A third factor of importance is a study of their myths. These are the savage's day dreams. The relation between myths and dreams is well known, both having their roots in the unconscious thinking of the race. In the individual this unconscious mental process produces dreams, in the race and society, myths. Only one instance will be cited, the legend of the Yahgan Indians concerning the creation of the first man and woman. When one of the tribe was asked how the first human being came into the world, he replied that a long time ago the first man came down from the sky on a rope and later, the woman followed. Here is a striking instance of how an adult Indian had applied his knowledge of individual births literally to a cosmic process, a genuine creation myth as a form of symbolic thinking. There seems little doubt in this case, that the sky, which to all savages appears like a bowl, represented the uterus and the rope, the umbilical cord. The resemblance of this myth to certain birth and parturition dreams, as encountered in the psychoanalytic investigations of civilized adults, is certainly striking.

How is this mass of material to be interpreted? The mental traits of these people, as shown by an analysis of their taboos, myths and dreams, are very primitive in organization, in fact, according to Mr. Furlong, they represent the most primitive types of culture in the world and are today actually living in the Stone Age. Individuals of such primitive mental traits have not learned to successfully repress their emotions and hence are liable to sudden emotional outbursts. Substitution and repression in civilized races are utilized to cover our complex and multifarious ways of expressing our social wishes and wants. In the savage there is little or no repression and substitution, because his desires are simple and easily satisfied.

These primitive people therefore resemble children, without inhibitions or repressions and hence their attacks of violence and furor as above described are sudden emotional reactions, perhaps hysterical, but without any phenomena of conversion. The relation of the attacks to an unsatisfied sexual craving is shown by the fact that the attacks occur only in young men whose libido remains unsatisfied, because according to tribal custom they are compelled to marry old women, or, in the words of the explorer who lived among these people, "old derelicts." This factor, combined with the observation that the victims of the attacks are free from loss of consciousness and amnesia and the absence of an absolute evidence pointing to foaming at the mouth or biting of the tongue, would seem to indicate that the outburst was hysterical rather than epileptic in nature. It would thus correspond to the Piblokto of the Eskimos as described by Brill. This resemblance was also noted by the explorer in his comparative description of the two disorders.

It seems that the attacks themselves are motivated, not so much by the actual gross sexual as by an ungratified or only partially gratified love which would occur in a man who is compelled by social and tribal custom to marry an old woman. Among the Eskimos this factor is at work in the women, among the Fuegians in the men. Conversion phenomena were absent, because their mental organization is very simple, in the same way that childhood hysteria is free from conversion symptoms or at the most is monosymptomatic.



REFERENCES

A. Brill—Piblokto or Hysteria among Peary's Eskimos. Journal of Nervous and Mental Disease, Vol. 40 No. 8—1913.

S. Freud—Totem und Tabu—1913.

E. Kraepelin—Vergleichende Psychiatrie. Centralblatt f. Nervenheilk. U. Psychiatrie. Bd. XV. July, 1904.



TWO INTERESTING CASES OF ILLUSION OF PERCEPTION

BY GEORGE F. ARPS

The Ohio State University

THE first case here reported came to the notice of the writer through the attending physician; the second case was reported by the father of the child after the attending physician had failed of satisfactory treatment. The second case is especially interesting and serviceable in connection with the phenomenon of visual space perception.

The first case is that of a boy, nine years of age, healthy, vigorous, who in his play ground and street reactions parallels that of any normal boy of his age. Aside from measles and an occasional disturbance of digestion he has been singularly free from childhood's common diseases. The father and mother are strong Hanoverian Germans holding with puritanic strictness to the dogmas of the Lutheran religious faith. So far as is ascertainable there can be no question of faulty inheritance, at least not so far as the immediate parents and grandparents enter into the problem.

The child upon retiring and usually while still wide awake uttered wild screams of terror. Upon inquiry the child complained of falling and clutched vigorously to the bed clothes and the arms of the parents. Usually the phenomenon disappeared when he was taken out of bed and walked about but reappeared when he lay down. He complained of pain in his eyes, neck and fore- and after-parts of his head. No amount of persuasion dispelled the illusion. It should be emphasized that the illusion occurred in full waking state and rarely as a dream.

An attempt was made to correlate the illusion with the momentum of the day's activity. According to the parents the illusion appeared in aggravated form when the neighborhood boys congregated in a cluster of trees at the edge of the village and when playing "train" in which case the barn-top functioned as the locomotive while a high board fence and an adjoining neighbor's barn functioned as the cars and caboose respectively.

The village physician offered no explanation. He prescribed a hot bath and a "closer supervision of the evening meal." The dilatation of the cutaneous capillaries consequent to the bath lowered the cerebral circulation and to some extent reduced the intensity of the illusion.

The cue to the cure appeared when the child, in expressing his fear, complained because he could not see the parent who sat beside him on the bed. Upon lighting the room the child seemed pacified but still held tightly to anything within reach. As a rule the illusion disappeared within thirty minutes after illumination. It was then suggested that the child be put to bed in a well lighted room. This was done but the phenomenon reappeared although in a less aggravated form. Degree of illumination and intensity of the illusion appeared related. The phenomenon failed to appear at all when a coal oil lamp was placed beside the bed not over two feet from the child's head. For six months the boy went to sleep facing the full glare of the lamp. Gradually the lamp was removed until it occupied a position in the hall. Whenever the illusion recurred the lamp was replaced in its original position.

It is quite probable that the intensity of the visual stimulus (the lamp) deflected the nervous current from the neural processes underlying the illusion and thus changed the direction of attention. Any intense distraction, other than the one employed, would probably have served the same purpose. At the end of a year and a half the phenomenon entirely disappeared.

The second case is that of a six-year-old girl, the daughter of highly educated parents. With reference to this case two interesting phenomena were observed: (a) that of mirror-writing of the common variety and (b) that of ambiguous interpretation of the retinal impressions.

The phenomenon of mirror-writing here observed parallels that of many other cases in which the left-right direction is reversed. These commoner cases take on an added interest when considered in connection with a case of double space inversion. Such a case is on record.[1] The double inversion consists in writing all verbal symbols and digits up side down and backward. In this case the boy had perfect pseudoscopic vision at the beginning of his school work. Stratton, by a system of lenses, artificially produces the same distortions and throws some light on the phenomenon.[2]

[1] G. F. Arps, a Note on a Case of Double Space Inversion. Annals of Ophthalmology, July, 1914, Vol. XXIII, p. 482.

[2] Psychological Review, Vol. IV, pp. 341-360 and 463-481.

It is in the phenomenon of ambiguity in the interpretation of the retinal eye processes that this case finds its value. At the dinner table the child complained of the decrease in size of a number of objects in the room, especially was this true of the apparent size of the father's head. The frequency of the complaint led the father to seek the advice of an occulist who pronounced the child's vision perfect in every way. Over and over again while seated at the dinner table the child would exclaim, "O father how small your head is!"

The explanation of this phenomenon is found in the method employed to dispell the illusion. It was suggested that, at the moment of the appearance of the phenomenon, the child be requested to fixate the end of the father's index finger which was revolved, in the air, to form various geometrical figures. This had the desired effect. Clearly we have here a case of the object altering its apparent size without altering its distance. Under normal conditions a change in size is followed by a corresponding change in the distance. It is probable that we have here inadequate convergence and that the optic axes do not intersect at the object but beyond, so that the axes are more or less parallel. Thus the feeling of convergence is less intense than experience teaches is necessary to perceive the object as such a size and at such a distance. If degree of convergence is a criterion for distance and if distance is a measure for the apparent size of an object then we have the conditions necessary for the appearance of the illusion.

Here we have the retinal image constant for the apparent and the real size of the object (head). Obviously the retinal processes are constant for the two interpretations of magnitude and the ambiguity is due to the concomitant factor of convergence.

The conditions necessary to decrease the real size of an object while still maintaining an unaltered image are produced without artificial means. Wheatstone, a long time ago, arranged his stereoscope so that a negative correlation obtained between the degree of convergence and size of the retinal image.[3]

[3] Philosophical Transactions, 1852.

Very interesting is the fact that Stratton demonstrated by artificial means what was naturally the case in that of the boy reported in the Annals referred to above. Wheatstone demonstrated by artificial means what was naturally the case in that of the girl here reported.



