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Full text of "The psychology of dementia praecox"

HE PSYCHOLOGY 



OF 



DEMENTIA PRAECOX 



DR. C?'Gf JUNG 



** 

PRIVATE DOCENT IN PSYCHIATRY, UNIVERSITY OF ZURICH 



AUTHORIZED TRANSLATION WITH AN INTRODUCTION 

BY 
FREDERICK PETERSON, M.D. 

PROFESSOR OF PSYCHIATRY, COLUMBIA UNIVERSITY, NEW YORK 
AND 

A! A. BRILL, PH.B., M.D. 

ASSISTANT IN PSYCHIATRY, COLUMBIA UNIVERSITY, NEW YORK 



NEW YORK 

THE JOURNAL OF NERVOUS AND MENTAL DISEASE 
PUBLISHING COMPANY 



1909 



1 



PSYCHOLOGY DEPARTMENT 



Order. 




/7 




Copyright, 1909, by 

THE JOURNAL OF NERVOUS AND MENTAL DISEASE 
PUBLISHING COMPANY 



- 

v , 

y \ 

\^\ 






, 



PRESS OF 

THE NEW ERA PRINTING COMPANY 
LANCASTER. PA 



CONTENTS. 



TRANSLATORS' INTRODUCTION v 

AUTHOR'S PREFACE xix 

CHAPTER I. Critical Presentation of Theoretical Views 

on the Psychology of Dementia Praecox. i 
CHAPTER II. The Emotional Complex and its General 

Action on the Psyche . . . .36 
CHAPTER III. The Influence of the Emotional Complex on 

Association 50 

CHAPTER IV. Dementia Praecox and Hysteria, a Parallel. 69 
CHAPTER V. Analysis of a Case of Paranoid Dementia 

as a Paradigm 99 

CONCLUSION 153 




111 



TRANSLATORS' INTRODUCTION. 



To Kraepeliii. belongs the credit of having introduced new life 
into psychiatry by his indefatigable study of his patients for long 
years, his keen clinical insight, and especially by an independence 
of thought which led him to fearlessly shatter the traditions of 
centuries as regards the classification of mental diseases. As a 
pupil of Wundt he was able to apply new methods of clinical 
investigation drawn from psychology. As is well known he has 
brought together mania and melancholia as a single disorder 
under the title manic-depressive insanity. This conception, vig- 
orously attacked at first, has probably come to stay. It is other- 
wise with his creation of dementia praecox, which is still strongly 
objected to in many quarters, chiefly because it seems to be a kind 
of waste basket into which are thrown all forms of mental dis- 
ease that cannot be tagged with another name. This disorder 
appears in so many guises that it is already divided into hebe- 
phrenic, catatonic and paranoid groups, and Kraepelin himself 
has intimated that in time it will be broken up into still further 
groups or types. It is his merit, however, to have placed before 
us this psychological species even if the outlines are gross and the 
details more or less obscure. 

In following Kraepelin we find that he only offers us a general 
and superficial view of the disease. From his description we 
learn that the patients are peculiar in speech and actions, that 
they utter numerous senseless remarks, repeat meaningless words 
or syllables, and that now and then they commit foolish and 
impulsive acts, but no attempt is made to examine the nature and 
origin of these peculiar utterances and actions. When we review 
the cases described in Kraepelin's works we find that whereas 
most of them show hallucinations and delusions, these are not at 
all of the same content or nature; the verbigerations and manner- 
isms, too, differ in different cases. The same similarities and 
divergences are to be noticed in every hospital. We recall a 
patient whose auditory hallucinations were attributed to a child, 



vi TRANSLATORS' PREFACE. 

and another who heard the voice of God. The mannerisms of 
one were characterized by a continuous rubbing on the top of his 
head, while another for hours described certain figures in the air. 
Are these diversities accidental or have they a reason? Is there 
any difference between Kraepelin's patient who saw a blue heart 
up above, and behind it quivering sunshine and another blue 
heart, " a little woman's heart," 1 and the patient who 2 lived by the 
word of God, a raven was at the window who wished to eat his 
flesh; or between the patient who repeated numerous times the 
same unintelligible sentences " one for all and all for one, and two 
for all and three for all," etc., 3 and the patient who speaks about 
" a poinard with a nuptial note " ? 4 The same questions could 
be asked about the manifold so-called senseless actions of patients. 
Kraepelin makes no attempt to explain these senseless utterances 
and actions. In other words, whereas he gives us an accurate, 
almost photographic account of the patient's general behavior, he 
does not enter into his psychological productions. He contents 
himself with noting that the patient entertains such and such hal- 
lucinations and delusions, and such and such mannerisms, with- 
out examining the causal relations. Those who work among the 
insane know that no two cases of dementia prsecox are alike; 
there is always a difference in the grouping and relationship of 
the symptoms, every case having its own individuality. Krae- 
pelin, like his predecessors, totally ignores individual psychology, 
a thing absolutely essential for the understanding of the psycho- 
sis, just as the microscope is for pathology. The present difficul- 
ties in classification are mainly due to a lack of knowledge of the 
influence of individuality without which no real classification is 
possible. 

Bleuler 5 and Jung 6 inaugurated a new epoch in psychiatry by 
attempting to penetrate into the mysteries of the individual influ- 
ence of the symptoms. They show conclusively why we have 
here this combination and there that combination of symptoms. 
In the cases described by them we see that the senseless expres- 

1 Kraepelin : Psychiatrische Klinik, p. 29. 

'Ibid., p. 26. 

8 Ibid., p. 37. 

* Kraepelin: Psychiatric, Vol. II, p. 152. 

5 Bleuler : Affektivitat, Suggestibility, Paranoia, Marhold, Halle. 

*Jung: Uber die Psychologic der Dementia Praecox, Marhold, Halle. 



TRANSLATORS PREFACE. vii 

sions and actions have their reasons. But both Bleuler and Jung 7 
are only pioneers in a new field; they are not the discoverers of 
this terra incognita. The honor of this belongs to Breuer and 
Freud. 

In 1895 Breuer and Freud published the " Studien iiber Hys- 
teric," 8 in which they showed that hysterical symptoms were 
symbolic representations of individual experiences which were 
incompatible with the personality and hence repressed from 
consciousness. This will be best illustrated by an abstract of a 
case described by Freud in the aforesaid work. 9 

Miss Lucy R., thirty years old, had been treated by a specialist 
for purulent rhinitis. Some time after she again applied for 
treatment; this time, however, she suffered from complete anos- 
mia and was almost constantly annoyed by two subjective sensa- 
tions of smell. She was also depressed and anergic, complained 
of a heavy head, loss of appetite and inability to work. As no 
local affection could then be found to account for these symptoms 
she was recommended to Freud. 

Besides the symptoms enumerated above Freud found distinct 
hysterical symptoms. She showed a general analgesia without 
any disturbances of tactile sensation. The nasal mucous mem- 
brane was totally analgesic and its reflexes absent. Freud then 
thought that the subjective sensations of smell and the depression 
were equivalents for hysterical attacks, that those odors were 
once objective and due to some trauma, and that they returned 
to memory in the form of symbols of subjective sensation. But 
in order to assume this theory it was absolutely necessary that 
the subjective sensations of smell should show such a specializa- 
tion as to correspond with the real object of their origin. When 
the patient was asked to describe the odor which annoyed her 
most, she stated that it was like " burned pastry." It was there- 
fore assumed that the odor of burned pastry was probably some 
actual traumatic experience. Her history was uneventful; she 
was a governess, having the care of two children whose mother 
died a few years ago, the father being a manufacturer in the 
suburbs of Vienna. The odor of burned pastry was taken as the 

' Jung : Diagnostische Associationsstudien, Earth, Leipzig. 

* Breuer and Freud : Studien iiber Hysteric, Deuticke, Leipzig und Wien. 

* Ibid., p. 90. 



viii TRANSLATORS' PREFACE. 

starting point for the analysis. Employing the method of con- 
tinuous associations the patient was asked to concentrate her 
mind on the odor of burned pastry and then tell under what cir- 
cumstances it originated. After long and persevering labor she 
finally recalled that it occurred about two months before. It was 
just two days before her birthday. She was with the two chil- 
dren (girls) in the school room teaching them to cook when a 
letter was brought to her from her mother in Glasgow. The 
children grasped the letter, remarking that it was probably a 
birthday congratulation and they would keep it until her birthday. 
While the children were thus bickering they forgot the pastry 
which they were cooking and it was burned. Since that time 
she had perceived that odor almost constantly and it was gener- 
ally enhanced on excitement. When asked why she was then 
excited she answered that " the children were so attached to her." 
They were always attached to her, but just then she received a 
letter from her mother. When asked to explain the contrast 
produced by the attachment of the children and her mother's 
letter, she stated that at that time she had intended to go home 
to her mother and had a heavy heart at the thought of leaving 
the children. To the question why she wished to leave her posi- 
tion, she stated that things were unbearable. She no longer lived 
in harmony with the other servants because they imagined that 
she considered herself too proud for her position. They said 
many things to her employers about her and when she com- 
plained she was not upheld. She then decided to resign and 
spoke about it to her employer. He was quite friendly and 
advised her to reconsider it. It was while she was in that state 
of indecision that the incident with the letter took place. Besides 
that she was a distant relative to the mother of the children who 
on her death bed asked her to care for the children and " take 
the place of their mother." When she was to resign she enter- 
tained many scruples about breaking this promise. 

This apparently analyzes the subjective sensation of smell. It 
was really once an objective sensation and intimately associated 
with an experience in which there was a play of contrary affects, 
the sorrow at leaving the children and the mortification urging 
her to that decision. The letter naturally recalled the motive of 
this decision, because she thought of returning to her mother. 



TRANSLATORS' PREFACE. ix 

The conflict of affects raised this moment to a trauma and the 
sensation of smell which was connected with it remained as a 
symbol of it. The sense of smell is rarely made use of as a 
symbol, but in this case we know that she suffered from a chronic 
nasal affection and just then she suffered from severe coryza and 
could hardly smell anything; in her excitement, however, she 
perceived the odor of burned pastry. 

As plausible as this sounded there was still something lacking. 
Freud asked himself why this conflict of affects should have led 
to hysteria, why did it not remain on a normal psychological 
basis; in other words, what justified this conversion? Previous 
experience showed that in all newly acquired hysterias one psy- 
chological determination is invariable, namely, that some presen- 
tation must intentionally be repressed from consciousness and 
excluded from psychical collaboration. 

" In this intentional repression I also noticed the reason for 
the conversion of the sum of excitement, be it partial or total. 
The sum of excitation which cannot enter the psychic association 
thus finds the way to bodily innervation. The reason for the 
repression can only be a painful feeling. The repressed idea was 
incompatible with the ego. The repressed presentation avenges 
itself by becoming pathogenic." 

From this he concluded that in the moment of hysterical con- 
version there must have been one trauma which she intentionally 
left in darkness. There was only one interpretation. He then 
told her that he believed that besides her attachment for the 
children she also loved her employer. Hesitatingly she answered, 
" Yes, I believe it is true." Asked why she did not mention this 
before she said, " Why, I didn't know it, or rather I did not wish 
to know it ; I wanted to crowd it out of my head, never to think 
of it, and of late I was successful." After this admission all 
resistance was broken. She then related that during the first 
few years of her service she entertained no such wishes until 
one day when her master, a rather reserved and very busy man, 
talked confidentially with her concerning the rearing of the chil- 
dren. He was then more cordial than usual. He said that he 
counted on her to bring up his orphaned children and looked at 
her rather peculiarly. It was at this moment that she began to 
love him and entertain pleasant hopes. But, as this was not 



x TRANSLATORS' PREFACE. 

followed by anything else, and in spite of her long wait, he never 
gave her another confidential heart to heart talk, she tried " to 
push it out of her mind." 

After this analysis there was some improvement, the subjective 
sensation became weaker, though it had not entirely disappeared, 
manifesting itself whenever she became excited. The persistence 
of this symbol was due to the fact that besides the main trauma 
it also represented many side traumas, so that it was necessary 
to analyze all episodes connected with the main scene. It finally 
disappeared, only to be replaced by another subjective odor " like 
the smoke of a cigar." As ungratifying as this was an imme- 
diate attempt was made to analyze it. When asked to recall the 
circumstances of the origin of this sensation she was at first 
unable to do so, remarking that the odor could be constantly per- 
ceived in the house, but finally under concentration she saw a 
picture of a table scene. It was in the dining room at dinner, 
where besides the usual company there was a guest, the chief 
accountant of the firm, an old gentleman who was a frequent 
visitor and who loved the children as though they were his grand- 
children. While taking leave the visitor attempted to kiss the 
children when the host cried out, " Please don't kiss the children." 
" I then experienced a stitch in the heart, and as they were smok- 
ing this odor remained in my memory." 

This therefore was the second scene causing the trauma and 
leaving the memory symbol. But why was this scene so affec- 
tive? On analysis it was found that it preceded the burned 
pastry by about two months. It was not, however, obvious why 
she should have been so affected when the old gentleman was 
prevented from kissing the children. She stated that the father 
objected to strangers kissing the children, and that a few months 
before this episode a lady visited the house and on leaving kissed 
the children. At that time the father said nothing to the lady, 
but afterwards upbraided her for permitting it, saying that if it 
ever happened again he would entrust the bringing up of his 
children to some one else. This happened while she believed 
herself loved and soon expected a second confidential talk. This 
episode shattered all her hopes because if he could reproach her 
for a thing of which she was perfectly innocent he could not 
entertain any feeling for her. This painful incident was mani- 



TRANSLATORS' PREFACE. xi 

festly recalled when the bookkeeper attempted to kiss the 
children. 

This ended the analysis and the patient was cured. A few 
days later the anosmia disappeared and the reflex returned. 

This abstract shows very nicely how the symptoms were noth- 
ing other than painful psychical experiences symbolically con- 
verted into physical ones. The traumatic moment causing this 
conversion is that in which the contradiction thrusts itself on the 
ego and is therefore banished by it. The banishment does not 
annihilate the opposing presentation, but crowds it into the un- 
conscious. This process occurring for the first time forms the 
nucleus and crystallization point for the formation of a psychic 
group separated from the ego, around which collects everything 
in accord with the contradictory presentation. The splitting of 
consciousness in such cases is intentional; it is often initiated by 
at least one arbitrary act. However something else happens than 
the individual intends; he wishes to eliminate a presentation as 
though it never came to pass, but only succeeds in isolating it 
psychically. 

The traumatic moment in our patient corresponds to the time 
when she was upbraided by her master for allowing the children 
to be kissed. For the time being this episode remained without 
any apparent effects, perhaps it caused the depression and sensi- 
tiveness. The hysterical symptoms commenced later in moments 
which can be designated as " auxiliary " and which are charac- 
terized by a simultaneous flowing together of both psychical 
groups. The first moment in which the conversion took place in 
Miss Lucy was the scene at the table when the chief accountant 
attempted to kiss the children. This evoked the traumatic mem- 
ory and she behaved as though she had not entirely banished her 
attachment for her master. 

The second auxiliary moment almost followed the mechanism 
of the first. It is interesting to note how the symptom coming 
second covered the first so that it was not clearly distinguished 
until the former was eliminated, a thing quite usually observed 
in psychanalysis. 

The therapy consisted in forcing the union of the split-off 
psychic groups with the ego-consciousness. 



Xll TRANSLATORS PREFACE. 

Similar conclusions were reached by Jung on the basis of 
experimental psychology. 10 

Jung and Riklin collected a great number of associations from 
normal persons with the intention of finding out first whether 
there exists any regularity in the reactions, and second whether 
there are definite reaction types. It was soon found that the 
process of association is an extraordinarily flighty and variable 
psychic process, and is under the influence of numberless psy- 
chical events which are beyond the limits of objective control. 
It was also found that attention exerts the greatest influence on 
the association process. It directs and modifies the associative 
process and at the same time can be most readily controlled by 
experiments. It is the delicate affective apparatus which is the 
first to react in abnormal physical and psychic conditions, thus 
modifying the associative accomplishments. It was therefore 
decided to investigate experimentally the following questions: 

1. The laws of fluctuation in association within normal limits. 

2. The direct effects of attention on the process of association, 
especially whether the validity of association relatively diminishes 
with the distance from the fixation point of consciousness. 

A number of educated and uneducated persons were exam- 
ined. A hundred stimulus words were given and the reactions 
noted. The reaction time was measured with a one fifth second 
stop watch. The second series consisted of one hundred asso- 
ciations plus internal distraction by means of the " A-phenome- 
non " (Cordes), and the third series of one hundred associations 
was taken by external distraction by means of a metronome. 
Altogether 12,400 associations were taken and were classified as 
follows : 

I. Inner associations. 

1. Coordination; e. g., cherry apple, murder gallows, 

sea depth, father God. 

2. Predicative relation; e. g., snake poisonous, war 

bloody, mountain beautiful, water refreshing. 

3. Causal dependence; e. g., cut pain, pain tears, 

appetite fat, frost cold. 

10 Jung und Riklin : Diagnost. Associationsstudien, Beit., I. 



TRANSLATORS' PREFACE. xiii 

II. Outer associations. 

1. Coexistence; e. g., ink pen, pupil teacher, Sunday 

rest, table chair. 

2. Identity; e. g., beautiful handsome, quarrel fight. 

3. Speech motor forms; e. g., to suffer hunger, to 

bow head, to do right, white black. 

III. Sound reactions. 

1. Word completion; e, g., wonder ful, friend- 

friendly. 

2. Sound ; e. g., blanket blank, haircut cut, longing 

long, biting fight. 

3. Rhyme; e. g., nice rice, ship trip, never clever, 

bone stone. 

IV. Remnant group. 

I. Mediate reactions; e.g., 

grass wheel 



hay green, Cleveland round 
water Miss X is a 

/\ /\ 

muddy shallow, false blond 

2. Senseless reactions, where no words or associations 

are given. 

3. Failure = no reaction, and is due mostly to emotivity. 

4. Repeated stimulus word, another emotional phe- 

nomenon. 

A. Perse veration, when reaction belongs to the preceding or 

following association. 

B. Egocentric reaction; e. g., rich am I, young am I. 

C. Repetitions = repetition of content or style. 

D. Speech combinations; e. g., alliteration, same endings, etc. 

On examining many associations it was found that the numer- 
ical relations in single individuals were quite fluctuating. The 
main reason for this, besides the individual ones, is the intensity 
of attention. The fact that certain individuals react by inner 
associations and others preferentially by outer associations is in 
the first place a phenomenon of attention. Every person en- 
dowed with speech has manifold qualities of associations at his 
disposal, the association quality uttered depending on the degree 



xiv TRANSLATORS' PREFACE. 

of attention evoked by the stimulus word. Whenever the dis- 
traction phenomena succeeded, the result was always the same, 
the outer associations and sound associations gained at the ex- 
pense of the inner ; that is, there was a deviation to the direction 
of the customary and smooth, hence to the automatically obvious, 
or habitual speech combination. 

" Attention is a state characterized by muscular tension mani- 
fested in an association complex and furnishes the accentuated 
complex with the psycho-physical subsoil. The aim of the phys- 
ical reflection seems to be the establishing of the toned presenta- 
tion into consciousness. By the somatic connection the accen- 
tuated presentation is probably held on the height of distinctness 
in the stream of presentations. It becomes the ' directing ' 
presentation (respectively the 'directing feeling') of the others. 
It causes two kinds of effects: 

" i. Promoting effects to all associated presentations and 
especially to all associated in the sense of direction. 

" 2. Inhibiting effects to all presentations not associated, espe- 
cially not associated in the sense of direction. 

" If a non-associated presentation gains in attention, the direct- 
ing presentation becomes correspondingly crowded from the fixa- 
tion point, i. e., it loses in tone. The effects emanating from it 
likewise correspondingly lose in intensity and therefore the dif- 
ference in the liminal value of all the others is diminished. The 
choice in the sense of direction becomes more difficult and is more 
and more subjected to the law of frequency, i. e., all those asso- 
ciations which through habit and practice form the most frequent 
content of consciousness push themselves forward. The law of 
frequency takes the place of the directing presentation. It means 
that the endeavor to conceive and elaborate the sense of the 
stimulus word is hindered by the interposition of presentations 
which are already blended and automatic in speech." Whenever 
there is a disturbance of attention we have to expect shallow 
reaction types or sound associations, and, conversely, whenever 
we get sound associations we have to presuppose a disturbance 
of attention. 



TRANSLATORS PREFACE. XV 

COMPLEX-PHENOMENA AND THEIR CONSTELLATIONS. 

By complex we mean the sum total of presentations connected 
with an emotionally accentuated event. 

On examining the following associations, taken from an intel- 
ligent man of thirty-two, we note a number of peculiarities. 

Stimulus. Reaction. Time. Reproduction. 

1. head hair 1.6" -+- 

2. smooth not 4.2" love 

3. to name James 3.4" no reaction 

4. seeing recently 3.2" + 

5. friendly very 2.6" + 

6. wedding never 4.0" bells 

7. to work hard 2.8" -f 

8. song love 4.0" -f- 

9. green hope 4.4" grass 
10. definite certain 2.6" + 

The average reaction time in a person of his type is 2.4" ; here 
we find quite a number above the average. We also note that 
some reactions are falsely reproduced, and in association 3 a 
failure of reproduction. Whenever such phenomena occur they 
are taken as complex-indicators. The stimulus word has either 
consciously or unconsciously touched a complex with strong 
affects. Here the reason for all this emotivity is readily ex- 
plained by the fact that the test person was involved in an unfor- 
tunate love affair, and although the associations were taken years 
later the stimuli readily awakened the dormant complex. The 
associations were analyzed as follows: Association 2, smooth 
not love. Association 3, to name James, means Jane, the name 
of his former fiancee. The test person was totally unconscious 
of this during the experiment, but on freely associating with the 
word James we got Jame Jane. The subsequent associations 
were perseverations of the same complex. Association 4, seeing 
recently, recalls the fact that the test person has recently seen 
his former fiancee. Association 5, friendly very, is a descrip- 
tion of their present mutual feelings. Association 6, wedding 
never bells, shows his definite decision. Associations 8 and 9, 
song love and green hope, belong to this same episode and are 
quite obvious without any further analysis. 

We have here associations which are determined by definite 
constellations, inasmuch as they refer to an emotionally accen- 



xvi TRANSLATORS' PREFACE. 

tuated experience. These phenomena can be readily observed 
whenever associations are taken. Past experiences or complexes 
of strong feeling remain in the subconscious in a dormant state 
until they are disturbed by associations. These associations may 
be purely adventitious or intentional as in the experiment. As 
soon as stimulated they continue to manifest themselves in dif- 
ferent automatisms. In the experiment we have definite re- 
sponses which refer to the complex. In our everyday life we 
sometimes begin to hum a certain melody which we have not 
heard for years ; for a time we become, as it were, possessed by 
it, and on analysis we find its definite meaning. It refers to some 
past episode evoked by some accidental association or by a defi- 
nite state of mind. 

" The preponderant part of all our thoughts and actions is 
really composed of small fragments which are infinitely and deli- 
cately determined by numberless moments lying entirely external 
to consciousness. To our ego-consciousness the association 
process seems to be its work, in its estimation the association 
process is dominated by the free will and attention, in reality, 
however, as is so nicely shown in the experiments, the ego- 
consciousness is only a marionette dancing on the stage by means 
of concealed automatic springs." 11 

Many assert that they can react of their free will and accord, 
but analysis shows that the reactions generally refer to their inti- 
mate experiences revealing just what they were endeavoring to 
conceal. The emotionally accentuated complex exerts a constant 
influence which successfully vies with the intentions of the ego- 
consciousness, and despite the repressing influences of the ego- 
complex it sends out associations about which the ego-complex 
has no notion. 

The complexes as developed by Jung are identical with the 
dissociated psychic groups described by Freud. Just as the com- 
plexes dominate our thoughts and actions, so do the repressed 
psychic groups assert themselves symbolically not only in patho- 
logical but also in normal individuals. In his excellent work, the 
Psychopathologie des Alltagslebens, 12 Freud shows that every- 
day forgetfulness, lapses in writing, talking, adventitious acts and 

"Jung: Diag. Associationsstudien, Beitr., IV. 
u Freud : Zur Psychopathologie des Alltagslebens. 



TRANSLATORS PREFACE. XVII 

mistakes are nothing but the assertion of the split-off groups 
which, though repressed by the ego-consciousness, continue to 
manifest themselves on every possible occasion in the form of 
symbolic actions. The same is true of our dreams 13 where our 
repressed wishes are realized. It is impossible to give examples 
here, as they would be too long for the subject in hand. 

These brief illustrations from the works of Freud and Jung 
give an intimation of the ideas expanded in this book. The 
author shows that just as in normal individuals and in hysteria 
the complex continues to play its part in dementia praecox, and 
as it does in dreams, the psychosis tends to actualize the repressed 
wishes from normal life. The otherwise known absurdities and 
incomprehensibilities become quite clear ; every case has its special 
interests and its own individuality. 

FREDERICK PETERSON, 
A. A. BRILL. 
NEW YORK, Jan., 1909. 

" Freud : Die Traumdeutung. 



AUTHOR'S PREFACE. 



This work is the fruit of three years' experimental labor and 
clinical observation. In view of the difficulty and magnitude of 
the material, my work cannot and will not lay any claims either 
to perfection of treatment or to perfect certainty of conclusions 
and statements ; on the contrary, it unites in itself all the disad- 
vantages of eclecticism, which perhaps to many a reader will seem 
so peculiar that he will call my work rather a confession of faith 
than a scientific book. Peu importe! What is of chief concern 
is that I may succeed in showing my readers how, by certain 
psychological investigations, I reached certain views, which I 
deem fit for the stimulation of the problems of the individual 
psychological basis of dementia praecox in a new and fruitful 
direction. 

My views are no contrivances of a roving fancy, but thoughts 
which matured in almost daily intercourse with my venerable 
chief, Professor Bleuler. I owe special thanks to my friend, 
Dr. Riklin, of Rheinau, for considerably enriching my empirical 
material. Even a superficial glance at my work will show how 
indebted I am to the excellent conceptions of Freud. As Freud 
has not yet attained fair recognition and appreciation, but is 
opposed in the most authoritative circles, I hope to be allowed to 
define my position towards him. My attention was attracted to 
Freud by reading some of his articles, and indeed, at first acci- 
dentally by his " Traumdeutung," after which I studied also his 
other works. To be sure in the beginning I naturally entertained 
all the objections which are advanced in literature against Freud. 
However, I thought that Freud could only be refuted by one who 
himself had thoroughly tried the psychoanalytic method, and who 
should really investigate like Freud, that is, by studying out 
patiently and for a long time the daily life, hysteria and dreams 
from Freud's point of view. He who does not or cannot do this 
ought not to judge Freud, else he acts like those famous men of 

:ience who disdained to look through the telescope of Galileo. 

xix 



XX 



AUTHOR'S PREFACE. 



Fairness to Freud does not signify, as many fear, a conditionless 
submission to a dogma; indeed independent judgment can very 
well be retained beside it. If I, for instance, recognize the com- 
plex mechanisms of dreams and hysteria, it does not at all 
mean that I ascribe to sexual trauma in youth an exclusive sig- 
nificance, as Freud apparently does; still less does it mean that 
I place sexuality so preponderantly in the foreground, or that I 
even ascribe to it the psychological universality which Freud 
postulates under the impression of the very powerful role which 
sexuality plays in the psyche. As for Freud's therapy, it is at 
best a possible one, and perhaps does not always come up to 
expectations. Nevertheless, all these are only side issues which 
completely disappear beside the psychological principles, the dis- 
covery of which is Freud's greatest reward, and to which the 
critic does not pay enough attention. He who wishes to be fair 
to Freud should act in accordance with the words of Erasmus: 
Unumquemque move lapidem, omnia experire nihil intentatum 
relinque. 

As my work is often based on experimental examinations, I 
hope that the reader will pardon me if he finds many references 
to the " Diagnostischen Associations-Studien." 1 

C. G. JUNG. 

ZURICH, July, 1906. 

X J. A. Earth, Leipzig, 1906. 



CHAPTER I. 

CRITICAL PRESENTATION OF THEORETICAL VIEWS ON THE 
PSYCHOLOGY OF DEMENTIA PR^COX. 

The interpretation of the psychological disturbances of demen- 
tia praecox are found in literature only in the form of frag- 
mentary attempts which although they at times go quite far, yet 
nowhere have they any clear coordination. The statements of 
the older authors have only a limited value as they refer now to 
this now to that form of mental disease which can only be indefi- 
nitely classified as dementia praecox. Hence one must not attri- 
bute to them any general validity. The first general view con- 
cerning the nature of the psychological disturbance in catatonia 
was that of Tschisch, 1 who, in 1886, thought that it was essen- 
tially due to inability of attention. A similar but somewhat dif- 
ferently conceived view was given by Freusberg. 2 He stated 
that the automatic actions of the catatonic are associated with a 
condition of reduction of consciousness which causes a loss of 
control over his psychical processes. The motor disturbances are 
only symptomatic expressions for the degree of psychic tension. 

According to Freusberg the motor catatonic symptoms are 
dependent upon corresponding psychological manifestations. 
The " weakening of consciousness " points to the quite modern 
view of Pierre Janet. Also Kraepelin, 8 Aschaffenburg, 4 Ziehen 
and others affirm that there is a disturbance of attention. In 
1894 we meet for the first time with an experimental psycho- 
logical work on the subject of catatonia. It is the investigation 
of Sommer, " On the Study of ' Inhibition ' of Mental Proc- 
esses." 5 

The author makes the following statements which are of gen- 

1 Cited from Ehrich Arndt: Uber die Geschichte der Katatonie, Zentr.- 
f. Nervenheilk. u. Psych., Bd. XIV, p. 81. 
1 Freusberg, 1886, Archiv f. Psych., XVII, p. 75& 
'Lehrbuch d. Psychiatric. 
'Allg. Ztschr. f. Psych., 1898. 
Allg. Ztschr. f . Psych., Bd. L. 

I 



2 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

eral significance: (i) The course of ideation is retarded. (2) 
The attention of the patient is frequently so fixed by pictures 
shown him that he can only with difficulty rid himself of them. 

The frequent obstructions (the retardations of reaction time) 
are explained by Sommer by the visual fixation. 6 The condition 
of absent-mindedness among normal persons occasionally shows 
similar phenomena ; e. g., amazement and " staring into vacancy." 
Because of this analogy of the catatonic condition to normal 
absent-mindedness Sommer affirms something similar to Tschisch 
and Freusberg, namely, that there is a diminution of attention. 
Catalepsy according to Sommer is another phenomenon closely 
related to optical fixation and which he considers " in all cases 
as a phenomenon of thoroughly psychic origin." With this con- 
ception Sommer places himself in sharp contrast to the view of 
Roller, to which also Clemens Neisser unconditionally adheres. 

Says Roller : " The presentations and sensations which among 
the insane chiefly come to perception, forcing themselves into the 
field of consciousness, are those which have been caused by the 
morbid states of the subordinate centers, and when active apper- 
ception, the attention, enters into activity it becomes fixed and 
held by the morbid perceptions," etc. 7 

By way of addition Neisser observes : " Wherever we look in 
insanity we always meet with something strange which cannot be 
explained according to the analogy of normal psychical activity. 
The logical mechanisms in insanity are put in motion not through 
the apperceptive or associative conscious psychic activity, but by 
pathological irritations lying under the threshold of conscious- 
ness." 8 Neisser therefore agrees with the concepts of Roller. 
This view does not seem to me to be without its objections. 
Firstly, it is based upon an anatomical conception of the psychic 
processes, a view against which too much warning cannot be 
given. What part the " subordinate centers " play in the origin 

"v. Leupold, who recently elaborated this symptom, names this mani- 
festation " das Symptom der Benennung u. des Abtastens " (the symptom 
of naming and touching). Zur Symptomatologie der Katatonie. Klinik 
fur psychische u. nervose Krankheiten, Vol. I, H. I. 

T Cited from Neisser's, Uber die Katatonie. Stuttgart-Enke, 1887, p. 61. 

8 Ernst Meyer, too, leans towards this view which was then also held 
by Kraepelin. E. Meyer: Beitrage zur Kenntnis der acut entstandenen 
Psychosen. Habilitationsschrift. Berlin, 1899. 



THEORETICAL VIEWS OF DEMENTIA PILECOX. 3 

of the psychic elements, such as presentations, feelings, etc., we 
do not know at all. An explanation of this kind rests merely 
upon words. 

Secondly, the Roller-Neisser view seems to presuppose that 
beyond consciousness the whole psyche ceases. From the French 
psychology and from experiences with hypnotism we learn that 
this is not the case. 

Thirdly, if I understand correctly, by " pathological irritations 
lying under the threshold of consciousness " Neisser means cell 
processes in the cortex. This hypothesis goes too far. All 
psychic processes are correlates of cell processes, as well accord- 
ing to materialistic conceptions as according to the doctrine of 
psycho-physical parallelism. It is therefore not singular that 
psychic processes in catatonia should be correlates of a corre- 
sponding physical series. We know that normal psychical proc- 
esses originate under the constant influence of numerous psycho- 
logical constellations which as a rule are unknown to us. Why 
should this fundamental psychological law suddenly vanish in 
catatonia? Is it because the ideational content of the cata- 
tonic is foreign to his consciousness? Is it not the same with 
our dreams? And yet no one will assert that dreams originate 
so to speak directly from the cells without psychological constel- 
lations. Whoever has analyzed dreams according to the method 
of Freud knows what an enormous influence the constellations 
have. The appearance of strange ideas in consciousness with- 
out any demonstrable connections with former contents of con- 
sciousness is not an unheard of thing in either the psychology 
of the normal or the hysteric. The " pathological fancies " of 
catatonics have rich analogies in the normal and in hysterics (see 
further). What we lack is not so much comparative material 
but the key to open the psychology of the catatonic automatism. 
It seems to me in general rather daring to assume something 
toto coclo new and absolutely foreign in natural science. 

In dementia praecox, where numberless normal associations 
actually still exist, we must expect that until we shall learn to 
know those very fine processes which are really specific, the laws 
of the normal psyche will long continue to be manifest. Unfor- 
tunately to the great detriment of psychopathology, in which we 
are just beginning to agree upon our misunderstandings of con- 



4 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

captions applied, our knowledge of the normal psyche is still on 
a very primitive basis. 

We are grateful to Sommer 9 for further fruitful studies of the 
associations in catatonia. 

In certain cases of catatonia 10 the associations flow in a normal 
manner only to be suddenly interrupted by an apparently totally 
disconnected, peculiarly-mannered connection of ideas, as will be 
seen by the following example: dark green, white brown, 
black " good day, William," red brown. 

These saltatory associations were also confirmed by Diem, 11 
who conceives them as sudden " fancies." Sommer justly con- 
siders them as an important criterion of catatonia. The " patho- 
logical inspirations " as described by Breukink, 12 who follows 
Ziehen, can be readily found in every insane asylum where these 
authors have observed them. They are exclusively seen in 
dementia praecox, and especially play an important role in the 
paranoid types. Bonhoeffer's 13 " pathological fancies " probably 
refer to the same manifestations. The problem instigated by the 
discovery of Sommer is by no means settled, but until we become 
more enlightened we are obliged to group under the same head- 
ing the phenomena observed by various authors which are nearly 
all designated by almost the same name. Although from clinical 
experience it would seem that " pathological fancies " appear 
only in the realm of dementia praecox, naturally excluding the 
falsifications of memory which often suddenly appear in organic 
dementia and in Korsakow's symptom-complex, I wish to observe 
that in the realm of hysteria, principally in cases that never seek 
the asylum, " pathological fancies " often play a great part 
Flournoy 14 reports the most interesting examples. Similar sud- 

"Lehrbuch der Psychopathologischen Untersuchungsmethoden, 1899. 

19 Sommer : Lehrbuch, p. 362. Recently Fuhrmann has made some asso- 
ciation experiments in "acute juvenile dementia" without any character- 
istic results. Arch. f. Psych., Vol. XL, p. 817. 

"Diem: Die einfach demente Form der Dementia Prsecox (Dementia 
simplex). Arch. f. Psych., Vol. XXXVII. 

"Breukink: Uber eknoische Zustande. Monatsschr. f. Psych, u. Neur., 
Vol. XIV. 

"Deutsche med. Wochenschrift, No. 39, 1904. 

"Flournoy: Des Indes a la planete Mars. Etude sur un cas de Som- 
nambulisme avec glossolalie. Paris et Geneve, 1900. III Nouvelles obser- 



THEORETICAL VIEWS OF DEMENTIA PRyECOX. 5 

den invasions of changed psychological activity I observed in a 
very clear case of hysteria, 16 and recently I could again confirm 
it in a similar case. Finally, as I have shown, sudden disturb- 
ances of association by the incursion of seemingly strange con- 
nections of ideas also appear in the normal. 16 In the saltatory 
association or " pathological fancy " we are perhaps dealing 
with a widely disseminated psychical phenomenon, and without 
further discussion we can agree with Sommer that the most 
marked type appears in dementia praecox. 

Sommer, in examining the associations of catatonics, found 
numerous sound associations and stereotypies. By stereotypies 
we mean frequent repetitions of former reactions. In our exam- 
inations we simply name it " repetitions." The reaction time 
showed enormous fluctuations. 

In 1902 Ragnar Vogt 17 again took up the problem of the cata- 
tonic consciousness. He proceeded from the Miiller-Pilzecker 
investigations 18 by considering mainly their observations about 
" perseveration." The continuation of psychic processes or their 
correlates, even after being replaced in consciousness by other 
ideas, is according to Vogt the normal analogy to cata- 
tonic perseveration, such as verbigeration, catalepsy, etc. Ac- 
cordingly, in catatonia the tendency to perseveration of the psy- 
chophysical functions would be especially marked. But inas- 
much as in the Miiller-Pilzecker observations perseveration is 
manifested most distinctly only when no new content of con- 
sciousness impresses itself, 10 Vogt claims that in catatonia perse- 

vations sur un cas de somnambulisme avec glossolalie. Archives de Psy- 
chologic de la Suisse Romande, T. I, p. 102. 

18 Zur Psychologic und Pathologic sogenannter occulter Phanomene. 
Leipzig, 1902. 

16 Diagnostische Assoz. Stud., IV Beitrag. Uber das Verhalten der 
Reaktionszeit beim Assoziationsexperiment. J. A. Earth, Leipzig, 1906. 

" R. Vogt : Zur Psychologic der Katatonischen Symptome. Zentr. f . 
Nervenheilk. u. Psych., Bd. XIX, p. 433. 

"Zeitschrift fur Psych, u. Phys. der Sinnesorgane, Erg. B. I, 1901. 

"In conditions of distraction there is an increase of preseveration in 
the association experiments. See Diag. Assoz. Stud., I Beitrag, and in- 
teresting experiments of Stransky: Uber Sprachverwirrtheit, 1905. Mar- 
hold, Halle. See also the excellent work of Heilbronner: Uber Haften- 
bleiben und Stereotypie (Monatsschr. f. Psych, u. Neur., Bd. XVIII, Erg.- 
Heft), which accepts similar theoretical views. 






THE PSYCHOLOGY OF DEMENTIA PR^COX. 



veration is only possible because no other interesting conscious 
process occurs. Hence it must be assumed that there is a certain 
narrowing of consciousness. From this we can also understand 
the resemblance between the hypnotic and the catatonic states. 20 
The impulsive acts of catatonia are likewise explained by the 
narrowing of consciousness, thus preventing the intervention of 
any inhibition. Vogt is apparently under the influence of Pierre 
Janet, to whom the " narrowing of consciousness " and diminu- 
tion of attention is the same as abaissement du niveau mental? 1 
Here then we again meet the already mentioned view, though 
in a somewhat more modern and generalized form, namely, that 
in catatonia there is a disturbance of attention, or as I prefer to 
express it in a more general term, there is a disturbance of posi- 
tive psychic function. 22 The reference to the similarity of 
hypnotic conditions is very interesting, but unfortunately Vogt 
gave us only a mere outline. 

Kindred views are advanced by Evensen. 23 He draws a skil- 
ful parallel between catatonia and absent-mindedness. Lack of 
ideas in a narrowed consciousness is the foundation of cata- 
lepsy, etc. 

A painstaking and detailed examination of the psychology of 
catatonia is the thesis of Rene Masselon. 24 The author first 
affirms that diminution of attention (distraction perpetuelle) is 
the main characteristic. He conceives attention in a very general 
and comprehensive sense corresponding to his French training in 
psychology. He says, " The perception of external objects, the 
perception of our own personality, judgment, the ideas of rela- 

20 1 call attention here to the work of Kaiser : Differentialdiagnose 
zwischen Hysteric und Katatonie. Allgem. Ztschr. f. Psych., LVIII. 

21 P. Janet : Les Obsessions et la Psychasthenie. Paris, 1903. Janet 
presents similar views in his earlier works : Nevroses et Idees Fixes, and 
Automatisme Psychologique. 

21 According to Binet attention is " a mental adaptation to a state which 
is new for us." Attention et Adaptation. Annee Psychologique, 1900. 

n Die psychologische Grundlage der Katatonischen Krankheitszeichen. 
Zentralbl. fur Neurol. Psych., etc. Edited by v. S. Kure and K. Miura, 
Tokio, Bd. II. 

M Masselon: Psychologic des Dements Precoces. These de Paris, 1902. 
(The work of Masselon " La Demence Precoce " is rather a clinical com- 
pendium of the disease.) 



THEORETICAL VIEWS OF DEMENTIA PR^COX. / 

tionship, faith and certitude disappear when the power of atten- 
tion disappears." 

As shown by this citation, much depends on attention as con- 
ceived by Masselon. The more general features of the catatonic 
condition he summarizes as " apathie, aboulie, perte de I'activite 
intellectuelle." A brief consideration of these three abstractions 
teaches that fundamentally they mean the same thing, and indeed, 
Masselon in his work always tries to find that word or simile 
which would best express the innermost essence of his correct 
feeling. However, scarcely any concept of human language 
should be so broad; indeed, there is no one who has not already 
been impressed by some school or system with the biased limits 
of meaning. We can best find out what Masselon conceives as 
the essence of dementia praecox by listening to the wording of 
some of his statements : " The habitual state is the emotional 
apathy . . . these disturbances are intimately connected with the 
disturbances of intelligence: they are of the same nature . . . 
the patients do not manifest any desires ... all volition is de- 
stroyed . . . the disappearance of desire is connected with 
all the other disturbances of mental activity ... a veritable 
weakness of cerebral activity . . . the elements of the mind 
show a tendency to live an individual life not being any more 
systematized by the inactive mind." 28 

In Masselon's work there is a mixture of many things and 
views that he feels belong to one root which, however, he is 
unable to find without obscuring his work. Nevertheless, in 
spite of his shortcomings, Masselon's researches contain useful 
observations. Thus he finds a striking resemblance between 
dementia praecox and hysteria in the marked self-distractibility 
of the patient by everything possible and especially by his own 
symptoms (Sommer's optical fixation), and also in exhaustibility 
and capricious memory. German critics have reproached him 
for this discovery, but certainly unjustly when we consider that 
Masselon means only the reproductive ability. If a patient gives 
a wrong answer to a direct question it is taken by the German 
school as by-speaking (Vorbeireden) as negativism; in other 
words, as active resistance. Masselon, however, considers this 
as an inability to reproduce. When superficially considered it 

a Masselon: /. c., p. 62, 71, 135, 140. 



