DR. TOM A. WILLIAMS, Washington, D. C.: I don't know that we can say that the fundamental differentiation of epilepsy is the unconsciousness. That is a psychological division. The paper did not give any differential why they were regarded as epileptics at all. There was no description of the convulsion, except in so far as this formed the hysteric form of convulsion, so I don't think we are in a position to discuss the paper without more clear data of these instances.

DR. WALTER B. SWIFT, Boston: I was interested in hearing about the case of stammering. That will be explained in my own paper and I have also run up against several who have done the same. I should like to ask Dr. Emerson if he considers stammering as an expression of an orgasm.

DR. L. E. EMERSON, Boston: Dr. MacCurdy well remarked that this adds nothing to the understanding of epilepsy. In a certain sense this is true. I do not feel that I could add anything to a deeper understanding of epilepsy. The whole development of psycho-analytic theory, up to a certain point, has been based on the actual recovery of patients, if you do not like the use of the word cure, from particular symptoms. Then this has been generalized. Now that has opened an enormous field for ratiocination. Therefore, I am not at all sure that these conceptions will really apply to essential epilepsies or to the real epilepsies. I do not know how far our conceptions which originate in the therapeutic situation will apply to the situation which appears to be absolutely beyond therapeutics. In regard to what Dr. White said of starting from the known and going through transitional stages to the unknown, you do get insight and it may be that the condition as described in this broad way by Clark and by Stekel and others may be true, but I am not perfectly sure. I am very grateful for Dr. Allen's approval of this way of putting things because perhaps it is a defence reaction on my own part that occasionally I feel it necessary to report things I have seen with my own eyes and really experienced, instead of following my natural tendency to go off into vague philosophizing.



REVIEWS

PSYCHOLOGY IN DAILY LIFE. By Carl Emil Seashore. 1914, XVIII plus 226 pp., N. Y., D. Appleton & Co.

This is the first volume of the "Conduct of Mind" series, the purpose of which, as stated by its editor, Professor Joseph Jastrow, in his introduction to the series, is "to provide readily intelligible surveys of selected aspects of the study of mind and its applications." The present work contains seven chapters, which were originally prepared as "semi-popular addresses." As a consequence, the book lacks somewhat in coherence, but, except in a few places, the emphasis is practical throughout. It is perhaps not surprising that the most subtle and modern part of the discussion, viz. the chapter on "Mental Law" should be the least practical in its bearing.

In the first chapter is discussed the practical importance of "Play," not only in offering the opportunity for sensory, central, and motor development in the child, but for releasing the broader life energies of the adult whose mind is confined by specializing work. It is shown that the fundamental motives of the play life are to be found in religion.

The next three chapters, on "Serviceable Memory," "Mental Efficiency," and "Mental Health," are full of sound practical advice. The first contains a clear and attractive presentation of the principles of remembering, so arranged as to exemplify the rules which it inculcates. The second emphasizes the importance of the wave form of attention in all mental work, the superiority of efferent to afferent response as an educational process, and the acquirement of mastery by a transfer of control from higher to lower mental levels. There is also good counsel with regard to the best time and manner in which to rest, although the author's deductions from the physiological "curve of sleep" appear somewhat hasty. "Mental Health" is defined in terms of our mental "members" in the classical way, and the "Ten Maxims of Wise Living," which are given, are selected from the history of moral philosophy rather than from current psychotherapeutic results.

The chapter on "Mental Law" is the most interesting one for the theoretical psychologist, and discusses in a general but illuminating manner, principles of perception and of perseveration which are of interest to the psychological psychiatrist. The chapter on "Law in Illusion" seems disproportionately long, but gives an interesting description and analysis of three different types of illusions: those based on "units of direction," the over-estimation of "cylinder height," and upon the "size-weight" error. In connection with the second, the results of original investigations in the author's laboratory are presented. It is shown that a knowledge of the complex but definite principles underlying illusions can be made practically serviceable, for example, in tests of mental normality.

The final chapter deals with a specific illustrative problem in "Mental Measurement," viz. the determination of a subject's fitness for a musical career. A detailed analysis of the problem is offered, and it is shown that the elemental questions involved can be answered by the methods of the psychological laboratory, but that these answers require expert interpretation before they can be made practically applicable.

The author's style is engaging and clear. LEONARD THOMPSON TROLAND.

AN OUTLINE OF PSYCHOBIOLOGY. By Knight Dunlap, Associate Professor of Psychology in the Johns Hopkins University. Baltimore, The Johns Hopkins Press, 1914. Pp. 121, octavo; illustrated.

This volume even though brief will be highly appreciated by very many students of normal and of abnormal psychology because it is the first book to afford them just what, in an elementary way, they need concerning the nervous system, the essential musculatures, and the epithelia, whose manifold activities are in some certain mode concomitant to the succession of compound mental events. Surely, and widely, those who a few years ago "came to scoff" at the ever-rising scientific stream of mind-protoplasm relationship will "remain to pray" to the rising and satisfying goddess of the new philosophy. The body with its unimagined intricacies and beauties of still unguessed adaptation and its marvels of Someone's ingenuity is surely now at length coming into its own. And when, after the years, it has come into its own in a reasonable measure, "the continuity of mind-and-energy" and "the dynamic-spiritualism of the Cosmos" when they are mentioned will no longer draw that quasi-withering smile of toleration to the face of the orthodox psychologist with which some of us are familiar.

This volume, happily devised by Professor Dunlap to meet this real need, at first in his own pupils and later in a wider public, will materially help this progress, for it has within it in fairly up-to-date and simple form much of the structure and function, always of surpassing interest when understood, of the human action-system. Seventy-seven excellently clear and well-chosen illustrations make the well-printed text still more informing. There is a good index; and short lists of books at the ends of the chapters.

The present reviewer notes only one omission of substantial importance from the neurologic part of the book, and that is the very recent, howbeit important, matter of the functional opposition between the sympathetic proper and the other, the cranio-sacral, portion of "the autonomic." The work lacks also, in this first edition, a statement and discussion of the important all-or-none principle which is now applicable to voluntary muscle, probably, and to the neurones. And it is to be hoped too that the author will take the bull by the horns and, in the next edition, show the nature of protoplasm in general in an homologous way, as the basis, through its uniquely complex kineticism, of the onward rush of the mental process. With this addition the essential nature of irritability too might be set forth in this already valuable (and inexpensive) treatise. GEORGE V. N. DEARBORN. Sargent Normal School.

PSYCHOLOGY, GENERAL AND APPLIED. Hugo Munsterberg New York and London: D. Appleton and Co., 1914; Pp. xiv X487 1.75.

In this volume, designed to serve the needs both of the general reader and of the college student, Professor Munsterberg has represented in most readable form the essentials of the entire range of his contributions to psychology. The well-known differentiation of the "two psychologies" is the core of the book; herewith is reintroduced the psychology of the soul, not merely as being on a level with, but ultimately even superordinate to, the descriptive psychology which had banished from so many systems all mention of the soul or even of the self. For we are shown how all description and explanation, whether of material objects or of conscious processes, is after all but construction in the service of purposes, to apprehend, understand, and realize which is the primary business, of life.

This exposition of purposive psychology, surely the most novel feature of the book, is what interests us most, and we discover with disappointment that though theoretically every conscious state is subject-matter for either type of psychology, i.e. may be either described in its causal relationships or immediately grasped as an act of will, still Professor Munsterberg fills five times as many pages with the usual descriptive psychology as with this newer departure. We willingly conceded the importance of tradition in textbook writing, but would urge upon Professor Munsterberg the impatience with which we await more extended treatment of this topic.

A second deviation for a book of this type,—if Professor Munsterberg may rightly be said ever to write books typical of anything but his own uniqueness,—is the inclusion of a section on social psychology. This too, we are inclined to regard as in nature of a promise, representing the germination of lines of thought which we are assured elsewhere[*] are later to receive more elaborate formulation.

[*] Munsterburg, H. "Grundzuge der Psychotechnik." Leipzig, 1914. Vorwort, S. VIII.

Thirdly, one of the main divisions of the book is devoted to applied psychology, the presentation here being essentially an abstract of the author's previous publications in the field of his acknowledged preeminence, psychotechnics.

Throughout the book discussion of general principles, whether of philosophy or biology, takes precedence over the presentation of concrete facts; the text contains no explicit references, though a brief bibliography of works in English is appended. The consequent gain in readability is only one of the many factors which insure this volume a very wide reading. R. M. ELLIOTT. Harvard University.



THE JOURNAL OF ABNORMAL PSYCHOLOGY

THE SEX WORSHIP AND SYMBOLISM OF PRIMITIVE RACES

BY SANGER BROWN II., M. D.

Assistant Physician—Bloomingdale Hospital.

PSYCHIATRY, during recent years, has found it to its advantage to turn to a number of related sciences and allied branches of study for the explanation of a number of the peculiar symptoms of abnormal mental states. Of these related studies, none have been of greater value than those which throw light on the mental development of either the individual or the race. In primitive races we discover a number of inherent motives which are of interest from the standpoint of mental development. These motives are expressed in a very interesting symbolism. It is the duty of the psychiatrist to see to what extent these primitive motives operate subconsciously in abnormal mental conditions, and also to learn whether an insight into the symbolism of mental diseases may be gained, through comparison, by a study of the symbolism of primitive races. In the following communication one particular motive with its accompanying symbolism is dealt with. The application of these findings must be left with the psychiatrist in his clinical studies.