REVIEWS

FEEBLE-MINDEDNESS, ITS CAUSES AND CONSEQUENCES. By H. H. Goddard. The Macmillan Co., N. Y., 1914. 599 pp., illustrated.

Two comprehensive attempts have been made in recent years to study the inheritance of mental abnormality, one in England at the Eugenics Laboratory of the University of London, the other in this country under the leadership, more or less immediate, of the Eugenics Record Office. Both the English and the American school of workers agree that different grades of mental ability, mental defect and insanity are strongly inherited. But the two schools have reached very different conclusions as to the manner of inheritance of mental traits and mental defects. Each school entertains profound disrespect for the scientific methods and conclusions of the other and with the frankness and honesty which devotion to truth demand has freely criticised the other. By this criticism, at the bottom friendly though sometimes caustic, science has undoubtedly profited. The later work of each school begins to show the chastening influence of adverse criticism.

The English school has leaned backward in its devotion to the inductive method of accumulating inheritance data, ostensibly without prejudice for or against any particular theory but in reality with an ill-concealed bias against anything savoring of "Mendelism." The American school recognizing in Mendelism a great advance and an important instrument for the discovery of new truth, has ignored the possibility that other undiscovered laws of heredity may exist and has cast aside as superfluous the valuable biometric tools wrought with much patient toil by Galton and Pearson. It will be the part of wisdom for students of genetics to imitate the hostile attitude of neither school, but to utilize the positive results of both. This is what Dr. Goddard has done in the work under review.

He apparently began studying the inheritance of feeble-mindedness without theoretical prejudice, but with a practical end in view, to discover, if possible, the causes of feeble-mindedness so as to deal intelligently with the inmates of the Vineland (N. J.) institution with which he is connected. Goddard received inspiration and suggestion from the Mendelian principles which dominate the work of the Eugenics Record Office, but has published his observations in detail so that the reader may test by them any theory he likes. This method can not be too highly commended for it gives permanent value to the publication, however much prevailing theories may change. The book contains a detailed study of 327 "cases," each being the family history of a different inmate of the Vineland institution, as made out by trained investigators who visited the homes of the inmates and held interviews with their parents, relatives, friends and neighbors. English criticism of American work of this sort had prepared the reader to expect carelessness of method and inaccuracy in the accumulation of data, but Dr. Goddard is evidently on his guard against this. He goes very fully into the method of obtaining and verifying the data, and in doing so gives a very strong impression that the data are "reliable." His treatment of the data is also cautious but thorough, so that when he works his way to a conclusion it stands firmly established. The conclusions reached are numerous and important, but the one of greatest theoretical interest is this, that feeble-mindedness is inherited as a simple recessive Mendelian unit-character. This conclusion, so far as earlier publications were concerned, might be regarded as insufficiently established, but the evidence presented in this work renders it, I think, beyond question. Goddard was himself apparently considerably surprised at the conclusion reached. He had expected to find different kinds or grades of mental defect independently inherited as units and confesses to leanings toward views of the physiological independence of different mental functions, but his "cases" give him no evidence of such inheritance. He finds only that feeble minds are minds of arrested development in regard to all functions, and that different grades of feeble-mindedness correspond with different stages of normal mental development completely arrested. How different grades may occur in one and the same Mendelian unit is apparently a puzzle to Goddard, who does not attempt its explanation. It is indeed an absurdity to the "pure line" Mendelian, but not to one who appreciates the fact that Mendelian units are subject to quantitative variation sometimes continuous, sometimes discontinuous. An example of the former is found in the hooded pattern of rats,[4] of the latter in albinism and other Mendelizing characters which assume multiple allelomorphic conditions.[5] Pearson has steadfastly refused to admit that albinism in man is a Mendelizing character, because it may assume various forms ranging from colorless to quite heavily pigmented conditions (blondes). We now find that albinism in guinea-pigs shows an even greater range of variation,[6] yet there can be no doubt of its fundamental unity as a Mendelian character, each grade of which is allelomorphic to every other grade and to normal pigmentation.

[4] Castle and Phillips, 1914, Publ. No. 195, Carnegie Inst. of Wash.

[5] Castle and Fish, Amer. Nat., Feb., 1915.

[6] Wright, S. Amer. Nat., March, 1915.

Goddard's findings as regards feeble-mindedness fit in perfectly with this scheme. That Goddard was unaware of it when his conclusions were reached is all the more evidence of their soundness because it shows that they were reached independently. Among albinos every higher grade of pigmentation dominates all the lower grades in inheritance, and so apparently it is with mental development; the higher grades dominate the lower. At every point there appears to be agreement in method of inheritance between albinism and feeble-mindedness. Each is a unit character but showing graded allelomorphic conditions which correspond probably with different stages of arrested development of pigmentation or mentality respectively.

The fact noted by Goddard that the feeble-minded resemble savages, that is backward races of low mentality, has much interest to the student of evolution. It indicates that the evolution of intelligence has occurred by a gradual progressive advancement, stages in which reappear as the higher grades of feeble-mindedness. Of course it is not certain that the ontogenetic stages, at which mental development may be arrested, correspond accurately with earlier phylogenetic stages, but the idea receives considerable support from the observed resemblance between the mentality of morons and that of savage peoples, if the observation may be accepted as accurate. I do not understand however that Goddard makes any claim to first-hand familiarity with the mental life of savages, so that no great emphasis should be laid on the point. But the mere fact that RETROGRESSIVE variation in mentality is GRADED favors the view that its PROGRESSIVE evolution has been gradual, rather than the view that it has arisen by mutation or sudden loss of inhibitors. (Bateson, Davenport).

Goddard points out that a high grade moron may be a useful and self-supporting member of society in some environments (usually rural) whereas he would be quite helpless in the keen competition of urban life. This suggestion leads the reader to wonder whether many peasant and peon populations of the old and new world represent survivals of an older and lower grade of mental evolution than has been attained in the more advanced nations, or whether it is merely lack of opportunity that makes these populations backward. The fact that in every generation great men come from the lower social levels shows that the lower classes are not entirely devoid of capacity; nevertheless it seems probable that a low grade of intelligence would stand a better chance of escaping elimination in the struggle for existence when placed in a simple environment than when placed in a complex one. Consequently, under modern conditions, we might expect a peasant or peon population to average lower in mental capacity than a community more advanced in civilization. Whether the peasant population would equal in average intelligence a band of North American Indians or a tribe of native New Zealanders is very doubtful, for in such peoples natural selection for intelligence was undoubtedly severe because of their intense struggle with nature and with other tribes, unaided by the accumulated knowledge and tools of civilized communities. Among such peoples greater demands were probably made on inborn intelligence than among modern industrial populations.

As regards the CAUSES of feeble-mindedness Goddard's findings are wholly negative, but not less valuable on that account. His case histories statistically studied indicate no causal relation to a number of reputed agencies in the creation of feeble-mindedness, such as alcoholism (which he regards as oftener a symptom than a cause), tuberculosis, sexual immorality, insanity, syphilis, accident and consanguinity. He recognizes HEREDITY as its principal source, i. e. he recognizes feeble-mindedness as a stage of mentality already existing and transmissible by the ordinary mechanism of heredity, but does not attempt further to account for it, either as a survival or as an atavism.

That humanitarian governments by shielding and supporting the moron without putting a limit on his naturally high reproduction will speedily increase this class at the expense of the more intelligent classes of the community is self-evident, if it is admitted that feeble-mindedness is hereditary, as all who have investigated the matter carefully now declare. Goddard shows further that a large percentage (probably more than half) of the alcoholism, pauperism, prostitution, and crime, of the United States are directly traceable to hereditary feeble-mindedness, another strong reason for taking measures to reduce it.

How is this to be done? Goddard has no cure-all to offer but urges first of all that the mental grade of each individual be accurately determined and education and occupation be provided suited to his capacity. This will tend to make the moron a useful and contented member of the community, not a menace to it. Segregation is recommended so far as practicable, but in view of the large number (estimated at 300,000 to 400,000 in the U. S.) Goddard considers segregation of all impracticable. Nevertheless he urges further and energetic efforts in this direction, that as many as possible may be segregated as a safeguard against their reproduction. In individual cases "sterilization wisely and carefully practiced" must be employed to insure non-reproduction.