8 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

may mean both, the divergence being due to different interpreta- 
tions bestowed upon this phenomenon. Masselon speaks of a 
"veritable obscurcissment de I' image-souvenir,' 3 he considers the 
disturbances of memory as " la disparition de la conscience de 
certains souvenirs, et I'incapacite du malade a les retrouver" 
The contradiction of both conceptions becomes clear without 
further explanation when one thinks of the psychology of hys- 
teria. When a hysterical patient replies during the anamnesis 
" I do not know, I have forgotten," it simply means " I cannot 
or will not say it, for it is something very unpleasant." 26 Very 
often the " I don't know " is so awkward that the reason for not 
knowing is quite obvious. I have given many experimental 
proofs to show that the defects occurring in the association ex- 
periments, such as want of reaction, have the same psychology. 27 
It is often only with difficulty that one can decide whether hys- 
terics really do not know or whether they merely cannot or will 
not answer. Those who are in the habit of examining cases of 
dementia praecox in a somewhat detailed manner realize what 
exertion is often necessary to obtain the proper information. 
Sometimes one is certain that the patients know it, again it is 
an obstruction (Sperrung) which makes quite an involuntary 
impression upon one, and finally there are cases in which one is 
obliged to talk about an " amnesia " just as in hysteria, where 
from amnesia to unwillingness to talk is only a step. Finally the 
association experiment shows us that these phenomena exist in 
the normal person, though only in nuce. 2S According to Masse- 
lon the disturbances of memory and attention originate from the 
same source, though it is not clear from what source. In con- 
trast to this the author finds ideas that obstinately persist, 
which he qualifies as follows : " Certain memories which were 
formerly more intimately connected with the effective personality 
of the patient tend to reproduce themselves incessantly and 

"See the works of Freud, also Riklin: Zur Psychologic hysterischer 
Dammerzustande und des Ganserschen Symptoms. Psych.-neur. Wochen- 
schr., 1906. 

"Diagnost. Assoz. Stud., IV Beitrag. Uber das Verhalten der Reak- 
tionszeit beim Assoziationsexperiment u. Experimentelle Beobachtungen 
uber das Erinnerungsvermogen. Zentr.-Bl. f. Nervenheilk. u. Psych., 
Jahrgang XXVIII, p. 653. 

28 Cf. Diagnost. Assoz. Stud., IV Beitrag. 



THEORETICAL VIEWS OF DEMENTIA PRyECOX. 9 

to continually occupy consciousness . . . the persisting mem- 
ories assume a stereotyped form . . . thought tends to become 
clotted (' gerinnen ')." 29 Without attempting to produce fur- 
ther proof Masselon declares that the stereotyped ideas (delu- 
sions) are associations of the complex of personality. It is a 
pity that the author does not linger any longer on this point. It 
would be very interesting to know in what way, for example, a 
few neologisms or a " word salad " are associations of the com- 
plex of personality, as indeed these are often the only remnants 
through which we become informed of the existence of ideas. 
That the psychic life of the adolescent dement " curdles " or 
" clots " seems to me an excellent simile for the gradual 
torpescence of the disease; it designates quite pregnantly the 
impressions entertained by every careful observer of dementia 
praecox. The author found it quite easy to derive automatism 
(suggestibilite) from his premises. As to the origin of nega- 
tivism he offers but vague suppositions, although the French lit- 
erature on impulsive phenomena afforded him many essential 
facts for analogous explanations. Masselon also tried associa- 
tion experiments. He found many repetitions of the stimulus 
words and frequent fancies of an apparently quite fortuitous 
nature. From these experiments he concluded that the patients 
are unable to pay attention. A right conclusion! Masselon, 
however, spent too little time on the " fancies." 

From the main results of Masselon's work it can be seen that 
this author, like his predecessors, is inclined to admit a true cen- 
tral psychological disturbance, 30 a disturbance which sets in at 
the source of life of all psychic functions; that is, in the realms 
of apperception, feeling and desire. 81 

Weygandt in his clear elucidation of the psychology of the 
weak-mindedness in dementia praecox follows Wundt's terminol- 
ogy and calls the terminal process of the disease apperceptive 

' Masselon : /. c., p. 69, 261, 263. 

"Seglas (Legons cliniques), 1895, says the following about the un- 
certainty of catatonic accomplishments: There is nothing surprising when 
one reflects that all movement requires the previous synthesis of a crowd 
of mental representations and it is precisely the power to make this mental 
synthesis which is defective in these individuals. 

"Kant: Kritik der praktischen Vernunft. 




IO THE PSYCHOLOGY OF DEMENTIA PR^COX. 

dementia. 32 It is well known that Wimdt's conception of apper- 
ception is a most general one. It embraces not only the Binet 
and Masselon conception of attention, but also Janet's idea of 
the " fonction du reel." 33 But we shall return to this. To show 
the universality of the apperception idea in the sense indicated 
I shall quote Wundt's own words : " The condition characterized 
by peculiar feelings which accompanies the clearer reception of 
a psychic content we call attention, the single process by which 
any psychic content is brought to clear conception is appercep- 
tion. 3 * The apparent antithesis between attention and appercep- 
tion is solved as follows : " Accordingly, attention and apper- 
ception are expressions for one and the same psychological fact. 
The first of these expressions we choose by preference for the 
' subjective ' side of this fact to express the accompanying feel- 
ings and sensations ; by means of the second we designate mainly 
the ' objective ' results, the alterations in the quality of the con- 
tents of consciousness." 35 

In the definition : apperception is the " single process by means 
of which any psychic content is brought to clear conception," 
much is said in few words. According to this definition apper- 
ception is will, sensation, affect, suggestion, impulsive phenom- 
ena, etc., because all these are processes by means of which " a 
psychic content is brought to clear conception." We do not 
attempt to give an unfavorable criticism on the apperceptive 
idea, but merely to indicate its enormous extent. It embraces 
every positive psychic function, especially the progressive acqui- 
sition of new associations; that is, no more and no less than all 
enigmas of physical activity both conscious and unconscious. 
Weygandt's idea, therefore, of apperceptive dementia expresses 
that which Masselon dimly felt. Nevertheless, in this we find 
only a general expression for the psychology of dementia praecox. 
It is too general to be of any force in the deduction of all 
symptoms. 

33 W. Weygandt: Alte Dementia Prsecox. Zentr.-Bl. f. Nervenheilk. u. 
Psych., Jahrgang XXVII, p. 613. 

13 Obsessions et Psychasthenie, Vol. I, p. 433. The fonction du reel can 
also be expressed in other words as psychological adaptation to the 
environment or acting up to reality. It corresponds to the " adaptation " 
of Binet, which represents a special side of apperception. 

"Gundriss der Psychologic, 1902, p. 249. 

'"Grundziige der Physiol. Psychologic, 1903, p. 341. 



THEORETICAL VIEWS OF DEMENTIA PRyECOX. 



II 



Madeleine Pelletier 36 examines in her thesis associations in 
manic flight of ideas, and in mental debility. By mental debility 
we understand typical cases of dementia praecox. The theoretic 
standpoint from which this author considers flight of ideas 
agrees in its essentials with that of Liepmann. 87 A knowledge 
of Liepmann's work is presupposed. 

Pelletier compares the shallow flow of associations in demen- 
tia praecox to the flight of ideas. The characteristic of flight of 
ideas is "absence du principe directeur" (absence of directing 
principle). The same takes place in the course of the associa- 
tions in dementia praecox. " The directing idea is absent and the 

ite of consciousness remains vague without any ordering of its 
elements." The only state of normal psychic activity which can 
be compared to mania is revery, yet revery may rather be a 
weak-minded than a maniacal mode of thinking. Pelletier is 
right in finding a great similarity between normal revery and the 
shallow associations of maniacs, but only when the associations 
ire written on paper. Clinically the manic does not by any 
means look like a dreamer. The author evidently feels this and 
finds the analogy rather more fitting for dementia praecox, which 
condition has been compared to that of dreams since the times 
of Reil (e. g., Chaslin: "La confusion mentale primitive"). 
The richness and acceleration of presentations in manic flight of 
ideas differentiates it sharply from the very stagnant slowly- 
coursing association type of dreams and especially from the 

yverty and numberless perseverations in the associations of cata- 
tonics. The analogy is correct only in so far as concerns the 
directing idea which is absent in both of these cases; in mania 

;cause all presentations crowd themselves into consciousness 

nth marked acceleration and with strong feeling tones, 88 there- 

1 L'Association des idees dans la manie aigue et dans la debilite mentale. 
These de Paris, 1903. 

Liepmann : Uber Ideenflucht, Begriffsbestimmung u. psychologische 
Analyse. Halle, 1904. 

"It is true that Aschaffenburg found a certain prolongation of the 
association time in manic cases. It should, however, not be forgotten 
that in acoustic-speech experiments attention and speech expression play 
a great role. One observes or measures expression of speech only, and 
not connections of ideas. 




12 THE PSYCHOLOGY OF DEMENTIA PILECOX. 

fore no attention can probably take place, 89 and in revery there 
is no attention to begin with, and where this is lacking the flow 
of associations must sink into revery. According to the laws of 
association there results a slowly progressive course, tending 
principally towards likeness, contrast, coexistence and motor- 
speech combinations. 40 Numerous examples can be observed 
daily by attentively following a general conversation. As Pelle- 
tier shows, the course of association in dementia praecox is con- 
structed upon a similar scheme. This can best be seen by an 
example : 

" Je suis 1'etre, 1'etre ancien, le vieil Hetre, 41 que Ton peut 
ecrire avec un H. Je suis universel, primordial, divine, catho- 
lique, Romaine, 42 l'eusses-tu cru, 1'etre tout cru, suprumu, 43 1'en- 
fant Jesus. 44 Je m'appelle Paul, c'est un nom, ce n'est pas une 
negation, 45 on en connait la signification. 46 . . . Je suis eternel, 
immense, il n'y a ni haut, ni bas, fluctuat nee mergitur, le petit 
bateau, 47 vous n'avez pas peur de tomber." 48 

This example shows us very distinctly the type of association 
in dementia praecox. It is a very shallow one and carries many 
sound associations. Yet the disintegration is so marked that we 
cannot compare it to the reveries of the normal state, but are 
obliged to compare it to dreams. Only in dreams is such speech 
observed. 49 Rich examples can be found in Freud's " Die 
Traumdeutung." 

In the first contribution of the " Diagnostische Associations- 
studien " it was proven that diminished attention produced shal- 
low association types, motor-speech combinations, sound asso- 
ciations, etc., and inversely, the appearance of shallow associa- 

** Acceleration and emotional strength of ideas are at least that which 
we can verify by observation. This, however, does in no way exclude the 
fact that there are other essential moments to consider which are, at 
present, inaccessible to our cognition. 

** Diagnost. Associationsstudien, I Beitrag, Einleitung. 

41 Assonance. Contiguite. 

41 Assonance. Assonance. 

"Assonance. "Assonance. 

41 Resemblance and contiguity, immense suggested to him the ocean, then 
the bateau and the aphorism which forms the shield of the city of Paris. 

48 Pelletier : /. c., p. 142. 

"Kraepelin: Arch. f. Psych., Vol. XXVI, p. 595, and Stransky: Uber 
Sprachverwirrtheit, 1905, point out the same thing. 



THEORETICAL VIEWS OF DEMENTIA PRAECOX. 13 

tion types always pointed to a disturbance of attention. 
According to our experimental proofs Pelletier is right when 
she refers to the shallow types of dementia praecox as the 
result of lowered attention. She calls this diminution by the 
words of Janet, " abaissement du niveau mental." From this 
work, too, it can be seen that the disturbance is again taken back 
to the central problem of apperception. 

It is to be noted that the author overlooks the perseverations, 
but on the other hand we are grateful to her for the valuable 
observation on symbolism and symbolic relations so very frequent 
in dementia praecox. She says : " It is to be remarked that the 
symbol plays a very great part in the discursions of the insane. 
It is encountered everywhere among the persecuted and weak- 
minded. It is a very inferior form of thought. The symbol 
mid be defined as a false perception of a relation of identity or 
very marked analogy between two objects which in reality pre- 
it only a very vague analogy." 50 

This quotation shows that Pelletier brings the catatonic sym- 
ls into relation with disordered attention. This supposition is 
:cidedly supported by the fact that the symbol has since long 
in known as a usual manifestation in revery and dreams. 
The psychology of negativism, concerning which numerous 
publications already exist, forms a separate chapter. The symp- 
>m of negativism certainly ought not to be considered as some- 
ling definite. There are many forms and grades of negativism 
rhich have not as yet been clinically studied and analyzed with 
ic necessary accuracy. The division of negativism into active 
and passive forms can be easily understood. The most compli- 
cated psychological cases appear under the form of active resist- 
ance. If an analysis were possible in those cases, it would fre- 
quently be found that very definite motives exist for the resist- 
ance, and it would then be doubtful if one could still talk of 
negativism. In the passive form, too, there are many cases 
which are difficult to interpret. Notwithstanding this there are 
numerous cases in which one may clearly point out that even 
simple processes of volition are always blindly converted into 
their opposite. According to our view negativism always ulti- 
mately depends on corresponding associations. Whether there 

* Pelletier : /. c., p. 129. 





14 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

is a negativism taking place in the spinal cord I do not know. 
The most general standpoint on the question of negativism is 
taken by Bleuler in his work on negative suggestibility. 61 He 
shows that negative suggestibility, that is, the impulse toward 
contrast associations, is not only a constituent part of the normal 
psyche, but also a frequent mechanism of pathological symptoms 
in hysteria, impulsive phenomena, and dementia praecox. The 
contrast mechanism is an independent function entirely rooted 
in " affectivity." It therefore manifests itself mainly in presen- 
tations of strong feeling as in decisions and similar things. 
" This mechanism protects against a rash act and forces the con- 
sideration of, for and against." The contrast mechanism is a 
counterpart of suggestibility. Suggestibility is the faculty of the 
reception and realization of strong feeling-toned ideas, while 
the contrast mechanism guards the opposite. It is for this reason 
that Bleuler appropriately calls it negative suggestibility. The 
fact that these two functions are so closely related readily ex- 
plains why they are met with together clinically. In hysteria 
we have suggestibility near insuperable contrary autosuggestion ; 
and negativism, automatism and echopraxy in dementia praecox, 
etc. 

The importance of negative suggestibility in every-day psy- 
chical occurrences explains why contrast associations are every- 
where enormously frequent. They are in the closest rela- 
tionship. 62 

In language, too, we see something similar. The words which 
express the usual contrasts are very closely associated and there- 
fore mostly belong to the intimate associations of language, as, 
white, black, etc. In primitive languages one occasionally finds 
only one word for contrasting ideas. According to Bleuler a 

n Bleuler : Die negative Suggestibility ein psych ologisches Prototyp 
des Negativismus, der contraren Autosuggestion und gewisser Zwangsi- 
deen. Psych.-Neurol. Wochenschr., 1904. 

"The following express themselves in a similar manner: Paulhan: 
L'activite mentale et les elements de 1'esprit, 1889. Svenson: Om Kata- 
tonie. Hygiea, 1902. Janet: Les Obsessions, 1903. Pick: On Contrary 
Actions. Journal of Nervous and Mental Disease, Jan., 1904. An in- 
structive case is given by Josiah Royce : The Case of John Bunyon. 
Psychological Review, 1894, p. 143. [Jelliffe : Pre Dementia Prsecox, Am. 
Jour. Med. Sc. 1907. Ed.] 



THEORETICAL VIEWS OF DEMENTIA PR^COX. 15 

relatively mild emotional disturbance will suffice to produce nega- 
tivistic phenomena. Janet ("Les Obsessions," Vol. I, p. 60) 
shows that in persons suffering from impulsive ideas, the " abais- 
sement du niveau mental" suffices to liberate a play of contrasts. 
What, therefore, can we expect from the " apperceptive demen- 
tia " in dementia prsecox ! Indeed, here we really find the appar- 
ently irregular play of positive and negative which is very often 
nicely reflected in the associations as expressed in speech. 83 
Hence in the problem of negativism we have sufficient evidence 
that this symptom too, is in close relationship with " appercep- 
tive dementia." The central control of the psyche is so weak- 
ened that it can neither further the positive nor inhibit the nega- 
tive acts, or the reverse may be true. 54 

Let us now recapitulate what has been said. The authors thus 
far mentioned have essentially affirmed that diminution of atten- 
tion, or more generally speaking, " apperceptive dementia " 
(Weygandt) is characteristic of dementia praecox. The exist- 
ence of the peculiar shallowing of the associations, symbolisms, 
stereotypies, perseverations, command automatism, apathy, abou- 
lia, disturbances of reproduction, and, in a limited sense, nega- 
tivism, are all due to apperceptive dementia. 

That neither apprehension nor retention take part as a rule in 
the general deterioration, seems at first sight rather singular. As 
a matter of fact one can find in dementia prsecox during acces- 
sible moments that there exists a surprisingly good, and an almost 
photographic memory, which preferably takes note of the most 
indifferent things that unfailingly escape the notice of normal 
persons. 65 But just such peculiarity shows what the nature of 
memory is. It is nothing but a passive registration of events 
which take place in the nearest surroundings. But all that which 
requires an effort of attention passes without heed by the patient, 
or at most it is registered a niveau together with the daily visits 
of the doctor and dinner ; at least so it appears to us. Weygandt 
(/. c.) very nicely describes this lack of active acquisition. Ap- 

* Compare the analyses of Pelletier, /. c., as well as the experimental 
examinations of Stransky : Uber Sprachverwirrtheit. 

M Further works on negativism have already been criticised by Bleuler : /. c. 

M Kraepelin, too, is of the opinion that the apprehension is not more 
intensively damaged ; it is only an increased inclination to an arbitrary pro- 
duction of incoming ideas. Lehrbuch, VII Aufl., p. 177. 



1 6 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

prehension is generally disturbed only during periods of excite- 
ment. Apprehension and retention, or impressibility and reten- 
tiveness, are for the most part only passive processes which take 
place in us without the expenditure of a great amount of energy, 
just as mere hearing and seeing when unaccompanied by attention. 

From Weygandt's idea of " apperceptive dementia " (Janet 
abaissement du niveau mental} one can in a measure deduce the 
origin of the above mentioned symptoms (automatism, stereo- 
typy, etc.) ; but we are unable from this to understand the indi- 
vidual multiformity of the symptoms, their capriciousness, the 
peculiar content of the delusions, hallucinations, etc. Many 
investigators have already attempted to solve this riddle. 

Stransky 56 examined dementia praecox from the clinical point 
of view. Proceeding from Kraepelin's idea of " emotional de- 
mentia," he asserts that by this conception two things are under- 
stood. Firstly, poverty or superficiality of emotional reactions, 
secondly an incoordination between the same and the content of 
consciousness dominating the psyche. 57 In this fashion Stransky 
differentiates the content of Kraepelin's idea, showing that clin- 
ically one sees more than the " emotional dementia." The strik- 
ing incongruity between idea and affect which we can daily 
observe in dementia prsecox, is a more frequent symptom 
during the development of the disease than the emotional demen- 
tia. The incongruity between idea and emotional tone forced 
Stransky to accept two separate psychical factors, the noopsyche 
and the thymopsyche. The former idea embraces all pure intel- 
lectual, the latter the affective processes. Both these ideas 
nearly correspond in Schopenhauer's psychology to intellect and 
will. In the healthy psyche there is naturally a constant, very 
fine, simultaneous, coordinated action of both factors. But as 
soon as incoordination steps in, it corresponds analogically to 
ataxia, and we then have the picture of dementia praecox with 
all its disproportionate and unintelligible affects. So far the 

64 Stransky : Zur Kenntniss gewisser erworbener Blodsinnsformen, 1903. 
Jahrb. f. Psych., Vol. XXIV, p. I. 

87 Jahrbuch. f. Psych., XXIV, p. 28. Idem : Zur Lehre von der Dementia 
praecox. Zentr.-Bl. f. Nervenheilk. u. Psych., XXII Jahrg. Idem: Zur 
Auffassung gewisser symptome der Dementia prsecox. Neurol. Zentr.-Bl., 
1904, Nr. 23, u. 24. Idem: Uber die Dementia praecox. Wiener mediz. 
Presse, 1905. 



THEORETICAL VIEWS OF DEMENTIA PR^COX. 1 7 

divisions of the psychic functions into nod- and thymopsychic 
agree with reality. But "it is a question whether a trite 
content of consciousness manifested in the patient with an enor- 
mous affect seems incongruous only to us who can only most 
sparingly look into his soul, or is it the same for the subjective 
sensation of the patient. I shall make myself clear by the fol- 
lowing example: 

I visit a gentleman in his office. Suddenly he starts up enraged 
and swears most excitedly at a clerk who placed a newspaper on 
the right instead of the left side of the table. I am astonished 
and make a mental note about the peculiar nervousness of this 
person. But after a while I learn from the other employees that 
the clerk has done the same thing wrongly dozens of times and 
hence the anger of the man was quite adequate. 

Had I not received subsequent explanations I should have 
formed a wrong picture of the psychology of this person. We 
are frequently confronted with a similar condition in dementia 
praecox. Owing to the peculiar seclusiveness of the patients we 
see into them but little, a fact which every psychiatrist will sub- 
stantiate. It is therefore readily understood that many excite- 
ments appear to us inexplicable because we do not see their 
associate causes. That may even happen to us. We are occa- 
sionally for a time in bad humor, and quite inadequately so 
without being conscious of its cause. The simplest responses are 
then uttered in a disproportionate, emphatic, and irritable tone, 
tc. If even a normal individual is not always clear about the 
causes of his ill-humor, how little can we know when confronted 
with the mind of a precocious dement? On account of the evi- 
dent inadequacy of our psychological diagnosis, we must be very 
careful about the supposition of a real incoordination in the sense 
of Stransky. Although judging from clinical appearances there 
are frequent incongruities, they are by no means exclusively lim- 
ited to dementia prsecox. In hysteria, likewise, the incongruity 
is an every-day occurrence. One can see it in the very trite fact 
of the so-called hysterical " exaggerations," whose counterpart is 
the well known " belle indifference " of hysterics. We also find 
violent excitements over nothing, at times over something which 
in no way shows any recognizable connection with the excite- 
ment. Yet psycho-analysis uncovers the motives, and we then 



1 8 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

begin to understand why the patients reacted in such a manner. 
In dementia prascox we are at present unable to penetrate deep 
enough so that the relations remain unknown, and we therefore 
assume an " ataxia " between noo- and thymo-psyche. Thanks 
to analysis we know that in hysteria there is no "ataxia," but 
only an oversensitiveness, which, as soon as we know the patho- 
genic ideational complex, becomes clear and intelligible. 58 
Knowing how the incongruity is brought about in hysteria, is it 
still necessary that we should accept a totally new mechanism in 
dementia praecox? In general we know by far too little about 
the psychology of the normal and hysteric 59 to dare to accept in 
such an untransparent disease as dementia prsecox, a totally new 
mechanism unknown to all psychology. One should be econom- 
ical with new principles of interpretation. It is for this reason 
that I repudiate the clear and ingenious hypothesis of Stransky. 
As a compensation for the above, we possess a very excellent ex- 
perimental work by Stransky 60 which gives us the foundation 
for the understanding of an important symptom, namely, the 
speech disorders. 

The speech disorder is the product of the main psychological 
disturbance. Stransky calls it " intrapsychic ataxia." When- 
ever there is a disturbance at the points of contact of the emo- 
tional life and ideation, as in dementia praecox, producing thereby 
in the normal thought the lack of orientation by a controlling 
idea (Liepmann), there must result a stream of thought resem- 
bling flight of ideas. As Pelletier has shown, the laws of asso- 
ciation predominate against the influence of direction. If it is 
a question of a process of speech there must result an increase 
in the purely superficial elements of connection (motor speech 
association and sound reactions), as was shown in our associa- 

68 An hysterical woman, for example, one day merged into a deep and 
persistent depression "because the weather is so dull and rainy." The 
analysis, however, showed that the depression set in on the anniversary 
of a very sad and important event in the life of the patient. 

88 Binet (Les alterations de la personnalite, p. 89) approximately re- 
marks: Hysterics are for us only subjects of choice, exagerating phe- 
nomena that one must necessarily find in some degree among a crowd of 
other persons who are not at all tainted, even slightly, by the hysterical 
neurosis. 

"Stransky: Uber Sprachverwirrtheit. 



THEORETICAL VIEWS OF DEMENTIA PRyECOX. lp 

tion experiments with distracted attention. Hand in hand with 
this there is a diminution of sensory connections. Besides these 
many other disturbances show themselves, such as an increase 
of the mediate associations, the senseless reactions, and frequent 
repetitions of the stimulus words. Perseverations show a most 
contradictory behavior during distractibility. According to our 
experiments they are increased in women and decreased in men. 
In a great many cases we could explain the resulting persevera- 
tions by the presence of a strong feeling tone. Every-day expe- 
rience teaches us that a strong feeling-toned idea shows a special 
tendency to perseverate. By distracting the attention there 
results a certain emptiness of consciousness 61 in which ideas 
can more easily perseverate than during complete attention. 

Stransky then studied the results of continuous speech asso- 
ciation under the influence of relaxed attention. His test per- 
sons had to talk at random into a phonograph for one minute on 
anything or in any way they chose. At the same time they were 
not to pay attention to what they said. A stimulus word was 
given as a starting point, and in one half of the experiments 
external distraction was caused. 

These tests brought to light interesting results. The sequence 
of words and sentences immediately recalled the speech as well 
as the writing of dementia praecox. A definite direction of 
speech was excluded by the arrangement of the experiment. 
The stimulus word at most acted for some time as a more or less 
indefinite " theme." Superficial connecting elements became strik- 
ingly manifest, corresponding to the disintegration of logical con- 
nections. There were numerous perseverations, or repetitions 
of the preceding word, almost corresponding to the repetition of 
the stimulus words in our experiments, and besides this there 
were numerous contaminations, 62 and closely connected with them 
neologisms or newly formed words. 

From Stransky's voluminous material I should like to quote 

* Comp. Diagnosf. Associationsstudien, I Beitrag. B. Durchschnitts- 
berechnungen, Abschnitt III. 

" Comp. Rud. Meringer and Karl Mayer : Versprechen und Verlesen. 
Eine psychologisch-linguistische Studie. Stuttgart, Goschen, 1895. 

By contamination we understand the condensation of many sentences 
or words into one sentence or into one word ; e. g., " I will soon him 
see home " is a contamination of " I will go home," " I will soon see him." 



2O THE PSYCHOLOGY OF DEMENTIA PR^COX. 

a few examples by way of illustrations : " On one leg stand the 
storks, they have wives, they have children, they are those who 
bring the children, the children, which they bring into the house, 
this house, an idea, which people have about storks, about the 
activity of storks, the storks are large birds with a long beak 
and live on frogs, frogs, f reegs, frogs, the frogs are f roogs, in the 
morning (Friih), in the morning they are with breakfast 
(Friihstiick), coffee, and with coffee they also drink cognac, and 
cognac they also drink wine, and with wine they drink every- 
thing possible, the frogs are large animals, and which the frogs 
devour, the storks devour the birds, the birds devour the animals, 
the animals are big, the animals are small, the animals are human 
beings, the animals are no human beings . . .", etc. 

" These sheep are . . . were merino sheep, from which the fat 
was cut out by the pound, with Shylock was the fat cut out, the 
pound cut out," . . . etc. 

" K . . . was a K . . . with a long nose, with a ramnose, with 
a rampnose, with a nose to ram, a ram gift, a man, who has 
rammed, who is rammed," etc. 

From these examples of Stransky's experiments it can be 
readily seen what laws of association the stream of thought fol- 
lows. It is mainly those of similarity, coexistence, motor speech 
connections and combinations of sound. Besides this one is 
struck by the numerous perseverances and repetitions ( Sommer : 
stereotypies). If we compare to this the sample of dementia 
prsecox associations which we have just quoted from Miss Pelle- 
tier we find a striking similarity. 63 Here, just as there, one finds 
the same laws of similarity, contiguity, and assonance. Only 
stereotypies and perseverations are lacking in Pelletier's anal- 
ysis, 64 although they can be plainly seen in the communicated 
material. Stransky also adds to these conspicuous similarities 
numerous nice examples taken from dementia prsecox. 

It is especially important that in Stransky's normal tests there 

"We must, however, mention that the speeches of Stransky show the 
unmistakable character of precipitation which is generally lacking in 
dementia praecox. What gives the impression of precipitation is hard 
to say. 

**As mentioned above, Sommer has already shown the sound associa- 
tions and stereotypies in simple word reactions. 



THEORETICAL VIEWS OF DEMENTIA PR.ECOX. 



21 



appear numerous word and sentence-conglomerations which can 
be designated as contaminations. 85 

Example : " Especially a meat, which one cannot get rid of, the 
thoughts which one cannot get rid of, especially when one ought 
to persevere at it, persevere, persevere, severere, severin," etc. 

According to Stransky this conglomeration contains the fol- 
lowing condensed series of ideas : 

(a) Mutton is consumed in England, 

(b) This idea I cannot get rid of, 

(c) This is perseveration, 

(a?) I am to talk at random whatever comes into my mind. 
The contamination is therefore a condensation of various series 
of ideas. It is essentially to be considered as a mediate associa- 
tion. 68 This character of contamination can be clearly proven 
from Stransky's pathological examples : 

Question : What is a mammal ? 

Answer (Pat) : It is a cow, for example a midwife. Midwife 
is a mediate association of cow and shows the probable way of 
thought. Cow bears living young human beings likewise 
midwife. 87 

Question: "What do you understand by the Holy Virgin?" 

Answer: "The behavior of a young lady." 

As Stransky rightly observes the thought probably goes as 
follows: Immaculate conception virgo intacta irreproachable 
conduct. 

Question: "What is a square?" 

Answer : " An angular quadrate." 

88 By contamination we understand the condensation of many sentences 
or words into one sentence or into one word ; e. g., " I will soon him sec 
home " is a contamination of " I will go home." " I will soon see him." 

** See the analysis of mediate associations. Diagnost. Associations- 
studien, Beitrage I, Introduction. 

" According to Professor Blueler, the following combination is more 
probable : 

Mammal 



cow- 



is an example 



-bears living young 

I 
midwife 



22 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

The condensation consists of: 

(a) Square is a quadrate, 

(b) The square has four angles. 

From these examples it should be evident that the numerous 
contaminations appearing in distracted attention are somewhat 
similar to the mediate associations which appear under distrac- 
tion in the simple word reactions. It is well known that our 
experiments have shown that in distractibility there is moderate 
increase of the mediate associations. 

The concurrence of three experimenters, Stransky, myself, 
and dementia praecox, can be no accident. It proves the cor- 
rectness of our conceptions and is another confirmation of the 
symptom of apperceptive weakness, which of all the degenera- 
tive symptoms of dementia praecox stands out most prominently. 

Stransky points out that contamination has frequently pro- 
duced such bizarre word formations that they unfailingly recall 
the neologisms of dementia praecox. That a great number of 
neologisms are really brought about in this manner I am con- 
vinced. Pointing to the picture of a horse a patient remarks, 68 
" This is a domestic-burden," by which he means : 

(a) The horse is a domestic animal, 

(b) The horse is a beast of burden. 

Based on clinical observation Neisser 69 remarked in 1898 that 
the newly formed words, which according to the rule as well as 
the roots are neither verbs nor nouns, are really no words at all 
but represent sentences inasmuch as they always serve to alle- 
gorize (Versinnbildlichung) a whole process. This expression 
of Neisser indicates the idea of condensation. He even goes so 
far as to talk directly about the allegorization of a whole process. 
Right here I should like to call attention to the fact that in his 
work " Die Traumdeutung " 70 Freud showed that there is a great 

88 Given by translators as play of words, in author's example can not 
be translated. 

89 Neisser : Uber die Sprachneubildungen Geisteskranker. Vortrag. 74. 
Sitzung. d. Vereins Ostdeutsch. Irrenarzte in Breslau. Allgem. Zeitschr. 
f. Psych., LV, p. 443. 

w Based on a large empirical material, Kraepelin, in his work, Uber 
Sprachstorungen im Traume (Psychol. Arbeiten, Bd. V, H. I), also occu- 
pies himself with these questions. In reference to the psychological 
genesis of the phenomena in question, Kraepelin's assertions show that he 



THEORETICAL VIEWS OF DEMENTIA PRJECOX. 2$ 

deal of condensation in dreams. Unfortunately I am unable to 
discuss in exienso the extent and extremely valuable psychologic 
material of this as yet hardly recognized investigator. It would 
lead too far. 

A knowledge of this valuable book is presupposed. No real 
refutation of the ideas of Freud have to my knowledge been 
advanced. I confine myself to the affirmation that dreams 
having already many analogies to disturbance of the associations 
of dementia praecox, possesses also the special speech condensa- 
tions in the sense of contaminations of whole sentences and situa- 
tions. Kraepelin too was struck by the resemblance between the 
speech of dreams and of dementia praecox. 71 From the numer- 
ous examples which I observed in my own and other's dreams, 
I will mention only a very simple one, illustrating at the same 
time condensation and neologism. One in his dream wishes to 
express approval of a certain situation and says: "That is 
fimous." 

does not differ much from the views developed here. Thus he says on 
p. 10 : " The appearance of speech disturbances in dreams is certainly 
very closely dependent upon the obnubilation of consciousness and the 
diminution in clearness of ideas conditioned by it." 

What Paul Meringer, Mayer and others designate as contamination, and 
Freud as condensation, Kraepelin names "ellipse" ("mixture of different 
series of ideas," " en elliptical concentration of several simultaneous series 
of thoughts"). Here I wish to call attention to the fact that as early as 
in the 8o's Forel used the expression " ellipsis " for the condensations and 
new word formations in paranoid states. It escaped Kraepelin that Freud 
had already, in 1900, treated dream-condensations in a detailed manner. 

By condensation Freud designates the blending together of situations, 
pictures, and elements of speech. The linguistic expression " contamina- 
tion " concerns only the blendings of speech, and is, therefore, a special 
idea which is subordinate to Freud's idea of condensation. The retention 
of the term contamination is to be recommended for condensation of 
speech. 

"Arch. f. Psych., XXVI, p. 595. Compare also Psych. Arbeiten, Bd, 
V, H. I, p. 79, where Kraepelin says : " It should perhaps be kept in mind 
that the peculiar expressions of the patients (dementia praecox) are not 
simple ' nonsense,' nor still less do they represent intentional productions 
of overbearing moods, but they are the expression of a peculiar disturb- 
ance of word findings which must be nearly related to those found in 
dreams." Kraepelin also expresses the view that " in confusion of speech, 
besides disturbances of word selecting and the speech expression of 
thought, there are even such disturbances of the process of thought which 
in part resemble those of dreams." 



24 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

It is a contamination of (a) fine, (b) famous. 

The dream is likewise an apperceptive weakness par excel- 
lence, which -is especially shown by its tendency towards sym- 
bolism. 72 

Finally there is still one more question which really should 
have been answered first, and that is : Does the state of conscious- 
ness -in' Stransky's normal experiments really correspond to one 
of disturbed attention? Before all it is to be noted that 
Stransky's experiments in distractibility show no essential changes 
from the experiments with the normal, consequently neither the 
association nor the attention in both conditions could have been 
so very different. But what is one to think of the disturbance in 
the experiments with the normal? 

It seems to me that the main reason is to be looked for in the 
forced character of the experiment. The test persons were 
instructed to talk at random, and that they have at times talked 
with great rapidity is shown by the fact that on an average they 
uttered from 100 to 250 words per minute, whereas in normal 
speech the average per minute is only from 130 to I4O. 73 Now 
if one talks and perhaps thinks more rapidly about indifferent 
things than he is accustomed to, he cannot bestow sufficient atten- 
tion on the associations. A second point which has to be con- 
sidered is the fact that most of the test persons were unaccus- 
tomed to the situation and it consequently influenced the emo- 
tional state. This may be compared to excited orators who 
develop a state of " emotional stupidity." 74 In such conditions I 
found extraordinarily high numbers of perseverations and repeti- 
tions. Emotional stupidity causes likewise great disturbance of 
attention. We can therefore take it as certain that in Stransky's 
experiments with the normal the attention was really disturbed, 
although the state of consciousness is surely not clear. 

We are grateful to Heilbronner for an important observa- 
tion. 76 By examining a series of associations in a case of hebe- 

' 2 Compare above the excellent observation of Pelletier, /. c.. Uber das 
Symbol. 

TS Stransky : /. c., p. 14. 

"Jung: Uber Simulation von Geistesstorung. Journ. f. Psych, und 
Neur., II, p. 191, und Wehrlin in Diagnost. Associationsstudien, Beitrag 
II. 

" Monatsschr. f. Psych, und Neur., Bd. XVIII, Erg. Heft, p. 324. 



THEORETICAL VIEWS OF DEMENTIA PRAECOX. 25 

y 

phrenia he found that on one occasion forty-one per cent., onl 
another twenty-three per cent, of the reaction words referred tct 
the patients' environment. Heilbronner considers this circum-* 
stance as an evidence for the fact that the perseverations are 
derived from the " vacuum," i. e., they are due to a deficiency of 
new ideas. I can confirm this observation from my own ex- 
perience. Theoretically it would be interesting to know in 
what relationship this manifestation stands to the Sommer-Leu- 
poldt symptom of " Benennen und Abtasten " (name and touch). 
New and independent views on the psychology of dementia 
praecox are brought forth by Otto Gross. 70 He proposes the 
expression dementia sejunctiva for the name of the disease. The 
reason for this name is the disintegration of consciousness in 
dementia praecox, hence the sej unction of consciousness. The 
idea of sej unction Gross naturally takes from Wernicke. He 
could just as well have taken the older synonymous idea of dis- 
sociation (Binet, Janet). Fundamentally, dissociation of con- 
sciousness means the same thing as Gross's disintegration of con- 
sciousness. By accepting the idea of sej unction we have only a 
new term of which psychiatry has certainly enough. Dissocia- 
tion according to the French school is a weakness of conscious- 
ness due to the splitting off of one or a series of ideas. They 
separate themselves from the hierarchy of the conscious ego and 
begin a more or less independent existence. 77 The hysteria 
doctrine of Breuer and Freud was developed on this foundation. 
According to the more recent formulations of Janet, dissociation 
is the result of " abaissement du niveau mental " which destroys 
the hierarchy and either favors or effects the origin of automa- 
tisms. 78 What automatisms are freed is most beautifully shown 
by Breuer and Freud. 70 The application made by Gross of this 
doctrine to dementia praecox is new and important. The funda- 

" Gross: Uber Bewusstseinszerfall. Monatschr. f. Psych, und Neurol. 
p. 45. Idem: Beitrag zur Pathologic des Negativismus. Psych.-neur. 
Wochenschr., 1903, Nr. 26. Idem : Zur Nomenklatur " Dementia sejunc- 
tiva." Neurol. Centr.-Bl., 1906, Nr. 26. Idem: Zur Differentialdiag- 
nostik negativistischer Phanomene. Psych.-neurol. Wochenschrift, 1906, 
Nr. 37, und 38. 

n See the fundamental work of Janet : L'automatisme psychologique. 

" Janet : Les Obsessions. 
' Studien liber Hysteric. 



26 



THE PSYCHOLOGY OF DEMENTIA PRJECOX. 



mental idea of the author is expressed as follows : " Disintegra- 
tion of consciousness in my sense signifies the simultaneous flow 
of functionally separated series of associations. To me the chief 
point lies in the conception that the activity of consciousness is to 
be considered as a resultant of many synchronous psychophysical 
processes. 80 

These citations ought to illustrate sufficiently the author's 
ideas. We can perhaps agree with the view that consciousness, 
or better, the content of consciousness, is the result of numerous 
nonconscious or unconscious psychophysical processes. In con- 
tradistinction to the current psychology of consciousness, in 
which beyond the epiphenomenon " consciousness " there imme- 
diately begins the nutritive processes of the brain cells, this 
aspect is really a refreshing progress for psychiatry. Gross 
seems to think that the psychic content (not the content of con- 
sciousness!) flows synchronously in single series of associations. 
This comparison seems to me somewhat equivocal. I think it 
more correct to assume successive conscious-becoming ideational- 
complexes which are constellated by antecedent association- 
complexes. The cement of these complexes is some definite 
affect. 81 If the connection between Gross's synchronous series 
is severed by disease, disintegration of consciousness results. 
Translated into the language of the French school, it means that 
if one or more association series are split off there results a dis- 
sociation causing weakness of consciousness. Let us not quarrel 
over words. Here, too, Gross returns to the problem of apper- 
ceptive disturbance; he, however, approaches this problem from 
a new and interesting side, from the side of the unconscious. 
Gross attempts to uncover the roots of the numerous automatic 
phenomena which break into the consciousness of dementia 
praecox with elemental power and strangeness. The symptoms 
of automatic phenomena in the conscious life of dementia praecox 
should be known to all psychiatrists. They are the autochtho- 
nous ideas, the sudden impulses, hallucinations, the manifesta- 

80 Gross : Zur Nomenklatur, etc. 

81 The pure laws of association play quite an insignificant role when 
I confronted with the unlimited power of the emotional constellation, just 
1 as in real life where the logic of thought has no significance when con- 
i\^ fronted with the logic of feeling. 



THEORETICAL VIEWS OF DEMENTIA PRyECOX. 2/ 

tions of thought-influence, imperative ideas with the character of 
strangeness, the cessation and disappearance of thought (appro- 
priately designated by one of my patients as " Gedankenentzug " 
thought deprivation), and inspirations (pathological fancies), 
etc. Gross states that the catatonic manifestations are "changes 
of the will brought about by an agent which is conceived as 
external to the ego-continuity, and is therefore referred to as a 
strange power." They are a "substitution of the will of the' 
ego-continuity by a crowding in from outside of another consciousl 
series." We have to keep in mind that many association series' 
can simultaneously flow in the organ of consciousness without 
influencing one another. From these series in consciousness one 
will have to become the carrier of the continuity of conscious- 
ness, while the other association series are then naturally " sub- 
conscious," or rather, " unconscious." Now at all times there 
is a possibility that also in these the nervous energy swells up 
and reaches such a stage that one of its end organs becomes 
endowed with attention, which means that a joint from the uncon- 
scious association series pushes itself illegitimately into the con- 
tinuity of the dominant one. If these conditions are fulfilled, 
the accompanying subjective process can be only of such a nature 
as any psychic manifestation entering into consciousness in an 
unadjusted manner, and is therefore perceived by the conscious 
continuity as something entirely foreign. Ideas of explanation 
are almost inevitably added, the referred psychic manifestation 
(idea) originating not from the ego-consciousness, but thrown 
into it from without. 82 As aforesaid, the displeasing part in this 
hypothesis is the assumption of synchronous independent associa- 
tion series. Normal psychology does not furnish us with any 
facts on this point. Where we can best observe split-off series 
of ideas, namely, in hysteria, we find that the opposite holds true. 
Even where one deals with apparently totally separated series, one 
can find somewhere in some hidden location the bridge leading 
from one series to the other. 83 In the mind all stands in connec- 
tion with all, the present psyche is the result of milliards of con- 
stellations. 