A great many of the institutions and usages of our present day civilization originated at a very early period in the history of the race. Many of these usages are carried on in modified form century after century, after they have lost the meaning which they originally possessed; it must be remembered, however, that in primitive races they were of importance, and they arose because they served a useful end. From the study of these remnants of former days, we are able to learn the trends of thought which activated and inspired the minds of primitive people. When we clearly understand these motives, we may then judge the extent of their influence on our present day thought and tendencies.

Now, in our present communication, we wish to deal with a motive which we find expressed very generally in primitive religion; this is the worship of sex. We not only find evidences of this worship in the records and monuments of antiquity, but our knowledge of the customs and practices of certain tribes, studied in comparatively modern times, indicates the presence of this same primitive religion. We feel that in sex worship we are dealing with an important motive in racial development, and our object at present is to give an account of its various phases.

Before we proceed, it is desirable to make reference to some of our sources of information. There are plenty of books on the history of Egypt, the antiquities of India or on the interpretation of Oriental customs, which make scarcely any reference to the deification of sex. We have always been told, for example, that Bacchus was the god of the harvest and that the Greek Pan was the god of nature. We have not been told that these same gods were representations of the male generative attribute, and that they were worshipped as such; yet, anyone who has access to the statuettes or engravings of these various deities of antiquity, whether they be of Egypt, of India or of China, cannot fail to see that they were intended to represent generative attributes. On account of the incompleteness of many books which describe primitive races, a number of references are given throughout these pages, and some Bibliographical references are added.

SIMPLE SEX WORSHIP

As will be presently shown, we have evidence from a number of sources to show that sex was at one time frankly and openly worshipped by the primitive races of mankind. This worship has been shown to be so general and so widespread, that it is to be regarded as part of the general evolution of the human mind; it seems to be indigenous with the race, rather than an isolated or exceptional circumstance.

The American Cyclopedia, under Phallic worship, reads as follows "In early ages the sexual emblems were adored as most sacred objects, and in the several polytheistic systems the act or principle of which the phallus was the type was represented by a deity to whom it was consecrated: in Egypt by Khem, in India by Siva, in Assyria by Vul, in primitive Greece by Pan, and later by Priapus, in Italy by Mutinus or Priapus, among the Teutonic and Scandinavian nations by Fricco, and in Spain by Hortanes. Phallic monuments and sculptured emblems are found in all parts of the world."

Rawlinson, in his history of Ancient Egypt, gives us the following description of Khem: "A full Egyptian idea of Khem can scarcely be presented to the modern reader, on account of the grossness of the forms under which it was exhibited. Some modern Egyptologists endeavor to excuse or palliate this grossness; but it seems scarcely possible that it should not have been accompanied by indelicacy of thought or that it should have failed to exercise a corrupting influence on life and morals. Khem, no doubt, represented to the initiated merely the generative power in nature, or that strange law by which living organisms, animal and vegetable, are enabled to reproduce their like. But who shall say in what exact light he presented himself to the vulgar, who had continually before their eyes the indecent figures under which the painters and sculptors portrayed him? As impure ideas and revolting practices clustered around the worship of Pan in Greece and later Rome, so it is more than probable that in the worship of Khem in Egypt were connected similar excesses. Besides his priapic or "Ithyphallic" form, Khem's character was marked by the assignment to him of the goat as his symbol, and by his ordinary title Ka-mutf, "The Bull of his Mother," i.e., of nature."

This paragraph clearly indicates that the sexual organs were worshipped under the form of Khem by the Egyptians. The writer, however, has fallen into a very common error in giving us to understand that this was a degraded form of worship; from numerous other sources it is readily shown that such is not the case.

The following lines, from "Ancient Sex Worship," substantiate the above remarks, and at the same time, they show the incompleteness of the writings of many antiquarians. In this book we read: "Phallic emblems abounded at Heliopolis and Syria and many other places, even in to modern times. The following unfolds marvelous proof to our point. A brother physician, writing to Dr. Inman, says: 'I was in Egypt last winter (1865-66), and there certainly are numerous figures of gods and kings on the walls of the temple at Thebes, depicted with the male genital erect. The great temple at Karnac is, in particular, full of such figures and the temple of Danclesa, likewise, although that is of much later date, and built merely in imitation of old Egyptian art.' " The writer further states that this shows how completely English Egyptologists have suppressed a portion of the facts in the histories which they have given to the world. With all our descriptions of the wonderful temple of Karnac, it is remarkable that all mention of its association with sex worship should be omitted by many writers.

A number of travellers in Africa, even in comparatively modern times, have observed evidences of sex worship among the primitive races of that continent. Captain Burton[1] speaks of this custom with the Dahome tribe Small gods of clay are made in priapic attitudes before which the natives worship. The god is often made as if contemplating its sexual organs. Another traveler, a clergyman,[2] has described the same worship in this tribe. He has observed idols in priapic attitudes, rudely carved in wood, and others made of clay. On the lower Congo the same worship is described, where both male and female figures with disproportionate genital organs are used for purposes of worship. Phallic symbols and other offerings are made to these simple deities.

[1] Quoted by H. M. Westropp, Primitive Symbolism

[2] J. W. Wood. The uncivilized Races.

Definite examples of the sexual act having religious significance may be cited. Richard Payne Knight[3] quotes a passage from Captain Cook's voyages to one of the Southern Pacific Islands. The Missionaries of the expedition on this occasion assembled the members of the party for religious ceremonies in which the natives joined. The primitive natives observed the ceremony with great respect and then with due solemnity enacted their form of sacred worship. Quite to the astonishment of the white people, this ceremony consisted of the open performance of the sexual act by a young Indian man and woman. This was entirely a religious ceremony, and was fittingly respected by all the natives present.

[3] The symbolical language of ancient art and mythology.

Hargrave Jennings[4] describes the same custom in India. An Indian woman of designated caste and vocation is selected. Many incantations and strange rites are gone through. A circle, or "Vacant Enchanted Place" is rendered pure by certain rites and sprinkled with wine. Then secret charms are whispered three times in the woman's ear. The sexual act is then consummated, and the whole procedure before the altar is distinctly a form of sacrifice and worship.

[4] The Roseicrucians.

Hoddar M. Westropp in "Primitive Symbolism" has indicated the countries in which sex worship has existed. He gives numerous instances in ancient Egypt, Assyria, Greece and Rome. In India, as well as in China and Japan, it forms the basis of early religions. This worship is described among the early races of Greece, Italy, Spain, Scandinavia, and among the Mexicans and Peruvians of America as well. In Borneo, Tasmania, and Australia phallic emblems have been found. Many other localities have been mentioned by this writer and one seems fairly justified in concluding that sex worship is regularly found at one time in the development of primitive races. We shall now pass to another form of this same worship, namely, sacred prostitution.

SACRED PROSTITUTION

There is abundant evidence to show that there was a time in the centuries before Christ when prostitution was held as a most sacred vocation. We learn of this practice from many sources. It appears that temples in a number of ancient cities of the East, in Babylonia, Nineveh, Corinth and throughout India, were erected for the worship of certain deities. This worship consisted of the prostitution of women. The women were consecrated to the support of the temple. They were chosen in much the same way as the modern woman enters a sacred church order. The returns from their vocation went to the support of the deity and the temple. The children born of such a union were in no way held in disgrace, but on the contrary, they appeared to have formed a separate and rather superior class. We are told that this practice did not interfere with a woman's opportunities for subsequent marriage. In India the practice was very general at one time. The women were called the "Women of the Idol." Richard Payne Knight speaks of a thousand sacred prostitutes living in each of the temples at Eryx and Corinth.

A custom which shows even more clearly that prostitution was held as a sacred duty to women was that in Babylonia every woman, of high rank or low, must at one time in her life prostitute herself to any stranger who offered money. In "Ancient Sex Worship" we read: "There was a temple in Babylonia where every female had to perform once in her life a (to us) strange act of religion, namely, prostitution with a stranger. The name of it was Bit-Shagatha, or 'The Temple,' the 'Place of Union.' " Moreover we learn that once a woman entered the temple for such a sacred act she could not leave until it was performed.

The above accounts deal exclusively in the sacrifice made by women to the deity of sex. Men did not escape this sacrifice and it appears that some inflicted upon themselves an even worse one. Fraser[5] tells us of this worship which was introduced from Assyria into Rome about two hundred years before Christ. It was the worship of Cybele and Attis. These deities were attended by emasculated priests and the priests in oriental costume paraded Rome in religious ceremony.

[5] Adonis, Attis and Osiris.

On one occasion, namely, "the day of blood" in the Spring, the chief ceremony was held. This, among other things, consisted in fastening an effigy of the god to a pine tree, which was brought to the temple of the Goddess Cybele. A most spectacular dance about the effigy then occurred in which the priests slashed themselves with knives, the blood being offered as sacrifice. As the excitement increased the sexual nature of the ceremony became evident. To quote from Fraser; "For man after man, his veins throbbing with the music, his eyes fascinated by the sight of streaming blood, flung his garments from him, leaped forth with a shout, and seizing one of the swords which stood ready for the service, castrated himself on the spot. Then he ran through the city holding the bloody parts in his hands and threw them into one of the houses which he passed in his mad career."

