* which,
after having had the experience of knowing the abnormality of
the secrecies,! was put to a test by relations as a verification and
a proof of absolute supreme order, hy having a desire for 'So-
dome,' ordered to feel affectionate against my will, toivards an-
other's and, had temporarily senses taken aivay; in other words,
rendered helpless, to prove the efficiency, supremacy, and ul-
timately, the positiveness of the order." (This is equivalent to
stating that when his anal eroticism became severe it ultimately
became so "positive" and "supreme" that it temporarily over-
powered him, taking his senses away. This is an interesting case
of segmental domination of the final common motor paths despite

532 - PSYCHOPATHOLOGY

the ego's resistence.) lie continued: "Similar to this, I have had
other things proven to me by parental consent which helped me
cast doubt aside, when only a young lad and a scholar, about secret
organizations and their standing, the 'Masonic' being the ranking.
The facilitations through these secrecies, have enabled others to do
as wanted and even play foul through its charmful order, which
seems to control ivill poiver temporarily until the acoomplishing of
an act."

The ivords in italics reveal that the soitrce of the "secret
power" is in .the repressed, dissociated, affective craving. _ Its
"charmful order" controls "the ivill-poiver temporarily-' wntil the
accomplishment of an act residting in-the gratification of the per-
verse erotic hunger. This, then, because of inaiility to transfer the
craving to such zones and stimuli as ivill mahe the act an enduring
memory pleasure, becomes, instead, a memory source of remorse.
His inability to control his autonomic erotic reactions to certain
types of men convinced him that these types of m.en possessed a
secret of n>ature and could Ivypnotize him against his will; hence, a
secret society. Masonry, etc. As a general rule, this "hypnotic"
power is. felt to be an attribute of the father-imago , as the superin-
tendent, director, president, "highest" secret society, etc.; that is,
the potent or powerful males ivho are in authority for society.

Gradually this patient became less dangerous and irritable
as he learned to control his homosexual cravings against the "hyp-
notic" influence of his associates. He quit fighting, and was given
freedom of tlie grounds. For a year or more his arrogant efforts
to elevate himself to a level of equality with the physicians and
officers were quite a nuisance. He talked to himself a great deal,
and usually referred to the hypnotizing "They" in whatever he
said to the physicians. He made playthings, such as cigar and
cigarette holders, which were probably oral substitutes for phallic ■
symbols, because he had, at the time, active, oral erotic interests
which he was. gradually forcing to use sjinbols.

Five years after his admission, he still believed that he could
be made the victim of "foul play," but that it would be more diffi-,
cult than heretofore. By the sixth year, he had cultivated so
much self-control that his feelings of persecution had largely dis-
appeared and he became decidedly less arrogant. Six years after
his admission, he was discharged to the care of a relative as im-
proved. He still struggled with homosexual cravings and held

CHRONIC PARANOID DISSOCIATION 533

Masons responsible for his difficulties and "constipation." He
was no longer combative, although sensitive and egotistical.

m * * *

The above case shows clearly enough hoAV the perverted sexual
cravings, when they become dissociated and acquire gratification
through wild perversions or through hallucinations, become the
foundation of the conviction that surely a mysterious foreign
power is controlling the ego.

The factor of this man's anal eroticism and its capacity to
take his senses away, make him unconscious, Avill be referred to
in the chapter on the anal erotic group and their convulsions and
stupors.

The mechanism of the paranoid personality who chronically
blames others for his hallucinations and sensory distress because
of the dissociated affective cravings is one of the most important
problems in psychopathology. Since no two cases are alike, vol-
umes written upon this mechanism would not exhaust it. That a
perverse affective craving should be struggled mth and repressed
because of its intolerable tendencies, is quite obvious, and that it
should become dissociated and uncontrollable when the superim-
posed, controlling, socialized affective interests, which are cul-
tivated in order to keep the content of consciousness pleasing in
the struggle for social esteem, become fatigued or depressed, is
also a simple, acceptable explanation. But this again brings up
the more intricate and important problem : How does an affective
craving become perverted? How does it become conditioned to
crave the use of abnormal stimuli and abnormal erogenous zones?
These questions take us at once into the influence upon the child
of secret loves and hates of the parents, those inaccessible intra-
familial feuds about which only the most astute observer ever ob-
tains evidence.

Such cases as the folloAving bring out the conditioning influ-
ence upon the child's biological career which results from too in-
timate relationship with homosexual or abnormally biased parents
or relatives. (Cases HD-1, AN-3.)

(For the past five years I have had opportunities to study
the parents of this boy as well as the patient, Case PD-35.)

Case PD-35 has a father, who is an impulsive, suspicious,
easily rattled, persistent, wiry, little Jew. At thirty-three, he

534 PSYCHOPATHOLOGY

married a pretty Jewess of twenty-four. She was 0ways ■unu-
sually prone to anxiety states, liad frequent seizures of "palpi-
tation of the heart, "was rather eccentric, proud, prudish, inclined
to keep herself aloof and fond of showering fastidious attentions
upon her child.

She had three children, two of whom died in infancy. The pa-
tient is her only living child. The maternal grandmother was
also given to "nervous spells" and was "too devoted" to the
grandson. He usually spent the summers of his boyhood with her.
The father's brother, an unmarried man of rather secretive
character, whom the patient styled as beini^Jmore of a woman than
a man, and who, the mother said, was a "crank on children,"
slept with the patient since his early childhood. The boy was al-
ways very fond of this uncle who showered him with attentions
and little gifts.

At birth, the patient weighed 3 lbs. The mother stated thkt
the unusual devotion of the grandmother, who "carried him in
her bosom,", saved him. He was a very delicate, tense child and,
from four to thirteen, was often nursed for his headaches. Al-
though he had measles, typhoid at fourteen, and a mild nephritis,
he become strong, well developed, though medium sized, tense,
energetic, and apparently without a physical defect, at twenty-
three.

The mother and grandmother devoted all their attention to the
cares and whims of the child, always dressed him "in white," kept
him spotlessly clean, selected playmates for him, never allowed him
to go barefooted, humored and flattered him assiduously, tailgkt
him to be' egotistical, selfish and to crave dominance above every-
thing. When the question about his going barefooted Avas askedf
the mother replied with a strange, cultured poise of feelings : "No
indeed! You never found a neater boy.' The doctor wanted me
to put him on a sand pile, but I never trusted him with "anyone.
He was so delicate * * * * ■ I never allowed a maid to take
care of him alone at any time * *' * Even his own shadow
would frighten him when he was a child and I had to explain it
to him. * * * jjp -^ag always afraid of being locked up and
disliked closed doors and gates." These statements, given with
unmistakable efforts at self -exoneration, show the chronic course
of suspiciousness, anxiety and foolish pride to which the child had
been exposed, throughout its life. (The psychopathologist must

CHRONIC PARANOID DISSOCIATION 535

suspect an unwelcome child in such instances, the aversion being
overcompensated for.)

The boys called him "Toney" because of the scrupuloiis tone
of his dress and teased him at every opportunity. He had numer-
ous fights to protect himself and his "screams of 'mamma' could
be heard for blocks."

"His health never permitted him to take an examination,"
his parents conscientiously maintained, until he entered high
school. Because of his headaches, etc., he was nursed on espe-
cially prepared foods and humored by the four adults of the house-
hold. This ruinously anxious mother was utterly unable to foster
fortitude and patience in her son. The father had to whip him
"once" because of his obstinacy.

At ten, he learned to masturbate, and the family's anxious
solution, upon the advice of the grandmother, was to encourage
him to visit prostitutes (aged fourteen). This was accomplished
through the guidance of older boys.

Throughout the patient's childhood he Avas nursed, humored
and never permitted to take his place in the boy's world. At
puberty he Avas engineered by the ambitious parents into an older
crowd so that at sixteen he had interests that made him compete
with young men of twenty.

During'high school he was extremely ambitious and the pride
(jf the household. He did well as a high school student, although
he had considerable trouble with his arithmetic at first. His his-
tory gives the impression of intense striving to keep ahead of his
associates. ' He was a "great reader" and took particular interest
in medical ioohs, although he never considered medicine as a pro-
fession. (From what developed later the boy was trying to solve
his sexual problem.)

At seventeen, the boy started his business career as a bank
clerk. He progressed very well, but his scheming, striving selfish-
ness, general suspiciousness, and tricky inquisitiveness soon made
him very unpopular and the butt of considerable nagging and dis-
favor. He was sensitive, irritable and arrogant, and unable to
niak'e friends although he made acquaintances very readily. He
had developed no capacity for gratitude, sincerity, self-sacrifice,
devotion, or humility.

His chronic feelings of inferiority, for which he desperately
strove to compensate, were pathognomonically revealed in a seem-

536 PSYCHOPATHOLOGY

ingly trivial incident. He was attending a night law school (aged
twenty-one) when, he said, the lecturer "looked at me when he
talked about delusions. ' ' (This should have indicated worry about
his self-control.) The feeling that he might be abnormal bothered
him persistently and he discussed the lecturer's remarks with
great seriousness at home.

His mother was a very pretty, girlish looking woman who de-
lighted in stylish clothing. This worried the son and in his vig-
orous protests were poorly concealed suspicions that she was
dressing to attract the attention of men. The patient's resistanoe
to the mother's dress seems to have begun at about thirteen and
has always persisted. It has since become evident that it is due
to a sexual interest in her. When seventeen, he happened to be
with his mother in a woman's store when the clerk complimented
the mother on her yoiithful looks and added the rather conomon re-
mark that the mother and son looked more like sister and brother.
The patient reacted immediately with intense indignation at what
he considered an insult to his mother. He was horrified at the sug-
gestion that she looked nearly as young as himself and might be
mistaken for his girl. The iniportance of this revelation of his
sexual attachment to his mother was completelv overlooked at the
time. He became very erratic in his demands that his mother
should dress in plain, severe, clothing, preferably black.

When nineteen his anxiety about his mother's morals reached
a climax. He seems to have been literally obsessed -with thoughts
and fears about her sexual life and was constantly A\'atching for
clues. He accused her of exposing her legs needlessly to his uncle
(father's brother). One night, just after he entered his home, he '
saw his mother, dressed in negligee, standing in the bathroom. As
he hurried up the stairs she turned the light out. Just across the
hall stood his uncle in an open bedroom. The situation absolutely
convinced the boy that he had surprised his mother in a compro-
mising situation with his uncle. With bitter invectives, he chafed
her A\'ith immorality. The father, who was do-wmstairs, entered
into the scene and tried to plead A^dth the patient, but no evidence
or reasoning could shake his absolute conviction. He charged his
father with stupidity. Previous to this incident, the members of
the family had noticed the patient's increasing exhibition of jeal-
ousy Avhen his mother became affectionate with his father or uncle.
This uncle was "like a father" because he contributed to the fam-

CHRONIC PARANOID DISSOCIATION 537

ily maintenance; and although his mother suggested it, tlie son
would not permit the uncle to leave.

The next evening his mother broiled a squab for the patient to
win his favor. He tasted it, and then, cunningly, this young Ham-
let asked her to eat it. Not appreciating the situation, she gave
the squab to his father, whereupon the patient furiously de-
manded that his mother should eat the bird and not the father, be-
cause it was "poisoned." He emphatically declared that he could
see through his mother's plot. She had poisoned the squab to kill
her son and husband in order to marry her huisband's brother.

From that time to the present, eight years later, he has been
unable to change that conviction. He has accumulated iramerous
"signs" and "remarks" that showed his- mother did not love him,
but cared more for his uncle. He has become a veritable melan-
choly Hamlet, brooding over his incestuous love for his mother
and her infidelity to him and his father.

^Vhen his mother an,d uncle cleaned the house together, when
his father became ill, and Avhen his uncle called him "the king,"
he interpreted these affairs as convincing signs that something
was ominously wrong. He consulted several physicians about his
health, and reported to his mother that a physician said his blood-
pressure was high. He said she "sighed" so peculiarly at this
that it meant she had given him up. During this period, he visited
his grandmother and, while swimming, struck the back of his head
in a dive. His neck was painfully wrenched and his grandmother,
in applying heat, blistered it. Later, when in a panic, he com-
plained about pains in the back of his neck which may have had
an association to this accident. He rubbed the back of his neck
constantly during the panic.

The patient's suspicions and anxiety were sho^vn in his work
also. He had advanced from a bank messenger to paying teller
and seems to have exercised no restraint of his ambition to push
ahead. During his banking career he worked in three institutions,
from one of which he was dismissed for prjdng into a private
secretary's papers. (Extending the family's secret intrigue.)

He fancied that he had discovered a scheme among some
bankers to consolidate several banks and in the course of the oper-
ation he was to lose his position. His assistant was given a raise
of salary and promoted over him. This convinced him that he
was in disfavor. On one occasion he assaulted a clerk for making

538 PSYCHOPATHOLOGY

"remarks," and could not forget a tannt made by another clerk
that he would become a cashier soon. He fancied that he had
learned a secret about his employers' business which would jeop-
ardize them if it became known and they were determined to get
rid of him. His pride, fastidiousness, insistence upon dominating,
and suspiciousness, increased his unpopularity.

The story of his sexual career should also be brought up to
this age (twenty). From fourteen he had been encouraged by his
grandmother, mother and father to visit prostitutes because of
their horror for masturbation. His mother believed she had some
control over his behavior because he confided some of his experi-
ence to her. At twenty, while on a vacation, he became involved
in a scandal with some married women, one of whom tried to com-
mit suicide. He is reported also to have forced himself upon
another woman and barely avoided being arrested. "Just out of
curiosity" he had induced several prostitutes to perform fellatio
upon him, but he denied all other sex p.erversions. About four
months later he entered the Phipps Psychiatric Clinic upon his
own judgment ' ' to find out if I am crazy or not. ' '' He complained
of "pains in the head," "uncertainty," "no confidence in myself,"
"feel that I have delusions." "Don't know, may be I was told."
He said that at times he felt "bkie." He complained that "stiff-
ness" of the eyes and spasms of the muscles at the base of the
skull occurred when he looked at people. He frequently would
thrust his head forward and stretch his neck, because it felt as
if it might "fly back:" He was inconsolable about his heart,
blood-pressure, the contraction and dilatation of his pupils, pains
in the "top of his head," "base of the brain," and "in the back,"
etc.

He was extremely curious about the record of his case and the
physical examination, trying to discover clues of a plot against
him,. and whether or not his physical condition showed signs of
collapse. His physical condition other tlian the anxiety symptoms
was excellent, except for a small inguinal hernia and hyperactive
reflexes.

He gave a complete history of his life, including his difficulties
as a bank clerk, the "remark" of the teacher in the law school,
and an account of the intrigues of his wretched home life. He was
not sorry for his miethical curiosity and significantlv justified
himself with his motto, "If there is anything I don't know I am

CHRONIC PARANOID DISSOCIATION 539

going to know it." He emphasized a personal cliaracteristic that
he was proud of — ' ' Never took anything off anybody. ' ' ( Compen-
sation for inferibrity.)

Plis description of his lioine life revealed the brooding, melan-
choly Hamlet. liis mother, he felt, did not love him or his father
but favored his micle. He was sure she was immoral and his ex-
perience with women was such that he said he could not trust any
of them. He was unable to love women and his home was ruined by
secret intrigues.

He complained about having been raised "like a hothouse
plant," being unduly "self-conscious," and "bashful." This
was in sticking contrast to his actual disposition of audacious in-
quisitiveness and impudence. For a year previous to his seek-
ing treatment he had refused to speak to his mother or uncle
and openly considered his father a stupid weakling, Avhile his
mother came from "a shrewd family."

I-Iis dreams were significant in their revelations of the oncom-
ing failure, such as often dreaming of falling off tlie world; of
being compressed between two big balls or worlds that carried
him up and down; of slipping off a curb and "nearly jumped out
of bed trying to catch myself," and a series of incestuous dreams
Avith emissions.

Although he Avas decidedly ambitious and Avorked hard he
had no "poAver," no self-confidence and could not concentrate
his attention. The mental test shoAved an inability to remember
test phrases as well as he should and simple Calculation tests con-
tained several mistakes. He recognized the deficiency and anx-
iously interpreted it as a sign of mental collapse. He denied hal-
lucinations.

The tendency to panic and delusional interpretation of en-
vironment soon became evident. Within a feAv days after his ad-
mission, through a cunning system of questions, he tried to dis-
cover whether or not two patients on the ward were physicians in
disguise put there to watch him. A few days later he had elabor-
ated this into imagining that he was surrounded Avith plotters and
his death was imminent.

Although the patient had applied Avith genial smiles and
friendly advances to find out whether or not he Avas going insane,
behind the mask of genial cooperation was a complicated delu-

540 PSYCHOPATHOLOGY

sional system of three years' elaboration of Ms intrigue and
hatred.

I had personal charge of this case, and although we had at
first regarded it as a mild anxiety state we soon became convinced
that grave difficulties were involved, possibly he was a case of
so-called paranoid dementia prsecox. But what was paranoid de-
mentia prsecox? That the patient was suffering from an intense
mother-attachment was obvious, but how should it be handled and
what was the significance of his chronic fear 1 Although the homo-
sexual panic was recognized, no one had insight into the mecha-
nism of the homosexual panic at that time, and 'the necessity of
cultivating a ' ' transference ' ' of affection from the patient, so that
he would feel safe, was not understood.

"Within a week after his admission he had become panic-
stricken. We were plotters intriguing for his death. He thought
the bath was arranged to dro-wm him, the tonics and foods con-
tained poisons, he would be destroyed while he slept, etc. He fre-
quently examined and rubbed his hands and feet because they
were ' ' dying. ' ' He would rub thenj vigorously to keep up circu-
latioii and often jumped out of bed and went through vigorous
deep-breathing exercises to save his life. (Michelangelo's "Cap-
tive," Fig. 47.) He would. not lie down in the tub and when or-
dered to do so, screamed and pleaded for mercy. His rapid breath-
ing and pulse rate, tense facial expression, dilated pupils, general
muscular tremors, insomnia and refusal to eat, indicated the se-
riousness of the panic. He came into the physician's office crying
from the pain in a tender spot on his neck which was in about the
location of the blister made by his grandmother. He constantly
rubbed this surface. When he became interested in other subjects
the pain tended to disappear. No inquiries into his fear of castra-
tion or actual homosexual assault were made at this time, although
the course of the anxiety, a year later, indicates that the patient
was passing through a classical fear of castration because of in-
cestuous cravings.

The patient gradually became more quiet and asked to be
pardoned for his excitement. He pleaded to see his parents, and
earnestly solicited their love, as if they had hated and abandoned
him. He also asked for religious attention. His confidence, how-
ever, could not be gained. To his parents he was beseeching, but

CHRONIC PARANOID DISSOCIATION 541

he had no confidence in them and was inclined to be ii'ritable and
rude as soon as they resisted his demands.

No further insight into the case was obtained at this time ex-
cept that an associatioji test showed his difficulties. To the stimu-
lus word "friendly" he reacted after twenty -five seconds with
"my father," and the next time said "everybody"; to "mother"
after eight minutes he responded "dear"; to "duty" after twelve
seconds, "obligation"; to "threaten" he gave no association and
the second time reacted Avith "to promise."

About three weeks after his admission it became evident that
he was interested only in one thing — his dismissal from the hos-
pital. He shrewdly won some confidence by disclaiming further
fears of being poisoned in the hospital and by becoming very
obedient. His restlessness, inability to amuse himself, or read,
the firmness of his refusal to go home, his plan to visit a relative
in the country, indicated that all was not well. He was removed
from the hospital by his father despite our advice. For six months
he now lived fairly quietly with some relatives in a distant state,
but would not live with his parents. Gradually he began to com-
plain that the Masons subjected him to strange sensations. He
worked in a real estate office, but had to quit because of his inability
to work accurately. Upon Ms discharge, his employer "made the
remairk," "If you ever get another job," which, he said, meant
the Masons had schemes for his destruction and would keep him
from working.

The patient's submissive homosexuality now came frankly
into the foreground as his most pressing difficulty. He had been
sleeping with his cousin, a physician. One night he charged this
cousin with perpetrating a sexual assault upon him during sleep.
His foundation for the charge was a peculiar taste in his mouth.
He also believed he had been infected with gonorrhea and syphilis
in this manner. To escape from the Masons he made an intricate
trail through. several cities and then stopped at a " 'Masons* Ho-
tel." That night "every sound" indicated an oncoming assault
or an initiation. All night long he remained in his room (9th floor)
in a panic expecting the Masons to rush into his room. He pre-
pared the window so that he could jump if the door was opened.
(His behavior suggests an explanation for some impulsive leaps
from windows by panic-stricken travelers in hotels.)

After this he returned to his home "frightened to death, tor-

542 PSYCHQPATHOLOGY

tured to death, by Masons." Everybody "eyed" him. He found
that several of his uncles iver-e Masons and his mother's father had
been a Mason. On one occasion he approached his mother with,
"Did yon ever take a Mason's degree?" His mother replied that
she had taken some sort of Masonic degree when she was twelve
years old. At this he cried out, "My God, can't you help your
own son?" The Phipps Psychiatric Clinic now was fancied as an
institution of Masonry in which, he had received a Masonic degree.

One night his mother, while lying in bed, suddenly became
aware of him standing over her. He said: "Mother, you have got
me hipped [hypnotized]. I can't get my mind off you." She was
terrified_by this arid a lively scene developed as the frightened
family tried to shut him into a room.

He was then sent to a sanatorium and the physician, he said,
put "poison," "spue" (semen) into his food and wanted him to
marry an immoral woman. The physician, he fancied, tried to
hypnotize him and promised to release him if he would perform
fellatio. He eloped from the sanatorium in a panic and was
committed to St. Elizabeths Hospital. (The cause of the panic
and delusions must be seen in the patient himself — in his uncon-
trollable homosexual cravings.)

Upon his first admission, age twenty-two, eight months after
leaving the Phipps Clinic, he was depressed, inaccessible and in-
cessantly worrying about property and money which he claimed
belonged to him (the inheritance he would probably receive upon
the death of his father). He had no insight, was certainly experi-
encing annoying sensory disturbances, and made numerous hypo-
chondriacal complaints.

He was well oriented, shrewd, performed the intelligence tests
well and his physical condition was excellent. A month after his
admission he convinced the jury that he was not insane and was
discharged.

Immediately upon his return home he complained of Masons
talking about him in the house. He threw the hysterical family
into an uproar and four days later was recommitted to St. Eliza-
beths Hospital. . He was suspicious, surly, asocial, seelusive and
would not work.

He has been here continuously for six years since the second
admission and his behavior shows that a pernicious dissociation
of the personality is now going on. Only the striking features in

CHROlSriC PARANOID DTSSOCIATTON 543

his behavior in the past six years need be recorded to show the
persistent influence upon his reasoning of the dissociated perverse
affect, i

About a year after his admission, I joined the staff of the
St. Elizabeths Hospital The patient promptly concluded that my
coming was -a scheme for further persecution. Although he had
been very xeticent about his sexual difficiilties to other physicians,
he was quite readily induced to tell the story of the sexual persecu-
tions that were disguised 1)y the social persecutions which he
characteristically preferred to talk about.

He said the hospital was a religious institution in which
Catholics, Jews and Masons were initiating him into a religious
ritual. They made him masturbate (which he did with little
effort at concealment), were making a c. s. out of him, and were
trying to give him syphilis in the "hach." For the impotent in-
feriorities he compensated with schemes worth vast sums of
money, wrote numerous letters to prominent men. begged his
father to give everything away to the Masons so that he would be
freed, made an emblem of toilet paper which he wore in his but-
tonhole as a sign that he had been initiated into the great secret
(anal erotic interests).

He schemed incessantly and accumulated numerous "signs"
and "remarks" to convince himself that he was surely being de-
prived of his sexual powers and freedom by Ms uncle. He could
hardly be persuaded to talk of anything else than his property,
money from his father's insurance, his Masonic uncles, etc. Usu-
ally his discussions wandered aimlessly, being unable to talk con-
sistently about anything except to disguise his troubles. Fre-
quently he stopped to whisper to himself.

When he came into the consultation room he asked me sud-
denly if I proposed to hypnotize him as Dr. — had and make
a c.s. out of him. Several weeks later he deliberately ventured that
he was willing to become a pervert if this was necessary for his
freedom. (The wish-fulfilling influence of the uncontrolled homo-
sexual cravings are to be seen throughout his delusions of perse-
cution. )

He finally confided that he was controlled by a stronger will
which masturbated him and forced him to submit to oral perver-
sions. (The dissociated atfect.) He was sure that this could
, happen because snakes could hypnotize birds. He said the Catho-

544 PSYCIiOPATHOLOGY

lies hated the Jews and were using him to degrade, the Jews.
Johns Hopkins Hospital was controlled by Catholics because a
large statue of Christ stood in the entrajice. Since he had been a
patient there, he had been admitted and initiated, and perhaps
there was "more than one Jesus Christ." The Jews were called
' ' Christ killers. ' ' While he was talking of himself as- a Christ he
spoke of Dr. — (who is a large man of about fifty). He de-
scribed Dr. #» as trying to make him submit to a sexual assatilt
and in it he made a significant error; "then I begged him not
to let me — I mean not to inake me doit. He kept me from eating
and tried to weaken my will." (The oral-erotic act often has
the significance of a religious act, a crucifixion of the rival son to
the virile father. Its expression is submission of the Jew to
Catholicism, of the son to the father. Homosexual perverts some-
times speak of their oral-erotic submissions as a crucifixion. Bio-
logically, this is quite true. ) »

A few days later he described how he was being "slept on"
by "someone" who was "getting old and needed strength to keep
young." He said: "It is too bad this old man did not use many
young men to get strength from each one and not ruin one young
man, who had his whole life before him, by sapping his strength
and ruining his mind and physical condition internally." He
described himself as being "sapped" by the old man as a fountain
of youth. He said he was being slept with day and night and could
feel electricity being drawn from him and from the air around
him. It is "static electricity" and this is "life." "Life is neces-
sary to prolong life" and because the "germ of life" was being
"sapped" out of him he was losing strength. He would not ex-
plain ' ' the germ of life, ' ' but Avhen asked where it came from, he
said ''the semen." His fancies about this procediire were that the
germ was obtained by using him in a mysterious sexual manner,
that his money was also being taken and with this complaint he
referred to himself as being like Christ.

When he was asked to describe the uncle that was "sapping"
his strength, although he gave the name of an older uncle, he de-
scribed the uncle he had slept with for eighteen years. (The idea
of sapping of the strength during sleep is not an uncommon one.
Among the laity one may hear the belief expressed that an older
person saps the strength of a younger person when they sleep
together.) The patient complained that this arrangement in his

CHRONIC PARANOID DISSOCIATION '545

boyhood was a mistake. His homosexual attachment to the uncle,
whom he accused of having coerced his mother, was evident. This
uncle had ' ' always been like a father. ' ' He really had two fathers.

This was the high tide of the psychoanalysis and was reached
after a few weeks of consistent painstaking effort. Then came the
over-transference. He said I was able to hypnotize him and -the
delicate affective rapport miscarried. We were never able to dis-
cuss the influence of this interest in me and the progress of the
analysis was arrested. No doubt this was largely due to my in-
ability to handle the transference which is usually a most difficult
thing to do if the patient will not try to sublimate and the physi-
cian is inexperienced.

For a year or more previous to this analysis, he had com-
plained of being masturbated and orally seduced by hypnotic
powers, etc., and spit continuously, in any direction and on any-
thing. His face was chapped and raw from the constant applica-
tion of a wet towel over his mouth to keep out * ' something. ' ' He
used great quantities of tooth paste to keep his mouth clean and
would not explain to us why he persisted in these prophylactic
measures. Usually, as he paced about the ward with the wet
towel over his mouth, he cursed and muttered, to himself his re-
sentment of the abuse. At last, the exiplanation was given in a
violent condemnation of his father, who, he ■ said, permitted a
woman, who wore black futs, to urinate in his moiith. A girl who
played with him in childhood Was sitting oh his face^ he said, and
men subjected him to oral seductions. He chewed inordinate quan-
tities of tobacco and smoked cigarettes incessantly to get rid of
a taste that distressed him. He usually had his trousers unbut-
toned and frequently inserted his- finger to scratch his genitalia,
which were also the field of persistent unpleasant sensations.
Probably castration fancies played a part in this because he com-
plained of haAdng had his potency ruined.

His parents' fear of him, when he was at home, was appar-
ently justified, because, about three years after the charges of
infidelity were made, he insisted that his father should examinfe
his mother because he had shot his mother and the girl who had
lived in their home when he was a boy.

He also felt that he should shoot the uncle and a boy friend. ,
He would not discuss his experiences with these people.

To the physician he denied his delusions and hallucinations,

546 PSYCIIOPATITOLOGY

but repeatedly told his father that the roof of his mouth was being
ruined and "urine was poured in by the quart." "I am dreaming
all the time. They are' bleeding me to death" (castration).

His -verbal attacks upon his father were wholly unrestrained.
He called him almost everything vile and accused him of living
with prostitutes, etc.

He had an occasional tic, jerking his back as if something
sharp were being thrust .into him, but would never discuss this,
usually only muttered and cursed to himself when it occurred.

Although very neat and tidy heretofore, about the fourth year
of his psychosis he became very careless and tore up his clothing.
When the excitement of war swept over the country he became an
army and naval officer, financier, diplomat, etc. He sleeps poorly
and at night tends to wander about the ward trying to escape
from persecutors.

He has passed through several brief panics in which he feels
he is being murdered and has made several desperate attempts to
escape. On the whole, he is a very unreliable patient.

At present he insists that his father and mother are dead,
that he is a lawyer, army officer, Mason, animal, everything. He
mutters to himself and has but one interest — to escape from hi^
sexual tormentors. Lately he begged for fat tablets.- He wanis
enough to increase his weight to ' ' two or three hundred pounds. ' '
(This has been found in other patients to be a reconstruction wish,
to counteract nocturnal emissions.)

He is very tricky and schemes constantly, but his general be-
havior shows marked disintegration of the personality.

At no time has he tended to be grateful, courteous or appre-
ciative. He is completely self -centered, lazy, proud, sensitive, sus-
picious, egotistical and hallucinates most of the time.

Some notes about "the voices," Avhich he wrote on an en-
velope a year and a half after his commitment, indicate the fixed
affective value of his hallucinations. They say, "if you ever get
another job, " " crazy, " " a rich wife, " " a good-looking girl, " " can
I be as witty as anyone else," "can I screw a girl and give satis-
faction," "be an inventor," "I am different from other people,"
' ' I can 't think, " " Be a study nature, " " How do your eyes feel 1 ' '
"ydii don't want to work," "Man or monkey," "I can't make
friends," "You are afraid you won't get a good job," "you know
too much," "A pain in the back of my neck," "Love me," "I am

CHUONIC PAUANOTD DTSSOGTATTON 547

jealous," "you are liippoed," "No reputation to lose," "you made
me love you, I didn't want to do it."

The patient lias no insight into his personal deficiencies and
concentrates all his efforts in maintaining that he is normal but
misunderstood and mistreated.

His crucifixion for the invigoration of his uncle, his fancies
about the death of his father and the immorality of his mother, tlie
heterosexual, incestuous interests in his mother, his inability to
love other women, and the sexual submissiveness to old males,
gives us considerable insight into the affective cravings of the
classical paranoid form of progressive disintegration of the per-
sonality. {There is occurring in this man a pernicious sexual
abortion, a biological growth, from ivhich he is striving desperately
to save himself.) An assumption of constitutional inferiority or
a toxin need not be made to explain this man's dementia. Should
anyone become conditioned to love and hate what this man loves
and hates, he could hardly be expected to avoid insanity.

Repressed hoinosextoal cravings may also cause a chronic dis-
sociation of the personality of the female. This woman (Case
PD-36), whose case is here briefly reported, had hallucinatory
sensory disturbances that indicated strong homosexual cravings
and a heterosexual attachment to an old man. She would not
permit a woman physician to ask her intimate questions or make
a gynecological examination, whereas she was inclined to become
quite friendly with men physicians.

This patient had several years of college training and was
teaching school when she became engaged. She married at twenty-
nine, after a two years' engagement which had been broken several
times. She placed the responsibility of the marriage upon her
husband's persistence and forcefulness and said it was noj; due to
her infatuation for him. When she accepted her husband's pro-
posal of marriage she was inclined to regard it as an agreement
merely for the sake of an engagement.

Later he forcibly persuaded her to write out her resignation
as a school teacher. They were soon after married, without prep-
aration. The night before the marriage she was depressed and
cried. She said she could not understand her reactions because
she should have felt elated.

(In this critical decision, forcing herself into an unsuitalile
biological career, she yielded to persuasion because she had lit-

548 , PSYOHOPATHOLOGY

tie or no definite heterosexual interests, and yet felt that she
should have. Her spontaneous reactions were depression and
aversion for the man.)

From the outset she never occupied the same bed with him
and not often the same room. She demanded arrangements
whereby she could live apart from him. When the first child was
born, the second year after the marriage, she chara;cteristically
transferred her affections to the child and ignored her husband.
This adjustment became even more eccentric after the birth of the
second child.

The pathetic story of their mismated relations and the pa-
tient's sexual aversion for her husband is told best by extracts
from a letter from her husband to her physician :

"As to my relations with her since our marriage, while they
were always friendly, I can not say much about her for she chose
to live away from me most of the time during the past sixteen
years — during all those years she preferred to live in W — while
I remained in Cuba. When I was in W — she went out in the coun-
try and the year of my coming to Porto Eico she spent in North
Carolina. Her claim was the tropics injured her health. Her trip
to North Carolina was upon the advice (she said) of a physician
who feared lung trouble. I do not think there was anything in
that, but it was easier to accede to her wishes than to deny them,
or to cross her in her desires. She came with me to Porto Eico,
but only remained six months. The number of times I have set
up housekeeping and sold out my furniture kept me broke and
frequently in debt. For seven years I did not see my family— her
letters fell off to about six a year; — there was less and less affec-
tion shown in her letters to me. In May, 1913, I was a very sick
man and went to M — . * I wrote to my wife to join me there (I had
not seen her for seven years as stated), but she did hot do so.
Finally, I went to W — where she was. Though the house was
small and crowded, I was able to obtain a hall bedroom next to
hers, where I was flat on my back. During that time she never
came near my room, but contented herself with sending the boys
to inquire about me. Later, we all went to a country place, where
I remained until the middle of September. She insisted upon a
room, with the boys, at the other end of the house from me. Ex-
cept at dinner we seldom met to speak. She cherished animosity
toward me and seemed to think that I was back of her troubles.

CHRONIC PARANOIP DISSOCIATION 549

present and past. I am sure that nobody who knows me and has
Avatched my life during the past sixteen years can possibly be-
lieve that I care or have cared for anybody but her. The life I
have been obHged to lead has all been because of her, but with the
hope that she would eventually return to live and share my life
as a wife should. [The only explanation of his ivife's behavior
that occurred to him was that she believedi him to he unfaithful.
Neither understood the hopelessness of her homosexuality, and he
waited for years hoping that she would return to him.] As to her
character no one can make me believe that she was ever otherwise
than pure and sweet, notwithstanding that I found numerous en-
dearing Tetters from an elderly (male) friend. I hope and pray
for a change that will make a cure in her case with our eventual
reunion. That is all my life has amounted to for all the years that
have passed since 1899. Anything that -will give her comfort and
the greatest happiness wherever she is, is my principle purpose in
life."

Apparently only a divorce, as soon as the incompatibility be-
came apparent, could have saved the happiness of these two peo-
ple from this tragedy.

The patient guarded her children prudishly from their play-
mates, who, she insisted, were trying to teach them immorality.
For nearly two years she managed to keep the youngest child out
of school to protect it from immorality. She lived in the same
room with the children and slept with the younger boy about whom
her obsessive fears of immoral seduction were most persistent.

Her delusions of persecution became so persistent and promis-
cuously referred to others, "particularly unmarried women and
bachelors," that finally she had to be relieved of her children's
care and sent to a sanatorium.

Now she misidentifies strangers for old acquaintances, weaves
about them persecutory designs and hallucinates homosexual as-
saults perpetrated upon her at night by older women. She says
they break down her abdominal organs and put their knees into
her abdomen, etc. (This compares interestingly with the ideas
about old men in the previous case, and the hallucinations of Case
PD-17.)

She has often dreamed two dreams. She said: "I try to
climb a long hill to a church on its top and I never seem to get
there. And I dreamed this after I Avas married also.

550 PSYCHOPATHOLOGY

"I also dreamed of having Billie [son] in a baby carriage,
trying to push it np the hill and I couldn't. It always seemed that
some day I would see that church."

The frequent dreams of trying to climb a long hill (ascend
to the biological levels necessary for maturity) indicate the
autonomie-affective indifference to her married life, and the ef-
fort to protect her children from the sexual immorality, which
she is compelled to feel they must endure, reveals her preadoles-
cent sexual fixation. That older women are gradually killing her
by weakening her reproductive organs shows the preadolescent
sexual cravings from which she can not free herself. Such cases
have a very poor prognosis unless handled with insight early in
life.

Her feelings of persecution still persist. She is irritable,,
quarrelsome, insolent, haughty, and scornful of all her associates
and physicians. They are- her inferiors. Thereby, sheovercom-
pensates in her attitude for her grave, unmodifiable biological de-
ficiencies. She lives in a world of fancy and distorts any reality
to suit her wishes, hates her husband and refuses to consider any
attentions that indicate a design to return her to him. Such
women, dreading their homosexiiality, often develop the convic-
tion (compensatory) that the immorality and vulgarity of their
husbands deprives them of love, or that, because of their fancied
charms, men persecute them with invitations and seductive inten-
tions.

The most important determinant of the 'malignancy and in-
curability of the psychopath's methods of thinking is hatred. A
conception that is formulated in order to permit hate to obtain
gratification is more difficult to change than any other. This is
due to the fact that the hater can not admit inferiority or error
to his opponent, that being a form of submission and acceptance
of the opponent's righteousness and superiority. Hatred does
not tend to accept a situation, but is so constituted that it must
modify or destroy it; hence, if a faulty conviction is established
gratifying hatred there is lil^ely to be a serious eccentricity in the
adjustment to reality.

Society soon becomes afraid of, or at least loses confidence
in, the man who chronically hates, and the tendency, if the hatred

CHRONIC PAEANOID DISSOCIATION 551

is quite volcanic and asocially eccentric in its demands, is to iso-
late the individual.

The individual begins in infancy and preadolescence with a
pathological overvaluation of one of his parents, usually son-
naother, daughter-father, which is generally due to the excessive
affection (hate or love) of the parent for the child. Because of
the overlove for the parent the individual becomes unable to love
any other person of the same sex unless it is an image; hence,
there is no autonomic sexual invigoration, in case of the son, upon
marriage or flirtation with an otherwise attractive female. She
only arouses tensions, anxiety and a tendency to precociousness
of sexual adjustments

The paranoiac 's love for his mother, although often attended
by incestuous dreams, is, in reality, fundamentally the love of the
nursling, and is decidedly dependent, submissive and receptive.
In comparison to this profound submissive disposition, essentially
feminine^ the projective, independent attitude of the virile male
may be considered.

The submissive cravings of the oral erotic male are of the
nursling type, making him a wretched man unless he can find a
love-object that gratifies this tendency. The need of a love-object
is characteristic of all types of males and females, and irritability
and cynicism is the natural reaction when society fails to produce
it. The male, however, can not admit his submissive cravings un-
less he is willing to admit himself to be biologically^ perverse and
inferior, and accept the relentless social condemnation that must
be directed upon him in order that the species may conserve its
integrity and future.

According to their adjustments there are three classes of this
submissive type: (1) those who indulge and abide meekly by the
consequences; (2) those who struggle directly, intensely to over-
come the cravings ; and (3) those who succeed in finding wholesome
distractions and sublimations in science, philosophy, religion, art,
etc., and keep themselves unaware of their homosexual tendencies.

It is the second type that makes the asocial compensation.
Despite his good intentions, his effeminate receptive cravings re-
act to the presence of the virile, projective, assertive male, and
reflexly he develops a love reaction. This frightens him because
he soon has vague premonitions as to the liiological dilemma it
will lead to and, fearful of the virile man's personal influence, he

552 PSyCHOPATHOLOGY r

defends himself. Most men despise the receptive cravings (to be
petted and fondled by males) in particular when this leads to ridi-
cule. The unfortunate individual, feeling persecuted by the possi-
bility of discovery, counteracts with anger and hatred of every-
thing that may humiliate him, particularly the one whom he loves.
The patient strives to master the unequal battle at this un-
compromising level, and becomes an eccentric nuisance or a men-
ace, and is sent to an institution. Now, truly persecuted, he shifts
his charges to the people that confine him and escapes admitting
the biological inferiority to himself. The cravings for submission
to virility's petting and flattery insidiously develop, even though

Pig. 53. — Tensions of facial muscles showing desperate Striving as a defense against
■ fear of becoming effeminate and homosexual. His final solution was suicide.

repressed, until they become uncontrollable and force the individ-
ual to become aware of hallucinated forms of sensory gratification.
Treating the hallucinations as realities, the individual becomes
hopelessly entangled within himself and his personality is grad-
ually destroyed.

The ideal way to rear a male to become a paranoiac is to be-
gin with a devoted, religious, prudish mother and a self -centered,
all-wise, domineering, irritable father. The mother, within a few
years, develops in her son, beginning from infancy, an insatiable
receptive dependence upon herself. This becomes the foimdation
of the later ineestuousness. His attachment makes him a rival
of his father, who, because he must dominate, and because he has

CHROWIO PARANOID DISSOCIATION 553

the enormous advantage of experience and power, becomes a sup-
pressive factor. The son tends to revolt and assert himself to
overcome the father's advantages and achievements that attract
his mother. An intrafamilial feud threatens, but the devoted, hor-
rified mother intervenes and instinctively pleads that if the son
loves her he must not oppose his father. He is thereby forced to
renounce his ambitious craving to become his mother's hero, and
crucified instead, he becomes her baby; a realm of ownership
wherein the father can not enter.

This triangular adjustment continues comfortably until the
son, maturing, is forced to leave home and compete with other
males. Having lost his capacity to initiate spontaneous assertions
of his interests, through voice and deed, he is forced into submis-
sion by his competitors and gradually finds his associates are forg-
ing ahead. Then he learns that he is regarded as a coward and ef-
feminate. Horrified, he compensates desperately, but eccentric-
ally, because he^ can not' compete frankly. Gradually, unless very
fortunate, his eccentricity defeats him. In the meanwhile his love
craving, to be protected and flattered, makes him miserable be-
cause he can not find comfort and a suitable love-object. Tired
and distracted, he regresses and is swept off his feet by the hal-
lucinations that gratify the perverted love cravings.

One of my paranoid patients, who" had struggled for years
against the nursling's form of receptive cravings, finally aban-
doned himself to them and performed cunnilingus. While in the
act, he was astonished at becoming aware of strong Avishes to
get inside of the female. (See Boecklin's "Isle of the Dead,"
Fig. 29.) Cunnilingus is usually abandoned for fellatio, and al-
though such males derive comfort and relaxation from the aban-
doned attachment to virile males, they tend later to make eccen-
tric compensations as a defense against the persecutions of their
inferiority. The compensation then is to invent or discover om-
nipotence at any cost (Cases PD-1, HD-4, PD-10).

It is reasonable to expect that the male or female, beginning
with a well-disposed bisexual equipment, if wrongly trained, will
have greater difficulties in maintaining a well-balanced social ca-
reer whereby the predominant autonomic cravings may be grati-
fied.

It is also to be expected that wherever the capacity to make as-
sertions or projections is imposeid upon and weakened by a resist-

554 . PSYOHOPATHOLOGY

ant jealous father or mother, later, when the man marries, if the
mate is also inclined to be resistant, he mil be gradually forced
back upon a dependent, submissive homosexual basis and concomit-
antly lose his power to project himself upon the interests of others.
This probably explains the phenomenon of the striving male,
who, making an impulsive marriage to establish his potency, finds
himself growing impotent after the novelties of the female disap-
pear (Cases PD-9, PD-10). In some types he becomes dominated
by her, craving to be mothered ; and, gradually becoming submis-
sive, he, in turn, becomes fearful and paranoid or avoids responsi-
bility when opposed by men.

Sununary

The fearful homosexual as a paranoiac strives incessantly to
reach a state of socially estimable biological potency (hetero-
sexual) which, however, he can not quite- maintain because he is
"conditioned" heterosexually to be stimulated by a tabooed love#.i:
object, or is socially obligated to depend upon a frigid mate and
is prevented by " overconscientiousness " from seeking another,
or he is so conditioned by adolescent experiences and infantile
submissions that certain types of males fascinate him and he can
not overcome this. The catatonic, it will be shown, gives himself
up to the repressed cravings and permits them to satisfy them-
selves through whatever they wish or tend to cause him to hallu-
cinate. He or she becomes "crucified," "dies," is "reborn"
and again grows up. The hebephrenic is not so inclined to em-
phasize death and rebirth, but regresses to a childhood or infan-
tile, excretory erotic level and tends to live in that playful, irre-
sponsible affective state indefinitely.

The determinants for these variations are due, it seems, to the
nature of the influence of dssociates, during the growth of the per-
sonality, conditioning the needs of the autonomic-affective crav-
ings. The nature of the social-economic resistenees to be overcome
in order to make life worth living no doubt greatly depresses those
individuals who have poorly developed heterosexual inclinations.

The dissociation of the personality and the tendency to per-
nicious deterioration, characteristic of the so-called paranoid type
of dementia prtecox, are due to the chronic, perverse eroticism and
the persistent fears of becoming influenced to yield to sexual as-

CHRONIC PARANOir DISSOCIATION 555

sault or onanism. The hatred with which they counter-attack the
social conventions which oppress them, and the friends and rela-
tives who are forced to oppose them, establishes a vicious circle
from which they become unable to extricate themselves.

In the paranoid type the craving for crucifixion is quite con-
sistently found to be active, but in the catatonic the crucifixion is
often actually acted out in some modified, symbolic ritual. The
crucifixion in the psychosis reveals the strong cravings for sexual
submission as a biological sacrifice.

CHAPTER XII

THE PSYCHOPATHOLOGY OF CHRONIC, 'PERNICIOUS
DISSOCIATION OF THE PERSONALITY WITH.
CRUCIFIXION AND CATATONIC ADAP-
TATIONS TO THE REPRESSED
CRAVINGS

(Catatonic Dementia Prsecox) — Chronic, Pernicious, Dissociation,

Regression Neuroses

The catatonic adaptation occurs in acute as well as chronic
anxiety and panics, and is an adjustment to the cause of sexual ex-
citement and fear: a reaction not alone characteristic of men and
■women. I have observed it' in monkeys as an adjustment to causes
of fear and sexual excitement. The catatonic adaptatiom to causes
of fear alone may be observed in animals, birds, fish and insects,
and the assumption that a toxin or cerebral lesion is the cause
of the catatonic attitude, or even the catatonic's stupor, has fla-
grantly failed to consider the phylogenetic origin of this adaptive
mechanism in man.

The observations that monkeys use the catatonic adjustment
to causes of fear were reported,* with considerable emphasis upon
two factors that seemed to influence the adjustment : the confine-
ment, preventing flight, and the sexual excitement, craving for
manipulation by the older monkey even though that monkey was
ordinarily reacted to as a cause of fear. He ustially punished the
young monkeys severely whenever he could reach them, and on the
occasions of the catatonic adjustments he roughly examined the
eyes, face, teeth, gums, and genitalia of his submissive, plastic ob-
jects while they were erotic. These two facts, the'inability to es-
cape and the sexual desire to be manipulated, make a most inter-
esting correlation with the same facts present in every catatonic
psychopath — especially the erotic craving to be subjected to ma
nipulations, ' ' initiations, " " crucifixions, ' ' etc.

The following selected cases shoAA^ that the mechanism is es-

*The Psychoanalytic Review, Vol. IV, No. 2.

55G

CHRONIC CATATONIC DISSOCIATION 557

serrtially that of an irrepressible sexual craving, which, becoming
dissociated from the personality, tJie ego, is considered by the
individual to be a foreign personality. This dissociated sexnal
craving, becoming nncontroUable, produces hallucinatory forms of
sensory disturbances of being sexually manipulated and assaulted.
The patient continues in his submissive, more or less non-resistant
attitude until the erotic cravings are gratified by the hallucina-
tions. As the eroticism subsides the individual is able to resume
his habitual social interests, and his friends, no longer uncon-
sciously arousing the erotic autonomic reactions, again have an
affective influence upon him which they can understand and of
which he is not afraid.

The catatonic adjustment in males is due, except upon rare
occasions, to the fact that the dissociated sexual cravings are per-
verse and require the reception of homosexual attentions. In the
female, however, they may be due to an unusual resistance to nor-
mal heterosexual cravings, the resistance being insurmountable be-
cause the patient has been taught. by those she loves that any
wish pertaining to sex is horribly licentious or disgraceful. In
this respect the asocial significance of the eroticism seems to be
about the same.

Case CD-I passed through a remarkable catatonic crucifixion.
The underlying affective attachment to his beautiful mother was
not so much due to her prudish resistance to his becoming hetero-
sexually free as it was due to the loyalty and devotion to her wel-
fare, which she unconsciously cultivated. The father was not a
domineering parent, we were informed, but Avas kind and devoted
to his son's welfare. Eivalry is often disarmed by kindness and
it is more likely, from what transpired during the psychosis, that
the son was iinable to free himself from a religiously sanctified
overlove for his mother. In turn, the. tendency to use his fiancee
as a subject for masturbation fancies made^ him feel that he had
been guilty of unworthy wishes that must be purged from himj
eliminated (like Case AN-S).

The patient was the only child of a beautiful, devoted, girlish
mother. His father was unusually chummy with him and taught
him many of the tricks that delight a boy, such as building toys, a
canoe, how to camp, play games, etc. The family situation seems
to have been delightful throughout the patient's boyhood. His

558 PSYCHOPATI-IOLOGY

heredity contained no psychopathic determinants. Except for -one
convulsion in infancy, and mild attacks of measles and scarlatina,
the patient was physically robust. He was interested in aagiiny out-
door sports.

His career in school showed that he did very well except for a
failure in mathematics when he tried to enter the Naval Academy.
His youth was considered as the reason of the failure.

When seventeen, his father died unexpectedly. The mother
and her son finally adjusted themselves to the situation, which
was very difficult because of their affective dependence upon the
father. The patient immediately entered a business firm and
learned to manage his mother's estate. For three yea.rs he did
ordinarily veil and seemed to enjoy the responsibilities of taking
caj-e of his mother. She devoted herself to the comforts of her son
and literally idolized him because "he was a perfect brick."
Friends of the family recognized the affections and devotion of
mother and son as an unusually happy solution of the family
problem. They both fondly cherished the memory of the man
who had devoted his life to their happiness.

Descriptions of the patient's personality given by the mother,
fiancee and several friends, as well as a series of kodak pictures,
gave unquestionable evidence as to his excellent social qualities.
He seems to have been a favorite in his set, fond of athletics, par-
ties, business, was an e:5j;cellent mixer, very good-natured, witty and
likable. All accounts of his character corroborated the impres-
sion that he was a good-humored, robust young fellow. None of
his friends considered him to be sensitive, timid or irritable, al-
though I pressed, the issue hard because of the unusual nature of
the psychosis occurring in a man with such excellent social qixal-
ities. He was not inclined to spend his money foolishly and in-
dulged in no compensatory debauches.

At twenty, he became engaged to a delightfully frank, inde-
pendent, self-reliant iindersized girl of about his age. Despite his
very unusual height (six feet, six inches) he seemed to enjoy the
jokes at the expense of their physical disparity. Although he
was apparently not sensitive about his height he seems to have
given it some consideration, because his mate was undersized and
he particularly enjoyed the novelty of being bossed by this little
woman.

At twenty, he enlisted in. the State Militia and enjoyed the

CTTRONTC CATATONIC DISSOCIATION 559

military work but his friends wore inclined to think that he
treated this work too seriously. A few months later the troops
were suddenly ordered to the Mexican border. The rush of prepa-
rations and the possibility of war threw everything into a whirl
of excitement. Just preceding this event, the patient had boon
worried by a hazardous business deal.

The young couple decided to announce their engagement on
the eve of the departure of the troops and the patient had it pub-
lished so that it read like a military order. Their friends re-
garded the unique announcement as a clever idea and the patient
himself seemed to think of it as a bit of fun. At the same time,
his fiancee worried about his being "too serious" about his mili-
tary work. She protested that he was more engrossed and worried
than his companions. He, however, seemed unable to regard the
situation in any other light than that of an extremely serious
event, which indicated an unusual affective pressure.

The officers, with whom he was a favorite, noticed that ho
tended to become confused Avith the details of his work and tlie
patient also expressed concern at his inability to make things come
out right, but objected when others offered to help him. This ap-
parently mild, but persistent, tendency to confusion was not rec-
ognized as the onset of a grave .affective disturbance and he was
hurried off to the border with the troops.

The above is the story of the man's behavior as any friend
or physician might have learned of it and is the essence of the
observations of the family. No other etiological factors, they em-
phatically maintained, were to be considered. The psychiatrist,
however, can not afford to rest contented with the socialized half
of the patient's career. If he permits himself to-be misled he will
never obtain insight into the actual problems involved in the ease.
The following information was obtained from the patient after
the psychosis was well started, but since it concerns his behavior
preceding the psychosis, it is brought in here in order to empha-
size the significance of the military form of announcing the en-
gagement and, later, the characteristics of the psychosis. The
patient had one heterosexual experience at fifteen which can only
be regarded as a sexual experiment. His masturbation career be-
gan at adolescence with other boys, but later, when it usually is
stopped by most boys, he secretly continued the practice under
the self-assurance of its being a physiological necessity. TTiis

560 PSYCHOPATHOLOGY' - " ' i

justification probably spared him from being timid and sensitive.
This practice occurred usually after he had retired. On some oc-
casions it followed after he awakened from erotic dreams. Usu-
ally the autoerotic escapades followed amorous situations with
his fiancee. These episodes, however, as usual, were finally fol-
lowed by remorse and a determination to make amends for the mis-
behavior. The announcement of the engagement as a military or-
der (sacred order from the government), just before the troops
were going away to a probable war, contained an indication that
the play of wit disguised the yearnings to attain a state of grace
which had been lost through sexual misuse of the sacred love-ob-
ject for masturbation fantasies (Cases AN-3, HD-1). This effort
at self-redeinption came strongly into the foreground after the
psychosis had progressed for several months. (It seems, from
my cases, that the paranoid type feels the necessity for self-re-
demption, but does not get relief because he does not allow the
affect to carry him through whatever it craves, like the catatonic.)

