In brief it is contended by Dr. Coriat that the stammering arises as a defense or compensation mechanism, the object of which is to keep from consciousness certain painful memories and undesirable thoughts, in order that they may not be betrayed in speech. In fact, as Dr. Coriat says, "all stammering, with its hesitation, its fear, its disturbing emotions, is a kind of an association test in everyday life and not a phonetic disturbance. It is a situation phobia, the same as phobias of open or closed places."

Consequently, according to this view, stammering is purposeful and intentional and not accidental. This purposiveness is psychological and individualistic. It is resorted to by the individual for very definite, intimate, personal reasons. It is due to unconscious, repressed hidden complexes which crowd or press between the words of syllables, as Stekel puts it, and which produce the inner resistance which inhibit the free flow of speech.

It is asserted that these hidden, repressed, unconscious thoughts are related to the sexual impulse or wish.

Dr. Coriat enumerates the types of repressed complexes in childhood which may bring about stammering as follows:

1. Repression of sexual acts or secrets and the fear of betrayal. 2. Typical Oedipus complexes, with a fear of betrayal of the hate for the father and a consequent embarrassment of speech in his presence. 3. Masochistic phantasies, wondering and imitating how it would sound to talk with the tongue cut out. 4. The fear of pronouncing or saying certain sexual and, therefore, tabooed words, and thus betraying what the child thinks, his hidden thoughts.

The stammering may then arise as a wish to say or think certain tabooed words and the wish encounters a prohibition from within. These words may relate to certain anal, urinary or sexual functions which are recognized by the child as unclean, and thus forbidden to pronounce. 5. As a manifestation of anal eroticism, that is, holding the feces so that he could talk while trying to conceal the act.

. . Talking at these times would be difficult, because talking would take away the muscular tension for withholding the feces."

At another place Dr. Coriat assures us that "the dreams of stammerers are interesting because these dreams reveal their wishes to talk freely, their resistances and transferences and, also, their reversions to childhood when the stammering arose as an embarrassment complex or as a gainer of time to conceal their sexual thoughts or libido."

I have presented Dr. Coriat's views so fully and quoted him so much at length in order that there may not be any question of the absolute accuracy of my statements.

What does this mean to the one who has followed the trail of the Freudian movement? The meaning is plain. It is like the handwriting on the wall. Dr. Coriat has permitted himself to be deluded by the Freudian sexual theories and their application to the psychoneuroses, and in this special instance to stammering.

What does this imply? It implies that Dr. Coriat accepts the Freudian theories en masse. Hence, to discuss this subject in a thorough way I should have to take up for discussion the various aspects of Freudian psychoanalysis. This would include a consideration of the method employed, the psychology, the attitude or standpoint assumed, the "art of interpretation" developed, and the real meanings, in their wider and more extended sense, of various unsupported, unfounded, dogmatic and untrue conclusions of a theoretical and practical nature. This cannot, it is obvious, be expected in this place. Attempts of a certain sort in this direction have been made by me in previous communications.[6] In the not very distant future I shall endeavor more successfully to cope with some of the problems mentioned.

[6] See, for example, the Psychoanalytic Review, January 1915 and the Journal of Abnormal Psychology, June-September, 1914.

With respect to the general problem of sexuality I may say that I have recently[7] taken up, for separate dissection, the conception of sexuality assumed by Freud and his followers. The present paper should, I feel, be read in connection with this particular paper, since it will, in a way, clear the field of many of the misunderstandings in interpretation. Everything depends upon what one means by "sexuality" or "sexual impulse" or "sexual tendency." Unless a mutual understanding is arrived at on this subject of sexuality, little advance toward the dissipation of conflicting views of Freudians and anti-Freudians can ever be had. And permit me to mention in this place that it is the Freudians themselves and not their opponents who are most to blame. Until the Freudian school decidedly and once for all gives up its false and distorted viewpoint of man's sexual impulse and of human mental life, little progress of a worth-while nature can be made by them.[8]

[7] "A Critical Review of the Conception of Sexuality Assumed by the Freudian School." Medical Record, March 27, 1915.

[8] Owing to the fixed, systematized theories of the Freudian school, I believe that little co-operation can be expected from it. We can only prevent the dissemination of their dangerous sexual theories.

Starting out, then, with certain concepts or theories which are basically wrong and can be summed up by stating that they assume an individualisitic, psychosexual conception of life and interpretation of vital phenomena, and with a psychology and a sexology which is radically wrong in its sweeping and dogmatic conclusions, Dr. Coriat, who has obviously accepted these theories as actualities, else he could not have arrived at the ideas concerning stammering which he presents in his paper, builds up or accepts an imaginatively constructed theory which he applies in full force to the problem of stuttering, and into which he crowds the phenomena of a physical and mental order which are manifest in this intermittent, special psychoneurotic disorder. As a natural consequence all the faults of Freudism have been transported to the elucidation of the genesis, nature and evolution of stammering. And this means that the theories of universally acting psychical repression, of the unconscious, of the endopsychic censor, of the significance of resistance and amnesia, of the employment of highly complicated and phantastic symbolism, of the manifestations of sexuality and so forth have been made use of in a high-handed, uncalled for, unnecessary and unscientific manner to prove the truth of the thesis with which the author set out upon his journey.

It is no wonder that in such a fashion and with such concepts the conclusions above cited were arrived at. Indeed, work along this line was unnecessary, except in a purposively corroborative way, if the theories of Freud in the case of the whole group of psychoneuroses is once seized upon and accepted as the basic truth. The problem for Dr. Coriat is to prove the truth of Freud's conceptions as laid down in his psychology and sexology, upon which his psychopathology is built.

I must stoutly protest against an evasion of the real issues by the leaders of the Freudian movement. Let them retrace their steps and first prove the truth, soundness and validity of their psychological and sexual theories and cease pressing on to pastures new, as Dr. Coriat has done here in the case of stuttering. If they are not prepared to do this, or are unwilling so to do, I do not believe that they are entitled to continue to inflict upon others views which have little real foundation in fact, which are unproven, unfounded, purely speculative, imaginative, pure figments of the imagination, a delusion and a snare. I have elsewhere[9] given credit to Freud and his co-workers where I think they deserve it. But that should not deter me from protesting against their evasion of the issues, their befogging of the problems involved, their failure to prove their case or to offer satisfactory replies to criticism which is given in a fair and frank fashion.

[9] "A Plea for a Broader Standpoint in Psychoanalysis." Psychoanalytic Review, January, 1915.

The method of burying one's head in sand, after the manner of the ostrich, and the refusal to see that which is pointed out or which stares one clearly in the face, cannot go far to establish one's case or as a method of defense. And the same thing applies to that oft-repeated and tiresome retort: "You do not (or perhaps you cannot) understand our theories and viewpoints." Or that other evasive accusation, rather than reply: "Your lack of understanding is of itself proof positive that our theories are absolutely correct in every detail." Or "Your attack or criticism just completely and undoubtedly proves our case. You are prompted by those very mental mechanisms and by that self-same mental content—meaning all the time the sexual content and sexual mechanisms—which we have been trying to explain to you so that you might understand us."

In response to this I should like to ask the Freudian school what it means by "censor," "wish," "unconscious," "sexual," and other similar and constantly used terms which form the stronghold of their defenses. I have shown,[10] at least to my own satisfaction, that the conception of sexuality is not at all clear to any of the Freudian school, including Freud himself. This should by no means be so. Surely the terms which are constantly used and are the sine qua non of their theories should have a definite meaning of some sort, at least to the Freudians themselves. Mystical and metaphysical implications should not continue to find a sheltering place in the province of psychopathology. They should be uprooted and driven forth from the dark and hidden recesses into the light and open highways.

[10] Loc. cit.