We see that this act directly corresponds with the part played by the female. The female prostituted herself, and the male presented his generative powers to the deity. Both the sacred prostitutes and emasculated priests were held in religious veneration.

The above references are sufficient to show that a simple form of sex worship has been quite generally found. It becomes apparent as we proceed that the worship of sex not only plays a part, but a very prominent part, in the developing mind of man. In the frank and open form of this worship it is quite clear that we are dealing with a very simple type of mind. These primitive people exhibit many of the qualities of the child. They are quite without sex consciousness. Their motives are at once both simple and direct, and they are doubtless sincere. Much misunderstanding has arisen by judging such primitive people by the standards of our present day civilization. Sex worship, while it held sway was probably quite as seriously entertained as many other beliefs; it only became degraded during a decadent age, when civilization had advanced beyond such simple conceptions of a deity, but had not evolved a satisfactory substitute.

We shall now pass to a less frank and open deification of sex, namely, sexual symbolism.

SYMBOLISM

As civilization advanced, the deification of sex was no longer frank and open. It came to be carried on by means of symbolism. This symbolism was an effort on the part of its originators to express the worship of the generative attributes under disguise, often understood only by the priests or by those initiated into the religious mysteries. The mysteries so frequently referred to in the religions of antiquity are often some expression of sex worship.

Sexual symbolism was very general at one time and remains of it are found in most of the countries where any form of sex worship has existed. Such remains have been found in Egypt, Greece, Italy, India, China, Japan, and indeed in most countries the early history of which is known to man.

One important kind of symbolism had to do with the FORM of the object deified. Thus, it appears that certain objects,—particularly upright objects,—stones, mounds, poles, trees, etc., were erected, or used as found in nature, as typifying the male generative organ. Likewise certain round or oval objects, discs, certain fruits and certain natural caves, were worshipped as representing the female generative organ. (The yoni of India.)

We also find that certain QUALITIES OF ANIMAL OR VEGETABLE nature were equally venerated, not because of their form, but because they stood for some quality desirable in the generation of mankind. Thus we find that some animals—the bull because of its strength and aggressive nature, the snake, perhaps because of its form or of its tenacity of life,—were male representatives of phallic significance. Likewise the fish, the dolphin, and a number of other aquatic creatures came to be female representatives. This may be shown over and over again by reference to the antique emblems, coins, and engravings of many nations.

Another later symbolism, which was adopted by certain philosophies, was more obscure but was none the less of distinct sexual significance. FIRE is made to represent the male principle, and WATER, and much connected with it, the female. Thus we have Venus, born of the Sea, and accompanied by numerous fish representations. Fire worship was secondary to the universally found sun worship. The sun is everywhere the male principle, standing for the generative power in nature. At one time the symbolism is broad, and refers to generative nature in general. At another time it refers solely to the human generative organs. Thus, the Greek God Hermes, the God of Fecundity in nature, is at times represented in unmistakable priapic attitudes.

Still another symbolism was often used in India. This was the addition of a number of members to the deity, possibly a number of arms or heads. This was in order to express a number of qualities. Thus the deity was both generator and destroyer, one face showing benevolence and kindness, the other violence and rage. In many of the deities both male and female principles were represented in one,—an Androgyne deity—which was an ideal frequently attempted. The idea that these grotesque deities were merely the expression of eccentricity or caprice on the part of their originator is not to be entertained. Richard Payne Knight has pointed out that they occur almost entirely on national coins and emblems, and so were the expression of an established belief.

We shall refer first to the simpler symbols, that is those in which an object was deified because of its form.

THE UPRIGHT

It is perhaps not remarkable that upright objects should be selected because of their form as the simplest expression of phallic ideas. The simple upright for purposes of sex worship is universally found. An upright conical stone is frequently mentioned. Many of the stone idols or pillars, the worship of which was forbidden by the Bible, come under this group. Likewise, the obelisk, found not only in Egypt, but in modified forms in many other countries as well, embodies the same phallic principle. The usual explanation of the obelisk is that it represented the rays of the sun striking the earth: when we speak of sun worship later, we shall see that this substantiates rather than refutes the phallic interpretation. The mounds of religious significance, found in many countries, were associated with sex worship. The Chinese pagodas are probably of phallic origin. Indeed, there is evidence to show that the spires of our Churches owe their existence to the uprights or obelisks outside the Temples of former ages. A large volume has been written by O'Brien to show that the Round Towers of Ireland (upright towers of pre-historic times) were erected as phallic emblems. Higgins, in the Anacalipsis, has amassed a great wealth of material with similar purport, and he shows that such "temples" as that of Stonehenge and others were also phallic. The stone idols of Mexico and Peru, the ancient pillar stones of Brittany, and in fact all similar upright objects, erected for religious purposes the world over, are placed in this same category. We shall presently give a number of references to show that the May-pole was associated with phallic worship and that it originated at a very remote period.

We shall now quote from some of the authors who have contributed to our knowledge of this form of symbolism, as thereby a clear idea of their meaning may be set forth. These interpretations are not generally advanced, and therefore we have added considerable corroborative evidence which we have been able to obtain from independent sources.

In an Essay on the Assyrian "Grove" and other Emblems, Mr. John Newton sums up the basis of this symbolism as follows: "As civilization advanced, the gross symbols of creative power were cast aside, and priestly ingenuity was taxed to the utmost in inventing a crowd of less obvious emblems, which should represent the ancient ideas in a decorous manner. The old belief was retained, but in a mysterious or sublimated form. As symbols of the male, or active element in creation, the sun, light, fire, a torch, the phallus or lingam, an erect serpent, a tall straight tree, especially the palm or fir or pine, were adapted. Equally useful for symbolism were a tall upright stone (menhir), a cone, a pyramid, a thumb or finger pointed straight, a mask, a rod, a trident, a narrow bottle or amphora, a bow, an arrow, a lance, a horse, a bull, a lion, and many other animals conspicuous for masculine power. As symbols of the female, the passive though fruitful element in creation, the crescent moon, the earth, darkness, water, and its emblem, a triangle with the apex downward, "the yoni"—the shallow vessel or cup for pouring fluid into (cetera), a ring or oval, a lozenge, any narrow cleft, either natural or artificial, an arch or doorway, were employed. In the same category of symbols came a boat or ship, a female date palm bearing fruit, a cow with her calf by her side, a fish, fruits having many seeds, such as the pomegranate, a shell, (concha), a cavern, a garden, a fountain, a bower, a rose, a fig, and other things of suggestive form, etc.

These two great classes of conventional symbols were often represented IN CONJUNCTION with each other, and thus symbolized in the highest degree the great source of life, ever originating, ever renewed . . . . . . . . . . "A similar emblem is the lingam standing in the centre of the yoni, the adoration of which is to this day characteristic of the leading dogma of Hindu religion. There is scarcely a temple in India which has not its lingam, and in numerous instances this symbol is the only form under which the god Siva is worshipped."

In "Ancient Sex Worship" we read, "As the male genital organs were held in early times to exemplify the actual male creative power, various natural objects were seized upon to express the theistic idea and at the same time point to those points of the human form. Hence, a similitude is recognized in a pillar, a heap of stones, a tree between two rocks, a club between two pine cones, a trident, a thyrsus tied around with two ribbons with the ends pendant, a thumb and two fingers. The caduceus again the conspicuous part of the sacred Triad Ashur is symbolized by a single stone placed upright,—the stump of a tree, a block, a tower, a spire, minaret, pole, pine, poplar or pine tree."

Hargrave Jennings, the author of several books on some aspects of religions of antiquity, among them one on phallicism deals freely with the phallic principles embodied in these religions. As do many other writers, he identifies fire worship with sex worship, and the following short paragraph shows his conception of their interrelationship, as well as the significance of the upright of antiquity. In the Rosicrucians he says: "Obelisks, spires, minarets, tall towers, upright stones, (menhirs), and architectural perpendiculars of every description, and, generally speaking, all erections conspicuous for height and slimness, were representations of the Sworded or of the Pyramidal Fire. They bespoke, wherever found and in whatever age, the idea of the First Principle or the male generative emblem."

We might readily cite passages from the writings of a number of other authors but the above paragraphs suffice to set forth the general principle of this symbolism. As stated above, such interpretations have not been generally advanced to explain such objects as sacred pillar stones, obelisks, minarets, etc. It is readily seen how fully these views are substantiated by observations from a number of independent sources.

In a book of Travel[6] in India we are able from an independent source to learn of the symbolism of that country. The traveller gives a description of the caves of Elephanta, near Bombay. These are enormous caves cut in the side of a mountain, for religious purposes to which pilgrimages are made and where the usual festivities are held. The worship of generative attributes is quite apparent. The numerous sculptured female figures, as remarked by the traveller, are all represented with greatly exaggerated breasts, a symbolism which is frequent throughout oriental countries for expressing reproductive attributes.

[6] Rousselet, India and its native princes.

In an inner chamber is placed the symbol which is held in particular veneration. Here is found an upright conical stone standing within a circular one. The stone is sprinkled with water during the festival season. The writer states that this stone, to the worshippers, represents the male generative organ, and the worship of it is not considered an impropriety. In this instance we feel that the symbolism is very definite, and doubtless the stone pillars in the other temples of India and elsewhere are of the same significance.