From the onset the difficulty in carrying out orders increased,
and by the time the train reached the border the patient was in
a grave state of confusion. He struggled desperately to control
himself against compelling feelings to remove his clothing. The
compulsion, however, mastered him within a few days, and in his
confused condition he tried repeatedly to remove his clothing be-
fore the men, with the compulsion (within himself) to go through
a sacrificial form of initiation. "I was very self-conscious about
the publicity of my engagement. I was numb all over as if there
was no force in me, and then, for a minute, I would get clear and
know everything. In San Antonio they [hallucinated] led me to
believe that my mother and girl were dead. I spoke to them all the
time. I don't know why. Over a year ago Tabout the time of the
engagement] I went to the doctor because one testicle was lower
than the other. It had been injured in a football game and I de-
veloped varicocele. ' ' He also intimated that perhaps circuincision
was necessary, and that masturbation had had something to do
with the varicocele.

A friend who was in his troop on the border described the pa-
tient's behavior, showing that he soon passed into a hallucinatory
panic during which he fled into the desert, poorly clad. He w^as
found in a haggard, desperate, terrified condition. He expressed
particular terror for the soldiers' knives.

CHRONIC CATATONIC DISSOCIATION 561

When the company surgeon examined him, he said of someone
who passed, "Do yon see that man? He has my face." When
a physician passed throngh the room, he said, "That man had a
frown on his face and now I have it and can't get rid of it." {This
marhed fendlency to imitate and passively submit to almost any im-
pression was later cotifrolled hy a catatonic resistance to the feel-
ing that we desired him to yield. It is absolutely essential to recog-
nise that the desire to be manipulated was in the man, and was
really the erotic affect seching a solution. If the reader can ac-
cept or understand such things, the remainder of the psychosis
becomes transparent.)

A few days after the onset of the panic he was sent to the St.
Elizabeths Hospital. Upon his arrival he was haggard, ex-
hausted, confused and tended to be disoriented and hallucinated.
There were relatively lucid intervals that lasted for several hours,
but he was never entirely clear. He persisted in confessing that
he had committed numerous crimes and perversions that involved
his friends and family. He had particular difficulty in understand-
ing the behavior of the other patients, and constantly read secret,
seductive meanings in the movements of everybody. The letters
written during the next few weeks varied greatly in continuity of
expression, and none of them were altogether free from errors.

For a week or so he seemed to improve, and asked to work in
the dining room in order to get his thoughts on other subjects.
For some unascertained reason he soon became too confused to do
any work and tended to lose touch with everything. He would
stand for hours in one place or follow people around a few steps
and keep asking unfinished questions about the meaning of things.

He complained of cardiac, respiratory and gastrointestinal
distresses: believed that he had syphilis, leprosy and infantile
paralysis. When he was a child his parents passed through an
infantile paralysis scare.

Another patient, who was sent with him from the border,
passed through a state of very erotic, symbolic dying, and for
several days yelled lustily to be "saved." It was very difficult
to restrain him from trying to render assistance to this man. He
was unable to comprehend the man's condition and felt strong
compulsions to save him.

The patient was polite and well mannered throughout his
psychosis. Even in his most confused states the influence of re-

562 PSYCHOPATHOLOGY

fined habits could plainly be seen in Ms courteous manner of ask-
ing for or refusing assistance.

In the third week after admission his confusion increased.
He explained in detail the nature of the thoughts and hallucina-
tions that distressed him. Various patients seemed to make signs
to him, indicating that he must submit to them sexually, voices
talked about his masturbation, a childhood oral erotic experience,
and accused his mother and fiancee of being prostitutes. He cHed,
clenched his fists and, with intense affect, exclaimed: "I want to
show them it is not so !" His medical record showed that he made
many sexual references to these same subjects while on the border.
He would not fight hack at the fancied persuasions of the men and
expressed confidence that they would be unable to hypnotize him,
although, he said, the men were stronger sexually and more mas-
culine than he was. Several times he fought, he said, in order to
be killed. His persecutions ivere not systematized, were not fixed
•upon any particular individual, and there was no hatred in his de-
fense. These facts encouraged us to give a good prognosis to his
people.

He eoinplained that everything in his life was coming back to
him with a double meaning of sexual and immoral significance.
He complained bitterly of this, and seemed to worry about the
cause of it, but could not understand that it was due to his own
uncontrollable emotions.

Voices (hallucinated) told him that his testicles were to be
removed (castration) and he could not understand why "they"
should speak of him as being Jesus Christ (biological crucifixion).

The crucifixion craving soon dominated everything, and he
had to be isolated because he persisted in removing his clothing
and being crucified. His stream of talk now became unintelligi-
ble. During his isolation he masturbated extremely frequently,
assumed the coitus position on the floor, and, on one occasion, when
I entered the room, he was manipulating his genitalia, and, with a
confused, wondering facial expression, he pleaded timidly, "I can't
please my' father innocently." The setting was conclusive evi-
dence as to its significance — namely, a crucifixion of his virility
and a sexual submission to the father as a solution of the mother
attachment.

"They," he believed, put poison into his medicine, and called
him c. s., fairy, s. b., bastard, snake, woman, etc. He said he had

CHKONIC CATATONIC DTSSOCTATTON 5G3

to go through a strange initiation of religious, sc^crct significaijce,
etc. ir.e fulfilled this craving later b}' acting it out in detail.

His memory for remote events was surprisingly good during
the niore lucid intervals if he could be induced to answer questions,
but recent events, however, were rather haz}' and inaccurate. Dur-
ing the early part of the psychosis he did the mental tests fairly
well and could repeat six numbers backward. The ethical ques-
tions were answered very well. He complained of retardation of
thought until he talked a while. Then his thoughts came more rap-
idly.

From the fourth A\'eek to about the thirty-fifth week, except
for a brief interval, his personality was markedly dissociated, and
he seemed to be unable to prevent himself from submitting to the
hallucinations. He muttered to himself constantly, and persisted
in certain mannerisms. During the first few weeks he wept bit-
terly at his plight and considered himself to be disgraced but he
later abandoned himself to the affective wave that swept the ego
under. He complained that he could not understand why he was
not ashamed when he talked about his masturbation, etc.

During the masturbation period he refused all food, vomited,
complained of headaches, extreme weakness, and his condition
became alarming because of the extreme emaciation. For two
weeks he had to be tube-fed. Then he adopted a female nurse
whom he usually insisted should feed (mother) him. Several
weeks later he began to eat ravenously.

About the tenth week he became decidedly negativistic and
assumed a catatonic attitude that endured more or less consist-
ently until about the thirty-fifth week. During this catatonic per-
iod he used manneristic expressions and symbols, and entertained
classical crucifixion fancies. He also informed the nurse that he
had given birth to a child, and actually simulated labor pains.
Then followed the birth of many children. When, during this ap-
parently profound stupor, he protested that his nurse was killing
his child, he spoke the nurse's correct name. He said his body
was destroyed, bones broken, he died, was female and male in one,
had all the thoughts of the world to care for, etc. He would be
absolutely mute for several days, then Become talkative and witty,
masturbate, and then lapse into mutism again. This cycle was re-
peated so frequently that a neighboring, bed-ridden, alcoholic pa-
tient was able to describe it accurately. His dull stare, dilated

564 PSYCHOPATHOLOGY

pupils, -haggard face, small rapid pulse, emaciation, negativism
and confusion, indicated the degree of his stupor.

Without going into details of the numerous symbolic expres-
sions, the record of the catatonic period may be abbreviated to
make clear its affective value and how it led to the manner of ad-
justment.. In the early part of the catatonic state his fiancee nursed
him. He responded sufficiently for her to take him into the
grounds for several hours daily, although he would say very little.
Then his mother joined the party, began to fix his clothing and as-
sert her motherly interests in his welfare. His response was a
startling regression. His fiancee had succeeded in inducing him
to leave his bed, shuffle about and look at things, but, when his
mother insisted upon mothering him, he regressed to a nursling
level. They were sitting on a bench when she persisted in fixing
his clothing despite his motions and signs that she should not do
so. He relaxed and slid from the seat to the floor, lying in a heap.
The mother and fiancee had to be sent home and the patient became
confined to bed in a catatonic, infantile affective state for several
months longer. The reaction was an eloquent confession of his
infantile dependence upon his mother and the disastrous influence
it was having on his mental integrity.

Most of the patient's mannerisms were intelligible as gratify-
ing the crucifixion craving. During the catatonic period he per-
sisted in assuming a position which was very similar to the posi-
tions of Christ in the paintings of "The Entombment" by Eaphael
and Carracci and the sculptured "Pieta" by Michelangelo (see
illustration). The most important features being the position of
the crucified feet which he persisted in maintaining despite all
efforts to make him walk. He believed that the scars on his feet
had been made by the crucifixion. His attitude toward his mother
and fiancee was in many respects like that of Christ- toward his
mother and Mary. Magdalen. The dead Christ seemed to be acted
out by his postures. Later, when he began his "reconstruction"
under the nursing of his fiancee he spoke to her about "our"
difficulties as though she were going through a purification proc-
ess with him.

When he was bathed he insisted that he was not dirty and sin-
ful and did not need it. At other times he protested that he should
not be touched because he contaminated everyone. He usually
looked at people with his left eye and kept the right eye closed or

CHRONIC CATATONIC DISSOCIATION

565

Fig. 54. — "La Pieta," by Mielielangelo. The loving, son of the too-devoted
mother becomes the instinctive , rival of the father. If he is unjust to wife and son,
the son develops parricidal impulses. If he is unjust to the son and the mother is
loyal to her husband, the son tends to become a wandering hero (hobo). If he is domi-
nated by a severe, just father and pitied by a timid mother, he becomes crucified and
sacrifices himself to Ms father's glory and potency. He often "dies," descends into
the hell of invalidism arid infantism, and is nursed and petted by the mother. Often
before the sacrificial regression, he seeks a mother substitute in Magdalen, the prostitute,
who having a reciprocal father attachment sympathizes with him and often marries
him. (Compare Figs. 28, 29, 55.)

566 PSYCHOPATHOLOGY

kept both closed. When alone for a considerable length of time
he opened both eyes and looked about. He crossed his fifth fingers
Tinder the fourth or passed the thumbs between the second and
third (see Fig. 6) and held up the right hand to the level of his face
and supported the right elbow with the left hand, somewhat like
statues of the Infant Christ. (His mother said that when he
played football he used to keep his fifth fingers crossed imder the
fourth for luck.) Wlien his tray was offered he refused to eat, but
when it was taken from him he begged for it, saying he was hun-
gry.

He resisted all efforts to attract his interest, talked very lit-
tle, and with his eyes squinting, fingers crossed and arms flexed
he shuffled about. His feet were almost useless. He talked about
the Jew in himself — said "she is inside" and caused his mastiir-
bation.

About the ninth month of the catatonic period his fiancee re-
turned to nurse him out of his condition. She was a charming lit-
tle M^oman, imbued with a mother spirit and thoroughly convinced
that her inspiration would induce him to take a new interest in
life. I had been in close touch with the progress of the psychosis
but was unable to win the patient's confidence. Somewhere he
had learned something about fransferevce, and while in his cata-
tonic moods he talked about it but complained that my personality
was too strong and he felt hypnotized by. my presence. This
clearly indicated the vigor of the submissive homosexual interests
and the value of the superimposed catatonic defense. He felt
too unsafe to trust himself. With his fiancee the situation was
.very different. A heterosexual transference is eagerly sought by
such patients, particularly if it can be refined.

Upon her first appearance he reacted with interest, and within
a few days was out on the grounds for short walks. The patient
began to speak of himself as being in a stage of ' ' reconstruction ' '
and maintained that "psychology only" could help him. Fortu-
nately, his fiancee was splendidly open-minded and frankly inter-
ested in the affective development of the personality. She soon
became a reliable medium through which I could influence the' ad-
justment of the patient. That he was going to recover was mani-
fested by his rapid gain in weight and his ability to talk about
impersonal affairs. The critical problem was how to prevent him
from repressing the memories of the psychotic episode. It was

CHRONIC CATATONIC DISSOCIATION

567

vitally necessary to the future of his personal integrity that he
should retain the memories of his psychosis as a part of his per-
sonal experience so that he would not lose sight of the wish-fulfill-
ment in it. Only in this manner of qualifying the wishes with his
other interests could sound emotional balance and judgment be
expected to result.

His fiancee, upon my recommendation, read Hazelton's play,
"The Yellow Jacket," and White's "Mechanisms of Character
Formation." She grasped the mechanism of the family romance
and realized her part in the psychotic fantasies. She seemed to

Fig. 55. — "The Resurrection or Eebirth, " from a painting by Raphael and Perugino.

have no hatred, jealousy or prudery Avhich might act as repressive
factors upon the patient, and her splendid sense of humor stood
her in good stead. It made the reconstruction decidedly easier.
The patient resisted the reading of ' ' The Yellow Jacket ' ' for sev-
eral days, but finally consented and became interested.

During the first few weeks he was like an infant learning the
ways of life (rebirth). See Fig. 55 of the resurrecting Christ.
He would not step on the lawn, cross the street, or go iii unusual
directions without asking permission of his escort. Numerous
other little adjustments Avere noted by Miss A — , and both seemed

568 PSYCHOPATHOLOGY

to delight in joking abont his infantile manners. Gradually, and
yet quite rapidly, he began to assert himself, and would often
ask her if she noticed his progress. Soon tramps into the country,
then trips into the city followed. Within several weeks after she
began to nurse him they went to the bathing beach, theatres, etc.
The patient's tendency to avoid things that pertained to his old
affective status showed in his refusal to eat in a basement cafe.
The basement cafe, being "low down," was still "immoral," al-
though the hotel iii which it was located, he said, was all right.

Even though the patient tramped and played with consider-
able zest, bought his clothing with good taste and entertained a
guest in a downtown hotel for dinner, when he returned to his
ward he quickly lapsed into his catatonic attitude, shuffling gate,
peeping eye, and hand mannerisms. He was convinced that a hyp-
notic force on this particular ward overpowered him so soon as
he stepped into it' (conditioned autonomic affective reaction). The
suggestible nature of the catatonic state and autohypnotic trance
surely have very similar mechanisms and contradict the presence
of a toxin or cerebral lesion as a cause of catatonic dementia
precox.

This tendency disappeared entirely after he was transferred
to another ward. He was proud of his readjustment, took firm
hold of himself, and applied for occupation in the dairy. His de-
voted mother could restrain herself no longer and insisted upon
returning to her son in order to take him home with her. The in-
sight he had acquired into the debilitating influence of her mother-
ing enabled him to grasp the critical nature of the situation, and
he met it firmly. He wrote her a letter in which he emphasized
that he was mastering himself and intended to become the head of
the family, and that he did not wish her to visit him.

Nearly one year after his admission he was discharged as re-
covered. He had fair insight, but was inclined to use witty little
defensive remarks about his case, and dodged an analytical review
of his psychosis."

His pretty, little, self-confident mother-fiancee surely exerted
a fine reconstruction influence over her charge. She was inclined
to have ",edlds on her lungs" and coughed affectionately as she
nursed and enticed him to exert a manly interest in life for her.
The coughing had, I am sure, unconsciously for her, an inciting
influence upon him to take a protective interest in her efforts. She

CHRONIC CATATONIC DISSOCIATION

569

glowed with enthusiasm over her success. During the first few
weeks he significantly, referred to himself and his fiancee as being
"in the dark" and that they were finding a way out.

Now the patient seems to be the master. The fondness of the
mother (Mary) and the fiancee (Mary Magdalen) for one another
and the son made the solution considerably easier than it could
have been had the slightest rivalry existed.

The many strange fancies, such as the food passing out of the

Mg. 56.— Seal of Lichfield Cathedral,
England.

3?ig. 57. — Window of Dumblane Abbey,
England. (From Buskin's works.)

back of his neck, of his being closed in a tomb for months like an an-
cient Egyptian, of being deserted by his "ancestors," and that
loud sounds of bells and knocks should be made for mysterious
reasons whenever anyone touched him, etc., can not be included
for want of space in the discussion of the case.

The crucifixion and submission "to please" the father, the
dying, burial, resurrection or rebirth as a purification of the
homosexual and incestuous fancies, the reconstruction and new
adjustment to meet the obligations of life, were obviously made

570 PSYCHOPATHOLOGY

to free himself from the abnormal affections which prevented him
from loving his fiancee. The psychosis, as a means of affective
readjustment in order to become able to love like a virile man-,
seems to have been necessitated in order that he might free him-
self- from his mother-attachment, father-submission and secret
autoeroticism.

The patient's inability to grasp the personal sources of the
affective regression — the cause of the dissociation — and to analyze
the various situations so as to appreciate the wish-fulfillment and
his own responsibilities in the psychosis, are a very important de-
fect in his adjustment. He had, however, fair insight into his af-
fective make-up and the nature of his family romance.

The catatonic adaptation as a defense after he became unable
to control the homosexual cravings to be crucified was obvious in
this case. The rapidity with which he assumed the catatonic atti-
tude when he felt that he was losing control of himself, or aban-
doned it when environmental conditions made him safe, gives fur-
ther support to the instinctive nature and defensive value of the
catatonic adjustment. During the catatonic attitude the erotic
cravings were permitted freedom through fantasies, hallucina-
tions and overt acts, and yet, the individual was fairly safe from
bursting into a wild orgy of sexual perversions, although he could
not prevent the masturbation. I have seen perverse outbursts oc-
cur in other catatonic cases.

The patient's mother, fortunately, had no repressions to main-
tain, nor feelings of having betrayed her son 's welfare for herself,
so she was very amenable to suggestion and cooperated Avith, our
wishes, yielding her own interests to the patient's welfare. Moth-
ers who have selfishly appropriated a son's powers to further
their own interests in life literally become hostile to any line of
readjustment or any psychotherapeutic measure that recognizes
their selfishness. They are not able to escape the feeling that they
secretly wronged the son and yet very few are able to admit it
frankly. The mother in this case had not consciously adopted her
son for a lover as an adjustment to her social obligations ; hence,
she had no feeling of guilt to hide. She resigned her interests
for the welfare of the patient's manhood, Avhich surely made his
readjustment and self-assertions much easier, and enabled him
finally to marry his fiancee one year after the psychosis.

The fundamental principle of the "golden rule" of Chris-

CHRONIC CATATONIC DISSOCIATION 571

tianity, "Whatsoever ye would that men should do to you, do ye
even so to them," is the renunciation of envy, of hatred, and the
sort of selfishness that tends to destroy or subjugate the other
man's independence and resistance. The attitude of many par-
ents, because they can not be comfortable imless they dominate
their children, often forces the son or daughter to sacrifice his
or her most intense yearnings in order that the anxious or selfish
parent may be happy. The natural reaction when the affections
are resisted is to overcome or remove the resistance. But the
parent who takes advantage of the solemn religious impressive-

rig. 58. — Drawing of a vulva, and its symbol, the doubly-pointed ellipse.

ness of parental authority disarms the son or daughter when
the parent is really loved. The son, as in the preceding case,
or the daughter, as in the following case, is forced to choose
between two great affective cravings, which finally results in a
crucifixion, or renunciation of the competitive vital craving un-
less a compromise can be established, as in Darwdn's case.
This is the biological significance of the crucifixion of Christ and
becomes intelligible as a biological phenomenon when this ancient
and catholic fantasy is compared to the emotional sacrifices of
some of our catatonic patients reviving the potency of the dying
god or father. '

The anger in the following case had to be repressed when it
produced a crisis. The renunciation of the anger and the submis-

572 PSYCHOPATHOLOGY

sion to the parent played an interesting part in the crucifixion
behavior.

The family situation in this ease also illustrates the manner
in which a personal difficulty in a parent influences the affective
development of the children and possibly the grandchildren.

The mother of this patient (Case CD-2) married at eighteen.
She became the second wife of a man of forty despite the objections
of her parents and the marriage developed into a very unhappy
mating. The patient's mother was obviously a girl of strong af-
fective compulsions who could not be easily guided. After her
daughter 's psychosis, Avhen it became necessary to study the nature
of her influence upon her daughter, she said that if her father had
definitely protested against her marriagp she would have given
the man up. But her father only objected to the inequality of
their ages and pointed out the difficulties to be expected. (Ob-
viously the daughter wanted the father to make stronger claims
for her future than the father-image, the man she finally married.)

Two children grew up from this mating and both of them are
decidedly subdued, dependent girls. They and their friends have
often remarked that they never learned to think for themselves
because their mother always thought for them.

The mother explained to me that her unhappiness, which re-
sulted from her determination to solve her own problems when she
was a girl, constantly influenced her to train her daughters to
depend upon her for trivial as well as important decisions.

She assiduously, jealously, cultivated this dependence in them,'
in order that when they became young womenj temptations would
not induce them to act impulsively. She is an aggressive, energetic
woman, large and vigorous, with quick wit and an unusual capacity
to forge ahead even if it involves serious personal retractions on
the part of her children. Her natural physical endowments sup-
ported her obsession to control her children in that she was large
and strong.

Her husband was an irritable, rather violent, selfish man
who did not hesitate to strike his daughters to satisfy his anger
though the act was an injustice. This finally produced a very un-
happy relationship between himself and his eldest daughter, the
patient. She seems to have been forced into a persistently sub-
dued, discontented attitude toward her father. The father finally
left his family and lived alone in the West until his death. ■

CHRONIC CATATONIC DISSOCIATION 573

The patient's development into Avomanliood was not impaired
by diseases and her education was snffieient to meet her social de-
mands. Her .personality at maturity Avas, however, much too sub-
dued and retracting. She had developed the fatal speech tendency
of starting to say something and then automatically stopping,
usually at the point where listeners show by the usual movements
of the head and eyes that they have surmised what she wants to
say. Almost invariably, she stopped as if expecting the listener
to finish the thought. The development of this serious habit, which
was fatal to maldng affective adjustments (considering speech as
the preeminent method of affective expression) was easily trace-
able to the overly eager dominant mother, who, as her son-in-law
had observed, had the habit of stealing her daughter's speech and
finishing it for her.

At twenty-one, with her mother's approval, she married a
rather tense, energetic, somewhat eccentric, but kindly man. The
patient was unduly ignorant of the sexual life of woman and ex-
perienced no little anxiety until her mother sanctioned sexual re-
lations by verifying the husband's claim that they were normal.
The husband recognized the suppressive influence of the mother
upon her daughter and tried to influence or train her to become
more self-reliant and independent. The first eight years of their
married life were happy and very satisfactory. About eighteen
months before her psychosis her father died, a recluse in a far
Western city. His death caused the young woman no little re-
morse, which she concealed. She felt that she might have made her
father's life more comfortable had she been more forgiving of his
abuses.

The patient 's first two pregnancies caused no distress and the
third pregnancy, which was welcome and occurred some time after
her father's death, was in most respects, except for "dreadful
dreams," a source of happiness. Her friends and relatives com-
mented on her unusual "madonna-like" appearance during this
pregnancy. The labor and convalescence were uneventful until a
sudden affective upheaval occurred four weeks after the labor.

A few weeks before the labor the cook left unexpectedly and
the patient's mother had to join the family and take charge of
the house in the emergency. She managed the household accord-
ing to her own methods, although on certain essentials of house-
keeping the mother and daughter persistently disagreed. The pa-

574 PSYCHOPATHOLOGY

tient's husband had always had a strong aversion for anything
that savored of being infested with "germs" and required .that
the foods, particularly the milk, should be carefully handled. The
mother felt that the germ phobias of the young couple were rather
extreme and was inclined to say so. Similar differences of opin-
ion were held about the best methods of controlling the children.
The vigorous mother, who had always handled her daughter's af-
fairs as if they were her own, could not refrain from exerting a
constant pressure that gradually forced her convalescing daughter
back into the old, submissive, dependent attitude. The submis-
siveness because of her convalescent state and the sense of ob-
ligation to the mother, for taldng care of the house in the emer-
gency, greatly weakened the daughter's resista;nce.

The climax came when the patient was unexpectedly called
upon to resume her household duties, because her mother had be-
come ill. The patient found most of the household disarranged
and the irritation reached a point where it could no longer be
restrained when, upon opening the ice-box, she found a piece of
foul smelling meat that h0,d been carelessly left there. The pa-
tient lost control of herself and a vigorous, angry upheaval fol-
lowed. She was unable to adjust herself or to criticize her ill,
well-meaning mother. The independence she had laboriously' de-
veloped during the eight years of her marriage, had been wrested
from her by the sincere, but tactless, inconsiderate woman who
would have only dependent, infantile daughters. (Compare Dar-
win and the sincere but domineering attitude of his father, and
Case AN-3.)

The patient's excitement and inability to control herself
frightened the household, and the husband and physician were
sent for. Attempts were made to smooth things over, but, in
order to avoid being rude to the mother, the situation could not
be handled in the natural manner of letting the daughter win a
personal triumph. The mother should have found some excuse
for having to go on a journey in order to give the daughter a
chance to make an affective adjustment and let things calm down.
Unfortunately, however, an affective vicious . circle had been es-
tablished. The patient was too distracted to manage the house,
and the mother, the cause of the distraction, now felt, character-
istically, that she had to stay and retain control of it. This neces-
sitated forcing herself upon the patient despite its inadvisability.

CHRONIC CATATONIC DISSOCIATION &/[)

Nothing but unusual luck and insight could now have prevented
the final break from occurring. The physician and family wanted
a cook to take charge of the kitchen, and the mother wanted a
nurse. They finally compromised by getting a nurse!

For several days the patient was very apprehensive of some
terrible disaster occurring to herself which was due, as the symp-
toms showed later, to the repressed affect vigorously trying to
make an adjustment. The last vestige of self-control was broken
when her husband, who had been dozing on the patient's bed,
awalfened in fright at some sudden disturbance. The husband's
startled manner of awakening frightened the patient and she be-
came unable to control her apprehensions, which Avere already
colored by vivid imaginations, such as being assaulted by German
soldiers who had captured Washington. The next morning she
was completely out of touch with reality and walked off her bed
as if in a dream, falling heavily to the floor. At this time "she
said something about being bad."

She was taken to a sanatorium on Easter Sunday, and after
several weeks, was brought to St. Elizabeths Hospital. She clung
desperately to her husband as if she Avere doomed to lose him and
everything. She recalled during the analysis that while at the
sanatorium she looked over some pictures of priests and thought
of herself as being like one of the priests who was effeminate look-
ing. (This bisexual interest should be compared to the bisexual in-
terests of the previous case.)

Upon her admission, about two months after the onset, she
was disoriented, poorly nourished, showed hyperactive reflexes,
small pulse, rate about 100 per minute, facial and finger tremors,
profuse sweating of the face; sometimes a Von Grsefe's sign was
present, thyroid was not enlarged, urine was not abiiormal. She
was disoriented and could not iinderstand or adapt herself to the
simple needs of the hospital situation. Because of her extremely
disconnected and unintelligible, retarded phrases no intelligence
tests could be made. There was no flight of ideas. Her behavior,
however, was a clear revelation of what the uncontrollable affect
was trying to accomplish.

She believed that she had died, but her husband would not let
her go. (She clung to him when admitted. His affective attach-
ment to her was genuine.) She carried her head in the position
of the crucified, dying Christ on the cross; her facial expression

576 PSYCHOPATHOLOGY

reminded one decid'sdly of the agony in Christ's face as depicted-
in many paintings of scenes before the crucifixion, and her eyes
were uplifted in religious fervor. She would stand in one position
for hours in the dormitory and move her head from left to right
and back again with inexhaustible monotony. While in bed, dur-
ing this stage, she was observed to lie with her head fallen back on
the edge of the bed, her arms dropped in some lose position about
the head and her pelvis going through the gyratiojis of copulation.
The nurse reported that when she dressed herself after the phys-
ical examination she tucked her skirts inside of her drawers like
a boy. (Again the bisexual.)

The baths were interpreted as mysterious sexual practices per-
formed by the nurses and she was always frightened by the ordeal.
One of the physicians was thought to be the Virgin Mary, "God"
talked to her, and she believed that she was in "heaven. ' ' She per-
sisted in having her hair hang loose (a surprisingly common pleas-
ure of heavenly brides). She never tallied except when asked
questions and then answered in broken phrase^ that could not be
connected with anything in the environment, as: "The voice said
that it mustn't. It said it musn't talk all the time— that was God's
voice. He told me to try to make some excuse. He said I must try
one way or another. He said I must not untie everything. ' ' She
said something frequently about drinking water, and frequently
washed and examined her hands. She spoke of herself as "she"
and said she had been "quite naughty" — "I didn't do all — ^I didn't
try to take away all the paints that were on me, etc. ' '

When taken out on the porch she would let herself collapse
on the floor as if utterly helpless. When asked how old she was,
she answered: "I am two hours," and Avhen asked for the year,
she gave the year of her birth.

She showed numerous infantile traits, such as pitch of voice,
manner of replying, would not attend to her excretions and had to
be spoon-fed. After the crucifixion she became mute and passive
for several weeks, during which time she was disoriented but
recognized her relatives. About three months after the onset she
began to improve, her mannerisms disappeared, and she gained
considerably in weight. She was glad to see her mother and hus-
band, and begged to be taken home. The process of reorientation
and reconstruction progressed gradually.

CI-inONIC CATATONIC DISSOCIATION 577

About six montlis after the onset she -was able to take care of
herself and her room and knit for the soldiers.

The patient was now well oriented and recovering rapidly, so
that it was deemed advisable to begin an analytical study of her
difficulties in order that she should have a reasonable amount of
insight. She had no difficulty in recalling the important features
of her illness which Avere essentially relative to the crucifixion,
death of her personality and the rebirth. At first she was inclined
to excuse herself on the ground that she had been exhausted by
child-bearing and had not regained sufficient strength to resume her
household diities. She remembered the essential details of her ill-
ness, the hallucinations and her fancies, but was inclined to evade
them in order to be discharged until she recognized the therapeutic
object of an analytical review of the content of the psychosis.

The father and mother situation had to be handled tactfully
until she had brought out the details of her psychosis and her life.

The father appeared (hallucinated) in the disguise of elderly
women. She said, that when he appeared in the reception room,
"He or she said [laughs], 'It was up to me to make him happy.'
He said: 'I hope you can do it, son Harry' and 'Welcome, son
Harry.' " In the dormitory, "He, she or It [laughs] was taken
out of the room and she looked at me and said: 'You will be
sorry some day.' This puzzled me to know what I should do to
restore happiness. T^lien I determined to stick it out and hear
ivhat I had to hear, the Lord's voice said: 'Well done, thou
faithful servant. ' ' ' She spontaneously identified the Lord 's voice
as her father's. (This sort of resignation to the dissociated affect
is typical of the catatonic.)

The sin that she felt she should suffer for she insisted was the
feeling that she had wronged her father by not trying to make his
life happy even though he had abused her. The general attitude
of the patient was such that when she said the sins did not refer
to masturbation, the point was dropped.

That her father should call her Harry, was due to the fact
that this was her nickname with some playmates Avhen she was a
child.

That her father should be associated with women and be
spoken of as "he, she or it" was probably due to the fact that
she not only craved to be crticified for her fa.ther's sake, but also
for her dominating mother's. The mother's attitude was so

578 PSYCHOPATHOLOGY

subtly ingratiating and yet domineering, that she would almost
have had to be destroyed as a mother if the patient were to free
herself from its terrible influence and win- her own womanhood
and personal independence.

It was this protest, which had always been curtailed because
she could not control its expression, that finally burst forth when
she found the decaying meat in the ice-box and was again subdued
through the anxious mother's, the husband's and the physician's
pleas for self-control in order to avoid illness.

The various sensory disturbances that gave elaborate color
to the crucifixion need not be discussed, because the submissive
value of the crucifixion solution of the affective dilemma is clear
enough. It saved the ideal family as she wished the parents to
have, it, and her personal integrity was crucified for the selfish
wishes of her parents.

Why should this patient have become masculine ("son
liarry") during her stuporous state? Christ and the young priest
had marked effeminate traits, as do many crucified heroes; and
males who go through the crucifixion, complain of becoming effem-
inate and even of losing all masculine attributes. The renunciation
of all. competitive sexual interests, in order that the rival parent
shall dominate, may perhaps be compensated for by the develop-
ment of a complete sexual cycle within the self. The female, devel-
oping masculine traits, and the male, developing feminine traits,
are protected, like Buddha, from the more virile members of their
sex who would dominate them. This conjecture is based upon ob-
servations of the completely autoerotie who are physically of one
sex and fancifully develop the attributes of the other sex, thereby
perfecting the autoerotie cycle. Some of our autoerotie patients
complain of being male at one time and female at others.

A series of analytical studies were necessary before the pa-
tient was able to talk over the father situation without losing con-
trol of herself. (When a patient tends to lose control of herself
while discussing a painful relationship or experience, she must,
by all means, be left to her own adjustment.) When she was disJ*
charged this situation had not been satisfactorily mastered, but
it had to be foregone because of the pressure to get her Jiome.

The attitude of the mother and husband was surprising, in
that they both spontaneously and independently asked for advice
because they felt that they had domineered the patient's emotional

CllUONIC CATATONIC DISSOGIATTON 579

adjustments. It was easy to trace the mother's desire; to con-
trol the daughter's personality to her own disastrous marriage.
The illumination caused no little sorrow, but it was very helpful in
furthering a readjustment on her part so as to encourage her
daughter's independence. Not too much can be expected from peo-
ple who have a lifelong established attitude toward another in-
dividual. Nothing short of a severe affective reaction can force
a readjustment that will make the situation comfortable for the
suppressed. The necessity of permitting the patient the joys of
exercising her own judgment was vigorously presented to the hus-
band and mother. Experience has taught that only with very in-
telligent, unselfish people can new relations l^e permanently ad-
justed without suspending all contact with one another.

The patient returned to her home with sufficient insight to
insist that her family must submit to some of her interests and
that she was going "to run the ranch." She was not tense in this
request and quite good humored about it. Her mother and husband
were very glad to make the adjustment. The prognosis depends
largely upon the length of time that this arrangement can be main-
tained. The patient said that upon her marriage she resolved to
raise her children so that they would not be suppressed and de-
pendent upon her. A tendency gradually to go to the other ex-
treme of not controlling the children sufficiently must be intelli-
gently guarded against in such cases.

It may be added that the patient's younger sister now en-
gaged, is struggling to overcome or avoid the domination of her
ingenious mother. Fortunately, the mother has learned to con-
sider the efforts of the unmarried daughter in a fairly impartial
light and is trying to force herself to be less domineering, but she
finds that it causes her no little anxiety when the daughter seems
about to make even a trivial mistake.

It is valuable to note that the revered, respected memory of
a domineering individual may exert a suppressive influence during
the psychosis although that individual is no longer in the environ-
ment and may even be dead, as in the case of the above patient's
father.

The following case (CD-3) of catatonic adaptation to an ir-
repressible erotic craving also shows how the erotic affect pro-
duced hallucinations of what it craved and how the hallucinations
terrified the patient.

580 PSYCHOPATHOLOGY

The patient's maternal grandmother liad some form of chorea
("St. Vitus' dance") and was considered to be a very irritable
woman. The patient's mother was married at seventeen to an
artisan. The marriage was unhappy because, as the patient
thought, her mother had a refined, artistic temperament and her
father, who was considerably older, was rough, slow and "not
finely tempered." Her mother had a series of "uterine abcesses"
after the birth of her children and finally developed "arthritis de-
formans." Even during her youth, the patient felt that sexual re-
lations, although she had an ill-defined notion of what they were
like, were the cause of her mother's unhappiness and illness. The
mother surely had insurmountable difficulties Avith her sexual af-
fections, because, when her daughter was twenty she had not yet
learned to realize that the menstrual functions were normal. The
mother was never able to answer the sexual questions of her chil-
dren, but met them with reactions of embarrassment and discom-
fort. (Such reactions on the part of the parents usually distort
the child's control of the sexual cravings.)

This ascetic tendency seems to have been a family trait, be-
cause the patient's cousin left her husband within a few days after
her marriage, and the patient's sister and mother both suffered
severely from anxiety because of the sexual experiences a,ttending
marriage. The patient's sister was even afraid that she mifht
become pregnant when dancing with a man, and the patient her-
self would not learn to dance because she believed the man's touch
during the dance might impregnate her. One can easily imagine
the eccentric effects upon a girl's adjustments to society and love-
making that such conceptions might cause.

The patient, the last child, was healthy, vigorous and of a
naerry disposition until she became a woman. Her mother liked
to call her "the lucky child," because she was born in an easy
labor. She won a scholarship in a normal school, taught for sev-
eral years and at thirty-one was appointed to a social worker's
organization because of her unusual -textbook information on so-
cial subjects, acquired after long, intensive study. As a practical
social worker she did very well until her psychosis began to de-
velop. Her physical constitution, except for mwistrual difficulties
which developed after twenty, was very good.

"During all the patient's girlhood she was the prey of her
mother's tales of woe and reacted with resolutions to give her

CHRONIC CATATONIC DISSOCIATION 581

mother some comfort when she should become able to earn a liveli-
hood. The daughter's womanhood was usurped by the mother's
invalidism. The patient was inclined to be overly ambitious, and
made exacting demands upon herself as a student and social
worker. She always showed impatience toward her "slow" father
and tended to compensate for his deficiencies, as well as to protest
against his causing her mother to suffer. She did not like the rich
relatives of her mother, but, on the other hand, prided herself on
her intellectual capacities (a compensation).

The nature of the mother's moodiness and irritability neces-
sitated her removal to a sanitarium for years at a time, and this
completely drained the family's finances and the patient's earn-
ings.

When the patient was about twenty she taught young chil-
dren and then began to realize that some of her pupils knew more
about the sexual life of woman than she did, and, as she expressed
herself after her psychosis, she resigned because of this and took
up other work. At twenty, she first realized that menstruation,
etc., was not an indication of a shameful defect in womanhood.
(Her mother's depressing, prudish attitude had given her this im-
pression.)

At twenty-three she became engaged to a man several years
older than herself, but was never quite able to make up her mind
to marry. For the next ten years she was neither able to break
the engagement nor fulfill its obligations. The principal causes
of fear of marriage were sexual ignorance and her mother's, sis-
ter's and cousin's unhappy experiences. She planned her house
and furniture which was strikingly like her mother's, but was un-
able to consummate the final act.

In her studies for social service (at twenty-eight) she came
upon literature that partly explained the sexual life of man and
woman and the diseases peculiar to sex. Here, according to her
statements, the discussion of the clitoris and masturbation aroused
her excitement and curiosity, which she hept secret. This led to
sexual experiments and masturbation episodes preceding her men-
struation, and it finally grew into a very serious autoerotic diffi-
culty.

At thirty-one she entered the social service. Her work was
characterized by periods of efficiency with periods of irritability,
headaches, dysmenorrhea, psychoneurotic disturbances and slug-

582 ' PSYCHOPATHOLOGY

gish thinking. For two years her friends and relatives recognized
her growing irritability and seclusiveness, but saw nothing in her
behavior that indicated to them an undne change of personality.

The secret autoerotic indulgences were no doubt considerably
augmented by the fancies and amorous pleasures with her fiance,
which had naturally groAvn out of a ten years' engagement.

By thirty-three, the autoerotic trend developed into serious
proportions and symptoms of its undermining the integrity of
her personality began to show in the form of chronic, neurotic
disturbance^. Her "hands broke out in red spots, swelled and
became so painful" that she had to consult her physician. He
failed to recognize the affective, autonomic significance of this and
sent her to a skin specialist who also failed to grasp the patient's
difficulty, but gave her an ointnaeht, diagnosed it as a "case of
nerves" and "handled the case very lightly." "Two or three
days" later she "began to feel weak" amd stopped at a certain
sanatorium for hydriatric and massage treatments. She ' ' fainted ' '
while in the bath, and this "alarmed" her because, as she said,
"I had alwajys said that when I fainted it meant a serious sick
spell." From that time, she later 'said, she felt a "clutching in
the back of the head. " (A very common symptom attending affec-
tive conflicts in which fear plays a part. Perhaps it is due to a
spasm of the muscles of the scalp and the posterior spinal occipital
muscles which naturallv become tense when a defense becomes im-
minent, as. may be easily observed in dogs and cats.) She said of
the onset of the psychosis: "One day in the office a sharp pain
like the prick of a pin struck me on the left side of the back of the
head and came out of the right eye. I at once thought of cerebral
hemorrhage (brother had a cerebral hemorrhage) and started for
Miss — . I became delirious, and after rambling for over an hour,
came to and heard Miss — saying 'You're sick.' I insisted that I
was not ill, but allowed Miss — to persuade me to go home. The
next morning I felt as though I were tied do-vim to my bed. After
several efforts I decided to go to the sanatorium for a treatment.
I told Dr. — about the clutching in the head, and she advised me
to spend several weeks at the sanatorium. I did so, and after
three weeks decided to go home. T was at home but a day when
my brain seemed to stop working; the clutching had stopped biit
I could not think. I managed to write a short letter to Mr. —
[fiance] telling him that I believed I was about to have a spell

CHRONIC CATATONIC DISSOCIATION 583

of typhoid fever, and requested liim to take charge of my business
affairs. The next morning I attempted to write a check, but could
not complete the last word — 'association.' "

(She. had, during a ten years' engagement, been unable to say
the last word consenting to marriage and the sexual act. Through-
out her psychosis she repeatedly hunted for something that she
said would complete her life. She would never complete a puzzle
or game, she said, because there was something incomplete in her
life. Later she decided that this was fear of heterosexual rela-
tions.)

She returned to the sanatorium for "treatment" and had a
"tenable screaming spell." "I had a loose bracelet on the arm
and it seemed to hecome so tight that I wds afraid I ivas being
choked although it ivas on my arm." [The reader will bear in
mind the arm and its relation to masturbation, and the tight brace-
let, choking, and oral eroticism, l)ecause much of the content of
the psychosis Avas later colored with oral impregnation fantasies,
which, of course, had their origin in infantile and preadolescent
cravings.]

"That evening a message ran up my spine and into the back
of my head. It said something like, 'You are going to become vio-
lently insane liy tomorrow morning. You will require the serv-
ices of several nurses and the best care, for you will be very ill.
If you go to the T — Sanatorium (her mother had been there seven
years) at once, where it is quiet and you will have the best of
nursing, you will recover, but not until every effort is made to
keep life in your body." [This wish-fulfilling "message," por-
tending unbridled abandonment to the erotic affect with final puri-
fication, was probably retrospectively elaborated, but in a general
sense it tells the truth about the undercurrent affective cravings
which now were allowed to dominate and sweep her into a grave
psychosis of the catatonic, dissociation type.]

"At 5 o'clock [a.m.] I was screaming to get out of the place,
thought I could not bend my knees, that I had arthritis. I had
often wondered if I vwvld get the disease my mother had." This
excitement, as is usual in such cases, was ushered in by religious
ecstasy and then came the lapse into" unconsciousness. ' ' (The pa-
tient often referred to herself as being "unconscious," but after-
wards said she really meant a "helpless dream state.")

Unfortunately, the patient now actually developed measles,

584 PSYCHOPATHOLOGY

and the skin rash, convinced her that she had syphilis (her broth-
er's disease). She was now in an affective state that tended to
assimilate everything that was destructive to the personality. Her
only brother had had cerebral syphilis and committed suicide
several years after he had what was probably a cerebral hemor-
rhage (at twenty-six). The erotic affect apparently was interested
in the experience that was naturally associated with syphilis.

Within a few days the affective storm reached the propor-
tions of a "delirium" and an unbridled orgy of masturbation fol-
lowed. Vivid sensory disturbances of the hallucinatory type gave
plenty of color to the situation. She destroyed the brown hot-
water bottles because they were "nigger babies" and cherished
the white hot- water bottle as her infant, and had "babies, babies,
babies, twins and triplets." "I masturbated most vigorously and
when I cleaned my death (her error for teeth) I rubbed the necks
of the teeth hard and long and then screamed with pain." (This
is an interesting association of masturbation with teeth; )

The erotic flights were usually followed by several days of
remorse and then repeated. "I could hear everything that went
on and imitated these patients in their vile habits. I knew I was
doing it but could not stop. ' '

During the analysis, a year later, she retrospectively de-
scribed her fancies about the red light in the hall, the male patients,
the red-light district, and that she had become a white slave who
had to submit to long lines of men. These autoerotic hallucina-
tions were vivid enough to cause her to attempt to jimip from the
window. (She later recognized their erotic source to be Avithin
herself.)

During the period of fancies, the fiance and father also were
believed to take possession of her. She had to submit to many
forms of sexual equivalents, including electricity, knives, razors,
drugs, injections, poisoned foods, etc. During the less erotic in-
tervals she realized what her behavior had been and a serious
tendency developed to mutilate herself, even destroy herself in.
order to destroy the masturbation "devil" (castration).

After a period of several months (about six) she regained
some control of herself and was permitted to return home, upon
her persistent begging. She was finally permitted to return to
work, but, after a day or so of trying, she found that she was un-
able to think about her work. Some wild attempts at suicide with

CHRONIC CATATONIC DISSOCIATION 585

self-accusations of degeneracy followed. She was then sent to
the Phipps Psychiatric Clinic where she was treated for about ten
weeks and then 'transferred to St. Elizabeths Hospital, where she
remained about nine months, when she was discharged as recov-
ered.

Her behavior during these eleven months and her final re-
adjustment throws considerable light on the mechanism of the
autoerotic-catatonic forms of dissociation of the personality. Un-
til the latter part of her psychosis, the reconstructive period,
she was not truly accessible and cooperative. Although she would
talk about herself, more or less, she was unable to consider the
nature of the intense straggle she was having with her autoerotic
cravings. Therefore, the physicians were unable to bring the
genetic determinants of the autoerotic interests to the surface.

(I am indebted to Prof. Adolph Mej^er and Dr. E. ^Y. Hall for
the summary of her behavior while she was under their care in the
Phipps Psychiatric Clinic. The following is an abstract of the
summary. )

Upon her admission the patient had to be "coaxed" to enter
the hospital. She was rather tense and nervous, and spoke of her-
self as eating and sleeping and living "like an animal." She com-
plained of a clutching sensation in her brain, that she desired to
expose herself, was vulgar, etc. She talked considerably about her
personal difficulties, but in a fixed, stereotyped manner, and per-
sisted in asking to be discharged. She seemed to be sad and de-
pressed, was poorly nourished; picked her face and chewed her
nails, refused food because it represented the blood of her rel-
atives ; and complained of being hypnotized and unable to pull
herself together and to think clearly. "I must have simple food
without seasoning; the season heats my blood and the heated
blood melts my brain." The electric switches and- signals af-
fected her; her flesh was being dried up and her body ^vas being
destroyed. (Before her admission she complained of having be-
come so degraded as to eat the dirt in the streets.) On the wards
she persisted in washing the floors, walls, etc., and would eat the
scraps from the other patient's trays. -

She complained of having lost all self-control, and wanted to
be chained to the bed to regain it. Her talk contained a note of no
little prognostic importance, in her tendency to repeat that she
could regain it with the proper treatment. "I can ne-^'cr get up.

586 PSYCHOPATHOLOGY

I am bound down by sin," was a complaint made during a time of
erotic abandonment. She begged to be given something that would
make her " vomit ' ' and "tear me to shreds. " She complained that
her hands and mouth were dirty and that she was dirty inside.

This behavior varied more or less with manneristic postures,
tense attitudes and considerable expression of fear and then a re-
turn for several hours to the ward interests and light work. She
seemed to be well oriented, despite her hallucinatory experiences
and distractions. During the last few days of her stay at the
Phipps Clinic she maintained a stooping posture because "some-
one is holding me down." She also retained saliva in her mouth
and refused to respond to simple requests.

For several days after her admission to St. Elizabeths Hos-
pital her behavior continued about the same. She resumed her
head-knee posture, continued mute, retained saliva, and showed
decided flexibilitas cerea. At times, Avith persistent urging, she
could be persuaded to dress herself. (Her analytic retrospective
discussion of this period, which is probably quite accurate, because
her memories of her behavior were accurate enough, showed that
she was still imitating her mother's illness, arthritis deformans,
as well as assimilating everything of a degenerative sort in her en-
vironment, but nothing constructive.) Elaborate, vi^dd sensory
disturbances of the hallucinatory type contributed greatly to her
confusion.

During her panic she developed the fancy that the physician
was experimenting on her with injections of semen which, to her,
accounted for the cessation of menstruation.

She complained to me that she could not hold the "sticky"
fluid (saliva) in her mouth, as if she believed it was necessary. In
her retrospective analysis she brought out many fancies that she
had about foods, such as custards, and yellow colors that "dis-
gusted" her. The custard she identified with semei'' and like the
"sticky" saliva, it throws considerable light on the tendency to
hold sali^'a in the mouth as part of the impregnation fancy. Her
knowledge of semen she said, had been gathered through reading.
(Saliva, nasal secretions, pus, greases and soaps are not uncom-
monly identified by patients as being semen.)

During this impregnation stage the patient's behavior was
more or less consistent in her unshakable tendency to pursue her
own course. This condition lasted about four months. Most of

CHROlsriC CATATONIC DISSOGlATlO^i 587

the time she was confined to bed and tube-fed. She resisted every
attention, kept her eyes closed, lips protruded and pressed to-
gether, and retained large quantities of saliva. She was unclean,
thin, haggard, ugly, and seemed to be in more or less of a stupor.
This, however, was not a true stupor, since she was later able to re-
member most of her experiences during this stage. (Later, during
the retrospective analysis, she explained the meaning of some of
her postures. The reason for holding her hands above her head and
digging her fingers into her palms was to keep from masturbating.
(See Fig. 46, Rodin's "Centauress.") During this period she real-
ized that she ivas deriving sexual pleasure from her fancies and
hallucinations. She yielded to this form of mental masturbation
with the justification that she was "experimenting," but later
realized that she was unable to control herself. These fancies were
probably in the form, as she expressed it, of acting out "every
character" that she had ever read of.

We felt we fully appreciated the erotic significance of her
catatonic dilemma and that the vigor of the autoerotic cravings
made it impossible for her to relinquish her bizarre adaptation
to control them. During one of her "stuporous states" in which
she had not tallied for several weeks and had to be confined
to bed becaiise of her extreme emaciation, rapid pulse, general
weakness and confusion, I asked her if she was enjoying her fan-
cies. A distinct wincing of the facial muscles revealed her sur-
prise that anyone should understand her, and, when the ward
physician came in, this "stuporous" patient got out of bed and
insisted upon having her clothing. She said she could stay here no
longer and "must go home."

The treatment was essentially of a threefold nature. The
hydriatric and dietary treatment to build up her exhausted physical
condition, and a preconceived plan of helping her to realize that her
personal difficulties were understood, but were not censured, and
that they were to be overcome because other interests in life were
more attractive and important to humanity. According to the
patient's behavior and her expressions of gratitude later, this last
step in the reconstruction started with a transference to Dr. Anita
Wilson, which was followed by efforts to win her approbation.
Before discussing the reconstruction, in order to bring out the
value of the psychosis to the patient as a gratification of the erotic
affect it should be given some further description. So long as the

588 PSYCHOPATHOLOGY

imitative tendencies continiTed she was the play-object of several
patients who had sadistic trends that dovetailed with her maso-
chistic cravings. She wanted to eat dirt, and one of the patients
had to be watched to be prevented from feeding her cockroaches,
flies, etc. Despite supervision she gulped down primes, seeds,
great quantities of food, etc., like an automaton. She stole keys,
buttons, light switches, steam valves from the radiators, and
smeared herself with black grease to keep the electricity out of
her body. At other times she sought the electricity. Her bones
were broken, eyes destroyed, flesh burned, and she believed that
she died, lived among her dead relatives (misidentifying patients
as such), and endured the torments of hell (intrauterine regres-
sion). The details of these hallucinatory and fancifuh experiences
would fill a volume. She was finally reborn after due purification.
The reconstruction of the new life became manifested rather sud-
denly, and she progressed up to the point of being able to work,
then something occurred that discouraged her and she again re-
gressed to a state of helplessness. After a few weeks she reacted
again and improved up to a certain point. She now began to write
the story of her life for me, but the sentences were poorly associ-
ated. She talked most about having had brain syphilis and that
she was recovering from it. My first intimation of her transfer-
ence to me came with her reaction to a rather simple but firm ex-
pression of belief that she never had syphilis. She rather joyously
abandoned the notion of syphilis, I thought, in order to believe
what I believed, and felt encouraged because now she could get
"absolutely well," as she expressed it. She attributed the onset
of the recovery (fifteen months after the first visit to the sanator-
ium) as being due to the resumption of menstrual function, which,
of course, must be, in turn, attributed to the benefits of hygienic
treatment and the disappearance of anxiety through weaning her
from her autoerotic interests.

The review of her psychosis and her emotional problems pro-
gressed rapidly, but it was nearly two months before she was able
to speak the word "masturbation." Her defense for her illness
shifted from brain syphilis to exhaustion from overwork, mother's
sufferings, etc. Finally, however, we were able to deal quite
frankly with the autoerotic cravings and she recognized that the
compiilsive feeling that she "must work" was a form of fighting
her fear that she might lose control of herself and relapse again.

