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 Psychopathology, 
 
 3 1924 012 465 732 
 
Cornell University 
 Library 
 
 The original of this book is in 
 the Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924012465732 
 
PSYGHOPATHOLOGY 
 
Fig. L-^Hygeia, the Greek Deity of Health. Health, virility and happiness 
 being established when the serpent (phallus) is potent enough to feed from the' bowl 
 (vagina). The physician's duty being to cure debilitating diseases and promote virility 
 henee insuring the safety of the state and raee. (See Kg. 87.) 
 
PSYGHOPATHOLOGY 
 
 BY 
 
 EDWAED J. KEMPF, M.D. 
 
 Clinical Pstchiatbist to St. Elizabeths Hospital (Formerly Government 
 
 Hospital tor the Insane), Washington, D. C. ; Author op 
 
 "The Autonomic Functions and the Personality" 
 
 EIGHTY-SEVEN ILLUSTRATIONS 
 
 ST. LOUIS 
 
 C. V. MOSBY COMPANY 
 
 1920 
 
CoPTRiGHor, 1920, B«r C. V. MoSBT Company 
 (All Rights Reseroei)':^^ 
 
 A f9uy^ 
 
 Prejs of 
 
 C. V. Moshy Company 
 
 St, Louis 
 
TO 
 
 DE. WILLIAM A. WHITE 
 Superintendent of St. Elizabeths Hospital 
 
 THIS BOOK IS DEDICATED AS AN ACKNOWLEDG- 
 MENT OF THE OPPORTUNITIES AND BNCOUEAGE- 
 MENT FOE EESEARCH WORK IN PSYCHOPATH- 
 OLOGY WHILE ON THE STAFF OF ST. ELIZABETHS 
 HOSPITAL 
 
PREFACE 
 
 This book lias been written for the professional student of 
 human behavior who must have an unprejudiced insight into hu- 
 man nature in order to deal justly and intelligently with problems 
 of abnormal behavior as they are brought to the physician, rec- 
 tory, police courts, prisons and asylums, and the directors of 
 schools and colleges, and the commanders of military and naval 
 organizations. 
 
 In order to avoid speculation and theorizing, most of the space 
 is devoted to plain expositions of the actual difficulties of cases. 
 They are presented to speak for themselves. Naturally an enor- 
 mous amount of valuable data on delusions, hallucinations, sym- 
 bols, symptoms, defensive and compensatory methods of thinking, 
 different types of inferiorities and causes of inferiorities, etc., is 
 scattered through these cases. The most important illustrations 
 have been collected together in the index to be readily accessible 
 to the reader. For this tedious, difficult work I am especially in- 
 debted to Mrs. Kempf. The index has greatly increased the use- 
 fulness of the book. 
 
 Most of the case material has been taken from the cases ad- 
 mitted to St. Elizabeths Hospital, and for this privilege I am in- 
 debted to Dr. W. A. "White, superintendent of the institution. I am 
 also indebted to Prof. Adolf Meyer for the privilege of using some 
 case material -I worked out while assisting him at The Phipps 
 Psychiatric Clinic in Baltimore. The members of the staff of St. 
 Elizabeths Hospital assisted me materially in collecting the more 
 interesting cases and I wish to thank especially Drs. Mary O'Mal- 
 ley, Anita Wilson Harper, Helen Clarke Kempf, Lieut. Col. Paul 
 Freeman, U. S. A., M. C, and Dr. James C. Hassell for coUectiiig 
 interesting observations on the wards which would otherwise have 
 been lost. I Avish also to thank Miss Clara Willard and Mrs. 
 Kempf for correcting and editing the manuscript and Mr. Edward 
 Clements for his patience and kindness in typewriting it. 
 
 Edward J. Kempf. 
 
 St. Elizabeths Hospital, 
 Washington, D. 0. 
 
CONTENTS 
 
 CHAPTEE I PAGE 
 
 The Physiological Foundations of the Personality 20 
 
 The Autouomie Apparatus, 21; The Projicient Apparatus, 21; Peripheral 
 Origin of Cravings (emotions, wishes, sentiments) in Different Segments of 
 the Autouomie Apparatus, 21; Mechanism of Postural Tensions, 21; The In- 
 fluence of the Autonomic- Affective Cravings on Postural Tensions and Kin- • 
 aesthetic Sensations, 22; The Mechanism of Conflict between Segmental 
 Cravings and between Segmental Cravings and the Bgo, 28; The Value of 
 the Projicient Apparatus to the Autonomic Apparatus, 29; The Nature of 
 Consciousness and the Content of Consciousness, 31; The Conditioning of 
 Autonomic- Affective Cravings, 36; Substitutions of Symbols, Fetiches, Im- 
 ages, Delusions, Hallucinations for Eealities Which Are Needed to Gratify 
 Uncontrollable Cravings or Believe Fear, 39; The Affect and the Use or Dis- 
 use of Organs, Anaesthesia and Hyperaesthesia of Receptors, 49; The Phys- 
 iological Nature of Memory, 49 ; Complex Nature of the Autonomic- Affective 
 Stream, 52; The Development of the Ego, 52; Mechanism of the "Trans- 
 ference," 56; Origin and Nature of the Will, 57; Affective Adjustments, 
 Suppression, Mepression, SiMnmcUion, Dissociation, Segression, Compensation, 
 Beadjustment, Assimilation, SublimMion, 61; Psychopathic Eliminations or 
 Simulations, 69; Formula of the Affective Conflict, the Environment and 
 Behavior, 74. 
 
 CHAPTER II 
 
 The Psychology aw the Family 76 
 
 The Conditioned Autonomic-Affective Cravings of the Individual and the In- 
 fluence of his Associates, 76; His Associates and Environmental Situations 
 as Compound Stimuli, 77; The Insidious Repressive Influence of Parents 
 and Associates Who tend to Repress their Own Cravings, 80; The Psychopath 
 aiid the Influence of Associates, 80; The Judge and His Son, 82; The Rus- 
 sian Peasant- <Jirl, 83; The Letter of A Business Man about His Mother's 
 Influence upon Himself and His Brothers and Sisters, 87; The Family's Re- 
 sistance and Pernicious Regression and Dissociation of the Youth's Personal- 
 ity, 88; Causes of Variations in Family Adjustments and Matings, 91; The 
 Child that Binds the Mismated, 93; The Child that is Hated Unconsciously 
 and the Matured, Brooding Psychopath, 93; The Wiii/'s Disgust for Sexual 
 Relations and Her Insidious Castration of the Husband, the Husband as a 
 Homosexual Regressive, 94; The Foundation of the Oedipus and Electra Love 
 Fixation in the Child Due to the Dissatisfied, Erotic, Clinging Parent, 102; 
 The Homosexual Father and Parricidal Inspirations in His Matured Son as 
 Biological Compulsions, 103; Competition for Social Esteem and the Serious 
 Influence of Flirtatious, Flattering Parents and Teachers, 104; The Insidi- 
 
CONTENTS 
 
 PAGE 
 
 ous PatMpgieal Influenee of Dominating the Child to Strive to be "First" 
 and "Beat," 112; The Despair of Relative Organic Inferiority, 112; Trans- 
 mission of Familiar Functional Traits through the Conditioning Influence of 
 Associates, 117. 
 
 CHAPTER III 
 
 The Universal Struggle for Virility, Goodness and Happiness 118 
 
 Definition of ViriUty, Goodness, Happiness, 118; The Biological Laws of the 
 Struggle, 119; The Bisexual Attributes at Birth, 120; The Influence of As- 
 sociates and the Development of Aggressive and Submissive Masculine Traits 
 in Competition where Adequate and Inadequate Compensations Are Developed 
 through Training in Childhood, 122 ; The Influenee of the Unconscious Attitude 
 of Others toward Superior and Inferior Organic and Functional Traits, 122; 
 The Seven Stages of Evolution of the Sexual Functions, 123; The Precedence 
 of Homosexual Interests to Heterosexual Interests in Man and the Inf rahuman 
 Primate, 139; Marriages as Cures for Psychopathic and Painful Situations, 
 156; The Biological Struggles of Males and Females with Conventions and 
 Perverse Resistances as Portrayed in Art and Myths, 165. 
 
 CHAPTER IV 
 
 Inplxjence op Organic and Functional Inferiorities upon the Personality . 179 
 Competition and Contrast of Organs and Functions, 179 ; The Necessity of 
 Compensation for the Inferiority, 180; Fear of Failure in Sexual Selection, 
 181 ; Failure and Avoiding Competition and Affective Regression, 183 ; Elim- 
 ination of the Inferiority, 183; Castrations (Surgical and Functional) 184; 
 Catatonic and Hebephrenic Adaptations, 184; Simulations and Eccentric Com- 
 pensations (Paranoid), 184; The Influence of Hatred, 185. 
 
 CHAPTER V 
 
 Mechanistic Classification op Neuroses and Psychoses Produced by Dis- 
 tortion OP Autonomic-Apfective Functions 189 
 
 Necessity of Abandoning the Old Modified Kraepelinian System of Classifi- 
 cation, 189; Advantages of a More Adaptable Simple Method, 192; Discus- 
 sion 'of the New Method, 193; Table, 190. 
 
 CHAPTER VI 
 
 The Mechanism of the Suppression or Anxiety Neuroses 201 
 
 Variations in Degree of Anxiety, 201; Symptoms of Anxiety and Spastic 
 Tensions, 202; Anxiety and Sexual Impotence, 203; The Influence of Fear 
 without Insight into the Cause, 203; Failures of Compensation, 205; The 
 Anxiety Neurosis of Charles Darwin, 208; The Conditioning Factors in His 
 PamUy that Determined His Professional Selections, 213; The Personal 
 Sources of His Theory of Evolution, 241; The Wish to Hallucinate His Fa- 
 ther, 244; 'The Anxiety Neurosis of a Scientist "Which Later Developed Com- 
 pensatory Paranoid Inspirations, 251; The Father's Repressive Rivalry and 
 
CONTENTS XI 
 
 PAGE 
 
 the Autoerotie Mother Fixation in Youth as tlio Foundation of the Parricidal 
 Compulsion, or Crucifixial Psychosis, or the Sacrificial Suicide after Maturity, 
 285. 
 
 CHAPTER VII 
 
 Eepkession or Pstchoneuboses ; Their Mechanisms and Relation to Psy- 
 choses Due to Repressed Autonomic Ckavings 289 
 
 Differentiation of Anxiety or Suppression Neuroses from Repression Neu- 
 roses, 289; Phobias, Compulsions, Obsessions, Delusions, Hallucinations, 292; 
 Elimination or Castration Strivings and Simulation Strivings, 293 ; Case of 
 Mysophobia, 293; Case of Convulsions, Vomiting, Anesthesia, Visual Con- 
 striction, Erythema and Itching, 297; Case of Functional Paralysis as a Cas- 
 tration of Incestuous Autoeroticism, 318; Suicidal Compulsions as Castra- 
 tion of Incestuous Autoeroticism, 322; Perverse Sexual Cravings and Suicidal 
 Compulsions, 323; Case of Fear of "Dying" and Choking, and an Abdom- 
 inal Tic Relating to Submissive Homosexual and Impregnation Cravings, 327; 
 Simulations to Escape Responsibility, Case of Railroad Spine, 335; Simula- 
 tions of Pregnancy and Labor Produced by the Dissociated Erotic Cravings, 
 335; Simulation of Diseases and Functional Distortion as Defenses against 
 External Causes of Fear in Fearful Perverse Erotic Compulsions, 345; Rela- 
 tion of Repression Neuroses to Dissociations of the Personality and Affective 
 Regressions, 352. 
 
 CHAPTER VIII 
 
 Benign Compensation or Regression Neuroses, with or v^ithout Dissocia- 
 tion or Personalitv, Manic-Depressive Psychoses. Elimination or 
 
 Simulation for Wish-fulfillment in Affective Crises 353 
 
 Two General Types of Depression, With Anxiety or Without Anxiety, "353; Case 
 of Prudish, Intelligent Woman Trying to Eliminate Uncontrollable Eroticism, 
 355 ; the Autoerotic Significance of Skin and Hair or Scalp Rubbing, Picking, 
 Scratching, Finger Biting, Rubbing Sputum in the Skin and Hair, Clothing 
 or Furniture, Picking out Threads, as Extraneous Bits and Placing Them in 
 the Mouth, 369; Oral-Gastric Erotic Cravings and Swallowing Sticks, Glass, 
 Needles, Nails, Hair, etc., 377; Autoerotic Fancies and Their Fixation, 378; 
 Depression Without Anxiety, as an Affective Regression to an Infantile or 
 Intrauterine Level, 379; The Erotic Flight Followed by Renunciation of the 
 Love-Object and Infantile Affective Regression, 379; The Mechanism of the 
 Manie-Erotic Flight and the Unrestrained Incestuous Fantasy, 379; The Sub- 
 limated Parental Attachment, 384; Case of Unrestrained Erotic Indulgence 
 and Dissociation of the Personality, 385; The Ego's Gradual Reassimilation 
 of the "Mysterious" Hallucinations as "Imaginations" (Meaning Wish- 
 fulfilling Creations), 400; Case Organic Inferiorities and Erotic Fancies Re- 
 vealing Mechanism of Compensation, 402 ; Manic Compensatory Striving as A 
 Defense against Uncontrollable Eroticism, 407; The Double Value of the 
 Symbols used and the Behavior, 410; Anal-Erotic Compulsions and the De- 
 fense to Conceal Them in One Case and the Heedless Indulgence in Another, 
 418; Differentiation of the Attitude Toward the Erotic Compulsions by the 
 Dread of, or Delight in Getting into Rapport with the Physician, 419. 
 
Xll CONTENTS 
 
 CHAPTER IX 
 
 PAGE 
 
 Pernicious Kepression Compensation Neuroses. The Pstchopathologt of 
 
 Paranoia 421 
 
 The Particular Nature of the Biological Inferiority and the Eccentric Com- 
 pensatory Strujggle to Develop Virility and Win Social Esteem, 421; Compe- 
 tition and Contrast of Inlgirior Organs and Punetions, 421; The Phylogenetic 
 Foundations of the Dread of being Biologically Inferior, 421; Compensations 
 for Sexnal Impotence and Pear of becoming Homosexually Submissive, 422; 
 Perpetual Motion Machines and Eccentric Inventions as CompensatioBS, 423; 
 Language Creations as a Defense and Self -aggrandizement, 431; The Poten- 
 tial Dangefousness of the Paranoiac lies in his Fear of becoming Perverted 
 and his Hatred of any Influence in that Direction, 435 ; The Domineering Fa- 
 ther and Parricidal Inspirations, 439; The Resultant Affective Compulsions 
 that Culminated in the Assassinations of Lincoln and Garfield, 440; The 
 Mechanism of Dissociation of the Personality in the Paranoiac and His De- 
 fense Without Deterioration, Differentiated from His Defense With Deterio- 
 ration, 449 ; The Enduring Nature of the Final Dissociated Adjustment When 
 the Individual Becomes Convinced that the Erotic Compulsions Are Caused by 
 Secret Plots of Other People (Case PD-1), 450; Marriage as a Defensive 
 Solution of Homosexual Compulsions, 457; The Parajioid Defense of Homo- 
 sexual Compulsions in the Female, 472; The Relation of Paranoid Compensa- 
 tions to Similar Compensations for Functional Inferiorities having an Organic 
 Foundation But a Perverse Tendency, 473. 
 
 CHAPTER X 
 
 The Pstchopathology or the Acute Homosexual Panic. Acute Pernicious 
 
 Dissociation Neuroses 477 
 
 Mechanism of the Homosexual Panic, 477; The Sensory Disturbances and 
 Hallucinations Caused by the Uncontrollable Erotic Cravings Which Become 
 Dissociated, 478 ; The Ego 's Desperate Defensive Striving and Terror of Eter- 
 nal Disgrace and Biological Impotence, 478; The Significance of Delusions 
 about "Poison" in the Food and Oral, Nursling Erotic Cravings, 480; The 
 Erotic Cravings Compelling Impulsive Gratification after the Ego Has Lost 
 Control, 480 ; Series of Cases Illustrating Homosexual Panics and Homosexual 
 Submissions, 480; Symbolic Manner of Describing Difficulties, 482; Symbol- 
 ism of the Hallucinated Snake, Poison, Dope, etc., 488; Paranoid Mechanism 
 in Women, 507; "Freezing" Repressive Influence of the Female upon the 
 Homosexual Male, 511; The Regressive (Intrauterine) Significance of Some 
 Suicides, 511 ; The Prognosis of Homosexual Panics, 514. 
 
 CHAPTER XI 
 
 The Pstchopathology of Chronic Perniciqus Dissociation of the Personal- 
 ity WITH Defensive Hatred, Eccentric Paranoid Compensations and 
 
 Pernicious Deterioration 516 
 
 The Reconstructive Influence of a Positive Transference in the Cases that 
 Recover, 516; Cases of so-called Paranoid Dementia Prsecox, their Behavior, 
 Fear, Defense, and Manners of Recovery, 518 ; The Paranoiac 's Vicious Cir- 
 cle because of Blaming Others for his Inferiorities When the Cause of the 
 Sensory Disturbances Lies in the Repressed Dissociated Cravings, 523; The 
 TJnadjustablfl Conflict When the Family Becomes Intimately Involved, 533; 
 
CONTENTS Xm 
 
 PAGE 
 
 The Sexual Kxatioii of the Male Paranoiac on the Mother and the Female on 
 the Father, 551; The Significance of Crucifixion Tendencies in the Paranoiac 
 in Contrast with the Overt Crucifixion in the Catatonic, 554. 
 
 CHAPTER XII 
 
 The Pstchopathology of Chronic Pernicious Dissociation or the Personal- 
 ity "WITH Crucifixion and Catatonic Adaptations to the Repressed 
 
 Cravings 556 
 
 Catatonic Adaptations in Animals and Man to Causes of Fear Associated 
 with Sexual Excitation, 55'6; The Dissociated Sexual Cravings and the Cata- 
 tonic 's Defensive Adjustment to Environmental Temptations but Submissive 
 Enjoyment of the Erotic P'ancies, Hallucinations, etc., 557; The Ego's Yield- 
 ing Crucifixion to the Uncontrollable Affect, 557; Impregnation and Labor 
 Fantasies, 563; Feelings of Dying and Rebirth, 563; The Significance of the 
 Catatonic Male's and Female's Feelings of Being Crucified and Being 
 ' ' Christ, ■' ' 569 ; Christ as the Symbolization of Equally Active Bisexual Ten- 
 dencies, 578; Variations of Adjustment, to the Erotic Pressure to Become a. 
 Love-Object, from Fanatical Compensations to Utterly Heedless Resignation, 
 590; A Case of Spontaneous, Unreserved Confession of Erotic Perverseness 
 with Gradual Assimilation of the Repressed Cravings and a Practical Re- 
 eoustitution, 605; The Essential Differences between Catatonic and Paranoid 
 Adjustments to the Erotic Pressure and the Differences in the Conditioned 
 Nature of the Erotic Pressure, 613. 
 
 CHAPTER XIII 
 
 The Pstchopathology op Chronic Pernicious Dissociation of the Personality 
 WITH Hebephrenic Adaptations — Predominance op Excretory Erotic 
 
 Interests 615 
 
 Paranoid, Catatonic and Hebephrenic Adaptations to Failure Determined by 
 the Conditioned Nature of the Erotic Cravings, 615; Fascination for the Ex- 
 cretions among Primitive Peoples, the Illiterate, and the Medical Profession 
 of Yesterday, 615; Case of Persistent Affective Repression, Pernicious Regres- 
 sion to the Intrauterine Level with Dissociation of the Personality, Panic and 
 No Insight, Predominance of Excretory, Autoerotic Interests followed by Pro- 
 gressive Reconstitution of the Personality through Psychoanalysis, 617; Influ- 
 ence of the Positive Transference, 654; Episodic Anal Erotic Compulsions 
 and Episodic Confusions of the Bpileptoid Type, 661; Anal Eroticism and 
 Cravings to Destroy, 662; Love of Filth and Waste in Anal Erotic,. 662; 
 Comparison with Mysophobic Compulsions in Attempts to Eliminate Anal 
 Erotic Cravings, 662; Case of Insidious Development of Anal Eroticism and 
 the Tendency to True Epileptic Orgasms, 684; Hebephrenic Self -Cures, 690; 
 Hebephrenic Impregnation Fantasies, 691; An Anal Erotic Paranoiac with- 
 out Deterioration, 691; Summary, 693. 
 
 CHAPTER XIV 
 
 Reconsideration op the Conditioned Autonomic Affective Determinants of 
 
 Abnormal Variations of Behavior 698 
 
 The Forces of the Personality, 698; The Repressed Segmental Craving 
 and the Symbol, Ritual, Fetich, Fancy, Fairy Tale. Novel, Psychosis, 704; 
 
XIV CONTENTS 
 
 ,- >'A'--ii-'-V PASE 
 
 Influence of Affective di!a#|a§&: on Postural Tensions, 706; Differences in the 
 Mechanisms of the Neuroses and Psychoses, 710 ; Determinants of the Prog- 
 nosis of Affective Distortions, 715; Symptoms of 'Affective Conflicts, 720. 
 
 CHAPTER XV 
 
 PSYOHOTHBEAPEUTIC PRINCIPLES 733 
 
 The Problem of the Ego and the Segmental Craving, 733; The Suggestive 
 Method of Treatment, 733; The Psychoanalytic Method, 734; The Necessity of 
 Restoring the Vigor of the Ego before Beginning a Psychoanalysis, 737; The 
 Development and Control of the Transference, 738; The Ahsolute Necessity of 
 Freedom of Association of Thought, 742; The Use of an Assistant in Psycho- 
 analysis when the Transference cannot be Controlled, 742; Responsibility of 
 Penal Institutions and Asylums, 743; Because of the "Wholesale Erotic Per- 
 versities that Must Occur Where Men or Women are Isolated and Discouraged 
 from Again Winning Social Fitness and Freedom, 745; The Biological Cas- 
 tration Tendency of Present American Social Practices, 746. 
 
