Case 2. The next case differs from the first in that the emphasis in the ideas was laid more on spiritistic and astrological than on religious lines. Another difference in the problems solved by the psychosis is that the personality of the patient was not incompatible with an outlet to the adult sexual demand through the channel of prostitution but a basic similarity lies in the fact that the delusions center around attachment to her father, again a family situation. The patient is an unmarried woman now forty-seven years of age, of whose early life we know nothing. She had applied for aid to a charity organization who, becoming suspicious on the report of a police captain that the woman was a street walker, sent her to the Cornell Psychopathological Clinic for mental examination. She had some petty complaints of not being fed properly where she lived, of things not being clean there and of the women around her being queer. Then she launched spontaneously into her delusional story, needing very few questions to stimulate a fairly complete recital. Throughout an her talk she showed no abnormalities in her train of thought. She talked in a quiet way of her "knowledge" but with enthusiasm, smiling frequently but more in a satisfied or sociable way than with any silly expression. There was not a trace of ecstasy in her expression. It would have been hard to say definitely that she had any inappropriate affect. At a later interview, however, she admitted recent acts of prostitution with no embarrassment whatever.

Her psychotic experiences began some ten years ago when she entered into illicit relations with an elderly married man R., in the South. A year before she had met a "mastermind" who told her that she would never be seen in the right light. Everything came as he predicted. Her lover soon lost his sexual capacity and so began to show his power by keeping her under his control but still at arm's length. But she has fooled him for now she has his power. This power was in the form of "influences." When they worked on her she would have a throbbing like a typewriter in her head, and would then be forced to some act. Such acts included affairs with various men and through R.'s influences she also lost many positions. For some time she tried to get him to support her, as it was his "influences" that had ruined her, but he merely called her a blackmailer and had her put out of his office. Soon, however, as the result of visions she learned that her father (who is dead) had become Christ in the other world. It was all his influence that had been acting on her through the medium of R. From Astrology she learned that she had been born under two planets—Jupiter, Influence; and Neptune, Spiritual. Her father's sign was Neptune and he was therefore a spiritual man. Shortly after his death, she had a vision of him floating up towards the moon and then she knew that he was joining her ethereally. She had visions of this Father-Christ.

When we turn to the constructive side of these delusions we find that she regards all her experiences as having been designed by the Father-Christ to give her training, training that would increase her psychic powers. For instance, she said part of her training had been frequent accusations of dishonor with men she never knew. She had to acquit herself of these charges; thus she gained power. Then she found that she did not even need to expostulate. She could defy them, defy the whole world. As soon as she knew she was not guilty she felt power. Things she WAS guilty of, she knew were right for her, because she gained power by these experiences. This was because through them she learned spiritistic facts and knowledge is power. According to her system one mind acts over another by greater penetrating power, though the recipient must be powerful too. Sometimes she found that she had to be reduced by lack of food or other privation to receive influence. Naturally, too, she could communicate with the dead and had many examples of this power to offer. She had learned, also, about the influence of the planets over the human brain and how to learn of conditions which exist for any person—what he should avoid and what to accept. As the patient was only seen for little over an hour the details of her system of ideas could not be obtained but she assured the examiner that she never could tell all she knows about the spirit world. In general, however, she said that all her knowledge was useful to her and she could give it to others individually without effort to herself but that she had no way of giving it directly to the world. If she had a rest and got well connected socially perhaps she might be able to do it. People who had met her casually told her that she had done them good. But she could never tell them about having seen Christ, they don't understand. The egoism of her faith is shown by her statement that, having met Christ in practical life, she had no more use for any church or ritual. Her great hope was for the future. When she passed away, she was to develop her powers more and when reincarnated was to come back with the big minds of the world. Once she had a vision of herself in some high trees and the "Master mind" told her what it meant. In the future she would have a great mind. She has it now, but the circumstances of her life are such that it is not recognized.

The essential feature of this case, for our purpose, is that we have in this woman a paranoid psychosis of a definitely dementia praecox type which after ten years has shown only suggestive signs of deterioration in her lack of purpose in work, and her dulling in emotional response. This failure to deteriorate seems to stand in definite relationship to her system of ideas. That these have a constructive tendency is shown by the translation of her cruder thoughts into the setting of the occult with the suggestion of propaganda and in their pragmatic value. With her "new religion" she has provided herself with an argument in favor of a life of desultory prostitution and general vagabondage. She was advised to go to a hospital but refused, though she will certainly be committed soon, as it is inevitable that she will run counter to society in some way.

Such cases as these first two are familiar to you all and these have been chosen for this paper practically at random. Any large hospital will provide dozens of similar history whose clinical pictures would serve as well as what we have given. The next two cases represent two special types of psychoses: one a chronic manic and the other a definite praecox with recurrent attacks. Any institutional physician is familiar with the chronically elated patient, who has become a hospital character— a good worker often who seems to be sufficiently repaid for his toil by the privilege of stopping the passerby to expound his ideas. Such a case is usually diagnosed as a chronic manic or a dementia praecox, according to the taste of the examiner.

Numerous works have demonstrated how the symbolism of the modern fraternal organization has grown out of alchemy, mysticism and rosicrucianism. Some centuries ago these symbols were charged with a literal meaning. If a man, however, in the 20th century attaches a similar significance to these symbols he is rightly adjudged insane. For instance, no one in a modern civilization can retain his mental balance and believe in a literal, physical rebirth. The patient whose case we shall now briefly recite had done this. He was observed at only one set interview because it was found that a few questions, apparently innocent, led to the awakening of some cruder ideas to which he reacted rather strongly with the statement that the physician was accusing him of harboring murderous designs which were, as a matter of fact, not even remotely suggested. The patient C. G., is a Hebrew, married, age sixty-one. When forty he had an attack of excitement lasting a few weeks. He was admitted to the Manhattan State Hospital in October 1899 and remained till April 14, 1900 with a similar attack. He was readmitted in April 1901 again in an excitement and has remained there ever since. It is claimed that these attacks were all preceded by a spree. The records of these admissions state that he was excited for some years, apparently with exacerbations, during which he is frequently noted as being delusional and hallucinating. No content is noted so that we cannot give the development of his ideas. He does not hallucinate now. All we know is that for five or six years he was a rather intractable patient, who worked intermittently but that of more recent years he has sufficiently adapted himself to the hospital environment to be granted ground parole which he uses largely to do a considerable amount of quite useful work. Any one who has once talked to him is saluted from a distance with the words—"Pleased to meet you, Doctor!" "Five fingers up!" or "Da liegt der schwarze Hund begraben!" All this is followed by an elated volubility. When asked what "Pleased to meet you!" meant, he said that was the password for entrance to the "Fellowship Lodge" of a certain fraternal order. He produced a match box with the insignia on it of a Grade in the Lodge. With this match box, once off Ward's Island, he insisted that it could get him his bread all the world over and hundreds of friends. He would never have been committed had he not been drunk and forgotten to make use of his signs. The world belongs to the Fellowship of Men. He spoke of his wife's ill treatment of him and then went on to "I am married to the American flag and it will go to the grave with me." This referred, he explained, to joining the red, white and blue lodge. "Five fingers up!" was shaking hands, the clasped hands on his match box. These hands, he said, were those of Moses and the Lord, for Moses was a "Fellowman," which is like the Fellowship of the Father, Son, and Holy Ghost. However, he went on to say that Moses, the Trinity and God were all a dream; Israel and the High Grade are real—the High Grade is the Lord. G. stands for God and he belongs to the G Lodge, therefore he belongs to God's Lodge. But he has a uniform of the High Grade at home, so he must be the High Grade himself. By using the symbols of his order in this way he disposes of his wife who has not treated him well, identifies himself with God (while he abolishes the regular God) and endows himself with the supremest power in a Lodge which he regards as omnipotent in the world. Another group of his ideas refer to his race. He has been put on Ward's Island as a result of the great struggle between Christians and Israel. But Israelites are the head of the Fellowship Lodge, so all Christians must follow him, the patient.

This is the explanation of "Da liegt der schwarze Hund begraben!" He is like a dog in the house and he is considered to be nobody, a corpse on the floor. But he really lies here buried—the missing man of the tribe. Once off Ward's Island, therefore, he will come to life as head of Israel, and head of the omnipotent Lodge. Patiently, hopefully, he awaits rebirth. The egoism of these ideas is obvious. Wherein do the constructive factors lie? Simply in this: this expansiveness could easily be formulated directly. But he does not do so. His ideas include two objective and potentially altruistic interests his lodge and his race. He is interested in them; in fact one can probably say that it is just in so far as he is insane that the selfish determination for these interests become manifest.