CHRONIC CATATONIC DISSOCIATION 589

For some time she complained of crainpin^' pains in tlie right
arm, but these disappeared as the anto(ux)tic trend waned. The
selfisli pleasures of autoerotieisra wore pretty vigorously dealt
with, and she responded with more enthusLastie and genei'ous feel-
ings toward the interests of humanity. It must be emphasized
here that her fiance's attitude gave her consideral)lo encourage-
ment, lie felt himself to be obligated to her, and would consider
no other adjustment than marriage. His reasons for this feeling
of duty were not investigated. We emphasized, however, that her
fitness to marry depended entirely upon the nature of her recov-
ery and insight.

The analysis did not succeed in completely bringing out the
value of the infantile gratifications in the psychosis. She summed
it up pretty well, however, in the analysis of the dream that pre-
ceded the onset of the autoerotic orgy, namely, of climbing a hay-
stack, and then sinking "down, down, down, and coming out on
the left side," moaning that she considered it to presage a moral
fall because of inability to control herself. During her illness she
thought her disease affected the right side. She would not accept
things from the right side, she said, but tliis was not altogether
true. She said her illness benefited her greatly, and now she could
begin life all OA^er again. "My case Avas like a prolonged night-
mare. ' '

The patient's recovery was, on the whole, rapid and unevent-
ful except for several periods of mild anxiety that arose when un-
pleasant situations threatened to stop the psychoanalysis. These
situations, which perhaps would have caused a patient in private
practice to discharge her physician, were, however, readjusted
when she was given an opportunity to express her resentment to
the significance of her affective relationship to the father and
mother. This caused such vigorous resistance, which was unfor-
tunately supported by an unsophisticated confidant, that the an-
alysis had to stop there. The conditioning of the wish to become
ill like her mother was never brought to the surface. (She be-
lieved the mother's illness was due to the father's sexual incon-
siderateness, and during the first part of the psychosis she hallu-
cinated herself in possession of the father. This, however, could
not be analyzed.)

The patient gained rapidly in weight, strength and mental

590 PSYOHOPATJIOLOGY

efficiency, aiid was discharged as recovered twenty-oiie months
after the onset of the illness.

Within a few months she returned to work and has since been
doing unusually well as a social worker. One year after her dis-
charge she was married, and several months later again resumed
her social work. She now feels satisfied with her marriage, but
has had no children as yet, because she feels the interval of re-
covery has not been long enough (two years).

This case is so transparent that it needs little discussion.
She was trained by a mother, who had herself been trained to
suppress her sexual emotions, to be fearful and ashamed of her
sexual functions. The resistance was so vigorous that she could
not love or marry, and when the erotic pressure excited by fancies
and courtship, finally dominated, it was diverted to autoerotic
fancies instead of heterosexual realities. A grave dissociation
of the personality with destructive erotic abandonment finally re-
sulted. The affective readjustment required, in order to be
healthy, insight and the practice of affective gratification char-
acteristic of normal, happy people.

This patient might have made a social recovery without psy-
choanalytic treatment, but it is certain that she would have so ad-
justed as to be eccentric, tense and sensitive about her autoerotic
inferiority, which would have always exerted a serious pressure
upon her.

It seems that a psychosis depends largely for its periodicity
or continuity upon the nature of the affective pressure that the in-
dividual is trying to control. The chronic type of psychosis is
naturally associated with a chronic affective pressure which forces
the individual into a sustained eccentric, asocial position, whereas
the periodic type is associated Avith periodic exacerbations that
may subside and be very well adjusted.

The following case (CD-4) shows that crucifixion psychoses,
also, may vary in their activity as the erotic pressure varies.

The psychosis of CD-4 was characterized by two years of in-
tensive striving in order to establish his biological potency ;
marked by periodic exacerbations of homosexual panic, serious
dissociation of the personality, with hallucinatory disturbances of
all sensory fields, no insight, and a tendency to make a grand re-

.CimONK! CATATONIC IHSSOCrATlON 591

ligious compensation for social uplift. He A\as constantly invent-
ing machinery and eccentric devices, with some success, "to con-
serve energy." This, it will be seen, was clearly a desperate com-
pensation for seminal wastage-.

The family history revealed no neuropathic or psychopathic
traits. His mother died Avhen he was three weeks old. At birth
he was considered to be a "weakling and not expected to live."
He never had a wet nurse. He had none of the serious diseases
of childhood, and no gonorrhea or syphilis. Upon admission his
blood test was negative for syphilis.

He did not learn to walk until he was three years old, but,
otherwise, his mental development and education showed no re-
tardation. Because of an unusual interest in machinery he suc-
ceeded, after six years of assiduous self-training and apprentice-
ship, in securing (at twenty-four) the rating of a first-class ma-
chinist. He derived unusual pleasure from improving machinery,
and, in several instances, made successful inventions, which are
now used by the Navy.

His sexual career was characterized by addiction to secret
masturbation from the years of nine to twenty. As usual be-
cause of secret autoeroticism he was unable satisfactorily to
transfer his affections, although he made anxious, "helpless"
efforts to do so. When twenty, his father tardily warned him
about the dangers of masturbation, and, as a criticism, praised
the physical fitness of the Zulus, who, he said, abstained from all
sexual relatioi:is until they reached the age of twenty-five. This
deeply impressed the patient and, during his psychosis, he tried
to develop the physical standard admired by his father. At
twenty-one, he married a girl of his age despite the protests of her
father. They had five children. The first was still-bom, the sec-
ond died of "marasmus" at five, the third died at four months
from "intestinal trouble." The other two children are living.
The weakness of the three dead offspring confirmed the patient's
notion of being a physically inferior man.

During the first year of his marriage, he practiced sexual in-
tercourse almost every night, usually resulting in ejaculatio
precox. He attributed his inability to perform coitus adequately
to his weakness at birth and his former masturbation. Apparently,
he had no insight into the requirements of sexual hygiene and
self-control.

592 PSYCI-IOPATHOLOGY

The sexual relations were unsatisfactory to his wife as well
as damaging to his self-confidence, and caused them no little dis-
appointment in one another.

While stationed away from liis family, he became very erotic
and indulged in promiscuous sexual relations with Avhite and
colored prostitutes, including instances of fellatio on the part of
his sexual object.

The patient was holding a responsible position as machinist in
a United States port at thirty-eight, the time of the onset of his
psychosis. His family was comfortably provided for and his po-
sition assured. He was, hoAvever, intensely interested in social-
sexual reforms, and devoted much of his time to teaching a Sunday-
school class. He worked out an endless chain plan for buying
churches, and planned several civic reform movements, and an
ambitious 4th of July celebration.

His Avife noticed that for some time previous to this celebra-
tion he had tended to be extravagant with his money. He slept
only a feAV hours at night, and was "constantly on the go." He
tried to induce the entertainment committee to invite the President
to the 4th of July celebration, and became so enthused over the
prospect, that he had to be restrained because he made wildly
enthusiastic speeches on the streets.

The onset of the psychosis was characterized by gradually in-
creasing insomnia, constant activity, poor appetite, and uncon-
trollable "inspiration." He Avould write speeches and articles for
publication throughout the night, and his wife, he said, was unable
to induce him to stop these "abnormalmental practices."

His associates and superior officers felt that the patient was
egotistical, and was flagrantly trying to aggrandize himself. "He
was very talkative, claimed to be an unusual genius in art, to have
musical talents, to be a social reformer, an inventor of marine
machinery, and to know a great deal about medicine and every-
thing else." At times he maintained an attitude of affected re-
serve, was irritable, and inclined to outbreaks of anger. He be-
lieved his mind "was keener than it had ever been before." He^
was obsessed Avith ^the desire to talk about the fall of Adam and
Eve because of their sex relations "for lustful purposes." These
talks were irrepressible, and to men and women, in fact, to anyone
Avho listened, he said: "We want to be Christians, we Avant to
understand the Bible in the beginning or we won't understand the

CHRONIC CATATONIC DISSOCIATION 593

rest correctly. ' ' The original sin, he said, was sexual intercourse
for pleasure. Sexual intercourse should be for the idea of con-
ceiving a child. He advised the nurses frequently: "If you want
to really know if the man is truly in love, look him in the eye, ask
him if he really wants to do that to have a child by you, and, if he
does, it is love, and, if he does not, it is lust." (His sexual ex-
cesses for which this was a compensation should be kept in mind.)

Sexual intercourse for lust, he said, was the cause of the fall
of Adam and Eve, and he believed, during the early period of his
psychosis, that this was the trouble with humanity and he himself
must correct it. (Two years later, when he discussed this subject,
he said: "Now, I think it was not that, but it was sex perversion.
The 24th and 25th verse of the 2d chapter and 1st verse of the 4th
chapter seem to confirm the idea that it was not sexual intercourse
but sexual conversion, I mean sexual perversion that caused the
downfall of man. ' '

Upon his admission to St. Elizabeths Hospital he was in
good physical condition, well developed, very strong and active.
He had good features and appeared to be more intelligent than
the average, enlisted seaman. His memory for most details was
remarkably accurate. He was well oriented despite his excitement
and the frequent hallucinatory vividness of the sensory disturb-
ances of all his major receptor fields. He felt compelled to do
many odd things, some of which will be described later, and com-
plained bitterly because he was unable to keep from lying. When
he improved, one of his triumphs was the ability to tell the truth
again.

He expressed himself as being decidedly happy and optimistic,
and acted accordingly; but, at times, he wept bitterly and com-
plained of being depressed. He insisted that nothing worried him,
which is quite typical of the so-called manic type, and yet he tried
desperately to obtain freedom and exercise in order to save himself
from "moral degeneration," about which he was very anxious,
even though he maintained that "nothing" worried him.

Insight was lacking in the sense that he never, even when dis-
charged, would consider that he had been insane. His "nervous
system was run down" and, as he said: "I realize I need rest
and quiet," was about the extent to which he would consider his
difficulties. His powers were concentrated upon the sole object of
establishing his biological fi.tness and self-control at any price of

594 PSYCHOPATHOLOGY

reality. Because his "memory was even a little keener than ever
before," he made the not uncommon contention that he could not
be insane. He performed the intelligence tests fairly well.'

Throughout the first few months of his siay in the hospital, ,he
denied his hallucinatory experiences and was not frank. He re-
fused to eat and wanted to fast, but would not explain its signifi-
cance (religious). For several months, he incessantly tried to
convert patients to accept his religious views, because he believted
that sexual perversions had caused the downfall of Man. He be-
lieved he was inspired by Christ and twice cultivated a beard like
Christ's, walked about with eyes uplifted in a soulful manner,
tried to heal the sick, and save the damned. The remark of a
woman visitor that he looked like Christ, elated him. He said,
' ' In my efforts to lead you and others back to Christ, I have taken
him into my life so much that if I grew a beard and proclaimed
myself as the Christ that is expected, it would be believed by
many, especially after my beard had grown out. A woman told
someone that I looked like Christ, and, besides, by taking him into .
my life, I have acquired some of his qualities." (See the photo-
graph of another patient who simulated Christ, Fig. 59).

The patient expended tremendous energies in writing. He
was almost indefatigable in the exposition of his version of the
biblical story of Adam and Eve. He made lavish claims of being
an inventor (creator) of battleships, guns, machinery, and, in fact,
anything that struck his fancy. He wanted to patent several of
his inventions and would willingly have spent all his income to
further these fancies. Strikingly enough, but as is characteristic
of the impotent and almost pathognomonic, his inventions were
always about the conservation of energy and utilization of all the
waste (reconstruction for the wastes of masturbation), with the
ultimate hope of perfecting perpetual motion (omnipotence.)

His religious fancies were intimately interwoven with his in-
ventions and indicated their common root. He originated a system
by which a community could accumulate money, build a churchy
and have sufficient funds left to start a second nucleus for a church-
building fund "like an endless chain" (perpetual motion).

During this prolific period of fancies, he was very courteous
and delighted with anyone who would listen to him. At the same
time, he was decidedly displeased with his "wife and Avrote numerous

CHRONIC CATATONIC DISSOCIATION 595

indignant letters, some frankly shoAving suspicions of her fidelity
and the renewal of the desires of her father to get rid of him.

About the sixth month of the psychosis the repressed, erotic
cravings could no longer be controlled or disguised. (It is in-
teresting to note that he never was sensitive about his tendency
to homosexual perversions.) He had been allowed limited freedom
of the grounds because of his harmlessness and his courteous
agreeable manner. For several weeks previous to the following
climax he had been secretly entertaining vivid erotic fancies about
another male patient. He fancied that this man was making "pas-
sionate love" to his wife, and he must go home and "save them
from themselves." He must "interfere and forgive them for
almost giving way to their feelings." This man seemed particu-
larly admirable to him at this time. A few nights later, while lying
in a dream state in a bathtub, he responded to these erotic
thoughts, and, jumping out of the tub, rushed into his room, ex-
claiming: "I love you! I love j^ou!" The erotic pressure soon
precipated a climax. (The fancy about loving the same woman is
often the meeting point of homosexuals.)

During this period he dreamed of being shot, burned, etc., and,
one night, that his house was burning in a great fire and his wife
and children were being destroyed. This dream, and its after-
images, were so vivid that he believ^ed it to be a reality and became
panic-stricken. He rushed about the ward looking for evidences
of the fire, and tried to telephone to his wife in New Orleans to
find out if it was true. The most pressing assertions that informa-
tion had been received from his home and that everything was all
right would not quiet him. He fought the attendants desperately
and tried to jump from the windows in order to escape. His
anxiety was intense and, while still worrying about the fire, the
next night, he evaded the attendants and sneaking iiito the bath-
room filled the tub and flooded the compartment. For several days
he continued to have hallucinations about his suffering wife, heard
God calling him and was unable to eat, sleep or rest because of his
anxiety. [Several months later, he explained that the panic had
resulted from increased weakness and seminal emissions with
dreams of great fires and loss of self-control, because he had per-
mitted his beard (Christ's) to be shaved off. He insisted that a
saving strength grew in the hair. J He called different nurses
"wife," and usually saved part of his food for his "wife." He

596 PSYCHOPATPIOLOGY "

considered himself to be doomed to die and "go to God," and that
he had to save the world (crucifixion). He temporarily improved
in his general behavior after this panic.

Abont the seventh month his parole of the grounds was re-
turned and, for a month, he restrained himself fairly well, until
the eroticism again dominated his behavior (eighth month). He
became noisy, talkative and bothersome, wandered about, usually
alone, would run up and down the steep hills to develop his en-
durance (like the Zulu) and indulged in a variety of unique ex-
ercises. He was always eager to compare his superior strength
with that of other men, and delighted in taldng punishment when
boxing. (This disguised his biological inferiority in one sense,
and, also, pleased his sexual cravings to be punished.) He said
when a certain man hit him in the chest, "it caused an erection."
In harmony with this, he begged the physicians to experiment on
him. (This compares strikingly with the panicky homosexual who
is afraid of being experimented upon.) He tried to prove that his
body was able to overcome any deleterious substances that might
be introduced into it. He ate all sorts of leaves and seeds, and
finally "produced a climax by drinking sewer water from a ravine
because "it was full of germs. ' ' His method was to dip his fingers
into the slime and lick them off. (In such erotic states, patients
often believe that fellatio or cunnilingus will relieve them. The
germ-laden sewage as a semen equivalent is obvious. Some pa-
tients drink from the hoppers.)

The uncontrollable craving that forced this impulsive act
frightened him and, although he ate sand "to scour" himself out,
he returned to the ward and anxiously sought a cathartic and bath.
He completely submerged himself in the tub and drank inordinate
quantities of water, exclaiming, enthusiastically, that he was able
to force the water directly through his bowels while he was sub-
merged. (The feminine sexual cravings were apparently being
gratified by this archaic submerging in water and emitting water,
germs and sand, as a parturition.) While in the tub he had in-
congruous fancies about a rebirth. A few days later, while still »
in this mental state, he ate a red poinsettia's leaves. Then he
felt inspired to eat "root and branch," whereupon he devoured
the stalk, chewing it down to the ground. Highly excited, he now
fell upon his knees and, as he said, "tried to go down on a man and
invited the man into a room." This behavior was attended Avith

CHRONIC CATATONIC DISSOCIATION 597

the most uncontrollable affective disturbances of weeping, resig-
nation, agitation and trembling.

By the ninth month this excitement again subsided, and a
depression with indifference, retardation and inactivity developed.
He frankly accused himself of being a "degenerate," and wrote
numerous self-accusatory letters to his wife. He would stand for
hours in one place, and showed great affect when he talked of his
general condition.

Gradually he resumed some interest, although he was con-
fused and still considered himself a degenerate. One morning a
steam pipe blew out in the hall and he hallucinated his son's voice
calling in distress to his mother. He was sure an accident had
happened at home and not only on the ward. (The feelings that
desired a disaster to the family were always fought against by the
patient. The sexual cravings which would destroy all the resist-
ances within the personality, in order to have free play, caused the
fancied destruction of the family ties as the destruction of the re-
sistances that opposed homosexuality.)

The feeling of unworthiness continued throughout the ninth
to the fourteenth month, although he was no longer retarded. He
compMned of being a miserable sinner because of his acts of de-
pravity, but would never confess what they really had been.
Whether or not he really committed fellatio, which he was in-
clined to say he might have done in his confusion, he never ac-
tually admitted. During this time he believed he had two fathers "
and mothers (probably heavenly and earthly) and again grew a
beard and renewed his fancies about being "like Christ." Be-
cause of his sincerity, courtesy and harmlessness his parole was
renewed. He started many enterprises about the grounds, but
never finished anything. Gradually his efforts became more prac-
tical and he became less self-assertive. Upon his own application
and our consent he was given a position in a machine shop.

In the twenty-seventh month, as the result of persistent beg-
ging, he was permitted to go to work in a nearby munitions fac-
tory. He worked very well there, but was simply unable to keep
from coming in conflict Avith his foreman and other supervisors be-
cause he delighted in displaying his inventiveness, and criticised
right and left by suggesting improvements. He worked on a lathe,
and soon discovered an improvement by which he could increase
its capacity two, and later, threefold. This little infringement

598 PSYCHOPATHOLOGY

upon the foreman's ingenuity (and social potency) aroused the
.latter 's animosity and, true to human nature, he tried to squelch
the patient's enthusiasm. This resulted merely in the patient's
utilizing another outlet^a man higher up.

From the improvement, however, of the machine, the patient
expanded from the practical to the absurd and insisted upon giv-
ing advice about remodelling all types of machinery and, in fact,
the entire place. lie was always kindly disposed about it, but ir-
repressibly insistent. He was discharged as a "nuisance" from
the factory three weeks after he started working.

During the next year he "experimented" and claimed to have
found methods of curing insanity. He freely advised the physi-
cians and incessantly urged- them to heed him. During the day he
wandered about the grounds looking for an outlet for his restless
energies. He cultivated a small plot of ground and raised vegeta-
bles and flowers, but allowed the garden to become weedy before
the season was through. Later, he gathered together large pieces
of cast-off machinery, and, at immense labor, dragged them to a
pit in the woods, dug a well, built a furnace and constructed a
bellows, engine, firebox, etc. He expended unlimited energy in this
pursuit with the ultimate object of creating an engine that would
utilise all its power and waste nothing. It was an approach to the
perfect engine like the state he ceaselessly strove to establish in
himself. (Compensation for the waste of masturbation and his im-
potence—Cases P-1, PD-12, CD-8.)

Although most of his plans miscarried, because he was too
ambitious and had no means, he derived great pleasure out of his
little successes. (If given suitable opportunities, these indefati-
gable workers, with their prolific imagination, practical experience
and humanitarian motives, might make invaluable contributions
to civilization.)

The following spring (thirty-second month), he abandoned
this work and devised a scheme for selling subscriptions to maga-
zines and developing a "big business." He still retained his re-
ligious fancies about himself, but was finally persuaded again to
have his beard shaved off, not however, until he felt absolutely
sure that the dreams of fire and nocturnal emissions would not
return. He had facetiously maintained that he wanted to see the
reactions of his wife to his beard. The fact that no erotic exac-
erbations occurred this time with the loss of the beard did not

CHRONIC CATATONIC DISSOCIATION 599

cause him to change his general attitude about its value to his
virility.

In the thirty-fifth month he was allowed to visit his wife after
emphatic warnings to avoid sexual excesses and worry in case of
precocious emissions or impotence. lie was discharged thirty-
seven months after his admission.

Althoiigh his general intelligence was unimpaired when he
was discharged his obsessive striving revealed the persistence of
the underlying fears. liis compensatory trend, his inventiveness
(creativeness) and religious-social reforms are absolutely neces-
sary to him in order to avoid another, collapse and further homo-
sexual difficulties. It gives him something definite to work for.
His affective career is essentially an incessant biological struggle.
With encouragement, and a healthful heterosexual attainment, he
may yet succeed in becoming a useful member of society.

Several months after his discharge, he wrote for adAdce about
an erotic dream that resulted in masturbation and was followed
by a "hideous sound" of "angry voices" (the old protest of na-
ture).

The man never showed anal erotic interests or hatred, and
had no systematized delusions fixed upon particular individuals.

Here was a clear case of prolonged masturbation in youth,
persistent eroticism, excessive sexual indulgence with ejaculatio
prsecox, nocturnal emissions, and, finally, a regression to homo-
sexual cravings, which were compensated for by tremendous striv-
ings not to only create machinery that would conserve and use all
its energy, thereby eliminating the sins of waste, but also to re-
form the sexual life of the herd. This patient was never analyzed.
His behavior attracted considerable attention from the hospital
staff and the foregoing data was freely given by the patient.

Surely, upon impartial consideration, the crucifixion and the
submission to the sublime father can have no other than a pro-
found biological significance, and a long established phylogenetic
foundation in the infrahuman ancestors of man.

I have observed frequently that monkeys (Macacus rh-esus),
when sexually fatigued and indifferent, ^YiY[ become highly excited
and erotic at the screams and panic of an intimidated monkey that
is being persecuted by another. This persecuted, terrified monkey,
if it can not escape, usually assumes the sexual position and its
persecutor generally ends by copulating with his viftim, where-

600 PSYCHOPATHOLOGY

upon the other previously indifferent monkeys, also having be-
come excited engage in copulating with one another. The primi-
tive man no doubt was 'greatly invigorated and sexually excited
by persecuting and maltreating his captives. Their terror and
pain, the gushing blood and dying gasps were sanctified by reli-
gious ceremonies and the erotic reactions culminated in the fruits
of numerous pregnancies. We still have the symbolic sacrifice of
the lamb and the attainment of divine grace in religion.

In man, the popular debauches and assassinations, and tor-
tures by beast and brute, as occurred in the Eoman ampitheatre,
and the public festive murders of the French guillotine, as well
as the dog-fights, cock-fights and prize-fights of today are popular
because of their erotogenic influence. Almost daily one may read
of the mutilation and murder, by some group of brutal assailants,
of an unhappy man, woman or child who is really crucified for
their lust. On the other hand one actually meets men and women,
who, erotic and uncontrollable, seek such mutilation and, not be-
ing able to acquire it at the hands of others, inflict it upon them-
selves, associating with it religious, crucificial fancies. Such acts
are not rare in the history of any asylum for the insane.

The above man's desire to be "experimented upon" is similar
in its value to the desires of the three following "Christ" who
prayed ardently to be crucified, one of whom excised one of his
testicles. The physician (Case PD-1) also, who became a brilliant
philologist at fifty, amputated his penis to save humanity, and at
eighty-five still begs to have his testicles removed for the same pur-
pose. Christ's public crowning of thorns, carrying of the cross
through the city's streets, the lashing and crucifixion, as a festival
that excited and pleased the mob, restless under the impetus of the
awakening Spring, should surely be compared as a biological phe-
nomenon to . the bloody sacrifices of the Mexican and Peruvian
Indians, the Egyptians and ancient Asiatics, as well as the erotic
attacks of the infrahuman primate and the ape-man upon their
victims.

It' is necessary to understand the behavior of man, including
his most sacred and tabooed rituals, in a biological light or it can
not be truly understood at all.

Case CD-5 was an uneducated Russian immigrant Avho was
sent to St. Elizabeths Hospital after having excised one of his
testicles. He said he did it to stop masturbating, but his behavior

CHRONIC CATATONIC DISSOCIATION 601

otherwise showed unmistakable religious fanaticism and the de-
sire to be crucified. He tried to raise a beard like Christ, and his
prayers and uplifted eyes, ecstatic crucifixial countenance, his tears
and impulsive giggles, revealing pleasure at the physician's ap-
proach on the ward, showed, as he persisted in attempts to bow
and kiss the physician's hand, not only his appreciation, but also
an intense desire to subject himself to the physician's domination.
The homosexual eroticism of this was suspected at first, but later
it became confirmed when we had to watch him continually to pre-
vent him from getting into homosexual embraces with other erotic
men.

Case CD-9 was a well-built, submissive-looking Bavarian, age
twenty-nine, unmarried. His crucifixion cravings and penitent at-
titude were frankly due to his sexual "sins."

When a child he spent several years in a monastery, received
a common-school education in Germany, and gave the impression
of being a man of fair mental capacity and not a mental defective.

He worked in a brewery and consumed an average brewer's
amount of beer daily, but his psychosis had no characteristics of
alcoholism. About three years before his admission he passed
through several months of anxiety and prayer because of sexual
perversions that he had committed. The psychosis for which he
was sent to St. Elizabeths Hospital was very similar in it charac-
teristics to the former period, and had endured for two years be-
fore his admission. Although he had resumed work in the interval
between the two psychotic periods, it is quite probable that the
disease process was one psychosis, the behavior being very simi-
lar.

The striking characteristics of his behavior were the almost
incessant kneeling, folding of hands, bowing of head, elevation of
wide-open, ecstatic eyes, and fervent praj'^er to be freed from sin.
He regarded almost all men who came near him as priests and de-
voutly made the sign of the cross, prayed for forgiveness, and if
anyone stood before him for a few moments he usually tried to
kneel, kiss the man's hand and begin a confession of freed sins.
(See Fig. 77.)

He practically lived on his knees and prayed incessantly with
sincere fervor and appeal, frequently weeping bitterly with copious
flow of tears. In due course of time a severe bursitis developed
over each patella for which he had to be confined to bed. Here he

602 PSYCHOPATHOLOGY

continued to fold his hands and pray. Frequently he made crosses
with his thumb on his forehead, lips or chin, and breast, and often
placed the hand of "your highness" on his head for a blessing.
Frequently he bowed his forehead to the floor and kissed the floor.

He frankly told almost anyone what his sins were, in usually
the following style and with most sincere feeling : "I make myself
too much trouble. My mother is not well off [sick]. I wish to
make my confession. I cursed marly times. I was bad many times
when I was a little boy." Here he confessed to a list of childhood
oral and anal erotic acts upon his younger brother and a pet dog.
That the oral erotic tendencies persisted is certain, because of
frequent practices of cunnilingus since he became an adult. "I
worry over this. It is my fault. I had no right to do it. ' '

His ideas about the hospital were significant. It was a place
"to create good men and ladies." (Such statements usually offer
a reliable prognosis because the feeling of having been made a
"good" man would eventually dominate the anxious personality
if he was not interfered with or mishandled.) He frequently
"saw" Christ and insisted one of the patients was the Christ who
had come to save him.

When he spoke of Grod and Christ he said: "Many times I
was not satisfied and prayed on everything he gave. I have a feel-
ing that I can not look at what your highness is writing. ' ' He was
inclined to become panicky, with all the symptoms of great fear,
such as blanched face, cold-beaded perspiration on the forehead,
wide staring eyes, trembling, and inability to attempt to escape.
He felt that he was going to be killed, burned and crucified.

He would not eat "because all trouble and fight — curses and
trouble come in my head when I eat. ' ' He felt that this was caused
by a poison in his food. "I said to my good mother once, 'I guess
you poisoned my spoon.' I had a feeling to help my mother, I
want to be a child of you and the U. S." (Eagerness to make a
transference.)

He complained most persistently that he had a snake in his
throat. This, associated with his expectant, pleased, yet anxious
attitude toward "dying," and pleasing his "dear God" (cruci-
fixion), and his passive supplications to men, with vivid feelings
of being oral erotic, made it obvious that strong submissive homo-
sexual cravings were the cause of his anxiety. The anguish about
dying and pleasing his "dear God" were crucifixion pleasures.

CHRONIC CATATONIC DISSOCIATION 603

The intelligence tests were unsatisfactorily responded to, but,
although he at times seemed to be confused, retarded and dis-
oriented, when answers were patiently insisted upon, we frequently
found that he Avas not disoriented and relatively not so confused.

His effusive smiles, when given some attention by the physi-
cians, showed his great pleasure and his happy transference to the
' ' highness. ' '

About four months after his admission he began to improve in
that he took more interest in his environment and it was quite easy
to convince him that we believed work was as necessary as prayer
to save his soul. He became a diligent worker and gi*adually an
incessant worker. When he was discharged seven months after
his admission, he was pleased with his "cure" and said that God
had forgiven him.

The phallic significance of the hallucinated snake was most
clearly demonstrated by Case CD-6, a married soldier, thirty-three
years of age, who was in a homosexual panic A\'ith predominant
crucifixial tendencies at the time of this observation. He refused
nourishment and withdrew from any contact A\'ith men. He said,
"They have switched the keys on me here. It looks to me in this
moving picture thing [visual hallucinations are often called by this
name] that someone is putting a job on me. It seems as though
someone is trying to poison me. It seems the carpets [red] are
poisoned. There has been a lot of cigarettes and poisoning going
on here in the U. S. The snakes have made greater discoveries on
us than doctors. Snakes understand us better .than we do them.
They have a great idea of business. Siiakes keep their forbidden
fruit better than anyone also. Forbidden fruit is a poison for
edible purposes. I am poisoned by forbidden fruit. There are
many snakes here in B-4. Battlers. I see their poison. It loohs
like semen. They give me snake poison, sem-en, here. They want
to land us all in the forbidden fruit country. The nurse here has
been poisoned. She was dead and was captured by snakes and
brought back to life. * * * j'he snake poison comes from the
human body through the penis. I think snake poison vvjvld give
me life."

The patient accompanied the above complaint with many ef-
forts to stop the hypnotic influences of the physician whose pres-
ence filled him with sensations, electricity, etc., and caused feelings
of weakness, loss of sexual poAver, etc.

604

PSYCHOPATHOLOG Y

Before this man collapsed in a state of homosexual panic he
made a wild effort to save himself by claiming great creative
powers, inventive faculties and prophetic inspirations. During
this state of grand compensation he bitterly accused his wife of
sexual infidelity.

During his panic he Avas not disoriented and could coordinate
sufficiently for simple mental tests.

Pig. 59. — Simulation of Christ to please the father and sublimate homosexual

cravings.

The following case (CD-7), (see Fig. 59), came to Washing-
ton, to advise the President how to stop the war. He said he was
inspired by his father, and the voice of God to fulfill a mission as
Jesus Christ. He also associated himself with the biblical heroes,
Joseph and David. This man had not passed through his cruci-
fixion at this time, but hinted that this would come when he became
thirty-three, his present age.

The long, flowing hair, carefully groomed beard, almost line-

CHRONIC CATATONIC DISSOCIATION G05

less face, wide-open, uplifted eyes, and fixed, sanctified, appealing
facial expression contrast strikingly, in a biological sense, with the
face of the virile, hard-working, average American or the tense,
egotistical paranoiac. This man's vaulting ambition, claiming
spontaneously to have been his "mamma's most beautiful baby"
and his father's favorite son, his egotism about being named after
a former president of the United States, and the fact that he never
has competed for the love of a woman, gives the psychopathologist
an insight into the disguised self-love of the neo-Christ. Afraid of
pain, too proud to be defeated or admit error, averse to vulgar
virility, and infinitely narcissistic, he is hopelessly doomed to live
as a biological' al)ortion that must surmount all obstacles with
fantasy instead of work.

One of the most astonishing atonements for having been sex-
ually perverse, hence, biologically, a betrayer of the aspirations
of the human race, is in the record of the following' case. Although
confronting almost hopeless odds in the form of sexual perverse-
ness this man after many months of the most bitter anguish and
despair, accompanying a most eccentric indefatigable compensa-
tion, actually succeeded in restoring himself to a constructive so-
cial attitude. The purifying purpose of his desperate striving
Avas always clear to him and he revealed it without reservation.

The brilliant sublimation made by the physician (Case PD-1)
in his struggles against perverse affective cravings (oral), making
many of the finest contributions on the classical use of words to
the Oxford Dictionary, may well be compared to the "inspired"
philological interests of this illiterate soldier (Case CD-8) who
passed through a terrific emotional struggle to free himself from
the influence of similar, but more overt polymorphous, perverse
affective cravings.

This soldier-miner (Case CD-8) had a meagre education and
"could not make sense out of some of the studies." He referred
to his father as a "severe father" but did not hold him responsible
for his difficulties. His father was insane for several months at
fifty-six.

The patient was raised on a farm, and worked in coal mines
from fourteen to twenty-two. From twenty-two to thirty-three he
served in the army and made a "good" record. He was a large,
powerful man, rough and inclined to rowdyism. At thirty-two he
was returned to the United States from the Philippines to be

GOG PSYCHOPATHOLOGY

.treated for pulmonary tuberculosis. At thirty-three he was dis-
charged from the service for disability. He had been an alcoholic
and had had gonorrhea.

A few months later he was sent to a state hospital as insane
and soon after transferred to St. Elizabeths Hospital.

The patient frankly complained that his sexual life was the
cause of. his insanity. As "a child on the farm he had played sex-
ually with pigs, dogs, sand holes, children, boys and girls, and
masturbated excessively. Although he made several attempts to
marry, each affair was disrupted by compulsions to avoid the
woman. During his life in the army he indulged in sexual de-
bauches with men and women, and said that during one drunken
episode he submitted himself to a dog for the amusement of others.
During his psychosis he considered himself tp have been a "rec-
tum subject," meaning anal erotic.

About a year previous to being returned to the United States
he felt that certain men exerted hypnotic influences over him,
made him have perverted dreams, and were planning to control
him.

When he was admitted to St. Elizabeths Hospital he was an
anxious, miserable, despairing man, who stood about on the ward
weeping and begging to be saved from insanity. Distressing, hal-
lucinated voices urged him to submit to perversions and crucifix-
ion, and he wrote numerous letters begging an opportunity to
make "a confession." Unfortunately this opportunity was -not
arranged, until a compensatory self -purification reaction had been
considerably elaborated.

The anxiety and weeping rather abruptly changed to an atti-
tude of inspired writing and talking that was quite characteristic
of a religious fervor.

His attitude about making an unreserved confession was as
follows: "This life is lived to publish to the world to show them
that the publishing of their sins is forgiveness. If you have a sin
and hide it in your life that worries you, and if you let other peo-
ple share, it that makes them just as much a sinner as you are, and
they are your equal. If you are ashamed}^ to look him in the face
you feel that he is your superior. By confessing to the rest of the
world you make them all the same thought and same idea as you
are." (This was entirely the patient's own conception and his
own method of solving his difficulties. It was surely a vital fac-

CHRONIC catatonic; dissociation 607

tor in his recovery because it permitted a free affective readjust-
ment.)

The change came, he said, when he believed that he was "lost."
"They were ticking off in my mind" through electrical devices,
and then "revelations" as to what he should do came to him.

The patient was tacitly encouraged to go ahead and given
means to carry out the dictation of his feelings. To anyone who
listened he poured out, without the slightest disguise, the details
of all his crime and misbehavior. The sorrow and contrition for
his wrongs was sincere and pitiful, although his story was full of
disgusting details.

For seven months- he worked incessantly on a "scientific"
system according to the dictations of the "hypnotic" influences.
He thoroughly worked over all his perverse sexual acts and many
little details, through a language system of his own invention by
which he proved that the misdeeds had been performed to test him
out, just as Christ, he said, had committed all the sins of the world ;
and through his "scientific language" he proved that he was a
"perfect man," "Christ," "the Son of God," "a redeemer," had
"a perfect mind" and could not be made insane. He saved all
his writings and accumulated a veritable library of note books.
From scrawls and writings on scraps of paper he refined his sys-
tem into note-book records and then aspired to typewrite them.
It was a sincere contribution to the redemption of mankind and
himself.

The "perfect language" was created by numbering each let-
ter in the alphabet as a-1, b-2, c-3, m-13, o-15, etc. Then by taking
an unpleasant word that referred to his depravity, as "crazy" he
found its number by adding up the numbers of each of its letters
as c-r-a-z-y equal 3-18-1-26-25 equals 73. Now any other word
that equaled 73 was its equivalent ; p-e-r-f-e-c-t equals 73. There-
fore, "crazy" equals "perfect." Therefore, there is no such
thing as being crasy. Then by substituting pleasing equivalents
for unpleasant words he proved that his depravities had an entirely
different meaning, that he was a "perfect man" and had invented a
"perfect language." He rewrote the Bible and created an enor-
mous dictionary for his new language. His additions were not
always accurate and gradually many new coined words were added
until the entire system was worked over into something like the
following example:

608

PSYGHOPATHOLOGY

Zaalo-

-55-1

Monday-

Zahlo-

-56-2

Tuesday

Zaclo-

-57-3

Wednesday

Zadlo-

-58-4

Thursday

Zaelo-

-59-5

Friday

Zaio-

-60-6

Saturday

Zasrlo-

-61-7

Sunday

"This is a perfect alphabetical and nu-
meral system; each word and number is
written on perfect science. Every letter is
perfect in its place. Every word and name
of its number is written on its equal. The
author of this system can perfect the Eng-
lish language and use it as a basis to write
a perfect language on a scientific basis that
will be adaptable for all modern sciences,
so that no word can be misinterpreted. Do
people wish this work done? I will do this
work if given a chance."

It is only possible to give a brief account of how he proved
himself to be a "perfect man" and was now Christ on earth for
the third time. The man had been struggling with obsessive crav-
ings to become the object of homosexual perversions and upon his
admission begged to be saved. The solution that saved him was
the inspiration that he was to be crucified and would be reborn a
perfect man. He frequently set the date for his crucifixion, but the
climax would never quite appear. When presented to a class in
psychiatry, which he greeted as jury, he described his language
system, and brought out the details of his life that proved his di-
vine origin, but before he could finish he broke do-^'iTi, buried his
face in his hands, and weeping bitterly, he announced that "to-
night I will be crucified." The severity of his anguish made it
necessary to take him back to the ward.

The following is a brief abstract of one of his innumerable
dissertations to prove the mystery and magic of his birth :

"I was born on my mother's birthday, which is the 15th of
March, the third month in the year. My father was born on the
fourth of March and was one of the 12 apostles, and I was born on
the 15th of March, which makes three fives, which is 30, and when
my mother was 19 years old I was born. My father makes me the
twelfth apostle and the first, second and third of March makes
me 15, which makes three fifteens, which is 45.

"When Jesus was to come back to the earth he was to go
through all kinds of trials and tribulations and was to be a soldier
in the army which I was on three full enlistments, ten years being
the same number. And I was a musician in three different com- ,
panies of the army. That is thirded, and everything that I ever
did ivas thirded. That is the important events, which I will give
you. On my father's farm there is 15 coal hatches which gets the
three fives again, and my father and mother (together) have three
eyes and I have two, that makes five eyes. Now my father has two

CHRONIC CATATONIC DISSOCIATION G09

good legs and I have two good ones and my mother one good one,
the ankle of the left leg being defective, which makes five good
legs. NoAV my father has two good arms, my mother two good arms
and I have two scars on my left arm, which makes my left arm
affected and will be in accordance with the Bible, which makes
five good arms. There is yonr three fives again. ■ Take the Eoman
V for the number five at the time of Jesus Christ was on earth
and my father has one good eye and two feet, Avhich makes V; and
also three "cornered. Take my two eyes, now there's a scar over
this one and two good feet and that gives me three corners and
the Roman V. Take my mother's two eyes and her one good foot,
her left ankle being affected, makes her the third Eoman V. This
is the three fives, which is thirded always. Our house on the farm
is the letter L, which is the 12th letter in the alphabet and gets the
twelve apostles, and the word twelve spelt gets 87, which is (equiv-
alent to) the truth — 87. Now my first name is Charley — Charley
Milton, Charley is the equivalent of 'first' and Milton is the equiv-
alent of wisdom, and is the equivalent of 'message' — that is 'the
first wisdom message. ' " (The fancy of the holy family is obvious.)

At great length he showed that "everything I ever did was
thirded" and being "thirded" meant something similar to being
given a divine heritage. He worked out his various sexual ex-
periences to show how they occurred in threes. H(^ referred to
his sexual affairs with his sister, when tliey were children, as
having "to third her." Three as a symbol for the male genitalia
is commonly used and had this value for him. He said this was
his third time on earth and a time of great power whereas the
second time was his ' ' dark time, " " secret time ' ' and meant weak-
ness. Tivo is usually the symbol of femininity and passivity.

All his sexual activities, he belieAT'ed were for the purpose of
extending his omnipotence and they included "mental intercourse"
with "all kinds" of animals, insects, etc. Mental intercourse, he
said, meant imaginary sexual intercourse.

He was in "direct communication with God at times. At
times it seems like the voice is far aAvay. It sometimes sounds like
my mother's voice. I am in connection with her spiritually or
something that way. ' ' His mother was the Virgin Mary, his fa-
ther was one of the apostles and all three together were God. His
brothers and sisters were not blood relations to him and he ex-

610

ESYCHOPATHOLOGY

pected to marry. a sister who was dead, saying she had only gone
away.

His discussions almost always included something about "dy-
ing ' ' and the completion of his ' ' life of mystery. " His discussions
of dying and crucifixion were always accompanied by strong feel-
ings of anguish and weeping. It was to be the consummation of
Ms career and final purification.

For six months he wandered about among the patients weep-

Pig. 60.— -Posture as God of omnipotent power in a catatonic dissociation neurosis.
The similarity of posture to the ancient Egyptian statues is obvious.

ing and preaching. The lining of his clothes and the pockets were
stuffed with papers and notebooks. He also claimed to be a greal:
inventor and planned to make Washington the capital of the world
and place the treasiiry in the" basement of the capitol. (He had
claimed to be a "rectum subject" and anal erotics often accumu-
late and hoard all sorts of trash. The meaning of the inspiration

CHRONIC CATATONIC DTSSOCMATION 611

of ti-easuro in tlio basement, in the light of anal erotic misers is
obvious. There is a common vulgar term applied to both stinginess
and constipation.)

By the end of the seventh month he had completed ' ' the alpha-
betical langiTage and numeral system ' ' and discarded his earlier
scribblings saying that he had been ' ' crazy, ' ' and his claims about
being "thirded," etc., were "nonsense." He still maintained,
however, that he could cure insanity and that he was Christ. He
seemed to feel considerable doubt about this, showing it in his
reluctance to discuss it. By the ninth month he gave up his lan-
guage system as also being absurd, and renounced all claims of
being Christ. He explained that while on the athletic field he had
overheard two patients arguing with each other to prove that they
were divine, and conchided that if men as insane as these two men
were, claimed to be Christ, he rnust doubt the sanity of his own
claims. [It is highly important tO' consider that this man had lived
for six months with a series of men who claimed +o be Christs
(asylum wards contain many of them) but he always passed them
up as impostors and firmly believed he alone was the Christ. This
is about the attitude of each case toward the other. The absurdity
of the claim is only appreciated after the eroticism wanes.] Dur-
ing all these months he was undergoing a profound affective up-
heavel, Avith tremendous cravings to be crucified by the "severe
punishment father, ' ' accompanied by strong sexual feelings in his
dreams and visions for his mother and dead sister. From his be-
havior and general composure it was obvious that his creativeness
was now subsiding with his eroticism. He now reached a state of
affective composure in which he could see himself as others saw
him. He was already giving up his cravings to be crucified when
he overheard the argument of his companions, hence he was able
to accept them as "insane."

By the eighth month he announced that he was curing himself
by "will-power," baths and careful living. Within a few months
after he gave up the Christ beliefs lie expressed doubts about the
existence of a God, etc.

By the tenth month he had developed considerable insight
without assistance, but persisted in feeling that he could cure any
case of insanity by the method with which he had cured himself.
His insanity, he still believed, was caused by a plot.

In the eleventh month he eloped and after a few weeks re-

G12 PSYCITOPATHOLOGY

turned voluntarily to get a discharge. He had started to work m
the mines.

He was discharged as a social recovery (about one year after
his admission). He had now also given up the feeling that he had
been the victim of a plot to ruin him, and added, that he now real-
ized that his homosexual cravings and feelings that his eoMraies
Avanted him to perform homosexual acts began nearly two years
before he was sent to an institution for mental diseases.

"When I asked him to write an impression of his experiences
he sent me a tablet containing some of his fantasies. On the cover
he had written "pure, unadulterated insanity." This was his
final estimation of his "perfect language" and his philosophical
system. It had served a serious purpose and was then cast away.
He considered himself to be soundly cured, was unashamed of his
past and no longer (?) perversely conditioned. He believed that
his sexual feelings for women were normal.

The following are some of his impressions of his experiences
at self -cure:

"This is not to give you the impression that I think this is
wisdom but the worst kind of foolishness. But when I came here
I determined to make a study of insanity while treating myself
and I have as good an idea as a man can have of the cause, for I
have suffered every symptom of insanity that can pass through
a man's mind * * * i have learned a great lesson and I am
in no danger of ever becoming insane any more for I have erased
these ideas from my mind as fast as I would get disappointed by
them, and I have learned the truth at last. ' '

Unfortunately there is no means of following this man's ca-
reer for the next few years.

This patient, while he was most erotic and polymorphously
perverse, saved himself by struggling day and night, in his own
waif, with some tacit encouragement, to prove himself to be a
"perfect man." He received no psychoanalysis and needed none.
He simply poured out everything "that came to mind," in order
to be relieved.

When his affective readjustment was made he resumed the
usual interests of the average uneducated man.

One of the most important features of his attitude differen-
tiated his struggle from other cases who have similar difficulties
— he showed no hatred as a defense for his deficiencies when others

CHRONIC CATATONIC DISSOCIATION 613

scorned Mm. When he was recovering, and the Government with-
drew his pension, because of the nature of his disability, he ac-
cepted the loss without resentment. His accessibility and sincere
sorrow perhaps made it possible for him to make a comfortable
affective readjustment despite the odious personal distortions
from his heinous perversions.

At no time did he show a flight of ideas or serious distracti-
bility. He had been sexually perverse all his life and from thirty-
three to thirty-four (about the age of the crucifixion of Christ)
he passed through a tremendous affective readjustment and came
out of it reborn in his attitude toward life and freed (!) from the
influence of ' ' the devil. ' '

The last case in the above group showed no flexibilitas cerea
or other forms of submission ; nor the opposite, the unreasonable
resistance and fear of the acceptance of authority required for ad-
ministrative routine and physical examinations ; characteristics of
the catatonic, dissociated personality. He did, however, have an
insatiable desire to submit (exhibit) the detailed history of his en-
tire life to all who would listen, no matter who they were. He
also desired to be crucified, become relwrn and purified, so that ,
essentially his case lielongs to the catatonic crucifixion group.

Summary

The catatonic 's variation of adjustment from the paranoid's
struggle is due to the manner in which the individual reacts to
the irrepressible, uncontrolled sexual craving which he feels to be
asocial and perverse. This variation, in turn, is not explicable,
upon the assumption of an inherent difference or a particular cere-
bral or physiological (toxin) difference. It is explicable, hoiuever,
by the manner in which those affective cravings irhich constitute
the ego, the socialized self, resist the sexual cravings. The method
of training and the impressions from associates and the environ-
ment determine the nature of the ego's resistance, hence the varia-
tions of adjustment, i.e., whether or not the individual will struggle
against his asocial craving like a paranoiac or submit like a ca-
tatonic.

The catatonic has, usually, a much better prognosis because
the surrender to the uncontrollable dissociated cravings gives
them some opportunity to obtain gratification and. become neu-
tralized by the wish-fulfilling (hallucinated) sensory images.

614 PSXCHOPATHOLOGY

Naturally the catatonic 's resignation to the terrific affective
(erotic) pressure that floods his mind with an interminable series
of weird, horrible hallucinations and compulsions to yield to un-
fathomable symbolic rituals, which the affect creates out of the
ordinary ward routine, not only confuses but terrifies the indi-
vidual. The crucifixion of himself or herself is truly a resignation
of all competition with the parent and usually a profound biologi-
cal submission and self-sacrifice.

I am inclined to believe that the phylogenetic foundation for
the catatonic 's tendency to submit and be crucified i-s based upon
the tendency of the higher monkeys and apes to submit themselves
as sexual objects to stronger males and females for the physical
protection and food favors which in turn are bestowed upon the
sexual object. The terror of the weaker monkey, as he yields to his
unavoidable master, is, in the symptoms of panic, remartefbly
similar to the panics of male and female patients while they enter-
tain convictions that they "must die," "-wfill be initiated," "will
be crucified, ' ' etc.

In all catatonic states the undercurrent affect that forces the
adaptation is the uncontrollable erotic craving. It is the erotic
craving that distorts the individual's sense of social proportions
and material values and converts the community ard the objects
on the ward and the routine behavior of strangers into solemn,
hypnotic, mystic rituals and weird sexual symbols.

CHAPTER XIII

PSyCHOPATHOLOGY OF CHRONIC, PERNICIOUS DISSO-
CIATION OF THE PERSONALITY AVITIi liEBE-
PHRENIC ADAPTATIONS— PREDOMINANCE
OP EXCRETORY EROTIC INTERESTS

(Hebephrenic Dementia Praecox) — Chronic, Pernicious, Dissocia-
tion, Regression Neuroses

It is perhaps well to reemphasize that there are no absolute
lines of demarcation between any of the functional psychoses.
Abnormal variations of behavior which are due to affective distor-
tion are to be regarded as varieties of biological abortion. The
predominant affective variations and symptomatic traits that
characterize the different types are due to the conditional needf<
of tlie auto)W)iiic cravi)igs and ihc ef/oistic, affective resistances
to these needs. Hence, catatonic and paranoid individuals may
be expected to show some distinctive traits which determine the
nature of the psychopathic abortion. The paranoid and catatonic
types have more highly organized cravings to become normal ma-
tured personalities than the hebephrenic. This seems to be due,
essentially, to the manner in which the autonomic affective crav-
ings have been conditioned to strive for the special stimulation of
particular sensory zones, without which stimulation the individual
tends to become irritoMe and depressed. The nature of the indi-
vidual's social strivings is influenced by the persistent pressure
of these fundamental cravings.

The predominance of fascination for the excreta and the anal
and urethral zones in the typical hebephrenic is astonishing. All
children pass through an age, from birth to aboiit ten, when the ex-
creta and their creation are among the great vague mysteries of
the universe. This fascination may continue, secretly, throughout
life. Among the most intimate and confidential secrets of many
adults is still to be seen a profound fascination for the marvelous,
recreative powers to be found in the excreta of man and animals.

615

616 PSYCHOPATHOLOGY

It is not ■ancommon to see country people maintain, with ab-
solute conviction, that cow dung, sheep and horse manure have
especial curative powers for the diseases attending old a,ge, for
snake-bites, bee-stings, rheumatism, nephritis, etc. The learned,
classical treatises of medicine written two hundred years ago by
eminent, scholarly gentlemen, literally teem with eulogies of purg-
ing, and the value of animal excreta when concocted with wines, as
marvelous remedies for rheumatism, deafness, failing vision, etc.
This fascination for the excreta is still traceable in the mainte-
nance of fashionable spas and watering-places where the odorif-
erous emissions from the bowels of the earth are enshrined in
festively decorated buildings that almost assume the proportion
of temples. That such institutions are valuable is not to be de-
nied. They are helpful so long as the constipated wish urges the
bejewelled onward to seek the aggrandized symbol of the shrine
that fascinated childhood.

It is not astonishing, then, if considered in a biological light,
that the genus Homo, when depressed and wretched because of
the ungrateful nature of the social system, should regress to the
balmy fancies that cheered the loneliness of childhood. There is
one period in every person's life when it may master all its social
surroundings and reap unlimited attention, no matter how lonely
it may be, nor how engrossed other people are, and this is by im-
pulsively excreting in the years of childhood when it is unable to
cleanse itself. Then, usually the child obtains thorough attention.

Hence, when a depressed, lonely, brooding, psychopathic
young man, timidly, childishly, approaches his physician each
morning for the administration of a generous cathartic and cau-
tious inquiry leads him to tell, with unmistakable smiles of pleas-
ure, how his mother xised to look after these needs with enemas,
we have revealed one of the conditioned cravings that constitute
the very foundation of his personality.

The following cases are selected for their preadolescent
style of behavior during the psychosis. A predominant num-
ber, not including the first case, show unquestionably that during
the psychosis the anal zone and its emissions dominated all other
interests in life.

The material of the following psychosis is presented in a
chronological order although much of this data was collected

CHRONIC HEBEI'HRENTC DISSOCIATION 617

through the psychoanalysis and was not obtained through the ordi-
nary method of asking questions for a case history. The chrono-
logical report has an advantage in that it is simple and reveals
the course of the evolution of the personality into a psychopatho-
logical adaptation to specific environmental influences. The most
difficult feature of presenting such cases is in revealing the wish-
fulfilling value of the hallucination, phobia, etc., without making-
monotonous, repetitious discussions. If the reader will bear in
mind the influence of the aiitonomic cravings for gratification
(AAishes), this value of most delusions, etc., will become obvious as
the case unfolds.

In order that the biological struggle and collapse of this pa-
tient (HD-1)* may be given its proper setting it is necessary to
include brief character studies of the people who Avere most inti-
mately associated Avith her. Her father was an engineer, and
through many years of hard, consistent work attained a high rank
in his profession. In his later years he was very conservative and
saving to the point of being stingy. This was probably the result
of fear of becoming destitute, due to a chronic gastritis and general
feebleness. He persistently talked to his children about being pre-
pared for misfortunes and old age. He loved his children, but
tended to conflict with them because of his prudish resistances to
an ordinary freedom of their general interests. Despite his care-
fulness about his money he made some poor real estate invest-
ments, which became a point of counter-attack later by his son-in-
law. He owned some houses in a distant city which, for a time, the
renters converted into houses of ill-repute. (This fact later con-
tributed considerable reality to his daughter's psychopathic fan-
cies.)

