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Full text of "Mental mechanisms"



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Nervous and Mental Disease Monograph Series No. 8 

Mental Mechanisms 





Nervous and Mental Disease 
Monograph Series will consist of 
short monographs, translations, 
and minor text-books, on subjects 
related to these specialties It is 
purposed to issue them from time to time 
as the material becomes available The 
editors will be pleased to consider the avail- 
ability of manuscripts for the series. 

Nervous and Mental Disease Monograph Series 




No. i. Outlines of Psychiatry. (Third Edition, 191 1.) Price,$2.5o 

By WM. A. WHITE, M.D. 


No. 2. Studies in Paranoia Price, $1.00 


No. 3. Psychology of Dementia Praecox. . Price, $2.00 

By C. JUNG, M.D. 


No. 4. Selected Papers on Hysteria and Other Psycho- 
neuroses Price, $2.00 


No. 5. The Wassermann Serum Reaction in Psychiatry Price, $2.00 


No. 6. Epidemic Poliomyelitis Price, $3. 00 

New York Epidemic 1907. 


No. 7. Three Contributions to Sexual Theory Price, $2.00 



No, 8. Mental Mechanisms . ............. .Price, $2.00 

By WM. A. WHITE, M.D. 


Address all communications to JOURNAL OF NERVOUS AND MENTAL 
DISEASE, 64 West Fifty-Sixth Street, New York. 

Nervous and Mental Disease Monograph Series No. s 






New York 




Edited by 

Numbers Issued 
i. Outlines of Psychiatry. By Wm. A. White, M.D. 

2. Studies in Paranoia. 

By Drs. N. Gierlich and M. Friedman 

3. The Psychology of Dementia Praecox. 

By Dr. C. G. Jung. 

4. Selected Papers on Hysteria and other Psychoneuroses . 

By Prof. Sigmund Freud. 

5. The Wassermann Serum Diagnosis in Psychiatry. 

By Dr. Felix Plaut. 

6. Epidemic Poliomyelitis. New York Epidemic, 1907. 

7. Three Contributions to Sexual Theory. 

By Prof. Sigmund Freud. 

8. Mental Mechanisms. 

By Wm. A. White, M.D. 

Copyright, 1911 
By William A. White 

Press of 

T::e New era Printing Compant 

Lancaster. Pa. 




Preface v 

Introduction vii 


Some Considerations on the Constitution! of Consciousness — Rela- 
tion of Mental and Physical i 

Types of Reaction — Defense and Compensation 19 


The Content of Consciousness — Dreams — Symbolism — The Psy- 
choses — Folk-Lore 32 


The Complex — Types of " Complex " Reactions — Modes of Expres- 
sion — General Considerations 49 


Current Conceptions of Hysteria — Psychological, Physiological, 
Biological and Clinical Theories 71 

The Psychological Approach to the Problem of Art 90 


The Theory, Methods and Psychotherapeutic Value of Psycho- 
analysis 117 

Preventive Principles in the Field of Mental Medicine 136 


G.' 55535 


The teacher becomes naturally the writer of books. Every man 
who tries to teach a subject inevitably comes to express himself 
in a way different from other teachers of the same subject, and 
different from the text-books. He is sure, sooner or later, to feel 
the need of a book as a medium of his own individual manner of 
expression. As the "Outlines of Psychiatry" (No. I of this 
series) came into existence as the result of a need which grew out ^ 
of my teaching in the medical colleges, so this work is the result 
of a need growing out of my efforts to present certain principles 
in the field of psychopathology to the younger members of my " 
staff. I trust it may find a wider usefulness in other similar 

W. A. W. 
Government Hospital for the Insane, 
Washington, D. C. 
June 15. 191 1. 


A few words only by way of introduction so that the reader 
may be assisted to an understanding of the plan of this book. It 
is always helpful to get a bird's-eye view of a city one is about to 
explore, or to look at a field under the microscope first with a 
low-power objective, for purposes of general orientation, before 
examining the minute details with a lens of higher magnification. 

In the first place the book does not pretend to an exhaustive 
setting forth of all the principles underlying psychopathology, but 
only to an explanation and emphasis of certain fundamentals 
which appear to me absolutely essential to an understanding of 
the problems of present-day psychiatry. 

The first chapter is devoted to a consideration of the building 
up of the structure of consciousness, the organization and opera- 
tion of the forces at work and somewhat of the laws of their 
interplay. The second chapter accounts, in a general way, for 
the content of consciousness, the nature of that content, and gives 
a general account of certain types of reaction. The third chapter 
deals somewhat more specifically with the content of conscious- 
ness as illustrated by dreams, the content of the psychoses, and 
certain phenomena of the content of the race consciousness — folk- 
lore. The fourth chapter is devoted to a definition of the com- 
plex and an explanation of its effects both in the normal mind and 
in the psychoses. Chapter five carries out the principles eluci- 
dated in the preceding chapters in the setting forth of the problem 
of hysteria, while in chapter six the principles are applied to an 
explanation of the problem of art, both from the standpoint of 
the creation of art and the nature of its appeal. Chapter seven 
sets forth the methods by which, in accordance with the princi- 
ples thus far laid down, it is possible to attain to a knowledge of 
the content of consciousness, and discusses certain therapeutic 
issues; while the final chapter, chapter eight, is a general discussion 
of the bearing of all that precedes upon the problems of preventive 
medicine, with some suggestions as to methods of procedure. 





The human mind is the crowning attainment of organic evolu- 
tion and as evolution proceeds from the simple to the complex 
it, and its physical substratum the human brain, are coordinately 
the most complex of the results of this process. 

Notwithstanding the fact that its placement in the scheme of 
things of necessity implies its complexity, it is remarkable how 
few people consider the mind and its phenomena as requiring any 
special consideration in order that they be understood. Either 
the most patent and obvious of explanations of mental facts are 
deemed sufficient or else, mirabile dictu, no explanation at all is 
conceived to be required. 1 We laugh " because we are happy " — 
nothing simpler — and if in passing along the street the number 
of a certain house is perceived and remains fixed in our memory 
why "it just happened so" and "there's an end on't." 

Undoubtedly one of the great reasons for this naive attitude 
towards the phenomena of mind is due to their familiarity. It is 
the unusual that attracts our attention and demands an explana- 
tion — not the every-day occurrence that confronts us at each 
moment of the day's work. A display of the northern lights 
invariably brings out exclamations of admiration and wonder, but 
no one stops for a moment to marvel at the phenomenon of human 

It is this strange state of lack of appreciation of the complexi- 

1 Ernest Jones: Rationalization in Every Day Life. Jour, of Ab. Psych., 
August-September, 1908. 

2 1 


ties of the mind and of the laws governing its actions that is 
responsible for much that is crude in psychological conceptions. 
It naturally becomes of the first importance for one entering upon 
the study of psychiatry — abnormal psychology — to get rid of such 
preconceived crudities if he has them or if not to start at any 
rate with a comprehensive grasp of what mind means in the large. 

We can only arrive at an understanding of the meaning of mind 
by considering it at once from the biological and evolutional view 

The simple organisms, the unicellular organisms, have problems 
of function that do not require the service of a nervous system 
at all. Their structure is relatively simple and the processes of 
ingestion, digestion and egestion are participated in by the body 
as a whole. The environment consists of but two kinds of 
forces — those attracting and those repelling, and the stimuli from 
them are conveyed at once by the protoplasmic mass without the 
necessity of special paths. 

As we proceed from this simple state of affairs, through the 
animal series, we advance by successive steps to structures that 
are progressively more and more complex and which correspond- 
ingly come into more and more complex relations with their 

With this gradual increase in the complexity of both structure 
and the relations with the environment there goes hand in hand 
an increase in the complexity of the nervous system and of that 
part of the nervous system in which we are primarily interested — 
the brain. The particular thing to which attention is invited by 
this survey is that at some point in this scheme of things con- 
sciousness makes its appearance. 

What consciousness is no one can say. It is a something about 
which all of us have certain immediate experiences and informa- 
tion but it is one of those fundamental, inscrutable facts of 
nature that defies definition. 

For our purposes it is unnecessary to discuss its nature or its 


origin further than to call attention to the fact that its advent 
appears to be associated with a relatively complex and advanced 
stage in evolution. We shall have occasion again to point out 
the apparent relation between the occurrence of the phenomena 
of consciousness and complexity in the relationship and adjust- 
ment between the organism and its environment. The thing 
primarily we are interested in is the constitution of consciousness, 
its functions, and the laws governing its activities. Questions of 
ultimate nature and the like belong to the metaphysicians. 

The fact that consciousness comes into existence only at a rela- 
tively late stage in evolution and in association only with rela- 
tively complex organisms would seem to indicate that it had some 
function in connection with the adjustment of the organism to its v 
environment and it is from this view point that we can with best 
advantage consider its activities. 

Speaking broadly the mind may be considered as an adjustive ^ 
mechanism or more properly as a complex of adjustive mechan- 
isms. To give a simple illustration of this rather abstruse state- 
ment. A man standing in the middle of the street sees a runaway 
team dashing towards him. It is because this man has a mind, 
served by numerous sense organs that bring in to it information 
about his environment, that he is able to use that information, 
assimilate it to similar experiences, and profiting thereby initiate 
certain activities calculated to remove him from the path of the 
runaway team and by so doing bring about a relation between 
himself and his environment that is efficient in saving him from 
injury and perhaps death. 

This illustration while it may appear simple at first sight is in 
reality a complex situation and also one which is unusual in the 
course of the average man's life. The functions of the bodily 
organs are much simpler and much more usual in the sense that 
the same activities are repeated each day and perhaps several 
times each day. The adjustment of the functions of the several 
internal organs to one another, the timing of these several activi- 


ties, so, for example, that respiration will be accelerated on 
increased muscular exertion and accurately related to it, is also 
a function of the nervous system but not a function of mind. 
Here we have a relatively simple activity, frequently repeated in 
precisely the same way and giving rise to well defined results 
along definitely established nervous paths and taking place without 
the intervention or cooperation of consciousness. 

From this illustration we may gather that mind brings about 
only adjustments to outside conditions, that internal adjustments 
are not effected by the mind, and that these external conditions 
are relatively complex and unusual while the internal adjustments 
are relatively simple and frequent. 

In other words, the lower nerve centers regulate the interrela- 
tions of the functions of the several organs of the body while 
the highest nerve centers that constitute the physical basis of the 
mind have to do with the adjustment of the individual as a whole 
— as a biological unit — to his environment. 

To approach the problem in another way let us try and see if 
we cannot shed light upon it by a survey of the way in which these 
reactions are builded up. 

In the first place every such reaction consists of three parts. 
The receipt of information from the environment through the 
medium of the special sense organs : the assimilation of this mate- 
rial and its relation to the traces left behind of previous similar 
experiences ; and the issuing as a result of certain actions that in 
their ensemble constitute conduct. 

The man in the example just given sees and hears the runaway 
team dashing towards him but he is only able to appreciate his 
danger because he has had innumerable experiences in seeing and 
hearing before to which he can relate his present experiences. 
The new-born babe in the same situation would derive no such 
information from the same set of conditions. It is because he 
knows the meaning of these experiences that he is able to initiate 
the proper movements and so control his body as to remove it 
from danger. 


Such possibilities of reaction as described are plainly seen to 
be the result of experience, of the continuous coming into contact 
with all sorts of external conditions which have to be reacted to, 
extending over all of the years of life. 

The child when born into the world has no mind, no conscious- *" 
ness. It has, however, a central nervous system and special sense 
organs. From the moment of its birth it begins to receive sensa- 
tions from the outer world and to react to them. Some faint 
conception of the tremendous mass of material that is poured into 
the central nervous system through the medium of the special 
sense organs can be gathered from the statement of Titchener 2 
that it is possible to distinguish 44,435 sensation qualities and the 
additional fact of the wide distribution of some of the special 
sense organs, especially those located in the skin, so that there are 
literally thousands, probably hundreds of thousands of points of 

In no other way can the stuff out of which mind is made find 
its way to the brain except by the sensorium. Whatever man 
may become must in the last analysis depend upon this material 
and so no conception of mind can fail to take it into account. A 
person at any particular moment is the end result of all the proc- 
esses that have been at work since his conception and in the same 
way a given state of mind can only be conceived to be what it is 
because of all that has gone before — it is the end product. 

In order that results may be attained, in order that the reactions 
of the individual should gradually develop from the meaningless, 
ill-directed, diffuse motions of the infant to the well-directed and 
efficient activities of the adult something more is necessary than 
the mere receipt of all this mass of sensory material. 

The mass of sensations that are hourly, even momentarily, being 
conditioned by the constant stream of neural changes from the 
periphery and which are the raw materials of mind, the matter 

'Edward Bradford Titchener: An Outline of Psychology. The Mac- 
millan Co., New York, 1899. 


later to be elaborated into percepts and ideas, are not received 
without order or classification. From the beginning they tend to 
group themselves about central points of interest, to be welded in 
association with one another by the dominant affect. Attention, 

■ interest, feelings of pleasure or pain and the whole host of affec- 
tive states make differences of value among the elements of the 

' perceptive mass and weld them into groups as a result. The ideas 
and their accompanying affects become constellated. 

The boy who has grown up in a Baptist home by living under 
conditions that constantly impress him with the absolute truth 
of the Baptist ideas, going regularly to the Baptist church and 
hearing the sermons there ; never having any experience with 
doubt as to the Baptist attitude invariably becomes a Baptist. 
His perceptions have all been directed towards that end and finally 
are constellated about a dominant idea and affect in a thoroughly 
definite way. And so it is with other beliefs and attitudes of mind 
or convictions. A man is a Catholic or a Protestant, a Repub- 
lican or a Democrat, a believer in the inheritance of acquired char- 
acters or a follower of Weismann, as an end result of the balances 
that have been struck among his various experiences throughout 
life that bear upon these several issues. 

The sensory and perceptual material is then not received and 
stored in disorder but arranged in definite and useful ways — con- 
stellated. These constellations, of course, are of all degrees of 
prominence and importance and bear all manner of associational 
relations with one another, and so operate in the most complex 
way to direct conduct. 

A man may be born a Republican and a Catholic and there may 
be absolutely no relation between these two convictions. But he 
may be a Republican and believe or not in the wisdom of a tariff 
commission, and finally his conviction on the wisdom of the tariff 
commission may be the conviction of the minority and he may be 
willing to renounce his attitude and go over with the majority to 
avoid a split in the party. Here two constellations are intimately 


connected but one is more powerful and dominates the other and 
so controls the conduct of the individual. 

And so is the mind made up. Growing through the years by 
the formation of these constellations. Some are extensive and 
complex. Some simple. Some are plainly and definitely estab- 
lished and have been in existence for a long time, others are of 
recent growth and not securely held together in their parts but 
susceptible of relatively easy disruption. They have all degrees 
of dominance and dependency and are related by a network of 
associations. The complexity of their interrelations is very great 
but conduct can only issue as a result of their interactions and 
although it would seem almost a hopeless task to endeavor to 
unravel this bewildering intricacy still it will appear that there 
are certain laws that govern here as we find laws governing else- 
where in nature and with their help we can define certain general 
principles, at least, which may prove helpful. Let us look into 
the method of growth of these constellations and examine some 
of the conditions surrounding them and the ways in which they 
influence conduct. 

For purposes of illustration let us take the example of the 
person who is learning to play the piano and see what happens. 
On the sheet of music there are a mass of signs that stand for 
notes of different pitch and duration, combinations of such signs 
indicating chords, other signs indicating pauses, and various direc- 
tions as to rapidity or slowness, expression, loudness, repetition 
of certain portions, etc. The piano keyboard is composed of 
black and white keys arranged in certain definite relations to each 
other. The notes on the sheet of music each refer to a certain 
one of these keys and no other and in order to know exactly to 
which it refers the player must be able to " read music." 

All this mass of impressions presented to the learner are just 
so many separate perceptions, jumbled together, without arrange- 
ment and without meaning. As the days pass by, however, there 
begins to emerge from this mass a perception of relationship 


among its several parts, it begins to become comprehensible, takes 
on meaning. The relation between the printed notes and the 
piano keys becomes definite, the keys are struck and sounds that 
are pleasant are produced if the correct relationship has been 
maintained in the striking, sounds of an unpleasant quality if a 
mistake has been made. The mass of perceptions are beginning 
to arrange themselves in an orderly way. Constellations are 
being formed. 

Now this process continues and the orderly arrangement of 
mental states as related to these outside conditions becomes more 
and more extensive and more and more perfect. There is taking 
place an adjustment of the individual to the environment, a build- 
ing up of a certain relationship between the outside conditions — 
the sheet of music and the piano keyboard — and the individual, 
and this relationship becomes progressively more and more exact 
and more and more efficient. As the adjustment becomes more 
perfect disharmonies with their resulting painful mental states 
are less frequent — the harmony and efficiency of the adjustment 
is improved with practice. 

It will be helpful at this point to point out briefly some of the 
differences in the state of consciousness of the beginner on the 
piano and of the finished product, the accomplished performer. 

At first while learning, each movement is painfully conscious, 
the fingers have to be watched, each note separately observed, and 
the required movements are slowly and awkwardly executed. 
When proficiency has been acquired the same results are accom- 
plished far better, with much less effort, and with so little atten- 
tion that an occasional glance over the shoulder and even enter- 
ing into the conversation of those about does not seem to interfere. 

At first a note has to be carefully looked at in order to recog- 
nize it, then the signature, the tempo, the various directions, and 
its relation to other notes in the other clef have all to be sepa- 
rately observed before it can be finally sought out on the piano 
and struck in its proper time and place. Later all these things are 


appreciated at a glance and the reproduction is instantaneous. 
In this way hundreds of notes in all sorts of relations and combi- 
nations may be struck in a single minute as the eye skims rapidly 
across the page of music, and the translation from the printed 
signs to the appropriate sounds is relatively immediate. 

It will be seen that a relationship has been established with out- 
side conditions that is very definite, the adaptation of the indi- 
vidual to the environment is highly efficient and takes place in a 
way so nearly absolutely fixed that it is practically predictable. 
There has been established by a slow process of growth a complex 
of mechanisms, mechanisms that are automatic or quasi-automatic 
in character so that whenever the appropriate stimulus is applied 
the whole machinery goes off in a perfectly well defined way in 
all its various parts. 

In this description it will be recognized that we are describing 
a sort of activity that reminds us of the reflex. The reflex, how- 
ever, is still more rigidly defined in its possibilities, its response 
is, to all intents and purposes, absolutely the same always, when- 
ever a stimulus is applied. Then too it is no longer under the 
control of the individual but occurs whether or no. The piano 
playing activities on the other hand are always under the control 
of the subject. He may play or not, as he sees fit, and he may 
vary the production from the written directions to suit his own 
whim. The various activities of his fingers in seeking the notes 
are, however, not changed in either instance, they go on in their 
accustomed way in both cases. 

This type of activity is called automatic, though it will be seen 
from the description that it is really a complex product containing, 
it is true, many automatic components, but containing also many 
that have not reached that degree of definiteness of response — 
activities that are still in the proving ground of automatisms. 

One of the changes then that has been undergone in the process 
of learning is a change toward an automatic character of the reac- 
tion. With continuous practice the activities become more and 
more automatic. 


Another change, which is important for us to note, is a change 
in the degree of awareness that accompanies these activities. The 
change toward greater automatism implies this change. From a 
condition of very acute awareness of every minute adjustment in 
the beginning there is reached a condition of almost absent aware- 
ness when a high grade of efficiency has been reached. At least 
those portions of the adjustment that have become truly automa- 
tisms have become activities of the unaware region of con- 

To put the matter a little differently, when the same or similar 
conditions in the environment are repeatedly presented to the 
organism so that it is called upon to react in a similar or almost 
identical way each time there tends to be organized a mechanism 
of reaction which becomes more and more automatic and is accom- 
panied by a state of mind of less and less awareness. Or to put 
the obverse. Consciousness, or at least clear conscious aware- 
ness, appears only upon attempts at adjustment to conditions that 
are unusual, at " moments of conflict," on those occasions the like 
of which have not previously occurred in the experience of the 
individual and in relation to which, therefore, there has been no 
possibility of organizing reactive mechanisms. To put it again 
in a little different form. Clear consciousness does not accom- 
pany reaction to stimuli when the issue in conduct can only occur 
in a single direction, when there are no alternatives. Conscious- 
ness is an expression, as it were, of conflict. It arises in response 
to stimuli under conditions that make it possible to react by a 
choice of a line of conduct in any one of many directions. 

This state of affairs calls to mind an analogy. Consciousness 
arises only under conditions of conflict, conditions of great com- 
plexity, of increased resistance as compared with the facile reac- 
tion along the definite lines of a reflex arc. When in the path 
of an electric current, a complex network of wiring is introduced 
that raises the resistance to the passage of the current, we find 
that accompanying its passage there goes along a marked rise of 


temperature. As heat goes along with increase in resistance in 
an electric circuit so consciousness goes along with increase in 
resistance in a mental circuit. Herrick 3 has said " the various 
degrees or grades of consciousness are expressions of succes- 
sively higher forms of the coordination of forces." 

We must think then of full, clear consciousness as only accom- 
panying those mental states of adjustment to new and unusual 
conditions: conditions permitting of various reactions and involv- 
ing therefore selective judgment, critique, choice — in short, rea- 
son; and in proportion to the frequency of the repetition of the 
same adjustment the mental state accompanying such repetition 
tends to sink out of the field of clear consciousness. If we will 
consider the infinitude of adjustments the individual has to make 
to his environment we will see that this is a conservative process. 
As soon as a given adjustment is well formed it is pushed aside 
and the field of clear consciousness left free for new problems. 

The same sort of process is responsible for phenomena in the 
race consciousness. The word " chandelier " originally was ap- 
plied to a holder for a candle. The application continued for a 
long time, was frequently repeated, and was organized, therefore, 
into a stably reacting mechanism. The change in the source of 
light to gas failed absolutely to change the reaction and it is only 
lately, now that gas has long since been replaced by electricity that 
we occasionally hear the word " electrolier." Stated in this way 
the method of reaction will be seen to have a biological signifi- 
cance and not merely an individual or even a human importance. 

All of these considerations go to demonstrate that the field of 
full consciousness and rational self-control is a very limited one, 
but that on the contrary the great majority of our mental states, 
our desires, inclinations, and actions are conditioned by mechan- 
isms of which we are more or less unaware. It is worth while in 
passing to call attention to the principle that in proportion as the 

' C. L. Herrick : The Metaphysics of a Naturalist cited by Professor 
Mary Whiton Calkins in General Standpoints : Mind and Body. The Psy- 
chological Bulletin, January 15, 191 1. 


control of conduct is outside of the region of clear consciousness 
it is apt to go astray under conditions even slightly different from 
those that were associated with the formation of the reaction — 
acting in accordance with the established mechanism even though 
conditions have changed, as with the example of the word " chan- 
delier " just cited. 

Up to this point we have been considering the constitution of 
consciousness in respect principally to its vertical dimensions — its 
depth. The illustrations have shown how reactions in propor- 
tion to their frequency and definiteness are more and more sub- 
merged from the region of clear consciousness to zones that are 
deeper. There remains to be considered the constitution of con- 
sciousness in its extent. 

The broad general fact to bear in mind is that the various mental 
processes and systems of ideas — constellations — require to be 
synthetized and it is this synthesis that constitutes the personality. 
J The breaking up of this synthesis, the dissociation, emancipation of 
systems of ideas plays such an important part in psychopathology, 
particularly in the psychopathology of hysteria, that they will be 
discussed in the chapter on hysteria. 

As may be inferred we probably are always dealing, in the realm 
of the abnormal, with problems both of the depth and extent of 
consciousness and not with either alone and it would be next to 
impossible in a given case to define just exactly the relations of 
the symptoms to these two dimensions. The important thing is 
to have a general understanding of the make-up of consciousness 
and its very great complexities and to realize that the obvious and 
the superficial seldom lead on the right track. 

The old idea of monomania is a good example of the sort of 
error a following of the obvious leads to. A delusion, a belief, 
whether it be the product of a disordered mind or not cannot pos- 
sibly come from outside and be engrafted, as it were, upon the 
surface of consciousness. The mere fact that it is a belief dem- 
onstrates that it is something more than a formula repeated by 


rote — that it is an expression of the individual, of the personality 
which as we have learned is a complicated product of the entire 
mental life of experience. On this point Mercier's 4 illustration 
is worthy of quoting. He says: 

"The delusion is not an isolated disorder. It is merely the 
superficial indication of a deep-seated and widespread disorder. 
As a small island is but the summit of an immense mountain 
rising from the floor of the sea, the portion of the mountain in 
sight bearing but an insignificant ratio to the mass whose summit 
it is, so a delusion is merely the conspicuous part of a mental dis- 
ease, extending, it may be, to the very foundations of the mind, 
but the greater portion of which is not apparent without careful 
sounding. Precisely how far this disorder extends, beyond the 
region of mind occupied by the delusion, it is never possible to 
say; but it is certain that the delusion itself is the least part of 
the disorder, and, for this reason, no deluded person ought ever 
to be regarded as fully responsible for any act that he may do. 
The connection between the act and the delusion may be wholly 
undiscoverable, as the shallow between neighboring islands may 
be entirely hidden by the intervening sea. But nevertheless, if 
the sea stood a hundred fathoms lower, the islands would be two 
mountain peaks connected by a stretch of low country ; and if the 
hidden springs of conduct were laid bare, the delusion and the 
act might be found to have a common basis." 

This illustration emphasizes the fundamental fact in the make-up 
of consciousness, of the connection and interdependence of all its 
parts. If this were not so a rational psychology would be impos- 
sible and all our therapeutic efforts would come to naught. 

Relation between Mental and Physical 
It will have been appreciated by this discussion thus far that * 
as reactions become more automatic and less aware, and approach 
the nature of reflexes, that they present less and less the quality 
4 Merrier : Criminal Responsibility. Oxford, 1905. 


of mental activities and become more and more physical in natuie. 
This naturally opens up the whole question of the relations of 
the mental and the physical. 

While I do not think it would be useful to discuss this question, 
at least from a metaphysical standpoint, still there are certain 
fairly patent features of the relationship that are of practical 

We are constantly meeting with evidences that go to show the 
intimacy of the relations between mind and body. We see this 
well under those conditions where a certain state of either mind 
or body gives rise to certain results in the other. For example : 
fear is a mental state and of mental origin but many physical 
changes follow close upon its heels — the rapid pulse, cardiac pal- 
pitation, vasomotor disturbances (pallor), dilated pupils, secre- 
tory disturbances (sweating), tremors, etc. On the other hand, 
the effect of the physical upon the mental is well seen in the 
toxemias as uremia and alcohol, in the mental states that go with 
certain diseases such as Basedow's disease, Addison's disease, and 
general paresis. A cut finger illustrates this relation well, for 
the cut is a purely physical thing while the pain is a purely mental 
fact, and finally there is the James-Lange theory of the emotions 
that accounts for our emotional states by preceding physical 

My own opinion is that the individual reacts by the develop- 
ment of mechanisms that include both physical and psychic com- 
ponents, as the examples just cited indicate, and that between the 
most definitely physical of bodily processes on the one hand, and 
the highest psychic on the other an infinity of gradations exist. 

The recent work of Pawlow, 5 on the salivary secretions of 

dogs, illustrates this conception well. He has shown that the 

physiological process, the flow of saliva, could be brought about 

reflexly by stimuli of sight, sound, touch, temperature or odor 

■ Pawlow : Naturwissenschaft und Gehirn. Wiesbaden, J. F. Bergmann, 
1910. Yerkes and Morgulis : The Method of Pawlow in Animal Psychol- 
ogy. Psych. Bui., August 15, 1909. 


provided only the stimulus had previously been applied in asso- 
ciation with the giving of food. Having applied the stimulus 
originally thus associated so that it entered into and became a part 
of the mechanism of the dog's reaction to the food, later the reac- 
tion took place by the application of the stimulus although the 
association with the food was left out. The physiological process 
had become organically linked with the psychic stimulus. In 
other words a mechanism had been created which acted as a 
whole. Like a watch, the parts were so intimately related that 
no portion could be set in motion without setting the whole going. 
Or like a train of gunpowder, no matter where it is lighted the 
fire spreads rapidly throughout the whole train so that it all 
explodes very nearly at the same time. 

Even when a portion of the mechanism is destroyed the rest 
may operate. The decerebrate dog turns and growls and bites 
at the fingers that hold his hind foot too roughly. Here there 
cannot be any possibility of the psychic state of anger. As Sher- v 
rington 6 says, " The action occurs, and plays the pantomime of 
feeling; but no feeling comes to pass." 

In these two examples we have mechanisms each of which con- 
tain both physical and psychic components. In the first the 
mechanism was " touched off " from the psychic end, in the second 
from the physical end. 

The action of a complex mechanism as a whole is shown excep- 
tionally well in a case reported by Prince. 7 The patient was sub- 
ject to hay fever in a very severe form when exposed to roses. 
On one occasion a bunch of roses was unexpectedly produced 
from behind a screen. A severe attack followed with lachryma- 
tion, congestion of the mucosa, dyspnea, etc., although the roses, 
unknown to the patient, were but paper. Here a pure psychic 
fact at one end of the scale produced a set of reactions which at 
the other gave rise to sensory, motor, vaso-motor, and secretory 

8 Sherrington : The Integrative Action of the Nervous System. London, 
Archibald Constable and Co., 1906. 


Prince: The Unconscious. Jour, of Abnormal Psych. Volume III, • 
Nos. 4, 5 and 6. Volume IV, No. 1. 


disturbances which can hardly be conceived to be remotely psychic. 
The important fact is that from the one to the other is an unin- 
terrupted chain of associations. 

Some further illustrations of the relation of mental and physical 
that seem particularly apt have received comment in the recent 
literature. They are important because they show clearly how 
the mental may be the starting point for physical changes. It is 
unnecessary to illustrate at any length the obverse — that the 
mental state is influenced through the physical. Everyone's expe- 
rience contains numerous patent illustrations of this relationship 
from the more subtle effect upon one's mind from taking small 
quantities of alcohol or other drugs to the grosser and more 
obvious effects of a blow upon the head. This aspect of the rela- 
tionship needs no support. 

The recent experiences in thyroidectomy for exophthalmic 
goitre show how very important the mental state may become in 
relation to the physical. The success or failure of this operation, 
with the resulting death of the patient in the latter case, has been 
shown to depend very largely upon the possibility of so orienting 
the patient emotionally with reference to the surgical procedure 
that it is possible to do the operation under favorable conditions 
so far as the mental state of the patient is concerned. Crile 8 in 
a recent article has discussed this whole matter fully and out- 
lined some of the methods for preventing or minimizing the ele- 
ment of psychic trauma. In working over this subject in con- 
nection with his study of a large series of cases he did some 
experiments on rabbits, and concludes that pure fear is capable of 
producing physical lesions in the cells of the rabbit's brain. 

The recent work of Cannon 9 on adrenal secretion is very inter- 
esting and suggestive. He found that a solution of I to 20,000,000 
of epinephrin inhibits the contraction of longitudinal intestine 
muscle. Blood taken from the vena cava of cats that had been 

9 G. W. Crile: Grave's Disease. A New Principle of Operating Based 
on a Study of 352 Operations. Jour. Amer. Med. Assn., March 4, 191 1. 

9 W. B. Cannon and D. De La Paz: The Stimulation of Adrenal Secre- 
tion by Emotional Excitement. Jour. Amer. Med. Assn., March II, 1911. 


frightened by a dog produced this same result but no such result 
followed in the control. If the adrenals were removed this effect 
did not follow the excitement. 