In this volume there is a pleasing absence of the rant which pervades some eugenic literature. The author has something of importance to contribute to science and he presents his contribution in a sober, dignified manner in keeping with the important character of his contribution. W. E. CASTLE.



CHRISTIANITY: THE SOURCES OF ITS TEACHING AND SYMBOLISM. By J. B. Hannay. (Francis Griffiths, London; pp. 394).

This is an attempt to expound the symbolism of the Christian religion. It is divided into three main parts: ancient cults (phallism and sun worship); ancient cults in the Old Testament; ancient cults in the New Testament. The author's main thesis can be stated in a sentence: the essential constituents of every religion, and the underlying meaning of its symbolism, are phallicism and sun worship. Of these the former is the more important, more primary, and more wide-spread; the latter is a superimposed layer better adapted to more civilized and educated people, but rarely penetrating into the hearts of the common people to the extent that the former has. "The great branches under which all the religious systems of the past have developed may be classed as based, on the one hand on the consideration of our world and the continuity of life upon it, expressed in Phallic symbolism, and on the other hand, on the Sun as the great giver and sustainer of man, expressed in Solar symbolism." (p. 21). "As the Phallic cult was much the older, it retained its position after the rise of the Solar cult. It required a much higher intelligence to grasp the facts of Solar worship, so it never entered the 'hearts' of the common people as did the Phallic worship, but it had a much more intelligent priesthood, and was the arbiter in all questions of dates, and regulated al) feasts; and, what was more important to the people, fixed the time for payments of debts or interest, and regulated the times of sowing and harvesting, so it became a much more 'official' religion than Phallism." In support of these conclusions the author marshals a huge number of facts, so that the work becomes a veritable encyclopaedia of symbolism.

Now in spite of the fact that the reviewer fully accepts the main thesis of the book, as stated above, and therefore has no prejudice or hostility on the score of the conclusions encunciated being distasteful, his judgment of the book is entirely unfavourable, for the following reasons: In the first place, any presence of the book to be a scientific, and therefore impartial, contribution to knowledge is invalidated by the author's moral bias evident from beginning to end, against religion in general, and Christianity in particular, which he maintains is the most phallic of all religions. His point of view is that of the older rationalists, to whom religion is nothing but an unfortunate instinct for "delight in the miraculous," expressing itself in phallic and sun worship, and fostered by the exploiting tendencies of priests. His desire seems to be, in writing the book, to "show up" religion and, by discrediting it, hasten its end.

In the second place, there is not a single new idea in all its closely packed pages, and therefore no excuse for writing them, since the material here laboriously brought together is easily accessible in other books. It never seems to dawn on the author that pointing out the sexual basis of religion, which countless other writers have already done, is but the beginning of the problem, the starting-point of all sorts of complex riddles. Having dogmatically divided all religious symbols into male and female, he is self-satisfied enough to think that he has explained religion. There is no inkling of the points of view suggested by such words as determinism, significance, genesis, so familiar to the modern psychologist.

Side by side with all this goes a disorderly arrangement and very imperfect powers of criticism. The latter feature is especially marked in the field of etymology, where the author fairly lets himself run wild. The following gem is a typical example (p. 110): "Bacchus became degraded into the God of Wine, and his fetes became drunken orgies, but he was originally the beneficent sun who ripened the fruits, and hence God of Wine, from which, indeed, is derived the English name of all our gods, angels, prophets, or even parsons,—"divines," "dei vini," "Gods of Wine." Jesus was the "True Vine."

The merits of the book are that it may direct the attention of some people to the connection between sex and religion, if there are any who are still unaware of this, and that it possesses a good index that may be useful to readers with limited facilities for looking up particular symbolisms; it is also well illustrated. ERNEST JONES.



LAUGHTER: AN ESSAY ON THE MEANING OF THE COMIC. Henri Bergson. Translated by C. Brereton and F. Rothwell. (Macmillan, London, 1913. Pp. 200).

In this stimulating little book Professor Bergson propounds his theory of the comic, which is shortly to the following effect. Noting first that laughter is purely a human phenomenon, and therefore probably has a social significance, he seeks for this by trying to define what are the essential features of the comical. He reduces the various characteristic features in the main to one, namely, automatism on the part of the comical person or thing. This automatism is of a special kind; especially is it an automatism that is out of place, that occurs at the expense of spontaneity, vitality, and freshness. It may thus be defined as "something mechanical in something living," "a kind of absentmindedness on the part of life." "The comic is that side of a person which reveals his likeness to a thing, that aspect of human events which through its peculiar inelasticity, conveys the impression of pure mechanism, of automatism, of movement without life." "To imitate anyone is to bring out the element of automatism he has allowed to creep into his person. And as this is the very essence of the ludicrous, it is no wonder that imitation gives rise to laughter. "This bald statement of Bergson's conclusion is, in the reviewer's opinion, made very convincing by the delicate analysis he proffers of numerous illustrations.

Up to this point Bergson's theory of the comic fairly well coincides with that of Freud. The latter author, it is true, summarises his conclusions in different language. But the meaning is not very different. For him the feeling of comicality is an "economy of ideational expenditure," and it is evoked by the sight of another person who in a given performance displays either a lack of mental activity or an excess of physical, i.e., who is either stupid or clumsy. Compare this formulation with Bergson's. The latter says that the opposite of the comic is gracefulness, rather than beauty. "It partakes rather of the unsprightly than of the unsightly, of rigidness rather than of ugliness." The replacement of mental by physical activity is insisted on in the following passage: "Any incident is comic that calls our attention to the physical in a person, when it is the moral (i. e. mental) that is concerned." Again, he compares a comical person to "a person embarrassed by his body." His automatism is essentially a lack of mental nimbleness, a formal lack of mental elasticity, a defective capacity for rapid adjustment, in short, a mental laziness. And especially is this defect one of consciousness. The failure is on the part of the higher mental activities, which should be the most alert, and what happens is a relapse into unconscious, automatic modes of functioning, a form of absentmindness. "The comic is that element by which the person unwittingly betrays himself—the involuntary gesture or the unconscious remark. Absentmindedness is always comical. Systematic absentmindedness, like that of Don Quixote, is the most comical thing imaginable . . . . . . . No one can be comical unless there be some aspect of his person of which he is unaware, one side of his nature which he overlooks; on that account alone does he make us laugh."

In substantial agreement on this general conclusion as to mental rigidity and bodily clumsiness, the two views diverge from here. According to Bergson, the comic presupposes "something like a momentary anaesthesia of the heart;" "laughter is incompatible with emotion." For Freud this absence of emotion is much more characteristic of humour than of the comic, two matters that Bergson quite fails to distinguish. Then, whereas Freud explains the subjective side of the comic purely on hedonic principles, Bergson sees in it an important social function. According to him, laughter is one of society's weapons for dealing with tendencies that threaten to diverge from the conventional and accepted norm. It "restrains eccentricity" and "corrects unsociability." "Any individual is comic who automatically goes his own way without troubling himself about getting into touch with the rest of his fellow-beings. It is the part of laughter to reprove his absentmindness and wake him out of his dream . . . . Each member must be ever attentive to his social surroundings; he must model himself on his environment; in short, he must avoid shutting himself up in his own peculiar character as a philosopher in his ivory tower. Therefore society holds suspended over each individual member, if not the threat of correction, at all events the prospect of a snubbing, which, although it is slight, is none the less dreaded. Such must be the function of laughter. . . . It represses separatist tendencies." "Unsociability in the performer and insensibility in the spectator—such, in a word, are the two essential conditions." This interesting theory leaves some questions unanswered. Why, for instance, should onlooking society remain emotionally cold in one case, and merely laugh, and in another case adopt much graver measures? Bergson deals with this point rather imperfectly. It is not the seriousness of the case that decides, for "we now see that the seriousness of the case is of no importance either: whether serious or trifling, it is still capable of making us laugh, provided that care be taken not to arouse our emotions." Nor is it the immoral nature of the deviation from the normal. "The comic character may, strictly speaking, be quite in accord with stern morality. All it has to do is to bring itself into accord with society." "It is the faults of others that make us laugh, provided we add that they make us laugh by reason of their UNSOCIABILITY rather than of their IMMORALITY." The most specific criterion seems, in Bergson's opinion, to be that of vanity. "It might be said that the specific remedy for vanity is laughter, and that the one failing that is essentially laughable is vanity."