In nis home all topics that had any sexual suggestions were
most severely tabooed. He criticized his daughters for indecency
when they sat with their legs crossed, and objected to seeing them
dressed in kimonas. This suggested to the patient that he had
sexual feelings toward his daughters when he saw them in kimonas
and was inclined to think of their sexual difference when they sat
with their legs crossed. Because of his reserve and obstinate tend-
ency to hold on to his old conceptions his children had great dif-

*This case was reported in The Psychoanalytic Review, Vol. VI, No. 1 ("The Psychoanalytic
Treatment of Dementia Prsecox").

618 PSYCHOPATHOLOGY

ficulty in realizing their own wishes or enjoying the freedom of
their companions.

In his later years he depended upon his oldest daughter to
manage his affairs, and was persistently inclined to make a baby,
of his youngest daughter, the patient. He was sensitive and un-
happy about one of his sons, who had revolted against his domina-
ting teachings. The other son and two daughters had very little
or no important influence upon the psychosis hence are not men-
tioned further.

At the time of the patient's illness the father was about sev-
enty, and an invalid from a chronic gastritis which necessitated
long periods of convalescence in hos|)itals.

The patient's mother- was a "nervous," kindty, home-loving
woman, tall and heavy, diabetic and extremely fond of eating. All
her children were inclined to eat excessively. She encouraged her
oldest daughter to be unusually self-reliant and persistently trained
her youngest daughter to be dependent upon her in every way, and
introduced her, when a young woman, to visitors as her "baby."
She encouraged the other children to shop and manage housekeep-
ing affairs, but would not trust the patient with any responsibilities
or allow her any initiative. She was usually displeased with this
daughter 's tastes and whatever she bought. She trailed her to be
dependent for advice about the style and material of her clothing,
what dresses to wear for the day, how to act, whom to talk to, etc.
She was consistently ver}^ emphatic and domineering in her con-
flicts with the patient, although tolerant of her other daughters.

Like her husband she severely tabooed all matters pertaining
to sex and never tolerated her children's intimate confidences.
She died of nephritis and diabetes about six months after the
onset of her daughter's psychosis.

Their oldest son remained wayward and irresponsible for
many years after his adolescence. He gambled, drank, would not
work," delighted in being considered a sport and was a soiirce
of anxiety and shame to his parents and sisters. The early years
of his manhood were devoted to an immoral revolt against his par-
ent's influence.

The oldest daughter, A — , was decidedly aggressive, large, ro-
bust, active, self-reliant, fond of business and executive responsi-
bilities, but inclined to be selfish and domineering. It was with the
greatest difficulty that she could allow her youngest sister to win

CHRONIC HEBEPHRENIC DISSOCIATION 619

in any conflict of opinion. Because of the attitude of her parents
and her age she naturally dominated the smaller, younger sister
and became imbued with a pleasing sense of superiority and per-
sonal responsibility for her welfare. When the patient announced
her engagement, A — became intensely angry and said that she
could never forgive her sister for leaving her. Undoubtedly the
masculine temperament of A — had been pleased by cultivating
dependence in her sister and it caused no little anxiety when she
had to give up her superiority.

Three other people played an intimate part in the develop-
ment of the psychosis; the patient's husband, and his father and
mother.

Her husband's father Avas also an engineer. He was a younger
man than the patient's father, with a better training, but had not
yet had time to surpass the older man in financial and business
standing. Under the surface of ostensible goodwill a keen rivalry
developed between the families, to show which father was the bet-
ter, wiser man. This quarrel developed most naturally out of the
desire to demonstrate that each family practiced the better way of
living, in order that the new family should adopt the better prac-
tices.

The husband's father had always been. a free spender and fond
of gay parties. He never worried about misfortunes and old age.
His business kept him away from home a great part of the time
and his wife had to depend mostly upon her only child for com-
panionship.

She was a beautiful woman, with a trim, girlish figure, small
feet, neat ankles, attractive personality, dressed in good taste,
traveled extensively and had a wide range of general interests.
She carefully groomed her figure and dieted to keep herself look-
ing attractive. She was inclined to have anxiety states and occa-
sionally retired to sanitariums for a rest. In her travels over the
globe to join her husband her son Avas her companion and hero.

He was also an engineer, very ambitious, tense, earnest, sin-
cere, fond of being heroic, obviously spoiled by his overindulgent
mother, and at times was irritable and impulsive without realiz-
ing it. He was slender, medium sized, and at thirty had the
figure of a wiry, active boy of twenty. He, like his parents, be-
lieved in enjoying life today and letting tomorrow take care of it-
self. He liked to spend his money for parties and play but frowned

620 PSYCHOPATHOLOGY

upon people who "gormandized" and was openly disgusted with,
such habits in his wife and her relatives.

Just how these two families became interested in each other
is unknown. To get a true perspective of their conflicts as they
were waged over their common battle ground, a timid, unsophis-
ticated, poorly trained girl, it will be necessary to study the de-
velopment of the personality of this girl.

She was the youngest of the children. At birth she was con-
sidered to be a "blue baby," the causes of which apparently dis-
appeared.

Other than a series of boils when an infant her health was
excellent until sixteen when she had chlorosis attended by a mild
chorea. Otherwise she was never seriously ill.

Her play interests included about everything in their proper
time, such as dolls, games, dresses, friends, swimming, sailing,
horseback riding, dancing, parties, etc. From twelve to fourteen
she was quite a tomboy and delighted to wear a boy's hat and
"cuss" like her oldest brother, who was her star. This occurred
about the time he openly flaunted his misdeeds at the family's
prudish conservatism and was an effort on the part of the young
girl to express her dislike for the restraints that held her in bond-
age.

Her home training and education were sadly unfitting for the
cultivation of self-reliance and efficiency.

Her father, mother and sister seemed to have irrepressible
desires to keep her the "baby" of the family, and she was not
only not encouraged to grow up, but was actually inhibited from
doing anything of a serious nature for herself.

She was dressed, petted and pampered, and given no choice
in the designing or purchasing of her clothing. Her efforts in
this direction were suppressed as "poor taste."

She was trained to ask advice about every little wish and to
constantly depend upon her mother and eldest sister. Even when
she became an adult and married, the three older women were un-
able-'to restrain their habits of advising and bossing her.

Most of the time she enjoyed this, and became a lazy, rather
obese type of girl. Initiative and responsibility became a burden
to her, and she was inclined to treat her irresponsibility as a joke.
At times she feebly revolted against the pernicious influence and

CHRONIC UEBEPHKENIU DISSOCIATION (')2i

tried to free herself, but the persistence of the older women and
her unreliable experience easily infiueiicod her to yield.

Her education Avas carelessly planned and indifferently car-
ried out. She was sent to public and private schools with no con-
tinuity of training. Subjects axovc taken up and never finished.
She was pemiitted to loaf at home during her school days on whim-
sical little pretexts of not feeling well.

Because of the prudishness with which her parents raised her,
almost every little interest that might have a sexual bearing was
rebuked and had to be developed in the child's secret fancies. She
had no adult or older companion in whom she could confide her
fancies and whose opinions she might assimilate to qualify. her
o•v^m.

When about four years old while walking with her parents she
became excited by the appearance of a bull. They were shocked by
her curiosity and questions about the bull's scrotum. The embar-
rassed parents told her to look at something across the street and
gave the child the impression that her curiosity was unnatural and
shameful. (The affective influence of this experience came out
in the psychoanalysis and played a part in the fancies of her psy-
chosis.)

Their attitude so emphasized the object of her curiosity that
she never forgot it. In diie time she felt an exciting but 'secret
curiosity in the sexiial behavior of cats, chickens, dogs, horses,
etc., which was forbidden by her parents, but she could not help
a secret enjoyment of these things. A woman's breasts while
nursing a cMld embarrassed her so that she had to hide her curi-
osity. When a little girl she demonstrated her pleasurable inter-
ests in excreta by chasing some visitors with a filthy stick. Her
mother failed to comprehend the situation and punished the child,
but did not make her feel- sorry for her behavior, rather leaving
her curious about the excitement she had created.

A few years after she entered school she saw a strange word
written on the walls of an outbuilding. (The word was a common,
vulgar term for sexual intercourse.) When she reached home she
innocently asked her mother about the meaning of the word in the
presence of visitors. Again the situation was too much for her
mother's resourcefulness and the child was surprised at the ex-
citement she created.

A number of such incidents indicate the vigor with which the

622 PSYGHOPATHOLOGY

child was trying to understand a secret that conld so easily cause
so much embarrassment.

When she was nine years old a boy of about her age tried ' ' to
spoon" with her and this caused so much excitement that she in-
voluntarily urinated in her clothing. This made her the butt of
almost endless teasing among the children and placed in 'their
hands an instrument of retaliation that she could not immunize
herself against.

Even when she was a child she was not allowed the natural
pleasure of sitting on her father's or her older brother's lap. It
was not long before she realized that this restriction was because of
something pertaining to her sex. Her father told his daughters
that it was indecent for girls to sit with their legs crossed, and
this so emphasized the factor of sexual difference that she became
obsessed with an impulse to look at men when they sat with their
legs apart, particularly fat men. Her father was a rather short,
heavy man. (In regard to this compulsion during the psychosis,
she complained of being unable to control her eyes from glancing
at men in street cars, etc.)

Her father's feelings, when he saw his daughters in kimonas,
were frequently expressed by his saying that it made him sick at
the stomach. (This, surely, associated together her father's sex-
ual feieliiigs and sick stomach and substantiated one of her most
unshakable convictions during her psychosis, which will be referred
to later.)

She was taught to be unduly modest and careful about her
person without due appreciation of the reasons for it. She never
''spooned" with boys, and, when her older brother, flaunting the
evidence of his postadolescent conquests and experience, demon-
strated to her how he mad"e love to the girls, she was painfully
embarrassed by his behavior and believed he was making sexual
advances to her. She learned that he frequented houses of prosti-
tution and this gave material for further wild, secret fancies.

When her oldest sister began to menstruate she found some
indications that this sister was passing through a most unusual ex-
perience and ventured to ask her mother about it. Again the well-
intentioned mother failed to grasp the tremendous significance of
her child's curiosity and after vigorously scolding- her sent her to
her room. This profound secret of nature shared by her mother
and sister, and denied to her made her feel that she lived in a pale

CHRONIC TTEBEPITRBNIC DISSOClATrON 623

beneath them and really outside their li\'('s. From that time on
she was unable to throw off a sense of personal inferiority and
neglect.

At sixteen she was sent to a convent school, but only remained
a few months because she thought the girls did not like her. They
teased her inconsiderately because of her naive, frank questions,
her unsophisticated beliefs and the case with -which she was
embarrassed and fooled by vulgar stories told by the older girls.
She learned to believe that the nuns put drugs in the food to stop
the menstruation of the girls. The nuns gave her medicine to
correct her amenorrhea. It happened that she was asked, when
returning from the toilet, if she had passed anything and she inno-
cently replied ' ' only a little wind. ' ' Some older pupils overheard
this and the teasing by the girls became unbearable. She left
school presumably because of chorea, but at the time she was
worried about masturbation and feelings of inferiority.

She lost confidence in herself and learned )wt to ask questions
because they might reveal her thoughts. This unfortunately cut
off the principal means of acquiring the knowledge necessary to
correct her archaic conceptions of her sexual life.

She had learned to masturbate l)y using the bed clothing in
some manner and was inclined to believe that the other girls did
not like her because of her habits.

Some gossip about a white woman Avho lived with a negro made
a deep impression upon her, and she felt that this scandal in some
manner was really talked about for her benefit. From her father
she learned that women sometimes lived with men without being
married, and around this she wove doubts about the legitimacy
of her parentage and whether or not she was actually a member of
the fainily. She became verj^ curious about an old Dutch picture
of a man and woman in a room. She wanted to know if they were
married and her father suggested that they might be brother and
sister. The sexual possibilities of such situations excited her im-
agination normally enough hut secretly.

Wlien she was about seventeen the family employed a colored
servant who had once been a maid in a house of prostitution. The
girls found in her an inexhaustible source of information which
their curiosity could not resist. She described scenes of beautiful
girls, dressed in stylish clothing, living a comfortable, lazy life,

624 PSYOHOPATHOLGGY

and being visited by married men, etc. The fascinated girl won-
dered what such a house must be like, and the serva.nt, to find an
example, suggested that the houses might look like one they were
living in. After this the red lamp shade, the dark halls, the ki-
monas, her father's mysterious behavior, etc., took on the atmos-
phere that might be found in a house of prostitution. The servant
said the matron of the house was called "madam" and her father
called her mother "madam," etc. Girls that were attractive to
men became "objects of wonder to her and she eagerly studied them.
This probably had a relation to her tendency to mimic people
Avhich she cultivated to an unusual degree.

Her sexual fancies, though more or less recurrent, were not
vigorous enough at this time to cause anxiety. She had many
social interests, such as dancing, games, SAvimaming, boating, etc.,
to keep her occupied and quite happy. She was very affectionate
and sincere, and enjoyed a reputation for her sense of humor and
ability to mimic her friends. While she was growing into physical
womanhood and living the emotional life of a child, not even being
allowed to go into the city alone, her sisters became self-reliant,
efficient young women. The eldest sister was capable of conduct-
ing business affairs and managing her grandmother's estate. This
contrast greatly emphasized her immaturity and she regarded her-
self as a simpleton. Her mother often spoke of her as an "enigma
to herself" and the patient thought she was "slyly'' referring to
her stupidity and masturbation.

At twenty-one she married after an engagement that was in-
teresting because of her worry about and utter inability to make
up her mind as to what behavior would be proper for an engaged
girl. When her fiance tried to put his arm around her and kiss
her she reacted with so much embarrassment that he had to be
contented Avith holding her hand. He was also unable to solve this
delicate situation because of his own rather naive conceptions
about propriety and decency.

She was still influenced by her brother's past demonstrations
of how he spooned with girls, and interpreted her fiance's petting
as a sexual advance.

The first serious shock came after a quarrel with her fiance.
She refused to see him, and he sought the company of other girls,
including a prostitute. He had considered the engagement broken
and plunged into a series of carousals.

Cl-IRONIC I-IEBEPHRENTC DISSOCIATION 625

Later the quarrel was satisfactorily adjusted and prepara-
tions were made for the marriage. A few days before the wed-
ding her fiance felt obsessed to make a confession of his misbe-
havior and inferiorities, including his long struggle with mas-
turbation. He wanted help and sympathy because of his feelings
of unfitness in the hour of his marriage.

The unexpected realization that her hero Avas not virtuous
and true, overwhelmed her with confusion. Her first impulse was
to cast him off but the expectations of her friends, the nearness of
her wedding, her sense of being equally inferior and her affection
for huu prevailed. She suppressed her resistances and married
him without talking over her dilemma with anyone. (During her
psychosis she said that she felt she gave up something when she
married under those conditions, and after that crisis she went
backward while her, husband went forward. She doubted the legal-
ity of her marriage during the psychosis.)

She knew nothing about the sexual life of woman until after
her engagement when she made her mother tell her about the
origin of babies. The revelation Avas shocking and she hated her
mother for having always deceived her. Despite her ignorance,
the sexual experiences did not distress her. On the other hand
they did not fully satisfy her curiosity. From another, entirely
unavoidable quarter, very serious difficulties now arose.

Her husband Avas a rather boyish type of personality. It
should be recalled, he was the only child of a pretty, devoted
mother. His wife in many fundamental respects Avas quite the op-
posite type of woman. His mother kneAv the world, groomed her-
self, dieted, AA^as trim and neat, had good taste and Avas self-reliant.
His wife was inclined to be lazy, overeat, Avas fat, Avore loose, com-
fortable shoes, dressed in poor taste, could not design or buy
clothing, had a limited range of interests, and had never gone any-
where alone. She AA^as AvhoUy dependent upon him.

He was greatly troubled hx his difficulties and "asinine
thoughts." He could not understand Avhy he should be so much
affected by certain physical attributes in a Avoman, such as small,
dainty feet, hairless body, firm breasts and small stomach, and
why he should so highly prize them. (Conditioned autonomic-af-
fective cravings.) Ho realized that they Avore the attributes of his
mother, but AA'hy should his Avife's large, soft breasts, rather full
abdomen, fat feet, and hairy ankles bother him Avlien he tried to

626 PSYCHOPATHOLOGY

make love to her ? His lieterosexual potency was being severely
tested by the inappropriateness of bis wife^s physical make-up as
an adequate stimulus for the invigoration of his conditioned auto-
nomic sexual reflexes. After the novelty of his sexual object and
the excitement attending, the first year of married life had worn
away, the biological problem became a serious one. (My impres-
sion of his problem, considering his type of personality and general
physical make-up, and the biological difficulties attending such
situations, is that it always will.be a source of irritation.)

These conditioned functions of his sexual reflexes made him
furious with himself. Although he was usually affectionate and
sincere, he became irritable and impatient with his wife. He
thought the sexual difficulty was an indication of sexual weakness
due to boyhood masturbation. Ejaculatio prsecox supported this
belief. He tried persistently to induce his wife to diet and take
exercises to reduce her abdomen and breasts. For a time she com-
plied and also removed the hair from her ankles, but when he be-
came impatient and critical she became negligent and resistant.

He reacted to her general unsophistication by taking her
to clubs, cafes, parties, teaching her to drink cocktails, smoke
cigarettes, play tennis, etc. He sincerely wished to make a chum
out of her and was fondest of her when she was like a tomboy,
but also she had to "mother him." Physically she was not con-
structed to be an athletic girl because of her broad pelvis and
obesity, but temperamentally she was delighted by such efforts.

I am sure that since his adolescence he had been aware of his
sexual fixation upon his mother because of incestuous dreams, and
in his striving to so train himself that he would escape the horrors
of incest, he married nearly the opposite type of woman. He
dreamed of having sexual relations with his mother both before
and after marriage and his horror was nothing less than intense.
He said he prayed to God to be spared from such terrible thoughts.
"When he learned the biological significance of the dream he was a
deeply relieved man. For these reasons and his previously noted
strivings, I am sure he sacrificed many naturally delightful inter-
ests to escape the feelings of incest. After his marriage, when his
conditioned sexual reactions made it evident to him, by their in-
difference to the stimuli to which he had bound himself, he desper-
ately strove to train his wife to become as nearly like his mother as
possible, in order to save his heterosexual potency. (Later in the

cnnoxic hebephrenio oissociATioisr G27

case -will be f oiind a sigiiifieant comment of his wife upon a remark
he made to her about homosexuality among men.)

She learned to travel alone and tried to keep house. She was
sincere in her work as a Avif e and looked forward to home building.
Unfortunately her husband's work necessitated his traveling about
and her living a great part of the time with her mother, or her
husband's mother. This prevented her becoming independent.
The wife's relatives persisted in trying to reform her husband, and
his mother tried to reeducate her son's wife. Her husband's
salary was barely ample to keep things going smoothly, and yet
the patient, by denying herself, managed to save several hundred
dollars in two years.

Her father was displeased with his son-in-law's behavior and
the latter reacted by gambling and carousing. The reactions of the
son and the son-in-law to the father were strikingly similar. The
two families naturally made the patient their common battle
ground because she was suggestible and unsophisticated. Her
family felt no compunction about criticising the behavior of her
husband. She remained faithful to her husband, however, and
tried to give up the habits of her family as "old fashioned,"
"selfish," "gormandizing," etc., and convince herself that his rel-
atives knew better how to live.

When they were not quarreling they were happy and optimis-
tic about the future, but they were unable to make a thoroughly
satisfactory adjustment to their family differences and biological
difficulties. He showed his displeasure by threatening to leave
her if she lost her beauty, if she did not groom herself, and if she
did not write to him daily.

Until she became pregnant the situation permitted enough
physical freedom to prevent her disappointments from becoming
oppressive. Her sexual life, of course, was not satisfactory with
her irritable husband, and some prodromal indications of the
nature of her adjustment appeared before she became pregnant.
She tended to become apprehensive when she happened to be alone
in the house with a man serv^ant. She apprehended that he might
make sexual advances and AA^orried because she Avouldn't know how
to repulse him if he did ; that is, control her sexual wishes.

During her pregnancy she masturbated and reacted with feel-
ings of unfitness and shame, but compensated by reading select
literature to cultivate in her child, through prenatal influence, a

628 PSYCHOPATHOLOGY

love for the beautiful. Despite her apprehension she was, how-
ever, delighted with the prospects of having a child. After labor
when she came out of the etherisalion she wanted to knoiv if her
baby was "marked." She said something about its being marked
by a chicken. (Chicken is a common name for a girl of the
streets.) During her convalescence after the labor, the nurse,
perhaps because she was unconsciously guided by the patient's
affective reactions, persisted in telling her all the sexual details
and scandals she knew; particularly that masturbation caused
insanity and that she must protect her son from masturbation.
Her sister reenforced this train of thought by giving, as her con-
viction, that masturbation was a symptom of insanity, and when
she asked her doctor about masturbation in boys, his conmient
corroborated her sister 's statements.

Her mother had often told her she was "an enigma to her-
self ' ' and she. believed that this meant being ' ' queer, ' ' and was
now magnified into meaning ' ' slightly insane. ' ' She felt that her
mother was responsible for her masturbation, because she failed
to educate her properly. (Such bitter reproaches are quite com-
monly made to parents by children for improper education.)

Her husband was indifferent to the infant. He showed much
more pleasure in the baby of a friend. The patient felt keenly '
the unwelcomeness of her child and his threats about leaving her
soon proved to be fertile suggestions, indeed. Her inability to
control the sporadic outbursts of autoeroticism troubled her in-
tensely, and her efforts to educate her child so that he would not
masturbate, became an obsession. She expressed it to her friends
in thoughts about raising her baby to be "good." The father
of the baby was rather indifferent about naming it and in her
fancy her unnamed infant grew into a foundling.

Not long after the birth of the child she became obsessed with
the feeling that she had served an allotted purpose in the family
and was no longer wanted since the birth of the child.

It is quite possible that the collapse of the patient might have
been avoided even at this late stage had her husband been able to
love her. This perhaps would have given her firm feelings of hav-
ing attained a worthy place in nature, and if the two families had
been less critical of her manner of mothering her child. At the end
of the fifth month she was unable to nurse her baby and both her

CHRONIC HEBEPHKENIC DISSOCIATION 629

mothers inconsiderately emphasized the failure by telling her of
their own ability to nurse their babies for a year.

The two families conflicted right and left about the way to
raise their only grandchild, and the timid, inexperienced young
mother was swept off her feet. Her husband's mother insisted
upon plenty of fresh air for the baby and her mother protested
that the child was freezing. When her husband happened to be
in a nearby city, his mother insisted that she neglected him because
she did not go to see him; and her mother objected to the visit
because she would be neglecting the baby. The patient said, "You
would have thought the child was her own." Unfortunately she
lived in her mother's house, occupying the upper floor. Most of
the time she was without a servant and the necessary physical ex-
ertions were too severe. Her husband reacted to her anxiety
about the education of the child by vigorousl}' criticising the "gor-
mandizing" tendencies of her relatives and insisted that his son
should have the freedom and interests of the modern child and
some day drink a cocktail with his father. The patient no longer
had confidence in the integrity of her husband, and this only ag-
gravated her obsessive fears that her baby must become sinful.

After a careful study of all the participants in this family
disaster, I was unable to find that the patient had, at this time,
a single adult who felt an encouraging sympathy for her efforts
to become a woman according to the dictates of her own feelings.

She regarded herself as a failure as a wife and a mother, and
an object of shame to her family. She read "The House of
Bondage" at this time and in her faaicies she became the woman
who had to go down, down the social scale until she reached the
gutter.

Her sexual obsessions were now met l)y a sincere, frightened,
but pooi'ly balanced effort of her husband to educate her. He
rather instinctively felt that her ignorance was the foundation of
her difficulties. Unfortunately, the book on sexology that he gave
her was filled with vigorous moralizations against the depravities
of masturbation and perversions. Its effect was the formation of
an unshakable conviction that she was a degenerate because of
her masturbation and certain sexual impulses which she was try-
ing to suppress. She concluded that she was an outcast or should
be one, that she was unfit to raise her baby, and people could see
the degeneracy in her.

630 PSYCHOPATHOLOGY

Her mother remarked one day about how wonderful it was
for her to have a baby that she could call all her own. The ' ' all
her own" she interpreted to mean a fatherless child and the baby
was regarded as a foundling. (It is evident that the erotic affect
was influencing her interpretations so as to discourage the efforts
to remain estimable.)

She frequently told her family that she wished she were dead
and these ominous wishes were not apprehended. She had un-
accountable fits of crying and depression for which she would
give no explanation. When her people talked about the European
War, she construed it to mean figuratively that she was a German
and all the others were Allies against her.

About a year after the birth of her child she began to talk
about her husband remarrying so soon as she was dead, and she
looked at him with a "queer sort of smile." She mshed that she
and her husband and baby were dead. She could not be pacified.
She began to speak of her masturbation openly and thought peo-
ple sneered at her as if she passed disgusting odors. She tried
to make her eldest sister promise that she would raise the child
carefully and teach him to love God when she married her hus-
band. She said- it was a case of survival of the fittest. Her sister
could not understand this talk and was horrified with being charged
with longings to have her sister's husband. The patient told this
sister of her masturbation fancies, and accused her of having in-
fluenced her in this.

She was very erotic at this time and had quite a series of
dreams of having sexual intercourse with different married men
whom she knew, and when her husband had intercourse with her
she felt that she was his mistress. One dream that impressed her
was about not being sexually satisfied. This eroticism gradually
became so persistent that during her waking states she could not
suppress it and the resulting fancies soon replaced the realities
of her environment. She insisted upon reexamining the marriage
license.

She now believed that she was no longer the daughter of her
father, but a girl kept in a house of prostitution conducted by her
father, and all the men talked of her beauty because of their
sexual interest in her. (The sexual value of beauty and the dan-
gers of becoming ugly had been emphasized by her husband long
before.) Nearly everything now had a "double meaning" and

CHRONIC HEBEPHRENIC DISSOCIATION 631

she read into the conversations she heard, subtle references to her
secret sexual cravings.

When her mother suggested that she should give the baby's
old clothing to a negress who was going to have a baby, it meant
that she herself was going to have "a little black Jesus," and she
now became the white woman ^vho had lived with a colored man
and had years ago aroiised so much curiosity during her adoles-
cence.

She begged her htisband not to leave her and prayed- that
God would protect her son when she was gone. She would not
allow her husband to touch her. She said he held his lips stiffly to
keep from laughing at her and put his fingers to his face to hide
his smiles. She believed people were lying when they talked about
her. She found a copy of the "Police Gazette," which she said
had pictures of her in tights, and her husband was not able to con-
vince her that he had not exposed her.

She was afraid to take medicine because it contained poison,
and she thought her urine was sticky (sugar). (Her mother had
diabetes.)

Her fancies, anxiety and irritability increased rapidly, and
one day she threw the household into a panic by drinking tinc-
ture of iodine to commit suicide. She was now completely out of
touch with her family and upbraided them all for deceiving her
and making a prostitute and degenerate out of her.

She was taken to a sanatorium and this environment became
at once converted into a house of prostitution conducted by "Dr.
Bull," the first syllable of the physician's name. All the inmates
and herself played an active part. She fancied herself the mistress
of the physician in charge. When the men talked about "billiard
balls" it meant testicles. She believed that she Avas doped at night
and was subjected to sexual assaults through her mouth. She spit
and vomited frequently to cleanse herself and complained of having
sexual difficulties like her father. His chronic gastritis, she said,
was put on and he Avas merely hiding his sexual perversions. She
had to be watched day and night because of her numerous at-
tempts to strangle herself, stab herself in the head with pins and
pencils, drink drugs, etc.

One day she ran into the bathroom and locked the door. She
tore up her dress, and tried to strangle herself Avith the strips
before the nurses could break the door open. When they caught

632 PSYCHOPATHOLOGY

her she fought violently and, half choking, she gasped : " I know
just what happened, you dirty devil. My husband told me about in-
tercourse through the mouth." As she was taken to her bedroom
she reacted mth the horror that Avould naturally have attended an
actual assault o£ this nature.

From that time on (for six months) she insisted that she had
been sexually assaulted and ruined the way her father had been
ruined. In her many tirades about her supposedly brutal treat-
ment in that sanatorium she completely neglected the fact that
she had strangled herself. Unfortunately, the nurses were not
able to resist the temptation to joke about this, and during the
remainder of her stay they delighted in playing upon her sexual
fears and curiosity with weird stories of immorality, which mate-
rial suited her affective cravings.

Throughout this erotic tide, however, the patient made a piti-
ful effort to be "pure" and "good." She was almost constantly
in an anxiety state about her exotic fancies and helplessly tried to
suppress them. She bit her fingers and pinched her skin, paced
the floor and tried to keep from sleeping in order to prevent mas-
turbation.

As a quite unusual feature in the setting, for several months
she consistently criticised herself for everything she did. She
spoke of herself as vain, overbearing, selfish, deceitful, lying,
stupid ; said her parents should have punished her, etc.

When her mother died she refused to believe it and did not
grieve.

Fourteen months after the birth of her son and about two
months after the attempt at suicide, she was transferred to Saint
Elizabeths Hospital where she remained for eight months.

It is only possible to relate the more important incidents in
her behavior while in the hospital and the underlying "cravings that
influenced her. Except for a slight cervical tear, her physical
condition was excellent upon her admission.

When she was not disinterested in the physician's efforts she
could perform the intelligence tests very well. Her letters were
always neatly written and full of affection and worry about the
future of her child.

She wrote to her husband as if he had divorced her. In a
pathetic letter she wrote: "I feel that the whole — family, while
maybe believing in God, are AvhoUy without religion and are very

CHRONIC HEBEPHREIsIC DISSOCIATION 633

ungodly, and as they allowed .me to i^row np in sin, never made
me go to Sunday-school, nor so much as taught me the Lord's
Prayer, I hate to think that my Babe is in their power. And I
very much fear that the sins of his father and mother will be
visited upon him and that those sins will be encouraged in him.

"Time and again I've prayed and hoped that Baby Boy [as
yet he has no name] would know the pinch of poverty inasmuch
as it would bring him nearer his God and cure him of hardness
of heart toward his fellow beings. I have an idea that one [her
maiden name] was only a meditan of propagation and after the
birth of that haby was to be cast off. The baby will one of these
days be 'comfortably off' and I'm quite sure he'll not be taught
charitableness at all but miserable greed Avill be fostered in him.

"About my Baby Bo^^ I plan and dream and hope for him,
plan and hope that I can go back to him and teach him to be a
good Christian. With all this planning the miserable thought
comes over me that he is to live his life without me."

(The obsessive fears about the ruin of her son can be read
throughout this letter as well as her pathetic struggle to avoid the
disaster.)

The feelings of sin, being cast off, the godlessness of her fam-
ily and the ruin of her child were her most dominant fears foi''
several months, all beliefs being due to the erotic affect getting
rid of the social obligations that inliibited its freedom of getting
gratification.

Among the people she met were the names Manor, SaA\n'pr,
Gay, Childs, and Slicer, which she pieced together to mean "Man-
her," "Saw-her," "Gay," "Slice-her," "Childs" (children).
"Man-her" meant sexual intercourse, etc.

She repeatedly asked the nurses if they thought she was a
hopeless case, believing that she had been confined in the govern-
ment institution for life. She was very pleasant and tractable
for several weeks and took care of her own room. At this time
she was quite playful and her fancies did not seem to be more
archaic than so far described.

Her husband came to visit her and most strikingly persisted
in being advised even in detail as to what to say to her. He was
very unhappy and took upon himself the entire responsibilitv of
her depression and anxiety. He was secretly drinking Avhiskey,
smoking cigarettes to excess, unable to sleep, and was constantly

634 PSYCHOPATHOLO&Y

resenting the criticisms of her relatives. He was willing to do any-
thing to regain her confidence. His first few visits were eantionsly
conducted and she reacted with an encouraging interest in him.

She began to talk about her hallucinations- and dreamed that
her nurse was explaining them away and that she had gone home.
She talked a great deal about the immorality of her family and her
masturbation to the patients and nurses, and was- constantly on the
lookout for anything that pertained to sex. She was surprisingly
frank and showed no embarrassment about her secrets. She said
she had always been reticent about her secrets and now she was
going to tell them to everyone. (See compulsion, Case CD-8.)
This satisfied the feeling that the whole world should know, the
dread of which is complained of when the patient resists the com-
pulsion.

For several days she could not be induced to come into the ex-
amination room. She said she thought I was a good man, but
she was afraid of me. Finally I won her confidence and she
learned to depend upon me for assurance and encouragement. She
was like a child in her acquisitive interests.

For some unaccountable reason, about six weeks after her ad-
mission, she slumped to a still lower method of gratifying her
cravings. Her husband had been visiting her regularly and be-
coming tired of her childish reasoning threatened to leave her, if
she did not try to get well. She also learned about his drinking
whiskey. Those were probably the causes of the regression.

"When she was transferred to St. Elizabeths Hospital from
the sanatorium she became encoiiraged and adjusted to a higher
level of interest, but now she regressed to her prostitution feel-
ings and this hospital also became a house of prostitution. For
several days she brought up the fancies of the sexual assault at
the sanatorium and now explained her vomiting as the result of
having a diseased stomach like her father's (which she imagined
to be caused by fellatio). She said she had not known of such be-
havior until her hiTsband unwittingly told her about such im-
morality among some types of men. She repeatedly remarked that
she thought it was ' ' so disconnected and funny" when her husband
added ''no one cou.ld make me do such a thing." Fox some time I
was unable to get the Avish Avhich was causing these persistent wor-
ries. She persistently maintained that she was horribly assaulted
Avhile half dazed from the strangulation. Finally she commented

CHRONIC HEBEPflRENIC DISSOCIATION 635

that she wondered if it was not a fancy, but then added that she
was sure she had been assaulted. Although she wavered, she was
not quite ready to give it up as a reality.

The pathological mechanism became clear to me during this
interview, but she was not able to control her eroticism. Her hus-
band's sexual failure during the last months of her pregnancy
and since the birth of her child, she felt, was responsible for her
uncontrollable eroticism. The sexual pressure made her mastur-
bate and her husband's advances only irritated her. At this stage
of the analysis she asked unusually simple, heedless sexual ques-
tions of almost anyone wlio would listen to her, and unblushingly
remarked before the ward full of people, almost innumerable times
during the day, that she was ' ' a masturbator ' ' and her family had
put her in an insane asylum for it. The naive abandonment
and persistence with which these remarks were made seemed to me
to be the production of an obsessive craving and not an effort to
explain her confinement.

She finally became aware of the feelings which prompted this
behavior as she talked about her husband's impotence and how
he only irritated her. Now, she said, she got her sexual pleasure
ont of talking promiscuously on the ward about sexual things and
did so at every opportunity. At this time she dreamed that she
was driving a carriage and was delighted Ijecause she could turn
it around in such a small space (turn facts around). It will be re-
called that she had allowed the erotic affect to turn around the facts
about a supposed sexual assault in the sanatorium, divorce, prosti-
tution, the immorality of her family, etc. Although she now
grasped the curious Avish-fulfiUment of her innumerable questions
and assertions about sexuality, she could not yet accept the wish-
fulfillment in the fancied oral sexual assault. (It is interesting to
recall here her tendency to ask naive sexual questions in child-
hood.)

She delighted in calling herself a "bad woman" and smil-
ingly asked if she ought to conmiit suicide.

The manner in which ordinary things in her environment took
on sexual values may be illustrated by a few notes from her letters
to me.

"I got so I could not read my prayers without seeing some-
thing vulgar in them. 'Forgive our trespasses,' a Avoman (nurse)

636 PSYCHOPATHOLOGY

used to accent the passes. I thought it was very queer and she laid
such, stress on it that I thought it meant something sexual.

" 'He leadeth me by his own hand.' Nurse said 'hands' in-
stead of hand and I thought it meant something about masturba-
tion.

" 'The incorrupt tree brings forth incorrupt fruit.' Then I
realized I was wicked and my baby would be bad.

"When I asked the nurse if I could ever see my people, she
said, ' Stop whorrying so. ' She put an h in worry which meant
I was bad" (whore).

She would sleep in a certain position to see if she would
awaken in the same position. She was afraid she was being mis-
used during her sleep.

"I used to plan to commit suicide, but I would say to myself
'no I mil wait until tomorrow, I have, too much curiosity now.'
Used to talk abqut curiosity in my sleep." When the physician
called to see her she thought she would kill herself because he
intended to misuse her. Then she decided that she would wait
until she was taken to the "bad house" because she wanted to see
what a "bad house" was like.

-During this discussion she said: "My! if all this energy and
curiosity was used for something else I ivould he hrilliant." (The
influence of twenty years of repression and deferred satisfaction
for her curiosity was unquestionably a determinant of this sexual
curiosity.) With this exclamation she spontaneously brought up
her childhood shame and embarrassment that prevented the learn-
ing of the truth about sex. She had not even been permitted to
watch a baby nurse. This treniendous sexual curiosity, despite
all resistance, was now being satisfied at any cost, even though
she could not get rid of her feelings of shame. When she forgot
herself she was happy and playful, but when her duties of woman-
hood were emphasized she reacted to her eroticism with shame and
fear.

In the ninth week of her confinement she passed into a more
serious anxiety state. She brought a page of a Sunday newspaper
to me on which was a full-page feature about a minister who had
disappeared and awakened later to find himself a sailor in the
New York Bowery. The article was illustrated with pictures of
a minister, a sailor and a group of women, etc. She said I had
published this and gave me an excellent demonstration of what

CJIRONIC IlEBEPIIRBN^lC DISSOOIATION G37

she could say -when she was angry. She said that it referred to
her love affair with a choir boy and her feeling that now she had
to become the mistress of a conmion sailor. (She had had fancies
about a sailor.)

She felt that her situation was hopeless and lier family was
using this means of making money out of her.

Now she lost all the reconstructive ground and insight she had
gained. She became confused, had to be confined to bed, com-
plained that she had been doped, felt stupid and seemed unable
to remember anything. She tried to find a place to hang herself
and made an attempt to stick a hatpin into her head. She refused
food, could not sleep and had the persistent feeling that she must
leave the hospital and walk the streets as a prostitute, and asked
innumerable times a day if she must go into the street.

Her father came to see her at this time and she noticed his
agitation and grief. She turned her cheek to him to be kissed
(their mouths were unclean) and paid no attention to his questions.
She stared at him stupidly, repeated at intervals, "I must be
queer," "It is the queerest thing." Then she tried to leave him
in the building and go in the street; was not interested in the pic-
tures he brought of her baby and only begged that he would be
well taken care of because she had to die.

I was at a loss to understand this sudden, profound confusion
and anxiety of the patient. The newspaper story did not seem to
be sufficient for such regressive changes. A few days later from
a repentant husband I learned what had happened.

The patient's mother willed all her property to the father
and this necessitated the signature of the heirs including the pa-
tient and her husband. Her husljand had carried the will about
for several days trying to decide whether or not he should sign
it. Finally in his dilemma he brought up the whole family con-
flict again and threshed it out with the patient. He lost his tem-
per despite explicit instructions to be careful, and told the patient
that he thought her mother was insane Avhen she made such an
unjust will. They were attending a patients' dance when this
occurred and she changed in a few minutes from a state of hope-
fulness and promise to one of serious confusion and inaccessi-
bility.

This lasted nearly two weeks, but gradually she became more
cheerful. She talked about herself as a "clinging vine" and said

638 " PSYCHOPATHOLOGY

she could not beat her "hoodoo number." She complained of
"feeling dazed, like in a dream," that "everything had a sexual
meaning, even the Bible." She asked about her father and sister
but showed no interest in her husband. She dreamed that her
hitsband and sister and baby were' waving good-bye to her and
she wanted to know if it meant that she must remain here.

About the twelfth week she made strong efforts to stop her
eroticism and tried to stay awake at night to prevent herself from
masturbating because she was afraid it occurred during her sleep.
She now cried because her mother was dead and begged to go home
to her father, sister and baby, but showed no interest in her hus-
band. In her dreams one of the older women physicians became
her mother and during the day she spoke of their similarities.

She sexualized nearly everything she heard and seemed to
feel that the patients were all put here to annoy and persecute her
for her wrongs as a masturbator and prostitute. She worried
about a ward patient who was deformed by a polyneuritis, because
it meant that she would become that way when "they" were fin-
ished with her. Another patient's bruised lip referred to her
mouth. The perfume of the spring flowers meant something about
the right way to live. The hard pillows meant a hard, bitter world.
For weeks she correlated everything, it seemed, into groups of
good and bad, right and wrong. She greeted her father with more
affection, but protested, when he called her his ' ' baby, ' ' that she
wanted him to call her a woman. He could not quite do this but
called her his "girl." This disappointed her. She needed to be
recognized as a woman and her family would not respond. She
was trying hard to get well.

She dreamed at this time about someone carying a sign with a
Latin word on it and when she tried to read the word it changed
to "rore" (whore). The man carried it before her to make her
miserable and she refused to read it because she wanted to sup-
press her sexual thoughts and get- well. This dream worried her
greatly because she could not get rid of the word it suggested.
She was utterly unable to tell me about the word. Later this word
persisted like an obsession and stopped the analysis and progress
of the case until she frankly discussed it.

Although she went to dances and understood the moods of
other patients she was troubled by a strange sense of unreality.

CHRONIC HEBEPHRENIC DISSOCIATION 639

She wanted to know if certain other patients were not herself,
and if she had been doped or jnst had "a spell."

These faint glimmers of insight that flashed out now and then
gave us the most encouragement for her future.

In the fourteenth week the family difficulties -were again forced
upon her by an impulsive outburst by the husband, sister and
father, and tliis time it gave impetus to an affective regression
that finally carried her into the intrauterine affective attitude.

Her face looked confused, she stared blankly ahead of her,
smiled and cried and frowned almost at the same time. She said
someone was trying to talk to lier from below and kept her in a
perpetual state of anxiety. ITer hands had to be bandaged to
keep her from picking the skin off and she was given bromides and
packs to quiet her.

During this anxiety her eroticism apparently asserted itself
at a much more infantile level as her sensations and delusions indi-
cated. The patients talked about the food. It horrified her be-
cause they meant she had a "queer appetite" and had abnormal
sexual desires. They noticed that she was "passionate," and
putting wax on the floors was done to remind her of her sexual
desires. When my pencil broke in taking notes of what she said,
she immediately said it was a sign that I was going to quit her
case. She said she wS,s to be made "crazy with the heat," "had to
burn," etc. A Mrs. Wilbur was to leave the hospital and she be-
lieved it meant that she herself had to leave and "will-burn."

She was having auditory hallucinations and charged the
women with hypnotising her and reading her thought ^^ hecause she
could not control her wandering sexual thoughts. In a few days
she became very stupid and drowsy and hallucinated grewsome
experiences with negroes

She said she did not know why she wished these things to
happen to her, but she thought she would be "burned," "buried,"
"crushed in a box that would grow smaller and smaller," that
hot irons or the floor brush would be put into her vagina, etc.
Horses, bulls, negroes, "morphrodites with three penises and large
breasts," her husband with two penises, her father, brother,
mother and sister would have intercourse with her. The police-
man's white horse as he rode by was "awful." "The horse was
nearly all penis." She had become a "morphrodite " and would
have intercourse with herself and use a horse's penis. "When

640 PSYCHOPATHOLOGY

you sp.eak I think I speak. I am trying to do everything." She
believed she was "everybody." Her father was hallucinated as
having sexual relations with her and when she told me about it
she added the experience of her childhood when she was four
years old and wanted to know about the bull. (This weaves in
with Dr. Bull's sanatorium.) "With great anxiety, she said, "To-
day the nurse threw the cat out and I thought it meant me." When
the nurse brought' her a postage stamp, corset, stocking, box of
powder, a whisk broom, etc., it meant that she took everything
and was "poor white trash. ' '

She identified herself with the manure on the lawn and was
afraid to use the toilet because she would pass out with the feces.
She frequently commented about people's shoes and said they

Fig. 61. — "Leda and the Swan," by Michelangelo. The Swan as Jupiter, the father,
disguises the incestuous fixation of the sexual cravings.

reminded her about "passing wind." At this time there was a
very noticeable fecal odor about the patient.

At brief intervals she improved enough to run the floor pol-
isher and the long handle became a penis that tried to have inter-
course with her. She complained of being ' ' t-y-d. " (" T-y-d ' ' was
her pet name for her baby's genitalia).

She would come into the examination room scowling and whis-
pering to herself, "Who am I, am I somebody else?" When I
drummed my fingers on the table, she said ' ' rats gnamng, hither,
thither anon. ' ' She watched every move I made and even such
trivial things as the movements of my pencil made her submit to

CHRONIC HEBEPHRENIC DISSOCIATION 641

its influence. (I do not think that this was a bromide delirium
because her memory was not actually confused and I could get
her to explain the meaning of the symbols, although the bromides
must surely have added to her feelings of unreality.)

She felt that slic teas a kleptvmaniac and associated the nu-
merous things she supposed she had accumulated with sexual curi-
osity and recalled hoiv she had stolen little things ivhen she was a
child. (Here a definite relationship existed between kleptomania
tendencies and the gathering of sexual symbols. This behavior
has been observed in other patients.) She was to gather all the
trash and dirt in the world and build a degenerating world which
would contrast with the beautiful world. "I think I steal all the
time and take delight in hoarding up trash. I think I yell out
dirty words about bowel movements" (hoarding, miserliness and
anal eroticism). She showed the restless, picking symptoms of
the anxiety depression and believed she had lost her soul because
she could not control the sexual fancies.

During this period she frequently referred to the hot box
(hot-air cabinet) with great anxiety, and begged to have the hot-
air bath discontinued. For several weeks she gave me so few
fragments about this particular fear that I did not understand
it. Gradually her fragmentary phrases were pieced together. The
hot-air cabinet, she said, was a "hot box" in Avhich she was to be
suspended and drawn up in the fetal position and to float "on
her side" in her own urine and feces and would be "whirled-
around and around. ' ' She would be cut open and worms put into
her, snakes would crawl through her, old rags would be sewed up
in her, and she would be smothered. The walls of the hot box
would contract around her and she would get smaller and smaller.

She also dreamed at this time about being smothered in the
"hot box," and a little white girl haying her mouth open for sex-
ual intercourse. The infantile determinant for oral eroticism
(nursing), is obvious in the little white girl and the afl'ective re-
gression (Case PD-17).

During the most vivid period of her intrauterine fancies she
had to be dressed and fed. She would curl up under a blanket,
and paying no attention to anyone, Avould laugh and giggle to her-
self for hours at a time.

While in this state she happened to see a cat eat the umbilical
cords of its young. She worried about the cat eating its young

642

PSYOHOPATHOLOGY

and worked herself into a panic abont having eaten her baby. A
severe panic about having circnmcised, eaten and killed her infant
continued abont three weeks. She was sad and cried as if her baby
were really dead. (The identification is made here of the entire
baby with the baby's penis which actually was circumcised. Later
the identification of the penis as a baby came out frankly and the

Fig. 62. — Affective regression to intrauterine attitude in suicidal negress; who sus-
pended herself for weeks" in a blanket before the window.

feeling that she had eaten her baby became recognizable, as an
oral erotic wish-fulfillment.)

When I asked, "Why do you thinli you ate your baby?" she
gave me to understand that she did not "hate" her baby. The
burdensome baby was disposed of in her dreams and hallucina-
tions in the form of abortions.

CHRONIC HEBEPHRENIC DISSOCIATION 643

At this stage of her psychosis she developed a mild nephritis
and otitis media which reacted readily to treatment. The ice bag
on her ear felt like a "horse's hoof" and she gave birth to a baby
from the ear Avhich was discharging pns. When I stooped over
her to examine her ear she watched my pnpils to see what kind of
a girl she could see there. It gave her an indication of how I looked
upon her. She said the light glinted in my eyes like a Japanese
sword and the impression was used to suit her. wishes.

She saw her sister crushed and her brother doubled up and
stuffed into a tower, which made her feel glad. She thought she
threw her infant down a shaft and burned it to death. She felt
that she walked on babies and something held them up to her.
She would walk about the ward and hold her hands behind her as
if dropping something. Later she explained that she was dropping
babies behind her and giving birth to a great number. She thought
the nurse directed unborn souls and old people into the clouds.

When the urinals were Avashed out they glistened in the sun
and looked to her as if they were filled with a fluid lilce ' ' glycerine
[meaning semen] from horses' eyes."

When she was in bed she would lie half exposed and as a
man approached she made little movements to uncover herself (to
submit herself)' and yet looked at him in great fear.

She would lie in bed in a half-reclining position as if about to
get out, and her facial expression, dilated pupils, dry lips and fixed
stare showed her anxious, perplexed state of mind. She seemed
to be terrified and complained of seeing most "awful things," de-
scribing a huge round muscle, "slick all over," with two "stubby
legs like an elephant's legs" sticking out of it, lying on the floor.
"When I tried to ascertain the meaning of this very unusual visual
hallucination she talked -about "hot box." For many weeks she
was unable to give any further clue of what it meant. * ' Hot box ' '
obviously meant uterus to her but why it should be seen lying on
the floor, and of such immense size with two "stubby legs" like
"an elephant's legs" sticking out of it, I could not imagine. (Par-
ticular care was taken to ask no suggestive questions about this.)

During this period when she Avas allowed to be up and dressed
she often dashed to a front window to look at something. This
behavior was considered as "queer" and "silly" by those in
charge of her until we learned, after no little effort, that she
thought she saw her baby in the form of a white parrot hanging

()44 PSYCHOPATHOLOGY

from the bough of a tree. lier dashes across the room to watch it,
she said, were to see if it changed its position and whether it was
real or not. Her feelings about its reality were so convincing to
her that she worried about this considerably, often asking ques-
tions about a parrot and her l)aby, and later when she had the
freedom of the grounds she examined this "parrot" and found a
white rag hanging on the bough.

Although her case looked very discouraging her dreams re-
vealed affective trends that suggested a reconstruction. She
dreamed that she saAv her sister pick up a girl who had slipped
(herself).

About the eighteenth week she began to show more interest
in her family and some of the patients. She again b&^aii to feed
and dress herself and crochet for her baby. She wrote affection-
ate letters to her husband and wanted him to send her candy.

She now entered upon what may be regarded as the recon-
struction. Her affective cravings had apparently regressed to the
intrauterine level and after a due period the craving for her child
and family began to dominate her behavior again.

She adjusted rapidly, took walks, studied birds, went to
dances, frolicked with the patients and became very hopeful. Un-
doubtedly she would have made a social recover}- without assist-
ance and wQuld have regarded her experience as a protracted night-
mare, but she would not have developed insight witliout the psycho-
analysis.

She became very skillful at analyzing her hallucinations and
dreams which threw significant light upon the behavior of similar
cases.

In the twenty-first week she went to the city and shopped. She
visited an art museum and that night dreamed of Napoleon (such
a statue is in the museum) in meditation. To this she sponta-
neously brought out the pleasures of uninterrupted dreaming and
fantasy.

Now she put her fancies about her father in the proper light.
She did not think now that he was immoral, because the type of
liis friends proved his Avorth; but during her illness she fancied
that if he were "bad" she might as well have sexual relations ^v^.t\\
him, and even hallucinated that she did. (This instance shows how
tlie affect influences the estimation of social values in order to find
gratification.) She begged for her watch and wedding ring and

CHRONIC HEBEPHRENIC DISSOCIATION 645

wanted to be a wife again. Her acquisitive interests attained an
excellent range, and her emotional reactions to her companions
were more refined, but she was still very unstable.

She still had erotic dreams and would have to awaken to keep
from masturbating. Her social interests were decidedly homosex-
ual. She delighted in dancing with certain women, dreamed of
being in continuous tubs with them and being tempted to mastur-
bate by them.

About the twenty-third week she had progressed so far that
her nurse took her out to visit her family. I had carefully in-
structed her husband, his mother and her eldest sister that under
absolutely no circumstances must their petty grievances be thrust
upon the patient in any way. These kindly, well-meaning people
promised faithfully to cooperate. They had been thoroughly
frightened by the regression.

With her husband I had given consideralile study to his sexual
problem, his irritability, and his mother fixation. Also his antag-
onism to her father. But human nature is not plastic when it has
its own struggle. She was at home only a few hours when the
family quarrel about spending money and the way to live came
into the foreground. The eldest sister was simply unable to al-
low the patient to become independent and assert herself while at
home. The latter tried to movp some of the furniture about and
criticised some of the decorative arrangements. A conflict was
promptly precipitated. The eldest sister regarded herself as hev
father's housekeeper and would not tolerate interference. She
Avanted to be her father's favorite and the patient foresaw an
unfair division of the estate, which was also her husband's fear.
She returned to the hospital angry and worried. Her father and
sister, she said, were scheming to cheat her out of the property,
did not want her, and the whole problem of caring for her child
without funds was resurrected. Much of the ground we had gained
was lost, but she did not give up this time. She began to quarrel
with the other patients, and derived especial delight out of "cuss-
ing." She used pi'ofanity liberally for almost everything, and was
very much like a tomboy in her vulgarity and heedlessness. (This
cussing method of adjustment she had learned from her brother
at twelve.)

At this tirne, while visiting the zoo with her nurse, a negro fol-
lowed them and exposed liimself. The nurse beramc excited, but

646 PSYCHOPATHOLOGY

the patient had so far regained control of herself that she coolly
took charge of the situation.

Her husband visited her frequently and she responded to his
encouragement by making plans to renew her housekeeping. At
the same tirfle, however, she complained of a dangerous undercur-
rent of laziness and longing to be protected by her mother. She
dreamed frequently about her dead mother and complained that
she did not feel quite right about resuming the duties of a wife
because, at times, she feared another "nervous breaJidown" (that
is a relapse to autoeroticism).