These statements have a direct application to the paper which I have undertaken to criticize. It is all very well and very commendable to come forward with new theories. They are entertaining, interesting and make one think, even if they are not at all true. But it should be definitely and plainly stated that we are dealing with theories and not with facts, that the theories will be considered theories until they are proven to be facts, and that if they are disproven, they should be thrown into the rubbish heap or discarded, or else they should be modified to meet with the facts and actual conditions—as they are and not as they ought in our opinion to be or as we should like them or as we imagine them to be. Here we are confronted with a problem (stammering) which has been the subject of much study and discussion by many men. Theories have been carefully and guardedly formulated by most workers in this field. Many of them were, it is true, in error in their conclusions or viewpoints. They were, as it were, on the wrong trail.

Here is a problem of the greatest interest and of the greatest importance— one which should demand the most careful research and the most positive deliberation and consideration, with prolonged and intensive study and observation of cases, combined with self-scrutiny and self-analysis and self-knowledge (which means a keen insight into human nature and the human mind in its manifold workings). Here is a serious, concrete problem of great practical importance. Its solution and elucidation means much. And he who comes forward with an explanation of this problem should be expected to give conclusive proof of his conception and for his conclusion. And we should, justly and as a matter of course, expect and demand it.

And what proof has Dr. Coriat given us for his conclusions? Here and there scattered through his paper one finds a few conclusions or explanations of a concrete nature, but they are his interpretations of the facts and not the facts. No real, in fact not a vestige of proof is offered. The few dreams which he presents do not, to the inquiring and demanding reader, show anything which permit of the conclusions which Dr. Coriat draws with reference to their meaning or significance. He seems to have interpretated (rather than analyzed) them in typical Freudian fashion. And, furthermore, even if his interpretations of the few dreams which he presents and which were taken from different cases were true, of what significance would that be? What right would we thus have of drawing conclusions which apply to all cases of stuttering (and, as mentioned earlier in this paper, to many other related states of a normal and abnormal nature)? Not the slightest.

Not a single case has been presented in proof of the conclusions drawn in the paper. Surely this is not what we have been accustomed to expect in other fields of medicine, especially when the conception newly put forth is entirely novel, sensational, revolutionary, contrary to all former beliefs, and based on theories and conclusions which have been for some time and still are a centre of storm, of wordy argumentation, and even of insult and abuse—at any rate sub judice,

Has the science and practice of psychopathology come to the stage when theories of any sort can be given to the reading public as fact, and no actual proof therefor presented?

I venture to say that in no other department of medicine or in fact in no other aspect of life would scientific men tolerate such presentation and promulgation, despite opposition and disproof and with no tangible or definite evidence or proof. Nor would men come forward to offer revolutionary, let alone dangerous theories, for general consumption, with so little proof, as is being laid on the platter for psychopathologists.

I find no evidence offered by Dr. Coriat to bolster up the conclusions of his paper.

In response to a question asked by one of those who discussed his paper in which he was requested to explain how he knew that stammering begins by concealing something, Dr. Coriat stated: "I have had an opportunity of examining a number of stammerers and subjecting them to a complete psychoanalysis, studying all the paradoxical mental reactions and in nearly every case this concealment of some sexual secret of childhood came up. It is easy to establish a certain relationship between the speech embarrassment and the concealed sexuality."

There is, as is seen, no other proof for this theory (that is all that one call it) of Dr. Coriat and the Freudian school in general, than his or their say-so. Those who are acquainted with the method of arriving at conclusions adopted by the Freudian school will demand more than this as proof of either the "concealment" of some "sexual secret" of childhood (and where lives there a man or woman that has not sexual memories, not necessarily secrets, of some sort or other, related to the period of puberty or antedating it by a certain varying period?) or the establishment of a relationship other than co-existence or coincidence, between the speech embarrassment and the "concealed sexuality" (just as if even proof of the existence of this relationship was sufficient testimony of the causative operating influence of the latter).

I could discuss Dr. Coriat's paper from many angles, and in each case show that its conclusions were not only unsupported but impossible.[11] But in the above remarks I have presented sufficient evidence, I believe, to carry out the objects of this criticism.

[11] The ideas in the paper are, in fact, absurd. If definite, practical, clinical issues were not involved matters might be different. But the situation is serious yes, dangerously antisocial, since the practical application of these theories to human beings is the point of greatest interest.

The reader should not lose sight of the cold but important fact that the application of Freud's sexual theories to stammering in children is, in my humble opinion, fraught with the greatest danger. I cannot do otherwise than look upon this as positively anti-social. It would, it is my belief, be a glaring and rife source of danger to the community and to society in general for these ideas to be spread broadcast. Freud himself has shown that the child, before puberty, with his more or less undifferentiated sexual impulse, may be swept along into any one or more of the sexual aberrations or to intrafamilial sexuality. These goals exist only as POSSIBILITIES and should not, I contend, be referred to as predispositions or tendencies (almost as if they were instincts). The direction of the child's thought along this line before or at or after puberty may prove disastrous in one or more of many different ways.

Think of hinting at or talking about or harping upon matters of this sort to children, let alone to adults of the usual sort! It would be nothing less than a crime to society, to the family and to the growing child. In this respect I look upon the application of the Freudian theories as a distinct and glaring danger to the individual, to the family and to the community.

Efforts to stem the tide from flowing in this direction should be unfettered. It means much for humanity.

Even hinting (to the children) in a remote way about the various aspects of sexuality described by the Freudian school should not find its place and has no place in treating stammering per se in children.

Think of the effect of continual conversation and thinking of this sort upon a child at or before puberty, or at adolescence, or even upon an individual in adult life! His thoughts are continually drifted to his urogenital organs and the sexual possibilities of all sorts of human relationships, intrafamilial as well as extrafamilial.

The Freudians may object to any statements to the effect that they tell their patients about these sexual theories. I find Jones,[12] for instance, declares that Freud "deliberately withholds from his patients all knowledge of psychoanalyses except what they discover for themselves." Even granting this, the patient doesn't have to wait long or think much before he does discover for himself just what the Freudians mean.

[12] Ernest Jones: Professor Janet on Psychoanalysis; A Rejoinder. Journal of Abnormal Psychology, Feb.-Mar., 1915, p. 407.

But Freud[13] himself contradicts this statement by Jones when he says: "If with my patients I emphasize the frequency of the Oedipus dream—of having sexual intercourse with one's own mother—I get the answer: 'I cannot remember such a dream.' Immediately afterwards, however, there arises recollection of another disguised and indifferent dream, which has been dreamed repeatedly by the patient, and the analysis shows it to be a dream of this same content—that is, another Oedipus dream."

[13] Brill's translation of Freud's Interpretation, p. 242. Italics mine.

Then again, listen to Brill:[14] "With reference to the question of determining that a person is homosexual.

[14] The Conception of Homosexuality, Journal of American Medical Association, August 2, 1913. See Brill's discussion on pages 339-340.

"A patient came to me who was said to have nothing the matter with his sexual life, but who had convulsions. I had seen him not more than three times when I said to him: 'You are homosexual,' and I explained what I meant. He told me that while at college he never indulged in sexual acts, and that for this reason he used to wrestle, during which he would have ejaculation, and he selected his partners. Unquestionably from the beginning of his existence he was homosexual, although he was able to have sexual intercourse with his wife, but he was compelled to marry when quite young; he was 'prodded into it,' as he said. He came to me to be treated for neurosis, but the neurosis was simply the result of homosexual lack of gratification.

"We should be particularly careful not to suggest anything. I never tell a patient that he is homosexual. Be reasonably sure that he is homosexual and you need not hesitate to tell him so."

It all depends on what one means by "reasonably sure" or what kind of and how much evidence one requires or demands to be "reasonably sure."

Furthermore the mass of popular Freudian literature is not by any means hidden from the patient.

In conclusion I may remind the members of the Freudian school that it behooves them to undergo that same self-analysis and self-scrutiny which they justly advise others to have. If they do this in a truly critical and impartial way they will find that the opposition which they have met has not been without foundation. They will find that there are serious and all-pervading flaws in their psychology and sexology, and that this is responsible for their one-sided and distorted analyses and interpretations. Most of the trouble will be found in the method of interpretation, flowing out of their attitude. They will find that they have been advocating a system of theories and conclusions which have been followed as a religion, a cult, a creed. And they will correct the errors which are so patent to so many of the rest of us.