All of these illustrations go to demonstrate, to my mind, that 
the relation between mental and physical cannot be expressed, 
for example, by the theory of parallelism. This theory would " 
have it that the two are absolutely different, that there is no real 
relationship of cause and effect between them, but that they go 
along side by side as a man and his shadow. All of the illustra- 
tions I have given seem to demonstrate indisputably that there is 
a relation of cause and effect between mental and physical, and 
further, that the cause may be physical and produce mental effects, 
or, on the other hand, that it may be mental and produce physical 

The practical and helpful way to consider the situation is to 
consider the individual as reacting as a biological unit. This * 
reaction has certain mental and certain physical factors. Viewed 
from one standpoint one set of factors is emphasized; viewed 
from another standpoint the other set comes to the fore. The 
real nature of these factors is a subject that, along with all such 
questions that deal with the ultimate nature of things, may well 
be left to the metaphysicians. 

One more matter in this relation of mental and physical. One 
not infrequently sees the statement that for every mental change 
one must postulate a physical change, and whether these two are 
considered to occur only side by side or to have relations of cause 
and effect it is assumed that the occurrence of one implies the 
occurrence of the other, and the two cannot be thought of in any 
other way. A further implication of such statements is that a 
sufficiently refined chemistry would give us the exact change from 
the normal that has occurred when a fixed idea, for example, has 
possessed the mind, and so there is no such thing as a strictly 
functional disorder. 

While I am willing to admit that it must be conceived that there 
is a physical change in the central nervous system corresponding 


to every mental state, still such an admission does not carry with 
it the necessity for the further deductions that are often made. 
A watch may be taken apart and the several wheels and springs 
thrown into a heap. No examination of the structure of brass 
or steel will show that any change has occurred. The structure 
of the watch as a whole has been greatly damaged but the nature 
of the several parts has not been changed. The disorder is a 
disorder of the relation of the parts to one another, not of the 
nature of the parts themselves. If a salivary duct is cut in two 
so that the saliva does not enter the mouth, the whole function 
of digestion may become disturbed; but the initial trouble was 
not a tissue change, not even a chemical change, but a disturbance 
in the relation of the several parts of a mechanism. 

In the same way in the functional mental disturbances, those 
of psychogenic origin, the individual as the result of bad educa- 
tion, vicious example, poor environment, comes to have faulty 
standards, distorted viewpoints, wrong ideas. There can hardly 
be conceived to be a different chemistry for such ideas than there 
is for the average individual. Of course it may be argued that 
the cut in the salivary duct is a physical, and so a physicochemical 
change, that accounts for the trouble; that the chemical changes 
in people of faulty standards were abnormal at the point where 
the ideas departed from the beaten paths and went wrong; that 
the chemism of a certain mental state in one person must be dif- 
ferent from a different mental state in some one else, and so on 
ad infinitum. To my way of thinking all such statements and 
arguments are academic in nature, and to say the least, bootless 
so far as practical helpfulness is concerned. Whether we can or 
cannot trace every fraction of a mental state to physicochemical 
changes is a matter for the laboratory and for the future. In 
the meantime it is decidedly more helpful to think of many con- 
ditions as being purely mental and in such cases, where disorder 
exists, to think of that disorder as being a disorder of relation 
(association) of the several parts of the mechanism rather than 
a disorder of the nature of those parts. 


I have spoken of the mind as a complex of adjustive mechan- 
isms. It will be well to study some of its mechanisms in action. 
In order that the nature of these reactions may be most easily 
understood it seems expedient to approach their discussion by 
first describing briefly the better known reactions of the same 
character in the physical realm. 

The types of physical action to which I refer are the bodily 
reactions, defense and compensation reactions we may call them, 
to the various inimical agencies that may be brought to operate 
against the organism. For example: we know how the body 
defends itself from the invasion of microorganisms and bacterial 
poisons — how the invader is actively attacked and there are devel- 
oped antibodies to counteract the disintegrating effects of toxins. 
We know that sometimes these efforts are fully successful, that 
sometimes they fail absolutely in the face of an overwhelming 
invasion and the individual dies, and that sometimes there is a 
compromise, the life of the host is saved, but at the expense of 
more or less destruction of certain parts with the formation of 
a scar. These are typical defense reactions. Then we have reac- 
tions that are more noticeably compensatory. Injury and disease 
frequently result in deformities, for example : a curvature of the 
spine, and when this takes place, we can see the development of 
a compensatory curve in the opposite direction so that the erect 
posture is not jeopardized. The man who has lost his legs de- 
velops tremendous strength in his arms and the muscles of the 
shoulder girdle so that he can use crutches and gets about with 

1 With certain additions (to be found in Chapter VIII) and minor 
changes this chapter formed the substance of a lecture at Cornell Univer- 
sity in the course in Hygiene and Sanitary Science, February 28, 191 1. 



remarkable facility. In cases in which the pathological changes 
are brought about slowly it is astounding what the body can 
accomplish in the way of adapting itself to new and unusual con- 
ditions. I have for example seen at autopsy a tumor as large as 
a hen's egg growing within the brain which it had distorted by 
pressure in every direction without producing hardly any symp- 
toms during life until near the end. The annals of medicine are 
filled with instances of the distortion of viscera, the migration 
and final extrusion from distant parts of foreign bodies and hosts 
of other examples of the wonderful capacity of the body for 
adjustment to conditions out of the ordinary. It is to this class 
of physical facts that I desire to call attention for the purpose 
of pointing analogies with certain classes of experiences in the 
mental sphere. 

First, in order that these analogies may be the better appre- 
ciated, let us bear in mind the conception of consciousness that 
regards it as a means for adapting the individual as a biological 
unit to his environment. 

Whereas the functions of the lower nerve centers have to do 
with the interrelations between the several organs of the body, 
so, for example, that the respiration shall be increased at the 
time of increased physical exertion and be accurately timed to 
that need, the functions of mind, considered in the large, are to 
bring about a proper relation of the individual as a whole to the 
several factors of his environment, more especially for our pur- 
poses, his social environment. He must be able to relate himself 
to his fellows in a way that makes for relative efficiency and we 
may say in a general way that those persons who find their way 
>> into the hospitals for the insane are those who have been unable 
to so relate themselves, have failed in making this adjustment and 
so being unable to live efficiently in their social milieu have to 
be taken out of its complexities and cared for in institutions. 

This adjustment to environmental conditions is not, however, 
limited to a passive moulding of the individual by the environ- 


merit but has an active side. The individual reacts upon his sur- 
roundings and endeavors to shape the world of phenomena in 
accordance with a plan he has in mind. He tries to mould the 
world about him to suit his needs, his desires. 

It will be at once apparent from this conception of mind as 
being acted upon by the environment and in turn reacting upon 
the environment under the stimulus of desire that conflicts must 
constantly ensue, between desire and attainment, conflicts that 
may reach a satisfactory conclusion, may rest in a compromise, 
or result in failure. 

It is at these points of conflict between the individual and 
forces either from within or without that are inimical or destruc- 
tive in tendency that there arise the types of reactions to which 
I desire to call attention and which correspond to the defense and 
compensatory reactions in the realm of the physical functions. 

One of the simplest of the mental defense reactions is for- 
getting. An analysis of examples of forgetting indicates that 
it is not the simple process it is usually supposed to be ; that it is 
not, in many cases at least, a passive process at all, but is emi- 
nently both active and selective. Forgetting in other words is a 
means of defense for it is the disagreeable and painful expe- 
riences that are characteristically selected. Recall some embar- 
rassing gaucherie you may have committed in the past, recall your 
active attempt to put it out of mind and at least your partial suc- 
cess, then compare the disagreeableness of having these remarks 
perhaps remind you of it and you will realize how much that is 
unpleasant you have been spared. This forgetting is a conserva- 
tive activity putting out of mind the disturbing and the painful. 
Sometimes considerable periods of time or a whole series of con- 
nected events are dropped out of consciousness en bloc as it were, 
and it will be found on analysis that these circumscribed amne- 
sias, as they are called, characteristically relate to painful events, 
such, for example, as the horrifying experiences of a train wreck. 
From being so gross and obvious the process of forgetting often 


occupies itself with very small affairs. One of my patients for 
certain reasons, which it is not necessary to detail, was not fond 
of her husband, in fact entertained a certain resentment towards 
him. He provided her, while in the hospital, among other things 
with pencils as she was very fond of writing. Invariably, how- 
ever, almost as soon as he gave her a pencil it was mislaid and 
lost. The pencil was a concrete reminder, it originated a painful 
emotional experience, so she defended herself from this source 
of unhappiness by losing it, putting it hors de combat, so to speak, 
where it could do no harm. 

This example of the pencil symbol shows well the mechanism 
by which a painful subject may be surrounded by danger signals 
as it were, warnings that any further progress in that direction 
will be disastrous. In this way a disagreeable or painful memory 
may be surrounded by a wall of defense which may grow in 
extent and circumference until there is hardly any approach to 
the personality at any point. This is very well illustrated by a 
case cited by the eminent French psychologist, Dr. Janet. 2 A 
woman had lost a very dear friend by death. She retained only 
one souvenir of him, an old dog. Two years after his master's 
death the dog died. From this event the woman began to have 
nervous crises at intervals. The details of her defenses are inter- 
esting. These crises were brought on by simply hearing a dog 
bark in the street, by seeing a cat pass by, or even hearing the 
name of one of these animals pronounced. Certain other words 
had the same effect, such as " love," " affection," " happiness," 
and she absolutely forbade their use. The mention of a certain 
date was similarly painful and so for fear of being reminded of 
that date she forbade the mention of any date whatever in her 
presence. My patient of the pencil symbol by this sort of mech- 
anism finally developed the delusion that she was dead and this 
idea made her almost inaccessible from any direction. 

2 P. Janet : The Mental State of Hystericals. G. P. Putnam's Sons, New 
York and London, 1901. 


It is in the realm of the abnormal that we often find the clearest 
examples of such defense reactions for we must remember that 
here, as in the phenomena of disease in the body, we are dealing 
with an experiment of nature — an experiment such as we are 
unable to make in the laboratory but which pulls apart and dis- 
sects for us the complicated structure of the mind and shows us 
what is going on within. 

Another of my patients 3 who was suffering from an hallucinosis 
heard a voice that advised him as a father would a son; it sug- 
gested to him to become a Catholic for he would then have a 
priest who would be a father to him. It is noteworthy that his 
father was dead — that he had been remiss in his religious duties 
and had been drinking a great deal, in fact his psychosis was the 
result of over indulgence in alcohol. His better self literally 
spoke to him in the form of this hallucinatory voice. 

A very instructive case is reported by a Swiss psychiatrist 4 of 
a Russian Jew, who, greatly against the dictates of his conscience, 
had decided to become a Christian. His mother appeared to him 
in a dream and said, " If you do this I will choke you." Here 
the " still small voice " literally spoke and he obeyed. Another 
most interesting case 5 is cited of a young woman who was so 
beside herself that she decided on suicide as the only escape from 
her sufferings. She went to the water's edge and was about to 
throw herself in when the image of a physician, in whom she had 
great confidence and upon whose advice she had learned to lean, 
rose from the water, took her by the arm and led her home, mean- 
time counciling her upon her duties to her children and otherwise 
pointing out to her how wrong was her contemplated act. See 
how wonderful are the defense mechanisms in these cases that 

3 Wm. A. White: A Case of Unilateral Hallucinosis (Alcoholic). Bul- 
letin No. 1, Government Hospital for the Insane, Washington, D. C. 
'Jung: Uber die Psychologie der Dementia Praecox. v 

"Flournoy: Automatisme Teleologique Antisuicide. Un cas de Suicide 
Empeche par une Hallucination. Arch. d. Psychologic, Tome VII, Octo- 
ber, 1907. 


serve to keep the individual to the right path and even in the last 
case actually to save a person from destruction. 

Although the defense mechanisms may work with great effi- 
ciency, in serious conditions when the pain is very great they 
do not succeed. No matter how thick or how high they build 
their wall the pain is still within and has to be reckoned with. 

Some compromise is now sought. Some compensation that 
will enable the person to bear his burden. We all know the 
usual examples. Emerson 8 has cited a number of the common- 
places and our experience has given us others. We are familiar 
with the great sorrow that turns out to have been a blessing in 
disguise, we have seen harsh, severe characters made mild and 
sweet by illness, we know of misfortune that has brought out 
great strength of character and efficiency in an individual that up 
to that time had shown only weakness, we have seen time and 
time again the disappointed and bereaved turn to the consolation 
of religion. These are the usual things. But the mechanism of 
compensation is more widespread than these simple instances 
would indicate. The character by which we are known is often 
the result of this sort of solution to the inner conflicts. People 
who are noted for their wit or for their cynicism are often per- 
sons sad at heart who have developed a character which expresses 
quite the opposite of what they really feel and as in the phe- 
nomena of immunity the bodies developed in the organism to 
antagonize a poison are always developed in greater quantity than 
necessary, here the reaction goes beyond the requirements and 
the wit and cynicism become obtrusive features in the character. 

It is these inner conflicts, the results of the discrepancies be- 
tween desire and possibility of accomplishment that furnish much 
of the energy, by a process of sublimation for our activities. It 
is a commonplace that the love-sick maid or youth may have their 
interests distracted by social activities and amusements — the 
energy of their conflict may be drafted in other directions. In 

* Essay on " Compensation." 


the same way we believe that, often at least, the beautiful things 
produced by the artist are the result of sublimated energies 
devoted to his art. These inner conflicts must be handled in 
some way. In the weak and poorly organized they literally tear 
the individual apart and make only too often nervous invalids or 
even result in chronic deteriorating psychoses. One of the most 
efficient of the mechanisms developed for dealing with them is the 
mechanism of compensation. 

It is no empty phrase, the saying that " an artist is wedded to 
his art." For a life of sorrow, bitterness and disappointment his 
art offers him the only avenue of expression, in this direction only 
can he mould to suit himself, here is the only opportunity for 
expression, for fulfilment, and he turns to it and finds in the 
oblivion it brings him his only happy moments. 

Look for a moment at the lives of those two Titans in the 
realm of art — Beethoven and Michelangelo. See Beethoven, a 
strange, distorted personality, practically a recluse, often with 
barely enough money to buy food, and living in poverty and want. 
He lavished all of his affection upon his worthless nephew who 
brought first one and then another sorrow upon his shoulders, 
disappointing him over and over again and finally indirectly caus- 
ing his death. In the latter part of his life he is still further cut 
off from the world and even from his music by deafness and still 
we find him repeatedly under all these miserable conditions in a 
very ecstasy of joy when possessed of some grand conception 
which he is weaving into a musical composition. 

So much as we know of Michelangelo reminds us of Beethoven, 
a sad, depressed, resentful character, forced by successive Popes 
to paint when he himself declared he was not a painter but a 
sculptor, and finally fighting for the liberty of his beloved Florence 
and seeing it fall and then with the irony of the relentless fate 
that pursued this tortured soul he was forced to serve its new 

In more recent times we see, I think, quite clear evidences of a 


tremendous, unresolved internal conflict in the life of Tolstoy. 
This remarkable character was always at war with himself, 
always unhappy and dissatisfied. The conflict at the end, when 
by age and sickness he had lost the power of keeping it in control 
produced that dramatic but bizarre, almost grotesque fugue just 
preceding his death that was almost pathological in its outward 

And so we find innumerable examples of men who have brought 
things to pass, creative geniuses in all walks of life who have been 
torn by inner unrest, but who have been able to turn all their 
magnificent energies into their life work — to sublimate. 

Let us turn again to nature's great psychological laboratory — 
the mind deranged. Here we find compensatory mechanisms 
quite characteristically. Take the following case: A man of 
sixty-five. During his early days he had been very successful 
and succeeded in acquiring a competency and was able to retire 
from business. Toward the latter part of his life, however, there 
was a falling off in efficiency and he lost all his money. Having 
been in the naval service of the United States he entered one of 
the naval homes. Here he secured a position in the office at 
clerical work. He is recorded as having exalted ideas of his 
own ability and being suspicious of those about him. He finally 
came into such acute conflict with his surroundings (personal 
encounters) that he was sent to the Government Hospital for the 
Insane. The explanation of his mental state is relatively simple. 
Having fallen off greatly in efficiency he is defended from the 
painful realization of this fact by exalted ideas of his ability. 
His work, however, as a matter of fact is not well done. He is 
again protected from the painful realization that it is because 
of his inefficiency by the ideas of suspicion which places the blame 
upon others who are jealous of him and try to injure him. Re- 
moved from the setting in which these troubles developed he at 
once calmed down and presented on the surface quite a normal 


In the mental disorders that are associated with deterioration 

the combination of exalted ideas with delusions of malevolent 

J outside influences is quite common. It is the protective device 

• erected as the result of a compromise between desire and accom- 


I take it Kipling gives us just such an example in his works. 
In saying this you will understand that I draw no hard and fast 
lines between the normal and the abnormal. My illustrations 
from the pathological are only illustrations and have no further 
connotations. The same mechanisms are found in every-day life 
as are disclosed in the insanities. To return to Kipling and see 
if we have not an excellent evidence of the productions of a 
writer as the result of a comproimse between desire and fulfil- 
ment. His story " They," written after he lost by death his 
favorite child, is a story of children, not real children but the 
children of fancy that are everywhere in evidence but yet have 
no real existence, the creatures of the mind, the wish children of 
the writer described in the pages of his book. 

This example calls to mind those delightful Alice stories 
written by Lewis Carroll — a bachelor, a semi-recluse, a mathema- 
tician — and seems inevitably to suggest the same kind of expla- 

Not only does the author reap compensations from his work 
but the reader may, too. In a delightful bit of Stevenson's, an 
essay on popular literature, he discusses the reasons for the vogue 
of the penny-a-liners. The type of story affected by the bar 
maid and the shop girl is usually a fervid tale of love under 
difficulties in which the heroine, who is, mark you, of the bar 
maid or shop girl persuasion, is finally won by her hero, a real lord, 
married and translated from her lowly state to the peerage. See 
what such a story offers. From the sordid life of serving mugs 
of ale at the corner pub Maggie has a magic wand with which she 
can at a moment's notice transfer herself into the land of dreams, 
the land where things come true, and identifying herself with the 


heroine live through the chapters of the story another life in 
which all her wishes are realized. It is no small happiness that 
Maggie gets out of her story and it is no small service to have 
written it. 

We psychiatrists must acknowledge that many of the things 
that we have discovered with great labor have been known in- 
stinctively by the writers for a long, long time. 

And this brings us to the land of real dreams. The most recent 
•* theory of dreams regards them without exception as wish-fulfil- 
ing. To cite an example: One of the most profoundly depressed 
women I have ever known, so depressed that she finally succeeded 
after several attempts in taking her own life, invariably had the 
pleasantest of dreams, always dreaming that she was at home, 
happy with her children. 

The dream is not usually so obviously wish-fulfiling as this. 
For reasons into which I will not enter now, the real mean- 
ing of the dream is so hidden that it can only be discovered by 
tedious methods of analysis. In such cases the meaning is gen- 
erally expressed in symbolic form. One of my patients dreamt 
that she stood beside a casket in which she saw her own dead 
body, the hands crossed and a red rose held in one of them. 
Analysis disclosed the meaning to be her desire to be united to 
her lover from whom she had ben cruelly separated, even though 
that union be in death. He and she had been schoolmates as 
children and every morning he used to bring her a bouquet of red 
roses from his mother's garden and place them on her desk. The 
red rose symbolized her girlhood's sweetheart. 

The child's dream is much more frankly wish-fulfiling than 
that of the adult. He has not yet become so complex as to pro- 
duce a symbolic dream like the last one I cited. He goes frankly 
and directly to the point. Yes, and more than that. He dreams 
in his waking state and in his play lives out his dreams so that 
the child world is very different from the world of realities, the 
world of cold facts that the adult learns to know. 


2 9 

It is a fascinating theory that assures us that after all, no matter 
how hard the world may be, we have but to sleep and presto ! all 
is as we wish it. 

There is considerable collateral evidence, however, that this may 
be so, evidence that goes to show that man will have his way 
whether or no, if not in the world of facts, then in the world 
of fancy. 

If we turn to folk-lore we will find that just as the heroine in 
the penny-dreadful represented all of the fondest wishes of the 
reader realized, so the hero of folk-lore stands for the realization 
of all that the race believes desirable. There is a remarkable 
similarity in the stories, particularly as to the origin of peoples 
and tribes. Almost in every instance the origin is traced in some 
myth back directly or indirectly to a god head. 

See here the same mechanism precisely that we saw in the 
dream, in the production of the artist and the wish-fulfiling of 
the writer and the reader, and in the self-aggrandizement of the 
insane man. People wish to be great and verily they are great. 

The child lives in a land of dreams, a fairy land of fancy. *" 
The myths, the legends, the folk-lore are the dreams of the child- v 
hood of the race. And as there are many grown-ups who still 
believe in ghosts so there are advanced races who stick to the 
legends of their childhood. Do our preachers not tell us that 
" man is made in the image of God ? " 

I have said that man will have his way, if not in the realm of 
facts then in the realm of fancy. It often happens, however, that 
things do not go as he wishes, they refuse to do his bidding, as 
it were. Particularly is this so with regard to his own impulses 
and actions. The reaction under these circumstances is inter- 
esting and instructive. Let me illustrate. I was talking a short 
time since to a man who had been sentenced to life imprisonment 
for manslaughter. He had killed a man by stabbing him in a 
quarrel. I questioned him for the purpose of seeing just how 
he felt with regard to his act. In the first place he was very 


emphatic in his blame of the deceased for picking a quarrel with 
him. He was very much bigger than the prisoner and so the only- 
way he could adequately defend himself was with some weapon. 
The deceased knew this and was virtually taking his life in his 
hands when he started the trouble. Then again the doctor didn't 
treat the wound as he should. The man came to his death really 
through his own foolhardiness and the lack of skill of the physi- 
cian. This was all told with a smiling countenance and without 
the remotest suggestion that the man blamed himself in the least. 

This is the reaction to which I referred. The reaction of justi- 
fication. The prisoner convicted of a crime, has deluded himself 
into the belief that he is blameless and that what happened was 
unavoidable and must simply be made the best of. Those who 
have the disagreeable duty of holding this man in custody are 
convinced that it is for the good of society and so you see every- 
body is happy, even the criminal, and we might say with Pangloss, 
"All is for the best in this best of all possible worlds." 

We see this reaction of justification on all sides. The drinker 
drinks when it is hot to cool off, he drinks when it is cold to 
warm up, when he is joyous to celebrate, and when he is sad to 
drown his sorrow. All of which simply means that he cannot 
control his habit so he must find a good reason for indulging it 
and so justifying his conduct to himself. 

The " sophisms of the indolent " are perhaps best known. Go 
down into your own soul and recall your reasonings when your 
desk was filled with work and a beautiful summer's day beckoned 
you to a day of recreation in the company of kindred spirits. We 
all indulge in the weakness but some do little else their whole lives 
long but invent excuses for being idle. 

There are many, many more types of defense. Sleep is per- 
haps the best organized one. We do not sleep because we are 
fatigued. We sleep long before the deleterious effects of fatigue 
are in a way to damage the organism. Sleep is a biological 
defense against fatigue. We sleep so that we may not become 


(fatigued. And so with laziness and diffused attention. These 
are not always to be condemned. They are often the only means 
at hand for preventing undue stresses. One could hardly invent 
■ a better means for preventing mental overwork and strain than 
: by a diffused attention, a degree of distractibility that prevents 
! close application. We must not after all be too harsh in our 

! judgments of the indolent but remember that they number in 
their ranks many relatively inefficient persons who are unable to 
bear the stresses incident to prolonged continuity of effort. 

From these illustrations, the thought I am endeavoring to con- 
;■ vey can, I think, be gathered. As the biologist sees in living 
beings creatures constantly at war with their surroundings, devel- 
oping weapons of offense and defense, succeeding, failing, but 
more frequently coming to some compromise in the struggle, so 
we may look upon the world of minds and picture each individual 
mind in just such a struggle with just such kinds of results. 



The fundamental conception which it will be the object of this 
v chapter to set forth is that every psychic fact must have been 
preceded by an efficient psychic cause. As we have already had 
repeatedly emphasized by examples, ideas, or better, mental states 
do not arise de novo. They must always be the outcome of other 
mental states from which they necessarily issue. This is so 
throughout the field of psychology, normal or morbid. It is true 
even in the realm of the psychoses due to organic changes in the 
brain. That an alcoholic should have a delirium may well be 
dependent upon a toxemia, but whether he sees in his delirium 
snakes or monkeys, visions of his office or of hell must depend 
upon purely psychic causes, upon the preexisting psychic material 
which has become involved in the disorder. Whether a paretic 
is exalted or depressed, whether the exaltation is largely erotic 
or expresses itself by delusions of great wealth must find its 
explanation in the mental make-up of the person afflicted, and 
the character of his psychic trends. The cards may be indefinitely 
shuffled or arranged in any way, but there are only fifty-two in 
the pack, and the result whatever it may be, must be conditioned 
by that fact. 

With this fundamental conception the psychiatrist, for example, 
is in a position to remind us of the chemist or the astronomer. 
>f If there is a hiatus in the logical connections of the different steps 
in a psychosis, like the chemist he can with confidence look for 
an element to fill the space. If there is a disturbance somewhere 
along the line he may expect, like the astronomer, to find a hith- 
erto unknown source of energy to account for it. 

Our assumption then is that every psychic fact has an efficient 



psychic cause ; that an idea does not spring into existence without *■' 
having been the logical outcome of other ideas; that for every 
mental state, for every idea or feeling, there is an adequate expla- 
nation whether that explanation can or cannot be found. It im- 
plies for example that every psychosis, if all the facts were known, 
by that is meant internal, conscious facts, would be found to 
have arisen as a logical necessity step by step ; that every state of 
mind should theoretically be capable of reconstruction from the 
elements that analysis shows it to consist of. 

If this is true it should hold under all circumstances, normal or 
abnormal, for we must always remember that there is no qualita- 
tive difference in the mental processes in disease and health — the 
difference is only quantitative. 

This conception has received a certain popular vogue in the 
general expression that we cannot dream of anything we did not 
previously know about though we might dream of an animal with 
a lion's head, a crocodile's body, and horses' hoofs still all the 
component parts were well known — nothing has been created. 

A good illustration of this view came within my experience 
during a recent ocean crossing. We were nearing the other side 
and were beginning to pack and get ready to land. As is usual 
we were often asked to write in each other's albums, exchange 
cards, etc. One of my fellow-travelers, in giving me a " souvenir 
de voyage " signed it as on board the " Kroondam." Now there 
is no such ship as the " Kroondam." There is a " Kroon-land " 
and we were on the " Noor-dam," so the material out of which 
the new name was made is plain to be seen. Of course I have no 
knowledge of the reasons that led to this lapsus calami. 

Another example will show this point perhaps better. A pa- 
tient during a delirium called a cigarette " Thingvalia." An 
analysis of this expression showed that the patient had once won 
some money betting on a horse by that name and that with the 
money thus won he had purchased some of a particularly expen- 
sive brand of cigarettes. The association thus became plain and 


the reason for the use of the word to designate cigarettes clear. 
And so again we find an apparently fortuitous incident fully and 
adequately accounted for. 

Let us look further, into some of the different kinds of con- 
sciousness, particularly in dreams and the psychoses and see 
whether this principle holds true there, and first let us take up 


One of my patients dreamt of a log cabin in the mountains 
with which he was familiar as a boy. There appeared in the 
dream two dogs, then two wild cats, a house cat, a man and finally 
a big gray wolf. The two dogs, the house cat and the man be- 
longed to the place as he remembered it. Wild cats, too, were 
plentiful in that locality and he had often seen them. He never 
saw but one wolf, however, and that one had been poisoned and 
was dead when he came upon him suddenly near the house one 
day, and he was badly frightened. This wolf, though, was a 
yellow wolf while the dream wolf was gray. The discrepancy 
is accounted for by the fact that he had been to the zoo a day or 
two before and had seen some gray wolves. This is an excellent 
example, not only of how the dream is conditioned by the just 
preceding waking experiences, but of the detailed picking out of 
a single element and its modification by such preceding experience. 

Let us take a more complex example. A young woman dreamt 
that she was standing on the edge of a precipice; a man came 
along and pushed her off. At the base of the cliff was a mass 
of writhing serpents; just as she was about to fall among them 
she screamed and awoke. The impression was created on listen- 
ing to the recital of this dream that she had been much frightened 
at being pushed from the cliff. This, however, was but the elabo- 
ration of the waking consciousness. She was not frightened to 
any extent. The analysis shows why. The cliff was familiar 
to her as being a place she had frequently visited. Standing on 
the edge of the cliff was symbolic of a social and moral danger. 


She had never seen an old-time lover since she had married, and 
had wondered, if she were thrown with him, if he would try and 
tempt her. The man who pushed her off the cliff was her lover, 
and the falling down really representing a moral fall, did not 
frighten her very much, but was rather pleasant as it involved his 
companionship. As she nears the bottom, however, she sees the 
den of serpents. The serpent for her represents sin and recalls 
the sin in the garden of Eden. Her fall has been pleasant until 
she sees its end in sin. This end is so hateful to her that she 
cannot even permit the idea to enter her thoughts. The censor 
of consciousness, lulled by sleep, has permitted this symbolic 
wish-fulfiling play to go on up to this point, but now must be 
aroused to full activity and press back to the furthest and darkest 
recesses even the suggestion of a sinful denouement. The patient 

So much for the meaning of the dream. It will be interesting 
and instructive to trace one of its component parts — the part 
played by the serpents. In the first place, we already have the 
utilization of the snake symbol in the dream, conditioned by its 
occurrence in the Bible as a symbol of sin in the story of Adam 
and Eve in the Garden of Eden. In passing it might be men- 
tioned that the snake appears very often in the folk-lore of many ^ 
peoples as a symbolic emblem. In addition to this, however, 
analysis disclosed three distinct snake experiences previous to this 
dream, and all had occurred within a period of three weeks. 

First : There was a disturbance in the hen house, and she went 
with her mother to see what the trouble was. They found a large 
snake coiled up on the eggs. Her mother, who had brought a 
pistol, shot it. The next morning she found its dead body nearby. 

Second: While walking out with her mother a snake (she 
thinks a spread-head adder) ran across the walk, and her mother 
stamped on it and crushed its head with her heel. 

Third : On the occasion of a visit to her sister's grave she found 
a snake coiled up on the grave. 


These three snake experiences were elicited by the method of 
free association (see Chapter VII) from the snakes of the dream 
as a starting point, and so I think we may be sure that they all 
played a part in conditioning that portion of the dream. The 
dream snakes, we would say, were over determined. That is, 
their occurrence was brought about from several directions, from 
several associations. 

Certain further ramifications of the serpent symbol are inter- 
esting, particularly in view of its frequent phallic significance in 
dreams, art and legends. 

When she was twelve years old (it was after the three snake 
experiences) a man passed her as she was sitting in a carriage 
with a girl friend. He returned, asked where she lived and later 
called on her parents. He became a constant caller, wanted to 
adopt her and finally induced her parents to let him take her for 
a few weeks to Havana. One day he grabbed her and tried to 
kiss her. She fought and screamed, was much frightened and 
went to her room and cried; shortly after she returned home. 
In describing this man she says she does not know how to express 
herself, but that his forehead was wrinkled, his shoulders drew 
together, expressing a disagreeable and disgusting feeling, and she 
says she always thought of him as a sort of snake. 