We may briefly refer to some other matters dealt with more incidentally; wit, and the relation of the comic to art and to dreams. The discussion of wit is perhaps the weakest part of the book. No analysis is given of the different forms of wit, and the important subject of what may be called its technique is quite passed by. Wit is identified in a superficial manner with the comic in general, the fundamental differences between the two, which Freud has dealt so exhaustively with, being altogether ignored. Bergson gives a more interesting and profitable study of the relation of the comic to art; especially of the nature of comedy as distinct from other forms of drama. According to him, comedy portrays character types rather than individual persons. He repeatedly insists on this point, adding that "it is the ONLY one of all the arts that aims at the general; so that once this objective has been attributed to it, we have said all that it is and all that the rest cannot be." Further, "comedy lies midway between art and life. It is not disinterested as genuine art is. By organizing laughter, comedy accepts social life as a natural environment, it even obeys an impulse of social life. And in this respect it turns its back upon art, which is a breaking away from society and a return to pure nature. "The discussion of the relation of the comic to dreams is, on the other hand, less satisfying. Comic absurdity is stated to be of the same nature as that of dreams. The main point of resemblance seems to be that in both cases there occurs an absence of social contact. In both there is a mental relaxation from the effort of "seeing nothing but what is existent and thinking nothing but what is consistent." This really applies much more to wit than to the comic itself.

As may be expected, the whole book is written in Professor Bergson's pleasing style, and is full of suggestive hints and fresh points of view. The most significant contribution, one which pervades the book throughout, is the view of laughter as a social censor. Even if this hypothesis is substantiated by detailed investigation, however, it cannot rank as a complete theory of laughter, or of the comic, until it is supplemented by some explanation, not given by the author, of the most striking feature of laughter, its capacity for yielding pleasure.

It only remains to say that the translation is literally excellent. ERNEST JONES.



ADDRESSES AND PAPERS AT THE OPENING OF THE PHIPPS PSYCHIATRIC CLINIC, JOHNS HOPKINS HOSPITAL. The American Journal of Insanity, Special Number, Vol. LXIX, No. 5. The Johns Hopkins Press, 1915.

This special number of the American Journal of Insanity contains the exercises and papers delivered at the opening at the Phipps Psychiatric Clinic at the Johns Hopkins Hospital, Baltimore, Md. The contents of the entire volume should prove to be of the greatest interest to all students and lovers of psychiatry. The volume opens with a brief but fitting Introduction by Dr. Adolf Meyer, Director of the Clinic, a man to whom American psychiatry owes so much for the stimulus and inspiration which he has injected into others. This is followed by A Word of Appreciation by Henry D. Harland, President Trustees, The Johns Hopkins Hospital, some brief remarks on The Psychiatric Clinic and the Community by Stewart Paton, the heart-to-heart talk on Specialism in the General Hospital by Sir William Osler, and a short talk on The Purpose of the Psychiatric Clinic by Prof. Adolf Meyer. There then follow a series of fascinating and inspiring papers, as follows: The Sources and Direction of Psychophysical Energy, by William McDougall; Autistic Thinking by E. Bleuler; Personality and Psychosis by August Hoch; The Personal Factor in Association Reactions by Frederic Lyman Wells; A Study of the Neuropathic Inheritance by F. W. Mott; On the Etiology of Pellagra and its Relation to Psychiatry by O. Rossi; Psychic Disturbances Associated with Disorders of the Ductless Glands, by Harvey Cushing; Primitive Mechanisms of Individual Adjustment by Stewart Paton; Demenzprobleme by K. Heilbronner; The Inter-relation of the Biogenetic Psychoses by Ernest Jones; Prognostic Principles in the Biogenetic Psychoses, with Special Reference to the Katatonic Syndrome by George H. Kirby; Anatomical Borderline between the So-called Syphilitic and Metasyphilitic Disorders in the Brain and Spinal Cord by Charles B. Dunlap; and Mental Disorders and Cerebral Lesions Associated with Pernicious Anemia by Albert Moore Barrett. The number is concluded by the penetrating Closing Remarks of Prof. Adolf Meyer.

The papers by Mott, Rossi, Cushing and Heilbronner are of the greatest interest. The discussions by McDougall and Bleuler are fascinating and uplifting. McDougall's paper is a masterpiece. Kirby, Jones and Hoch present us with the modern standpoints in the conception of the psychoses. Throughout the volume one sees the adoption of the broad biological standpoint in mental life. The adoption of the term "biogenetic psychoses" is indicative of the general trend. The adoption of this well-chosen phrase is, I venture to suggest, the product of Dr. Meyer.

The reviewer regrets that the papers do not very well lend themselves for brief reviews. Furthermore, he would not attempt to briefly present the views which have been so lucidly and succinctly expressed by the individual writers.

Prof. Meyer is to be commended for the very splendid program presented at the opening exercises of the Phipps Psychiatric Clinic.

May it be a lasting inspiration for those who drink at the fountain of psychiatry and psychopathology. MEYER SOLOMON.



BOOKS RECEIVED

SLEEP AND SLEEPLESSNESS. By H. Addington Bruce. Pp. IX + 219. Little, Brown & Co., 1915. $1.00 net.

THE MEANING OF DREAMS. By I. H. Coriat. Pp. XIII + 194. Little, Brown & Co. $1.00 net.



THE JOURNAL OF ABNORMAL PSYCHOLOGY

A PSYCHOLOGICAL ANALYSIS OF STUTTERING[*]

[*] Paper read May 6, 1914, at Albany, New York, before the American Psychopathological Association.

Copyright 1915 by Richard G. Badger. All rights reserved.

BY WALTER B. SWIFT, A.B., S.B., M.D.

Instructor in Neuropathology, Tufts College Medical School, In Charge Voice Clinic, Boston State Hospital, Psychopathic Department.

THE object of this paper is to carry the analysis of stutter phenomena deeper than before. In my last year's paper I showed that chronologically the diagnosis of dyslalia mounted step by step from a material external affair, up through the nerves until we came to the basal ganglia. I showed conclusively that it was an involvement that did not exist in any of these places. I further took steps to demonstrate and present evidence that indicated that dyslalia was in its essence some trouble with the personality. I mean by this: that the trouble was located in the nervous system beyond the lower sensory areas of the sensorium; and also above the lower motor areas on the motor side. By the broad term "personality" I mean the total of the activities and interrelations of mental activities that occur above our lower sensory and motor areas. The paper of last year clearly located the trouble vaguely in this region of the personality.

Since that time I have been interested to ascertain just what the nature of this changed personality is. In order to do so, I have carried on an investigation that has reached interesting conclusions. To me it is new truth. It may not be all the truth, but as far as it goes, and as for what it is, it surely is truth and a new finding! This research is an effort to show not only where it is but WHAT IT IS.

The method was as follows: For the purpose of finding out some of the activities going on in the area of collaboration during speech, I asked my stuttering patients two simple questions. I thus found that their methods of collaboration complied to a certain mental type.

Then I carried this same method into the study of normal individuals in the collaboration of their ideas, just before and during speech in order to establish a norm; and to see whether or not it differed from my preliminary test of stuttering cases just mentioned. It did, and therefore I formulated a series of questions in order to pin the type of collaboration down to certain fields of mental action. To make this clear, let me present an outline of these different steps in tabular form.

1. Orientation tests on stutterers. 2. Orientation tests on normal individuals. 3. The research, its objects and methods. 4. Final detailed results.

Let us now pass to a minuter description of each of these procedures and a tabulation of the data that resulted.

1. PSYCHOLOGICAL ORIENTATION TESTS ON STUTTERERS:

By orientation test I mean simply a vague try-out to see just where the problem lies; an initial step to see what further steps are necessary; or in other words enough of an investigation to know where to look next.