ILLUSTRATIONS 
 
 FIG. PAGE 
 
 1. Hygeia Frontispiece 
 
 2. African Pliallic Wand 39 
 
 3. Aztec Phallic Ceremonial Knife 39 
 
 4. Symbols of Sexual Union 40 
 
 5. Symbols of Sexual Union 
 
 A. Winged Phallus 42 
 
 B. Phallus Grasped by Crab 43 
 
 C„ Maiden and Serpent 44 
 
 D. Copulation Design .... 45 
 
 E. Double Vase 46 
 
 F. Copulation Design 47 
 
 6. Symbolic Postures of Hands ... 48 
 
 7. Maha-Kali, Wife of the God Siva 95 
 
 8. Egyptian God Phtha 97 
 
 9. Java Temple and Legend 100 
 
 10. Costa Eiean Phallus as Diety 107 
 
 11. Pygmalion and Galatea — Eodiu 108 
 
 12. Courtesan — Eodin 114 
 
 13. Martyr— Eodin 115 
 
 14. In the Garden — Brush 116 
 
 15. Costa Eican Copulation Fetich (Prehistoric) 125 
 
 16. Mars and Venus United by Love — Veronese 126 
 
 17(a) Two Natures of Man — Barnard 137 
 
 (b) St. Michael, the Archangel — Zurbaran 137 
 
 (c) Theseus Slaying Minotaur — Barye 137 
 
 (d) Theseus Slaying Centaur — Barye 137 
 
 18. Centaur and Cupid 138 
 
 19. Hercules and Omphale — Boulanger 142 
 
 20. Eternal Spring — Eodin 143 
 
 21. Lost Hour and Maternity — Beveridgo 146 
 
 22. Caryatid — Eodin 147 
 
 23(a) The Storm— Cot 148 
 
 (b) The Eing— Alexander 148 
 
 24. Madonna of the Eose — Dagnan-Bouveret 149 
 
 25. Mother; — ^Lewin-Funcke 150 
 
 26. Bacchante — ^MacMonnies 151 
 
 27. Der Sphinx— Von Stuck 153 
 
 28. Eequiem — from Pfister 160 
 
 29. Isle of the Dead— Boeeklin 161 
 
 30. Fetal Position of Egyptian Burial 163 
 
 31. Buddha 164 
 
 32. Ivory Coast African Copulation Fetich 167 
 
 33. Aztee God— Phallic Border of the Kobe 168 
 
XVI rLLUSTEATIONS 
 
 PIG. PAGE 
 
 34. Aegean Goddess, with Serpent Attributes 169 
 
 35. Falling Leaves — Merle 170 
 
 36. Graziella— Lefebvre ' 171 
 
 37. Laehrymffi — Leighton 172 
 
 38. Eve— Rodin 173 
 
 39. Eve . . . ^ . 175 
 
 40. Simulation of Manhood '. r™f^ 182 
 
 41-A. Spastic Distortion as Defense against Anal Erotic Cravings , 347 
 
 41-B. Biting off Lips as Defense against Oral Erotic Cravings 351 
 
 42. Cupid and Psyche — Eodin 354 
 
 43. Posture of Begression 355 
 
 44. Mother Earth as Madonna 363 
 
 45. La Pensfie — Eodin 371 
 
 46. Centauress — ^Eodin 372 
 
 47. Captive — Michelangelo 374 
 
 48. Hand of God— Eodin 382 
 
 49. Die Hoffnung — v. Bodenhausen 406 
 
 50. Inspired, Dissociated Paranoid Type with Purified Hands 413 
 
 51. "Pirst Church — Perpetual Motion" — ^Patient 428 
 
 52. Cover of Magazine — Ert6 489 
 
 53. Desperate Striving to be Fiercely Masculine 552 
 
 54. Pieta, — Michelangelo 5^;; 
 
 55. The Resurrection or Rebirth 567 
 
 56. Seal of Lichfield Cathedral 569 
 
 57. Window of Dumblane Abbey 569 
 
 58. The Vulva and its Symbol, the Ellipse 571 
 
 59. Imitation of Christ as a Biological Type 604 
 
 60. Catatonic as God 610 
 
 61. Leda and Swan — Michelangelo 640 
 
 62. Petal Posture of Negress 642 
 
 63. Regression to Early Childhood 655 
 
 64. Costa Rican Sculpture, Fetal Position (Prehistoric) 6fl|; ; 
 
 65. Hebephrenic Fetal Postures 660 
 
 66. Hebephrenic in Primitive Posture 661 
 
 67. Crochet Work Showing Preadolescent Incest Fantasy (A and B) 694 
 
 68. Regression to Infancy 696 
 
 69. Masculine Compensation in Homosexual Female 701 
 
 70. African Fetich Tree 705 
 
 71. Omnipotence as a Compensation for Impotence 706 
 
 72. Asylum Group 707 
 
 73. Characteristic Biological Result of Dissociated Oral Eroticism 708 
 
 74. Auto- and Anal-Erotic Catatonic Showing Posture of Hands 721 
 
 75. Autoerotie Joy , 721 
 
 76. Autoerotie Terror 722 
 
 77. Prayer to be Saved from Oral Eroticism 722 
 
 78. Anal Erotic Joy 728 
 
 79. Anal Erotic Hate 723 
 
 80. Anal Erotic Terror 723 
 
 81. Oral Erotic Suppression 724 
 
 82. Adaptations to Anal Eroticism 725 
 
ILLXTSTRATIONS XVU 
 
 FIG. PAGE 
 
 83. Adaptations to Perverse Eroticism 726 
 
 8i. Adaptations to Perverse Eroticism 727 
 
 S5. Castration of Eye as Defense against Auto Eroticism (Incestuous) .... 728 
 
 86. Contrite Virgin 728 
 
 87. Aesculapius 739 
 
 ILLUSTEATIOXS AEBANGED ACCOBDING TO TSEIE AFFECTIVE OB 
 SYMBOLIC SIGNIFICANCE 
 
 Fliallic 
 
 2. African Pliallic Wand . 39 
 
 3. Aztec Ceremonial Knife 39 
 
 10. Costa Bicau PhaUus as Deity 107 
 
 33. Aztec God— Phallic Border of Eobe 168 
 
 34. Aegean Goddess, with Serpent Attributes . . 169 
 
 70. African Fetich Tree 705 
 
 Vulvar 
 
 56. Seal of Lichfield Cathedral 569 
 
 57. Window of Dumblane Abbey . . ... . . • 569 
 
 5S. The Vulva and Its Symbol, the Ellipse . 571 
 
 Symhols of Sexual Union 
 1. Hygeia Erontispieee 
 
 4. Sexual Union ... .40 
 
 5. Sexual Union • • 42-47 
 
 6. Symbolic Postures of Hands ....... . . . 48 
 
 15. Costa Eican Copulation Fetich • 1-5 
 
 16. Mars and Venus United by Love 126 
 
 32. African Ivory Coast Copulation Fetich .... 167 
 
 51. First Church — Perpetual Motion 428 
 
 87. Aesculapius ^^^ 
 
 Sexual Attachment to Parents or Children 
 
 9. Java Temple l^^O 
 
 11. Pygmalion and Galatea ■ • 1"^ 
 
 27. Der Sphinx 1^^ 
 
 54. Pieta ^^^ 
 
 61. Leda and Swan ''^^ 
 
 67. Crochet Work ^^^ 
 
 Seterosexuality 
 
 12. Courtesan ^^^ 
 
 13. Martyr ^^^ 
 
 14. In the Garden ^^^ 
 
 20. Eternal Spring ^^^ 
 
 21. Lost Hour and Maternity ^^^ 
 
 22. Caryatid "^^^ 
 
 48. Hand of God ^®^ 
 
 49. Die Hoffnung • *°^ 
 
XV] 11 ILLUSTRATIONS 
 
 FIG. PAGE 
 
 23. A. The Storm 148 
 
 B. The Eing ; 148 
 
 24. Madonna of the Rose 149 
 
 25. Mother 150 
 
 26. Bacchante . . 151 
 
 35. Falling Leaves 170 
 
 36. Grazi^Ua - . . . . 171 
 
 37. Lachrymse 172 
 
 38. Eve 173 
 
 39. Eve 175 
 
 42. Cupid and Psyche 354 
 
 44. Mother Earth as Madonna 363 
 
 Somosexuality 
 
 7. Maha-Kali 95 
 
 17. A. Two Natures of Man 137 
 
 B. St. Michael, the Archangel . 137 
 
 0. Theseus Slaying Minotaur . .- . 137 
 
 D. Theseus Slaying Centaur ... 137 
 
 18. Centaur and Cupid 138 
 
 19. Hercules and Omphale 142 
 
 52. Cover of Magazine 552 
 
 72. Aslyum Group 707 
 
 73. Dissociated Oral Erotic Personality 708 
 
 74. Catatonic 721 
 
 77. Prayer to be Saved from Homosexuality . . 722 
 
 78. Anal Erotic Joy 723 
 
 79. Anal Erotic Hate 723 
 
 SO. Anal Erotic Terror 723 
 
 81. Oral Erotic Suppression . , 724 
 
 82. Adaptations to Anal Eroticism 725 
 
 53, 84. Further Adaptations to Perverse Eroticism 726-727 
 
 Autoeroticism 
 
 8. Egyptian God Phtha! 97 
 
 3J.. Buddha 164 
 
 45. La Pensee 371 
 
 46. Centauress 372 
 
 47. Captive 374 
 
 75. Autoerotic Joy 721 
 
 76. Autoerotic Terror 722 
 
 Begressions 
 
 62. Fetal Posture of Negress 642 
 
 55. The Resurrection or Rebirth 567 
 
 63. Regression to Early Childhood 655 
 
 64. Costa Rican Sculpture, Fetal Position (Prehistoric) .... .... 659 
 
 65. Hebephrenic Fetal Postures 660 
 
 66. Hebephrenic in Primitive Posture 661 
 
 68. Regression to Infancy 696 
 
ILLUSTRATIONS XIX 
 
 FIG. PAGE 
 
 28. Requiem 160 
 
 29. Isle of the Dead 161 
 
 30. Fetal Posture of Egyptian Burial 163 
 
 43. Posture of Kegressiou 355 
 
 Compensations and Defenses 
 
 40. Simulation of Manhood 182 
 
 41. A. Spastic Distortion . . 347 
 
 B. Destruction of Lips . 351 
 
 50. Purified Hands in Autoerotic 413 
 
 53. Desperate Striving to be Fiercely Masculine 552 
 
 59. Imitation of Christ . 604 
 
 60. Catatonic as God . . 610 
 
 69. Masculine Compensation in Homosexual Female ... .... . 701 
 
 71. Omnipotence as a Compensation for Impotence ... 706 
 
 So. Castration as a Defense Against Eroticism .... ... . 728 
 
 86. Contrite Virgin 728 
 
LIST OF CASES 
 
 AN = Anxiety neurosis 
 
 PN = Psychoneurosis 
 MD := Manie depressive dissociation 
 • P = Paranoia 
 
 PD = Paranoid dissociation 
 
 CD = Catatonic dissociation 
 HD = Hebephrenic dissociation 
 
 GP ■= General paresis 
 
 AS ^= Arteriosclerotic deterioration 
 
 CASES PAGE 
 
 AN-1. Fixed grandfather attachment with hallucinations and suicidal compulsions 83 
 AN-2. Affective sources of Darwin's inspirations and anxiety neurosis .... 208 
 AN-3. Mother fixation, father domination, autoeroticism and pernicious sense of 
 inferiority with parricidal ilispiration in maturity, final suicide as a 
 sacrifice 251 
 
 PN-1. Mysophobia of young woman 293 
 
 PX-2. Convulsions, anesthesia, vomiting, erythema, itching of young woman . 297 
 
 PN-3. Functional paralysis 318 
 
 PN-4. Compulsion to smash head 322 
 
 PN-5. Compulsion to suicide 323 
 
 PN-6. Abdominal tic and laryngeal tensions ... 327 
 
 PN-7. Spastic distortion, defensive 345 
 
 MD-1. Anxiety because of eroticism aiid simulations of pregnancy 355 
 
 MD-2. Anxiety because of erotic hallucinations 364 
 
 MD-3. Anxiety because of autoerotie compulsions 372 
 
 MD-4. Anxiety because of autoerotie and oral erotic compulsions 376 
 
 MD-5. Periodic erotic flights and regressions 379 
 
 MD-6. Manic-overeompensation to be mother's hero, followed by infantile regres- 
 sion, later followed by paranoid brooding • . . 381 
 
 MD-". Abandonment to erotic flight with hallucinatory gratifications .... 385 
 
 MD-8. Erotic fancies, overcompensation for organic and functional inferiorities . 402 
 
 MD-9. Fear of homosexual submissive compulsions with violent, bluffing defense 407 
 
 MD-10. Wild manic compensation for fear of inferiority 409 
 
 MD-11. Wild manic compensation as defense against uncontrollable anal erotic 
 
 cravings , . 409 
 
 MD-12. Abandonment to autoerotie cravings without- fear 418 
 
 MD-13. Abandonment to autoerotie prsadolescent cravings without fear .... 516 
 
 XX 
 
LIST OF CASES XXI 
 
 CASES PAGE 
 P-1. Heterosexual impotence, fear of liomosexual submissiveness with defensive 
 
 compensations of divine omnipotence 423 
 
 P-2. Similar to P-1 in divine inspirations resulting in violent tragedy .... 434 
 P-3. Tear of small genitalia and sexual inferiorities with compensatory compul- 
 sions to invent world's most powerful cannon 436 
 
 P-4. Paternal persecution in youth with parricidal compulsions in maturity — Guiteau 440 
 P-5. Paternal influence in youth with parricidal inspiration in maturity — J. "Wilkes 
 
 Booth 447 
 
 PD-1. Fear of homosexual submissive compulsions, with dissociation of personal- 
 ity, and brilliant literary compensations 450 
 
 PD-5. Fear of homosexual submissive compulsions with marriage as a defense, 
 
 final pernicious dissociation of personality 457 
 
 PD-6. Fear of homosexual submissive compulsions with systematized delusions and 
 
 counterattack 458 
 
 PD-7. Pernicious dissociation due to homosexual submissive cravings ... .95 
 
 PD-8. Pernicious periodic dissociation with eccentric omnipotent compensatory 
 
 fancies 96 
 
 PD-9. Fear of hom'osexual cravings with defensive marriage 459 
 
 PD-10. Pernicious dissociation due to homosexual compulsions, finally suicide as 
 
 escape 462 
 
 PD-11. Fear of homosexual compulsions with violent counterattack 469 
 
 PD-12. Pernicious dissociation due to autoerotic cravings with compensatory fan- 
 cies of developing omnipotence 470 
 
 PD-13. Pernicious dissociation due to homosexual cravings with omnipotence defense 480 
 PD-14. Acute panic upon homosexual regression in male with recovery .... 484 
 PD-15. Acute panic upon homosexual regression in male with recovery .... 486 
 PD-16. Acute panic upon homosexual regression, marriage, with eventual perni- 
 cious dissociation 325 
 
 PD-17. Uncontrollable erotic simulations with panic at hallucinated homosexual 
 
 assault in female 335 
 
 PD-18. Panic upon homosexual regression in male with pernicious dissociation 489 
 
 PD-19. Homosexual regression without panic in male 491 
 
 PD-20. Acute panic upon homosexual regression in male, with recovery . . 493 
 
 PD-21. Acute panic upon homosexual regression in male, with recovery . . . 494 
 
 PD-22. Acute panic upon homosexual regression in male, with recovery . . . 496 
 
 PD-23. Panic upon homosexual regression in male, with recovery . . . 498 
 
 PD-24. Pernicious dissociation in negro 500 
 
 PD-2'5. Pernicious dissociation with fear of castration 501 
 
 PD-26. Pernicious dissociation with crucifixion cravings 502 
 
 PD-27. Acute pernicious dissociation with vivid wish-fulfilling hallucinations : . 502 
 PD-28. Pernicious dissociation in female, panic upon uncontrollable homosexual 
 
 cravings 507 
 
 PD-29. Pernicious dissociation in female with systematized paranoid delusion of 
 
 persecution due to secret autoeroticism 508 
 
 PD-30. Panic with suicidal compulsions upon heterosexual failure in an illiterate 
 
 Eussian male immigrant 511 
 
 PD-31. Panic with suicidal compulsions upon heterosexual failure in an intelligent 
 
 American 51."! 
 
XXU LIST OF CASES 
 
 CASES PAGE 
 
 PD-32. PetJjioioiis dissociation in anal erotic female having vigorous prostitution 
 
 compulsions _ . . . 691 
 
 PD-33. Pernicious dissociation due to irrepressible ora,l homosejiual oravii^wwith ' 
 paranoid defense, recovery '■'"w . . 517 
 
 PD-34. Pernicious dissociation due to irrepressible homosexual cravings with para- 
 noid defense, partial recovery 526 
 
 PD-35. Incestuous mother fixation, father-uncle hatred, homosexual fears, final per- 
 nicious dissociation .... 533 
 
 PD-36. Pernicious dissociation in female with homosexual cravings and heterosex- 
 ual aversions 547 
 
 CD-I. Homosexual regression in male with crucifixion to the father, catatonic 
 
 adaptation, impregnation, rebirth, reconstitution, manner of recovery . 557 
 
 CD-2. Cruciiixion to the father and mother, with catatonic adaptation to uncontrol- 
 lable erotic compulsions in female, manner of recovery 572 
 
 CD-3. Uncontrollable autoerotic compulsions with catatonic adaptation, manner of 
 
 recovery 579 
 
 CD-4. Uncontrollable homosexual orucifixial compulsions with wild compensatory 
 
 defensive strivings 590 
 
 CD-5. Self-castration compulsions as compensatory defense against uncontrollable 
 
 autoerotic and homosexual cravings .... 600 
 
 CD-6. Acute homosexual panic in male showing erotic value of hallucinated snake 603 
 
 CD-7. Orucifixial inspirations and sublimations of father attachment . . 604 
 
 CD-8. Chronic tendency to polymorphous sexual perverseness culminated by eccen- 
 tric fervid compensatory compulsions, crucifixion and elimination of per- 
 verseness 605 
 
 CD-9. Oral eroticism with panic and self-purification 601 
 
 HD-1. Chronic sexual repression, pernicious dissociation, regression, reconstitution, 
 
 manner of recovery with insight 617 
 
 HD-2. Pernicious dissociation with permanent regression to infantile level . . . 654 
 HD-3. Pernicious dissociation with permanent regression to infantile excretory 
 
 erotic level 656 
 
 HD-4. Pernicious dissociation due to homosexual cravings with omnipotent com- 
 pensatory defense . . . . 662 
 
 HD-5. Bpileptoid convulsions in dissociated personality having uncontrollable 
 
 submissive anal erotic cravings 671 
 
 HD-6. Epileptoid stupor in dissociated personality having uncontrollable submis- 
 sive anal erotic cravings 672 
 
 HD-7. Stuporous confusion in hebephrenic erotic state ... 678 
 
 HD-8. Submissive anal erotic compulsions 673 
 
 HD-9. Submissive anal erotic compulsions in stupid dissociated personality . . 674 
 
 Hl)-10. Violent hatred in anal erotic female 674 
 
 HD-11. Pernicious dissociation due to uncontrollable submissive anal erotic crav- 
 ings, impregnation and father fancies 675 
 
 HD-12. Pernicious dissociation due' to submissive anal erotic cravings, social re- 
 covery 680 
 
 HD-13. Pernicious dissociation due to anal and autoerotic cravings 682 
 
LIST OF CASES XXlll 
 
 CASES PAGE 
 
 HD-14. True epilepsy of insidious development, pernicious regression in anal erotic 
 
 youth having an infantile mother attachment 684 
 
 HD-15. Pernicious dissociation with eccentric compensatory defenses against auto- 
 eroticism 325 
 
 HD-16. Pregnancy feelings and fancies in male 691 
 
 HD-17. Naive cures for impotence 688 
 
 OP-1. Paretic Avith fears of heterosexual impotence and compensatory euphoric 
 
 defense . . 473 
 
 <JP-2. Paretic with homosexual fears and compensatory defense 474 
 
 AS-1. Arteriosclerotic witli compensatory defense for homosexual fears . . . 475 
 
PSYCHOPATHOLOGY 
 
 INTRODUCTION 
 
 Psychopathology treats of abnormal behavior, that is, ab- 
 normal thoughts and actions and their causes as they are found 
 in individuals. No other study must deal so intimately witli 
 the most tabooed and secret tendencies of human behavior. The 
 psychopathologist believes that the most grewsome maladjust- 
 ments of humanity can be understood and in many instances can 
 be happily corrected, and this conviction justifies his study of 
 phases of human behavior that are regarded by some as the most 
 sacred interests of humanity, -which must never be violated by 
 doubts or questions, and by others are believed to be the perverted 
 causes of most of humanity's suffering, -which must be uprooted 
 or suppressed at any price. 
 
 A treatise on syphilis must deal frankly with syphilis, and on 
 gjTiecology, -with the diseases of the organs of the pelvis, even 
 though the subjects are tabooed by refined society. The student 
 of human behavior should train himself, because he has been 
 educated to take quite the opposite vic-w, to appreciate the tremen- 
 dous behavioristic significance of the fact that Man has ascended 
 from some branch of the ape family. In a biological sense, Man 
 is a species of ape that has gradually developed an intricate social 
 system of laws and beliefs (methods) which direct the gratifica- 
 tion of the indi-vidual's affective cravings. By developing systems 
 of laAvs that are designed to prevent heedless excitation and grat- 
 ification, and systems of punishment that, make him fear uncon- 
 trollable or tabooed cravings within himself, forcing him to 
 compensate with strivings to control them, he has succeeded, upon 
 the one hand, in directing the forces within himself so as to build 
 up a civilization, but, on the other hand, he has gradually become 
 so constituted that, Avhen these same forces become uncontrollable 
 and tend to run their own biological course, they distort and 
 even destroy his personality. The uncontrollable, tabooed crav- 
 
I PSYCHOPATHOLOGY 
 
 ings, and the struggle with them, constitute the functional neu- 
 rosis or psychosis. For these vital reasons the psychopathologist 
 or psychiatrist, if he is true to his duty and his cause, must learii 
 to think honestly and without prejudice, prudery, or mock finery 
 about any abnormal cravings in man, no matter where local- 
 ised in their physiological activities or what they tend to do. No 
 work can be more difficult, because we must often study abnormal 
 affective cravings that are naturally extremely offensive to even 
 think about. The reaction of disgust or aversion is of the utmost 
 protective value to man as well as to many other forms of animal 
 life, but the psychopathologist must learn to prevent such reac- 
 tions from becoming obvious to the patient or from diverting his 
 study and treatment, or misleading his prognosis and judgment, 
 because it is the possibility of being considered disgusting that 
 terrifies most psychopaths and compels them to conceal the nature 
 of their inferiorities. The almost universal tendency to accept the 
 camouflaging, complaint as the true difficulty rather than uncover 
 cravings that may be incomparably more offensive and distressing 
 is the principal factor that has retarded the insight of psychopath- 
 ology and, in turn, psychology and philosophy. 
 
 The reader who can not study the abnormal tendencies of 
 Man without prejudice is advised not to study the case histories 
 in this book. The student who is determined to understand the 
 nature of Man, in order to contribute intelligently to the improve- 
 ment of Man and his social systems, will surely find much valuable 
 material for his work and no little information that may influence 
 him to see Man as quite a different problem than his parents and 
 teachers had interpreted and taught him to believe. The averie^p 
 American has been taught, through the influence of his associates, 
 to react to most things that pertain to sex in either a prudish or 
 vulgar manner. My experience with classes in psychopathology 
 shows that it is difficult for sortie individuals to avoid becoming 
 prudish or vulgar when the abnormal sexual tendencies of a 
 patient have to be studied with the same scientific sincerity -~with 
 which any other biological deviations are studied. 
 
 The psychopathologist must free himself from the earlier 
 impressions of both influences and train himself to accept the 
 degrading and refining tendencies of Man for what they are worth 
 to the individual, on the one hand, and to society on the other, 
 
INTRODUCTION 6 
 
 for maintaining the functional statiis of virility, goodness, and 
 happiness. This state is most conducive to fulfilling the biological 
 career of the individiial and the species. Vulgarity is as intoler- 
 able to the prude as prudery is to the vulgar aad both of these 
 tendencies are to be avoided, because one is conducive to a bio- 
 logical degeneration of Man and the other, to his castration ; both 
 eventually leading to the development of abnormal behavior and 
 misery. The truly normal attitude is to recognize that anything 
 which tends to insidiously pervert or discourage the cultivation and 
 enjoyment of love, has, biologically, an abnormal influence. But, 
 to emphasize publicly the importance of cultivating the capacity 
 to love to the average American, who, although he secretly knows 
 it to be the truth, has always been influenced to make a joke of it, 
 is like telling him to glorify interests that all his life he has treated 
 as abject "mushiness." 
 
 The biological destructiveness of the persistent tendency to 
 vulgarity or to prudishness becomes evident time and again in the 
 study of abnormal people and is typically illustrated in the des- 
 perate struggle of Case CD-8 to refine himself, and in the frantic 
 efforts of Case MD-1 to save herself from a prudish conception of 
 disgrace. 
 
 No one can study this collection of cases of abnormal behavior 
 and sexual (biological) maladjustment without realizing more 
 than ever that civilization is indeed a delicate structure that must 
 be protected and fostered with eternal vigilance and sound 
 msdom, in order that its growth shall be full, progressive and 
 healthy. Never has it been so evident that social taboos and com- 
 munistic sublimations must be thoroughly protected from the in- 
 fluence of ignorance, fanaticism, superstition, vulgarity, laziness, 
 envy, lust, prudishness, autoeroticism, homosexuality and per- 
 verse heterosexuality. It is clear that we must not accept from 
 religious fanatics or purveyors of sex that the body is a filthy des- 
 ecration of the soul. Man is a biological creation and only exists 
 as a healthy, happy, constructive force so long as he lives in har- 
 mony with the self -refining tendencies of Nature and avoids both 
 the castration tendencies of the prude and the degenerating ex- 
 ploitations of the vulgar. It is comparatively simple and very 
 easy to be an extremist in anything, but it requires eternal care, 
 sound common sense, and no little patience and endurance to main- 
 
4 PSYCIiOPATHOLOGY 
 
 tain a progressively refining', healthfully constructive attitude to- 
 ■vvard the fundamental needs and pleasures of hiiman nature. 
 
 The prejudiced attacks upon Freud's conception of the nature 
 of the influence of love and sex upon the normal and abnornial 
 mind, by physicians who have earned, through years of work and 
 study, the reputation of sincere mindedness, shows how extremely 
 difficult it is for many people to study the problems of love and 
 sex without losing control of themselves. This is largely due to 
 the way they haVe been trained to adjust to these vitally important . 
 functions. 
 
 The analytical study of a large variety of abnormal people, 
 of both sexes, from many nationalities and of nearly every age, 
 educational and mental level, has demonstrated that all peojjles 
 tend to suffer from similar affective difficulties and that similar 
 adjustments to similar cravings produce similar psychoses, no 
 matter what country or race they come from. That is to say, the 
 suppression-,. repression and dissociation of segmental cravings re- 
 sult from fear of the cravings, and, when the segmental cravings 
 are similar and the defensive compensatory strivings are similar, 
 the psychoses, as the symptoms, are sim,ilar. Hence, if given a 
 good account of the psychosis and the compensatory strivings, we 
 are able to diagnose and often correct the repressed cravings of 
 the individual, although the patient himself has not been conscious 
 of their existence or influence. 
 
 It is almost needless to say that this is a dynamic biological 
 conception of mental disease and is decidedly different from the 
 Kraepelinian method of classifying cases into symptomatological 
 groups, and, in turn, assuming these groups to be distinct t^^pes 
 of diseases of obscure etiology but fairly definite prognosis. The 
 Kraepelinian and Freudian concepts have been enthusiastically 
 supported and bitterly assailed, which is the common greeting of 
 all movements that tend to overturn old gods and older dogmas. 
 The discoverers of the mechanics of the circulatory system, the 
 process of vaccination, the bacterial cause of disease, the first 
 users of anesthetics, obstetrical forceps, percussion, ligatures, 
 rubber gloves, hypnotism as well as psychoanalysis have had to 
 endure bitter personal attacks; hence it is quite to be expected 
 that many of the cases, records, and particularly the physiological 
 formulation of the personality and processes which cause abnor- 
 mal behavior and psychoses will be inipartially criticised by some 
 
INTRODUCTION 5 
 
 and violently attacked by others who can not avoid i)li rasing their 
 criticisms in a bitter personal liglit. From the first type of crit- 
 ical attitude much is to be expected that is constructive and woi'th 
 while ; from the latter type, nothing. 
 
 It seems necessary to remind the reader again that he must 
 never allow himself to forget that Man is by no means a perfected 
 species of the ape family, that he is undoubtedly in one of his most 
 critical periods of development and refinement, indicated by the 
 growing vision of an international social system to prevent war 
 and subjugation, and promote free social development, and by the 
 discovery that the most destructive forces in Nature Avhich bear 
 upon the individual are not external to himself but within himself 
 and actually constitute his personality. 
 
 The Darwinian conception that Man has ascended. from some 
 species of the infrahuman primate is freeing humanity from 
 countless confusing dogmas and fancies as to the origin and des- 
 tiny of Man and has enabled the student of human behavior to be- 
 gin to approach his problem as a biologist. Freud's discovery that 
 the tvish is the dyilamic factor in the personality, as one feels it in 
 himself, did as much for psychology and psychopathology, as Dar- 
 win's theory of evolution did for biology. Tlie next logical devel- 
 opment is to account for the physiological nature and origin of tlie 
 wish. James and Lange, before Freud, taught that the emotions 
 had their origin in the peripheral activities of the viscera, but 
 James seems to have had no clear idea of the existence or dynamic 
 influence of the repressed (forgotten) wish as later discovered l)y 
 Freud. On the other hand, Freud has not given us a conception of 
 the physiology of the repressed ivisJi and how it continues to exist 
 in the personality after the individual has succeeded in making 
 himself "forget it;" that is, has prevented the wish or affective 
 craving from causing him to be conscious of its influence and 
 needs. Freud's conception that the repressed wish (energy or 
 libido) becomes converted into pliysical distortions or symptoms, 
 a concept now freely used l)y some writers on the "conversion 
 mechanisms" in liysteria, is a l)i()logical riddle and utterly unin- 
 telligil)le. Most Freudians do not try to explain it. They simply 
 accept and use the explanation dogmatically as if it settled most 
 questions — a method of working that is similar to the method of 
 the pre-Darwinian biologists, who explained the origin of a spe- 
 
6 
 
 PSYCHOPATHOLOGY 
 
 cies by. assuming tlie conversion of some' sort of divine energic 
 constituent into a type of organism. It is just this assumption of 
 libidinous conversions that has made it impossible for many ear- 
 nest neurologists and psychologists to follow Freud. Holt's timely 
 warning that we had best not assume a "psychic energy" to con- 
 stitute the wish, although we are safe in accepting that the wish is 
 the dynamic force in the personality, "directs our attention directly 
 to the physiological origin and nature of the ivish. 
 