It is or should be evident to him who reads between the lines and surveys this question as from a mountain top, that there is not the slightest proof, not one jot of testimony in support of the ideas which Dr. Coriat has given us in his paper.

As a final word I cannot refrain from remarking that it will be a sad day for humanity and for society when psychoneurotics of whatever sort, stammerers, normal individuals with their psychopathologic acts of everyday life, and all the rest of us, particularly children, shall be subjected to Freudian psychoanalyses, with the numerous sexual theories and sexual implications with regard to everything of vital or human concern, as seen especially in family and social relations. A study of the origin, nature and evolution of these is not only not out of place, but on the other hand finds a distinct place of honor for purely scientific purposes. Theories, however unfounded and untrue, may, not inappropriately, be offered for this purpose. But we come upon a decidedly different situation when we have to deal in a practical sort of way with individuals, particularly children, who are the objects of the experimental application of full-blown theories. Especially is this so in the case of sexual theories.

Propagation of such views concerning the origin and nature of stammering as are presented to us in Dr. Coriat's paper should be sternly discountenanced. Nay more, they should be unflinchingly denied and even severely condemned. I, for one, protest vigorously against the propagation of such views, especially when they represent nothing more than an inflated theory.

The writer wishes to assure Dr. Coriat and the reader that his remarks are intended in a thoroughly impersonal sort of way. He is concerned only with the problems involved. Personalities do not at all enter into the proposition. He hopes that his criticism will be accepted in the same spirit in which it is given. If, to the reader, it may seem at times that the writer has spoken too strongly, he can only say in defense that he has seized upon this occasion as the time and the place to so express himself briefly, frankly but without malice. The situation more than demands such outspoken expression of opinion.



ABSTRACTS

THE PSYCHIC FACTORS IN MENTAL DISORDER. Milton A. Harrington, Am. Jour. of Insanity. Vol. LXXI, No. 4, p. 691.

The writer has taken the scheme of the instincts which William McDougall has given in his book, entitled "An Introduction to Social Psychology" and has attempted to show how it may be used in studying the problems of mental disorder. The paper falls into three parts. In the first part McDougall's conception is presented, modified, however, so that it may be better fitted to the needs of the psychiatrist. Briefly it is as follows:

Man has instincts as well as the animals and all his mental activity is due to impulses coming from these instincts. An instinct may be defined as an innate specific tendency of the mind which is common to all members of any one species and which impels the individual to react to certain definite kinds of stimuli with certain definite types of conduct, without having first learned from experience the need of such conduct. For example, there is an instinct of pugnacity which impels us to attack that which injures us or interferes in any way with the attainment of our desires, an instinct of flight which impels us to seek escape from danger, a parental instinct from which come the impulses that lead us to protect and care for our young. But, beside impelling the individual to react to certain definite kinds of stimuli with certain definite types of conduct, an instinct, when stimulated, gives rise in every case to an emotion which is characteristic of it. For example, with the instinct of pugnacity, we have the emotion of anger; with that of flight, the emotion of fear; with the parental instinct, the emotion of love or tender feeling. An instinct, therefore, is regarded as a mechanism made up of three parts:

First, an afferent or cognitive part, through which it is stimulated.

Second, an affective part through which it gives rise to the emotion which is characteristic of it.

Third, an efferent or conative part through which it gives rise to a characteristic type of conduct.

McDougall gives a list of about twelve instincts, each with its accompanying emotion. These he regards as primary and the source of all thought and action.

Considering the instincts from the standpoint of evolution, one may assume that they first developed in extremely low forms of life in order to produce the few and simple reactions of which animals low in the scale are capable. One might almost say in regard to such primitive organisms, that for each situation an instinct is provided and the situation calls forth its appropriate reaction almost as automatically as the pressing of an electric button causes the ringing of a bell. But, as animals rise higher in the scale, the kinds of conduct required become more varied and complex. For example, an impulse from the flight or fear instinct, in the lower animals, will always produce some simple reaction such as flight or concealment. But, in man, the forms of conduct, to which it gives rise, may be extremely varied. Thus in one case a man may be impelled to run away, in another to work hard at some disagreeable task in order to escape the harm which might result if he failed to do so. This capacity to direct the instinctive forces into various forms of activity, we call the capacity for adjustment and we may assume that it depends upon the operation of certain mechanisms which we may call the mechanisms of adjustment. The mind may, therefore, be regarded as made up of certain instincts from which come the impulses that give rise to all our mental reactions and certain mechanisms of adjustment by which these impulses are directed into the most useful forms of activity.

This conception of the human mind enables us to form some idea of how a mental disorder may arise from purely mental causes; for it is obvious that conditions may sometimes arise when the mechanisms of adjustment will prove inadequate to the demands made upon them, when they will be unable to control the instinctive forces or find for them satisfactory outlet and, as a result, these impulses will escape by undesirable channels, giving rise to forms of thought and action which we recognize to be abnormal. To show that this theory may be successfully applied to explain the facts of abnormal psychology, the analysis of an illustrative case is presented. This case, which is worked out in considerable detail, forms the second section of the paper. It is the case of a young man who, partly owing to inherited tendencies and partly to environment, developed during early life certain habits and characteristics which, when he approached maturity and the sexual instinct awoke to its full activity, caused the impulses from this instinct to be directed into wrong channels, giving rise to a psychosis which took the form of a catatonic stupor.

The conception of mental disorder here presented inevitably leads to certain views regarding the causes which give rise to it. Since mental health is dependent on capacity for adjustment being equal to the demands made upon it, mental disorder must always be due to failure to maintain this relationship between capacity and needs. The causes of insanity must therefore be of two kinds:

First, those which make the task of adjustment so difficult as to overtax the capacity.

Second, those which lessen the capacity so that it is unequal to the demands made upon it.

The third section of the paper is a brief discussion of what these causes are and how we should deal with them. Author's Abstract.



A STUDY OF SEXUAL TENDENCIES IN MONKEYS AND BABOONS. By G. V. Hamilton. Journal of Animal Behavior, September-October, 1914, vol. 4, No. 5, pp. 295-318.

The writer asserts that the work and problems in sexuality in human beings place upon the animal behaviorist an obligation to lay the necessary foundations for a scientific and thoroughly comprehensive investigation of sexual life. This has led him to formulate the following two problems in animal behavior: (1) Are there any types of infra-human primate behavior which cannot be regarded as expressions of a tendency to seek sexual satisfaction, but which have the essential objective characteristics of sexual activity? (2) Do such sexual reaction-types as homosexual intercourse, efforts to copulate with non-primate animals and masturbation normally occur among any of the primates, and if so, what is their biological significance?

The author presents a list of the subjects (monkeys and baboons) employed in his study; gives a description of the environmental conditions in his laboratory which is in the midst of a live oak woods In Montecito, California, about five miles from Santa Barbara; gives a list of the types of situations that were arranged by the observer or encountered by the subjects in consequence of their spontaneous activities, and under each description of a typical situation one or more detailed descriptions of typical responses thereto; and finally offers the classification of sexual tendencies as expressions of reactive tendencies observed.

The author then enters into a discussion of the use of the term reactive tendency, and explains that this term, according to his definition, is meant to explain something more specific than an inclination to direct activity toward one of a limited number of general ends, and to include both the innate and the acquired features of an individual's reactive mechanism.

He then presents his conclusions which I shall here include in full and verbatim, because of the fact that these findings should prove of great importance, especially in the light of Freud's theories of infantile sexuality. The author states that "At least two, and possibly three, different kinds of hunger, or needs of individual satisfaction, normally impel the macaque toward the manifestation of sexual behavior, viz., hunger for sexual satisfaction, hunger for escape from danger and, possibly, hunger for access to an enemy.

"Homosexual behavior is normally an expression of tendencies which come to expression even when opportunities for heterosexual intercourse are present. Sexually immature male monkeys appear to be normally impelled toward homosexual behavior by sexual hunger. The fact that homosexual tendencies come to less frequent expression in the mature than in the immature male suggests the possibility that in their native habitat these animals may wholly abandon homosexual behavior (except as a defensive measure), on arriving at sexual maturity.