She dreamed : "I saw mother in a white wrap and I came out
of the bath (waters of birth). I said look at these funny marks
on me. Mother said not to worry, they were the result of boils
when I was a baby. ' '

"When she told the above dream, she added : ' ' The marks were
on the abdomen and looked like childbirth — ^wonder if I -could ever
wear a straight-front corset again [reduce abdomen]. When I
was about fourteen, mother introduced me to an officer. She intro-
duced my sister first like a woman and then introduced me as her
'baby.' I cried and it put the bosh on it right there because I
wan.ted to be a woman. It seemed as if I took the cue and followed
it since. I'll tell you one thing, I was disappointed when mother
didn't make a fuss over me in the dream." Then she explained
that her husband had recently told her of a girl friend who had
gone to a maternity hospital.

Another infant would be a serious biirden and her dread of it
now naturally became quite pronounced. A f^.w days later, she
dreamed: "Someone and I were going through a poor district
[her poverty] making investigations, and upon looking over a
fence saw any number of pink and white, bright-faced young 'uns
probing the bony hip of an old horse. The children were having
a very good time and because they were, at the expense of the old
horse, I rapped them smartly on their wrists with a stick. That
dream seemed to fade and it got on toward dark and W— [hus-
band] and I were coming home through a field. Near a barbed*
wire fence we both espied what looked to be a covered telephone
wire^spotted black and red — but upon inspection W — exclaimed,
'By Jove, it's a worm, queer thing — sort of a glow worm of some
kind. ' It seemed to be about 100 ft. long and not so large around
as one's little finger."

CHRONIC HEBEPHRENIC DISSOCIATION 647

The above dream revealed the wish for children, but also the
dread of maternity at the expense of the bony old horse. She was
like the broken down old mare, and this particular symbol of her-
self recurred in quite a series of dreams.

She continued to be afraid to sleep because of the dreams. At
night the sexual images tended to become vivid, and she resorted
to means of keeping awalce to avoid them. • During th'fe day she
was busy enough to crowd out the unpleasant imagery.

She now spontaneously resurrected the fancies of the sexual
assault in "Dr. Bull's" sanatorium. This time she gave an aston-
ishing explanation of the craving to strangle herself and jab pen-
cils and pins into her head, etc. She reviewed the scene in detail
and then said the assault might have been imaginary. "The,
strangling might have had the same effect as putting my finger
do-\vn my throat. ' ' She explained that she felt the same affections
for her husband's penis that she did for an infant and felt impulses
to submit to the wish. This horrified him and he vigorously tried to
impress upon her how degrading men thought oral erotic women.
She now recalled that when she had the obsession of having eaten
her baby, that baby was associated with "t-y-d" and penis, which
explains the influence of the oral craving of which she was fearful.
The oral erotic cravings had compelled her to strangle herself, put
her fingers into her throat, stick pins and pencils in her head, eat
wasted food (symbolic of the censored phallus), chew up a ther-
mometer, drink, tincture of iodine, and eat her baby in fancy, etc.
The genesis of this affective craving was now intelligible as the
reaction to her husband's enticing and then repressive attitude,
which he corroborated.

Following this adjustment the patient emphasized her fear
that she talked in her sleep. She was afraid people would under-
stand her "awful thoughts." She giggled and laughed, and yet
worried about a certain awful thought. She felt that she fmisf
tell it to someone to free herself of its exasperating presence,
and yet said ; " I can not tell it. I would simply die. It got so that
it identified itself with masturbation and got worse than ever."
The thoughts were about a word (previously referred to as hav-
ing occurred in a dream) she had seen in an outbuilding when
about eleven. As a child, she thought of it with pleasant fancies
when at home in the toilet. She innocently told her mother about
her fancies and was whipped for indulging in vulgar thoughts.

648 PSYCHOPATHOLOGY

After such impressive reactions of her mother she was unable to
forget it. Before this she had not realized the triTe import of her
behavior.

Although her sexual thoughts were troubling her constantly
(she was trying to get rid of them) she was unable to tell me about
that word, and its persistence stopped the progress of the analysis
until she told her husband. It was the vulgar word for sexual
intercourse.

After this the tendency to self-repression greatly decreased
and her confidence in her relations with her husband increased.

She dreamed (twenty-eighth Aveek) : "My husband and I
seemed to hav^ a house. [They were planning to go housekeep-
ing.] We were coming across a field and saw horses dying. One
had something like a big lump or tumor on his brown side. Some
horses were in agony about the war. They lay with their legs
drawn up. (She explained the legs drawn up as the fetal position.
"War, farnily wars, and maternal problems were still her difficul-
ties.)

A few nights later she dreamed: "I was back of a peculiar
house on a terrace. A child and I were trying to climb down steps
and we got to squabbling and wrestling. I was thrown on my back
and she landed into me pounding me in the stomach" [pregnant
uterus] .

The relief and comfort she derived after telling her husband
about the obsessive vulgar word probably encouraged her to con-
fer the following secret which made her dread to sleep "with him,
fearing that she might talk in her sleep about it^ — namely, that
during her pregnancy she had fancied herself carrying the baby
of an old suitor, and this reenforced her feelings of infidelity.
After this confession to him her relations became still happier and
less restrained. At the time that she told me of this she also dis-
cussed the masturbation fancies during her pregnancy and it is
quite probable that the fancies about the old suitor, which made
her foel guilty of infidelity, mado her feel that her husband was
laughing at her with scorn. At this stage of the psychoanaly|is
she dreamed that she gave birth to a "young-un" but it was a
miscarriage. She now explained the old horse dreams as old nags
and she was. "nagged to death," which was the meaning of the
nags in the fetal position dying because of the war. "The one
that looked like it was carrying a colt stood on tottering legs * *

CHRONIC HEBEPIIKENIC DISSOCIATION 649

I was nagged to death with a big, fat, lieavy baby and I did not
Avant to go through it again."

Now the glycerine fancies and the horses' eyes of the psychosis
were brought up and she explained them. "My sexuality ivas noi
satisfied and it just took hold of everything. I wondered how if
ivould he to have sexual contentment. I courted it in my dreams
and hnew it h^it it wasn't in me to stop. I remember when I ivas
lying with my head on my nurse's hnee I determined not to commit
masturbation, but I ivould have anything for happiness, so I let
my imagination go and it got bigger and worse all the time. When
I was indifferent to people my mind was rank and tvhen I paid at-
tention to people my thoughts got better." She explained the gly-
cerine as a sticky fluid and "when I was in the sanatorium tlic
nurse told me about saving sexual fluid in a bottle and trying to
make AA^omen pregnant Avith it. [The horses' eA^es blinked as her

eyes blinked Avhen she was sexually excited.] I read 's book

on 'Advice to Young Men' and he said something about not marry-
ing a girl Avho Avould secretly jDeep through a curtain at bulls and
cows having intercourse. There AA'ere cattle near our house and
my sister and I used to Avatch them, but Ave never mentioned tlio
Avord 'bull' in our house because it Avas vulgar."

During her psychosis she had complained of her hands being
hot, and now she explained that it Avas associated with her mastur-
bation during pregnancy.

As the psychoanalysis progressed she spontaneously explained
the origin of the great round muscle lying on the floor with th(>
"stubby feet sticking out." When she AA-as pregnant she Avas
fond of playing Avith the uterus and feeling the kick of the baby's
feet through the abdominal wall. They felt "stubby, like an ele-
phant's foot." Her distressing thoughts about having torn her
infant to pieces were associated also Avith the fears of her labor.
She had learned that sometimes this Avas done in labor and Avor-
ried about the probabilitA' of haA'ing to undergo a similar expe-
rience.

Seeing her baby as a Avhite parrot Avas explained as folloAvs:
When her husband was stationed in Cuba he sent her souvenir
cards decorated with parrots. She was afraid she had become
pregnant after he returned and by taking medicine to establish
her menses she believed that perhaps she had had a miscarriage.
(The baby on the bough Avas an abortion.) The popular asso-

650 PSYCHOPATHOLOGY

ciation of cliattering, imitative babies as parrots must also be in-
cluded here.

The affective value of many of the grewsome hallucinations
that had distressed her for many weeks now became clearly appar-
ent. They were the productions of a biological struggle to castrate
or abort the uterus and its contents in order to save the remainder
of the personality from destruction. She stood on "tottering
legs" and had been "nagged to death" over her maternity by her
inconsiderate families.

The patient made remarkable progress in the recall and anal-
ysis of the content of her psychosis and the understanding of her
affective cravings. (It is almost a universal tendency in the grave
psychoses for patients to "forget" all the disagreeable details
they possibly can and smooth their difficulties over only to find
that with the next stress the repressed affections break through
Avith more disastrous effects than ever.)

To make sure that her insight into her conflicts and tendency
to regression was clear I asked her to write oiit her estimation of
her case, part of which is quoted here. "One part of me would
say, 'see what you've done! You'll be punished for this!' And
would thoroughly frighten the other part of me and perhaps it
Avas the self-scolding that started 'the make-believe-you-don 't-
know, make-believe-you'-didn 't-do-it. ' One part took great delight
in the scolding and beating the other part around the bush. And
the second part was fond of dodging and scheming and getting
aAvay from the scolding and making the get-away caused the fool-
ish giggles I think. I would preface everything with ' Oh, wouldn't
it be funny if such and such a thing could and would happen — (for
instance if there could be an old Mother Time and I could be she)
or if I could be Mrs. Gargantua and eat the world up. ' But being
'Mother Time' would mean that I'd have to go on unceasingly,
forever and forever — through all eternity — then having come to
the end of eternity would have to start all over again, for there is
no end to eternity and I'd be so tired. Had this in mind when I
remarked that I seemed to do my best to jump from the frying
pan into the fire. ' ' (This was an occasional remark she made while
having the fancies of returning to the intrauterine state.)

Her general attitude was now so satisfactory that she was
permitted to go home and return several times a week for the psy-
choanalysis. Several days after she had been living with her

CHKONIC HEBEPHEEKIO DISSOCIATIOK 651

husband in her father's honse she brought the following dream
and its analysis, which she made herself.

Dream : I was chasing around a high granite house looking
for a broom to sweep the pantry with. The great pillars made
dents like rooms. When I found the broom it Avas worn out.

Analysis: Chasing around the house meant seeking sexual
gratification. The new broom [laughed frankly] sweeps clean —
my husband came home after working all night. Was like an old
broom, all worn out.

The patient's nurse was discharged (thirty-seventh week), she
was given complpte freedom to do as she pleased. From the time
the patient returned home, her sister had conflicted with her when-
ever the patient asserted her independence. During this conflict
the nurse was retained for an extra month becaiise the patient's
sister was in an anxiety state, about the patient possibly commit-
ting suicide. The sister insisted to me, with a vigorous display of
anger, that she had to "protect her responsibilities" and did not
"care a hang" what the patient did about it.

A few days later the patient had to oppose her hiTsband's
mother, who was trjdng to influence him to change his work. The
importance of making the first year of her return to the household
one of sincere welcome and comfort had been carefully discussed
with her husband and he generously agreed to adapt himself to his
wife 's wishes. I hoped by this measure to make him feel also that
as a woman his wife 's interests were to be considered preeminent
to his mother's.

Unfortunately his mother could not accommodate herself to
their plans and strongly opposed them. The patient dreamed:
"W — 's mother was saying good-bye on board a ship on a long
gang-plank and embracing W — . I had been waiting for W — and
I thought it a good time to get away and I ran down the plank to
get away." She brought the following analysis mth the dream.
His mother wanted him to take a position in a foreign country.
(This would have been very undesirable for the patient.) "You
see before I married I expected to work out things for myself but
his mother is an old "but-inski," and so when I ran away from
them and the baby Avas drowned I escaped my troubles." The
night of the above dream she also dreamed that she saw her sister
and her baby drowning in a shower bath.

This incessant, miserably petty struggle betAveen the two fam-

652 I'SYCHOtATHOLOGY

ilies and her husband did not cease. Although the exasperating
persistence with which the older people tried to work out this
young woman's plans was finally slightly checked, it has by no
means, within two years, assumed the proportions of sensible con-
siderateness.

About two months after the discharge of the nurse the pa-
tient's fears were realized and she became pregnant despite pre-'
caution. Although she was urged by some members of the fam-
ily to submit to a hysterectomy and be contented with one child,
she decided the matter for herself and made it plainly understood
that she was delighted with her prospects for another child. All
she wanted was a fair amount of consideration for her wishes
and material needs.

During this period, when her relati-\-es were again trying to
mold her against her desires and her husband could not free him-
self from the direct influence of his mother, she had several dreams
of being on the stage and at work, and had strong wishes to sever
her relations with his family.

Two years later: This patient has two fine children and is
trying to work out her life plans to her heart's desire, despite the
resistances that she has to deal with. ^Tien she began to recover
from her psychosis her husband spontaneously promised to ab-
stain from gambling and alcoholics, but now he has resumed taking
an occasional drinlc which disappointed her but not grievously.

When I discharged her she seemed to be uncomfortable about
two things — inability to find a religion that was not free from
dogma and hypocrisy, and a feeling that her education was not am-
ple. She made a special visit to ask me if I believed in a personal
God. My indefinite reply, made with the object that she should
formulate her conception for herself, I have always regretted. It
was, I have always felt since, the one point in the psychoanalytic
procedure where I should have crystallized things for her so that
she might feel optimistic. My position in her life, due to the al-
truistic traiisrci-enco, made this essential, but I had not quite
grasped the full importance of its sublimating value in her case.

Her husband has not changed sufficiently to make me feel as-
sured about the solution of their mating problem. Although he
is attentive, sincere and "faithful to her, and she is a devoted, af-
fectionate woman, he shoAvs a constant undercurrent of criticism
and displeasure about her diet, tendency to become heavy, dressing

CHKONIC HEBEPHEBN30 DISSOCIATJON 653

carelessly and lier personal style, lie can not renounce his at-
tachment to his mother and his work does not permit him to have
a psychoanalysis.

Her feelings of inferiority about her education had to be given
serious consideration. Her education had been badly supervised
and her conception of her fitness as a woman was not at all com-
mensurate with the magnificent affections of a practical nature
which were natural to her. She had become more of a woman in
her sympathies and insight than the average social light. Her in^
sight into the affective mechanisms of those about her was unusu-
ally keen, and yet gracious and not critical. Among her friends
she was delightfully amusing despite her feelings of inferiority.
To meet this inferiority, upon advice, she read biographical
sketches of famous women and reacted A^dth the conviction that
much of her suffering had been due to her suppressed, censured
existence. She determined to join the movement for woman's
emancipation. This was very encouraging and, although I could
not frankly urge as much to her, forseeing her husband's resist-
ance, I explicitly insisted to him that he must not suppress this
but shonld support her. He quite agreed Avith me, but a year later,
iipon a visit to their home, I found that he had been unable to com-
ply. He had suppressed this most encouraging adjustment and
Avas tending even to further remodeling pressure with no little
irritability.

Two years after her discharge, despite the critical pressure
of her people, she was asserting herself according to her oa\ti
judgment. She met their arguments Avith the unshakable convic-
tion that first of all she must use her own judgment because her
physician had insisted upon it and she did not care what they
had to say. She could not please everyone, and no matter what
happened, she kncAV that her physician respected her personal in-
tegrity and sincerity.

Possibly this reliance upon me Avill gradually force the fami-
lies to quit criticizing by discouraging them. I feel that in such
problems the patient's considerations must come first.

The manner in which she managed her second pregnancy and
conducted herself and household is very encouraging, although
she has openly stated that if any hopeless family estrangement
should ever occur she would commit suicide.

The committing of suicide Avould of course be equivalent to a

654 PSYCHOPATHOLOGY

final regression to the eternal mother : the intrauterine regression
was the most predominant interest during the period of dissoeia*
tion of the personality. (See the "Isle of the Dead" by Boecklin,
Fig. 29. The suicide's effort is to return to the ancient state of
intrauterine dependence.)

The mental confusion, that is, the flood of distressing delu-
sions and hallucinations through which she passed, was caused
by the repressed affect becoming uncontrollable and dissociated.
The distressing elements in the content of consciousness, such as
the abortion and prostitution fantasies, horrifying as they were,
were nevertheless wish-fulfilling.

Her psychosis may be regarded as an episode of confusion in
her biological struggle. The nature of the affective dissociation
and regression, as revealed by the hallucinations, was quite charac-
teristic of the so-called dementia prsecox type. The nature of her
recovery and insight I believe was entirely due to the psychoanal-
ysis, which, in turn, was dependent fundamentally upon the nature
of the transference that she required.

It is important for the physician to recognize when a patient
is tending to make an affective regression to a lower integrative
level, because nothing but an adequate transference can prevent it.
When the person upon whom the patient is most dependent for
sympathetic encouragement can not respond to the situation, be-
cause of death, marriage, selfishness, unconscious resistances, or
disinterestedness, it is necessary that a physician be engaged
whose personality and insight are so constituted as to enable the
patient to develop intelligently an affectionate transference to the
physician, which, however, must plainly have only an altruistic
purpose.

The following cases are typical of the mechanism of affective
regression to an infantile level because the conflicts attending ma-
turity were too severe and the form of transference conducive to
maintaining mature interests is lost.

Case IiD-2 is a slender little woman of thirty-eight, unmar-
ried, who had a common school education and later worked as a
domestic. She developed a psychosis at twenty-six, two years
after her mother's death. The psychosis was characterized by a
sudden onset, long period in bed, the refusal of food, passing of
excreta in bed, indifference, hallucinations, feelings of inferiority,
and a tendency to adopt her nurse as "mamma" and follow her

CHRONIC HEBEPHRENIC DISSOCIATIOK

655

constantly about the ward like a child. She talked of her worries
about her mother and her ability to communicate wdth her parents
in "heaven" (wish-fulfilling hallucination). The nurse and a
woman physician were adopted as mothers by her.

Mg. 63. — Regression to intrauterine attitude and dying followed hj reconstruction

to this early childhood level.

She developed the facial expression and affective attitude of
a little child. Eleven years after her psychosis (age thirty-eight)
she still claims to be a baby, uses baby words, baby pronunciation

656 PSYCPIOPATHOLOGY

and carries a large Teddy bear about witli her. day and night.
(See Fig. 63.)

She says, in a baby's voice, that she has always been a baby
and never grew up. Although one brother is younger than she,
she says he was never the baby. She tells with pleasure that she
is now awaiting the time of her death when she "will be Avith
mamma in heaven."

No physical anomalies Avero noted upon examination. Her
memory and general orientation are excellent.

Case HD-3 was a very affectionate, attractive girl who had
many friends and a wide variety of social interests. ^Vhen she
was nine years old, an older brother coerced her into sexual play
and the moral compensations later became the foundation of undue
aversions for functions pertaining to sex.

At twenty she married an effeminate man of about her height,
five years older than herself. He had a strong affective attach-
ment to his mother, was rather erotic, tense and inclined to be
irritable. He regarded her as sexually frigid althoiigh willing.
She resented his tendency' to favor his mother above her and an
uncompromising situation developed in which she and the mother-
in-law avoided speaking to each other for a year or longer.

The patient was a sincere Catholic and protested when her
husband insisted upon an abortion the first time she became preg-
nant. She finally took some "pills" for this purpose, which, how-
ever, were ineffective and the fetus was delivered vnth instruments
at full term but only lived nine days. Her reactions of remorse
were serious, but finally she succeeded in smoothing the situation
over, although she held herself responsible for the death of the in-
fant because of the drug.

Fourteen months later she gave birth to her second son and
seemed to improve finely until the eighth day when she showed
considerable anxiety about something Avhich Avas not understood.
On the ninth day she began to talk about her first infant (died 'on
ninth day) and mentioned its nanio. She had premonitions that
something serious was going to happen and asked to see her
mother-in-law. Unfortunately an understanding AA^as not only not
effected, but the situation Avas, as usual, decidedly aggravated.
(The physician probably did not grasp the serious incompatibility
alwavs to be found in tAvo Avomen avIio demand the first considera-

CHRONIC HEBEPHRENIC DISSOCIATION 657

tions of one man, even if he is the son of one of the women. The
mother-in-law mnst step back or the situation is hopeless.)

The patient now became confused and rapidly developed a
delirium. She said she mnst sacrifice herself and added something
abont "the devil." She seemed to be obsessed with feelings of
sinfulness and confessed the sexual transgressions of her brother
for which she seemed to feel she AA'as responsible. She had another
secret. She said her husband was the Father, Son and Holy Ghost,
and Grod was the Father and she A^-as the Virgin Mary. She called
frequently for her first infant.

She was finally admitted to St. Elizabeths Plospital in a very
toxic, delirious condition. She tossed restlessly from side to side
iu bed, tongue coated, breath foul, eyes staring, and was unrespon-
sive to questions. At times she rubbed her hand along the wall
and then kissed it. She had to be tube-fod, was disoriented, and
persisted in misnaming the nurse. A few days after admission she
began to talk incessantly. The stream of thought Avas disconnected
and not influenced by the environment but tended to refer to her
affective disappointments, her husband, and persistent feelings
that she had to leave him. In the continuous bath she spoke of
snakes, bedbugs, negroes, and thrcAV the pilloAv out of the tub,
because it was a "negro." She wrote several letters filled Avith
vulgar sexual phrases, references to feces and her love for the
nurse.

The delirium continued for nearly a month, during which she
gave birth (simulated) to tA^dns, tAA^o boys, instead of one child (a
compensation for the dead child).

Then she improved gradually, became oriented, helped to
nurse other patients and seemed to be readjusting A^ery Avell, al-
though she still had hallucinations. Unfortunately her narcissistic
husband did not vnderstand her, he really could not be made to un-
derstand her, and could not give her the affectionate consideration
she required, because of his mother-attachmevt. He tried to be
Jiind, but ivas stiff, proud, insistent, even haughty, and was unable
to develop the slightest comprehension of his affective influence in
the situation. He AA^as adAased not to Adsit his wife, but his unrea-
sonable persistence had to be yielded to occasionally although it
Avas regarded as an ominous risk because she so frequently asked
her nurse to tell her the truth about whether or not she might get
Avell. She Avas afraid she never could, Avhich Avas regarded as an in-

658 PSYCHOPATHOLOGY

dication of the perniciousness of the regressive reaction to her hus-
band's attitude. She was, however, playful and kind. The crisis
came at an unguarded moment. A profound affective regression
occurred and she has remained fixed in this condition for nearly
four years.

Her husband would never share his responsibility for the epi-
sode. He used the defensive phrases that people usually use when
they want to avoid responsibilities. He simply forgot most of the
things he said while they were in the hospital parlor together. He
said he did not notice anything unusual about her behavior. "V\Tiat-
ever disappointment the patient experienced, she returned to the
ward and cried like a broken-hearted girl. She soon passed into
an excitement, destroyed her clothing, rubbed saliva over her arms,
put food into her mouth, spit it up and ate it again, became mute
and masturbated excessively. Later the frequency of the mastur-
bation subsided and she assumed the fetal position under blankets
which she placed on the floor (mother earth). She would not lie
in bed. She preferred dark rooms and when anyone entered she
rolled over and over. On the open ward she turned ' somersaults
over the furniture, exposed herself, and crawled into dark corners.
She has remained almost consistently mute since the episode in the
parlor.

She was fond of resting her hack against the electric light
switch and turning on the light. Sometimes she assumed the fe-
male sexual position on the floor and then assumed the male sexual
position and imitated coitus : she usually left her slipper in the
office when she started to leave. On one occasion, when asked to
write out her troubles because she would not speak, she drew an
eagle among the clouds for me and when she handed back the pen-
cil, cleaned it off as if it had been soiled by her hands.

For several days at a time she had periods when she crawled
about on all fours, barked and grunted like an animal. She Avould
not eat in anyone's presence and mixed her foods into a homoge-
neous mass on the floor and only ate part of it. She also played
with her excreta and rubbed urine into her hair. (Excretory
erotic interests were very active.)

She grabbed her sister's wrist watch and swallowed it. It
was recovered later and then she tried to swallow her nurse's
watch. (Probably a pregnancy substitution, as the ticking, watch
may symbolize an animated object. One is inclined to feel that the

CHRONIC HEBEPHRENIC DISSOCIATION

659

affective craving to have the first child return was partly gratified
by this as well as by fancies of its rebirth.)

The patient was finally taken to her home for several months
and nursed, but failed to respond.

Since her return to the hospital she Avill not wear clothing,
but tears her dresses, wraps them around her body. like a blanket,

Fig. 64. — Prehistoric Costa Biean sculpture showing squatting, ape-like posture
with genitalia displayed to the foreground. Compare with squatting postures of
hebephrenic deteriorated types on next page.

sits on the floor for hours with her head buried in her arms and her
knees pulled up to her chest — a very common dementia prsecox
position in which such patients freely play with their pelvic ori-
fices. It is also a position very common to apes and savages. (See
Fig. 64, a decidedly fetal position.)

660

P.SVGHOl'ATHOI.OGV

She now calls her nurse "mamma," and occasionally talks in a
playful, childish voice, sings childish songs about school days, begs
to be loved, petted and fed, but most of the time she is mute, de-
structive, plays with excreta and masturbates openly.

She complains of having died and says her baby was killed on
a railroad track.

Kg. 65. — No. 1 shows the primitive ape-like posture with erotic facial expres-
sion. No. 2 shows a similar bodily posture with significant differences in posture of
the arms and head which is more like the affective attitude of intrauterine regression.
While in this mood patients often insist they are dead.

Previously she menstruated regularly every two weeks, but
since the psychosis the menstrual functions have been inactive.
Her prognosis is hopeless, I believe, not because of her present
affective disposition, but because of the insurmountable resist-
ances in her husband and his mother to the affect readjusting at a

CHRONIC HEBEPHRENIC DISSOCIATION

661

higher, independent level. Her religion and the law prevent a
divorce which' might permit the repressed affect an opportunity
to adjust itself along more constructive lines.

The following group of hebephrenic dissociated personalities
has been selected to illustrate further the influence upon behavior
and character formation of the repressed, dissociated anal erotic

JTig. ti6. — Ape posture in excretory erotic liobeplirenio dementia prseoox — a dis-
sociation neurosis with regression to infantile level and abandonment to pelvic
segmental cravings.

(sodomistic) cravings, and the fascination for the excreta. The
peculiar stupor which patients are inclined to develop while in an
anal erotic tension is decidedly worth more detailed investigation
in selected cases. Two of the preceding cases showed marked
interests in the excreta, but the following group showed predomin-
ant interests of this nature Avhen in the depths of the psychosis.

662 PSYCHOPATHOLOGY

As the obverse corollary to the hoarding of the seclusive anal
erotic miser, who must accnmnlate material in order to prevent the
visceral anxiety that comes on when he f eel-s that he may lose his
wealth and possibly not be able to provide the alimentary tract and
its outlet with sufficient stimuli, we have the case of compulsive,
anxious cleansing to remove the guilt of the incestuous anal erotic
craving (Case PN-1), and the opposite types, who delight in ac-
cumulating debris, reducing their clothing to loose rags, and
spending their time in trying to defecate. At the same time the
latter type have very active sodomistic tendencies toward their
companions. The typical miser and the mysophobic patient are
self-centered and seclusive, whereas this other anal erotic type is
more inclined to companionship and revelling in waste and debris,
hoboism and irresponsibility.

Case HD-4 was a large, well-muscled, almost brawny, sailor,
6 ft. tall, weighing about 180 lbs. He was twenty-six years old,
unmarried, and had never had a love affair with a female. He
had a large masculine figure, no deformities, and a heavy distri-
bution of hair. His genitalia were well developed and no stig-
mata or indications of physical inferiority of the gross type were
detected. His forehead gave the impression of being a little lower
than normal, because the scalp grew closer to the eyebrows than
usual. His head, however, was actually of good height and breadth.
He was an excellent example of that group of men who are physi-
cally better sexed than the average man, but, becaiTse of their af-
fective development, are not truly matured males.

He had had no serious diseases except gonorrhea. Syphilis
was denied, and his blood (Wassermann) reaction was negative.
He had been inclined to delight in alcoholic debauches, and had
one scar over the left hip from a stab wound received in a Mexi-
can gambling house brawl, and another from a bullet wound in the
leg acquired in a saloon fight. (When drunk, he was inclined to
become brutal and quarrelsome, which is rather a significant in-
dication of old repressions of hatred.)

The family history (inadequate) obtained from the patient
revealed no neurological or psychopathic determinants in his he-
redity.

The patient was born in a rural district of Tennessee in 1888,
developed normally as a child, and had no serious illnesses. He
attended a southern eoimtry school intermittently until sixteen

CHRONIC HEBEPHRENIC DISSOCIATIOH 663

years of age. This gave him a meager education. As a pupil, he
was indifferent.

He worked on a farm with his father and conflicted frequently
with his parents Avho evidently did not understand him. This was
disposed to make him brood and sullenly resent their impositions
and punishment.

lie refused to Avork with his father because of their quarrels
and obtained little sympathy from his mother. With uncontrol-
lable affect of grief and facial tremors he commented, when a pa-
tient, upon her, as follows : ' ' My mother had no use for me when
I was a child. She loved my brother and sister * * * Tliey
[not a reference to parents] used to get her under control and she
would whip me. * * * j have no use for my mother and would
not go home if she were living."

At seventeen, he ran away from home and travelled with a
circus as an assistant to an animal trainer. He wandered about
the Southwest for several years working as an unskilled laborer,
earning from $40.00 to $90.00 a month. At twenty-one, he enlisted
in the navy and served for three years, receiving an honorable
discharge as a third-class gunner's mate.

At this time he inherited $1800.00 from liis parent's estate
which was totally lost when a boarding house which he had es-
tablished, was destroyed by fire. This misfortune discouraged him
seriously and for several months he wandered about the Pacific
coast doing odd jobs in lumber camps, judging from his behavior,
apparently in a very abnormal frame of mind.

During this period of anxiety he reenlisted in the Navy, (aged
twenty-five). As he expressed himself, he was "afraid that they
would break me down and get me into trouble." "They," he said,
followed him over the Pacific coast. He was actually undergoing
a grave biological struggle into which he had no insight.

Three months later while on board ship he was observed to be
acting "queerly" and spending much of Ms time reading oriental
books of mystery. A few days later, he threatened to shoot some
of his companions whom he accused of persecuting him. He tried
to obtain a revolver for this purpose and attracted the attention
of the officer in charge. "When questioned by the medical officer
he broke down completely and, with uncontrollable affect, ex-
plained that he, himself, was a "beast." He also repeatedly
told his comrades that he was a "moral degenerate." (Evidently

664 PSYCHOPATHOLOGY

the "they" who would "break him down" had succeeded despite
his pathetic, earnest attempts to transcend them by reading orien-
tal books about the development of occult mental powers. The
"they" were his irrepressible homosexual cravings as will be
shown later.)

He was sent to a naval hospital, and became panic-stricken
because "someone" had told him that he was to be "hung." Be-
cause of his feelings of impending punishment, he tried to escape.
After several weeks of terrifying hallucinations, he gradually be-
came indifferent to work and spent his time in listless day dream-
ing. He talked freoly about his super-human powers to anyone
who would listen and now elaborated them without reserve.

He was admitted to Saint Elizabeths Hospital (aged twenty-
six) about seven months after his personal difficulties had devel-
oped to the degree of a psychosis. In its essential characteristics
the psychosis had not changed after the acute stages of the panic.

Upon admission, he performed the routine intelligence tests
very well. (This accomplishment reqiiires control of attention and
fairly accurate recall of details for past and recent experiences,
but very little education.)

The patient showed clearly, by his affective reactions and
fancies, that he was seriously troubled by grave, personal deficien-
cies. Their nature became apparent later in the study of his case.
He derived great comfort out of his fancies that he was a super-
man. Those who feigned to believe him, he liked, those who
doubted him, he tried to convince of his powers, and those who
criticised him were hated. It pleased him greatly if one paid some
attention to his fancies, abstracts of which from a series of talks
are given with some detail here. (The fancies, through the tend-
ency to develop the opposite in order to hide the painful weakness,
often indicate the personal deficiency (Case MD-11).

"Every so often someone is born with these [his] powers,
which are controlled by the spirits that rule the universe, and a
person so gifted is compelled to iTse his powers or else he is put to
death. [Death, meaning the destruction of the virile traits of the
personality, is very commonly so used by such patients.] If, on
the other hand, they use these poAvers, they are condemned to a
life of trouble. ' '

"I was father of all the people. [Omnipotence and perpetual
power fantasy.] I built the Panama Canal, naval hospital at Brem-

OHROSriO HEBEPHRENIC DISSOCIATION 665

erton, including ships, maciiinerv, big guns, and about everything
in the world. ' ' He was fond of talking about his (fancied) friendly
relations with the commanders of various vessels and how they
Avere awed by his superhuman wisdom. He said he had studied
"metapathiwn [metaphysics] ivhich ieaches a man to contract un-
seen forces and coinmimicale with 'people,"

He was convinced that there was no need of his again trying
to overcome the mysterious, all powerful forces which were trying
to "pull me down," "break me down," and anyone who tried to
lielp him, he said, was in danger of becoming the same way. With
a marked display of affect and sincere pleading, he liesought me
to give up his case and not try to help him, because if I did I would
surely become like himself. He had developed, after several
months, a strong transference to me, and this anxiety was quite in-
dicative of the undercurrent homosexual feelings that were react-
ing to my personal interest in his difficulties.

"A man has got to get where he don't realize his surroundings,
but at that time I would be in a helpless state. When a man tries to
concentrate his mind to get into a higher form of life, that is when
thejj try to harm you in many ways * * * * jj d^ j,,^,, eovhJ
irorh himself up hic/h enough lie could co)iirol himself." (Com-
pensate sufficiently. )

(The above comments, when theii became inlelliciible, proved
to be most significant and revealed lus biological difficulty, shoiving
in a sense the insight, that if a man could develop himself to a high
enough biological level, he could cotiirol liimself from the tevdency
to relapse to adolescent and preadolescent sexual interests. This
man's hint led to the investigation of the secret of the paranniac's
grand compensation, presented in the chapter on the 2^aranoid type
— namely, his struggle to reach a biological level that at times he
can vaguely feel but can not qiiite attain because of the conditioned
sexual cravings.)

For five months, he was indifferent to the other people about
him, many of Avhom were sailors of his own age. He rarely quar-
relled with anyone and was not sensitive about his honor. He was
rather sluggish and enjoyed himself best when lying on a bench
■with his face covered, lost in dreams. He worked well on the ward
so long as urged and flattered. AH his discussions were giA^en with
an attitude of deep confidence in his wisdom.

The attempts to convince him, made by the Avard phA'sician,

666 PSYCHOPATHOLOGY

that he was not being persecuted were met by vigorous assertions
that his difficulties were real. The defense was often accompanied
by marked agitation. He felt his case to be beyond help and never
seemed to vary from this opiiiion. Because of this he was consid-
ered to be incurable.

Further than relating fa,ncies about his omnipotence and per-
secutions he was not inclined to be accessible. There was consider-
able repetition and rambling in. his discussions which are included
in the history in as intelligible a sequence as possible.

The "absurd, discouraging" ideas of the patient, as some of
the physicians were inclined to call them, which he discussed with
so much conviction, later proved to he figuratively or symbolically
true, although not literally so, as the patient himself had main-
tained them to be at the first. They contained the biological se-
cret of his life, into which he had to gain insight in order to make a
more practical adjustment.

For several interviews the frequent inquiries into his difficul-
ties yielded nothing more than heroic fancies and expressions of
the following type, but they were usually accompanied by marked
aifect: —

"When I was twelve I was in Tennessee. A man named -?;fa^-=
had his legs cut off when in Saint Louis. He was only ten

or eleven. He was a nice lad. They tried to do something with
him but could not. Then I gave him his leg back. I thought of
this just a few days ago. " (Perhaps a figurative castration fan-
tasy which may be conipared with the definite castration fantasy
given later.)

The following example of his mysterious fantasies was woven
into his account of his confinement in a hospital: "When the
guard who had taken me to the hospital had returned to his ship
I was there. They asked me how I managed to get back so soon
and I told them I had returned to the ship by wireless while they
had to use the train." When asked to explain what he meant by
getting back by wireless, he said: "I used the word 'wireless'
merely as a figure of speech, but I meant that I was already on
the ship. Although I had gone to Uldah, California, I had Tiever
left the ship."

As in all such cases it is useless to attempt try correct such
glaringly inconsistent statements.' It only provokes indignation
and further inconsistent statements when the physician attempts

CHROKIO HBBBPHEBNIO DISSOCIATION 667

to force the patient to recognize his falsifications. A more suc-
cessful method seems to be to patiently listen to the seemingly in-
exhaustible supply of fancies, and, as the patient gains more con-
fidence in his physician's purpose, more intelligible personal sto-
ries are related. He often told various physicians and patients at
this time that if he could concentrate his mind more thoroughly he
would have enough power to pass oiit through the roof and trans-
fer himself instantly to any distant land. This naturally aroused
no little impatience in busy members of the staff, and their severe
but well meant criticisms of his "nonsense" insulted the patient
and he soon learned to keep his fancies and diflficulties to himself.

"When he found his fancies were listened to with patient so-
briety he felt encouraged to elaborate those about mental concen-
tration and astral flight. Although disconnected, they give at least
an impression of the numerous unintelligible difficulties to be met
with before the truth will out.

""When a man thinks — they claim when he lives this lower
life they call that thinking. I '11 try to explain it differently. Sup-
pose a man has three bodies, a material body, an astral body and a
spiritual body. It is hard to maintain this body without food.
My enemies try to make me live this body [the material]. The
spiritual body is one no one can explain. The astral body is an
imaginary body, is not material, but it is a body, that is just about
all [everything] ; there is no limit to space or time. You are just
as old as God, as anyone else. ' '

The spiritual body was passed by with the remark, "No one
can explain. ' ' The discussions of the material body revealed that
he felt it to be controlled by "they," "those people," "my ene-
mies," which try to "keep me down, — ^make a brute out of me."
He escaped from these unhappy cravings by developing, through
"concentration," the "astral body" or bodies which were onrni-
potent and omnipresent, if estimated by his fancies of their deeds.

He avoided, for a long time, discussing freely the unpleasant
difficulties of ' ' the material body ' ' or the lower self, and delighted
in the omnipotent traits of his astral self.

"When I quit thinking I can he made to do anything." He
often referred to this state as being made "mentally thick" (stu-
pid.) "You see, to do that, I must forget everything. After I
make myself strong I cannot be influenced. ' ' He often talked about
the "concentrated" or astral state's achievements in the past.

668 PSYCHOPATHOLOGY

Eidieule of it had taught him not to attempt any further explana-
tions. He earnestly claimed that at one time he could make several,
even a dozen, astral bodies, and delighted in relating their potent,
heroic achievements, such as building canals, ships, railroads, etc.,
but, particularly, detailed accounts of their heterosexual conquests,
and the plan to get married because then "they" would let him
alone. (The number would be astonishing if the males and fe-
males were knoAvn who marry with the desperate hope that hetero-
sexual intercourse will free them from homosexuality and mastur-
bation. Sadly enough, physicians are frequently inclined to rec-
ommend such procediires under pathological conditions.)

During the conference in which the fancies about the value of
the marriage of the astral self was discussed he made his first con-
fession of his past heterosexual difficulties, although the difficulties
of the material self had been quite frequently referred to. Pie
told of his attempts to have sexual relations with a prostitute and
how "they" (the mysteriously destructive forces) fought him and
made it difficult for him to ' ' concentrate and have an erection. ' ' He
finally succeeded in having sexual relations, but felt no pleasure
or passion, as he expressed it. He said he made this effort because
if ho got into trouble people would think that he had tried to live
rigM. (Heterosexual potency and the higher life.)

From that time on, the patient's transference was such that
he allowed me to remind him of Avhat he actually meant by coji-
centrating to attain omnipotenco and live a higher life. As this
insight developed he tended to abandon his wild fancies about the
astral self.

Patients who persist in their striving and hope to attain
heterosexual potency delight in fancies about promiscuous hetero-
sexual conquests. This ignorant sailor gave a detailed account,
with great pleasure and earnestness, of how, Avhen he Avas fifteen,
college girls lived in a house for his pleasure, and tried to make a
"Brigham Young" out of him. (This was probably a recasting of
his old masturbation fancies.)

The patient usually showed considerable affect, and even anx;^
iety, when he discussed the process of his mind "getting thick"
and ' ' forgetting everything. " " They keep fighting me all the time.
If I were discharged [from the hospital] they would keep right
after me, get me restless [erotic] and get me into a state of not
thinking. Then one is Aveak and they use him. I have never had

CHRONIC HEBEPHRENIC DISSOCIATION 669

rest. That lias been the one thing in the world that I have been
looking for. Now I am as helpless as a babe. These people make
me live the life of a brute."

"When a man tries to do well they fight him so much that they
tear his mind up and wear him out." He complained of his strug-
gles to live the higher life (heterosexual), but that sooner or later,
when he tvas not on his guard, he luould suddenly become "thick"
and "mean" and while in this state of covfitsion lie would he com-
pelled to commit sodomij.

During the analysis ho related this dream: "Trees, fruit trees,
chestnut trees in full bloom in June. Snow all over the trees
[trembles]. ^Vt that time they were going to use me and I awak-
ened." (To be used meant for homosexual purposes.)

His discussion is given here in part : "The snow destroys the
crops, is cold." (He was unable to practice coitus and was unable
to feel passion.) When "they" use him, he said: "They make me
quit thinking and confuse me with ideas of sodomy." He main-,
tained he did not realise ivhnt he was doing at such times and could
only give a vngtte, account of what happened. His description of
his behavior, although colored trith fanci('s, teas decidedly like the
behavior of some confused epileptics while suffering hallucina-
tions and fears of being assaulted.

When his accounts of his sodomistic tendencies became less
guarded, he said, with great agitation, that he was not only forced
to live like "a brute" but also something Avas trying to make a "c.
s." out of him. Unfortunately, just as he was confessing these
difficulties, the discussion was interrupted by a knock on the office
door. I was not again able to obtain a reference to his oral erotic
difficulties although he frequently discussed his anal eroticism.

After I succeeded in having the pleasure principle recognized
in his homosexual submissions and aggressions, he became less
inclined to shunt the responsibility onto an impersonal "they"
and accepted the inclinations as his own. This seemed to be the
most important step toward a more healthy readjustment of his
conflict, which, however, I believe, never entirely disappeared and
may be expected to recur later in life Avith grave mental conse-
quences.

The following fancies, at first seriously given reveal the mech-
anism of the compensator}' striving to avoid this cause of fear.
He discussed the inclination of the second cruise men (old sailors)

670 PSYCPIOPATHOLOGY

on his sHp to kiss the soft skinned, effeminate boys who were in
the crew. Then he told of how he himself transformed "a lady"
(effeminate boy) into a blue jacket, and kept "her" for some time
on board ship, practicing sodomy with "her."

The pleasure fancy was expressed as follows : "She said, 'they
put me here for you to use me so you wouldn't get into trouble.' "
He was fond of giving imaginary quotations about being called
"father" by his sexual objects. He quoted them as saying Avith
awe, "Father can do anything." With this phrase he frequently
diverted to heroic stories about making wonderful machinery, etc.,
or vanquishing an enemy. He had an enemy in sailor C — who was
at one time a drinking companion and probably a paramour. He

tallied with great affect about a quarrel with C and af how he

smashed a plate over his head. Then he put the pieces together
and the fellow called him "God" and "Father" and marvelled at
his great powers and ability to "do anything."

' ' People have always called me father all over the world * *
Hate, fear and worry are the worst enemies of man. I know they
will be forgiven, when I know enough to let the devil let me alone.
I know the spirits. I know Mother. She is mother to the world.
She is in heaven. She is everyone's mother, not that one I had on
earth," (said with emotion).

This patient's fancies about having superhuman power when
he could concentrate, Avere intimately based upon his struggle to
establish heterosexual potency and be socially respected. His
strivings to escape from the influences of the "they" which make
him homosexual, commit sodomy, etc., were his biological struggle
to develop adult male sexual attributes. Whatever conditioned the
homosexual fixation was not analyzed, but is indicated in the fol-
lowing :

When his sexual difficulties were frankly considered in the con-
sultations, he talked of influences to which he had not properly ad-
justed when an adolescent. "I used to go to bed Avith my trousers
on, so I could not put my hand on my privates. At night, they used
to fight me. They would malfe me think of haAdng intercourse with
women. ' ' This account of his early difficulties may be more or less
true, but at least it established the "they" as a personification of
his sexual cravings.

To the masturbation discussion he added the fancy, perhaps
partly true, that when fifteen he helped a man to escape from the

CHRONIC HEBEPHRENIC DISSOCIATION 671

eommunity. "They" were trying to make a masturbator out of
him, and if he did not quit they would cut his testicles out. Later,
they cut out his testicles but healed him up. (The self -cure of
masturbation by castration is not imcommon.) Upon another oc-
casion he related the same story about this man and included that
his grandfather had warned him not to associate with the fellow
because he was a "c. s." "They," however, made him associate
with the man and he "cured" the fellow by teaching him to "con-
centrate his mind."

During the psychosis he would not recognize his brother's let-
ters and was inclined to regard him as dead. He gradually re-
sumed an interest in his family and the realities of life. He
disposed of his fancies as something he would no longer discuss
because it Avas "foolish," although at times he intimated that he
still tended to solve his troubles through mental concentration.

Seventeen months after the onset of liis panic he Avas dis-
charged from the hospital as a social recovery, because of his con-
genial attitude and the fact that by Avorking he demonstrated his
ability to take care of himself.

This man's explanations of his mental state of becoming
"thick" (confused) by the pressure of the anal erotic cravings and
his tendency to get into fights and become "a brute" possibly
throws a significant light on some types of epileptic personalities.
It is Avell known that epileptics may become A-ery abusive and cruel,
and even commit horrible erotic crimes, while in the epileptic con-
fusion.

A variety of reactions to anal eroticism are given here be-
cause they indicate that the fall and the conATilsions in some cases
of idiopathic epilepsy are related frankly to anal-rectal eroticism.

Case HD-5, considered to he a hebephrenic type of dementia
prcecox, had been seen submitting himself to sodomy with affec-
tions that made his anal eroticism unmistakable. One day when I
entered the Avard I saAv him standing alone near the center of the
living room. His eyes were staring, out of focus, his face showed
profound perplexity and his body seemed quite rigid. I advanced
and greeted him, but he did not seem to see or hear me. Suddenly,
his muscles stiffened, he swayed backAvard and fell at full length
on the floor in an epileptiform type of seizure. Although dazed,
he did not completely lose consciousness and got up within a few
seconds. Physically, this man's condition was excellent. He had

672 PSYCHOPATHOLOGY

occasionally approached me, trying to show, in a confused mum-
bling voice, that he was willing to do something, and seeming to
feel that I wanted him to do something. His perplexed emotional
state was largely due to an intense affective pressure (anal erotic)
.and the fall signified submission. He was several times ca%|iifin
sodomistic submission to other homosexual patients.

The inference as to the significance of the moral fall will cer-
tainly seem iinreasonable to those who have not made a definite
study of these particular phenomena; hence, the following case is
added to support the inference that such states of becoming "men-
tally thick, ' ' as Cases HD-4, PD-34 described their states, are due
to the autonomic-affective influence of this form of erotic tension.

Case HD-6, a sailor, about twenty-five, had passed through a
period of confusion with hallucinations. He was a dull, sluggish
type of fellow who had not fared well as a sailor. He seemed to
be dazed and sat about in stupid wonder at the behavior of the
other patients. His face looked dull, congested, and showed no
emotional response. No replies which were relevant to questions
could be elicited. He persisted in complaining that on board ship
he had not been considered a good f elloAV, and that now he wanted
to do whatever Avas wanted. Despite efforts to divert him, Avhen
his genitalia were examined, he persisted in lowering his trousers,
stooping over and turning his buttocks toward us. His mental
state of being dazed and bewildered Avas quite similar to that of
Case HD-5.

Case PD-34: (p. 526) protested for four years against the se-
cret powers that took his "senses temporarily aAvay" and forced
him to submit to sodomy (segmental cravings AA^thin himself).

The fall, if in a proper affective setting in the dream and the
psychosis, signifies sexual submission, and the conAnalsion, if it
then occurs, seems to be the orgasm and is as genuine as if it oc-
curred as the result of adequate irritations of the primary eroge-
nous zone.

A big, uneducated Swede ahvays greeted me with a smile Avhen
I arrived on the ward. If given an opportunity he usimlly asked in
a smiling way, (a pleasure and not a hatred smile), Avhy I Avanted
to hypnotize him. (I had no sucli interests in the patient.) These
approaches Avere later followed by complaints of suffocation dis-
tresses and feelings of "dying." (See Michelangelo's "Cap-
tive.") The climax came one day Avhen I AA^as on the AA^ard. He

CHKONIC HEBEPHRENIC DISSOCIATION 673

fell in a heap on the floor and "died." lie had to be put to bed,
and when I examined him he told me, with indications of no little
pleasure, that I was causing him "to die." The erotic nature of
the man's affective state could hardly be mistaken. A few days
later he looked upon me with beaming pleasure and seemed to re-
gard me with awe, as if the procedure had had some wonderful
significance.

The above case was considered to be both oral and anal erotic
and is presented to point out the significance of the fall and the
"dying" in certain cases.

Case HD-7 was a boy, soldier, Avho, when a class in psychiatry
surrounded him on the ward, became agitated. He had been in a
state of protracted confusion and decidedly destructive for several
Aveeks. He threw liimself at full length, face down on the floor and
Avept violently, blurting something to "God" about having given
up his ' ' soul. ' ' I-Iis confused erotic state, was typicah Two days
later some members of the class who were observing him, allowed
him, upon his confused, stiipid insistence, to enter the room of a
sick man. With much confusion he tried to show affection to the
sick man, exposed his penis and tried to undress. Such compul-
sions are common in this type of erotic state.

Case HD-8 was a sergeant in the army who resigned because
he believed that the men were trying to induce him to submit to
homosexual advances. '\^Tien admitted to the hospital he was very
erotic. When in the presence of patients or physicians he fre-
quently accused them of trying to tempt him, even though no un-
usual demonstration of personal interest in him was made.

In the examining room he complained of the attitude of the
physicians toward him aiid spoke of himself as being like Christ.
When the physician handed him a pencil to write he refused it and
accused the physician of having evil intentions because he handed
the pencil to him with the sharpened end pointed toward him. He
said the pencil should have been handed lengthAvise to him.

Later, he again accused the physicians of having sexual de-
sires for him, and turning his back, spoke of himself as being
Jesus Christ and said to them, ' ' Get behind me, Satan. ' '

This anal erotic man was a constant source of dissension
wherever he was placed. He had no 'insight, and AA^as inclined to
blame others for his difficulties. (In its mechanistic sense, this is
of course true because his autonomic-erotic functions react to the

674 PSYCHOPATHOLOGY

presence of certain types of men and he becomes embarrassed and
unoomfortable, perhaps anxious, and if very erotic, may even be-
come panicky upon loss of self-control.)

Case HD-9 was a patient on my wards in the Cleveland State
Hospital. He was extremely untidy, would wear almost no cloth-
ing, or old torn clothing, leave his shirt and trousers unbuttoned,
and keep the buttons torn o:ff (typical costume of the anal erotic).
He would spend hours at a time in the lavatory seated on the hop-
per. If the door to the toilet was locked, or he was prevented from
access to it, he would quickly get into a panic and Beg:; pitifully to
be allowed to enter.

Defecation was the one grand pleasure of his existence. Most
of his waking time was spent in making innumerable visits to the
watercloset. The expression of his full, dull, apathetic face ;g||ye
one the impression of stupidity and indifference to all other in-
terests, and a marked dementia.

Case HD-10 is recorded because of the striking indications of
unusual anal and nasal itching, her mannerisms, feelings of per-
secution, her intense hatred, cruelty and stealing.

She was admitted from a federal prison at twenty-three be-
cause of her violent temper and feelings of persecution by the pris-
on authorities, who, she insisted, were plotting "to shoot her"
and "cut her throat."

She was sent to prison twice for increasing the denominations
of money orders. Her father and mother are reported to have
been alcoholic and the patient has been a prostitute and an alco-
holic.

Since her admission, her general attitude has not changed.
Occasionally, she has made desperate attempts to carry out her
threats to kill people.

Her general demeanor was most grotesque. She usually
combed her rather short, curly, thick, shaggy hair so that it stood
out from all over the head in great twining masses like the caput
of Medusa. Her facial muscles Avere contorted in a snarl and she
nearly always spoke with a high-pitched, sneering, mocking voice
to everyone. Her nose was usually swollen, very red, pitted, and
she habitually rubbed and picked it. The skin of the face around
the nose was also congested, looked toughened, and her cheeks and
lips usually were spotted with large acneiform eruptions.

She walked with stiff, deliberate, step and was not inclined to

CHRONIC llEBEPJIRENrC DtSSOCIATJOSr 675

move out of the way for anyone. She dressed very grotesquely
and adorned her legs with gaudy colored ribbons and strips of
cloth. She often walked along with one hand on her buttocks,
scratching herself, and Trequently used tlie phrase, "Kiss my ass."

She never smiled, but scowled and fi-owiied, rarely spoke ex-
cept to swear and threaten. She was considered to be a dangerous
Avoman, particularly homicidal. On one occasion, she attacked the
nurse and attempted to stab her in the throat Avith a safety pin.
One day, she smashed a window, crawled through it and jumped
from the second floor to the gronnd to escape.

To bluff the nurses and physicians, she threatens in a hideous,
sneering voice, "I'll kil — 1 you, I'll kil — 1 you! You don't believe
it, do you ? I '11 crush your skull ! ' '

Sometimes she A^ciously throws the furniture about to make
a noise, exposes herself before the men passing the ward, spits at
people and is a constant source of trouble. She is also inclined to
be dirtjr in her toilet.