We have also studied two cases of recurring excitements in patients one of whom was an evident praecox, the other of doubtful classification. Both showed queer behavior during their intervals with mild indications of their ideas which gained freer expression in their attacks. These episodes showed, of course, markedly a typical feature in a tremendous amount of queer behavior and more excitement than true elation. As there was nothing in their ideas essentially different in principle from the cases already quoted, they need not be further detailed.

The last case, R. E. O'M., is one of no less interest from a formal standpoint than from a psychological one, while the trend presented is so copious that it can well serve as a resume of the cases we have just recited. He is now an unmarried man of thirty-three, and although he was diagnosed dementia praecox ten years ago is now earning $1200 year as a stenographer in the government service. His father was an Irishman banished from Great Britain because of his political agitations. His mother was a French woman of Huguenot extraction who died of cancer before the patient reached his teens but to whom he was greatly attached. He has a sister two years older than himself, given to hysteric attacks, for whom his love is "Platonic," to use his own term. Although of more than normal intellectual vigor, judging by his success in school work, he probably always had a psychotic tendency. At seven or eight he saw a vision of God in the clouds; at puberty he masturbated considerably and used to stand before the mirror and "hypnotize" himself. In the fall of 1903 (then twenty-one) he was staying at a summer hotel where he met a girl who made love to him, when he began to have frequent emissions. Being caught together out in a storm, in an effort to protect her his hand found its way to her hair. He was greatly upset. On returning to the hotel he endeavored to avoid her, and, his father being slightly ill, he became convinced he was going to die. A month or so later he moved from Baltimore, which had been his home, and began employment with the government in Washington. He had more emissions and immediately developed hysterical heart trouble, and from his retrospective account also had ideas of people influencing him. A year later (June 1905) a frank psychosis with considerable manic flavor developed. Secretary of State Hay had died, and peace negotiations between Russia and Japan were in progress. He got the idea that he was to succeed Hay (whose face he saw in the clouds) and that he would make peace between the nations. The accompanying excitement was so intense that when he came to see his father in Baltimore the latter had him committed to the Sheppard and Enoch Pratt Hospital.[3] He remained there for one year and eight months, during which time his mood showed great variability. At times he would be elated, again depressed or anxious, often silly with irrelevant laughter. Towards the end of his admission he had quite long intervals when he appeared normal. Eight months after his discharge he began to have monthly attacks lasting from one to two weeks. At the beginning of 1911 he came under the observation of one of us at the Johns Hopkins Hospital Dispensary. His case was followed minutely for some months when the following extraordinary clinical picture was seen to develop with regular periodicity. His interest would gradually withdraw from his work and an abstracted, "dim" look come into his eyes. He ceased to sleep either day or night. Ideas, in the intervals latent, would become more insistent, and he talked of them in a distracted way with occasional silly laughter and some scattering. At the same time he would show considerable physical unrest: rocking in his chair, nodding his head, sucking with his lips, and making occasional grimaces. A sharp word would, however, bring him to reality and normal behavior and speech, or the same result could be obtained by his own volition. In fact sufficient effort from either without or within could, it was several times demonstrated, postpone the further development of these symptoms for several days. Inevitably, however, control over his psychosis was lost. He became more excited; was assaultive till chastised by his father, after which that symptom no longer appeared; he would give none but irrelevant answers to questions; he masturbated openly. In the next phase he refused to answer questions altogether, sat in a chair by the window, rocking and tapping the floor or wall with his feet; reading a paper in a whisper or tearing it into scraps; spitting on the floor, his clothes or the window pane and then drawing pictures with his finger on the wet glass; intermittently chanting the same air over and over again with words, totally indistinguishable, except for the name "Jesus Christ" apparently interpolated irregularly in the course of the song. All this time he wore a silly smile occasionally breaking into a low chuckling laugh devoid of real emotion. In a short time his clothes and his immediate surroundings were in a state of horrid filth from his saliva and the torn papers. Towards the end of the attack he ceased making any sounds, simply rocked, spat and grinned. He would often pass twenty-four hours without emptying his bladder, though he never wet nor soiled himself. Few psychiatrists would have required more than a casual examination to give a diagnosis of hopeless deterioration, if they saw the patient only in the latter stage of one of these attacks. Yet in from seven to fourteen days after the first onset he would go to bed, sleep well, and in the morning appear perfectly normal and resume his efficient work. And this story had been repeated regularly once a month for four years! When normal his memory was hazy for the external events occurring during his attack, corresponding with his objective lack of contact with his environment, but the recollections of his ideas showed that he had been living in a perfect riot of fancies. The inference from this is inevitable that what we regard as a "Trendless praecox" or a taciturn dement may simply be one who does not choose to talk and not necessarily a vegetative wreck with neither delusions nor hallucinations.

[3] For the privilege of using observations made on this patient at the Sheppard and Enoch Pratt Hospital, we wish most heartily to thank the Superintendent, Dr. Edward N. Brush.

His ideas were found to be no less interesting than his formal picture. In fact, if the theory we are now advancing be correct and we had had it then, we believe it would have been possible to state at the time of his first attack that his psychosis would not show rapid deterioration; we might even have gone further and predicted that he would reach some such stage of relative sanity as he now enjoys. He has presented three types of ideas. The first is crude expressions of bald sexual fancies; the second is transitional in that—as many praecox patients do—he gave these ideas a religious or philosophical setting, but in the hallucinations and delusions embodying them, still retained his personal connection with the fancies. For instance, he identified himself with Christ, or he suffered from psychological influences exerted by others on him. These two types occurred only during attacks. The third type represented the real constructive tendency, during his "normal" intervals when he objectivized these ideas in the form of speculations as to the origin of life, the laws of society, religion, etc. The second type—the transitional—represented reciprocally two tendencies: in the psychosis it showed his constructive, healing capacity, while the development of such fancies, as allied himself directly with his speculations when "normal," was invariably the signal for another attack, the severity of which was in direct proportion to the crudity which his formulations reached. The complexity and number of his theories when going about his work was tremendous, which could be partially accounted for by his omnivorous reading. He read all sorts of historical, occult, scientific and philosophical works, the material of which he absorbed only in so far as he could weave it into the fabric of his depraved speculations. This colored his transitional ideas as well, for in each attack he would have a new dramatization of his fancies determined by what he had just been reading. To present these ideas with anything like completeness would take hours. We must be content, therefore, with a few fragmentary examples.

The more important of his crude ideas were: His trouble was caused by loss of semen (his attacks were always ushered in by emissions), to prevent which he sometimes put rubber bands around his penis; numerous homosexual fancies, he was a woman, he had a vagina, there was a maiden head in his forehead which was operated on to cause him to lose semen; different people made immoral proposals or had designs on his virginity. These people he all identified directly or indirectly with his father. Finally there was an idea that his mother's marriage with his father was not right, that he was not his father's son, and that his father was inimical to him. He talked of killing different persons whom at other times he identified plainly with his father. During an attack he assaulted his father; not infrequently he would take his father's picture from the wall and spit on it. The relations between his father and mother were adulterous, he claimed.

If we now take the crude homosexual fancies and study their first elaboration we find that he had many ideas about eunuchs. They worked on him by psychological influence. The eunuchs, who could control sun and moon, influenced him through them. Once he had a vision of the sun approaching him with which he was physically connected; the vision would disappear if he lost his virginity. These influences when referred to himself were agencies causing loss of semen, so that he would become a eunuch himself. At the time of his heart attack and later he thought there was a snake around his heart. This was a man who had turned himself into a snake in order to incorporate himself into the patient's body. His religious fancies apparently began with his delusion that he was Christ and in connection with this we find he had the theory that Christ was a virgin. One setting of his "psychological influence" experience, when he was in bed in one room and eunuchs were influencing from the next. he duplicated by saying he was Jesus Christ in one room and God was in the next. He explained after one of his attacks that his attention was fixed on the windowpane on which he spat because there was a flower there. During an attack he was heard to say something about the struggle of men against being raped by ions and flowers. In these primitive elaborations we find an effort at distortion, a getting away from the absolutely crude and that the added elements which cause this distortion are in the form of ideas which imply a certain degree of philosophizing. The truly constructive delusions appear when he has ceased to dramatize these theories with himself as the hero and treats them objectively. We then find that eunuchs are very important people in his philosophy (the medium of their power we shall see shortly). All women are eunuchs because they have no testicles. There is no difference between men and women; if a woman is stronger than her husband, he takes on her qualities. In India men suckle the children. He says that this is a well-known fact. A person could change himself into a cancer and so get into another's body. This is perhaps an echo of something he had read of Ribbert's theory of neoplasms. Another pseudoscientific theory concerns a method of reproduction which could be developed, he thought. If a beautiful, strong man reaches his normal growth, all life above that is moulded by his ideals. He can develop within himself another personality which may be divorced from his body. Immaculate Conception takes place this way. An argument he had in favor of this view was prenatal influence and the strong influence a woman's belief is supposed to have on pregnancy. Eunuchs control the sun and moon. The Jews have a secret process of eunuchry; they have a way of inserting an instrument (a drawing of which he made, showing distinctly phallic features) by psychological means into the glands or bodies of men, thus cleaning them out. The eunuchs of the Romans used to cure their fellow countrymen of snakes growing around the heart by ingratiating themselves into persons, thus displacing the snakes and killing them. The government has many eunuchs in their employ. The influences of these men are malign or beneficial. They can injure enemies of the government or the government can incorporate them into bodies of other men to save the latter. All cardinals, most diplomats and many missionaries are eunuchs. The psychological influence exerted by such individuals may cause a loss of blood to their victims or they may use this power beneficially. The Romans, for instance, put blood of crucified people into the hands of eunuchs, who impregnated it by psychological influence into others. This would save their lives and eventually save the nation.