 If the student will see the "will-to-be" or the "will-to-have" 
 and the wish to he or have as different ways of regarding the af- 
 fective cravings that are acceptable to and constitute the ego, and, 
 -further, recognize that all emotions and sentiments are cravings 
 that have their origin in the tensions and movements of different 
 autonomic (visceral) segments, then the dynamic forces in ab- 
 normal and normal personalities become relatively simple. This 
 conception, which is amply supported by physiological data, is 
 thoroughly workable and is a consistent biological conception of 
 the dynamic forces that make up the personality : one that is com- 
 prehensive enough, if fully applied, to cover all the phenomena 
 which are to be found in normal and abnormal behavior, and upon 
 minute introspective self-analysis. 
 
 The various systems of the body, if grouped according to their 
 functions, form two great divisions, the autonomic apparatus and 
 its projicient apparatus. The sensory streams flowing from the 
 periphery of different segments of the autonomic apparatus (de- 
 fined in Chaptet I) constitute the affective cravings or feelings, 
 and the sensory streams flowing from the projicient apparatus, as 
 it is compelled to work by the affective stream, constitute the kin- 
 esthetic stream. The kinesthetic stream and exteroceptive sensory 
 streams become associated in a manner that makes the organism 
 conscious of them as thoughts or conceptual images of past experi- 
 ences and present external realities. These sensory images or 
 mental pictures are as much of a reality as the mountains and the 
 ocean, and the realization of this pertinent fact is of tremendous 
 value in understanding the delusion, hallucination and dream, in 
 fact, the whole psychotic misinterpretation of the environment. 
 
 This is decidedly a monistic biological conception of the 
 I^ersonality and leaves no room for the notion that the mind is 
 one thing and the body another, and that these artificially created 
 
INTRODUCTION 7 
 
 entities work upon each other in an intimate parallelistic manner : 
 hand in hand in a metaphysical romance. There have been vigor- 
 ous attempts to bridge the gap that is created when the old as- 
 sumption, that "the body" and "the mind" are distinct from on*^ 
 another, is given a negative belief by trying to adopt an attitude 
 that subordinates and evades the dilemma. The older phys- 
 iologists worked mth physical processes without considering 
 what they made the individual conscious of, and the older psy- 
 chologists studied what the individual was conscious of without 
 caring what particular physiological changes occurred that de- 
 termined the nature of the content of consciousness; hence, the 
 confusion of views. 
 
 An ardent movement to avoid or bridge this chasm is being 
 made in some psychiatric centers by using " psych obiological" 
 terms and phrases on the common-sense assumption that, since 
 Man is after all only a biological product, his thoughts are in some 
 manner dependent upon physiological processes; hence, it would 
 be more practical for psychopathology to subordinate the mental 
 and physical dilemma. This casts a fog over the chasm and denies 
 "its presence, depending upon no one's asking for an explanation of 
 what has become of it or how it is to be bridged. This has one 
 value in that it encourages some students to work without bother- 
 ing about the two points of view that create the chasm, but it is 
 far from satisfactory, because the psychopath is incessantly 
 troubled by a content of consciousness that distresses him, which 
 can not be explained or relieved by assuming that somewhere in 
 the brain some neurones are out of order (such assumptions ex- 
 plaining anything and nothing), or that there is a constitutional 
 maladjustment. 
 
 Meyer's teaching that the psychiatrist, psychologist or physi- 
 ologist must do more than think of the isolated phenomenon which 
 he happens to be interested in, such as the hallucination, the con- 
 tent of consciousness or the physiological functions of a neurone 
 or segment, if he wishes to understand the entire problem and see 
 the phenomenon as it occurs in its relationship to the personality 
 or organism as a whole, has been of the utmost importance in forc- 
 ing many workers to take account of their attitudes. But we must 
 go much further than merely pointing out that the personality 
 must be considered to work as a unity. The very attitude forces 
 
b PSYCHOPATHOLOGY 
 
 US to develop an explanation of hoiv the personality, as a unity, 
 works if we care to be understood. 
 
 The contributions of the psychoanalysts have greatly clarified 
 this problem. Particularly the work of Freud and Jung, and oth- 
 ers, on the activities of the repressed wish working against the 
 egoistic resistance and the use of symbols to avoid the fear of 
 failure or of being censured ; and Adler on the compensatory striv- 
 ings because of fear of being organically or functionally inferior 
 to the competitor for the love-object ; and Bleuler on the compensa- 
 tory value of autistic thinking; have been of decisive value in de- 
 veloping a better understanding of the personality. But none of 
 these contributions get us on a truly physiological basis, and no 
 conception of the personality or any of its attributes is sound until 
 it is so formulated and clarified as to be readily understandable in 
 terms of the integrative functions of the nervous system. 
 
 -It is almost needless to say that this could not possibly have 
 been brought aboiit until Sherrington gave the world his remark- 
 able series of studies on the integrative action of the nervous 
 system, on the' postural tonus of muscle and nerve, and on the 
 proprioceptive system especially in its reflex aspects. The" 
 interesting differentiations of the fimctions of cortical areas and 
 the localization of neurone groups that have to do with the func- 
 tions of some muscle group or sense organ have a definite neuro- 
 logical value but contribute little to the actual solution of the rid- 
 dle of the personality. They encouraged the conviction that there 
 is an intimate relationship between physiological activities and 
 the content of consciousness, but not until we learned to under- 
 stand the integrative functions of the organism were we actually 
 able to explain in a physiological manner such phenomena as the 
 adjustments of allied and antagonistic wishes and thoughts, func- 
 tional conflicts, inhibition or suppression, repression, summation 
 and dissociation of antagonistic cravings, the necessity of sym- 
 bolical compromises in methods of thinking, the source of the pres- 
 sure of the repressed craving or wish in the postural tensions of 
 visceral segments and its manner of causing delusions and halluci- 
 nations. 
 
 No explanation of the personality can be expected to be satis- 
 factory so long as it is not as clearly integrative in its mechanisms, 
 and as definable in its elements as the integrative functions of the 
 
INTRODUCTION 9 
 
 nervous system, because the content of consciousness and beluvvior 
 are results of the integrative functions of the whole organism and 
 not the localized activities of different centers of the nervous sys- 
 tem. It seems to be very difficult for many of our most important 
 psychiatrists and psychologists to recognize this fact. I am deeply 
 indebted to the late Prof. J. J. Putnam for his encouragement in 
 this point of view, because it came at the time that a series of 
 dogmatic objections, that I Avas dealing in "neurologizing tautol- 
 ogies," greeted my efforts to show how many of the features of a 
 psychosis could be explained as phenomena of integrative conflicts 
 Avithout either assiiming lesions of the nervous system or the pres- 
 ence of a destructive toxin. These unintelligible resistances, which 
 made neither a pointed criticism nor gave a Avorkable alternative, 
 loomed up like foggy, mountainous obstacles that prevented the 
 recognition of critically important principles. 
 
 The integrative conception Avas further clarified by two most 
 important contributions to our knowledge of the dynamic forces 
 of the personality, Cannon's Avork on the bodily effects of pain, 
 fear, rage and hunger, and PeavIoav's and BechtereAv's on the con- 
 ditioned reflex. Cannon clearly shoAved that the intragastric itch- 
 ing, felt as hunger, Avas produced by peripheral activities in that 
 viscus, and that the hunger craAT.ngs compelled the projicient ap- 
 paratus to seek and acquire food. This Avas of the greatest signif- 
 icance, although he still seemed inclined to l)elieve that other emo- 
 tions or cravings, as such, had a cerebral origin. FoUoAving the 
 suggestion, I belieA-e made by Freud, that all emotions, sentiments 
 and hungers Avere really different types of cravings and the 
 James-Lange theory of the peripheral origin of the emotions, the 
 researches of Cannon on fear and rrifie were capable of interpre- 
 tation in a manner that explains, like the craving for food, the 
 physiological or rather autonomic sources of all the wishes, emo- 
 tions and sentiments of the personality. 
 
 The neutralization theoiy of the dynamic or autonomic mech- 
 anism of the personality is as folloAvs: The different segments of 
 the autonomic apparatus are stimulated to assnme different tapes 
 of postural tensions cuid activities, trliicli (jive rise to an affective 
 nervous stream, irhich, in turn, coordinates llie priijieienl appa- 
 ratus cmd compels it to act so as to expose the receptors of the 
 organ-ism so that they loill accjuire certain types of stimuli and 
 avoid others. The stinmli which m.ust he acquired in order to 
 
10 PSYCHOPATflOLOGY 
 
 avoid prolonged unrest and distress, which may become decidedly 
 WMlnutritional in their influence, must have the capacity to coun- 
 ter-stimulate the autonomic segment so that it will resume a state 
 of comfortable tonus, We find that this occurs in hunger, fear, hate, 
 love, siiaiaie, jealousy, sorrow, eroticism, etc. This lalsr of com- 
 pulsion by the segment .to seek counter-stimulation and neutralisa- 
 tion of its craving seems to me to be the physiology of the wish and 
 the fundamental dynamic principle of all behavior; and not until 
 this law and its physiology are understood and applied can nor- 
 mal or abnormal behavior be really understood. 
 
 The segmental craving when hyperactive or hypoactive needs 
 certain types of stimuli to bring about a comfortable adjustment in 
 its postural tonus. What determines what the stimuli sha,ll be? 
 Is it an inherent predilection or a- matter of experience? It is 
 both, no doubt. We have an inherent metabolic preference for 
 oxygen and are compelled to acquire it as the pulmonic segment 
 becomes distressed. But how sjidivhere we shall seek oxygen is 
 a.matter of experiences conditioning the segmental craving to ac- 
 quire certain stimuli which are associated with the primary stim- 
 ulus and eventually lead to it, and to avoid the stimuli that are 
 associated with its loss. That the segmental cravings of different 
 people should have different preferences and aversions is readily 
 traceable to the conditioning influence of experiences with the en- 
 vironment and particularly the influence of other people. 
 
 The researches of Pawlow, Bechterew and Watson have given 
 us the mechanisms by which segments of the autonomic apparatus 
 and the simple projicient reflexes are conditioned. Hence, the ab-. 
 normal or tabooed segmental cravings of the psychopath must be 
 studied, particularly through the psychoanalytic method, so that 
 he will become aware of their influence and the experiences that 
 conditioned the segment to crave certain stimuli and avoid' others 
 that are socially important. For example, a large number of sol- 
 diers and sailors are received at St. Elizabeths Hospital each year 
 who state that they are disgusted with life and care for nothing. 
 They are depressed, sullen, morose, slovenly, destructive, and 
 often have hallucinations pertaining to pleasant anal and gluteal 
 stimulation — sodomistic in their general trend. They usually give 
 a history of having been discouraged by bullying companions and 
 impleasant work. In studying this peculiar segmental domination 
 
INTRODUCTION 11 
 
 of the personality, I found that mothers often stimulate the gluteal 
 and anal regions of their babies to comfort them when they are 
 pouting and sullen. An incident may, perhaps, illustrate how this 
 occurs. ^^Tiile in a street-car, a young mother held an infant on her 
 knee as it played contentedly with a soldier's keys and chain. 
 When he left the car, taking his keys and chain, the child began to 
 fret and cry. The mother slipped her hand under the dress so as 
 to cover the gluteal area and began to shake the child up and 
 doAvn with slow rhythmical movements. The child soon stopped 
 fretting, having acquired a satisfactory substitute in the gluteal 
 stimulation. Here is a distinct illustration of the countless ex- 
 periences that this infant will have, which eventually, will prob- 
 ably detennine what stimuli are needed as a solution of its sullen, 
 depressed, morose states and also its most pleasing substitution for 
 demonstrations of love and sympathy upon its trials and losses. 
 (For further illustrations, see the excretory erotic fascinations 
 of the sullen, hebephrenic type of dissociation of the personal] tv. 
 Chapter XIII.) 
 
 To return to the significance of conditioned segmental crav-- 
 ings. It is obvious that many secondary stimuli become associated 
 Avith primary stimuli that are pleasing to some segment and par- 
 ticular states of tension of this segment, but also become asso- 
 ciated AAT.th the primary painful or obnoxious stimuli of other 
 segments or states of tension, such as the color red in fruits and in 
 danger signals that may happen to be stationed between the hungry 
 stomach and the fruits. Through an endless variety of experiences 
 we see the principal autonomic segments eventually becoming quite 
 firmly conditioned to seek socially approved stimuli in a manner 
 that wins social esteem. Furthermore, and herein lies the crux 
 of the neuroses and abnormal behavior, as people become ashamed 
 or fearful of a segment's activities they try to disown it as a part 
 of their personality, as when individnals feel fearful, angry, erotic, 
 covetous, or embarrassed in a situation and refuse to admit it but 
 m-aintain that they only feel "nervous" or "worried." In every 
 matured personality there is something that thinlfs of itself as "I" 
 and the divisions and functions of the body as "mine." This 
 entity that constitutes the "I" or "me," or "myself" (the ego), 
 does not exist at birth but can be observed to develop gradually 
 from infancy to adolescence and reach its final integrations as a 
 
12 PSYCHOPATHOLOGY 
 
 highly organized unity in late maturity. It is constituted oi the 
 inherent segmental functions that have become conditioned to seek 
 stimuli in" a manner that not only obtains gratification but also 
 wins social justification and esteem. Hence, this egoistic unity 
 must keep the asocial segments under control. 
 
 This conception of the personality is purely biological and be- 
 havioristic, and, it will be shown, fully accounts for the content of 
 consciousness and memory, will and choice, purpose and reason, 
 or that vaguely, chronically used concept, the mind in contradis- 
 tinction to the body, or psychological processes in contradistinc- 
 tion to physiological processes. The whole parallelistic issue is 
 completely avoided if the student will but learn to see that con- 
 sciousness and the content of consciousness is the reaction of the 
 body as a unity to the sensc^tional activity of one or several of its 
 parts. And when toxins, injuries, fatigue, etc., prevent the seg- 
 ments from integrating into a unity, consciousness of the activities 
 of a part disappears, as when passing under a general- anesthetic 
 or going to sleep. 
 
 The struggle of the egoistic unity to keep any perversely con- 
 ditioned segmental craving from causing us to be conscioiTS of its 
 needs, because we rightly fear it, becomes a psychopathic strugffe 
 when it forces us into an eccentric biological adaptation or asocial 
 position. All the abnormal variations of human behavior, as 
 purely behavioristic phenomena, can be explained in this manner. 
 Tt is the only explanation that fully covers all the issues raised in 
 the study of psychoses and normal minds. 
 
 This very simple conception of the personality requires the rec- 
 ognition of the fact that there are fundamental differences between 
 the ego's adaptations to an autonomic segment's craving: (1) 
 when it accepts it as a part of the ego, as ' ' mine, ' ' and supports or 
 justifies its domination of the projicient apparatus and the free 
 seeking of its stimuli ; or (2) when the ego prevents it from seeking 
 freely by suppressirig the segment so that it can only dominate the 
 projicient apparatus sufficiently to cause the organism to be con- 
 scious of its presence and needs; and (3) when it represses the 
 segment so that it can not even cause consciousness of its, needs; 
 and (4) when the segment becomes dissociated and forces the or- 
 ganism to become conscious of sensory images that are wishfulling 
 or gratifying, constituting the endogenous sensory elements of 
 
INTRODUCTION 13 
 
 hallucinations, delusions and dreams, compulsions, obsessions, 
 phobias, mannerisms, persistent thoughts, etc. 
 
 The egoistic unlfij can not attach the segmentnl cravings dl- 
 rectlij, hut controls them throngJh controlling the, final-coninion- 
 motor paths of the projicient apparatus. (Some psychopaths ac- 
 tually attempt to destroy the segment or the functional distortions 
 cau,sed by the segmental cravings, as in castrations to prevent 
 masturbation fancies or seeking radical surgical operations that 
 may eliminate the source of the craving.) 
 
 The terms, suppression, repression, dissociation, summation, 
 readjustment, regression, progression and sublimation applied to 
 the affective cravings, seem to me to be as important for psycho- 
 pathology as any terms in physiology can be for that science. De- 
 spite their great value one still meets with prominent psychiatrists 
 who refuse to use them but persist in using whole phrases and 
 sentences to describe the same phenomena. It is difficult to see 
 common sense in such methods, and it would be well Avorth while 
 if they explained away their resistances in order to get within 
 "shouting distance of one another." 
 
 Watson's work on the behavior of animals and infants has 
 been of value in teaching the psychiatrist to see his cases as prob- 
 lems of behavior, although his explanations of abnormal behavior 
 are wholly inadequate. The psychiatric student must be trained 
 through the study of animal behavior to be able to recognize the 
 movements and postural tensions of fear, anger, love, shame, sor- 
 roiv,. jealousy, etc., because only in this manner can he learn to 
 study his cases from a truly biological point of view. So far, 
 practically nothing is taught the medical student about the prin- 
 ciples underlying human and animal behavior. 
 
 The student of animal behavior has not gone so far as the 
 psychopathologist and psychologist in his schematic reconstruc- 
 tion of the personality, apparently because he wishes to avoid the 
 use of terms or concepts that savor of purpose, although he has 
 a purpose in doing this ; and has so far been unwilling to consider 
 the phenomenon of consciousness of self, even though it is one 
 of the critically important factors which determine enormous 
 variations in the development of the personality; such as the 
 psychopath's eccentric compensatory defensive strivings that 
 are initiated by the fear of becoming conscious of or dominated 
 
14 PSYCHOPATHOLOGY 
 
 by abnormal segmental cravings ; like the erotic perversions, bed- 
 wetting, kleptomaniacal or parricidal compulsions, etc., which 
 once dominated him in infancy and adolescence. 
 
 Sherrington and Langelaan, on the postural tonus of striped 
 and unstriped muscles, have given its an insight into physiological 
 mechanisms that may be used to explain how a repressed segmtent 
 ct)ntinues its pressure, like a compressed spring, through its 
 heightened postural tensions, causing the individual to be conscious 
 of a kinesthetic stream, constituting thoughts which, although un- 
 desirable or distressing, are means of getting gratification. The 
 psychiatrist must recognize that when a man spends an exhaust- 
 ing afternoon wandering about the market trying to purchase a 
 particular kind of food a segmental craving for this particular 
 food is compelling the complicated behavior ; and so with the un- 
 intelligible, confused behavior of a dissociated personality, who 
 spends weeks in religious incantations and prophetic exhortations 
 and finally eats the plants on the ward, "root and all," and then 
 tries to perform fellatio and be "crucified," we must recognize 
 that the psychosis has been largely a struggle Avith uncontrollable 
 oral homosexual cravings, which finally dominated the ego and 
 obtained free control of the projicient apparatus after perhaps 
 years of repression- and certainly months of suppression of the 
 cravings. 
 
 The behaviorist recognizes that the tensions of the sex ap- 
 paratus dominate the behavior of birds and animals during the 
 mating season and their tortuous cotirses through the environment 
 are due to the sexual cravings striving to acquire appropriate 
 stimuli. Similarly, the psychopath's struggle with the environ- 
 mental resistances (social taboos) and the tortuous, tangled course 
 of his behavior and fancies during his psychosis must be seen as 
 a biological struggle to obtain gratification for the cravings. 
 
 No student of human behavior, no matter what his point of 
 view, can^ for one moment, afford to lose sight of the fact that all 
 men and women are bisexual in their anatomical construction and 
 in their affective cravings, and that all the segmeints contribute to 
 the affections and wishes of the personality. The tragedy in the 
 struggle to fulfill the biological career occurs when the male de- 
 volps a preponderance of effeminate or indirectly aggressive traits 
 and the female a preponderance of masculine or directly aggres- 
 
INTRODUCTION 15 
 
 sive traits. This distortion may not lead to misery if in the mating 
 the abnormal tendencies of the pair reciprocate well enough. The 
 ease histories show that certain social influences and fears often 
 force an individual to have a predominant craving for homosexual 
 interests, and later a new environmental adjustment may lead to a 
 return to heterosexual interests. This is shown plainly in the 
 maladjustments which men and women often force each other into 
 after marriage ; and after divorce or death removes the oppressive 
 influence, the repressed affections swing back to a biologically nor- 
 mal, more comfortable course. These profound changes in the 
 autonomic tensions and cravings always have a tremendous influ- 
 ence upon the individual's content of consciousness and his social 
 career (professional or vocational) even though he may have no 
 appreciation of what is going on within himself. 
 
 The conditioning influence upon the child's autonomic-affec- 
 tive cravings by the parent's autonomic attitude accounts for the 
 unconscious development of characteristic family functional traits 
 in generation after generation; and, furthermore, there can no 
 longer be any doubt that most infants who begin life Avitli fairly 
 normal equipments and end as social or biological abortions, that 
 is, as criminals or insane, have become asocial through the patho- 
 logical influence of their parents and those associates to whom they 
 are obligated by society. The general understanding of how these 
 conditioning influences work will, no doubt, lead to reforms in 
 education and social laws which will be of the greatest importance. 
 
 When the physician and surgeon come to realize the tremen- 
 dous influence of the repressed hypertense or hypotense autonomic 
 segment and its local circulatory system as an influence in recov- 
 erability from infections, diseases and surgical shock, the localiza- 
 tion of destructive germ colonies, and derangement of metal^- 
 olism, a new epoch in the progress of medicine will begin. The 
 psychopathologist, physiologist and clinician have enormous un- 
 explored fields of research open before them in this direction. 
 Means for training men to carry on this work should be established 
 by the medical schools. There is not the slightest doubt that the 
 termination of many infections of vital organs, such as pulmonary, 
 genitourinary, cardiac, gastrointestinal and cerebrospinal, are in- 
 fluenced by the blood supply and tonus of the segments and the 
 reciprocal changes in the blood supply of their nerve centers. 
 
16 
 
 PSYCHOPATHOLOGY 
 
 The affective mechanisms of local vasoconstriction and vasodila- 
 tion and chronic spastic tensions of impor1?aait nnstriped muscles, 
 particularly those groups that may occlude or open ducts and 
 valves, are so far unknown; such ag, the largeT bile ducts' sudden 
 occlusion in an emotional crisis of a certain type as a possible etio- 
 logical factor in some cases of acute yellow atrophy of the liver. 
 Some forms of diabetes and hyperthyroidism are no doubt inti- 
 mately related to compensatory strivings against certain types of 
 repressed fear. The researches of Cannon on the physiological 
 changes in the blood stream upon fear and rage, which, in turn, 
 indicate marked changes in the activities of different organs, such 
 asthe liver, adrenals, and thyroids, certainly show that great dis- 
 turbances of the metabolic processes must occur during the psy- 
 choses, if delicate enough means of biochemical analysis can be 
 developed to find them, because the extremes of fear and terror, 
 hatred, envy, eroticism, shame and sorrow are to be found in the 
 psychoses. The metabolic disturhances should not he interpreted 
 as the primary caitses of the psychoses hut as contributing factors 
 to a vicious circle of adjustment. 
 
 This new understanding of the physiological functions and 
 the personality is becoming the foundation of a new psychopathol- 
 ogy and a new psychology, with sweeping changes in the interpre- 
 tation of normal and abnormal behavior and their causes, and, 
 eventually, a new classification of the so-called "mental diseases." 
 The author hopes that this volume may help revolutionize present 
 psychiatric notions, and contribute to the foundations of a truly 
 biological psychiatry. 
 
 Since Freud made his illuminating contribution to the study 
 of hysteria, despite the bitter criticism of hopelessly prejudiced 
 men, a legion of earnest workers in the psychoanalytic method of 
 studying the psychoses have followed him. Their contributions 
 are to be found now in almost every modern language, ranging 
 from shy to cautious references to the sexual difficulties of their 
 cases to sound, dignified, erudite studies, to unrestrained helter- 
 skelter speculations and fancies, i'his sort of thing always occurs 
 with new methods. All sorts of men become interested in new dis- 
 coveries, whether an arctic gold field, aviation, vaccine therapy, 
 salvarsan, brain surgery or what not. Out of the great herd tlie 
 conservative world must choose the careful, reliable student from 
 
INTRODUCTION 17 
 
 the inefficient, the ultra-cantious, and the plunging speculator. The 
 soundness of a new scientific procedure is greatly increased when 
 large numbers of sincere students apply similar methods to similar 
 problems and yet maintain a constructively critical attitude toward 
 each other's Avork. The psyeliiatrists who avoid the sexual prob- 
 lems of their cases and the psychoanalytic method of studying 
 them are to be classed with the medical cults that avoid the study 
 of anatomy and physiology. Their resistance to the problems of 
 sex is, as rational as the medieval persecution of dissection and 
 the present-day hubbub by the iiltra-esthetic .about vivisection. 
 
 The analytical studies of a great variety of cases in the func- 
 tional neuroses and psychoses, by many different workers in 
 Europe and America show, on the one hand, that the symptom- 
 atological classification of cases is misleading and hopelessly con- 
 fusing, and, on the other, that a mechanistic classification is highly 
 necessary and practical. The analytical studies of Freud, Bleuler, 
 Jung, Jones, Ferenzi, Pfiester and Adler, in Europe, and Putnam, 
 White, Jelliffe, MacCurdy, Frink, Prince, Sidis, Clarke, Brill, 
 Coriat, Emerson, Campbell, Burrow, Tanneyhill, Dooley and many 
 others in America so consistently reveal that the neuroses and psy- 
 choses are produced by the autonomic-atfective cravings that the 
 development of a new mechanistic system of classifying cases is 
 necessary. Chapter V is devoted to this work. It is not expected 
 that the system advanced is to be accepted as thoroiighly satis- 
 factory but rather it is a pragmatic attempt in which simple 
 critical psychological, mechanistic differences are used to differ- 
 entiate cases into types. It has the advantage of elasticity and 
 adaptability, fundamental attributes of human nature, which the, 
 old German, static system utterly failed to recognize. 
 