** Gross: Zur Differentialdiagnostik, etc., /. c. 

M Just this point I have thoroughly proved (depending on Flournoy) 
in a case of somnambulism. Zur psychologic und pathologic sog. okkulter 
Phanomene. Leipzig, 1902. 



28 THE PSYCHOLOGY OF DEMENTIA PILECOX. 

Aside from this slight inconvenience, I believe that I may call 
Gross's hypothesis a rather happy one. It tells us in brief that 
the roots of old automatic phenomena lie in the unconscious asso- 
ciation connections. If consciousness becomes disintegrated 
(abaissement du niveau mental apperceptive weakness) the 
complexes accompanying it are freed from all restraint and are 
then able to break into the ego-consciousness. This is an emi- 
nent psychological conception, and agrees in the clearest possible 
manner with the doctrines of the French school, with the expe- 
rience of hypnotism, and with the analysis of hysteria. If we 
weaken the power of consciousness by suggestion and produce 
thereby a split-off series of presentations, as, for example, in 
post-hypnotic commands, we find that this series reappears with 
a power inexplicable to the ego-consciousness. In the psychology 
of ecstatic somnambulists we have the typical breaking in of 
split-off ideas. 84 

Unfortunately Gross leaves one question open, and that is, 
which are the dissociated series of ideas and what is the nature 
of their content? Some time ago, long before Gross wrote, 
Freud answered this question very brilliantly. As far back as 
1893 Freud 85 showed preliminarily that a hallucinatory delirium 
originates from an unfulfilled wish, and that this delirium is a 
compensation for unsatisfied yearnings, that the person takes 
refuge, as it were, in the psychosis in order to find in the dream- 
like delirium of the disease that which was refused to him in 
reality. In 1896 Freud analyzed a paranoid condition, Kraepe- 
lin's paranoid form of dementia praecox, and showed how the 
symptoms were accurately determined according to the scheme 
of the transformation mechanism of hysteria. Freud then stated 
that paranoia, or the group of cases belonging to paranoia, are a 
defensive neuropsychosis; that is to say, that just like hysteria 
and obsessions, they, too, originate from the repression of painful 
memories, and that the form of the symptoms is determined by 
the content of the repression. 86 

84 See especially the magnificent script examples of Helene Smith, 
Flournoy: Des Indes, etc. 

** Uber den psychischen Mechanismus hysterischer Phanomene. Neurol. 
Centr.-Bl., 1893, H. i and 2. 

86 For further remarks on Defensive Neuropsychoses, see Neurol. Centr.- 
Bl., 1896. 




THEORETICAL VIEWS OF DEMENTIA PR^COX. 2Q 

In view of the far-reaching significance of such an hypothesis 
it pays to enter somewhat more fully into the classical analysis 
of Freud. 

It was the case of a thirty-year old woman who manifested the 
following symptoms: She imagined that her environment had 
changed, she was no longer respected, she was annoyed, she was 
watched, and her thoughts were known. Later she thought 
that she was watched in the evening while undressing. She also 
experienced sensations in her abdomen which she believed were 

casioned by an unseemly thought on the part of the servant girl. 

isions then appeared in which she saw female and male genitals. 
Whenever she was with women alone she had hallucinations of 
emale genitals, and at the same time imagined that the others 
saw her own genitals. 

Freud analyzed this case. He observed that this patient be- 

ved just like a hysteric; that is, she showed the same resist- 
ances, etc. What seemed unusual was the fact that the repressed 

oughts did not appear, as in hysteria, in the form of loosely 
connected fancies, but in the form of hallucinations, and hence 
:he patient compared them to her own voice. (I shall later take 
ie opportunity to produce experimental proof for this observa- 
tion.) The hallucinations here mentioned began to manifest 
themselves after the patient saw in the asylum a number of naked 
female patients bathing together. " It may be presupposed that 
the reason these impressions repeated themselves was because 
something of great interest was connected with them." She 
stated that she felt ashamed in the presence of these women, 
is somewhat forced and altruistic modesty was striking, and 
pointed to something repressed. Patient reproduced " a series 
of scenes from her seventeenth to her eighth year, during which, 
while bathing before her mother, her sister and her physician, 
she was ashamed of her nakedness. This series, however, 
reached back to a scene in her sixth year, when she undressed in 
the children's room before going to sleep without feeling 
ashamed of her brother, who was present. Finally it was found 
that for years the brothers and sisters were in the habit of show- 
ing themselves naked to one another before retiring." At that 
time she was not ashamed. " She is now trying to make up in 
shame what she lost as a child." 




3O THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

" The beginning of her depression began at the time of a dis- 
agreement between her husband and her brother, on account of 
which the latter no more visited her. She was always much 
attached to this brother." 

Besides this she spoke about a moment in the history of her 
disease during which, for the first time, " everything became 
clear"; that is, during which she became convinced that her 
assumption about being generally despised and intentionally an- 
noyed was true. She gained this assurance during a visit of her 
sister-in-law who, in the course of conversation, gave utterance 
to the following words: " If such a thing should happen to me 
I would not mind it." Mrs. P. at first took this lightly, but when 
her visitor left her it seemed to her that these words contained a 
reproach, meaning that she was in the habit of taking serious 
matters lightly, and since that hour she was sure that she was a 
victim of common slander. The tone in which her sister-in-law 
spoke was especially convincing. It was, however, shown that 
the sister-in-law spoke about another subject before giving utter- 
ance to this sentence. She related to the patient that in the 
father's home there were all sorts of difficulties with the brothers, 
and added : " In every family many things happen which one 
would rather keep in darkness, and that if such a thing should 
happen to her she would take it lightly. Mrs. P. had to acknowl- 
edge that her depression was connected with the sentences uttered 
before the last one. As she repressed both sentences which could 
recall her relations with her brother and retained only the last 
meaningless one, she was forced to connect with it the sensation 
of being reproached by her sister-in-law; but, inasmuch as the 
contents of this sentence offered absolutely no basis for such 
assumption, she disregarded it and laid stress on the tone with 
which the words were pronounced." 

After this explanation Freud turned his attention to the analy- 
sis of the voices. " It is to be noted that such indifferent remarks 
as ' here goes Mrs. P.' ' she now looks for apartments ' were 
very painfully felt." The first time she heard voices was after 
she read the story " Heiterethei," by O. Ludwig. After reading 
it she took a walk on the highway, and suddenly while passing a 
peasant's cottage voices told her: "That is just how the house 
of Heiterethei looked! Here is the well and- here the bush! 



THEORETICAL VIEWS OF DEMENTIA PR^COX. 31 

How happy she was in all her poverty ! " The voices repeated 
whole paragraphs of what she had just read, but the contents 
were of an indifferent nature. The analysis showed that while 
reading she at the same time entertained extraneous thoughts 
and that she was excited by totally different passages of the book. 
Against this material analogy between the couple in the romance 
and herself and her husband, the reminiscences of intimate things 
of her married life and family secrets, against all these, there 
arose a repressive resistance because they were connected with 
icr sexual shyness by very simple and demonstrable streams of 
thought, and finally resulted in the awakening of old experiences 
of childhood. In consequence of the censorship exercised by the 
repression the harmless and idyllic passages connected with the 
objectionable ones by contrast and vicinity became reen forced in 
consciousness, enabling them to become audible. For example, 
the first repressed thought referred to the slander to which the 
secluded heroine was subjected by her neighbors. She readily 
found in this an analogy to herself. She, too, lived in a small 
place, had no intercourse with anybody and considered herself 
despised by her neighbors. The suspicion against the neighbors 
was founded on the fact that in the beginning of her married 
life she was obliged to content herself with a small apartment. 
The wall of the bedroom, near which stood the nuptial bed of 
the young couple, adjoined the neighbors room. With the be- 
ginning of her marriage there awakened in her a great sexual 
shyness. This was apparently due to an unconscious awakening 
of some reminiscences of childhood of having played husband 
and wife. She was very careful that the neighbors should not 
lear through the adjacent wall either words or noises, and this 
shyness changed into suspicion against the neighbors." On fur- 
ther analysis of the voices Freud often observed " a character 
of diplomatic uncertainty. The morbid allusions were generally 
leeply hidden. The continuity of some sentences was marked 
by strange expressions, unusual forms of speech, and, in other 
ways, characteristics common to the auditory hallucinations of 
paranoiacs. The hallucinations also showed a slight disfigure- 
icnt caused by compromise formation." 

I have purposely given the floor to the author of the first analy- 
sis of paranoia, a thing so highly important for psychopathology. 



32 THE PSYCHOLOGY OF DEMENTIA PR.ECOX. 

I did not know how to abridge the ingenious demonstrations of 
Freud. 

Let us now return to the question of dissociated series of ideas. 
We now see what meaning Freud gives to Gross's assumed disso- 
ciations. They are nothing other than the repressed complexes 
found in hysteria, 87 and last but not least also in the normal, 88 
The mystery of repressed series of ideas reveals itself as a psy- 
chological mechanism of general significance and of quite usual 
occurrence. Freud puts in a new light the problem of incon- 
gruity between the content of consciousness and emotional tone 
discussed by Stransky. He shows that indifferent, even insignifi- 
cant ideas may be accompanied by intense feeling tones which 
they take from a repressed idea. Freud uncovers a way which 
can lead us to the understanding of the inadequate feeling tone 
in dementia praecox. I need hardly discuss the significance of 
this. The results of Freud's investigations may be summed up 
as follows : 

Both in form and in content of the symptoms of paranoid 
dementia prgecox there are thoughts which in consequence of 
their disagreeable tone became unbearable to the conscious ego, 
and hence are repressed. They determine the nature of the delu- 
sions and hallucinations as well as the whole general behavior. 
Whenever apperceptive paralysis appears in a person the mani- 
fested automatisms contain the dissociated idea complexes the 
whole army of subjected thoughts become unyoked. Thus we 
may generalize the result of Freud's analysis. 

As everybody knows, Tiling, 89 uninfluenced by Freud, and 
based on clinical experience, came to conclusions closely resem- 
bling those of Freud. He, too, would contribute to individuality 
an almost boundless significance for the origin and formation of 
the psychosis. The importance of individual psychology is un- 
doubtedly underestimated in modern psychiatry, owing less per- 
haps to theoretical reasons than to the helplessness of practical 
psychology. One can therefore cover a great distance with 

OT Compare Diagnost. Associationsstudien, Beitrag V, VI, VII, VIII. 

"* Diagnost. Associationsstudien, Beitrag IV. 

"Tiling: Individuelle Geistesartung und Geistesstorung. Idem: Zur 
Aetiologie der Geistesstorungen. Centr.-Bl. f. Nervenheilkunde u. Psych., 
1903, P. 561. 



THEORETICAL VIEWS OF DEMENTIA PR^COX. 33 

Tiling, at any rate, even further than Neisser 90 thought he could 
go. At the question of etiology, that is, at the nucleus of the 
problem, one must halt. The individual psychology of neither 
Freud nor Tiling explains the origin of the existing psychosis. 
In the citation from Freud's analysis we very clearly see that the 
" hysterical " mechanisms uncovered by him suffice to explain 
the origin of hysteria, why then does a dementia praecox orig- 
inate? We can readily understand why the content of the delu- 
sions and hallucinations are of such a nature and of no other; 
but why non-hysterical delusions and hallucinations should at all 
appear we do not know. Here at the basis of all there should 
be one physical cause embracing all the psychological ones. Let 
us assume with Freud that every paranoid form of dementia 
)raecox runs according to the mechanism of hysteria, but why is 
the paranoid unusually stable and resistive, while hysteria is 
characterized by the great mobility of its symptoms? Here we 
strike against a new phase of the disease. As Neisser 01 puts it, 
the mobility of the hysterical symptoms is based on the mobility 
of the affects, while the paranoid state is characterized by the 
fixation of the affects. This thought extraordinarily important 
for dementia praecox is formulated by Neisser as follows: 92 

From without only a very poor assimilation takes place. 
The patient is able to exert less and less voluntary influence on 
the stream of his ideas and in this manner there originate sepa- 
rate groups of idea complexes of much greater volume than in 

ic normal. These complexes are, as to contents, connected by 
certain inherent personal relations, but hardly coalesce in any 
)ther way, so that depending on the momentary constellations it 
now this and now that one which more intensively determines 

ic direction of the continued psychic elaboration and association, 
fn this way there results a disintegration of the personality which 

scomes so to say a passive spectator of the inflowing impres- 
sions from the various irritative sources and an inanimate puppet 
for the freed irritations thus generated. The affects normally 

90 Neisser, Individualitat und Psychose. Berlin, 1906. 

n Neisser, Individualitat und Psychose, p. 29. 

**To be sure Neisser only does that for paranoia, under which he can 
hardly include original paranoia (Kraepelin). His representations fit 
mainly the paranoids. 




34 THE PSYCHOLOGY OF DEMENTIA PILECOX. 

destined to regulate our relations to our environments and to 
direct our adaptation to the same, which are a protection to the 
organism and represent the motive powers of self-preservation, 
are alienated from their natural destiny. Owing to the organ- 
ically strong feeling tone of the delusional stream of thought, no 
matter what the emotional state may be, this and this only is 
always reproduced. These fixations of the affects destroy the 
ability of feeling joy or compassion and lead to an emotional 
isolation of the patient which runs parallel with the intellectual 
alienation." 

Neisser describes here the familiar picture of apperceptive 
dementia. Lack of new acquisition, paralysis of purposeful prog- 
ress (adapted to reality), disintegration of personality and 
autonomy of complexes. Finally, he adds the " Fixierung der 
Affecte " (fixation of affects), that is, the fixation of the emo- 
tionally accentuated complexes (for affects have always regu- 
larly an intellectual content, though it is not always known). 
From this he explains the emotional dementia (Masselon invented 
for this the fitting expression "clotting"). Following Freud, 
fixation of affects means that the repressed complexes (the car- 
riers of affects) can no more be disconnected from the contents 
of consciousness, they remain and so prevent the further develop- 
ment of personality. 

To avoid misconceptions I must here add that the continued 
persistence of a strong complex in normal psychic life can lead 
only to hysteria. Yet the consequent manifestations of the hys- 
terogenic affect are different from the symptom-complex of 
dementia praecox. For the origin of dementia praecox we must 
demand a totally different disposition than we do for hysteria. 
If a purely hypothetical supposition be permitted one could per- 
haps venture the following train of thought : The resultant mani- 
festations of the hysterogenic complex are reparable, while the 
affect of dementia praecox gives opportunity for the appearance 
of an anomalous metabolism (toxine?), which injures the brain 
in a more or less irreparable manner, so that in consequence of 
this defect the highest psychic functions become paralyzed. It 
is for this reason that the acquisition of new complexes becomes 
difficult or ceases altogether. The pathogenic or rather the incit- 
ing complex remains to the last, and the further development of 



THEORETICAL VIEWS OF DEMENTIA PRyECOX. 35 

personality is definitely checked. In spite of an apparently gap- 
less causal chain of psychological events leading from the normal 
into the pathological, one can never disregard the possibility that 
in certain cases a change of metabolism (in the sense of Kraepelin) 
may be primary, whereby the accidental newest and last complex 
" clots " or " curdles," and thus inherently determines the symp- 
toms. Our experience does not as yet reach far enough to war- 
rant the exclusion of this possibility. 

SUMMARY OF THE FIRST CHAPTER. 

This anthology from the literature, in my judgment, shows 
quite distinctly that all the views and investigations which among 
themselves hardly exhibit any apparent connection nevertheless 
converge to the same point. The observations and intimations 
plucked from the different realms of dementia prsecox point 
above all to the idea of a real central disturbance which is desig- 
nated by different names, such as apperceptive dementia (Wey- 
gandt), dissociation, abaissement du niveau mental (Janet, Masse- 
lon), disintegration of consciousness (Gross), disintegration of 
personality (Neisser et a/.). Then there arose the idea of tend- 
ency towards fixation (Masselon, Neisser) and from this Neisser 
adduces the emotional dementia. Freud and Gross find the im- 
portant fact of the presence of split-off series of ideas. To 
Freud, however, belongs the credit of being the first to show in 
a case of paranoid dementia praecox the " principle of conver- 
sion " (repression and indirect reappearance of the complexes). 
Nevertheless the mechanisms of Freud do not reach so far as to 
explain why there originates a dementia praecox and not a hys- 
teria ; hence it must be postulated that for dementia prsecox there 
is a specific resultant manifestation of affects (toxins?) which 
causes the definite fixation of the complex by injuring the sum 
total of the psychic functions. However, the possibility cannot 
be disputed that the " intoxication " may appear primarily from 
" somatic " causes and seize the accidentally remaining complex 
and change it pathologically. 



CHAPTER II. 

THE EMOTIONAL COMPLEX AND ITS GENERAL ACTION ON THE 

PSYCHE. 

My theoretical propositions for an understanding of the psy- 
chology of dementia prsecox are in reality almost entirely ex- 
hausted in the contents of the first chapter, for Freud in his 
works on hysteria, imperative neuroses and dreams has, after 
all, given all essentials. Nevertheless our ideas gained on an 
experimental basis differ somewhat from those of Freud. Per- 
haps my conception of the emotional complex even oversteps the 
limits of Freud's views. 

The essential basis of our personality is affectivity. 1 Thought 
and action are only, as it were, symptoms of affectivity. 2 The 
elements of our psychic life, sensations, ideas and emotions are 
given to consciousness in the form of certain entities, which can 
in a manner be compared to a molecule, if one may venture upon 
an analogy with chemistry. 

To illustrate : I meet on the street an old comrade and imme- 

1 For feeling, mood, affect, and emotion, Bleuler proposes the expres- 
sion " affectivity," which not only designates the affects in the proper 
sense but also the light feelings or feeling tones of pleasure and pain 
in every possible occurrence. Affektivitat, Suggestibility, Paranoia. 
Halle : Marhold. 1906. p. 6. 

2 Bleuler says (/. c., p. 17) : "In all our actions and omissions affectivity 
is a much greater motive element than reflection. It is likely that we act 
only under the influence of pleasure and pain, and it is chiefly due to the 
affects connected with them that logical reflections obtain their force. 
Affectivity is the broader conception of which volition and effort represent 
but one side." 

Andre Godfernaux says : " The affective state is the dominating force, 
the ideas are nothing but its subjects. The logic of reasoning is only 
the apparent cause for the wheeling about of thought. Below the cold 
and rational laws of association of ideas there are others which conform 
more to the deep necessities of existence. It is the logic of sentiment." 
Le sentiment et la pensee et leurs principaux aspects physiologiques. 
Paris, Alcan, 1894. 

36 



THE EMOTIONAL COMPLEX. 37 

diately an image is formed in my brain, it is a functional entity, 
the picture of my comrade X. We differentiate in this entity 
("molecule") three components ("radicals"); sensory percep- 
tions, intellectual components (ideas, memory pictures, judg- 
ments, etc.) and emotional tone. 8 These three components are 
firmly united, so that if the memory picture alone of X comes to 
the surface the elements appertaining to it are regularly always 
with it. The sensory perception is represented by an accompany- 
ing centrifugal stimulation of the sensory spheres concerned. I 
am therefore justified in speaking here of a functional entity. 

Through some thoughtless gossip of comrade X, I once became 
involved in a very unpleasant affair, the consequences of which 
I suffered for a long time. This affair embraces a large number 
of associations (it can be compared to a body made up of a num- 
ber of molecules), many persons, things and events are contained 
therewith. The functional entity " my comrade " is only one 
figure among many. The entire mass of memory has a definite 
feeling tone, a vivid feeling of anger. Every molecule partici- 
pates in this feeling tone, so that as a rule it is always accom- 
panied by this feeling, whether appearing alone or in connection 
with others, and the more identified it becomes with this great 
union the greater is the feeling tone.* 

I once witnessed the following incident: I was taking a walk 
with a very sensitive and hysterical gentleman. The village bells 
were pealing a new and very harmonious chime. My companion, 

'Compare Bleuler, /. c., p. 5. "Just as we are able to distinguish in 
every sensation of light, even in the very simplest one, between quality, 
intensity, and saturation, so we may speak of processes of cognition, of 
feeling, of will, though we are well aware that no psychic process exists 
to which all three qualities are not common, even if it is now one, now 
the other that is in the foreground." 

Bleuler therefore divides the " psychic forms " into preponderantly intel- 
lectual, preponderantly effective, and preponderantly voluntary. 

*This can be directly compared to Wagnerian music. The leitmotif 
designates (in a measure like the feeling tone) an important complex 
presentation of the dramatic construction (such as Walhalla, Vertrag, 
etc.). Whenever an action or speech incites this or that complex, the 
leitmotif appertaining to it immediately resounds in some variation. It 
is exactly the same in ordinary psychological life. The leitmotif is the 
emotional tone of our complexes; our actions and moods are nothing 
but variations of our leitmotif. 



38 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

who generally displayed great feeling for such tunes, suddenly 
began to rail at it, saying that he could not bear the disgusting 
ringing in the major key, that it sounded abominably, that this 
was an especially disagreeable church and unsightly village (the 
village is famous for its charming location). This remarkable 
and inadequate affect interested me and I continued my investi- 
gation. My companion then began to abuse the local parson. 
His reason for the abuse was that the minister had an ugly beard 
and wrote very bad poetry. My companion, too, was talented 
lyrically. The affect then lay in poetic rivalry. 

This example shows how the molecule (the chiming, etc.) takes 
part in the feeling tone of the whole mass of presentations 5 of 
the poetic rivalry. We designate this by the name of the emo- 
tionally accentuated complex. Considered in this sense the com- 
plex is a higher psychic entity. When we come to examine our 
psychic material, for example, that supplied by the association 
experiments, we find that every association belongs, as it were, 
to some complex. (I refer to Contribution IV ff. of the Diag. 
Assoz.-Stud.) To be sure, it is somewhat difficult to prove this 
in practice, but the more carefully we analyze the more we find 
that single associations belong to some complex. Undoubtedly 
they are related to the ego-complex more than any other. The 
ego-complex in the normal person is the highest psychic instance. 
By it we understand the ideational mass of the ego which we 
believe to be accompanied by the potent and ever-living feeling- 
tone of our own body. 

The feeling-tone is an affective state which is accompanied by 
bodily innervations. The ego is the psychological expression for 
the firmly associated union of all general bodily sensations. The 
personality proper is therefore the firmest and strongest complex, 
and asserts itself (provided it be healthy) throughout all psycho- 
logical storms. It is for that reason that the ideas which directly 
concern one's own personality are the most stable and interesting ; 
in other words, they possess the strongest attention-tone. (Atten- 
tion in the sense of Bleuler is a state of affectivity. 6 ) 

"The individual presentations are connected among themselves accord- 
ing to the different laws of associations (similarity, coexistence, etc.). 
But the higher connections are grouped and selected by an affect. 

"Bleuler: Affektivitat, etc., p. 31, says: "Attention is nothing more than 
a special form of affectivity" (p. 30). "The attention just like all our 



THE EMOTIONAL COMPLEX. 39 

ACUTE EFFECTS OF THE COMPLEX. 

Reality sees to it that the quiet circles of egocentric ideation 
are frequently disturbed by strong feeling tones, so called affects. 
A situation threatening danger pushes aside the tranquil play of 
ideas and places in its stead a complex of other ideas of the 
strongest feeling-tone. The new complex then appears very 
prominently, crowding all the others into the background. It 
totally inhibits all other ideas, retaining only those direct ego- 
centric ideas which fit its situation. Under certain conditions it 
can even momentarily suppress to complete unconsciousness the 
strongest contrary ideas. It has the strongest attention-tone. 
(We therefore do not say we concentrate attention on anything, 
but the state of attention enters into this presentation. See 
" Diagnost. Assoc.-Stud.," I. Beitrag, Abschnitt B. L.) 

Where does an ideational complex get its inhibiting or pro- 
moting force? 

We have seen that the ego-complex on account of its union 
with the general sensations of the body is the most stable and 
richest in associations. The perception of a situation threaten- 
ing danger excites fear. Fear is an affect, hence it is accom- 
panied by physical conditions, by a complicated harmony of 
muscular tension and excitation of the sympathetic. The per- 
ception has therefore found the way to bodily innervation and 
in this manner has immediately helped its association-complex to 
get the upper hand. Owing to this fear numberless general 
sensibilities of the body become changed, changing thereby most 
of the sensations lying at the foundation of the general ego. 
Corresponding to this the ordinary ego loses its attention-tone 
(or its clearness, or its promoting and inhibiting influence on 
other associations or other synonyms). It is compelled to give 
way to the stronger and other general sensations of the new com- 
plex. Notwithstanding this, it does not normally perish but 
remains as a feeble affect-ego 7 because even very strong affects 

actions is always directed by an affect," or better expressed, "Attention 
is a side of affectivity which does nothing but that which is already known 
of it, that is, it smooths the way for certain associations and inhibits 
others." 

T The modification of the ego-complex resulting from the setting in 
of a markedly accentuated complex I designate as the "affect ego." 



4O THE PSYCHOLOGY OF DEMENTIA PILECOX. 

are unable to change all sensations lying at the foundation of the 
ego. As every-day experience shows, the affect-ego is a feeble 
complex, and is considerably inferior to the affect-complex in 
constellated force. 

Let us now assume that the dangerous situation clears rapidly. 
The complex then soon loses some of its attention-tone, because 
the general sensations gradually resume their normal character- 
istics. Yet the affect continues to oscillate for a long time in its 
physical and hence also in its psychical components. " The knees 
shake," the heart continues to palpitate excitedly for some time, 
the face is either flushed or pale, " one can hardly recover from 
fear." From time to time, at first after short, and later after 
longer intervals, this picture of fear returns and is charged with 
new associations, thus exciting waves of affect-reminiscences. 
This perseveration of the affect, in addition to the great emo- 
tional force, also contributes towards the proportional increase 
in the number of the associations. Therefore extensive com- 
plexes are always of great feeling tone, and inversely, strong 
affects always leave behind extensive complexes. This is simply 
due to the fact that on the one hand strong complexes contain 
numerous bodily innervations, and on the other hand, strong 
affects can constellate many associations, owing to their strong 
and persistent excitement of the body. Affects may normally 
continue to act for a long time (in the form of disturbances of 
the stomach, heart, sleeplessness, trembling, etc.). Gradually, 
however, the^y die away, the complexes disappear from conscious- 
ness, and only occasionally in dreams there appear more or less 
hidden intimations. In the associations they continue to show 
themselves for years in characteristic complex disturbances. But 
their gradual extinction is prevented by a general psychological 
peculiarity, namely, their readiness to reappear in almost full 
force on similar or much weaker stimuli. For a long time after, 
there exists a condition which I should like to designate as com- 
plex-sensitiveness. A child once bitten by a dog will scream with 

This modification will, as a rule in painful affects, consist of restriction 
and recession of many parts of the normal ego. Many other wishes, 
interests, and affects have to give way to the new complex, insofar as 
they oppose it. The ego in the affect is reduced to its lowest, as can 
be seen in such scenes as theater fires and shipwrecks, where in a trice 
all culture disappears, being replaced by the crudest lack of consideration. 



THE EMOTIONAL COMPLEX. 4! 

fear if it observes a dog even at a distance. People who have 
received a painful message will thereafter open all their mail with 
apprehension, etc. These complex effects, which under certain 
conditions will extend over long periods, leads us to the consid- 
eration of the 

CHRONIC EFFECTS OF THE COMPLEX. 

There are two kinds to be differentiated: 

1. There is a complex-action which extends over a very long 
period and which is often evoked by a single affect. 

2. There are special chronic effects which become lasting 
because the affect is always in a continuous state of provocation. 

The first group is best illustrated by the legend of Raymundus 
Lullus, who, as a gallant adventurer, was for a long time enthu- 
siastically courting a lady. Finally the longed for billet arrived 
inviting him for a nocturnal rendezvous. Lullus, full of expec- 
tation, arrived at the appointed place and as he approached the 
lady who was there awaiting him she suddenly parted her apparel 
and uncovered her bosom eaten away with cancer. This event 
made such an impression on Lullus that henceforth he devoted 
his life to pious asceticism. 

There are impressions which last a lifetime. Indeed the last- ' 
ing effects of strong religious impressions or shocking incidents 
are well known. The effects in youth are particularly strong. 
Education, to be sure, is based on this; that is, to impart lasting 
complexes to the child. The durability of the complex is guar- 
anteed by a constantly active feeling-tone. If the feeling-tone 
becomes extinguished the complex, too, becomes extinguished. 
The persistent existence of a complex with feeling-tone has nat- 
urally the same constellating effect on the other psychical activi- 
ties as an acute affect. Whatever suits the complex is taken up, 
everything else is excluded or at least inhibited. The best exam- 
ples can be found in religious convictions. There is no argument, 
no matter how threadbare, that is not advanced if it is pro, on 
the other hand the strongest and most plausible arguments contra 
do not thrive ; they simply glide by, because emotional inhibitions 
are more powerful than all logic. Even among people of intelli- 
gence who have great education and experience at their com- 
mand, one sometimes observes a real blindness, a true systematic 
anaesthesia when an attempt is made to convince them of the 






42 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

doctrine of determinism. How often we notice that an old 
unpleasant impression will, in many people, produce an imper- 
turbable false judgment that no logic, no matter how clear, can 
dislodge ! 

The effects of the complex extend not only over thought but 
also over action, forcing it continually in a very definite direction. 
How many people thoughtlessly practice religious rites and many 
other possible baseless actions, though intellectually they long 
since are above it all ! 

The second group of chronic complex-effects in which the 
feeling-tone is constantly sustained by actual stimuli, offer the 
best examples of complex constellations. The strongest and most 
persistent effects are especially seen in the sexual complexes 
where the feeling-tone is constantly maintained by unsatisfied 
sexual desire. A glance through the " History of the Saints," 
or, e. g., Zola's " Lourdes," or " Reve," will show numerous 
examples. Nevertheless the constellations are not always of a 
totally coarse and sensuous nature, often they are finer influences, 
marked by symbolisms acting on thought and action. I refer 
to the numerous and instructive examples offered by Freud. 
Freud presents the conception of " symptom-action " as a special 
act of the constellation. (One should really speak of " symptom- 
thought" and " symptom-action.") In his " Psychopathologie 
des Alltagslebens " Freud shows that apparently fortuitous dis- 
turbances of our actions, such as lapses in talking and reading, 
forgetting, etc., are due to the infringement of constellated com- 
plexes. In his " Traumdeutung " he points out a similar influence 
in our dreams. In our experimental work we have proven that 
complexes disturb association experiments in a characteristic and 
regular manner. (Peculiar forms of reactions, perseveration, 
retardation or loss of reaction, subsequent forgetting of critical 
or post-critical reactions, 8 etc.) These observations give us val- 

8 Compare Jung: Experimentelle Beobachtungen iiber das Erinnerungs- 
vermogen. Zentr.-Bl. f. Nervenheilk. u. Psychiatric, 1905. Freud, too, 
says the following (Traumdeutung, 1900, p. 301): "If the report of a 
dream appears to me at first difficult to understand, I request 'the dreamer 
to repeat it. This he rarely does with the same words. The passages 
wherein the expressions are changed I recognise as the weak points of 
the dream's disguise. The narrator is admonished by my request that I 
mean to take special pains to solve the dream and immediately under the 



THE EMOTIONAL COMPLEX. 43 

uable indices for the complex-theory. In selecting my stimulus 
words I took care to employ as far as possible words in colloquial 
use, principally to avoid difficulties of understanding by the 
subject. It would be expected that an educated subject would 
react easily, but indeed this is not the case. At the very simplest 
words there appear obstructions and other disturbances which 
can be explained only by the fact that the stimulus word has 
excited a complex. But why should it be difficult to reproduce 
easily an idea which is closely connected to a complex? The 
emotional inhibition must be cited as the main hindering cause. 
The complexes exist mostly in a state of repression. As a rule 
one deals with most intimate secrets which are anxiously guarded 
and which one either does not wish to expose or is unable to do 
so. The repression may even under normal conditions be so 
strong that there exists a hysterical amnesia for the complex; 
that is, there is a feeling of an emerging idea, of a significant 
connection, but the reproduction is held back by vague hesitation. 
There is a feeling as though one wished to say something 
which immediately slipped away. That which slipped away 
is the complex-thought. Occasionally there appears a reaction 
which unconsciously contains the complex thought but the test 
person is blind to it, and it is only the experimenter who can 
lead him on in the right way. The repressing resistance may 
also show afterward a striking effect in the reproduction test. 
Amnesia influences by preference the critical and post-critical 
reactions. These facts show that the complex has a certain 
exceptional position in relation to the more indifferent psychic 
material. Indifferent reactions follow " smoothly " and generally 
have very short reaction times. They are always at hand for 
the ego-complex to dispose of at pleasure. It is different with 
the complex reactions! They appear only with opposition, and 
often when about to appear they again withdraw from the ego- 
complex. They are peculiarly formed; often they are the 
products of embarrassment, of which the ego-complex itself is 
unaware, often they merge into amnesia in contradistinction to 
the indifferent reactions which frequently possess great stability 
and are reproducible even after months and years. We see, then, 

impulse of resistance protects the weak points of the dream's disguise, by 

tacing the treacherous expressions by remoter ones." 



44 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

that the complex-associations are much less at the disposal of 
the ego-complex than the indifferent ones. From this it must 
be concluded that the complex takes a relatively independent 
position to the ego-complex, it is like a vassal who does not bow 
implicitly to the domination of the ego-complex. Experience 
also teaches that the stronger the feeling-tone of a complex, the 
stronger and more frequent will be the disturbances of the experi- 
ment. A person dominated by a complex of strong feeling is 
less able to react " smoothly," not only to association experiments 
but to all stimuli of daily life, for the uncontrollable influences 
of the complexes constantly exert hindrances and disturbances. 
His self-control (the control of his frame of mind, thought, 
words and actions) suffers in proportion to the strength of the 
complex. The purpose fulness of his actions is more and more 
replaced by unintentional lapses, errors, and unaccountabilities 
for which he himself often can give no reason. A person with a 
strong complex shows, therefore, intensive disturbances during 
association experiments, for a great number of apparently inno- 
cent word stimuli excite the complex. The following two exam- 
ples elucidate the aforesaid: 

CASE i. The stimulus word " white " has numerous intimate 
connections. The subject, however, could only hesitatingly 
react with "black." By way of explanation I obtained another 
series of reactions to " white." " The snow is white, so is the 
sheet covering the face of a dead person." The subject had 
recently lost a beloved relative. The intimate contrast " black " 
shows symbolically perhaps the same thing, that is, mourning. 

CASE 2. " Paint " excites hesitatingly the reaction " land- 
scapes." This peculiar reaction is explained by the following 
successive fancies. " One can paint landscapes, portraits and 
faces as well as cheeks if one has wrinkles." The subject, an 
old maid who sorrows over the departure of an admirer, bestows 
a loving attention on her body (symbolic action), thinking that 
by painting she will become more attractive. She adds, " One 
paints the face when one takes part in a theatrical performance. 
I took part once." It is to be noted that she took part in a 
theatrical performance when she was still in possession of her 
lover. 

The associations of persons with strong complexes swarm with 






THE EMOTIONAL COMPLEX. 45 

such examples. But the association experiment is only one side 
of the daily psychological life. The complex- sensitiveness can 
also be shown in all other psychic reactions. 

CASE i. A young lady cannot bear to see the dust beaten out 
of her mantle. This peculiar reaction is based on the fact that 
she is somewhat masochistic. As a child her father frequently 
chastised her by spanking her a posteriori, which eventually 
caused sexual excitement. For this reason, to whatever even 
remotely resembles this form of chastisement, she is forced to 
react with marked rage, which rapidly changes into sexual excite- 
ment and masturbation. On saying to her once on a quite indif- 
ferent occasion, " You must obey," she went into a condition of 
strong sexual excitement. 

CASE 2. Mr. Y. falls in love with a lady who soon afterwards 
marries Mr. X. In spite of the fact that Mr. Y. knew Mr. X. 
for a long time and even had business transactions with him, he 
again and again forgot his name, so that on a number of occa- 
sions, when wishing to correspond with X., he was obliged to ask 
other people for his name. 

CASE 3. A young hysterical woman was suddenly assaulted 
by her lover during which she was especially frightened by the 
erected member of the seducer. She was after the incident 
afflicted with a stiff arm. 

CASE 4. A young lady while frankly relating a dream, without 
any apparent reason suddenly hid her face under a curtain. This 
striking reaction of shame was explained by the analysis of the 
dream which revealed a sexual wish. 9 

CASE 5. Many persons commit peculiar complicated acts 
which at the basis mean nothing but complex-symbols. I know 
a young lady who when promenading wished to take along a baby 
carriage. The reason for this, as she blushingly admitted, was 
because she desired to be looked upon as married. Elderly 
unmarried women are wont to use dogs and cats as complex- 
symbols. 

As the aforesaid examples show, thought and action, both in 
general and particular, are constantly disturbed and peculiarly 
distorted by a strong complex. The ego-complex is, so to say, 

"For further examples of symbolic actions see Beitrag. VI ff. of the 
Diagnost. Assoz.-Stud. 



46 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

no longer the whole personality, as alongside of it there exists 
another being, living in its own way and therefore inhibiting and 
disturbing the development and progress of the ego-complex, 
for the symptom-actions very frequently take up time and exer- 
tion which are thus lost to the ego-complex. We can readily 
imagine how the psyche is influenced when the complex increases 
in intensity. The most lucid examples are always furnished by 
the sexual complexes. Let us take as an instance the classical 
state of being in love. The lover is possessed by his complex. 
All his interests hang only on this complex and the things belong- 
ing to it. Every word, every object recalls to him his sweetheart 
(experimentally even apparently indifferent word stimuli excite 
the complex). The most insignificant objects are guarded like 
priceless jewels, corresponding to their value in the complex. 
The whole environment is considered sub specie amoris. What- 
ever does not suit the complex glides by ; all other interests sink 
to nothing, hence there results a standstill and a temporary reduc- 
tion of the personality. Only that which suits the complex 
excites affects and is psychically elaborated. All thought and 
action move in the direction of the complex. Whatever is not 
impressed into this direction, is repudiated, or is accomplished 
with superficiality, unemotionally, and without any care. In 
attending to indifferent affairs there will appear the most peculiar 
compromise-productions; in business letters, lapses referring to 
the love-complex slip in, and in conversation one finds suspicious 
mistakes. The flow of objective thought is constantly inter- 
rupted by the incursions of the complex. Many pauses of thought 
result which are filled in by episodes of the complex. This well- 
known paradigm shows clearly the influence of a strong complex 
on the normal psyche. We see how all psychic energy is entirely 
bestowed on the complex at the expense of all the other psychic 
material which in consequence remains unused. All the other 
stimuli which do not suit the complex undergo a partial apper- 
ceptive dementia and emotional reduction. Even emotional tone 
becomes inadequate. Insignificant things, like little ribbons, dried 
flowers, pictures, billets-doux, hair, etc., are treated with the 
greatest care, while vital questions are often treated laughingly 
or indifferently. On the other hand the slightest remark touch- 
ing the complex even remotely, immediately excites violent anger 



THE EMOTIONAL COMPLEX. 47 

and painful outbreaks which may assume disproportionate dimen- 
sions. (In a case of dementia praecox we may note that when 
asked whether he is married, the patient falls into inadequate 
laughter or he begins to cry and becomes completely negativistic, 
or he shows an obstruction, etc.) Had we not the means to look 
into the mind of a normal lover we would have to consider his 
behavior that of a hysteric or catatonic. In hysteria where the 
complex-sensitiveness reaches a higher grade than in the normal, 
we lack almost all means of penetrating the mind and are obliged 
to laboriously habituate ourselves to enter into the feelings of 
hysterical affects. We totally forego this in catatonia, perhaps 
because we do not as yet know enough about hysteria. 

The psychological state of being in love can be designated as a 
possession-complex. Besides this special form of sexual com- 
plex which for didactic reasons I have chosen as a paradigm for 
the complex of possession (it is the most common and best 
known form), there are naturally many other kinds of sexual 
complexes which can similarly exert a strong influence. Among 
women one frequently finds complexes of unreciprocated or even 
hopeless love. In such cases one generally notes an extremely 
strong complex-sensitiveness. The slightest intimations on the 
part of the other sex are assimilated into the complex and elabo- 
rated with a total blindness for the weightiest arguments against 
them. An insignificant utterance of the adored one is construed 
as a powerful subjective proof. The accidental interests of the 
one desired become similar interests to the adoring woman a 
symptom-action which often rapidly vanishes if the wedding 
finally takes place or if the object of adoration is changed. The 
complex-sensitiveness manifests itself also in an unusual sensitive- 
ness to sexual stimuli, which especially appears in the form of 
prudery. Those possessed of the complex at an early age ostenta- 
tiously avoid everything that may call up sexuality the familiar 
" innocence " of grown-up daughters. They know indeed every- 
thing, where it lies and what it signifies, but there whole behavior 
is as if they never had the slightest notion of things sexual. If- 
the subject must be broached for medical purposes one at first 
believes that he is on virgin soil, but he soon finds that all the 
necessary knowledge implicitly exists, only the patient does not 



48 THE PSYCHOLOGY OF DEMENTIA PRyECOX. 

know where she got it from. 10 A psychoanalysis usually finds 
that behind numerous resistances there is hidden a complete rep- 
ertoire of fine observations and subtle deductions. In a some- 
what more advanced age prudery often becomes unbearable, or 
there appears a naive symptomatic interest for all kinds of 
society news in which " one ought to take an interest because 
one is of an age when . . ., etc." The objects of those symp- 
tomatic interests are brides, pregnancies, births, scandals, etc. 
The cleverness of elderly ladies for the last is proverbial. These 
interests pass then under the flag of the "objective, purely human, 
interests." Here we simply have a transference; the complex 
must under all circumstances assert itself. As the sexual com- 
plex cannot in many cases assert itself in a normal manner, 
it makes use of by-ways. During the age of puberty they exist 
in the form of more or less abnormal fancies, frequently alter- 
nating with religious ecstatic phases (transferences). In men, 
sexuality (if not directly lived through) is frequently changed to 
a feverish professional activity or to some eccentricity, such as 
dangerous sports, etc., or to peculiar academic passions, such as 
a collecting mania. Women take up some altruistic activity 
which is usually determined by the special form of the complex. 
(They devote themselves to nursing in hospitals where there are 
young assistant physicians, etc. ) Or there may be strange eccen- 
tricities, affectations, " putting on airs " which shall express dis- 
tinction and proud resignation. The artistic predispositions are 
especially wont to gain by such transferences. 11 One very fre- 
quent manner of transference is hiding the complex by means 
of a contrasting frame of mind. This manifestation is frequently 
seen in those who are constantly endeavoring to banish a chron- 
ically irritating sorrow. Among these one generally finds the 
best wags, the finest humorists whose jokes however are spiced 
with a grain of bitterness. Others hide their pain under a forced 
and convulsive cheerfulness, which, on account of its boisterous- 
ness and artificiality (lack of emotion) allows of no ease in 
society. Women betray themselves by an unbridled aggressive 

10 Freud expresses himself in a similar manner. Compare also the case 
in Beitrag VIII, Diagnost. Assoz.-Stud. 

u Freud calls this transference " sublimation " : Drei Abhandlungen zur 
Sexualtheorie. Deuticke, Leipzig und Wien, 1905, p. 76. 