The ideas we have mentioned showing rivalry with his father, apparently in relation to his mother, were largely elaborated in political and religious disguises in their transition states, which in turn led to an objective interest in politics and religions. He spoke of killing the President which may be taken as a disguise for killing his father since he often claimed that his father was this or that ruler. He also spoke of killing one of his employers. He was prone to speak of his father as Edward VII. His envy of this situation of authority was shown when he once told the physician that his face was suspended in the face of the physician who was a King of England. But not the real King, he added, Edward VII was the real King. Again he said that he was Robert Emmet and the physician was Lord Norbury, the judge who convicted Robert Emmet, after whom the patient was named. In that role the physician told him it was all up, that there was no more Irish race. (It must be remembered that his father was a Fenian.) A fruitful source of speculations about international politics was found in the transitional ideas he expressed about the extraction of his parents. Beginning with his cogitations about the friction which actually existed between his parents, he ascribed this to their differing nationalities and religions. This led in turn to his fancying that on both sides his blood was drawn from many sources. He was particularly fond, for instance, of identifying his father with Hebrews, or Chinese; his mother with Romans, Italians or Spaniards. His original interest in the union (or disharmony) of his parents was easily transferred to this international setting and most of his attacks were heralded by dramatizations of political ar international situations with which he was intimately connected. This was true of his first attack when he had an idea that he was to succeed Secretary Hay and make peace between Russia and Japan (his mother and father). On recovery these fancies were objectivized into a most intense interest in diplomacy. He knew the history and achievement of every diplomatist in Europe, though of course his data were always being distorted to fit with his insane theories. Intermarriage, for example, was the cause of political trouble. He developed the ideas as follows: When an Irishman marries one of another race a confusion of races results; this was what took place in the tower of Babel; this is what causes disunion between states. He elaborated, too, on popular associations of certain customs with certain peoples. Gypsies, it is popularly supposed, frequently abduct children. With the patient this became an elaborate theory about an Egyptian custom or Egyptian influence. The Egyptians, he said abducted children and brought them up as their own acquiring a sinister influence over them because of the belief the children had that these adults who were their guardians were their real parents. In one attack he spoke of his father as "An Egyptian influence." This is plainly the same idea as he put into another form when he remarked that he would be all right if he could become English. When in his free intervals, he made it a practice sedulously to cultivate English people.

This undercurrent of rivalry with the father came out in a religious disguise as well. His first attack when he was for many months interned he described as a religious mania. By means of identifying himself with Christ he dramatized both his subjugation and defiance. He went through many crucifixion experiences; said he was commanded by God. On the other hand he said Christ was a virgin and retained his virginity in order that he might discover the secrets of the elders. For this reason he was crucified. The crudest expression he gave of defiance in a religious form was when he said "I was two persons in one—God and Jesus Christ. God was damned." The more constructive tendency was shown by his fasting. This was due to an experience of some duration when he was translated back to the first century, was in a convent (sic!) and was tempted by the devil to eat. His fasting, he claimed, saved the other patients. His most constructive delusion was that all the churches would come together and then there would be only one church. During his first attack this was his "prophecy," during his saner intervals there were endless ramifications of this idea which are too tedious to recite. It is important to note as evidence of the purely psychotic character of his ideas that he has never been either religious in his spirit or in action a propagandist.

Perhaps the most luxurious fancies this patient evolved were around the theme of semen. We have seen that his emissions were his constant worry, an increase in their frequency heralded an attack and he was convinced that if he could but retain this secretion he would be permanently cured; nay more, if he could retain enough he would grow to be like the giants of old. Whenever he had an emission he felt on waking a pain in his head and could never get totally rid of the idea that this was cancer. In his attacks the cancer was the result of a homosexual assault and in his intervals he elaborated theories as to the origin of cancer; it came from friction, therefore coitus could produce it, it might be the result of adultery or cancer of the breast could come from a man rubbing his penis on the breasts of a woman; the cancer germs might come from semen if one believed in cancer and in germs. Life both as vital force and in the biological sense he identified with semen. Psychic activities too had the same origin which he explained thus: food taken into the mouth goes into the stomach and becomes chyle, chyle passes to the scrotum, thence to the spine and brain. Brain power is in direct proportion to the amount of semen retained. We see now why eunuchs had such power according to his philosophy. By childish reasoning, since they could not have emissions, their semen must be retained. He spoke of psychological influence in these terms: "It is the transformation from the moisture state of the life principle to the moist electric state of warmth and its transference from the central ducts and glands to the head and being thrown out of the head in waves from the top of the head and eyes. It redounds to the other person's good. Have an eunuch near you—it tends to make semen go to the head and gives the mental mouth something to think of. It could be used in a baleful way if one had will power over another person like hypnotism—(Svengali and Trilby)—In hypnotism the will goes on the same lines as psychological influence." The Jews, he said, lay around temples so much that their life had to go into sensuality or wisdom and it mostly went into wisdom. Continual seminal losses, he claimed, would lead to a change in personality. "Life," he said, permeated nature, it could not be lost. Wind was thus identified with it: "life" goes on a sheet (from an emission), the sheet is washed and the "life" passes to the water, then is taken up by the air and breathed. Thus he suffered both immediate and remote effects from emissions. The first result was to make him incapable of work; by breathing in the "life" later on he became a degenerate. Wind or the spiral movements of air was another origin of life. Wind is a spirit, in defence of which he quoted the Greek pneuma. The words wind and word are the same, the former being derived from the latter through wird. (Cf. "In the beginning was the word," or "The word was made flesh"). A cyclone is an effort hampered by civilization of what the world was originally. Life began as a spiral movement of air. Wind as the origin of life could be duplicated by mechanical methods or eunuchry. The sun he claimed was an accident. Men lived for centuries without it, till an accident, internally, led to vital forces being emanated and that was the origin of sun. The accident was the cutting of some man's testicles.

Now what was his further course? We have seen that in his attacks he expressed resentment against his father's domination. At the beginning of one of them, for instance, which he said was brought on by "Egyptian influence," he had a dream of an old Hebrew play of father and son. In this play they were trying to make him return to the old situation of bondage to his father. This bondage was an actuality. Owing to his monthly attacks he could hold no regular position and so worked for his father. The latter gave him no money except occasional small silver but bought for him clothes or anything else he might need. A psychotic man of nearly thirty, with a feminine character, he was hopelessly dependent on his father. It is small wonder that he sought relief in recurring psychotic episodes. But a change came. On May 12, 1911, his father died suddenly of heart trouble. The patient was beginning to go into an attack at the time but pulled himself together, managed the funeral three days later, got his sister home, who had a hysterical attack at the grave, and then proceeded to indulge in his postponed attack. The sister was unable to care for him so he was sent again to the Sheppard and Enoch Pratt Hospital. In a few days he recovered. He was then talked to, told that this baleful relationship was over and that there was no longer any reason for his having attacks. With the exception of one attack at the beginning of 1912 he has had none, and seems to be able to maintain the mental equilibrium that previously characterized his intervals. For two and a half years he has been employed in the Customs House, Baltimore, a position which he secured by competitive examination, and has received an advance in salary from $900 to $1200 a year. He was recently written to and replied in exceptional literary form detailing more of his ideas. They seem to be essentially similar to those held four years ago. One may be quoted. A favorite "scientific" method with him has always been (from boyhood, he said) to divide up or distort words so as to get at their true meaning. This is now his explanation of the word "cancer."

"You may remember the origin of the word 'cancer' was once the topic of our meeting and strangely this matter has kept revolving itself in my mind ever since. My new solution is 'Kahns' and 'Ur.' You know there are a good many people named 'Kahn' and as probably you have noted in the Bible allusion to the ancient race of the name 'Ur.' Now, you can place what construction you will on the combination. There are several; here is one: I have heard it stated that the word 'Ur' originally meant 'wife' hence, from our point of view the solution is easy, Kahn's Ur or Kahn's wife, but what has puzzled me is what she is doing in so many people.