A clergyman in the Chinese Review of 1876, under the title "Phallic Worship in China," gives an account of the phallicism as he observed it at that time. He states that the male sexual organ is symbolized by a simple mound of earth and is so worshipped. Similarly, the female organ is represented by a mound of different form and is worshipped as the former. The writer states that at times these mounds are built in conjunction. He states this worship is similar to that of Baal of Chaldea, etc., and that probably all have a common origin. It appears to be a fundamental part of the Chinese religion and the symbolism of the Chinese pagoda expresses the same idea. He says that Kheen or Shang-te, the Chinese deities of sex, are also worshipped in the form of serpents, of which the dragon of the Chinese is a modification. This furnishes a concrete instance in which the mound of earth is of phallic significance, and substantiates an interpretation of serpent worship to which we shall presently refer.

Hoddard M. Westropp has given us an excellent account of phallic worship and includes in his description the observations of a traveller in Japan at as late periods as 1864 and 1869.

A temple near the ancient capital of Japan was visited by a traveller. In this temple the main object of worship was a large upright, standing alone, and the resemblance to the male generative organ was so striking as to leave no doubt as to what it represented. This upright was worshipped especially by women, who left votive offerings, among them small phalli, elaborately wrought out of wood or other material. The traveller remarked that the worship was most earnest and sincere.

The same traveller observed that in some of the public roads of Japan are small hedged recesses where similar stone pillars are found. These large pillars unquestionably represent the male organ. The writer has observed priests in procession carrying similar huge phalli, painted in color as well. This procession called forth no particular comment and so was probably not unusual. It is stated that this is a part of the ancient "Shintoo" religion of Japan and China. There are frequent references to certain of the gods of the Ancients being represented in priapic attitudes, the phallus being the prominent and most important attribute. Thus Hermes, in Greece, was placed at cross-roads, with phallus prominent. This was comparable to the phallus on Japanese highways. In the festivals of Bacchus high phalli were carried, the male organ being represented about the size of the rest of the body. The Egyptians carried a gilt phallus, 150 cubits high, at the festivals of Osiris. In Syria, at the entrance of the temple at Hieropolis, was placed a human figure with a phallus 120 cubits high. A man mounted this upright twice a year and remained seven days, offering prayers, etc.

In Peru in the Temple of the Sun an upright pillar has been described covered with gold leaf, very similar to those existing elsewhere and to which has been ascribed similar significance.

A number of writers have expressed the belief that the May-pole is an emblem of ancient phallic worship. We know that May-day festivals are of the most remote antiquity. We are indebted to R. P. Knight for a description of what May-day was like about four centuries ago in England. The festival started the evening before. Men and women went out into the woods in search of a tree and brought it back to the village in the early morning. The night was spent in sexual excesses comparable to those of the Roman Bacchanalia. A procession was formed, garlands were added to the May-pole, which was set up in the village square. The Puritans referred to it as an idol, and they did not approve of the festivities. Until comparatively recent years there was a May-pole in one of the squares of London, and Samuel Pepys,[7] writing of his time, speaks of seeing May-poles in the front yards of the prominent citizens of Holland. A festival much the same as this was held in Ancient Rome and also in India. The May-pole properly pierces a disc and thus conforms with the lingam-yoni of India. We also know that the first of May was a favorite time for all nature worship with the ancients. For a number of interesting suggestions the reader is referred to R. P. Knight, Worship of Priapus, and Hargrave Jennings, Indian Religions (Page 66.)

[7] Pepys Diary.

Tree worship is frequently mentioned in the religions of antiquity. We are told that the mystic powers of the mistletoe comes from the fact that it grows on the oak, a once sacred tree. The pine of the North, the palm and the fig tree of the South, were sacred trees at one time. John Newton made a study of tree worship, especially the Ancient Grove Worship of Assyria. He shows that the object of veneration was a male date palm, which represented the Assyrian god Baal. Sex was worshipped under this deity, and it is shown that the tree of the Assyrian grove was a phallic symbol. Palm Sunday appears to be a relic of this worship. In France, until comparatively recent times, there was a festival, "La Fete des Pinnes," in which palms were carried in procession, and with the palms were carried phalli of bread which had been blessed by the priests.

Richard Payne Knight tells us that Pan was worshipped by the Shepherds under the form of the tall fir, and Bacchus "by sticking up the rude trunk of a tree." It is shown throughout these pages that sexual attributes were worshipped under both these deities. In reference to other symbols, the writer continues,[8] "The spires and pinnacles with which our churches are decorated come from these ancient symbols; and the weather cocks, with which they are surmounted though now only employed to show the direction of the wind, were originally emblems of the sun; for the cock is the natural herald of the day, and therefore sacred to the fountain of light. In the symbolical writings of the Chinese the sun is still represented by a cock in the circle; and a modern Parsee would suffer death rather than be guilty of the crime of killing one. It appears on many ancient coins, with some symbol of the passive productive power on the reverse; and in other instances it is united with priapic and other emblems and devices, signifying other attributes combined."

[8] Symbolic language of ancient art and mythology.

Dr. Thomas Inman has made a study to show how this phallic symbolism found its way into ancient art, and even into some designs of modern times. Thus, many formal designs are studied in which the upright plays a part; likewise, the oval and the circle receive a similar explanation. The architectural ornaments spoken of as eggs and anchors, eggs and spear heads, the so-called honey-suckle ornament of antiquity, and the origin of some church windows and ornaments, are all studied by this writer, and his text is accompanied by illustrations. Hargrave Jennings has also traced the origin of the symbols of Heraldry, the emblems of Royalty and of some church orders with similar explanations.

We may add that the crux ansata of the Egyptians, the oval standing upon the upright, or letter Tau, may be shown to be a sex symbol, the union of the oval with the upright being of symbolic significance. The crux ansata is found in the hand of most of the Egyptian deities. It is found in the Assyrian temples and throughout the temples of India as well. Prehistoric monuments of Ireland have the same design. Priests are portrayed in adoration of the crux ansata before phallic monuments. This symbol, from which our modern cross is doubtless derived, originated with the religions of antiquity. Much additional evidence could readily be given to illustrate this prehistoric origin. The present Christian symbol affords another example of the adoption by a new religion of the symbols of the old.

Some reflection will show that the origin of many church customs and symbols, and indeed of a great number of obscure customs and usages, may quite properly be traced to the religions and practices of primitive races. Lafcadio Hearn has insisted upon this in the interpretation of the art and customs of the Japanese. He says,[9] "Art in Japan is so intimately associated with religion that any attempt to study it without extensive knowledge of the beliefs which it reflects were mere waste of time. By art I do not mean painting and sculpture but every kind of decoration, and most kinds of pictorial representation—the image of a boy's kite or a girl's battledore not less than the design upon a lacquered casquet or enameled vase,—the figure upon a workman's trowel not less than the pattern of the girdle of a princess,—the shape of the paper doll or wooden rattle bought for a baby, not less than the forms of those colossal Ni-O who guard the gateways of the Buddha's temples," etc.

[9] Japan, an attempt at Interpretation.

In the above pages, we have given an account of the views of a number of writers upon certain forms and symbols, and at the same time we have offered considerable evidence in substantiation from independent sources. These origins, found associated especially in art and religious usages, have not been generally understood. Yet when we reflect upon the fact that many religious customs are of great antiquity; that when once a certain form or custom becomes established, it is well nigh ineffaceable, although subject to great change or disguise throughout the centuries; when we reflect upon these conditions, and realize the fact that sex worship with its accompanying symbolism is found throughout primitive religions, we may then more readily appreciate the entire significance of the above interpretations.

It must, of course, be borne in mind that no one now gives these interpretations to spires, minarets, and to the various monumental symbols of which we have been speaking. We are here dealing exclusively with pre-historic origins, not with present day meanings. The antiquity of certain symbols is truly remarkable. The star and crescent, for example, a well known conventionalized symbol, is found on Assyrian cylinders, doubtless devised many centuries before Christ.

The full force and meaning of these various symbols may be very readily grasped by reference to a number of designs, ancient coins, bas-reliefs, monuments, etc., which have been reproduced in plates and drawings by C. W. King, Thomas Inman, R. P. Knight and others. To these we refer the reader.

(TO BE CONCLUDED)

REFERENCES.[10]

[10] For a number of additional references consult New York Library under Phallicism.

Cox, Rev. G. W.: The Mythology of the Aryan Nations.

Deiterich, A.: Mutter Erde.

Fraser, J. G.: Adonis, Attis and Osiris; Balder, the Beautiful; Psyche's Task.

Grosse: The Beginnings of Art.

Higgins, Godfrey: The Anacalypsis; Celtic Druids.

Harrison, Miss Jane: Ancient Art and Ritual; Themis.

Howitt, A. W.: The Native Tribes of South East Australia.

Inman, Dr. Thomas: Ancient Faiths Embodied in Ancient Names; Ancient Pagan and Modern Christian Symbolism.

Jennings, Hargrave: The Rosicrucians; The Indian Religions.

King, C. W: The Gnostics and their Remains; Hand-book of Engraved Gems.

Knight, R. P.: The Symbolical Language of Ancient Art and Mythology; Two Essays on the Worship of Priapus.

Layard, A.: Babylon and Nineveh; Nineveh and its Remains.