She accuses the girls of trying to assault lier sexually and
-often threatens to protect herself. She is very erotic, and be-
lieves the nurses cause it. She has made no friends in a year and
a half and still believes the authorities are planning to slioot her,
cut her throat, hang her, etc.

This case decidely demonstrates the delight in cruelty and
hatred that may be shoAvn by an anal erotic.

Case HD-11 Avas a newly enlisted seaman, age nineteen. When
thirteen his mother divorced his father and remarried Avhen the
boy was seventeen. He could not adjust himself to his step-father
who was an alcoholic. From his thirteenth to eighteenth year he
was very Vestless, brooding, and dissatisfied, and unal)le to hold a
position. He Avorked as a messenger boy and general helper until
his eighteenth year AA^hen he hoboed his Avay to Florida (Avandering
hero).

Here, he enlisted in the navy, because he was destitute, and
about one month after being placed on the training ship, he had
to be sent to St. Elizabeths Hospital because of a serious dissocia-
tion of the personality. Physically, he Avas a AA^ell-developed
healthy boy.-

When he arriAJ-ed at the hospital, he AA^as disoriented for time
and place, and could not tell hoAv he had enlisted or give a satis-
factory account of his last few days on the training ship. He

676 PSYCHOPATHOLOGY

watched his environment with wide, staring, wonderi^Beyes Md
seemed unable to comprehend the meaning of the beha:vior of the
physicians and the patients Jbout him. He talKed in disconnected
phrases about having seen "spooks" at home, "saw aw&^V in his
house and "heard chains rattling^" which frightened him. He
said he had seen his father or a man who' "looked exactly" like
his father. He said fie "hngged the man" and the "man fed me
and gave me some candy. ' ' He acted as if he believed he Itaid seen
his father and had a confused notion about expecting something
further to happen in relation to his father.

On the ward, he would stand about in the way of the workers
and seemed unable to comprehend what they were doing. He
asked to be put "on shore" and seemed to feel that he was on a
ship. He complained of being "all stopped up," that he had not
defecated for "six days" and had eaten "the wrfsig f ood. " He
complained that when he tried to defecate something prevented
him. He said the "boys call me chicken and kid me about corn-
holing me (sodomy) and they call me shitpot." He was very sus-
picious of everyone and reluctant to tell me about his case. He
was having auditory hallucinations and other vivid sensory dis-
turbances. When asked, using his phrase, if he had been "corn-
holed," he said not unless they had "chloroformed" him. He be-
lieved that this might have occurred. He admitted having had
such sexual relations with his brother when a boy.

He continually felt of his abdomen and looked confused as if
trying to understand some strange sensation there. The only ex-
planation he would give was that he was "all stopped up." He
almost continually fumbled at his clothing and tried to remove it,
would open the buttons on his blouse, and when I told him to dress
after finishing an examination of his abdomen, he partly dressed
himself and then forgot about his unbuttoned clothing, but sat
staring into space. When he was reminded of his negligence he
showed a little surprise at his f orgetfulness and buttoned his cloth-
ing further, but still left the buttons in front of his trousers open.
This behavior was decidedly like the behavior of Case HD-6.

He was completely distracted by cravings to defecate and his
tendency to keep his clothing open was concomitant with, and
surely related to, his obsessions about defecation and sodomy, be-
cause they occurred in the same consistent affective setting.

He gradually became destructive, and on the fifth day, he

CHKONIC HBBEPHKENIC DISSOCIATION 677

tore the pockets out of his trousers and worked for hours pulling
out the threads of the lining on which his name was stamped, also
rubbing the cloth against the furniture to erase the name, insisting
that it was not his name (regression to the nameless, wandering
hero ) .

Although he was given cathartics, he persisted that he could
not defecate, insisting that some strange influence bothered him
when he went to the toilet. He tried to trade his clothing for the
clothing of others in order to get another name.

He practically tore the lining out of his clothing and ripped
the uppers of his shoes into shreds so that they fitted his feet very
loosely. Finally he traded them to another patient for a pair of old
worn out slippers (typical behavior for this erotic type). He be-
came very slovenly, worried about having been subjected to sod-
omy and his feelings of an enlarging abdomen. He walked so
that his abdomen was protruded forcefully, a distinct effort to
have a pregnant abdomen.

About the seventh week he taUced a little more freely about
his troubles. His memory was accurate for remote events and was
more detailed for recent experiences. He was noAv oriented but
had no insight. He performed the intelligence tests quite well,
but complained that voices bothered him.

He said his own voice sounded queer. He frequently assumed
the attitude of prayer, and said, "I Avanted to get out of this build-
ing. I have been praying hard enough. I don't Avant to be drown-
ed." He hallucinated accusations of sexual perversions, of rap-
ing his sister, being a spy, of having electricity shot into his body,
etc., and insisted that he had been "nearly dead."

He complained frequently that "this patient in my stomach
talks to me all the time and mixes me up. "Water or something
moves up and doAvn in here [his abdomen] . It might be a rupture
or something." He said it took him all over the country and
showed him many things and talked "plainly" to him. He would
not talk freely about it because it might get him into trouble. He
seemed to believe that the feelings were the result of some form of
pregnancy and explained it by "someone stuck a stick of dyna-
mite in there," and stuck needles into his "back."

I happened to be sketching a man's face on a piece of paper
and he burst out laughing. He explained that the voice said,
"The face is more of a man than I am."

678 PSYOHOPATHOLOGY

(The tendency to pull off buttons from clothing, to loosen, de-
stroy and remove clothing, tear shoes into shreds and only wear
loose, torn shoes or socks is apparently an effort to find and get
free from the resistances to defecation. This is probably analogous
1o those Balkan Avomen who open the doors and windows of their
houses in order to induce an easy labor.)

He later felt compelled to remove his clothing and without ex-
planation stood about naked. He persisted in fondling certain
other patients and became extremely persistent in getting: into
physical contact with them. He had a particular attachment to
another patient who had similar difficulties and frequently halluci-
nated someone trying to perform sodomy on him.

Four months after his admission he tied a rag around his left
leg so that the band covered an old scar. About two inches above
this he tied a very stout cord. After I had examined the scar he
rebound the leg with the rag which he had ripped from the bottom
of the white sailor's trousers he wore. As he replaced the bandage
belabored and grunted and spat until he had it tied as tight as
possible in order he said, ' ' to keep the air out. "

As he showed me the scar he explained that when seven years
old, while whittling on a tree with Ms father's pocket-knife, he ac-
cidentally cut his leg. He said lie nearly bled to death and now
he believed the knife had cut a "leader," which has never been
right since. The supposed defect of this leader he demonstrated
with movements of his foot, as follows : "See! My toe drops and
it drags around when I put my shoe on. It has never been right
since. Tt has been leading me around ever since. I almost bled to
death, and my left leg is weak. My whole left side is weak, There
isn't enough blood in it." "While he talked in this manner he ma-
nipulated his toe and spoke of its weakness, saying it had no blood.
Almost at the same instant, as if the two subjects were intimately
associated in his mind, he opened his trousers and drew out his
penis, which was edematous and swollen. A deep groove around
it showed where he had tied a string. He said he tied a "green
string" arotmd it the night before, "because there isn't enough
blood in it." He talked of the penis as being Aveak, and when I
asked about his testicles, he replied, "They are all right, if I have
any" (castration).

All during the conversation he continued to spit over his right
shoulder. When asked why he did this, he said that after he had

CHRONIC HEBEPHRENIC DISSOCIATION 679

cut his leg, "everybody in town spit around everywhere and the
Avhole town became dirty. Before it happened nobody was allowed
to spit on the streets."

He interpolated the following remarks during the demonstra-
tion: "I guess the blood is still on the ground there. My father
was good to me then [began to cry] and [pettishly] we had cows
and chickens and turkeys. I was my father 's boy. My brother got
typhoid fever after that. ' ' He said he wanted to die and felt that
his body Avas dying.

Referring to the cutting incident, he said: "I never grew up
after that. I have had to lean ever since." (On the ward he is
very fond of leaning against his chums.)

He talked about his father with deep sorrow, and tears came
into his eyes. He said his father and mother were never happy
when he was at home and always quarrelled. (Their separation
and divorce was never adjusted to by him.)

The nature of this boy 's affective disposition is to be inferred
from his feelings about being pregnant, the result of sodomistic
relations. Whether such acts occurred is not so important as the
fact that the affective cravings have restored the hallucinated
father to him and in the same dissociated, confused mental stat<^
he is pregnant as the result of a symbolical "stick of dynamite,"
needles stuck into his back, etc.

The lonely, unhappy father means the boy is lonely for him,
and the submissive extreme to which his love has gone is evident
from the vivid impregnation feelings. The loss of blood refers to
his impotence, the voice in his abdomen said the pencil sketch of a
man's face was more of a man than he was, and the tying up of
the penis and leg were restorative attempts. The green of the
string was probably a virility fancy, the edema enlarging the
penis. ! ' f '''■ ''

Fourteen months after his admission this boy had shown no
important changes. No record of convulsions has been made.

The tearing off of all bindings and buttons from the clothes
and shoes in order to have everything loose has been found to be
consistently symptomatic of a certain type of anal erotic patients
who seem (Case H.D-9) to feel rectal sensations that presage com-
pulsive defecation. Even though they are unable to defecate, the
vigor of the sensory disturbances absolutely convinces them

680 PSYCHOPATHOLOGY

that the crisis might occur at any moment; hence, they become
uneasy when restricted.

Case HD-12, aged twenty-one, had served two years in the
navy when he acquired syphilis and reacted with delusions of per-
secution which seemed to have an obscure foundation.

As a boy he had been indifferent in school and disinterested in
his studies. At sixteen he ran away from home, inducing his
parents to consent to his joining the navy.

Ten months after an infection of syphilis (no active lesions of
the nervous system were indicated by physical signs or the spinal
fluid), he complained of feeling weak, unable to work, and seemed
to be confused.

Two months after the tendency to confusion began he devel-
oped a mental state which in its characteristics was not unlike an
epileptoid confusion in that he showed no toxic symptoms, was
difficult to control^ could not be influenced, seemed to be disoriented
and misinterpreted everything, apparently fearing that he was to
be killed or subjected to a mysterious initiation which he could not
understand.

The third month after the onset of the psychosis he was ad-
mitted to Saint Elizabeths Hospital. He called the physician
''father," said he wanted to become "a priest," and from his
behavior it was evident that tlie whole environment had been dis-
torted into an initiation ceremony. He looked under furniture, be-
hind doors, etc., for secret signs, and studied people quizzically, as
if they had a mysterious significance.

His replies to simple questions were prompt, but very often
irrelevant and incoherently broken, up. When asked if he was
married, he replied, "No, no, doctor; but my mother and father's
married ; but I 'm not married. ' ' He seemed to think that he had
been made a naval officer, and stupidly talked aboiit himself in the
third pers'^n, as: " [name], as they generally call me; he is good;
he ought to be on one of the big ships; he's good; he's a good
man."

He had no insight, was disoriented for a time, partly knew
where he was but, when not stimulated by questions, lapsed into a
state of mind wherein almost everything became misidentified, and
yet he was able to take care of his personal needs.

He believed he had been given cocaine ; heard voices accusing
him of murder, masturbation, sodomy, and other misconduct. He

CHKONIC HEBEPHEEKIC DISSOCIATION 681

reacted to the erotic pressure by persisting in trying to prove him-
self to be innocent. He had the nsnal beliefs of being subjected to
electrical devices, etc., etc.

Much of the time was spent in kneeling, praying, and crossing
himself, because he thought he had been chosen a "son of God."
He thought the sodomistic subjugation made him impotent. He
paced the floor, held his head and wrung his hands, but not in true
grief. His eyes were decidedly uplifted, and his facial expression
was the classical crucifixion type. He said he dreamed the sky was
full of floating angels but he could see only their heads and wings.

He delighted in confused castration fancies. ' ' I told them
[voices] to cut me open and take my balls out. There are a lot
of women inside who want to throw a child over on the navy. I am
a pretty good fellow, but I don't want to take men. I am different
than all the men in the world. I am in all the lodges. ["Weeps.]
I'll get married if you say so." He frequently approached a phy-
sician to say, as if it Avere expected of him, that he would never
get married.

This was only intelligible from what followed in the sense
that he was resisting his feminine cravings to marry a man.

He always slept in a corner bed, with his back to the wall, and
watched the men so that they could not secretly perform sodomy
upon him while he slept. He had a characteristic Avalk, passing
along through the Avard for several steps, then turning to look
down close behind him, as if sensory disturbances jnade him feel
that someone Avas approaching him. Such back and anal sensa-
tions persisted more or less vividly for about ten months, as his
behavior indicated.

One day he approached me asking if I Avere a detective and
adding. ' ' I am carA''ed from here to here. ' ' (Passing his hand from
anus to scrotum.) He further added that he had difficulty in pass-
ing feces and was "all choked up." During most of this period,
frank sodomistic interests and fancies occupied his entire time.
He could not be interested in anything. Although he Avas tractable
and almost "harmless," he occasionally got into fights with those
whom he suspected, and he seemed to enjoy his bruises.

Whenever I met him on the ivard he AA^ould come up to me,
grinning and shaking his head oddly, to say that he was not sure
that anyone had performed sodomy on him, but that he Avould
Avatch out for them. He frequently said, "I guess I just imagine

682 PSYCHOPATHOLOGY

it"; then doubtingly, "But I don't know"; "I'll watch out for
them. ' ' With this he usually walked away smiling and pleased.

During this long period the affective cravingf-worked up into
several crescendoes, and during such states he was wholly dis-
oriented, confused, went about, characteristically, with loose, un-
buttoned clothing and torn shoes and had to be isolated because
he removed his clothes. Also, characteristically, he made love to
a patient having similar affective interests.

This man's cravings are to be regarded as unchangeable.
Tattooed pictures on his arms revealed the fixed nature of his af-
fective make-up. They were done in red, black and green. On his
right arm, upper, were a large flag,. shield, eagle, and sun rising out
of the waves, and on the opposite side, a setting sun. On the lower
right arm were a crucified Christ on the cross, a double shamrock
and a large dagger passing through a bleeding wound. On the
lower left arm was the bust of a sailor, shield and anchor, and an
anchor mth sailing ship, wreath and flag. Most of these were
symbols of his patriotism. The crucifix pleased his crucifixion
cravings, and the dagger in the bleeding wound also satisfied his
masochistic anal erotic cravings. (He described his anus as being
widely "split" open.)

During his less confused states his conversation ran about as
follows: "Eckinrode's horse — it got out in the night and some-
thing happened to it, and I am like that horse [centaur] * * * I
got so low down I didn't have anything until I came out of my
mother — they can crucify'' me if they want to — they can fool around
and fool around, and a Chinese woman can have a Chinese baby in
two weeks — ^I guess they'll make a Chinese baby but of me."

Nineteen months after his admission he was discharged as im-
proved upon the request of his relatives. He was in excellent
physical condition, regarded his difficulties as " imaginations, "
had very little insight, showed no tendency to irresponsible be-
havior, was decidedly indolent and useless. He was, however, need
and courteous.

The probable outcome of such cases as the above, because of
their great unlikelihood of finding a satisfactory environment,
may be inferred from the career of the following man :

Case HD-13 is a Russian Jew, a peasant, who immigrated to
the United States, at the age of ten. Illiterate, wanderer, soldier,
unmarried; pyschosis began at twenty-four. Twelve years after

CHRONIC HEBEPHRENIC DISSOCIATION 683

his second admission the following behavior was observed. (The
second admission was made three months after his discharge as
improved after a four months* confinement during his first psy-
chosis.) He is well oriented, with memory accurate, considerable
insight, an incessant reader, lazy and irritable. He prefers white
shoes to black and will not wear black ones if he can avoid it (Case
MD-11). Keeps his shoes unlaced, clothing loose, unbuttoned,
torn, suspenders hanging down, trousers half-unbuttoned, belt
loose, pockets full of debris and papers for which he ahvays has
some plausible use.

He is very irritable, quarrels a great deal, often injures him-
self when he gets angry and has made innumerable half-serious at-
tempts to commit suicide ; threatens to do so openly, and yet states
that he hasn't "nerve enough." He has often cut his wrists A\dth
pieces of glass, cut his throat, and tried to hang himself.

He says he ' ' masturbated to kill himself, ' ' and complains that
when patients "sneer," "sniff" or "cough" at night it hypnotizes
him and makes him masturbate. In a recent conversation about
his difficulties, he said that when he worked in the laundry and had
to handle the sheets he thought about ■v^'hat was in the sheets and
"everything got yellow" and it made him weak. He went on to
say with this, that he had seen his grandmother sharpen a candle
and insert it into the rectum of children when they were consti-
pated, and his mother made a paste of mud and urine when he
stepped on a nail and applied it to stop the bleeding. (Here were
vivid impressions of childhood related to the difficulties which fol-
lowed.)

He complained in this same trend of conversation that one
patient used to excite him by blowing on his arm with his mouth
against the skin, imitating emission of gas from the rectum. An-
other fellow excited him by sniffing and hawking. The yellow
color of the wall on one ward "affects" him so that he has to in-
sert his finger into his rectum, etc.

There is here a distinct relation in his loosened, slovenly
clothing, hoarding debris, and torn loose shoes, to constipation,
rectal sensations and excitement when patients sniff (odors).

He complains of being hypnotized and rendered helpless by
others, and when he feels such influences he gets wildly excited
and threatens to attack his persecutor.

684 PSYCHOPATHOLOGY

Case HD-14 is a young man, aged twenty-two, unmarried, who
has been having grand mal attacks since seventeen.

The personality of the father in this #^P was clearly a de-
termining influence in his son's life. He was a "literary man" ; al-
though comfortably established financially, he was extremely
stingy, dressed shabbily, and was decidedly careless about his toi-
let, apparently deriving considerable pleasure from slovenliness.

On the other hand, his religious enthusiasm was excessive in
its zeal and most dogmatic. His fervor was born of hatred of all
that seemed to him to be evil, and a few minutes * conversation, in
which he freely expressed his fervid religious convictions in the
presence of his son, thOTialighly showed what a profoundly repres-
sive influence they had subtly exerted upon the son (causiu^Unvol-
untary tremors in the boy's face during the conversation) under
the disguise of Truth, God and Eeligion.

The fearful boy had conscientiously striven to suppress all
overt sexual interests on the one hand, and on the other, he assid-
uously responded to his father's appeals to Jaggra^iidize Grod, f^^fe-
eousness, etc. >■ . ^. ;..=;:,;-

The patient was the overly petted "baby" of the family and
learned to regard his father with great fear and reverence.

As a child he Avas inclined to play alone and rather timidly
joined in play with older boys. In school he was "bright," and
usually attended classes a year or so ahead of his age. At thirteen
he had "strange sensations in the right ai'm."

All overt sexual interests characteristic of the average boy
were denied. He insisted that masturbation had never occurred,
and that he never listened to the "smutty" stories and jokes of
his playmates.

He became decidedly out of touch with his companions, and,
because of his resistance to their sexual curiosity he was consid-
erably ridiculed.

He graduated from high school a year earlier than the aver-
age age and entered a university with ostensibly bright prospects,
but was decidedly a self-suppressivo, socially eccentric youth Avho
found the average social interests of college life to be "shallow,"
irreligious, sinful and unattractive. He did not realize that this
was due to his training, but egotistically considered it to be due to
the inferior interests of Ids associates.

An older brother, a much more congenial personality, whom

CHRONIC HEBEPHRENIC DISSOCIATIOK 685

the patient tried to surpass as a student, became, probably be-
cause of his merits, the pride of tlie famih'. The patient had al-
ways tried to surpass him as a student and in religious fervor, but
in the first year at college lie began to lose interest in study and
seemed to suffer excessively from homesickness (regression).
Among the embarrassing, urgent problems to be met at this
time was the interest of a schoolmate Avho persisted in showing a
personal attraction and expressed a desire to sleep with him.
This boy's interests were coarsely sexual and caused considerable
excitement for the patient. No overt sexual behavior transpired,
but the affair increased the guilty unattractiveness of the world.

The first serious convulsion occurred aljout one month later
(aged seventeen), but apparently had no especial reference to the
behavior of his companion. The convulsion started significantly
with the cry, "Oh! mamma," and developed into a grand mal type.
It showed, decisively, his affective dependence upon his mother,
and may be regarded as the turning crisis, marking the renuncia-
tion of the world and the beginning of a pernicious regression to
the mother.

Collegiate interests became burdensome and, after two years
of struggling, he returned home to regress gradually into more
and more of a "baby."

The convulsions increased in frequency and general severity,
occurring more frequently at night. They Avere often accompanied
by periods of confusion lasting from several hours to several days.
Confused periods also occurred Avithout convulsions. On one occa-
sion he found himself wandering at night several miles from his
home on a country road. He could not recall when he started
or how he got there.

Four years after the first convulsion, in one period of con-
fusion, he believed he was Christ, the Son of GTod and a Redeemer.
He assumed "queer" attitudes, removed his clothing, and talked
about "doing something, accomplishing something," and broke
up some of the furniture in the room.

He progressively became more irritable, violent, obstinate,
petulant, selfish and egotistical. To his father, who sternly com-
mands him during his confusions, he meekly submitted.

The frequency of his convulsions varied from one a week to
one a day or so.

Five years after the onset, aged twenty-two, he had become

686 PSYCHOPATHOLOGY

very egotistical, uncongenial, irritable, suspicious, was unable to
take part in conversations or social interests, had to be petted
and condoned, regarded all general interests as a waste of time,
and spent most of his time in day-dreaming. He talked in a very
slow, labored manner, that made one wonder if he would be able
to finish his thought, expressed himself emphatically and unshak-
ably, believed that he was "divine," and had a sublime mission
on earth.

He did not wish to be considered as having a mental disease,
but only consulted physicians because his father insisted upon -it.

As a subject for psychoanalysis he was inaccessible because
lie insisted in devoting all of his time to the discussions of the di-
vine personal state that he had reached. During one play at dis-
cussion, he said with profound sobriety, "This thing will kill me
or I will be God.'.'

He was in love, he said, with a neighbor's daughter. She was
then twelve, but he would wait for her because by her ways he
could tell that she loved him.

Since I never saw him in a state of confusion, a description of
his behavior and an inference as to the nature of his affective
striving under such conditions can not be given. But, from his
anger, suspiciousness, and determination to protect himself, it is
obvious that he becomes afraid of some craving or influence.

He learned to speak of himself as becoming a divided person-
ality during these attacks. Like all such cases, the source of con-
flict and fear was in himself, and his repressed affections persisted
in trying to do something that made him fearful of the conse-
quences and responsibility. "What they persisted in doing may be
inferred from several dreams and a comparison of his symptoms
with those of similar, more accessible, instances of behavior.
(The above group of cases, however, is not truly epileptic al-
though related in certain fundamental cravings.) He frequently
dreamed about privies and his father or some friend of his father
meeting him there.

A most significant dream was the following: It was Sunday
(God's day) and he was driving an auto with his mother as "a
companion (he had never driven an automobile) and they were
passing along an asphalt street. He became aware of the pres-
ence of a large hole in the asphalt on the right side of the street.
In the hole lay an old, dead mule that "looked more like an ass

CHRONIC HEBEPHRENIC DISSOCIATION 087

than a mule." This seemed to stop his machine, but his friends
appeared to pass "right on over the mule giving me many unavail-
able suggestions." (The analysis, which aroused the patient's
indignation, showed its importance, when to "asphalt" the pa-
tient associated "ass felt," and to the mule in the hole, "ass in a
hole," then "ass hole.")

The dream continued: Finally a young lady (with more
money than she needs) suggested the street cars and we started
home. She pulled out a purse Avith ten times the cash I had. I
refused to accept her offer until the whole party placed itself,
individually, on the level with the dead mule Avhich was left some
ten blocks behind.

The patient's, difficulties with money (father's penuriousness),
and his mother-attachment (the two, together, in the automobile),
and the infantile affective pleasure in the anus, which he could
not pass over (repress) as others had, seemed to be extremely
pertinent revelations as to the nature of his repressed affective
cravings. He could not accept the social and sympathetic in-
terests of his friends until they met him on the level of anal in-
terests (ass-in-hole), because he could not understand them. The
above dream, he thought, was accompanied by a mild convulsion.

Later, he dreamed while sleeping with his mother that his
mother was ' ' tickling ' ' his anus. He said he ' ' suffered painfully, ' '
and yelled out, "G — damn it ! Mother, wliy don't you quit tickling
my ass ? ' '

Upon another occasion he dreamed that his mother took a
small dose of powder, after he refused it, "just to see the effect."

He related numerous other dreams, some plainly sexual (mas-
turbatory only) ; others more obscure, which were not apparently
associated with anal and fecal interests. The above quoted dreams,
however, have a vastly greater significance in their setting of re-
pressed, uncongenial, extremely egocentric, affective interests,
than they would have in a personality having extensive affective
interests in earning a living and making others happy.

His suppressed hatred and jealousy of his brother and father
prevent him from becoming a frank competitor for his mother's
love by working for it. He, however, takes a short cut to gran-
deur by becoming a zealous Son of God (outdoing brother and fa-
ther), and creates his own world in which he enjoys the petting

688 PSYCHOPATHOLOGY

and fostering of his mother. At twenty -two he still slept with
her, justified as an invalid, helpless boy.

The convulsions often began with tingling and jerking^ of his
right arm,. and by vigorously rubbing the arm the progress of the
attack was sometimes checked. Such arm symptoms are, as is
well known, extremely frequently an expression of repressed mas-
turbation functions.

The patient's penurious, hoarding interests Were nicely illus-
trated by his notebook in which he recorded facts about his
thoughts and behavior. To it, he had tied a pencil with a very
clumsy excess of string which he laboriously wrapped about the
pencil and tablet, each time he finished a notation (hoarding).

No important physical defects, that could be related to his
disease, were found upon extensive, highly specialized, efficient ex-
aminations, except that he had the fat, stuffed, dull face of the
advanced epileptic.

His mental labors show a decided deterioration of spontaneity
and efficiency, and a growing concentric affective restriction upon
himself.

His symptoms indicate that, eventually, he will become Qod
and the Universe at the total loss of everything that makes life
worth living.

Case HD-17 was a salesman of mediocre ability and very much
inclined to shift from one position to another. At thirty-six he
had "typhoid" which was attended by a psychosis of which no
satisfactory account could be obtained.

At forty-one he was admitted to Saint Elizabeths Hospital
because of feelings of being persecuted which were reenforeed
by well-systematized delusions of a bizarre nature. He believed
he had been "overcome by the heat" on July 4 (year of his ad-
mission), and dated his troubles from that experience. Upon his
admission he tried to justify his feelings of being persecuted by a
Yery lengthy, detailed, involved discussion which Avas constructed
out of fantasies. The principal featiire of this system was that a
detective watched him because he owed money.

In a general sense there was no impairment of his mental
faculties unless prolonged, accurate coordination was required.

■About one month later he admitte'd auditory halkicinations
and thought "the whole world knew everything" by means of a
fancied recording dial in the superintendent's office. He was very

CHRONIC HEBEPHRENIC DISSOCIATION 689

suggestible, and laughed or cried frequently about his troubles. He
devoted most of his time to delivering orations from the veranda,
lecturing on ' ' any subject. ' ' Electricity was played on him and he
became "the Son of God on earth" with unlimited power and abil-
ity as the mouthpiece of God. He coined many words and preached
incessantly.

Seven months later he said he must have been "very crazy"
in the past and tried to explain the most common of his original
Avords, such as " telephonalizations, " as analyzations of wireless
and telephonic communications, and "vonedating," as telephoning
from the soul which had been ignited by electricity and voices that
were located in his abdomen. He secretly tried to remove the voices
with a mustard plaster, producing a severe blister.

His insight into his condition was about as follows: "About
a year ago I became voiced. I had a crawling, nagging or eating
sensation about my navel which was very annoying. I thought
it was a tapeworm. Later on I Avas standing waiting for dinner
and something crawled up from the floor and took full possession
of my person and I felt as though the voice came out. My mother
ahvays called me Willie and it said, 'Is this "Willie?' and I said
'Yes.' It said, 'You know Avho this is?' and I said, 'No.' It said,
' This is Jesus Christ talking to you. ' I kneeled right down in the
hall. It was a very exhilarating feeling. And then I went to
dinner — then the voice came out in full, saying, ' This is my beloved
Son, Jesus Christ,' and this took me from the table. After a test
of faith this voice cussed me and called me vile names because
I would not pray every second. The voices Avould say, 'That is
an evil thought and I am going to punish you for it. ' Then they
would shock me with electrical strokes. These nearly tore my in-
sides out. They worked through the rectum, privates, eyes, nose
and the organs, also the A^eins. I believe the blood is carbonated
in the glands just like carbonated AA-ater, and if kept up Avill cause
mortification of the human body. ' '

He never doubted the reality of these sensations and con-
stantly begged for treatment. He was quite suggestible, Avell
behaved and not destructiA^e. At the end of the third year he
eloped and succeeded in maintaining himself fairly Avell for nearly
one year Avhen he Avas readriiitted iipon his OAAm request.

He discussed his condition this time as follows: "When I
was here before my head cracked, my ear bones rattled and they

690 PSYCHOPATHOLOGY

were all dried up. I asked Dr. S — if I could drop olive oil in my
ears, and by Jove it cured it. I keep a little olive oil 'at home. I
decided to get some tallow and I made a cake and put it right here
[epigastrium]. I believe the soul is right here and I believe it
helped. The devil is using the "fridation" process on me and it
constitutes the drying up or waste of the anatomy of man ; sapping
the Kfe out of him — the germing cells are cut down by the mag-
netic influence in the blood and it dries up the life cells." (Oils
as semen.)

(This was definitely related to his sexual impotence and feel-
ings of being castrated. He used oils to cure himself and restore
the losses due to "fridation.")

This patient's solution of his difficulties was made along the
following lines. "I believe honestly we have the devil right in us.
We are double. When the devil becomes overmagnetic we fall
insane. I am not properly balanced, but I take care of it like you
would. After two years and a half I struck a refined intellectvM
atmosphere to go on and make the best of it and death would
solve. ' '

Since this second year of his second psychosis he has main-
tained an atmosphere of personal aggrandizement and talks with
an affected enunciation. During his second admission he also had
feelings of infidelity about his wife, and he wrote numeroiis letters
charging her with being pregnant and later spoke of her as a poor
little girl "crucified" by a scoundrel.

Eighteen months after his second admission and nearly six
years after the onset of his psychosis, he has made a fairly com-
fortable adjustment to his difficulties. He reasons that "the
devil" causes his persecutions, and by tiTrning his mind along "re-
fined" channels of thought he has improved considerably. He is
congenial and ostensibly interested in his wife. He is, however,
lazy and seems to have difficulty in working steadily, usually re-
quiring tonics and a man's sympathy.

He gives the impression of being harmless and one feels no
difficulty in talking freely to him about his problems. Hatred is
not evident in his reactions, but he is too suggestible and plastic
in his adaptations to assume responsibilities and readjust.

Another patient, who passed through a psychosis and
panic because of fear of being destroyed and sexually misused,
finally recovered and returned to work. A few years later he vol-

CJUIONIG IIEBF-PJIIIENIC mSSOGlATlON fiOi

untarily sought admission to St. Elizabeths Hospital He said
his genitalia Avere disappearing and his rectnm was changing into a
vagina. He Avas decidedly pleased and livod his belief, devoting
his time to erotic fancies about his hermaphroditic nature, not
caring to return to society, Irat probably better pleased with tlie
men on the wards.

Case HD-16 was a soldier, divorced, alcoholic, and a hobo..
His left eyeball had been enucleated, loft face badly scarred and
right arm amputated in accidents.

At one time he was a well-developed man Avith masculine fea-
tures and resonant voice.

He Avas sent to St. Elizabeths Hospital because of his imfit-
ness to remain in the Soldiers' Home. He says: "I represented
the Spirit of American Service, the Navy Service and the Depart-
ment of Justice, through a method of transfiguration, the purity of
the Church represented in it." (Grand compensation.)

On the Avard he often shouted "get out of my stomach," and
rubbed his left hand on the right side of his abdomen. AVhen
asked about the trouble, he said it was a "composition put in by
magnetism through a transfiguration," and "a divorced woman, a
AA'hore," is trying to get inside.

He said he had been bothered considerably more than usual in
the past ten months or year. He earnestly asked the physicians
to feel his abdomen and note the movements in it. Sometimes he
insists that there is something "aliA^e" in his "stomach."

When the remark Avas passed that ten months Avas a long
time to carry anything there, he looked decidedly pleased and
smiled effiisively. When asked Iioav he acquired it, he thrcAv back
his head and looked upAvard and smiled knoAvingly (as if it came
from Grod).

He will not frankly state today that he is pregnant, but he is
pleased by such fancies, and characteristically rubs his abdomen.
"Wliile making this note he suddenly denounced in vigorous lan-
guage the "diA'orced Avhore" Avho is trying to get into his ab-
domen.

Dissociated anal erotic cravings do not ahvays cause a pro-
gressive deterioration of the personality, even though they cause
intense hatred and violent outbursts of rage.

Case PD-32, a strong, healthy, Avell-deA-eloped, energetic, un-
married woman of thirty-six, rather suddenly developed halltici-

692 PSYCHOPATHOLOGY

nations and delusions al)out a religious initiation wMeli were at-
tended by considerable excitement. The tendency to an affective
dissociation had been developing for some time, but the crisis
did not occur until the day previous to starting on a vacation,
which was looked forward to with considerable feeling, because
of a secret liaison that was to occiir with it. Then followed a year
of sexually indulgent fancies in which she cohabited with Christ,
God, was taken through ' ' the Holy Land, ' ' was persecuted and tor-
tured, "skin turned to rubber," insides were removed, saw the
world destroyed, etc. She finally adjusted with a fixed conviction
that an older sister and her husband had discovered a mysterious
means by which, in disguise, they had opened up the ground under
the surface and, following her about wherever she went, subjected
her anal-rectal and vaginal tracts to incessant tortures.

For four years she has resorted to many wild schemes to in-
sulate her pelvis from exposure to the tortures, and spends hours
literally damning and berating with vulgar epithets this sister
and her husband who would make a prostitute out of her. She
has frequently inserted her finger into the rectum to find out
Avhether or not it has been destroyed, sits on her foot to insulate
it (Case PN-7) from contact with the furniture, and begs daily
that the government will dig down into the earth and remove
"Sharewould" or " Cherrywould " and his wife and destroy their
instruments with which they make her suffer "hell on earth."

Besides the persistent anal and rectal sensations, she has also
vivid auditory hallucinations of this coiiple taunting and sadis-
tically torturing her. She has attempted to commit suicide and
pleads pitifully to be cremated when she dies so she will not be tor-
tured in her grave.

Despite this, she is neat, clean and an excellent worker and
during periods is pleasant and sociable. There has not been the
slightest change in her case within the last four years. That the
anal sensations are secretly pleasing to her is indicated by the unu-
sual attentions she gives to her defecation, and, previoiTS to the
psychosis, her practice of cleansing her moiith, taking a purgative
and then following it with an enema.

This woman is not inclined to indulge in play and does not
show the hebephrenic pleasure in destruction and waste which
self-indulgent patients of this sort show. Daily she : submits
to the "hell" and lies on her bed, cursing and weeping, and talks

CHRONIC HEBEPHRENIC DISSOCIATION 693

back vigorously to the voices of the two people while they subject
her to tortures of her pelvis and throat. This is so vivid as an
experience that she can not differentiate it from the persistence
and vividness of sensory disturbances caused by external realities.
She regards another woman who makes similar complaints about
her father being under the ground, etc., as insane.

Summary

The hebephrenic type of dissociation of the personality, like
all dissociated states, is due to the affective cravings working
for certain types of stimuli which they need and conflicting with
other cravings which try to do something entirely different to ol)-
tain gratification. The ego that wishes to develop itself, work,
win social influence and esteem becomes depressed and lonely
through fatigue, lack of affection, and a sequence of painful expe-
riences. During the period of retraction and loss of initiative the
repressed segmental cravings dominate the personality and are re-
garded as a foreign influence. The dissociation of the ecjo and self-
control enables the perverse affect to urge the behavior that pleases
this affect most; hence, the 6170 beeonics helpless and is swept
into a world of infantile dreams and anal erotic play. The re-
pressed segmental cravings may then seek for what please them
most. Since they seek what they have been conditioned to need
through the pleasant experiences of infancy and earl}- childhood,
they tend to restore the ancient experiences in imagery. Hence,
the levels to which the regression occurs and the degree of the
dissociation largely, if not entirely, depend upon the stage of the
growth of the personality when serious aff'ective repressions be-
gan to be made and what tabooed objects and sensory zones are
especially craved.

It is natural that, if a large proportion of the affective crav-
ings of the personality are fixed upon infantile or perverted in-
terests, the personality will not be able to adjust comfortably to
the customs, requirements and objects which society demands
should be used by the matured of the species in order that the sex-
gan to be made and what tabooed objects and sensory zones ar(>
especially craved.

The rampant vulgarity and destructiveness of the hebephrenic
ai'"e, with astonishing frequency, concomitant with, hence, probably

694

PSYCHOPATHOLOGY

urged by, the same affective cravings. Predominant anal, fecal,
urinal and sodomistic interests are characteristic of children ahd
immature apes and monkeys. The diagnosis of this biological
state of the genus Homo, when well defined, can often be made on
sight.

The typical hebephrenic type of dissociated personality is to

Pig. 67-A. — Crochet work of patient having a preadoleseout incestuous attaeli-
nient. Througli creating such fancies of herself with her parents and childhood
surroundings she restores images of past experiences which aroused and gratified
the affect. Dr. Arrah B. Evarts reported this creation in The Psychoanalytic Eeview,
Vol. V, No. 4, showing the significance and affecti-\'c ^alue of the figures and details.
(See also Fig. 67-B.)

CHRONIC HEBEPHRENIC DISSOCIATION 695

be differentiated from tlie typical catatonic and paranoid types
in that during the psychosis there is little or no interest in re-
turning to a mature level or in earning social esteem by doing
socially constructive things. This feature, however, is not so con-
sistent, as a characteristic, as the gross preadolescent and infantile
forms of play which they indulge in. The prognosis is usually

Pig. 67-B.

poor because the autonomic-affective cravings would rather re-
main infantile than strive for the responsibilities of maturity.
They tend again to regress to the hebephrenic level, after having

696

PSYCHOPATHOLOGY

temporarily resumed an interest in earning a living, and the second
regression, if not the first, is nsnally permanent.

The anal-erotic patient, when giving vent to his pleasures,
is far more destructive than the oral erotic, and this destructive-

Fig. 68. — ^Eegression to iafaiicy, thereBy escaping the trials of an unhappy marriage
and the responsibilities of raising her family. ^

ness, when not used as an intimidating defense, is an important
diagnostic symptom.

The anal-erotic mysophobia, presented in the chapter on the
psychoneuroses, showed that anal eroticism, when it causes fear

CHRONIC HEBEPHRENIC DISSOCIATION 697

and no dissociation of the ego, may become the foundation of a
compulsion to cleanliness. Miserliness is a compensatory defense
against the fear of food poverty.

The behavior of the anal- ( rectal f) erotic patient is character-
ized by the fact that he is not only unable to control his thoughts
and loses his powers of adaptation and social orientation when the
affective pressure becomes too vigorous, but certain very charac-
teristic adjustments are made which seem decidedly different from
the oral-erotic patient's. During an intense emotional conflict an
individual's capacity for adaptation and orientation is greatly re-
duced; hence, confusion is only a general characteristic of affec-
tive conflict, but the particular acts, which the uncontrollable anal
erotic persists in doing, are highly indicative of the nature of the
craving.

The anal-rectal erotic persistently destroys the binding ap-
pliances of his clothing and shoes (as buttons, ties, etc.), re-
moves his clothing, loves debris and filth, and his face assumes,
for prolonged durations, the dull perplexed, often congested as-
pect of defecation strivings. He usually has marked submissive,
sodomistic interests in the "father" or a substitute (in one case a
grandmother), and the defecation is frequently treated like a cre-
■ ation or parturition (Cases HD-11, PD-17). Not infrequently, the
condition is attended by grand mal types of epileptoid convulsions
which occur during the perplexed hallucinated erotic state of mind,
and the patients complain of becoming ' ' mentally thick, " " senses
taken away," etc.

It is possible that some of these cases are truly epileptic in
character, or better, that some cases of idiopathic epilepsy, so-
called, belong to this group, as case HD-14 indicates. This possi-
bility is certainly worth extensive psychopathological research.

CHAPTER XIV

RECONSIDERATION OF THE CONDITIONED AND RE-
PRESSED AUTONOMIC AFFECTIVE DETER-
MINANTS OF ABNORMAL BEHAVIOR

Anyone, who is seriously interested in human behavior and
its normal and abnormal, or social and asocial, variations, upon
reading the difficulties and struggles of the cases discussed in
the preceding chapters, will see the necessity of formulating a
conception of the forces of the personality, which will enable us
to deal intelligently with the variations of behavior that may occur.

The conception that all affective craviBLgs (a,ll emotions,
wishes, feelings, sentiments) originate in the peripheral sensa-
tions caused by muscular tensions and vascular tumescence, or
detumescence, in different segments of the autonomic apparatus,
gives us an insight into those functions of the personality which
are fundamentally and intimately related to metabolic changes
and organic structures. These affective-autonomic tensions or
cravings, constituting the ivish to do, to be, to have,, etc., compel
the organism to expose the favorite receptors of the craving so
that they may receive from the environment those stimuli which
have the quality, through counter stimulation, of arousing auto-
nomic reactions, Avhich, in turn, neutralize the undue autonomic
tensions and restore a state of comfortable autonomic tonus.
Through this principle, the constant tendency of the everchanging
environment and metabolism to cause a state of autonomic ten-
sion and unrest is relieved, more or less, by a compensatory effort
to reestablish a state of autonomic comfort.

This gives us a loorldng conception of the principles upon
which, and the forces out of which, the personality is constructed.
The personality's intricacy and variability are accounted for by
the manifold segmental cravings which are all active at the same
time, one or several dominating now, and others surging into dom-
inance later : some struggling to get into contact with the environ-
ment, and others struggling to maintain an established contact

698

RECONSIDEEATION OF DETERMINANTS OF BEHAVIOR 699

and trying to keep repressed the antagonistic cravings so that they
can not interfere with the use of the projicient apparatus.

From birth, the autonomic apparatus, having been forced to
abandon its parasitical attachment to the mother, begins its strug-
gle of coordinating its projicient (skeletal) apparatus into an
efficient instrument, Avith progressive refinements of self-control
and skill of adaptation, in order to keep up with the standards
of its rivals and the race. Upon the nature of the skillful coor-
dinations and the conditioning of the cravings depends the exis-
tence of its biological potency (of social influence and fitness,
commercial or professional prowess and sexual power).

The inherent capacity of differcnit autonomic segments (gas-
tric, cardiac, etc..) and of the affective cravings (as food-hunger,
fear, anger, etc.,) to react at first to primary stimuli and then
become conditioned to react to associated stimuli, rapidily trains
the personalitv to develop special acquisitive and avertive tenden-
cies toward different objects and customs in society, literature,
commerce, art, science, religion, mating, etc., etc.

The conditioning of the autonomic apparatus to react so as
to produce pleasure-giving sensations upon the acquisition of cer-
tain classes of stimuli, and unpleasant sensations upon being ex-
posed to the presence of other stimuli, is the very foundation of
the differences in interests and aversions that arc to be met in
everyone. This inherent attribute of tlic autonomic-affective ap-
paratus, in relation to character formation, places an enormous re-
sponsibility upon rxpcyieiirc and ediirafion, and emphasizes the
most important problem of all, the influence of the family, the
school, the church and community upon the biological forces of the
personality. The reading of the preceding cases makes one se-
riously doubt the fitness of the present educational system and its
puritanic ideals, the present expositions of religion and social law.
and of the average parent to train a child, so that during maturity
the individual will have sufficient affective vigor to maintain the
state of virility, goodness and Kap'piness despite the stresses and
worries which attend responsibilities and competition.

^\Tien any of the different autonomic-affective cravings be-
come conditioned so as to need certain stimuli to be applied to
certain sensory zones, constituting interests that are perverted
or asocial, then these cravings become a serious, if not a grave,
menace to that personality and cA^en to the race. When such

700 ' PSYCHOPATHOLOGY

cravings become overstirmalated and uncontrollable, and, because
of their vigor, or because of the weakness of the opposing, con-
trolling wishes of the ego, due to fatigue, discouragement, toxins,
etc., then the personality faces a crisis : grave, often, because the
cravings, which are urging the commitment of perverse or dan-
gerous acts, are jeopardizing the personality's social fitness. The
individual, horrified and fearful, struggles desperately, eccentri-
cally, even frantically against this endogenous force. It is not sur-
prising then that the pelvis and the devil are so often believed to
be allied as one, and that this uncontrollable craving is regarded
as a foreign influence, a hostile, hypnotic power, threatening the
peace and safety of "the soul," which is secretly introduced into
the personality through the diabolical schemes of a secret society,
an associate or a parent, and must be eliminated or destroyed at all
costs. The fear and anxiety, which the obsessive craving causes,
may become intolerable. This /ear is not a strange or unexpected
freak of evolution, however. It is obvious that humanity, by
becoming afraid of and hating biological inferiority- and perverse
waste, succeeded in avoiding it best. The individuals who procre-
ated young naturally trained them to approximate most nearly such
requirements as contributed most to the further development of
the race, by their example and affective influence. Thereby was
fostered the tendency to become apprehensive of Inological per-
•verseness and to regard it as an inferior attribute in an individual,
because it tended to mislead the resources of the race. That the
failure of an affective craving to acquire its needed Stimulus should
arouse uncomfortable autonomic tensions and sensations was the
sole means the autonomic apparatus had of compelling the profi-
cient cellular masses to work, endure fatigue, pain and destruction
in order that the autonomic craving might be relieved. Those in-
dividuals, who do not feel uncomfortable when the craving is not
gratified, naturally become careless and retrogressively less able
to compete with the sensitive members of the herd. In turn, they
become isolated and tend to die oif without procreating or raising
their young.

The general method of controlling a perverse craving or infe-
rior attribute is to get as far from it, as a cause of fear, as possi-
ble ; hence, tend to develop opposite interests. -The asocial or per-
verse craving, as a functional inferiority, must be compensated for
in some m&nner in order to acquire sufficient social esteem and

RECONSIDERATION OF DETERMINANTS OF BEI-IAVIOR

701

social influence to feel safe. This is natural and invaluable.
Throughput animal life wo find that inferiorities, oi-ganic or func-
tional, due to disease or injury, have to be compensated for at a
level far too deep to be considered to he instinctive; as in the de-
velopment of antibodies to counteract infection, phagocytosis, car-
diac compensation for valvular deficiency, muscular hypertrophy

Fig. 69. — Masculine compsiisation in a woman. Following the mother's inter-
ference with her mating she developed a psychosis in which she solved her unhappi-
ness by becoming male, the priest of an elaborate new religion and philosophy. Her
attitude is that of aggressive homosexuality. She made the costume.

to compensate for fatigue, or hunger to compensate for the deteri-
orations of metabolism. Similarly the autonomic compensations
(adrenal secretion, adequate vasomotor changes, glycogen in
the blood, increased cardiac rate and systole, and appropriate
motor tensions) occur reflexlj^, preparatory to attacking the cause

702 PSYCHOPATHOLOGY

of fear ; as bluff in the face of danger (the arched back and erect
hair of the apprehensive dog or cat, or the lond profanity of the
bully), the creation of machinery to compensate for physical in-
feriority in our competition with climate and space, or with an en-
emy : producing out of Demosthenes, the stammerer, Demosthenes,
the orator.

Physical competition in battle, games, mating, commerce, tends
to reveal the relative inferiorities of the competitors as well as
their superiorities. The presence of an inferiority, organic (as
color) or functional (as stammering), requires either an ade-
quate compensation or a withdrawal from competition. In com-
mercial and political struggles for social esteem and social influ-
ence a tactful withdrawal is often more practical than a fight to
the finish, but in mating there is but one solution, either -win or
lose the love-object. Naturally, also, the presence of a pernicious
fear, while competing for a mate, is in itself an inferiority and ex-
poses the individual to severe tests of self-control. If the founda-
tion of the fear is a specific functional inferiority, as autoeroti-
cism or homosexual perverseness, or incestuousness, or a criminal
record or scheme, the competition for the mate not only necessi-
tates unusual compensations, but also concealment of the inferior-
ity, and even repression of an adverse craving, so that it can not
cause awareness or consciousness of its presence. This repression
of the perverse wish is always attended by more or less defensive
tension, sensitive pride, and anxiety; hence the mild neurosis as
a disturbance of autonomic comfort.

Whenever the segmental autonomic-affective craving meets
with an unmodifiable resistance, the individual begins to feel un-
comfortable from the autonomic pressure. He can not sleep well,
is restless, does not think consistently, loses appetite, becomes irri-
table, etc., symptoms of the autonomic-affective pressure using
the trial and error method of finding a weak place in the resistance
and obtaining control of the final common motor paths of adjust-
ment. If the struggle is hopeless because of unchangeable ethical
and moral obstacles, as the inability to marry because of obliga-
tions to a parental invalid, or the attitude of a frigid mate, or the
inability to retaliate against a nagging, superior officer, a depres-
sion of the autonomic apparatus develops which may vary from a
mild malaise to severe loss of power to coordinate acts and
thought for a future purpose (as so-called paraphrenia, etc.).

RECONSIDERATION OJ? DETERMINANTS OF BEHAVIOR 703

Dissociation of the personality is essentially due to the re-
pressed craving (a state in which the craving is not permitted to
produce consciousness or aAvareness of its needs) overcoming the
wishes to be socially estimable and proper, and despite the ego's
resistance, causing behavior and sensations which tend to gratify
its needs.

The discovery of the existence of the repressed craving (for-
gotten wish in the "nnconscions"), and of its subtle influence upon
human behavior and the content of consciousness (thought and
judgment), is the great contribution to knowledge by Sigmund
Freud. If the experiences of psyehopathology in the use of this
discovery are a reliable criterion of its value, it will become an
important contribution to the progress of civilization.

Sherrington, in his work upon the integrative functions of the
nervous system, showed how two neurones, converging upon a
third which is efferent to them, may be stimulated to inhibit or
suppress one another or to reenforce one another. This mecha-
nism applies not only to individual neurones but to segmental
groups when acting as a unity against antagonistic cravings or
wishes, as they converge upon the use of a limb, or group of limbs,
or the special exposure of a receptor or group of receptors. The
same principle exists in the struggles „of antagonistic cravings
with the ego to dominate the final common motor paths of adjust-
ment and direct our overt behavior. As the vigor of the conflicting
wishes varies, incoordinations may occur; hence, errors in move-
ment, execution of work, and wish-fulfilling mistakes. Conversely,
the occurrence of an error under ordinary conditions, as a slip, fall,
unintentional self-inflicted injury, mistake in speech or writing,
swallowing food into the larynx or biting the tongue, is indica-
tive (symptomatic) of the repression of an affective craving or
wish having been made at the moment of the incoordination.

Similar in mechanism is the misinterpretation or misrepresen-
tation, in that the cause of either is usually traceable, if explain-
able at all, to the direct or indirect fulfillment of a wish (grati-
fication of a suppressed autonomic craving). The craving not
only causes the seeking for a satisfactory stimulus, but, moreover,
through the reflex maintenance of characteristic postural ten-
sions of the striped muscle apparatus, forces the individual to be
conscious of a kinesthetic stream of sensory images which tends
more or less to relieve the craving. It is this autonomically

704 PSYCHOPATHOLOGY

aroused stream of hinesthetic imagery, wMch,. ivJien combined with
sensations produced by exogenous stimuli playing upon the extero-
ceptors, produces the ivish-fulfilling delusion, dream and hallucina-
tion, or misinterpretation of the behavior of others. This meclian-
ism applies as well to the ■wish-fulfilling errors of substitutiorL or
elimination, as in misspelling, misreading, misselecting, even
though they may be disastrous to the ego. The dream is a minia-
ture, transitory psychosis occurring when the capacity of the or-
ganism to remain coordinated as a unity is lost (as during fatigue,
toxemia, sleep). The psychosis occurs when the repressed auto-
nomic-affective cravings, through summation, or depression of the
ego, become too vigorous to be controlled by the repressing crav-
ings and becoming dissociated, cause hallucinations (auditory,
visual, tactile, olfactory, gustatory and hinesthetic sensory dis-
turbances) which tend to gratify the dissociated affect. The
individual hears himself called a pervert, because the dissociated
affect has perverse needs, or he dreams (hallucinates in sleep)
that his absent or dead mother is present, becaiise he is home-
sick, or that he is drinking water when he is- thirsty, because he
wishes to sleep and will not get up, etc.

The symbol, image,. feiich, ritiial, -fancy, fairy' tale, novel, or
psychosis, etc., is adopted by the affect ivhcn it can not obtain
the reality. The image or symbol,' being associated with the re-
ality by the similarity of some of its qualities or the accidental con-
tiguity of its special or temporal position, seems to relieve the af-
fect to a marked degree. When the affect can not acquire what it
needs, uncomfortable tensions or anxiety (fear) are felt, and the
use of the symbol or fetich, relieving this anxiety, has a marked
physiological vahoe in that it prevents the adrenal, thyroid, cir-
culatory, hepatic, and pulmonic compensatory striving from be-
coming excessive. Hence, religious symbolism, ritualistic formu-
lations of faith, fetichistic administrations of grace, artistic fan-
cies, mystic rites, etc., all have a great value in the restoration of
biological potency until the environment, climate, social jeopardy,
disease process, or bereavement, change sufficiently so that the
autonomic cravings may again acquire the reality. The ritual of the
medieval northern Europeans inducing the return (rebirth) of the
Sun, thereby increasing the food supply and decreasing privations
and restoring potency, has a psychotherapeutic value. It seems
to me that this conception of the physiological nature of the per-
sonality and the theory of neutralizing affective cravings, alone, of

RECONSIDERATION OF DETERMINANTS OF BEHAVIOR

705

all the tlieories advanced, gives the (uithropologist, behaviorist
and psychologist a satisfactory explanation of the compensatory
origin of folk lore, song, language, mysticism, art, religious ritual,
hallucination, etc., in primitive a/rid civilized man. Obviously, rit-
uals and fetiches ichich tend to stimulate sexual potency, despite
the depressing fears of the m.ate's indifference, economic stress,
political oppression, religious dogma and social intrigues, are to
be highly favored, not only by the savage, but by the modern
civilised man and ivoman, as ivell a\s the psychopath.