"Here's another: Signifying the overcoming of the Jew by Ur or Kahn by Ur (Kahn by 'er) much on the same principle as the words 'Spanish-American' and 'Graeco-Roman' are used with reference to the late 'unpleasantness' and the ancient one.

"Here's another: Simply meaning that Kahn is not a Jew at all but simply an Ur.

"So you see I have not altogether forgotten some of the topics of our meeting."

If our claims be allowed we should be able to make some deductions of value to psychiatric theory. The first is an explanation of scattering of thought. We find that, in all our cases showing constructive delusions, the utterance of these highly elaborated fancies is not accompanied by scattering. On the other hand it is an every day experience that a dementia praecox patient may show no scattering when conversing on indifferent subjects but that his train of thought loses logical sequence when he launches into his ideas. These findings may be reconciled by studying the reaction with types of ideas such as the last patient showed. In his intervals he was (and is) continually busy with delusional thoughts but of a constructive character, but was never scattered as long as these were alone present. As soon, however, as an attack commenced and cruder ideas appeared he became scattered. Where were these crude ideas in the intervals? They were represented in his constructive delusions it is true, but in their native form they did not appear. The cruder fancies must therefore have been in the unconscious during his intervals. Now actual verbatim records show with him that these crude ideas did not come to expression in logical sequence but that each appeared in response to an idea previously in his consciousness which was a distorted formulation of the crude fancy next to appear. His utterances during these attacks would have a logical sequence if they were translated into terms of the underlying crude ideas. The scattering, therefore, was due to the fact that his utterances were a mixture of crude and elaborated fancies. Had they been entirely one or the other there would have been no scattering. During his intervals he dealt with objective fancies and was logical. As these fancies, however, could be easily demonstrated to be derived from the unconscious crude ones, which appeared during his attacks, we are safe in assuming that one factor at least in the production of an attack was the lifting of some inhibition which kept the cruder ideas from entering consciousness except in a form in which they could be objectively viewed and so logically arranged. Scattering of thought therefore arises from the intermittent action of this censor or from an incomplete abolition of the inhibition allowing varying formulations of the crude ideas to gain expression which have no logic surface connection. If entirely done away with, of course, the latent ideas appearing in perfect crudity would have a logical connection. The content of consciousness is what is within the sphere of introspection. We can therefore say that the praecox who is scattered really does not know his own ideas. This is, of course, an every day experience for those who examine such patients. A suitable case left to himself will give expression to a limited number of delusions which he does not correlate. A few suggestive questions, however, will educe a mass of delusions, which when pieced together demonstrate the logical unconscious ideas that give rise to them. If such a patient be asked "What are your ideas?" he can give no reply. Ask him, however, if any one is mistreating him and you will start a train of thought in which one fancied insult leads to another or to delusions which do not represent mistreatment at all. On the other hand approach a patient with constructive delusions with the same question as to his ideas and he will produce a theory of the universe, often with a chronological account of how these ideas developed. He is insane in that his fancies do not reach an outlet in action being an end in themselves; but he is sane in so far as he keeps his ideas within the range of introspection and has not allowed them to become autonomous. The inferences from this to the laws of normal association are obvious.

The second point is really a historical one. Psychiatrists are often asked, "Was Joan of Arc crazy?" "Was Saint Louis a dementia praecox?" In an endeavor to answer such questions wise books have been written detailing the "psychoses" of historic or religious leaders. There is probably not a single delusion expressed by any one of the patients whose cases have just been recited that is not duplicated or paralleled by the belief of savants of a few centuries ago or the uneducated of to-day. The last patient said "All nature is artificial, man made it all. All the world would disappear, if man lost the power of reproducing. The reproduction of nature by man is founded on faith—constant reiteration and association with a thing will produce that thing." Is this not analogous to the working hypothesis of the alchemists? The more sincere among them sought salvation for their souls. To gain this they worked with metals to which they ascribed abstract or moral qualities. Their metallurgy was primarily symbolic, yet they seriously hoped for results by working with symbols. And to what extent of absurdity and crudity did they go? Many of their metallurgic terms were sexual processes. Their "prima materia" was called by the name of many of the secretions or excretions of the body. A whole school—the Seminalists—adhered to the view that the great original substance was semen. Other thought it was hermaphroditic. Paraceleus spoke of the birth of monsters as a result of sodomy. A natural history[4] written three centuries ago tells of semen being carried by wind. Notoriously there was no limit either to the absurdity or crudity of these conceptions. Were these men—the wisest of their time—insane? Here again we may quote the last patient—"Insanity," he says, "is the elemental human mind left to itself, unimproved by other minds." The last is the important phrase. What minds were there to improve those of the alchemists? What critic was there to tell Joan of Arc that visions and voices were pathological? That was the regulation form of inspiration in her day. Comparative mythology like a comparison of mysticism, alchemy, rosicrucianism and masonry shows that the human mind left to itself will formulate similar ideas. These ideas, however, are modified by the advance of learning as time goes on. The individual whose critical faculty allows him to maintain an idea incompatible with the knowledge of his age and his fellows is insane.

[4] The Historie of Foure-Footed Beastes, by Edward Topsell, London, 1607.

Our last point is a corollary to the claim we have just made. It has been the sport of iconoclasts for many years to discount all religious beliefs as psychopathic. This is not the forum where the problem of science versus religion may be discussed but these cases have certain features which should warn us to be wary of such generalizations. We have seen that religious formulations have been used to embody crude fancies. That does not preclude the possibility of the formulations having an actual basis. A flag may gain its importance to a given individual because it symbolizes for him his native land but that does not prove that the flag has not an existence of itself. This, however, is a matter of logic and not of psychiatry. Let us now grant that all religious formulations have an unconscious origin. But there still remains a wide gulf between patients such as we have been describing and the devout church-goers. The former show in their productions how their religious ideas arise, their egocentric quality is patent, they manifestly are but thin cloaks for selfish wishes. The latter, however, never in consciousness connect their religious formulations with their subjective creations. To the true believer his God is as objective a reality as is the electron of the physicist. Finally, real religious faith has a pragmatic value. Granting it be only a theory it nevertheless produces results in conduct. This is in sharpest contrast to religious delusions. They never lead to sustained effort, they bring with them no social potentiality. They exist for the comfort of the patient alone.

To sum up: We have endeavored to establish the claim that delusions in dementia praecox which takes the form of objective speculations rather than subjective experiences are an evidence of a milder psychotic reaction and hence warrant a prognosis of chronicity rather than deterioration. From the cases presented we argue that scattering of thought arises from a failure to formulate underlying fancies in an objective way; that the insanity of ideas depends not on themselves but on the critical judgment of the age which produces them, and lastly that there are essential psychological differences between creeds and religious delusions.



SOCRATES IN THE LIGHT OF MODERN PSYCHOPATHOLOGY

BY MORRIS J. KARPAS, M. D.

Assistant Resident Alienist, Psychopathic Department of Bellevue Hospital of New York

(Read before the Vidonian Club, New York, October 16, 1914.)

"CONSCIOUSNESS had reached this point in Greece, when in Athens, the great forum of Socrates, in whom subjectivity of thought was brought to consciousness in a more definite and more thorough manner, now appeared. But Socrates did not grow like a mushroom out of the earth, for he extends in continuity with his time, and this is not only a most important figure in the history of philosophy—but perhaps also a world famed personage." Hegel.



"When Columbus set sail across the untraversed western sea, his purpose was to reach by a new path, a portion of the old, known world, and he lived and died in the belief that he had done so. He never knew that he had discovered a new world. So it was with Socrates. When he launched his spiritual bark upon the pathless ocean of reflected thought, his object was to discover a new way to the old world of little commonwealths and narrow interests, and he probably died thinking he had succeeded. He did not dream that he had discovered a new world—the world of humanity and universal interests. But so it was; and tho mankind are still very far from having made themselves at home in that world, and from having availed themselves of its boundless spiritual treasures, it can never be withdrawn from their sight, or, the conquest of it cease to be the object of their highest aspirations." Thomas Davidson.



INTRODUCTION

The Hellenic influence upon the intellectual development of the world is infinite. The intellectual force emanating from the sources of Greek art, literature and philosophy permeated thru the ages and have helped to shape the destiny of our civilization. "Except the blind forces of Nature," says Sir Henry Sumner Maine, "nothing moves in this world which is not Greek in its origin." [1.] Without a shadow of doubt, Greek Philosophy forms the firm background of progressive and reflective thought in all its phases and ramifications.

In the history and evolution of Hellenic thought, we find two tendencies of inquiry,—one dealing with the objective manifestations of the universe, and the other directed towards the study of the mind. To the former class belong Thales, Anaximander, Anaximenes, Pythagoras, and others that attempted to discover some principle for the explanation of the natural phenomena. To accomplish this end, mathematics, physics, metaphysics, etc., were resorted to. The other great epoch, which may be termed the Renaissance of Greek Philosophy, was conceived by the Supreme Greek thinker, Socrates, who forms the subject thesis of this paper.