The orientation tests consisted in requesting a series of twenty stuttering cases to answer two questions. Following their answers an immediate inspection was made of the content of their consciousness before, during, and after speech. These two questions were as follows:

1. Where do you live? 2. Say after me "The dog ran across the street."

After these questions I asked the patients to state whether there was any picture in the content of consciousness and how long it lasted; also whether that was detailed, intense or weak. I noted the presence of stuttering in relation to the presence or absence of this mental imagery; and also made a note of any other unusual data that happened. The results of the tests indicated above can be summarized as follows:

Of the twenty stutterers examined, ten made no visualization of their homes, some even after a residence of years; one of these twenty visualized home very faintly; two others visualized home clearly but the picture vanished on speaking; seven others visualized home clearly but these had been under treatment.

On repeating the dog statement, ten stutterers made no visualization whatever; one visualized faintly; four visualized well but the picture vanished on speaking; five others reported visualization, and four of these had been under treatment.

At first I did not know but what this was the norm of average visualization methods; so I tried this same series upon a number of normal individuals for comparison; by normal individuals, I mean, at this time, merely anyone who is free from stuttering, and chosen in a haphazard way from the hospital community; for example, one was our executive secretary, another a typewriter, another a telephone operator and so on.



2. PSYCHOLOGICAL ORIENTATION TESTS ON NORMAL INDIVIDUALS

The results of these orientation tests upon normal individuals were as follows:

The normal individuals examined almost without exception visualized clearly before and during speech. Sometimes this visualization was very marked in detail and resulted in emotional responses, such as pleasures, etc.

From the above two sets of figures were thus obtained a fair norm of visualization for ordinary individuals; and in comparison a marked variation from this in stutterers. This data therefore warranted the tentative conclusion that stutterers have a loss or diminished power of visualization. This assertion may seem a little more than is warranted by such meagre data and perhaps would be better revised pending further data into the following: As compared with the normal, stutterers show a weakness in visualization.



3. THE RESEARCH, ITS OBJECTS AND METHODS:

These general orientation tests for a norm and its pathological variation were the basis upon which I proceeded on broader lines with a further and more exhaustive investigation with the following points in view:

To what extent is visualization weak?

Is it weaker in the worst cases?

Is it less and less weak as cases appear less severe?

Is it the same for past, present and future memories?

Is visualization equally at fault in all sensory areas of the cortex?

Do cases approach normal visualization processes in proportion as they progress in their cure? and

Lastly, numerous other minor queries presented themselves.

All these questions were answered in the following research, which after thus much orientation found a more complete and final form.

In order to answer these questions I formulated the following series of tests to the number of twenty-four in all, and asked them in series to nineteen stutterers, making almost four hundred tests:

1. Speech: Say, Today is sunny. The dog ran across the street. Submarines will sink all the steamers.

2. Motor: Do you dance? Did you ever skate? Would you sew for a living?

3. General Sensory: How does a pinch feel? Did you ever get hurt? What would you like to do if it was very hot next summer?

4. Hearing: (Eyes closed) Do you hear anything? Did you ever hear a rooster crow? What sounds would you like to hear next summer?

5. Sight: (Eyes closed) What do you see now? What did you see yesterday? What would you like to see next summer?

6. Smell: (Eyes closed) (Pen to nose) Do you smell anything? What have you told by smell? What would you like to smell next summer?

7. Taste: (Eyes closed) Do you taste anything? What have you been able to tell by the taste? What would you like to taste next summer?

8. Muscle Sense: (Eyes closed) Put one arm up; the other like it. Put one arm up, down; the other like it. How would you hold a hand to read from it?

This long series of questions with careful introspection tests upon the content of consciousness constituted then my main research in the field of stuttering. Perhaps further details in explanation of the questions chosen is unnecessary. Three or more questions on introspection were asked at each test.

4. FINAL DETAILED RESULTS are found in the following conclusions as drawn from 1440 answers.

In our average conversation a visual picture is created before we begin utterance. Severe stutterers never visualize at all. In direct proportion that these cases become less severe, does visualization increase in frequency, strength and continuation in consciousness before and during utterance.

When severe stutterers are free from spasms they visualize, and when they stutter they do not visualize.

When mild cases are free from spasms, they visualize, and when they stutter they fail to visualize.

In a word, when visualization is present stuttering is absent; when visualization is absent stuttering is present.

This is true not only of EACH UTTERANCE, in most cases, but is true of severe as well as mild forms as a whole.

Stutterers gain in visualization as they approach cure.

For past, present and future memories: visualization is slightly more frequent for past and future.

Therefore stuttering is an indication of absent or weak visualization either in isolated words, occasional stutterers, mild stutterers or the severest type, either before or during speech, or both.

The slump, then, in personality which I showed last year as the main thing in stuttering as its cause and condition, is thus found by further psychological analysis, to be a slump in the power to consciously visualize.

By personality I mean as mentioned above the composite of collaborative activities that lie between the low sensory repository areas and the low motor expression areas. In other words, personality includes all those collaborative processes that lie between the sensory intake areas and the motor output areas; in a word, any unexpressed use the mind makes of its intake. Conscious visualization is a part of personality processes, then. In my last year's paper([1]) the whole matter was left vague. Here something definite and constant is found. In other words the psychoanalytical method revealed no conscious subconscious cause. Granted there is room here to "interpret" (or create according to Freudian mechanisms) a definite subconscious complex, a step which I could not feel justified in taking; I leave this to better psychoanalysts than I. For me to twist stutter phenomena to comply to a theoretical complex is unscientific to say the least. But the psychological method—as represented by this paper—shows a definite constant cause for all the phenomena of stuttering.

FAULTY VISUALIZATION EXPLAINS ALL PHENOMENA:

Upon this basis of an involved visualization all the intricate phenomena of stuttering may be explained. Let us take some of these up in detail.

THE START. Visualization processes are a matter of growth through exercise and development and use from the sensory area mostly of the eye. If these processes in their early start and evolution receive a setback through the treatment of people in the environment, such as interruptions of their early speech efforts, constant inattention of those to whom they speak, and persistent refusal by older people to answer questions propounded or the allowing of the little one to ask the same question without hopes of answer for a great number of times, these visualization processes receive a setback. This kind of treatment in the home is one of the chief causes of the slump of visualization processes. Another cause is hearing other stutterers interrupt their own visualization processes as they stutter; and still other minor causes may be almost any psychic trauma; these traumata, such as an operation, an accident or a severe illness, are sufficient to bring to the surface or intensify a growing lack of visualization that has been started by bad environment long before.

THE DEVELOPMENT OF STUTTERING. When the habit of visualization is lessened, the action upon speech is the same as the withdrawal of an inhibiting or regulating reflex arc.

It is thus that visualization processes act like reflex inhibition. When visualization is present a higher inhibition arc is functioning and we have a normal speech as a consequent reflex expression. When and in proportion as visualization is absent this higher inhibition arc is not functioning; and the speech thus uncontrolled flies away in spasms which we call stutter. It should be called an exaggerated or uninhibited speech reflex.

The stutter, then, is merely the externalization of an exaggerated reflex of motor speech, exaggerated through the loss of the inhibitory action of a more or less weakened visualization process.

Not only does this explain the phenomena at large but seems to be a satisfactory explanation for all its intricate, minute details. Some examples may, perhaps, be welcome at this point. I say to two stutterers: "Tell your first name." One of them stutters and the other one does not. On furthering questioning, it is found that the one who did not stutter visualized, and the one who did stutter did not visualize.

CONCRETE: These conditions are also seen when stutterers talk about concrete and abstract matters or when they promulgate some important plea that cannot be visualized. On concrete matters that can be easily visualized the stuttering is gone; and on abstract matters where visualization is hard, the stuttering again appears.

ANGER: In anger, when an intense visual picture is presented and occupies the mind, there is then no stuttering, and also in other similar situations there are periods when the individual is abandoned to some visual concept which acts in the same manner.

SINGING: We all know that stutterers can sing without stuttering. The process here is a similar one; only that there is held up over the speech before utterance an auditory image of a melody in place of the visual image as held in normal speech. This auditory image may be more easily applicable as supplying the needed inhibition reflex arc than the visual because it is nearer to the speech area.

PRAYER: For the same reason prayer is uttered without stuttering when there is faith enough in a God to hold an image of Him during utterance. There may also be other images held during prayer.