"Homosexual behavior is of relatively frequent occurrence in the female when she is threatened by another female, but it is rarely manifested in response to sexual hunger.

"Masturbation does not seem to occur under normal conditions.

"The macaque of both sexes is apt to display sexual excitement in the presence of friendly or harmless non-primates.

"It is possible that the homosexual behavior of young males is of the same biological significance as their mock combats. It is clearly of value as a defensive measure in both sexes. Homosexual alliances between mature and immature males may possess a defensive value for immature males, since it insures the assistance of an adult defender in the event of an attack." MEYER SOLOMON.

AN EXPERIMENTAL STUDY OF STUTTERING. By John Madison Fletcher. American Journal of Psychology, April, 1914; Vol. XXV, pp. 201-255.

This paper is a dissertation submitted to the faculty of Clark University, Worcester, Mass., in partial fulfilment of the requirements for the degree of Doctor of Philosophy. It is thus from the Psychological Laboratory of Clark University.

This interesting study of Fletcher includes some general remarks in the introduction, the question of differentiation and definition, the physiological aspects (including breathing, vocalization, articulation and accessory movements), psychophysical changes (including volumetric changes, changes in heart rate and galvanic changes), a consideration of the interpretation of the results, the psychological relations (including emotions, attitudes, imagery, responsibility for Aufgabe, psychoanalysis, and association), heredity and conclusions. A valuable bibliography is added, and seven illustrative plates complete the paper.

Fletcher would reserve the word "stammering" for mispronunciation or incorrect speech, this stutter being anatomical (due to malformation of one or more organs of articulation) or developmental (due to incorrect functioning of the organs of articulation resulting in certain cases of immaturity, such as lisping). Stammering, in this sense, is of no psychological interest. The reviewer is in favor of employing the terms "stammering" and "stuttering" synonymously, as is the practice in England and America. The writer (Fletcher) finds that he cannot accept the Freudian interpretation of stuttering which has been offered by a number of different members of that school.

Although the entire paper is of interest and of value to the student of psychopathology, the purposes of this review can best be served by citing the following conclusions of the author: The motor manifestations of stuttering are found to consist of asynergies in the three musculatures of speech—breathing, vocalization and articulation. Certain accessory movements, which tend to become stereotyped in each individual and which consist of tonic and clonic conditions of other muscles not involved in normal speech, accompany these asynergies. The type of asynergy and more particularly of accessory movements differ so widely that it is impossible to state that any special form of breathing, or articulation, or of vocalization is the fundamental factor in stuttering. Disturbances of pulse rate, of blood distribution and in psychogalvanic variations, appearing before, during and after the speaking interval, and the intensity of which varies approximately with the severity of the stuttering, accompany the motor manifestations of stuttering. The essential condition in stuttering is the complex state of mind, the quality rather than the intensity of these feeling states governing the rise of stuttering. Such feeling states as fear, anxiety, dread, shame, embarrassment, in fact, those feelings that tend toward inhibition and repression, are most likely to precede stuttering, and probably operate in a vicious circle as both cause and effect. The permanent condition of nervousness thought to be characteristic of stutterers should be regarded as effect rather than cause. The states of feeling that have to do with the production of stuttering vary in degree from strong emotions to mere attitudes or moods, the latter being often so slight in degree that it is difficult for the subject to report their presence. Stuttering also seems to be affected by the quality of mental imagery, by attention and by association. The affective and emotional experiences associated with the pronunciation of sounds rather than the nature of the sounds themselves determine the rise of stuttering. The author's final remarks are: "Stuttering, therefore, seems to be essentially a mental phenomenon in the sense that it is due to and dependent upon certain variations in mental state. Hence the study of stuttering becomes a specifically psychological problem; and it seems evident that a detailed analysis of all the various aspects of the phenomena of stuttering will furnish important contributions to general psychology." MEYER SOLOMON.



REVIEWS

THE FOUNDATIONS OF CHARACTER. By A. F. Shand. Macmillan and Company, London, 1914. Pp. xxx, 532.

In his preface the author says: "A great difficulty which I have found in the course of my work has been to collect the facts or observations of character on which I had to rely. Such material as I have obtained has been drawn much more from literature than from any other source; and this was inevitable, because psychology has hardly begun to concern itself with these questions." This reproach levelled against psychology rebounds on the author, for throughout the book he shows himself evidently unacquainted with those branches of psychology, notably the medical ones, that have contributed so brilliantly and extensively to the science of characterology. It need hardly be pointed out, further, that to rely on second-hand material, which cannot be checked, analysed, or immediately studied, as the living facts can is a procedure that is open to insuperable objections.

The author repudiates any analytical approach to his problems, preferring what he terms "a concrete and synthetic conception of character," and so "avoids breaking up the forces of character into their elements, and being driven to consider the abstract problem of their mutual relation." His method consists in assuming the existence of these forces, as part of his working hypothesis, and in formulating general laws based on a study of them. As he himself puts it, "It is in the first place a method of discovery rather than of proof;—a method reaching no further than a tentative formulation of laws; for organising the more particular under the more general; for interpreting the generalised observations which every great observer of human nature forms for himself, and by this interpretation making some advance towards their organization. "It follows from this that the book is predominantly descriptive in nature, and in this field it must be said that the author has accomplished great work, one that will be of almost indispensable value to future students of the various emotions.

The book is really a study of the emotions rather than of character, and so we have to pay special attention to what the author has to say concerning them. As is well known, he formulated some years ago a special conception—it can hardly be called a theory—of the emotions, and the most novel part of the present work is the way in which this conception is expounded and elaborated in detail. He rejects the usual sense of the term in which it is taken to express a certain degree of elaboration of the affective aspect of the mind, and adopts a much wider definition in which the conative, affective, and cognitive aspects are all represented. "'Emotion' for us will connote not feeling abstracted from impulse, but feeling with its impulse, and feeling which has essentially a cognitive attitude, however vague, and frequently definite thoughts about its object." He distinguishes, none the less, between an emotion and the entire system to which it belongs. It is the part of the system that is present in consciousness, there being two other parts that are not; namely, the processes connected with it in the body, and the executive part concerned with its outward expression and modes of behaviour. The three main primary emotions are fear, anger, and disgust; other are curiosity, joy, sorrow, self-display, and self-abasement. The four emotional systems of anger, fear, joy and sorrow have an innate connection not only with one another, but also with every other primary system. Most of the book is taken up with a very detailed study of the emotions just enumerated, and in this study the author insists on the functional point of view, constantly enquiring into the dynamic aspects and tendencies of the emotion under consideration. This is perhaps the only respect in which it could be seen that the book was written within the last forty years.

Mr. Shand's view of the relation between the emotions and the instincts has led to an animated controversy with Dr. McDougall, published in the Proceedings of the Aristotelian Society for 1914-1915. According to the latter writer, every emotion has a corresponding instinct, and is merely the affective aspect of this instinct. Mr. Shand, on the contrary, holds that there are vastly more instincts than emotions, that a given instinct may enter into several different emotional systems, and that each emotional system may at various times, and according to its needs, make use of almost any number of different instincts. The reviewer is unable to determine whether these different points of view have any further implications than a difference in the definitions adopted by the two writers. McDougall obviously employs the term instinct in a much more comprehensive and inclusive sense than Shand does.

In the discussion of this interrelation there occurs, by the way, the following suggestive passage: "There are no fears so intense as those which arise in situations from which we cannot escape, where we are forced to remain in contemplation of the threatening events. There is no anger so intense as when the blood boils and all the sudden energy that comes to us cannot vent itself on our antagonist. The arrest of an instinct is that which most frequently excites the emotion connected with it; and therefore we feel the emotion so often before (or after: Reviewer) the instinctive behaviour takes place, rather than along with it." This seems to after-shadow the modern views on intrapsychical conflict and abreaction.