Socrates was the father of psychology and the grandfather of modern psychopathology. He was the first one that attempted to study man from the point of view of subjectivity. In the words of Snyder, "In Socrates, the human mind burst forth into knowing itself as thinking."[2.] And Zeller very thoughtfully remarks: "The interests of philosophy being thus turned away from the outer world and directed towards man and his moral nature, and man only regarding things as true and binding of the truth of which he was convinced himself by intellectual research, there appears necessarily in Socrates a deeper importance attached to the personality of the thinker."[3.] In Phaedrus, Socrates speaks: "I am a lover of knowledge, and in the cities I can learn from men; but the fields can teach me nothing."[4.] Although Aristophanes pictures Socrates in the clouds as preaching natural philosophy, yet there is no authentic record of this.

The source of information regarding the biography of Socrates and his philosophy comes from two authors, Xenophon and Plato. The former portrays him as a moral philosopher and in his book, Memorabilia, he seems to eulogize his master. The latter however presents him as a thinker, and it is maintained by many critics that Plato put into the mouth of Socrates his own ideas. It is lamentable that this great philosopher committed nothing of his monumental work in writing.



THE PERSONALITY OF SOCRATES

It is difficult to construct a biographic sketch of Socrates in a chronological and systematic order. He was born in the year 469 B. C. His father was Sophroniscus, a sculptor, and his mother Phaenarete, a midwife. He followed his father's vocation and it is believed that he showed poor skill in the profession. We know nothing of his early intellectual and moral development. Since he was bred in Athens, he most probably received the usual education peculiar to that age. He was a soldier and took part in military campaigns and wars. It is maintained that in military life he displayed considerable bravery, endurance and fortitude. The exact date of his appearance in public arena is difficult to ascertain, however, "in the traditions of his followers he is almost uniformly represented as an old, or as a gray-headed man."[5.]

There are distinctive traits in the personality of Socrates that are worthy of emphasis because of their dynamic import.

He was described as eccentric in his general mode of conduct. He "strutted proudly barefoot along the streets of Athens; he was careless and shabby in his dress; in his manner he was affected and haughty and was subject to ecstatic trances and visions. During these trances he would maintain a standing posture for hours, buried in his thoughts, and was quite oblivious to the external world. There was a celebrated occasion in the camp at Poteidaice, when Socrates was not quite forty; on that occasion he stood motionless from early morning on one day till sunrise on the next, right through a night when there was a very hard frost. When the sun rose he said his prayer and went about his business." [6.] It is also claimed that he would give vent to bursts of anger and fiery passion.

Ever since early boyhood Socrates is supposed to have heard an inner voice, which he called a divine sign. It came to him quite often both on important and on insignificant occasions. According to Xenophon, this voice gave him both negative and positive warnings; however, Plato holds that this voice only exercised its influence in opposing the execution of certain things. "And not only was he generally convinced" says Zeller, "that he stood and acted in the service of God, but he also held that supernatural suggestions were communicated to him, not only through the medium of public oracles, but also in dreams, and more particularly by a peculiar kind of higher inspiration which goes by the name of the Socratic daimoviov."[7.]

Even by his contemporaries he was regarded as singular and eccentric and his general behavior was ever foreign to his compatriots. Indeed Lelut [(8)] boldly asserts that Socrates was "un fou." Nevertheless "attempts were not wanting to excuse him," so writes Zeller, "either on the ground of the universal superstition of his age and nation, or else of his having a physical tendency to fanaticism."[9.]

Another interesting feature in the life of Socrates is that he married late and that his matrimonial life was far from being happy, and in the words of Schwegler, "He nowhere shows much regard for his wife and children; the notorious, though altogether too much exaggerated ill-nature of Xantippe, leads us to suspect, however, that his domestic relations were not the most happy."[10.] It is also important to note that there was a turning point in the history of his life when he took up the preaching of philosophy. It must be borne in mind that he took no money for his teaching and at the same time he left his wife and children destitute. In regard to this Draper remarks, "There is surely something wrong in a man's life when the mother of his children is protesting against his conduct, and her complaints are countenanced by the community."[11.]

It is also significant that Socrates displayed a certain degree of masochism; our historians tell us that Socrates would deny himself bodily comforts and insist on enduring hardship. Xenophon in Memorabilia says: "But they knew that Socrates lived with the utmost contentment on very small means, that he was most abstinent from every kind of pleasure, and that he swayed those with whom he conversed just as he pleased by his arguments."[12.] Again, "Is it not the duty of every man to consider that temperance is the foundation of every virtue, and to establish the observance of it in his mind before all things? For who, without it, can either learn anything good or sufficiently practice it? Who, that is a slave to pleasure is not in an ill condition both as to his body and his mind? It appears to me, by Juno, that a free man ought to pray that he may never meet with a slave of such a character, and that he who is a slave to pleasure should pray to the gods that he may find well-disposed masters; for by such means only can a man of that sort be saved."[13.] And, "He appeared also to me, by such discourses as the following, to exhort his hearers to practice temperance in their desires for food, drink, sensual gratification, and sleep, and endurance of cold, heat and labor."[14.]

Although he condemned poederastia, yet he was always fond of the male sex, particularly of the young. This, however, may be explained on the ground that his object was to appeal to the young. Nevertheless, dynamic psychology demands a deeper meaning for such a motive. In this connection it would be interesting to quote Xenophon: "As to love, his counsel was to abstain rigidly from familiarity with beautiful persons; for he observed that it was not easy to be in communication with such persons, and observe continence. Hearing, on one occasion, that Critobulus, the son of Criton, had kissed the son of Alcibiades, a handsome youth, he asked Xenophon, in the presence of Critobulus, saying, "Tell me, Xenophon, did you not think that Critobulus was one of the modest rather than the forward, one of the thoughtful rather than of the thoughtless and inconsiderate?" Certainly," replied Xenophon. "You must now, then, think him extremely headstrong and daring; one who would even spring upon drawn swords, and leap into the fire." "And what," said Xenophon, "have you seen him doing, that you form this opinion of him?" "Why, has he not dared," rejoined Socrates, "to kiss the son of Alcibiades, a youth extremely handsome, and in the flower of his age?" "If such a deed," returned Xenophon, "is one of daring and peril, I think that even I could undergo such peril." "Unhappy man!" exclaimed Socrates, "and what do you think that you incur by kissing a handsome person? Do you not expect to become at once a slave instead of a freeman? To spend much money upon hurtful pleasures? To have too much occupation to attend to anything honourable and profitable? And to be compelled to pursue what not even a mad man would pursue?" "By Hercules," said Xenophon, "what extraordinary power you represent to be in a kiss!" "Do you wonder at this?" rejoined Socrates; "are you not aware that the Tarantula, an insect not as large as half an obolus, by just touching a part of the body with its mouth, wears men down with pain, and deprives them of their senses?" "Yes, indeed," said Xenophon, "but the Tarantula infuses something when it bites." "And do you not think, foolish man," rejoined Socrates, "that beautiful persons infuses something when they kiss, something which you do not see? Do you not know that the animal, which they call a handsome and beautiful object, is so much more formidable than the Tarantula, as those insects instil something when they touch, but this creature, without even touching, but if a person only looks at it, though from a very great distance, instils something of such potency, as to drive people mad? Perhaps indeed Cupids are called archers for no other reason but because the beautiful wound from a distance. But I advise you, Xenophon, whenever you see any handsome person, to flee without looking behind you; and I recommend to you, Critobulus, to absent yourself from hence for a year, for perhaps you may in that time, though hardly indeed, be cured of your wound." Thus he thought that those should act with regard to objects of love who were not secure against the attractions of such objects; objects of such a nature, that if the body did not at all desire them, the mind would not contemplate them, and which, if the body did desire them, should cause us no trouble. For himself, he was evidently so disciplined with respect to such matters, that he could more easily keep aloof from the fairest and most blooming objects than others from the most deformed and unattractive. Such was the state of his feelings in regard to eating, drinking, and amorous gratification; and he believed that he himself, with self-restraint, would have no less pleasure from them, than those who took great trouble to pursue such gratifications, and that he would suffer far less anxiety."[15.]

There is another interesting anecdote which is worthy of mention: "The Syrian soothsayer and physiognomist, Zopyrus, saw in the countenance of Socrates the imprint of strong sensuality. Loud protests were raised by the assembled disciples, but Socrates silenced them with the remark: 'Zopyrus is not mistaken; however, I have conquered those desires.' "[16.]