FAMILIAR SIGHTS: Familiar sights are less stuttered upon than the detailing of situations that are less familiar and therefore can be less well visualized. This is also true of sights that have been recently seen or that have been repeatedly seen, or that in some other way have been made intense as pictures in the visual field.

AS CURE PROCEEDS: In the process of recovery where visualization is seen to increase as the stutter decreases, there is another illustration where this visualization attitude explains the whole situation. I have taken a severe stutterer and told him a story that could be well pictured, got him to work up the pictures properly by several complicated processes (which we will not consider now) and when he had them well in hand, I have seen him stand up and relate the story from beginning to end with little or no stuttering If at any point he would trip up, the inevitable confession would be that at that point he dropped the picture, or, in other words, the visualization could not be held over in its inhibitory action; and therefore the stutter came. On further request to hold it over that point, the same passage would be again expressed smoothly if he succeeded in holding the picture.

This constancy, this presence and absence of the picture, its presence to make smooth talk and its absence to cause stuttering, is so constant at every turn of the situation, that I would offer it as a new interpretation of all these phenomena. I know of no other interpretation that can EXPLAIN EVERYTHING UNDER ONE HEAD as does this absence, weakness or interruption of visualization processes.

TERMINOLOGY. We have found in our orientation tests that in a vague way the visualization was at fault. We have also found in normal individuals that a marked visualization was an automatic process that preceded speech, and lasted during utterance; and we have found in the long series of stutterers that visualization is entirely absent in severe cases; that it is weak in milder forms; that it is intermittent in most cases, and that on words that are smooth it always appears, and in occasional stutter it is as occasionally absent.

We have also found that the form of visualization common in normal speech is the visualization of eye sensations; that in unusual situations we may have visualizations from other sense areas, such as the ear, taste or smell, but these are the RARE EXCEPTION.

From all this data it would naturally follow that some sort of term is needed to designate this condition. Last year I probed to find such a term without much success.

At present I see no reason why it should not be called an Asthenia; it is surely the weakening of a mental process that is strong in normal individuals. The evidence here presented shows that. I doubt whether there is any marked pathological change, since the individual may be educated out of it; but this does not necessarily follow as proven with my dog in Berlin.[2] As a general designation, then, I should consider Asthenia as apropos.

One objection to this is that the weakness is by this terminology lacking in localization. Our data above has shown us that the location of the trouble is visual; that is, it is situated about a centre of sensory registration that deposits data from the eye; this must naturally then be located somewhere in or near the cuneus. We could therefore add to the terminology this idea of a minute localization and call it a Centre Asthenia.

Some may prefer to carry the matter one step farther and add the name of the centre in which this weakness is located, but I fear if I take this step and complete my terminology by the word "Visual Centre Asthenia," it will, as such, not cover quite all the cases, for I find that sometimes the visualization is absent in other areas as well, and also the holding of an emotion of pleasure or pain and of other dominating mental attitudes that are sometimes visualized would not, therefore, be included. I would therefore retract the broader claim in order to place the term on a conservative basis and call the essence of the lesion simply no more or less than a Centre Asthenia. As well as visual Asthenia, the following terms might be considered as applicable: collaborative centre asthenia; imaginative centre asthenia; visual creative centre asthenia; picture producing centre asthenia. We say neurasthenia when the trouble is not in the nerves as such, so much as it is in the collaborative centres. More of this later. Here in stuttering the trouble is also collaborative, and we can be still more definite than that and say the trouble is with the collaboration of visualization. So if I were forced, however, to choose one term from all these, my choice would be "Visual Centre Asthenia." This indicates a new and rational treatment. But of this later.

SUMMARY: Psychoanalysis reveals stuttering as some vague trouble in the personality[1]. Psychological Analysis shows stuttering is an absent or weak visualization at the time of speech. This new concept of stuttering as faulty visualization may be called Visual Centre Asthenia. This lack or weakness in visualization accounts for all the numerous phenomena of stuttering in severe, medium, or mild cases. A new treatment is indicated.



REFERENCES

[1] Swift: Walter B, A Psychoanalysis of the Stutter Complex with Results of Synthesis.

[2] Swift Walter B., demonstration eines Hundes, dem beide Schafenlappen xtirpiert worden Sind. Neurologisches Centralblatt, 1910, no 13.



THE ORIGIN OF SUPERNATURAL EXPLANATIONS[*]

[*] Read at the 7th Annual Meeting of the American Psychopathological Association, New York, May, 1915.

BY TOM A. WILLIAMS, M. B., C. M. (EDINBURGH)

Corresponding Member Neurol. and Psychol. Societies of Paris, etc. Neurologist to Freedmen's Hospital and Epiphany Dispensary, Lecturer on Nervous and Mental Diseases, Howard University, Washington, D. C.

THERE is a general impression that the explanations of natural phenomena, including human destinies, to which the term superstitious is given are usually attributable to the vestiges of traditional cosmogonies of our tribal ancestors handed down to children at the knees of their parents or guardians. This explanation however, is only true of a portion of the beliefs which we call superstitions. The demand for superstitious explanations depends upon psychophysiological tendencies of the human organism, the root of which is comprised in the affect which we call craving. This theorem I have tried to develop as follows:—

I

Craving is a sign of physiological need. It is a sensory phenomenon, of which, however, explicit awareness cannot always be discovered. It is conspicuously noticed in cases of disturbance of the body secretions, such as occurs in over-function of the thyroid gland. It is regarded as a crude body-consciousness that something is the matter. In motorial organisms it causes visible reaction: this expresses itself in what is termed restlessness. But the unrest may show itself by a fixation more particularly in the muscles of emotional expression, although the manifestation is not confined to these; shallow respirations and restricted amplitude of movement in limbs and trunk may be observed also. In cerebrate animals the reaction of the individual is under the guidance of preceding impressions stored in the pallium and known as memories; whereas in the animals without a pallium all reaction is accomplished through stable mechanisms known as instincts. Both of these types of reaction are tropisms merely; but the former are labile, conditionable; whereas the latter cannot be modified. The science of conditionable reactions of cerebrate animals is called psychology, and the means by which the reactions are influenced are called psychogenetic, whether these are healthy or diseased. It must not be forgotten, however, that the genesis of a psychological disturbance may be purely somatic, although the manner in which the reaction shows itself is contingent mainly upon the features of the individual which have been derived from previous sensory impressions and their resultant motor reactions commonly known as experience. It is the influence of these upon the hereditary dispositions of the individual which constitute what is known as "make-up" or character; and it is this which determines the form which reaction to stimulus must take, whether the stimulus is purely psychological or somatic.

Now physiological discomfort is an experience universal at one time of life or another; but the reaction to it is infinite in variety; and while part of it depends upon the congenital dispositions which are the common property of humanity, a larger part is contingent upon the psychogenetic factors which have stamped the individual.

II

Now an influence which has been of great significance to every human being since the traditional period, at least, has been the concept of the universe regnant at the period of that individual's life. The insistence by its protagonists upon this concept as the ultimate motive of human endeavour made its acceptance almost universal at periods when it was the custom to lean upon the dicta of authority for guidance in life even when blind obedience was not the rule. Now in natural affairs, inconvenient questionings and scepticisms towards dogmatisms would ultimately reach truth. But as inaccessibleness to verification of what was called supernatural made authority, rather than investigation, its criterion, excommunication from the tribe would still all criticism.[1] Thus every act of life became permeated by motives, originated in arbitrary interpretations of a super-nature.

[1] A dramatic study of this occurrence is presented by Grant Allen in "The Story of Why-Why" in his book "The Wrong Paradise."

These influences were specially conspicuous concerning the difficulties of man's almost blind struggle against the uncomprehended astronomical and geodetic phenomena marvelled at and fled from, as well as the pestilences which ravaged him. In his sociological affairs too, every act or thought became embued with relationship to an extraneous power.

It is by these social and physical phenomena that the greatest appeal is made to the states of feeling termed emotions and sentiments. So that it became the custom to invoke, concerning ill states of feeling, the reference to a supernatural influence. Thus, from the cradle up, the ordering of social relationships was made dependent upon the simple expedient of the supernatural extraneous agent, rather than upon the more difficult and elaborate analysis and synthesis which would have been required for a proper investigation of each perturbing circumstance in its relation to life as a whole. The power of this influence was inversely proportional to the resiliency and tenacity as well as the general well-being of the individual.