 The contents of Chapter I are devoted to an abbreviated pres- 
 entation of the physiological foundations and mechaiiisms of the 
 personality Avhich 'have been more fully presented in th'te author's 
 monograph on ' ' The Au.tonomic Functions and the Personality. ' ' 
 Chapter II covers the conditioning influence of the family upon 
 the autonomic cravings of the infant and child, and in Chapters III 
 and IV, the struggle to fulfill the biological career, despite func- 
 tional and organic inferiorities, is discussed in order to approach 
 the mechanisms underlying the. psychopathic deviations that con- 
 stitute functional neuroses and psychoses. 
 
18 PSYCT-IOPATIIOLOGY 
 
 Chapter VI deals with the anxiety or suppression' neuroses, 
 anxiety due to the ego 's fear of the segmental cravings, and Chap- 
 ter VII deals with the repression neuroses or psychoneuroses 
 which are produced by the ego's attempts to make a permanent 
 adaptation to the segmental craving. This leads directly to the 
 psychoses (dissociation neuroses) of more or less benign and per- 
 nicious types, varying from rather brief, acute or periodic, mild to 
 violent dissociations of the personality, to chronic mild fixed types, 
 to chronic dissociations that utterly destroy the personality. This 
 broad group is covered in Chapters VIII to XIII. A discussion 
 of the factors that detennine what the psychosis will be like and 
 what its prognosis will be, is made in Chapter XIV, and Chapter 
 XV covers prophylactic measures and the essential principles of 
 psychotherapy. 
 
 The case records have been selected from a large variety for 
 the purpose of illustrating the more important mechanisms, and 
 to support certain facts, such as the explanation of the delusion 
 that secret intriguers are putting "poison" in the food. If some 
 of the cases seem too unpleasant to study the reader must not for^- 
 get that this is psychopathology and not romance or an essay on 
 how to sublimate and maintain the refined and beautiful. 
 
 I would like to emphasize again, as the cases are read, to al- 
 ways keep in mind the factor of ivish-fulfillment in the delusions 
 <m,d hallucinations, the physiological nature of the wish, the ex- 
 periences that conditioned it, the stimuli that excite it, and the 
 patient's manner of compensating to his fear of it. The behavior 
 of the cases is presented so as to be as free from speculations and 
 impressions as possible. 
 
 Much of the information about the patient's difficulties was 
 gathered through observation and asking questions. In some cases 
 this material was enormously enriched through the psychoanalytic 
 method of inducing the patient to permit a free association of 
 thought; that is, to allow, himself to be made conscious of what his 
 repressed cravings tend to seek, no matter where they would go 
 or how. This method is often attended by no little embarrassment 
 and at times by nothing less than temporary terror and suffering, 
 but there seems to be no alternative ; and surgery uses the principle 
 that, although operations may be more painful than tumors or 
 fractures, in the end they generally prove worth while. Some- 
 
INTRODUCTION 19 
 
 times the ego's horror and despair at tlie repressed cravings ends 
 in suicide, but this is a rare adaptation and must be compared to 
 many fatal results of surgical and clinical therapy. 
 
 A series of illustrations from modern and prehistoric painting 
 and sculpture is used to emphasize the fact that symbolism is as 
 much used today by Man, in order to relieve his repressions, as 
 by his primitive fathers. "When one recalls the ridiculous tirades 
 some inspired psychiatrists levelled at the psychoanalysts' recog- 
 nition that the appearance of a knife, Avand or beast in a dream or 
 hallucination probably had a phallic or erotic significance, it seems 
 worth while to publish illustrations of such things having an actual 
 phallic value. These same thinkers, who would refer to the asocial 
 sexual cravings as "bestial," seem to be too prejudiced to recog- 
 nize that the bestialness might be expressed by the image of a 
 beast, and, conversely, the sacredness of socially approved love by 
 beautiful images of many varieties. Without recognizing the 
 stimulating value of symbols to the autonomic affective cravings 
 and understanding in a large degree the universal language of 
 normal or abnormal behavior of Man and tlie biological value of 
 his creations. 
 
CHAPTEE I 
 
 THE PHYSIOLOGICAL FOUNDATIONS OF THE 
 PERSONALITY* 
 
 A critical review of the more prominent, current conceptions 
 of psychopathological processes and the nature of the personality 
 would require such extensive discussion to adequately treat the 
 works of the authors, and is itself so important for psychopathol- 
 ogy, that an entire monograph should be devoted to . this work. 
 
 It is justifiable, therefore, for the author to present his case 
 material as he understands it, without confusing it with the 
 injection of surmises of another psychopathologist 's impres- 
 sions of such processes. The controversial method never does suf- 
 ficient justice to the other student of huma,n behavior, beyond mak- 
 ing an acknowledgment of his work; hence, it is suggested that 
 those who are seriously interested in psychiatry will themselves 
 review the literature (a list is appended) and take what they can 
 use. 
 
 All the cases herein presented are carefully arranged on the 
 basis that the affective cravings or wishes resisting one another 
 in their struggle with the environment (emphasizing other people) 
 determine the nature of our behavior. Hence,. the history of the 
 development of the peculiar conditioning of the individual's af- 
 fective cravings and the nature of the environmental resistance 
 are elaborately presented in many cases, because, when completely 
 worked out, this is enough to logically explain the psychosis with- 
 out bringing any other complicating assumptions, such as meta- 
 bolic, constitutional or hereditary inferiorities, into the oase. 
 
 The results of the intensive study of a large variety of psy- 
 chotics of many nationalities have forced the abandonment of the 
 Kraepelinian symptomatological classification of psychoses, be- 
 cause of its futility, for the much more interesting, practical and 
 resourceful conception of uncontrollable autonomic affective crav- 
 ings originating in autonomic segments opposed by the ego. 
 
 The ivish, as we are prone to recognize it in everyday life, and 
 
 *This discussion of the physical foundations of the personality is largely taken from the 
 author's monograph on "The Autonomic Functions and the Personalityi" Exact references for 
 the data are given there. 
 
 20 
 
PPIYSIOLOGICAL FOUNDATIONS OF PERSONALITY 21 
 
 no one should be misled into assuming for its source a "psychic 
 energy" (Holt), may be completely accounted for if it is recog- 
 nized to be none other than a localized autonomic-affective crav- 
 ing and its compelling influence on the striped muscle apparatus 
 of the personality. This fact can be demonstrated by using the 
 researches of James, Sherrington, Cannon, Mosso, Wertheimer 
 and a collection of psychoses and psyclioneuroses. The term "af- 
 fective craving," has a distinct advantage in that it can be clearly 
 correlated with its physiological source in the streams of craving 
 feelings or itching sensations that are aroused by increased ten- 
 sions of different segments of the autonomic apparatus. 
 
 The autonomic apparatus is constituted of all the vital organs, 
 including the ductless secretory glands, unstriped muscles and the 
 ganglionic nervous systems that have to do with the assim.ilatio}i, 
 conservation, distribution and expenditure of energy-giving meta- 
 bolic products and the elimination of the waste products. This in- 
 cludes the entire digestive, circulatory, respiratory and urinary 
 systems, sex organs, glands of internal secretion, glands of ex- 
 ternal secretion and the autonomic nervous system. This nervous 
 system includes all the ganglia outside the central nervous system 
 that innervate the above visceral systems and those autonomic 
 centers that are imbedded within the cord and brain-stem and 
 directly or indirectly innervate the viscera; as, for example, the 
 vagus centers. Also the autonomic neurones of the cord and 
 cerebellum that maintain the postural tonus of the striped muscle 
 cells (Langelaan, De Boer, Sherrington). The striped muscle 
 apparatus and the cerebrospinal nervous system proper consti- 
 tute the projicieut apparntvs which has been developed liy the 
 autonomic apparatus in order to master the environment.* 
 
 The Mechanism of Postural Tensions and the Peripheral Origin 
 of Cravings in the Autonomic Apparatus 
 
 Sherrington has shown that all the striped muscles that must 
 maintain a certain degree of postural tension in order to overcome 
 the influence of gravity, that is, practically all of the skeletal mus- 
 culature except perhaps the abdominal, are in a state of constant 
 
 *The term "'segmental craving" will be frequently used and by it is meant the craving that 
 originates in some autonomic segment, i.e., some viscus or organ such as the stomach, bladder, 
 throat, heart or genitalia. As physiological segments they include their nerve and circulation 
 divisions. As excised anatomical segments or dead organs we do not usually consider the cir- 
 culatory and innervating systems but in psychopathology we must deal with organs as they func- 
 tion in life. 
 
22 ■:.-■'. PSYCHOPATHOLOGY- 
 
 postural contraction or tension. This may vary, in intensity for 
 different muscles ;aa4 organs at different times, arid the degree of 
 variation seems to be rather characteristically different for each 
 individual. Its mechanism depends upon the presence of the pro- 
 prioceptor, embedded within the muscle walls, tendon sheaths and 
 about the joints, and its afferent nerve. The proprioceptors are 
 stimulated by the pressure of the muscles as they contract and 
 pull against tha skeletal frame: or in the hollow viscera, by the 
 contraction in t|e form of a postural grip on the contents; as, the 
 heart, blood-vessels, stomach, bladder and rectum. Since the mo- 
 tor cell in the cord stimulates the muscle-cell and the latter in turn 
 stimulates the proprioceptor and its afferent impulse agairi stimu- 
 lates the motor neurone, it is necessary to recognize that prac- 
 tically all raotor functions are part of an efferent-afferent-efferent 
 continuous circuit. We have external stimuli, and afferent im- 
 pulses with efferent responses, but also afferent-efferent-g-fferent 
 internal circuits in both the skeletal and visceral functions to 
 consider. Since the rate of the impulses maintaining postural 
 tension varies from 40 to 90 per second (Sherrington) the con- 
 verging streams! must be recognized as continuous and composed 
 of almost innumierable minor circuits and combinations of circiTits. 
 -^ The postural tensions of the hollow viscera, although they 
 vary in degree, are also continuously active, and this gives rise to 
 a continuous, complex, converging affective stream- from all parts 
 of the-rautonorpic musculature, to which the organism as a unity 
 is -constantly, reciprocally adjusting itself. • Most of the 'time this 
 afferent affective stream from 'a visceral or axitdnomic segment 
 is subliminaliy active and does not cause the organism to adjust 
 overtly as ^ unity, that is, to become conscious of the segment's 
 activities. '' "VVlien, however, the tension ' of some visciis is in- 
 creased, the sensory stream is felt in the form of a' craving; that 
 is, a mo^e or less intermittent, persistent itching (which in the 
 stomach/ causes a craving or wish for food, or in the bladder causes 
 a craving or wish to urinate). This mechanism is characteristic 
 of pleasing as well as disagreeable (anxious) tensions. Sherring- 
 ton y^ays that postural tensions are relatively indefatigable and 
 najnes the sexual .clasp of the frog and the catatonic attitude of 
 patients as examples. It is, therefore, satisfactory, as an expla- 
 nation of the origin of persistent cravings or "wishes to recognize 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 23 
 
 that they are caused by the persistent hijpeiieiisiun and contrac- 
 tiiral, activities of some autonomic segment or viscus. , 
 
 cHoV wishes come and go may be seen in the functions of the 
 bladder. When the intracystic pressure is over 18 centimeters of 
 water the craving to urinate is aroused (Mosso and Pellacini), but 
 in due time the desire disappears as the bladder adjusts its tension 
 by enlarging itself so as to accommodate' to the increasing quantity 
 of urine, thereby lowering the 'intracystic pressure. The desire 
 again returns when the pressure is again increased by the accumu- 
 lating urine to 18 centimeters. If, however, for some stimulating 
 reason, the postural tension of the bladder is greatly increased, so 
 that a small quantity of urine raises the pressure to 18 centimeters, 
 and the bladder is unable to relax its grip, the individual becomes 
 obsessed with the necessity for frequent micturition which may 
 constitute a very abnormal condition (a not uncommon feature in 
 the psychoneuroses). 
 
 This explanation also may be applied to the mechanism of 
 cardiac anxiety, respiratory or asthmatic anxiety, gastric anxiety, 
 rectal, intestinal, and sexual anxiety, on the basis of distressing 
 sensations due to a persistent hypertension that prevents a return 
 to normal comfortable functioning — hence, the obsession or com- 
 pulsion to act so as to get relief. But the relief may be unobtain- 
 able, because it depends upon changing the attitude of an unmodi- 
 fiable environmental resistance, as a hopelessly indifferent, or ta- 
 booed, or dead love-object, or the fear of failure when compelled to 
 act, asUn addressing an andrencel 
 
 'Cannon and Carlson'have shown that a definite type of" gastric 
 contraction precedes and' is concomitant with a "gnawing" or, bet- 
 ter, itching sensation in the stomach commonly spoken of as hun- 
 ger. This autonomic-affective craving compels the organism to 
 acquire such stimuli as have the especial capacity to relieve the 
 craving, and, as a counter-irritant, cause the gastric muscle to re- 
 sume comfortable tensions and movements, ' neutralizing the 
 craving. 
 
 These physiologists have also shown that when a potentially 
 painful distant stimulus or an actually painful contact stimulus is 
 permitted to play upon a distance or contact receptor, the stomach 
 particularly, (other viscera also), promptly assumes spastic or 
 fixed postural attitudes which are decidedly conducive to malnutri- 
 
24 PSYCHOPATHOLOGY' '' 
 
 tion; shoAvn by the constriction of the gastric blood-vessels, de- 
 crease in hydrochloric acid secretion, increase in secretion of mu- 
 cus, and decrease in size and ability to empty the contents into the 
 duodenum. This status produces the disagreeable sensations or 
 feelings of fear or anxiety. As the autonomic compensation fol- 
 lows through shifting of the blood supply to the muscles and or- 
 gans that must remove the receptor from the dangerous stimu- 
 lus we feel the affect fear. As we attack or destroy the danger- 
 ous qualities of the stimulus, we feel the affect of anger. That is 
 to say, a compensatory series of autonomic tensions follows the 
 fear tensions and the affect flowing from them constitutes the 
 anger and the compulsion to attack. Similarly a reversed gastric, 
 esophageal and pharyngeal peristalsis gives off the feelings of 
 disgust and the compulsion to get away from or get rid of the 
 disgusting stimulus. 
 
 The autonomic-affective craving for food, which is a typical 
 acqmsitive-assimilative craving and the autonomic-affective crav- 
 ing to urinate, which is a typical emissive-avertive craving, indi- ' 
 cate that probably all the acquisitive or avertive emotions or af- 
 fective cravings and the most delicate sentimentSj such as hunger, 
 love, fear, anger, grief, sympathy, pity, joy, can probably be best 
 understood as having a peripheral origin in characteristic varia- 
 tions of postural tension of autonomic or visceral segments. In 
 its essential respects this is the James-Lange theory of the 
 emotions. 
 
 This explanation is all that is necessary to account for the 
 origin of the dynamic forces of the personality. Nothing else, 
 such as "soul," or "will," or "psychic energy," is needed. All 
 such notions, being superfluous, are only confusing and have no 
 biological value. 
 
 All the autonomic-affectiA'e cravings, whether they compel an 
 acquisitive or -an avertive course of behavior or attitude toward 
 the environment, follow the same two laws : 
 
 1. When an autonomic-affective craving is aroused, either to 
 compensate for the deficiencies due to metabolism {as in Mmger) 
 ■or through the influence of an exogenous stimulus {as. iu fear), it 
 compels the projicient {striped wAiscle) apparatus to shift the ex- 
 teroceptors about in the environment so that they will acquire 
 such stimuli as are necessary to counterstimulate and neutralise 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 25 
 
 the autonomic deraugemenf so that flie segment luill assume com- 
 fortable tensions. 
 
 2. The projicient apparatus that shifts the receptors about 
 SO as to expose them to appropriate stimuli is organized and co- 
 ordinated so as to bring a vinximuin. of affective gratification 
 tvitJi a minimum expenditure of energy. 
 
 When fear is aroused the distressing autonomic tensions 
 force the organism into flight until comfort giving stimuli are 
 acquired. For example, a frightened man or animal seeks the 
 comforting stimuli of his house or den, the bird reduces the dan- 
 gerous stimulus to subliminal influence by flight to or hiding in 
 secure places. When an adequate compensation of anger occurs, 
 the stimulus is attacked and its threatening qualities are destroyed 
 or rearranged into submissive forms. This occurs in the fight to 
 kill or subdue, and in polite society it is refined to demands for an 
 apology, or compensation, or submission. 
 
 If one will introspectively study the mechanism of his affec- 
 tive cravings, he will recognize the folloAving compulsions. 
 
 Fear ahvays removes the receptor from the painful contact 
 stimulus or the potentially dangerous distant stimulus. - 
 
 Anger is the aggressive compensatory reaction that follows, 
 more or less promptly and intenseh', the fear reaction, and, as a 
 compensatory reaction, compels the removal of the stimtdus from 
 the receptor. That is, it compels an attach upon the painful stim- 
 ulus, whereas fear compels an evasion of the stimulus. 
 
 Shame is a type of fear reaction following the misapplication 
 of receptor and stimidus, as in error, masturbation or stealing. 
 
 Disgust is a type of fear reaction associated with anger in 
 which the organism tends to emit or avoid the obnoxious stimidus, 
 as the nauseating, emissive peristalsis of the stomach, esophagus 
 and pharynx when fetid odors are associated with food ; as upon 
 finding a dead mouse in a tub of butter. 
 
 Grief is a fear reaction due to the loss of an energizing or 
 comforting stimulus and is the result of the respiratory, circula- 
 tory and digestive system assuming certain tensions which are 
 distressing and disposed to malnutrition. 
 
 Love, like the craving for food, has its origin in the metabolic 
 and reproductive functions forcing the seeking for, and acquiring 
 of, certain types of stimuli. There is unquestionably a character- 
 
-O PSYCHOPATHOLOGY 
 
 istic tontts of the circulatory, respiratory, digestive, and repro- 
 ductive organs of the body when love predomin,ati|i:r There. is ^| 
 certain tenderness and* gentleness of reaction to the envlfomaent, 
 .depidedly different from the tonus when enraged, fearful or,, fam- 
 ished. The love status, although as yet we can give it no definite 
 physiological description, has a well-defined ■ influence ' upon be- 
 havior and what it tries to accomplish. It strives to, bring g,bout 
 similar autonomic-affective states in others, particularly the love- 
 object, in order that, it 'will obtain the stimuli associated with 
 caressing, reproduction, and protection, such as petting, praise, 
 admiration, sympathy, interest, esteem, faith, encouragement, re- 
 ward, justice, etc. The general trend of the love cravinps is to 
 create, construct, protect, and cherish that which keeps away dis- 
 tracting fear, shame, sorrow, rage, suffering and extermination; 
 these states of existence being conducive to malnutrition and jeop- 
 ardizing reproduction and the race. Although the love behavior 
 may be varied and disguised, its natural goal, if not interfered 
 with, would be the sexual act and reproduction. In civilized man 
 this trend has been directed by laws and taboos to seek a sexual 
 object having at least certain qualities, such as racial and intel- 
 lectual development, freedom from certain diseases, not too close 
 blqod relationship or too great disparity in ages, etc. The result 
 is that society makes the individual seek farther and work harder, 
 thereby enriching society as he tries to Ayin esteem and fitness 
 for the love-object. His love attachments for parents, relatives, 
 children, friends are directed so as to be refined from sex. 
 
 In contradistinction to fear, shame, sorrqw or hate, love cher- 
 ishes the stimulus and its accessibility- for the receptor. It is on 
 gu^rd to prevent the loss of the stimulus so as not to develop the 
 reactions _of'fear, or.rg^ge. Fear or rage are aroused by resist- 
 ances to , acquiring, the love-object. The ancient Greeks taught 
 that- when Love (Eros) flies away, the Mind (psyche) dies. We 
 find this, to be true in the ,psychopath and the uninspired. In the 
 latter,- the. love functions -are depressed ; in, the former, they have 
 been crowded out i of normal methods of seekil^g for the love- 
 object. ! 
 
 - When an autonomic-affective craving compel^ the projicient 
 apparatus' (cerebrospinal) tO' make movements in order that a 
 certain receptor shall be so exposed as to acquire the stimulus that 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 27 
 
 is necessary to relieve the autonomic tension, the movements tend 
 to be coordinated so that the maximum of gratification is acquired 
 through a minimum expenditure of energy. Thereby, the excess 
 of energy is conserved to increase the extension of influence over 
 the environment. Man's civilization is simply the building of a 
 more comfortable, controllable environment within the greater 
 environment. He conserves his powers to extend his influence in 
 order that his wishes- may be more and more surely and satis- 
 factorily fulfilled. Civilization is to be recognized as a protective 
 compensation against the anxiety and autonomic unrest caused 
 by the unfulfilled wish and uncontrollable' environment. 
 
 '"An individual is constantly in a complex affective state 
 whether he is asleep or awake, in an emotional turmoil or a state 
 of reverie. He is never possessed by purely one affective craving 
 or emotion although he is often dominated by a distinct craving, 
 such as hunger or anger. Under such conditions one can recognize 
 other wishes and interests also at work in the background of con- 
 sciousness, all characteristically striving to overcome one another 
 and doniinate the final common motor path in order to acquire 
 gratification. 
 
 During sleep states, except during dreams, the autonomic 
 tensions seem to subside sufficiently so as not to cause the organ- 
 ism, as' a whole,' to readjust to their activities. When the activity 
 of any viscus increases, it affects the nature of the dream, as in 
 the case of thirst upon eating salty food before sleeping or the 
 dream of urinating. As its activity compels the organism to re- 
 spond more completely as a unity, the individual awakens. 
 
 To sum up the significance of the peripheral origin of the 
 ivish or affective craving: Hunger, fear, disgust, anger, shame, 
 love have their origin in the feelings aroused by the hypertensions 
 or hypotensions and movements of different visceral segments 
 and it'.is quite probable that all the viscera, including' the blood- 
 vessels, give rise to an. afferent or affective stream, and the nature 
 of the'ivishes ive are aware of at any time is determined by the 
 organs that happen to be hyperactive at the time and in conflict 
 ivith the resisting environment, as stomach-hunger for' food, 
 bladder-wish to urinate, etc. The complexity of the intricate auto- 
 nomic apparatits, arousing simultaneously more or less vigorous 
 manifold cravings, fidly accoilnts for the complicated- nature of 
 
28 tSYCHOPATHODOGY - 
 
 the affections of the personality. When one hears in mind the 
 fact that all the cravings have hut one means of ohtaining gratifi- 
 cation; that is, through using the skeletal neuromu^sGular appa- 
 ratus, the hasis of autonomic-affective conflict for control or dom- 
 ination of the final common motor path hecomes ohvious. It is also 
 ohvious that the affections which have control of the projicient 
 apparatus, indirectly hut irresistihly, control the antagonistic, re- 
 pressed affections. 
 
 Sherrington has shown that wherever two neurones converge 
 iipon a third, which is efferent to them, they may oppose (antag- 
 onistic) or reenforce (allied) one another in their efforts to con- 
 trol the nature of the impulses along the efferent nerve. This 
 principle applies to the autonomic apparatus as well (Cannon, 
 Sherrington) and is very easily observed in oneself when one has 
 two wishes to do different things at the same time with the same 
 thing, as one hand or foot, or with one automobile, one dollar, etc. 
 
 It is in the mechanism of the struggle between different auto- 
 nomic segments to control the final common motor path for ad- 
 justment that the psychopathic and the well constituted person- 
 ality are organized. A severe anxiety would arise if compulsive 
 tensions in the stomach and bladder and rectum were aroused at 
 the same time by the presence of food. When certain foods (such 
 as butter, oils, cream, gelatines) tend to cause undesirable erotic 
 reactions in the oral erotic psychopath he becomes fearful and 
 often starves himself as a defense. 
 
 The cravings or aversions of some particular autonomic seg- 
 misnt or viscus may jeopardize the safety or comfort of the entire 
 organism; as, for example, the tendency of the stomach to react 
 with a reversed peristalsis (nausea) or a type of spastic tension 
 (fear) when a certain drug or food, which is vitally needed, is 
 presented ; or the persistent hunger cravings may force the entire 
 organism to jeopardize itself by stealing food. In animals and 
 people we may see the more severe hunger cravings (intragastric 
 itchings) compelling behavior that often leads to destruction or 
 revolution. 
 
 The mechanism by which most of the segments of the auto- 
 nomic apparatus become associated as a unity against the demands 
 of a particular visCus or segment and its cravings seems to be 
 largely a matter "of the segments becoming so conditioned as to 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 29 
 
 react to the same enviroHinental conditions in a similar manner 
 (acquisitive or avortive) requiring the same sort of overt adjust- 
 ments, while the particular viscus reacts in an antagonistic man- 
 n(>r requiring socially tabooed stimuli. The incessant compen- 
 satory integrations to prevent the autonomic apparatus from get- 
 ting into the fear state (because of the possibility of failure to 
 gratify the cravings or wishes) greatly contributes to the develop- 
 ment of the egoistic viilti/ of the autonomic segments. Man, as a 
 descendant of the ape-man and the ape, has inherited the polymor- 
 phous sexual cravings of the ape, and the greatest problem of 
 modern man is to establish social ideals, conventions, religions 
 and laws which will direct these primitive affections so that they 
 will have a constructive value for society and yet will not be de- 
 stroyed by being prudishly refined. Should they be castrated by 
 too fanatical asceticism disguised with "righteous wrath" the 
 more highly developed families of the race will be destroyed with 
 their parental-sexual cravings, and the race will automatically fall 
 back becoming constituted of lower types who do not have suffi- 
 cient integrative capacity to develop an ego tliat can control the 
 primitive cravings. 
 
 Before considering the mechanism of the development of the 
 ego and man's personality, the relation of the autonomic appara- 
 tus to the skeletal or projicient apparatus, the mechanism of con- 
 ditioning the affective cravings, and their influence npon each 
 other, as antagonistic or allied cravings, must be considered. 
 