Another conception peculiar to the author, first propounded in 1896, is that regarding the sentiments. Sentiments, in the author's sense, are "those greater systems of the character the function of which is to organize certain of the lesser systems of emotions by imposing on them a common end and subjecting them to a common cause." A constant conflict seems to go on between the organizing tendency of these sentiments and the tendency of the constituent emotions to achieve freedom and autonomous action, a conception quite in harmony with the modern views of "complex-action," although Shand's "sentiments" are far from being synonymous with either "complexes" or "constellations" in our sense. The implications that follow from his conception of the sentiments, and the importance he attaches to it, are well shown by the following interesting passages. "The result of the modification which the systems of the emotions undergo in man, and especially the multiplication of the causes which excite and sustain them, is (1) to make man the most emotional of animals, and (2) to render possible the debasement of his character. For that which is a condition of his progress is also a condition of his decline,—the acquired power of ideas over emotions, and the subsequent power of each indefinitely to sustain the other. Hence the existence of the emotions constitutes a serious danger for him though not for the animals, and the balance which is lost when the emotions are no longer exclusively under the control of those causes which originally excite them can only be replaced by the higher control of the sentiments. There are then three stages in the evolution of emotional systems; the first and primitive, in which they are under the control of the stimuli innately connected with their excitement, undergoing a certain change through individual experience, but not radically altered; the second, in which they become dangerous and independent systems; the third, in which they are organized under the control of the new systems which they are instrumental in developing." "There are three principal stages in the development of character. Its foundations are those primary emotional systems, in which the instincts play at first a more important part than the emotions; in them, and as instrumental to their ends, are found the powers of intelligence and will to which the animal attains. But even in animals there is found, some inter-organization of these systems, or, at least, some balance of their instincts, by which these are fitted to work together as a system for the preservation of their offspring and of themselves. This inter-organization is the basis of those higher and more complex systems which, if not peculiar to man, chiefly characterize him, and which we have called the sentiments, and this is the second stage. But character, if more or less rigid in the animals, is plastic in man: and thus the sentiments come to develop, for their own more perfect organization, systems of self-control, in which the intellect and will rise to a higher level than is possible at the emotional stage, and give rise to those great qualities of character that we name "fortitude," "patience," "steadfastness," "loyalty," and many others, and a relative ethics that is in constant interaction with the ethics of the conscience, which is chiefly imposed upon us through social influences. And this is the third and highest stage in the development of character, and the most plastic, so that it is in constant flux in each of us; and the worth that we ascribe to men in review of their lives, deeper than their outward success or failure, is determined by what they have here accomplished."

We have given some indication of the positive side of the book, one which deserves great praise for both its matter and style. On the negative side we have to remark on the following important omissions. As was mentioned to start with, no acquaintance whatever is shown with either the methods or findings of what may broadly be called medical psychology, the only psychology that has at its disposal the material on which a science of character could be founded. That the important work of Klarges on characterology is not considered may be accounted for by the fact that there is not a single German reference given in the whole book. In the second place, the genetic point of view is almost completely overlooked, one of cardinal importance in such a field. Thirdly, the whole subject of the unconscious is treated as non-existent. It is a complete misnomer to entitle a book on descriptive psychology "The Foundations of Character" when no notice whatever is taken of that region of the mind where the very springs of character take their source, and where the most fundamental features of character are to be found. Last, but not least, is the absence of any study of the sexual instinct and emotions, surely of cardinal importance for any investigation of character. Apart from the general contributions made by this instinct to character, one thinks of such clearly-cut pictures as the masochistic, voyeur, and anal types of character.

An inadequate index closes an unsatisfactory, though in many respects valuable, book. We note no fewer than twelve references to "Seneca," but none to "sex" or "shame;" sixteen to Hudson, but none to Freud, Janet, Prince, Adler, or Klarges. ERNEST JONES.



AN INTRODUCTION TO SOCIAL PSYCHOLOGY. By William McDougall. Published by John W. Luce & Co., Boston, 1910.

Although this book was published a few years ago, nevertheless it seems sufficiently important to the reviewer to have it brought prominently before psychopathologists.

In the introduction McDougall reminds us that the instincts are the prime movers, the mental forces, the sources of energy, the springs of human action, the impulses and motives which determine the goals and course of all human activity, mental and physical. These instincts, being the fundamental elements of our constitution, must be clearly defined, and their history in the individual and the race determined. For this purpose, comparative and evolutionary psychology is necessary, for the life of the emotions and the play of motives in mental life are the least susceptible of introspective observation and description. "The old psychologising," says McDougall, "was like playing 'Hamlet' with the Prince of Denmark left out, or like describing steam-engines while ignoring the fact of the presence and fundamental role of the fire or other sources of heat." A knowledge of the constitution of the mind of man is a prerequisite for any understanding of the life of society in any or all of its many aspects. And this applies to psychopathology. I venture to assert that had certain individuals read and digested a book of this sort it might have been a prophylactic against an exclusively sexual conception of human conduct.

The work is divided into two sections. Section one deals with the mental characteristics of man of primary importance for his life in society, while section two is concerned with the operation of the primary tendencies of the human mind in the life of societies. The successive chapters of the first section take up in order the following questions: the nature of instincts and their place in the constitution of the mind, the principal instincts and the primary emotions of man; some general or non-specific innate tendencies, the nature of the sentiments and the constitution of some of the complex emotions; the development of the sentiments; the growth of self-consciousness and of the self regarding sentiment; the advance to the higher plane of social conduct; and volition. In the second section the author considers the reproductive and the parental instincts, the instinct of pugnacity, the gregarious instinct, the instincts through which religious conceptions affect social life, the instincts of acquisition and construction, and there is a final chapter on imitation, play and habit.

McDougall dividends the instincts into specific tendencies or instincts and general or non-specific tendencies. He calls attention to the abuse of the term "instincts" and himself defines an instinct as an inherited or innate psychophysical disposition which has the three aspects of all mental processes: the cognitive, the affective and the conative—or a knowing of some object or thing, a feeling in regard to it, and a striving towards or away from that object. "The continued obstruction of instinctive striving is always accompanied by painful feeling, its successful progress towards its end by pleasurable feeling, and the achievement of its end by a pleasurable sense of satisfaction." He reminds us that "the emotional excitement, with the accompanying nervous activities of the central part of the disposition, is the only part of the total instinctive process that retains its specific character and remains common to all individuals and all situations in which the instinct is excited." We may experience the emotional excitement and the impulse to the appropriate movements of an instinct or the re-excitement of an instinctive reaction in its affective and conative aspects without the reproduction of the original idea which led to its excitation. Pleasure and pain but serve to guide these impulses or instincts in their choice of means towards these ends.

One of McDougall's important conclusions is that "each of the principal instincts conditions some one kind of emotional excitement whose quality is specific or peculiar to it, and the emotional excitement of specific quality that is the affective aspect of the operation of any one of the principal instincts may be called a primary emotion." This is McDougall's definition of emotion.

McDougall then takes up for discussion and analysis the principal instincts and the primary emotions of man which include the following: the instinct of flight and the emotion of fear; the instinct of repulsion and the emotion of disgust; the instinct of curiosity and the emotion of wonder; the instinct of pugnacity and the emotion of anger; the instincts of self-abasement (or subjection) and of self-assertion (or self-display) and the emotions of subjection and elation (or negative and positive self-feeling); the parental instinct and the tender emotion, and such other instincts of less well-defined emotional tendencies as the instinct of reproduction (with sexual jealousy and female coyness), the gregarious instinct, the instincts of acquisition and construction; and the minor instincts of crawling, walking, rest and sleep. McDougall denies the existence of such instincts as those of religion, imitation, sympathy and play.

There then follows a consideration of some general or nonspecific innate tendencies or pseudo-instincts which are not specific instincts with special accompanying emotions, and this leads to the analysis of sympathy or the sympathetic induction of emotion, suggestion and suggestibility, imitation, play, habit, disposition and temperament.