THE EMOTIONAL COMPLEX. 49 

gayety, the men by sudden disproportionate alcoholic and other 
excesses (also fugues!). These transferences and simulations 
may, as is known, produce real double personalities, which have 
long excited the interest of writers with a psychological trend 
(see Goethe's " Zwei-Seelen-Problem," and among the modern 
writers Herman Bahr, Gorki, et a/.). "Double personality" is 
not a mere literary term, it is a fact in natural science of general 
interest to psychology and psychiatry, especially when it mani- 
fests itself in the form of double consciousness or dissociation 
of personality. The dissociated complexes are always differ- 
entiated by peculiarities of mood and character, as I have shown 
in a case of the kind. 12 

It happens not seldom that the transference gradually becomes 
stable and at least superficially replaces the original character. 
Every one knows people who when judged by their exterior are 
considered very gay and entertaining. Inwardly, or under cir- 
cumstances seen in private life, they are sullen grumblers nurtur- 
ing an open wound. Frequently the true nature suddenly breaks 
through the artificial investment, the assumed blithesomeness 
suddenly disappears and we are then confronted with a new per- 
son. A single word, a gesture, striking this wound, shows the 
complex lurking within the soul. Such imponderabilities of 
human emotional life must be borne in mind when we enter with 
our coarse experimental methods into the complicated mind of 
the diseased. In association experiments with patients who 
suffer from marked complex-sensitiveness (as in hysteria and 
dementia prascox) we find exaggeration of these normal mech- 
anisms; hence their description and discussion will require more 
than a mere psychological apergu. 

"Jung: Zur Psychologic und Pathologic sogenannter okkulter Pha- 
nomene. Leipzig, 1902. 
Comp. also Paulhan : La simulation dans le caractere. 



CHAPTER III. 
THE INFLUENCE OF THE EMOTIONAL COMPLEX ON ASSOCIATION. 

How the complex manifests itself in association experiments 
we have discussed a number of times, and the reader is therefore 
referred to our earlier publications. We must, however, return 
to one point which is of theoretical value. We frequently meet 
with complex reactions which are built up in the following 
manner : 

(to kiss to love 3.0" 
burn ing 1.8" 

to despise someone 5.2" 
tooth teeth 2.4" 
friendly amiable 4.8" 
dish fish 1.6" 

The first reaction of the three examples contains the complex 
(in i and 3 we deal with erotic references and in 2 with 
an injury). The second group of reactions shows a persever- 
ating feeling-tone from the preceding reactions, as can be readily 
seen by their slightly prolonged reaction time and their super- 
ficiality. As explained in the first contribution of the " Diagnost. 
Assoz.-Stud.," associations like tooth teeth belong to the motor- 
speech combinations, burn ing to word completion and dish 
fish to rhyme combinations. When attention is distracted, there 
is an increase in motor-speech combinations and in sound reac- 
tions, as was positively shown from the results obtained in dis- 
traction experiments. Whenever there is a diminution of atten- 
tion there is an increase in the superficial associations and their 
value diminishes. Therefore, if during an association experi- 
ment without any artificial distraction there suddenly appear 
striking superficial associations, one is justified in supposing that 
a momentary diminution of attention has taken place. The cause 
of this is to be sought in an internal distraction. According to 
instructions the subject is supposed to fix his attention on the 

5 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 51 

experiment, if his attention decreases, that is, if without any 
external reason the attention is turned away from the meaning 
of the stimulus word there must be an internal cause for this dis- 
tractibility. We find this mostly in the antecedent or in the same 
reaction. There appears a strongly emotional idea, a complex, 
which on account of its strong feeling tone, assumes great dis- 
tinction in consciousness, or when repressed sends an inhibition 
into consciousness, and in this way either suspends for a short 
time the effect of the directing idea (attention to the stimulus 
word) or simply diminishes it. The correctness of this suppo- 
sition can usually be proven without any difficulty by analysis. 1 
The phenomenon described is therefore of practical value as a 
complex-indicator. Of theoretical value is the fact that the com- 
plex need not be conscious for the subject. From the repression 
it can send an inhibition into consciousness, thus disturbing the 
attention ; in other words, it can check the intellectual functioning 
of consciousness (prolongation of reaction time), or can make it 
impossible (errors), or can diminish its value (sound associa- 
tions). The association experiments merely show us the details, 
whereas clinical and psychological observation show us the same 
phenomena in gross outlines. A strong complex, such as a tor- 
menting grief, hinders concentration ; we are unable to tear our- 
selves away from the grief and direct our activity and interests 
into other channels. When we make an attempt to do this, " to 
drown our sorrow," we succeed perhaps for a short time, but we 
are able to do it only " half-heartedly." Without our knowing 
it at the time, the complex prevents us frdm giving ourselves up 
entirely to our tasks. We undergo all possible inhibitions, dur- 
ing pauses of thought (deprivation of thought in dementia prae- 
cox) there appear fragments of complexes, which just as in 
association experiments, produce characteristic disturbances in 
intellectual functioning. We make mistakes in writing according 
to the rules of Meringer and Mayer, 2 we produce condensations, 
perseverations, anticipations, etc., and especially Freud's errors, 
which last reveal by their content the determining complex. 

'For the technic of the analysis see Diagnost. Assoz.-Stud., VI and 
VIII Beitrag, and Jung: Die psychologische Diagnose des Tatbestandes. 
Jurist.-psych. Grenzfragen, 19x16. 

'Versprechen und Verlesen etc., Stuttgart, 1895. 



52 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

Our lapses in talking are at critical points, that is, the words we 
say have a complex significance. We make mistakes in reading 
because we think that we see in the text words of the complex. 
Frequently the complex words appear in the peripheral field of 
vision 3 (Bleuler). In the midst of our diversions we are sur- 
prised to hear ourselves sing or whistle a certain melody, the text 
of which can only seldom and with effort be found, and is a com- 
plex constellation; or we continue to murmur a word, frequently 
a technical term, or any foreign word, which also refers to the 
complex. Sometimes we may be dominated by an obsession, a 
melody or word continually thrusting itself into our mind. Here, 
too, are complex constellations. 4 Or we may draw lines on paper 
or on the table, complex signs which are frequently not difficult 
to decipher. Wherever the complex disturbances refer to words 
we find displacements by sound-similarity or phraseological com- 
binations. I refer here mainly to Freud's examples. 5 

I mention the following from my own observations: To 
the stimulus word " lawn " a gentleman reacts with the peculiar 
association " broker." The analysis readily shows that he was 
contemplating some transactions with a loan office " pawn- 
broker." 6 The word-automatism, " Bunau-Varilla," 7 by free 
associations gave the following series : " Varinas-Manila 
Zigarillo Havana cigar." It was because I forgot my matches 
that I resolved not to throw away the butt of my cigar, so as to 
light another good cigar with it. The word " Bunau-Varilla " 
appeared just at the moment when I was about to throw it away. 
A boy who won a prize for passing a brilliant examination in 
arithmetic continues to chant for hours the word " rithmication."' 

3 The greatest distinctness lies in the point of fixation where, too, is 
the greatest attention, hence for the peripheral field of vision attention is 
diminished, and the inhibition for the unsuitable is less than in the point 
of fixation, therefore in this location it is easier for repressed complex- 
fragments to manifest themselves. 

* See examples in Beitrag IV Diagn. Assoz.-Stud. Compare also the 
mediate associations Beitrag I, Abschnitt B. III. 

* Psychopathologie des Alltagslebens and Traumdeutung. 

"Given by translators as play of words, in author's example can not 
be translated. 

7 Beitrag I, Diagnost. Assoz.-Stud. 

' [Example given by translators. The example in the German text does 
not lend itself to translation. Ed.] 



i 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 53 

These examples serve to illustrate that which Freud treats con- 
clusively in his " Traumdeutung," namely, that repressed thoughts 
disguise themselves in similarities, be it in speech similarities 
(sound), or similarities of optical pictures. For the latter forms 
of displacement dreams afford the best examples. 

Those who reject Freud's analysis of dreams can discover rich 
substitutes in melody automatisms. At a merry entertainment 
some one remarked that if a person marries he should marry a 
proud lady. A gentleman present who recently married a woman 
noted for her pride began to softly whistle to himself the melody 
of a familiar street song. I immediately asked this gentleman 
whom I knew well to tell me the text of this melody. I received 
the following answer: "What I whistled just now? Oh that's 
nothing, I believe I heard it often in the streets but I do not 
know the words." I insisted that he should recall the words 
which I knew well, but he was unable to do so; on the contrary 
he assured me that he never heard these words. The text reads 
as follows: 

" Meine Mutter hat gesagt : Nimm dir keine Bauernmagd." 
(" My mother has said do not take a peasant maid.") 

During an excursion, a young lady accompanied by a gentle- 
man whose proposal she soon hoped for quietly sang the Wed- 
ding March of Lohengrin. 

A young colleague who just finished his doctor's thesis had to 
whistle for half a day Handel's " Lo the conquering hero comes 
crowned with glory," etc. 

An acquaintance who was happy over a new and lucrative posi- 
tion betrayed himself by the following melody which obsessed 
him : " Are we not born for glory ? " 

A colleague meeting a nurse during his rounds, who was sup- 
posed to be pregnant, immediately afterwards finds himself 
whistling : " There were once two royal children who loved each 
other so much." 

I do not wish to increase unnecessarily this collection of melody 
automatisms, every person can daily make the same observation. 
We learn from this another method of disguise of the repressed 
thought. It is well known that whistling or singing is a frequent 
accompaniment in those occupations where the full attention is 
not required (Freud), the rest of the attention can therefore 



54 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

suffice to produce a dreamy movement of complex-thoughts. 
The conscious activity, however, prevents the complex from 
becoming clear, hence it can only show itself indistinctly, and this 
eventually happens in the melody automatisms which contain the 
thought of the complex in a general metamorphosed form. The 
resemblance lies in the situation or in the frame of mind ; as, 
" Lo the conquering," etc., Bridal March, " There were once two 
royal children, etc.," or in the expression (" My mother has 
said, etc."). The complex-thought in these cases was not clear 
to consciousness, but manifested itself more or less symbolically. 
How far such symbolic constellations can go is best seen in the 
wonderful example of Freud in his " Psychopathologie des All- 
tagslebens." From the sentence " Exoriar aliquis nostris ex 
ossibus ultor" Freud was able to trace back to the forgotten 
word "aliquis" [a liquis liquid fluid blood miracle of S. 
Gennario ] the thought of a much overdue period in the be- 
loved. I shall quote a similar example from my own experience 
in order to corroborate Freud's mechanisms. 

A gentleman wishes to recite the familiar poem (" Ein Fichten- 
baum steht einsam ") "A pine tree stands alone, etc." In the line 
" he felt drowsy " he becomes hopelessly stuck. With the words 
" with white sheet " he forgot everything. This forgetting in 
such well known verse seemed to me rather peculiar and I let 
him reproduce what came into his mind with the words " with 
white sheet." The following series 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 tc 
have died of heart disease he was also very corpulent mj 
friend is corpulent, too, and I thought it might also happen tc 
him probably he does not exercise enough when I heard oi 
this death I suddenly became frightened, it could also happen to 
me, as we in our family are predisposed to obesity my grand- 
father 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." 

From this example it can be clearly seen how the repression 
draws out of consciousness symbolic similarities and chains them 
to the complex. This gentleman unconsciously identified himself 
with the pine tree which was enveloped in a white sheet. 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 55 

From this fact it can also be assumed that he wished to recite 
this poem as a symbolic act in order to effect a discharge of his 
complex excitement. Another preferred realm of complex- 
constellation is the joke of the pun type. There are persons who 
possess special talent for this and among whom I know some who 
have very strong complexes to repress. What I mean I should 
like to show in a simple example which may serve as an illus- 
tration. 

At a gathering there was a gentleman who made many good 
and bad puns. While oranges were being served he made the 
following pun : "O rangierbahnhof " (shunting station). Mr. 
who obstinately disputed the complex theory, called out: 
" You see, doctor, here you could again suppose that Mr. X. 
thinks about a journey." Mr. X. embarrassingly replied: " That 
is really the case; lately I thought much about travelling, but 
:ould not get away." Mr. X. thought particularly about a jour- 
ney to Italy, hence the constellation through the oranges, a num- 
ber of which he recently received from a friend in Italy. To 
sure, at the moment of pronouncing the pun the meaning of 
it was totally unknown to him, for the complex constellation is, 
and must remain, obscure. 

Dreams, too, are constructed according to the nature of the 
examples mentioned, that is, they are symbolic expressions of 
repressed complexes. In dreams we find very fine examples of 
symbolisms used for expression. 9 As is known, Freud finally 
advanced the dream investigations on a way towards progress. 
Let us hope that psychology will soon take cognizance of this 
fact. It would profit immensely by it. As for the conception of 
expression by means of symbolisms in the psychology of demen- 
tia praecox, Freud's " Traumdeutung " is epoch-making. In 
view of the importance of symbolic expression in dementia prge- 
cox it will not appear superfluous if I add another to the dream 
analyses reported in Contribution No. VIII of dream analyses. 
A friend 10 related to me the following dream : 

" I saw how horses were hoisted by thick cables to indefinite 
heights. One of them, a powerful brown horse which was tied 

*See examples in proof of this in Beitrag VIII, Diagnost, Assoz.-Stud. 
"I am well acquainted with the personal and family relations of this 
gentleman. 




56 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

up in a belt and dispatched upward like a package, especially took 
my fancy. Suddenly the cable broke and the horse dropped to 
the street. I thought that it was surely killed when, all at once, 
it started up and galloped away. At the same time I noticed 
that the horse was dragging along the heavy trunk of a tree, and 
I wondered how, in spite of that, it could advance so rapidly. 
Evidently it became skittish and was liable to do some damage. 
Then a rider on a small horse came along and slowly rode 
towards the unruly horse which also assumed a somewhat slower 
gait. Nevertheless, I feared that the horse might run over this 
rider when a cab came along and paced in front of the rider, 
thus bringing the horse to a still slower gait. I then thought 
now all is well, the danger is over." 

I then took up the individual points of the dream and asked 
my friend X. to repeat to me whatever came into his mind at 
each point. The hoisting up of the horses recalled to him the 
idea of hoisting horses on a sky scraper and indeed they seemed 
to be covered up just like horses that are lowered into mines to 
work. X. recently saw in a periodical the picture of a sky 
scraper in process of building where the work is done at a dizzy 
height and at the same time thought that it was hard work that 
he would not care for. I then attempted to analyze this strange 
picture of hoisting a horse into the air. X. stated that the horse 
was tied around by a belt just as they used to tie horses which 
they lowered into the mines. What particularly struck the 
dreamer in the picture of the periodical was the work at such a 
dizzy height. The horse in the mines must also work. Perhaps 
the expression for mines (Berg-Werk, literally translated moun- 
tain-work) gave origin to the two thoughts of the dream, 
" mountain " expressing height and " work " expressing labor. 
I therefore asked X. to concentrate his mind on the word 
" mountain " and tell me the associations following it. He 
immediately remarked that he was a passionate mountain climber 
and especially about the time of the dream he had a great desire 
to make a high ascent and also to travel. But his wife felt very 
uneasy about it and would not allow him to go alone. She could 
not accompany him, as she was pregnant. For the same reasons 
they were obliged to give up a journey to America, whither they 
had planned to go together. They then realized that as soon as 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. $7 

one has children it becomes more difficult to move about and one 
cannot go everywhere. (Both are very fond of travelling and 
formerly travelled much.) The idea of relinquishing his trip to 
America was especially unpleasant to him, as he carried on com- 
mercial transactions in that country and always hoped that per- 
haps by a personal visit to the country he would benefit commer- 
cially. On this hope he built many vague plans for the future, 
rather lofty and flattering to his ambition. 

Let us briefly summarize that which has been so far said. 
Mountain can be interpreted as height. To ascend a mountain = 
to get to the top. Work = labor. The underlying sense of this 
may be " By labor one gets to the top." The height in the dream 
is especially plastically produced by the " dizzy heights " of the 
sky scrapers which designated America, where my friend's ex- 
pectations lie. The picture of the horse which is evidently asso- 
ciated with the idea of labor seems to be a symbolic expression 
for " hard labor," for the work on a sky scraper upon which the 
horse was hoisted is very difficult, as is also the work which is 
accomplished by horses lowered into mines. In colloquial lan- 
guage we have such expressions as " work like a horse " and 
" harnessed like a horse." 

By disclosing these associations we gain a certain insight into 
the sense of the first part of the dream. We have found the way 
which apparently leads us to very intimate hopes and expecta- 
tions in the dreamer. Let us then assume that the sense of this 
part of the dream signifies, " By labor one gets to the top." The 
dream pictures appertaining to it can easily be taken as symbolic 
expressions for this thought. 

The first sentences of the dream read : " I saw how horses were 
hoisted by means of thick cables to an indefinite height. One of 
them, a powerful brown horse which was tied up by a belt and 
dispatched upward like a package, especially took my fancy." 
This seems to contradict the analysis which is that by labor one 
gets to the top. To be sure one can also be hoisted up. In this 
connection X. recalls how he often looked with disgust upon those 
tourists who had themselves hoisted up to the high summits by 
the "flour sack" method. He never needed anybody's help. 
The various horses in the dream are therefore others who were 
unable to get to the top by their own effort. The expression 



\ 



58 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

" like a package " seems also to express some contempt. But 
where in the dream is the dreamer himself represented? Ac- 
cording to Freud he must be represented and indeed he is gener- 
ally the chief actor. He is undoubtedly the " powerful brown 
horse." A powerful brown horse resembles him firstly because 
it can work much, then the brown color is generally described as 
" a healthy reddish brown color " such as mountain climbers are 
wont to have. The brown horse then is probably the dreamer. 
It is hoisted up like the others the content of the first two sen- 
tences seem to be exhausted to the last point. The hoisting up 
of the dreamer is not clear, it even contradicts directly the applied 
sense " through work one gets to the top." 

It seemed to me of special importance to find out whether my 
supposition that the brown horse represents the dreamer was 
really confirmed. For this reason I asked him to concentrate his 
attention on the passage " I remarked that the horse dragged 
along a big trunk of a tree." He immediately recalled that for- 
merly he was nicknamed " tree " on account of his powerful stout 
figure. My supposition was therefore correct, the horse had even 
his name attached. The trunk on account of its heaviness en- 
cumbered the horse, or at least should have done so, and X. 
wondered that in spite of that it advanced so rapidly. To ad- 
vance is synonymous with to get to the top. Therefore in spite 
of the burden or encumbrance X. advances and indeed so rapidly 
that one gets the impression that the horse is skittish and may 
perhaps cause some misfortune. On being questioned X. stated 
that the horse could have been crushed by this heavy trunk if 
it had fallen, or the force of this moving mass could have thrust 
the horse into something. 

These associations exhausted the fancies of this episode. I 
therefore began my analysis from another point, that is, at that 
part where the cable broke, etc. I was struck by the expression 
" street." X. stated that it was the same street in which his 
business was where he once hoped to make his fortune. One 
deals here with the hope for a definite career of the future. To 
be sure it came to nought, and if it would have come to anything 
it would have been due not so much to his position or his own 
merits as to personal influences. Hence we get the explanation 
for this sentence, "The cable broke and the horse dropped 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 59 

down." It symbolically very properly expresses the disappoint- 
ment. He did not fare like many others who get to the top 
without any trouble. The others who were " preferred " to him 
and got to the top could not begin to do anything of value for 
" what could a horse do up there ? " They were, therefore, in a 
place where they could not do anything. The disappointment 
over his failure, was, as he stated, so great that on one occasion 
he was almost desparing of his future career. In his dream " he 
thought " that the horse was " killed " but soon he verified with 
satisfaction that it rose again and galloped away. He therefore 
could not be subdued. Here apparently commences a new part 
of the dream which probably corresponds to a different period 
of his life, if the interpretation of the preceding part be correct. 
I asked X. to fix his attention on the horse galloping away. He 
states that for a moment in his dream he saw another but very 
indistinct horse appearing near the brown one ; this, too, dragged 
the trunk and started to gallop away with the brown one, but it 
soon became very indistinct and disappeared. As shown also by 
the late reproduction, this horse seems to be under a special 
repressing influence and hence important to the dream. X. there- 
fore dragged the log with some one else and this person must 
have been his wife with whom he is harnessed " in the yoke of 
matrimony." Together they pull the trunk. In spite of the 
burden which encumbers his progress he gallops away. This 
again expresses the thought that he can not be subdued. The 
galloping horse recalls to X. Welti's painting " Eine Mondnacht " 
(a moonlight night) which represents galloping horses on a cor- 
nice among which one very distinct fiery horse is mounting. In 
the same picture there is the representation of a married couple 
lying in bed. The picture of the galloping horse (which at first 
galloped with another) leads therefore to the very suggestive 
painting of Welti. Here we get a very unexpected view into 
the sexual nuance of the dream, whereas we thought we saw only 
the complex of ambition and future career. The symbol of the 
horse which until now showed only the side of the hardworking 
domestic animal now assumes a sexual significance which is 
specially confirmed by the horse scene on the cornice. There 
the horse is the symbol of the passionate impulsive desire which 
without any further discussion can be identified with the sexual 



6O THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

desire. As shown by the above-mentioned recollections, the 
dreamer feared that the horse would fall or that the force of 
the moving trunk might thrust it into something. This vis a 
tergo can readily be perceived as X.'s own impetuous tempera- 
ment which he feared might sometimes force him into many 
thoughtless acts. 

The dream continues: Then a rider on a small horse came 
along and slowly rode toward the unruly horse which also 
assumed a somewhat slower gait. His sexual impetuosity is 
bridled. X. states that the rider by his dress and from his gen- 
eral appearance resembled his superior. This fits the first inter- 
pretation of the dream. His superior moderates the rash pace 
of the horse; in other words, he hinders the too rapid advance- 
ment of the dreamer because he is his superior. Now we have 
to search for the further development of the sexual thought. 
Perhaps there is something behind this peculiar expression, "a 
little horse." X. states that the horse was little and pretty like 
a child's toy and recalls to him an incident of his youth. While 
still a boy he noticed a woman far advanced in pregnancy, wear- 
ing hoops. It was then the style. This appeared to him very 
comical and he asked his mother whether this woman wore a 
horse under her dress. (He thought of horses worn at carnivals 
or circuses which are buckled to the body.) Since then, when- 
ever he saw a woman in a pregnant state, it recalled to him this 
childish hypothesis. His wife, as we mentioned above, is preg- 
nant. Pregnancy was also mentioned above as a hindrance to 
travelling. Here it bridled the impetuosity which we were 
obliged to designate as sexual. This part of the dream appar- 
ently means that pregnancy of the wife imposes restraints on the 
husband. Here we have a very clear thought which is evidently 
intensely repressed and extraordinarily well hidden in the meshes 
of the dream. It is composed entirely of symbols of the upward 
striving conduct. Pregnancy, however, does not seem to be the 
only reason for the restraint, for the dreamer feared "that the 
horses may in spite of all overrun the rider." But then we have 
the slowly advancing cab which moderated still more the gait of 
the horse. On asking X. who was in the cab, he recalled that 
there were children. The children therefore were apparently 
subjected to some repression, as the dreamer recalled them only 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 6l 

on being questioned. In the vulgar expression known to my 
friend it was " a whole car full of children." The wagon with 
the children inhibits his impetuosity. The sense of the dream is 
now perfectly clear. It reads as follows : 

The pregnancy of the wife and the problem of too many chil- 
dren restrained the husband. This dream fulfills a wish as it 
presents the self-restraint as accomplished. At first sight the 
dream, just as all others, seems senseless, but when its first 
stratum is uncovered it already shows distinctly the aspirations 
and the disappointments of an upward struggling career. In- 
wardly, however, it hides a most personal question which must be 
accompanied by many painful feelings. 

In the analysis and treatment of this dream, I omitted to refer 
to the numerous recurring analogous combinations, the similarity 
of pictures, and allegorical representations of phrases, etc. A 
careful examination of the reported observations shows that they 
contain the characteristic features of mythological thinking. I 
only wish to point out that the ambiguity of the individual pic- 
tures of the dream (Freud's overdetermination) simply shows 
the obscurity and haziness of thought in dreams. The pictures 
of the dream belong to one as well as the other complex of the 
waking state, although both complexes are sharply separated in 
the waking state. Due to a deficiency of the discriminating 
ability in the dream both complexes may at least symbolically 
flow together. 

This manifestation is perhaps not clear without further expla- 
nation, but we can readily deduct it from our former premises. 11 

Our experiments in distraction confirm our supposition that in 

"For the fusion of simultaneously existing complexes we may find 
some corroboration in the elementary fact not unknown in psychology 
(Fere in La pathologic des emotions, mentions it by way of intimation) 
that two stimuli simultaneously existing in two different sensory spheres, 
reinforce or respectively influence each other. From researches with 
which I am at present occupying myself, it seems to show that a volun- 
tary motor activity is visibly influenced by a simultaneously existing auto- 
matic activity (breathing). From all that we know of complexes they 
are continued automatic incitements or activities. Just as they influence 
the conscious activity of thought so do also the complexes act upon one 
another formatively, so that every complex contains elements of the other, 
a thing which may psychologically be designated as fusion. Freud from 
a different point of view calls this Uberdeterminierung (overdetermination). 



62 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

diminished attention, thought is rather superficially connected. 
The state of diminished attention expresses itself in a decrease 
of clearness of ideation. Whenever the ideas are not clear their 
differences, too, are not clear; hence our sensitiveness to differ- 
ences is naturally diminished, for it is nothing but a function of 
attention or clearness (synonyms). Therefore there is nothing 
to prevent the mistaking of one idea ("psychic molecule") for 
another, although normally they are clearly defined. The experi- 
mental expression for this fact is the increase of mediate asso- 
ciations produced by the distractibility. (See Beitrag IB of the 
" Diagnost. Assoz.-Stud.") It is known that the mediate associa- 
tions of the association experiments (especially in a condition of 
distraction), are generally nothing else than a displacement of 
an intimate connection by phrase or sound. (For example, see 
Beitrag I. Intr. "Diagnost. Assoz.-Stud.") On account of the 
distraction the psyche becomes uncertain in the choice of expres- 
sion, and has to be satisfied with all sorts of errors in the speech 
and acoustic systems, thus resembling a paraphasic. 12 We can 
readily assume the external distraction in our experiments to be 
replaced by a complex which displays its autonomous effect 
beside the activity of the ego-complex. We have discussed 
above the resulting association phenomena. Whenever the com- 
plex becomes excited the conscious association becomes disturbed 
and superficial, due to an escape of attention (or inhibition of 

"Kraepelin (Uber Sprachstorungen im Traume, Psychol. Arbeiten, Bd. 
V, H. i) is of the opinion that the proper formation of a thought is 
hindered by the encroachment of a distracting by-idea. On p. 48 he 
expresses himself as follows : " The common feature in all these observa- 
tions (Dream paraphasias) is the displacement of the basal thought by the 
entrance of a by-association for an essential link of the chain of presenta- 
tions. The derailment of speech or of thought to a by-association is due 
in my opinion, to lack of distinctness in the ideas." Kraepelin further 
asserts that " the by-idea causing the displacement of thought was dis- 
tinctly a narrower and more significant idea which suppressed the more 
general and more shadowy one." Kraepelin calls this symbolic manner 
of derailment " metaphoric paralogia " in contradistinction to the purely 
" displacing " and " derailing paralogia." The " by-associations " are mostly 
perhaps associations of similarity at all events we deal here very fre- 
quently with such it is therefore easily understood how the paralogia 
has the character of metaphor. Such metaphors may give the impression, 
as it were, of an intentional disfigurement of the dream-thought. In 
this point Kraepelin is not very far from Freud's ideas. 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 63 

attention) to the a parte existing complex. During the normal 
activity of the ego-complex the other complexes must be inhibited 
else the conscious function of the directed association would be 
impossible. We therefore see that the complex can only indi- 
rectly reveal itself by indefinite symptomatic association (sym- 
bolic actions), all of which show a more or less symbolic char- 
icter. 13 (See all examples mentioned above.) The effects eman- 
iting from the complex must in the normal be weak and obscure 
jecause they are not in possession of their full attention which 
is taken up by the ego-complex. Therefore in the experiment 
on distraction the ego-complex and the autonomous complex 
must be directly compared to both psychic activities, just as 
in the experiment most of the attention is bestowed on the 
writing and only a fraction on the association, so in activity most 
of the attention lies in the ego-complex while the autonomous 
complex receives only a fraction of it (provided the autonomous 
complex is not abnormally excited). It is for this reason that 
the autonomous complex can think only superficially and vaguely, 
that is, symbolically. Its productions (automatism, constella- 
tions) which it sends into the activity of the ego-complex and into 
consciousness must be created in a similar manner. 

We shall here give a brief analysis of the symbolic. We use 
the symbolic in contradistinction to the allegoric. Allegory is 
an intentional interpretation of a thought reinforced by emblems, 
while symbols are only indistinct by-associations of a thought, 
causing more vagueness than perspicuity. Says Pelletier : 14 " The 
symbol is a very inferior form of thought. One can define the 
symbol as a false perception of a relation of identity or of a very 
great analogy between two objects which in reality present but a 

"Stadelmann (Geisteskrankh. u. Naturwissensch., Miinchen, 1905) in 
his regretably affected manner of representation, says : " The psychotic 
furnishes the partially or completely deranged feeling of his ego with a 
symbol, but unlike the normal he does not compare this feeling with other 
processes or objects, but it is stretched to such an extent that the pic- 
ture which he has brought in for comparison he allows to become a 
reality, a subjective reality which in the judgment of others is a delusion." 
" The genius finds the necessity of forms in his inner life which he pro- 
jects outwardly, and whereas the symbolized associations in the psychotic 
become delusions, in the genius it only manifests itself as a somewhat 
exaggerated experience." 

14 L'Association des Idees dans la Manie aigue, etc. These de Paris, 1903. 



64 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

vague analogy." Pelletier also presupposes that for the origin 
of symbolic association there must be a deficiency in power of 
discrimination. Let us now apply these reflections to the dream. 
At the onset of sleep there is the suggestive imperative, "you 
wish to sleep, you don't wish to be disturbed by anything." 15 
This is an absolute command for the ego-complex which subdues 
all associations. But the autonomous complexes as shown above 
are no more under the direct control of the ego-complex. They 
allow themselves to be pushed back quite far, and to be reduced, 
but not to be completely lulled to sleep. For they are like small 
secondary minds having their own affective roots in the body and 
by means of which they always remain awake. During sleep the 
complexes are perhaps just as inhibited as during the waking 
state, for the imperative call to sleep inhibits all side thoughts. 16 
Nevertheless, just as during the noises of the day and in the 
waking state, so they succeed from time to time in presenting to 
the sleeping-ego their pale, apparently senseless, by-associations. 
The complex thoughts themselves are unable to appear, as the 
inhibition of sleep-suggestion is especially directed against them. 
If they are able to break through the suggestion, that is, if they 
can come to the full possession of attention, of course sleep 
immediately ceases. We see this very frequently in the hypnosis 
of hysterics; the patients sleep a short time, then they suddenly 

15 Of course this is only a figurative expression for the sleep obsession, 
or sleep instinct (see Claparede : Esquisse d'une theorie biologique du 
sommeil. Archives de Psychologic, Tome IV, p. 246). Theoretically I 
agree with the point of view formulated by Janet : Par un cote le sommeil 
est un acte ; il demande une certaine energie pour etre decide au moment 
opportun et pour etre accompli correctement." Les Obsessions, I, p. 408. 
Like every psychic process, sleep probably has its special cell chemism 
(Weygandt !). In what it consists no one knows. Considered from the 
psychological side it seems to be an autosuggestive phenomenon (Forel 
and others utter similar views). Thus we understand that there are 
many transitions from the pure suggestive sleep to the organic sleep 
obsession which gives the impression of a poisoning by some meta- 
bolic toxin. 

18 The instinctive sleep inhibition can be expressed psychologically as 
"desinteret pour la situation present" (Bergson, Claparede). The effect 
of the " desinteret " on the association activity is the " abaissement de la 
tension psychologique " (Janet) which as afterwards described manifests 
itself in the characteristic association of dreams. 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 65 

become awakened through fright from some thought-complex. 
Insomnia in many cases is due to uncontrollable complexes 
against which the energy of the auto-suggestion of sleep can no 
more be effective. If, however, by proper means we reinforce 
the energy of such persons they are again able to sleep, because 
they can restrain their complexes. But restraining the complex 
means nothing more than the withdrawal of the attention, that 
is, its distinctness. Hence in their thought the complexes depend 
only on a small fraction of distinctness and because of deficiency 
of discrimination they manifest themselves in rather vague and 
symbolic expressions and become mingled. A real censorship of 
dream-thoughts in the sense of Freud we need not admit. The 
inhibition emanating from the sleep-suggestion perfectly suffices 
to explain all. In conclusion we must mention another charac- 
teristic complex-effect, that is, the inclination to contrast-associa- 
tion. As was fully shown by Bleuler (see Chap. I) psychic 
activity tending towards an aim must be accompanied by con- 
trasts. This is absolutely necessary for proper coordination and 
moderation. From experience we know that every decision is 
accompanied by the association of contrasts. Normally we are 
never impeded by contrasts, they only induce reflection and are 
useful for our actions. But if for any reason the energy is 
impaired, then the individual readily becomes the victim of an 
opposition between positive and negative, inasmuch as the feeling- 
tone of the decision suffices no more to overpower and restrain 
the contrasts. We see this very often wherever a strong complex 
absorbs the energy of the individual. The energy being dimin- 
ished, the attention for everything not belonging to the complex 
becomes superficial, and the associations lack a firm course. As 
a result we get on the one hand shallow associations, and on the 
other the contrast can no longer be suppressed. Sufficient exam- 
ples can be found in hysteria where one deals entirely with con- 
trasting emotions (see Bleuler's works) and in dementia praecox 
where we deal with emotional and speech contrasts (see Pelle- 
tier's work). Stransky experimentally found speech contrasts in 
his forced talking. 

A few general remarks will be made on the manner and course 
of the complex by way of addition to Chapters II and III. 

Every emotional event becomes a complex. If it does not meet 



66 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

an already existing kindred complex it is only of momentary 
significance, and gradually sinks with lulled emotional tone into 
the latent mass of memory where it remains until a kindred 
impression reproduces it. But if an emotional event meets an 
already existing complex, it reinforces it and for some time 
assists it in gaining the upper hand. The clearest examples of 
this kind are to be seen in hysteria, where apparently insignificant 
things may lead to strong emotional outbursts. In such cases 
the impression touched either directly or symbolically the rather 
loosely repressed complex and in this manner called forth a 
complex-storm, which, in view of the unimportance of the event, 
appears entirely disproportionate. The strongest complexes unite 
themselves with the strongest emotions and impulses. We must 
therefore not be surprised at the fact that most complexes are of 
an erotic-sexual nature (as are also most dreams and hysterias). 
Especially in women where the sexual is the center of psychic 
life there hardly exists a single complex not in relation to sex- 
uality. The significance of sexual trauma for hysteria univer- 
sally assumed by Freud probably rests on this circumstance. At 
any rate, sexuality should always be kept in mind during psy- 
chanalysis which does not, however, mean that all hysterias are 
exclusively traced to sexuality. Any strong complex may call 
forth hysterical symptoms in those predisposed, at least so it 
seems. I do not mention here all the other kind of complexes, 
as I have already attempted to sketch the most frequent kinds. 17 
It is for the interest of the normal individual to free himself 
from any obsessing complex which impedes the further proper 
development (adaptation to environment) of his personality. 
Time generally takes care of that. Frequently, however, arti- 
ficial aid must be invoked so as to help the individual rid himself 
of an obsessing complex. Transference we have learned to know 
as a very frequent help. One is wont to grasp at something new, 
especially something which strongly contrasts with the complex 
(masturbatic mysticism). An hysteric can be cured if one is 
able to produce a new complex which will obsess her. 18 Soko- 

" Arch, f iir Krim.-Anthropol., 1906. 

18 Hysteria makes use of all sorts of detailed measures in order to pro- 
tect itself against the complex, such as conversion into bodily symptoms, 
disassociations (splitting) of consciousness, etc. 



INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 6/ 

lowski 10 expresses himself in a similar manner. If one succeeds 
in repressing the complex, there remains for a long time a strong 
complex-sensitiveness, that is, there is a marked tendency to 
recrudescence. If the repression was produced by compromise- 
formation there exists a lasting inferiority, a hysteria, in which 
only limited adaptation to the environment is possible. If the 
complex remains entirely unchanged which, to be sure, is possible 
only when there is most serious damage to the ego-complex and 
its functions, we must then speak of dementia praecox. 20 Of 
course, I speak here only from the psychological side and only 
affirm what one may find in the psyche of dementia praecox. 
The view expressed in the above sentence in no way excludes the 
idea that the inveterate persistence of the complex may be due 
to an internal poisoning which may perhaps have been originally 
liberated by the affect. This assumption seems probable because 
it is consonant with the fact that in most cases of dementia 
praecox the complex is in the foreground, while in all primary 
intoxications, such as alcoholic, uremic poisoning, etc., the com- 
plex plays a subordinate role only. Another fact which speaks 
for my supposition is that many cases of dementia praecox begin 
with striking hysteroid symptoms, and only during the course of 
the disease do they " degenerate," that is, only during the course 
of the disease do they merge into the characteristic stereotypy or 
senselessness. It was for this reason that the older psychiatrists 
spoke directly of degenerative hysterical psychoses. We may, 
therefore, formulate the above conceptions in the following 
manner : 

Considered from without we see the objective signs of an 
affect. These signs gradually (or very rapidly) grow stronger 
and more distorted so that to ingenuous observation it finally 
becomes impossible to assume a normal psychic content and one 
then speaks of dementia praecox. A more perfect chemistry or 
anatomy of the future will perhaps sometime be able to demon- 
strate the objective metabolic changes belonging to it, or the 
toxin effects. Considered from within, which, of course, is only 

19 St. Petersburger Medic. Wochenschr., 1895. 

*A similar? idea, which, however, is unfortunately almost choked by 
its weedy exuberant conception is uttered by Stadelmann, Geisteskrankh. 
u. Naturwissensch. Miinchen, 1905. 



68 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

possible through complicated analogical conclusions, we observe 
that the subject can not psychologically free himself from a cer- 
tain complex. Because he continually associates with this com- 
plex and allows all his actions to be constellated by it, there must 
result a certain reduction of personality. How far the purely 
psychological influence of the complex reaches in such case we 
are unable to say at present; we may, however, suppose that 
the toxin effect plays an important part in the progressive 
degeneration. 









CHAPTER IV. 
DEMENTIA PR^ECOX AND HYSTERIA. 

A PARALLEL. 

To write an exhaustive comparison between dementia praecox 
and hysteria would be possible only if we knew more thoroughly 
the disturbances of the association activities of both diseases, and 
especially the affective disturbances in normal individuals. At 
present we are far from this. What I intend to do here is to 
recall the psychological resemblances based on the preceding dis- 
cussions. As a later treatment of the association experiments in 
dementia praecox will show, an antecedent comparison between 
dementia praecox and hysteria is necessary in order to under- 
stand the manifestations of the associations in dementia praecox. 

i. THE DISTURBANCES OF THE EMOTIONS. 

The more recent investigators of dementia praecox (Kraepelin, 
Stransky and others) group the emotional disturbances about the 
central point in the picture of the disease. On one side one 
speaks of emotional dementia, and on the other of an incongruity 
between ideation and affect (Stransky). 