 The Value of the Projicient Apparatus to the Autonomic 
 
 Apparatus 
 
 The autonomic apparatus is constituted of the organs that de- 
 termine an animal's or man's growth, and, in the lower organisms 
 and the embryo, the autonomic apparatus is quite well developed 
 long before the cerebrospinal sensory-motor apparatus (includ- 
 'iSig muscles and skeleton) begins to develop. Any part of the 
 skeletal apparatus can be sacrificed without serious danger to life, 
 whereas no division of the autonomic apparatus, such as circula- 
 tory or digestive system or adrenal glands, can be sacrificed with- 
 out disintegration of the organism. But an autonomic apparatus 
 can only continue to work comfortably and healthfully as long as 
 it can acquire appropriate stimuli from the environment. As the 
 power of the primitive autonomic apparatus to conserve energy 
 
30 PSYCHOPATHOLOGY 
 
 increased' it developed an apparatus that could be used to shift 
 the entire organism about in the environment. In other words, 
 the autonomic apparatus developed and immersed itself in a pro- 
 jicient apparatus (the skeletal striped muscle-system) for the 
 purpose of projecting itself about in the environment in order to 
 be able to obtain gratification of its needs. (Because of this mech- 
 anism it is valuable for understanding the personality to speak of 
 an autonomic apparatus and its projicient apparatus.) 
 
 The relationship between their nervous systems is very inti- 
 mate although probably not fully understood. It seems Lange- 
 laan, De Boer, and others are inclined to regard the striped mus- 
 cle-cell to be really a dual cell; that is, a " sarcoplasmatic mass" 
 containing a striped apparatus. The sarcoplasmatic mass is in- 
 nervated by the "autonomic component" (Langelaan) and the 
 striped apparatus by the cerebro-spinal system. 
 
 The intimacy of dependence of postural tensions of the striped 
 muscles upon the autonomic apparatus may be seen in many ways 
 such as certain disastrous accidents due to change of postural ten- 
 sion and in efficiency word-association tests. For example, a man 
 was holding a knife in a fixed postural grip, pressing the point 
 against a hard surface while brooding over some personal trouble 
 (an autonomic disturbance which was trying to adjust itself) and 
 the remark of a companion, Avhich revealed that he might have 
 guessed the secret of the man's troubles, startled him. Instantly, 
 the hand's grip relaxed, and the open knife slipped through, caus- 
 ing a disastrous cut in the hand. The dropping of a razor or good 
 cigar through a sudden, reflex relaxation of the light postural grip 
 is in turn due to a sudden change in the autonomic-affeotive ten- 
 sions. The ego 's wish to hold the cigar is interfered with by being 
 forced to repress an embarrassing affective reaction that was sud- 
 denly aroused by a suggestion. One may easily collect numerous 
 accidents of this sort in his behavior in a few days' observation. 
 If he will analyze the mistakes and accidents that he creates he 
 will find that they are caused by sudden changes in his postural 
 tensions, in turn due to reflex changes in his affective or auto- 
 nomic tensions caused by repressing their activities. 
 
 One may also observe ill himself, and in his relatives and 
 friends, that the general carriage and postural tonus of the mus- 
 cles of the body, particularly of the hands, arms, shoulders, neck 
 
PHYSIOLOGICAL POXTNDATIONS OF PERSONALITY 31 
 
 and head, and the style of the walk, hand-shake,' voice sounds, etc., 
 reveal the characteristic affective tensions and wishes more than 
 what is said and done. The postural tensions of the individual 
 reveal the character of the "sneaking," "spineless" coward, the 
 bombast's strut, the confidence in movement of the victor, the sub- 
 missive posture of the vanquished. The postures of timidity, 
 anger, hatred, love, disgust, shame, deceitfulness, jealousy, joy, 
 guiltiness and sorrow are recognizable on sight, and cannot be 
 concealed from the trained observer. If the student will try to 
 conceal his affections from himself (that is, try to make himself 
 feel glad when he is sad, love when he hates, feel indifferent when 
 he fears, act boldly when timid, etc.), he will become distinctly 
 aware that vigorous postural tensions in various segments of the 
 body are the source of the resisting affect and he can not get him- 
 self to be unconscious of them without prolonged repressive mus- 
 cular effort and even then he does not eliminate their influence. 
 
 The Nature of Consciousness 
 
 This brings lis to the nature of consciousness and the content, 
 of consciousness. Because one is never conscious without being 
 conscious of something, and consciousness can not be separated 
 from its content, they are here considered as one phenomenon.* 
 
 Neuropathology and neurophysiology have not been able to 
 demonstrate that any cerebral center or group of centers or nerve 
 cells anywhere within or without the brain, has anything like the 
 functional capacity that may be regarded as a " center of conscious- 
 ness." On the other hand, apparently every living cell in the body 
 has the capacity to react to certain stimuli with such qualities in 
 the reaction that it may be regarded as a manifestation of 
 "awareness" or "consciousness" of the stimulus. Hence, it is 
 necessary to recognize that the nervous system has only the ca- 
 pacity of integrating and reoiforchig the activities of the periph- 
 eral organs. 
 
 "When we are conscious or aware of anything or any event in 
 the environment we are not accurately conscious of all its attri- 
 butes but of only a few of them, and we use these attributes to rep- 
 resent the whole; as, for example, when discussing England, or a 
 
 *For'a more detailed discussion of tlie mechanism of ' consciousness see "Tlie Autonomic 
 Functions and the Personality." By 15. J. Kempf, Nervous and Mental Disease Monograph Series, 
 No. 28. 
 
62 . - PSYCHOPATHOLOGY 
 
 cannon, congress, the nation, a friend, a cigar, gold, an experience, 
 a book, etc. 
 
 When we are conscious of ourselves, we are not conscious of 
 all the attributes of ourselves, or of all of our experiences or crav- 
 ings but we are conscious of only that small portion of ourselves 
 that happens to be in the ascendency of activity at the moment, and 
 these few attributes represent the ivhole organism or ego. For 
 example, a part of our clothing (color and style) some of the af- 
 fei'ent currents due to our positions, a tight hat-band, a flushed 
 face, and the sensations of a vigorous hunger may constitute the 
 principal part of the content of consciousness at a certain moment. 
 Then we say "I am hungry" or "I feel," "I wish," as if it con- 
 stituted all of the ego's interests. When a lesion occurs that pre- 
 vents the organism from becoming integrated into a unity, con- 
 sciousness of self can not occur and only segmental activities go 
 on at a low level of integration, similar to the status at birth or 
 during sleep. We see this behavior in the dumb reflex adjust- 
 ments of the stuporous or the dissociated man or animal when 
 asleep. 
 
 We can only become aware of the activities of our sense or- 
 gans. The phenomenon of consciousness of self or of the envi- 
 ronment is the result of ail the segments reacting together more 
 or less vigorously, as a UNITY, to the sensational activity of any 
 one or several of its parts. The destruction of a contributing or 
 - an integrating mechanism like the conducting optic nerve, or 
 the coordinating visual centers in the cerebral occipital cortical 
 area prevents the organism from reacting as a unity to the activ- 
 ity of the visual receptors in the retina ; hence, prevents the organ- 
 ism from becoming conscious of their reactions. But such lesions 
 in the coordinating areas of the visual apparatus do not indicate 
 the destruction of a " center of consciousness. ' ' One may imagine 
 a lesion in the brain stem that will prevent the organiism or any 
 considerable part from reacting as a unity, thereby obliterating- 
 the organism's capacity to become conscious of itself. This oc- 
 curs particularly in some tabetic lesions in which the organism 
 must apply the visual receptors to the part in order to become 
 aware of its position ; as the man must watch his feet in order to 
 know where they are, or else he will stumble because the organism 
 can not adjust. When a drug (ether) or shock causes uncon- 
 sciousness it does something that reduces the integrating capacity 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY o.J 
 
 of the nervous system and perhaps the irritability of the receptors. 
 When we desire to become aware of the sensation of saltiness 
 we must apply a definite receptor to the stimulus and when that 
 receptor is destroyed Ave lose the capacity to become aware of the 
 quality of saltiness. This principle applies to other capacities for 
 sensations, but in selecting an example one must not overlook the 
 fact that we habitually apply many receptors to an object; hence, 
 have many impressions of it, such as visual, auditory, tactile, kin- 
 esthetic, etc. Crile's method of "blocking" a nerve, through the 
 injection of novocain along its trunk, prevents the nerve impulse 
 from ascending from the receptor to the brain and spreading over 
 the organism in a diffused wave. He has shown that, even when 
 the indi\T.dual is unconscious, under an anesthetic, the destruc- 
 tion of a peripheral nerve causes changes in many cerebral cells. 
 It has been demonstrated by Wertheimer (cited by Cannon) that 
 the stomach's tensions change when painful stimuli are applied to 
 the sciatic nerve while the animal is unconscious. The stomach's 
 reactions are very similar to the reactions that would give fear- 
 ful sensations if the animal were conscious. Hence, it must be 
 recognized that the notion of the cerebral or central origin of the 
 emotions, as such, or of perceptions always preceding emotional 
 reactions, is not acceptable. The only explanation that satisfac- 
 torily covers all the facts is that lue are conscious of representa- 
 tive parts of ourselves, or of our experiences, or the environment, 
 just in the degree with which the body reacts as a UNITY to the 
 especial or sensation producing activity of any one or several of 
 its various receptor fields. 
 
 The nature of the content of consciousness can be entirely 
 explained by the activity of our receptors. The greater part of 
 the active receptor field is the proprioceptive from which 
 arise the kinesthetic sensations of proportion and movement. The 
 content of consciousness may therefore be compared to a compli- 
 cated moving picture of vivid and dim figures which are composed 
 of black dots, and, as the black dots are shifted in their arrange- 
 ments and intensity, the picture changes. Let us assume that each 
 receptor in the body is represented by a dot, and the vigor of the 
 receptor's activity is represented by the vividness of the dot, then, 
 as the various receptor fields become associated together or dis- 
 sociated in. their converging afferent contributions, the content of 
 consciousness becomes changed. 
 
34 PSYCHOPATPIOLOGY 
 
 This is virtually saying, that we think with our muscles, be- 
 cause the kinesthetic impulses (dots) arising from the proprio- 
 ceptors are much more numerous than all the others. For example, 
 if we' allow -ourselves to become aware of the visual image of a 
 moving automobile, the awareness of its movement is furnished by 
 the extrinsic muscles of the eyeball as they shift the image by 
 shifting their postural tensions. Overt movements are not neces- 
 sary unless we desire a very vivid image, then, also, the muscles of 
 the neck may contribute by moving the head. If the image of the 
 moving automobile is one of ourselves pushing it, then the muscles 
 of the body are active to furnish the images (receptor dots), and, 
 if it is to include pushing it through a cold, wet, muddy road, the 
 sensations of coldness and wetness arise fronl the tactile receptors 
 of the skin of our faces, hands, backs and legs. If the description 
 of the experience includes the reproduction of an accident (say 
 slipping), we feel the image of the movement of the slipping in our 
 legs first, and then the remainder of the body adjusting and co- 
 ordinating to the change of posture. (The reader must discrim- 
 inate between this printed word image of the automobile incident, 
 as he reads, and his own visual-motor image as he reproduces a 
 similar fantasy. If the reader will allow the wish to reproduce a 
 fantasy to proceed, he can feel the motor tensions slightly preced- 
 ing the mental picture.) 
 
 The postural motor tensions of our striped muscles contribute 
 the kinesthetic impulses or images of movements that reproduce 
 the experience. If we can not reproduce the movements of the ex- 
 perience we ca/n not recall it. The child, savage and illiterate can 
 much more easily react an experience than describe it and can only 
 vaguely recall the experience if not allowed to react it. Those who 
 have not had the experience of hearing and seeing a savage play- 
 ing a I'botanco" are unable to become conscious of anything more 
 than a vague, indefinite picture, because they can not grossly re- 
 produce the movenients and weird rhythms, but if some one should 
 speak of a small boy playing "In the Good Old Summer Time" on 
 his mouth harp, we quickly get a vivid visual and motor image of 
 it and are therefore able "to think" about it clearly. 
 
 Children, in order to recall an image of an experience, tend to 
 reproduce it with overt movements besides using postural ten- 
 sions. One may often observe adults spontaneously, assuming 
 
PHYSIOI.OGICAL rOXJNDATIONS OF PERSONALITY 35 
 
 overt movements, as in making motions to explain tlie proportions 
 of an experience. While in the droAvsy state preceding sleep we 
 often jerk or find ourselves making reflex movements before we 
 become conscious of the dream-image of doing something, as mak- 
 ing a winning stroke with ^ tennis racket. 
 
 This integrative conception of the personality brings up the 
 question as to what determines, besides the stimulus, the degree of 
 activity of a receptor field and its association with other receptors. 
 It can be sho-\vn that the determining force is the autonomic need 
 or affective craving. That is, our wishes determine the content of 
 consciousness through controlling the postural tensions and overt 
 movements of our miiscles as well as controlling what shall be ac- 
 cepted from our extero-ceptors as stimuli. In this effort to con- 
 trol, the wish is constantly opposed by the environment, hence 
 the environment must be modified to suit, either by changing it, 
 or changing the organism's position in it; as in changing our 
 social positions or business in order to change our obligations so 
 that our affections will be more nearly satisfied. 
 
 When the hunger cravings in the stomach dominate the ac- 
 tivities of the projicient apparatus, they make us become aware 
 of suitable foods and methods and places of getting the food. In 
 producing this awareness, the autonomic apparatus is already on 
 its ivay to get the food. The overt actions that follow only com- 
 plete the journey. This mechanism is also true for fear, shame, 
 anger, grief, the desire to urinate, to copulate, etc. 
 
 When autonomic-affective tensions (anger)- are not permitted 
 to attack the stimulus, say, demand an apology for an insult, one 
 is conscious of a persistent stream of thought as the affect forces 
 us to be conscious of its needs, as well as persistent tensions in 
 the neck, arms, scalp, eyes, face and epigastric region. The af- 
 fective attitude, determining characteristic postural tensions of all 
 our muscles, explains why we think in harmony with the way we 
 feel, and, also, reciprocally, why often w^e are greatly relieved, 
 when in an affective dilenmia, by a decisive thought. This thought, 
 or postural attitude happens to be a suitable resultant for reliev- 
 ing the affective conflict ; as, when we finally assume a conclusive 
 attitude in a dilemma. The cause of the old belief that the mind 
 is in the upper front part of the head is probably due to the con- 
 stant postural activity of the extrinsic muscles, of the eyeballs. 
 
36 PSYCHOPATHOLOGY 
 
 which are the niost active proprioceptor fields, perhaps, in the 
 body. As the source of the most active sensory stream, naturally 
 it is the most prolific contributor to the content of consciousness 
 and causes the organism to adjust more as a unity to activities 
 there than to the activities of any other receptor field. ' 
 
 This now brings us to the significance of conditioning or spe- 
 cialization of our affective cravings. It is not necessary to explain 
 why the itching craving in the stomach (hunger) is best satisfied 
 by certain kinds of food, but it is valuable to understand how such 
 things come about, how it happens that the autonomic status of 
 love or hate requires for each individual quite definitely character- 
 istic stimuli that do not at all suit other individuals. 
 
 Conditioning of the Autonomic-Affective Functions 
 
 The researches of Pawlow, Bechterew, "Watson, Latchley, and 
 others indicate that most reflexes, projicient as well as autonomic, 
 at birth have the capacity to react to certain stimuli which may be 
 said to be the primary stimuli for those reflexes. All other stimuli 
 are, insofar as the particular reflex is concerned, then indifferent 
 to it. When, however, a combination of a primary and an indiffer- 
 ent stimulus ■^is permitted to, intentionally .or accidentally, stimu- 
 late the organism simultaneously for a number of times, the reflex 
 becomes conditioned to react to the formerly indifferent stimulus. 
 If this is repeated often enough, the conditioning becomes fixed, 
 and the associated stimulus may, in turn, become the foundation 
 for still further associations of stimuli, until important reflexes 
 may become very intricately conditioned, or, conversely, com- 
 pounded stimuli may cause very intricate reactions. 
 
 For example, a pain stimulus applied to the hand will arouse 
 a reflex retraction. A color stimulus to the eye (say, red) or a 
 sound stimulus to the ear (say, ringing bell), if associated simul- 
 taneously for a number of times with the pain stimulus, causes 
 the reflex to become conditioned to react when the color stimiilus 
 or sound stimulus is applied to the eye or ear. This conditioning 
 capacity also exists in the different autonomic segments; as the 
 parotid, or sex glands, or stomach, becoming active when certain 
 pietiires, sounds, odors, colors, or subjects that are associated 
 with previous experiences are brought to our attention. The hu- 
 man infant, or puppy -or kitten becomes conditioned to react pleas- 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 37 
 
 antly to the voice, personal and physical attributes of the person 
 who nurses, pets and comforts it. Gradually that person condi- 
 tions the segmental reactions of the entire infant through feeding, 
 bathing, cleansing, nursing, petting, Avhipping, scolding, humor- 
 ing and praising it.* 
 
 It requires no effort of the imagination to recall how our OAvn 
 anger, fear, shame, sorrow and love reactions have been conditioned 
 by experiences to react, despite ourselves, to stimuli that do not 
 affect other individuals. It is also easy to see how an individual 
 may become conditioned to feel anger when he sees a certain per- 
 son or situation and love when he sees another, and then, when 
 they are brought together by some coincidence, the combination 
 arouses bewildering activities in himself because it arouses both 
 vigorous acquisitive and avertive reactions toward the situation. 
 
 It is upon this mechanism that mates often develop the un- 
 fortunate capacity to arouse avertive reactions in one another; 
 through becoming associated with a disgust producing stimulus, 
 such as illegitimate affection for some one who is disliked by the 
 other person. 
 
 It is safe to assume that all organically normal individuals at 
 birth have the inherent capacity to react to appropriate primary 
 stimuli, with love, hate, fear, joy, or hunger, etc. But it is in the 
 conditioning of the segmental autonomic-affective cravings to react 
 to associated stimuli that the individual comes to develop char- 
 acteristic traits. These functions constitute the very foundation 
 of character formation and our vitally important preferences and 
 aversions for different social^conditions. 
 
 We understand how a child's fear, love, hate, disgust, shame, 
 sorrow, pride, himger, and other affections become unconsciously 
 conditioned by experiences and the influence of associates, par- 
 ticularly parents and playmates, to react to people and situations 
 in ways that are excusable while relatively easily compensated for 
 in childhood. But, furthermore, how this same conditioning, when 
 fixed, may cause the most serious anxiety and social criticism when 
 the individual matures, such as the tendency to incest, masturba- 
 tion, sexual perversions, coAvardice, arrogance, narcissism, thiev- 
 ery, lying, etc. 
 
 If one will retrospectively consider his own behavior or study 
 
 *This entire mechanism is so important that it is elaborated in the chapter on "The Psychol- 
 ogy, of the Family." 
 
38 PSYCHOPATHOLOGY 
 
 the behavior of others he will find that his wishes or affections are 
 conditioned to do certain things in order to be gratified and that 
 this conditioning depends npon past experiences and adjustments, 
 and the things that will arouse or gratify similar wishes in others 
 may have an indifferent effect upon him. The affect compels us 
 to avoid everything in proportion as it is not pleasing to the con- 
 ditioned needs and also to seek the especial things that reduce the 
 tension, hence in the treatment of psychoses we must be constantly 
 on the search for the wish-fulfillment and the memories of the ex- 
 periences that so definitely conditioned the craving. 
 
 It is a law, common for all emotions, that no matter what the 
 vdsh, when it can work freely and is realizing gratification, the in- 
 dividual feels a pleasing sense of potency, and, when he can not 
 acquire the object, he feels a certain amount of discomfort, which 
 may "become prolonged and severe under certain conditions. 
 The individual -tends to feel the compensatory striving of anger 
 when food is withheld, or when his time or property is wasted, 
 reputation jeopardized or love seeking infriiiged upon. In other 
 words, no matter what particular autonomic-affective tensions an 
 object or situation relieves, whether hunger, hate, shame, grief, 
 love, etc., its potential loss causes a fear reaction which may or 
 may not be compensated for by anger reactions. The determi- 
 nant for the nature of the compensation lies in the submissive or 
 resistive qualities which the environmental situation has for the 
 individual. Compensation is a most fundamental attribute of 
 living tissue and is in principle like making a compensatory leu- 
 cocytosis for infections or the compensatory hypertrophy of an 
 organ for the painful or distressing insufficiency of another organ. 
 
 The itching autonomic segment and its affective craving are 
 confined by nature to obtaining relief through the successful ex- 
 posure of an especial receptor to an adequate stimulus. When 
 we study the behavior of man or animals, normal or abnormal, 
 this principle must be constantly borne in mind. Most of our 
 segmental cravings come to be so conditioned that the adequate 
 stimulation of any one of several different receptor fields may 
 gratify them. 
 
 The autonomic-affective cravings do not reason. Lilce other 
 physical forces they cease to strive just in proportion as they are 
 neutralized. Therefore, when the perfect reality can not he oh- 
 
PflYSIOLOGIGAL FOUNDATIONS OF PERSONALITY 
 
 39 
 
 taiiied, a substitute is adopted or accepted, as an imar/e, delusion, 
 hallucination, fetich, ritual or sijmhol. The use of rituals, sym- 
 bols and images is adopted or substituted reflexly, and one image 
 is often quickly dropped for a better. On the other hand, he who 
 would force the abandonment of a pleasing image or fetich is at- 
 tacked — as the persecution of religious reformers. 
 
 For example, Frazer* reports that some African savages nail 
 strips of ox hide to their shields and spears to make themselves 
 
 Fig. 2. — African negro wand as a phallus. The glans penis carved as a head and face. 
 
 Fig. 3. — Early Mexican (Aztec?) ceremonial knife as the erect phallus. (By permis- 
 sion of the National Museum, Washington, D. C.) 
 
 feel as strong as the ox, and tie frog skins around their necks to 
 make themselves feel that they are elusive and difficult to hold in 
 combat, because this desirable quality of the frog's skin enters 
 their bodies. No doubt the suggestions and the reflex imitative 
 responses greatly compensate for the inferiorities and prevent 
 fear. I saw children take angle worms, cook them into a paste 
 
 *The Golden Bough. 
 
40 
 
 PSYCHOPATHOLOGY 
 
 Pig. 4-A. — The black line on the vase shows masculine (M) and feminine (F) 
 sexual symbols. The design irst developed in a dream of an unhappy Woman suf- 
 fering from the unresponsiveness of her lover. While completing the design on the 
 vase she became conscious, of its sexual sigjaiAcance ajid its comforting influence. She 
 had the courage not to destroy the sublimation. 
 
 Pig. 4-B. — Symbols of sexual union; the linga-in-yoni and the arba are signs of 
 union; the symbol of wisdom is a male and female triangle joined by the serpent, or 
 passion; the systrum is a symbol of virginity.. 
 
■PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 41 
 
 and rub this into their backs, arms and legs in order to obtain the 
 angle Avorni's power of contorting itself. A little girl's mother 
 drank from a glass of water before going on a long journey. The 
 little girl Avas obsessed with the fear that her mother would die 
 and preserve'd the glass of water to keep her alive. An impotent 
 dementia prsecox male rubbed tallow into his abdominal skin to 
 restore his potency. Some savages sprinkle water on the ground 
 amid religious incantations to simulate rain. This is a common 
 practice in some present-day religions. We collect mementoes 
 and souvenirs, erect monuments, dedicate books, buildings, char- 
 ities, wear colors, styles of clothing, go to the play, attend church, 
 etc., all for the purpose of giving ourselves stimuli that, as sub- 
 stitutes, have the capactiy of relieving the affective cravings, or, 
 by arousing compensatory reactions, diminish the fear of failure 
 and loss of potency. 
 
 It would be very valuable for the physician to know some- 
 thing of the language of symbols which seems to be surprisingly 
 similar all over the world, among all peoples of every educational 
 level. It is the only avenue for understanding a patient's affec- 
 tive cravings in order to work in psychopathology. 
 
 It may be Avell to enumerate here a few of the male and female 
 sexual symbols to be seen used by people, many of whom are not 
 psychopaths : 
 
 Mate genitalia. — Key, pole, stick, gun, pistol, sworrl, knife, tower, monumejit, pillar, 
 post, wire, flower, fish, horse, dog, tree, stone, serew, pencil, pipe, column, snake, worms, 
 rat, mouse, frog, insects entering flowers, fork, spoon, ax, saw, teeth, tongue, finger, 
 toe, broom, leg, arm, watch, clock, stove, number 1 or 3, sheep, lamb, dove, etc. 
 
 Female genitalia. — Beetles, vase, chalice, globe, curtains, earth, flowers, fish, books, 
 bottles, key-holes, lock, food, mouth, hands, wound, violin (female's body), windows, 
 doors, halls, number 2, sheep, lamb, dove, etc. 
 
 Copulation symbols. — Putting key into a key-hole"; killing animals, birds, etc., by 
 shooting or stabbing, sweeping a floor, polishing a floor, cutting bread, entering a room, 
 ascending stairs, insects and birds and butterflies entering flowers, ploughing ground, 
 fires, electricity, flashing lights, injections, numbers 23 and 5, or "2 in 1," or "3 in 2," 
 "3 in 1," etc. 
 
 Seminal symtols. — Almost anything thrown off, emitted or passed off by a 
 larger body, such as sputum, pus, perspiration, urine, feces, scabs, hair, falling leaves, 
 etc. 
 
 Parturition symbols. — Almost anything given off by the body, such as pus, 
 vomitns, feces, urine, etc. 
 
 Impregnation fantasies. — Any odd little trinket in a box, vase, jar, trunk, pack- 
 age, bundle, number 3 or 4, tumors, etc. 
 
42 
 
 PSYCHOPATHOLOGY 
 
 To sum up : It seems that anything that may enter something 
 else, even as a blanket being put into an automobile, may repre- 
 sent the tnale genitalia (in this case, impotent phallus) and the 
 sexual act; anything that is cast off from- the body may represent 
 semen or parturition; and anything retained within something else 
 may represent an impregnation fantasy; anything devouring or 
 liilling something or stealing something may symbolise seduction 
 or rape. 
 
 Vulgar stories, religious rituals, and dreams, psychoses, fe- 
 
 tJ 
 
 Tt-.! 
 