It is also evident that Socrates' mother must have played some role in his mental life. It should be recalled that at first he followed his father's profession, which seemingly made no impression upon him, and later he took up his new vocation, preaching philosophy, which he loved to identify with that of his mother, and indeed by reason of this the positive side of the Socratic method is known as "the art of intellectual midwifery." "Socrates compared himself," writes Schwegler, "with his mother, Phaenarete, a midwife, because his office was rather to help others bring forth thoughts than to produce them himself, and because he took upon himself to distinguish the birth of an empty thought from one rich in content."[17.]

Further evidence of the deep reverence for his mother is seen in Memorabilia where his eldest son, Lamprocles, finds fault with his mother, and Socrates, though apparently entertaining very little love for his wife, yet takes up a defensive attitude towards her and offers the following argument to his son: "Yet you are displeased at your mother, although you well know that whatever she says, she not only says nothing with intent to do you harm, but that she wishes you more good than any other human being. Or do you suppose that your mother meditates evil towards you?" "No indeed," said Lamprocles, "that I do not imagine." "Do you then say that this mother," rejoined Socrates, "who is so benevolent to you; who, when you are ill, takes care of you to the utmost of her power that you may recover your health, and that you may want nothing that is necessary for you, and who, besides, entreats the gods for many blessings on your head, and pays vows for you, is a harsh mother? For my part, I think that if you cannot endure such a mother, you cannot endure anything that is good." [18.]

And in Crito, Socrates relates a dream shortly before his death, in which his mother appeared, and to quote Plato: "Crito says, 'And what can this dream have been?' Socrates replied, 'I thought a woman came to me, tall and fair, and clothed in white, and she called me and said 'Socrates, Socrates, in three days' time you will come to the fertile land, Phthia.' "[19.]

To sum up briefly, the personality of Socrates showed some psychopathic traits. It must also be borne in mind that in that critical period, middle age, a sudden change occurred in his mental life when he suddenly commenced to exhibit profound interest in preaching philosophy. Moreover, it must be emphasized that he apparently reacted to hallucinations of an auto psychic nature. The self-asceticism, and most probably the mother-complex cannot be passed without mention. Although he presented these negative qualities, nevertheless he left a great school of philosophy, which beyond doubt is still felt in the intellectual and moral world. Despite this, Athens committed an unpardonable crime in putting Socrates to death. He, like other martyrs, shared the same fate of the mob. Lowell's verse very justly applies to Socrates:

"Truth forever on the scaffold; Wrong forever on the throne."[20.]

With this characterization of Socrates, we are now in a position to discuss that part of his philosophy which has a definite bearing on modern psychopathology. Three important phases of his philosophy come under consideration:

1. The dialectic method; 2. The conception of virtue; 3. Know thyself.



THE DIALECTIC METHOD

In Socratic philosophy the Dialectic Method occupies a lofty position. By this method he was enabled to penetrate deeply into human nature and unfold all phases of man's experience. Aristotle characterizes this method as the induction of reasoning and the definition of general concepts. Gomperz, speaking of the great zeal that Socrates exhibited in this method, says, "to him (Socrates), a life without cross-examination, that is, without dialogues in which the intellect is exercised in the pursuit of truth, is for him not worth living."[21.] And Schwegler pertinently asserts "that through this art of midwifery the philosopher, by his assiduous questioning, by his interrogatory dissection of the notions of him with whom he might be conversing, knew how to elicit from him a thought of which he had been previously unconscious, and how to help him to the birth of a new thought."[22.]

Briefly stated, the Dialectic Method is divided into two parts, the negative and the positive. The former is known as the Socratic Irony. By this method the philosopher takes the position that he is ignorant and endeavors to show by a process of reasoning that the subject under discussion is in a state of confusion and proves to the interlocutor that his supposed knowledge is a source of inconsistencies and contradictions.

On the other hand, the positive side of the method, "the so-called obstetrics or art of intellectual midwifery"[23] leads to definite deductions. To illustrate the two phases of this method, the following example may be taken. A youth of immature self-confidence believed himself to be competent to manage the affairs of state. Socrates would then analyze the general concept of the statecraft, and reduce it to its component parts, and by continuous questions and answers would show to this supposed statesman that he was lacking true knowledge. Again, a young man of mature judgment, but of an exceedingly modest temperament, being reluctant to take part in the debates of the Assembly, Socrates would prove to him that he was fully competent to undertake such a task.

In a word, the Socratic method presents two striking tendencies; one destructive, the other constructive; the former annihilates erroneous conceptions, and the latter aids the building up of a healthy mental world, in which men may find pleasure. In a broad sense, the dialectic method bears some resemblance to the psychoanalytic, inasmuch as both seek to analyze human nature in the light of individual experience; to find the ultimate and predominating truth underlying such an experience; both attempt to make the individual realize the extent of his limitations and capacity of adjustment by subordinating the antagonistic forces and at the same time aiding the construction of a world of healthy concepts.



SOCRATIC CONCEPTION OF VIRTUE Before attempting to discuss the Socratic Conception of Virtue, it is important to call attention to two facts;

1st, The principles of mental life, and

2nd, The Greek conception of the state.

Roughly speaking, mental life is composed of two parts; the unconscious, or instinctive, and the conscious. In the early development of the child, mental adjustment is purely instinctive or unconscious. As the child grows older, the unconscious life becomes gradually subordinated to the conventional and cultural requirements. The influence of education, religion, morality and environment begin to exert their influence upon the child and the conscious life commences gradually to assert itself. The characteristic difference between a very young child and the conventional adult, lies in the fact that the former's behavior is not controlled by conventionalities or tenets, whereas the latter conforms with all the rules and customs of society.

The Greeks entertained a very high idea of the function of the state. It was invested with a high moral value and pedagogic aim. In fact, Plato's republic demonstrates this very well. An important point must be emphasized, that the state exercised a potent influence upon the development of the conscious life of the individual.

Now we can understand the Socratic Conception of Virtue in relation to the conscious and unconscious life. What Socrates maintained was that true virtue must depend upon knowledge; hence knowledge is the strongest power of man and cannot be controlled by passion. In short, knowledge is the root of moral action, and, on the other hand, lack of knowledge is the cause of vice. In other words, no man can voluntarily pursue evil, and to prefer evil to good would be foreign to human nature. Hence, in the Socratic sense, in the unconscious lies the root of antisocial deeds, and, as Forbes puts it: "Socratic view of sin, in fact, keeps it in a region subliminal to knowledge. The sinner is never more really than an instinctive man, an undeveloped, irrational creature; strictly speaking, not a man at all."[24.]

Since Socrates identified virtue with knowledge, and made knowledge a conscious factor in mental life, it is evident that education, environment, religion and conventionality are the determining factors in the cultivation of the conscious. "What may be called institutional virtue," writes Snyder, "is for Socrates the fundamental and all-inclusive Virtue, the ground of the other Virtues. He believes in the State, obeys the Laws, performs his duties as a citizen. This does not hinder him from seeing defects in the existent state and its Laws, and trying to remedy them. Indeed, his whole scheme of training in Virtue is to produce a man who can make good Laws, and so establish a good State. 'What is Piety?' he asks, not a blind worship of the gods, but worship of them according to their laws and customs, which one must know. That is, one must know the law of the thing, the time of mere instinctive action and obedience is past." [25.] And Zeller expresses himself in a similar manner: "Of the importance of the state and the obligations towards the same, a very high notion indeed is entertained by Socrates:—He who would live amongst men, he said, must live in a state, be a ruler or be ruled. He requires, therefore, the most unconditional obedience to the laws, to such an extent that the conception of justice is reduced to that of obedience to law, but he desires every competent man to take part in the administration of the state, the well-being of all individuals depending on the well-being of the community. These principles were really carried into practice by him throughout his life. With devoted self-sacrifice his duties as a citizen were fulfilled, even death being endured in order that he might not violate the laws. Even his philanthropic labors were regarded as the fulfillment of a duty to the state; and in Xenophon's Memorabilia we see him using every opportunity of impressing able people for political services, of deterring the incompetent, of awakening officials to their sense of their duties, and of giving them help in the administration of their offices. He himself expresses the political character of these efforts most tellingly, by including all virtues under the conception of the ruling art."[26.]

To recapitulate briefly; the Socratic conception of the unconscious conforms in many respects with our present knowledge of it, especially insofar as our psychoanalytic experience shows us conclusively what a potent factor is exercised by the unconscious in the determination of psychotic and neurotic phenomena. Indeed in the Socratic sense such manifestations are anti-social and cannot be identified with virtue, hence they are not conscious. One may say that Socrates unconsciously conceived the modern idea of the dynamics of the unconscious.



KNOW THYSELF

The great Socratic Maxim, "Know Thyself," is one of the strongest moral precepts in Ethics. Although the sophists had already called attention to the fact that "man is the measure of all things," however they applied to the individual and not to human nature in general. "But Socrates proclaimed that this self-knowing Ego knows itself likewise as object, as the principle of the world, in which man is to find himself in order to know it."[27.]