Murray, Gilbert: Hamlet and Orestes.

Newton, John: Assyrian Grove Worship.

O'Brien, Henry: The Round Towers of Ireland

Rawlinson, G.: History of Ancient Egypt; Ancient Monarchies.

Rhyn, Dr. Otto: Mysteria.

Rocco, Sha: Ancient Sex Worship

Spencer, B.: Native Tribes of the Northern Territory of Australia.

Westropp, Hodder, M.: Primitive Symbolism.

Wood, Rev. J. G.: The Uncivilized Races.

ADDITIONAL REFERENCES (Primitive customs, religious usages, etc.)

Bryant: System of Mythology.

DeGubernatis, Angelo: Zoological Mythology.

Judson: Myths and Legends of the Mississippi Valley and the Great Lakes.

Langdon, S.: Tammuz and Ishtar.

Perrot, and Chipiez: History of Art in Phrygia, Lidia, Caria and Lycia; History of Art in Persia.

Prescott: Conquest of Peru.

Rousselet, Louis: India and Its Native Princes.

Stevens, J.: Central America, Chiapez and Yucatan.

Solas, W. J.: Ancient Hunters.

Wood-Martin: Pagan Ireland.



THE PSYCHOANALYTIC TREATMENT Of HYSTERO-EPILEPSY

BY L. E. EMERSON, PH. D.

Psychologist, Massachusetts General Hospital; Examiner in Psychotherapy, Psychopathic Hospital, Boston, Massachusetts; Assistant in Neurology, Graduate School of Medicine, Harvard University.

WHEN a new method of working in any field of endeavor is devised, or a new point of view is discovered, it is natural to turn to other similar fields to see if the method will work there. This is what is done when one approaches the study of Epilepsy from the point of view of psychoanalysis.

It is not my purpose to undertake an exhaustive psychoanalytic study of Epilepsy. Neither is it my purpose to enter into a discussion of the problems of differential diagnosis. It has already been shown, in borderland cases, that one cannot tell the difference between epilepsy and hysteria, without a prolonged psychoanalysis, and even then one cannot be certain. This suggests that the whole thing is more or less a matter of definition. Into such questions I cannot enter. My aim is much more modest. The immediate purpose of my paper is to study some of the problems of therapy, from the psychoanalytic point of view, of that small class of patients on the borderline between hysteria and epilepsy, or patients with epileptiform attacks.

The first publication of studies of this general nature was made by Dr. James J. Putnam and Dr. George A. Waterman in the Boston Medical and Surgical Journal for May, 1905, under the title "Certain Aspects of the differential Diagnosis between Epilepsy and Hysteria." In this paper the authors say, "No one, so far as we are aware, has as yet studied with sufficient thoroughness the subconscious memories of epileptics, and for all we now can say, closer resemblances may be found between these and the subconscious states of the hysterics than we now imagine." p. 513.

In this paper, however, therapy is only hinted at.

A contribution to our insight as to the epileptic state of mind is made by Jung, under the title, "Analyse der Assoziationen eines Epileptikers," in his, "Diagnostische Assoziationsstudien. Beitrage zur experimentellen Psychopathologie." p. 175 (1906).

He found an extraordinary number of emotionally toned, egocentric relations. There were some signs to suggest that the emotional tone in the epileptic was unusually lasting.

The first thing published on epilepsy avowedly from the psychoanalytic view-point was by Maeder: "Sexualitat und Epilepsy." Jahrbuch BI HI, 1909.

Maeder goes into the subject rather exhaustively, after characteristic German fashion, but his conclusions are comparatively simple. He says, "The sexuality of the epileptic is characterized by the prominence of auto- and allo-erotism. It retains much of the infantile form, but has undergone, nevertheless, a certain development, which I designate as 'sexual polyvalence.' For some unknown reason the libido seems to have an abnormal intensity." p. 154.

This is an important contribution to our knowledge of the psychic state of epileptics but it is notable that not a word is said as to therapy.

Sadger published the same year, "Ein Fall von Pseudoepilepsia hysterica psychoanalytisch erklart." (Wiener klein. Rundschau, p. 212, 1909.) But neither does he have anything to say about therapy.

Dr. Wilhelm Stekel, however, treats the problem from the therapeutic point of view in, "Die psychische Behandlung der Epilepsie." (Zentralblatt fur psychoanalyse p. 220 No. 5-6, Vol. 1).

The essential kernel of Stekel's view is that the epileptic is a repressed criminal. The convulsion is a substitute for the criminal act. He announces categorically that pseudoepilepsy is curable by psychoanalytic procedures. Of three cases which he completely analysed, two were cured. His final conclusion is fourfold: (1) Epilepsy, more often than we have hitherto thought, is of psychogenic origin. (2) In all cases there is a strong tendency to criminality which is unbearable to consciousness. (3) The attack is a substitute for an offense, hence, eventually a sexual offense. (4) Pseudo-epilepsy is curable by psychoanalysis.

Spratling calls attention "to the value of an occasional convulsion in certain cases. In some patients the fit acts as a safety valve that unquestionably permits escape from insanity. . . In many cases the convulsion seems t o come as the termination of an obscure (auto-toxic) cycle which varies in duration in different individuals and bears some relationship to the ascending period of the folie circulaire of the French. It seems that the specific cause of the fit in these cases is something that permeates the entire organism; something that comes and goes; that grows rapidly in intensity, exerting a pernicious influence on the patient by making him act out of harmony with his normal state, until the limit is reached and the mind loses its direction and control. The power of inhibition being finally destroyed, the nervous storm breaks with great force and violence." p. 361.

Although Spratling had in mind a toxic agent, one cannot but be struck with how completely his terms describe an emotional outburst.

In a paper read in Boston last winter, Dr. L. Pierce Clark advanced the view that the epilpetic seizure was the symbolical expression of the desire of the patient to return to the mutterleib. The convulsive moments were such reflect and random acts as one sees in infants or infers in the embryo. Regard for social sanctions is lost. This, of course, suggests the first step in criminality. Clark found that favorable cases were amenable to psychic treatment and said that some cases had been very much helped by psychoanalysis. I am not certain whether he claims to have cured any particular case of pseudo-epilepsy or epileptiform attacks, by psychoanalysis. In presenting some of my own cases let me begin with one that certainly was not a complete success, but nevertheless was much helped by psychoanalysis.

This case is that of a young girl, aged 14, without known inherited tendency. Her first attacks had occurred about a year previous in the form of fainting spells. These were afterwards followed by convulsions. In convulsions the patient thrashed about, kicking her legs and clawing at her chest. These convulsive movements stopped after a while and were followed by a deep sleep, after which the patient awoke without any memory of what had happened.

It was found that during the convulsion the patient imagined she was being pursued by a black-faced figure with claw-like hands, of a peculiar shape like her father's.

Further investigation showed that her father got drunk and did chase her, sometimes kicking her out of the house. She would undress her father sometimes and put him to bed. Once when taking off his shoes he kicked her, as she was bending over him, in the lower part of the abdomen. This was just before the convulsions developed. The fainting spells occurred soon after she had first seen her father naked. The image of his nakedness so distressed her by continually coming before her mind that she made the most desperate efforts to repress it, finally partially succeeding. Speaking of her father she said, "Every time I think of him I feel like taking a fit. Oh! It makes me feel terrible."

Her father had kicked her in the chest, too, which perhaps partially accounts for the clawing.

In the light of this knowledge the convulsive movements become a little more comprehensible. They are futile attempts to run away. They are the partial movements of flight.

The cries that sometimes initiated and accompanied the convulsions at first, afterwards became sufficiently articulate to be understood as calls "Mama, Mama, Mama."

It was found that when her father would chase her about the house, in drunken fury, she would call for her mother in frantic fear. Here, apparently, is a meaning of the call preceding the convulsions.

Under a very short psychoanalytic treatment the patient showed marked improvement. Her attacks became much less violent and much farther apart. She became able to control them to a great extent. Finally she became so well that one might say she had practically recovered.

Apparently there is no hint here of a repressed criminal complex. But a little deeper analysis suggests it, however. The first attack, which was in the form of a faint, occurred under the following circumstances. The patient was at the funeral of the father of her best girl friend. As she looked at the dead body of her friend's father the thought flashed through her mind, "He was so good, and now he is dead, while my father who is so bad, still lives. I wish he were dead." Shortly after she fainted.

There were a number of reasons, seemingly adequate, for incomplete success in this case. In the first place, the patient had been in this country only a few years and spoke very broken English. She is a Russian Jew. Obviously this was a very great barrier to understanding. In the next place it was almost impossible to change conditions of home, although Social Service worked wonders in this case. The father continued to get drunk, and one of the last of her now infrequent attacks occurred on his return from jail. The patient was dreadfully afraid lest her father find out that the knowledge of his delinquency had been discovered through her.

Not the least of the reasons militating against complete success was the short time possible for psychoanalytic treatment. The patient was seen only three weeks. As the time needed for a psychoanalysis is variable depending on the particular patient, it is clear that this would be too short a time to enable a young girl, only recently here from Russia, to understand, or to overcome resistances. That the treatment was as nearly successful as it was is perhaps encouraging to the hope that suitable cases under favorable conditions might be cured.