After her marriage she resorted to the usual means to prevent 
conception, but always considered it wrong. She used to then 
recall the snake coiled up on the eggs (first snake experience) 
and think of it as symbolic of her sinfulness in preventing con- 

Previous to the patient's admission to this hospital she was in 
a sanitarium for some months. While there she was occasion- 
ally given a hypodermic injection, and used to think of it each 
time as the sting of the spread-head adder (second snake expe- 
rience). One night — she had been taking bromides for a long 
period — she awoke and saw the room full of snakes of every 
kind. They were on the ceiling even, and the quarter round was 


a tape worm. On another occasion she looked out from a watch 
tower upon the sea of eternity, upon which was a rowboat in 
which were her husband and children. She tried to get to them 
but could not, because a large boa constrictor was wound about 
her. On one occasion she told of this vision somewhat differ- 
ently. Said her dead child called to her from the boat, " Mamma, 
please come with us ! " But she realized that she was lost and 
could never get to them. Did not recall about the boa constrictor 
when reminded of it, but says she feels as though a big snake was 
coiled about her every minute of her life. 

Another dream of the same patient is equally illuminating. To 
understand this dream it must be known that the central event 
which was the determining factor in producing her psychosis was 
her separation from the man she loved through the machinations 
of her mother, who brought it about in such a way that she 
thought he had deserted her, and her subsequent marriage to the 
man of her mother's choice whom she did not love. 

One month after the separation she attended the funeral of a 
young man who had been engaged and whose fiancee had nursed 
him in his last illness. At the funeral she wished it were she 
that was dead, and thought it would have been better to have died 
than to have been parted. Following this experience she had the 
first of what I shall refer to as the coffin dreams. 

She dreamt that she was standing beside a coffin in which she 
saw, instead of the body of the young man, her own dead body. 
The coffin of the dream was the coffin she had seen. It was black, 
had silver handles, and was lined with white satin. Her hands 
were folded across her chest, too, just as his hands had been. 
There were certain differences, however. There was one candle 
burning at the head and another at the foot of the coffin, and in 
her hand she held a red rose. 

Now as to the meaning of this dream. In the first place, after 
she had been separated from her sweetheart she had plunged into 
social dissipation, opera, teas, social functions of various sorts, 


in order to distract her mind from her sorrow, and as a result 
had become very much tired out. The candles were symbolic of 
this state of affairs and were emblematic of the old adage, " Burn 
the candle at both ends." The rose, too, had symbolic signifi- 
cance. Her sweetheart, when they were children together in 
school, used to lay a bouquet of red roses, that he had picked in 
his mother's garden, each day upon her desk. The rose sym- 
bolized her sweetheart, and in accordance with the theory of 
Freud that all dreams are wish-fulfiling, we can interpret the 
meaning as being the wish to possess her lover, even though that 
possession were in death. 

It is of great significance that this coffin dream occurred three 
times during her life. Once after the funeral, then the night 
before she was married, and finally the night before her second 
child was born. Note the critical moments it selected for its 
appearance, or more properly note that these are occasions, above 
all others, when the thought of her girlhood's sweetheart would 
tend to recur to her. 

A further example of the symbolism of the red rose and the 
vivid emotional coloring it received in her consciousness, is 
offered by a visit to a florist. The place was filled with red roses, 
she saw an hallucinatory figure of her old-time sweetheart, 
greeted him with an exclamation of surprise and fainted. When 
she came to she inquired if a gentleman had been standing 
"there," and was, of course, told "no." 

During her delirium in the sanitarium, and before admission to 
this hospital, she saw her own funeral procession in the clouds. 
She had considerable nose bleed at that time, and the bleeding 
seemed like red roses gushing out, and the blood would rush out 
forever, run down the stairs, and the people fled in terror. 

So much for the phenomena of dreams. These examples show 
the intimate relation of constellations in consciousness, and how 
they are associated. It is naturally impossible to separate the 
dreaming and the waking consciousness, because they are merely 


different experiences of the same thing; and so we see how the 
same influences that condition the dream also condition certain 
phenomena in the waking state. 


A word only about symbolism in connection with this subject 
of dreams, for it seems the most appropriate place, although the 
phenomenon is widespread and by no means confined to expres- 
sion in dreams. 

A symbolic method of thought or expression implies a primi- v' 
tive, simple type of mind ; one that does not look beneath the 
surface of things, but accepts without question the obvious. One 
thing resembles another in some single character only perhaps, 
and immediately the conclusion is reached that they are related 
in nature or perhaps even identical. This is the crudest of all 
forms of reasoning — reasoning by analogy, 1 and gives rise not 
only to all sorts of errors but to beliefs that are most grotesque 
and fantastical. Examples are many and may be found in abun- 
dance in the superstitions and folk-lore of all peoples. 

We all know something of the good and evil spirits, in the 
beliefs of different peoples, that are supposed to account for 
things; of the dryads and nymphs, the demons and the furies, the 
fairies and trolls, the banshee, hobgoblins, ghouls, ghosts and 
gnomes. They could all be pressed into service as examples of 
symbolism and reasoning by analogy. 

Shute gives in illustration 2 the belief of the English peasants 

that they hear in the gale that sweeps past their cottage the wail 

of the spirits of unbaptized children, and cites Tylor, who 

recorded an experience in Cornwall of the belief that " shingles " 

was attributed to a kind of coiling serpent. A young girl was 

afflicted and the family waited in grave apprehension lest the 

animal completely encircle her. They believed that if the crea- 

l D. K. Shute: The Philosophical Foundations of Charlatanry in Medi- 
cine. Washington Medical Annals, Vol. VI, No. 6. 
* Loc. cit. 


ture's head and tail should meet the patient would die. See on 
what flimsy, superficial, inconsequential similarities an inherent 
relationship of some sort between phenomena is posited! 

y It is in the realm of dreams par excellence that the phenomenon 
of symbolism manifests itself in all its richness. The dream con- 
sciousness is uncritical ; ideas come and go without direction, the 
whole scene suddenly shifts without calling forth even an excla- 
mation of surprise; the faintest resemblance is enough to cause 
one object to symbolize another. We are dealing with a state of 

•J mind quite as lacking in intelligent selection as the mind of primi- 
tive people ; and so, as we might expect, the results are similar, for 
myths and dreams are quite alike in structure and meaning. 

If dreams offer the best opportunity for symbolism, it is not 
the only opportunity. We meet with this phenomenon constantly, 

v especially in the psychoneuroses. As we have seen that the 
symptoms of the psychoneuroses have their inception in a region 
of consciousness that is removed from the full, bright light of 
conscious awareness, a region that is not in the focus of atten- 
tion, we might expect that the result would be similar to that 
found in dreams. This is so. The symptoms of these disorders, 
and in fact of the psychoses, have their birth in the twilight region 
of consciousness, where critique is in abeyance. For the same 
reason, therefore, as in dreams, we find that resemblances are 
taken at an obvious face value that results in symbolism. 

From this brief digression on the subject of symbolism, let us 
now turn to the symptoms of 

The Psychoses 
Here the evidence is often not so clear because of the rich 
growth of material that has been going on for years, so that, 
more than anywhere else, we will be led astray if we follow 
the obvious. The psychosis, so far as the mental symptoms are 
concerned, is an expression of a conflict in the individual's mind 
between desire on the one hand and attainment on the other. The 


psychosis is an expression of failure plus the more or less well 
organized compensatory and defense mechanisms. Let me illus- 
trate by repeating a case cited in Chapter II. 

A fairly successful business man 3 begins to lose efficiency in 
the arteriosclerotic period of life. He had acquired what, at that 
time (twenty years ago), and for such a man, was a fortune — 
about sixty-five thousand dollars. With the falling off in effi- 
ciency he lost all this and entered the Naval Home. Here, 
because of his business experience, he was given a place in the 
office at clerical work. He came into immediate and frequent 
conflict with those about him. Two sets of ideas developed side 
by side, both of which are expressions of a defense reaction to his 
failing efficiency. He had very exalted ideas of his own ability. 
Such ideas you see are distinctly defensive, for they save him 
from the pain of a realization of his defects. Then along with 
these ideas goes the delusion that he is being interfered with by 
those about him. Another defense reaction which serves to ex- 
plain how a really efficient man, such as he considers himself, can 
after all, turn out such poor work. Again he is saved from a 
realization of his failings. 

You see how, if we seek to understand our patients, each symp- 
tom will be found to have its raison d'etre, and not be in any sense 
whatever fortuitous or accidental. This association of grandiose 
and persecutory ideas is frequent and I am sure often has a simi- 
lar explanation. Take another case. 4 

A single woman, in middle life, breaks down and develops a 
well marked prsecox type of reaction, with a loosely organized 
system of delusions of marked sexual coloring. She believes that 
she is married to a Mr. A , that she has had a criminal opera- 
tion performed on her, complains of having had a vaginal hemor- 
rhage and says she has two large cuts in the vagina. Without 
going into details I may summarize the situation by saying that 

'White: The New Functional Psychiatry. Case II, Arch, of Diag., 
October, 1910. 
4 Case III, loc. cit. 


here we are dealing with a woman in whom the conflict is a 
sexual one, with the development of a compensatory and wish- 
fulfiling delusional system. Wishing for a child she becomes 
impregnated. Being a virtuous women this has to be accounted 
for, and she therefore develops the delusion that she is married to 

Mr. A . Inasmuch as no child appears upon the scene, a 

delusion that she has had an abortion performed accounts for its 
absence. But because this is a criminal operation and there- 
fore repugnant to her, a further delusional formation meets the 
difficulty. The operation was performed without her knowledge 
while she slept. See how logical such a delusional system really 
is! Note also how it compensates for certain well-defined defi- 
ciencies in the patient's life. 

To revert again to the patient already mentioned, the one who 
had the snake and coffin dreams. She had the delusion that she 
was dead and spoke of herself constantly in the third person as 
" the corpse." Without going to the full length of analyzing and 
explaining the growth of this delusion, I want to invite your 
attention to the great number of unusual experiences that she had 
in her lifetime with death. 

At the age of five, when she was living in New Orleans, a 
convent in that city burned down. It had double walls and be- 
tween the walls were found many babies' bones. She used to be 
frightened as a child in passing the convent for fear they might 
get her and throw her down between the walls. 

When about fourteen she read " The Murder of Nancy by Bill 
Sykes," and fainted while reading it. 

She has read Voltaire, Paine, " Letters from Hell," etc. 

She saw three of her schoolmates drowned. One of these 
drowning accidents occurred just a week before her only mis- 

She had two experiences in the South in seeing a crowd of men 
about to lynch a negro. 

During the Spanish-American War she dreamt of seeing a 


young man, the son of friends, who had gone to Miami where 
the troops were stationed. He was seated on a bench on a long 
wharf and was quarreling with a soldier who was walking in 
front of him. He got up and struck the soldier, they had a strug- 
gle, and the soldier stabbed him and threw him overboard. As 
his body struck the water she awoke. At ten o'clock that morn- 
ing the boy's mother received a telegram informing her that her 
son had been murdered. (The temporal relations may of course 
be reversed — paramnesia.) 

After her little boy died she received three postal cards, each 
bearing the picture of a stork, but sent by different persons. 

When twenty-three years old a funeral passed the house. She 
said to a woman present that she envied the corpse. The woman 
remonstrated with her. 

In 1894 she took tea one day at the house of Mrs. O. Next 
morning a lady met her and told her she had news for her, and 
asked her if she could imagine what it was. She replied that 
Mrs. O. was dead. This was the fact. Mrs. O. had been found 
dead in bed; was well the night before when she was there. 
(This may also be paramnesia.) 

About one month before her marriage a girl friend at whose 
house she was married, sent her her photograph. She had been 
ill and looked bad as a result. On the back of the picture she 
had written, " Susie going to her own funeral." 

Her mother has always had a depressing influence upon her. 
Says it seems as though her whole life had been a struggle against 
the gloomy view of life of her mother. Her mother was always 
saying, "What's the use of life," etc., and when she was eight 
or ten years old she remembers her mother used to talk about life 
and take a gloomy and pessimistic attitude towards it. Only yes- 
terday (June 4) she received a letter from her mother telling, 
among other things, of three suicides among her friends. 

She had three experiences taking railway journeys, and found 
out after she had completed them that the dead body of a friend 
was on the train. 


Once she was discussing death with a girl friend. Her friend 
said she had never had a death in her family. Just then the door 
bell rang three times. Mrs. W. said, " Maybe that's a death now." 
It was a telegram announcing the death of her friend's father. 

She received a letter from a friend who committed suicide. 
The letter arrived after her friend was dead. 

When she was twenty-two a young man whom she knew was 
arrested for running up and grabbing an actress. Later he mar- 
ried a girl friend of hers, and three years afterwards was found 
murdered in a house of ill-fame. 

When she was eighteen she had a flirtation with a young man 
in a town she was visiting. This man was noted for the con- 
quests he had made, but he fell in love with her. He asked her 
to marry him and she refused. He asked her again, with the 
understanding that her answer would be final. She refused again. 
He walked home with her and blew out his brains in front of her 
house. As a result of this experience she was ill for several 

A lieutenant who had asked her to marry him was killed at San 
Juan hill. 

She had a narrow escape from death once in a cyclone. The 
house was nearly destroyed and two nearby houses were. The 
horse was killed and her mother stunned. 

She used to recite a great deal, for example at Chautauqua. 
She recited once " Death Doomed " by Will Carleton. There 
were three thousand people present. The professor had told 
her to really see the gallows when she was reciting. Says she 
actually did see them for an instant and felt as though she were 
being led to be hung. 

She says that of the different recitations she used to give she 
cannot recall one that did not have to do with death. 

She remembers such things as Tennyson's comparison of mar- 
riage to a winter funeral, and recalls Marie Corelli's book " Ven- 
detta " begins, " I who write this am dead." 


There are other features in this case that led to the culmination 
in a delusion of death. These I will not enter into here. It 
would seem to be quite evident, however, from this rich expe- 
rience, that the subject of death was held before her mind very 
prominently throughout her entire life; that her life must have 
been distinctly colored by these numerous, often highly emotional 
experiences, and that later on it was a matter of comparative 
ease, an issue that might almost have been expected, for the psy- 
chosis to take up this material and use it in weaving a delusional 

It is hardly open to question that this is exactly what happened. 
All of these experiences were obtained from this patient by the 
method of free association with her delusion as a starting point, 
so that it is clear that they all had associational relations with the 
delusion. The delusion then bears at least a similar if not the 
same relation to the several experiences as did the snakes of her 
dream to the actual srtake experiences — it is over-determined. 
The delusion was brought about as a result of tendencies, pres- 
sures from many different directions. It has the value of an 
over-determined idea, an over-valued idea, a hyper-quantivalent 
idea or a dream thought continued in the waking state. The pre- 
cipitating reagent that brought all this material together so that 
the delusion of death issued therefrom I will not discuss. 

The thought I wish to convey is that no idea, no desire, no 
impulse, no action of any sort whatever but what has its sufficient 
cause, and that cause, too, in the realm of mind. 

There has recently been an attempt made to apply to folk-lore 
the principles that have been brought out in the study of dreams 
and in the psychoanalysis of the mentally deranged. The dream 
as related, the obvious, or as it is generally called, the manifest V 
content of the dream, is but the fagade behind which one finds 
the essential, that is to say, the idea of the dream or the latent 


content. Similarly with the psychoses, and in fact with any 
mental fact that is not most simple. To follow the indications 
of the obvious is only too often to go astray. 

The study of folk-lore, the fairy tales, myths, and legends, has 
led to conclusions of the same character as the study of dreams 
and the psychoses by psychoanalysis. 

The principles of wish-fulfilment and of symbolism appear 
characteristically in the various fairy stories, fables and legends. 
Ricklin 5 particularly deals with these principles in relation to such 
fairy stories as are found in Grimm, the Russian fairy stories, 
and the Icelandic sagas. He particularly lays stress upon the 
appearance of certain similar features in all these stories, no 
matter what their origin. There appear to be some common fea- 
tures that are more fundamental than race or environment. He 
traces these fundamental features to certain infantile psycholog- 
ical characteristics. 

Abraham 6 endeavors to relate the subject matter of dreams 
and myths. He calls attention to the results of the analysis of 
dreams, namely, that if a considerable number of dreams are 
analyzed in a large number of persons it will be found that certain 
dreams are common in their essential characteristics, that is, are 
fundamental and seem to belong to the race. The analysis of 
these dreams shows that in each instance they have their root in 
childhood experiences. Now over against these facts of analysis 
of dreams he takes up for discussion the Prometheus saga, the 
birth of Moses and of Samson, particularly discussing the myth 
of Prometheus. He applies to the elucidation of these myths the 
same principles which Freud has brought to bear in his analysis 
of dreams. He discovers as a result in all the myths funda- 

5 Franz Ricklin: Wunscherfullung und Symbolik im Marchen. Schriften 
zur angewandten Seelenkunde. Zweites Heft. Franz Deuticke, Leipzig 
und Wien, 1908. 

"Karl Abraham: Traum und Mythus. Eine Studie zur Volkerpsychol- 
ogie. Schriften zur angewandten Seelenkunde. Viertes Heft. Franz 
Deuticke, Leipzig und Wien, 1909. 


mental, underlying common factors which are hardly varied even 
superficially in their expression. These fundamental, underlying 
factors are the same underlying factors that were found in the 
fundamental dreams. These fundamental dreams which have 
their origin in the childhood of the individual are therefore in 
every way analogous to the myths which have their origin in the 
childhood of the race. 

Rank, 7 in his study of the myths relative to the birth of heroes, 
especially Sargon, Moses, Kama, CEdipus, Paris, Telephos, Per- 
seus, Gilgamos, Kyros, Romulus, Heracles, Jesus, Siegfried, 
Lohengrin, shows that in these myths we have the same psycho- 
logical mechanisms that go with the dreams and fantasies of 
childhood. The childish dreams are egocentric. The child occu- 
pies the center of the stage and the events of the dream serve 
for his aggrandizement. In the same way the people in explain- 
ing their origins have traced them back in each instance, me- 
diately or immediately, to a god-head, serving thus to aggrandize 

These studies all tend to show that the human mind reacts 
according to certain fundamental principles no matter under what 
conditions or circumstances it may, for the time being, be placed. 
Even if the several authors had not suggested or endeavored to 
demonstrate what that principle was the remarkable similarities, 
amounting in many instances almost to identity, which they have 
pointed out in the folk-lore of widely different races and separate 
peoples would indicate that there must be such a principle to 
account for such results. 

In the face of such a principle we would expect to find here, 
in the realm of mind, as elsewhere in the course of bodily devel- 
opment, that there would be certain relations, certain similarities, 
between the development of the child and the development of the 

7 Otto Rank: Der Mythus von der Geburt des Helden, versuch einer 
psychologischen Mythendeutung. Schriften zur angewandten Seelenkunde. 
Fiinftes Heft. Franz Deuticke, Leipzig und Wien, 1909. 


race. This is shown in the similarities between the fundamental, 
common types of dreams and myths. There is then a childhood 
of the race which has a certain likeness to the childhood of the 
individual. The principle is a well-known one in biology — onto- 
genesis epitomizes phylogenesis. 



The term complex as used in this chapter is comparatively new 
but like most new terms it does not correspond to an altogether 
new idea. It is but the recent German clothing of an idea that has 
found expression for many years in France and later in this 
country under the designation of " dissociated state." With the \S 
advent of the theory of the complex, however, the study of what 
had formerly been called dissociated states received a new impetus 
and as a result, complex, as used to-day, has a considerably dif- 
ferent connotation than dissociation. 2 

In order that we may approach the discussion of the " com- 
plex " logically and for the purposes of clearness in presentation 
it will be worth while to introduce the subject by still further 
illustrations of mind as adaptive mechanism. 

True to this characterization it is constantly exhibiting adaptive 
phenomena. While we all recognize those more patent adapta- 
tions of the individual, mental in origin, whereby he adjusts him- 
self to the social conditions in which he lives, adopts the customs, 
observes the conventions, and obeys the laws, we hardly appre- 
ciate the extent and the minute detail to which efforts of adjust- 
ment are carried under circumstances where they are not quite 
so obvious. 

1 This chapter was printed, substantially as it appears here, under the 
title " The Theory of the ' Complex,' " in the Interstate Med. Jour., April, 

2 Janet: The Mental State of Hystericals. (Trans.) New York, 1901. 

Sidis : Psychopathological Researches in Mental Dissociation. New / 
York, 1902, Boston, 1908. 

White: The Retraction Theory from a Psychical Standpoint. Proceed- 
ings Am. Med. Pysch. Assn., 1899, and Arch, of Neurol, and Psychopath., </ 

5 49 


Some years ago during a vacation trip abroad I saw for the 
first time the Alps. My drive over the Furka Pass was a reve- 
lation of the most gorgeous scenery I had ever beheld, but I was 
nevertheless disappointed. The mountains did not seem nearly 
so stupendous as I had pictured them to my " mind's eye." My 
companion who had been through the Alps many times insisted 
that I was drawing entirely erroneous conclusions as to dis- 
tances. But I knew better, for could I not see? However, he 
was so positive in his statements, that I " lay about " with my eyes 
for proofs to disconcert him. I no sooner did this than I began 
to find that I was wrong — not he. Distances that had seemed 
insignificant were thousands of feet, and mountain peaks where 
I was sure I could have seen a man, had he been standing there, 
proved to be at such an altitude that a man would have been lost 
to vision as an insignificant speck against a neutral background 
long before reaching them. The marvelous grandeur of the Alps 
was beginning to unfold itself before my vision. The character 
of the images on my retina had not changed but it took my mind 
some time to adapt itself to these new circumstances and sur- 
roundings, some time to realize — to see — the stupendous heights 
which were presented to its wondering gaze for the first time. 

In many cases the adjustment is not so readily made nor is the 
difficulty at all appreciated. Those who are fond of music and 
who are affected by a voice know how tiring a recital may be if 
the singer is, for any reason, unequal to the proper rendering of 
a difficult piece and must make a very constant and very evident 
effort in the interpretation. The listener finds himself uncon- 
sciously trying to assist, his muscles at times actually tense, and 
if he is a singer he may actually go home with a throat tired out 
by his efforts to assist the artist in reaching high notes and sus- 
taining difficult phrases. 

So, too, we get a feeling of unrest from certain illy balanced 
structures. The Greeks recognized this in their architecture. 
The Greek column is made bulging in its middle and is thus rein- 


forced at a point which, in a column with straight lines, seems 
weak and therefore gives a sense of unpleasantness to its con- 
templation. 3 

This consideration of mind as adaptive mechanism is necessary 
in order to understand its various modes of reaction under dif- 
ferent conditions. Here as elsewhere in natural science we are 
most often assisted in understanding difficult and intricate mech- 
anisms by a study of those cases in which, for any reason, the 
machinery is out of order, and so a few of the simpler examples, 
particularly those where the adaptation fails, are worthy of note 
as forming a natural introduction to the subject of this chapter. 

Whatever it may in essence be, the mind has its limitations and 
restrictions which in every-day life must be observed. Like any 
mechanical force its operations cannot be spread efficiently over ^ 
a wide area. To accomplish results the attention must be cen- 
tered on the work in hand to the more or less complete exclusion 
of other and distracting influences. The college professor who 
takes out his watch to observe the time and then calmly tosses it 
into the nearby lake, or while pondering over a mathematical 
problem runs into a cow and raises his hat politely with a " beg 
pardon" are familiar examples of the defects of conduct resulting 
from this conservation of mental energy — its restriction in narrow 
channels — the so-called absent-mindedness. 

Of a considerably different type is the case communicated to 
me of a young man who as a child had been disagreeably affected 
by seeing some criminals and who all through life thereafter 
would walk any distance out of his way to avoid passing a prison 
or a jail. Similarly the case of a child who was frightened by a 
false face and always thereafter had a marked dislike for a 
homely countenance. Mosso 4 gives the interesting reply of an 
old soldier to the query as to what his greatest fears had been. 
He said: "I have only had one, but it pursues me still. I am 

'Judd: Psychology. New York, 1907. 
* Fear. 


nearly seventy years old, I have looked death in the face I do not 
know how many times, I have never lost heart in any danger, but 
when I pass a little old church in the shades of a forest, or a 
deserted chapel in the mountains, I always remember a neglected 
oratory in my native village and I shiver and look around, as 
though seeking the corpse of a murdered man which I once saw 
carried into it when a child, and with which an old servant 
wanted to shut me up to make me good." 

These last three examples all show modes of reaction to dis- 
agreeable conditions in the environment and were all developed 
upon the basis of states of fear. 

In this connection it is in order to make a passing comment on 
the much worn subject of the relation of body to mind (discussed 
in Chapter I ) . The fact for us to consider is that the individual 
reacts to external conditions not simply from a physiological or 
from a mental basis but that he reacts as a whole — as a biological 
unit — and in this reaction are both physiological and mental ele- 
ments, sometimes one and sometimes the other, dominating the 
picture. Now in fear, for example, we know that there are many 
physiological changes — the tachycardia, dilated pupils, tremor, 
relaxed sphincters, respiratory and secretory disturbances — but 
the only reason we give it a name that applies primarily to the 
mental rather than to the physical state is simply because the 
mental facts so overshadow the others that they are quite over- 

This fact, that mental reactions, illustrated by the extreme case 
of fear, are fundamentally reactions of the whole individual, is 
important to bear in mind and serves to explain many otherwise 
inexplicable phenomena in psychopathology and to indicate the 
directions in which explanations for still others may be found. 

So far all my examples are from normal reactions. The way 
to the abnormal, however, is not far and these are, of course, 
what interest us most. We see in all these cases that ideas, ten- 
dencies, inclinations, fears, disappointments, are capable of bring- 

" a>^-..-t.t T^-«r " 


ing about mental reactions that are manifested entirely apart from 
the individual's volition. The forgetting, a sudden religious fer- 
vor, a pleasant dream, perhaps, come about without any reason so 
far as the subject knows. 

Take for example the case of Irene, cited by Janet. 5 This 
poor girl, living in a garret in abject poverty, nursed her mother 
through a long illness with consumption ending in her death. 
During two months she watched her mother gradually nearing 
her end and was at the same time forced to work at sewing to 
get a little money for the bare necessities of life. Her mother 
died and in her anguish she tried to revive the corpse which during 
her manipulations fell to the floor and was only lifted back to the 
bed with great exertion. After all this was over Irene forgot 
completely not only her mother's death but the amnesia was retro- 
grade and she did not even remember her illness. She said, " I 
know very well my mother must be dead since I have been told 
so several times, since I see her no more ; but I really feel aston- 
ished at it. When did she die? What did she die from? Was 
I not by her to take care of her? There is something I do not 
understand. Why, loving her as I did, do I not feel more sorrow 
for her death ? I can't grieve ; I feel as if her absence was nothing 
to me, as if she were traveling, and would soon come back." 

This example from the realm of hysteria, gives us a good idea 
of what is meant by a complex. This term is employed to desig- 
nate a group of ideas (constellation) 6 clustered about, constel- 
lated as it were, a central event, which event has a large content 
of painful emotional coloring. You will see how this describes 
our cases if you will review them for a moment. All of the 
acutely painful circumstances of her mother's death and even 
such associated ideas as those connected with her early illness are 
dropped in toto from Irene's memory. 

The special thing to note is that the ideas that are thus asso- 

8 The Major Symptoms of Hysteria. 
•See Chapter I. 


ciated together are grouped about a certain event and that this 
event conditions a highly painful emotional state. 

It is to such a constellation of ideas, cemented by painful emo- 
tion, that the term " complex " is applied and when the complex 
produces a mode of reaction (in this case amnesia) without the 
patient being aware of its existence it is spoken of as dormant. 
Let us, however, go a little further in this direction. Muthmann 7 
has compared the complex to an abscess and the defensive reac- 
tions to the limiting wall of fibrin. I think, however, that it 
were better compared to a localized inflammation with its sur- 
rounding area of tenderness. Take for example the lover who 
has had a quarrel with his mistress : He enters into conversation 
with a lady when a chance expression, a vague suggestion of the 
odor of a well known perfume, a something equally as trivial 
reminds him of her and the quarrel, he flushes, becomes confused, 
changes the topic of conversation, leaves unceremoniously and 
otherwise shows that the sore spot has been touched and the 
defense reactions are brought into play to remove him from the 
source of irritation. This method of reaction is quite common 
and typical of the dormant complex with large emotional content. 

We typically find evidences of the complex then under circum- 
stances in which the mental reactions are aimed at an effort of 
adjustment to inimical, disagreeable, disintegrating factors in the 
environment. Under such circumstances we find a series of pro- 
tective reactions, guarding the mind against these inimical influ- 
ences, which are just as well defined as the protective colorings 
of insects are the defense reactions of the body against infection. 

Types of " Complex " Reaction 
(a) Forgetting 

Of this class of reactions the various types of forgetting are the 
most pronounced. Painful, disagreeable experiences, the mind 
in its protective, conserving efforts tends to avoid, to put aside, 
*Zur Psychologie und Therapie Neurotischer Symptome. 

the "complex" 55 

to consign to the limbo of the forgotten. With all the thousand 
and one things to be done the painful facts of life must not be 
permitted to occupy the center of the stage — they must give way 
to the business of the hour. Take, for example, the case of the 
young man cited by Jung. 8 He suffered the pangs of unre- 
ciprocated love — the young lady married another man. When 
later he came to have business relations with his rival he found 
himself always unable to call his name and had repeatedly to ask 
it of others in conducting his correspondence. Or take the case 
cited by Maeder. 9 A young man sees a performance of Samson 
and Delilah; it awakes a series of painful memories. A few 
weeks before he had read the review of a book to his fiancee, 
which treated of the indelible impressions of the first love on a 
woman. He thinks of the possibility of a separation from her 
and later the whole event, together with the contents and author- 
ship of the book, very kindly drop from his memory. Later they 
are revived under the influence of an optimistic mood which they 
are incapable of affecting. 

(b) Compensatory 
Another type of reaction which is wisely provided for in the 
general scheme of things is the " compensating." For the sadness 
and sorrow, the blasted hopes and disappointments, the trials and 
tribulations, the mind again comes to the rescue. We are familiar 
with the way in many cases. We understand the young woman, 
disappointed in love, who takes herself to a nunnery and devotes 
her life to the service of religion. We have all seen men under 
similar circumstances plunge into the distractions of a strenuous 
life, or not infrequently into the elusive forgetfulness of alcohol 
or opium. The ideal occupation of the disappointed woman is 
that of a nurse — for while it brings forgetfulness in new interests 

8 Ueber die Psychologie der Dementia Prsecox. (Translation is pub- 
lished as No. 3, of the Nervous and Mental Disease Monograph Series.) 

8 A la Psychopathologie de la Vie Quotidienne. Archives de Psychologie. 
Tome VII, No. 27. (February, 1908.) 


it likewise affords compensation by giving play to the maternal 

How large a part these compensations play in daily life, what 
a tremendous force they are against the "slings and arrows of 
outrageous fortune " we can hardly appreciate. It is well worth 
while to read the philosophy of the great German immoralist from 
this standpoint. Nietzsche founded his explanation of Christian 
ethics upon the theory of compensation. The Jews, a weak and 
persecuted race, made of necessity a virtue and glorified humility 
and the " poor and lowly in spirit." This, the " slave-morality " 
shows us on its obverse side a fully adequate compensation for 
the sorrows of life, not in this world, but by life and a " joy ever- 
lasting " in the next. Whatever may be said of Nietzsche's phi- 
losophy we surely know many persons whose path is made easier 
among many troubles by an abiding faith that all things are for 
the best, and everything will ultimately come out all right, if not 
in this life then in the life to come. 