But not only is reference to the supernatural favoured by traditional cosmogony, but because of certain psychological features of the individual himself there is a tendency towards supernatural explanations of the introspective observations. The Occasions of introspection of this kind are two, and I am not speaking of the inculcated introspection of the moralists. One of these Occasions is the self-examination into his conduct which is a normal character of a thinking being. This may give rise to supernatural explanations even when the introspection is not determined by the tradition of which I have already spoken.

The second kind of Occasion demanding introspection, is the autochthonous emanation of feeling of unaccustomed character. Such feelings occur at the physiological epochs;—but at these times they are readily explained in a familiar and simple way, and hence no supernatural agency is usually invoked. A similar explanation is made readily enough in cases of evident bodily disease, even where mental symptoms are prominent, for it is no longer the custom to speak of demon-possession even in the acute deliria. But even where no physiological epoch or clearly defined physical disease stands forth, unusual feelings are no uncommon phenomenon, and they demand explanation. Such occur conspicuously in the psychopathological syndrome so completely described by Janet under the term psychasthenia. Persons thus afflicted feeling an incapacity and an impediment to their free activity and not recognizing that they are sick, endeavour to interpret their feelings. Of course, the interpretation varies somewhat in accordance with the nature of the feelings, and with the person's information about the world and his psyche. But quite apart from modifications of this type, I have found it very common for patients to declare "I feel as if there was another person in me," or "I feel compelled as if by another agency to act thus." The explanation of a supernatural agent weighing upon them becomes very easy. For the purpose of this discussion, it is not important whether psychasthenia arises purely from degeneration of structure, or from faults in the chemistry of the plasma which bathes the nerve structures, or whether it is a purely psychopathological condition to which the physical phenomena are secondary, as some would have us believe. Our object is merely the setting forth of the fact that it is a diseased condition which disposes its victim towards metaphysical explanations.

It is a sort of uneasiness which prevents comfort in the feelings of certainty, in the operations of the intellect and decision of action. The patient finding himself abulic, and perhaps too critical minded to accept the mundane supports in his vicinity, seeks a solace in that which to him seems powerful because incomprehensible, that is to say in something supernatural.

For this, it is not essential that the victim's mind be pervaded by the infantine cosmogony which parades often as religious truth. Without anything of the sort, there may arise naive interpretations, hardly even having explicit reference to supernatural agents. For example, a patient may say "If I begin on Friday, a certain undertaking will fail," "If I do not turn my vest twice, misfortune will occur," "It is incumbent upon me to turn round in my chair, or the negotiations will fail." The enumeration of expedients would be useless. The above are from three different patients, one a boy of fourteen now completely cured; the second from the son of a prominent public man now quite restored to health; the third from a case still under care. In none of these was the bodily state of importance, the psychological reactions were the sole object of therapeutic effort, and their ordination was accomplished by purely psychological means.



DATA CONCERNING DELUSIONS OF PERSONALITY WITH NOTE ON THE ASSOCIATION OF BRIGHT'S DISEASE AND UNPLEASANT DELUSIONS.[*]

[*] Presented in abstract at the Sixth Annual Meeting of the American Psychopathological Association, held in New York City, May 5, 1915. Being Contributions of the State Board of Insanity, Whole Number 47 (1915. 13). The material was derived from the Pathological Laboratory of the Danvers State Hospital, Hathorne, Massachusetts, and the clinical notes were collected by Dr. A. Warren Stearns, to whom I wish to express my indebtedness but to whom no one should ascribe the somewhat speculative character of the present conclusions. (Bibliographical Note.—The previous contribution was State Board of Insanity Contribution, Whole Number 46 (1915.12) by D. A. Thom and E. E. Southard entitled "An Anatomical Search for Idiopathic Epilepsy: Being a First Note on Idiopathic Epilepsy at Monson State Hospital, Massachusetts," accepted by Review of Neurology and Psychiatry, 1915.)

E. E. SOUTHARD, M. D.

Pathologist, State Board of Insanity, Massachusetts; Director, Psychopathic Hospital, Boston, Mass., and Bullard Professor of Neuropathology, Harvard Medical School, Boston, Mass.

ABSTRACT

Previous work on somatic delusions. Suggestion that allopsychic delusions are as a rule in some sense autopsychic. A genetic hint from general paresis (frontal site of lesions in cases with autopsychic trend.) Mental symptomatology of general paresis. Work on fifth-decade psychoses. Statistical summary. Group with pleasant (or not unpleasant) delusions. Three cases of senile dementia, delusions of grandeur, and frontal lobe changes. Three cases with religious delusions. Remainder of pleasant-delusion group. Group with unpleasant delusions. Nephrogenic group.

THE suggestions here put forward concerning personal (autopsychic) delusions are based on material of the same sort as that previously analyzed for a study of somatic and of environmental (allopsychic) delusions. Our conclusions are also influenced by two analyses of the types of delusion found in general paresis. Moreover, at a period subsequent to the analysis presented here, some work on fifth-decade insanities had been completed, and the delusional features constantly found in the functional cases of insanity developing at the climacteric, entered to modify our general point of view.

The situation may be summed up as follows:

The accessibility to analysis of the clinical and anatomical data at the Danvers State Hospital was such as to prompt the use of its card catalogues for statistical work upon delusions. The more so, because in a period of enthusiasm over the Wernickean trilogy (autopsyche, allopsyche, somatopsyche) of conscious phenomena, the Danvers catalogue had attempted to divide the delusions recorded into the three Wernickean groups. Putting these clinical data side by side with the anatomical data, we were speedily able to single out those cases with normal or normal-looking brains and thus to secure a group approximately composed of functional cases of insanity.

It shortly developed, as to the CONTENT of delusions, that somatic delusions were exceedingly prone to parallel the conditions found in the trunk-viscera and other non-nervous tissues of the subjects at autopsy.) A subsequent study has confirmed this conclusion for the distressing hypochondriacal delusions found in climacteric insanities, which delusions, however distressing, are often far less so than the true conditions found at autopsy. And it may be generally stated that the clinician can get very valuable points concerning the somatic interiors of his patients by reasoning back from the contents of their somatic delusions.

But how far can we, as psychiatrists, reason back from the contents of environmental delusions, e. g. those of persecution, to the actual conditions of a given patient's environment? In a few cases it seemed that something like a close correlation did exist between such allopsychic delusions and the conditions which had surrounded the patient—the delusory fears of insane merchants ran on commercial ruin, and certain women dealt in their delusions largely with domestic debacles. But on the whole, we could NOT say that, as the somatic delusions seemed to grow out of and somewhat fairly represent the conditions of the some, so the environmental delusions would appear to grow out of or fairly represent the environment.

Thus, however brilliant an idea was Wernicke's in constructing the allopsyche (or, as it were, social and environmental side of the mind) for the purpose of classification, our own analysis promised to show that for genetic purposes the allopsyche was much less valuable. These delusions having a social content pointed far more often inwards at the personality of the patient than outwards at the conditions of the world. And case after case, having apparently an almost pure display of environmental delusions, turned out to possess most obvious defects of intellect or of temperament which would forbid their owners to react properly to the most favourable of environments. Hence, we believe, it may be generally stated that the clinician is far less likely to get valuable points as to the social exteriors of his patients from the contents of their social delusions than he proved to be able to get when reasoning from somatic delusions to somatic interiors. Put briefly, the deluded patient is more apt to divine correctly the diseases of his body than his devilments by society.

Our statistical analysis, therefore, set us drifting toward disorder of personality as the source of many delusions apparently derived ab extra and tended to swell the group of autopsychic cases at the expense of the allopsychic group,

In the statistical analysis of a group of cases corresponding roughly with the so-called functional group of diseases, we find false beliefs about the some on a somewhat different plane from those about the patient's self and his worldly fortunes. We can even discern through the ruins of the paretic's reaction that his false beliefs concerning the body are often not so false after all, and that his damaged brain of itself is not so apt to return false ideas about his somatic interior as about his worldly importance and plight. There then seems to be more reality about somatic than about personal delusions: the contents of somatic delusions are rather more apt to correspond with demonstrable realities than the contents of personal delusions. Accordingly our analysis of delusional contents includes a hint also as to genesis. Taken naively, the facts suggest a somatic genesis for somatic delusions exactly in proportion as these delusions are not so much false beliefs as partially true ones.