The sentiments are now taken up for analysis and definition. A sentiment, according to McDougall, who accepts Shand's definition, is an organized system of emotional tendencies or dispositions centred about the idea of some object. Among the complex emotions not necessarily implying the existence of sentiments McDougall includes admiration, awe and reverence, gratitude, scorn, contempt and loathing, and envy. Among the complex emotions implying the existence of sentiments he considers reproach, anxiety, jealousy, vengeful emotion, resentment, shame, joy, sorrow and pity, happiness, surprise. The nature and the constitution of the sentiments and the complex emotions comes in for very illuminating analysis. The chapters on the growth of self-consciousness and of the self-regarding sentiment, the advance to the higher plane of social conduct, and volition are to be considered among the best chapters of this very excellent work. The discussion and analysis is very penetrating and clear. It is well worth while presenting the following abstract of the chapter on volition: All impulses, desires and aversions, motives or conations are of one of two classes: (1) from the excitement of some innate disposition or instinct; and (2) from excitement of dispositions acquired during the life of the individual by differentiation from the innate dispositions, under the guidance of pleasure and pain. When in the conflict of two motives the will is thrown on the side of one of them and we make a volitional decision, we in some way add to the energy with which the idea of the one desired end maintains itself in opposition to its rival. The idea of the self, or self-consciousness, is able to play its great role in volition only in virtue of the self-regarding sentiment. The conations, the desires and aversions, arising within this self-regarding sentiment are the motive forces which, adding themselves to the weaker ideal motive in the case of moral effort, enable it to win the mastery over some stronger, coarser desire of our primitive animal nature and to banish from consciousness the idea of the end of this desire.

Volition, therefore, following McDougall, may be defined as the supporting or re-enforcing of a desire or conation by the cooperation of an impulse excited within the system of the self-regarding sentiment. The sentiment of self-control is the master sentiment for volition and especially for resolution. It is a special development of the self-regarding sentiment. The source of the additional motive power, which in the moral effort of volition is thrown upon the side of the weaker, more ideal impulse, is ultimately to be found in that instinct of self-display or self-assertion whose affective aspect is the emotion of positive self-feeling. These remarks are given more or less verbatim.

McDougall next analyzes strength of character which he differentiates from disposition and temperament which are innate. In section two, as stated previously, the author takes up for separate and more minute analysis the family (the reproductive and the parental) instincts, the instinct of pugnacity, the gregarious instinct, the instinctive bases of religion, and the instincts of acquisition and construction. Imitation, play and habit receive separate treatment in the final chapter.

The reviewer can freely recommend this book as one of the best, if not the best book of this sort that has come into his hands. His personal opinion is that it is the best. McDougall presents us with an acceptable and clean-cut classification of the instincts, emotions and sentiments, he accurately defines these terms, he gives the analysis and constitution of these instincts, emotions and sentiments, and develops the motive sources of human conduct. He adopts many original and novel standpoints. He is an independent thinker. He has here presented us with a book which, because of its clearness and its frank meeting of the problems, is of the utmost value to the psychopathologist and the psychiatrist. In fact the contents of just such a work as this should be the first lesson of every worker in this field. In this way only can he really begin to understand human conduct.

This work should find its place in the forefront of those books which should be read and digested by all workers in any of the social sciences.

For the reviewer it has been a genuine pleasure to read and to review this book and he most heartily recommends it to the reader of these pages. MEYER SOLOMON.



BOOKS RECEIVED

THE THEORY OF PSYCHOANALYSIS. By C. G. Jung. Pp. 133 and Index. Nervous and Mental Diseases Monograph Series, No. 19, 1915, $1.50.

PSYCHOLOGY AND PARENTHOOD. By H. Addington Bruce. Pp. IX plus 293. Dodd, Mead & Co., 1915. $1.25 net.

THE INDIVIDUAL DELINQUENT. By William Healy. Pp. XV plus 830. Little, Brown & Co., 1915. $5.00 net.

HUMAN MOTIVES. By J. J. Putnam. Pp. XVII plus 179. Little, Brown & Co., 1915. $1.00 net.



THE JOURNAL OF ABNORMAL PSYCHOLOGY

CONSTRUCTIVE DELUSIONS[*]

[*] Read at the sixth annual meeting of the American Psychopathological Association, May 5, 1915, New York City.

JOHN T. MACCURDY, M. D. Psychiatric Institute, Ward's Island

and

WALTER L. TREADWAY, M. D. Assistant Surgeon, U. S. Public Health Service

MOST psychiatrists state or tacitly assume that dementia praecox is a disease of a steadily progressive nature, where the first symptom of dementia is a signal for relentless degradation of the patient's mental capacity except in the sphere of the more mechanical, intellectual functions. Yet the experience of every institutional physician denies the universality of this deterioration, and the statistics in any good text book demonstrate that many cases are "chronic" rather than "deteriorating." Woodman[1] has made a careful study of 144 such chronic cases, and shows what a surprisingly large proportion of these develop a good adaptation to the artificial environment of the institution. So far as we know, however, no one has attempted to formulate any definite features of onset which could be taken as a guide in determining the gravity of the mental derangement. In fact Bleuler states categorically that "up to the present no correlation has been discovered between the symptoms of onset and the gravity of the outcome." Kraepelin has split off from dementia praecox a separate psychosis—Paraphrenia systematica—which he timidly defends as a clinical entity apparently because the course is a long one and the deterioration less marked than in dementia praecox. But he gives us no concise prognostic data; in fact one feels on reading his paper that the diagnosis must be made post hoc. This problem is manifestly of equal importance from the social and the scientific standpoint: until we can predict the outcome our treatment must be empiric and palliative; we confess ourselves ignorant of the disease process if we cannot make a prognosis.

[1] R. C. Woodman, N. Y. State Hospital Bulletin, Vol. II, No. 2, 1909.

It is possible to make certain a priori speculations as to prognostic criteria based on classification and what that implies. We know that pure paranoia is not a deteriorating psychosis—that it does not necessarily preclude the possibility of considerable social usefulness—and that it grades off almost imperceptibly into dementia praecox. The features differentiating these two diseases should therefore supply us with data for determining the prognosis. A case undoubtedly, praecox, which shows markedly the differential features of paranoia, should have a proportionately better outlook. In a vague way our common sense uses this standard when it makes us "feel" that the case will have a long course which shows a relatively well retained personality in conjunction with praecox symptoms. But "feelings" are hardly objective criteria. What symptoms may we make use of? We may say that the praecox patient as opposed to the paranoia has a poverty or inappropriateness of affect, a scattering of thought and a lack of systematization in his delusions. The weakness of will on which Kraepelin lays so much stress may be included, though that can probably be derived from the scattering of thought. What of these symptoms may be analyzed for our purpose? Affect changes and dissociation in the stream of thought are themselves signs of the deterioration we wish to predict; to make use of them we should have at hand some theory as to the relation between their quality and quantity, and that we have not. There remains the content of the psychosis, a definitely objective material with which to work. This is naturally a big problem—almost as wide as insanity itself—and one brief communication cannot pretend to solve it. What we wish to do is merely to put forward tentatively the claim of one type of delusion formation to prognostic value.

Now if delusions are to be an index to deterioration they must in some way hold a mirror to the changes in the personality, repeat them or prefigure them. If we generalize our conception of functional dementia, we can say that one of its most striking features is a destruction of the faculty of appropriate reaction, a loss of what one may term the sense of reality. The patient in direct proportion to the degree of his dementia loses his capacity to recognize the reality of his environment or his relationship to it, and builds up more and more a world of his own in which he lives untroubled by the demands of adaptation. No one who has ever argued with a paranoic will forget how keen a sense of reality he may retain, how logical his arguments are, and how reasonable his delusions appear, if only some one point be granted. With the praecox, however, the opposite impression may be quite as striking. His delusions are bizarre, inconsistent, kaleidoscopic; he has no logical explanation and cannot even state them consecutively. And all gradations from pure paranoia to dementia praecox seem to have corresponding losses in the sense of reality as embodied in delusions.

May we not hope to find in the content of the psychosis some objective criterion as to the degree in which the sense of reality is lost, with all that it implies?