To know one's self implies calmness of self-possession, fearlessness and independence. Furthermore it leads one to a striking realization of one's limitations and shortcomings, which form the foundations of success, and, as Forbes expresses it, "in this self-knowledge is the secret of blessing and success in the handling of human affairs, and right relationship with others."[28.]

Socrates, discussing his maxim with Euthydemus, gives a clear and comprehensive idea of this interesting subject: "Socrates then said: 'Tell me, Euthydemus, have you ever gone to Delphi?' 'Yes, twice,' replied he. 'And did you observe what is written somewhere on the temple wall, Know Thyself?' 'I did.' 'And did you take no thought of that inscription, or did you attend to it, and try to examine yourself to ascertain what sort of a character you are?' 'I did not indeed try, for I thought that I knew very well already, since I should hardly know anything else if I did not know myself.' 'But whether does he seem to you to know himself, who knows his own name merely, or he who (like people buying horses, who do not think that they know the horse that they want to know, until they have ascertained whether he is tractable or unruly, whether he is strong or weak, swift or slow, and how he is as to other points which are serviceable or disadvantageous in the use of a horse so he), having ascertained with regard to himself how he is adapted for the service of mankind, knows his own abilities?' 'It appears to me, I must confess, that he who does not know his own abilities, does not know himself.'

" 'But is it not evident,' said Socrates, 'that men enjoy a great number of blessings in consequence of knowing themselves, and incur a great number of evils, through being deceived in themselves? For they who know themselves know what is suitable for them, and distinguish between what they can do and what they cannot; and, by doing what they know how to do, procure for themselves what they need, and are prosperous, and by abstaining from what they do not know, live blamelessly, and avoid being unfortunate. By this knowledge of themselves too, they can form an opinion of other men, and, by their experiences of the rest of mankind, obtain for themselves what is good, and guard against what is evil.'

"But they who do not know themselves, but are deceived in their own powers, are in similar case with regard to other men, and other human affairs, and neither understand what they require, nor what they are doing, nor the character of those with whom they connect themselves, but, being in error as to all these particulars, they fail to obtain what is good, and fall into evil.

"They, on the other hand who understand what they take in hand, succeed in what they attempt, and become esteemed and honoured; those who resemble them in character willingly form connections with them; those who are unsuccessful in their affairs desire to be assisted with their advice, and to prefer them to themselves; they place in them their hopes of good and love them, on all these accounts, beyond all other men.

"But those, again, who do not know what they are doing, who make an unhappy choice in life, and are unsuccessful in what they attempt, not only incur losses and sufferings in their own affairs, but become in consequence, disreputable and ridiculous, and drag out their lives in contempt and dishonour. Among states, too, you see that such as, from ignorance of their own strength, go to war with others that are more powerful, are, some of them, utterly overthrown, and others reduced from freedom to slavery."[29.]

What Socrates attempts to show, is that self-knowledge is conducive to human happiness. Indeed, sanity in a broad sense, depends upon insight into one's true knowledge of his limitation and capacity for adaptation. However, Socrates holds that madness is not ignorance, but admits that for "A man to be ignorant of himself, and to fancy and believe that he knew what he did not know, he considered to be something closely bordering on madness. The multitude, he observed, do not say that those are mad who make mistakes in matters of which most people are ignorant, but call those only mad who make mistakes in affairs with which most people are acquainted; for if a man should think himself so tall as to stoop when going through the gates in the city wall, or so strong as to try to lift up houses, or attempt anything else that is plainly impossible to all men, they say that he is mad; but those who make mistakes in small matters are not thought by the multitude to be mad; but just as they call 'strong desire' 'love,' so they call 'great disorder of intellect' 'madness.' "[30.]

This Socratic principle plays an important role in psychopathology; in psychoanalysis, what the physician does is to acquaint the patient with the unconscious mental processes, thus putting him in full knowledge of his condition to enable him to adjust himself to his environment. In mental diseases the prognosis of a psychosis is not looked upon so gravely when the patient has some realization of his situation, and likewise the recovery from a mental infirmity is more hopeful when the patient exhibits considerable insight into his condition. It is a well known fact that in a malignant psychosis, self-knowledge does not exist, and this in part is responsible for its malignancy. On the other hand the benignant nature of a psychoneurosis may be in part attributed to the patient's appreciation of his affliction.

However, the Socratic maxim has another moral and social value, that is, by only knowing one's self can one understand his fellowmen. Indeed, Plato makes Socrates say, in Phaedrus, that it is ridiculous to trouble one's self about other things when one is still ignorant of one's self. It is well known to every psychoanalyst that a patient cannot be analyzed by the physician unless the latter has conquered his own resistances and adjusted his complexes. The Immortal Poet, Shakespeare, truly says:

"This above all—to shine own self be true And it must follow as the night the day, Thou canst not then be false to any man. " Hamlet Act I, III.



BIBLIOGRAPHY.

[1.] Sir Henry Maine—Village Communities and Miscellanies, Page 238. Amer. Ed.

[2.] Denton J. Synder—"Ancient European Philosophy," page 216.

[3.] Zeller—"Socrates and the Socratic School, 1877—London," Page 116.

[4.] Plato—Phaedrus.

[5.] Schwegler—"History of Philosophy," Page 63.

[6.] Gomperz—"Greek Thinkers," Page 87.

[7.] Zeller—"Socrates and the Socratic School," Page 81.

[8.] Lelut—"Du Demon de Socrates—1836.

[9.] Zeller—"Socrates and the Socratic School," Page 83.

[10.] Schwegler—"History of Philosophy," Page 84.

[11.] Draper—"Intellectual Development of Europe," Vol. I, Page 147.

[12.] Xenophon—"Memorabilia," Page 8. (Dutton & Co., Every Man's Library).

[13.] Ibid—"Memorabilia, Page 29.

[14.] Ibid—"Memorabilia" Page 35.

[15.] Ibid—"Memorabilia," Page 21-23.

[16.] Gomperz—"History of Philosophy," Page 48.

[17.] Schwegler—"History of Philosophy," Page 75.

[18.] Xenophon's "Memorabilia," Page 417-418.

[19.] Plato—"Crito."

[20.] Lowell's "Present Crisis."

[21.] Gomperz—"Greek thinkers," Page 59.

[22.] Schwegler's "History of Philosophy," Page 75.

[23.] Ibid—"History of Philosophy," Page 741.

[24.] Forbes—"Socrates" Page 191.

[25.] Denton Snyder—"History of Ancient European Philosophy," Page 248-249.

[26.] Zeller—"Socrates and the Socratic School," Page 167.

[27.] Denton Snyder—"History of Ancient European Philosophy," Page 234.

[28.] Forbes—"Socrates," Page 173.

[29.] Xenophon—"Memorabilia," Page 121-123.

[30.] Ibid—"Memorabilia," Page 97-98.



PSYCHONEUROSES AMONG PRIMITIVE TRIBES[*]

[*] Read by title at the Sixth Annual Meeting of the American Psychopathological Association, New York, N. Y., May 5, 1915.

BY ISADOR H. CORIAT, M. D. First Assistant Visiting Physician for Diseases of the Nervous System Boston City Hospital, Instructor in Neurology, Tufts College Medical School

THE complex construction of a psychoneurosis in an adult, due to the influence exerted by the multiplicity of factors of civilization and cultural advancement, is sometimes so bewildering as to almost defy all attempts at analysis. In children, the organization of a psychoneurosis is usually very simple, almost monosymptomatic, and in children too, we often discover these neuroses in the actual process of making. When adult life is reached, the individual has left behind him all the factors of his childhood life and all the repressed experiences and desires which tend to produce his adult characteristics. Among adults of primitive races however, where the mental organization is far less complex than that of civilized man, certain psychoneurotic disturbances are found, which if analyzed, might disclose the mental mechanisms of these disturbances reduced to their simplest terms.

It has been my good fortune to be able to secure data of this sort, pertaining to certain curious nervous attacks which occur among the primitive races of the Fuegian Archipelago. These facts were supplied me, following along the lines of a questionnaire, by the well known explorer Charles Wellington Furlong, F. R. G. S., who in 1907-1908, was in charge of the first scientific expedition to cross through the heart of Tierra del Fuego. Mr. Furlong's keen powers of observation, have made the data unusually complete. While he had no theory to offer in explanation of the attacks as seen among these primitive tribes, yet it is interesting to note, that certain of the facts corroborate the well-known ideas of sexual repression as elaborated by Freud. The mental organization of these people likewise, seems to substantiate certain psychoanalytic conceptions. For a clear comprehension of these attack, certain preliminary anthropological and geographical data are necessary.