The next case is one where the diagnosis lay between hysteria and epilepsy. The symptoms were as follows: The patient had attacks in which she became unconscious, gasped, and spittle ran from her mouth. She also bit her tongue. She becomes stiff, eyes stark, and is left tired and weak. These attacks were first noticed about five years ago. Since then she has had about five similar attacks, the last three coming within five months. The last two were within a day of each other and frightened her so she came to the hospital. At the age of eight or nine she said that she had flashes of speechlessness, and a thought which she cannot define, as of a horse or a man. She never became unconscious or bit her tongue. After her first catamenial these flashes of speechlessness and thought came only at this time. At the age of two the patient said that she had fallen down stairs and hit her head. She said she was unconscious twenty-four hours.

As a result of a psychoanalysis the following facts were learned. The patient was a very sensitive child, exceedingly responsive to her environment. She was also stubborn and self-willed, at times. She was reserved and capable of great repression. When she was about three or four she remembers seeing in the Bible a picture of the Devil on a white horse. This used to make her shudder, but it also had a sort of irresistible fascination. Later, when she was seven or eight, it would come into her mind in school even and make her feel so badly she would lay her head on her arms. But she never told anybody what it was that troubled her and she would put it out of her mind. She thoroughly believed her mother when she told her that the Devil would come and get her if she did wrong.

At about the age of ten or eleven she began going with a girl much older than herself. She used to visit this girl and spend the night with her, and in turn have her at her own home. In this way they spent the night together quite frequently. Soon the girl wanted to masturbate her and although she repelled her advances at first she finally allowed it because she was told she would be regarded as queer if she didn't as other girls did it and liked it. She, however, never did get any pleasure out of the practice, and remained perfectly passive. She thought if her friend enjoyed it and it didn't hurt her she should let her have her pleasure. She never told of this.

The patient now began having what she called staring spells. These never lasted more than a second or so and they were never observed. She carefully concealed them. Just before the patient began to menstruate which was when she was about fourteen, she noticed that the day after she had been with the girl who masturbated her she had a terrific headache. Then she remembered that for a long time it had been so though she had never connected the headaches before with the masturbation. She stopped the practice immediately and never allowed it to be resumed.

After menstruation began the staring spells became grouped and came only during her periods. But they were more numerous. She would have a number in one day. They were not yet sufficiently observable to be noticed. At about this time she had a terrible fright. She was kneeling at her mother's side listening to a story when she thought she saw a woman's face looking at her over her mother's shoulder. She was speechless with terror. This was not noticed and she did not tell. Around this time too she had another fright. She was studying one evening at the dining-room table when she saw a face looking in at the window. She screamed, and kept on screaming, but finally was able to tell that she had seen someone looking in at the window. Her father took her out and showed that it couldn't be so because there were no tracks in the snow which was on the ground. She wouldn't or couldn't stop crying, however, and kept it up all night, she said. Just before menstruation she did some sleep-walking. She got up one night and went to her mother and said she had something to tell her. Her mother tried to get her to say what it was but could not, and saw that her daughter was asleep. She kept saying, "you know what it is." The mother did not dare to waken her and finally got her quietly back into bed. The next morning she remembered nothing of what had happened.

When the patient was about sixteen she married. Her husband did not want any children and practiced coitus interruptus, but she became pregnant nevertheless and had an abortion performed. Although c.i. continued to be practiced she became pregnant again and this time she had a daughter. Four more years of c. i. followed. During all this time the patient had the staring spells, but they were never noticed and she never told, not even her mother. Then, like a thunder bolt out of a clear sky, came a tragedy.

She was pregnant again, and visiting her mother, expecting her husband for over Sunday, when she received a letter saying he had left her and had gone off with another woman. When she read the letter she lost consciousness.

Then followed a terrible time. In hate of her husband and on account of fear lest she be unable to care for her baby she had another abortion performed. This time she nearly died through not having proper medical attendance afterwards, but she finally recovered and lived a life of feverish activity and hate.

During her marriage she had been entirely frigid with respect to the sexual act. A friend told her she had been missing an essential experience of marriage. About a year after her husband left her she met a man who thrilled her through and through, and thought, "this is what my friend meant." This man showed her some attention and she set out consciously to seduce him. She soon succeeded and though he was wildly in love with her and wanted to marry her, she steadfastly refused on the score of not loving him, but was his mistress for two or three years. During this time her staring spells seem to have been at a minimum, but I cannot assert that they disappeared.

Then she met the man who became her second husband. She had refused to marry her lover because she did not "love" him. She now dropped him completely, and getting a divorce from her husband on the ground of desertion, married.

She was happy about a year and a half when her husband moved to a country cross-road near a "hotel" (bar-room). Here he began drinking badly, and consorting with prostitutes. For three years she fought her husband off, in fear of infection. During this time she had no intercourse. At this time began the attacks of unconsciousness. She was alone one night, while her husband was off carousing, when she had a terrible fright on seeing a man trying to get in at the window. This was probably hallucinatory as nothing came of it. But from this time forth she was subject to attacks, in which she lost consciousness, had convulsions, frothed at the mouth, and bit her tongue badly.

At the end of about three years, however, her patience broke, and she told her husband that if he did not stop she should leave him. This threat brought him to his senses apparently, and he completely reformed. But her love for him was dead. And though she now permitted marital relations to be resumed, she remained from this time on absolutely frigid. Her husband too, now suffered from premature ejaculation. Thus from the point of view both of "passion" and of "love" the patient was not satisfied. Her attacks increased in number and violence, coming now at any time, not being confined to the menstrual period as at first, and coming days as well as nights.

In this patient we have represented the points of view both of Stekel and of Clark. The patient showed conclusively her capacity for criminal action. She also illustrates the craving for a return to the mother. The morning of the day on which she had the first attack in which she bit her tongue, she passed through the town where her mother was living and thought, "Oh, if I could only go to my mother." But remembering she had promised her lawyer to live a year with her husband, she went on. Of the sexual character of her conflicts no further comment is necessary.

Here then we have the natural history of what? Hysteria? or Epilepsy? This question I shall not attempt to answer. But what has been the therapeutic result of psychoanalysis? This question I can answer.

In the six months during which the analysis has been in progress the patient has had no attacks in which she has had convulsions, frothed at the mouth, or bitten her tongue. She has had only three spells in which consciousness was lost and these were mild. The last one was described by the daughter. She said it was like a faint; that her mother was in it only a short time; that she had none of the symptoms she used to have; and was all right soon afterwards with no bad after-effects. She added that since her mother had been coming to the hospital she had improved so much they never thought of her now as being sick. The bad feelings have diminished so much in number and intensity as to be almost negligible. Family relations have so improved husband and wife are practically at one in their purposes. Social relations have also improved to such an extent that the patient has been able to prevent the wreck of the home of a friend, and in her church is an active worker on a number of committees. She is now doing her best to get her daughter started right in life. The patient regards herself as having practically recovered.

The next case I wish to present for your consideration is that of a young man twenty-six years old. He was brought into the accident-room of the hospital one night last Summer suffering from convulsions. He continued to have convulsions throughout the night, and as many as five interns were required to hold him quiet. These convulsions seemed to have enough purpose in them to warrant the diagnosis of hysteria, so the next morning he was referred to me.

"Last Wednesday night," he said, "I was having dinner with a customer at the Hotel Thorndike. I began to feel sick and went to the toilet and vomited. Then I went back and got my friend and started for a drug store in Park Square to get some quinine. But before I got very far I began to shiver and shake and I knew that it took quinine two or three hours to work so I started back to the hotel to get a room. No rooms were to be had, so I said 'get a taxi and take me to the hospital.' I lost the use of my legs on the steps and they had to carry me. In this attack I was more or less conscious all through it." What were you thinking of in the taxi, I asked. "I don't know. I felt as if I wanted to jump at something and grab something." Can you not remember what was in your mind, I continued. "Only what I've told you," he answered. Will you lie down and close your eyes and imagine yourself back in the taxi, I asked. Now tell me what you see. After a moment he said, "I see flames." What else do you see? "Nothing, only flames. I feel as if I wanted to jump into the fire." Did you see flames in the taxi, I asked. "Yes, that was what I wanted to jump at." At this moment the patient gave a start. What did you see then, I asked. "There is something in the flames, an object, I don't know what it is. It might be a thing or a person. I feel as if I wanted to grab the object." At this instant the patient gave a violent jump into the air and then sank back relaxed. What did you see, I asked. "This object. It seemed to be attracting me." Can't you tell what it is, I said. "No. But it seems almost like a person. It seems as if I could see an arm." What else do you see? "The arms seem beckoning me." It is a person then? Is it a man or a woman? "I don't know. I can't make out." Look. "It is a woman. I can see now." Is it anybody you know? "No, I can't see any face." What do you see? "Just a woman, standing in the flames, with outstretched arms, as if imploring me to come. I feel a yearning, as if I must jump and grab her." The patient stiffened slightly and gave a sort of spring up from the couch and then sank back, breathing a little heavier. What did you see, I asked. "I thought she beckoned me to come." Can you see who it is now? "No The face is blank." Look again and see if you can't tell who it is. What do you see? "I can't tell. I see several faces come and go." Do you recognize them? "Yes. The first is my little girl's; then I see a former sweetheart of mine; then I see my wife's face."