But what takes the place of the sense of reality or what causes it to go? With what tendency of the psychotic individual is it in conflict? The answer is a psychological truism—the indulgence in fancies. Imagination, of course, is essential to every human being, no purposeful action can be instituted without its first being carried out in imagination. Phantastic thinking begins when the subject fails to apply the test of reality to his mental image and exclude it if it be not adapted to realization. If environment or internal inhibitions prevent this realization, however, the craving: lying back of the fancy must be diverted to a more practical channel—the normal solution—or the fancy must persist in spite of its impracticability. This latter process is the germ of the psychosis. But not its development. A certain compromise may be reached—he who digs for gold in his back-yard is not so crazy as he who reaches out his hand for the moon. Nor is the paranoic who chooses to put his interpretation on the surliness of his employer as far estranged from reality as the praecox who recognizes his employer in the person of the physician. The content of the psychosis may then express the relative strength of the two antagonistic factors, sense of reality and fancy, the two factors whose relative importance decide the issue for sanity or insanity.

It is easier to imagine than to act, so no human being is free of this tendency. But what does the normal man do? He diverts these thoughts into channels where fancy has a legitimate place—he writes romances; he imagines himself using an instrument to talk with his friend miles away and invents the telephone; he imagines a better society than the one which galls him, and writes a "Utopia"; above all he theorizes and speculates. According to his age or ability these speculations give us alchemy or chemistry, astrology or astronomy, magic or religion, spiritism or psychology, the were-wolf or psycho-analysis, phrenology or psychiatry, and so on. Now three generalizations can be made about these primitive or elaborated philosophizings: first, they all represent a constructive tendency; second, the degree to which this constructive tendency is exhibited is historically a measure of the cultural development of any age, an index of the development of the sense of reality of the time, that is, the particular speculation is not only accepted as reasonable but has its practical application for the period; and third, the more primitive forms of these speculations are represented in the delusions of insane, particularly dementia praecox, patients. Following a suggestion of Dr. Hoch we have termed these ideas "constructive delusions." As they correspond to what was historically a compromise between reality and phantasy, they should represent a corresponding mildness or severity in the psychosis where they appear. Our observations—far from being extensive—have so far demonstrated this that we feel justified in offering the hypothesis that when such delusions are present one can base a mild prognosis on their presence with a rather specific relationship between the crudity of construction and the degree of deterioration. It must be borne in mind, however, that we make no claim as to the invariable presence of such delusions when marked deterioration does not take place. We hope only to show that when present this particular form of content may constitute a valuable prognostic guide, as it represents the degree to which the patient has gone in recapitulating the history of his civilization.

It should be understood that we are not describing highly unusual cases; many such have been published. A highly typical one is given by Freud in his analysis of the Schreber case.[2] In this extremely stimulating paper Freud puts forward the claim that all delusions are an attempt at regaining health on the part of the psyche. From a broad psychological standpoint, this is undoubtedly true but the generalization is too wide to be of any practical psychiatric value. Moreover, by choosing for analysis a case which was neither dementia praecox nor paranoia but a combination of the two, he reaches conclusions which are valuable additions to our knowledge of psychotic processes but merely confuse the issue as to the specific mechanisms of paranoia and dementia praecox. In Schreber a profound psychotic reaction corresponded to crude formulations of his fancies, whereas, when he built these ideas into constructive speculations, he became relatively sane and an efficient citizen. If Freud had emphasized the point that this later formulation was more than a vehicle for the cruder thoughts, that it contained components which were potentially of social value, which implied a broader contact with the world—had he done this—then the present paper would be superfluous.

[2] Psychoanalytische Bemerkungen uber einen autobiographischen beschrieben Fall von Paranoia (Dementia paranoides). Jahrb. f. psychoanalyt. u. psychopath. Forschungen, Jahrg. III.



The first case we wish to present, John McM., is at present thirty-six years of age, unmarried, a Catholic. For at least nine years he has been objectively psychotic, though, according to his own account his delusional habit of thought began seventeen years ago. He had little education but made the most of it and has read widely (for one of his station) on such topics as socialism. He was always somewhat distant and did not make friends easily. From early childhood he was antagonistic towards his father and brother and, since his mother's death six years ago, to whom he was strongly attached, towards an aunt as well. He has struck both his father and his aunt. His antagonism towards his father is of great importance as a determinant for his later symptoms. When young he feared him, as he grew older disputed his authority and, according to the father, always disobeyed him. He was always shy with women and, as we shall see, his first conflict in the sexual sphere was solved by a psychotic reaction. Once an efficient salesman, for the past nine years he has drifted from one position to another. As he says himself, he lost ambition after he decided not to get married, and concluded he would not attempt to gain worldly possessions, but merely enough to subsist on. His early life showed not so much tendency towards elation and depression as towards imaginative thinking with a leaning towards day-dreaming and "mysteries." Of late years his reading has been confined to sexual topics, as discussed by various quacks, astrology, phrenology, Christian Science, and religion. Although he said he discovered God for himself he never gave up the Catholic religion. Gradually his energy has been so engrossed by these interests that he lost position after position as a result of continually talking of his ideas to his fellow workers or employers. This tendency eventually led to his commitment, but as long ago as 1906 a physician said he was insane. For the past six years he has been cross, stubborn and self-willed so that none of family dared to speak to him. He even left home and took a furnished room by himself. In spite of this evident anti-social tendency he speaks of himself as having been filled during this period with a great hope; he has been looking into the future and content that he will reach the goal and sees happiness in the future. For some months he had talked much of the world coming to an end and said that those who had money should spend it as it would soon do them no good. He wanted every one to divide his money with him as, he said, everything belonged to God. Many people were against him and he wrote letters about this to various officers. It was when he showed some of these to an assemblyman that he was advised to go to Observation Pavilion.

When he arrived at Manhattan State Hospital he was quiet and agreeable, cooperated readily with his examination and seemed to take his incarceration as a matter of course, though he has always had mild arguments to prove that he should be allowed parole. A certain degree of deterioration is evidenced by his failure to make much of an effort in this direction, although such effort would be immediately successful. In his manner he was quiet, occasionally somewhat affected and when talking of his ideas was apt to assume an expression bordering on ecstasy. At no time did he show an inappropriate affect or any evidence of scattering or flight. He could talk quite objectively of his idea. He had had only one halucinatory experience and even it should, perhaps, be called merely an illusion. "On the 14th of March, 1912," he said "I came face to face with God Almighty. He spoke in a Jewish dialect and was dressed as a carpenter." The patient was in the Cathedral at the time and that night he had a vision of this man, though this may have been just a dream. He also heard Bishop H. speak of the man who had come to prepare the world for the second coming of Christ. The bishop looked at this patient which meant that he, the patient, was the man.

Before detailing his ideas it may be well to outline their general tendency. In his psychosis he succeeded in fulfilling the wish of the Persian enemy of reality:

"Ah, Love, could you and I with Him conspire To grasp this sorry scheme of things entire, Would we not shatter it to bits and then Remould it nearer to the heart's desire."

By the simple expedient of translating his interest from this world to that of spirits he built up a new Heaven and a new Earth, where he was supreme and his chief enemy, his father, was subject to him. Beginning with astrology he found that his father's sign and his showed different characters, the father's strong in earthly affairs, while the patient's showed preeminence in spiritual qualities. Passing from astrology to the Heavens, he discovered that his father had been Jehovah, while he had been Christ. There had been a struggle between them in which the father had been temporarily successful. But when his father's spirit had entered into a body, he had become subject to Christ. In the Heaven to come, Jehovah was to give way to precedence to Christ, was to enjoy with the Virgin Mary, his mother, a union of love, as much more fervid as it was to be free from carnal features. In extolling this life of the spirit the patient excluded that physical problem which had caused him so much trouble— the adult sexual demand which, in the form of marriage he could not agree to meet nor yet to put out of his mind. At the same time this religious formulation gave him a comfortable ascendancy over his hated rival, his father. But it gives him more than this: he has a mission, he says, he must prepare the way for the new world, the new heaven. This is an objective interest and it is that, we think, which has a causal connexion with his mild degree of deterioration— for he has been what we must regard as a praecox for many years and yet has lost so little of his personality that to a layman he would certainly be regarded as little more than a crank. Where his system fails of having a sane outlet it is of course in the fact that his prophecy has little to do with anything of advantage to others. It is merely a cover for self-glorification.