I do not speak here of terminal dementia as seen in the terminal 
stages of the disease which can hardly be compared to hysteria 
(they are two totally different diseases), but I limit myself to the 
apathetic conditions during the acute stages of the disorder. 
The emotional apathy so striking in many cases of dementia 
praecox has a certain analogy to the " belle indifference " of many 
hysterics who describe their complaints with smiling serenity, 
thus giving a rather inadequate impression, or speak with equa- 
nimity about things which should really profoundly touch them. 
In Contributions VI and VIII of the "Diagnost. Assoz.-Stud." 
I endeavored to point out how the patients apparently speak 
unemotionally about things which to them are of the most inti- 
mate significance. This is especially striking in analyses where 

69 



7<D THE PSYCHOLOGY OF DEMENTIA PR^COX. 

one occasionally discovers the reason for the inadequate behavior. 
So long as the complex connection which is under special inhibi- 
tion does not become conscious, the patient may tranquilly speak 
about it in a rather light manner and without going into detail. 
This manner of light talking may result in a condition of evasion 
producing contrasting actions. I had a hysterical patient under 
observation who, whenever she was tormented by a depressing 
complex, entered upon an unbridled jovial behavior, thus repress- 
ing the complex., When she related anything very sad which 
really should have deeply moved her, she accompanied it by loud 
laughter. At other times she spoke with absolute indifference 
(the accent, however, betrayed her deliberateness) about her 
complexes as if they did not in the least concern her. The 
psychologic reason for this incongruity between the ideational 
content and the affect seems to be due to the fact that the com- 
plex is autonomous and allows itself to be reproduced only when 
it wishes. Hence we see that the "belle indifference" of hys- 
terics does not last very long but is suddenly interrupted some- 
times by a wild emotional explosion, a crying spell, or something 
similar. We notice the same in the euphoric apathy of dementia 
praecox. Here, too, we see, from time to time, now an appar- 
ently unexpected moodiness, now a violent act, or a striking 
freak, which have nothing in common with the former indiffer- 
ence. Professor Bleuler and I have frequently noticed at our 
joint examinations that as soon as analysis succeeded in laying 
bare the complex, the apathetic or euphoric mask immediately 
disappeared and was replaced by an adequate affect often quite 
a stormy one, just as in hysteria when the sore spot is touched. 
There are, however, cases in which the obstructions defending 
the complex can in no way be penetrated. The patients then 
continually give contemptuous and meaningless answers, that is, 
they simply do not enter into the question, and the more direct 
bearing the questions have on the complex the less they answer. 
Not seldom we see that after intentionally or unintentionally 
producing complex stimuli in apparently apathetic patients, there 
subsequently appears a reaction having a distinct relation to the 
stimulus. The stimulus therefore acted after a certain period 
of incubation. In my experience with hysterical cases I fre- 
quently observed that in conversation the patient spoke with an 



DEMENTIA PR^COX AND HYSTERIA. 7 1 

apparently affected indifference and superficiality about certain 
critical points so that this pseudo-self-control surprised me. 
But a few hours later I would be called to the ward because this 
very patient had fallen into a spell. It was then ascertained that 
the trend of the conversation subsequently attained an affect. 
The same thing can be seen in the origin of paranoid delusions 
(Bleuler). Janet 1 observed in his cases that at the time of the 
event which should have really acted as an excitant they remained 
calm, but after a latent period of a few hours or even days the 
corresponding affect manifested itself. I can confirm this obser- 
vation of Janet. Baelz 2 observed on himself, during an earth- 
quake, the manifestations which he calls " emotional paralysis." 
The affective states without adequate ideational content which 
are so frequent in dementia praecox have likewise their analogies 
in hysteria. Let us for example recall the state of anxiety in 
obsessive neuroses ! Here as a rule the ideation is so inadequate 
that even the patients recognize it by its logical instability and 
rate it as senseless, yet it seems to be the source of anxiety. 
That this is not so is shown by Freud, in a manner which until 
now has not been refuted and we can only confirm it. I recall 
the patient from Contribution VI of " Diagnost. Assoz.-Stud.," 
who had the obsession that she infected her minister and physi- 
cian with her obsessive ideas. In spite of demonstrating to her- 
self that this idea was totally unfounded and senseless, it did not 
cease to cause her intense anxiety. The frequent depressions in 
hysteria are in a great many cases referred by the patients to 
reasons which can only be predicated as concealing-reasons 
(Deckursachen). Really one deals with normal reflection and 
thought which is hidden in the repression. A young hysterical 
woman suffered from such a marked depression that at each 
answer she causelessly burst into tears. Her depression she 
obstinately and exclusively referred to a pain in her arm which 
she accidentally felt while at work. It was finally found that 
she had a love affair with a man who refused to marry her, which 
was the real cause of her constant vexation. Therefore before 
we state that the precocious dement is depressed for reasons 

'If I identify here the cases described by Janet in his Obsessions with 
hysteria, it is because I cannot differentiate Janet's obsessed from 
hystericals. 

' Allg. Ztschr. f. Psych., Bd. 58, p. 7*7. 



72 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

inadequate we have to represent to ourselves the mechanisms 
existing in every normal person, which always tend to repress 
the unpleasant and to bury it as deeply as possible. 

The explosive excitements in dementia praecox may be brought 
about in the same way as the explosive affects in hysteria. 
Every person treating hysteria is acquainted with the sudden 
affect and acute exacerbations of the symptoms. Frequently we 
are confronted with a psychological riddle and deem it sufficient 
to note " patient is again excited." But a careful analysis al- 
ways discovers a clear reason for the excitement; now it is a 
careless remark from those about her, now a certain letter, or 
the anniversary of a critical event, etc. To liberate the complex, 
a mere nuance, perhaps only a symbol will suffice. 3 So also in 
dementia praecox, by careful analysis one may frequently find 
the psychological thread leading to the cause of the excitement. 
Of course we do not find this in all cases, the disease is too 
opaque for that, but we have absolutely no reason to suppose 
that no sufficient connections exist. 

That the affects in dementia praecox are probably not extin- 
guished but only peculiarly transposed and blocked, we see on 
rare occasions when we obtain a complete catamnestic view of 
the disease. 4 The apparently senseless affects and moodiness are 
subjectively explained by hallucinations and pathological fancies 
which can with difficulty or not at all be reproduced during the 
height of the disease because they belong to the complex. If a 
catatonic is constantly occupied by hallucinatory scenes which 
crowd themselves into his consciousness with elemental force and 
with a much stronger tone than the external reality, we can then 
without any further explanations readily understand that he is 
unable to adequately react to the questions of the physician. 

8 Thus Riklin mentions the following instructive example : A hysterical 
patient periodically vomited all milk she took. The analysis during hyp- 
nosis showed that while patient lived with a relative he once assaulted her 
sexually as she went to the stable to fetch some milk. " Ibi homo puel- 
lam coagere conatus est, ut semen, quod masturbations effluebat, ore red 
peret." During the week after the hypnosis patient nearly always vomited 
what milk she took, though she had total amnesia for the hypnosis. Ana- 
lytische Untersuchungen der Symptom und Assoziationen eines Falles 
von Hysteric. Psych.-Neurol. Wochenschr., 1905. 

4 See Forel : Autobiography of a case of acute mania, and Schreber : 
Denkwiirdigkeiten eines Nervenkranken. Mutze, Leipzig. 



DEMENTIA PR^COX AND HYSTERIA. 



73 



Furthermore, if the patient, as described by Schreber, perceives 
other persons in his environment as fleeting shadows of men, we 
can again understand that he is unable to react adequately to the 
stimuli of reality, that is, he reacts adequately, but in his own 
way. 

The lack of self-control or the inability to control the affects 
is characteristic of dementia praecox. We find this defect wher- 
ever there is a morbidly enhanced emotivity, especially in hys- 
teria, epilepsy, etc. The symptom only shows that there exists 
a marked disturbance of the ego-synthesis, that is, there exist 
powerul autonomous complexes which no longer submit to the 
hierarchy of the ego-complex. 

The lack of affective rapport so characteristic of dementia 
praecox we also frequently meet in hysteria, where we are unable 
to chain the personality and penetrate into the complex. In hys- 
teria, to be sure, this is only temporary, because the intensity of 
the complex is rather fluctuating, but in dementia prsecox, where 
the complex is stable, we can get an affective rapport only for the 
moment if we get the power to penetrate into the complex. In 
hysteria we gain something by this penetration, but in dementia 
praecox we gain nothing, for immediately thereafter we are again 
confronted by the personality of dementia praecox just as cold 
and strange as before. Under certain circumstances one may by 
means of analysis even cause a flaring up of the symptoms. In 
hysteria, on the contrary, a certain loosening takes place when 
the analysis is over. Whoever has penetrated into the mind of 
a hysteric by means of analysis knows that he has thereby gained 
a moral power over the patient (this is also true of confessions 
among normal individuals). But in dementia praecox, no matter 
how thorough the analysis may be, everything remains as before. 
The patients cannot enter into the mind of the physician, they 
adhere to their delusional assertions, they attribute hostile mo- 
tives to the analysis, they are, and in a word, they remain 
uninfluenced. 

2. CHARACTEROLOGICAL ABNORMALITIES. 

The characterological disturbances claim an important position 
in the symptomatology of dementia praecox, though one can 
really not speak of " dementia praecox character." Yet one 



74 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

might just as well speak of it as of a " hysterical character " into 
which, as every one knows, all kinds of prejudices are smuggled, 
such as moral inferiority and many similar ones. Hysteria cre- 
ates no character, but only exaggerates the already existing 
qualities. In hysteria we find all temperaments, we have the 
egotistic and altruistic personalities; criminals and saints, sexu- 
ally excited and sexually frigid natures, etc. Indeed what really 
characterizes hysteria is the existence of powerful complexes 
which are incompatible with the ego-complex. Under the char- 
acteriological disturbances of dementia prsecox we might mention 
the embellishment; that is, mannerism, affectation, mania for 
originality, etc. This symptom we frequently meet in hysteria 
and especially often whenever the patients think themselves out 
of their social element. This embellishment is especially fre- 
quently seen in the form of pretentious and studied behavior 
among women of a lower station coming in contact with those 
socially above them, such as dressmakers, maids, servants, etc.; 
also among men who are dissatisfied with their social standing 
and who are attempting to put on the appearance of those of a 
higher education and more imposing station. These complexes 
readily connect themselves with aristocratic gaits, with literary 
and philosophic enthusiasms and " original " views and expres- 
sions. They manifest themselves in exaggerated manners, and 
especially in studied speech, such as bombastic expressions, tech- 
nical terms, affected eloquence and high-sounding phrases. We 
therefore find this peculiarity especially in such cases of demen- 
tia praecox as entertain any form whatsoever of the delusion of 
social elevation (Delir der Standeserhohung of v. Krafft-Ebing). 
In this case the disease takes over the mechanism from the 
normal, that is, from the caricature of the normal (hysteria), 
but the embellishment contains nothing specific in itself. Such 
cases show a special inclination to neologisms which are em- 
ployed as learned or otherwise distinguished sounding technical 
terms. One of my patients named them "power-words" (Macht- 
worter) and showed a special liking for all possible peculiar 
expressions which to her seemed quite pregnant. The " power- 
words " serve to elevate and garnish the personality as much as 
possible. The expressive emphasis of the " power-words " accen- 
tuates the value of the personality against doubt and enmity, 



DEMENTIA PR^COX AND HYSTERIA. 75 

icnce they are frequently used in dementia praecox as defensive 

id conjuring formulae. A precocious dement under my care, 

whenever the doctors refused to grant him anything, threatened 

icm with the following words : " I grand duke Mephisto will 

lave you treated with blood revenge for Orang-Outang-represen- 

ince." Others use the " power-words " to conjure the voice. 5 

'See, e. g., Schreber's " Denkwiirdigkeiten.") 

This embellishment is also expressed in gesture and writing; 
ic latter, as is known, is especially decorated with all kinds of 

:uliar flourishes. We find a normal analogy to this, for exam- 
)le, in young girls who, out of capriciousness, imitate an espe- 
:ially marked or original script. Precocious dements frequently 
ive a characteristic writing. The contrasting tendencies of their 
)syche are in a way expressed by their script, which is sometimes 
low and flowing, now precipitous, now large and now small. 

ic same thing can readily be observed in temperamental hys- 
terics, where one may demonstrate without any difficulty that the 
script variations begin at a complex. In the normal we also 
observe disturbances associated with complexes. 

The tendency to embellishment is of course not the only source 
of neologisms. A great many originate from dreams and espe- 
cially from hallucinations. Not seldom we meet with analyzable 
speech contaminations and sound-associations, the origin of 
which can be explained according to principles treated of in the 
receding chapters. (For excellent examples see Schreber.) 
The origin of the " word-salad " can be explained by Janet's con- 
:eption of the " abaissement du niveau mental." Many patients 
fho are somewhat negativistic and refuse to consider the ques- 
tions show " etymological " inclinations, inasmuch as instead of 
answering they disjoint the question and eventually furnish it 
with sound-associations. This is nothing else than a transfer- 
ence and concealment of the complex. They do not wish to con- 
sider the questions and direct themselves therefore to the sound 
manifestations. (For the analogy of not taking up the stimulus 
word see Contr. VIII Diagnost. Assoz.-Stud.) There are many 
indications besides to show that the sound features of speech 
are more striking to precocious dements than to other patients, 
since they so frequently occupy themselves with word-dissection 

'Resembles the "Conjurations" of Janet (Les Obsessions). 



76 THE PSYCHOLOGY OF DEMENTIA PRvECOX. 

and interpretations. 6 The unconscious shows a special tendency 
towards new speech formation. ( See the " Himmelssprachen " 
of the classical somnambulists, and especially the interesting crea- 
tions of Helene Smith.) 7 

Regardlessness, narrow-mindedness, and an inaccessibility to 
persuasion, we find both in the normal and pathological spheres, 
especially when accompanied by affective causes. Under certain 
conditions there need only exist a firm religious or other convic- 
tion to make a person careless, cruel and narrow-minded. There 
is no necessity to assume for this an emotional dementia. On 
account of their excessive sensitiveness hysterics become egotis- 
tic and inconsiderate, and in this manner they torment themselves 
as well as their fellow beings. For this, too, there need be no 
dementia, it is simply a blinding through the affect. Indeed I 
must here again repeat the already often-mentioned restriction, 
namely, that between hysteria and dementia prsecox there is only 
a resemblance of the psychological mechanism, but no identity. 
In dementia praecox these mechanisms reach much deeper per- 
haps because they are complicated by toxic effects. 

The silly behavior of the hebephrenic finds its analogy in the 
Moria states 8 of hysterics. I had under observation for some 
time a hysterical woman of high intelligence who frequently suf- 

* Ford's patient (Arch. f. Psych., XXXIV) was forced to make many 
such interpretations, thus, for example, she interpretated the name Vater- 
laus as "pater laus tibi." A patient of mine complained of the allusion 
which was made by means of the food. He had lately found in his food 
a linen thread (Leinenfaser). He guessed that it referred to Fraulein 
Feuerlein (an earlier acquaintance) with whom however he had certainly 
had no intimate relations. One of my patients complained one day to 
me that he could not understand what " a green figure " had to do with 
him. He got this idea because they put chloroform into his food (chloros, 
forma) . 

T In examinations of unconscious writing (" Psychographie ") it can 
especially be well observed how the unconscious plays with the presenta- 
tions. The words are not seldom written in a reversed sequence of 
letters or there are singular conglomerations of words in otherwise clear 
sentences. Under constellations of spiritualistic convictions attempts are 
made towards formation of a new language. The most prominent medium 
known is Helene Smith (comp. Flournoy, Des Indes a la Planete Mars). 
Similar manifestations I have reported in my work: Zur Psych, u. Path, 
sog. occulter Phanomene. 

Fiirstner: Arch. f. Psych., Bd. XXXI. 



DEMENTIA PR^COX AND HYSTERIA. 77 

fered from states of excitement during which she presented an 
cquisitely childish and silly behavior. This happened regularly 
whenever she was forced to repress sad thought-complexes: 

Janet is acquainted with this behavior which naturally appears 
all gradations. He says : " These persons play a sort of comedy, 
ley are young, naive, coaxing, they pretend complete ignorance 
id get to be quite like little children." (" Obsessions," p. 391.) 

3. INTELLECTUAL DISTURBANCES. 

Consciousness in dementia praecox shows anomalies which 
ave in many ways been compared to those of hysteria and hyp- 
otism. Often there exist signs of narrowing of consciousness, 
at is, there is diminished clearness of one idea with abnormal 
crease of unclearness in all by-associations. Conforming to the 
iews of various authors we may thus explain blind acceptation 
f ideas without inhibition or correction, a thing analogous to 
uggestion. Many would explain the peculiar suggestibility of 
catatonics (echo symptoms) on this basis. The only objection to 
be advanced against this view is the fact that there is consid- 
erable difference between normal and catatonic suggestibility. 
Normally we observe that the subject will, if possible, accurately 
adhere to the suggestion if he attempts to realize it, whereas in 
ysteria peculiar modifications may take place corresponding to 
:he degree and kind of the disease. A suggested sleep may easily 
ransform itself into a hysterohypnosis or into a hysterical dream- 
tate, or the suggestions are only partially executed by the addi- 
ion of unintentional by-actions. 9 It is for this reason that 
ypnosis is less controllable in pronounced hysterics than in nor- 
mal persons. The accidental in the suggestive manifestations of 

'For some time I treated a hysterical patient who suffered from intense 
depression, headaches, and total inability to work. Whenever I suggested 
to her to find pleasure in work and to be more cheerful, she was, on the 
following day often abnormally happy, laughed incessantly, and had a 
strong impulse to work so that she worked till late in the night. On the 
third day she was profoundly exhausted. The happy disposition appear- 
ing without any motive was unpleasant to her because she constantly 
thought of nonsense and silly jokes, and laughed impulsively. 

An example of hystero-hypnosis can be found in my work, Ein Fall von 
hysterischem Stupor bei einer Untersuchungsgefangenen. Journ. f. Psych, 
u. Neur., 1902. 



7# THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

catatonics is still greater. Suggestibility often limits itself en- 
tirely to a motor sphere, resulting only in an echopraxia and often 
only in an echolalia. Verbal suggestion can rarely be carried out 
in dementia praecox, and even if it succeeds the effects are uncon- 
trollable and as if accidental. There are always a number of 
strange elements mixed together with the normal suggestibility in 
dementia praecox. Nevertheless there is no reason why catatonic 
suggestibility, at least in its normal remnants, could not be re- 
duced to the same psychological mechanism as in hysteria. We 
know that in hysteria the uncontrollable part of the suggestive 
effects is to be sought for in the autonomous complexes, and there 
is nothing against this being the case in dementia praecox. A 
capricious behavior similar to the one shown in suggestion is seen 
in dementia praecox in relation to other psycho-therapeutic meas- 
ures, such as transfer, discharge, 10 education by example, etc. 
That improvement in old catatonics when transferred to new suf- 
roundings depends on psychological causes is shown by the fine 
and very valuable analyses of Riklin. 11 

The lucidity of consciousness in dementia praecox is subject to 
all possible forms of obscuration; it may change from perfect 
clearness to the deepest confusion. Through Janet we know that 
in hysteria the fluctuation of lucidity is almost proverbial. In 
hysteria we are able to distinguish two kinds of disturbances, 
momentary and persisting. The momentary disturbance may be 
a slight " engourdissement " of a few seconds duration, or it may 
be a momentary hallucinatory and ecstatic invasion likewise of 
very short duration. In dementia praecox we know the abrupt 
obstructions, the momentary " thought-deprivation," and the 
lightning-like hallucinatory incursions with bizarre impulses. 
The lasting disturbance of lucidity in hysteria we know in the 
form of somnambulistic states with numerous hallucinations or 
in the form of " lethargic " (Lowenfeld) or cataleptic conditions. 
In dementia praecox it is shown in the form of persisting hallu- 
cinatory phases with more or less marked confusion and in stu- 
porous states. 

Attention in dementia praecox is, so to say, regularly disturbed, 
but the same disorder also plays a great part in the realms of 

10 See Bleuler: Friihe Entlassungen. Psych. Neur. Wochenschr., 1905. 

11 Uber Versetzungsbesserungen. Psychiatr. Neurol. Wochenschr., 1905. 









DEMENTIA PRJECOX AND HYSTERIA. /9 

lysteria. Janet notes the following as to the " troubles de 
['attention " : " One can say that the main trouble exists not only 
in a suppression of the intellectual faculties, but in the difficulty 

f fixing the attention. Their mind is always distracted by some 
vague preoccupation and they never give themselves up entirely 
to the object which one assigns to them." As shown in the first 
apter, the words of Janet may also be applied to dementia 

raecox. It is the autonomous complex which disturbs the con- 
centration of the patients, it paralyzes all other psychic activities, 
a fact which curiously escaped Janet. What is striking in hys- 
teria (just as in other affective states) is the fact that the patients 
always return to their " stories" (as in traumatic hysteria!) and 

at all their thoughts and actions are constellated by the complex 

nly. A similar narrow-mindedness, but of the highest intensity, 
we frequently observe in dementia praecox, especially in the para- 

:oid form. It is hardly necessary to give examples. Orienta- 
tion in both diseases changes in a similar capricious manner. In 
dementia praecox, where one is not actually dealing with marked 
excitability and deep confusion, we often get the impression that 
the patients are only disturbed by illusions, but that in reality 
they are properly oriented. In hysteria we do not always receive 
the same impression, but we may convince ourselves that proper 
orientation exists by hypnotizing the patient. Hypnosis represses 
the hysterical complex and allows a reproduction of the ego- 
complex. As in hysteria, disorientation is due to the fact that 
some pathogenic complex pushes the ego-complex away from the 

eproduction, a thing which may happen instantaneously; like- 
wise in dementia praecox it may readily happen that quite clear 
answers are often replaced at the very next moment by the most 

ingular utterances. 12 The lucidity of consciousness is especially 

"A nice example of momentary variations in hysteria is found in the 
work of Riklin : Uber den Ganserschen Symptomencomplex. Psych, neur. 

Wochenschr., 1904. He shows that a patient manifested correct or de- 
lusional orientation depending on the manner of questioning. The same 
thing can happen spontaneously when the complex is excited by a stimulus. 
Riklin reports a corresponding experimental case in Cont. VII of the 
iag. Assoz.-Stud. where at a critical stimulus word a dreamy state oc- 
rred and held on for some time. The pathological fancies are principally 
e same thing, as e. g., the automatic insertions in the language or writ- 
ing in somnambulism (See Flournoy). 




8O THE PSYCHOLOGY OF DEMENTIA PR^COX. 

injured in the acute stages where the patients often are in a real 
dream, 13 that is, in a " complex-delirium." 14 

The hallucinatory delirious phases may, as we have said, be 
placed parallel to hysteria (of course it must always be kept in 
mind that we deal with two different diseases). The content of 
the hysterical delirium, as we readily discover when we use 
Freud's method of analysis, is always a clear complex-delirium; 
that is, the pathogenic complex appears as self-acting and spends 
its vitality usually in the form of wish-realization. 15 

In the corresponding acute phases of dementia praecox we do 
not have to look long in order to find similar things. Every 
psychiatrist knows the deliria of unmarried women who pass 
through betrothals, marriages, coitus, pregnancies and births. I 
content myself here with this allusion, reserving everything till 
later, when I shall return to these questions. They are of extra- 
ordinary importance for the determination of the symptoms. 16 

18 See E. Meyer: Beitrag zur Kenntnis der akut entstandenen Psychosen. 
Berlin, 1899. 

14 1 recall the fact that a normal dream is always a " complex-delirium " ; 
i. e., its content is determined by one or more complexes which are actual. 
Freud as we know has shown this. If one analyses his dreams by the 
Freud method he immediately sees the justification for the expression 
" complex-delirium." A great many dreams are wish fulfilments. Endog- 
enous dreams exclusively concern complexes while exogenous ones; i. e., 
those influenced or produced during sleep by physical stimuli are as far 
as I have observed until now, blendings of complex constellations with 
more or less symbolic elaboration of bodily sensations. 

15 Ganser's dreamy states and the deliria of somnambulists furnish good 
examples. Comp. Riklin : Psych. -Neur. Wochenschr., 1904. Jung, Jour. 
f. Psych, u. Neur., 1902 u. 1903. A fine example of complex-delirium with 
misinterpretations is given by Weiskorn : A twenty-one year old primi- 
para refers to her labor pains as follows ; grasping her abdomen she asks : 
" Who presses me here? " The descent of the caput she refers to as a hard 
passage of the bowels. Transitorische Geistesstorungen beim Geburtsakt., 
Diss., Bonn, 1897. v. Krafft-Ebing reports transparent deliria, Lehbr. and 
C. Meyer in Jahrb. f. Psych., XI, p. 236. Clear complex-deliria are the 
semi or unconscious fanciful creations of the hysterics described by Pick 
(Jahrb. f. Psych, u. Neur., XIV, p. 280) as well as the romances of Helene 
Smith described by Flournoy and the somnambulists observed by me. 
Another clear case is found by Bohn (Ein Fall von doppeltem Bewusstsein, 
Dissert., Breslau, 1898). 

16 Riklin in his works on Versetsungsbesserungen has already given some 
contributions worth mentioning (Psych. Neur. Wochenschr., 1905). As 






DEMENTIA PR^ECOX AND HYSTERIA. 8 1 

We pass then to the realm of delusions and hallucinations. 
)th symptoms occur in all mental diseases and also in hysteria. 
)ne therefore deals with mechanisms which are universally 
>rmed and are set free by the most variable injuries. What 
liefly interests us is the content of the delusions and hallucina- 
tions to which we may also add the pathological fancies. Here, 
), hysteria, this most transparent disease, can help us. Obses- 
sive ideas can be placed parallel to delusions; so may also the 
Fective narrow-minded prejudices which are so often met with 
hysteria, and the stubbornly asserted bodily pains and com- 
plaints. I cannot repeat the genesis of these hysterical and delu- 
sional assertions, I must presuppose a knowledge of Freud's 
ivestigations. The delusional assertions of the hysteric are 
ransferences, that is, the accompanying affect does not belong 
them but to a repressed complex, which is veiled in this man- 
icr. An indomitable obsessive idea only goes to show that a 
5mplex (generally sexual) is repressed; the same is true of the 
Dther stubbornly asserted hysterical symptoms. We now have a 
well-grounded hypothesis (I base this on many dozens of analy- 
ses), that an undoubtedly similar process exists in the delusional 

an example I cite one of his cases : Miss M. S. twenty-six years old, edu- 
ated and intelligent, six years ago passed through a brief psychosis, but 
is so well recovered that she was discharged as cured and the diagnosis 
dementia praecox was not made. Before the present attack she fell in 
3ve with a composer from whom she took singing lessons. Her love 
xm reached a passionate height accompanied by periods of insane excite- 
lent. She was then brought to the Burgholzli asylum. At first she looked 
Jon her confinement and her new experiences in the asylum as a descent 
ito the underworld. She got this idea from her teacher's last composition 
ihich was " Charon." Then after this purifying passage through the 
iderworld she interpreted everything happening about her in the sense 
:>f vicissitudes and struggles which she had to undergo in order to become 
lited with her lover. Patient then considered another patient as being 
lover and for a couple of nights went into her bed. She then thought 
icrself pregnant, felt and heard twins in her womb, a girl resembling her- 
slf and a boy resembling the father. Later she thought that she gave birth 
a child and had hallucinations of having a child in bed. With this 
le psychosis came to a close. She had found a solacing substitute for 
reality. She soon became quiet, her behavior freer, the rigidity in her 
ittitude and gait disappeared and she readily gave catamnestic informa- 
an, so that her statements could be well compared with those in the 
Jspital records. 



82 THE PSYCHOLOGY OF DEMENTIA PRyECOX. 

system of dementia prsecox. 17 To illustrate my view I will cite 
this simple example. 

A thirty-two-year-old servant had her teeth extracted so as to 
have a complete new set inserted. During the night following 
the operation there appeared a marked condition of anxiety. 
She considered herself damned and lost forever because she had 
committed a great sin. She should not have had her teeth ex- 
tracted. People should pray for her that God might forgive her 
sins. The following morning the patient was again quiet and con- 
tinued her work, but during the succeeding nights the anxious- 
ness increased. I investigated her antecedent history obtained 
from her employers in whose service she had been for a number 
of years. Nothing, however, was known and the patient denied 
any kind of emotivity in her former life and emphasized with 
great affect that the extraction of the teeth was the cause of her 
disease. The disease rapidly progressed and the patient, mani- 
festing all the symptoms of catatonia, had to be committed. 
Then it was discovered that for many years she had been con- 
cealing an illegitimate child, of whose existence even her family 
had not the slightest knowledge. For a year past the patient 
had been acquainted with a man whom she wished to marry, but 
could not fully decide to do so, as she was constantly worried by 
the fear that her lover would cast her off on learning of her 
former life. Here, then, was the source of the anxiety, and at 
the same time it becomes clear why the affect was inadequate to 
the extraction of the teeth. 

The mechanism of transference shows the way to the compre- 
hension of the origin of a delusional assertion. This way, how- 
ever, is made difficult on account of infinite impediments. The 
well known oddness of the delusions in dementia prsecox barely 
admits of any analogies. Nevertheless we have essential facts 
in normal as well as in hysterical psychology to allow of at least 
approaching the most familiar delusional forms. 

" Godf ernaux in his psychological analysis of Magnan's delere chronique 
a evolution systematique finds at its base mostly an effective disturbance : 
" In reality the thought of the patient is passive ; he orients himself with- 
out taking into account all of his conceptions in the direction prescribed 
by his affective state." 

Le sentiment et la pensee, p. 8. 



DEMENTIA PR^COX AND HYSTERIA. 83 

Delusions of reference have been thoroughly analyzed and 
explained by Bleuler. 18 Feelings of reference are found where 
there is a markedly accentuated complex. It is the peculiarity 
of all strong complexes to assimilate as much as possible; it is 
also a known fact that at the time of a strong affect we often 
have a momentary feeling as if " some one noticed it." An acute 
affect will especially cause assimilations of quite indifferent occur- 
rences from the environment and thus the coarsest errors of 
judgment result. When we meet with some mishap we are quite 
ready during our first outbursts of anger to assume that someone 
intentionally injured and insulted us. In hysteria such prejudice 
may establish itself for a long time, corresponding to the magni- 
tude and duration of the affect, and through which, without any- 
thing further, slight delusions of reference result. From this to 
the delusional assumption of strange machinations is only a step. 
This road leads to paranoia. 19 The incredible and grotesque 
delusions of dementia praecox are frequently with difficulty ex- 
plained by the delusions of reference. If, for example, a preco- 
cious dement perceives everything taking place within and without 
him as unnatural and "concocted," we may assume a stronger 
disturbance than delusions of reference. 20 There is evidently 
something in the apperception of dementia praecox which prevents 
normal assimilation. The apperception either lacks a nuance or 
possesses one too much, thus receiving a strange accentuation 
(Berze!). In the hysterical realms we find analogies to this in 
disturbances of the feelings of activity. Every psychic activity, 
aside from the tone of pleasure and pain, is accompanied by still 
another feeling-tone which qualifies it in its own particular way 
(Hoffding). What we mean by this will be best explained by 
the important observations of Janet in psychasthenics. The 

18 Aff ektivitat, etc. Compare also Neisser: Allg. Ztschr. f. Psych., 
Bd. LIII. 

"Compare Margulies: Monatschr. f. Psych, u. Neur., Bd. X, and Gier- 
lich : Arch. f. Psych., Bd. XL. See Nervous and Mental Disease Mono- 
graph Series No. -2, Studies in Paranoia, for a translation of Gierlich's 
article. 

" A precocious dement under my care finds everything artificial ; what 
the doctor tells him, what the other patients do, the cleaning in the ward, 
the food, etc., all are artificial. It is all done by " one of his persecutors " 
who has a princess " by the head and thus blabs to the people what 
they are to do." 






84 THE PSYCHOLOGY OF DEMENTIA PRAECOX. 

decisions of volition and action are not accompanied by the same 
feeling as under normal conditions, but, for example, by "senti- 
ments d'incompletude " : "The subject feels that the action is not 
completely finished, that something is lacking." 21 Or every 
decision of volition is accompanied by a " sentiment d'incapacite" : 
" These persons from the beginning experience painful feelings 
in the thought that it is necessary to act ; they fear action above 
all things. Their dream, as they all say, is of a life where there 
will be nothing more to do." 22 A most important abnormity of 
the feeling of activity in dementia praecox is the "sentiment 
d'automatisme." 23 A patient expresses himself about it as fol- 
lows : " I am unable to give an account of what I really do, every- 
thing is mechanical in me and is done unconsciously, I am only 
a machine." 2 * 

Closely related to it is the "sentiment de domination." 25 A 
patient describes this feeling as follows : " For four months I 
have had queer ideas ; it seems to me that I am obliged to think 
and say them ; someone makes me speak, someone suggests to me 
coarse words and it is not my fault if my mouth works in spite 
of me." 

A precocious dement might talk in a similar manner. Hence 
one may be allowed to question whether we are not here dealing 
with dementia praecox. I carefully examined the lectures of 
Janet 26 in order to see whether or not among his pathological 
material there were cases of dementia praecox. This might be 
quite possible in the works of French authors. But I found 
nothing that would point to the fact that the above cited patient 
was a case of dementia praecox. Moreover, we frequently hear 
such utterances from hysterics and somnambulists, and finally 
we hear similar expressions among many normal persons who 
are under the domination of an unusually strong complex, like 
poets and artists (see for example what Nietzsche says about 
the origin of Zarathustra) , 27 A good example of disturbance of 

21 Obsessions et Psychasthenie, V. I, p. 264. 

22 L. c., p. 266. 
28 L. c., p. 272. 

24 Comp. Ball, Revue scientifique, 1882, II, 43. 

28 Janet, /. c., p. 273. 

28 Works, Vol. VI, p. 482. 

27 Works, Vol. VI, p. 482. 



I 



DEMENTIA PR^COX AND HYSTERIA. 8$ 

feeling of activity is the " sentiment de perception incomplete." 2 * 
A patient says : " It is as though I see things through a veil, a 
mist, or through a wall which separates me from reality." A 
normal person who is under the immediate influence of a great 
affect might express himself in a similar manner. But preco- 
cious dements express themselves in a like manner when they 
speak about their indefinite perception of the environment (" It 
seems to me as if you are the doctor," "they say it was my 
mother," " it looks like Burgholzli, but it is not "). 29 The expres- 
sion of Janet's patient, " The world appears to me like a gigantic 
hallucination," is true in the fullest sense also of precocious 
dements who always (especially in the acute stages) live, so to 
say, as in a dream, and they express themselves in a correspond- 
ing manner both during the disease and catamnestically. 

The "sentiments d'incompletude" are also especially related 
to the affects. A patient of Janet said : " It seems to me that I 
will not see my children again; everything leaves me indifferent 
and cold and I wish I could despair, cry out from pain; I know 
that I ought to be unhappy, but I do not arrive at that state; I 
have no more pleasure than pain ; I know that a repast is good but 
I swallow it because it is necessary without finding in it the 
pleasure that I would have found before. There is an enormous 
thickness preventing me from feeling the moral impressions." 
Another patient says : " I would like to try to think of my little 
girl but I can not, the thought of my child barely passes through 
my mind and does not leave me any feeling." 

I have repeatedly heard similar spontaneous utterances from 
hysterics as well as from precocious dements who were still able 
to give more or less information. A young catatonic woman 
who was forced to part from her husband and child under espe- 
cially tragic circumstances, showed a total lack of emotion for all 
familiar reminiscences. I placed before her the whole very sad 
situation, and attempted to evoke an adequate feeling. While I 
spoke she laughed, when I finished she became calm for a mo- 
ment and said, " I simply can not feel any more." 

According to our conception, the "sentiments d'incompletude," 
etc., are products of inhibition which emanate from an over- 

38 Janet, /. c., p. 282. 

" Excellent examples can also be found in Shreber's, Denkwurdigkeiten. 



86 THE PSYCHOLOGY OF DEMENTIA PILECOX. 

whelming complex. Whenever we are dominated by a complex 
it is only the ideas belonging to it which possess a full tone, that 
is, they alone possess perfect clearness, all other perceptions origi- 
nating either from within or 1 without are subject to an inhibition, 
through which they become indistinct, that is, they lose some 
feeling-tone. This is the basis for the resulting imperfection of 
the feeling of activity and finally for the want of emotion. These 
disturbances alone condition the feeling of strangeness. The 
reasoning faculty which is preserved in hysteria prevents the 
immediate outward projection as happens in dementia praecox. 
But if we by judgment facilitate the outward projection by 
allowing some superstitious ideas to creep in, there soon result 
explanations in the sense of a power coming from without. The 
clearest examples are given by the spirit mediums where a mass 
of insignificant things are referred to as transcendental causes; 
of course, it must be said that they are never as awkward and 
grotesque as in dementia praecox. We see something similar in 
normal dreams where there is outward projection with absolute 
certainty and ingenuousness. The psychological mechanisms of 
dreams and hysteria are most closely related to those of dementia 
preaecox. A comparison with dreams is therefore not too daring. 
In dreams we see how reality is spun with fanciful creations, how 
the pale memory pictures of the waking state assume tangible 
forms, and how the impressions of the environment adapt them- 
selves to the sense of the dream. The dreamer finds himself in 
a new and different world which he has projected out of himself. 
Let the dreamer walk about and act like one awakened and we 
have the clinical picture of dementia praecox. 

I am unable to discuss here in detail all delusions. I should 
like, however, to discuss briefly the well known delusions of 
influence. The idea of influencing of thought occurs in many 
forms, the most frequent being that of "thought-deprivation." 
The patients often complain that their thought is taken away 30 
whenever they wish to think or say something. 31 

**An original form of thought-deprivation is reported by Klinke: "A 
patient's thoughts are made to come out by the passing to and fro of 
the other patients in the ward." 

II Also in hysterics these manifestations are not at all rare, as I have 
observed. Janet calls them "eclipses mentales" (T. complains of often 
feeling a singular arrest of her thought, she loses her ideas), /. c., p. 369. 



DEMENTIA PR^COX AND HYSTERIA. 87 

By the method of outward projection they frequently place the 
responsibility on some foreign agency. Externally "thought- 
deprivation" is manifested in the form of "obstructions." 82 
The examiner suddenly receives no answer to his questions and 
the patient then states that he is unable to answer as his thoughts 
were "taken away." The association experiments taught us 
that long reaction times and incorrect reactions (" mistakes ") 
regularly appear where one deals with a complex-reaction. The 
strong feeling-tone inhibits the associations. This phenomenon 
more intensified is also found in hysteria where at critical points 
the patient " can simply think of nothing." This is almost 
thought-deprivation. The same mechanism is found in dementia 
praecox; here too thought is inhibited at complex-locations (be 
it in experiments or conversation). This can easily be seen in 
suitable cases when we at first speak about matters indifferent to 
the patient and later about things referring to the complexes. 
With the indifferent material the answers follow smoothly, while 
with the complexes one obstruction succeeds the other; the 
patients either refuse to answer or give deliberately affected 
evasions. Thus, no matter how patiently one tries, it is impos- 
sible to obtain detailed statements from a patient about her hus- 
band with whom she has lived unhappily, whereas about anything 
else she gives ready and detailed information. 

Another phenomenon to be considered is impulsive thought. 
Singular and even senseless ideas crowd themselves into a 
patient's mind, about which he is obsessively forced to deliberate 
and ponder. An analogy to this we find in psychogenic obses- 
sive thoughts. The patients regularly realize the absurdity of 
the thoughts, but are unable to repress them. 33 The thought 
influences also manifest themselves as " inspirations." 

**" Theories," like those, for instance, of Rogues de Fursac, only verify 
the fact. " The most suitable term is perhaps that of psychic interference. 
The two opposed tendencies annul each other, as contrary waves do in 
physics." (Cited after Claus : Catatonic et Stupeur, Bruxelles, 1903.) See 
also Mendel : Leitfaden der Psych., p. 55. 

* An analogy of this is Janet's " reverie forcee " in his " Obsedes," /. c., 
p. 154: "J. feels that at certain moments all his life concentrates itself 
into his head, that the rest of his body is as if asleep, and that he is 
forced to think enormously without being able to stop himself. The 
memory becomes extraordinarily and excessively developed so that it 



88 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

That we have here a phenomenon which does not exclusively 
limit itself to dementia praecox is already shown by the word 
" inspiration," which designates a psychic event appearing wher- 
ever there exists an autonomous complex. We deal here with 
sudden invasions of complexes into consciousness. Inspirations 
are not at all unusual in religious people. The modern protestant 
theologians have gone so far as to call it " inner experiences." 
" Inspirations " are an every-day occurrence in somnambulism. 

Finally we have another form of obstruction, " fascination " 
(an expression coined by one of my female patients). Sommer 
described this phenomenon as " optical fixation." We observe 
" fascination " in association experiments even outside of demen- 
tia praecox, especially in conditions of emotional stupidity. This 
condition may be evoked under circumstances by an experiment 
or through a complex stimulated during the experiment. The 
patients then begin to react (at least for a time) not to the stimu- 
lus word, but they simply name objects from the surroundings. 
I have especially noticed this in imbeciles, in normal persons dur- 
ing a strong affect, in hysterics at complex-locations and in 
dementia praecox. 

" Fascination " is distraction to the environment in order to 
conceal the vacuum of inner associations or the complex produc- 
ing the vacuum. It is the same in principle as breaking away 
from an unpleasant conversation by sudden diversion to some 
remote banality. As a starting point any object of the environ- 
ment serves. We have therefore enough evidence to enable us 
to place the mechanism of " fascination " on a parallel with the 
normal. 

Experience shows that all these disturbances appear in demen- 
tia praecox about the complex and belong to the measures of 
defense. Here we are also obliged to discuss negativism. The 
prototype of negativism is " obstruction " which, in some cases, 
gives the impression of an intentional refusal, just as the " I 
don't know " of hysterics. One can just as well speak of nega- 
tivism when the patients refuse to answer questions. The pas- 
sive negativism readily becomes active, whereby the patients 
also psychically defend themselves against the examination. If 
we exclude these cases where the negativism has generalized 

is impossible to direct it by attention." Compare also the case in Beitrag 
VI of Diag. Assoz. Stud. 



DEMENTIA PR^COX AND HYSTERIA. 89 

itself into a common state of defense, we find that in the still 
accessible cases the negativism as well as the obstructions are at 
complex-locations. As soon as the association experiment or 
the examination strikes the complex, that is, the tender spot, the 
patient refuses to answer and retreats, just as the hysteric uses 
all sorts of pretexts in order to conceal the complex. How great 
an inclination the catatonic symptoms have towards generaliza- 
tion is particularly shown in negativism. Whereas in hysteria, 
in spite of a repeatedly very strong and impeding negativism, 
we still find certain accessible tracts to the mind, the negativistic 
catatonic shuts himself in completely, so that at least for the 
moment there are no means of penetrating. Occasionally the 
negativism is called forth by a single critical question. A special 
form of negativism is the evasive speaking, which we know in a 
similar form in the Ganser symptom-complex. Here, just as 
there, one deals with a more or less unconscious refusal to enter 
into conversation, hence something similar to the fascination and 
thought-deprivation. The Ganser symptom-complex, as was 
shown by Riklin's and my own works, has its own good reasons ; 
the patients wish to repress their complex. In dementia praecox 
it is probably due to the same thing. In the psychoanalysis of 
hysteria we regularly find that the by-speaking or circumlocution 
occurs at the complex ; the same is found at the complexes of de- 
mentia praecox, only that here this symptom, as well as all the 
catatonic symptoms, show a tendency to generalization. The 
catatonic symptoms of the motor spheres can be conceived with- 
out any difficulty as radiating effects of generalization. This is 
probably true in the majority of cases. It is true, however, that 
catatonic symptoms appear in localized and general brain dis- 
turbances where one cannot very well think of a psychological 
icxus. But here we also see at least just as frequently hysterical 
lanifestations, whose psychogenesis is otherwise an established 
fact. What we should learn from this is never to forget the pos- 
sibility of thinking " the other way." 

An hallucination is crudely an outward projection of a psychic 
element. Clinically we know all gradations from inspiration or 
pathological fancy to loud hallucinations of hearing or to plastic 
vision. Hallucinations are ubiquitous. Dementia pracox only 
sets in motion a preformed mechanism which normally regularly 



9O THE PSYCHOLOGY OF DEMENTIA PR^COX. 

functionates in dreams. The hallucinations of hysteria, just as 
those of dreams, contain symbolically disfigured complex frag- 
ments. This also holds true 34 of most of the hallucinations of 
dementia praecox, only that here they are pushed still further 
and are of a more dreamlike disfigurement. Disfigurements of 
speech, after the example of dream-paraphasias (comp. Freud, 
Stransky and Kraepelin), are extraordinarily frequent; most of 
them are contaminations. A patient who entertained delusions 
of sin, noticing a Japanese in the clinic, heard the voices call out 
" Japansinner " (Japansunder). It is remarkable that not a few 
patients who tend to form numerous neologisms and peculiar 
delusions, that is, who are under the complete domination of the 
complex, are often corrected by the voices. One of my patients, 
for example, was twitted by the voices about her grandiose delu- 
sions, or the voices commanded the patient to tell the physician 
who was occupying himself with her delusions that " he should 
not bother himself with these things." Another patient who 
has been in the hospital for a number of years and always speaks 
in a disdainful manner about his own family is told by the voices 
that " he is homesick." From this and numerous other exam- 
ples I received the impression that the correcting voices are per- 
haps invasions of the repressed normal remnant of the ego- 
complex. That the normal ego-complex does not entirely perish, 
but is prevented from reproduction by the disease-complex, 
seems to me to be shown by the fact that during severe physical 
diseases or any other deep-going changes, the patients suddenly 
begin to react in a tolerably normal manner. 35 Sleep disturb- 

84 During the absence of her fiance a girl was seduced. She concealed 
it from her fiance. More than ten years later she was afflicted with 
dementia praecox. The disease began by feeling that people entertained 
suspicions against her morality, and that she heard voices talking about 
her secret, which finally compelled her to make a confession to her hus- 
band. 