Gradually the following story was elicited from the patient. His mother died when he was seven and his father married again in less than a year. The former sweetheart was his step-mother's half-sister who came to live at their house because the schools were better. He became infatuated with this girl and his step-mother did everything she could to encourage his feeling as she thought it would be a good match. The vision of his sweetheart in the flames was based on an actual occurrence. She was sitting in front of a fireplace once when a log of burning wood fell out and he jumped to pull her away and held her close in his arms for a moment.

Finally, however, he broke off absolutely all relations with the girl. The reason seems quite adequate. Why didn't you marry, I asked. He answered, "we quarrelled and I left her. I didn't like her morals. She went with other men and had connection with them. I saw her go into the woods one night with another fellow, and once at Salisbury Beach I saw her go into a hotel with a man and register as his wife."

About a year after this the patient began going with another girl more in an attempt to crowd the image of his former first love out of his mind than because he had fallen in love again. A year later they married. From the first his married life was not entirely happy. More or less unconsciously he began to regret lost opportunities. He was a travelling man and soon after marriage his route was enlarged necessitating his being away from home a month at a time. On these trips he used to get exceedingly lonesome especially as he steadily refused going with other travelling men and making a night of it as they often did. One of his routes took him to Virginia and he said that he had returned from New York on the way there just for the sake of spending a night with his wife. Once, in New York, he was unfaithful to his wife and on that occasion contracted gonorrhea. This, however, was the only time he has ever had extra-marital sexual relations, he said.

Just before his attacks began, which was about four years ago, he was told by his wife's doctor that it would be impossible for her to have any more children as she was suffering from heart disease. To his mind this meant giving up coitus. Then, unconsciously, he began to dream of Anna, his first love. He regretted more than ever not taking advantage of his former opportunities, and unconsciously dallied with the thought of deserting his wife. Just at this time his attacks began.

As the analysis progressed his attacks diminished and shortly disappeared. Gradually the image of his wife took full possession of his mind and the image of Anna disappeared. Towards the end of the analysis as he was lying on the couch with his eyes shut, he saw Anna in the flames and felt the yearning but not so strongly as to lead to any impulsive movements. What do you think all this might mean, I asked. "I don't know," he answered, "it might mean I still cared for Anna and that if I let myself go it would break up my home." With his full realization of the meaning of this symbolization, it was assumed that he was cured.

Seven months later, in company with a colleague, I visited my former patient and he told me that he had not had a moment's illness since I last saw him. He told me that while occasionally the thought of Anna would come to his mind, it never disturbed him, and never distracted his attention from other things. He has prospered in his business, and I saw every evidence of a happy home.

This case merits consideration for a number of reasons. In the first place the attacks were cured by psychoanalysis. No one who saw the association of the symbolical imagery and the convulsive movements could fail to see that there was a causal connection between them. The subsidence in violence and frequency of the convulsive movements as the conscious grasp of the meaning of the mental symbolical imagery increased was also completely convincing of the therapeutic value of the analysis. The question of the permanence of the recovery is of course open, because seven months is far too short a time to carry complete conviction.

The comparison of this case with the one immediately preceding raises a very interesting question. Why is this patient apparently completely cured and the other one not? Several reasons may be noted. The patient is much younger. He had never been through anything like the same mental strains. His trouble was of short duration. But above all as he was successful in his business he was successful in his sublimation. Here is a sine qua non of a successful psychoanalysis: the capacity and the opportunity for successful sublimation. If these are present the prognosis is good.

It is interesting also to compare this case in its results with the contentions of Clark and of Stekel. It is hard to see any signs of a definite criminal tendency. Inasmuch as the temptation to go back to his early love is a sign of a tendency towards regression and erotism generally the patient shows what Clark has spoken of as a desire to return to the mother-body. This case is not very important, however, to the views of either Clark or Stekel as the analysis is relatively superficial, and there is no knowing what a more thorough analysis might reveal. From the point of view of superficiality, however, the case is important as it emphasizes Taylor's view of the value of a modified analysis. The patient was seen only five times.

On the basis of these, and a number of other similar cases, I should like to suggest, from a descriptive point of view, that the epileptiform seizure is of the nature of an orgasm. An orgasm is a sudden, explosive, discharge of nervous energy, raised to the breaking point of nervous tension. I should like to generalize the idea of orgasm. Ordinarily, of course, it is confined to the sexual sphere. In the last case I reported it seems to me fairly clear that the explosive actions, convulsive-like impulses, were closely associated in the mind of the patient with sexual ideas. That they were substitutes for the normal relief of sexual tension, seems to me also clear. This idea is perhaps more convincing if I add the fact, as stated by the patient, that his last attack started when he saw an attractive girl sitting at a nearby table in the Thorndike Hotel, and who started him dreaming about Anna, because she looked so much like her.

The second case I reported seems also easily brought under this conception. Here we know more about the earliest childhood of the patient and we can easily imagine that there was an especial predisposition for the form the symptoms took. This, however, does not militate against the descriptive value of the above conception. That the epileptiform attacks did not take place until after actual sexual orgasms had been experienced, lends weight to the conception I am presenting here. The first case is not so clear. This is partly due to the fact that it was impossible to make anything like a complete analysis. But it shows nothing contradictory to the conception, and indeed has some slight value as added evidence in favor of the conception, in as much as the original trauma consisted of a kick in the genitals, by her father.

This conception does not contradict either Stekel's or Clark's ideas, but rather supplements them. The essence of the criminal act lies in its unrestrained aggressive character. From this point of view anything getting in the way of the libido discharge has to take the consequences. This also agrees with Clark, only his idea seems to me perhaps a little too passive to describe fully the dynamic quality of the attack.

Here, as in Hysteria, the therapeutic effect of an analysis depends on the possibility of sublimation. The three cases I have given in some detail may easily be arranged in order. The last case having the best chances for sublimation shows the best results.



ON THE GENESIS AND THE MEANING OF TICS

BY MEYER SOLOMON, M. D.

Associate in Neurology, Maimonides Hospital, Chicago

THE problem of the genesis and meaning of the strange manifestations which we find in that peculiar disorder which goes by the accepted name of tics is indeed difficult of solution. The analytic and genetic standpoint only comparatively recently assumed in the domain of neurology and psychiatry is having an ever wider and wider application. The problems in neurology and psychiatry which still cry loudly for solution and rational explanation are indeed numerous. Some of these questions are so baffling that at times they seem almost beyond the ken of the human mind. Nevertheless, with persistence and the "Don't give up the ship" spirit keenly imbued into us, and with that irrepressible spirit of investigation and of research born of optimism and of curiosity, we may expect to see many of these problems which now seem to us so hopelessly unsolvable gradually rescued from the uncertain waters of speculation and theorization and brought to the more sound shores and land of the knowable and the known. If our theories be but tinctured with due admixture of that sound self-criticism that comes of prolonged and serious reflection and deliberation, and if the results of observation and investigation be brought forth in support of these theories, then we need have no hesitancy in permitting freedom in theorization and speculation. Let us also remember that unsound theories or standpoints do not come to stay, but, after surviving for a certain time, give way before that which is more sound, more tangible, more near the truth, which, to be sure, is always but approximately attained. If, therefore, the theory which I intend to set before you for consideration may seem on first thought far-fetched and unsupported, I beg you to remember that in a field where but comparatively little is known with absolute certainty, it behooves us to take notice of all theories or conclusions which may be propounded, since, even though they may not contain the whole truth, they may, perhaps, contain certain germs of truth, which may contribute, in some measure, however slight, toward the ultimate solution of the problem under consideration.

With these brief prefatory remarks, I shall forthwith enter into the discussion of the genesis and meaning of the tics.

I may say at once that this is not merely a theoretical and purely academic proposition which has no practical bearings in the way of prognosis and treatment. On the other hand, a real understanding of the nature, origin, and significance of the tics is of decided value in giving us proper standpoints and orientation with respect to the prevention, prognosis and cure of the condition.

I need not enter into a description of the characteristics of tics in this place. I may merely mention that tics have two aspects—a psychic and a physical. It is, in other words, a psychoneurosis. The characteristic mental state is one of doubt, of indecision, of inadequacy, of restlessness, of tension, of discomfort and of dissatisfaction, which is more or less unappeasable and irrepressible and uncontrollable until it finds vent in a rather explosive series of motor expressions which, as it were, are the safety valve for the peculiar feeling of tension and discomfort which the individual has been experiencing and which is accompanied by a sense of relief, satisfaction and a relative degree of comfort and mental rest. The mental imperfection (Charcot) of the ticquer is a polymorphic psychic defect (Brissaud, Meige and Feindel) characterized by mental infantilism; for ticquers, like other psychoneurotics, are like big children. They have the mind of children, in respect to the emotional make-up.

The mental condition of ticquers is especially characterized by the imperfection or weakness of volition, by a certain degree of mental instability and lack of inhibitory control of the desires, tendencies, activities and motor expressions of the individual, this defect laying the groundwork for the impulsions and obsessions, as also for hysterical, so-called neurasthenic, hypochondriacal, depressive and so-called dementia praecox reactions. The tic movement is the symbol of the psychic defect or degeneration or instability.