It is but natural tliat, when a fearful, oppressive, unpleasant,
or disgusting stimulus enters into tlie love or mating situation,

Fig. 70. — African feticli place; a tree and two stones.

before the erotic state is well established — the blood-supply be-
coming reflexly shifted from the pelvic and gastrointestinal organs
to the organs of defense, as the limbs, head, heart and lungs, pro-
ducing more or less sexual impotence, — the individual tends to seek
a fetich, drug, companion, play, or ideal, which, as a counterstimu-
lus, tends to restore his potency or feelings of power and general
reassurance.

Only with this understanding of human nature do the psycho-
pathic deviations from the requirements of the social herd become
intelligible as truly biological phenomena.

The intimate influence of the affective-autonomic activities

106

PSYCI-IOPATHOLOGY

upon the postural tensions of the striped muscle apparatus, hence,
the kinesthetic stream and in turn, the content of consciousness,
has been shown in a variety of cases besides the classical exam-
ples of anger and fear used by Darwin.

The proud, arrogant, egotistical paranoiac displays his af-
fective compensation in his carriage, walk, play, conversation, work
and conflicts, and a little study of his case shows that he strives to
free himself from a persistent sense of personal inferiority due
to his secret autoerotic or homosexual tendencies. In such exam-

Fig. 71. — Terrific striving to become omnipotent as a defense against fear of homo-
sexuality and impotence.

pies we find a complete similarity in the man's general muscular
tone and the trend of his thought.

On the other hand, the individuals, who finally yield- to their
perverse erotic cravings and resign themselves to live at the level
of non-resistance to it, may be found on the wards by the hundreds
as so-called chronic dementia prseeox types. A study of these peo-
ple shows that they are preoccupied with an incessant stream of
lurid, weird polymorphous perverse sexual thoughts and sensa-
tions, ajid a most grotesque, primitive estimation of their places
in the social herd. Their slovenly appearance and characteristic-
ally relaxed,, si ouchy carriage reveal the marked indifference of

IIECONSIDEIIATIOX Ol-" PHTBIUII iVANTS 01'' BK.IIAVKIR

ro7

the erotic affect to social esteem, and the sensuous, postural tonus
of the striped muscles, as the source of the kinesthetic stream, co-
incides with the erotic Avish-fulfiUing content of consciousness.
(See Figs. 65, 66.) A more easily defined relationship of the pos-
tural tonus of the projicient apparatus to the affective craving and
the content of consciousness is to be seen in the catatonics' gro-
tesque postures and mannerisms, as compelled by the dissoci-
ated affect and their literal interpretation by the ego (see cases in
Chapter XII). One may become aware of these mechanisms in

Pig. 72. — Charaeteristie postural tensions of striped muscle system revealing
affective cravings. (1) Depressed, intrauterine state of regression with sufficient
adaptability to walk when forced. (2) Paranoid adjustment, showing expectation
of assault from Behind,- probably sodomistie. (3) Hebephrenic excretory erotic in
characteristic dress and defecation position; face shows pleasure at fancies. This
photograph, taken, in ari American State Hospital shows the primitive method of
herding the dissociated personalities into groups without regard for the individual's
repressed or dissociated cravings.

himself if he will learn to analyze his dreams wliile the dream
process is active. Ordinarily, the dream is taken at its literal face
value during sleep, whereas by learning to analyze its symbolic
values, one learns to recognize that the grotesque dream imagery
decidedly portrays the incongruous relations of the affective ten-
sions. We often feel incongruous postural tensions when, we have
forgotten to do some important thing. These tensions indicate

708

PSYCHOPATHOLOGY

that a wish to do some certain thing has been repressed and is
trying to work.

The quickness with which a change of postural tonus of the
striped muscles is compelled by an affective change, is to be seen
in the innvimerable, undesirable, little accidents that occur every
day as the result of a brief relaxation of some postural grip that
holds the body or an object in place against the influence of grav-

!Fig. 73. — This biological result is typical of the dironio oral erotic dissociated

personality.

ity, such as slipping, or dropping a razor or cigar as the result of
being momentarily distracted by the necessity of making a repres-
sion of an affective reaction which, if allowed free play, might
be embarrassing.

The psychologist, psychopathologist and physiologist must

BECONSIDERATION OF DETERMINANTS OF BEHAVIOR 709

learn to recognize that his affections or feelings, as he becomes
aware of them, consist of a stream of sensations which have so
coalesced as to be reacted to as a characteristic feeling, and
this craving constitutes the anger, hunger, fear or love. For exam-
ple, in anger, the hypertensions in the epigastric region, the
thoracic inflation, increase of cardiac vigor, tumescence of the
muscles for attack, as chest, arms, legs, neck and face, are popu-
larly expressed by the phrase, "itching for a fight." When fear
is also a part of the reaction, the face may be blanched and tense
instead of congested, as "white with rage," signifying that the in-
dividual has become afraid of his ability to control the compul-
sions of anger and his responsibility.

The delusions and hallucinations about the behavior of other
people are not due, essentially, to the actions of these people, but
are the result of the individual's own, autonomically determined,
wish-fulfilling, kinesthetic sensory stream so coloring his impres-
sions of the meaning of the behavior of others as to produce the
misinterpretation. Naturally, when the delusion is accepted as an
accurate representation of the behavior of others, the delusion it-
self becomes the cause of elation or anxiety. Thus a vicious circle
of adjustment develops.

On the other hand, only those individuals are hiologically well
adjusted, ivhose sexual affections are so conditioned that, in their
striving for gratification, they reenforcc the ego's struggle for
social esteem.

The affective difficulties of the cases presented lead to a most
important conclusion, which, if correct, calls for a significant, more
biological readjustment of our social, educational and religious
ideals. It is, namely, that no individual can have a psychosis or
anxiety neurosis so long as he can maintain his sexual potency
ivithout jeopardising his needs for social esteem.

If he or she maintains sexual potency at the price of social
esteem, a social delinquent results. If sexual potency is sacri-
ficed for the sake of social esteem, an anxioty neurosis develops
unless the sexual affections can be thoroughly sublimated. Such
sublimation is rare and most difficult except for some philosophers,
scientists and social workers of the modern and ascetic religious
schools. (Teaching and the ministry come iinder the social forms
of sublimating the erotic affect.)

If the sexual cravings Iiavo to be kept repressed in order to

710 PSYCHOPATHOLOGY

protect the struggle for social esteem, a psychosis is very likely
to occur, -whether the erotic affect is perverse or not, when the
power to control the self is weakened by disease, injury, discour-
agement, etc. : whereas the social virility of an individnM is enor-
mously increased ivhen reenforced by estimable, refined, condi-
tioned sexual cravings.

Mechanisms of Neuroses and Psychoses

The psychopathologist must answer two questions in every
case: (1) how long Avill the psychosis last? and (2) what will be
its effect upon the personality? My experience is that one's an-
swer is best guided by an estimation of the ego's attitude toward
the ungratified unavoidable cravings and the nature of these crav-
ings. If the ego is inclined to accept or recognize that the source
of the neurosis or psychosis, that is, the visceral distress, preoc-
cupation of thought, hallucinations, etc., lies in his emotions, crav-
ings or ' ' feelings ' ' getting gratification or striving to get gratifica-
tion, we have a benign mechanism that is curable. If the ego per-
sists iai treating the cravings as foreign to his personality, per-
haps a part of his body but not a part of himself, or the result of
the secret work of an enemy, Grod or society we have a pernicious
mechanism that is incurable unless the attitude of the ego can be
changed to a benign one. This often can be brought about through
cultivating a transference of affection from the patient.

The duration of the neurosis or psychosis seems to depend
ixpon the means the affective cravings develop for obtaining grati-
fication and this is largely determined by the attitude of the ego
and what the environment can offer. Each case is decidedly dif-
ferent and as intricate as only humanity can be. One can not
afford to be too sure of the prognosis of pernicious cases.

The symptoms produced by the autonomic-affective conflict,
while often important because of the distress and vicious circle of
preoccupation which may result, are after all, not so important as
the attitude of the ego toward the cravings and what the cravings,
are. For this reason, unlike the older psychiatries, wherein most
of the space was given to describing symptoms, attention has been
mostly directed to the wishes or cravings of the individual and
how his resistance distorted their seeking for relief and their ef-
fects upon his comfort and the content of consciousness.

RECONSIDERATION 0]? DETERMINANTS OF BEHAVIOR 711

There are, it seems, four types of adjustment to the disturbing
pressure of an autonomic-affective craving: (1) yielding to the
craving at any cost of self-control and social esteem; (2) eliminat-
ing it from the ego by repressing it and keeping it repressed so
that it can not cause awareness of its needs, as in the functional or
organic castrations; (3) simulating conditions that tend to gratify
the craving, as in selfish fancies, dreams, imitations of pregnancy,
use of symbols; or (4) sublimating the love or hate by creating
socially estimable images -which are related to the true object of
the affect, as creating artistic, scientific, religious, philosophic, or
social works.

In the suppression anxiety neuroses we meet with distressing
sensations originating in the persistent tensions of some segment
or segments of the autonomic apparatus. This is usually due to
the inability to make the overt adjustment which is necessary to
acquire the conditioned affect's object and thereby its neutraliza-
tion; therefor the persistent increased cardiac rate and vertigo,
gastric anemia, and visceral hypotension associated with feelings
of weakness and inability to think clearly and accurately in a
crisis that threatens failure and loss of a love-object.

In the repression neuroses the individual represses the cause
of his anxiety (makes himself forget it), whereas in the anxiety
neuroses he is more or less aware of the cause but will not give it
its due value in his personality, as disguising his love or hate.
In the repression neuroses (phobias, compulsions, obsessions, func-
tional distortions) the repression of a wish or craving is main-
tained by a vigorous coordination or converging of the remainder
of the autonomic apparatus (which, acting as a unity, constitutes
the ego) upon a substituted or compromised line of behavior,
thereby preventing the intolerable craving from causing aware-
ness of its needs and jeopardizing the futiire of the whole organ-
ism. This is similar to concentration of interest in order to pre-
vent distractions Avhen trying to study, or work, or play golf, hide
a guilty or scheming wish, etc.

In the adaptations to vigorous cravings and critical situations
we find two general types of compensation and two types of re-
gression adjustments. The manic either abandons himself with-
out reservation to the enjoyment of the erotic craving and becomes
a jovial, amusing, mischievous, autoerotic player, or he develops
a wild, threatening, bluffing over-compensation, because he is

712 PSYCHOPATHOLOGY

fearful of being unable to control bis perverse sexual cravings.
The depressives are either types ■\vbo renounce all competitive
interests in the world, give up hope of Avinning the love-object
through the striving methods of maturity and regress to an
infantile, or intrauterine mother dependence; or, autoerotic, they
struggle anxiously, desperately to escape the obsessing cravings
of the pelvic segment. The determinants for these variations of
adjustment to the tabooed affect, psychoanalysis of these cases
shows, are based upon the influence of the individual's associates.

There are no well defined lines of demarcation between psycho-
pathic adjustments to intolerable or ungratifiable cravings upon
Avhich to erect very satisfactory nosological classifications of the
different adaptations as true diseases; hence, it is much more
practical to speak of cases according to the affective mechanisms
which are involved.

For example, the term dementia pracox i§ of necessity used
here because it has been popularly adopted as a division for classi-
fying people who show certain behavioristic traits, affective trends
and physiological symptoms. Through a loose usage of its origijtipl
purpose, the classification of certain psychopathic personalities,
the term dementia prcecox has been gradually, indiscreetly a;ccepted
as being a definite disease entity, and the classification of the per-
sonality as a dementia precox type has become adopted as the
diagnosis of a specific disease process. Because of the absence of
definite etiological factors, this has reduced the psychiatrist to
the sad plight of having to define what is meant by dementia prce-
cox in terms of the symtoms which he has grouped imder the name.
This circular method of reasoning from symptoms to name and
from name to symptoms, while it satisfies the court's and jury's
demand for logic and the custodial psychiatrist's need for short,
convenient names in order to pigeon-hole his cases, is diverting
the major part oE psychiatric curiosity from its task of working
out the particular pathology of each individual.

The general lack of confidence and respect by the medical and
surgical profession for the psychiatrist is due, largely, to his psy-
chotherapeutic inefficiency^ and circular mode of presenting his
eases, characteristically obscuring the unrecognized etiological fac-
tors behind the assumption of tmdefinable inherent or constitu-
tional defects. The profession's critical attitude is having, how-
ever, the effect of forcing the psychiatrist to present his case in
terms of its etiological factors or admit that he does not under-

RECONSIDERATION 01'' DETEII.MI XAXTS OK BEHAVIOR 713

stand it. The necessity for etiological factors lias changed the in-
terest in making wholesale, statistical, group studies to more prac-
tical, intensive, analytical studies of individual cases. The indi-
vidual, analytical method is not only clearly revealing many of the
psychopathological mechanisms which cause the functional psycho-
ses, but, almost equally important, it is decisively establishing the
fact that these mechanisms, constituting the disease process, are
all that need to be known, or used for the diagnosis, treatment and
presentation of cases. Necessarily, the old symptomatologieal
classification of psychopathic individuals has become scientifically
useles, except where lack of knowledge of the affective mechanisms
still makes it a convenience.

The study, or history of a case should include, besides an ac-
count of the environmental setting and an estimation of the indi-
vidual's intellectual, social, economic, vocational and esthetic-moral
development, an account of the psychopathological processes which
are involved : as the attitude of the ego in the coijflict, ivhether be-
nign or pernicious, the nature of the affective repression, acute or
chronic (love, hate, fear, shame, sorrow) ; the degree of the affec-
tive regression (as adolescent, preadolescent, infantile, intrauter-
ine); the type'of affective dissociation, recent, chronic, progres-
sive, fixed (as obsessions — persistent feelings and thoughts, de-
lusions, hallucinations, compulsions — mannerisms and acts, pho-
bias, confusion, delirium) ; the presense or absence of functional
simulations or eliminations, recent or chronic (as wish-fulfilling
postural tensions for their kinesthetic value, anesthesias, hyper-
esthesias) ; the presence or absence of compensations, if pres-
ent, whether recent, chronic, progressive or fixed (harmless, dan-
gerous grandiose) ; the degree of insight into the wish-fulfilling
influence of the cravings involved in the maladaptation process;
the symptoms of autonomic reactions (condition of hair, skin,
pupils, eyes and their extrinsic muscles, muscle tonus, pulse
rate, blood-pressure; glycemia, glycosuria, areas of vasodilation
or vasoconstriction, and spastic or flaccid visceral postural ten-
sions— pleasant or unpleasant — and degree of activity of glands
of external and internal secretion).

When some such procedure is followed, a comprehensive cap-
tion like dementia pnecox obscures the nature of the biological
adaptation or psychosis, and its particular dynamic factors.

The progressive biological deviations from the norm, dreaded
by the social herd, which are due to uncontrollable autonomic

714 PSYCHOPATHOLOGY

cravings, an nnmodifiable environmental resistance, and the re-
quirements for social esteem, vary greatly from mild feelings of
anxiety and inferiority with eccentric compensations to prevent
detection, as in the suspicions or paranoid type, to the arrogant,
eccentric, domineering, sensitive, grandiose paranoiac and the
paranoid dissociated (dementia prsecox) type.

In the pernicious dissociation neuroses (dementia prsecox
types, paranoid, catatonic or hebephrenic) or the benign dissocia-
tion neuroses (the hallucinated manic and depressive types) the
repressed affect has broken away from control by the ego and is
causing hallucinations of what it needs. The ego in turn may ac-
cept and enjoy them or fight desperately to stop them. In the
paranoid dissociation neurosis the repressed intolerable cravings
have become dissociated, and, producing vivid sensory disturbances
(hallucinations) are understood by the desperately striving ego to
be the voice and influence of a foreign personality. Utterly with-
out insight, the personality may or may not undergo a pernicious
deterioration, depending upon the degree of hatred, and the con-
ditioned nature of the love affect for infantile or adolescent types
of experiences, such as excretory or oral erotic play with certain
associates.

The catatonic adaptation is a renunciation of resistance and
submission to the dissociated cravings, which, usually, becoming
gratified by the hallucinated experiences, gradually subside and
permit a reconstitution of the personality along its preceding habit-
ual lines of behavior. (The mechanism of the catatonic 's "pro-
longed nightmare" is probably not unlike the erotic dream which
causes fear but gives sexual relief.)

The hebephrenic, having an affective fixation at the infantile,
or preadolescent polymorphous perverse level, usually predomi-
nantly excretory and anal erotic, finds life to be productive of the
greatest happiness in that irresponsible state. The affective re-
gression is to be regarded as an escape from the anxiety and vigi-
lance necessary to maintain fitness for social esteem, by resuming
a previous, irresponsible affective attitude, usual!}' a dependence
upon the mother.

The delirium is to be recognized as the loss of the organism's
capacity to maintain the compensatory nervous integrations which
acting as a unify control the proj'icient apparatus {overt behav-
ior) so that some hyperactive segment may not dominate avd com-

RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 715

pel behavior which might jeopardise the entire personality. The
hypertense autonomic segments and their nngratified cravings are
able, during the delirium, to dominate and cause awareness or con-
sciousness of images of previous sensory impressions (hallucina-
tions) which are, in some manner, related to the needs of these
cravings. The hallucinations may seem to be utterly irrelevant
and incongruous, but, upon analysis, will be found to be intimately
related to the atf active needs. The delirious, alcoholic homosexual
may frankly hallucinate an impending sexual assault by a potent,
dominant male, or its equivalent, by hallucinating being crushed
by a gigantic engine, or overcome by beasts.

This is not a strange or ridiculous symbolism. One needs but
to recall that politicians, big business men, athletes, generals, ar-
mies, fate, etc., are often compared to steam rollers or gigantic
irresistible monsters, and symbolized as such in cartoons. This
certainly reveals that the individual members of society have simi-
lar affective reactions in regard to them, or the cartoon would be
meaningless.

Explanations of delusions, say about having been shot with a
pistol in a certain spot in the chest (Southard, Franz) are not
satisfactory when based upon the finding, at autopsy, of a fresh
pleural adhesion near this spot. The conclusion that the adhesion
probably caused a piercing type of pain and therefore the mentally
deranged individual thought it was due to a pistol shot, is not
sufficient, because, although the lesion may explain the patient's
tendency to localize the supposed shot, it does not, in the least, ex-
plain why she specifies a pistol shot instead of a stab wound, or
pleurisy.

Such delusions, if explainable at all, will be found upon an
adequate analysis to be determined by the conditioned nature of
the ungratified affective cravings of the individual.

Determinants of the Prognosis of Affective Distortions

The ever recurring question as to the prognosis of the psycho-
sis, as a biological divergence, may be given some consideration
here. Distresses, confusions and psychoses, which are solely due
to affective maladjustments can not always be given definite prog-
noses. Sometimes most astonishing, efficient readjustments are
made, which, even though occurring in an apparently hopeless sit-

716 PSYCHOPATHOLOGY

nation, may endure for the remainder of the individual's career.
As a general rule, however, when certain affective tendencies ap-
pear persistently in an individual, the prognosis is proportionately
discouraging, particularly if there is hatred, or- fear of external or
environmental reality.

In proportion as fancies, delusions and hallucinations are
secretly pleasing and detract from the cultivation of efficient in-
terests in environmental reality, the prognosis is poor.

Individuals, who use eccentric compensatory strivings in order
to establish a sense of social fitness and obscure the feeling of in-
feriority, and maintain them at all costs, are not likely to acquire
insight and readjust, particularly if the eccentricity attracts so-
ciety's criticism and in itself becomes an inferiority.

Wherever an individual persists in making an eccentric claim
of unusual potency in art, science, commerce, mechanics, religion,
etc., ivhich is not fov/nded upon reasonable facts, fear of the tend-
ency to become heterosexually impotent is indicated. This type of
male or female's future depends largely upon the capacity to toler-
ate the cause of the fear (usually homosexuality) and sublimate it.

The earlier in the career that the affective cravings become
fixed and dependent upon a parent, the less affective capacity or
energy seems to be possessed for the fulfillment of the responsi-
bilities and independence of maturity; hence, less stress and dis-
appointment can be endured.

The probable difficulties of a psychopath, in adjusting to a
perverse craving or functional inferiority, may be inferred fairly
reliably from the comfortableness and success of his previous
social adjustment and the sincerity with which he seeks to control
himself. When such individuals o])enly haie those who resist their
eccentric struggle for potency and social infiuence, they tend to
establish a vicious social circle for themselves. When an indi-
vidual hates another, reactions seem to be aroused in himself that
tend to prepare for a counter attack by his rival or victim. These
compensatory tensions are disagreealile and, in turn, are reacted
to, reflexly, by others, although the latter may not become clearly
aware of what is occurxing. Thus the paranoid individual soon
finds himself cultivating, unconsciously, a fertile field from which
to gather remarks, signs, etc., which indicate that he is disliked,
distrusted, despised, and, in turn, soon actually becomes distrusted
and avoided, establishing a vicious affective circle.

nECONSIDERATIOK OF DETEEHINANTS OF BEPIAVIOU 71.7

It seems, as a general rule, tliat paranoiacs are not able to
re-establish a comfortable relationship with society if they tend
to systematize their delusions, fix them upon sohie definite person
or event, hate the resistance to their struggle for virility, and fear
their OAvn inferiorities.

Psychoses which are duo to intvafamilial feuds, arousing and
maintaining vicious affective circles, often disappear when an af-
fective readjustment is permitted, as upon the death of the oppres-
sor, or upon the severance of repressive obligations through di-
vorce. Most intrafamilial feuds are too intricate and involved and
of too long standing to permit of a solution through a sincere recog-
nition of the mechanism by the members of the family. In the
wealthy we often find an earnest, prosperous grandfather, and a
perverse, dissolute, unproductive grandchild. In such cases it
often happens that while the vigorous, virile grandfather built the
foundation of Ms family and established its economic resources,
he also unwittingly established an affective situation which was
destined finally to abort his descendants.

Psychoses which are due to periodic, erotic upheavals or pe-
riodic regressions have a better prognosis than the chronic erotic
or regressive.

The histories of psychopaths show, again and again, that the
foundation of the abnormal or eccentric tendency is established in
childhood through the influence of associates, and that psycho-
pathological adjustments in a parent tend to influence the child to
make abnormal adaptations and when the child matures its off-
spring also become the victims of an abnormal influence. The de-
velopment of insight through educational measures, more than
anything else, promises to reduce the tendency to assume an
abnormal attitude toward the fundamental inherent autonomic
cravings of the personality. Because of the changes incident to
the development of knowledge, severe conflicts with many tradi-
tions and religious conceptions and the social conventions must be
expected. The pressure of the restless, dissatisfied autonomic-
affective apparatus can no longer be lulled by platitudes and
preachments and dogmas, and the social readjustment, as a biolog-
ical process, is becoming irresistible.

A detailed discussion of the symptoms and mechanisms in the
eases presented in the chapters on the different types of neuroses
and psychoses was avoided in the case histories for the sake of

718 PSYCHOPATHOLOGY

brevity and clearness of presentation of the cases. It is impor-
tant, however, that some explanation of the mechanisms and symp-
toms be made. Theories or explanations are valuable as working
hypotheses in so far as they actually explain what actually occurs.

All the cases presented are alike in that we have people strug-
gling with strong affective cravings which are trying to get con-
trol of the individual or the environment in order to acquire the
stimuli which will neutralise or gratify them ; and because they are
resisted they cause distressing tensions of certain parts of the
body. Many ask the question that seems to arise naturally from
the case material, "Why do all neurotics and psychotics have sex-
ual difficulties?" This should be followed by the question, "Why
do people who have sexual difficulties tend to become neurotics or
psychotics?" These questions are very much like asking, "Why
do all cardiac incompensations develop general muscular weak-
ness, or all paretics have syphilis?" The answer would be that it
is the inherent nature of the forces involved to produce certain
mechanisms, and so the ego and its struggle Avith its sexual crav-
ings, when the cravings are ungratifiable and vigorous enough,
causes distress and distortions of behavior. The ego rarely has
to struggle continuously with the other primary emotions because
they are not taboo.

Under unusual conditions (as in the army or navy) we see
irrepressible hatred of an unavoidable superior or irrepressible
fear of an unavoidable cause causing neuroses or psychoses. They
clear up, however, when the cause is removed.

It seems that the erotic cravings may be (predominantly, not
entirely) balanic, vaginal, iirethral, oral, anal, or autoerotic. The
latter type, occurring in an individual who is his own lover and love
object, is quite different from the other types which must have
love objects that are not a part of the personality.

It is certain that we may have a neurosis or psychosis in an
individual who is normally heterosexual. By normally heterosex-
ual is meant individuals whose sexual cravings need the re-
sponses of the opposite sex and when free play of the sexual cravr
ings occurs a form of sexual intercourse results that relieves the
autonomic tensions and gratifies love, may reproduce their kind,
and gives a sound feeling of biological and social fitness. Case
MD-1 struggled against such cravings because of prudishness and
Case MD-7 abandoned herself to the cravings, obtaining in this

RECONSIDERATION OE DETERMINANTS OV BEHAVIOR 719

manner what they needed because of her impotent husband and
her fears of immorality, syphilis, betrayal and abandonment.

Both were women. Men are not so likely to have neuroses
from ungratifiable heterosexual cravings because the social taboo
is fortunately not (yet) as severe and punishing as it is against
the female. When his autonomic tensions and sexual cravings,
however, tend to force him to yield to an abnormal (autoerotic or
perverted) means of getting relief because the resistance to a
normal means is insurmountable then the signs of tensions and
distress begin to show. The type and seriousness of the neurosis
or psychosis is the type of conflict that is waged between the ego
and the erotic cravings.

The manner in which the erotic cravings are gratified is de-
termined by the same laws that determine how stomach cravings
for food shall be gratified. That is to say, if we punish or threaten
to punish a young or old dog, horse, any animal, man or woman,
often enough when trying to get food in a certain way (the
younger and more timid the animal or person, or the more violent
and certain the punishment, the less often need it be applied) the
fear of pain will force the development of some other means of
getting gratification. This other means is determined throughout
animal life by the nature of the organic equipment (motor and
sense organs). The small horned stag is subdued during the rut-
ting season, the timid youth is subdued by his more courageous ri-
val or the suggestions of his prudish parents and remains auto-
erotic. The monkey, elephant, or stallion, upon being subdued by
man and placed in captivity, masturbates. When the monkey is
isolated from the female he becomes homosexual; and so when
youth is placed in captivity by moral preachments, prudish par-
ents, fears of disease, pangs of conscience, all depriving him of a
heterosexual outlet, he finds his sexual cravings trying to get
homosexual or autoerotic gratification. If his organic equipment
is effeminate, or her equipment is masculine and unattractive to
the opposite sex, the fear of punishment and ridicule upon seeking
heterosexual means is increased.

The sexual hunger mechanism, like the food hunger mech-
anism is extremely simple. It tends to follow the line of least
resistance and requires controls and reenforcement to overcome
dangers and become refined. Society must recognize this and in-
stead of despising and discouraging heterosexuality it should

720 PSYCHOPATHOLOGY

encouage and promote the development of heterosexual potency
in order to prevent biological abortions . through fear of the re-
sponsibilities of heterosexuality — ^pregnancy, labor, parenthood.
Many of -the preceding cases show that as the sexual cravings
become normal (heterosexual) 'the panic and fear of homosexual
submission T,vith perversions (the psychosis) decreases. (See
Cases P-3, PD-14, PD-15, PD-20.) This" should be sufficient warn-
ing against heeding moralizing fanaticism, under whatever dis-
guise it may appear — religious, academic, medical, esthetic, etc.,
which would place too severe obstacles, laws and conventions
against heterosexual living. Particularly is this likely to be over-
done wherever men or women are congregated together in large
numbers, as on board ship, in army camps, colleges, prisons, con-
vents, monasteries and asylums, because it is certain that a large
proportion of the males or females will become obsessed by the sex-
ual cravings tending to revert to masturbation or homosexuality.
On the other hand, heterosexual license, Ijesides increasing ve-
nereal disease, is decidedly conducive to degeneration of the per-
sonality and inability to love (PD-1, AN-S). Life is a serious
game which requires courage, fortitude, and common sense to play
it well.

Significance of Symptoms of Affective Conflicts

The most difficult features of a person's behavior to describe
in words that will give the reader the desired impressions are the
postural tensions of the patient's limbs, body and facial muscles.
It requires genius to convey an accurate idea -with draAvings, paint-
ing or sculpture, hence description by words, far more difficult, is
beyond reach of the average psychiatrist. Photography is perhaps
the best method and avoids the tedious descriptions of behavior
and emotions that once burdened psychology and psychiatry. (See
following pages.)

The postural tensioiis of the striped muscles reveal the nature
of the ego 's struggle with the repressed affect to the observer who
is familiar with their significance. The cravings for oral or anal
erotic submission and the attitude of the ego can often be differen-
tiated by the postural tensions. Autoerotic anxietj'-, autoerotic
abandonment, infantile regression, paracidal or manic compensa-

RECONSIDERATION OF DETERMINANTS OK BEHAVIOR

r2i

Fig. 74. — Note the posture of tlie hands and rigidity of the body. This postural
interest in the hands is usually a defense against autoerotieism. This patient seized
u, knife and attempted to amputate his penis.

Fig. 75. — The postural tensions of the facial muscles show silly, unrestrained abandon-
ment to autoerotic cravings.

722

PSYCHOPATHOLOG Y

tions, and defensive postures to keep from becoming conscious of
undesirable cravings or inferiorities are often self-explanatory
when one has had clinical experience with the predominant types.

ITig. 76. — The postural tensions of the facial muscles show anguish and despair. The.
cause was secret autoeroticism.

rig. 77. — Compulsion to prayer as a defense and purification against oral eroticism.

The ego's attitude toward the use of the different sense or-
gans of the body also reveals the nature of the affective struggle.
Anesthesias and hypesthesias mean an affective resistance to

RECONSTDEUATIOSr OF DETERMINANTS OF BEirAVrOU 72'.]

Fig. 78. — Joyous abandonmoiit to anal and autoeroticism.

Fig. 79. — The face shows intense Fig. 80. — Postural tensions of facial

hatred. This individual is the victim of muscles show extreme terror and emaci-
intense anal erotic cravings. ation. At this time she had the convic-

tion of having teen the subject of
sodomy, apparently a wish-fulfilling de-
lusion.

724 PSYGHOPATI-IOLOGY

the sensations that might be received through using a particular
sense organ. These sensations may be aroused by stimuli in the
environment or memories, that is images, of past sensory experi-
ences which the ego might become conscious of. So-called visual
constriction of hysteria, deafness for certain sounds, areas of an-
aesthesia for contact stimuli, anosmia, etc., are due to affective re-
sistance or fear of using the sense organ because that would force
the recall of a painful memory or sensorj'' images of experiences
that caused distress. (See Case PN'-2.)

Amnesias, circumscribed for an experience or the details of a
period of life, are, physiologically, forms of anaesthesia. The ego

Pig. 81. — Tlio tensions about the mouth show tremendous striving as a defense

against oral eroticism.

resists making movements and assuming postures which would
stimulate the proprioceptors (kinesthesis) and external sense or-
gans which in turn would reproduce a sensory image of the pain-
ful experience. Thus the patient prevents himself from becoming
conscious of the experience, hence the amnesia is a valuable form
of adaptation. Partial memories are similar to hypesthesias.
(See Case PN-2.)

Hyperesthesias and paraesthesias are caused by an excessive
craving for the sense organ and its stimuli. Persistent memories,
delusions and hallucinations are forms of hyperesthesias caused
by the ungratified affect striving to get gratification despite the
resistance of the ego. (See Cases PN-2, PN-1, PN-7, MD-1, MD-2,

RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 725

Fig. 82.

A. Tensions of facial muscles showing perplexity and fear caused by anal
erotic cravings.

B. Facial tensions showing fear — anal erotic cravings.

0. Facial tensions showing slight suspiciousness but general tendency to seek
seduction — cause anal eroticism.

D.. Facial tensions showing extreme suspiciousness.

726

PSYCHOPATHOLOGY

HD-1,, CD-I.) Fear of injury, for example, lowers the resistance
to the sense organs that indicate the approach of an avoidable
cause of injury. The painful or hypersensitive vagina is often
caused by fear or repressed hatred lowering resistance to the pain
sense organs there. The delusion or hallucination often gratifies
erotic or hatred cravings although it terrifies the ego just as the
stomach hunger cravings often force the eating of waste or dan-
gerous food or getting into situations that terrify the eg'o. (See
Cases PD-33, PD-35, CD-6.)

The theory that delusions or hallucinations are caused by the
misinterpretation of an external situation or the peculiar condition

Fig. 83. — (A) Facial tensions show weak striving to control fearful oral erotic crav-
ings. (B) Facial tensions showing despair at uncontrollable eroticism.

of the environment is not acceptable. (See Case HD-1.) What
actually occurs in the delusion or hallucination is that the individ-
ual's perceptions and conceptions are made up, as a synthesis, of
the sensations of which he is conscious. The sensations now m
from the three great sensorj?- divisions, exteroceptive, enterocep-
tive and proprioceptive. Now the inflow from the exteroceptors
may be qu.ite alike for a group of people and each member's con-
ceptions may be more or less alike in general but decidedly differ-

EECONSIDBEATION 01? DETERMISTANTS OF BEHAVIOR 727

Fig. 84.^ Tensions of facial muscles showing desperate striving (hate) to control

dissociated perverse erotic cravings.

728

PSYCHOPATHOLOGY

■

^ -0"^

>^.

■^ ^

^^1

"^ 't'V*79^B^^ti^^^H

I^M

^^K "^^WfP**

tji^^^^^^^^^^^^D

^^^^H

Im^

H^H

Pig. 85. — Elimination or eaatration of eyeball as a defense against eroticism.

Pig. 86. — Facial tensions and posture of eyes express the "contrite virgin" —
the result of tremeadous compulsions to prove innocence following a sociarseandal
that forced her into the position of an immoral intriguer. Striving to forget (make
herself unconscious of the sexual wishes and memories).

RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 729

ent in important details, as the testimony of observers or wit-
nesses of a crime always shows. This difference in the significance
of what was seen or heard is due to the differences in the kinaes-
thetic stream or stream of sensations flowing into consciousness
from the proprioceptors and enteroceptors. Hence it is more ac-
ceptable to say that any individual having the same flow of sensa-
tions from the internal sense organs and external sense organs
would think the same things ; that is to say, would have the same
delusions or hallucinations. The difference between delusional
and rational inividuals lies in the proprioceptive activities, that
is, hyperesthesia of certain proprioceptive fields and anesthesia of
others, in turn, aroused by postural muscle tensions, in turn deter-
mined by the repressed and ungratified affective cravings trying
to get what they need. Therefore in psychotherapy we endeavor
to induce the patient to become conscious of his repressed affective
cravings and the wish fulfilling value of his delusions and halluci-
nations, just as men lost in a desert would not hesitate to explain
why they could not resist the craving to drink urine, or water which
they knew to be poisoned by alkalies.

Paralyses (s-pastic and flaccid) are compelled by the repressed
affect in order to escape from a distressing situation, escape from
the distressing memories or sensations of a situation, or they are
the best available means of getting sensations that will gratify the
affect in a hostile or unresponsive environment. (See Case PN-3, '
PN-7.) Convulsions and tics, as clonic-spastic motor tensions,
also are caused by the affect to acquire similar results — relief or
neutralization. (See Case PN-6.) Fear of the enemy in front
and court-martial behind, if unendurable and uncontrollable will,
as soon as fatigue or toxemia sets in, force a reflex postural ad-
justment in the soldier which will permit escape from the cause of
fear. Hence the war neuroses as repression of fear or perverse
eroticism neuroses.

Dreams, fancies, myths, tales, stories, novels, poetry, paint-
ing, sculpture, music, drama, delusions, hallucinations, religious
ritual, forms of faith, scientific research and theories, philosoph-
ical and social systems, laws and ministrations of justice are the
result of forms of behavior urged by the affective cravings trying
to get gratification through solving the environmental resistance.
In order to understand the significance of a man's fancies as
forms of reasoning, look for wish-fulfillment and how it gratifies

730 PSYCHOPATHOLOGY

his struggles for potency and social esteem and avoids the fear of
failure, loss, pain, etc.

Fear, panic, terror, anxiety, uneasiness, douht, apprehension
are all degrees of fear of failure to gratify the affect, avoid pain
or control the perverse affect.

Apathy, lethargy, "loss of will power," loss of muscle tone
or energy are failures to compensate to the cause of fear and an
unconscious submission to an insurmountable environmental re-
sistance. (Case AN-3.)

Phobias seem to be of two types, one is due to the fear reac-
tions being conditioned to be aroused by stimuli that are associ-
ated with a former dangerous or fearful experience which may or
may not have been forgotten. (Case AN-1.) The associated stim-
uli may also be symbolized, as the fear of open spaces due to fear
of losing the mother's attachment. The other type of phobia is
the fear of a suppressed, persistent wish bringing about an indul-
gence or an event or getting joy out of an event; such as the death
of a father, mother, mate or child who has become an obstruction
to obtaining a love-object. (Case PN-1.)

Compulsions and obsessions naturally arise as confipensations
to keep the intolerable or unjustifiable wish repressed, that is, pre-
vent it from causing consciousness of its needs or efforts ; such as
the compulsion to maintain innumerable protective appliances
about the house or of performing a ritual each day in order that
a certain person -will not be killed. (Cases PN-1, P-1.) The unrea-
sonable dread of the person being killed is due to the wish for
relief from that person's unconscious obstruction of the affective
cravings, usually love.

Mannerisms, fetiches, ritioals are methods of repressing from
consciousness ("banish out of mind" or "banish the thought")
thoughts or environmental conditions that tend to cause fear of
loss of potency (particularly fear of yielding to perverse or auto-
erotic cravings) and on the other hand to stimulate heterosexual
potency. (Cases MD-8, MD-2, MD-3, MD-11, P-1.)

Manias or cravings such as kleptomania, mania for lying, for
causing others to hate one another, injure one another, or love one
another, are means of getting erotic gratification through bringing
about events that may establish an opportunity for or that actually
cause the orgasm. (Case HD-1.) In surgical clinics we often find
erotic females and males who periodically become obsessed with

RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 731

cravings for minor or even radical major operations, entailing even
the loss of large parts of vital organs. The operation and excision,
being equivalent to a sexual submission or labor and birth, attended
by affective readjustments which are equivalent to a sexual or-
gasm, force such people to seek for and submit themselves repeat-
edly to the ordeal. When erotic affect runs a rampant course,
the visceral tensions, hence visceral areas of tenderness and pain,
become unendurable. The simulations of tumors and visceral an-
omalies are often amazingly real and may mislead the most skill-
ful diagnostician.

The obvious defense against irresistible cravings is the elim-
ination from the environment of all things that might arouse them.
This mechanism gives rise to an enormous number of chronic ec-
centric social reformers. (Cases P-1, CD-4.) Psychopaths often
solve their conflicts with repressed cravings in this manner.
Asylums are full of them. The more practical and harmless,
though not less obsessed and inspired, biologically anomalous re-
formers must be controlled or avoided because of their persistent,
unconscious tendency to mislead the race in its ciiltural develop-
ment. They are compelled to make life easier for their own con-
flicts and being biologically abnormal are potentially misleading
for the biologically normal.

The influence of secret cravings and secret memories of past
indulgencies upon the behavior of the psychopath is the same as
upon the normal child and adult. They all feel, because of many
minor experiences of the sort, that others recognize their efforts
to conceal something shameful. The next stage is the persistent
dread that people will shun them because of trying to conceal
something and this may develop into the belief that people can
read their minds and steal their thoughts. This develops the com-
pensatory defense or claim of the psycopath that he can read the
minds of others, even building up a defensive philosophy on this
conviction.

Fear of croivds usually means a repressed craving for exhibi-
tionism or a secret violation of the laws of the race and fear of the
anger of the race. -

Fear of death, dying, crucifixion or stdcide often results from
ungratified sexual cravings that are trying to get gratification
through the act. (Cases PD-30, PD-31.) Such fears also may
mean an uncontrolled regressive tendency of the affective cravings

732 PSYCHOPATHOLOGY

to return to an intrauterine attachment to the mother. ( Case HD-
1.) Dying means returning to a state of existence similar to that
which was lived before birth. In many religions , it signifies a
reidentification with divinity.

Cravings to steal, lie, rape, sedivce, nmrder, to be cruel, brutal
or sadistic are often caused by the erotic affect trying to get fur-
their excitation in order to become potent enough to obtain grati-
fication.

Cravings to be beaten, punished, cheated, misled, seduced,
raped, persecuted, bullied, injured are often caused by erotic
cravings to submit to and be overcome by a powerful, brutal, ir-
responsible force and are often shown in the psychosis as the cause
of delusions and hallucinations of having had such experiences.
(Cases PD-33, PD-34, PD-35.)

CHAPTER XV
PSYCIiOTIlERArEUTIC PRINCIPLES

All neuroses and psychoses which are due to uncontrollable or
ungratifiable affective cravings have a common psychotherapentic
problem which resolves into a question either of diminishing the
vigor of the uncontrollable autonomic tension and its craving or
of increasing the vigor of the ego (the socialized cravings), so that
the latter may dominate the final connnon motor paths (overt be-
havior) and thereby control the undesirable craving.

The psychoanalytic method is primarily interested in reducing
the vigor of the uncontrollable craving, whereas the suggestive
and hypnotic methods, reeducation and rest cures, etc., endeavor
to reconstitute and reenf orce the ego so that it will be able to con-
trol the cravings which tend to jeopardize the individual's efforts
to retain social esteem. Both methods have splendid merits which
a prejudiced advocate of either one would be likely to neglect in
the other.

There are types of cases, particularly where unmodifiable in-
trafamilial feuds are involved, which may become aggravated by
a psychoanalytic procedure. On the other hand, there are more
cases which can only be cured through psychoanalysis and which
only receive a meagre, temporary benefit from the suggestive
smoothing-over process. There is, moreover, a critical stage in
many psychoses that is highly favorable to a psj'choanalysis, but
is often missed and lost because the physician in charge inclines to
favor the rest-cure and suggestive method at the wrong time.

The suggestive method of treating the psychopath rarely, if
ever, effects a permanent cure, whereas the psychoanalytic method
often effects remarkable, apparently permanent cures. The lat-
ter method has not, however, been used long enough to justify
absolute confidence in its capacity to effect permanent cures, even
though the results are, so far, most encouraging.

The suggestive method depends for its success upon the con-
vincingness of the personality of the physician and his ability to

733

734 PSYOHOPATHOLOGY

win the patient's confidence; that is, a transference of affection
from the patient. Most suggestion therapeutists refuse to recog-
nize this fact, but insist that they merely win the patient's confi-
dence through the administration of impressive therapy and op-
timistic suggestions. Early in the history of hypnosis a form of
magnetic influence was assumed to be possessed by the hypnotist,
but this is now recognized by the psychoanalyst to be nothing more
than the winning of a positive transference of affection, love.

The psychoanalytic method of treating the psychopath is often
stupidly objected to on the grounds of expense of time and lack
of foreknowledge of practical results, and being useful only "in
selected cases," because it "may do more harm than good." I
have often heard these ultra-wise platitudes, which are as appli-
cable to surgery or internal medicine, pronounced with conviction
by physicians who had neither experience in psychoanalysis nor an
unprejudiced interest. One usually sees men maintain this atti-
tude as a justification for neglecting to conscientiously read
psychoanalytic literature for the welfare of their patients, or, be-
cause their own affective repressions mal^e them unable to endure
the tensions which would be aroused in themselves when listening
to a patient's difficulties which are other than organic and imper-
sonal.

It must be admitted that the psychoanalysis of a case may
result in a suicide, serious panic, or wild, homicidal outburst. But,
it must also be consistently admitted by the opposition to psycho-
analysis that the mistakes of medicine have buried their thousands,
and surgery, their tens of thousands. Because tuberculosis, car-
diac diseases, nephritis, pellagra, cancer, syphilis, etc., require
indefinite time and great labor, and cancer is often ineradicable,
should these cases be abandoned? The same unapologetic answer
to men who would advocate the neglect of such patients is not
too severe for men who strive to bring about the disfavor of the
psychoanalytic method.

The viciousness of the attacks upon psychoanalysis is so ut-
terly ill-founded and unjustifiable that it automatically directs at:
tention to the source of the prejudices in the personalities of these
critics. One man, a surgeon of national reputation, has written
severe attacks upon the psychoanalytic method without a justify-
ing study of the literature. At a medical society meeting in which
he presented an interesting theory on the pathology of dementia

PSYCHOTI-IERAPEUTIO PrJNCIPLES 735

prsecox, he said, when informed that I desired to discuss the physi-
ology of the emotions in relation to the pathology of dementia
prsecox, that he did not care anything abont the emotions, and,
further, that since he was an older man, it was only courtesy that
I should withhold my discussion. So, to please his personal preju-
dice, science and fairness had to be aborted. Later, I learned that
his prejudice was, at the least, related to repressions which were
intimately associated Avith a psychopathic tragedy in his family.

Another instance was that of a young physician, who, because
of marked bisexual physical anomalies (organ inferiorities) was
subjected to no little unpleasant ridicule by his classmates. He
wrote a paper denouncing the psychoanalytic method and the con-
ception that sexual inferiority was a cause of anxiety. It was
founded upon a gross mixture of misquoted data and fancy. The
only critic of psychoanalysis who can be considered at all reliable
by the medical profession is the man who has himself practiced
psychoanalysis and did not have to abandon it because of Ms own
affective discomforts. Similar qualifications would, at least, be
required of the critical surgeon or internist upon equivalent ques-
tions pertaining to surgery and therapeutics.

Another prejudice that is often hurled at psychoanalysis is
a professed abhorence for the "transference." Itis condemned as
immoral and unethical to have a patient develop an affectionate
regard for the physician. As ridiculous and inconsiderate as this
hypocritical attack has been, it can not help but be amusing when
considered in the light of the fact that few, very few, physicians,
surgeons, gynecologists, obstetricians or priests have not had to
solve the problem of the unhappy individual developing an affec-
tion for them. Also any fair-minded physician or minister will ad-
mit that much of his success is due to the fact that he is able to
control the patient through winning his confidence and affection.
The psychoanalyst has been merely honest enough to recognize
this fact at its true affective and therapeutic value, and, desiring
that his patient should become a self-reliant, independent person-
ality, regards it as his duty to educate the patient as to the signif-
icance of the transference. Many physicians find it decidedly
profltahie to keep the yearning neurotic attached to them even
though they realize that their impressive examinations and thera-
peutic methods are practiced for the sole purpose of humoring the
patient. This type of physician is, naturally, the thinker AA^ho ab-

736 PSYCHOPATHOLOGY

hors a frank consideration of the mechanism of the transference
and therefore feels it his mission to attack the psychoanalyst Avho
uses it honestly.

To. return to the two general psychotherapeutic methods of
treatment of neuroses and psychoses and the principles upon which
they are based. It must be recognized that an important part of
successful therapy in which drugs, mechanical devices and surgieal
intervention are used, is due to the comfort the patient derives
from being nursed and attended to by a matrtre personality for
whom the patient has great fondness, respect and a;dmiration. This
encouraging; invigorating influence counteracts the patient's tend-
ency to become depressed and yield to the attack of disease, the
neglect of a mate, parent, son, or daughter; or the probability of
economic failure due, in turn, to the patient's inability to summon
sufficient courage and resourcefulness to save himself. It is, in
brief, an expression of the infantile tendency to seek the moral
support and sympathy, during stress, of the more potent father
or mother. This is to be -seen in the tendency of the forlorn and
discouraged to make fathers and mothers out of their physicians,
priests and nurses. In other words, the autonomic coordinations
that have been built up to win social esteem are the first to dis-
integrate under pressure of misfortune or disease. This failure
of the ego is to be seen in the symptoms of depression and the
hypochondriacal complaint. The weaJmess and confusion of the
ego is complained of as "I feel," "I am," "I can't," "can you
help me?" or "please help me," etc.

Considering the personality as a mechanism of primary mani-
fest wishes plus subsidiary wishes (as the manifest e^o) be'conodng
superimposed, through compensation to avoid fear of failure upon
the repressed primary segmental wishes plus suhsidary wishes, the
fact that an injury, shock, stress, disease or drug tends to weaken
or fatigue the wishes of the ego and permits the repressed wishes
to force themselves into, control of the final common motor-paths
becomes intelligible ; as compulsions or obsessions cause persistent,
uncontrollable streams of thought and behavior. These, in turn, be7
ing intolerable to the ego, arouse more or less anxiety, complained
of as disagreeable visceral sensations. Why should the functional
integrations which constitute the ego, the "I," "me," "myself,"
become disintegrated by fatigue, drugs, toxins or injuries instead
of the repressed craving? The explanation lies in the probability

PSYCHOTHERAPEUTIC PRINCIPLES 737

that the integrations constituting the ego are only compensatory
integrations which are developed to enable the organism to act
as a unity and maintain biological fitness. This is necessary be-
cause individual autonomic segments tend to compel adjustments
which may be punished, or may be dangerous, as indiscriminate
evacuations, reckless indulgences, thievery, selfishness, cruelty, ly-
ing, sexual perversions, etc. The wish for the death of a child that
binds the individual to an unattractive or impotent mate must be
compensated against in order to control it, because it is reenf orced
by the sexual affections which urge the removal of the child.
The delirious son, who, during a typhoid intoxication, hates and
attacks (verbal) his father and will only permit his mother to
nurse him, is an illustration of the old repressed craving of child-
hood for the mother's love attacking the rival (father) who claims
her attention.

When talcing anesthetics, it is not uncommon to hear patients,
as they lose self-control (become unable to coordinate for the pur-
pose of retaining social esteem) burst forth into a heedless ex-
posure of their most carefully guarded secrets and repressions.

In vino Veritas is the same in principle as from delirhim comes
truth. The delirious alcoholic, who is on the verge of collapse from
the fear of assult by serpents, beasts, giants, fiends, engines, is
the victim of his homosexual cravings to be sexually overcome by
a potent male. The delirious female, who, following parturition,
becomes the bride and love-object of God (the father), is the vic-
tim of the repressed wish of childhood, to become the love-object
of her father.

The rational therapeutic procedure, in all cases where the func-
tional integrations of the ego are too depressed and weakened to
control the segmental craving, is to eliminate the toxin and restore
the organic vigor of the individual first.

■This is best done by protectvng the patient from causes of fear
and anxiety while reconstructive measures are used. If the pa-
tient is enjoying an incestuous liaison, careful nursing and pa-
tience with the most careful avoidance of censure, even if mastur-
bation should occur, is necessary. This behavior will nearly al-
ways stop as the repressed cravings of preadolescence become
gratified. The danger lies, not in the self-indulgence, but in the
stimulation of horror by the criticisms of sanctimonious prudes.
The patient, in my experience, will sooner or later beg relief from

738 PSYCHOPATHOLOG-?

the compulsion. Then comes the stage of the psychoanalytic pro-
cedure (Cases CD-2, HD-1, HD-4, PD-33).

So long as the delirious patient can he kept happy and fear or
hate is avoided, the prognosis is good if organic destructions do
hot occur.

The best methods of restoring the patient's capacity to con-
trol his overt behavior, foUowiitig the loss of self-control during
disease, injury, stress, or shock, are principally rest in bed, good
food, sunlight and fresh air, eliminative and tonic drugs, and con-
genial, sympathetic nursing. Sedatives may be cautiously admin-
istered for insomnia when the patient is anxious, but not when
happy. It is far better to let the patient go the limit of his whims
if he feels compelled to do so despite persuasion. Hydrotherapy,
mechanotherapy, electrotherapy, massage, and delightful (play)
occupations are always valuable in restoring vigor and distracting
the patient from the conflict.

The capacity to control repressed cravings varies enormously
for different individuals and for the same individual at different
times. This capacity seems to depend upon such complex factors
as fatigue, toxemia, misfortimes, the summation of the repressed
cravings, the efficiency of the compensatory strivings, and the en-
couragement the latter receive from individuals upon whom the
patient is dependent for affection (friendship). The establish-
ment of the altruistic transference is essentially the foundation of
suggestive therapeutics and faith cures. Suggestions have no
value unless made Avhen the patient is in an impressionable (re-
ceptive) attitude toward the physician {en raport). The sugges-
tions made when- the patient is feeling obstinate, or, more techni-
cally, negativistie, often arouse compulsions to do the opposite.

Freud first appreciated the significance and mechanism of
transference, and cautiously warned against its indiscriminate cul-
tivation, because suggestions, under such conditions, might influ-
ence the patient to' attempt to do what pleased the physician even
though it would be unsatisfactory. This is the great danger in
suggestive therapy and is not usually recognized because the dif-
ficulties suggestions cause do not often follow immediately and are
not attractive to the erring physician.