 Fig. 5-A. — Winged phallus or sun disk uniting with another world creating a third. 
 Note. — Figs. 5-A, 5-Bj 5-0, 5-D, 5-E, 5-P are symbols of sexual union, and were 
 drawn by a patient of paranoid homosexual striving. (Published by courtesy of Dr. 
 Mildred Sheetz.) 
 
 tiches and decorations reveal the amazing extent to which symbols 
 are used to relieve oiir autonomic tensions. 
 
 The psychoses presented later will shoAV the use of symbols in 
 innumerable, odd ways, and many of the symbols are logically ex- 
 plained as they are presented. 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 
 
 43 
 
 The presence of the image or symbol in a psychosis need not 
 mean that it has a sexual significaaice. It may gratify quite a 
 different Avish, but, as the professor of surgery advised the medi- 
 
 IHi 
 
 
 Fig. 5-B. — Phallus grasped by arms of crab. The crab as a devouring oauecr often 
 symbolizes the destrucCiveuoss of excessive eroticism. 
 
 cal student, in all lower abdominal tumors in females that have 
 the capacity to menstruate, rule out the possibility of pregnancy 
 first, also, in all obscure chronic diseases, rule out syphilis first; 
 
44 
 
 PSYCHOPATHOLOGY 
 
 SO the psyohopathologist must consider the patient's sexual life 
 in every abnormal adjustment. 
 
 It is a psychological law, universally found active throughout 
 
 ^^. 1 
 
 Fig. 5-O.^Maiden standing over cross inspired by the serpent as the phallus. The 
 cross symbolizes the sexual act. 
 
 the race of Man that children and adults, ivhether savage or highly 
 civilized, will use an image or symbol, or a suhstitute when the 
 
PHYSIOLOGICAL FOUNDATIONS 01? PERSONALITY 
 
 45 
 
 reality can not he obtained in order that the affective craving, no 
 matter what it is, may he neutralized. In this manner, the individ- 
 ual gets relief from the autonomic tension, and, for this reason, 
 the image or symhol has a psijchotherapeutic value, in that it has 
 
 
 
 THE GtAiTtS or HO?N. 
 
 0Aid> Hilt' A^jxh-iuq-fuwii oj -/^^T^^vm., 
 
 Fig. 5-D.^This design show§ the male above united with female below. Above is an 
 algebraic formula used for a similar significance. 
 
46 
 
 PSYCHOPATHOLOGY 
 
 a protective influence against the loss of the true stimulus causing 
 the autonomic apparatus to assume fearful tensions, which are 
 alivays conducive to malnutrition and impotence. 
 
 Fig. 5-E. — The double vase with crossed designs symbolizing sexual union. This 
 design signifies homosexuality and has its origin in the crossed gluteal lines". A series 
 of such drawings were made by the patient while having such cravings. 
 
 If one will analyze the wish-fnlfillment in a scientist's re- 
 searches, an artist's paintings, a writer's characters and theme, a 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 
 
 47 
 
 child's fantasies, a laborer's tools, a housekeeper's choice and ar- 
 rangement of furniture, colors, etc., one will find that it satisfies 
 certain conditioned autonqmic-affectivo cravings. The selections 
 appeal to the individual Avho has similarly conditioned wishes, 
 and, conversely, this la\\- is just as true— it is disliked by the in- 
 dividual who has either i-epressed intolerable wishes that crave 
 the object or has manifest wishes that are imposed upon by the 
 object. 
 
 Fig. 5-F. — Symbol of sexual union, same design as Fig. 5-E but signifying hetero- 
 - ■ . sexual relations. 
 
 In the gravest, most confused psychoses, whether related to 
 organic or metabolic disturbances, the autonomic cravings are the 
 dynamic factor. They determine what environmental conditions 
 will be accepted or rejected by the individual, the practical or 
 impractical nature of his stream of thought and what organs, 
 movements and postures of the body shall become favorites and 
 be cultivated assiduously or shall be avoided and allowed to atro- 
 
4:8 PSYCI-IOPATI-IOLOGY 
 
 phy through disuse, or even be mutilated and destroyed. To il- 
 lustrate: Many prudish young women hold the chest as flat as 
 possible so that the breasts will not be.prominent. The bashful, 
 awkward boy or girl avoids competitions that require the dem- 
 onstration of physical skill because of fear of being inferior, 
 and through disuse- becomes more inferior. One son takes to 
 athletics to win pleasure and esteem and a rival brother becomes 
 a scholar and a third brother, a musician, or two brothers become 
 physicians, and both, trying to become a parent's favorite, hate 
 each other. One daughter physically more beautiful than her sis- 
 ter becomes a society belle, and her sister, desiring the same things, 
 but, being discouraged because her family openly favor the beauty, 
 
 Fig. 6. — Showing sexual significance of postures of fingers. Hands in blessiij^i^,^ 
 First, male trinity; second, Hindu symbol through which worshippers gaze at saerect 
 objects; third, male and female symbols; fourth and fifth, sexual union. 
 
 becomes sullen, brooding and autoerotic. In a similar situation 
 the less beautiful sister imitates a sympathetic, "brilliant," though 
 ugly looking aunt. Narcissistic boys and girls make features of 
 any superior organ that happens to win praise, such as the hair, 
 eyes, hands, voice, face, the dance, etc. 
 
 The chapter on the "UniveTsal Struggle for Virility, Good- 
 ness and Happiness," is devoted to the behavior of males and 
 females, normal and abnormal, in their struggle to master the 
 causes of fear and compensate for inferiorities in order to win 
 virility and social esteem. 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 49 
 
 The Use or Disuse of Organs, The Anesthesia or Hyperesthesia! 
 of Receptors and the Physiological Nature of Memory 
 
 The collection of psyehoneuroses and psychoses will show how 
 autonomic-affective resistance to a receptor lowers its power to 
 produce sensational reactions in consciousness, as in visual con- 
 striction, regional anesthesia, functional anosmia; and, also, how 
 a persistent affective craving increases the receptor's capacity to 
 produce sensations, probably not by directly affecting the re- 
 ceptor, but because the affective craving, through seeking its 
 needs, raises or lowers its reaction threshold to the particular 
 receptor and its stimulus. For example, when we wish to learn 
 through the use of our eyes (reading), while in a noisy room, the 
 affect lowers its resistance to what it sees (reads), and raises its 
 resistance to what it hears or feels, blocking out distractions ; or, 
 when a mother sleeps her autonomic reactions are conditioned to 
 be aroused by those sounds which are characteristic of her baby 
 becoming restless but other sounds are resisted. 
 
 When children are forced to study, or adults are compelled to 
 work with things that their love cravings are conditioned to have 
 aversions for, their capacities for recall and associations of 
 thought become dull, slow and unprogressive ; whereas the same 
 child's learning capacity or the same laborer's or scientist's work- 
 ing ability is tremendously increased so soon as the love cravings 
 can work with a medium that pleases them. This is to be clearly 
 seen in the analysis of Darwin's working capacity as a child and 
 as a man.* 
 
 When an animal, child or adult, educated or uneducated, sane 
 or insane, is forced to attain affective gratification through work- 
 ing with a medium that it has aversions for, its constructive capac- 
 ity is greatly depressed. 
 
 This law should be understood by every educator and advisor, 
 no matter what may be his especial line of work. Darwin, like all 
 of us, found it difficult to learn, remember and use, or do that which 
 did not please his wishes. Plence, in analyzing a man's character, 
 it is to be remembered that he retains what pleases and tend\s to 
 forget what displeases; except when indirectly the displeasing may 
 later become a useful means. 
 
 •Chap. vi. 
 
50 PSYCHOPATHOLOGY 
 
 This has been demonstrated in the psychological laboratory* 
 and verified through psychoanalysis. The content of conscions- 
 ness is largely composed of kinesthetic sensory streams, aroused 
 by the postural tensions, -vvhich please the affect, being retained. 
 In recalling images (memories) of past experiences or of objects, 
 the affect or wish so coordinates the postural tensions and move- 
 ments as to reconstruct a sensory-motor image of the experience. 
 
 The efficiency of the acquisitive coordinations or learning 
 curve when not complicated by fear and aversions may well be 
 represented .by the following experiments : 
 
 "When food Avas held by the hand, under carefully controlled 
 conditions, to a cage in which a hungry monkey was imprisoned, it 
 projected itself in practically a straight line to the food and seized 
 it. Now, when a stick was held by the hand in the same place, the 
 monkey projected itself in a tangled line in back of the cage, show- 
 ing a typical avertive-fear reaction. "When food was placed on the 
 end of the stick, the monkey cautiously approached in a zigzagged 
 line, a compromise between the straight food line of approach and 
 the tangled-avertive-stick line ; showing that a compound or com- 
 plex stimulus or situation may arouse both acquisitive (hunger) 
 and avertive (fear) reactions. The autonomic cravings struggle 
 to dominate the final common motor paths and cause the confused, 
 inefficient coordinations. The less fearfiil man or monkey, given 
 the same acquisitive cravings, therefore generally wins in compe- 
 tition because he coordinates more accurately and freely. 
 
 The above curves or trails of efficiency apply very well to a 
 child learning Avhat it has cravings for from some one it likes (the 
 straight line), as compared to its manner of learning what it dis- 
 likes from someone it dislikes (the tangled line), or learning some- 
 thing it likes from someone it dislikes (the zigzagged line). This 
 applies equally well to the adult working at what pleases his condi- 
 tioned cravings under an encouraging, appreciative employer or di- 
 rector, and the uncomfortable adult who must work at what dis- 
 pleases him. This principle is also shown in the marked difference 
 in the constructive, and destructive compulsions of the happily and 
 imhappily married. 
 
 The unbiased study of human behavior in males and females 
 sho\YS that both sexes, at all ages, must constantly strive to main- 
 tain a relatively high quality of virility and efficiency, and, no mat- 
 
 *I/angfeld, li. S.: Psychological Keview Publications, xvi, No. 5, 1914. 
 
PHYSIOLOGICAL FOUNnATIONS 01? PERSONALITY 51 
 
 ter what course is pursued it must be a protection from fear of 
 possible failure due to the superiorities of a rival or disastrous 
 incidents in the environment, such as accidents, responsibilities, 
 failure, etc. Compensated fear causes a convergence of the l)lood 
 supply upon the liead, arms, and shoulders, and prevents sexual 
 potency by depriving the pelvic vessels of sufficient blood. Hence 
 the cause of fear must be counteracted by a fetich or faithful rit- 
 ual. This fact is not believed by many because they regard their 
 sexual interests as something other than admissible to a refined 
 state, and by keeping the sexual cravings repressed so that the 
 latter must use obscure symbols and disguised fantasies the indi- 
 vidual maintains that he has freed his ego from the influence of 
 the sexual autonomic segments. Only those individuals make such 
 repressions who dread- the peculiar requirements of their sexual 
 cravings and the resiiltant course of adjustment is always char- 
 acterized by a semifanatical or prudish castration tendency. 
 
 A large, vigorous, well-developed army officer, 48, consulted 
 me for relief from high blood-pressure (180-200), cardiac palpita- 
 tion, and the fear of dying from cerebral hemorrhage due to his 
 assumed "arteriosclerosis." Eepeated physical examinations by 
 competent men showed no physical lesions or arteriosclerosis. 
 (Cannon has demonstrated the compensatory value of increase of 
 blood-pressure and cardiac systole during fear.) The man's self- 
 exhibitionistic behavior, conspicuously checkered clothing, button- 
 hole carnation, eccentric movements that attracted attention, and 
 his general attitude of making himself the center of attention, 
 indicated that he was suffering from an unavoidable feeling of 
 social inferiority. Several of his family had died from heart 
 lesions and cerebral hemorrhage, and this suggested the specific 
 grounds of his fear and seemed to be sufficient cause to his phy- 
 sician. 
 
 ' The psychoanalysis showed that he had repressed his, sexual 
 cravings from acquiring a heterosexual object because (1) he loved 
 his mother too devotedly to love smother woman, she clung to him 
 most persistently, and (2) woman stood, not for love, but sj'-philis, 
 social scandal, blackmail, or impregnation. Hence, the female's 
 sexual approach did' not invigorate him but aroused a sexually 
 depressing fear reaction. Since he could not love a female his 
 sexual cravings were strongly reacting to homosexual situations, 
 and fear of this inferiority caused his overcompensation of os- 
 
52 PSYCHOPATHOLOGY 
 
 tentatiously assuming masciiline traits even though they became 
 so grotesque as to be reflexly scorned or ridiculed by other men. 
 His persistent fear of becoming homosexual (subconscious) 
 had aroused the compensatoiy autonomic striving and explained 
 the cause of his increased blood-pressure. When he acquired in- 
 sight and learned how his selfishness was ruining his heterosexual 
 potency, he made a quite comfortable readjustment, and his blood- 
 pressure soon subsided to about 160. Thq. course of his blood- 
 pressure must be expected to vary with the hygienic nature of his 
 affective adjustment. 
 
 The Complex Nature of the Autonomic-Affective Stream 
 
 Since all of the autonomic apparatus is more or less active all 
 the time, the stream of cravings flowing from its tensions is more 
 or less active; that is, all of our wishing functions whether we are 
 conscious of them or not are more or less active all the time. Each 
 moment's behavior is the resuUcmt of the Tnanner in which the 
 cravings, reenforcing or inhibiting one another, converge upon the 
 striped muscles; hence, upon the sequence of acts or stream of 
 activity, and the content of consciousness. 
 
 In the lower animals and children it is quite easy to arouse a 
 wish and see its influence upon behavior, but in the matured male 
 and female, civilized, the nature of the dominant wish is often 
 neatly disguised behind other more manifest wishes. This is due 
 to the necessity for each individual in civilized society to acquire 
 social approbation or esteem for his wishes and avoid censorship 
 in some direct or indirect form. 
 
 The Development of the Ego 
 
 The struggle to acquire the approbation and esteem of the 
 social group and, more important, of those few particular indi- 
 viduals whom we love, fear or hate, is a vital determinant of our 
 behavior. One rarely does anything without having thought, more 
 or less, of how some other person may censure or esteem it. Or- 
 dinarily, one is inclined to regard himself as an absolutely inde- 
 pendent personality, but, in reality, there is no such thing, except 
 perhaps in certain types of pernicious deterioration of the per- 
 sonality. 
 
 The need for social approbation begins with nursing, and has 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 53 
 
 its root, no doubt, in- the years of helpless dependence upon some 
 other person npon whose wishes and favor most comforts and life 
 itself depends. The child becomes conditioned to fear losing esteem 
 and favor when heedlessly indulging in segmental pleasures, such 
 as anal and genital sensations, slobbering, finger sucking, stealing, 
 asocial behavior. This dependence becomes further developed 
 through loneliness, illness, and the prospective dependence of old 
 age. Nearly all of our comforts should be and are obtained 
 through the direct or indirect assistance of other individuals, and 
 we depend upon the reactions of others to our achievements for 
 orientation as to our social fitness. One may observe this in the 
 innumerable little tricks of speech and behavior people use in 
 order to win a pleasing comment of esteem for some act, creation, 
 sacrifice, accomplishment, discovery, ideal, etc. 
 
 The most important factor in an adult's career is the measure 
 of security and confidence other adults have in his honesty, sin- 
 cerity and integrity. Hence, very rarely can an individual afford 
 to gratify any particular wish that may jeopardize the wish for 
 social esteem, unless, like the thief and prostitute, he becomes will- 
 ing to renounce all interest in true social esteem and regress to a 
 lower social or phylogenetic level where he may associate with in- 
 dividuals who gratify their cravings in a similar manner. 
 
 The individual's cravings for social esteem become the most 
 manifest and persistently active of all the compensatory auto- 
 nomic functions because from infancy to old age he is conditioned 
 to obtain his needs in a lawful, fair, equitable, justifiable manner ; 
 that is, in a manner that will give satisfaction to or at least will 
 not jeopardize others. 
 
 The herd, beginning with the parental influence in the home, 
 trains the infant to contribute to the general progress of the herd's 
 development. The infant's segmental cravings (as nursing and 
 defecation) are early counterbalanced by developing wishes to con- 
 trol them in order to please the mother and mn her favors. These 
 Avishes are jeopardized by heedless self-indulgence and the fear 
 of losing favor and esteem initiates more vigorous compensatory. 
 striving to prevent a recurrence of submitting to the segmental 
 indulgence. We see the infant defecating or crying heedlessly, 
 then gradually forces develop in it that try to prevent defecating 
 except under certain conditions. This struggle is particularly 
 
54 PSYCHOPATHOLOGY 
 
 common in overcoming the segmental pleasures attendant upon 
 bedwetting, stealing and lying. At first there is but little success, 
 but as the act is followed by greater fear the latter initiates 
 stronger compensatory strivings to control the segment, which suc- 
 ceed in preventing the segment from controlling the striped muscle 
 apparatus under most conditions, and finally altogether. When 
 the segmental indulgence not only has the pleasant value of warm 
 sensations but also dominates the mother, punishes her, or wins 
 attention during the lonely night, or comes to have an erotic value, 
 as a birth fantasy to please the father, the compensatory striving 
 for self-control must be decidedly greater and more difficult. 
 
 Obviously what occurs is that whenever the projicient appa- 
 ratus is allowed to be controlled by a segmental craving and the 
 indulgence does not jeopardize the functions of the other segments 
 no compejtisatory defense occurs, as an animal or child taking food 
 or urinating as it pleases without fear of punishment. But when 
 other autonomic segments are jeopardized by yielding to' some 
 segmental craving they tend to keep control of the projicient appa- 
 ratus and thereby prevent the segmental indulgence because, al- 
 though, the indulgence has its pleasures, it is followed by fear of 
 punishment or loss of esteem. That is, the autonomic apparatus 
 (gastric, circulatory and respiratory segments) reflexly assumes 
 tensions which are anxious or fearful and which initiate a com- 
 pensatory striving to prevent a repetition; as in the fear and de- 
 pression following masturbation. Autoerotic people make the 
 common complaint that for several hours or days following the 
 indulgence they suffer from a horrible sense of inferiority, fear of 
 discovery and shame which is followed by firm resolutions (com- 
 pensations) to prevent a similar recurrence. After several days 
 the conditioned sex organs again tend to become congested by 
 certain stimuli and the sexual (segmental) cravings become more 
 active until they finally dominate the entire organism and the 
 resolutions to maintain self-control and win social esteem are 
 again overcome. This sort of struggle goes on incessantly with all 
 sorts of simple and complex segmental cravings in the child, as 
 oral and pharyngeal (sucking, eating, drinking), gastric (drink- 
 ing, eating), anal, urethral, and genital itchings, and they must be 
 thoroughly controlled by the time the individual becomes an adult. 
 Those who tend to allow themselves to become avaricious, envious, 
 
PHYSIOLOGICAL FOUNDATIONS OP PERSONALITY 55 
 
 jealous, slothful, gluttonous, erotic under perverse conditions, or 
 those who can not prevent such segmental reactions are most de- 
 cidedly shunned, ridiculed and punished if they can not be ostra- 
 cized. 
 
 The innumerable compensatory strivings of the autonomic 
 apparatus that become conditioned to attain social esteem as well 
 as segmental gratification become integrated into a imity or ego 
 which is opposed by the segments which tend to compel actions 
 that may jeopardize the ego. In this manner the conflict between 
 the ego and the not quite socially justifiable or utterly unjustifiable 
 cravings becomes established and is incessantly waged even in the 
 normal. In the psychoses the conflict is far more severe than nor- 
 mal, due to the vigor of the segment or the weakness of the ego. 
 
 This peculiar striving of the autonomic apparatus to act as a 
 unity, in order to control an individual segment, develops gradu- 
 ally, and should be regarded as a compensatory reaction to di- 
 rectly avoid the causes of pain and fear, and, indirectly, to retain 
 love. When the child has developed the power to reliably control 
 the more simple autonomic adjustments, such as the eliminative, 
 it achieves its first great social triumph. When this capacity be- 
 comes so soundly established that no tendency to segmental indul- 
 gence remains, the individual's strivings change their tendencies 
 and, feeling its power, it begins to strive directly, more and more, 
 to win love and esteem, and, indirectly, to control itself. Adults 
 who suffer from "self -consciousness" failed to make this change 
 in childhood. The supreme triumph comes with the gradual com- 
 pensatory development of the power to control fear, self-doubt, 
 gluttony, envy, sloth and narcissism; usually from fourteen to 
 eighteen. This compensatory mechanism applies also, obviously 
 enough, to perverse sexual and homosexual interests, and must 
 not be considered in the sense of applying merely to the act of mas- 
 turbation, but to all the fancies, movements, interests, associa- 
 tions etc., that are related to autoeroticism. Most boys, when they 
 conquer the autoerotic cravings, develop an aversion for all the 
 associations that are connected with them, and compensate with 
 high resolutions to enrich society. 
 
 One must, therefore, see that, slowly, but incessantly, from 
 infancy, the autonomic apparatus develops a compensatory capac- 
 ity to act as a sociaUsed unity in order to control the segmental 
 
56 PSYOHOPATHOLOGY 
 
 cravings, and these compensatory* cravings, through their condi- 
 tioning by associated stimuli, gradually become interwoven into a 
 personality as a unity of constantly active wishes. This imity re- 
 sponds to the mother's address of "yon," or "John." The child 
 begins to think of itself, as "John won over the bad little boy" or 
 bad impulse or spirit or devil. In this manner is slowly developed 
 the I, Me, Myself and the Not-I, Not-me, Not-myself. When the 
 personality or organism acts as a unity with the hunger cravings, 
 v/e say, "I am hungry." When the personality wishes to do some- 
 thing and hunger is disconcerting us, we say, "my hunger," or 
 "this hunger." 
 
 Gradually, in youth, this mechanism develops into the 
 "good," "conscientious" I and the evil, uncontrollable Not-I. 
 Many people are stillinclined to differentiate this as the "soul" 
 striving against the "flesh" or the "devil." In the chronic func- 
 tional deteriorations, the segmental cravings become dissociated 
 and the "I" interprets the dissociated wish and the behavior it 
 produces as another personality. This mechanism is of the ut- 
 most importance to the insight of the psychopathologist, and for 
 all people who wish to relieve the suffering and anxiety that is 
 caused by the eternal feud between the ego and the segment. It 
 will be discussed in detail in the chapters on the psychoses. 
 
 Any man or woman may learn to know, upon introspective 
 self-analysis, that anxiety is generally due to fear of the possibility 
 of failure to live at the level that pleases his refined wishes best. 
 The possibility of failure may be caused by a disease in an im- 
 portant organ or by the pressure of an unmodifiable, persistent 
 affective need that we can not or dare not permit to acquire grat- 
 ification. 
 
 The Mechanism of "Transference" 
 
 This is the key to successful psychoanalysis and psychother- 
 apy, and upon it depends the physician's ability to sincerely 
 appreciate the patient 's conflict. He must genuinely wish to assist 
 the patient for his welfare and the welfare of society and the 
 analysis must proceed upon a clearly defined altruistic basis. The 
 physician must not become a censor, moralist, or temptation. He 
 must remove, as soon as possible, the fear of censure in order 
 that the repressed functions may manifest themselves. The phy- 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 57 
 
 sician represents the highest reconstructive interests of society; 
 hence, so soon as the patient confidently feels that the revelation 
 of his repressions will not lose for him the physician's esteem, he 
 quickly begins to show a relief from anxiety ; that is, relief from, 
 fear of the affective cravings that he has repressed (that he tried 
 to " forget '■') because they Avere "selfish," "vulgar," "per- 
 verted," etc. In turn the functions to love become reestablished 
 and this force makes life worth living and suffering. For a time 
 this affection transfers or attaches itself to the physician and 
 works to make the personality attractive to him thereby giving up 
 the delusions for methods of thinking that win his confidence. 
 Thus is developed the bridge to normal, practical interests, new 
 "will power" and neAv love attachments. 
 
 Before considering the mechanisms of suppression and re- 
 pression of affections or cravings, the physiological nature of the 
 will must be considered. The riddle of the nature and origin of 
 the ivill, which has baffled philosophy and psychology since man be- 
 gan to assume its existence, may be remarkably clarified for the 
 student if he ynll follow Holt's suggestion to see the ivill to be or 
 the ivill to have as the wish to he or the trish to have. 
 
 Origin and Nature of "The Will" 
 
 When Ave will to do this or that, go here or there, rve really 
 WISH and compensate or strive, ivithout restraint, in order to 
 overcome the potential possibility of failure to obtain gratification. 
 This capacity should be assiduously cultivated by the individual 
 throughout life provided it does not make him asocially aggressive. 
 
 It should become, with reserve, a consistent attitude toward 
 everything in the environment. The affect craves for an event or 
 an object, and the likelihood of its not becoming a pleasing reality 
 causes a more or less vigorous fear producing reaction in the 
 autonomic apparatus, in proportion to the seriousness of the msh 
 and the likelihood of its not being gratified. The fear reaction, in 
 turn very quickly arouses a reflex compensatory speeding up of 
 the autonomic apparatus, as sho'wm by Cannon and others, in the 
 increased rate and strength of the heart beat, increase of adrenin 
 and sugar in the blood, and an appropriate shift of the blood sup- 
 ply to the Avorking parts.- This compensatory increase of physio- 
 logical power, greatly envigorating it, enables the ivish to attack 
 
58 PSYCHOPATHOLOGY 
 
 and reconstruct the environment so that at a certain time certain 
 events must occur. 
 
 This mechanism Avorks incessantly in every person's daily life 
 in a ceaseless stream of minor events. When I wish a pencil, I 
 must compensate for the pencil's failure to place itself in my hand 
 by picking it up, an aggressive act. When I need someone's as- 
 sistance, I must compensate for the discomforts caused by not hav- 
 ing it, by expending the energy which has been aroused by the in- 
 conveniences of the situation, and seek it. 
 