Among the very common types of compensation are the wish- 
fulfiling dreams and the wish-fulfiling deliria. We are all more 
or less familiar, for example, with the very remarkable life of 
imagination which children lead, how they live in a world of 
fancy peopled by the creations of their own minds and teeming 
with events of the most dramatic interest. For hours these little 
ones at play will live in a world all their own, associated with kings 
and queens and waited upon by mighty soldiers, and in their hours 
of sleep they find in the land of dreams their hopes and ambitions 
all realized. The little boy dreams he is a motorman, or a police- 
man, the little girl reigns as a beautiful princess, so with these 
wish-fulfiling dreams added to the day-time fancies the world 
becomes a beautiful place to live in even under circumstances in 
which we older ones find little that makes for happiness. 

Quite parallel with this example, we find in the realm of the 
abnormal, that many cases of the most profound melancholia have 
compensatory dreams. If they are parents, for example, they 


dream of being back with their family, surrounded by their chil- 
dren and those they love, and so the misery of the day often finds 
relief in the visions of the night — certainly a very practical, and 
undoubtedly efficient, so far as it goes, defense reaction against 
conditions that tend to destroy. 

Or take another case cited also, I believe by Janet, 10 in which 
a young girl about to be married is deserted at the altar by her 
fiance. She falls into a wish-fulfiling delirium 11 in which all the W 
events of the marriage as it would have occurred, take place. 
What I have called a vicarious psychosis. The patient in order 
to get what she wants out of life and what she had expected and 
prepared for, resorts, so to speak, to the device of a psychosis. 

(c) Mental Attitudes, Moods, Character 
We are surrounded at all times by innumerable examples of 
the effects on conduct of suppressed disagreeable or painful emo- 
tional states. Take for example the man who is past middle life 
and with whom the subject of his age is a somewhat tender point. 
See how by his attitude he resents being helped on with his coat. 
He refuses to acknowledge to himself that time has wrought any 
changes and he resents such a suggestion from another no matter 
what the kindly motive behind it. 

We see again these defense reactions toward special situations 
shown exceptionally well by the deaf who insist upon appearing 
to understand what is said to them though perhaps hardly hearing 
a word. They attempt by their attitude to conceal their infirmity 
and thus ward off criticism of their defect and consequent de- 
creased efficiency. 

Persistent moods are also often conditioned by dormant, sub- 
merged complexes. That witticisms, jokes, puns, are means of 
side-tracking painful emotions is a commonplace, while the sad 
and melancholy mien of the professional funny man is proverbial. 

10 1 have been unable to verify this reference. 

"The word delirium here is used in the sense given it by the French, 
namely, to apply to the sum of the patient's delusional experiences. 


The anecdote is told of a noted Parisian entertainer who sought 
the advice of a physician for great depression of spirits. The 
physician advised his patient to go to the theater and hear a 
certain wonderful comedian for, as the physician said, "Mon- 
sieur X. can make any one laugh." His patient replied, "Alas, 
doctor, I am that unfortunate individual myself." 

And so complexes not only dominate special attitudes, and con- 
dition moods, but if persistent, deep-seated, and continuous, they 
are often at the bottom of the prominent traits of character. 
These prominent character traits are especially well seen in those 
cases in which the complex has been constellated by a painful 
emotion of sexual 12 origin. The stereotyped example of the 
" old maid " scandal monger is a case in point. Deprived of that 
"J great boon to woman, maternity, robbed of love, living a life of 
bitter disappointment and unfulfilment, if she mayhap has a dis- 
tinctly sexual longing she takes this method of adjustment, this 
method of approach and contact. The reading of an erotic novel 
would be distinctly improper, and if she were discovered would 
be adversely criticised, but the scandalizing of her neighbor is a 
highly respectable proceeding and keeps her quite within the con- 
ventions, and so the delectable morsel is rolled over and over 
again and as life becomes more bitter, as fulfilment becomes more 
and more impossible so does her resentment show more and more 
aggressively, more and more openly. 

The phrase "misery loves company," takes its origin from the 
desire of those who have failed to pull others down to their level. 
It is an expression of the jealousy, envy, resentment, that they 
feel for the successful, for if they cannot succeed literally they 
can at least play at it in their fancies. Compensation is approached 
by a mental trick, a deception practiced upon one's self. 

"The word sexual is not used here in the narrow sense in which it is 
often employed but with the broadest possible meaning. It refers not only 
to the physical relations between the sexes, but to the most distant and 
most indirect mental and emotional reverberations. It is used to include 
a domain much more extensive than that usually comprised in the word 
" love." 

the "complex" 59 

Modes of Expression 

We have already seen in our previous examples several means 
by which the complex asserts its presence and seeks expression. 
We have seen how, in hysteria especially, the means employed is 
often amnesia for the painful occurrences. 13 In certain condi- 
tions of depression the dream comes to the rescue, while in certain 
other states displacements occur and methods of expression are 
chosen to take the place of those denied. 

Quite frequently the mind seizes upon a single feature in con- 
nection with a painful incident and the complex reaches expres- 
sion through this alone. This feature thus becomes the complex 

One of my cases, a young girl, had received a severe shock by 
the suicide of a young man at a party. She saw the blood and 
was deeply affected. The memory of the whole affair dropped 
completely out of her mind but it was only necessary to show her 
something red to produce the feeling of fear. I sent her on an 
errand one day to a ward carpeted in red. She quickly came run- 
ning back to me, trembling, crying and frightened, although she 
could not explain why she was so affected. 

The case of Janet's 14 (cited in Chapter II) of the woman who 
lost a very dear friend by death shows a very similar condition. 
She only retained a souvenir of her friend — a valuable old dog. 
Two years after his master's death the dog died. The lady had 
a very profound emotional disturbance as a result and later 
suffered from hysterical seizures which might be brought on by 
simply hearing a dog bark in the street. The case shows well how 
thoroughly the outposts can be sentried to protect the vulnerable 
point. Not only the barking of a dog but certain words might 
bring on an attack so she forbade the use of them in her pres- 
ence. The words, "love," "affection," "happiness," are exam- 

13 White : Mental Dissociation in Psychic Epilepsy, in Sidis : Psychopath. 
"Mental State of Hystericals. 


pies. She forbade also that any date be mentioned before her — 
in fear of being reminded of a certain date she forbade the men- 
tion of any. 

Not only are such incidents or accompaniments singled out as 
complex indicators as are illustrated in these two cases but quite 
frequently the motor accompaniments become much exaggerated 
and in attacks so overshadow every other symptom that the cases 
seem to have lost their essentially mental characteristics and in 
fact may be mistaken for epilepsy. 

Sidis 15 cites the case of a young man who had epileptiform 
attacks that manifested themselves by " shaking spells." The 
shaking began in the extremities and soon involved the whole 
body. Sometimes he fell down shaking and trembling all over. 
The attacks were traced to his experience as a child when he was 
forced to sleep in a dark, damp, and bitterly cold cellar. 

This last well illustrates the association of the physiological 
with the psychic. These physiological disturbances are constel- 
lated with the mental and the two classes of phenomena recur 
together. We have already seen that with emotional experiences 
there always go along certain physiological disturbances. In 
these cases the physical appears in the foreground and the mental, 
while it exists, is not apparent on the surface. But why should 
this prominence be given the physical? Why should not the emo- 
tional expression find its natural, mental, channel of outlet? 

The answer to the question why the complex does not express 
itself by mental phenomena primarily is that the whole affair is 
a defense reaction, a protective device for repressing the complex, 
for keeping painful mental facts out of consciousness. These 
repressed emotions must, however, find an expression somehow. 
Their episodic manifestations in crises finds an explanation not 
unlike that for the epileptic attack. The complex with its large 
emotional content being repressed, dissociated, falls out of asso- 

15 Studies in Psychopathology. Boston Med. and Surg. Jour., March and 
April, 1907. 


ciation with the other facts of mental life and so its accumulated 
energy finds no easy channels of exit. The complex therefore is 
dynamogenic and when sufficient energy has been accumulated to 
overcome resistance, to break down barriers, an explosion — an 
attack — takes place. In this attack the energy set free naturally 
flows along lines of least resistance. If we consider the various 
activities of consciousness as constituting a hierarchy we will see 
that the psychomotor levels are relatively low, so that as the ten- 
dency in attacks is for the energy to seek lower rather than higher 
levels, these" psychomotor outlets furnish the channels of least 
resistance. Ideas tend always to expression. Expression is 
mainly a matter of conduct and so largely muscular. We find, 
therefore, convulsive phenomena — conversions — quite the rule. 

Distinct sensory types of reaction may also be found and when 
sensory disturbances come on apparently spontaneously and pre- 
cede the crises the similarity to epilepsy with a sensory aura is 
often marked. One of my patients had attacks resembling petit 
mal each time preceded by a headache. She had during an early 
seizure fallen and hurt her head. Another case had psychic 
attacks preceded by a sensation of green. His original trauma- 
tism occurred on a stage carpeted with green baize from which 
he was carried, face downward. 

A more baffling method of manifestation of the complex still is 
the symbolic. One of my patients 16 in his delirium when asking 
for a cigarette used a peculiar sounding expression which I dis- 
covered later was a foreign word. The explanation of the appli- 
cation of this word as the name for cigarette transpired when I 
discovered that he had upon one occasion been to the races and 
won considerable money by betting on a horse of that name. 
Afterwards he had indulged himself in some very expensive cig- 
arettes with the money thus won. The connection is obvious — 
the cigarette was symbolically represented by the race horse. 

Jung 17 cites a very instructive example. " A gentleman wish- 

" Case cited in Chapter II. 
"Loc. cit. 


ing to recite a poem beginning ' a pine tree stands alone, etc./ 
with the words ' with white sheet ' " he forgot everything. This 
seemed so peculiar that Jung got him to reproduce what came into 
his mind with these words. The following very significant series 
of associations resulted. "White sheet makes one think of the 
cloth for the dead — a linen cloth with which one covers a dead 
person — (pause) — now I think of a near friend — his brother died 
quite recently — he is supposed to have died of heart disease — he 
was also very corpulent — my friend is corpulent too, and I thought 
it might also happen to him — probably he does not exercise enough 
— when I heard of this death I suddenly became frightened, it 
could happen to me, as we in our family are predisposed to obesity 
— my grandfather also died of heart disease — I too find myself 
somewhat too corpulent and have therefore within the last few 
days begun treatment for reducing fat." 

Here we see how the repressed anxiety which this gentleman 
had about his condition resulted in a reaction while reciting a 
poem in which he saw himself symbolized by the pine tree envel- 
open in its white sheet of snow. Jung also explains the wish to 
recite this poem as based upon a desire to effect, in this symbolic 
act, a discharge of the complex tension. 

If this explanation of Jung seems far-fetched, think again of 
some of the phenomena of wit. We all know how frequently the 
man whose life is filled with sorrow and disappointment becomes 
noted for his witticisms, while the explosion of a jumble of puns, 
thin jokes, and " airy nothings " is a method belonging to the 
stock-in-trade of every " emotional actress " to use to turn away 
suspicion when surprised in a situation she cannot explain. 

These displacements of emotional expression into channels other 
than the normal and usual ones are quite common. The transfer 
may become permanent and often takes on a symbolic character. 
Take, for example, a certain type of childless woman who lavishes 
all sorts of affection upon dogs, cats, or birds. Here the nature 
of the repressed complex is quite evident, while the cat, or the 


dog, as the case may be, becomes symbolic of this complex and so 
may be considered as a symbolic complex-indicator. 

An excellent example of symbolism in dream consciousness is f 
given by Freud. 18 In this case the dreamer is symbolized by a 
powerful brown horse that was being hoisted by a thick belt to a 
great height. Suddenly the belt broke and the horse was precipi- 
tated to the ground but soon rose and galloped away. The 
strength of the horse stood for the power of the dreamer to work, 
the ascent to dizzy heights his ability to succeed, the belt indicated 
that he could not succeed by his own efforts alone but must have 
help, the breaking of the belt showed failure when this influence 
was withdrawn, but the fact that the horse was not killed but got 
up and galloped off symbolized his indomitable energy and ability 
to rise again when once defeated. 

General Considerations 

These displacements, conversions, symbolisms and other phe- 
nomena form interference complexes with each other and with 
the train of thought and produce very complicated results that 
often become practically impossible to unravel. It is really won- 
derful, however, how successful psychoanalytic methods applied 
with great patience have been. In Jung's 19 classical case of para- 
noid dementia praecox the apparently incoherent remarks amount- 
ing at times to "word salad" and the neologisms of the patient 
which she freely made use of, were explained in a way little short 
of marvelous. He was able to explain, for example, the expres- 
sion "double polytechnic," which was frequently used by the 
patient, as an expression standing for the highest art and wisdom. 
The words "Hufeland" and "unhufeland" are found to refer to 
a once celebrated doctor by that name while the sentence " I affirm 
a million Hufeland to the left on the last fragment of earth on 
the hill above " Jung says is a metaphoric paralogic condensation 

M Cited by Jung, loc. cit. tS 
"Loc. cit. 


for what to a normal mind would be expressed approximately by 
" For the bad treatment of the physicians which I have to endure 
here and with which I am tortured to death, I claim a high 

And so we see how the mind develops certain modes of reac- 
tion which are aimed at adjustment with surrounding conditions 
or as we often say " getting square with events." We see, too, 
how, when disease has pulled the mental superstructure to pieces 
and it comes tumbling down in ruins, the same effort at adjust- 
ment continues, but it is, of course, expressed in a much more 
imperfect and incomplete way. Such studies as I have indicated 
V lead us to the inevitable conclusion that nothing mental is fortui- 
tous, that for every mental fact, be it the most trivial or apparently 
meaningless expression, there is an adequate reason. If the 
theory of the complex had done nothing more than this it would 
have accomplished a great deal for it has given us a new outlook 
upon the mental factors in the psychoses. We no longer should 
, I \ feel satisfied with passing mental symptoms by with the remark 
I that they are " strange," " remarkable," " incoherent " and with 
the use of like vague and meaningless terms. We should feel 
that we have a new avenue of approach, that a host of new facts 
have been opened up and that much can be accomplished by pa- 
tient, intelligent observation and study of cases. 

I feel quite sure, for example, that the patient who says to me, 
" Now you have a body like a young man who says he is of the 
prestigitis," or the other patient who says, " I have been raking 
away at it outside and in and inside and out again. I have tried 
to write poetry, but could not write any more than six fools," 
have both fairly definite ideas at bottom of this apparent incoher- 
ence to which their methods of expression correspond. 

This whole matter harks back to the fundamental necessity of 
having our mental facts in their proper setting if we are to under- 
stand them at all. A very simple incident will illustrate what I 
mean. I had called at a home one evening to see a patient when 


I noticed that the nurse, a Miss B., who had had charge of the 
case, had been replaced. I asked where she was and was in- 
formed that she had gone in conformity with a previous arrange- 
ment to take care of Mr. X.'s daughter who had recently been 
married and expected to be confined. Just then the telephone 
rang and some one inquired for the nurse. The young lady who 
had given me the information about the nurse answered the tele- 
phone and I heard her say that she had left but she could not tell 
where she had gone as she did not know who the people were, 
the nurse having failed to tell her their name. The first impres- 
sion, very naturally, might well have been that my lady was 
indulging in that well known social evasion a "white lie," but 
when she returned from the telephone with the comment that it 
was rather unfortunate for the nurse to go away without telling 
her the name of the family where she was going, that she did not 
know who Miss so-and-so married, the explanation was perfectly 
clear. We cannot expect to be able to judge of mental facts in other 
than their mental setting, a thing, however, which we have been 
trying to do for long years with rather discouraging results. 

From another view-point the illustration given by Jung 20 is ^ 
instructive. Suppose we go into a man's office and while seated 
engaged in a business conversation with him a clerk brings in a 
paper and lays it down upon his desk. Immediately the man flies 
into a passion, gets red in the face, gesticulates, and uses forceful 
language. We wonder what ails him but when we find out that 
day after day, time after time, he has cautioned the clerk, told 
him not to do just that particular thing we can understand his 
behavior. The act of the clerk was simply the " last straw " that 
served to break the back of his self-control. And so how often 
in life we only see the last link in a chain of events, and how prone 
we are to draw conclusions which would probably be entirely dif- 
ferent if we knew all the facts. 

Another and equally instructive example in the realm of the 

20 Loc. cit. 


abnormal is that of Miss P., a case of dementia prsecox. She 

wrote the following letter to her uncle 

"Washington, D. C. 
Dear Uncle: 

I am insane as I have been place — in the asylum in the brain favor as 
Uncle Bee — was once accused of being craisy over seeing to much of the 
Doctor intuition of being deying of death over worrying of seeing my own 
self Home, where I belong as I am " Eplay, in trouble all my life & Hope I 
re gain cinarc tonces of mind in Body & Kind show me by my own be able 
in Doctor Office I hope Mrs. E. & Aunt Ida I join love to all Very own to 
claim my own Mind bye from 

Affection Neice Sarah." 

This patient although noticeably demented presented a quite 
natural appearance to casual observation and despite the fact that 
her writing is so incoherent, talked well about simple things and 
answered questions with a fair showing of intelligence. I showed 
her this letter and asked her to read it aloud and tell me if she 
wrote it. She took the letter and read it with a perfectly serious 
manner and said that she had written it. Her whole attitude 
when reading the letter and being questioned about it gave no 
indication that it impressed her as in any way strange. On the 
contrary it was quite natural and she appeared while reading the 
letter to have a full comprehension of its contents. Here again 
we are not justified in coming to hasty conclusions without the 
proper mental setting for the mental facts. The mere fact that 
this letter is hopelessly incoherent and incomprehensible to us 
does not necessarily mean that it was to her, and her attitude while 
reading it certainly indicates that it was not. 

I am tempted at this point to illustrate a conception of mind, 
which the consideration of complexes leads to, by a figure of 
speech. The mind cannot be conceived as consisting of or con- 
taining ideas which are deposited here and there, helter skelter, 
without order as the scraps of paper that are thrown carelessly 
into the waste basket. Quite the contrary. Ideas are grouped 
about central experiences, constellated as we have seen, built up 
into coherent and harmonious structures not unlike the way in 


which bricks and stones are brought together to form buildings 
and these buildings are again grouped according to the purpose 
they fulfill, as government, business, residential, etc. The city is 
built according to a general, though often not very definite plan, 
it has its avenues of approach, its highways and byways, its sys- 
tems of traffic lines communicating between the different sections, 
etc. The central part of the city is pretty well organized and con- 
structed, here little change goes on, but in the outskirts new ways 
are being opened up and we see lying all about building material 
not yet assembled to form new structures. Now suppose an 
earthquake destroys the city — what happens? All these fine 
buildings come tumbling down. The walls crack and crumble and 
the bricks come falling to the ground. Here and there only a 
wall, a tower, perhaps a whole building remains standing. The 
foundations of all these buildings, however, remain fairly well 
preserved, in outline at least; it is for the most part the super- 
structure that has been destroyed. Now suppose we try to enter 
the city by the usual way, we will find ourselves almost imme- 
diately arrested by masses of debris, we will see that the streets 
that we were familiar with are blocked at many points, that the 
whole picture looks unfamiliar and that landmarks are very diffi- 
cult to recognize. Here for example the foundation of a church 
which was razed by the shock has been buried beneath the bricks 
of an adjoining commercial house. All of the component parts 
of the city are still here but in quite different relations and in this 
mass of confusion only the trained eye of the old resident can 
see the traces of the old order of things and pick out the old 

And so it is with many of our patients, particularly our praecox 
cases, where the dilapidation of thought is so pronounced. The 
fundamental things of mental life, the foundations, remain until 
the last but they are often buried under masses of debris and their 
location indicated by ideas with which before they never had any 
connection. So, too, if we try to approach these cases we will 


find them quite inaccessible by the usual avenues ; we must take 
our bearings anew, draw up a new ground plan — the old one will 
not suffice. 

Our patients live a mental life all their own, even talk their 
own language which is incomprehensible to us. If we are to gain 
access to them we must learn the avenues of approach. No atten- 
tion may be paid to ordinary efforts at conversation but the use 
of a complex indicator may open the flood gates so that all there 
is left for us to do is to listen. 

The differences between the sane and the insane, however, are 
only differences of degree, not of kind. Every process that we 
may divine in the insane mind has its counterpart in the sane. 
This is especially well seen in the manifestation of complexes that 
are dormant or submerged. In the insane these buried complexes 
determine largely the symptoms of the mental disorder, while in 
the sane they are often at the bottom of the moods, the disposi- 
tion, the " make-up," in short the character of the individual, and 
it is the organized constellations that determine his actions along 
conventional lines, lines prescribed by training and custom. 

A study of the conventions and customs, the folkways, would 
be very instructive in showing us the methods by which these 
buried constellations operate. They would show, for example, 
that reactions directed by them are not amenable to reason — in 
this respect resembling the obsessions of the psychasthenic. For 
example, to show respect we uncover our heads, the Orientals 
uncover their feet. Why is this? The reason for it lies buried 
in history, the foundation for their reaction has long since been 
hidden by a complicated and bewildering superstructure. The 
foundation being inaccessible it would be quite impossible to 
change the custom by an appeal to reason which does not reach 
to the root of the matter ; it is not the avenue of approach. 

This example reminds one of another much nearer home and 
more familiar. It might be facetiously referred to as the bipolar 
variation of modesty. I refer to the changed feeling of shame 


which affects the modern society woman depending upon whether 
she is in a ball-room or on the sea-shore. The dictates of fashion 
in this instance have nothing reasonable about them and I think 
it would be quite easy to gain general assent to the proposition 
that the mere surroundings could not possibly affect the funda- 
mental question as to the inherent impropriety of the exposure 
of a certain portion of the body. But even though we gained this 
assent we surely would not expect the custom to change as a 
result. The whole reaction seems ridiculous just as an obsession 
does because we do not know the real rationale of it. It would 
seem more absurd still in comparison with other peoples. For 
example, among the Tuaregs — an Arabic tribe of the Sahara — 
the men wear a veil over the mouth and would consider it im- 
proper to remove it except in extreme intimacy. It is worn while 
eating and not even removed to sleep. 21 

And so I might go on indefinitely with illustrations from normal 
and from abnormal mental life and from the realm of the social 
customs and usages. In the end we find that we have a some- 
what broader and more comprehensive view-point of the phe- 
nomena of mind in action, a view-point I believe pregnant with 
many results for the future. Much has already been accom- 
plished, as a result of the new outlook, in the way of developing 
methods of examination and analysis of cases, and as a corollary 
to these new methods we are beginning to see the way to a more 
rational treatment. 22 

The main conclusions to which this chapter tends are that the 
operations of the mind are never fortuitous — if we ever seem to 
see mental events that have no efficient cause it is only because 
we are not in possession of all the facts. Ideas neither arise 
spontaneously nor do they exist without having established rela- 
tions with other ideas — again because of a good and sufficient 
reason. The relationships thus established are brought about and 

21 See Sumner: Folkways, 1907. 
23 See Chapter VI. 


cemented by the emotional content of the event which brings them 
together and they bear thus a relation of interdependence as 
among themselves — they are constellated. These constellations 
exist as the mental counterparts of events and correspond to expe- 
riences which have emotional content. Thus do our sorrows and 
our pains, our longings and our desires, in fact, all of the springs 
for action, exist as organized though submerged groups of ideas 
which, from behind the scenes, as it were, direct our conduct. 



The various phenomena now comprised under the term hysteria 
have always, throughout the period of man's history, been matters 
of interest, of mystery, and of speculation. It is only in recent 
times that it has been possible to approach the subject in a sci- 
entific way that offered hopes of getting somewhere, as it has only 
been in the last few years that adequate methods of investigating 
such problems as hysteria presents have been evolved. 

The fundamental idea upon which present-day conceptions of 
hysteria are built is that the phenomena of hysteria are mental — 
that hysteria is a mental disorder — a psychosis, and not a neurosis 
as has been at times supposed. This idea has been of gradual 
growth, but has been slowly increasing until it has become a wide- 
spread conviction as a result of the constantly repeated observa- 
tion that hysterical phenomena could be brought on, influenced, 
and made to disappear by means which in their last analysis were 
almost invariably shown to be appeals more or less directly to 
the mind. 

The psychic origin of hysteria is the prevailing note now run- 
ning through its theoretical consideration. There are still, how- 
ever, many phenomena, especially vaso-motor, secretory, and 
visceral upon which the several theories break. Some very easily 
escape from the difficulty by excluding such symptoms from their 
conception. Supposing hysteria to be a mental disorder, certain 
symptoms occur which are not mental, therefore, they are not 
hysterical — an excellent example of an argument in a circle. 

1 This chapter was printed, substantially as it appears here, under the 
title " Current Conceptions of Hysteria " in the Interstate Med. Jour., 
January, 1910. 



Others, because of these supposedly physical disturbances, prefer 
a theory more physiological than psychological. 

The end result of all this seems to be quite clear — namely, that 
hysteria has not yet been defined, its inclusions and limitations 
are yet unknown. 

To discuss a theory of an indefinable subject might be consid- 
ered premature except that numerous theories actually do exist 
to account for the phenomena, and as a matter of fact the theories 
themselves are after all attempts at explaining the nature of hys- 
teria, so that the discussion of theory goes along hand in hand 
with the attempt at definition. 

In this chapter it is my intention to discuss very briefly the 
most prominent of the hysteria theories, those especially which 
throw most light on the hysteria question. These theories can 
be divided, according to their predominant note, into psycholog- 
ical, physiological, biological, and clinical. 

I will leave out of consideration, because I think them unim- 
portant, the many attempts to explain hysterical phenomena from 
the purely physical side, such as the various chemical theories, 
the theories of auto-intoxication and the like. 

Psychological Theories 

The strictly psychological theories have much in common and 

are the best known and most widely accepted. We can probably 

come to an understanding of these theories best by way of certain 

experimental work done on hysterics a number of years ago, espe- 

>y cially by Binet. 2 

Binet's most significant work was done with the hysterical 
anesthesias. For example he placed a patient with anesthesia of 
the hand and arm so that the anesthetic arm was passed through 
a screen which shut it and the hand out from the patient's view. 
If now the skin of the hand was pinched or pricked, or the fingers 

•/ 2 Binet: On Double Consciousness. Chicago, The Open Court Pub. Co., 
1896. Also Alterations of Personality. New York, D. Appleton & Co., 1896. 


seized and moved the patient felt nothing and could give no infor- 
mation as to the position of the fingers which were hidden from 
her sight. If a pen were placed in the anesthetic hand it was 
immediately grasped in the appropriate way between the thumb 
and index finger and the hand assumed the position of writing. 
This though the patient had no knowledge of what was going on. 
Let the experiment be still further complicated. With a pen in 
the anesthetic hand the hand was made to trace a word but in so 
doing an error was made in spelling. When this was done the 
hand would sometimes, still without the patient's knowledge, 
re-write the word correcting the error. 

A still further elaboration and we have the phenomena of 
automatic handwriting. Not only will the anesthetic hand as 
above trace words, but some subjects will write page after page 
with no knowledge of what they are going to write and no con- 
scious effort. Such writing is as novel to the subjects themselves 
when they come to read it as to strangers. The writing often 
contains information which is entirely new to the patients and as 
to the knowledge of which they can give no clue. 

These experiments and many others of similar kind prove con- 
clusively that the anesthetic hand is actuated in its movements by 
an intelligence. Binet concluded that there was a condition of 
double consciousness, that is, two streams of consciousness flowing 
side by side, relatively independent, and separated by amnesia. 

This is well shown in one of my own experiments upon a case 
in which this class of phenomena was studied by Dr. Sidis 3 and 

The subject in her normal state was given a book; she was 
directed to read aloud to some one in the room, in a slow, clear 
tone, taking pains meanwhile to understand clearly what she was 
reading. While she was reading I approached her from behind 
and spoke to her in a low tone of voice, directing her to raise her 

8 Sidis and White: Mental Dissociation in Functional Psychosis in Sidis; 
Psychopathological Researches. New York, G. E. Stechert, 1902. 


right hand to the table; the hand obeyed; I placed a pencil in the 
hand, and the hand grasped it. Now any question that was pro- 
pounded to her was answered in writing while she continued to 
read aloud. If a suggestion of a visual hallucination was given 
to her, the hand wrote, in reply to a question, that she saw the 
thing suggested. It was noticeable, however, that the two proc- 
esses interfered with one another, and that while one was carried 
on at its best the other was interrupted and hesitating. When 
she stopped reading, she had no recollection of anything said or 
suggested, and her remembrance of what she had read was rather 
indistinct. If, however, she was hypnotized after one of these 
experiments, she remembered everything said and what her written 
replies had been. When questioned once during this period of 
distraction about an hallucination of a rose which had been given 
her in a former hypnotic state, and asked if she remembered it, 
the hand wrote " Yes," asked what she did with it, the hand wrote 
" I gave it to Mrs. S.," which was a correct answer and showed 
complete recollection of the hallucination. Questioned after she 
finished reading, she had no recollection either of the hypnotic 
state or of the answers her hand had written. 

Here we again have evidence of two streams of consciousness 
separated by amnesia. The experiments also indicate that areas 
of hysterical anesthesia, Jn this case anesthesia of the hand, are 
connected with the submerged stream of consciousness, and 
further that the hypnotic state is such a submerged stream tem- 
porarily brought to the surface during hypnosis but sinking back 
again during the waking, normal state. 

Similar demonstrations were made with other anesthesias. For 
example, retinal anesthesia. Objects so placed as to be reflected 
on the anesthetic area, could of course not be seen, but it was 
shown both by automatic handwriting, and by hypnosis that the 
patient actually had full knowledge of them. 

With this introduction we are in a position to take up the 
modern dissociation theories of hysteria. The first one I will 


describe will be that of the eminent Parisian psychologist, Dr. 
Pierre Janet. 

Janet 4 believes hysteria to be entirely a mental malady. This 
conception he clearly outlined in his address on the subject at 
the Amsterdam Congress in 1907. There and in his latest work 5 
he sums up his views and defines hysteria in purely mental terms. 

For him there exists in consciousness a region below, if such a 
term be permissible, the normal waking, or personal conscious- 
ness, which is called the subconscious. Groups of ideas may 
exist in this, so to speak, twilight region without being at all clearly 
perceived by the individual — in fact without being known at all, 
and yet they may operate to produce results very much as if they 
were the subject of voluntary attention. The hysteric is an access 
of delirium lives through fancied experiences about which he 
knows nothing when he " comes to " ; he has an amnesia for all 
of these events. 

The hysterical amnesia does not confine its manifestations to 
such conditions but invades the details of every-day life. The 
patient who is sent on an errand forgets what she is sent for be- 
fore she gets half way to her destination. This is a simple, but 
common example. Janet would explain this by a disorder of 
attention. The directions are imparted to the patient but they are 
not acutely attended to and drop at once into the region of the 
subconscious — they are forgotten by the waking, personal con- 
sciousness. The anesthetic arm is explained in the same way. 
The patient does not attend sufficiently to the sensations from the 
arm to perceive them. 

The hysterical symptoms then are dependent upon an increase "V 
in the field of the subconscious and correspondingly in its activi- 
ties dependent upon a defect of attention and resulting in a nar- 
rowing of the field of the personal consciousness. In fact the 

* Janet: L'Hysterie maladie mentale. i er Congres International de Psy- ^ 
chiatrie, de Neurologie, de Psychologie et de l'Assistance des alienes. Am- 
sterdam, 1907. 