At nineteen he talked to his friend W. of sexual matters, and, being troubled with constipation and "rheumatism" at the time, he asked the physician who was treating him as to whether he should indulge himself sexually. The physician told him to, but he worried over this advice and went to a priest, who said for him to get married. This he did not wish to do, and so turned his attention to astrology and phrenology, the other subjects which his friend talked of. That this was only a cover for his original sex problem is shown by his conclusions: that he had a weakness in amativeness—"the faculty of sexual power," his "concentration" on sexual matters was poor. "If I had more amativeness there would be trouble; I am glad I haven't so much. I was always more of a companion to my mother, and when I wasn't with her I went to the theatre with W." He and his father, he learned, had strong faculties of destructiveness; the patient, however, could control his by reasoning; his reasoning was so strong that he could even control his father and settle disputes between father and mother. Phrenology also taught him his intellectual superiority to his father in other ways.

From phrenology he learned there was a time to be born; from this he passed to astrology. His father had arranged that he should be born in the sign of Virgo, which guaranteed his truthfulness and obedience to his father. He explained this by speaking of Adam and Eve disobeying God, from whose sexual intercourse all evils sprang. Manifestly, then, it was his father's arrangement that he should have to abstain from sexual intercourse.

His father was born in the sign Gemini; this is a fighting sign; the father selected this sign himself, by his great fighting power; the sign is not a spiritual one but a worldly one, and shows avarice in great grasping of worldly things. He never thought that his father was so great, until three or four years ago. He wrote a minister, asking him what became of God the Father; he asked another man about religion, and was told how obedient Christ was to his foster-father Joseph. He thought of how disobedient he was to his father, and then decided that his father was the God, the Father, and in the Kingdom of Heaven he was called Jehovah. (Here he identifies himself with Christ). He says about this "I tried to reason myself away from it many times, but was finally convinced"—The father came to this world as John; Jehovah was the patient's father in the other world. In the other world he had a falling out with the father, and now the father has that revenge in his soul. He had some kind of a falling out, a fight; his father, then Jehovah, ruled the third Heaven; one of the twelve, which he says is about the earth, the earth making the thirteenth; this formulation he derived from astrology: the first Heaven Aries, the second Taurus, and the third Gemini, etc.

His father was born in the sign of Gemini, whose symbol is the twins, which means a duel; and people born in this sign have a dual nature; the father had a dual nature; and when the father ruled in the third Heaven as Jehovah, a duel took place between the patient and the father, and the son's spirit was separated from a body and roamed about. After a time the patient's spirit got back into the Kingdom by worrying the father, but he was never admitted in the form of a body. The father and son while still in a body could both create man and woman; the patient then knew all about creation, and was endowed with all the powers the father possessed, and helped the father to build up that kingdom; but when the patient's spirit was separated from the body his powers became less, so that he could not create a human being. His physical personality was weakened by this, but the spirit of love was increased; the father had carried revenge in his soul since then. The patient was never a ruler of a Heaven, but "I was my father's son—I was next to him—the sons never become rulers unless they win out;" the patient's spirit remained out of his body until he was born into this world; the patient's father came to this world as John, and married Mary McE.; when the father came on earth he placed himself under the jurisdiction of Christ this came about automatically when the father was born.

In the next Heaven the patient will be on the same plane as Christ, but perhaps in a lesser degree. There can be only one father, and he will be under Christ's jurisdiction. Christ will be supreme. He is part of the Trinity; there is one God as three united persons; they agree on everything; Father, Son, and Holy Ghost. These will be possessed of equal powers, but one will be looked upon as the father, and another Son, and another the Holy Ghost. In the new Heaven he will have equal rights and powers with the father.

After the father married two children were born, brothers, the younger being the patient. He says about this that he was born in the usual way, "The spirit entered the womb of the mother from outside, and from the seed of the father, and I was born by the will of the father." Christ was born of Mary through the will of Jehovah—simply the spirit entered the womb and the word was made flesh. When the father lived as Jehovah he created Adam and Eve, "I was simply my father's son and son of Jehovah—perhaps my name was John, which had some great meaning"—Jehovah was the greatest spirit in the universe, but is not now, for when he was born he placed himself under the jurisdiction of Christ; his name is now John, the patient's father. Christ was selected to be the son of Jehovah; he was selected by Jehovah because Jehovah had a great personality; his father arranged all of this, and he even selected the sign that the patient was to be born in. When asked who he is, he said, "I am who I am—When I was positive that I am who I claim to be."

When the patient's spirit was thrown out of the body, it caused Adam and Eve to be created—Eve was a great spirit in the third heaven—the father thought that if he could create two persons, and they were congenial to each other, that Adam's soul would be increased or developed by being in company with Eve. When Adam and Eve were created they were not to have sexual intercourse; they were merely to come in contact by spoken words—love could exist without intercourse; it started all the trouble. To Adam and Eve two sons were born, and the brotherly love that existed turned to fire and hatred. They probably became jealous of each other, and so one deceived the other. At one time he said that perhaps the mother made more over one than she did the other; again, perhaps father and mother might have favored one more than the other; hence jealousy arose; his brother was born in the sign of Capricorn, which ordinarily is a sign which is congenial to Virgo; his brother, however, is a crank and not congenial; the brother is jealous of the patient, because the mother favored the patient.

He did not take his mother's death to heart, as he had expected for two years that she would die. His aunt said that he told her it was a good thing the mother was dead. He says that in the other heaven, Jehovah's wife was Martha, a sister of the Virgin Mary. In this life she was Mary; the father may have had many wives in the third heaven; perhaps his mother's sisters were his wives, as they seem attracted to him. His mother's soul existed before birth, lived in Jerusalem in the time of Christ, and was Mary's sister. His mother was born in the eighth sign and could be trusted with great secrets; his mother kept things to herself. She was both feminine and masculine; that is, she was strong and sociable. In the sign in which he was born they have great spiritual conception, keen, searching and penetrating vision; The symbol is the Virgin, and pride makes them more feminine than masculine, and they are sensitive; he at one time was more feminine than now, which was due to his sensitiveness. The sign of Virgo is the mid-heaven, where love is more intent; there they understand each other, and there is no disagreement. "The magnet of the male and the magnet of the female are attracted, and they agree with each other in words spoken; this is true love, like that which existed between Christ and the Virgin Mother; the Virgin Mother was born in that sign—there's where she got her name."

When he dies the soul of his mother will enter heaven.

In heaven Christ is to raise his mother's soul from purgatory, and she will become the Virgin Mary. A spirit rapping in the house, which began shortly after his mother's death, is her spirit and his guardian angel.

Jehovah was jealous of Christ as a greater spirit, so had him crucified. Joseph was also jealous of Christ because Mary loved him more.

Further ramifications of his ideas are the cruder conceptions that semen is the equivalent of thought, and that thoughts of women cause him to have nocturnal emissions. Semen comes from food; to the sacrament he gives a definitely sexual significance, and it was following communion that he realized that he was Christ.

At one time he thought he could live, and that he could marry a girl and not have sexual intercourse; because if he got married and had sexual love trouble would arise. He was convinced by what he saw of his friends and every one else he knew, his aunt, his mother and father, that they did not get along well. The Divine Power knowing that this could not be in this world, broke the affections he had for this girl; and he concluded he would never get married. From a worldly point of view he knew that he was a failure; he had failed in all his business. But he did not care for worldly things. When he reached this point he knew that he had a mission to perform, and began to write and preach religion to people who were qualified to understand. He wrote many letters, all dealing with religion, saying that he had to get things ready for the second coming of Christ; that he was the successor of Christ; and that he was to get things in readiness for the union of religion; when there should be one Shepherd and one Fold.