 The man, who, after due consideration, allows himself to wish 
 to have an object, such as a position, factory, invention, be an hon- 
 ored guest, conduct a hazardous responsibility to a successful con- 
 clusion, or make a scientist of himself, naust not only be able to 
 wish for the event, but be able to freely and successfully compen- 
 sate for all the fears of faihore that may arise. In proportion as 
 his compensatory powers begin to fail, the weakness of his so- 
 called "will poiver" becomes manifest. When we wish for an 
 event, but do not act to make its fulfillment possible the wish is 
 only strong enough to cause awareness of its need (thought) and 
 not strong enough to act. Through the introspective analysis of 
 the occasions of what might be called increased will power in my- 
 self, I have been able to find a repressed, banal fear of losing the 
 thing I wished to acquire. For example, while working on a manu- 
 script, my capacity to coordinate details and to visualize the object 
 for which I was striving (demonstration of a theory) had greatly 
 subsided, and, for several days, I could get nothing done. Then, 
 one day, about noon, the capacity to work had become greatly ac- 
 celerated. This acceleration had occurred so spontaneously that 
 it was well under way before I realized it had occurred. At first, 
 I could not account for it. No one had relieved any diffident, re- 
 pressive tendencies in myself through an expression of esteem for 
 my work, but, with further recall, I became aware of the fear that 
 another psychopathologist, who was acquainted with my material 
 and theory, was finding it difficult, revealed in his manner of say- 
 ing what he would like to do, to refrain from usurping my rights. 
 The only practical defense was being reflexly made through vigo- 
 rous self-assertion which discouraged the other man. Within a 
 few minutc>s the vigorous autonomic compensation for the fear of 
 the possibility of losing the fulfillment of an important wish began 
 
PHYSIOLOGICAL FOUNDATIONS OF PEBSONALITY 59 
 
 to show itself in an aggressive onslaught upon tlie environment, 
 my data, making it conform to please the wish by assuming the 
 form of a completed article. 
 
 The grand, old law, that "honesty is the best policy," has a 
 critical significance in the development of personal power. It 
 often requires the endurance of great anxiety to honestly endure 
 the prospect of failure, particularly when a dishonest adaptation, 
 as a lie, secret, or malicious advantage may give temporary relief 
 or advantage. But the enduring of the anxiety, in turn, gives the 
 individual a sublime reward, in that the autonomic apparatus is 
 so constituted that the situation forces it to augment its vigor and 
 thereby develop additional skill, endurance, insight and power. 
 One may see this compensatory mechanism wonderfully developed 
 in such remarkable characters as Charles Darwin. (An analysis 
 of his personality is included in the chapter on the anxiety neu- 
 roses.) 
 
 The failure to endure anxiety makes the vicious, secret, in- 
 triguer, the pathological liar, the drug liabitue, the shyster, etc. 
 Society can only protect itself from the destructive influence of 
 such dishonest adjustments ))y resolutely, promptly, severely pun- 
 ishing' the perpetrator of asocial acts. Because, then, the greater 
 fear of punishment will influence the individual to endure the 
 lesser fear of failure until the compensation is established. Then 
 the individual becomes a stronger link in the social chain. 
 
 The so-called paraphrenic .types, that is, individuals who are 
 "Aveak of will," fail to make socially approvable adjustments be- 
 cause of the poorly developed nature of the wish to be socially 
 esteemed. This is due, in turn, to the nature of the conditioning 
 of the love cravings during youth and the insidiously repressive 
 influence of more powerful, competing hostile associates, usually 
 a parent or mate. 
 
 The self -lover or autoerotic type naturally sacrifices society's 
 interests in the innumerable petty crises as well as in the greater 
 crises, in the sense that he would rather gratify his cravings with 
 dream images of the reality than woi'k for the reality in a manner 
 that has a practical social value also. This is not his conscious 
 choice, but, during his growth, his parents failed to give him suf- 
 ficient love and esteem without cost during critical tests. (This is 
 clearly brought out in the masturbation difficulties of Case AN-3 
 
60 PSYCHOPATHOLOGY 
 
 and many others.) The attitude of wishing to be esteemed was 
 not developed sufficiently to endure the stresses of competition 
 when a more self-reliant older rival had to be beaten. Hence, the 
 timid retreat into autoeroticism where no rivals care to or can 
 enter. 
 
 To sum up: The "will-to-become" is the same as the wisTi- 
 for-esteem and the ivish-to-have. It is the autonomic apparatus' 
 reflex compensation to prevent fear of the estimable or justifiable 
 wish's failure to acquire gratification, or to prevent the asocial 
 wish from jeopardizing the organism as a whole that gives us the 
 power to endure anxiety and refine our methods. 
 
 (In the chapter on "The Universal Struggle for Virility, 
 Goodness and Happiness" it is necessary to give considerable im- 
 portance to the manner in which mortal struggles between father 
 and son, mother and daughter, husband and wife, may force one or 
 the other to abandon the struggle for virility and power unless 
 they develop considerable insiglit.) 
 
 This now brings us, logically, to the significance and mecha- 
 nism of the affective conflict between what may be designated as 
 the socialised wishes of the personality, which constitute the erjo, 
 and the perverse, segmental craving, or wish, that arises from 
 some individual autonomic segment, as the digestive or sexual 
 apparatus. 
 
 To illustrate: The hunger craving in the stomach may, 
 through its compulsive powder, place the entire organism and its 
 future in jeopardy by forcing the stealing of fdod. This compel- 
 ling influence occurs much more commonly in the commitment of 
 sexual transgressions; particularly when the compulsive craving 
 for autoerotic, or perverse homosexual, or incestuous indiilgence 
 is "insistently forcing itself upon the individual. This sort of inter- 
 autonomic-affective conflict, it will be shown, is the mechanism 
 that produces the destructive psychoses, and is to be found under- 
 lying every functional deterioration of the personality. Where the 
 sexual cravings support the ego or socialized wishes of the per- 
 sonality, if of a high order, the individual becomes virile, good and 
 happy, and a most constructive social influence. 
 
 Out of the affective conflict between the cravings of the or- 
 ganism as a unity, and the cravings of a segment or segments for 
 control of the final common motor path of adjustment, arise the 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 61 
 
 mechanisms of suppression, repression, the summation of allied 
 cravings, and the summation of the antagonistic cravings, disso- 
 ciation of the personality, or affective readjustment, with satis- 
 factory compromises as sublimations. 
 
 Affective Adjustments 
 
 Sherrington has shown, to repeat, and Cannon and others 
 maintain that the following mechanism holds for the autonomic 
 apparatus: Wherever two neurons simultaneously converge 
 upon a third that is efferent to them, in order to direct its move- 
 ments, the mechanism of reenforcement or of inhibition may occur, 
 depending upon whether or not, the impulses are allied or antago- 
 nistic in their tendencies. 
 
 The mechanism of affective suppression may therefore be ap- 
 plied to those instances, almost continuously occurring in every- 
 day life, when the individual must prevent a wish to act from con- 
 trolling his behavior, (such as to be negligent or show anger to a 
 superior officer w^hile, at the same time, an obedient attitude is 
 necessary). Under such conditions we do not "forget" the wish ; 
 that is, we allow it to cause us to be conscious of its needs but are 
 dominated by other wishes that prevent the anger from freely 
 dominating the projicient sensorimotor apparatus. 
 
 Affective repression occurs when we prevent the wish from 
 making us conscious of its needs ("forget it"). The difference 
 between affective suppression and repression lies in the degree 
 with which the wush is prevented from controlling the projicient 
 apparatus and arousing an appropriate kinaesthetic stream. In 
 all cases, the wish is inhibited because we are afraid its conse- 
 quences will jeopardize the whole personality if allowed free play. 
 An inhibited wish or affective craving, being the sensations caused 
 by the hypertension of an autonomic segment, persists so long as 
 the hypertension of the autonomic segment exists. This tension, it 
 seems, can not he relieved except through the acquisition of ap- 
 propriate stimuli. Certain stimuli come to have the capacity, 
 through the manner in which the segment has been cond&tioned, to 
 couhterstimulate a comfortahle adjustment of the viscus. The 
 avoiding of the stimuli that have the capacity to stimulate the 
 visctis to become hypertense often becomes a necessary hygienic 
 measure whenever the individual is unable to acquire the means 
 
62 PSYCI-IOPATI-IOLOGY 
 
 that can give him relief. This can be seen in the careful manner in 
 which Darwin avoided personal conflicts because he was nnable to 
 control the genesis of cravings, which, in turn, tended to demand 
 submissions from others. All people eventually become forced to 
 evade many situations for which they are conditioned to have un- 
 comfortable reactions. 
 
 Hence, the psychopathologist must recognize that," during sup- 
 pression or repression of autonomic-affective cravings the indi- 
 vidual merely walls in the wishes but does not disintegrate them. 
 Moreover, although we may be no longer aware of their true na- 
 ture or the manner of their genesis, we, nevertheless, feel physical 
 disturbances, such as localized or vague tensions, inability to work 
 or think Avell, the tendency to make mistakes, have a poor appetite, 
 sleep restlessly, etc. The repressed affections are incessantly try- 
 ing to force us to become conscious of their needs; that is, to dom- 
 inate our behavior so that they can obtain gratification ; and they 
 may be seen to seize upon the slightest opportunity that may pos- 
 sibly bring relief. This is evident in our dreams, errors, selec- 
 tions, prejudices, the tensions we feel when we have forgotten to 
 do something important and the neuroses and .psychoses. 
 
 The seriousness of autonomic repression depends, largely, 
 upon the nature of the segment involved axid the importance to 
 the daily life of the circumstances attending the repression. This 
 may be estimated only through a study of the patient's affections 
 and his responsibilities. 
 
 The tendency to suppress our affections may accumiTlate ; that 
 is, a summation of the repressing or suppressing egoistic wishes 
 may occur, usually through the influence of puritanical associates. 
 Also, a summation of the repressed and suppressed autonomic ten- 
 sions may occur and they can not be prevented from showing their 
 influence on the postural tensions of the striped muscle apparatus, 
 as in the summation of fear through a series of dangerous ex- 
 periences. Through the summation of proprioceptive and exoge- 
 nous stimuli (the kinaesthetic stream of erotic imagery and the 
 influence of an attractive person) the repressed affect may become 
 so vigorous that an acute, mild or even severe, dissociation of the 
 personality may result. The repressing or socialized wishes for 
 esteem (which constitute the ego) become unable to prevent the 
 tense repressed autonomic segment from forcing the organism to 
 
PHYSIOLOGICAL FOUNDATIONS OV PERSONALITY 63 
 
 be conscious of its needs. Logically, the manner in A\'}iicli the 
 individual becomes conscious of the needs of the dissociated seg- 
 mental cravings is in the form of obsessive thoughts, phobias, 
 compulsions to bring about a particular act, or confusing wish- 
 fulfilling sensations, dreams, delusions and hallucinations, and 
 distressing bodily sensations. 
 
 The mechanism of Avisli-fulfillment in the dream, delusion, cre- 
 ation, fantasy and hallucination should be thoroughly understood 
 by anyone professing to have a serious interest in psychology and 
 psychopathology. 
 
 It has been pointed out in the discussion of the peripheral or- 
 igin of the affective craving and its means of obtaining gratifica- 
 tion, that, through the tense segment striving to be restored to a 
 degree of comfortable tension, the autonomic apparatus has the 
 capacity to force the projicient or striped muscle apparatus to 
 la'dke such movements and assume such tensions as are appropri- 
 ate for so exposing the exteroceptor as to (1) avoid the unsatis- 
 factory stimuli in the environment, and (2) to acquire satisfactory 
 stimuli from the environment. But, also, through this means of 
 controlling the postural tensions of the striped muscles, the kin- 
 aesthetic stream- of sensory images is regulated. The affective 
 craving makes the individual aware of such kinesthetic images 
 of previous experiences as are suitable to gratify the craving [as 
 gastric (segmental) hunger and the thought of how, where, and 
 when to get food]. Whenever the individual has repressed crav- 
 ings which resist assuming a submissive attitude when dominated 
 by an aggressor, he finds that it is almost impossible to forget the 
 domination and think freety or impartially about another subject. 
 When the wish recalls or reconstructs an insulting experience we 
 actually reproduce an image of the experience liy reproducing ap- 
 propriate postural tensions which give us the kinesthetic images 
 of the experience. This can be seen in children and in ourselves 
 when trying to adjust an old quarrel. 
 
 We only know the ultimate nature of why, vhnt, or how an}'- 
 thing is by wTiy, what or hoiv it is not. That is, by comparing an 
 object or beha^dor of a person Avith similar objects, persons, or ex- 
 periences and diife-rentiating it from dissimilar objects or experi- 
 ences, we estimate its nature, physical qualities and affective 
 value to us. Our capacity to understand anything depends upon 
 the nature of this imitative or apperceptive capacity. As ire are 
 
64 PSYCHOPATHOLOGY 
 
 able to accurately reproduce the factors in an environmental situa- 
 tion of the present moment, we are able to foresee the fivture re- 
 sults and, accordingly, make practical efficient adjustments. Our 
 apperceptive functions, however, depend, fundamentally, not only 
 upon tlie organic construction of the peripheral sense organs, and 
 the integrative capacity of the nervous system but, more so, upon 
 the way they are used by our affective needs, Therefore, when we 
 can not avoid unduly including irrelevant Avish-fulfiUing sensory 
 images, that is, images or fancies of past pleasing experiences, in 
 a present situation, our adjustment will be proportionately im- 
 practicable. We fail to be practical in so far as undue fancies are 
 injected into the situation, as the anxious lovesick girl reads wish- 
 fulfilling meanings in her indifferent idol's manner of accenting 
 words, his looks, signs, etc. Southard gave an example of an or- 
 ganic foundation for a delusion in a woman who repeatedly said 
 she had been shot in a certain spot in the thorax with a "seven 
 shooter. ' ' Upon autopsy, a plural adhesion was found under that 
 spot, which probably accounted for the local pain delusionally at- 
 tributed to the shot. The psychopathologist and psychologist can 
 not, however, accept the single fact, the adhesion, as a complete 
 explanation of this delusion, because it does not explain why she 
 said she was "shot" and why she said a "seven shooter" did it. 
 Why did she not say she was stabbed, etc., or according to Der- 
 cum's idea of the influence of suggestions accounting for delusions, 
 why did not the old lady accept the diagnosis of an intrathoracic 
 disease process? 
 
 (Throughout all the cases presented in the following chapters; 
 it is the endeavor to demonstrate that all creations, delusions, 
 dreams, hallucinations, psychoses, gratify autonomic cravings that 
 can not be gratified by external realities because social conventions 
 and obligations force the ego to prevent the autonomic cravings 
 from acquiring the external stimuli which they are conditioned to 
 need. Many psychoses will be shown in which the dream, delusion 
 and hallucination are so obviously produced by the same affective 
 need that it is not necessary to give a series of examples here.) 
 
 It is usually so easy to recognize the compelling wish in a psy^ 
 chotic's behavior that one needs only to learn how to look for it. It 
 is important, however, to bear. in mind that often the Avish that 
 produces the behavior, say the -wish to go back to a past experience 
 and reconstruct it, is not the fundamental cause of the difficulty; 
 but is a resultant compromise between conflicting wishes. For ex- 
 
PHYSIOLOGICAL FOUNDATIONS 03? PERSONALITY 65 
 
 ample, one of our cases lias, for six months, been screaming that 
 she wants to go back one year, six years, twenty years, etc., in order 
 to start life over again. After cantious inquiry, we found that this, 
 in turn was due to the conviction that she had ruined her woman- 
 hood through masturbation which began in childhood. This, in 
 turn, upon analysis, as is often shown, as in Case AN-3, is due to 
 the domineering resistance of some adult (parent) preventing the 
 love affections from frankly competing for a certain heterosexual 
 love-object. 
 
 Art and literature, as the illustrations show (see Mars and 
 Venus, etc.), are literally composed of images that allow the so- 
 cially tabooed or repressed affect to obtain some gratification 
 through the use of a symbol which is substituted for the reality. 
 
 On the other hand, the affect may not be repressed, but, be- 
 cause it is physically impossible to obtain the reality, it may use 
 an image to ol)tain gratification, as in the imitative, "make-be- 
 lieve," play of children or the savage's manner of substituting 
 an energizing image for the reality, as in imitating rain by sprin- 
 kling water on the parched ground, or the civilized man cherishing 
 a photograph, memento, autograph, memory, etc., or the delusions 
 of a psychopath. 
 
 ."When the repressed affect can not be controlled by the social- 
 ized wishes, the ego becomes more and more inclined to regard its 
 influence as the work of another personality, and, throughout the 
 psychoses later presented it will be seen that the patients speak 
 of it as "God," "the devil," "they," "a secret society," "the 
 president," "bad blood," etc. Most commonly, "they" is the term 
 used for the dissociated affect. But, often, when the affect is de- 
 cidedly conditioned to react to some definite person, the patient 
 openly blames that person for having hypnotic powers over him, 
 and the "voices" heard, or the "pictures" seen, are "thrown into 
 the mind" by a "brain machine," etc., supposedly under that per- 
 son's direction. 
 
 Intoxications due to disease, exhaustion or drugs, or a serious 
 disappointment, depress or weaken the ego 's wishes to attain social 
 esteem. That is, since the latter are composed of compensatory 
 functional integrations of the nervous systein superimposed to con- 
 trol the segmental cravings from asocial influences, they tend to 
 weaken first, and then, the repressed affect forces the individual 
 
66 ' PSYCHOPATHOLOGY 
 
 io become conscious of thoughts and sensations, such as tactile, 
 auditory or visual hallucinations, constituting the delirium or 
 psychosis, which in some manner gratify the affect. 
 
 As the vigor of the repressed, dissociated affect subsides, the 
 vividness and persistence of the hallucination subsides. As the 
 hallucinations weaken, grow dimmer, the socialized ego, if it be- 
 comes reorganized, again becomes able to direct its attention upon 
 subjects that gratify its practical needs for social esteem. Just in 
 proportion as the individual grows able to prevent himself from 
 becoming conscious of the sensory image, he begins to doubt its 
 being an external reality. We attribute the quality of reality to 
 the persistence and vividness of the sensations wMcJi objects in 
 the environment force us to become conscious of when we expose 
 our receptors to them; as when we can not "believe our eyes" or 
 "ears" we try to touch the object. This mechanism applies also 
 to the hallucinated image, the delusion and the dream. The dream 
 is often so vivid that it has the physiological effect of an actual 
 experience. If the reader will bear this in mind, when reading the 
 case records, it will become quite obvious that the mechanism of 
 the fading obsession or delusion is due to the assimilation of the 
 repressed affect as the ego becomes less fearful of it and allows it 
 to become a part of the ego. 
 
 Through the psychoanalytic method of studying suppression 
 neuroses and repression neuroses (psychoneuroses) it was first 
 recognized that functional derangements or symptoms disappear 
 after an adequate affective readjustment is made, and that, while 
 the affective readjustment is in progress, the individual becomes 
 aware of the true value of "trivial" or forgotten memories and 
 old desires or cravings to do certain things. Usually, the history 
 of the genesis of the desire is such that it conclusively, in a sense, 
 logically, explains the cause of the symptoms and why they should 
 disappear when the desire is allowed to seek gratification with 
 the help of the ego (assimilated into the ego). Such phenomena 
 are only intelligible on the assumption that the desire or affective « 
 compulsion, because of the persistence of the symptoms or ten- 
 dencies, existed somewhere; continuously, from the time of its 
 genesis until its readjustment. Since the .affective craving has a 
 remarkably persistent tendency to remain true to its original form 
 upon its recall, and, since it disappears or subsides after an ade- 
 
PHYSIOLOGICAL FOUNDATIONS QP PERSONALITY 67 
 
 qnate readjustment of the conflict or gratification, it is reasonable 
 to conclude that the affective craving persisted after its genesis in 
 something like its original form, because it was not permitted to 
 adjust itself. Since the host has no awareness of its nature or 
 origin after the repression but only feels distressing symptoms of 
 its pressure, it is also reasonable to consider that it has continued 
 its repressed existence in the postural tensions of those autonomic 
 segments of the organism in which it had its genesis. A splendid 
 but too puritanical young woman, who strove assiduously to have 
 a "pure mind," that is, repress all the kinesthetic influences of the 
 sex organs, suffered from dysmenorrhea and quickly recovered 
 (without dilatation and curettage) upon learning to make a natural 
 adjustment to the hyperactive phases of the uterus. A man who 
 felt strong compulsions to damn his domineering father suffered 
 from a husky, aresonant voice for years because of the suppres- 
 sion of the affect of anger that would use this means of attack. 
 The individual is constantly seeking, though without realizing 
 it, an opportunity to obtain relief from the influence of the re- 
 pressed affect. It shows in his innumerable individualistic prefer- 
 ences and aversions through which relief, may possibly be obtained. 
 The persistence of the repressed affect may cause such disturb- 
 . ances of judgment and selection, or aversion, as to induce serious 
 faulty adjustments in mating, business and professional conduct, 
 whereby the man, having become his own greatest enemy, makes a 
 false adjustment and ruins his business or career. Not uncom- 
 monly, however, the individual, by changing his location, business, 
 or associations, greatly relieves the repressed tensions, through 
 avoiding the stimuli that irritate them or cause the repression. 
 But, the individual whose moral and economic interests are so in- 
 volved that a change of adjustment is not possible faces disaster, 
 unless he can make an adequate affective readjustment through a 
 psychoanalysis. It is this outwardly normal but inwardly miser- 
 able individual whom a psychoanalysis can help. That is, through 
 the controlling influence of the transference, the fear of permitting 
 the repressed wish to express itself is obviated. Thereby, the re- 
 pressed craving is gradually allowed to fully exercise itself by 
 making the individual conscious again of what he had forced out 
 of consciousness upon previous critical occasions. This is often 
 a most painful and embarrassing procedure, but so are many 
 
(j8 psychopathology 
 
 surgical operations. No alternative is as practicable. The re- 
 pressed affect often, but not always, causes tremendous physio- 
 logical disturbances (such as the physiological effects of violent 
 rage, anxiety, shame, fear, despair, eroticism) as the individual 
 becomes aware of his true affective constitution and the unjusti- 
 fiableness of his wish. If it is justifiable, usually, vigorous in- 
 dignation, with an unmistakable expression of opinion about some 
 offensive, selfish individual who forced the repression, concludes 
 the recall and a splendid robust adjustment follows. 
 
 Sighs, weeping, anger, etc., followed by more or less gradual 
 relaxation and general physical comfort, with spontaneous ten- 
 dency to become generous, appreciative and playful (not witty), 
 show that the readjustment has been completed, and the playful- 
 ness shows that the autonomic tensions are again normally re- 
 ciprocating in their functions in order best to fulfill their biological 
 career. 
 
 It is as necessary as putting a roof on a house for the patient 
 to permit the wish to talk and say what it pleases. Merely "know- 
 ing" or "realizing" what the trouble is is not sufficient. All our 
 affections are conditioned to obtain much of their gratification 
 through speech. The wish must be permitted to talk and act freely 
 in ord\er to acquire the reality or imuge of what is needed. In this 
 manner the individual wish loses its obnoxious or fearfuV qualities 
 and becomes completely assimilated into the ego. 
 
 The affective mechanism by which the personality becomes 
 more and more accurate in its capacity to make constructive as 
 Avell as pleasing social adjustments, and its capacity to project its 
 influence farther into the society of the present and future, may.be 
 considered to be a form of affective progression. This is in direct 
 contradistinction to the mechanism of affective regression, where- 
 by the discouraged, depressed personality recedes from the higher, 
 more intricate and more delicate adjustments to the earlier and 
 more simple, childish methods of adjusting. In the hebephrenic 
 and catatonic dissociated types, as the cases show, the regression 
 may continue to the infantile or nursling level or even intrauterine 
 attitude. In the catatonic cases, it will be shown, the personality 
 passes through a "rebirth" and progressively redevelops, resum- 
 ing its former interests ; some stop at a childish, others at an ado- 
 lescent, and still others even attain a more matured, efficient level 
 than they had reached before. The degree of readjustment de- 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 69 
 
 pends mostly "apon the nature of the obhgations and the attitude 
 of certain associates (usually family) and, very important, the 
 physician's constructive influence through the transference and 
 psychoanalysis. 
 
 The psychopathologist must develop the habit of seeing any 
 adult person's behavior as the resultant of many wishes and never 
 as the adjustment of simply one wish. It requires considerable 
 training to develop this viewpoint, because we are educated to be- 
 lieve that any wish that we try to forget, or disown, is not to be 
 considered as a part of ourselves, but belongs to the devil, or some 
 organic cause or disappears entirely. 
 
 The mechanisms of compensation and sublimation now logic- 
 ally follow for consideration. 
 
 Compensation is one of the most fundamental attributes of 
 living tissue and occurs particularly where there exists some sort 
 of painful irritation or the tendency of the autonomic-affective ap- 
 paratus to be forced into the fear state. The cause of the fear state 
 may be due to pain from the disease or injury of some organ (as 
 the heart, lung, kidney, skeleton, skin) or the potential danger of 
 injury, failure, persecution, prosecution, loss of social esteem or 
 property, etc. In either case the digestive circulatory and respi- 
 ratory segments and the adrenal, tliyroid and hepatic glands are 
 forced into a state of hypertension by the potential danger and 
 this continues until an adequate defensive course of adjustment or 
 insurance of protection and safety is established by protecting or 
 concealing the vnlnerable part or defect, or by destroying the dan- 
 gerous qualities of the attacking organism or person. If the cause 
 of fear is a segmental compulsion within ourselves an attempt to 
 eliminate it, or, if regarded as a social inferiority, an attempt to 
 compensate by some estimable work is reflexly initiated. 
 
 The elimination process not only may lead to the most drastic 
 surgical procedures, justified as the last resort to relieve an ob- 
 scure cause of distress, but to violent self-inflicted castrations and 
 suicides, or the chronic disuse of organs and functions that are of 
 the utmost importance in the struggle for life and happiness. The 
 elimination method of relieving the ego from the pernicious or dis- 
 tressing influences of a tense, painful organ is justified by the 
 surgeon who desires to perform plastic operations on the stomach, 
 colon, rectum and particularly the female genitalia. Many sur- 
 
70 PSYCHOPATHOLOGY 
 
 geons still reason that in order to remove the distresses of a seg- 
 ment the segment needs only to be excised. This procedure fails 
 in a most inglorious manner if the cause of the repression is not 
 removed; as the fear of failure in business, the tendency to per- 
 verseness, or secret autoerotic indulgence. 
 
 A panhysterectomy did not relieve the erotic cravings of a 
 woman. Although performed as a last resort the elimination of 
 most of the sex organs did not eliminate all the erogenous zones 
 which had become conditioned through fancies and masturbation to 
 be aroused by many forms of environmental conditions, particu- 
 larly the presence or thought of nearly any type of man. A bril- 
 liant, paranoid army surgeon amputated his penis to prevent young 
 women, whom he hallucinated, from using him for sexual purposes. 
 The erotic segments continued to exercise a pathological effect 
 upon the personality even though partly destroyed. He now begs 
 to have his testicles excised for the same purpose. 
 