8 Janet : Les Nevroses. Paris, 1909. 


narrowing of the field of the personal consciousness and the 
defect of attention are different sides of the same phenomenon. 
/ Events do not come into the clear light of the acute waking self, 
they are not perceived within the field of the attentive, personal 
consciousness, they fall outside into the subliminal, subconscious 

It will be seen then that this process of enriching the subcon- 
scious does so at the expense of the personal consciousness. It 
is the synthesis of mental processes into a coherent whole that con- 
V stitutes the personality. The hysterical process causes a splitting 
up, a disintegration, or as Janet says, a doubling of the person- 
ality. He thus comes to the definition of hysteria as " A form of 
mental depression characterized by the retraction of the field of 
personal consciousness and by the tendency to the dissociation 
and the emancipation of systems of ideas which by their synthesis 
constitute the personality." 

A prominent feature of Janet's theory is that he believes the 
hypnotic state to be the same thing as an hysterical somnambu- 
lism. In other words, to be suggestible is to be hysterical and 
only hysterics can be hypnotized. 

The essential things in Janet's theory are then the tendency to 
disintegration, splitting up, or as he says doubling (dedouble- 
ment) of the personality, its outward sign the presence of a 
pseudo-amnesia due to defect of attention, and the identity of the 
hysterical and the hypnotic states based upon the common factor 
of suggestibility. 
V Sidis' theory is similarly a dissociation theory. Sidis, however, 
lays more stress upon the process of dissociation, and the inde- 
pendent, automatic activity of the subconscious ideas or systems. 

The crises of hysteria are due to the automatic activity of these 
dissociated ideas, or better, as Sidis 6 says, constellations. Ideas 
alone have no existence, not only are they indissolubly bound up 
with a feeling-tone, but they necessarily exist only in association. 

"Sidis: Psychopathological Researches. New York, G. E. Stechert, 1902. 


To a group of ideas associated together, or more properly to a 
mental state grouped about a central idea or event, Sidis gives the 
name " constellation." It is these constellations that exist disso- 
ciated and more or less independent in the subconsciousness. 

The dissociation having once begun tends to continue and new 
material is constantly being added to the subconsciousness by 
further cleavage and also by assimilation by this state itself as 
it begins to lead an independent existence — secondary state. Thus 
the tendency is for it to continually grow, and when that growth 
takes place by repeated cleavage, to grow at the expense of the 
personal consciousness. 

These split-off constellations tend always to become dynamic. 
In the normally functioning mind there is constantly going on a 
" battle of motives," a struggle for supremacy among the different 
tendencies present, not unlike the struggle which has been de- 
scribed among the physical elements of the body and which leads 
to certain structural types. The result is that differences of ten- 
sion — psychological tension Janet would probably say — tend to 
occur in the various systems. As these systems are all con- 
nected intimately by association, discharge takes place along the 
lines of least resistance and so drains the systems at high tension 
— inhibition by drainage as McDougall 7 would have it. 

Now in these dissociated states, separated from the personal con- 
sciousness by a plane of cleavage, energy accumulates, and because 
of an absence of avenues of association through which drainage 
can take place, accumulates to the point of explosion and breaks v 
over the gap separating it from the upper or personal conscious- 
ness producing a paroxysm. 

On the other hand, during periods of inactivity of the upper " 
consciousness, as in hypnotic, hypnoidal, and dream states, the sec- 
ondary states tend to assume the ascendancy. 

Whether the secondary states ever assume the dignity of a per- 

7 McDougall : The Nature of Inhibitory Processes Within the Nervous 
System. Brain, 1903. 


sonality or not is merely a question of degree. They tend to 
organize and to grow and if the process keeps up it is only a ques- 
tion of time when a new personality will be born. If these states 
grow largely at the expense of the personal consciousness this 
latter may finally assume a position of relative inferiority. 

Sidis' theory of the hysteric state and the hysteric attacks is 
closely bound up with his therapeutic ideas and really can only be 
fully understood by taking them into consideration. 

His principle of treatment is by reassociation of the dissociated 
states. The secondary state is gradually merged into the upper 
consciousness so that the cured patient no longer has two indepen- 
dent states separated by an amnesia but the events of both states 
are fully known to the personal consciousness. A significant fact 
is that the cured patient is no longer hypnotizable, which speaks 
J strongly for Janet's position as to the identity of the hysterical 
and hypnotic states. 

This cure is brought about through the intermediation of the 
hypnoidal state — a state Sidis 8 places between waking and sleep 
on the one hand and hypnosis on the other. It is, he believes, the 
primitive rest state of animals and in the higher animals has devel- 
oped by differentiations into sleep. Under certain conditions, 
however, hypnosis may develop instead of sleep. The therapeutic 
value of the hypnoidal state is due to its being the portal to the 
psychic " reserve energy." 

As we are all possessed of more liver, more kidney, more 
everything than is necessary for our ordinary needs and are sup- 
plied with a large surplus to be called on in times of emergency, 
so it is with psychic energy. Through the utilization of the 
psychic reserve energy the dissociated systems may be restored 
to equilibrium. 9 

The main features of Sidis' theory then are — the process of 

8 Sidis : An Experimental Study of Sleep. Jour, of Abnormal Psych., 
Vol. Ill, Nos. i, 2 and 3, 1908. 

9 Sidis : Studies in Psychopathology. Boston Med. and Surg. Jour., Vol. 
CLVI, Nos. 11, 12, 13, 14 and 15, 1907. 


dissociation, the principle of dynamogenesis and automatic activity 
of the dissociated systems, the cure by reassociation, and the 
principal of reserve energy and its accessibility through the hyp- 
noidal state. 

Breuer and Freud in their " Studies " 10 published in 1895, set 1^ 
forth also a modification of the explanation by dissociation. They, 
however, devoted more attention to the process and causes of the 
dissociation. For them dissociation occurred at the moment of 
psychic trauma. It might be the result of a single severe shock 
or a multitude of small ones. 

The reason the dissociated states are able to continue actively 
and in their original clearness year after year without growing 
dimmer as time goes on as do other mental states, is that they 
are isolated from the upper consciousness and from the world 
of events in general and are therefore not thrown into the back- 
ground and rendered obscure and buried by the rush of events 
day by day. 

The characteristic of the psychic trauma which produces hys- 
teria is its large content of painful affect. A painful affect fully 
reacted to at the time may produce no harm, but if for any reason 
reaction fails, and the feelings are contained and repressed, the 
possibilities of dissociation are created. 

Failure of reaction may be due to the failure of conditions that 
make efficient reaction possible, as for example, an insult is " swal- 
lowed " or a dear friend or parent who cannot be replaced, or for 
whose loss there seems to be no compensation, is lost by death. 
This gives rise to " retention hysteria." Again ideas, usually of a 
sexual nature, which are incompatible with the personal conscious- 
ness are repressed — reaction is not permitted, no effectual " ca- 
tharsis " takes place. This condition produces " defense-hysteria." 
Finally experiences occur in a hypnoid state. This is a condition 
midway between waking and hypnosis, a dreamy state of mind 

10 Breuer and Freud: Studien uber Hysteric Leipzig und Wien, Franz 
Deuticke, 1895. 


such as is favored, for example, by the needle work that women 
y do so universally. The essential point is, however, that it is a 
split-off, dissociated state. Events occurring in this state of mind 
never having reached the personal consciousness, have of neces- 
sity and by implication always been dissociated — they produce the 
so-called " hypnoid hysteria." Freud is inclined, however, to find 
the real basis of all three varieties in the principle of defense. 

The final principle of the Breuer-Freud theory is the principle 
of conversion. The strangulated affect, the unreacted-to emotion, 
belonging to the dissociated state which has been repressed, finds 
its way into bodily innervation thus producing the motor phe- 
nomena of hysteria. In this way the strong idea is weakened by 
being robbed of its affect — the real object of conversion. 

From 1895 on Breuer's activity in the realm of hysteria ceased. 
Freud, however, continued his investigations and elaborated still 
further the position he took in the " Studies." 
v The really most important and significant feature of Freud's 11 
theory is the tracing of every case to a trauma of sexual nature. 
Not only does hysteria always originate in sexual traumatism 
but the original traumatic moment must have been in childhood — 
in the pre-pubescent period. 

These infantile sexual traumas are of the nature of seduction 
by grown people or older children, they consist of actual irritation 
of the genitals (coitus-like processes), and occur before puberty 
(which occurs earlier in the psychic sphere than the maturing of 
the body). Freud has traced this class of traumas to very early 
life, three and four years of age, and in one instance actually to 
one and one half or two years. 

The reason why sexual experiences of infancy and early child- 
hood are so potent for trouble in later years is because of the 
peculiarity, in one particular, that sexual experiences have — dif- 
fering in this respect from all other psychic experiences. Ordi- 

11 Freud : Selected Papers on Hysteria and Other Psychoneuroses. Nerv. 
and Ment. Dis., Monograph Series No. 4, New York, 1909. 


narily a mental experience once had tends to fade out and become 
progressively more indistinct as time goes by. Sexual ideas pro- 
duce actual genital excitement. Now — if these ideas which origi- 
nated before sexual maturity are revived after sexual maturity, 
puberty having intervened in the meantime, has rendered the 
affective and genital capacity for reaction much greater so that 
the response instead of being less has actually accumulated powers 
for being greater. This disproportionate capacity for increased 
reaction taking place in the subconscious is responsible for the 
mischief. In the words of Freud "hysteria is the expression of 
a special behavior of the sexual function of the individual " and 
" this behavior was already decisively determined by the first 
effective influences and experiences of childhood." — 

These infantile sexual traumas form the necessary precondi- 
tion for the outcrop of hysterical symptoms in later life. These 
symptoms may be produced by the most banal occurrences and 
even by bodily traumatisms. 

There must, however, be a connecting link between the infan- 
tile sexual trauma and the later manifestations. This connection 
Freud finds in the so-called " hysterical fancies." These are the 
" day dreams " of erotic coloring, " wish gratifications " originat- 
ing in privation and longing. These fancies hark back to the 
original traumatic moment and either originating in the subcon- 
scious or shortly becoming subconscious are transformed into 
hysterical symptoms. They constitute a "defense" of the ego 
against the revival as reminiscences of the repressed traumatic 
experiences of childhood. 

We find, therefore, an infantile sexual trauma which has been 
repressed. In certain individuals this repression results in an 
independent activity of the repressed experiences (complexes). 
These repressed experiences condition the erotic fancies which 
take forms incompatible with the personality and are in turn 
repressed. The repressed ideas are rendered harmless, greatly 
weakened, by the transformation of their affective excitement into 


bodily innervation — a process Freud calls " conversion " while the 
mental symptoms of the attack represent the incursions of the 
erotic day dreams to the surface. Thus in Freud's words : " Psy- 
choanalysis of hysterical individuals show that the malady is the 
result of the conflict between the libido and the sexual repression, 
and that their symptoms have the value of a compromise between 
both psychic streams." 

Physiological Theories 

The only one of the physiological theories which is of sufficient 
prominence to be taken up at this time is that of Sollier. 12 His 
definition of hysteria is as follows : " Hysteria is a physical, func- 
tional disturbance of the brain, consisting in a torpor or a sleep, 
localized or generalized, temporary or permanent, of the cerebral 
centers, and manifesting itself consequently according to the cen- 
ters affected by vaso-motor or trophic, visceral, sensory and 
motor, and finally psychic disturbances, and, according to its 
variations, its degree and duration, by transitory crises, perma- 
nent stigmata or paroxysmal accidents. Confirmed hysterics are 
only vigilambulists, whose state of sleep is more or less profound, 
more or less extensive." 

This definition is nothing but a statement of dissociation in 
physiological terms. An explanation still further removed for 
while dissociation may be a theory it is an interpretation of cer- 
tain psychic facts. Sollier's hypothesis is, on the contrary, purely 
conjectural without any facts additional to those of the dissocia- 
tionist on which to rest. It is interesting and without the other 
theories might be helpful but it has no facts to support it. 

Biological Theories 

In the consideration of the psychological theories of hysteria 
it was shown how the hysterical manifestations were a result of 
dissociation. This dissociation occurs in the realm of the per- 

13 Sollier : Hysterie et Sommeil. Arch, de Neurol., Mai et Juin, 1907. 


sonal consciousness and constitutes a breaking down, a disin- 
tegration of the personality. It would seem to follow from this 
view that dissociation and disintegration of the personality would 
occur in those individuals in whom the synthesis of the person- 
ality was defective, that is, in persons in whom the elements that 
go to make up the personality are not being held together, not 
closely knitted by association but fall apart upon slight provo- 

This is a conception of the hysterical type which is essentially 
biological. Snyder 13 holds hysteria to be a mode of reaction in 
persons of naive, simple, infantile mentality. A mentality lacking 
in development and defective in judgment and critique. Such 
individuals placed in a new environment to which they cannot 
adapt, or adapt only with difficulty, develop the hysterical type 
of reaction. 

Similarly — as hysteria is a manifestation of an infantile men- 
tality so it is, when considered racially, the manifestation of the 
infancy of the race, of people who are primitive and simple. For 
example Kraepelin 14 found it very prevalent among the natives 
of Java. That and dementia prsecox were the most prevalent of 
mental disorders — both disorders incident to poor development of 
the mental powers. 

Snyder would explain the outbreaks of hysteria among the 
masses that occurred so frequently in the middle ages as the 
result of the repression of the human spirit. Wherever the aspi- 
rations, the Teachings out, the efforts to go ahead have been re- 
pressed, as they were by the conservative forces of society during 
the middle ages, then hysteria comes to the front and as the repres- 
sive forces operated on all the people alike we find the reaction 
commensurately widely distributed. This is the period of the 
" infancy of individualism " according to Hellpach, 16 who thinks 

18 Snyder : Definition et nature de l'hysterie. L'Encephale, Aout, 1907. 
"Cited by Jelliffe: Hysteria and the Reeducation Method of Dubois. 
N. Y. Med. Jour., May 16, 1908. 
u Cited by Snyder, loc. cit. 


that the socialistic aspirations of the proletariat of to-day are the 
equivalent of the hysteria of the masses of the middle ages. 

It is at least interesting to contemplate, in the light of Freud's 
ideas of repression and retention, that the individual through 
many avenues, public speaking, newspapers, etc., has many ways 
open of letting off steam, means for emotional catharsis that were 
denied him in times past. 

Claparede 16 in his consideration of hysteria lays special stress 
upon the fact that the hysteric shows a marked resistance to the 
recall of painful memories which he considers to be biologically 
a defense reaction. Equally also is suggestibility a defense reac- 
tion against personal peculiarities and tendencies which never 
could be given free play or they would isolate the individual from 
the social world in which he lived. Instead of yielding to these 
impulses the suggestion of another is followed because safer. 

The theory of Claparede 17 is a portion of a broader theory which 
would explain sleep, not as it is usually explained, as a negative 
function, but as a positive function. We do not sleep accordingly 
because we are exhausted but in order not to be. In other words, 
sleep is a function of defense. It makes itself felt before real 
fatigue. Prevent the animal from sleeping and it becomes ex- 

This digression into the theory of sleep is interesting because 
of the close relation sleep bears in theory to hysteria. Sidis 18 in 
recent studies has come to the conclusion that the primitive state 
of rest in animals is a semi-waking state to which he gives the 
name hypnoidal. Out of this state there develops on the one 
hand sleep — on the other the hypnotic state, so that it is impos- 

10 Claparede : Quelque mots sur le definition de l'hysterie. Arch, de Psych., 
October, 1907. 

"Claparede: Esquisse d'une theorie biologique du sommeil. Arch, de 
Psych., Tome 4, Nos. 15 and 16, February and March, 1905. Reviewed by 
Vaschide : La Theorie Biologique du Sommeil de M. Claparede Revue de 
Psych. April, 1907. 

"Sidis: loc. cit. 


sible to pass into or out of the sleeping or hypnotic state without 
passing through the hypnoidal. 

The consideration of sleep from a biological standpoint is espe- 
cially interesting. Claparede considers both sleep and hysteria 
as being defense reactions, while Sidis develops both sleep and 
hypnosis from a primitive hypnoidal state. These facts are par- 
ticularly significant when we recall that Janet believes that to be 
hysterical is identical with being hypnotizable. Then Bernheim, 
for instance, believes the state of hypnosis to be clearly allied to 
sleep and now lately we find McDougall 19 pointing the similari- 
ties between sleep and hypnosis, and explaining hypnosis as a 
state of dissociation, and treating of the dynamics of the disso- 
ciated states in a way quite like what we are already familiar with. 

Clinical Theories 

What I have called here clinical theories might almost better be 
called clinical definitions. The very attempt to define, however, 
although perhaps not primarily directed to a discovery of the 
nature of the thing defined must by implication consider it. 

The principal author to be considered here, because of the 
great attention his pronunciamento relative to hysteria has re- 
ceived, is Babinski, and we will see that whereas his effort is 
primarily addressed to the definition of hysteria, still it necessarily 
implies somewhat of its nature. 

The fundamental proposition of Babinski 20 is that the hysterical 
phenomena are distinguished by the fact that it is possible in cer- 
tain subjects to "reproduce them by suggestion" "with vigorous 
exactitude " and " cause them to disappear under the exclusive 
influence of persuation." To the condition in this group of cases 
in which the symptoms are capable of being produced by sugges- 
tion and removed by persuasion Babinski has given the name 

19 McDougall : The State of the Brain During Hypnosis. Brain, Vol. 
XXXI, 1908. 

20 Babinski: My Conception of Hysteria and Hypnotism. Alienist and 
Neurologist, Vol. XXIX, February, 1908. 


His distinction between suggestion and persuasion is to my 
mind wholly academic. It is suggestion to influence a patient to 
accept an idea which offends the reason, which is manifestly irra- 
tional, while it is persuasion if the idea is reasonable, rational. 

Babinski believes that a large number of the symptoms mani- 
fested by the hysteric are caused by the examinations of the phy- 
sician. The methods employed, for example, to determine the 
presence or absence of anesthesias, suggest these very anesthesias 
to the patient who forthwith presents them. This I think will be 
admitted as true in not a few instances. 

Similarly he would exclude from the realm of hysteria dis- 
turbances of the tendon reflexes, cutaneous ecchymoses, paralysis 
of the third nerve, anesthesias of the cornea and conjunctiva, 
inequality of pupils, mydriasis, visceral hemorrhages — hemopty- 
sis and hematemesis — anuria, fever, etc. 

It will thus be seen that Babinski relegates the phenomena of 
hysteria to the psyche and to the higher psychic functions at that. 

It is interesting to note further that for him hysteria and hyp- 
nosis are the same except that hypnosis requires the intervention 
of a second person to develop its manifestations while hysteria 
does not. 

From a consideration of all these theories it seems to me that 
I the most fruitful conception of hysteria is that expressed by Janet 
in the phrase "weakening of the faculty of psychological syn- 
thesis," which condition is brought about by the repression of 
painful experiences — complexes — and their subsequent quasi- 
independent activity with the resulting phenomena as described 
in Chapter IV. The personality, which is the highest expression 
* J of the psyche, the acme of complexity of association in a har- 
i monious psychological synthesis, tends rather easily to fall apart. 
The associations are not sufficiently strong, sufficiently binding 
and it splits up under the influence of certain kinds of stresses. 
This aptitude for disintegration has both an ontogenetic and a 


phylogenetic substratum. It is the infantile mentality that is thus 
affected and when hysteria has manifested itself in the masses, 
the people have been afflicted while the race was in its childhood. 

As to the manifestations of the hysterical type of reaction their 
number is legion, their forms protean. All attempts up to the 
present time to gather them together within a given definition 
have, to my mind, been quite futile. 

From a conception of hysteria that admits a symptomatology 
covering the entire realm of nervous and even visceral disorders, 
implicating both the psyche and the unquestionably physical bodily 
processes the effort of Babinski is a reaction while Bernheim 21 goes 
even further and says " hysteria is not a morbid entity, it is not 
a disease," " the disease hysteria, such as is described, does not 
exist." Bernheim 22 would reserve the name hysteria solely for 
the crises, a position some others also take. In harmony with 
this tendency we see coming into general use the word " hysteri- 
form " to express conditions which resemble hysteria but because 
of associations with other conditions are supposed not to be. 

The whole question of the relation of hysteria to other diseases, 
to mental diseases such as dementia prsecox, to neuroses such as 
epilepsy, to multiple sclerosis, chorea, etc., has been admirably 
and sanely reviewed by Voss 23 in his recent work. 

If, as seems to be generally acknowledged, the hysterical An- 
lage, the tendency to hysteria, or hysterisability as Bernheim 
would have it, may remain indefinitely latent until something hap- 
pens to produce the characteristic response, then I do not see why 
the so-called hysteriform accompaniments of these various dis- 
eases cannot properly be considered as true hysteria. Why should 
not a multiple sclerosis be the activating agent in breaking down 
the resistance to the outcrop of the hysterical reaction? 

All these efforts to limit, to bind in, to define hysteria within 

"Bernheim: Conception du mot Hysteric. Paris, 1904. 
23 Bernheim : loc. cit. 

23 Voss: Klinische Beitrage zur Lehre von der Hysteric Jena, Gustav 
Fischer, 1909. 



certain prescribed boundaries are not at all convincing and they 
fail, it seems to me, simply because hysteria does not confine its 
manifestations to any definite limits. It spreads out into all the 
available and adjoining territory and is indefinite and hazy in its 
outlines quite like other natural phenomena. We must not forget 
that definitions are human devices — nature has few sharply de- 
fined boundaries. 

The effort of Babinski to exclude all phenomena which seem 
to be physical in character seems to rest on entirely inadequate 
conceptions. The whole field of psychopathology has too long 
been dominated by that bug-a-boo, the relation of the mental and 
the physical and the implied necessity of conceiving of each as in 
essence different from the other. This is but another example of 
an attempt to define an artificial boundary where none exists. 

As between the most definitely physical of bodily processes on 
the one hand and the highest psychic on the other, an infinity of 
gradations exists and at no point can it be said that what was one 
has become the other. It is much more stimulating and effective 
to stick to facts wherever they may lead us than to create arbitrary 
boundaries which later on only serve to cut off our entrance to 
certain territories. 

It seems to be very well demonstrated that the individual reacts 
to conditions by the development and organization of mechanisms 
which in their complex manifestations may include both physical 
and mental components (as set forth in Chapter I). 

It seems to me that in a consideration of such facts we may 
find an explanation for the association of physiological disturb- 
ances with hysteria, such as the false gastropathies for instance, 
and also an explanation of those cases which start as hysteria 
apparently but which later on show symptoms of permanent 
mental deterioration. Those cases, which lead to a change of 
diagnosis from hysteria to dementia prsecox, also lead to the belief 
that the original diagnosis was in error. Why? Could it not be 
possible for a hysterical type of reaction in a badly organized 


individual to gradually unloose bits of physiological mechanism 
until organic changes had wrought permanent damage ? 

And so I think we must come to recognize the hysterical type 
of reaction wherever we see it whether in connection with other 
conditions or alone. By so doing we will have a broader under- 
standing of our cases than by always insisting upon a one-disease 


To anyone who has felt the intense pleasure that comes from 
the contemplation of a work of art, and who at the same time is 
of an enquiring and analytical turn of mind, there must have at 
times arisen the query as to wherein lies the explanation of this 
pleasurable feeling-tone. If an inquiry has been pursued in this 
direction, if the critics have been read for light on this problem, 
there must have come as a result a more or less well defined feel- 
ing of dissatisfaction with the conclusions. Why are some works 
of art great? Why have they survived the centuries in the 
hearts of men? These are the questions for which we have in 
vain sought a satisfactory response. The explanations of the 
critics are not only unsatisfactory but contradictory. 

To dilate upon the wonderful poise of the Venus de Milo, the 
perspective of a Turner, the chiaroscuro of a Corot, the coloring 
of a Tintoretto, a Ruebens or a Raphael, the high lights of a 
Rembrandt, or the grouping in a Franz Hals, touches only the 
surface, and after all resolves itself largely into a matter of tech- 
nique. Whether the paint is applied with a brush or with the 
finger, whether with the minute care of a Memling or laid on in 
large thick pieces of color after the pointilliste method, is of little 
or no consequence. 

While the arrangement of the draperies on the figures of 
Etruscan vases or the strange lack of perspective in Giotto's 
frescoes have great chronological importance, great works of art 
seem in some way to rise superior to such details of composition 
and technique. Although reflecting the taste and the customs, 
the religions, conventions and superstitions of the age and peoples 
in which they originated, the great masterpieces have risen supe- 



rior to locale and to time. Time, change of customs, new stan- 
dards of critique, nothing in fact, has dimmed the glory of the 
Venus de Milo, Michael Angelo's il Pensieroso or his marvelous 
decorations of the Sistine Chapel, the Raphael Stanze, Giotto's 
Campanile, Homer's Iliad, or Shakespeare's Hamlet. What is it 
that lives in all these great works ? 

Whether we turn to the art critic or the artist himself for a 
solution of this riddle we meet with results that are far from 
satisfactory. In fact we find that they really have no explana- 
tion, for the explanations they offer have little in them that is at 
all satisfying. 

It is this apparent paradox, a great work of art produced by 
one who does not understand the nature of the motives actuating 
him, and viewed by an enthusiastic but uncomprehending public, 
generation after generation, that seems to me most significant. 

To my mind this lack of comprehension is the rule, not the 
exception, and its explanation lies in the fact that the work of art 
takes its origin from motives which are not clearly in the con- 
sciousness of the artist; and the effect of the work of art in like 
manner is exercised not upon the superficial, clearly comprehended 
elements of the mind, but that they reach deeper, beyond the 
fagade of our intellectual and emotional life; they have entered 
the portals of our personality, and if they have continued to exer- 
cise this effect throughout the centuries it is because they have 
penetrated to a something fundamental, a something common to 
all mankind which is therefore and necessarily independent of 
time, place or the particular social, religious or political condi- 
tions of the age in which the artist lived. 

That the true raison d'etre of a work of art and the secret of 
its effect upon us is not to be readily explained, that the reasons 
are not on the surface, where " he who runs may read," is at once 
evident if we turn to the writers on art for light on the subject. 
Here we find that the Good, the True, the Beautiful, the Ideal 
and the Sublime, play a very large part in explanation ; but unfor- 


tunately what constitutes goodness, truth, beauty, perfection and 
sublimity seems to be at least open to great difference of opinion. 
Some see art only in works that set forth great religious or moral 
truths, while others would have it that art is justified by simply 
pleasing, and that it can necessarily have no useful purpose. And 
so the story goes. Some authors write entertainingly and well ,* 
others, because they are trying to set forth through the medium 
of the intellect something they feel but cannot intellectually formu- 
late, write mere twaddle. 

The situation has had its counterpart frequently in medicine. 
When we see all sorts of remedies extolled by different but equally 
able practitioners as effective in a certain condition, we have a 
right to suspect them all, and to conclude that the explanation of 
their apparent results lies elsewhere. We must not fail to remem- 
ber, though, that there is probably some grain of truth in all of 
the experiences — probably the natural tendency of the disease to 
get well, irrespective of the remedy applied. 

Now this state of affairs is precisely what we would expect 
if it is true that the origin and the effects of art are confined to 
that region below clear consciousness, to which have been vari- 
ously applied the terms, subconscious, co-conscious and even 
unconscious. This region we know is not susceptible of being 
reached by introspection. It is therefore self-evident that what 
occurs in it must be unknown to the possessor. It is therefore 
not strange that the results of a subconscious activity, the springs 
of which are unknown to the possessor, should receive many and 
varied explanations. 

That the artist is, as a matter of fact, unconscious of the under- 
lying motives that prompt him to produce, I may illustrate by a 
couple of examples. Bernard Shaw, 1 one of the most incisive of 
our present-day critics, speaking of the necessity which forced 
him " to make up his mind definitely as to what Ibsen's plays 
meant," says: "I allow due weight to the fact that Ibsen himself 
1 The Quintessence of Ibsenism. 


has not enjoyed this advantage ; but I have also shown that the 
existence of a discoverable and perfectly definite thesis in a poet's 
work by no means depends on the completeness of his own intel- 
lectual consciousness of it." The same writer 2 quotes from 
Wagner in a letter he wrote to Roeckel as saying : " How can an 
artist expect that what he has felt intuitively should be perfectly 
realized by others, seeing that he himself feels in the presence 
of his work, if it is true art, that he is confronted by a riddle, 
about which he, too, might have illusions, just as another might? " 

It is this subconscious origin of the forces which result in the 
creation of a work of art which has led to the common explana- 
tion of inspiration. This feeling impelling the artist to create, 
coming from he knows not where, he was unable absolutely to 
clearly explain. Inspiration was a sufficiently hazy conception to 
fit the state of mind, and so was accepted, and effectually clouded 
the issue and prevented any effort to find out what lay beneath. 

If these instances are proof of the subconscious origin of the 
artistic sentiments, so also, I believe, is the possibility of translat- 
ing the same feelings from one mode of artistic expression into 
another. Wagner, for example, has been accused of being a 
painter at heart. His conceptions, it has been claimed, were more 
calculated to create great canvases than great operas, while his 
stage settings are criticised as being examples of pictorial art to 
which the music and verse were secondary. 

This confusion of the different art fields and translation of 
the feeling-tone from one to the other is quite common. The 
great effort of operatic music is that it should help to express the 
idea conveyed by the words and actions, and though music is not 
nearly so definite a means of expression as written or spoken lan- 
guage, the leit motif in the hands of Wagner reached a definite- 
ness practically verbal in quality. A recent specific effort is that 
of the Russian pianist and composer Rachmaninoff to translate 
into music the " Isle of Death," that masterpiece of the German 
mystic painter Boecklin. 

2 The Perfect Wagnerite. 


The poem of Hildegarde Hawthorne 3 to St. Gaudens' master- 
piece, the Adams memorial, is to my mind not an interpretation 
of that wonderful work, but a translation from stone to verse. 
It has the same mystery, the same elusiveness, and I have often 
wondered whether, if an artist were given the poem without 
having seen the statue, and asked to sketch the effect it produced 
on him, he would not produce something like the statue — a figure 
draped, silent, calm, accepting, yet full of mystery. 

The character of the emotional tone that comes from the sub- 
merged regions of consciousness is of importance. Freud has 
emphasized the dominance of the sexual emotions in their influ- 
ence upon thought and actions. Their importance is great; per- 
haps it can hardly be exaggerated, especially when we consider 
that in the last analysis all life centers down to and resolves itself 
into the problems of self-preservation and the preservation, by 
propagation, of the species. Perhaps, too, these are only dif- 
ferent aspects of the same thing; for what, after all, is a desire 
for children than a desire, from another point of view, to preserve 
our life beyond our personal existence, to extend our influence 
into future generations? 

8 Yea — I have lived, pass on 
And trouble me with questions nevermore. 
I suffered, I have now a solemn peace, 
My peace forevermore. 
Leave me in silence here 
I have no hope, no care, 
I know no fear, 

For I have borne, but nevermore can bear. 
Deep-hid sorrow calls me kin, 
But my calm she cannot break; 
I know not good, I know not sin 
Nor love not hate can me awake. 
Though I have sought — I care not now (o find, 
If I have asked — I wait for no reply. 
Mine eyes with too much seeing have grown blind, 
I am not dead — yet do not need to die. 
Pass on — you cannot reach me anymore, 
Pass on, for all is past. 
Hush — silence settles ever more and more 
Silence and night at last. 


It is unfortunate that we have no word in our language that 
better expresses what I have called sexual. This word has dis- 
agreeable reverberations that I wish might be done away with. 
The term is here used in the broadest of senses to comprise all 
the broad and complex group of experiences centered about the 
differences of sex. It includes not only those more immediate 
experiences associated with the sexual approach, but the secon- 
dary, tertiary and even more remote sexual characteristics which 
distinguish the sexes ; such as the differences in habits of thought, 
decorative features of dress, social life, and is represented in art 
all the way from a Velasquez Venus to a della Robbia bambino. 
Perhaps for our purposes we might substitute for the word the 
term love motive. 