Many patients state directly that the " sin register " is read for them 
with all its details and that voices " know everything " and take it 
up with them. It would therefore seem very strange that most of the 
patients are unable to give satisfactory information about their hallucina- 
tions. It is due here to the reproduction of the complexes which, as 
we have seen, are under special inhibitions. 

85 A patient who was quite inaccessible and who always greeted the 
doctors in the most scurrilous manner fell ill with a grave gastro- 




DEMENTIA PR^COX AND HYSTERIA. 



ances are quite usual in dementia praecox and manifest them- 
selves in a manifold manner. The dreams are often very vivid 
and we can readily understand that frequently patients are un- 
able to properly correct them. Many patients draw their delu- 
sions exclusively from the dreams to which they attribute real 
validity. 36 The part played by the vivid dreams of hysteria is 
well known. Besides disturbances by dreams, many other com- 
plex-fragments may disturb sleep, such as hallucinations, fancies, 
etc., just as hypnosis does in hysteria. Frequently patients com- 
plain about their unnatural sleep, which is not at all a real sleep, 
but an artificial rigidity. We hear similar complaints wherever 
there exists a strong affect which cannot be totally extinguished 
by sleep-inhibition and therefore accompanies sleep as a constant 
keynote (e. g., melancholia and depressive affects in hysteria). 
Not seldom intelligent hysterics feel the " complex-restlessness " 
in their sleep and can precisely detail it. A 7 patient of Janet says : 
" There are always two or three of my personalities who do not 
sleep, nevertheless I have fewer personalities during sleep ; there 
are some who sleep but little. These persons dream, but not 
the same dream. I feel that there are some who dream of 
different things." With these remarks the patient nicely ex- 
presses the feeling of the unrelenting and laboring autonomous 
complex which does not surrender to the sleep-inhibition of the 
ego-complex. 

enteritis. With the onset of the disease he became completely changed, 
he was patient and grateful, obeyed all requests and always gave polite 
and precise information. His convalescence manifested itself by his 
again becoming monosyllabic and shut in, and one fine morning he sig- 
nalled his complete recovery by receiving the doctor with the following: 
" Here comes again one of the flock of dogs and apes who wishes to 
play the Saviour." 

"Compare Sante de Sanctis: Die Traume, Halle, 1901, and Kazowsky: 
Neuro. Zent'r.-Bl., 1901, p. 440. 

We have a patient who entertains the most manifold sexual delusions 
which exclusively originate from dreams, as we were able to convince 
ourselves on numerous occasions. Patient simply takes the contents of 
her dreams which are all very vivid and plastic, as real, and correspond- 
ing to the dream she becomes abusive, querulous and complaining, but 
only in writing. In her general behavior she is nice and orderly in contra- 
distinction to the contents of her letters and writings. 




92 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

4. STEREOTYPY. 

By stereotypy in its broadest sense we understand the persistent 
and constant reproduction of certain activities, such as verbigera- 
tion, catalepsy, persistent phrases, perseverations, etc. These 
manifestations belong to the most characteristic symptoms of 
dementia praecox. Yet stereotypy in the form of automatization 
is also one of the most usual manifestations in the development 
of the normal psyche (Spencer). All our abilities and the whole 
progress of our personality rest on automatization. The process 
leading to it is the following: In order to perform a certain 
activity we direct all our attention on the appertaining ideas and 
through this markedly accentuated tone we engrave the phases 
of the process into memory. The effect of frequent repetitions 
causes a " smoother " path, upon which the activity finally moves 
automatically almost without our aid. Only a slight impulse is 
necessary to immediately put the mechanism in motion. The 
same thing may take place in us passively through strong affects. 
We can be forced to certain action by affects; at first there is 
great inhibition, but later, on account of numerous repetitions of 
the affect, the inhibition becomes less and finally the reaction 
succeeds promptly even on a very slight impulse. This can espe- 
cially be observed in the bad habits of children. 

The strong feeling-tone creates tracks, whereby we again ex- 
press the same things that we have said of the complex : Every 
complex has a tendency to autonomy and to independent living; 
it has a greater tendency to persist and to reproduction than 
indifferent thought ; it has therefore the best prospect for becom- 
ing automatic. Hence if anything becomes automatic in the 
mind an antecedent feeling-tone must always be postulated for 
it. 37 This is most clearly seen in hysteria, where we are able 
to trace all stereotypies (like convulsive attacks), absences, com- 
plaints and symptoms, to the underlying affects. In normal 
association experiments we find so-called perseverations regu- 
larly at complex-locations. 38 

87 As previously stated attention belongs under the collective idea of 
Gefiihlston (feeling tone). 

88 Occasionally the complex-content continues to persevere. In the 
majority of cases, however, there exists only one persevering disturbance 
which may perhaps be ascribed to the fact that the complex through dis- 






DEMENTIA PR^COX AND HYSTERIA. 93 

If a strong complex exists, there results a cessation of progress 
adapted to the environment, and associations gyrate altogether 
about the complex. This is generally so in hysteria where we 
meet the strongest complexes. The progress of personality is 
suspended and a great part of the psychic activity is spent in 
dressing the complex in every possible form (symptom-actions). 
It is not in vain that Janet calls attention to the general disturb- 
ances of the " obsede," of which I will mention the following: 
" {'indolence, I' irresolution, les retards, la fatigue, rinachevement, 
I'aboulie, I'inhibition, etc." 89 If a complex succeeds in fixing 
itself, monotony results, especially the monotony of external 
symptoms. Who does not know the stereotyped and tiring com- 
plaints of hysterics? the obstinacy and invincibility of their 
symptoms? Just as a constant pain will always call forth the 
same monotonous plaintive sounds, so will a fixed complex grad- 
ually stereotype the whole mode of speech of the individual, so 
that we can finally know that day after day we will receive with 
mathematical accuracy the same answer to a certain question. 

In these processes we find some of the normal prototypes for 
the stereotypy of dementia praecox. 40 When we examine the 

traction leaves an association-vacuum. This similarity occurs in the dis- 
traction experiments where, on account of a vacuum of association, one 
despairingly resorts to antecedent associations. If, however, as in the 
cases of Heilbronner, somewhat more difficult questions are given, it 
may result in an emotion and serves the same purpose as a complex. 
The association-vacuum is primary, inasmuch as there exist no fluent asso- 
ciations to the stimulus ideas in question. In the normal it is the complex 
which mostly perseveres. 

"Janet, /. c., p. 335 ff., p. 349, says: "This more or less complete 
stoppage of certain actions is one of the most essential phenomena in the 
mental states of the obsessed" (p. 105). "These forced operations are 
not normal. They are the operations of thought, of action, and of 
emotion, which are at once excessive, sterile, and of inferior kind." 

"Pfister (Uber Verbigeration. Vortrag auf der Versammlung des 
Deutsch. Ver. f. Psychiatric in Miinchen, 1906. Ref. Neurol.-Psychiatr. 
Wochenschr., No. 7, 1906) asks whether the stereotypies or the verbigera- 
tions have psychological motives or not. He however leaves the question 
open. Pfister seems to be of the same opinion as we; that each stereo- 
typy has an ideational content as its basis, which, however, on account 
of its morbidly disturbed manner of expression manifests itself in a 
distorted manner. ("It is conceivable that ideation stereotypies have an 
impulse to express themselves, but in their places there is a reproduction 



94 THE PSYCHOLOGY OF DEMENTIA PILECOX. 

origin of linguistic or mimic stereotypies, we often find the asso- 
ciated emotional content. Later the content always becomes 
more indistinct just as in the normal or in the hysterical auto- 
matism. But in dementia prgecox the corresponding process 
seems to run a more rapid and thorough course, so that one soon 
reaches the vacuum as regards content and emotion. 

As experience undoubtedly teaches, it is not only the complex- 
content that becomes stereotyped in dementia praecox, but also 
accidental material. It is known that the verbigerating patients 
will take up an accidental stray word and repeat it constantly. 
Heilbronner, Stransky and others justly interpret such phenom- 
ena as symptoms of association-vacuums. The motility stereo- 
typies can also be easily interpreted in the same manner. We 
know that precocious dements suffer very frequently from asso- 
ciative obstructions ("thought-deprivation"). This disappear- 
ance of thought is found by preference around the complex. If 
then the complex plays the enormous role entrusted to it, it is 
to be expected that it very frequently absorbs many thoughts, 
and in this way disturbs the f auction du reel. In the place of the 
alienated realms it creates association-vacuums and those phe- 
nomena of perse veration which may be explained by the 
" vacuum." 

It is a characteristic of most of the ontogenetically acquired 
automatisms that they are subjected to gradual changes. The 
anamneses of Tiquers (see Meige et Feindel, " Le Tic") afford 
many proofs of that. The catatonic automatisms are no excep- 
tions, they too change slowly, frequently the transformation 

of senseless phrases and neologisms. This is due to the simultaneous 
existence of the decaying and exciting processes in the central apparatus 
of speech which make their clear manifestation impossible, and in- 
stead of stereotyped thoughts [as results of paralogic-paraphasic malfor- 
mations] only unintelligible remnants come to view.") There is still 
another way in which the decay of speech can undermine the manifesta- 
tions of correct ideation stereotypies, and that is, that (on account of the 
disturbances in the recoinage of ideas and thoughts both in word and 
speech) through the monotonous repetition of ideas no equivalent speech 
formation can be incited. In the conversion of thought to expression 
of speech, numerous paralogic derailments occur, the presentations be- 
come erroneously associated, changing everywhere, so that, forthwith, 
in place of the thought stereot'ypy which remains hidden, there is a repro- 
duction of constantly changing nonsense. 



DEMENTIA PR^COX AND HYSTERIA. 95 

process taking years. The following examples will show what 
I mean. 

A catatonic sang persistently for hours a religious song with 
the refrain " Hallelujah." Then she began to verbigerate for 
hours " Hallelujah," which gradually degenerated into " hallo," 
" oha," and finally she verbigerated " ha ha ha " accompanied 
by convulsive laughter. 

In the year 1900 a patient combed his head a few hours every 
day in a stereotyped manner, so as to remove the " gypsum " 
which " was smeared into the hair " during the night. The fol- 
lowing year he gradually stopped using the comb on his head. 
In 1903 the patient beat and scraped his chest with it, and at 
present he has reached the inguinal region. 

In quite a similar manner the voices and delusions degenerate. 41 
In a like manner the " word-salad " originates. The original 
simple sentences become more and more complicated with neo- 
logisms, they are constantly loudly or quietly verbigerated and 
gradually become blurred, so that an unintelligible medley results 
which probably sounds similar to the " stupid chattering " with 
which many patients are affected. 

A patient under my observation during convalescence from 
acute dementia praecox begins quietly to relate to herself how she 
packs her trunk, goes from the ward to the asylum gate, then 
to the street, and then to the railroad station; how she gets 
into the train and reaches her home, where her wedding is solem- 
nized, etc. This story became more and more stereotyped, the 
individual halting places became mixed without any order, the 
sentences became imperfect, some were abbreviated to a single 
catch-word, and now after more than a year the patient only 
occasionally uses a catch-word ; all other words she has replaced 
by " hm hm hm " which she utters in a stereotyped manner 
with the same tone and rhythm as when she formerly told her 
story. At times when she becomes excited the former sentences 
reappear. We also know from hallucinatory patients that the 
voices in time become emptier and quieter, but when they become 
excited the voices regain in content and distinctness. 

" Compare especially Schreber : Denkwurdigkeiten. Schreber describes 
very well how the contents of the auditory hallucinations become gram- 
matically abbreviated. 

! 



96 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

These gradually creeping changes are very distinctly seen in 
obsessive ideas (see Cont. VIII). Janet, too, speaks of the 
gradual changes of obsessive processes. 42 

There are, however, stereotypies or rather stereotyped auto- 
matisms which from the very beginning do not show any psychl 
content by which they can be understood even symbolically, 
am thinking especially now of the almost muscular manifesta- 
tions of automatism, like catalepsy, or certain forms of negati- 
vistic muscular resistances. These exquisite catatonic sympto 
as has been already shown by many investigators, we also find 
organic disturbances, such as paralysis, brain tumors, etc. Brain 
physiology, especially the well-known experiments of Goltz, teach 
that in vertebrates when the cerebrum is removed a condition of 
automatism par excellence results. Forel's experiments with 
ants (destroying the corpora quadrigemina) shows that automa- 
tism results when the greatest (and most differentiated?) part of 
brain tissue is removed. The debrained animal becomes the 
well-known " reflex machine," it remains either sitting or stand- 
ing in a certain preferred attitude until it is forced by external 
stimuli to a reflex action. It is certainly a somewhat daring 
analogy when some cases of catatonia are compared to such reflex 
machines, although they frequently appeal to one as such. But 
when we go somewhat deeper and consider that in this disease 
a complex occupies almost all the associations, holding them per- 
sistently, that this complex is absolutely unassailable by psycho- 
logical stimuli, that it is, as it were, split off from all external 
influences, it would then seem that the before mentioned analogy 
is of somewhat greater significance. The complex on account of 
its intensity lays claim to the brain activity in its greatest extent, 
so that a great number of impulses belonging to other spheres 
become dissipated. It can then be easily understood that on 
account of the predominance, the congealing of a complex, a con- 

42 Janet, /. c., p. 125. A female patient says : " Formerly I used to look 
back in memory in order to know whether I ought to reproach myself 
for something, in order to reassure myself about my conduct but now 
it is not at all the same thing. I always recall what I have done a week 
or two weeks ago, and I see the things exactly, but I have absolutely no 
interest in seeing them." 

In this example the deviation from the content proper is especially 
noteworthy. 




DEMENTIA PR^COX AND HYSTERIA. 97 

dition will result in the brain which functionally at least will be 
more or less equal to a destruction of a great part of the brain. 
To be sure this hypothesis cannot be proven any further, but it 
may explain many things not reached by psychological analysis. 

SUMMARY. 

Hysteria contains in its innermost essence a complex which 
could never be totally overcome; in a measure the psyche is 
brought to a standstill since it is unable to rid itself of the com- 
plex. Most of the associations go in the direction of the com- 
plex, and the chief function of psychic activity is to elaborate 
the complex in every possible direction. For this reason (in 
chronic stages) the individual is forced to retire more and more 
from an adaptation to the environment. The wish-dreams and 
wish-deliria of hysteria occupy themselves exclusively with the 
fulfilment of the wish-complex. Many hysterics succeed, after 
a time, in regaining equilibrium by conquering the complex and 
by avoiding new traumas. 

In dementia prsecox we likewise find one or more complexes 
which become tenaciously fixed. Here, too, we have complexes 
which can no longer be conquered. Whereas in hysteria there 
exists an unmistakable causal relation between the complex and 
the disease (a predisposition is presupposed), we are not at all 
clear about this in dementia praecox. We do not know whether, 
in predisposed cases, it is the complex that causes or sets free 
the disease, or whether at the moment of the outbreak of the 
disease, a definite complex is present which determines the symp- 
toms. The more detailed and sharper the analysis, the more we 
see that in numerous cases at the onset of the disease there was 
a strong affect from which the initiatory moodiness developed. 
In such cases one feels tempted to attribute causal significance to 
the complex, but one must add the already mentioned restriction, 
that is, that the complex, besides its psychological effects, pro- 
duces also an X (toxin?) which helps along the process of 
destruction. Yet I am fully cognizant of the possibility that the 
X may primarily result from other than psychological reasons 
or causes, and then seize the last remaining complex and spe- 
cifically change it, so that it may seem as if the complex had 
causal effects. Be this as it may, the psychological consequences 



98 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

remain the same, namely, the psyche never rids itself of the com- 
plex. With the desolation of the complex an improvement takes 
place, but this is also accompanied by a destruction of a more or 
less greater portion of the personality, so that the precocious 
dement at best escapes with a psychic mutilation. The separa- 
tion of the precocious dement from reality, the loss of interest 
in objective happenings, is not difficult to explain when we con- 
sider that he persistently stands under the ban of an invincible 
complex. He whose whole interest is chained by a complex must 
be like one dead to all surroundings. Janet's normal " fonction 
du reel" must cease with it. He who is possessed by a strong 
complex continues to think in the complex, he dreams with open 
eyes and psychologically no more adapts himself to his surround- 
ings. That which Janet says about the "fonction du reel" in 
hysteria is, in a certain measure, also true in dementia praecox: 
" The patient constructs in his imagination small, very coherent 
and very logical stories; it is when reality is to be dealt with 
that he is no more capable of paying attention or of understand- 
ing." The greatest difficulty in these really not simple problems 
is the hypothetic X, the metabolic toxin ( ?) and its effects on the 
psyche. It is uncommonly difficult to characterize, in a measure, 
these effects from the psychological side. If I may be allowed 
to give expression to a supposition I would say that to me it 
seems that the effects most distinctly manifest themselves in the 
enormous tendencies towards automatization and fixation; in 
other words, in the persistence of complex effects. Accordingly, 
the toxin ( ?) is to be considered as a highly developed body which 
adheres everywhere to the psychic processes, especially to those 
which are emotionally accentuated, reinforcing and automatizing 
them. Finally it must be considered that the complex to a great 
extent absorbs the brain activity, on account of which something 
like a deencephalization takes place. The results of this may be 
the origin of those forms of automatism which are principally 
developed in the motor system. 

This more programmatic than exhaustive review of the paral- 
lels between hysteria and dementia prsecox may probably sound 
hypothetical to those readers not accustomed to Freud's views. 
By no means do I intend to give here anything conclusive, but 
rather something preparatory in order to support and simplify 
the illustrations in the following experimental investigation. 



CHAPTER V. 
ANALYSIS OF A CASE OF PARANOID DEMENTIA AS A PARADIGM. 

Anamnesis: B. St., seamstress, single, born in 1845. Patient 
was admitted to this hospital in 1887 and since then has remained 
continuously in the hospital. She is greatly tainted by heredity. 
Many years before admission she heard voices slandering her. 
For a time she intended to drown herself. She referred the 
voices to invisible telephones. She heard that she was a woman 
of doubtful character, that her child was found in the water 
closet, and that she stole scissors in order to pierce a child's eyes. 
(According to the anamnesis the patient led a thoroughly exem- 
plary and quiet life.) The patient used here and there peculiar 
expressions. She generally employed a rather pretentious style. 
Her letters of that time will illustrate this : 

July 5, 1887. 
Dear Superintendent: 

With these lines I request you once more to instantly discharge 
me. My head, as I already remarked to you in my last letter, 
is clearer than ever. What I have to suffer secretly on account 
of novelties in all domains is unfortunately known to me alone, 
and is too smashing for my health as well as for my mind. Un- 
fortunately they have gone so far as to torture to death poor 
victims by secret cruelties, for I suffer more than you can im- 
agine and in this manner fully expect my end, which sadly 
touches me more and more. I hope you will act in your place 
as physician and will have no need of any further reflection. 

Yours respectfully, etc. 

August 16, 1887. 
Dear Sir: 

Unfortunately I cannot make it possible for you to appreciate 
the sad conditions which have intruded themselves. I again call 
your attention to the simple fact, to discharge me without more 
ado, as I alone suffer under these novelties, and if you were to 

99 



IOO 



THE PSYCHOLOGY OF DEMENTIA PRyECOX. 



be convinced of it you would surely immediately discharge me, 
because I have suffered from the beginning since I came here, 
and am totally at the end of my health. I want an immediate 
discharge. It will be immediately better when I leave Zurich 
for another air where the horrors are not represented, etc. 

The patient manifests active delusions. She has a fortune of 
millions, in the night her bed is full of needles. In 1888 her 
speech became more and more disconnected and her delusions 
less understood ; she has for example the " monopoly." She 
makes peculiar gestures with her hands. A certain " Rubin- 
stein " from St. Petersburg sends her money by the wagonload. 
In 1889 she complained that her spinal cord was torn out in the 
night time. " Back pains are caused by substances covered with 
magnetism which penetrate through the walls." The " mon- 
opoly " confirms the pains which " do not stick in the body and 
do not fly about in the air." " Extracts " are made by means 
of " inhalation of chemistry," etc. By means " of suffocation " 
legions are murdered. " Station for station must keep its proper 
governmental position so that existence-questions of the ward 
cannot be chosen to hide themselves behind, all things can be 
chosen." 

In 1890-91 the delusions became more and more absurd, a 
great but incomprehensible role is played by the word " note- 
monopoly." In 1892 the patient became " queen of the orphans," 
" owner of the asylum Burgholzli," " Naples and I must provide 
the whole world with noodles." In 1894 patient at every visit 
asked for her discharge in a stereotyped and totally unemotional 
manner. In 1895 patient feels herself paralyzed and claims to 
have tuberculosis. She is the owner of a " seven-floored note 
factory with coal-raven-black windows, which signifies paralysis 
and starvation." In 1896 patient says, " I am Germania and 
Helvetia of exclusively sweet butter, but now I have no more any 
supply of butter not even as much as a fly would leave behind 
hm- hm hm that is starvation hm hm." (The syllable 
" hm " is a characteristic stereotyped insertion which still exists.) 
She also says, " I am Noah's ark, the life boat and the esteem, 
Maria Stuart, Empress Alexander." 

In 1897 patient relates that recently Dr. D. came out of her 



PARANOID DEMENTIA AS A PARADIGM. IOI 

mouth " the little tiny D., the son of the Emperor Barbarossa." 
In 1899 she was tormented nightly by many hundred thousands 
of snakes, etc. 

From the extracts taken from patient's history one can easily 
recognize the nature of the case. At present the patient is as 
ever a diligent worker. She now and then gesticulates and 
whispers during her work. During the physicians' visits she puts 
her questions in a stereotyped and unemotional manner, such as 
" Have you heard nothing from the notes ? I have so long ago 
established the monopoly, I am a triple world proprietress," etc. 
When she does not talk about her delusions her manner of ex- 
pression and behavior show nothing abnormal, though there is a 
certain unmistakable prinking, not rarely seen in elderly unmar- 
ried women who strive to acquire an equivalent for unsatisfied 
sexuality by the greatest possible perfection. She naturally has 
no insight as to her disease, yet to a certain extent she finds it 
conceivable that her delusions are not understood. There is no 
imbecility. Her speech is changed only in the spheres of her 
delusions, otherwise she speaks in a normal manner. She re- 
peats what she reads and defines ideas in a clear manner, insofar 
as they do not touch her complex. During the experiments and 
analyses the patient readily collaborated with the examiner, 
apparently taking the greatest pains to explain herself as well as 
possible. This behavior is especially due to the fact that the 
examination as such is also a complex-incitor, as the patient 
always demands interviews, hoping thereby to finally convince 
everybody, and thus reach the goal of her desires. The patient 
is always quiet and shows nothing striking in her general be- 
havior. While at work she whispers to herself " power-words." 
These are stereotyped sentences or sentence- fragments of a quite 
strange content, such as : " Last evening I sat in the night train 
to Nice, I had to pass there through a triumphal arch we have 
established all this as a threefold world proprietress we are 
also the lilac-new-red-sea wonder," etc. Such fragments appear 
in great numbers, but are altogether stereotyped and can always 
be reproduced in the same form. Motor stereotypies but rarely 
occur. One stereotypy, for example, is a sudden extension of 
the arms, as though patient would wish to embrace some one. 



IO2 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

SIMPLE WORD ASSOCIATIONS. 

For the last two years, at different times, I have taken from 
the patient simple word associations (corresponding to those 
discussed in the Diagnost Assoz.-Stud.). I now present some 
of them: 

Stimulus. Reaction. 

1. Pupil 2. (This figure gives the number of repeti- 

tions of the antecedent word stimulus.) 

" Now you may write Socrates." 12.4" 

2. Father Yes, mother 7.6" 

3. Table i. Sofa 3.8" 

4. Head i. Yes, irretrievable 14.8" 

5. Ink i. Nut water 9.0" 

6. Needle i. Thread 11.4" 

7. Bread i. Butter 3.4" 

8. Lamp i. Electricity, petroleum 6.4" 

9. Tree i. Fruit 6.0" 

10. Mountain i. Valleys ; 9.4" 

11. Hair 2. Hat 6.2" 

Among these repetitions some sound quite incomprehensible. 
Socrates, the first reaction to " pupil," is quite a striking reaction 
for a tailoress; it looks very affected and gives the appearance 
of a complex constellation. It also shows the tendency to 
affected speech and behavior. The same holds true for R. 8. 
" Lamp electricity " (patient would like electricity instead of 
gas). R. 4 "yes irretrievable" to "head" is incomprehensible 
if one does not know that the word " irretrievable " is one of 
the patient's preferred stereotyped words. The reaction " nut 
water " to R. 5 " ink " is explained on subsequent questioning. 
Nut water is dark brown, ink is black. But how does patient 
get to nut water? It is again a complex constellation like 
Socrates. Nut water is something that patient likes very much. 
[It is made from the green shells of unripe nuts.] Besides these 
oddities one is struck by the numerous repetitions of the stimulus 
words, the unusually long reaction times, and the frequent begin- 
ning of the reaction with " yes." As is known we take these 
signs also as symptoms of complex constellations, it is the inter- 
vention of an emotionally strong idea feeling. But it must be 
realized that we deal with a patient with dementia prsecox who 
presents her delusions (which according to our conceptions are 



PARANOID DEMENTIA AS A PARADIGM. 



103 



nothing but complex-expressions) with marked want of emotion. 
If we really dealt here with a true want of emotion, it would at 
first sight seem contradictory that just here, where we always 
have the impression of an emotional defect, there should be signs 
of a vivid feeling tone. From numerous examinations in the 
normal and hysterical we know that these signs in experiments 
always, as it were, show the appearance of a complex, we there- 
fore retain the same view in dementia praecox. The consequence 
of this supposition is that most of the above reactions are so to 
say constellated by complexes. That this is the case in R. i 
we have already seen. R. 2 " father yes, mother " is designated 
by the complex-indicator " yes." 1 As we shall see later the 
parents play a certain role in the delusions of the patient. R. 3 
" table sofa " seems objective and has therefore a short reaction 
time. R. 4 " head yes, irretrievable " has on the other hand 
again a very long reaction time. Patient refers " head " to her- 
self and predicates this part of the body as " irretrievable," an 
expression which she otherwise applies to her own person and 
usually in the stereotyped formula, " I am double polytechnic 
irretrievable." R. 5 " ink nut water " is a very far-fetched 
mediate complex-constellation. The patient, among other things, 
desires nut water. R. 6 " needle thread " excites her trade- 
complex she is a tailoress. R. 7 " bread butter " is objective. 
R. 8 " lamp electricity, petroleum " also belongs to her desider- 
ata. R. 9 " tree fruit " she likewise desires, she frequently 
complains about getting too little fruit. Occasionally she also 
dreams of a large gift of fruit. R. 10 " mountain valleys." 
Mountain plays a great part in her delusions. She expresses it 
as follows in her stereotyped manner : " I created the highest 
pinnacle, Finsteraarhorn " [mountain near the Jungfrau], etc. 
R. ii "hair hat" should also contain a self-reference, but it 
has not been confirmed. We see then that by far most of the 
above associations are constellated by complexes, hence the objec- 
tive signs of the feeling-tone are readily understood. What is 
not, however, understood at first sight is the unusually large 
number of complex-constellations. We see such an excess 
among the normal and hysterical only when the complex is extra- 

1 " Yes " as a complex indicator we found in an epileptic. See Beitrag 
III, Diagnost. Assoz.-Stud. 



IO4 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

ordinarily accentuated, that is, when there is present a wholly 
fresh affect. But this is not the case with our patient, she is 
perfectly calm, she simply shows the results of the affects in the 
associations, the one-sided prominence of the complexes without 
the concomitant affective excitement. From this we receive the 
clinical impression of " lack of emotion." We still have the 
shells of the affect; the content, however, is gone. Perhaps the 
patient has misplaced the affect and these shells are only the 
wornout expressions for a repressed complex, having a more 
sensible and comprehensible content, but it is no longer repro- 
ducible and hence the affect, too, is buried. We wish here to 
call attention to these possibilities concerning which we shall 
speak later. 

12. Wood i. Cushion 10.2" 

13. Dream i. Reality 3.8" 

14. Copy-book I. Map 144" 

15. Paper i. Stamped paper 2 5.0" 

a Government paper. 

16. Book i. Books 6.8" 

17. Lead pencil i. Pens 7.6" 

18. Sing i. Songstress 5.0" 

19. Ring i. Band, union or engagement 16.4" 

20. Tooth i. Set of teeth, teeth 14.8" 

R. 12 " wood cushion " refers to her complaint that there are 
only wooden benches in the asylum ; for her own use she desires 
padded furniture ("I establish upholstered furniture"). R. 13 
" dream reality " : Most of her delusions she takes from 
dreams, and when they are refuted she always emphasizes ener- 
getically the reality of all objects of her desire. R. 15 " paper 
stamped paper " is connected with her delusions that there exists 
a state document about her enormous activities. R. 16 " book 
books " refers to her stereotypy, " I saw the book awfully high 
above the grounds of the city hall," etc. This stereotypy like- 
wise refers to her unusual activity, as we shall see below. The 
many reactions in R. 19 " ring band, union or engagement " show 
an especially strong feeling-tone. The erotic complex is here 
quite plain it plays a great part, as we shall see later. R. 20 
" tooth set of teeth, teeth " also belongs to her wishes ; she 
would like a new set of teeth. 



PARANOID DEMENTIA AS A PARADIGM. 10$ 

21. Window I. Door, movable pane or ventilation 10.6" 

22. Frog i. I like best paralysis 18.2" 

23. Flower i. Camelia 24.8" 

24. Cherry I. Pear 9- 8" 

25. Asylum i. Causing I2 .8" 

26. Nurse i. Locked in 8.0" 

27. Pianoforte I. Piano 4.8" 

28. Oven i. Draughts of interest 84" 

S. 21 " window " has a multiform significance in her delusions, 
one of the most important is what she designates as " ventila- 
tion." She is nightly disturbed by fecal odors which she hopes 
to remove by better ventilation. The very odd reaction to S. 22 
" frog " is explained by patient as follows : " A person is like 
that when he watches how a frog leaps, I always have such 
paralysis in my legs." " I have a paralysis," or " that is a 
paralysis " are stereotypies meant to indicate a feeling of paraly- 
sis in her legs. It can be seen how very far the patient leads the 
assimilations to her complexes. In S. 23 " flower " the reaction 
camelia again sounds as though affected. The camelia belongs 
to the ornaments of which she dreams. S. 24 " cherry " belongs 
to the fruit-complex. The remarkable R. 25 " asylum causing " 
is explained by patient as follows. " Private people cause such 
asylums. I as world proprietress* established this asylum but did 
not cause it, in spite of the fact that someone cried out that I 
did on my entrance." When patient was entering this asylum 
the voices told her that it was her fault that this asylum existed ; 
she, however, denied this, but since then she has delusions of 
owning this asylum, for as " world proprietress all great build- 
ings, so to say, are established as her property." R. 26 " nurse 
locked in " is as shown by the reaction a perseverance of the 
preceding complex. R. 28 " oven draughts of interest " is ex- 
plained by patient as follows : " We are the ovens for the State, 
I am the lessor of interest-draughts." The last sentence is 
stereotyped what it signifies we will see later. Reactions like 
"asylum causing," "oven draughts of interest," are certainly 
typical of dementia praecox, and are not found in any other 
psychic abnormality. 



IO6 THE PSYCHOLOGY OF DEMENTIA PILECOX. 

29. To promenade i. That means also for me an extraordinary 

pleasure, when I can go out. 
(Patient is allowed to go out once a 
week.) 

39. To cook i. To roast 6.8" 

40. Wafer i. Lemonade 5.0" 

41. To dance I. Prim, I am Mr. Prim 10.0" 

Here again a delusion is set free. Patient states that " Mr. 
Prim is the first dancing teacher in Zurich." This name and 
person are totally unknown to me ; we probably deal here with a 
delusional formation. 

42. Cat i. Slandering 21.8" 

This far-fetched complex-constellation is explained by patient 
as follows : " I was once slandered by somebody because I al- 
ways carried cats in my arms." It is not clear whether the 
slandering came from voices or from persons. The carrying 
about of cats is not rare as a symptomatic action in erotic com- 
plexes (child!). 

43. Heart i. Reason 11.2" 

44. To swim i. I was once almost drowned, to drown. 

This is a recollection of a complex from the beginning of the 
disease, when there were many ideas of suicide. 

45. Emperor Empress 3.0" 

46. Moon 'Sun 2.8" 

" I am Empress Alexander " is one of her stereotypies. 

47. To strike i. Is always a proof of rudeness 15.8" 

This refers to occasional attacks by other patients. 

48. Star i. Should one say, sun, moon, and all fixed 

stars? 

The complex constellated here is a delusion which is expressed 
stereotypically as "I am Forel and Forel's star." [Forel former 
Superintendent of Burgholzli.] 

49. To stroke i. A word which can not be so well written : 

to caress. 

Here, too, an erotic complex is constellated, as probably also 
in the above association. Both reactions came hesitatingly, with 
introductions, showing a feeling of uncertainty, a "sentiment 



PARANOID DEMENTIA AS A PARADIGM. 

d'incompletude" This is probably due to a co-excitement of a 
strong unconscious complex, on account of which the conscious 
idea loses in clearness and completeness. 

50. Splendid i. Annoyance 6.6" 

Again a far-fetched complex-constellation. Patient says one 
speaks though about unpleasant things, " that is really splendid." 
She finds it especially annoying that her fortune which she has 
long ago " established " is kept away from her " so imposingly." 

51. Child I. Parents 6.2" 

52. Sweet i. I have to experience the bitterness of 

life 1 1.0" 

53. To ride I. I must now be satisfied with driving 8.8" 

Here patient again reacts egocentrically, that is, her complexes 
employ every available occasion to manifest themselves. R. 53 
" to ride " also refers to a stereotypically expressed delusion. 
" I should have been horseback riding since 1866." This idea 
belongs to the grandiose delusions. 

54. Friendly i. Yes, friendly, lovely 12.8" 

This refers to a stereotypically expressed grandiose delusion, 
" I am royally lovely, so lovely and so pure." 

55. Crown 2. Villa 174" 

Patient explains this as follows : " The villa S. in T. is my 
crown. I affirm it as my property." The villa S. is one of the 
finest villas in the suburbs of Zurich. 

56. Rough i. Is mostly rude 5-6" 

An assimilation of the complex of rudeness (R. 47). 

57. Ill 2. Ill is poverty 

Patient explains that " poverty grows out of illness." 

58. Victim 2. Cruelty 7-8" 

As patient explains she is the " victim of unheard of cruelties." 

59. Marriage i. State affairs 7-8" 

The marriage is an affair of state insofar as concerns her mar- 
riage, for she is the " world proprietress." 

60. Grandmother I. Is happiness 6.6' 



io8 



THE PSYCHOLOGY OF DEMENTIA PR^COX. 



Patient states that " where there is still a grandmother in a 
family there is happiness." 

61. To quarrel 2. Always a sign of the dangerous 10.4" 

62. Blue I. Sky-blue 3.4" 

63. Sofa i. Pillow 7-2" 

64. Thousand i. 150,000 7.0' 

This sum corresponds to the amount of payment which patient 
daily expects. 

65. To love i. Great inconveniences 11.4'' 

She states that " people only love themselves," meaning thereby 
that no one cares about her demands and hence she must wait 
for her payments. 

55. Wild i. Indian 8.2 

56. Tears I. Mourning 4.4' 

57. War i. I never caused any, always wretched. . . . 6.8" 

58. Faithful i. Imperishable 9.0" 

59. Wonder i. Summit 10.0" 

Patient states : " It is not conceivable to others that I created 
the highest summit." 

60. Blood i. Ennobled 9.0" 

61. Wreath i. Is festal 7.0" 

The first association is a distinct complex-constellation, the last 
is a fragment of her fancies which always occupy themselves with 
great festal occasions. 

62. To part i. Mostly causes .tears 7.2" 

63. Right i. Righteousness 5-8" 

64. Violence I. Mostly it is cruelty, violent act 13.0" 

65. Revenge i. Quite natural in cruelty 14.2" 

66. Little i. Often it is a loss 10.0" 

Patient says: "If one has been great and then becomes little 
it is a loss." This refers to her grandiose ideas. 

67. To pray i. Is a " groundpostament " 114" 

Patient explains this as follows : " Without religion no one 
can do anything great." " Groundpostament " is one of her pre- 
ferred neologisms. 

68. Unjust i. Is always cruel 8.2" 

69. World World proprietress 4.2" 






PARANOID DEMENTIA AS A PARADIGM. 



IO9 



Strange i. Unknown 34" 

Fruit i. Blessing 15.0" 

False i. Bad 6.6" 

Helmet 3. Hero, heroic act 114" 

Patient compares herself and her acts to the greatest hero 
lown in the world's history. She therefore uses helmet to 
cpress a complex expression. 

To dress i. Taste 34" 

Patient is a tailoress and always boasts of her excellent taste. 
75. Gentle i. Tact 6.0" 

Patient says " if one passes through a bedroom one should 
/alk gently, so as not to awaken the others." 
Here we have a distinct constellation of the asylum life. She 
iplicitly shows that she possesses the right tact. 

Wretched i. Crutches 7.8" 

This is a mediate association of " lame." Patient feels herself 
" paralyzed." 

77. Hay i. Harvest 4.8" 

78. Cleanly I. Good conditions 244" 

Patient says " cleanliness creates good conditions," a general 
>ression for implicit self praise. 

Raspberry i. Sweetmeats, syrup 3-8" 

A part of her desiderata. 

Head i. Wisdom 22.0" 

This also belongs to the complex of her extraordinary 
itelligence. 

I do not wish to heap up examples, for we can find all the 
ssentials from those mentioned. We are struck before all, by 
enormous number of quite clear complex-constellations. 
r ith few exceptions all associations are scantily veiled complex- 
cpressions. Because the complexes stand everywhere promi- 
icntly in the foreground we have the corresponding disturbances 
)f the experiments. The extraordinary long reaction times 
iroughout could be partially explained by the constantly en- 
roaching complexes, a thing more rarely seen in the normal and 



IIO THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

even in the hysteric. From this it can also be concluded that the 
patient's psychical activtiy is fully occupied by the complex. She 
is under the yoke of the complex, she speaks, acts and dreams 
of nothing else but what the complex inspires. There seems to 
exist some intellectual weakness which expresses itself in a tend- 
ency towards definitions, which, however, in contradistinction to 
the reactions of imbecility does not tend towards generalization, 3 
but the content of the stimulus is defined or designated in the 
sense of the complex. What is characteristic here is the unusual 
affectedness and embellishment of the expressions which often 
merge into incomprehensibility. The awkward and peculiarly 
sounding definitions of imbeciles are found at situations which 
are intellectually somewhat difficult, where they are of course to 
be expected ; but here the affected definitions appear in unex- 
pected locations which accidentally stimulate the complex. In 
the normal and hysteric we always see striking and disturbed 
reactions, such as unusual or foreign words, in the critical situa- 
tions. Corresponding to this we have here the neologisms which 
represent nothing else than especially forceful and rich expres- 
sions for the complex-thought. Hence we also understand why 
the patient designates her neologisms as " power-words." Wher- 
ever they appear they always refer to the whole system hidden 
behind them, similarly to technical terms in normal language. 

We see then that the complex is connected with the most far- 
fetched words; it assimilates, as it were, everything. 

In the normal and hysterical we see similar relations in com- 
plexes with very strong feeling-tones where the affect is still 
fresh. In regard to the experiment the patient behaves like a 
person with a fresh affect. In reality this is naturally not the 
case, but the effects on the associations are such as can only 
occur in strong affects; that is, by far most of the reactions are 
constellated in the clearest manner by subjective complexes. 
This fact is explained by the hypothesis constructed in the pre- 
ceding chapters, namely, that in the content of dementia praecox 
there is an abnormally strong affect which becomes fixed at the 
onset of the disease. If this hypothesis be correct and holds true 
for all forms of dementia prgecox we have to expect the associa- 
tions in dementia praecox to be characterized by the presence of 

8 Comp. II Beitrag des Diagnost. Assoz.-Stud. 



PARANOID DEMENTIA AS A PARADIGM. 1 1 I 

an abnormally strong complex. As far as my experience goes, 
this is really everywhere the case. In this point, too, we can see 
the great resemblance to hysteria. The complexes which have 

rincipally impressed themselves on this experiment are the 

bllowing : 
The complex of personal grandeur constellates most of the 

ssociations. It especially manifests itself in the embellishment 

hich serves no other purpose than to raise the dignity of the 

ersonality. So far it is a normal and very familiar concomitant 

f self-sufficiency, but here it reaches an exaggerated height cor- 
sponding to the morbid degree of self-consciousness. Because 
e propelling affect lying at its foundation never apparently 
:omes extinguished, it remains for decades, becoming a man- 

erism and glaringly contrasting with reality. The same may 
also be seen among the normal who are unreasonably vain, and 

ho retain their imposing attitudes even when the real situation 
no way warrants it. Hand in hand with this exaggerated 
embellishment we find the exaggerated grandiose delusions which 
in view of their contrast with reality and als6 in consequence of 
their pretentious and indistinct expressions, show something of 
the grotesque. The principle of this manifestation we also find 
among normal persons whose self-consciousness contrasts with 
their intelligence and station. In the patient we again deal with 
an exaggeration which points to the conclusion that there is a 
corresponding deep affect. What goes beyond the normal me- 
chanism is the difficulty of comprehension, and the inadequacy of 
expression which indicates injury to the fundamental conception. 
The complex of personal grandeur expresses itself also in inap- 
propriate demands and wishes. 4 

The persecutory complex contrasts with the grandiose complex, 
and also manifests itself with great distinctness. In this disease 

t is the usual compensation for the greatness. Here, too, the 
expression is exaggerated and often difficult to understand and 

ence grotesque. 
We also find some indications of an erotic complex which is, 

owever, considerably concealed by the two former complexes. 
Yet it is possible that the erotic complex is the principal one; 
indeed in women one must expect it. Perhaps it is only charac- 

* Patient continually makes absurd demands by asking for millions, etc. 