The earlier investigators were responsible for the differentiation of the tics from such other conditions as Sydenham's chorea, Huntington's chorea, the spasms, the stereotypies, the habit movements, the myoclonias, and other allied conditions. It is due to their pioneer work that tics were recognized as a definite and distinct clinical entity. The process of disintegration of these various movements and their differentiation one from the other cannot be overvalued. Among those who have contributed most to this subject may be mentioned Magnan and his pupils, especially Saury and Legrain, Gilles de la Tourette, Letulle, Guinon Noir, Pitres, Cruchet, Grasset, Trousseau, Charcot, Brissaud Meige and Feindel. Although Trousseau recognized the the ticquer was mentally abnormal, it was Charcot who first called definite attention to the psychic origin of the condition and to the fact that tic was indeed a mental disorder, a psychoneurosis, a psychomotor reaction. His lead was subsequently followed up by Brissaud, and by the latter's pupils Meige and Feindel, the latter two authors giving us a comprehensive discussion of the subject in their well-known classic. [1]More recently the Freudian school has attempted to dig down into the roots of the tree which ultimately sends forth its branches in the guise of tics.

[1] Tics and their treatment. English translation by S. A. K. Wilson. New York, 1907. This book contains an extended bibliography.



VIEWS OF THE FRENCH SCHOOL

The usual conception of tics, as laid down by Brissaud, Meige and Feindel,[1] may be stated as follows: Tic movements are physiological acts which were originally functional and purposeful in character, but which have become habits, apparently purposeless and meaningless. The motor reaction is the result of some external stimulus or idea (normal or abnormal) or both, which originally was necessary for the production of the tic movement, which latter eventually became habitual and automatic, and, owing to repetition, was executed, even in the absence of the external stimulus or idea, without apparent purpose or meaning. At first but little more than purposive habit movements, they finally became irrepressible acts which sought for expression, which were but little under the control of the will, which occurred in attacks varying in frequency, duration and severity, which decreased under distraction and generally ceased during sleep, which were increased in frequency and duration and severity by fatigue, emotional upset, mental unrest, conflict and strain, while the lack of inhibition and will power, the lack of self-control was the dominant mental state, leading to feelings of insufficiency, doubt, indecision and incapacity, and making the ground work for the psychasthenic reactions in the form of morbid impulses and obsessions, and for the hysterical, so-called neurasthenic and other morbid psychic trends.

The inherent or acquired neuropathic and psychopathic state is the basic condition which prepares the subsoil.

From a consideration of the motor symptom we may say that it is but a pathological habit, which, however, is apt to lead to the tendency toward or generation of an increasing number of such pathological habits.

Characteristic of tics we may mention their being conscious before and after but not during their execution, their being disordered functional acts, their impetuous, irresistible demand for execution, the antecedent desire, and the subsequent satisfaction.

The etiology of tics, as laid down by Meige and Feindel, may be summed up by stating that they occur most frequently in young subjects, less frequently in savages and animals than in the civilized, there is a psychic predisposition based on heredity (of a similar or dissimilar neuropathy or psychopathy) upon which Charcot laid great stress, imitation (especially in the young) plays a role, as also brain fatigue (emotion, mental upset and worry) and indolence, with the frequent exciting cause of an external or internal stimulus or an idea, which is the explanation of the origin, source, situation and form of the tic or tics present in any particular case.

Scattered references to emotional shock acting as a possible exciting cause of tics, as at times of obsessions, can be found in the literature. Dupre[2] has made such reference. Meige and. Feindel[3] themselves make the statement that "Fear may elicit a movement of defense, to persist as a tic after the exciting cause has vanished." They also state that "in ticquers the impulse to seek a sensation is common and also to repeat to excess a functional act."

[2] Soc. de Neur. de Paris, April 18, 1901, quoted by Meige and Feindel, page 54, of the English translation (reference 1).

[3] Loc. cit., p. 62.

Bresler[4] has called attention to the fact that the movements are in the nature of defensive and protective movements of expression and mimicry and originally in reaction to some external irritant or as the result of some idea, and he proposed the name "mimische Krampfneurose" for them. This is somewhat allied to Breuer and Freud's theory of hysteria.

[4] Quoted by Meige and Feindel, Loc. cit., p. 267.

The object of tic is some imaginary end, the influence of the will always being present in the beginning, although later it may be absent. Tics are of cortical origin, being coordinated and synergic, clonic or at times tonic[*] muscular movements, physiologically and not anatomically grouped, premeditated, purposive, of abnormal intensity, apparently causeless and inopportune.

[*] Cruchet objects to calling these tonic reactions tics.

Insufficiency of inhibition is the cause of the beginning and of the persistence of bad habits and of tics.

Tic is a sign of degeneration, in the biological and evolutionary sense, a degenerative neuropathic and psychopathic basis, as mentioned previously, being present, although often latent.

The maladie des tics is but the extreme form.

The onset is as a rule insidious, with a tendency to spread.

Spontaneous cures may occur, while Gilles de la Tourette's disease is but the extreme form of a condition in which antagonistic gestures are frequently adopted by the patient to adapt himself and to get to a state of rest.

This, as I see the situation, is as far as the French students of this subject (including Brissaud, Meige and Feindel, and even Janet) have permitted themselves to go. And, in my opinion, their observations and conclusions seem to be quite accurate.



VIEWS OF THE FREUDIAN SCHOOL

Recently the Freudian school has endeavored to penetrate more deeply to the nucleus of the problem and to solve it. Freud has delimited what he calls obsessional or compulsion neurosis (Zwangsneurosis), which is classed under psychasthenia by the French and under neurasthenia by others. The Freudians regard this as a distinct neurosis, sometimes complicated by neurasthenic or hysterical symptoms. The characteristic symptom is a feeling of compulsion. The symptoms may be motor (obsessional acts, impulsions), sensory (obsessional hallucinations or sensations), ideational (obsessions), and affective (obsessive emotions, particularly doubt and fear). In this condition we find that there is an excessive psychical significance attached to certain thoughts. Obsessions are characterized by dissociations from the main personality. They thus exist in the unconsciousness. The original unconscious mental processes have brought about, by displacement, an excess of psychical significance to these thoughts. Ernest Jones[5] states that Freud found, by his work in psychoanalysis, that obsessions represented, symbolically, the return of self-reproaches of ancient, infantile and early childhood origin, which had been repressed and buried until the obsession made its appearance. "They always refer to active sexual performances or tendencies;" and, as Jones further explains, "there occurs early in life an exaggerated divorce between the instincts of hate and love, and the conflict and antagonism between the two dominate the most important reactions of the person. A fundamental state of doubt, an incapacity for decision, results from this paralyzing doubt. The patient oscillates between the two conditions of not being able to act (when he wants to), and of being obliged to act (when he doesn't want to). The symptom symbolizes the conflicting forces. These are not, as in hysteria, fused into a compromise-formation, but come to separate and alternating expression; one set of manifestations, therefore, symbolizes the repressed forces, another the repressing."

[5] See his article on "The Treatment of the Psychoneuroses," White and Jelliffe's Modern Treatment of Nervous and Mental Diseases, Vol I, pp. 408-409.

To put the matter plainly, the Freudians contend that obsessions are symbolical representations of the repressed sexual activities and tendencies of infantile and early childhood origin. It must be remembered that the Freudians employ the term sexual in a very broad sense, including under it the most indirect and distant physical, mental and moral reverbations. conscious or "unconscious," of the relations between the sexes. The sexual impulse is here conceived of as having incestuous, bisexual and polymorphous perverse sexual tendencies. The word sexual is not only used as synonymous with love, but practically all emotional surgings, all feelings, all affectivity, all sense-cravings and bodily heavings are classed by certain members of the Freudian school as sexual. This latter interpretation and extension of the connotation generally accorded by us to the term sexual we surely have no right to give it.

Clark, of New York City, is the author who has carried out the Freudian idea to its ultimate conclusion. I refer to his series of three papers[6] in the Medical Record, and call particular attention to his last (third) paper in which he has fully elaborated his theory of the meaning of tics.[*]

[6] His three papers, which appeared in the Medical Record, New York, in the issues of February 7 and 8, and March 8 1914, are entitled: (1) "Some Observations upon the Etiology of Mental Torticollis," (2) "A Further Study upon Mental Torticollis as a Psychoneurosis," and (3) "Remarks upon Mental Infantilism in the Tic Neurosis." A fourth paper by Clark on tics appeared in the Medical Record of January 30, 1915.

[*] J. Sadger has also come to similar conclusions.

Clark's conception of the meaning of tic movements and of the mental state characteristic of ticquers must be here given. Although not denying the basic neurotic constitution present in ticquers, Clark sums up by giving the following definite and fully developed theory:

"The ticquer has a strong sexual attachment; this is so strong that the love instinct ineffectually sublimates the hate instinct and in the warring conflict doubt and physical and psychic inadequacy arise. The situation continues and generates mental, and physical infantilism, which in turn make for increased feelings of tension. Motor and psychic restlessness succeed. The motor expression manifests itself most often in habit movements of disguised sexual significance (autoerogenous pleasures) a form of physical stereotypy, in its broadest psychophysical meaning. The mental state often pari passu takes up obsessive thinking and various physical acts and thoughts are formed as defense mechanisms, born of conscious guilt. The motor habits are usually inhibited or displaced in part, and the tic remains as a motor symbol, usually in itself non-sexual, as a fragment of the former complete habit movement. The mechanism of the completely evolved tic is either a conversion (hysteric) or substitution (obsessive) mechanism or both."