To consider this love motive as the spring from whence come 
the aesthetic experiences of art has a certain considerable sanction. 
In the first place, no variety of experience begins to furnish such 
a rich content of feeling as this. About it centers not only the 
sweetest experiences of our lives but the bitterest conflicts, the 
deepest hatreds, the profoundest repulsions. It is a never failing 
source from which to draw on feeling, and if we will consider 
we will perhaps be surprised to note the extent to which its use 
has been obviously put. The galleries are filled with paintings 
that openly profess it; poetry would indeed be poor without it; 
music is essentially sensuous, while dancing is obviously so. 

Then again, another and most important reason for giving the |/* 
love motive due consideration is its universal character. Tradi- 
tional, historical, social, economic, political conditions may all 
change ; men, nations, aye civilizations may come and go, but the 
love of a youth for a maid endures. This is surely a most impor- 
tant consideration. If great works of art have endured through 
the centuries and have been enjoyed by people under all varieties 
of existence, it can only be because they have appealed to a some- 
thing in man more fundamental, more lasting than the changing 
conditions under which he has lived. May not the love motive 
be that something?' 


If we look to the writers on art who have endeavored to define 
the nature of artistic experience, we will find here and there a 
vague appreciation of this possibility. 

"According to Burke 4 (1729-1797, Philosophical Inquiry into 
the Origin of our Ideas of the Sublime and Beautiful), the sub- 
lime and beautiful, which are the aim of art, have their origin in 
the promptings of self-preservation and of society. These feel- 
ings, examined in their source, are means for the maintenance 
of the race through the individual. The first (self-preservation) 
is attained by nourishment, defense and war; the second (society) 
by intercourse and propagation. Therefore, self-defense, and 
war, which is bound up with it, is the source of the sublime; 
sociability, and the sex-instinct, which is bound up with it, is 
the source of beauty." I shall return to this definition later. 
According to Schiller, Darwin and Spencer, 5 " Art is an activity 
arising even in the animal kingdom, and springing from sexual 
desire and the propensity to play." 

The reasons, then, that the love motive is considered necessary 
for great works of art are the necessity for a universal motive, 
common to mankind in every phase of their existence — the 
strongly emotional character of the motive, the obviously fre- 
quent use of it, more frequent in fact than any other — the vague 
realization of its necessity by many who have examined into the 
art problem. 

If this motive is accepted it will explain many phenomena. 
Symbolism in art, in religion, in folk-lore is, we know, largely 
of sexual origin. Such are, for example, the allegory of the 
origin of sin, the biblical song of Solomon and the whole subject 
of phallic worship. The origin of such symbols can be explained 
by an appeal to this motive on the principle of the Freudian psy- 
chology. We lead two more or less distinct and conflicting 
psychic lives. One rich in emotion but submerged beneath the 

* R. Kralik : " Weltschonheit, Versuch einer allgemeinen ^Esthetik," 
cited by Tolstoi: What is Art? 
8 Tolstoi : op. cit. 


region of clear consciousness, is the home of our crude, untamed 
desires of which the sexual is the most prominent. The other is v 
the fully conscious life, the psychic veneer of civilization. Desire 
speaks for recognition, convention refuses ; a conflict results. 
Desire is primitive and strong, and will not down. Convention — 
the result of education, suppresses the primitive because, accord- 
ing to its standards, it is hateful. Finally a compromise is reached 
by which desire may be recognized, received in the precinct of the 
conventional, provided only it comes properly disguished — sym- 
bolized. Legendary, folk-lore and particularly religion, where 
the suppressive elements have their greatest sway, are rich in 
examples. 6 It is sufficient to merely mention the symbolism of 
the serpent, particularly in religious art, as representing sin. 

Grant Allen 7 approached this explanation without realizing it 
when he derived the feelings which give origin to poetry and 
romance, and in large part to painting and sculpture from " day 
dreaming or building castles in the air." This process he believed 
to be " purely ideal " and " not connected with necessary vital 
functions." The air-castle-building-day-dreaming idea is all right, 
but is far from a useless procedure as Allen thought. Such 
reverie has a distinctly compensatory function, it is wish-fulfiling 
in its character, highly symbolic as a rule, and of sexual origin, 
frequently at least. 

Writers on art recognize this same thing. Rea writes: 8 "We 
must all be conscious of a certain dreamland of our own, in which 
things and ideas are pictured in our minds, not necessarily as they 
really are, but as we should like them to be, and as they might be 
were our mutual relations different." 

Aside from this aspect of the question the love motive explains 

why great works of art center about distinctly human interests 

and represent the human form. No mere landscape ever rose to 

8 A. Maeder: Die Symbolik in den Legenden, Marchen. Gebraiichen 
und Traiimen. Psych.-Neurol. Wochen., May 2 and 9, 1908. 

7 Physiological Esthetics. 

8 Hope Rea : The Tuscan and Venetian Artists. 


universal acceptance as have works involving the human form. 
Of course it must be remembered that landscape painting is 
a comparatively recent development. As wonderful as Paul 
Potter's Bull is, many people care little for it ; while I have never 
heard anything but praise for Le Febvre's La Dame d'fiventail, 
especially the Broun copies. The Greeks, of course we know, 
from whom so many of our ideals come, worshipped the human 
form, naked, undraped, and indeed it would be hard to find a 
more universally accepted work of art than the Venus de Milo. 
Although the Greeks made the human form the basis of their art, 
it was not the Greek human form they portrayed. Albrecht Durer 
painted idealized persons, but they were distinctly German. Franz 
Hals and even Rembrandt painted not only characteristic types 
of their day, but quite frequently they painted the actual indi- 
viduals, so that their appeal was necessarily limited. The Greeks 
painted a perfect human form, and added an idealized face that 
might be German, Flemish, Dutch, Italian or what not, and so 
appealed alike to all. They dealt truly in the universal motive. 

This brings us naturally to a consideration of motives that are 
less fundamental than the love motive; motives that are less 
universal — the secondary motives. Before touching this subject, 
however, the question may be asked — Is the love motive the only 
fundamental, universal art motive? 

We have seen that we may reduce all human activities to two 
general categories. Those calculated to preserve and perpetuate 
the race, and those addressed to self-preservation. The love 
motive is an expression of the instinct to perpetuate the race. 
Has the instinct of self-preservation, too, a fundamental emo- 
tional element that may form the basis of an art motive ? I think 
perhaps it has, and I would call it the mystery motive. 

The instinct of self-preservation is stirred into great emotional 

activity by conditions in the environment which are recognized 

as of overwhelming power, 9 and the emotion aroused varies all 

8 See Mercier : The Nervous System and the Mind. Mercier's classifi- 
cations and definitions of feelings are illuminating in this connection. 


the way from terror when the conditions are recognized as over- 
whelming and inimical and counteraction is not elicited — the indi- 
vidual is transfixed — through fear, when the power is not over- 
whelming but is superior, to states of vexation, resentment and 
contempt when the conditions are recognized as of insignificant 

A material factor in fear states is mystery — a failure to under- 
stand the nature of the impending conditions. Mystery is the 
half-brother of fear, and attaches itself to those experiences that 
are unusual, outside of the realm of every-day experiences. The 
horse is frightened by a simple piece of paper that suddenly, as 
the result of a passing breeze, takes on the attribute of motion. 

Then come the feelings of reverence and devotion to over- 
whelming power which is recognized as beneficent and finally 
states of feeling of awe and sublimity to great power in the envi- 
ronment which is not directed towards the individual at all but is 
merely contemplated in action or at rest. 

It is not probable that such violent emotions as terror and fear 
can become sources of art, but the allied mental state of mystery 
frequently is a large factor. In fact I believe it is present in the 
contemplation of tremendous edifices, such as the choir of Beau- 
vais, which is so immense, so much larger than anything with 
which we have any experience in our every-day lives, and have 
therefore become adapted to, that it is simply impossible to take 
in, to grasp, and we are apt to stand before its immensities agape 
at the wonder of it all. Mystery, too, enters into many art pro- 
ductions that are not overwhelming by virtue of their size. It 
is a prevailing note, for instance, in St. Gaudens' Adams memo- 
rial. When it comes to overshadow all other motives we find 
it emerging as a distinct movement in art. Here, however, we 
are probably dealing with an entirely different feeling-tone than 
that which results from contemplating Beauvais or St. Gaudens. 
This is rather the result of a motive often perilously near the 
abnormal that takes obscureness as a criterion of beauty and 


Of coequal importance to these fundamental motives in art is 
beauty. Beauty is an essential of all art and lies at the basis of 
aesthetics. The painting of an ulcer, no matter how well done, 
could never be art. There are certain elements of it to which 
I think it worth while to call attention. This particular thing is 
brought out in classic architecture. If we will study the Greek 
column, for instance, we find that it does not taper regularly from 
below upward, but that there is a gradual swelling about two 
thirds up. If this swelling were not there the column would look 
weak at that point. A careful examination of the stylobate of 
the Parthenon, the floor on which the great columns rest, will 
show that it has a slightly upward curvature, else it would appear 
sagged by the great weight. So the architrave has a similar curve 
for similar reasons. 

The physiological and psychological reasons which make it 
necessary to make these corrections are, that if they are not made 
a mental state of discomfort is produced as a result of the muscu- 
lature being thrown out of harmonious balance. We uncon- 
sciously make muscular efforts to correct such defects as these 
when we see them, and are so made uncomfortable. This may 
be better appreciated by an example within the experience of all. 
How frequently we find ourselves moving this way and that, per- 
haps distorting our faces in an almost grotesque way as we sym- 
pathetically watch some person making a great effort of some sort, 
perhaps an acrobat on the stage. Such movements can be seen 
in their crudity in the schoolboy, twisting and squirming, with 
outstretched tongue as he bends in wrapt attention over his copy 

I believe the great charm of the simple Doric buildings lies in 
their perfect balance, so that they give the impression of absolute 
harmony in all their parts. All of the parts have been so arranged 
that they not only, as a matter of fact, are in perfect balance, but 
the lines have been curved a little here and a little there, a column 
has been placed at a slightly different distance from its neighbor 


than the one on the opposite side, so that aside from the real 
harmony there is an apparent harmony; the structure looks bal- 
anced, all of the distortions that optical illusions would have 
created have been corrected. In contemplating such a structure 
the muscular system remains in balance ; there are no disagreeable 
sensations from muscular tensions unequally distributed in the 
two symmetrical halves of the body, a condition of muscular calm 
is brought about that produces a feeling of quiescence, of rest, of 
harmonious adjustment that is pleasurable. 

It is interesting, in this connection, to refer to Merrier. 10 He 
refers to the view expressed by Grant Allen 11 who regards the 
feeling of beauty as corresponding with the maximum of stimula- 
tion with the minimum of fatigue or of waste. After some hesi- 
tation, however, he discards this view and retains his own, which 
regards it as the maximum of action of the environment on the 
organism with the minimum of reaction of the organism on the 
environment. The correspondence between this view and the 
one just expressed is so great that I think it is worth while at this 
point to quote Merrier in full. He says with reference to his 
view as compared to that of Grant Allen : " Although the correct- 
ness of this expression is not nearly so evident as that of Mr. 
Allen's, it is not only more in harmony with the system of classi- 
fication here expanded, but it brings into prominence elements 
which I believe to be equally in accordance with truth and of more 
fundamental character. Stimulation, it is manifest, can only 
occur by an action of the environment on the organism. It is 
not at first sight equally manifest that fatigue necessarily implies 
action of the organism on the environment; but it will be admitted 
that it usually does so, and I think it can be shown that it always 
does. Fatigue as commonly used means the feeling that accom- 
panies exhaustion of muscular power after exertion, — that is to 
say, it implies much previous action on the environment. But we 
speak also of fatigue of the eyes after working long at the micro- 

10 Loc. cit. 
u Loc. cit. 


scope, or after many hours in a picture gallery. In the former 
case there is true fatigue — exhaustion of the ocular muscles, and 
this may also be present to a certain extent in the latter — but the 
feeling here is not mainly, I think, one of true fatigue ; it is mainly 
a feeling of satiety. There is, however, another application of 
the term fatigue which must be admitted to be correct, and which 
appears at first sight to have no reference to muscular action — to 
reaction on the environment. This is the feeling that follows con- 
tinued intellectual exertion. When this feeling is present there 
may have been no preceding muscular exertion. The body may 
have been in complete repose with reference to its surroundings. 
Yet there has been great internal activity, and there is a consid- 
erable volume of feeling to which the term fatigue is universally 
applied. Can this feeling be said to correspond with action of 
the organism on the environment? If by correspondence is 
meant direct correspondence, of course it cannot; but if the cor- 
respondence is to be thus restricted, neither can fatigue of the 
muscles of the eye and ear be said to correspond with such action. 
Intellectual exertion is on the physical side the opening up of new 
elements — the rendering permeable of new tracts — for the cur- 
rents or the waves of molecular movement in the cerebral cortex. 
Every conclusion reached, every judgment formed, every simi- 
larity perceived, every difference distinguished, implies a modifi- 
cation of the structure of the brain — implies a redistribution of 
the resistance to molecular change — implies a modification in the 
direction that future changes must follow. But the cerebral cor- 
tex, regarded physiologically, represents combinations of muscular 
movements; and a modification of the structure of the cerebral 
cortex is, on the physiological side, a modification in the grouping 
of muscular movements — is a modification of the way in which 
the organism acts upon the environment. Now if we bring 
together the first and last links in this chain of reasoning we find 
that intellectual exertion necessarily implies a modification of 
the action of the organism on the environment, and that the 


fatigue which follows great intellectual exertion is the feeling 
which corresponds indirectly with a modification of the action of 
the organism on the environment." 

We get a very interesting confirmation of this general position 
from a study of sound stimuli. A recent study of melody by 
Bingham 12 is particularly illuminating, especially when taken in 
connection with the more modern view of attention as essentially 
an affective state, and with a recognition of the muscular-tension 
components of this state. In the course of this study several of 
the observers remarked upon certain motor adjustments, strains 
and tensions, which were relieved when the melody seemed to 
them to possess "finality." This suggested the study of the 
effects of melodic stimuli upon muscular movement. The author 
concludes among other things, that a melody begins by upsetting 
some set of muscular tensions ; it " includes the taking of a proper 
'attitude,' the organization of a set of incipient responses," and 
ends finally "with the arrival of a phase of the complex ongoing 
activities in which the balanced tensions can merge into each 
other, etc." " Two or more tones are felt to be ' related ' when 
there is community of organized response." " Unrelated pitches 
fall apart because each demands its own separate attentive act of 

Thus we see that there are at least two fundamental elements 
to be considered in the explanation of the effect works of art 
have upon us. One is distinctly psychic and the other both psy- 
chological and physiological. This latter element I have already 
illustrated in the balance of the Greek architecture, the muscular 
imbalance brought about by seeing one make an effort, the relief 
of certain muscular-tension states by the resolving of a melody. 

One more important matter should be considered in connection 
with this psycho-physiological factor, especially with reference to 

" Studies in Melody by W. Van Dyke Bingham. Psychological Review 
Monograph, No. 50. Review by T. L. Bolton, Jour, of Phil., Psych. & Sci. 
Methods, January 19, 191 1. 


painting; that is the fact that the eye is never at rest 13 but is in 
constant and rapid motion. A landscape, therefore, is never 
actually seen by the eye, disregarding for the moment the receiv- 
ing mind, for two consecutive instants the same. In endeavoring, 
therefore, to reproduce a landscape upon canvas the very best 
that can be done is to paint something that will be an acceptable 
compromise with all these shifting perceptions. 

When we take into account the varying quality of the perceiv- 
ing minds it is easy to understand how many different schools 
have arisen with their several theories as to how nature should be 
portrayed on canvas. The important thing in all these illustra- 
tions is that, in order that a work of art shall be beautiful, it must 
strike a certain number of psycho-physiological balances. If 
these balances are thrown out beyond a certain point, if for ex- 
ample, a badly constructed melody results in muscular strains and 
tensions that are disagreeable, the feeling of the artist, no matter 
how properly a subject for art, cannot be conveyed effectively. 
The medium is inefficient. Beauty is lacking. 

Now let us consider the more distinctly psychic element and see 
if the two cannot be effectively correlated. 

Art is the language of the emotions. We have already seen 
that there is reason for believing that if a work of art is at all 
great it must appeal to a fundamental emotion, and I have sug- 
gested what I designated as the love motive as perhaps the most 

That this thesis is correct in its general statement, at least, can 
be more readily appreciated by a series of illustrations of the limi- 
tations of appeal and their reasons. This will involve a consid- 
eration of certain secondary motives. 

Many motives are relatively universal only. That is, they are 

universal only for a certain group of people or during a certain 

u On this subject of eye movement see the work of Judd, McAllister, 
Steele, Cameron, Courten, which is accumulated in several articles and 
published as No. i, Vol. VII, of the Monograph Supplements to the Psy- 
chological Review, March, 1905. 


period of time. One of the dominant motives of medieval art, 
for example, was Catholicism, and its greatest appeal was made, 
and is still made for that matter, to the Catholic world. The 
appeal is not a universal one, a Roman Catholic motive would 
hardly appeal to a Buddhist and vice versa. 

Quite comparable to the relative universality of Catholicism 
is the beauty motive, that is, the use of beauty as an end and not 
a means. We must remember that while beauty is essential to all 
works of art the standards of beauty vary greatly among different 
peoples. In that resplendent period of French art which grew 
up largely during the reign of Louis XIV and just antedating the 
Revolution, we find a notable tendency to subordinate all motives 
to the production, above all else, of a work of beauty. Pictures 
embody no great idea, they are largely decorative in purpose and 
often, naturally as a result of royal patronage, even directly per- 
sonal. Watteau is the type of the appeal to the beauty motive. 
His picture — The Embarkation for Cythera — is the type in which 
each individual feature is subordinate to the one fundamental 
purpose of beauty. More restricted still than either the religious 
or beauty motives is the war motive. The restrictions of this 
motive, so far as we are concerned at least, are temporal largely, 
depending much on historical interest though the abstract, gen- 
eral idea of conquest and the exultation that comes with victory 
which are so often associated with the war motive, are well nigh 
universal motives and are the obverse of the mystery motive. 
Meissonnier's pictures, representing specific historic incidents, 
and in their minutest detail true to the actual conditions of the 
time, are excellent examples. 

And so we might pick out this and that motive and discuss it in 
its various bearings down to motives that are really minute — so 
minute in fact as to make it very doubtful if they deserve at all 
serious consideration. The boiled lobster-cabbage-asparagus type 
of picture of Snyder's seems to me to hardly deserve considera- 
tion as a work of art at all, while if the pots and kettles of the 


Dutch genre painters are more worthy it is because of the implied 
human motive that they stand for. As symbols of a simple, aus- 
tere, God-fearing people they have their raison d'etre. 

We have seen thus far how the value of a work of art is depen- 
dent upon the nature of its appeal, the dominant motive it stands 
for. It is evident from this analysis that no mere landscape or 
still life can ever be great except symbolically, while they mostly 
resolve themselves into being pretty or as exhibitions of a specially 
developed technique. It is evident, too, that the majority of 
works of art appeal to many motives and that they vary to a 
considerable extent according to the nature of the person appealed 
to. Millais's Sower was supposed by many, when it was first 
exhibited, to be symbolic of anarchy. The attitude of the peasant 
appeared to indicate that he was hurling maledictions against the 
conditions that bound him to toil. 

It must be plain also that the great work of art not only makes 
appeal by use of a fundamental motive, but that the use of that 
motive is simple and direct and not surrounded by and made 
obscure by secondary and minor motives. Piloty's Thusnelda at 
the Triumph of Germanicus is, to my mind, a really splendid 
work, but one must know something of the story to fully appre- 
ciate it. This same principle of limitation of appeal is well illus- 
trated by Poussin's picture " I too have been in Arcadia." Four 
figures are grouped about a tomb. One of them is stooping and 
rubbing away the collection of lichens and moss to more clearly 
reveal an inscription. The inscription reads " Et Ego in Arcadia." 
Unless the percipient knows Latin much of the appeal, the real 
meaning of the picture, is lost. No one, however, thinks to ask 
for the story of the Winged Victory of Samothrace. Perhaps 
there is a story, but if there is it wouldn't add one bit to the 
appreciation of the marvelous grace and beauty of this, to my 
mind, the greatest of all works of sculpture. In the same way 
one needs no explanation of Giotto's Campanile. That it is the 
bell tower for the Duomo beside which it stands is not necessary 


to know to feel all of the charm of its unexcelled grace, harmony 
and beauty. I believe Ruskin has said that it was the finest 
product of architecture in the world. 

There are heights to which art rises, however, which are greater 
than any thus far discussed. There is what has been called the 
sublime in art and which, of course, has only been most rarely 
attained. However, here too I believe we are using a relative 
term. For a certain time, for a certain people, more particularly 
for the Union soldier, Lincoln's Gettysburg oration 14 rises to sub- 
lime heights. That the appeal is not so simple and straightfor- 
ward as in the examples we have just given, but requires some 
knowledge of something not in the oration itself I can perhaps 
illustrate by an example. The epitaph written by Simonides to 
the three hundred at Thermopylae, 15 although expressing almost 
identical sentiments in a wonderfully simple and direct way, still 
I hardly think will stir at all deeply those who do not know the 
story; while even those who do will hardly respond with one 
tenth part of the emotion of an old Union veteran to Lincoln's 

"Fourscore and seven years ago our fathers brought forth upon this 
continent a new nation, conceived in liberty, and dedicated to the propo- 
sition that all men are created equal. Now we are engaged in a great civil 
war, testing whether that nation, or any nation so conceived and so dedi- 
cated, can long endure. We are met on a great battlefield of that war. 
We have come to dedicate a portion of that field as a final resting place 
for those who here gave their lives that that nation might live. It is 
altogether fitting and proper that we should do this. But in a larger sense 
we cannot dedicate, we cannot consecrate, we cannot hallow this ground. 
The brave men, living and dead, who struggled here, have consecrated it 
far above our power to add or detract. The world will little note, nor 
long remember, what we say here, but it can never forget what they did 
here. It is for us, the living, rather to be dedicated here to the unfinished 
work which they who have fought here have thus far so nobly advanced. 
It is rather for us to be here dedicated to the great task remaining before 
us, that from these honored dead we take increased devotion to that cause 
for which they gave the last full measure of devotion ; that we here highly 
resolve that these dead shall not have died in vain ; that this nation, under 
God, shall have a new birth of freedom, and that government of the 
people, by the people, and for the people, shall not perish from the earth. 

10 " Thou who passeth by say at Lacedaemon we lie here in obedience to 
her laws." 


The effect that a work of art produces upon a person varies 
directly according to the mental makeup of that individual — 
varies in accordance with the character of his mental constella- 
tions. If his mind has never been constellated with reference to 
Latin, a picture requiring a knowledge of Latin for its under- 
standing fails in appeal. 

That the nature of the individual's constellations can be worked 
out with reference to an aesthetic factor has been well shown by 
Bullough 16 in an analysis of color and perception. He was able to 
differentiate four perceptive types, viz., objective, physiological, 
character and associative, and a considerable number of " combi- 
nation criteria " ; i. e., the effect produced in different persons by 
combinations of colors, the way in which one color influences 
another when associated with it. 

It is plain to be seen then that a work of art, to make an at all 
broad appeal, must strike deep in its emotional appeal and reach 
those elements that approach, at least, to being the common pos- 
session of all mankind. 

It is plain also that as we get away from this fundamental 
appeal we are dealing with relatively minor motives that are 
always of more restricted effect, and that therefore the risk be- 
comes progressively greater of striking a combination in any 
individual that is not simply less pleasant but perhaps actually 
unpleasant. As we saw that beauty required the striking of cer- 
tain psycho-physiological balances, so here, with reference to the 
more purely psychic factor in art appreciation, we may conclude 
that the appeal depends upon the striking of certain emotional 

Beauty may be both means and end and its use to both ends is 
fully justified. Beauty alone though has a relatively restricted 
appeal as we may appreciate by comparing the ideals of the Occi- 
dent and Orient, and as we may appreciate even better by consid- 

" Edward Bullough : The ' Perceptive Problem ' in the ^Esthetic Appre- 
ciation of Simple Colour-Combinations. British Jour, of Pysch., Decem- 
ber, 1910. 


ering a beautiful bit of lace. The lace is beautiful, it is true, 
but its appeal is a very superficial one, it fails absolutely to touch 
the depths. 

The great works of art use beauty as a means; and a funda- 
mental motive, a profound emotional appeal is made through this 
means. I believe, too, that this appeal must be made in a rela- 
tively simple manner because of the reasons already cited — that in 
proportion to the complexity of the work the danger is increased 
of touching discordant tones in the observer. It is in this respect 
that Wagner erred. He failed to appreciate both this fact and 
the further fact that the different forms of art — painting, sculp- 
ture, architecture — have developed from a more or less homo- 
geneous beginning in which they were scarcely at all differentiated. 

The greatest art, according to Wagner, in accordance with the 
views thus far expressed, should be possible in grand opera. 
Here the motives may be universal and dominant, and secondary 
motives may be subordinated to the fundamental appeal, and that 
appeal is made through music, poetry, dancing, and all of the 
motives of architectural and pictorial art — the stage setting and 
stage picture. The effect sought is comparable to that of the 
orchestra or church organ in music. 17 We hardly expect to pro- 
duce great musical effects from the simple instruments such as 
the flute, the oboe, the French horn, or cornet. It is only in the 
more complicated instruments that we begin to find such possi- 
bilities as in the violin, the cello, or the piano, while for the great- 
est effects a complete orchestra is required. The only simple 
instrument that combines the qualities of a whole orchestra is the 
church organ with its several banks of keys, multitude of stops, 
and pedal base. So in grand opera all means are made to make 
for the same end and the results are correspondingly massive. 
As an actual matter of fact, though, we are disappointed in the 

"As a matter of fact the orchestra is necessary to produce harmony, 
impossible upon many single instruments such as the flute. The complex 
of orchestral tones is no more complex than the complex of color tones 
in a picture. 


appeal made by grand opera if we expect all that I have indi- 
cated. We really go to opera to hear Madame this or Seignor 
that sing a certain part, for which, quite likely, they are especially 
noted and if our sensibilities are at all easily jarred we are con- 
stantly offended by the awkwardness of the chorus, the poor 
support of the prima donna and such like details. The whole 
thing is so complex that some parts of it offend some persons. 

As to the artists' state of mind I refer to what was said in the 
forepart of this chapter and particularly to the quotations from 
Wagner and Shaw (pp. 92, 93). Here we are confronted by a 
demonstration that the springs from which arise the activities 
leading to the production of a work of art are without the clear 
field of conscious awareness. The evidence all goes to show that 
the activity is of the same character, in reference to the attitude of 
the artist towards it, as the activity which has its origin in that 
region I have called the proving ground for automatisms. It is 
the same in kind as that arising from a " complex." 

The work of art then is peculiarly the expression of the indi- 
vidual because it has its origin in the hidden springs of character 
which are beyond control. 

The inability to get away from these submerged determinants 
of conduct is admirably illustrated by the Flemish painters who, 
at the time of the Italian renaissance tried to borrow from the 
artists of Florence and Rome. Taine, 18 in his inimitable style, 
describes the result. 

" There are two traits characteristic of Italian art, both of which 
run counter to the Flemish imagination. On the one hand Italian 
art centres on the natural body, healthy, active and vigorous, 
endowed with every athletic aptitude, that is to say, naked or 
semi-draped, frankly pagan, enjoying freely and nobly in full 
sunshine every limb, instinct and animal faculty, the same as an 
ancient Greek in his city or palestrum, or, as at this very epoch, 
a Cellini on the Italian streets and highways. Now a Fleming 
M H. Taine : The Philosophy of Art in the Netherlands. 


does not easily enter into this conception. He belongs to a cold 
and humid climate; a man there in a state of nudity shivers. 
The human form here does not display the fine proportions nor 
the easy attitudes required by classic art; it is often dumpy or 
too gross; the white, soft, yielding flesh, easily flushed, requires 
to be clothed. When the painter returns from Rome and strives 
to pursue Italian art, his surroundings oppose his education; his 
sentiment being no longer renewed through his contact with living 
nature, he is reduced to his souvenirs. Moreover, he is of Ger- 
manic race; in other terms he is organically a morally good- 
natured man, and even modest; he has difficulty in appreciating 
the pagan idea of nudity, and still greater difficulty in compre- 
hending the fatal and magnificent idea which governs civilization 
and stimulates the arts beyond the Alps, namely, that of the com- 
plete and sovereign individual, emancipated from every law, sub- 
ordinating the rest, men and things, to the development of his 
own nature and the growth of his own faculties. Our painter is 
related, although distantly, to Martin Schcen and Albert Diirer; 
he is a bourgeois, almost docile and staid, a lover of the comfor- 
table and the decent, and adapted to family and domestic life. 
... It is evident that pupils of this class, even with great labor, 
will produce but little more than academic figures ; man, according 
to their conceptions, is a draped body ; when, following the ex- 
ample of the Italian masters, they attempt the nude, they render 
it without freedom, without spirit, without vivacity of invention ; 
their pictures, in fact, are simply cold and meagre imitation ; their 
motive is pedantic; they execute servilely and badly that which, 
in Italy, is done naturally and well. On the other hand, Italian 
art, like Greek art, and, in general, all classic art, simplifies in 
order to embellish; it eliminates, effaces, and reduces detail; by 
this means it gives greater value to grander features. Michael 
Angelo and the admirable Florentine school subordinate or sup- 
press accessories, landscape, fabrics, and costume ; with them the 
essential consists of the noble and the grandiose type, the anatom- 


ical and muscular structure, the nude or lightly draped form taken 
by itself, abstractly, through the retrenchment of particulars con- 
stituting the individual and denoting his profession, education and 
condition ; you have man in general represented, and not a special 
man. Their personages are in a superior world, because they 
are of a world which is not ; the peculiar feature of the scene they 
depict is the nullity of time and space. Nothing is more opposed 
to Germanic and Flemish genius, which sees things as they are in 
their entirety and complexity; which, in man, takes in, besides 
man in general, the contemporary, the citizen, the peasant, the 
laborer, this citizen, that laborer, that peasant; which attaches as 
much importance to the accessories of a man as to the man him- 
self; which loves not merely human nature but all nature, ani- 
mate and inanimate — cattle, horses, plants, landscape, sky, and 
even the atmosphere — its broader sympathies forestalling any 
neglect of objects, and its more minute observation requiring the 
fullest expression. You can comprehend how, in subjecting itself 
to a discipline so contrary, it loses the qualities it had without 
acquiring those it had not ; how, in order that it may arrogate the 
ideal, it reduces color, loses the sentiment of light and atmosphere, 
obliterates the true details of costume and of interiors, deprives 
figures of original diversities peculiar to portrait and person, and 
is led to moderate the suddenness of motion constituting the im- 
pulsiveness of nature's activity, and thereby impairing ideal sym- 
metry. It finds difficulty, however, in making all these sacrifices, 
its instinct only partially yields to its education. Flemish remi- 
niscences may be traced underneath Italian velleity; both in turn 
predominate in the same picture; each prevents the other from 
having their full effect; their painting, consequently, uncertain, 
imperfect and diverted by two tendencies, furnishing us with 
historical documents and not beautiful works of art." 

A man cannot get away from himself. He is what he is at any 
one particular moment because of everything that has gone 
before. Whether he produces art or is merely an appreciator of 


it the result depends upon the whole mass of mental material 
which has gone to the construction of his personality. 