What genetic hint have we for the delusions concerning personality? One genetic hint was obtained from a correlation of delusions with lesions in general paresis,[2] in which disease perhaps the most profound and disastrous of all alterations of personality are found. Amidst the other alterations of personality found in paresis, autopsychic delusions are characteristic: indeed allopsychic delusions are conspicuously few in our series. And, as above, the somatic delusions, fewer in number, can be fairly easily correlated with somatic lesions, or else with lesions of the receptor apparatus (thalamus) of the brain.

Now it was precisely the cases with autopsychic delusions, as well as with profound disorder of personality in general, that showed the brunt of the destructive paretic process in the frontal region. The other not-so-autopsychic cases did not show this frontal brunt, but were less markedly diseased at death and had a more diffuse process.

Our genetic hint from paresis, therefore, inclines us to the conception that this disorder of the believing process is more frontal than parietal, more of the anterior association area than of the posterior association area of the brain. And if we can trust our intuitions so far, the perverted believing process is thus more a motor than a sensory process, more a disorder of expression than a disorder of impression, more a perversion of the WILL TO BELIEVE than a matter of the rationality of a particular credo.

Again we may appear to burst through from an undergrowth of statistics into the clear field of truism. False beliefs are more practical than theoretical, more a matter of practical conduct than of passive experience, more a change of reagent than a reaction to change. The man on the street or even many a leading neurologist would perhaps accept this formula as his own.

Certainly in general the least satisfactory of these chapters on the nature of delusions was the chapter on environmental effects,[3] and this perhaps because the results seemed so nearly negative.

A further contribution to delusions of environmental nature was somewhat unexpectedly derived from a piece of work on the general mental symptomatology of general paresis.[4] Dichotomizing the paretics (all autopsied cases) into a group with substantial, i. e., encephalitic, atrophic or sclerotic lesions of the cortex and a group without such gross lesions or else with merely a leptomeningitis, I found the latter (or anatomically mild) group to be characterized by a set of symptoms which were all "contra-environmental," whereas the former (or anatomically severe) did not thus run counter to the environment. The conclusions of that paper, so far as they concern us now, are as follows:—

The "mild" cases showed a group of symptoms which might be termed contra-environmental, viz. allopsychic delusions, sicchasia (refusal of food), resistiveness, violence, destructiveness.

The "severe" cases showed a group of symptoms of a quite different order, affecting personality either to a ruin of its mechanisms in confusion and incoherence, or to mental quietus involved in euphoria, exaltation, or expansiveness.

The most positive results of this orienting study appear to be the unlikelihood of euphoria and allied symptoms in the "mild" or non-atrophic cases and the unlikelihood of certain symptoms, here termed contra-environmental, in the severe or atrophic cases. Perhaps these statistical facts may lay a foundation for a study of the pathogenesis of these symptoms. Meantime the pathogenesis of such symptoms as amnesia and dementia cannot be said to be nearer a structural resolution, as these symptoms appear to be approximately as common in the "mild" as in the "severe" groups.

But in both papers dealing with paresis [2,4] we rest under the suspicion that the delusions are possibly of cerebral manufacture. Of course, a lesion somewhere outside the brain is not unlikely to be projected through the diseased brain, and SOMATIC delusions in the paretic are rather likely to represent something in the viscera.

It was desirable to get back to normal-brain material, to learn how the INTRINSICALLY NORMAL brain[5] could perhaps produce delusions from a particular environment. Could a particularly "bad" environment actually PRODUCE delusions?

By chance, at about this stage in our studies of delusions, some work on fifth-decade insanities[6] was completed. This work seemed to show that the most characteristic (non-coarsely-organic) cases of involutional origin were much given to delusions (each of 24 cases studied), somewhat more so than to the hypochondria and melancholia which we commonly ascribe to the involution period. But this result is equivocal as to the environmental (i. e. allopsychogenic) power to produce delusions, since one could not rid oneself of the suspicion that the delusions were due to the degenerating brain.

To return to our former results with the normal-looking brain:

Case after case of the quasi-environmental group proved to be more essentially personal than environmental, until at last it almost seemed that the environment could seldom be blamed for any important share in the process of false belief. In short, we seemed to show that environment is seldom responsible for the delusions of the insane.

Be that as it may, we secured several lines of attack on the delusions of personality by our study of quasi-environmental delusions. First, we were irresistibly led to a consideration of the emotional (pleasant or unpleasant) character of the delusions. We heaped up a large number of unpleasant delusions in that (quasi-environmental, but actually) personal group. It is interesting to inquire, accordingly, whether our more obviously autopsychic cases will also be possessed of an unpleasant tone. Secondly, we came upon the curious fact that cardiac and various subdiaphragmatic diseases were correlated with unpleasant emotion as expressed in the delusions. It was therefore important to inquire whether similar conditions prevailed in the new group. Thirdly, we found ourselves inquiring whether our patients were victims of what might be termed a spreading inwards of the delusions (egocentripetal) or a spreading outwards thereof (egocentrifugal delusions). But this difference in trend, clear as it often is from the patient's point of view, remains to be defined from the outsider's point of view.

Again, it remains to determine, if possible, how far delusions are dominated respectively by the intellect or the emotions, or even by the volitions.

As before, I begin with a brief statistical analysis.

SUMMARY

Danvers autopsy series, unselected cases 1000 Cases with little or no gross brain disease 306 Cases listed as having autopsychic delusions 106 Cases listed as having only autopsychic delusions 50 Cases for various reasons improperly classified 13 Cases of general paresis in which gross brain lesions were not observed 15 Residue of autopsychic cases 22

The group of 22 cases thus sifted out can be studied from many points of view. We may recall that our former study of allopsychic delusions proved that a large proportion of delusions concerning the environment were in all probability not essentially derived from the environment. Their contents might relate to the environment, but their genesis could better be regarded as autopsychic (intrapersonal). In fact we really found only 6 out of 58 cases of pure allopsychic delusions, which could be safely taken as showing so much coincidence between anamnesis and delusions that a correlation could be risked.

Following the method of our former work on somatic and on environmental delusions, we sought in the first instance PURE cases of autopsychic delusion-information. For a variety of reasons, more than half of the original list, namely, 28 cases, had to be excluded. Many of these exclusions were due to the strong suspicion that the cases were really cases of general paresis, despite the normality of the brains in the gross. The residue of 22 cases include, we are confident, no instance of exudative disease of the syphilitic group, though general syphilization cannot safely be ruled out in all cases.

There are two groups of cases, a group of eleven cases with delusions of a generally pleasant or not unpleasant character (in which group there is a small sub-group of three cases of octogenarians with expansive delusions reminding one of those of general paresis) and a group of eleven cases with delusions of an unpleasant character.

I. CASES HAVING DELUSIONS OF A NATURE PLEASING OR NOT UNPLEASING TO THE BELIEVER

The true emotional nature of the beliefs placed in this group cannot fairly be stated to be pleasurable. But, if not pleasurable, they may perhaps be stated to be complacent, expansive, or of air-castle type. The criteria of their choice have been largely negative: the patients are not recorded as expressing beliefs of a painful or displeasing character: in the absence of which we may suppose the beliefs to be either indifferent or actually pleasing in character.

Of the 11 cases whose delusions were supposedly of an agreeable nature or at least predominantly not unpleasant, there were 3 with delusions reminding one of general paresis. The ages of these three were 80, 84, and 87 respectively. They did not show any pathognomonic sign (e.g. plasma cells) of general paresis. They all showed in common very marked lesions of the cortex, including the frontal regions (in two instances the extent of the frontal lesions was presaged by focal overlying pial changes) .999 was a case of pseudoleukemia with marked cortical devastation but without brain foci of lymphoid cells. Two of the cases showed cell-losses more marked in suprastellate layers; in the third there was universal nerve cell destruction, with active satellitosis caught in process.