! 



112 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

teristically in the background, while the other complexes are noth- 
ing but its transferences. We shall speak of this later. 

A very sensitive person possessing an exaggerated self -con- 
sciousness will generally meet with many obstacles in life. This 
fact alone may be the reason for the complexes of grandeur 
and of being wronged. But in this mechanism we do not find 
the specific cause. We have to look for it among those symp- 
toms which farthest deviate from the normal, that is, in the 
unintelligible. Among the latter the neologisms stand first. It 
is for this reason that I subjected the new speech formations of 
the patient to a special study, hoping thereby to find the clue to 
the essential. 

CONTINUOUS ASSOCIATIONS. 

At first I attempted to have the patient explain to me what she 
meant by her neologisms. This attempt was a total failure, for 
she immediately produced a series of fresh neologisms which 
resembled " word-salad." She spoke in a self-confident tone, as 
if she were perfectly clear about the meaning of her words, and 
seemed to think that what she said was an explanation. I then 
realized that direct questioning would lead to nought, just as in 
hysteria, when one interrogates directly as to the origin of symp- 
toms. I therefore made use of a means which is also applied in 
hysteria. I asked patient to tell me all her thoughts evoked by 
the stimulus word. In this manner it was possible to exhaust in 
every way the content of the idea and to learn its different rela- 
tions. As stimuli I employed the neologisms which are repeat- 
edly used by the patient. As the patient spoke very slowly in 
reference to her delusions, and was constantly disturbed by 
"thought deprivations" (complex-inhibitions) it could readily 
be literally transcribed. I reproduce the tests verbatim, omitting, 
however, the repetitions. 

A. WlSH-FULLFILMENT. 

I. Socrates scholar books wisdom modesty no words in 
order to express this wisdom it is the highest groundpostament 
his teachings had to die on account of bad people falsely 
accused sublimest sublimity self-satisfied that is all Socrates 
the fine learned world no thread cut I was the best tailoress, 
never had a piece of cloth on the floor fine artist world fine 






PARANOID DEMENTIA AS A PARADIGM. 113 

>rofessorship is doubloon twenty-five francs that is the 
lighest prison slandered by bad people unreason cruelty 

ccess rudeness. 
The thoughts did not follow smoothly, but were constantly 

ihibited by " thought-deprivation " which patient designated as 
m invisible force which always takes away just what she wishes 
say. Thought-deprivation especially appears whenever she 

rishes to explain something conclusive. The conclusive is the 

rniplex. Thus we see in the above analysis that the essential 
ippears only after having been preceded by a number of obscure 
analogies. 5 The object of the test is, as the patient knows, to 
explain the neologisms. If it takes her so long to reproduce the 
important phrase ("no thread cut") her imaginative faculty 

lust suffer from a peculiar disturbance which can be best desig- 
nated as deficiency in the faculty of discrimination between the 
important and the unimportant material. The explanation of 
her stereotype " I am Socrates " or " I am Socratic " lies in the 
fact that she was the " best tailoress " " who never cut a thread " 
and " never had a piece of cloth on the floor." She is an " artist," 
a " professor " in her line. She is tortured, she is not recognized 
as world proprietress, etc., she is considered sick which is a 
" slander." She is " wise " and " modest." She has performed 
the " highest." All these are analogies to the life and end of 
Socrates. She therefore wishes to say " I am and suffer like 
Socrates." With a certain poetic license, characteristic in a 

loment of strong affect, she says directly " I am Socrates." The 
pathological part in this is the fact that the degree of her identifi- 
cation with Socrates is such that she cannot free herself from it. 
She takes her identification in a way as self-evident and presup- 

joses so much reality for the metonymy that she expects every- 
)dy to understand it. Here we distinctly see the inability of 
discriminating between two ideas. Every normal person can dif- 
ferentiate between an assumed part or a metaphoric designation 
and his real personality, even if a vivid phantasy, i. e., an intense 

feeling-tone will for a time firmly adhere to such a dream or 
wish-formation. The correction finally comes with a reversal 
of feeling and with a readaptation to reality. The process is 
somewhat different in the unconscious. We saw, for example, 

"Freud's analysis in the Psych, des Alltagslebens (Exoriar'alquis, etc.) 
is a prototype. 



I 14 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

how the dream changed a metaphoric expression to a reality 
which it inserted into the personality of the dreamer, or, e. g., 
an unconscious complex immediately condensed a distant analogy 
with the personality and thus attained the necessary intensity to 
disturb the conscious process, as in " A fir tree stood alone, etc." 
If in a brief dreamy state the unconscious complex could have 
reached the speech innervation he would have said " I am the 
fir tree." As was pointed out in the preceding chapters, the 
necessary presupposition for this condensation is the indistinct- 
ness of ideas as they normally exist in the unconsciousness. 
From the above source we explain the condensation in our case. 
As soon as the patient thinks in the complex she no more thinks 
with the normal energy, i. e., distinctness, but her thought is in- 
distinct and dreamy, as is normally the case in the unconscious 
or in the dream. As soon as the patient's associations reach 
the realms of the complex, the hierarchy of the chief ideas 
ceases and the stream of thought moves in dreamlike analogies, 
which, in the self-evidence of dreams, is put on an equal value 
with reality. The complex works here automatically following 
its laws of analogy. It is equally freed from the dominations 
of the ego-complex, and for that reason it is impossible for the 
ego-complex to properly direct the complex associations. On 
the contrary it is subjected to the complex and is constantly dis- 
turbed by defective reproductions ("thought-deprivation") and 
by obsessive associations (pathological fancies). The same 
process of obscuration, which takes place in the ideas, is also 
found in the speech of the complex. It gradually becomes indis- 
tinct, similar expressions readily substitute one another and there 
are also sound displacements and mediate (speech) associations. 
Thus it makes no difference to the patient whether she says 
" artist " or " fine artist world," " professorship " instead of 
" professor," " fine learned world " instead of " learned tailor- 
ess." These conceptions substitute each other with the same 
facility as the patient's personality with Socrates. The accent is 
characteristically not on the simple but on the unusual, because 
that corresponds to the tendency towards external distinction. 

2. Double polytechnic (stereotype: "I am double polytechnic 
irretrievable"); that is, the highest of the highest, the highest 
of tailoring, the highest accomplishment the highest intelligence 






PARANOID DEMENTIA AS A PARADIGM. 115 

the highest accomplishment of the art of cooking the highest 
accomplishment in all spheres the double polytechnic is irre- 
trievable the universal with 20,000 francs to cut no thread 
fine artist world not to apply lace trimming where nothing is 
seen plum cake on an indian meal layer it is of great impor- 
tance finest professorship is a doubloon twenty-five francs 
snail museum clothing is the highest parlor and bedroom I 
should live there as double polytechnic. 

The content of " double polytechnic " is very similar to 
" Socrates," only here the " arts " are more elevated. Next to 
the tailoring we have the cooking art with its specialities " plum 
cake on an indian meal layer." The art of tailoring reappears, 
as before, in the same stereotyped associations. It is quite evi- 
dent that " polytechnic " is only another metonymy for the acme 
of art and wisdom. This is further determined by the " I should 
live there " meaning in the " polytechnic," as patient subsequently 
stated. At the same time it is no contradiction for either her 
consciousness or for the dream that she lives in the polytechnic 
as " double polytechnic." It is quite impossible to make her rea- 
lize this incongruity, she simply answers with one of the above 
stereotypies. " The polytechnic is a government building " and 
hence " belongs to her." " Double " is an obscure epithet which 
perhaps resounds in " doubloon." Perhaps by this is meant the 
expected reward for this " highest " activity. " Double " may 
also have the sense of augmentation, or it may have another sense 
of which we shall speak later. 

If the " double polytechnic " is the " highest," the epithet 
" irretrievable " then becomes clear. 

3. Professorship (stereotype: "I am the finest professor- 
ship"). This is again the highest activity double twenty-five 
francs I am double polytechnic irretrievable professorship 
includes in itself the fine learned world the finest world of art 
I am also these titles snail museum clothing, am I, that emanates 
from me to cut no thread, to choose the best samples, those rep- 
resenting much the finest learned world includes that in itself 
to choose the best samples, those representing much, and con- 
suming little cloth I created that that concerns me the fine 
art world is, to apply the trimming where it can best be seen 
plum cake on indian meal layer the finest professorship is 



Il6 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

double twenty-five francs it doesn't go any further, no one 
can earn more than twenty-five francs snail museum clothing 
is the highest clothing the others wish to bring together the 
learned world always with astronomy and everything possible. 

The content of this idea " professorship " coincides with the 
two above analyzed ideas. " Professorship " is nothing but a 
further symbolic designation for the grandiose idea that the 
patient is the best tailoress. Through sound similarity " doub- 
loon " is here replaced by " double," both expressions apparently 
have the same value for the patient. A doubloon corresponds to 
the value of twenty-five francs, and here it is clear that it means 
the highest day's wages that can be earned by labor. The ex- 
pression " snail museum clothing " is a symbolic designation for 
the product of her art which she takes as the highest order of 
dress. It is explained as follows: The museum is a place of 
rendezvous for the intellectual gatherings of Zurich; the house 
" To the Snail," a prominent guild hall, stands near the museum. 
These two presentations fuse together, forming the singular idea 
" snail museum clothing," which, as the patient says, designates 
also the highest type of clothing. Her manner of speech, too, 
is interesting ; patient does not say " I make," but " I am the 
snail museum clothing, it emanates from me." She " condenses " 
or identifies herself also with this object, in so far as she treats 
with the same value the " I am " and " it emanates from me." 
The " I am " seems to be nothing but a reinforcement of the " I 
have " or " I make." 

The three ideas thus far analyzed are technical terms which 
in brief designate (as it seems to the patient) in a pregnant man- 
ner an abundance of ideas and relations. Whenever she whis- 
pers to herself she simply repeats these terms and nods affirma- 
tively, without adding any further explanations. The origin of 
these technical terms is unknown ; some according to the patient 
come from dreams. Probably these expressions originated on 
some occasion spontaneously and on account of their strangeness 
were quite obvious to the patient, just as philosophers occupying 
themselves with obscure ideas readily play with obscure words. 

4. Summit: sublimest sublimation I am self satisfied club- 
house " To the Plate " the fine learned world world of art 
snail museum clothing my right side Nathan the Wise am I 



PARANOID DEMENTIA AS A PARADIGM. 117 

father, mother, brother, sisters, I have none in this world an 
orphan child am Socrates Loreley Schiller's Bell and the 
monopoly God, Mary, mother of God main key, the key in 
heaven I always legalize our hymnbook with the gilt edge and 
the Bible am proprietress of southerly zones royally lovely, 
so lovely and so pure in my single personality I am a von Stuart, 
von Muralt, von Planta, von Kugler highest reasoning belongs 
to me no one else should be dressed here I legalize a second 
six floored note factory for the Socrates representation the 
insane asylum should accept the Socrates representation, no more 
the former representation, which the parents had, but Socrates 
this can be explained to you by a doctor I am Germania and 
Helvetia from sweet butter this is a life symbol the highest 
summit I created I saw the book awfully high over the city hall 
gardens, covered with white sugar high in heaven, is the highest 
summit created higher than the highest height you can bring 
no one who can prove a mightier title. 

In the conception of " summit " we find an enormous number 
of senseless ideas, some of which sound extraordinarily comical. 
From this material we see that the patient designates by " sum- 
mit " the sum total of all her " titles " and activities. The sub- 
titles such as Schiller's bell, Loreley, etc., probably designate 
special analogies which will have to be looked for in the special 
words. 

5. Loreley: is world proprietress it expresses the deepest 
mourning because the world is so depraved a title which for the 
others is the greatest happiness I might say that usually those 
personalities are extraordinarily tormented, who have the mis- 
fortune to be world proprietors Loreley is also the highest liv- 
ing portrait no higher memory can the world prove no higher 
reverence it is like a statue for example the song runs " I 
know not what ere it presages " it often happens that the title of 
world proprietor is not at all understood that the people say, 
that they know not what it means, this is really a great misfor- 
tune Yet I affirm the greatest silver island that is a very old 
song, so old that the title didn't become known that is mourning. 

When the patient says " I am the Loreley " it is simply, as can 
be seen from the above analysis, a condensation of the connection 
of an awkward analogy, namely, the people do not know what 



Il8 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

world proprietress means ; that is sad ; the song reads " I know 
not," etc., hence patient is the Loreley. It can be seen that it 
follows the type of the example of the " pine tree." 

6. Crown (stereotype: "I am the crown"): greatest good- 
ness of life, which one can gain by conquest those who accom- 
plish the highest come to the crown highest fortune of life and 
goodness of earth the greatest wealth of earth it is all ac- 
quired there are also lazy people who always remain poor 
highest picture of heaven the highest godliness Mary, mother 
of God the main key and a key in heaven with which one severs 
relations I myself saw how a door was bolted the key is neces- 
sary for irrefutable justice title Empress world proprietress 
highest merited nobility. 

" Crown " is another analogy with " summit," but it expresses 
the nuances of the merits and rewards. The reward is not, how- 
ever, consummated on this earth in the form of the gifts of the 
greatest earthly possessions such as wealth, crowning as empress, 
and merited nobility, but reaches into the religious heaven, into 
which patient is allowed to enter by means of a key and where 
she even becomes Empress of heaven. In consideration of her 
merits this development seems to her " irrefutable justice." A 
simple-minded dreamlike fragment which recalls to an extent the 
"Ascension of Hannele " (Hauptman). 

7. Main key (stereotype: "I am the main key") the main 
key is the house key, I am not the house key but the house the 
house belongs to me yes, I am the main key, I affirm the main 
key as my property it is a house key to fold a key which can 
again unlock all doors therefore it includes also the house in 
itself it is a keystone monopoly Schiller's bell. 

By this patient has reference to the pass key carried by the 
physicians. With the stereotypy " I am the main key " she solves 
the complex of her confinement. Here it can very well be seen 
how obscure her ideas as well as her expressions are; now she is 
the main key, now she only affirms it; likewise she is now the 
house, and now it belongs to her. This key, which opens every- 
thing and frees her, gives her also the occasion for the analogy 
with the key to heaven, which opens for her the entrance to bliss. 

8. World proprietress (stereotype: "I am threefold world 
proprietress " ) : grand hotel hotel establishment omnibus 



PARANOID DEMENTIA AS A PARADIGM. 119 

theatrical performance comedy public parks equipage cab 
tramway street mobile houses railway station steamship 
railroad post telegraph national holiday musics stores- 
library state letters monograms postal cards gondolas 
delegate great occasions payments lordship coach negro on 
the box flags one-horse carriage open carriage pavilion 
public instruction banknote factory mightiest silver island of 
the world gold precious stones pearls rings diamonds- 
bank central court credit establishment villa male and fe- 
male servants carpets curtains mirrors, etc. 

The picture which appears to patient at " world proprietress " 
concerns the requisites of a princely existence, some of which are 
situations carefully and most diligently pictured, such as " negro 
on the box." These references give us an idea of the incessant 
inner complex-activity of dementia prsecox which objectively 
makes itself known through a few unintelligible fragments. The 
psychic activity reaches no more to the " fonction du reel," but 
turns internally to an infinite thought elaboration which exhausts 
itself in the building up of the complex. 

9. Interest draughts (stereotype: "My interest draughts will 
have to be accepted ") : cocoa, chocolate, noodles, macaroni, cof- 
fee, petroleum, black tea, green tea, sugar candy, white sugar, 
nut water, red wine, honey cake, winecake cloths, velvet, merino, 
double merino, saxonian merino, alpaca, twilled goods, fustian, 
white percale, shirt cloth, linen, wool, shoes, boots, socks, under- 
shirts, underwear, coats, umbrellas, hats, jackets, mantles, gloves 
these are interest draughts which in reality belong to me. 

The above is only a sample of the content of the " interest 
draughts." We deal here with the concrete wishes of everyday 
life, which have nothing to do with the " world proprietress " 
complex. The imagination runs into the finest details and gives 
the impression of careful assortment. 

10. To affirm: to corroborate, to verify, to recommend mostly 
quite conclusion to express an opinion to take into considera- 
tion what one affirms to take in hand the heathens chatter 
so, the same thing is daily explained to them, yet they do nothing 
in the matter I affirm that I am paralyzed nine years ago I 
needed eighty thousand francs payments through superintendent 
Forel they are rough to me I affirmed the insane asylum six- 
fold as world proprietress. 



120 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

The content of affirm is the same as mentioned above. The 
clearest meaning is in the sentence " I affirm that I am paralyzed." 
Here " affirm " has its exact and original sense. Mostly, how- 
ever, patient uses " affirm " in a figurative sense as " I affirm the 
insane asylum " meaning " I affirm it as my property " or " I 
affirm a payment," meaning " I affirm that I have a claim on a 
payment." As was shown in the analysis of " main key " 
patient's speech is abnormally flexible and tends toward arbitrary 
and odd expressions. Normally changes in speech occur very 
slowly, here the changes take place rapidly and within the limits 
of the individual's life. The reason for these rapid changes 
seems to lie in the vagueness of her conceptions. She scarcely 
differentiates, and her conceptions are used and expressed now 
this way, now that way (compare " main key "). Judging by its 
content the sense of affirm is here very equivocal. Affirm con- 
tains corroborate, and verify, which at all events may be under- 
stood, although both terms go somewhat beyond the sense of 
affirm, but to recommend, to give one's opinion, and to take 
notice of, can no longer be logically connected with affirm unless 
it be as superficial associations. Both expressions do not in any 
way explain the sense of " affirmation," on the contrary they only 
cause it to become blurred. This is due to the fact that the 
presentations of the words are but indistinctly perceived and 
hence she does not recognize their dissimilarity. 

ii. Universal (stereotype: " I am the universal ") : I came as 
the universal seventeen years ago universal firmly includes the 
reposal regulated conditions it is also by inheritance it in- 
cludes also wealth conditions the title of world proprietress 
includes in itself one thousand millions that is really the villa, 
equipage since 1886 I was riding horseback and driving I am 
universal since the death of my father in the winter month I 
affirm the universal even if I had not affirmed it in the dream 
I would have known it on account of being a bequeathor at 
least twenty-five thousand with what an energy! the Swiss 
life annuity is one hundred and fifty thousand according to the 
telephone, Mr. O. drew my life annuity universal is something 
definite you can be that through deceased through inheritance 
universal is property the property belongs to me. 

According to these associations " universal " means universal 






PARANOID DEMENTIA AS A PARADIGM. 121 

heiress; at least this expression seems to be thus derived. The 
idea, however, is used quite promiscuously, now for persons and 
now for property. Again we have the same uncertainty. In- 
stead of " affirm " patient prefers to use here " include " and on 
one occasion she condenses the two words into " festschliessen " 
(firmly include). The characteristic uncertainty exists also in 
her use of moods and tenses. Patient says, for example, " since 
1886 I was riding horseback, etc."; she knows, however, quite 
well that this is not the case. On another occasion she says, 
" since 1886 I should have been riding horseback, but I adhered 
to driving." It makes no difference to her whether she expresses 
a subjunctive instead of a present or imperfect. She speaks as 
if in a dream. As is known, Freud 8 has pointed out this pecu- 
liarity in dreams. This clearly coincides with her other dream- 
like, partially condensed and disconnected manner of speech. 

" Universal " is another symbol of her wealth which she not 
only acquired herself, but also inherited. In this we also get 
a glimpse of her family whom, as we shall see later, she includes 
in her wish-dream. 

12. Hero: I am a hero of the pen pride patience heroic 
act a hero of the pen, by the content of which, what one writes 
the highest intelligence the highest gifts of character the 
highest perseverance highest noblesse the highest that the 
world shows includes in itself letters business letters and 
letters of credit. 

" Hero of the pen " is really a ludicrous expression which, 
however, the patient takes in earnest. Perhaps due to her defi- 
cient education, probably, however, because the comical has lost 
all its feeling, as is generally the case in dementia praecox. Fur- 
thermore this deficiency is also characteristic in the dream. 
" Hero " is another symbolic expression for " highest intelli- 
gence," etc. Her concluding remarks explain how much " hero 
of the pen " she is. The patient does not write anything except 
a letter on rare occasions. Her fancies, however, seem to be in 
favor of writing more letters, and especially " business letters 
and letters of credit," another requisite of her acquisition com- 
plex. Here it is also interesting to see how she expresses this 
distant thought symbolically by " hero." 

" Die Traumdeutung, 1900. 



122 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

13. Conclusion: alliance, counter-bill, closures, signatures, 
title-right, procuration it mostly includes in itself the " key," 
the highest closures dedication of the highest adoration I 
have dreamt that the adoration, reverence and admiration, of 
which I am worthy, cannot be brought to me so wanders the 
noblest of women, with roses she would like to surround the 
people Queen Louise of Prussia I affirmed this long ago I 
am that too those are the highest conclusions in life key stone. 

The limits of the conception of " conclusions " is again very 
indistinct. It seems to me that " counter bill, signature, procura 
tion, title-right," etc., accentuate more the "validity" (Giiltig 
keit), while "closure, alliance and keystone" put forward more 
the " conclusiveness " or finality (Endgiiltige). In reality these 
two relations merge into each other. From " procuration " the 
association goes to " key " which, as we know, plays a great role 
as " main key," and regularly also evokes its symbolic counter- 
part, the " heavenly key." Here, too, it goes from " key " to 
similar religious associations, such as " motto," which in her 
sense represents something " highest " and hence she can assimi- 
late it. From " motto " it goes via " dedication " to " adoration." 
In a former analysis the patient identified or " condensed " her- 
self in a similar passage with " Mary, mother of God " ; here it 
is only the " noblest " of women, the " Queen Louise," which is 
another symbol for her greatness. She designates by this an- 
other acme of human virtue which, in addition to her other 
numerous attributes, she adds to the conception of " conclusion." 
This citation is a preferred complex-expression. 

14. Mountain peak (stereotype: "I created the highest moun- 
tain peak"): I effected the highest of all mountain peaks by 
mending apparently this makes a sugar cone it comes out quite 
white one has to descend the mountain for meals it was 
kingly little houses are built on the slope during clear weather 
one will go up there with tourists it must be very remunerative 
I, too, was there once but the weather was bad sea of fog 
I wondered that such eminent inhabitants still remained up there 
they had to descend for their meals during pleasant weather 
it is very remunerative it may also be thought that bad people 
are up there the sense is royal because it is the best sense if 
one has a royal sense it is excluded, that one should be killed and 



i 



PARANOID DEMENTIA AS A PARADIGM. 123 

robbed in such a place yes, this is the mountain peak the 
Finsteraarhorn. 

The patient has long occupied herself with mending linen, she 
has mended enough linen to make a " whole mountain," " the 
highest mountain peak." Linen is white, hence " sugar cone." 7 
The snowy mountains can be compared to sugar cones which are 
white on top and blue below, hence " Finsteraarhorn." Among 
these dreamlike but transparent associations the patient also in- 
serts a dreamlike intermezzo about a mountain upon which 
prominent people live. Involuntarily one thinks of the Rigi 
peak, whose large hotels doubtless excited the covetous fancies 
of the patient. When subsequently asked about this intermezzo 
she states that she does not refer to any particular mountain, that 
she only dreamed of it. Nothing further could be elicited. 
She, however, talks about it as something real or as though it 
were a vision. Manifestly we again deal with an extraordinarily 
strong realization of a fanciful formation which occurs otherwise 
only in dreams. 

15. Turkey (stereotype: "I am the finest Turkey"): I be- 
long to the finest Turkey of the world no other woman in the 
world can be drawn by lot to choose I am the owner of Cham- 
pagne, and the strongest black wine especially of the finest 
products we are the mightiest preservers of the world Switz- 
erland as the most magnificent and mightiest state comes to my 
side Biel, Liestal, Baden, Seefeld, Neumiinster no discord 
Switzerland expresses itself in Turkey the fine Turkey intro- 
duces the finest victuals fine wine cigars much coffee, etc. 

This recalls certain advertising pictures of Greek wine and 
Egyptian cigarettes, ornamented with the picture of a beautiful 
oriental girl (the patient also says, " I am an Egyptian"). Sim- 
ilar advertising pictures are also used for champagne. This is 
probably the source of these symbols. We again deal with some 
of her desiderata, such as " wine, coffee," etc. It also seems as 
if she imagines that she distributes all these things to humanity 
("I am the bequeathor," etc.), perhaps only commercially, for 
such importation appears to her especially lucrative. She also 
" affirms businesses," as we shall see below. Be it as it may, 

1 Sugar comes from the refinery in the form of big heavy cones wrapped 
in white and blue paper. 



124 THE PSYCHOLOGY OF DEMENTIA PRyECOX. 

what is essential for us is how figuratively the patient expresses 
herself and how she assumes a geographical collective idea 
(Turkey) as her title. This technical term expresses for her 
the whole material mentioned. 

16. Silver (stereotype: " I affirm the mightiest silver island in 
the world"): speech is silver, silence is gold silvery star 
moneys are suspended by silver creation of moneys the great- 
est silver island in the world silver medals one must adhere to 
that out of which it is created watches silver snuff boxes 
curios spoons highest eloquence speech is silver, silence is 
gold the mightiest silver island in the world belongs to me as 
world proprietress I afterwards gave the order to produce 
money only, no external things the already existing dishes will 
have to be melted into money. 

The silver island belongs to the requisites of the world pro- 
prietress, it is from there that her numerous millions come. Sil- 
ver is, however, also speech ; hence she also possesses the highest 
eloquence. This example again shows quite clearly how indis- 
tinct her ideas are. One cannot really speak here of directed 
associations, as these are only association principles of speech 
combinations or of picture similarity. 

17. Zahringer 8 (stereotype: " I am a Zahringer since 1886 ") : 
Means paymaster extraordinary health often in life they say 
you are tough! I am a Zahringer since 1886 long life extra- 
ordinary accomplishments incredible with many people it is in 
the realm one is so misunderstood there are so many people 
who always wish to be ill they do not agree with the Zahringer 
quite extraordinary highest age do you know where the 
Zahringer quarter is? it is near the Franciscan church a nice 
quarter extraordinary ordinary people are not reminded by 
this title one often says they are so tough this concerns the 
state of health it is such a great thing, this difference in age 
I am a Zahringer on account of health that is extraordinary 
they often say what she accomplishes is to be admired how 
tough she is in 1886 I affirmed this quarter, I have to live there. 

The symbolic significance of Zahringer is clear. Patient is a 
Zahringer because she is Zah (tough). This sounds like a pun, 
but to her this sound metonymy becomes reality. At the same 

* Family name of Duke of Baden, Zah = tough. 









PARANOID DEMENTIA AS A PARADIGM. 

time Zahringer also "means to her a nice residence in the " Zah- 
ringer quarter." Again we have a dreamlike condensation of 
the most multiform ideas. 

1 8. Recently patient repeatedly uttered the following neo- 
logism : " I am a Switzerland." Analysis : Long since I affirmed 
Switzerland as double I do not belong here confined I came 
here free he who is free from death and error retains a child's 
pure soul I am also a crane one cannot confine Switzerland. 

It is not difficult to see how patient is Switzerland: Switzer- 
land is free patient " came here free," hence she should not be 
confined. The tertium comparationis " free " leads to a " con- 
tamination " with Switzerland. Similar but more grotesque is 
the neologism " I am a crane." " He who is free from debt," 
etc., is the familiar quotation from the " Cranes of Ibykus." 
Patient therefore identifies or " condenses " herself very rapidly 
with " crane." The analysis thus far given concerns only sym- 
bols, of the unusualness, power, health, and virtue of patient. 
They are purely thoughts of self-admiration and self-glorifica- 
tion, which express themselves in enormous and hence grotesque 
exaggerations. The fundamental thought: I am an excellent 
tailoress, I have lived respectably and therefore claim respect and 
financial reward, can be readily understood. We can also under- 
stand that these thoughts are the cause of many wishes, such as 
recognition, praise, and financial provision for old age. Before 
her disease patient was very poor and belonged to a family of 
low station, her sister being a puella publica. Her thoughts and 
desires express a striving to come out of this milieu and to attain 
a better social standing; it is therefore no wonder that her wish 
for money, etc., is especially accentuated. All strong wishes are 
themes for dreams, in which they are represented as fulfilled, 
not in the conception of reality, but in dreamlike obscure meta- 
phors. In this patient the wish-fulfilling dreams go side by side 
with the associations of the waking state. The inhibiting ability 
of the ego-complex being destroyed by the disease, the complex 
appears in the waking state and automatically spins its dreams 
on the surface, in the same manner as it used to do under normal 
conditions, only in the dim depths of the inhibited unconscious. 
Dementia praecox has here pierced the investment of conscious- 
ness, that is, destroyed the function of the clearest purposive 



126 



THE PSYCHOLOGY OF DEMENTIA PR^COX. 



associations, so that it is now possible to see from all sides the 
automatic workings of the unconscious complexes. What the 
patient and we see are only the complicated, distorted and dis- 
placed products of complex-ideations which are analogous to our 
dreams, wherein we only see the dream-picture but not the com- 
plex-thought hidden beneath it. Thus the patient takes her 
dream productions also as substantial and claims that they are 
realities. She acts just as we do in dreams, when we are no 
longer able to distinguish the connection between the logical and 
analogical. It is therefore the same to her whether she says 
" I am the double polytechnic " or " I am the best tailoress." 
When we speak about our dreams we speak as it were of some- 
thing apart, we speak from the point of view of the waking 
state; when the patient talks about her dreams she speaks as if 
still in the dream. She is involved in the automatic machinery 
in which naturally all logically adjusted reproduction ceases. 
She is then thrown entirely upon her sudden fancies and is wholly 
dependent on the complex for any new reproductions. Accord- 
ingly, her stream of thought is burdened, constantly reiterating 
(perseverations), and is frequently interrupted by thought- 
deprivation which the patient considers very trying. If an ex- 
planation is asked the patient is able to reproduce only new 
dream fragments, so that no one is the wiser for it. She is 
unable to dominate the complex material and to reproduce it as 
if it were indifferent material. 

From this analysis we see that the pathological dream has ful- 
filled the wishes and hopes of the patient in a most splendid man- 
ner. Where there is so much light there must also be shadow. 
Large estates of happiness must psychologically be bought dearly. 
We therefore come to another group of neologisms or delu- 
sions, which have to do with the contrasts, with the injuries or 
derogations. 

B. THE IDEAS OF INJURY. 

i. Paralysis (stereotype: " That is paralysis ") : bad victuals 
overwork sleep deprivation telephone these are the natural 
causes consumption backbone from there comes the paralysis 
rolling chairs, only these do they mention as paralysis tor- 
tured expresses itself in certain pains that is the way it is with 
me woe is not far away I belong to the monopoly, to the pay- 



PARANOID DEMENTIA AS A PARADIGM. 127 

ment bank notes in this the distress is affirmed this is a right 
system crutches dust development need immediate help. 

Here we have the reverse of the medal. Just as on the one 
side the fancies lead automatically to every splendor, so on the 
other side we meet with all possible malicious persecution and 
suffering. It is for this reason that patient requests an indem- 
nity which she expresses by " I belong to payment," which is 
synonymous with " the payment belongs to me." In consequence 
of her distress (Not) she claims bank notes (we shall refer to 
this pun later). Her complaints are of the physical injuries 
which are common to paranoid states. What the psychological 
root of the sufferings described may be I am unable to say. 

2. Hieroglyphical (stereotype: "I suffer hieroglyphical ") : 
Just now I suffer hieroglyphical. Mary (nurse) said that I 
should remain today in the other ward, Ida (nurse) said that she 
could not even do the patching, it was only due to my kindness 
that I did the patching I am in my house and the others live 
with me I affirm the asylum sixfold, not that I am capricious 
to remain here, I was forced to remain here in the church yard 
I also affirmed the house fourteen years I was confined so that 
my breath could nowhere come out that is suffered hieroglyph- 
ically this is the highest suffering that not even the breath 
could come out yet I affirm everything and I don't even belong 
to a little chamber that is suffering hieroglyphically through 
speaking trumpets which are directed outward. 

From this analysis, which was interrupted by an intermezzo 
with nurses, we are unable to see what she means by " hiero- 
glyphical," though she illustrates by examples. During another 
analysis of this neologism she says " I suffer in an unknown 
manner that is hieroglyphical." This explanation is quite sensi- 
ble. Hieroglyphics for the uneducated is the proverbial example 
for the incomprehensible. Patient does not understand why and 
to what end she suffers. It is a hieroglyphical suffering. To be 
confined for fourteen years so that "not even the breath could 
come out " seems nothing but a very exaggerated apostrophizing 
of her being forced to remain in the asylum. The suffering 
through " speaking trumpets which are directed outwards " seems 
to refer to the voices from the " telephone." Another interpre- 
tation may also be possible. 



128 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

3. Discord (stereotype: "It is such a great discord"): Dis- 
cords it is even criminal I have to be cared for I saw in a 
dream how two persons twisted two cords in the loft these are 
two such big discords I have to be cared for discords can by 
no means go any more on this floor it is too great discord that 
they don't wish to care for me they made laces in the loft and 
worked on without thinking or caring for me discords come 
from negligence discords do not belong to this floor, but to 
Siberia it is the highest time that I should be cared for, I have 
consumption instead of providing for me now the bank title 
they always continue to work both have accidentally made laces 
in the loft. 

" Discord " seems to express something like " precarious 
states." Patient especially feels precarious because the doctor 
never wishes to hear anything regarding the payment which she 
demands at each visit. She then mostly complains about the sel- 
fishness of humanity who only think of themselves and " always 
continue to work on " without thinking of the payment. The 
dreamlike intermezzo of the two men who were twisting two 
cords in the loft and " always continued to work " without think- 
ing of caring for patient can be conceived as a symbol for the 
indifference with which patient is here treated. " Siberia " also 
points to the bad treatment. In spite of the splendid health 
which she on another occasion claims to enjoy she considers her- 
self " consumptive." But just like all other self-evident absurdi- 
ties these too do not conflict. Dementia praecox has also this in 
common with normal dreams. Moreover it can also be observed 
in hysterics and in somewhat emotional normal individuals; as 
soon as they mention their complex they talk in a contradictory 
manner. The reproduction of complex-ideas is always disturbed 
in this or that direction or it is falsified. Judgment concerning 
the complexes is almost always somewhat clouded or uncertain. 
Everyone who occupies himself with psychoanalysis knows this. 

4. Monopoly (stereotype: " I am Schiller's Bell and the mon- 
opoly or bank monopoly") : With me it expresses itself in the 
bank note factory very black windows I saw that in my dream 
that is paralysis seven floored note factory it is a double 
house, a front one, and the back is the residence the note fac- 
tory is real American the factory is drawn into the monopoly 



PARANOID DEMENTIA AS A PARADIGM. 



129 



just as, for example, also Schiller's bell and the monopoly the 
monopoly includes in itself all that can happen all diseases which 
are due to chemical products, poisonings without seeing anyone, 
then attacks of suffocation from above it is credible again the 
awful extension they always spread me out with these victuals 
one cannot get such a figure the awful system of burdening as 
if there were tons of iron plate on the back then the poisoning, 
it is invisible it is shot through the window then as if one 
were in ice the pains in the back, this too belongs to the mon- 
opoly as Schiller's bell and monopoly Forel should have paid 
me eighty thousand nine years ago, because I had to pass through 
such pain I am in need of immediate help monopoly is a con- 
clusion of all innovations since 1886, chemistry productions, ven- 
tilations and sleep deprivations a government would be forced 
without this to give immediate help I affirm a note factory 
even if I were not " world proprietress" the state would be com- 
pelled to bring help as " world proprietress " I should have 
already fifteen years ago paid out with gentlemen through the 
note factory, forever, as long as I live therefore it is such a 
great loss if one has to die only a year earlier since 1886 the 
oleum belongs to me all those who pass through such suffering, 
should be advanced, have to be advanced to the note factory, to 
the payment such innovations are all comprehended in the 
word monopoly just as there are people who have the powder 
monopoly." 

The sense of monopoly is again a very indistinct one. It is 
associated with a series of tortures. To this distress (Not) also 
belongs the " note factory." The patient emphasizes repeatedly 
that she needs immediate help. The often-mentioned " pay- 
ments " are connected with " she has to be advanced to payment 
on account of her great suffering. The probable trend of thought 
should be as follows: her unheard of and unique suffering, as 
well as her advanced age, demand that she should once for all 
be given her rights, which she probably designates by the idea 
"monopoly." The special content of monopoly is that patient 
as " world proprietress " is alone entitled to manufacture bank 
notes. The psychological connection is probably through the 
sound associations Not (distress) notes. 

5. Note factory: this is the creation of circumstances on 



I3O THE PSYCHOLOGY OF DEMENTIA PR^COX. 

account of too great distress (Not) the notes are of the same 
value as the moneys all that is necessary to order banknotes 
to alleviate the greatest (Not) distress payments of wealth cir- 
cumstances I should with the town through life the note fac- 
tory should at all events be on our soil I with four gentlemen 
should forever pay out with it it would be a great loss to die 
one year earlier than is necessary, etc. 

We can be satisfied with this fragment of the much longer 
analysis originally made. I believe it is clear whence the con- 
ception of " bank note factory " originates. Bank notes mitigate 
the (Not) distress. In this way another sound-symbolic con- 
nection was created, as so frequently happens in dreams. Thus 
one complex assimilates the other, and the two complexes are 
condensed in the words Not (distress) and bank notes, so that 
one conception always contains the other. It is quite character- 
istic of dreamlike ideation, that the most banal resemblances give 
cause for condensation. Two simultaneously existing complexes 
always blend also in normal conditions, especially in dreams, 
where the tertium comparationis may be any superficial resem- 
blance. The money complex and the distress complex are both 
related as to contents; for this reason alone they must blend; 
distress (Not) and bank notes on account of their sound-asso- 
ciation gain as to contents even greater significance. This type 
of thinking, as all psychiatrists know, is met with not only in 
dementia prgecox, but in many other obscure manifestations. I 
call attention, for example, to the mystical interpretation of the 
name " Napoleon." 

6. Oleum: belongs to the title " eternal " it is for an old age 
if I die, the title is gone, everything is gone it is a somewhat 
longer duration of office of life oleum serves toward prolonging 
it belongs to me, but I don't know of what it is composed one 
affirms the age already since 1886. 

Oleum seems to be an elixir of life which is to prolong the 
precious life of the patient. The expression " duration of office 
of life " is quite a characteristic pleonasm of patient. We see in 
this mainly the hazy thinking which joins together two totally 
different ideas. It also shows the pronounced tendency of 
patient to express herself as learnedly as possible (court lan- 
guage), a thing also common to many normal persons who strive 



PARANOID DEMENTIA AS A PARADIGM. 



to assume an air of special importance, as for instance in minor 
official reports. The pompous style of the courthouse or of 
half-educated journalists may under circumstances offer similar 
productions. Such individuals and the patient both exhibit a 
striving towards importance. The origin of the word " oleum " 
I do not know. The patient claims to have heard it from the 
voices just as she heard "monopoly." The creation of such pro- 
ductions is frequently due to fortuitous coincidences. (Compare 
" Japansiinder.") 

7. Huf eland (stereotype: "I affirm a million Hufeland left," 
etc.) : Whoever belongs to Hufeland is universal, a millionaire 
on a Monday between eleven and twelve o'clock I slept and 
affirmed a million Hufeland to the left on the last fragment of 
earth up on the hill to this belong the highest qualities wisdom 
many people make themselves sick, this is really a great loss 
as is known, one of the most prominent doctors, who affirms, 
what is true in life seven eighths make themselves sick through 
unwise things the million belongs in the realm of the million 
for distinction a million on the last fragment of earth you 
have also two sides doctor, that now concerns left they would 
have had to pay me a million this is extraordinary the empty 
lazy people do not belong here the money always goes into false 
hands these are the deadly enemies of Hufeland, the empty, 
lazy, unwise Hufeland is extraordinarily famous to be a Hufe- 
land is so mighty, to feel one's self quite healthy or quite sick, 
yes the will power does a lot the highest essence of man is neces- 
sary in order to be Hufeland perhaps doctor, you do not belong 
to Hufeland Hufeland has no relations to cruelty, not at the 
present time they also conditioned away my underskirt and 
but only two bed sheets, that is unhufeland, that is murdered, if 
they make one violently ill I once had an abstract from him, it 
is beautiful to read, how he agrees with every fiber of life I am 
Hufeland to Hufeland belong no cruelties. 

Patient is " Hufeland " ; we know her usage of speech and 
know, therefore, that that means that there is something in her 
relations which may be symbolically expressed by " Hufeland." 
She once read about Hufeland and therefore knows that he was 
a celebrated doctor. Perhaps she knows something of his " Mak- 
robiotik," as is suggested by " will power does so much." It is 



132 



THE PSYCHOLOGY OF DEMENTIA PR^COX. 



unhufeland to take away her skirt and to receive only two bed 
sheets. In this manner she gets a cold, and this happens by the 
doctor's orders. Only a bad doctor who is no Hufeland can 
order such things. I was the physician and therefore she says: 
" You have also two sides doctor perhaps you do not belong to 
Hufeland, doctor." The adjective " unhufeland " is most note- 
worthy, it has the meaning of " not in accordance with Hufe- 
land." She employs the word " Hufeland " like a technical term, 
just as the surgeons say "We will do a Bier here" (sc. Bier's 
stasis) or a " Bassini " (sc. Bassini's operation), or, as the psy- 
chiatrists would say, " this is a Ganser " or " this symptom gives 
the impression of a Ganser" (sc. Ganser's symptom-complex). 
In the word " unhufeland," therefore, only the prefixed " un " 
is the pathological formation. The many complaints of the 
patient about unjust cruel treatment will justify the supposition 
that she wishes a " Hufeland " for her doctor. This thought 
may also be expressed quite well by the fact that she designates 
herself as " Hufeland " : such a metonymy as we have seen is 
not at all unexpected. The idea of bad, unhygienic and danger- 
ous treatment always associates with it " payment " which patient 
apparently conceives as a sort of indemnity. She does not make 
herself sick as seven eighths of the others do, but she is made 
" violently " sick. Probably for this reason a million should be 
paid to her. With this we approach the sense of her stereotype, 
" I affirm a million Hufeland to the left on the last fragment of 
earth," etc. The meaning of " left " in this stereotype is not 
quite clear to me. As in " oleum " we meet again the complex 
of death-expectation. The " Makrobiotik " is therefore a fur- 
ther nuance in the idea of Hufeland. The stereotype " I affirm 
a million Hufeland to the left on the last fragment of earth on 
the hill above " must therefore be a peculiar metaphoric paralogic 
condensation ("ellipse") for the sentence: For the bad treat- 
ment of the physicians which I have to endure here and with 
which I am tortured to death, I claim a high indemnity. 