The following data relates to the running amuck or outburst, among the Yahgan and Ona tribes of the Fuegian Archipelago. This data was obtained in 1907 and 1908 during expeditions through the regions of the Fuegian Archipelago.

The Yahgans, some forty years ago, numbered perhaps 2,500 but in 1908 had been reduced through contact with civilization and principally through an epidemic of measles to 173. These peoples are canoe Indians and inhabit today the island coasts from Beale Island to the Wollastons inclusive, in the neighborhood of Cape Horn; from about 54 degrees 50' S. Lat. to about 55 degrees 56' S. Lat., making them the southern-most inhabitants of the world. The Ona Indians, a taller and finer race physically, who are foot Indians, occupy the mountain and forest regions of southern Tierra del Fuego from approximately 53 degrees 50' S. Lat. to 55 degrees 3' S. Lat. The Onas formerly occupied the entire northern half of Tierra del Fuego and possibly numbered some 3,000, but through contact and warfare with the whites, who drove them south off the open lands of the north, they have been reduced to about 300. These peoples are of a light cinnamon colored skin, black haired, and of a decided Amerindian type. The Onas are above average stature, the Yahgans below it.

It is not an infrequent occurence for individuals among both the Yahgans and Onas to be subject to sudden outbursts of furor and violence. At such times the individual will generally dash from the wigwam and rush wildly away, and will continue running until nearly or completely exhausted. The one afflicted may dash madly through the woods or sometimes climb up dangerous cliffs. At such times, however, it is the custom of some of the men to follow closely behind to see that harm does not come through injury against trees, stumbling, or falling from the cliffs. However, at such times they rarely touch the afflicted one except to prevent harm, and finally will lead him back to the camp, when the attack is over or when he is exhausted.

While the attack occurs both among men and women, it seems to be more prevalent among men. The individuals in whom these attacks predominate are men in the prime of life, ranging from 25 to 35 years of age. These people are polygamous and as it is the custom for the old men to marry young girls, thus leaving the old women to the younger men, which in many instances causes a scarcity of women, it leaves a somewhat undesirable condition.

In many instances the character of the attack confines itself to the mad rushing away, as above described, at other times attempts to injure or kill others are made. For instance, a rancher of Tierra del Fuego, was in the company of some Onas when suddenly a hatchet whizzed by him, barely missing his head, and buried itself in a log of the Indian shelter. This was the result of an attack which seized upon one of the Onas who was afflicted thus from time to time. The actual outburst in this case was sudden, although it is difficult to tell how long it might have been coming on in the form of brooding, which seems to be a premonitory phase of this condition.

Concerning a personal experience with one of the early phases of an attack, Mr. Furlong states as follows:—"I am fully convinced that one night, while camping alone with Onas in the heart of the Fuegian forests, that my head man Aanakin, who had a good many killings to his credit, was brooding as he sat in his wigwam, which opened towards the fire; he watched me for nearly an hour with an attitude and expression which reminded me of the look a dog takes on sometimes before he snaps. Aanakin I knew to be of a very moody nature but this particular mood was so marked and portended evil so noticeably toward me without any apparent cause, that I decided to do something to break its mental trend. So putting fresh wood on the fire, to make a more brilliant blaze, I walked directly into his wigwam and motioned to one of his two wives, who were lying beside him. There was a passing look of half-anger, half-surprise, but I gave no time for his mind to dwell in the same mood, for simultaneously I produced my note book and pencil and began to make drawings of animals and other things they were familiar with. They like to watch one draw and name the thing, and so I kept them busy for perhaps an hour, and finally had them in gales of laughter. I am quite convinced that I forestalled an attack or a condition akin to it."

It seems that an attack usually begins suddenly. However, an instance is given where an Ona became moody and realized that one of these attacks was coming on and putting his hands together begged to have his wrists and feet bound in order that he would not do himself or others any harm, or that it would not be thought that he meant to kill and consequently be shot in self defence. This would in a way seem to indicate that there was no amnesia for the attack, as the Indian undoubtedly realized what he had done in previous attacks.

The moody state and the realization of what might follow as the attack comes on demonstrates a sense of uneasiness as the premonitory symptom of an attack, which ends in a state of utter exhaustion and sleep. The normal condition is resumed, practically on the awakening from sleep and recovery of strength.

From a description of Donald McMillan the explorer, the Eskimo Piblokto strongly resembles these attacks of the Ona and Yahgan Indians with the exception that Piblokto was particularly prevalent among the women.

How an attack begins is shown by the case of Aanakin, an Ona of Furlong's expedition. A certain form of melancholia, brooding or moodiness, seems to precede many of these attacks, with a realization sometimes that an attack is coming upon them. The Onas not being naturally a quarrelsome people, it may be that this realization and foreboding of the attack accounts for their tendency to run away from their associates, when they have endured the strain as long as they can, thus placing themselves in a position to avoid deliberate attack or injury to those about them.

It was further stated, in answer to the questionnaire—"I cannot give you absolute data regarding laughing or crying in an attack, screaming, yells, foaming at the mouth, biting of tongue, tearing of clothes, although I am of the opinion that any or all of these things may and do occur. As to violent resistance, the case, where the man wished to be bound, would show there was violent resistance, and it is probable that partly for this reason the Onas and Yahgans do not molest the afflicted except to prevent them from harming themselves, preferring to wait until the paroxysm exhausts them. I cannot state positively as to whether the attack is explained by the natives as being due to an evil spirit. While these people are polygamous, though having no religious form of worship, they usually believe when any one has a disease that something has entered them or some one who dislikes them has surreptitiously sent some small animal or an arrow into them. Among the Yahgans the 'Yuccamoosh' (doctors) or magicians proceed to pretend to extract these objects by a form of squeezing and hugging the patient, in the meantime blowing, hissing, etc., to force the object or evil out. I have never known of their doing this, however, to a person suffering from an attack.

"I am unable to supply any direct data as to the relation of love, hunger, sexuality, death of relatives or absent relatives to an attack. On the death of a relative the Yahgans go through incantations in the form of a sort of weird death chant, which they often sing in unison at certain times of the day and night. They paint their faces to show the death to strangers, but they rarely mention the name of the dead, in fact by most it is considered an offence to do so. They say simply 'He is gone,' 'He is no more'; they feel the loss of relatives very keenly and sorrow for them, and sometimes become violent with grief and rage.

"Regarding the primitive type of mental organization among these natives,—despite Darwin's first opinion of them, which was subsequently modified, I consider these people inherently intelligent, though of a very primitive type as far as their culture is concerned, probably the most primitive in this hemisphere, perhaps in the world, as the Onas are today living in the Stone Age. Dr. E. Von Hornbostel of Berlin University, who has collaborated with me in making a special study of my phonographic records of their songs, informs me that these songs are the most primitive American-Indian songs of which they have any record." Of importance for a clear understanding of the mental traits of these Indian tribes, as the source from which these attacks develop, are the study of their dreams, their system of taboos and their myths. So far as could be determined from the data supplied, the dreams of these primitive races strongly resemble the dreams of children, as these aboriginal tribes possess many childlike attributes. In fact up to a certain age the civilized child is really a little savage, with his strong egotism and feelings of rivalry, his taboos, his jealousies and his few or no altruistic tendencies. In the child as in the savage, the wish and the thought are synonymous, both want their desires immediately gratified, although such gratification may be impossible in reality. The dreams of the Yahgan Indians are simple wish fulfilments, without disguise or elaboration, like the dreams of a civilized child.

The Yahgan attitude toward death is the same as that of many primitive races. Any reference to death is strongly tabooed amongst them and to transgress this taboo, exposes the individual to grave danger and severe punishment, even the punishment of the thing tabooed. Thus the person who transgresses this taboo becomes himself taboo by arousing the anger or resentment of other members of the tribe. However, a certain ambivalent tendency seems to be present, for while the word death and the mention of the dead is prohibited, yet they feel deep grief and sorrow for dead relatives. Transgression of the taboo may arouse the other aspect of the ambivalent attitude, (for instance anger instead of sorrow) and it thus becomes a source of danger to the guilty individual and so by contagion and imitation to the community. This ambivalent tendency which leads to taboos is prominent among primitive races as well as in civilized children for instance, in the latter, the taboo of pronouncing certain words which leads to stammering or the taboo of objects possessing a sexual significance in producing kleptomania. As civilization and cultural advancement increase or as the child becomes the adult, the taboo tendency gradually declines, yet under certain conditions it may manifest itself as a psychoneurotic symptom. Since these particular primitive races have no conception of immortality, this taboo cannot be a religious or a moral obligation or prohibition, but a social phenomenon for the benefit of the tribe or for the physical welfare of the individuals comprising the tribe. Freud also has pointed out how the avoidence of the names of the dead because of fear of offence to the living is found among certain South American tribes.