It is a matter of ordinary common sense to recognize that no
physician would care to expose his secret personal inferiorities
to another physician if the latter had merely a technical interest

PSYCHOTHERAtEirTlO PRINCIPLES

739

in the case and no friendly sympathy for the difficulties, or if he
entertained secret aversions for them. The physician should not
expect a refined woman to reveal autoerotic or prostitution crav-

Fig. 87. — ^Aesculapius as the restorer of virility and happiness like Hygiea enables
the serpent to feed and drink from the dish.

ings, or a man to confess, or even to recognize, that he is suffering
from homosexual cravings without first winning the patient's con-
fidence and respect. Neither may the medical profession expect a

740 PSYCHOtATHOLOGY

physician, who fears a tendency to regress to homosexual cravings
and has no insight, to become able to psychoanalyze a male patient
having similar difficulties, or ever to give an unprejudiced opinion
for or against the case. The mechanism of the transference would
prevent it. The physician's sympathy for a distressed patient
eventually makes him aware of his own abnormal difficulties as the
patient relates the details of his inferiority. If this becomes un-
endurable, the physician's defense shows in the form of some
disgust-expressing mannerism, intonation of voice, or sarcastic
cast of a question, or a siTperior self -installation in the advice. The
physician who has really mastered himself and has clear insight
into his own inferiorities and defensive compensations, and does
not have to keep concealing them from the patient, can psycho-
analyze the patient; but just so soon as he becomes preoccupied
with his own difficulties, the psychoanalysis becomes automatically
stopped by the patient becoming uneasy or inquisitive. It is neces-
sary to feel a sincere interest, not a mawkish sympathy, in the
welfare and difficulties of the patient, and absolute freedom from
personal resistances, or it is not justifiable to undertake the psy-
choanalysis of the case. In fact, the disastrous consequences of an
experimental psychoanalysis are comparable to the tragedies of
major surgery Avhen practiced by a tyro. However, psychoanaly-
sis is so important that it must be learned and practiced by spe-
cialists, and understood by the profession.

The psychoanalytic procedure becomes valuable in most cases
just in proportion as the patient spontaneously desires to under-
stand his difficulties and is willing to talk over whatever may per-
tain to them. So soon as he shows resistance, in the form of in-
dignation or a tendency to change the subject, it is important to
await the disappearance of the resistance before urging further
inquiries or recollections. No matter what the difficulty of the in-
dividual, it may be analyzed so long as he spontaneously desires
it. The essential aim of the psychoanalyst is to enable the patient
to become conscious of the repressed craving and to permit it to
say what it wishes without restraint of the affect. This permits
the assimilation of the repressed affect into the ego; that is, theo-
retically, the dissociated or repressed akttonomic functions are
thereby enabled to become integratively associated with the auto-
nomic functions which constit^de the ego, as a part of the ego in its
common strivings.

PSYCHOTHEEAPEUTIC PRINCIPLES 741

When the distresshag tensions of the repressed segmental
autonomic functions and their obsessive influence are relieved, the
neurosis disappears; the individual's compulsion, by a "foreign
influence" to perform an intolerable act, no longer exists. The
personality, thereby becoming integrated into a imity, becomes
able to coordinate itself much more efficiently for the pursuit of
its social career, and the autonomic segments are able to freely
cause awareness of their needs.

The psychosis (Case PD-33), when this stage of reconstitution
or reintegration of the personality is reached, often changes to a
suppression neurosis, in which hallucinations and delusions no
longer exist, biit a tendency to anxiety may remain. Further psy-
choanalytic procedure usually enables the patient to make a com-
plete affective readjustment and a final selection of his social-
biological career. He either becomes able to renounce his envy for
his father or brother or, if the distress is due to an obsessive or
perverted love, he becomes able to make a decisive social readjust-
ment and sublimate his love craving by concentrating his interests
upon altruistic work which he feels will please his love-object, as
the father, mother, physician.

The psychoanalytic procedure is essentially a therapeutic pro-
cedure if adequately carried out. The recognition of the signif-
icance of the repressed craving or the recall of the forgotten con-
ditioning experience is, however, not sufficient. The therapeutic
result occurs in the form of relief from the autonomic tension
upon permitting the affect free play ; that is, by allowing the hyper-
tense autonomic segments to dominate the speech motor-apparatus
and thereby make a common adjustment with the great tendencies
of the remainder of the autonomic apparatus. This greatly re-
duces the necessity for disguising compensations, as the hiding
of anger or fear when again meeting an old embarrassing situa-
tion.

The necessity of speaking seems to be due to the fact that in
modern civilization the prime weapon of social offense and de-
fense is speech. From infancy, the individual should be, and usu-
allv is, encouraged to speak according to the dictates of his feel-
ings ; hence, the socialized ego is developed about the autonomic af-
tive use of the speech apparatus (much of the content of conscious-
ness being constituted of word sound and sign images) . It is often
in the struggle to speak, or to keep from speaking, according to the

742 PSYCHOPATHOLOGY

dictates of the affect, tliat the causes of much of the discomfort
and preoccupation rest. When we are prevented from speaking
to satisfy our justifiable anger, we become obsessed with uncom-
fortable laryngeal and thoracic tensions in the presence of the as-
sailant or, conversely when we have impulsively betrayed our
secrets through yielding to the wish to speak, we often feel infe-
rior and uncomfortable. The therapeutic value of the confessional,
in which the feeling of having betrayed the struggle for social
esteem by a sinful act is removed by the penitent confession of the
act or thought to one who is loved and respected, lies in the affec-
tive readjustment that follows.

Patients are often considerably benefited by writing out their
difficulties ; but not until they become able to speak of them without
effort at self-control and yet without anxiety, do they really master
their reactions to society's conventions.

In a book of this nature, wherein psychopathological mecha-
nisms are studied in detail, it is not suitable to consider the tech-
niqae of psychoanalysis. There are at present a series of excel-
lent monographs to be had on the subject, and the reader is re-
ferred to them. Freud, Jung, Pfister, and Jelliffe have given
us excellent presentations of the psychoanalytic method, and the
writings of Dubois, Janet, Prince and Sidis, Weir Mitchell and
Dercum present well the suggestive method of psychotherapy.

Psychoanalysis is essentially based upon inducing the patient
to permit, through, free association of thought, the repressed af-
fect to cause him to become conscious of its influence and needs.
This is often very difficult, because, when once repressed, the reflex
tendency is to avoid reexperiencing painful or embarrassing situ-
ations or memories of them, particularly when the individual is
confronted by a critic or censor. Psychoanalysis, as such, does not
occur until the spontaneous, free association of thought is made by
the patient, and it is just in this fact that most experimentors with
psychoanalysis blunder, and defensively assuming themselves to be
qualified in such psychotherapy, having read an article or so on the
subject, they attack it as nonsense or dangerous. Psychoanalysis,
like surgery, is an extremely important therapeutic measure when
carefully used by a duly trained physician. Often it is necessary
to conduct the psychoanalysis through a medium, because the pa-
tient is unable to trust himself or herself to the psychoanalyst, or,
more frequently, the psychoanalyst is not able to endure the pa-

PSYCHOTHERAPEUTIC PRINCIPLES 743

tient's transference, because of his personal difficulties ; both situa-
tions preventing the patient's spontaneous associations of thought.

In Case CD-I, the patient's fiancee induced him to confess his
troubles and inferiorities to her, and she, in turn, discussed them
with me. In this manner, I was able to direct his study of himself
until he developed considerable insight into his psychosis. In Case
HD-1, when certain experiences were recalled, the patient was un-
able to discuss them with me even though they worried her con-
stantly, but she obtained relief from the obsession through telling
her husband. I have frequently used men and women physicians
as mediums for the analysis, because I was either unable to manage
the transference, or the patient could not disregard some personal
attribute about myself that acted as a censor, being conditioned to
associate it with a previous censor. The use of a fiance or mate
for the analysis is only safe ivhen the healthy viate is actually in
love ivith the patient. This is a rare situation, the fact that the
mate does not love often being a factor in the psychosis.

The hallucinations, delusions, creations, and dreams, wlien the
wish-fulfilling attributes can be analyzed out, are by far the most
satisfactory means of getting at the needs of the repressed affect
and the compensatory striving. Word association tests are often
valuable, but are inclined to encourage guessing upon the part of
the physician. It is never profitable to tell the patient your im-
pressions of his difficulties, because he is almost sure to use Avhat is
said, if it is wrong, as a defense, or a means of evading responsi-
bility. In conclusion, few physicians can expect to become good
psychopathologists or psychoanalysts, because the work requires
an unusual freedom from prejudice and sound self-control with
an earnest, vigorous desire to assist the prejudiced, the depressed
and the perverted to readjust so as to become able to live construc-
tive, comfortable lives. The work requires often an unusual sym-
pathy for and insight into human nature in the face of the most
odious revelations of feeling that may possess humanity.

Responsibility of Penal Institutions and Asylums

In regard to the management of patients we have found in
Saint Elizabeths Hospital that confused males who are fearful of
their ability to control their cravings to submit themselves to
homosexual seductions are greatly relieved by being attended or

744 PSYCPIOPATHOLOGY

supervised by a female. The more maternal she is in her personal
attributes the more successful her infliience. The narcissistic or
homosexual type of female nurse is of little value in such cases.
The patient apparently does not feel confidence in her presence
because he can not trust her sympathy. Similarly, the female pa-
tient who is in a panic because of fear of homosexual assault will
attack (defensive) female physicians and nurses when they ap-
proach her, but will show signs of relief when attended by a male
physician.

On the other hand, male and female patients who are actually
heterosexually erotic (they must be discriminated from the indi-
viduals who affect heterosexual interests in order to hide their
homosexual difficulties), often become difficult to control when a
nurse or physician of the opposite sex supervises their treatment.

In all cases of dissociated personalities, as soon as the organic
functions are vigorous enough to endure work, the patient should
be given individual attention and persistently induced to work and
play, with the idea of getting back into the social herd. The tend-
ency to show this interest comes, more or less vigorously, in most
cases of dissociation of the personality, and, if it is not judiciously
heeded by the physicians and nurses, the tide of affective interest
in reconstruction may again regress and the case become incurable
(Case HD-3). It is just in this principle of psychotherapy that
most state institutions are deplorably inefficient. The reconstitu-
tion of the dissociated personality should be the principal interest
of the medical and nursing staff of the state institution and oc-
cupy most of their time and Avork. At present, despite the impos-
ing demonstrations of crafts at the meetings of the psychiatric
societies, the practice of reconstitution and insight into its princi-
ples is far from being truly efficient and intelligent. This is prob-
ably due to the fact that special work of this nature would require
considerable increase of expense to the state until it is Avell es-
tablished, and it requires years to overcome inherent institutional
prejudices. After the preliminary expense, however, an enormous
yearly per capita expense would probably be saved by the reduc-
tion of the number of chronic and confined cases. Every institu-
tion that is maintained by the state or a society for the compulsory
confinement of patients is obligated by the nature of its trust to
provide a means for the patient's return to society and respect-
able self-sustainment there.

PSYCHOTHEKAPEUTIC PRINCIPLES 745

Not -until every institution has erected a vocational depart-
ment in the most imposing architectural structure on its grounds
and maintains an adequate vocational bureau, the sole business
of which is to secure employment for its efficient members in the
factories, shops and fields of the people of the state, can the physi-
cians, lawmakers and custodians of the state be considered to have
fulfilled their obligations to its mentally diseased citizens. We
have shut our eyes to the tremendous obstacles and prejudices the
psychopath must overcome to regain the confidence of the people.
The conviction of having lost social esteem is most seriously de-
pressing to his ego.

It is also of the utmost importance, because money is the most
practically useful of all encouraging instruments for Avinning social
esteem, that the state shall pay its patients according to the work
they do, and establish a bureau for selling their products. In this
manner, above all others, will the patient regain confidence in his
ability to win social esteem and a means of maintaining his per-
sonal independence. The additional intricacy of institutional
management, under such conditions, can not be justifiably consid-
ered as a hindrance, because returning the helpless individiial's
status to that of social usefulness is the first duty of the physician
and the administrative department of the institution.

These innovations would have a direct bearing on the sexual
lives of the confined men and women. It is an incontrovertible fact
that most males and females, normal or abnormal, when perma-
nently sexually isolated and prevented from sublimating the sexual
cravings, revert to homosexual perversions or masturbation. At
present, society confines the criminal and the insane to reform or
cure him, but in actual practice, by depriving him of the privilege
of improving himself and his resources through remunerative
work, forces him to degenerate to an even lower sexual and social
level. The confined should be encoiiraged to earn money, and
master themselves, instead of being herded together, dressed in
misfit, slouchy garments, and forced to entertain themselves with
brooding and autoerotie fancies. It is certainly impossible for
society to offer any man sexual inducements of any sort, but it is
vitally important that society should not put up barriers which pre-
vent the individual from entertaining a reasonable hope that some
day he may win a love-object and therefore he should keep himself
fit, because this alone keeps him from degenerating.

746 PSYCHOPATHOLOGY

The solution of the progressive tendency to cultivate abnormal
variations in human behavior, that is, more specifically, asocially
conditioned and biologically perverted autonomic cravings, is in
the organically normal, a matter of influence of associates, hence,
is, broadly, an educational problem. The psychopathologist must
recognize that all individuals (pairents, teachers, playmates, un-
known members of the community, writers, actors, etc.) who, in
any manner, induce the individual to adopt or avoid certain social
interests or methods of self-expression, through any method that
influences him either consciously or unconsciously, are his associ-
ates. For example, certain orders of monks have isolated them-
selves in monasteries and are supposed to live there a voiceless
existence to counterinfluence the speech sins of people whom they
have never seen or known.

The Biological Castration Influence of Present American Educa-
tional and Social Tendencies

In America, it is a common observation that the ;general bio-
logical careers of the last three generations are markedly different
from one another in certain critical respects. Particularly is this
true for the play interests, the manner of self-display and the
interest in children. The present tendency is decidedly toward
a radical increase in self-exhibitionism in the form of multifarious
changes in styles of clothing, despite its enormous waste of energy
and economic resources. The increasing craving for newspaper
recognition and social notoriety, prompting a wider and wider
range of mingling with associates for novel entertainment, and
a mania for automobiles, magazines, novels, movies and social-
political affiliations, are resulting in a decided decrease of interest
in reproduction of the species; offspring per pair having been
greatly reduced despite the enormous increase of power in con-
trolling the forces of nature. This is essentially the result of at
least two great social factors. One is the tendency in America
of placing children under the direct influence of non-reproductive
teachers who are either homosexual or too self -centered to be
able to marry and reproduce, or who do not dare to have chil-
dren because of the certainty of being ostracised as teachers with
the loss of the privilege of practicing their vocations and earning
a livelihood, or who have no sincere interest in teaching or in the
social development of the child.

In New York City, the trustees of the New York schools in-

PSYCHOTHEEAPEXJTIC PRINCIPLES 747

delibly impressed upon hundreds of thousands of school children
their disfavor of motherhood by their attempt to remove a teacher
■who had asked for several months' leave of absence in order to
give birth to a child. This single act, of the wise fathers of edu-
cation, will probably, by its subtly implied sentiment, counterin-
fluence years of propaganda directed against race suicide. It is
not what is said or done, but the affective attitude with which
people do things, that impresses the youth despite all platitudes
and explanations. Ascetic males and females, whether covered
with cassock or not, stand as diverting examples of biological non-
reproduction if their lives are comfortable. The unmarried, the
mainstay of the American public school system, can not avoid, be-
cause of their eternal examples, becoming a sterilizing influence
upon the species. For the woman, if she will maintain the appear-
ance of social propriety, the tendency in children toAvard a certain
degree of a:ffective convergence upon the pelvis, which is vitally
essential for a successful parenthood in the future, is a desecration
of her ideals of decency. She is compelled, unconsciously, to de-
fend her ideals in order to protect herself from feeling that she is
functionally inferior. The homosexual males, many of whom be-
come teachers, by upholding intellectual development to the youth
as the only ideal of the race, support the movement to steriliza-
tion. Hence married teachers, who are parents, offer the best
solution.

The child, surrounded in its growth, from preadolescence to
maturity, by ascetic trainers of its biological career, can not help
but become conditioned to crave a career which would be decidedly
imposed upon by the sacrifices and distractions of parenthood.
On the other hand, supporting this influence, is society's rush for
the accumulation of money and pleasures and the inane tendency
to estimate the individuals' social capacities by the clothing they
wear, the words they use, and the money they spend. The child
is naturally a distracting menace to social climbing and self-indul-
gence, and, as such, is decidedly unwelcome. The direct effect of
these conditions is to be seen in our large cities, where one may
walk for blocks in the residential districts occupied by middle-class
and wealthy American couples and see very few or not any chil-
dren at play. These people, as mates, have become conditioned to
have for their chief interests in life, the struggle to earn and spend
money in order to maintain a popular social standard.

748 PSYCHOPATHOLOGY

The ultra-rich, many women of which class have very few
children and rarely nurse any of them, are largely preoccupied
with social intrigues and anxiety iieuroses.

We have the ascetic minister's preachment for unlimited fam-
ilies (he, not having to endure the pains and privations of such
ordeals, can enjoy preaching them), and the overly burdened
Avoman's demand for the right of birth control, pleading that unless
life is made worth living for herself it can not be worth giving birth
to children who are doomed to social and functional inferiority.

Out of this biological chaos of commercialized, loveless mar-
liages and sterilized ideals are produced the insane and the crim-
inal. Already more money must be spent upon the state 's asylums
and criminal institutions than is spent upon her institutions for
higher education. The disease, for it is actually a social tendency
to functional abortion, is too deeply rooted and intricate to be
rectified by anything but an unusually profound, persistently main-
tained, general social readjustment. The existence of the child,
the affections of the child, and the racially constructive biological
career of the individual during maturity must become the religious-,
social ideal of humanity. Less energy must be devoted to the glor-
ification of religious fantasy and economic display, and, in its place,
the virility, goodness and happiness of the individual must be
directly, frankly worked for and jealously guarded from being mis-
led by asceticism or exploitation. Otherwise, the American people
can not readjust to a normal biological course and the heritage of
the continent must pass on to the more primitive European im-
nligrant.

The most practical methods for bringing about a healthy
readjustment must be solved by the people through the serious,
impartial reconsideration of social and religious ideals and con-
ventions.

Since an enormous proportion of psychopaths and criminals
are the offspring of loveless marriages, and, since many people,
because of the prudish or vulgar manner in which they are raised,
often can not knoAV Avhether or not they actually love each other
until sometime after trying marriage, either trial marriages and
easy divorces must be practiced or the entire educational system
must be readjusted, including teachings and teachers, so that stern
biological facts may take precedence over half -religious fantasies.
Social conventions must be reorganized for furthering the pro-

PSYCHOTHERAPEUTIC PRINCIPLES 749

gressive refinement of the biological career of the individual. Only
a generation ago it was considered a moral crime for a physician
to advise an abortion in order to save the life of the mother, or
for the mother to take an anesthetic during labor. It is now be-
coming evident that the physician must assume the responsibility
of advising divorces as well as marriages, for wretched people
who are mismated. This must be done to protect the suppressed
individual as well as to save the affections of the child. When
granting a divorce the court shoiild never expose the child to two
conflicting parental influences. This is almost certain to so con-
fuse the affective interests of the child that when it becomes an
adult it will not be able to find its place in nature.

A new movement is to be seen in the general encouragement
of domestic science in our public schools, the institution of more
courses in biology, nature study, athletic training and attractive
self-expression in voice, movement and crafts, and the dilatory
attempt to teach the truths about the sexual functions. In colle-
giate education, however, we still find the ascetic, biologically ab-
stracted professor teaching vague notions about a castrated ethics
instead of defining for the youth a clear ideal of the most efficient
means for realizing a healthful, virile, refined biological career.

The autonomic functions of the youth should be so conditioned
(trained) that they may vigorously, frankly seek for and create
such social conditions as will most thoroughly gratify their vital
affective needs. The implications of such striving by the individ-
uals of the herd must necessarily be such as to bestow upon the
race and the individual himself the most constructive and health-
ful influences and the most satisfactory sense of virility, goodness
and happiness. We must not forget that we, as animals, lived in-
finitely longer as apes than ape-men, and less time as men. We
have only recently learned to Avear clothing, use comforting sym-
bols and create media for the transmission and transmutation of
the forces of natiire. We must recognize that the sexual affections
are still the greatest constructive forces of the personality if prop-
erly conditioned and adjusted, but also that they may become the
most insidiously, irresistibly destructive if perverted or uncondi-
tionally repressed. This statement is based upon the personal
study of more than two thousand psychopathic and criminal per-
sonalities of many nationalities and intellectual levels.

Much has been written as to the utilitarian value of art, lit-

750 PSYCHOPATHOLOGY

erature, religious ritual, and communistic forms of worship. Some
maintain that purity in music, art, literature and religion requires
that their motifs and expression shall not be measured by their
utility but shall transcend all other human interests and be created
to please feelings ("Soul") that have no relationship to the striv-
ing emotions. For such sickly claims for art, etc., the author has
no comment except that the view seems to contain the same pleas-
ure principle as the compensatory autoerotic fantasy, the senti-
mentalist accrediting the fantasy with a transcendental value after
having disguised its previous affective value for himself.

The utilitarian view of the artistic and religious sublimations
is supported by the fact that the loss of a love-object (through
death, desertion or disinterestedness) causes, in proportion to its
affective value, more or less severe autonomic tension and dis-
comfort, which is greatly relieved by finding or creating a substi-
tute. The creation of substitutes for unattainable love-objects
or to perpetuate the perishable memories of the love-object essen-
tially constitutes art and religious ritual. The comforting value of
pastoral scenes and lyrics to the bereaved or tired autonomic func-
tions, or the invigorating influence of martial music and heroic
figures for the oppressed, or the social and moral justification of
decisive actions can be seen throughout artistic creations and
rituals. Just as the individual's creation pleases the needs of the
greater number it becomes immortalized. The savage's fetich and
weird incantations have a splendid psychotherapeutic value in
invigorating the autonomic functions that tended to become de-
pressed by the insidious influence of unavoidable dangers (lurking
animals, diseases, droughts, floods, storms, the night, death, ster-
ility, tribal intrigues, slavery, etc.). In our present social system,
that besets civilized man with the incessant dangers and tempta-
tions of social intrigues, any communistic or religious ritual, or
philosophy, as masonry or Catholicism or monism, or any art, as
the drama of Shakespeare or the sculpture of Rodin, which tends
to cultivate similar ideals in the people, furthering the brother-
hood of man, has a tremendous psychotherapeutic value.

When the value of art and song and ritual, as stimuli to the
striving autonomic apparatus, is considered, then we appreciate
that civilization could not possibly "be maintained for even one
generation without such creations. American civic centers will
not be half developed until the supreme interests of the different

PSYCHOTHERAPEUTIC PRINCIPLES 751

types are given overt expression in athletic stadiums, civic thea-
tres, art galleries, music halls and gardens, parks and libraries.

The solid convergence of the affections of the people upon
constructive esthetic interests has a tremendous influence in pre-
venting social situations that are conducive to distrust, hatred and
intrigues, or sexual perverseness and social degeneration." An
overconvergence of the puritanical type, because eventually this
course tends to become repressive and sterilizing (my cases show
that it gradually tends to biological abortion after a few genera-
tions), is certainly as disastrous as exploitation and dissolute
wastage. Man, in his eternal struggle to transcend his former
state and progressively refine his nature, must neither cut himself
off from, nor waste, the sexual affections that made his existence
and personal development possible.

BIBLIOGRAPHY*

Abraham, K. : Dreams and Myths, Nervous and Mental Diseases Monograph Series,

No. 15.
Abler, A.: Study of Organ Inferiority and Its Physical Compensation. Nervous and

Mental Disease Monograph Series, No. 24.
Adlek, a.: The Neurotic Constitution, Moffat Yard & Co.

BjERRE, P.: The History and Practice of Psychoanalysis, Richard G. Badger.
Bleuler, E. : The Theory of Schizophrenic Negativism, Nervous and Mental Disease

Monograph Series, No. 11.
Brill, A. A.: Psychoanalysis, W. B. Saunders Co.

Brown, S. : Sex Worship and Symbolism of Primitive Eaces, Eichard G. Badger.
Bruce, H. A. ; Handicaps of Childhood. Little, Brown & Co.
Brown and Williams: Neuropsychiatry and the War, National Committee for Mental

Hygiene.
Cannon, W. B. : Bodily Changes in Pain, Hunger, Fear, Rage, D. Appleton Co.
Carlson, A. J.: The Control of Hunger in Health and Disease.
Clark, D. P.: Clinical Studies in Epilepsy, Psychiatry, Bulletin, 1916, ix.
Dercum, F. X. : A Clinical Manual of Mental Disease, W. B. Saunders Co.
Ellis, Havelock: Psychology of Sex, Philadelphia, 1905.
Frazer, J. G. : Golden Bough, ed. 3, i.

Ferenczi, S. : Contributions to Psychoanalysis, Eichard G. Badger.
Freud, S. ; Three Contributions to the Sexual Theory, Nervous and Mental Disease
Monograph Series, No. 7.
Selected P'apers on Hysteria and Other Psyclioneuroses, Nervous and Mental Dis-
ease Publishing Co., No. 4.
Origin and Development of Psychoanalysis, Lecture delivered at Clark University,

Worcester, Mass., September, 1909.
The History of the Psychoanalytic Movement, Nervous and Mental Disease Mono-
graph Series, No. 25.
The Psychopathology of Everyday Life, Macmillan Co.
Totem and Taboo, Moffat Yard & Co.
Leonardo da Vinci, Moffat Yard & Co.
Delusion and Dream, Moffat Yard & Co.
Wit and the Unconscious, Moffat Yard & Co.
Introduction to Psychoanalysis.
Frink, H. W. : Morbid Fears and Compulsions, Moffat Yard & Co.
Hart, H. : The Psychology of Insanity, Cambridge, University Press.
HiTSCHMANN, E. : Freud 's Theories of the Neuroses, Moffat Yard & Co.
HiGiEB, H. : Vegetative Neurology, Nervous and Mental Disease Monograph Series,

No. 27.
Holt, E. B. : The Freudian Wish, Henry Holt & Co.

Hug-Hellmuth, H. von: A Study of Mental Life of the Child, Nervous and Mental
Disease Monograph Series, No. 29.

*For a more extensive bibliography of papers and publications on subjects pertaining* to
psychoanalysis, see Tridon's Bibliography in his book on Psychoanalysis.

753

754 BIBLIOGRAPHY

Kkaft-Ebbing : PsyohopatHa Sexualis, Eebman Co.
Janet, P. ; Major Symptoms of Hysteria, Macmillan Co.

Jelliffe, S. E. : The Technique of Psychoanalysis, Nervous and Mental Disease Mono-
graph Series, No. 26.
Some Notes on Transference, Journal of Abnormal PsyeiiiBliip^ viii, No. 5, p. 302.
The Bole of Animals in the Unconscious, Psychoanalytic Review, 1917, viii, No. 3.
Psychotherapy and the Drama, New York Med. Jour., September, 1917.
Jones, E. : Papers on Psychoanalysis, William Wood & Co.

Jung, C. G. : Psychology of Dementia P'rsecox, Nervous and Mental Disease Mono-
graph Series, No. 3.
Psychology of the Unconscious, Moffat Yard & Co.
Analytical Psychology, Moffat Yard & Co.
Kempp, E. J. : The Autonomic Functions and the Personality, Nervous and Mental Dis-
ease Monograph Series, No. 28.
Lay, W. : Man's Unconscious Conflict, Dodd, Mead.

McCuBDY, J. T.: A Clinical Study of Epileptic Deterioration, Psychiatric Bulletin,
1916, ix.
War Neuroses, Psychiatric Bulletin, 1917. i.
Maedeb, a. E. : The Dream Problem, Nervous and Mental Disease Monograph Series,

No. 22.
Pfisteb, O. : The Psychoanalytic Method, Moffat Yard & Co.
PtaNCE, M. : Psychotherapeutics, Eichard G. Badger.
POTNAM, J. J. : Human Motives, Little, Brown & Co.

Eank, 0.: The Myth of the Birth of the Hero, Nervous and Mental Disease Mono-
graph Series, No. 18.
Bank, C, and Sachs, H. : The Significance of Psychoanalysis for the Mental Sciences,

Nervous and Mental Disease Monograph Series, No. 23.
RiCKLiN, E.: Wish Fulfillment and Symbolism in Fairy Tales, Nervous and Mental

Disease Monograph Series, No. 21.
EOBIE, W. F. : Eational Sex Ethics, Eichard G. Badger.

Sherbington, S. C. : Experiments on the Vascular and Visceral Factors for the Genesis
of Emotion, Proceedings of the Eoyal Society, Ixvi.
Postural Activity of Muscle and Nerve, Brain, xxxviii, part III.
Integrative Action of the Nervous System.

On the Proprioceptive System, Especially in its Eeflex Aspect, Brain, xxix, No. 4.
SiLBEEEE, H. : Mysticism and Its Symbolism, Moffat Yard & Co.
Stekel, W. : Die Sprache des Traumes, Wiesbaden, 1911.
Teidon, a.: Psychoanalysis, Heubsch.

Von Beci-iteeew, V. M. : La Psychologie Objective, Chapt. IX.
Watson, J. B. ; Psychology, J. B. Lippinoott Co.
Wall, 0. A. : Sex and Sex Worship, C. V. Mosby Co.

White, W. A. : Outlines of Psychiatry, Nervous and Mental Disease Monograph Series,
No. 1.
The Mental Hygiene of Childhood, Little, Brown & Co.
Principles ,of Mental Hygiene, Macmillan Co.
Mechanisms of Character Formation, MacmiUan Co.
White, W. A., and Jellii'I'E, S. E.: Diseases of the Nervous System, Lea & Febiger.

INDEX

Abdominal distress, 98
Adier, 181

Adolescent period, 131
Affective adjustments, 61, 66, 314
conflict, 104
dependence, 89
progression, 68
reactions, 314
reformation, 227
regression, 68
state, 27
Alcoholism, 325, 423, 469, 493, 674, 691
as a defense, 463, 471
brutality with, 662
Amnesias, 724
Amulet, 169

Anesthesia, 49, 297, 308, 722
Anger, 24, 25, 241, 303, 709
Anxiety, 24, 56, 201, 700, 704, 730
chronic, 224, 251, 287
symptoms, 201, 485, 538
Apathy, 730

Apperceptive capacity, 63
Apprehension, 500, 575, 730
Arrogance,- 518, 526, 527, 530, 535
Art, 65, 174

utility of, 750
Asocial tendencies, 104, 748
Assaults, 465
Association test, 514
Asylums, 743

inefficiency in, 744
Athletic interests, 158
Autoerotic cycle, 563
Autonomic affective stream, 52
apparatus, 6, 21

as asocialized unity, 55
mechanism, 9
pressure, 702

adjustment to, 711
segment, 21

pathological tensions of, 185
Aversion, 304

Beard, 594, 595, 597, 598, 604
Beating head, 322, 491, 506, 512
Beohterew, 9, 10, 36
Behavior, 69, 74
Benign compensations, 353

mechanism, 710
Biological crucifixion, 562

principles, 119
Birth control, 748

Bisexuality, 120, 362, 501, 563, 575, 576,

578, 639, 691
Bluffing, 165, 407, 465, 491
Body, 7
Booth, 447
Boring into scalp, 373

Case history, 713
Cannon, 9, 23, 202, 303
Carlson, 23

Castration, 293, 322, 325, 330, 450, 453,
600
as cure of masturbation, 671
disguised, 318
fancies, 678, 681, 690
fear of, 486, 495, 497, 499, 502, 544
psychic, 94, 96, 457
Catatonic adaptations,
as a defense, 570
cause of, 566, 614
in monkeys, 556
prognosis in, 613

reconstruction after, 566, 576, 588
transitory nature of, 568
stupor, 564, 587
Centauress, 370, 373, 587
Charm, 167

Christ, 416, 499, 544, 562, 673, 685, 689
bisexual, 578

simulation of, 594, 601, 604, 607, 611
Classification, 190
Clothing,

careless, 500, 546
grotesque, 675

loose, 662, 674, 676, 677,, 682, 683
meaning of, 678
Compensation, 1, 38, 69, 70, 165, 180, 184,
203, 268, 292, 730
asocial, 551
autonomic, 701
for impotence, 425, 604
for sexual inferiority, 438, 449, 458,

550, 596, 664
for waste of masturbation, 598
in arteriosclerosis, 475
in paresis, 473, 474
moral, 656

sexual excesses as, 463
psychoses, 420, 711
Compensatory striving, 53, 78, 245, 383,

449, 470, 516, 552, 592
Competition, 180, 243

755

756

INDEX

Complaints, 202
bad blood, 326, 524
bad dreams, 488, 500
blood carbonated, 689
body destroyed, 563
bones broken, 563, 588
brain fag, 357, 582
burning, 366, 490, 513, 588, 639
cardiac distress, 51, 561
choking, 327, 329, 332, 366, 490, 493,

583, 632
confusion, 487, 561
constipation, 616, 676, 683, 692
contamination, 294, 564, 586
crying, 485, 547, 563, 601, 606, 630,

692
depression, 485, 487, 493, 547
dizziness, 485, 492, 521
dope, 484, 492, 497, 521, 631
dying, 327, 332, 493, 521, 540, 563,

602, 672

electricity, 366, 396, 460, 461, 467, 501,

508, 544, 603, 607, 677, 689
eyes destroyed, 588
falling, 332
gasping, 327
gastric discomfort, 81, 366, 485, 489,

492, 500, 561
hair in throat, 377
hatred, 297

headache, 513, 563, 581
homesickness, 493
hot blood, 585
hot hands, 649
hypnotic influence, 396, 479, 484, 518,

527, 542, 566, 585, 603, 606,

639, 672, 683
inability to work, 492, 582
initiation, 479, 485
injections, 493, 500
insomnia, 357, 460, 478, 487; 493, 546,

592, 702
itching, 299
anal, 674, 687
nasal, 674
jerking, 297, 330
poison, 338, 359, 460, 480, 487, 562,

631
queer feelings, 485
respiratory distress, 330. 561
restlessness, 357, 478, 493, 702
shock, 337
sinking feeling, 281
stiffness of neck, 338, 366, 538, 582
strangling, 330
torture, 338, 692
vomiting, 299, 485, 492, 563, 631
weakness, 485, 501, 529, 563, 582, 595,

603, 678
Compulsions, 289, 292, 730 '

cleansing, 292, 294, 359, 662
initiation, 560
prostitution, 399
to eat plants, 596

Oonfpulsions^-Cont 'd

to lie, 593, 730

to remove clothing, 337, 340, 391, 560,
672, 673, 676, 678
Conditioned cravings, 11, 400, 625
Conditioning, 36, 37, 314, 533, 699
Confession, 366, 561, 601, 606, 634, 657

recovery through, 612
Confusion, 495, 559, 637, 654, 657, 680
Consecration, 230, 434

content of, 3'3, 35, 50

control of, 420

nature of, 31

of self, 13, 32, 128
Constitutional inferiority, 80, 206, 250,

547
Conversion mechanisms, 5, 291, 316
Convulsions, 297, 685, 688, 729
Craving, 9, 22

acquisitive-assimilative, 24

allied, 28 '

antagonistic, 28

autonomic affective, 24,' 698

emissive-avertive, 24

for manipulation, 556, 561

for social esteem, 53

incestuous, 105. -

neutralization oii 122

segmental, 21, 54
Crile, 33

Crucifixion, 90, 103, 254, 285, 333, 449,
596, 602

as an atonement, 320, 326, 608

as sexual submission to the father,
562, 569
Cruelty, 662, 675
Cutting wrists, 323, 326

Darwin, 208

Death (see complaints)

significance of, 664, 732
DeBoer, 30
Decadence, 156
Defective heredity, 80
Defense mechanisms, 315, 588

bluffing, 465, 491

compensation, 392, 408

insanity, 498

wit, 568
Degeneration, 745

Degradation, 258, 341, 585, 597, 640, 663
Delirium, 66, 584, 657, 714, 734
Delusions (see complaints'), 66, .292, 401,
704, 715, 726, 729
about food, 500, 585

broken pills, 481

cream, 480, 482

dope, 480, 492

drugs, 480, 492

filth, 455, 480, 492

flint, 369

poison, 480, 487, 493, 540, 602

INDEX

757

Delusions — Cont 'd

powder, 480, 482
saltpetre, 480
spue, 542
stuff, 480, 492
of assault, 452, 454, 486, 495, 497,
501, 541, 639, 689
anal, 692

oral sexual, 631, .632
of death, 575, 660
of infant, 660
of love objects, 560
of eating infant, 642
of mate's infidelity, 386, 433, 460, 464,

595, 604, 690
of persecution, 519, 539, 549, 665, 674,
688
by secret societies, 530, 541
systematization of, 717
unsystematized, 562
of reference, 359, 469, 508, 521, 524,

530, 543, 630, 683, 731
Tvishfulfilling, 388
Dementia prEeeox, 192, 712
catatonic, 714
hebephrenic, 714
paranoid, 516, 518
Depression
anxious, 353
without fear, 379
Destructiveness, 693, 696
Disgust, 25

Dissociation, 4, 12, 129, 339, 449
chronic pernicious, 516
mechanism of, 693, 703
significance of "they," 65, 664, 670
Drama, 729

Dreams, 66, 397, 704, 729
anal erotic, 686
homosexual, 453, 645
incestuous, 539, '626
of abortion, 642, 648
of compression, 539
of death of relatives, 651
of failure, 539, 589
of fire, 595
of freedom, 652
of maternity, 646, 648
of pregnancy, 648
of recovery, 634, 644
of striving, 549
oral erotic, 488, 522, 641
seductive, 397, 452
sexual, 529, 630, 651
terrifying, 500
wishfulfilling,_ 387
Drug habitue, d9
Dynamic mechanism, 9

Eating dirt, 585, 588, 596
Eccentricity, 70, 71, 440, 475, 716
Education, 746
careless, 621

Ego, 11, 78, 477

development of, 52, 128
Egoistic unity, 13, 29
Egotism, 436, 441, 448, 482, 489, 546,

592, 686
Ejaculatio prtecox, 127, 326, 591 626
Electra complex 102
Elimination 69, 293, 318, 335, 351

of an inferiority, 183

of functions, 289

of organs, 728

of perverse cravings, 322, 480
Emaciation, 563
Embarrassment, 204
Epileptiform seizure, 671
Epilepsy, 684
Erotic flight, 584
Eroticism (see perverse eroticism)

anal, 296, 346, 412, 418, 616, 661, 669,
671, 672, 673, 696, 697

auto, 97, 133, 136, 375, 470, 509, 570,
585, 628

oral, 327, 376, 378, 455, 468, 481, 492,
497, 523, 528, 543, 545, 596,
602, 632, 647
determinant of, 342, 641

polymorphous perverae, 606

reaction to, 345
Errors of speech, 544, 584
Erythema, 299, 311, 582
Esthetic interests, 158
Excreta

in infancy, 124, 127

interest in, 131, 615, 640, 657, 658,
661, 674, 676, 681, 692

potency of, 616
Exhibitionism, 396, 560, 585
Experience, 77

P
Fairy tale, 704
Faith, 165, 167, 729
Falling as submission, 672
Family adjustments, 91, 111, 533

conflicts, 629, 749

feuds, 110, 117

intrigue, 106

mother-in-law domination, 301

parental domination, 86, 256, 572,
579, 618

prudishness, 87, 514, 621

rivalry, 619

sister domination, 619
Fantasy, 704, 729

enjoyment of, 587, 686

symbolic truth of, 666
Father attachment, 82, 102, 154, 380,
679

imago, 532
Favorite son, 99

Fear, 1, 24, 25, 51, 165, 204, 287, 289,
317, 430, 730

biological value of, 700

of assault, 408, 435, 495, 499

758

INDEX

Fear — Cont 'd

of consequences, 314

of crowds, 731

of failure, 58, 179

of heterosexual relations, 583

of inferiority, 478

of moral degeneration, 593, 633

of sexual craving, 470, 472, 627

of sleep, 359, 647

physiological reactions to, 478, 582
Feminine functions, 120
Fervor, 684

Fetich, 39, 165, 169, 704, 730, 750
Final common motor path, 13

control of, 28

segmental domination of, 531
Flexibilities cerea, 586
Flight of ideas, 527

analyzed, 392
Forced feeding, 484, 563
Forgetting, 246, 318, 351, 650, 658
Foundling, 628

Freud, 5, 16, 291, 315, 705, 738
Frigidity, 78, 94, 457, 656

in homosexual female, 548
Functional traits, 15

G
Godding, 440
Goodness, 118, 748
Grandfather attachment, 83, 85
Grandiloquence, 436
Grief, 25, 317
Guiteau, 440

Hallucinations, 66, 91, 292, 704, 726, 729
affective value of, 399, 650
auditory

accusatory, 367, 481. 490, 499, 519,
522, 527, 562, 677, 680

bells, 499, 569

castration, 562

mother's voice, 527, 609

music, 522

shouting, 499

steam blowing, 499

telephone, 501
gustatory, 366, 522. 541, 545
of sexual assalilt, 335, 464, 519, 523,

549, 639
olfactory, 366, 391, 485, 493, 495, 499
visual,

angel, 522

dead relatives, 84, 499

father, 577

flashes of light, 493

infant, 643

pictures, 390, 501

snakes, 424, 488

stars, 522
wishfulfilling, 390, 503, 597
Hamilton, 447
Hamlet's tragedy, 537

Happiness, 118, 748

Hatred, 72, 112, 315, 317, 675, 716

prognostic importance of, 516, 550

suppressed, 687
Headaches, 98, 535

Heavenly bride, 107, 396, 407, 576, 692
Hebephrenic adaptations, 615, 693

reconstruction after, 644
Hereditary taint, 80
Hoarding, 641, 662, 683
Holt, 21
Homicide, 452, 470

attempted, 277, 674

double, 435
Homosexual cravings, 481, 484, 507, 547
Homosexuality, 136, 511

in infrahuman primates, 139

in men, 511, 595, 601, 670

in women, 94, 507, 508, 645, 701

readjustment of, 525, 532

submissive, 531, 551, 602
Hunger, 23

Hyperesthesia, 49, 724
Hypertension, 23, 27, 51, 289
Hypesthesia, 722
Hypochondria, 529, 538
Hypotensions, 27, 289, 730
Hypnosis, 733
Hysteria, 315

I
Images, 159, 704
Imitation, 166

in catatonic, 561, 586
Impotence, 46, 98, 152, 165, 326, 433,

668, 705
Impregnation fancy, 586
Incest, 109, 152, 536

fantasy, 106, 527, 584, 622, 639
Infantile period, 124
Infantilism, cultivation of, 572, 618, 646,
_ 684

Inferiority, compensation for, 71, 404,
422, 543
defense for, 183
functional, 179, 183, 187
organic, 179, 181, 186
sexual, 422
Influence of associates, 76, 554, 572, 613,
699, 717, 746
repressive, 86
unconscious, 121
Inhibition,
of speech, 573
of writing, 583
Insanity as a defense, 498
Insight, 522, 639, 650, 654
Insomnia (see complaints), signiflcance

of, 647, 702
Inspiration, 434, 443
paranoid, 275
parricidal, 439, 445, 448

INDEX

759

Inspiration — Coiit 'd

religious, 426

as a defense, 504

towards social sexual reforms, 592,
731
Inspired act, 284
Intoxications, 65
Intrauterine period, 123
Intriguer, 59
Introspection, 529
Inventions, cannon, 436

drill, 475

electric generator, 435

language, 431, 607

perpetual motion, 427

to conserve energy, 591, 598
Irritability, 440, 451, 478, 498, 535, 550,
581, 592, 683, 686

significance of, 702
Isolation, 745
Itching (see complaints), 311

James, 5

Jealousy, 687

Kinesthetic imagery, 34
Kissing, 125
Kleptomania, 641, 730
Kraepelinian classification, 20, 189

Lange, 5

Langelaan, 14, 30
Latcliley, 36
Laws, 729
Laziness, 620
Learning, 50
Lethargy, 730
Literature, 65
Love, 13, 25, 112, 317
sublimation of, 72

Madonna, 337, 396, 403

Manias, 730

Manic compensation, 384

happy type, 384, 419

fearful type, 407
Manna, 430
Mannerisms, 528, 563, 576, 586, 730

of eyes, 564

grabbing tongue, 490

grimaces, 491
Marriage, 91, 155

as a, defense 328, 457, 458, 459, 462,
554

fear of, 581

loveless, 748
Masculine function, 120
Masochism, 596, 600, 732

Masturbation, 78, 158
cycle, 563, 584
fantasies, 256
incestuous, 321
in cliildren, 131, 132, 622
in men, 259, 322, 324, 463, 470, 485,
496, 513, 518, 520, 559, 591,
683
in women, 367, 373, 377, 396, 509, 581,
584, 6"" ' ^
Maturity, 152
Mechanistic classification, 190
Memory, 49

Menstrual disturbances, amenorrhea, ■'588
660
dysmenorrhea, 84, 98, 318, 581
Mind, 7
Miser, 662

Misinterpretation, 703
Misrepresentation, 703
Mosso, 23

Mother, attachment 81, 82, 99, 152, 244,
321, 327, 381, 434, 502, 534,
542, 557, 625, 685
domination of 572, 579
invalidism of, 58
infantile, 103
hostile, 570
Muscular tensions (see postures), 21, 28,

698
Music, 729

Mutism, 379, 563, 586, 658
Mutilation, 323, 420, 584, 683
Mysophobia, 292, 294, 662
Myths, 141, 729

Narcissism, 150, 154, 605

in husband, 657
Nausea, 302
Negativism, 563
Neurasthenia, 206, 261
Neuroses

benign, 195

compensation, 196

dissociation, 197

pernicious, 195

regression, 197

repression, 195, 289, 293

suppression, 195, 206
in war, 285
Neutralization, 23, 698, 704
Night terrors, 84
Nocturnal emissions, 546, 595
Novel, 704, 729
Nursing, 738

Obsessions, 292, 730
chewing tobpceo, 545
cleanliness, 294

of mouth, 545
language reform, 607
of sin, 633, 657
sexual, 629

760

INDKX

Obsessions — Coat 'd

■vnlgar word, 647

wishfuffilling, 472
Odors, 391, 630, 683
Oedipus complex, 102 .
Omnipotence, 409, 418, 431, 436, 483,
610 > ! >

as defense for impotence, 427, 664
striving for, 494, 706
Onychophagy, 377, 585
Organism as a unity, 22, 28
Overwork, 265

P
Painting, 729

Panic, 268, 325, 361, 455, 540, 560, 595,
730 ' > )

homosexual, 514

mechanism of, 477, 479
prognosis, 480, 514
-symptoms of, 540, 602
Paresthesia, 689, 724
Paralyses, 319, 346, 729
Paranoia, 421, 475, 510, 552, 706
Paranoid mechanism, 449, 533

in female, 472
Paraphrenia, 206, 702
Parricidal compulsion, 285, 440
Pathological liar, 59
P'awlow, 10, 36
Pellaeini, 23
Penal institutions, 743
Pernicious mechanisms, 710
Perpetual motion, 427, 594
Personality, 74, 736

stages of deyelopment, 123
Perverse eroticism (see eroticism), 158,
478
atonement for, 605
cunnilingus, 162, 342, 368, 487, 520,

553, 602
fellatio, 328, 342, 468, 538, 592, 634
sodomy, 493, 661, 669, 676
and convulsions, 671
and stupor, 531, 667
unrecognized, 525
Phallic worship, 107
Philosophy, 729
Phobias, 289, 293, 730

sexual, 549, 580
Play, 744
Poetry, 729

Postadolescent period, 134
Postural tension, 21, 30, 67, 315
P'osturar tonus, 708
Postures, 31, 701, 720
crucifixion, 564, 575, 681
dying, 487

facial, 465, 573, 605, 639
fetal, 355, 641, 642, 658, 659, 660
kneeling, 601, 681
of eyes, 308, 460, 594, 601, 605, 681,

728
of feet, 350, 564, 692

Postures — Gont 'd

of hands, 556, 601

of lips, 322, 368, 460, 480, 496, 525, 587

of vocal muscles, 490, 676, 690

meaning of, 587

sexual, 562, 576, 658

standing, 495, 506, 561, 597

stooping, 586

submissive, 98

walking, 674, 681
Potency, 145, 1S2, 422

and social esteem, 409

striving for, 668, 705
Prayer, 165

Preadolescent period, 130
Premonition, 583, 656
Preoccupation, 353, 563
Prognosis, 710, 715
Frojicient apparatus, 6, 21, 29
Proprioceptors, 23, 33
Prostitution, 107, 154, 157, 399

cravings, 396

fantasies, 107, 584, 624, 630

homosexual, 464
Psychasthenia, 206
Psychic energy, 24
Psychoanalysis, 67, 733, 734

essential aim of, 740

experimental, 740

of benign dissociation (manic), 385

of catatonic dissociation, 577

of chronic paranoid dissociation, 518

of hebephrenic dissociation, 644

of paranoia, 508

of repression neurosis, 301

of suppression neurosis, 251

technique of, 742
Psychopathic personality, 206, 748
Psychopathology, 1
Psychoses, 704

in heterosexual individuals, 718

periodicity in, 590, 717
Pulling threads, 364

Eapport, 286, 738
Reality, 66, 400, 704
Rebirth, 567, 576, 588, 596

as a purification, 569
Receptors, 23, 32,
Recreation, 158
Reeducation, 733
Regression, 162, 353„ 384, 420, 461, 634

infantile, 367, 576, 637, 654

intrauterine, 379, 514, 641, 642, 658

to homosexuality, 94, 95, 97

to nursling, 553, 564

types of, 711
Religion, 72
Religious compensations, 409," 414, 424,

435, 442, 592
Religious symbolism, 704, 729
Repressed wish, 5

INDEX

761

Eepression, 4, 12, 61, 160, 711

successful, 315

symptoms of, 72, 73
Resistance, 291, 702, 740
Rest cures, 733
Restlessness, 702
Retardation, 495
Retention,

of feces, 337, 340

of saliva, 586

of urine, 340
Revelations, 427, 607
Ritual, 39, 165, 704, 730
Rubbing,

saliva, 364, 375, 658

sealp, 373

skin, 264, 540

urine in hair, 658

S
Sacrifice to parents, 110, 254, 285, 571
Sadism, 600, 732
Schools, 158
Scientific research, 729
Screaming, 540, 583
Sculpture, 729
Seclusiveness, 500, 542, 582
Secret power, 461, 465

society, 390, 401, 455
Seduction, 732

as a compensation, 463, 469
Selection, 243
Self-control, 128, 158, 738
Self cures, 671, 690
Self-redemption, 560, 607
Sensitiveness, 257, 424, 475, 500, 533,

535
Sex taboo, 96, 718
Sexual curiosity, 130, 621, 635

ignorance, 573, 581, 624

interpretations, 633, 635

phobia, 134, 135

reversion, 139, 140

selection, 89

trauma, 104
Shame, 25, 312, 317
Shamming, 275

Sherrington, 8, 14, 21, 22, 28, 290, 703
Shock, 624
Simulation, 121, 293, 321, 335, 344, 351

of dying, 487

of father's illness, 320

of mother's illness, 583, 631

of parturition, 335, 338, 563, 643, 657

of pregnancy, 360, 376
in male, 332, 677, 691
Skin picking, 369, 373, 585, 639, 674
Soaking, 359, 596
Social systems, 729
Somersaults, 658
Speech, 741

errors of, 544, 584

hesitating, 573, 686

Speech — Cont 'd

stereotyped, 585

sneering, 674

cautious, 460

mumbling, 495, 563
Spitting, 460, 491, 545, 631, 678
Stories, 729
Struggle for existence, 241

esteem, 128, 187, 709

sexual favor, 187, 702
Stupor, 661

associated with sodomy, 551, 667, 672,
673
Sublimation, 72, 456, 709, 745
Submission, 250
Sucking, 124, 332
Suggestibility, 527
Suggestive therapy, 733
Suicide, 284, 323, 480

as a regression, 512, 513, 653

as a solution, 84, 469, 498

attempted, 584, 631, 683, 692
by poison, 487, 519
by strangling, 487, 522

cutting throat, 491

fantasies, 162

hanging, 491

impulsive leaping from windows, 541

plunging on head, 322, 491

poison, 491

pounding head, 491
Summation, 62
Superiority, 424
Suppression, 4, 12, 61, 205, 711

of sexual functions, 88
Surliness, 542
Survival of the fittest, 241
Suspicion, 458, 460, 463, 542, 686
Swallowing objects, 377, 480, 486, 588,

596, 659
Sweating, 575
Symbols, 19, 39, 159, 166, 704, 715

ambivalence of, 410

erotic, 403, 405

of evil, 414, 488

of immorality, 339, 568

of impotence, 492, 669

of infants, 584

of parturition, 643

of pregnancy, 658

of purity, 411, 413

phallic,- 174, 438, 488, 602, 603, 640,
679

seminal, 391, 480, 484, 491, 492, 586,
596, 603, 649, 690

sexual, 41, 381, 424, 430, 488, 584, 631

Thought, 6, 34
Tic, 546, 729
abdominal, 327

762

INDEX

Timidity, 312

Transference, 67, 286, 398, 509, 517, 587,
654

altruistic, 378

danger in, 738

heterosexual, 566

mechanism of, 56

negative, 267, 477

positive, 267, 274, 477, 516

prejudice against, 735
Tremors, 540, 575

Vascular tumescence, 698
Virgin Mary, 403, 657
Virility, 118, 138, 178, 279, 748
Visuarconstriction, 299, 315
Vocational department, 745
Vomiting, 84, 304
Vulgarity, 693

War neuroses,, 285, 729
Watson, 10, 13, 36
Wertheimer, 33
Will, 6, 24, 57, 129

diseases of, 206
power, 58, 205
overcome, 532
loss of, 730
Wish, 35, 129, 698

dissociated, 56

for death, 630

fulfillment, 63

neutralization of, 12''

peripheral origin of, 27
Work, 744

remunerative, 745

Yellow, 586, 683

Internet Archive Audio

Featured

Top

Images

Featured

Top

Software

Featured

Top

Books

Featured

Top

Video

Featured

Top

Mobile Apps

Browser Extensions

Archive-It Subscription

Save Page Now

Full text of "Psychopathology"

See other formats