One is constantly running across admirable illustrations of 
this principle in reading — particularly of the old works of art. 
Neale and Webb 19 writing of church architecture say: "An age 
of church-building, such as this, ought to produce good archi- 
tects, not only from the great encouragement given to their pro- 
fessional efforts, but from the increasing appreciation of the 
principles and powers of their art. And yet it cannot be denied, 
however we may account for the fact, that (at least among those 
for whom we write, the members of our own communion), no 
architect has as yet arisen, who appears destined to be the 
reviver of Christian art. It is not that the rules of the science 
have not been studied, that the examples bequeathed to us have 
not been imitated, that the details are not understood. We have 
(though they are but few) modern buildings of the most perfect 
proportions, of the most faultless details, and reared with lavish 
expense. It is that there is an undefined — perhaps almost un- 
definable — difference between a true ' old church,' and the most 
perfect of modern temples. In the former, at least until late 
in the Perpendicular era, we feel that, however strange the pro- 
portions, or extraordinary the details, the effect is church-like. 
In the latter, we may not be able to blame; but from a certain 
feeling of unsatisfactoriness, we cannot praise." 

Their explanation runs as follows : " A Catholic architect must 
be a Catholic in heart. Simple knowledge will no more enable 
a man to build up God's material, than His spiritual temples. 
In ancient times, the finest buildings were designed by the holiest 
bishops. Wykeham and Poore will occur to every churchman. 
And we have every reason to believe, from God's Word, from 
Catholic consent, and even from philosophical principles, that 
such must always be the case." 

18 Introductory Essay on Sacrimentality : A Principle of Ecclesiastic?! 
Design to William Durandus : The Symbolism of Churches and Church 
Ornaments. London, 1906. 


I think one must admit that it is quite impossible to imagine 
how anyone not imbued to the depths with the faith could have 
conceived of the marvellous beauties of the facade of Rheims or 
the choir screen of Chartres. 

Not only is this so but this work can not, apparently, be ade- 
quately copied or reproduced at this day. Mrs. Pennell's 20 
delightful descriptions of the French cathedrals are literally 
filled with lamentations over the work of the restorer. She says 
characteristically of Notre Dame of Laon : " But seldom any- 
where has the restorer been so pitiless, and now, as you first 
stand before the fagade, instead of being awed by its rudeness 
and strength, you are impressed chiefly with the excessive care 
the State has taken of it." 

Art is a matter of emotion, not a matter of the intelligence. It 
is concerned with states of feeling not with syllogisms. As we 
have seen that feeling largely originates from springs of which 
the individual knows naught, and therefore cannot control, we are 
therefore prepared for an explanation of the problem of art which 
takes that fact into consideration. The Hamlet tragedy 21 is one 
of the very best illustrations of this condition. Here we have a 
great work of art produced by a man who did not know the 
motive actuating him, in which the principal character is through- 
out unable to explain himself, and viewed generation after genera- 
tion by an enthusiastic but uncomprehending public. These are 
all characteristic of mental states that are conditioned by that 
region of mind which is the home of the "complex": the place 
from which emotions rise to the surface and make themselves 
known though their source remains a mystery. 

In concluding this essay it will be well to review the general 
propositions which have been set forth. 

20 Elizabeth Robins Pennell : French Cathedrals, Monasteries and Abbeys 
and Sacred Sites of France. New York, 1909. 

"Ernest Jones: The GEdipus-Complex as an Explanation of Hamlet's 
Mystery: A Study in Motive. Amer. Jour. Psychol., January, 1910. 


Beauty is what may be called the universal aesthetic motive. 
Art must first of all be a beautiful expression. Beauty is the 
medium, and the only universally necessary medium, for artistic 
expression. In order that a thing may be beautiful there must 
be produced by it in the observer a certain psycho-physiological 
balance of effects. In addition to this it must produce, on the 
purely psychic side, if it is a true work of art, a certain emotional 

With beauty as a sine qua non must go certain motives pri- 
marily in the soul of the artist, but which, as a matter of con- 
venience, we have spoken of as residing in the work of art. 
These motives are fundamental or primary and minor or secondary. 

That fundamental motives are necessary to great works of art 
is apparent from the fact that these works persist generation after 
generation, despite changes in the political, social, economic con- 
ditions, despite changes of standards, and are accepted by peoples 
of different nations having widely different national traits of 

The only springs of human character sufficiently fundamental 
to be the starting point of such motives are the emotions asso- 
ciated with self-preservation, and species-preservation. This 
thesis is demonstrated in its application. 

The minor or secondary motives are less fundamental and 
relate to matters either of more restricted interest or resolve them- 
selves into questions of technique. 

All works of art are the result of, and appeal to, a complex 
of motives. Art can only be great which appeals to the funda- 
mental motives and it is greater in proportion either to the sim- 
plicity and directness of that appeal or the complete domination 
of the appeal to the fundamental and the subordination as acces- 
sories of the minor motives, utilizing them solely to enhance the 
appeal of the dominant. 

Minor motives may be made dominant even in works where 
appeal to the fundamental exists, and fundamental motives may 


be greatly limited in their appeal in various ways, thus impairing 
the universality of their acceptance. Their appeal may be made 
to only a certain class of people, or a certain nation ; to those 
only who speak a certain language, or who know certain historic 

The proper balancing of motives is the work of genius. 

A full understanding of a work of art must be reached by an 
understanding of the artist and of the nation to which he belongs, 
which must include the social, political, economic, moral, religious 
conditions, geographic and climatic conditions, etc. 




There seems to be an apparent, almost absolute, lack of com- 
prehension which seems to be rife as to what may be included 
under the term psychotherapy. On the one hand, I hear the sub- 
ject discussed by those who know much about it but who invari- 
ably assume, on the part of their audience, a knowledge which 
I feel sure they do not possess. On the other hand I am con- 
fronted on all sides by physicians who sum up all that is included 
under the term psychotherapy with the word " suggestion." 
These latter men see in the whole subject nothing but the use of 
suggestion and assume very much the attitude towards its use as 
a psychotherapeutic agent, as do many who consider the writing 
of a prescription the crowning act of the practice of medicine. 
These same men, too, will invariably make the statement that all 
physicians use suggestion more or less in their practice, and have 
done so since the days of Egypt and Babylon; and their attitude 
implies that there has been very little, if any, progress in its use 
or the knowledge regarding it since then. It seems to me high 
time that this state of blissful contentment, comfortable as it may 
be, should give way to some realization of the immense amount 
of work that has been done along these lines in recent years and 
to some of the results, both theoretical and practical, that have 
been reached. 

In the first place we must escape from the influence of the 
shibboleth " suggestion," 2 which for so long seems effectually to 

1 This chapter was printed, substantially as it appears here and under the 
same title, in the Interstate Med. Jour., September, 1910. 

2 1 would define suggestion as the uncritical acceptance of an idea and 
its realization in action. 



have blighted any efforts at individual thinking. It has been in 
the past a word to conjure with and use as a cloak for ignorance. 
The average use of the term suggestion implies a conception of 
mind that would permit of the addition of ideas, much as one 
would sprinkle the particles of salt upon his morning egg and 
permit their removal in quite as simple a way. There seems to 
be a popular delusion to the effect that an idea is something 
almost tangible in its definiteness, something distinct, and quite 
apart from other ideas and other phenomena of consciousness. 
To those who have some acquaintance with the phenomena of 
mind it is hardly necessary to say that all this is absolutely not so. 
As an illustration of the complexity of consciousness compared 
with its simplicity, as implied in the conception of suggestion, 
let us consider a relatively simple mental fact. Suppose I look at 
an orange and so have what we call a percept of an orange. This 
percept, it can at once be seen, is composed of many elements. 
The perception is possible only as a result of the fusion of many 
sensations — roundness, yellowness, and the complex sensations 
coming from the eye-muscles in accommodation — plus the resid- 
uals of many previous experiences of the same character and 
which included the additional sensations of taste, touch, and 
smell. In addition to all this mass of material necessary to the 
formation of the percept, I tend to assume a certain attitude of 
mind towards the orange, to relate myself to it. I am pleased or 
displeased, the orange is mine or some one else's, and I tend to 
reach out and possess it with the intention and desire to eat it 
or I restrain myself because perhaps it is not mine. If now I 
shut my eyes and think of the orange, the idea of the orange with 
which I have replaced the percept is different from the percept, 
and calls up still further and more complex associations. In this 
illustration we can see how complex a simple mental fact is, and, 
more important still, how intimately it is bound up in a complex 
of associations with other mental material. Ideas cannot exist 
alone; what does exist is a mental state conditioned by events in 
the environment and related to those events. 


Every mental state is a synthesis and like a chemical compound 
may bear little relation in its qualities to the qualities of its con- 
stituent elements. Every mental state, too, reaches back through 
an immeasurable line of other mental states to the very dawn of 
consciousness. There is nothing fortuitous in mental life. De- 
terminism holds as definitely in the psychic as in the physical 
world and no mental fact can exist that has not its efficient cause 
in antecedent mental states. The sum total of the material of 
consciousness constitutes the personality, and I trust my illustra- 
tion will give some vague idea of its almost infinite complexity. 

The important thing to remember is the fact that all states of 
mind have efficient causes and are definitely associated with those 
causes in quite as inevitable a way as in the physical world. 
Psychoanalysis would be quite impossible if it were not for the 
presence of inexorable law in the field of mind. 

Now let us examine a little the effects of suggestion. Perhaps 
I can illustrate best by a case. One of my patients had a phobia 
for red. Although very suggestible, sinking readily into deep 
hypnosis, and accepting posthypnotic suggestions, I found it almost 
impossible to remove this phobia except for a short time. It kept 
coming back but I finally succeeded only after I had taken up 
the same problem with other symptoms. The same patient often 
thought of suicide. I suggested to her in hypnosis that when 
the desire to kill herself came to her mind she would think of 
an hallucinatory cat that had been suggested to her during a 
previous hypnosis. After this suggestion was made, and I began 
to work on the suicide idea, the fear of red disappeared. At 
first the suggested cat came whenever she thought of killing her- 
self. The cat amused her immensely and the idea of suicide was 
robbed of its affect. Then the cat came less often and the suicide 
idea resumed its sway until the suggestion was repeated. This 
only worked for a short time. The same day she broke a window 
to get glass to cut her throat. The next day the cat idea came 
when she thought of killing herself, but it was too weak to dis- 


place the suicide idea. During the time these experiments were 
going on I was trying also another substitution. She had an idea 
at times that people hated her. I suggested in hypnosis that when 
this idea came she would see a bright flash which would distract 
her attention but not alarm her. This substitution worked very 
well and the idea that people hated her and the hallucinated flash 
of light gradually disappeared together. It was while this was 
disappearing, however, that the suicide idea returned in strength 
as described above. During this time a depression developed, a 
fear that when she went home she would get worse again. It 
was suggested that her right arm would jerk whenever she felt 
this dread. This suggestion was not well carried out and the 
idea that people hated her returned. Now, while in the midst of 
these attempted substitutions, she complained that she could not 
remember the names of persons and even of things ; she said that 
this difficulty was getting worse. 

These experiments suggest that we are dealing with conditions 
similar to those in the physical world that are controlled by the 
law of the correlation and conservation of energy. At first it is 
impossible to make the phobia for red disappear. It goes finally 
when the mind is taken up with the suicide idea. This is par- 
ticularly rebellious, however. The idea of hate is made to dis- 
appear like the phobia for red. The cat idea comes for a while, 
then weakens and disappears. During this time a depression 
develops. An attempt to substitute an arm jerk for this is not 
carried out and the idea that people hate her returns. Then 
appears an anterograde amnesia. She forgets names of people, 
where she put her fancy-work, etc. There seems to be just so 
much energy, but not enough to go around. When it is used in 
one place it must necessarily be drafted from another, and so, 
although a symptom may be removed it either returns or some 
other takes its place. The basket will only hold so many eggs. 

We see by these examples that suggestion really plays on the 
surface. The fundamental, underlying conditions are not reached 


by suggestion. These underlying conditions which produce the 
symptomatology of the psychoneuroses are the same conditions 
that make suggestion possible. The accepted suggestion is quite 
as much a pathological product as the various symptoms them- 

The particular way in which a psychoneurosis manifests itself 
is largely accidental. Given the pathological foundations, any par- 
ticular thing that may be about and available at the time being may 
be used as a vehicle of expression. For example, one of my 
patients had epileptiform seizures preceded by an aura of green. 
He had had a fall which rendered him unconscious. He was 
lying upon a green baize face down so that the first thing he saw 
on coming to was green. Had the baize been red his aura would 
probably have been red. Had he been looking up instead of down 
perhaps he would have had no aura. Another case fell striking 
her occiput severely, became unconscious, and awoke in an attack 
— the first one. Thereafter each attack was ushered in by pain 
in the occiput. 

These illustrations serve to show, I think, that the psycho- 
neurotic symptom is an end-product only and that it may be varied 
to any extent, even removed, without affecting the underlying 
condition out of which it grew and which made it possible. Just 
as the old psychiatrists sought patiently in the autopsy-room for 
the solution of the insanity riddle without appreciating that they 
were dealing only with end-results, so the psychotherapeutists 
have for long been using suggestion without appreciating the 
necessity of going deeper than the surface in attacking the 

Psychoanalysis aims to avoid this superficiality and to go to the 
root of the whole matter and disclose fully the mechanisms upon 
which the symptoms depend. In order to explain how this can 
be done a few words are necessary to outline a little further some 
of the mechanisms of consciousness and the theory of these 
abnormal mental reactions. 


The field of full, clear, conscious awareness is a relatively 
restricted one. A mental act repeated a few times tends to be- 
come automatic, to retire from the full light of attention so that 
consciousness may occupy itself with new adjustments. The 
example of the piano-player (Chapter I) is a good illustration. 
The painfully conscious attention to every detail during the period 
of learning is later substituted for a nonchalant, quasi-automatic 
production of a piece while engaged in casually carrying on a 
desultory conversation. Clear consciousness only arises at points 
of conflict, at times when new adjustments are to be made. All 
other acts tend to sink into the dimly lit, twilight regions from 
which the focus of attention has been removed. 

The majority of our acts then are controlled from this un- 
aware region of mind, relatively few being directed from the 
field of full, clear, conscious awareness. Let me give an example 
to illustrate this and how clear consciousness only arises under 
the necessity of a new adjustment. A lady to whom I had 
occasionally to address a note had asked me to address her by 
her given name and middle initial rather than the way I had 
been addressing her. I had occasion to write to her several 
times but did not comply with her request. She called me to 
account for not doing so and thus forced me to discover why I 
had not. In analyzing the situation I found that each time I 
had written to her I had had a distinct feeling of conflict, when 
I came to address the envelope, without being fully conscious of 
the reasons for it. Further analysis showed the components of 
this conflict to be a knowledge that there was another person by 
the same surname in the apartment where she lived, and, while 
I knew my letters had never heretofore gone astray, I did not 
know the other person's given name, and thus felt the possibility 
that they might be the same; then the name I was requested to 
use called up a painful memory which I automatically escaped by 
not using it. These inhibitions naturally interfered with carrying 
out the request and I went on following the line of least resist- 


ance, controlled by the subconscious motives. By bringing the 
whole matter fully to my attention, into clear consciousness, a 
new adaptation, a compliance with the request, became possible. 

This example is a very good illustration of the mechanism as 
we see it in the psychoneuroses, for we must remember that there 
is no difference in nature between the mechanisms of health and 
disease. The psychoneurotic suffers from just such a disintegra- 
tion of the elements of his personality. Certain mental states are 
not adequately synthetized. These are the disagreeable expe- 
riences of life. The mind in self defense endeavors to crowd 
out, to relegate to the limbo of the forgotten, experiences and 
memories that are painful. These experiences are, so to speak, 
put aside, pushed into a dark corner, into the obscure regions of 
consciousness outside of the focus of the bright light of attention. 
To be technical, they are repressed. If repression has been 
accomplished, however, it is not without a certain cost. These 
experiences, crowded out of clear consciousness, out of the possi- 
bility of synthesis with the rest of the personality, begin to lead 
a quasi-independent existence. They constitute submerged 

The complex, crowded out of relation with the personal con- 
sciousness, seeks for expression and because it is not synthetized 
with the rest of consciousness, because the individual is not aware 
of its existence, its expression cannot be controlled and guided 
into the usual channels and so it creates the symptoms of the 
psychoneurosis. One of my patients suffered from accesses of 
anxiety and fear without apparent cause. A short time before 
her husband had been on a " spree " and one night got up about 
two o'clock to go out. His wife was frightened for fear in his 
condition he would associate with lewd women. The thought 
was so hateful and painful to her, however, that it was crowded 
out of consciousness. The detached emotion continued to mani- 
fest itself even though the reason for it was not permitted to 
enter her mind. 


This is a relatively simple example but shows quite well that 
the feelings of fear this patient had and which prompted her to 
throw herself out of the window could not have been reached by 
suggestion. The mechanism on which they were dependent must 
first be uncovered before there was any hope of dealing adequately 
with the situation. 

The extreme difficulty in locating and uncovering the complex 
is due to the symbolic form in which it usually manifests itself. 
The painful memories of disagreeable experiences, unethical, un- 
conventional, and otherwise impossible and hateful wishes, while 
crowded out of mind by what Freud has so aptly termed "the 
censor of consciousness," nevertheless struggle to find expression. 
The complex cries for recognition, the censor will have none of 
it — the fight is on, the conflict wages, until finally a sort of com- 
promise is reached by permitting the complex to come into clear 
consciousness, but only on pain of not disclosing its true self, 
under the cloak of a complete disguise. 

For example Freud's case of Elisabeth. 3 She was engaged in 
nursing her sick father who afterwards died. One evening, 
spent away from home at the solicitation of her family, she met 
a young man of whom she was very fond and he accompanied 
her back home. On the walk home she quite gave herself up 
to the happiness of the occasion and walked along oblivious of 
her duties. On reaching home she found her father much worse 
and bitterly reproached herself for forgetting him in her own 
pleasure. She immediately repressed this disagreeable thought 
from her consciousness. Now she had, each morning, to change 
the dressings on her father's swollen leg. To do this she took 
his leg upon her right thigh. The suppressed complex seized 
upon the feeling of weight and pain of her father's leg upon her 
thigh as a handy and efficient means of expression and so the 
repressed erotic wish comes into consciousness under the disguise 

* Freud: Selected Papers on Hysteria and Other Psychoneuroses. Jour. 
of Nerv. and Ment. Dis., Monograph Series, No. 4. 


of a painful area of the right thigh corresponding in extent and 
location to the place upon which she rested her father's leg. 

From the situation as presented thus far two problems are 
immediately suggested. First, of course, the therapeutic prob- 
lem; and secondly, the problem of uncovering the submerged 
complex, of discovering the hidden mechanisms of the psycho- 
neurotic symptoms. They are the problems of psychotherapy 
and of psychoanalysis. Let us take the latter first. 

When we have a case that we have decided to try psychoanalysis 
with, the first thing to do is to have a detailed talk with the patient, 
covering the manifestations of the disorder and also touching 
the main events of the entire life as far as possible. We must 
remember that the symptoms with which we have to deal are only 
end-products — the results, perhaps, of a mechanism that seems 
fairly simple, but in the last analysis they are results made pos- 
sible by all that has gone before — the entire psychic life of the 
individual. Our initial talk, therefore, serves not only to give us 
an account of the symptoms but to orient us with regard to the 
general makeup of the personality with which we have to deal. 

During the course of this conversation it is inevitable that cer- 
tain points will stand out as being important to pursue further. 
Here begins the real problem of psychoanalysis. 

The method of procedure, the so-called method of free asso- 
ciation, is roughly as follows : The patient needs to be alone 
with the physician in a room as far as possible from distracting 
influences — noises, bright lights, etc. To this end, too, the patient 
should be disposed as comfortably as possible so that physical 
discomfort or uneasiness will not interfere. It is well to have 
the eyes closed also, so that distractions from the visual field may 
be eliminated as far as possible. This general state of quies- 
cence, and passivity can be enhanced by having him observe some 
monotonous sensory stimulus that dominates the sensorium and 
shuts out less insistent and inconsiderable sensations, such as the 
buzzing of a faradic coil. In this condition the particular feature 


of the history that it is desired to pursue further is presented to 
the patient, and he is asked to hold that event before his mind, 
to make no mental effort of any sort, such, for instance, as trying 
to remember, but to tell absolutely every thought that comes to 
his mind, no matter how fleeting, no matter how inconsequential 
it may seem or no matter how little bearing it may appear to have 
on the question at issue. 

The theory of this procedure is that if the patient does not 
direct the thought in any way, every idea that comes must of 
necessity have some relation to the event held before the mind 
about which enlightenment is sought. The monotonous sensory 
conditions are observed to prevent distracting influence from 
outside sources. The directions to the patient, if carried out, 
prevent distractions from inside sources. 

It is difficult to secure this condition of passivity in many cases, 
especially those who have never consciously used their minds and 
therefore do not know how to comply with the directions. It is 
difficult to get the patients to tell all the ideas that come. They 
naturally refrain from mentioning those that appear to be entirely 
fortuitous and to have nothing to do with the case. It will be 
seen from the theory, however, that these ideas cannot be unim- 
portant, and that they must bear some relation to the central event. 

This is the method of attack to fill out the information acquired 
in the initial conversation. The symptoms should all be dealt with 
in this way for the purpose of uncovering the submerged com- 
plexes and disclosing their mechanisms. As we proceed new 
events will constantly be brought to light that must also be pur- 
sued, as must also all the significant events of the patient's life. 

Nothing is too trivial to be worthy of analysis, nothing but may 
throw light upon the situation. All the little slips of the tongue, 
forgotten incidents, points at which two recitals of an occurrence 
do not agree, even witticisms are necessary to trace out, while the 
dream life offers an abundance of rich material for study. Let 
me give an example from a case I have been recently studying. 


A young lady, refined, educated, and modest, entered a ball-room 
at a country club, from the piazza where she had been strolling 
with a gentleman with whom she was in love. She wore a bril- 
liant diamond star at her breast. A gentleman stepped up to her 
and admired the star whereupon she said : " Yes, the stars are 
always brightest in the milky way." Immediately realizing what 
she had said she retired, confused and blushing and filled with 
apprehension as to what the gentleman would think of her. 
Analysis of this gaucherie showed that while walking on the 
piazza with her lover they had been observing the stars. They 
had picked out the big and little dipper and she had remarked 
that the stars were brighter in the milky way. Meanwhile a 
popular song was being played " Love Me Only," and her lover 
told her that her eyes were the only two bright stars in the world 
for him. She was frequently told she had bright eyes and now 
thinks of herself at this period of her life as having had bright 
eyes. Incidentally she knew how to use them. She was wearing 
a diamond ring given her by her lover on her birthday. She evi- 
dently regarded it as an engagement ring for she wore it on the 
engagement finger. She told him the ring reminded her of a star. 
He told her that she was so good and kind that she would have 
a good many stars in her crown. At this point I tried free asso- 
ciation, and she told me of a time when a friend had written her 
destiny to be opened ten years afterwards and read. This destiny 
pictured her at twenty-six with three children, the youngest a 
bright blue-eyed baby. She recalls also that her lover wrote a 
poem to her called " My Star." It is significant that her lover 
had bright blue eyes, that she always associated blue eyes with 
him, that she dreamt of blue-eyed children, that once when hold- 
ing the blue-eyed baby of a neighbor her lover had said to her, 
" You make a pretty picture. Blue-eyed babies are becoming to 
you." It is also significant that in the word associations her reac- 
tion to the word " sky " was very long, 4.6", the preceding reaction 
being 4" long, because it evidently was significant, while the sub- 


sequent association which was evidently indifferent was 3". Her 
response to the word "sky" was "beautiful blue" and on repeti- 
tion, " blue, sunny blue sky." 





Pet I had once. 


To talk, 


I've always loved to talk. 




Carriage at home. 




Beautiful blue. 

Blue, sunny blue sky, 





No matter which way we turn we are confronted by love, mar- 
riage, bright eyes and blue-eyed babies. I think the explanation 
is fairly apparent. It meant a wish, concealed in the remark, to 
belong to her lover and to have beautiful, bright, blue-eyed babies 
of his at her breast. 

We must never forget, too, to investigate the dream life. Freud 
has shown that the mechanism of dreams is quite the same as 
that of the symptoms, so we may expect to get valuable informa- 
tion from this realm. The method of procedure is the same. 
The patient quite likely will deny dreaming at all at first but pur- 
suit of the inquiry may very well disclose a rich dream life. The 
dreams are especially valuable and often throw a great deal of 
light on the situation. To illustrate from the same patient: She 
told me she dreamt she was standing by the edge of a precipice, 
a man came along and pushed her off, at the base of the cliff was 
a mass of writhing serpents, just as she was about to fall among 
them she screamed and awoke. The impression was created on 
listening to her tell of this dream that she had been much fright- 
ened at being pushed from the cliff. This, however, was but the 
elaboration of the waking consciousness. She was not frightened 
to any extent. The analysis shows why. The cliff was familiar 
to her as being a place she frequently visited. Standing on the 
edge of the cliff was symbolic of a social and moral danger. She 
had never seen her lover since she had married and had wondered, 
if she were thrown with him, if he would try and tempt her. The 
man who had pushed her off the cliff was her lover and the falling 


down really representing a moral fall, did not really frighten her 
very much, but was rather pleasant as it involved his companion- 
ship. As she nears the bottom, however, she sees the den of ser- 
pents. The serpent for her represents sin and recalls the sin in 
the Garden of Eden. Her fall has been pleasant until she sees 
its end in sin. This end is so hateful to her that she cannot even 
permit the idea to enter her thoughts. The censor of conscious- 
ness, lulled by sleep, has permitted this symbolic wish-fulfiling 
play to go on up to this point, but now he must be aroused to full 
activity and press back to the furthest and darkest recesses even 
the suggestion of a sinful denouement. The patient awakes. 
See how full of information such a dream is of the innermost 
thoughts, inclinations, and desires (Chapter III). 

This is the method of unraveling the tangled network of mental 
life. It takes weeks, months, perhaps years of constant effort. 
There is no royal road, no short cut to results. What it has taken 
a life time to produce cannot be laid aside in an hour. How dif- 
ferent a conception dominates this method of procedure from 
that of the method of suggestion. 

At times in the course of the analysis it seems as though no 
further progress were possible. At these points, and perhaps also 
to start with, just after the initial conversation, it is well to try 
some word associations. This is done by taking the reactions to 
a list 4 of say one hundred words carefully chosen to cover the 
ordinary field of the average person's possibilities of complex 
formation. There may be distributed through this list words that 
for some reason may be supposed to have significance. 

The method of procedure is to read the words to the patient, 
instructing him to answer immediately the first word or thought 
that comes to his mind after hearing the word read, and recording 
the time it takes for this reaction. The most practical way for 
recording the time is by a stop-watch graduated to fifths of a 

*For such a list see White: Outlines of Psychiatry. Jour, of Nerv. and 
Ment. Dis., Monograph Series, No. 1. 


second. After the list has been completed it is repeated in the 
same way, the time need not be recorded, however. The patient 
is asked to repeat the same associations he gave the first time if 
he can recall them. 

When one of the words in the list touches a complex, is a com- 
plex indicator, a marked disturbance in the reaction is noted. 
This disturbance shows in several ways : peculiarity of the type 
of reaction ; increased length of reaction time ; irradiation of the 
disturbance to the next one or two associations; and failure to 
repeat the same association. I have already given some illustra- 
tions. I will add another at this point. The association to the 
word "wagon" in the same patient I have been giving illustra- 
tions from, was "wagon, many I see on street," but took 11.8". 
Free association disclosed an escape from a sanatarium and a 
drive in a wagon, which she had come up with on the road, to her 
friends. Another patient I casually gave a few words to. Know- 
ing that her mental breakdown was associated with the stealing 
of jewelry by her nephew, I included the word " pin." She could 
not reply but said she could if the word were medal. She then 
flushed, began to cry, and detailed an incident when her sister 
had left a medal in her room and upon returning discovered it was 
missing. It was quite evident that her nephew had stolen it. 
She had never told of this incident although repeatedly questioned 
with a view to discovering all the things of importance in her 
history. Both of these instances illustrate the uncovering of 
events in the lives of patients, which although in these particular 
examples might not have been of much importance, still would 
probably never have been brought out by ordinary questioning. 
This method is valuable then for with it we may find some unex- 
pected complex or some new line of inquiry, that we can continue 
with to advantage. 

The method of word association is often just a "fishing expe- 
dition " in the hopes of catching something and the list of words 
generally used is chosen to cover as wide a field as possible of 


experience. Oftentimes, of course, words may be introduced 
that are thought to be suggestive by the examiner. 

It will probably occur to many to wonder how it is that we can 
expect to find memories reaching back for years sufficiently well 
preserved to be helpful. As a matter of fact the memories of all 
repressed experiences are perfectly clear, no matter how old. 
The explanation for this is that being repressed they are disso- 
ciated from the every-day events of life, they are kept in their 
original form, they have not been subjected to the attrition and 
amalgamation with the intricacies of associational life. They do 
not fade out by this process of absorption as do the memories of 
indifferent events, but remain where ever after they may be 
brought to light by analysis and used as helps for cure. 

Thus we have three main inquiries, three avenues of approach 
to our psychoneurotic patient — word association, free association, 
and the analysis of dreams. With these at our disposal possi- 
bilities, heretofore little expected, open up. 

It will be seen from this short description what a far-reaching 
method this is. A method of analysis from which no event of 
life, no matter how apparently trivial, is free. A method that in 
its results lays bare not only the immediate antecedents and 
causes of the symptoms, but the whole innermost life of the 
patient reaching back even to the period of early childhood. This, 
of course, takes time. A case of any complexity and difficulty 
quite generally takes several months, of at least two or three 
seances each week, to reach a final result. 

The element of time is an important one for more than one 
reason. In the first place, it may, and does, largely preclude the 
possibility of the general use of this method by the average practi- 
tioner. It should not, however, lead to adverse and destructive 
criticism of the method for that reason alone, as it has done in 
some instances. If the psychology upon which the method is 
based is true, we must of necessity accept it whether it meets with 
our convenience or not. Then it is rather silly after all to have 


a scientific position condemned because to carry out the resulting 
methods takes too much time. An effort might legitimately be 
made to improve upon the method, but truth does not yield to 
attack based upon such principles. 

There is some reason to believe, however, that the time needed 
to effect lasting results in this class of cases cannot be materially 
shortened. These cases come to us in a sea of trouble, tossing 
about blindly and hopelessly on the waves of emotion, far from 
shore and safety, resigned often to a life of suffering, desperate 
often at seeing no hope of release, but quite unable to help them- 
selves at all. Of course, in the nature of the case, the real trou- 
bles — the buried complexes — not only are not known by the pa- 
tient, but they cannot be known, and the obvious explanations 
for the symptoms that the patient often has ready at hand, not 
only are not the real explanations but they cannot be. Never- 
theless, the original repressions and the dissociations in conscious- 
ness resulting are quite characteristically due to a false attitude 
towards the problems of lfe. The young woman, in love with 
some one of whom the father disapproves, may have a fleeting 
thought that the father's death would straighten matters out and 
enable her to marry without further opposition. Now, instead 
of reacting to such a thought naturally, by realizing that as a 
conscious human being such a thought was merely an expression 
of her wish to marry the man she loved, by the expression of a 
natural desire that the obstacles in the way be removed, and put- 
ting it quietly and without passion aside as impossible of con- 
sideration because of its unethical character, in fact unworthy of 
even contemplation, she becomes terribly horrified that such a 
thought could even find entrance to her mind and represses it 
immediately as not only too horrible for consideration, but with 
a sense of chagrin, shame, and self-reproach. Such a putting 
aside, side-tracking of a disagreeable thought, such a refusal to 
meet an unwelcome guest in the open, frankly, such a refusal 
even to see the disagreeable does not make for effiecient reaction, 
does not enable the individual adequately to adjust. 