8. Gessler (stereotype: "I suffer under Gessler"): Gessler's 
head is set up here below, I saw it in the dream Gessler is the 
greatest tyrant I suffer under Gessler, William Tell is therefore 
the greatest tragedy in the world, on account of such personalities 
as Gessler I shall tell you what he exacted of the people he 






PARANOID DEMENTIA AS A PARADIGM. 1 33 

demanded that they should have always the same linen and cloth- 
ing and never the smallest coin he was always for war, for bat- 
tle all cruelties, which these battles legalize to cause, I suffer 
under Gessler, he is a tyrant, there are people who are quite 
inadmissible, of unnatural lack of reason and bloody cruelty. 
For three fourths of a year I should have had trimmings on my 
coat it was only not given to me, that is Gessler, yes, Gessler 
bloody cruelty. 

Patient uses the word " Gessler " just as she used " Hufeland " 
as a technical term, with which she distinguishes the petty dis- 
turbances of everyday asylum life, under which she imagines she 
suffers. The tertium comparationis, which this metaphor has 
taken from " William Tell " is the humility which Gessler ex- 
acted from the people. It is interesting to see how this thought 
immediately blends with the personal vexations of the patient. 
Gessler does not demand of the people to greet the set up hat, 
but " to have always the same linen and the same dresses." 
Patient then assimilated completely the scene from William Tell 
to her own complex. 

9. Schiller's bell (stereotype: "I am Schiller's bell and the 
monopoly"): That is then as Schiller's bell I am also the 
monopoly Schiller's bell is in need of immediate help he who 
achieved this is in need of immediate help belong to the highest 
title of the world includes the greatest conclusion in itself is 
in need of immediate help. All who affirm this are at the end of 
life and have worked themselves to death immediate help is 
necessary. Schiller is the most celebrated poet for example 
William Tell is the greatest tragedy I suffer under Gessler 
that is really famous the poem, the bell this really affirms the 
whole creation creation of the world this is the greatest con- 
clusion. Schiller's bell is the creation the highest conclusion 
that is a state's groundpostament the world should now be in 
the best of conditions we have examined everything so practi- 
cally and so thoroughly. Schiller's bell is the creation the work 
of powerful masters the world was helped out of misery it 
should be in the best conditions. 

As can be readily seen the tertium comparationis is the great- 
ness of the accomplishment. Schiller's masterpiece is the Bell; 
the patient too has created something exceedingly great, hence 



134 



THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 



resembling Schiller's Bell. Following her familiar practice of 
thought and speech the condensation takes place without any 
further considerations, and the patient is then Schiller's Bell. 
Because the patient now created her greatest and utmost work 
("the world was helped out of misery"), therefore nothing 
greater can follow, besides she is of advanced age. It is there- 
fore no wonder that the complex of death-expectation becomes 
manifested (even among normal persons at such an age it plays 
no small part), and she then urges "immediate help," whereby 
she naturally means the payment. By way of instructive inter- 
mezzo I may mention here that the patient took it very much 
amiss of the former superintendent Forel because he did not 
give her the " payments." Once during an analysis she said : 
" I saw also in my dream how Mr. Forel was struck by a bullet 
by means of which he caused his own death that is really 
awfully stupid one has not always continued to do thus, if one 
really affirmed the note factory." Patient rids herself of her 
enemies by shooting them in her dreams. I mention this exam- 
ple, not because it is of interest for the psychology of our patient, 
but because it is the usual typical way by which normal and mor- 
bid individuals rid themselves in their dreams of persons who 
stand in their way. We can repeatedly confirm this in our 
analysis of dreams. 

I content myself with these nine analyses, they ought to suffice 
for a general view of the patient's painfully accentuated com- 
plexes. Her principal sufferings play an important part, such 
as " the burdening system " and the " paralysis," etc. The fol- 
lowing thoughts express themselves in the stereotypies : she suf- 
fers under the discipline inflicted by the doctors and under the 
treatment of the nurses. She is not recognized, and her merits 
are not rewarded in spite of the fact that she created the best of 
everything. Of great significance for the determination of vari- 
ous stereotypies is the complex of death-expectation which she 
attempts to appease by " affirming " an elixir of life. A person 
with vivid self-consciousness who was for any reason forced 
into such a hopeless and morally annihilating situation would 
probably dream in a similar manner. Every emotional and aspir- 
ing individual experiences moments of doubt and apprehension 
in the very hours of his keenest self-confidence, during which 



PARANOID DEMENTIA AS A PARADIGM. 135 

any reverses of his hopes seem exceptionally heavy. The ideas 
of injury are therefore the usual compensation for over-estima- 
tion, and we rarely meet one without the other. 

C. THE SEXUAL COMPLEX. 

The analyses thus far have shown us in the main the obverse 
and reverse of the social aspirations, but we have not as yet en- 
countered the most frequent and most usual complex manifesta- 
tions, namely, those of sexuality. Wherever there exists such 
a richly developed complex symbolism there can be no lack of 
the sexual complex. Indeed it is present and is also perfectly 
developed, as will be seen in the following analyses. 

i. Stuart I have the honor to be a Stuart it is so described, 
when I once mentioned it Dr. B. said, why she was beheaded 
von Stuart, Empress Alexander, von Escher, von Muralt this is 
also the greatest tragedy in the world our all potent deity in 
heaven, the Roman Mr. St. 9 expressed himself in the most pain- 
ful expressions, and with the greatest indignation about this most 
abominable intention of the world which pursues the life of the 
innocent beings thus my eldest sister had to come here so inno- 
cently ( from America) so as to die then I saw her head on the 
side of the Roman deity in heaven why it is abominable that a 
world should come to light which pursues the life of innocent 
beings Miss S. caused me consumption it is for that reason 
that I saw her lying in the hearse, a Mrs. Sch. whose fault it is 
that I am here was near her it is incredible that the world is 
not freed from such monsters. Mary Stuart was also such an 
unfortunate who had to die innocently. 

The last sentence shows clearly why patient happened to con- 
dense herself with Mary Stuart. We again have here an analogy 
only. Miss S. is an inmate of the asylum with whom patient 
could not agree. She therefore, like the other person who was 
the cause of her confinement, is in the " hearse." Whether we 
leal here with a delusion, a dream, or a hallucination makes no 
iifference, it is the same mechanism as above (Forel). A re- 

larkable figure in this analysis is the " Roman Mr. St., the most 

)tent deity in heaven." We have seen above that patient be- 
stows upon herself the title " God," we have therefore in this 
connection a firm association with the idea of deity. Here we 

* Name of patient. 



136 



THE PSYCHOLOGY OF DEMENTIA PR^COX. 



get another link, the name of the highest deity is " St." as is 
also the name of patient. The predicate " Roman " probably has 
to thank for its origin the vague analogy to " Pope." The deity 
like the Pope is of masculine gender and differentiates itself from 
the patient as " God." Next to the masculine deity, which name 
is apparently meant to express a close relation to her family, she 
sees the head of her deceased sister, a picture which reminds one 
of the two pagan deities Jupiter and Juno. She therefore in a 
way marries her sister to the godly Mr. St. This seems nothing 
more than an analogy, it is a presagement of her own ascension, 
where she will become (the sexually not indifferent) queen of 
heaven, Mary, mother of God, symbolizing the earthly mother. 
Such a sublimation of the very worldly matrimonial desire is, 
since the oldest Christian epochs, a loving toy of woman's dreams. 
From the Christian interpretation of the Song of Songs to the 
secret rapture of St. Catherine of Siena and the marriage of 
Hauptmann's " Hannele " it is always the same theme, it is the 
prelude in heaven to the earthly comedy. To represent one's 
own complexes in strange actors, as seen in dreams, is a recog- 
nized fact even by those investigators of dreams who absolutely 
reject Freud's theories. As transitivismus it is not at all un- 
known in psychopathology. The above intrepretations I express 
hypothetically, hoping to confirm them in the following analysis. 
2. Stereotype : " I came at first with the deaf and dumb Mr. 
W. from the city and first also with Uster." I came for example 
at first with the deaf and dumb Mr. W. from the city you go 
here with Mrs. W. Uster I am Uster to guard against mis- 
takes I state to you who must accept my interest draughts from 
Uster a Mr. Grimm Uster, Jud, Ith, and Guggenbiihl have to 
accept my interest draughts I came at first with the deaf and 
dumb Mr. W. from the city and first also with Uster that is 
equal interest draughts that is the equilibrium with the interest 
draughts from Uster. I affirm the churches of the city to guard 
the money. Mr. K. in M. manages my money in St. Peter. 
There I see the deaf and dumb Mr. W. near St. Peter, in dream 
one Sunday while I slept Mr. W. can give information about 
the last penny belonging to me. Mr. W. belongs to the city and 
not to Uster I came at first with the deaf and dumb Mr. W. 
from the city and at first also with Uster that is double 
equilibrium. 



PARANOID DEMENTIA AS A PARADIGM. 137 

By " city " the patient naturally means Zurich. Uster is a 
small prosperous and industrious town near Zurich. Mr. W. is 
unknown to me, hence I cannot speak about his more intimate 
determinations. The essential content of the above analysis lies 
in the first three sentences. Mr. W. " can give information 
about the last penny " of patient. He is therefore in her dreams 
firmly associated with her wealth and indeed as it appears in the 
above analysis with her sums deposited in her Zurich churches. 
(The patient once dreamed that the church of St. Peter was filled 
for her up to the roof with five franc pieces.) This wealth is 
compared with that of Uster. We know already that everything 
pleasing to patient is affirmed. Among the things affirmed we 
find large business houses of the city, and among others the 
whole Bahnhof street of the town of Chur. It is therefore no 
wonder that she " affirms " also the prosperous factories in 
Uster, hence she says " I am Uster," she also says " I am Chur." 
Furthermore she said to me " You go with Mrs. W. Uster I 
am Uster." This clears up matters. She simply indicates by 
this that she is married to Mr. W. Through this marriage she 
unites all the wealth of Zurich and Uster. " That is double 
equilibrium with the interest draught from Uster." I wish to 
recall the former use of " double " which was there incompre- 
hensible; here we can attach to it a satisfying erotic sense. The 
marriage which in the former analysis was simply indicated by 
transcendental symbols is here effected in a rather prosaic man- 
ner. The real, I might say, the coarse symbols are still lacking. 
We shall, however, find them in the following analysis. 

3. Amphi. This word comes to the surface but rarely in the 
form of " doctor this is again too much amphi." Patient rather 
vaguely deduces this word from " amphibian." If she occasion- 
ally complains about being disturbed at night by amphi and when 
asked to explain it, she talks about " a ritze-ratze animal," which 
" gnaws the floor " ; it is, however, impossible to discover what 
harm " amphi " occasions her. 

Amphi that expresses itself in hedge hog, so broad and so 
long (indicating about a foot in length and somewhat less in 
breadth) one morning, Mr. Zuppinger, through pork sausages 
now I don't know if the men purposely wish to bring to the 
world such an animal I affirmed this through pork sausages 



138 



THE PSYCHOLOGY OF DEMENTIA PILECOX. 



I always hear : that is too much amphi. The animal might have 
become so big only through mistake it must be in the evacua- 
tion (stool) instead of a factory in S. there was a building for 
amphi for productions I saw in my dream in Weggen St. on 
an arch it was written " only by well replenished tables after 
supper " I never saw such production it requires a great 
building one seemed like in a theater there above I think 
that all kinds of animals will be named amphi expresses that 
the animals have probably human reason they can make them- 
selves understood like human beings they are really amphibians, 
snakes and that kind the hedge hog is so long (indicates with 
her hands a little less than a foot), and Sunday morning it came 
creeping to the well yes, Mr. Zuppinger that was through pork 
sausages Mr. Zuppinger ate pork sausages. While I once 
affirmed in my dream 1,000 millions, a green little snake came as 
far as my mouth it had the finest, loveliest sense, just as if it 
had human reason, and wished to tell me something just as if 
it wished to kiss me (at the phrase " a green little snake " patient 
manifested vivid symptoms of affect, such as blushing and timid 
laughing). 

From the peculiar content of this material we ought to under- 
stand without anything further what the meaning of amphi is. 
Amphi is manifestly an animal of oblong form, it creeps, it is 
associated with amphibians, snakes, hedge hogs, probably also 
with " pork sausages." Moreover amphi is also associated with 
" men " (" whether the men purposely wished to bring to the 
world such an animal"), and especially by pork sausages with 
" Mr. Zuppinger," about whom I was unable to obtain any more 
information from patient. The comparison of two passages will 
be of special value for the explanations. 



The hedge hog is so long 
and came on Sunday morn- 
ing, creeping up to the well 
yes Mr. Zuppinger that was 
through " pork sausages." Mr. 
Zuppinger has 'eaten pork sau- 
sages. 



While I once in my dream 
affirmed 1,000 millions, a green 
little snake came up to my 
mouth, it had the finest, love- 
liest sense, as if it had human 
reason and wished to say some- 
thing, as if it wanted to kiss 
me. 



PARANOID DEMENTIA AS A PARADIGM. 



139 



It is no difficult task for the dream to condense, much less to 
make an analogy of two objects having an external resemblance. 
Such an analogy seems to exist between the kissing snake and 
the eating of pork sausages. The word " kiss " which produced 
a vivid affect in patient gives to the analogy the unmistakable 
sexual tinge. If a real plastic presentation is made of the proc- 
ess how the snake creeps to the mouth in order to kiss it, one 
will inevitably be struck by the symbol of coitus. According to 
the known mechanism of Freud " the transposition from below 
to above," this localization and interpretation of the act of coitus 
is a preferred one. This mechanism we have found in a number 
of both normal and psychological cases. 10 If the symbol of 
coitus is localized in the mouth the vague dreamlike fancy readily 
merges in the direction of eating, and it is for this reason that 
this act too is frequently drawn into the symbolism of coitus. 11 
Hence it is readily understood why under this constellation the 
snake is changed into an edible sausage. 12 " Eating " should 
therefore be the analogue of kissing. The hedge hog plays the 
special part of an oblong animal. By its creeping to the well it 
seems to be blended with the snake presentation. Mouth, how- 
ever, is represented by " well." Mouth can be understood as a 
sexual symbol if one assumes a " transposition from below to 
above," " well " on the contrary only if one assumes no trans- 
position, but a figurative metaphoric designation on the basis of 
familiar analogy which the ancients have already applied to their 
fountains. Here then we encounter the " coarse sexual " sym- 
bols which we have thus far missed and which are as a rule 
extraordinarily prominent. Considering it from this point of 
view the individual details of the above association can be under- 
stood without any great difficulty. That " amphi " has human 
reason is not at all remarkable when it is meant to represent a 
man. Likewise can it be understood how the animal is " in the 
evacuation" (stool). There seems to be a vague analogy to an 
intestinal worm ; the essential, however, is the localization of the 
symbol in the cloaca (Freud), which has already been expressed 
by another symbol, the " well." The obscure passage " only 

"Compare, e. g., Beitrag VIII, Diagnost. Assoziations-Stud. 

11 See Beitrag VIII, Diagnost. Assoziations-Stud. 

13 " Sausage " is a familiar vulgar expression for penis. 



140 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

after a well-replenished table after the supper " belongs to the 
sexual symbolism of eating. The nuptial night generally follows 
a good supper. As an old maid, the patient is able to say calmly. 
" I never saw such a production." In the expression " theater " 
and " animals of all kinds," one gets the feeling as though there 
is a presentation of a menagerie. The expression " a factory 
in S." also points to this, as S. near Zurich is the usual location 
for menageries, carrousels, etc. 

4. Maria Theresa. I belong to the synagogue in Lowen street 
since 1886, I am a Jewess since 1886 world proprietress I am 
therefore three Empresses I am also Maria Theresa as von 
Planta that is conclusion in my dream I was at a table with 
omelets and dried plums then there was a dam with speaking 
trumpets in it then there were four horses with mustaches over 
their tails they stood near the speaking trumpets the third 
Emperor has already legalized this I am Emperor Francis from 
the city of Vienna in spite of that I am a woman my Liesel 
rises early and yodles in the morning it is also there every 
horse stood near a speaking trumpet (Patient suddenly goes 
through the gestures of embracing someone and on being ques- 
tioned she states that she once dreamed that a man took her in 
his arms.) 

This analysis, unlike the preceding one, was constantly inter- 
rupted by obstructions (thought-deprivations) and motor stereo- 
typies (embracing), from which we may conclude that it con- 
cerns particularly markedly repressed thoughts. The patient for 
example described for some time with her index finger a circle 
in the air, " she must show the speaking trumpets " or she desig- 
nated small half moons with both hands " these are the mus- 
taches." Besides this the " telephone " made mocking remarks, 
to which we shall return later. 

By " Maria Theresa " patient again understands a particular 
quality of her greatness. This part of the analysis therefore 
interests us no longer. We have here a peculiar dream forma- 
tion which ends with " I am Emperor Francis." Emperor 
Francis was the husband of Maria Theresa. Patient is Maria 
Theresa and at the same time Emperor Francis, " in spite of her 
being a woman." She condenses therefore the relations of both 
persons into her own, which in her hazy way of talking probably 



PARANOID DEMENTIA AS A PARADIGM. 14! 

signifies nothing more than that both persons stand in connection 
to each other and that this has some resemblance to her. The 
erotic reference, especially the wish to have a distinguished hus- 
band, is very prominent. That it is most probably erotic we can 
see by the association immediately following which is an erotic 
song, " my Liesel rises early in the morning." This song is 
immediately followed by the horses which " stood near the speak- 
ing trumpets." Horses as well as bulls, dogs and cats appearing 
in dreams are often sexual symbols, because it is with these 
animals that one is likely to see the coarse sexual procedures, a 
thing which even impresses children. In a similar manner 
patient connects the horses with Emperor Francis. This justi- 
fies the suspicion of an erotic complex. The horses have " mus- 
taches on their tails." This symbol probably represents the mas- 
culine genitals and thus we can explain their relation to " Em- 
peror Francis," the symbolic husband. Every horse stands near 
a speaking trumpet in a " dam." 13 I took pains to discover 
whether the patient was acquainted with the anatomical meaning 
of the word dam, but I was unable to come to any conclusion 
without using suggestive questions. I am therefore leaving the 
question in suspense. But considering the patient's otherwise 
fair education the fact that she might know the meaning cannot 
be disregarded. The sense of speaking trumpets would then be 
a very definite one. In the gesture of embracing and the men- 
tioning of the sexual dream, the situation takes on a definite 
erotic coloring, which elucidates much of the dark symbolisms 
of the aforesaid pictures. 

5. Empress Alexander. That speaks of von Escher and von 
Muralt world proprietress as Empress Alexander I become 
the proprietress of the silver island Mrs. F. told me that I must 
send one thousand milliards to the family of the Russian Czar 
I have ordered that they should make money exclusively of the 
silver islands I am three Empresses, von Stuart, von Muralt, 
von Planta and von Kugler because I am world proprietress I 
am Empress Alexander I am three excellencies I am the high- 
est Russian lady catheter, chartreuse, schatedral, carreau I 
saw a carreau (square) of white horses on the hill under the 
skin they had the half moon like little locks they were hungry 

13 German word " Damm " can be translated as " dam " or " perineum." 



142 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

Emperor von Muralt was also up there I betrothed myself to 
him in my dream these are Russians, that was a battle attack 
on the horses were men like Mr. Sch. of U. with long lances 
like a battle attack. 

The first associations refer again to the grandiose ideas. The 
peculiar collection of sound associations like catheter, chartreuse, 
etc., leads over to a carreau of white horses, which although they 
had no half moon shaped mustaches over their tails, had however 
" half moons " under the skin " like little locks." We probably 
deal here with a similar but a more concealed sexual symbol. The 
horses are hungry ; the association nearest to it is to eat. " Hun- 
ger" indicates a desire, perhaps a sexual desire (this recalls the 
sexual symbol " hungry dog " in Beitrag, VIII, Diagnost. Assoz.- 
Stud.). Unlike the former analysis the association does not 
touch the direct symbolic husband " Emperor Francis," but a 
similar distinguished synonym " Emperor von Muralt." The 
associations again go from the horse to the husband and this 
time the sexual reference to the man is obvious, inasmuch as 
patient asserts that she has betrothed herself to " Emperor von 
Muralt." The horses, too, now receive a characteristic attri- 
bute ; they are mounted by men with " long lances " like a bat- 
tle attack. Whoever has analyzed dreams knows that whenever 
women dream of manly figures who come in the night into their 
rooms armed with daggers, swords, lances and revolvers, it is 
without exception a sexual symbol, in which the pricking or 
wounding weapons symbolically represent the penis. This dream 
symbolism can be encountered repeatedly in normal persons and 
in the diseased. I shall cite a case that I recently saw at the 
polyclinic. It is the case of a young girl who out of submission 
to her parents discontinued her love affair. She then suffered 
from depression with sporadic sexual excitements. Nightly she 
had stereotyped anxious dreams in which " someone " always 
came into the room with a long spear and struck her in the breast. 
In a similar case the patient repeatedly dreamed that she walked 
the street at night and that someone waylaid and shot her in the 
leg with a revolver. In dementia praecox we often find sensory 
hallucinations of knives in the genitals. The sexual significance 
of the horses in both this and the preceding analysis, as well as 
the meaning of " battle attack," ought to be quite obvious after 



PARANOID DEMENTIA AS A PARADIGM. 143 

the above explanation. The transition of the associations to 
" Russians " is not so remote in spite of the fact that mounted 
lancers are at present quite an unknown spectacle in Switzer- 
land. The " Russians," especially the Cossacks of Suwarow 
from the days of the battle of Zurich, 1799, are, however, living 
figures of popular tradition to which many reminiscences of the 
older generations are attached. The " battle attack " is probably 
a synonym for the embrace of the former analysis. The word 
" hunger " probably conceals the thought of virile activity. 

This analysis agrees in contents with the former, only the 
speech and the figurative symbols are changed. 

The analyses thus far occupy themselves with the betrothal, 
wedding and coitus. The patient has plastically and forcefully 
elaborated all the details of the wedding celebration; she sum- 
marizes it in the expression : " I am the lilac new red sea 
wonder and the blue." I withhold the representation of this 
dream formation, not wishing to indefinitely increase this already 
extensive analysis (the wedding celebration alone fills ten closely- 
written folios). What we lack now is the result of this sexual 
union, the children. These, however, appear in the following 
analysis. 

6. Bazaar: double bazaar I affirm two bazaars W. bazaar in 
the Bahnhof St. and one on the strand ladies work the most 
wonderful tinware, glassware, all jewels, toilet soaps, purses, etc. 
Once in my dream Mr. Zuppinger shot out of my mouth as a 
little doll boy he had no uniform but the others had military 
uniforms these are Czars, the sons of the highest in Russia, 
represented as Czars, therefore the word bazaar bazaars are 
extraordinarily good business czars are dressed for such busi- 
ness, they have their incomes from these bazaars, because they 
are the sons of world proprietors and proprietresses also a 
little girl jumped out of my mouth, with a little brown dress and 
a little apron the little daughter was allotted to me oh, God, 
the representation it is the representation, the end of the insane 
asylum came out of mouth the little daughter was shot out of 
the mouth until the end of the insane asylum it is already 
slightly paralyzed, sewn together with rags it belongs to a 
bazaar do you know these businesses have a great income, I 
came first as double, as the only world proprietress, first with 



144 



THE PSYCHOLOGY OF DEMENTIA PR^COX. 



the deaf and dumb Mr. W. from the city and then with Uster- 
I am the double bazaar. (In a later partial repetition of the 
analysis patient says : " Both children look like dolls, their names 
I also have from the bazaar.") 

As is shown by the contents of this analysis there is no dout 
that the delusions also created children for the patient. The 
more intimate circumstances and determinations of these delu- 
sional formations are especially interesting. While prolixly 
enumerating the contents of the show cases of the bazaar (only 
slightly indicated above) patient stated that in her dreams Mr. 
Zuppinger shot out of her mouth as a little doll boy. It recalls 
the third analysis of this paragraph where Mr. Zuppinger is 
firmly associated with all kinds of sexual symbols. We appa- 
rently deal here with the results of these delusional references. 
This peculiar way of representation is historical with the patient. 
As early as in 1897 it is noted in patient's history that the first 
assistant, Dr. D., who was at that time revered by the patient, 
" came out of her mouth " ; that is, " the very tiny D., the son 
of the Emperor Barbarossa." Dr. D. had a reddish beard which 
probably aided the formation of " Barbarossa." The advance- 
ment to the position of Emperor, which is probably a symbol of 
high estimation as well as veneration, has been transferred to 
Dr. von Muralt, the successor to Dr. D. (Emperor Muralt, with 
whom patient betrothed herself). The above passage can be 
easily conceived as the birth of a son from Dr. D. The event 
with Mr. Zuppinger is construed on the same plan. The manner 
of birth, that is, the child stepping out of her mouth, is an evi- 
dent confirmation of the " transposition from below to above," 
and therefore firmly supports our view about the snake and the 
mouth as given under " amphi." That the little boy, Mr. Zup- 
pinger, has some connection with this gentleman agrees perfectly 
with the sexual significance advanced above. Referring to the 
child as " little doll boy " is explained by its connection with 
" bazaar " in the show windows of which dolls can be frequently 
seen. Just as the mouth is a complex-representative for genitals, 
so is " doll " a more harmless complex-representative for " child," 
a thing quite usual in ordinary life. " He had no uniform on," 
" they are Czars," etc. these sentences seem to contain a rem- 
iniscence from the preceding analysis, No. 5, where the critical 



PARANOID DEMENTIA AS A PARADIGM. 145 

" battle attack "of the lancers stands in close associative connec- 
tion with the " Russians," ' hence the transition to Czar. By 
sound-association the patient again finds the way back to 
" bazaar," a very characteristic train of thought in the obscure 
ideation of dementia praecox. The sentences " the bazaars are 
extraordinarily good business," and " the Czars have their in- 
comes from these bazaars," in which is the sound-association 
Czar bazaar, give to the patient an apparently sensible connec- 
tion. She says " the sons of the highest in Russia represented 
as Czars, therefore the word bazaar." This formation is an- 
other " contamination." Patient " affirms " all bazaars as her 
property just as she " affirms " all good business houses. She is 
a Czarina just as she is all the other eminent personalities. 

The special determination of this dignity emanates perhaps 
from the lancers. These two diverse trains of thought appa- 
rently flow together by clang-association, and so we have the 
Czars as owners of bazaars. As the " battle attack " of the 
lancers results in a son this son becomes a Czar and is furnished 
with a bazaar. 

The strong tendency of dreams to analogical formations leads, 
just as in the other sexual symbols, to the formation of a second 
delusional birth, a little girl is born out of the mouth. It wears 
" a little brown dress with a little black apron." That is the way 
the patient generally dressed. This way of dressing has since 
long been displeasing to her; hence she often complains, and in 
her dreams she has already " affirmed " a very rich wardrobe. 
The passage " just as sewn together with rags " refers to this. 
The similarity of mother and daughter is crowned by the fact 
that the child is already slightly paralyzed. It is therefore sub- 
jected to the same afflictions as the patient. The child was allot- 
ted to her " as a representative," that is, by virtue of which 
resemblance it, so to speak, takes upon itself the vicissitudes of 
the patient. Through it the patient becomes absolved from the 
suffering of the insane asylum; hence patient can in a trans- 
posing sense say " the end of the insane asylum came out of my 
mouth." In another rather remotely transposed sense patient 
says that the child is the " Socrates representation." As will 
be recalled the patient identifies herself with Socrates, as he, just 
as she, was unjustly imprisoned and suffered. He was impris- 



146 



THE PSYCHOLOGY OF DEMENTIA PR^COX. 



oned, while she is in an insane asylum. The daughter then takes 
the part of Socrates, and hence she becomes a Socrates represen- 
tation. This explains perfectly that peculiar and rather incom- 
prehensible neologism. In order to complete the analogy the 
little daughter by way of indemnity receives a bazaar, as did also 
the son, the Czar. The idea of the double bestowing of bazaars 
leads to the expression of patient, " I came first as double I 
am the double bazaar." She adds to it a well-known Uster 
stereotype which has a distinct sexual sense. " Double " may 
also have a variously determined sexual sense, that is, the sense 
of marriage. 

In the further course of this analysis, which for the sake of 
brevity I have not reported in extenso, the patient continues to 
develop the thought of caring for her children and expands it 
also to include her parents who died in poverty. " With me the 
parents are dressed, the severely tried mother I sat with her at 
the table covered with white sheet with abundance." 

D. SUMMARY. 

The preceding documents show us how the patient brought up 
under sad domestic conditions, amid distress and hard labor, 
creates in her insanity an enormously complicated, wholly con- 
fused and senseless fantastic formation. The analysis which we 
have made, precisely as we would a dream analysis, shows a 
material which is centered in certain " dreamy thoughts," that 
is, in thoughts which, considering the personality and circum- 
stances, can psychologically be readily understood. The first 
division of the analysis discusses the afflictions and their sym- 
bols, the second the wishes and their realization in symbolic 
pictures and events, while the third division treats of the inti- 
mate erotic wishes and the solution of this problem in the resig- 
nation of her power and suffering .to the children. 

Like a poet impelled by his inner impulses, the patient pictures 
to us in her symptoms the hopes and disappointments of her life. 
The poet, however, even in his metaphors, speaks the language 
of the normal brain, and therefore most normal persons under- 
stand him and recognize in his psychic productions the true 
reflections of his joys and sorrows. Our patient, however, 
speaks as if in dreams I know of no better expression. The 



PARANOID DEMENTIA AS A PARADIGM. 147 

nearest analogy to her method of thinking is that of normal 
dreams which make use of the same or at least similar psycho- 
logical mechanisms, and which no one can understand without 
paying homage to Freud's analytic method. The poet creates 
by means of rich expressions and mostly consciously, his thought 
follows a definite trend, whereas this uneducated and scantily- 
endowed patient thinks without any directing idea, in obscure 
dreamlike pictures and amid indistinct expressions. All this 
contributes to making the stream of thought as incomprehensible 
as possible. That every person is unconsciously a poet espe- 
cially in dreams is a banal expression. In dreams he coins his 
complexes into symbolic forms, to be sure, but it is only in an 
aphoristic manner, and it only seldom reaches a more extensive 
or a more connected formation, as this requires complexes of 
poetic or hysteric force. In our patient, however, we have 
long and extensively elaborated fancies which on the one hand 
are comparable to a great poem and on the other to the romances 
and fantastic pictures of somnambulists. The waking state of 
our patient just like that of the poet, is filled with fanciful forma- 
tions, while in somnambulists the extension and the elaboration 
of the system mostly results in the dissociated " other " state of 
consciousness. But just as somnambulists prefer to translate 
into exquisite fantastic and many mystic forms, and often allow 
their pictures to fade into dreamlike imperfections, so does our 
patient preferably express herself in monstrous and grotesquely 
distorted metaphors, which resemble much more the normal 
dream with its characteristic absurdities. What our patient has 
therefore in common with the " conscious " poet and the " un- 
conscious " poet, the somnambulist, is only the extension and 
constant elaboration of the phantasms, while the absurd, the 
grotesque, in brief the lack of all that is beautiful, appears to be 
taken from the dream of the average normal person. The 
psyche of the patient stands therefore psychologically about mid- 
way between the psychic state of a normal dreamer and a som- 
nambulist, but with the exception that through serious injury of 
the " f auction du reel" and adaptation to the surroundings, the 
dream persistently replaces the waking state. How dream for- 
mations may grow out of complexes I showed for the first time 
in the little book, " Zur Psychologic und Pathologic sogenannter 



148 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

okkulter Phanomene. 14 I am obliged to refer the readers to this 
book, as it would lead me too far should I attempt to enter into 
this special domain. Flournoy 15 has at least indicated the com- 
plex-roots of the dreams of the familiar Helene Smith. For an 
understanding of the problems here touched upon I consider a 
knowledge of these phenomena indispensable. 

The conscious psychic activity of the patient restricts itself to 
the creation of a systematic wish-fulfillment, as it were, as an 
equivalent for a life of labor and deprivation and for the depress- 
ing effects of an unhappy family milieu. 

On the other hand the unconscious psychic activity is totally 
under the influence of the repressed contrasting complexes, on 
the one side under the complex of injury and derogation, on the 
other under the remaining fragments of normal censorship. 18 
The entrance of fragments of these dissociated series into con- 
sciousness asserts itself principally in the shape of hallucinations 
in the manner described by Gross and from psychological roots 
as conjectured by Freud. 

The associative phenomena correspond to the expositions of 
Pelletier, Stransky and Kraepelin. The associations, though 
following a vague theme, are without any directing presentation, 
and therefore show all manifestations of the " abaissement du 
niveau mental" of Janet, viz., liberations of automatisms 
(thought-deprivation and pathological fancies) and the diminu- 
tion of attention. The result of the last is inability for clear 
presentations. The presentations being indistinct, no proper dif- 
ferentiation takes place and hence there result many errors 
condensations, contaminations, metaphors, etc. The condensa- 
tions result principally according to the laws of similarity of 
picture or sound, through which the connections of meaning are 
quite completely abolished. The metaphoric variations of the 
complexes result in a near analogy on the one side to the normal 
dream, on the other to the wish-dreams of hysterical somnam- 
bulists. 

The analysis of this case of paranoid dementia therefore con- 
firms in extenso the theoretical hypotheses set forth in the ante- 
cedent chapter. 

"Leipzig, 1902. 

18 Des Indes a la planete Mars. Paris et Geneve, 1900. 

"Comp. Supplement. 



PARANOID DEMENTIA AS A PARADIGM. 149 

E. SUPPLEMENT. 

In conclusion I take the privilege of calling attention to two 
special points. Let us first consider the expressions of speech. 
As is the case with normal speech, our patient's speech, too, 
shows a tendency to change. The new creations of language are 
in the main technical terms serving to designate in concise form 
certain complicated domains of ideation. In normal speech the 
formation of and habituation to new terms is usually a very slow 
process and their application is generally dependent on certain 
limits of intelligence and logic. The new speech formation and 
habituation process in the patient merged into a pathological 
acceleration and intensity reaching far beyond the understanding 
of her environment. The process of building up pathological 
terms shows a resemblance to the principles of change in normal 
language. Recall, for example, the changes of interpretation of 
the " Languedoc " dialect. 17 Many similar examples may be 
found in the history of language. Unfortunately I am not at 
home in this domain and do not dare search for further analogies. 
I feel, however, that a philologist would be able to make many 
important observations among patients with confused speech 
which would be of use in the study of the changes that have 
taken place in normal language in historical times. 

Hallucinations of hearing play a particular part in the case of 
our patient. She elaborates her wishes of the day in the waking 
state, and at night in her dreams. It seems that she finds pleas- 
ure in this occupation, for it follows the direction corresponding 
to the inner inclinations of her personality. He whose thoughts 
run exclusively and perseveringly in a very definite and limited 
direction is forced to repress contrasting ideas. We know that 
in normal persons, or at least in tolerably normal individuals, 
such as moody men, though the same mood may continue for a 
long time, it is apt to be interrupted suddenly by an invasion 
with almost elemental force from another sphere of thought. 
We see this in its highest development in hysterics with dissocia- 
tion of consciousness, where one state is not seldom suddenly 
replaced by the contrasting one. The contrasting state often 
manifests itself through hallucinations or other automatisms 

17 Compare also Henry : Antinomies linguistiques. Bibliotheque de la 
Faculte des Lettres de Paris, 1896. 



I5O THE PSYCHOLOGY OF DEMENTIA PR^ECOX. 

(comp. Flournoy), just as every split-off complex is wont to 
disturb the activity of another simultaneously existing complex. 
This may be compared to the disturbance caused by an invisible 
planet moving in the orbit of a visible one. The stronger the 
split-off complex, the more intensely will the automatic disturb- 
ances assert themselves. The best examples are offered by the 
so-called teleological hallucinations to illustrate which I should 
like to report three examples from my experience. 

1. A patient in the first stages of progressive paralysis wished 
in his despair to kill himself by jumping from a high window. 
He got upon the window ledge, but at this moment there sud- 
denly appeared in front of the window a powerful light, which 
practically threw him back into the room. 

2. A psychopathic individual to whom, on account of some 
misfortunes, life became unbearable wished to commit suicide by 
inhaling gas from an open jet. He inhaled the gas forcibly for 
a few seconds, when he suddenly felt a heavy hand grasp him 
by the chest which threw him to the floor, where he gradually 
recovered from his fright. The hallucination was so impressive 
that the following day he could still indicate the place where he 
was grasped by the five fingers. 

3. A Russian-Jew student, who later developed a paranoid 
form of dementia praecox, related to me the following: Under 
pressure of great unhappiness, he resolved to become converted 
to Christianity, although he was orthodox and entertained strong 
religious scruples against changing his faith. Finally, after a 
hard struggle, he determined to take the step. With this thought 
he fell asleep and dreamed that his dead mother appeared to him 
and admonished him against it. After his dream his religious 
scruples became stronger, so that he was unable to make up his 
mind to go over to Christianity. Thus he was wretchedly tor- 
mented for a few weeks longer until forced by his persistent 
distress he once more decided to apply for conversion. That 
night his mother again appeared to him in a dream and said, 
"If you do this I will choke you." This dream had such a terri- 
fying effect on him that he definitely decided to desist from 
becoming a convert, and to escape his misery he emigrated to a 
foreign land. We see how in this case the repressed religious 
scruples made use of the strongest symbolic arguments, i. e., the 






PARANOID DEMENTIA AS A PARADIGM. !$! 

veneration for the dead mother, and in this manner repressed 
the ego-complex. 

The psychological life at all times is rich in such examples. 
As will be remembered, the Daemon of Socrates also played a 
teleological role. We may recall for example the anecdote in 
which the Daemon warned the philosopher against a herd of 
swine (in Flournoy we find similar examples). Dreams, the 
hallucinoses of normal life, are nothing more than a hallucina- 
tory representation of repressed complexes. Thus we see that 
split-off thoughts have a tendency to crowd themselves into con- 
sciousness as hallucinations. It is therefore to be expected that 
we find in our patients that all contrasting complexes as a result 
of repression should effect consciousness by means of hallucina- 
tions. Their voices are therefore almost exclusively of a disagree- 
able and derogatory content, also the panesthesias and other auto- 
matic phenomena have by preference a disagreeable character. As 
usual we also find in a patient near the complex of grandeur the 
one of injury or derogation. To the derogation also belongs the 
normal censorship of the grotesque grandiose ideas. That a 
censorship still exists seems a priori possible, for we see that 
patients who intellectually and emotionally are less well pre- 
served than our patient still have an extensive insight into the 
disease. The censorship naturally contrasts with the grandiose 
complex which completely fills consciousness; it therefore prob- 
ably acts from the repression by means of hallucinations. This 
really seems to be the case since at least some observations speak 
in favor of it. While the patient was telling me what a misfor- 
tune it would be for humanity if she as world proprietress 
should have to die before the payments the " telephone " sud- 
denly said " it would do no harm, they would simply take another 
world proprietress." 

While the patient during the association of the neologism 
" million Huf eland " was constantly troubled by thought-depriva- 
tion, and was unable to elicit anything definite, the " telephone " 
to the great chagrin of the patient called out " the doctor should 
not be bothered with such things." At the neologism " Zah- 
ringer," when the patient was having some difficulty with the 
associations, the " telephone " said " she is embarrassed and 
therefore she can say nothing." During an analysis when the 



152 THE PSYCHOLOGY OF DEMENTIA PR^COX. 

patient remarked that " she was Switzerland " and I was forced 
to laugh, the " telephone " called out " that is going somewhat 
too far." During the association-test connected with the neo- 
logism " Maria Theresa," the patient was especially impeded and 
I could not follow her ; things were really too complicated. The 
following colloquy took place: 

Telephone : " You lead the doctor about the whole forest." 

Patient : " Because it goes so far." 

Telephone : " You are too smart." 

At the neologism " Emperor Francis," the patient as usual 
began to whisper, so that I could not understand her. She was 
therefore required to repeat over aloud many sentences. I be- 
came somewhat nervous at this and told her impatiently to talk 
louder, to which she answered rather irritably. The "tele-, 
phone " then said " now they will probably begin to pull each 
other's hair." Patient once said, emphatically, " I am the key 
stone, the monopoly, and Schiller's Bell," to which the " tele- 
phone " remarked : " This is so important as to cause a drop in 
the markets." 

In these examples the " telephone " has the character of an 
ironical correcting spectator or censor, who is thoroughly con- 
vinced of the uselessness of the morbid machinations, and there- 
fore mocks the patient's assertions in a rather superior tone. 
Such voices give the impression of a personified self-irony. Un- 
fortunately in spite of zealous search I lack the necessary mate- 
rial for a closer characterization of this interesting dissociated 
personality. But this small material allows us at least the con- 
jecture that besides the complexes of grandeur and injury, there 
exists still another complex which retains a certain normal cen- 
sorship, but is prevented from reproduction by the complex of 
grandeur, so that no direct intercourse can be had with it. 
(Direct intercourse can be had with such personalities in som- 
nambulists by means of automatic writing.) 

This apparently three- fold division gives material for reflec- 
tion, not only from the psychological, but also from the clinical 
side of dementia prsecox. In our case intercourse with the outer 
world is controlled by the complex of grandeur. This could be 
quasi-accidental. We know many cases where the reproductions 
are controlled by the derogatory or persecutory complex and 



PARANOID DEMENTIA AS A PARADIGM. 1 53 

where we receive only intimations of the presence of grandiose 
delusions. Finally there are cases where a certain corrective, 
ironical, and fairly normal ego-remnant is in evidence, while the 
other two complexes perform in the unconscious and are only 
made evident by hallucinations. Single cases may from time to 
time vary according to this scheme. In Schreber for example 
we see during convalescence the reassertion of itself by the crit- 
ical ego- fragment. 

CONCLUSION. 

I do not imagine that I have offered anything conclusive in 
this work; this domain is too extensive and as yet too obscure 
for that. It would be far beyond the power of a single person 
to carry out in the course of a few years all the experimental 
work himself which alone could support my hypothetical views. 
I have to content myself with the hope that the above case of 
dementia praecox, analyzed as thoroughly as possible, will give 
the reader an idea of how we think and work here. If in addi- 
tion to this he will consider the fundamental thoughts and experi- 
mental proofs of the " Diagnostischen Assoziationsstudien " he 
will perhaps be placed in a position to form for himself a detailed 
picture of the psychological point of view from which we study 
the morbid mental changes of dementia praecox. I am perfectly 
conscious of the fact that the above case only partially confirms 
the views presented in the preceding chapters and that it can 
only serve as a paradigm for certain kinds of paranoid dementia. 
It manifestly does not touch the wide domains of catatonia and 
hebephrenia. So far as relates to these I must prepare the 
reader to expect future contributions to the " Diagnostischen 
Assoziationsstudien " which will, I anticipate, contain some fur- 
ther experimental work in connection with the psychology of 
dementia prsecox. 

I have made it easy for the critics ; my work has many weak 
points and gaps for which I beg the reader's kindly considera- 
tion. The critic, however, must be regardless in the interest of 
truth. Somebody had to take it upon himself at length to set 
the stone rolling. 



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The psychology of 
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