These patients come to us with no adequate philosophy of life, 
no raft with which they can safely reach shore in their sea of 
trouble. They have narrow, distorted, perverted view-points, and 
these it is necessary fully to appreciate in the course of the anal- 
ysis, for these must be corrected. They cannot be corrected by 
a pronunciamento, by laying down what the analyzer believes to 
be the law and the gospel on the different questions involved, but 
must be slowly changed by a process of reeducation in which the 
personality of the physician and his attitude towards the whole 
situation plays a prominent part. And herein lies the importance 
of the element of time. 

This reeducation of the patient is dependent perhaps more upon 
the attitude of the physician than upon any particular thing he 
may say. The personality of the physician plays a certain role. 
Whereas, theoretically, his personality should be nil in its effects, 
if the method were accurate, still the method is not perfect and 
has to be carried out by human means. The patient, before the 
analysis has proceeded far, sees that to go on means to bare his 
very soul. One does not confess his innermost thoughts to every- 
one; the hysteric, for example, is not impelled to unburden him- 
self of his story to the passer-by like the Ancient Mariner. Quite 
the contrary. The whole trend of his malady is toward conceal- 
ment, repression. The personal characteristics of the physician 
do, I think, play some part, although I am willing to admit that 
this part is less in proportion to the perfection of the method. 

Now as to the physician's attitude. In the first place his atti- 
tude should be one of absolute lack of critique. The physician is 
merely after facts, for by the analysis he hopes to help the patient 
by removing the symptoms. He will in the course of his analysis 
hear many intimate thoughts, learn of many wrong, perhaps dis- 
gusting or even criminal acts. He should express no surprise. 
They are but facts, that is all. The patient must not be blamed 
or laughed at. He has already done that for himself many times. 
In fact that is often the trouble. Self-blame may have been the 


cause for the original repression. His moral sense is already 
keen, in fact, perhaps, too keen, and an element of prudery or 
over-scrupulousness must be removed for a more healthy attitude 
of mind. 

Sympathy is likewise not to be indulged in. The patient does 
not want it and it is not helpful. The attitude of the physician, 
however, has as an element the most important factor in sympa- 
thy — understanding. To be understood is indeed a privilege. 
For years the psychoneurotic has failed of being understood, has 
refrained from talking to persons about himself, perhaps, after 
one or two disagreeable experiences, for fear of being laughed 
at. In fact, he has failed to understand himself. Now to find 
some one who does understand — what a relief — and it is helpful 
in no small degree in the progress of the work. 

The demands upon the physician are very great. Not only 
must he have no end of patience, and be able to give a great deal 
of time, but he must be constantly on the alert to grasp every clue 
and must be always resourceful in the face of the unexpected. 
For example, a woman suddenly injects a query as to the sinful- 
ness of preventing conception. Here is an opportunity for moral 
orthopedia to be grasped, it must not be allowed to slip by. It 
requires, however, full preparation, full preparedness. In the 
particular case I have in mind a great deal of the emotional depres- 
sion hinged about this question. It was necessary to discuss it, 
but by no means was it easy to do so. A discussion of such a 
subject, if it is to be helpful, requires a view-point free from all 
narrowness, free from petty dogmatism, religious or otherwise, 
broad, comprehensive and above all humanistic. 

I am reminded in this connection of a recent experience. A 
woman of education and refinement told me in the course of an 
examination of a sexual experience in early childhood. She never 
had told anyone else in her whole life about it and it was with 
the greatest difficulty she could bring herself to speak of it. 
When she had related it to me, however, I was able at once to 


correlate it with certain pre-nuptial practices carried out by the 
women of certain savage tribes, and indicated to her how this 
experience was an instinctive carrying out by children of practices 
that were well developed by savages. This correlation was help- 
ful in enabling a discussion of the occurrence from a social stand- 
point and did much to rob the event of that disgust which is so 
frequent and disturbing an element in the recollection of such 

It is these elements in the attitude of the physician — his lack 
of critique, and his understanding — that are the quiet determi- 
nants making through the weeks and months of psychoanalysis 
for a more wholesome, a more robust philosophy of life, and 
finally when all the submerged complexes and the mechanisms of 
the symptoms have been uncovered our patient emerges literally 
born again. The disordered material which the patient brought 
to us has, if we have been successful, been sorted over, re-arranged, 
added to, and built into a new and enduring structure. Such, in 
brief, are the theories, the methods, and the aims of psychoanalysis 
as a psychotherapeutic agent. 




The field of mental medicine, which by the way is much broader 
than that implied by the term insanity, with which it is ordinarily 
supposed to be coextensive, is generally presumed to offer little 
either as a result of treatment or prophylaxis. It will be my 
object in a few words to try and dispel this impression — to bring 
a message of hope. 

There are many causative factors that may operate to unbal- 
ance the mind. In fact there are but few cases that come to us 
but owe their condition to several rather than to one cause. 
Many of these causes are familiar and well recognized. Such 
causes as the infectious diseases, such as typhoid, yellow fever, 
malaria, smallpox, diphtheria, I need not mention. The work 
that is being done in controlling infections of this character nat- 
urally controls also the mental sequelae that are not infrequent. 
I may say in passing, however, that important as is the problem 
of tuberculosis, and little as I would desire to minimize that 
importance, still I am of the opinion that the two venereal dis- 
eases, syphilis and gonorrhea, produce quite as much suffering 
and I am sure that the former alone produces much more insan- 
ity, directly at least than tuberculosis, and further, while the ten- 
dency of tuberculosis is, to a considerable extent at least, to weed 
out the unfit, here is a disease the distribution of which is con- 
trolled by accident and so it takes from us only too often the 
most useful and efficient members of the community while the 

1 This chapter, in an abbreviated form, was read at the annual meeting 
of the American Public Health Association in Milwaukee in the summer 
of 1910 and is published under the same title in the Jour, of the Am. Pub. 
Health Ass., February, 1911. 



latter disease sterilizes many a woman who would make a good 

The venereal diseases, particularly syphilis, are of extreme im- 
portance in the causation of insanity and come directly within 
the province of the public health officials. Of equal importance, 
though having directly sociologic as well as medical bearings, is 
alcohol. Alcohol and syphilis taken together are generally re- 
garded as being responsible for 25 per cent, of the insane. 
Although at first sight this statement is alarming on second 
thought it is reassuring because both of these causes are strictly 
preventable. 2 

However, it is not my intention to treat here with matter of 
this sort but rather to call attention to some opportunities for 
the utilization of preventive principles which are less obvious. 

These preventive principles have to do with those mental dis- 
orders that are not primarily dependent upon physical disease. 
There are a host of such disorders that are dependent to a greater 
or less extent upon purely psychological factors — mental causes. 
The individual at some point or other comes into conflict with 
the conditions about him, in which he must live, and to which 
he must adapt if he is to proceed in life with anything like effi- 
ciency and he fails to make the necessary adjustment. He is 
unable, for example, to reach a condition of emotional calm after 
the loss by death of a dear friend or relative, or after a disap- 
pointment in love; he cannot get on his feet again after being 
ruined by a trusted employe; he is placed in a position of too 
great complexity for a limited mental equipment and cannot pro- 
duce results that are up to reasonable expectations. At these 
periods of conflict failure is not infrequently expressed by the 
development of a psychosis. Failures of this sort, the inability 
of the individual to square up with the events of every-day life, 
upon analysis are found to depend largely upon faulty and erro- 

2 Salmon, Thomas W., M.D. : Two Preventable Causes of Insanity. Pop. 
Sci. Monthly, June, 1910. 


neous view-points, upon vicious habits of thought, upon narrow 
and inadequate ideals, false notions and ambitions, in short upon 
a biased mental attitude towards the world of things and events. 

Here are a series of conditions which strike one immediately 
as due in the larger sense to bad education, and in fact they are. 
The conflicts which arise, arise in large part because the mind 
has been so constituted by previous experience as to make con- 
flicts out of certain kinds of circumstances rather than to adjust 
peaceably. Take for example the man who is always criticising 
every one about him, this thing and that are wrong, his superior 
in rank should have done thus and so, he would have done differ- 
ently, etc. That man makes the greatest amount of trouble for 
himself, he positively insists upon being unhappy, instead of 
accepting conditions which he cannot change and making the best 
of them he frets and chafes under them, he actually looks for 
things with which to find fault, he positively will not be content 
in the sense in which contentment is desirable. Such a man is 
inviting disaster by using up his energies in a useless thrashing 
about usually without the corrective of that satisfaction which 
comes from things accomplished. The young woman, of a dis- 
tinctly different type, who develops a hysteria as the result of a 
disappointment has actually succumbed to a psychosis because of 
her failure to accept — to adjust. Instances might be indefinitely 
multiplied but the fact I mean to bring out is that numerous psy- 
choses are dependent upon mental causes which in their nature 
are removable or preventable, and subsequent attacks after re- 
covery may be produced in the same way. 

People such as these, who present characteristics unfitting 
them for a peaceful adjustment to the difficulties of every-day 
life owe their defects to faults of education — by which term I 
include all that life of experience which is addressed directly or 
indirectly to the preparation for the independent life of adulthood. 

The places where this education is for the most part acquired 
are two — the school-room and the home. Let us speak for a 


moment first of the home. The fundamental fact here is that 
the important groundwork of later life is laid much earlier than is 
ordinarily supposed — perhaps in the first four or five years of 
life, and this is the period in which no one will question that the 
mother's influence is supreme. Home conditions during this 
period are therefore most vitally important for the future. I 
will not mention the obvious effects of sickness, crime, alcoholism, 
all of which go to make a sordid, wretched place for the child 
to grow up in, but call your attention to two matters of impor- 
tance. Child labor and the employment of women. 

We cannot expect much of the generation the children of which 
were brought up in the mines and factories. Child life that is 
deflected into hard labor and unsanitary health-destroying sur- 
roundings when it should be unfolding and developing character 
in school, home and play must become deformed and stunted. 

These industrial conditions have gone even further than placing 
the child at labor. The mother, too, has found her way in large 
numbers into the factories, so that again the child is robbed of 
its own and not only he but the generations to come must pay 
the toll of this greed for gold. 

It has been shown that hard work by the pregnant woman tends 
to bring about miscarriages, or if the child is born at term, to 
result in a poorly, undeveloped child. The energy which should 
have gone to the growing child has been deflected to the loom. 
Children born under such conditions must of necessity be seriously 
handicapped; they must find the difficulties of life often too great, 
so what wonder that later they break down, become insane, 
paupers, criminals, it matters not for all these are evidences 
primarily of mental defect, mental insufficiency, inability to meet 
life's problems. I am in hearty sympathy with laws governing 
child labor and the employment of women. The laws governing 
the employment of women that are in existence in most of the 
European countries seem to be well conceived. They provide 
for a certain number of weeks both before and after confinement 


free from labor with the salary continued. They are a healthy 
reaction against the too great individualism of the present day 
and an acknowledgment that we owe something to those others 
in whose society we live and from which we derive so much. 
The day is past when the individual will be conceived to have 
the right to ruin as many souls and bodies as he wishes and then 
toss them ruthlessly aside on the dump heap of public charity for 
this and succeeding generations to care for. 

A propos of this question of the child and the home Miss Dorr,* 
in a recent magazine article, has emphasized the present condition 
of affairs by calling attention to the lack of provision for the 
child in the modern city. There is literally no place for him. 
There is no ground for play and many apartment houses even 
refuse families with children. Then again the conditions that 
used to maintain in the home have changed. In the old days the 
child not only could run wild in the woods but he was early 
initiated into some form of wholesome craft work. Now, it is 
the immense factory, and if the family be poor both child and 
mother work there, while if they be rich or well-to-do the child 
slowly becomes an artificial product of civilization with all the 
animal trained out of him and neither he nor the mother have any 
form of wholesome physical occupation. 

A great deal is said about the strenuous life of the present day 
as a cause of neurasthenia but my experience is that more people 
become nervous because they have nothing to do then because 
they have too much. The man is relatively well off and he may 
always have work to do, but for the middle class and well-to-do 
woman there seems very little. Everything she needs can be 
supplied better and usually cheaper than she can produce it. 
With practically nothing to do, with time hanging heavily upon 
her hands, she ekes out a miserable existence of dreams that don't 
come true, of ambitions unrealized, of lack of fulfilment — in short 

8 Dorr, Rheta Childe: A Fighting Chance for the City Child. Hamp- 
ton's Magazine, August (?), 1910. 


of failure. These are the potential neurasthenics and it is against 
this hopeless, useless existence that so many of our women have 
to lead that the so-called suffragette movement is to my mind a 
healthy reaction. 

At this point I cannot fail to mention that recent development 
of the desire for race betterment — sterilization of the criminal. 
It is very hard to find any justification for such legislation unless 
it be the good intention back of it and we all know the fate of 
so many good intentions. The only basis on which I can conceive 
that such legislation might be founded is on that of the theory of 
unit segregation and gametic purity as set forth by followers of 
the Mendelian hypothesis. I have never heard the suggestion of 
any such reason but even so this theory has already been vigor- 
ously attacked and there seems little warrant for such applications 
of hereditary principles. 

The whole question of heredity is altogether too vague in its 
application to man to warrant any such radical measures. Per- 
haps the matter of heredity might be summed up best in the 
characteristic chapter heading of Ellen Key 4 in her admirable 
book, " The Century of the Child," as " the right of the child to 
choose its parents." This is not a witticism but involves a funda- 
mental privilege which is rarely consulted. How frequently in 
this super-sensitive civilization of ours are the rights of the next 
generation given consideration ? How often is the bringing of a 
new soul into the world given as much consideration as the canary 
or the selection of a suitable paper for the dining room? Why 
we are not even permitted to talk of such things. A salacious 
prudery which fills columns of the public press with the descrip- 
tion of the seduction of a young girl insists upon a becoming 
modesty in such matters that relegates the question of human 
breeding to the background. 

It is well to keep in mind that the symptoms of that group 

4 Key, Ellen: The Century of the Child. G. P. Putnam's Sons, New 
York and London, 19x19. 


of mental disorders comprised under the general term insanity 
are acquirements. Whatever potentialities the germ may have 
had these symptoms have been added to them and not developed 
as an innate necessity — at least in the special form they assume. 
The full possibilities of the influence of environment are only 
beginning to be appreciated. If a change in environment will 
actually change the shape of the skull in one generation, as has 
been recently shown by Professor Boas, what may we not expect 
from hygienic surroundings and proper educational methods? 

Passing from questions of heredity and other factors that are 
uncontrollable in the individual, let us consider the difficulties that 
arise in the course of mental development. 

I can approach this question by asking why it is that only in 
adult life do dreams become symbolic and thus hide their real 
meaning from us. The answer to the question is the crux of the 

The child in his wish-fulfiling dreams, be they sleeping or wak- 
ing* goes direct to the point unhampered by conventions, unre- 
strained by social customs or the fear of disapproval. He knows 
nothing of these things. The adult on the contrary has become 
so painfully conscious of them all that he even disguises them to 
himself, he is afraid to acknowledge them to himself and so 
clothes them in a complex symbolism. At least so goes the theory. 
What has happened in the meantime? Education. 

One need not be disturbed by this use of the word education. 
Remember that this term includes all that life of experience 
which is addressed directly or indirectly to the preparation for the 
independent life of adulthood. From our standpoint let us see 
some of the things this process implies. 

The whole process of education has to do very largely with the 
building up of certain attitudes of mind towards the usual expe- 
riences of life. 

As has been seen, acts have been divided into reflex, automatic, 
and voluntary. But this by no means exhausts all their possibili- 


ties. Many acts result from experiences that have been so fre- 
quently repeated that they issue as a natural consequence under 
certain conditions but by no means sink to the level of the auto- 
matic. The conventional mode of greeting, shaking hands, " How 


do you do, I'm glad to see you," reaction has become so much a 
habit that it does not require the clear consciousness of close 
attention, nor hardly a grade of activity that could be dignified 
by the term voluntary. Conscious volition may initiate the reac- 
tion but once started it proceeds in the usual channels. 

This region of consciousness, beneath the voluntary activities 
but above the automatic activities, it will be recalled, is the region 
which I have called the proving ground for automatisms. It is 
the intermediate state on the way from the voluntary to the auto- 
matic. We are all the time submerging into this territory, the 
ready made mechanisms, as it were, for responding to the ordi- 
nary events of life. The usual occurrences are soon reacted to 
in an habitual, stereotyped fashion. And so with our attitudes 
of mind, we come naturally and unconsciously to be pleased or 
offended, as the result of our education, by the occurrences that 
go on about us. 

Certain types of reaction are common to a large proportion of 
persons, as for example, the admiration displayed for acts of 
physical courage or the disgust felt for acts involving moral turpi- 
tude. On the other hand certain types of reaction vary among 
individuals according to their education and their habitual expe- 
riences. Human excreta generally give rise to feelings of dis- 
gust. In the laboratory man, however, they frequently give rise 
to quite opposite effects. The clinical pathologist is quite capable 
of ecstasies over a urinary sediment which is to him beautiful. 
For the scientific mind the saying that " dirt is matter out of 
place " is quite true and might well be paraphrased to apply to 
the moral sphere. 

This submerged portion of consciousness, whence issue these 
reactions we are discussing, is of great importance so far as the 


activities of the individual are concerned because of its large 
emotional content. Human actions, to the everlasting despair of 
the idealist, are initiated and controlled only to a limited extent 
by reason. The vast majority are more or less automatically set 
in operation by already organized mechanisms which determine 
the attitude of mind de novo towards the experience whatever it 
is. Attitude of mind is essentially an emotional, as opposed to 
an intellectual state and so is rarely subject to review. The whole 
process of education, the results of experience, are considered to 
be successful or not depending upon whether the proper attitudes 
of mind, the proper feeling-tones, emotional states, constellations 
have been cultivated with reference to the experiences of life. 

Education from beginning to end is a process, largely of sup- 
pression. It is the " Thou shalt not " of the Mosaic law that 
dominates at least in childhood. The spontaneous natural im- 
pulses must be repressed and made to fit the mould of the social 
conventions. This means that conflicts begin at once between 
inclination and desire and the restraints that limit the individual 
in carrying out his wishes. Some sort of compromise has to be 
struck that will result in relatively adequate adjustment. When 
we realize that one of the most serious of afflictions, an incurable 
psychosis, may result from a failure to compromise, or from a 
broken compensation, we can see how important becomes the 
study of the laws that govern this process. 

Think what it would mean to be able to appreciate the begin- 
ning of the conflict, to understand the nature of the forces in- 
volved before they had succeeded in impressing the phole psyche 
into service ! Then would be the time to turn the forces aside into 
more useful channels — to sublimate the conflict. 

Pus is a product of the defense mechanisms of the organism, 
but if left to itself may burrow from its place of origin and pene- 
trate a vital organ and so bring about death. The surgeon, by a 
skilful stroke of the scalpel, at the point of election can liberate 
it and without in any way impairing the defenses of the organism 


help to so direct them as to make for health. For the smaller 
and less important accumulations of painful emotion a ready 
outlet is usually found. The woman has her cry, the man roundly 
curses his enemy whom he conjures up before his mind's eye. 
These reactions are more often than not effective. As small col- 
lections of pus near the surface are easily removed so in these 
cases the emotional tension is easily relieved. 

Some of the more serious conditions require more careful 
handling. Talking the trouble out with a confidant is a frequent 
means, while the confessional has through the ages served largely 
as an agent of psychotherapy. Again the psychiatrist must 
acknowledge his indebtedness — this time to the priest. The old- 
time father confessor was wise beyond his generation. 

The aim should be the same in the realm of mind as in the 
realm of body — to direct the natural defenses of the organism. 
The possibilities here are quite as great as in the other depart- 
ments of medicine for not only may it be made possible to direct 
the natural forces, but as the public health officer can so regulate 
conditions as to prevent infection, why cannot the same principles 
be applied to the educator to so form the mind as to do away, in 
part at least, with the possibilities or probabilities of certain kinds 
of conflict? The scheme is an ambitious one, but we are justified 
in dreaming of the possibilities when a new outlook is opened to 
us. When Franklin drew the spark from the clouds he could 
have had no possible conception that within a century that same 
force would be generated by mammoth dynamos and sent miles 
over the surface of copper strands to turn the ponderous wheels 
of factories employing thousands of human beings. Let us dream 
if we will, but let us not forget and consign to oblivion. 

I shall not try to tell you what has been accomplished in this 
direction further than to say in passing that a form of treatment 
has been outlined (Chapter VII), based upon this theory which 
bids fair to produce results otherwise unattainable. The funda- 
mental principle in this treatment is absolute honesty with one's 
1 1 


self. Many of the difficulties, such as I have been discussing, 
come about from a failure to frankly face situations with a result- 
ing effort at self-deception. The first requisite of navigation is 
a compass. To insist upon seeing things as they are not — self- 
deception — is as if the navigator expected to make a certain port 
to the east by steering west. One must know clearly where he is 
going otherwise the means he uses to get there are more apt to 
be ineffectual than not. We have learned that much may be 
accomplished by getting the patient to honestly probe his own 
desires and motives and by getting back to first principles, as it 
were, he can get hold again of the lost threads and so reassemble 
the tangled network of his personality. He can so be given an 
opportunity to begin afresh with a clean record and try again 
from this new vantage ground the problem of adjustment. 

The careful study of individual cases, particularly with a view 
to determine the cause of the breakdown, has given a new impetus 
to the study of character. Although not a very great deal of 
progress has been made in this direction, owing to the extreme 
complexity of the subject, still the problem has been fairly well 
defined. We already feel that there are certain types of char- 
acter that portend danger to the individual possessing them and 
it is our aim, as far as possible, in dealing with the insane, to go 
back in the history of the individual, previous to the development 
of the psychosis, and endeavor to analyze the character make-up 
and determine the factors that led to the break. We hope in this 
way to accumulate that sort of information that will enable us to 
see the danger ahead and teach us the means of averting it. 

A cramming of the mind with information is not education. 
Education should be a process both of unfolding and development. 
Certain habits of mind should be fostered, others need to be dis- 
couraged, to the end not only of bringing out all the latent facul- 
ties, of developing the best that lies within the individual but more 
important still of developing a properly balanced structure that 
will not be forced out of equilibrium by the first breath of 


We have already learned to study the imbecile to determine his 
mental make-up and how he must be approached, what avenue 
offers the greatest prospect of success, if we would develop his 
faculties still further. In the same way, though the problem is 
vastly more difficult, I believe it will be possible to study those 
children who present certain danger signals and so outline their 
education as to bolster up the weak points and perhaps prevent 
hopeless disaster in the future. 

Such a purpose is, I am sure, a worthy one and falls in line 
with the great general principles of preventive medicine. 

One of the inquiries we always make of a soldier or sailor 
boy when he is admitted to the Government Hospital for the 
Insane is as to the number of summary courts-martial he has 
had. This is the simplest and most practical sign of the amount 
of difficulty he has had in adjusting to the service and the charac- 
ter of his conflicts with his new environment. In the same way 
I believe that every boy and girl in school or college who is per- 
sistently inefficient, as shown by their record in class, should be 
the subject of inquiry. It may, of course, only prove to be the 
outcropping of original sin but in practice I am sure it will be 
astonishing how often such an inquiry will develop something 
vastly more serious. 

But to revert to the question of education. Many of the psy- 
choses that later go to the making of the classes of chronic insane, 
criminals, paupers, prostitutes, tramps, and ne'er-do-wells begin 
early in life. They have their incipiency in the school-room 
and in the factory, they develop often under the very eyes of 
the teachers and, too, of the school and factory physicians. Our 
studies lead us to believe more and more that these psychoses 
are to a large extent preventable, yet they are only recognized 
when in full bloom and at a time when the possibility of applying 
preventive principles has long since past. They are not seen 
when in the making. 

The reason for this failure to see the obvious is because of lack 


of training of teachers and physicians in what to look for. We 
see what we have learned to look for, few of us see anything else. 

To say nothing of the pedagogic aspects of this state of affairs 
and the training of teachers, we may well inquire into the reasons 
for the neglect of psychiatry by our medical colleges. It is true 
that in the past few years most of the medical colleges have added 
a course on mental medicine to their curriculum, but it usually 
consists only of a few didactic lectures, and almost always is 
considered as a sort of extra subject dealing with a department 
of medicine that the average practitioner will have little to do 
with. While interminable amounts of time are spent in discuss- 
ing the appendix or the gall-bladder the mind is almost totally 
neglected, and yet after all the object of life is a contented, peace- 
ful mind ; in short, happiness to which the body is only secondary. 
The patient who consults a doctor does so because he is in pain, 
worried, unhappy, and yet pain, worry, and unhappiness are 
mental facts. What he really wants is peace of mind to which 
the doctor contributes by making well again a sick body without, 
as a rule, appearing to realize that a mind has been involved at 
any point in the proceeding. How much we hear in our medical 
schools of pathology and how little do we ever hear of mental 
hygiene — of what Seneca has called the "business of a happy 
life." In this respect our medical courses are open somewhat 
to the same criticism as the miser. They fix their attention too 
much upon the means to happiness and in doing so often miss the 
goal by not using those means to purchase the desired thing. 

In all preparations for life there is no suggestion that there is 
anything to be learned about self-knowledge, self-mastery, no sug- 
gestion that there is any light to be shed upon the problems that 
arise within one's self, that it is possible to direct the forces of 
our inner conflicts. We are not taught how to curb the hot bursts 
of passion by passing them in review under the scrutiny of the 
intellect nor how to compensate for the sorrows of life by their 
sublimation through newly awakened interests. All these things 


are left to mere chance. We know much of the efficiency of 
engines under various loads and thought and money unlimited 
have been spent upon making the necessary adjustments. But to 
the development of efficient mental mechanisms to meet the loads 
of adversity we devote hardly a passing thought. 

Incipient mental cases in the community could be reached if a 
regular dispensary service were established as in other depart- 
ments of medicine. Each municipal hospital should have its 
psychopathic ward to which patients could be admitted with no 
further preliminaries than are needed for admitting a patient to 
the general wards with, for example, a pneumonia or a broken 
leg. Each community should have also an after-care society for 
the purpose of caring for patients discharged from hospitals for 
the insane and by helpful instruction and otherwise attempt to 
establish them in the community — and prevent a recurrence of 
those conditions which before led to the mental breakdown. 

A law was passed at the last session of the New York legisla- 
ture that should be of interest. It provides for taking out of 
the hands of the poor authorities the care of the insane previous 
to commitment and putting it into the hands of the health officer. 
This is surely a step in the right direction. Not only are the 
insane cared for by the poor officers in many localities but quite 
as frequently by the police. I will not attempt at this time to 
dwell upon the abuses that have resulted as a consequence but 
only emphasize the fact that the problem of insanity is a medical 
one from beginning to end and that it should be in the hands of 
medical men only. The segregation of an insane person should 
be considered as a quarantine measure and not dealt with from 
the standpoint of criminal law. When this is done, when the 
problem of insanity is definitely turned over to the medical pro- 
fession it will not be long before the value of preventive princi- 
ples will be recognized and efforts made to put them in effect. 

The practical things then that may be done at once in any com- 
munity are these : 


1. The securing of legislation that places the responsibility for 
the care of the insane previous to commitment in the local health 

2. Every city of 100,000 inhabitants, or over, should have a 
psychopathic ward connected with its municipal hospital which 
is as accessible for the mental case as the other wards are for 
general medical and surgical cases. This ward should have an 
out-patient department. 

3. The organization of an after-care society to assist persons 
who have been discharged from a hospital for the insane to get 
on their feet and to point out to them ways of avoiding the con- 
ditions which led to their breakdown. 

4. The passage of adequate laws for the control of the labor 
of women and children. 

5. Popular education. By the use of this term I am not merely 
dealing in a glittering generality that may mean nothing or every- 
thing. We have in this country nearly two hundred state hos- 
pitals for the care of the insane. These hospitals, each one of 
them, should be a center of information for the community in 
which it exists and its medical officers should use their position to 
spread information about mental disorders. The superintendent, 
or a member of the staff, should deliver one or more popular lec- 
tures each winter to which the public are invited. Much might 
be accomplished in this way if all hospitals would do this. 

6. Field work from the state hospitals and psychopathic wards 
as centers to study conditions under which insanity has developed, 
to furnish assistance to the hospital in dealing with its patients, 
and to cooperate with the after-care society. 

7. More liberal support by city and state of scientific research 
work in this field, especially along the lines of etiology and pro- 

In this connection it may be of interest to know that in 1906 
there was organized at Milan an international committee for the 
study of the causes and the prophylaxis of mental disorders. It 


is the object of this committee to form an international institute 
for the study of the causes and prophylaxis of mental disorders 
and the King of Italy has consented to become the patron of this 
institute. Nineteen countries sent official delegates to this com- 
mittee, but as yet no one of them has made any appropriation to 
enable the work of the committee to be carried forward. 

The possibilities of the application of preventive principles in 
mental medicine are as broad as the multiplicity of human activi- 
ties, as deep as the human soul. It has its medical, sociological, 
economic, legislative, pedagogic and humanistic aspects. Of 
prime importance, however, is the recognition of the problem and 
to this end no one thing is more important, to my mind, than the 
inclusion in our medical curricula of a course in mental medicine 
that shall not be an unimportant secondary affair, but shall be 
on a par in extent and importance at least with the course in 

Twenty-five years ago a claim for the exaltation of mental 
medicine to a position of such importance might well have been 
criticised as unwarranted, but since then no department of medi- 
cine has advanced more rapidly or attracted a relatively larger 
number of able students. The advances in this field and the 
cognate subjects fully warrant such a claim. There is now such 
a mass of well established data in general psychology, child psy- 
chology, pedagogy, psychopathology, and the anatomy and physi- 
ology of the central nervous organs as to make it quite impossible 
much longer to resist the claim of mental medicine to its proper 
place in the medical curriculum and when that time comes the 
mind will be in a fair way to attract as much attention from the 
devotees of public health as does now the subject of infectious 
diseases. We will have learned that a healthy body is of no use 
to the individual or to society unless there dwells within a healthy 
mind. The maxim "Mens sana in corpore sano" will still be 
true but in a sense amplified and vitalized. 

£be Journal 


fterwus ana Mental Disease 


The American Neurological Association 
The New York Neurological Society 
Boston Society of Psychiatry and Neurology 
The Philadelphia Neurological Society, and 
The Chicago Neurological Society, etc. 



64 West 56th Street, New York City 












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Edited by 

Numbers Issued 
i . Outlines of Psychiatry. By Wm. A. White, M.D. 

a. Studies in Paranoia. 

By Drs. N. Oierlich and M. Friedman 

3. The Psychology of Dementia Praecox. 

By Dr. C. G. Jong. 

4. Selected Papers on Hysteria and other Psychonenrosts. 

By Prof. Sigmnnd Freud: 

5. The Wassermaun Serum Diagnosis in Psychiatry. 

By Dr. Felix PI tut. 

6. Epidemic Poliomyelitis. New York Epidemic, 1907. 

7. Three-Contributions to Sexual Theory. 

By Prof. Sigmund Freud. 

8. Mentat Mechanisms. 

By Wm. A. White, M.D. 


Los Angeles 

This book is DUE on the last date stamped below. 

OCT 2 8 1957 

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JUL2 4 1975 


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