 Where the cause of fear exerts a continuous, pernicious influ- 
 ence the defensive compensation tends to become eccentric and 
 eventually, like an excessive hypertrophy, defeats its purpose; 
 thereby establishing a vicious circle. Conversely, when a psycho- 
 path presents eccentric compensatory claims of power or ability 
 the psychopathologist should look for a repressed segmental crav- 
 ing that is asocially conditioned, the influence of which he fears. 
 Many of the paranoid psychoses which are presented reveal this 
 mechanism. 
 
 "When we have done something that we regret, we reflexly feel 
 a compulsion to compensate with restorations. When we have a 
 wish to do something that we regret, we also tend to compensate 
 with restorations in order to maintain a state of estimableness. In 
 both cases, the tendency is to get as far from the intolerable mem- 
 ory or craving as possible by tending to keep ourselves conscious 
 of the direct opposite. This is to be seen in the case of mysophobia 
 presented in the chapter on psychoneuroses. The ' ' contaminated" 
 girl (anal autoerotic) was compelled by the compensations to get 
 clean in order to save herself from the shame and fear state. 
 
 An enormous field for psychological research lies in the di- 
 rection of ascertaining hoAv the sexual indulgences of youth, which 
 later become regarded, desperately, as inferiorities, influence the 
 compensatory striving for self-mastery, and how this extends it- 
 
PHYSIOLOGICAL FOUNDATIONS OP PERSONALITY 71 
 
 self in tlie direction of some vocational or professional pursuit for 
 society's esteem and welfare. 
 
 One patient, who was persecuted by the memory of a series of 
 oral erotic transgressions when a boy of eight to fourteen, passion- 
 ately strove to compensate by developing unusual linguistic pow- 
 ers. Another patient had literally every tooth in his head covered 
 with a gold crown. The latter did not frankly admit oral eroti- 
 cism, but his psychosis was such that it definitely indicated it. He 
 thought men regarded him as a sexual degenerate. 
 
 The most common inferiorities that are compensated for in a 
 manner that may become pathological are segmental cravings for 
 masturbation and homosexual and heterosexual perversions. This 
 is true for both sexes. The manner of compensating for having 
 inferior sexual cravings is to fancy haAdng great prowess even 
 without supporting facts. This demonstration of prowess must be 
 absolutely differentiated by the psychopathologist from the natural 
 demonstration of abilitj^ in order to win the esteem of a splendid 
 love-object, in order not to grievously offend worthy men and 
 women. The former is characterized by chronic sensitiveness and 
 irritability, a compulsion to overvalue fancies, always on the look- 
 out for hints of having been discovered or of being spontaneously 
 disliked, utter inability to be humble, inclination to domineer un- 
 justly, to be ostentatious, egotistical and destructively or depreci- 
 atively critical, but not able to be generously and constructively 
 critical. 
 
 One can diagnose such cases on sight, when, with meager 
 actual accomplishments, they come into the ward, walking stiffly, 
 proudly, with head erect, face staring, hair combed so as to radi- 
 ate (intelligence), face flushed or tense, inability to become agree- 
 able, and inclination to have vague physical discomforts from the 
 tensions of repression and overcompensation. 
 
 The general rule is that any eccentric claim having <M eccen- 
 tric value, which is not substantiatedi hy facts, is to he regarded as 
 a compensation for a personal inferiority. The mechanism of sub- 
 limation is directly related to the compensatory striving, and really 
 means the refinement of the needs of the affective craving by other 
 wishes which are compromising on acquiring substitutions in the 
 form of stimuli which are associated with the primary stimuli of 
 the repressed cravings. For example, an unmarried woman, who 
 had strong maternal cravings, derived great comfort and relaxa- 
 
72 PSYCHOPATHOLOGY 
 
 tion throTigli creating babies in bronze, satisfying both the procrea- 
 tive and social cravings ; many impotent men try to build perpet- 
 ual motion machines. 
 
 One finds, npon analysis, that the artist creates his play, his 
 novel, poem or model to please his affective disposition, but this 
 artistic fantasy is using an image or substitute for the gross 
 reality. This is the mechanism of sublimation. Eeligion is man's 
 supreme method of sublimating the repressions of infancy and 
 childhood and gratifying the unfulfilled desires of maturity and 
 old age, through the use of sacred rituals and fancies without 
 which the autonomic apparatus would become depressed and 
 might even fall back to a lower primitive level. 
 
 A very common form of affective adjustment and sublimation 
 of ungratified love is devoting oneself to becoming proficient in a 
 field that is attractive to the love-object. This applies also to 
 hate, in becoming proficient in a field of work that is envied or 
 hated by the hate-object. 
 
 In the presentation of the cases, many data are included 
 to show how the unhappy men or women strove to attain certain 
 ends to protect themselves from unhappiness caused by physical 
 inferiorities and imgratified yearnings. 
 
 Whenever a sudden shift in the affective tensions occur in an 
 individual, say, when something reminds us of an unpleasant wish 
 or experience, certain symptoms of the quick, critical, subconscious 
 conflict always occur, and these the psychopathologist must regard 
 as symptoms of repression. By learning the motor symptoms 
 and the use of symbols, the physician becomes able to recognize 
 what affections are being repressed. 
 
 The symptoms may be divided into two general groups: (1) 
 motor incoordinations, and (2) unpleasant sensations, in turn, due 
 to motor tensions. (Wherever any of the following symptoms are 
 complained of, organic lesions must be ruled out first.) 
 
 The motor incoordinations occur in the form of slight, quick 
 changes in postural tensions, and the environment, which requires 
 exact postural tensions, shows the subtle change in the muscle ten- 
 sions by a great disturbance in the form of an error. For example, 
 the light postural grip of the hand may be deftly holding a delicate 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 73 
 
 structure when an affective repression is made. The sudden pos- 
 tural relaxation lets gravity pull the object from between the fin- 
 gers, and an accident results or reflexly, the next instant, the 
 fingers clutch desperately to prevent the fall and crush the object; 
 as a delicate bit of china. If the object is an open razor, the re- 
 adjustment of the fingers may come in the form of a gra]), even as 
 it is falling through the air. 
 
 The more common forms of motor symptoms to be met with 
 are tensions in the muscles of the scalp and base of the skull, or 
 "stiffness" of the extrinsic muscles of the eyes, due to a repressed 
 fear; sneezing, when not due to an actual irritant, is caused, it 
 seems, hj the contracting nasal muscles arousing itching sensa- 
 tions in the mucous membrane; biting the tongue, lips or cheek, 
 swallowing food or drink into the trachea; sudden loss of vocal 
 resonance ; coughing when not due to an irritant ; sudden nausea 
 or loss of appetite ; vertigo, or migraine ; cystic or rectal tenes- 
 mus ; stumbling or falling ; errors in mechanical adjustments ; er- 
 rors in speech or writing; forgetting of names of people or ob- 
 jects, places, dates; inability to recall and, often, losing or mis- 
 placing objects. 
 
 The more common unpleasant sensations complained of, that 
 indicate affective repressions, are the disagreeable sensations 
 aroused by any group of tense, striped or unstriped muscles, usu- 
 ally complained of as a "jerking pain," "gnawing pain," "burn- 
 ing pain," "tingling," "muscle spasm," "stiffness, or hardness of 
 the muscle ; ' ' inability to empty a viscus or to retain the usual quan- 
 tity for the habitual length of time; "heart burn," "tightness 
 around the chest, or throat," "inability to swallow," "choking 
 voice," "hoarseness," "stiffness of the tongue," vertigo, weak- 
 ness of the grip, or knees ; nausea, vomiting, diarrhea or constipa- 
 tion in anxiety (the nature of the peristalsis apparently depending 
 upon the nature of the compensatorj'' aggressive reaction to the 
 cause of fear) dysmenorrhea, amenorrhea, impotence, rapid pulse, 
 high blood-pressure, headaches, mental dullness, inability to work 
 or think, hypersensitiveness of a receptor field, or anesthesia of a 
 receptor field, an uncommon aversion for some definite color, ob- 
 ject, place, person, position of the body, work, event, food ; or an 
 eccentric fondness for some particular thing, event, posture or 
 form of thought. 
 
74 PSYCHOPATHOLOGY 
 
 Conclusion 
 
 The behavior of .animals, children, most illiterate people, the 
 lower savages, and the mental defectives of lower grade may be 
 formulated as follows : 
 
 Primary Wish -j- Subsidiary Wishes X Resistance (environmental) ^Behavior-.* 
 
 But, in the more complicated civilized personality, where re- 
 pressions are necessarily retained, and in the psychoses, the form- 
 ula becomes complex. 
 
 Primary Wish + Subsidiary Wishes (manifest ego) 1 v, f> ■ 4. 
 Primary Wish -[- Subsidiary Wishes (repressed) j 
 
 (environmental) = Behavior. 
 
 As a personality develops and compensates for one disap- 
 pointment, and then meets with a second crisis and again compen- 
 sates or distorts itself, the complex affective makeup may be form- 
 ulated as : 
 
 Manifest Wishes 
 
 over 
 Later Eepressed Wishes 
 
 over 
 Adolescent Repressed Wishes 
 
 over 
 Preadolescent Eepressed Wishes 
 
 X' Resistance (environmental) = Behavior. 
 
 In the study of a personality, we can usually get a satisfactory 
 account of the behavior, such as the productions, many fancies, the 
 vocational pursuits, hobbies, religious and social affiliations, eco- 
 nomic resources, addictions, hallucinations, delusions, dreams, 
 methods of obtaining comfort, associates, ^tc. 
 
 Through inquiry from the relatives and the patient, we are 
 able to get, if great caution and persistence is used, a partly true 
 account of the resistance the individual had to overcome, both in 
 the form of the wishes and prejudices of other people (father, 
 mother, sister, brother, wife, husband', children, friend, employer, 
 etc.) as well as the material the wish had to work with — vocation, 
 disinterested husband, etc. 
 
 Given then the behavior and the resistance, we can infer, using 
 the diagnostician's method, from manifold indications, what the 
 wish or affective craving is that compels the pathological adjust- 
 ment. (We must assume, like all diagnosticians, that the patient 
 "has a heart.") 
 
 •In the above formula the sign x is used in the sense of opposed by. 
 
PHYSIOLOGICAL FOUNDATIONS OF PERSONALITY 75 
 
 Given the wish and the behavior, we can infer the nature of 
 the resistance, as in the amorons wife, who hallucinates sexual 
 gratification, we know that her husband is indifferent, or, more 
 usually, heterosexually impotent. 
 
 When the nature of the ivish is ascertained, and the patient 
 himself recognizes and admits it as a part of his personality, the 
 psychosis changes proportionately into an anxiety neurosis, the 
 dissociation of the affective forces disappears through accepting 
 the socially inferior cravings as a part of the personality (Case 
 PD-33). 
 
 When this has been accomplished, the origin or the genesis of 
 the craving logically comes into the foreground. The analysis 
 leads regressively from the conditioning of one wish to the influ- 
 ence of an earlier Avish, and so on, back into adolescence and pre- 
 adolescence. This brings us to the psychology of the family which 
 will be covered in the next chapter. 
 
CHAPTEE II 
 
 THE PSYCHOLOGY OF THE FAMILY 
 
 This study of the influence of members of the family upon the 
 affections of the individual is based upon the families that it be- 
 came necessary to study in order to enable the neurotic or psy- 
 chopathic member to attain a normal degree of independence so 
 that a healthy emotional life might be developed. 
 
 In the introductory chapter, wherein the physiological nature 
 of the emotions is presented, the mechanism was discussed by 
 which emotions or affective cravings become conditioned to need 
 certain environmental conditions. The influence of associates upon 
 an individual seems to be essentially the mechanism of condition- 
 ing his affective cravings through indifferent stimuli being asso- 
 ciated with primary stimuli until he also needs the formerly in- 
 different stimuli. The mother's voice, facial expression, color of 
 hair, odors, eyes, skin, the shape of her mouth and conformations 
 of teeth, her neck, bosom, arms and hands, touch and step, postural 
 tensions, irrita,bility and goodness, habits, ideals and eccentricities 
 are all stimuli that come to have a potent autonomic-affective in- 
 fluence upon the child through being frequently, simultcmeously 
 associated with the giving of nourishment, physical comfort and 
 relief from fatigue, loneliness and anxiety. This continues as an 
 almost incessant combination of stimuli, varying somewhat as the 
 mother's affections (love, anger, sorrow, shame, pride, jealousy) 
 determine her reactions to the infant. It persists throughout 
 the child's growth, and, somewhat intermingled with the condition- 
 ing' influence of other females, determines the value of different at- 
 tributes of the female to the child as a source of comfort or cause 
 of anxiety. Similarly, the father's physical attributes and emo- 
 tional traits determine the relative value of the various types of 
 males as comfort-giving or anxiety-producing stimuli. 
 
 It seems naive to urge that every person, friend or enemy, is 
 essentially a compound stimulus that varies more or less in its 
 gratifying or distressing influence upon an individual, but the 
 
 76 
 
rfn 
 
 THE PSYCHOLOGY OF THE FAMILY 77 
 
 stupid resistance to psychoanalysis and the adjustments of repres- 
 sions make it necessary. The conditioning of fear, hate, love, 
 shame, sorrow, hunger, occurs without our conscious choice that 
 these affective-autonomic functions should or should not prefer to 
 have or to avoid certain objects, persons or situations. These 
 mechanisms may often be obscure, but in one respect they are 
 consistent. They are always determined by experiences. 
 
 There is no such thing as a definitely circumscribed experience 
 or one person having a fixed emotional value for another, because 
 the causal relations of events and the affective changes of people 
 are not fixed; hence the term experience is used to designate a 
 complex situation that has more or less graduallly assumed a 
 distinct affective influence or value for an individual. The psy- 
 chopathologist must, therefore, train himself to think of experi- 
 ences and personalities as complex influences which may be both 
 loved and hated at the same time. This is not generally recognized 
 and often leads to ridiculuous discussions because of the absurd 
 attitude: "flow can a patient hate his wife Avhen he shows that 
 he loves her I" The child or adult, when living in a relatively 
 consistent environment, as at home, in a village, in school, at work 
 or in an office, meets with an endless stream of complex experi- 
 ences, having, however, a common quality wliieh conditions tlie 
 affections, and, characteristically, these external and internal 
 forces mold the personality into the typical farmer, sailor, race- 
 horse man, schoolmaster, minister, lawyer. Naturally, tlie period 
 from infancy to adolescence is the most impressionable ; the child, 
 having little previous experience witli which to qualify the influ- 
 ence of its associates, is helpless to control the affective reactions 
 that others arouse in itself. In fact, the infant seems to be so con- 
 stituted that no socialized interests exist in its personality imtil 
 the compensations to prevent unpleasant social experiences begin 
 to develop them. The compensatory wish to remain pleasing to its 
 benefactors must eventually be developed and associated with any 
 perverse wish that might be aroused in order that its restricting 
 influence will regulate the influence of, the asocial, perverse wish. 
 For example, infants liave to be trained to control their segmental 
 cravings such as to eat or void promiscuously. Unless trained 
 through the infliience of clear-sighted, earnest parents, they are 
 likely to be perversely curious about anything pertaining to the 
 sexual or excretory functions, and this curiosity when repressed 
 
78 PSYCHOPATHOLOGY 
 
 later becomes, during maturity, the determinant of asocial inter- 
 . ests, such as frigidity, peeping, lying, exhibitionism, etc. 
 
 The older children and adults exert an incessant pressure upon 
 the child to control its affective cravings and reward it with all 
 sorts of praise and tokens of esteem when it succeeds. On the 
 other hand, when it is indifferent to the general interests of its 
 group and selfishly yields to the pleasant influence of an auto- 
 nomic segment, such as stealing money or food for the gastric 
 cravings, or indulging in anal or masturbation pleasures, it is 
 severely punished and more or less ridiciiled and ostracized. 
 Through pain and the fear of arousing the disgust and dislike of 
 its associates a general autonomic compensatory striving is re- 
 flexly initiated, which, above all else, becomes devoted to control- 
 ing any autonomic segment that may tend to compel asocial be- 
 havior. This general, incessant, autonomic compensation becomes 
 essentially integrated into a unity to prevent any division from 
 jeopardizing the unity. This UNITY, having the capacity of re- 
 acting so as to lye conscious or aware of any segment's activities, 
 constitutes the ego, and learns to speak of itself, as "I," "me," 
 "myself," "I am," "I wish," etc. Before this fimctional inte- 
 gration develops in the child it is regarded as "it," and only 
 gradually does it become a personality that is named. Even the 
 devoted mother instinctively speaks of her new-born infant as 
 "my child" or "the baby" or "it," and not until "it" begins to 
 talk does the tendency to apply its name begin in other personal- 
 ities. Naturally, the ego that masters itself most thoroughly and 
 is supported by its segmental cravings so that it can control the 
 environmental and social factors constitutes a potent factor in 
 society. In proportion as the segmental cravings are asocially 
 conditioned and uncontrollable we have social delinquents, crim- 
 inals, psychopaths, etc. The nature of the influence of associates 
 upon the ego also explains why people adjust differently to their 
 asocial cravings, as the homosexual and autoerotic. 
 
 A man of thirty-six, who had masturbated almost consist- 
 ently every third night for many years with no distressing feel- 
 ings of inferiority, although always very eccentric and effeminate, 
 began to grow progressively sensitive, irritable and paranoid," as 
 he tried to master himself and overcome his autoerotic inferiority. 
 His confessions emphasized the mechanism that the feeling of be- 
 ing an inferior developed in proportion as he strove to master him- 
 
THE PSYCHOLOGY OF TPTE FAMILY 79 
 
 self. His adaptation became so seriously paranoid that lie had to 
 be advised to quit trying to readjust his affections, and, instead of 
 continuing to attack himself, he was urged to develop vigorous in- 
 terests in a hobby which might distract him from his sexual self- 
 love. 
 
 The most common factor that influences people to flock to- 
 gether into characteristic groups is the finding of associates who 
 will not become critics of each other's organic, functional, or seg- 
 mental inferiorities, and who also express some admiration for 
 whatever aggressive, efficient compensations one or the other might 
 make, whether criminal or not. Hence, when the compensatory 
 strivings are too eccentric and annoying, as a vocal mannerism in 
 an oral erotic, the individual's associates, through nagging, try to 
 force a change in his adjustment or force him out of the social 
 group as much as possible. The individual when not able to aban- 
 don the compensation, becatise of its value for the control of the 
 obsessive segmental craving, either becomes seelusive or goes 
 through an affective reformation, or a distortion that may even 
 require confinement in an institution. (See illustration of a man 
 with a spastic functional paralysis. Fig. 41.) 
 
 Many boys and girls suffer agony and despair from seductions 
 or pernicious asocial (autoerotic) habits simply because they can 
 not go to an adult, particularly the father or mother, and through 
 a confession, win assurances that they have not irretrievably dam- 
 aged their parent's esteem for them and may continue to feel 
 worthy of winning their love. Such secret shames and fears often 
 become the foundation of eccentric defenses and compensations, 
 such as deceitfulness, shyness, and seclusiveness. If the distress- 
 ing factor continues to be vigorous, as irrepressible masturbation, 
 the child may develop a very pathological trend of adjustment 
 which will, unless later corrected, become the foundation of a 
 wretched personality. (See Case AN-3, p. 251.) 
 
 It is highly important- for the psychopathologist to bear in 
 mind that vicious affective circles as well as benevolent affective 
 circles may be established between any two people or the members 
 tff a group of people, whether they are of the same family or not, 
 because we are usually misled by the evasive first story of the 
 family. A benevolent relationship in a group of individuals may 
 
80 PSYCHOPATHOLOGY 
 
 become changed into a vicious one through some disturbing event, 
 as the death ' or marriage of one of the group. 
 
 An unhappy parent, conventional and miserable because of 
 his affective repressions, tends, insidiously, to make those about 
 him cause repressions of all affective interests that tend to arouse 
 the intolerable, repressed Avish in himself. In this manner, such 
 adults incessantly influence the defenseless child to make repres- 
 sions of the very affective functions whose freedom of expression 
 is absolutely essential to the development of a healthy, creative 
 personality.. In this manner also, the tendency to make psycho- 
 pathic repressions becomes a characteristic of a family, and may 
 be traced from the patient to the father's or mother's influence, 
 and, in turn, to grandparents, and so on, almost indefinitely. The 
 fact that psychopathic personalities are to be found among the 
 ancestors of a psychopath has been the flimsy ground upon which 
 the dogmatic thinkers in psychiatry have made the assumption 
 of "defective heredity," "hereditary taint," "constitutional in- 
 feriority," etc. This assumption, upon mature consideration, is 
 nothing less than amazing, and could hardly have been wilder or 
 more unproductive. That is to say, simply because two organ- 
 ically defective individuals beget mentally defective children it 
 can not safely be assumed that two organically normal but func- 
 tionally abnormal parents will beget functionally abnormal chil- 
 dren. The early school record of many children of such par- 
 ents indicates that they have excellent functional capacities, but 
 the personal influence of the aff-ectively distorted parents distorts 
 the affective requirements of the child, and this mechanism, plus 
 the insidious censorship of society, imposed upon those who have 
 insane relatives, may cause miserable maladjustments in post- 
 adolescence and maturity, particularly if other personal inferiori- 
 ties exist, such as autoeroticism. 
 
 A series of families is presented to show how the abnormal 
 affective adjustment in a parent influences a son and the son .in 
 turn influences the grandson; or how the unhappy grandparent 
 may persistently impose himself or h(?rself upon the grandchild 
 and ruin it. These relations are cultivated through innumerable 
 experiences, day after day, extending throughout the growth of 
 the child. I am convinced (this conviction is based upon profes- 
 sional experience) that no one can become a functional psycho- 
 path who is not greatly so influenced through the intentional or 
 
THE PSYCHOLOGY OF THE FAMILY 81 
 
 unintentional attitude of his associates. The question as to the 
 moral responsibility for influenee is not to be considered by the 
 psychopathologist. It is far better, since it can only be a matter 
 of controversial estimation in each ease and has no biological 
 value, to leave the question of moral responsibility strictly alone, 
 as a matter for the judge and jury to decide. 
 
 The judge of a circuit court suffered from a severe suppres- 
 sion or anxiety neurosis, ^dth particularly persistent, distressing 
 gastric sensations, apparently due to peculiar gastric hypoten- 
 sions and a marked reduction of hydrochloric acid secretion. Be- 
 cause of these deficiencies, he had placed himself on a progress- 
 ively restricted diet until finally it consisted of milk. He had the 
 habit of massaging his stomach for relief after eating by gently 
 rubbing his hand over the pyloric region. This was frequently 
 continued until the gastric contents were regurgitated. A large, 
 darkly pigmented blotch over the epigastric area had developed 
 apparently from the persistent massaging. His general attitude 
 was that of covertly pleading for sympathy and attention. He 
 tallied almost incessantly to anyone who would listen about his 
 misery and goodness, incurability and expected death, in a way 
 which clearly indicated that he derived great relief, even pleasure, 
 from the manner in which he had adjiisted the secret cause of his 
 anxiety. 
 
 What proved to be the essential features of his life, which he 
 persisted in repeating to almost anyone, were that his father, who 
 had been an "impractical" man had been inclined to neglect the 
 family, and that he, even as early as six years of age, and his 
 mother, he being the oldest son, conducted the farm and raised the 
 family. It was quite evident that his father suffered from an un- 
 gratified affective need and tended to neglect his family while he 
 sought for the rainbow of his dreams. The unhappy wife, like all 
 such mothers when they are heterosexually conditioned and have 
 strong moral interests, turned to her son for what comfort and 
 relief from loneliness he could give her. This affective rapport 
 continued for years, that is, throughout the mother's life, and re- 
 sulted in the mother unwisely conditioning a fixed attachment for 
 her son, and the son for the mother. He became a successful law- 
 yer and judge, but did not marry until after forty. He made a 
 mother substitute out of his wife, and turned to her incessantly for 
 
82 PSYCHOPATHOLOGY 
 
 sympatliy and petting. Like most cases of affective attachment 
 wMeli must be ungratified, he suffered from anxiety and gastric ir- 
 ritability. 
 
 After his mother died, the tendency to seek mothering from 
 his wife increased until he abandoned all other interests. Later, 
 when he became aware of the ruinous influence of his mother- 
 attachment and the depressing effect it was having on his children, 
 he made a determined effort to bring about a common sense ad- 
 justment. The fact that probably brought him to a full realization 
 of the seriousness of his mother-attachment was not so much the 
 autonomic distress as the danger of ruining his children by his 
 depressing manner of soliciting sympathy and his seductive, in- 
 sidious appeals for them to relieve his loneliness and suffering.* 
 The incident that made this decisively clear was the discussion of 
 the manner in which his eldest son had responded to him. 
 
 "While bemoaning his sad state of health, incurability and cer- 
 tainty of dying (following his recently dead mother), his son, an 
 adolescent, heroically promised not to forsake him. He said he 
 would lie on his father's grave, until he could join his father, be- 
 cause he could not bear the loneliness of being without him. 
 
 It is to be accepted that just as the lonely mother had de- 
 veloped a pathological attachment in her son, her son, although 
 now a judge who was chosen by his people for his common sense, 
 was, in turn, innocently cultivating an even more serious affective 
 attachment in his son. Such an attachment would surely make him 
 a passive homosexual. That is, by having been induced to sac- 
 rifice himself to please the unhappy father, he would become 
 morose from the craving to become his father's love-object. (See 
 Cases CD-I, CD-2. This type of attachment to the mother, when 
 it becomes uncontrollably incestuous, is illustrated by Von Stuck 's 
 Der Sphinx, Fig. 27.) 
 
 The unhappy, yearning adult, whose affective cravings have 
 been so conditioned in childhood as to cause a persistent longing to 
 return to that ancient state of rapport with his mother, even when 
 an old man, when permitted to associate with children, insidiously 
 cultivates the affections of some favorite child from whom he de- 
 rives a degree of comfort and sjonpathy. With this child, he is 
 more or less able to live over again his own childhood. This is 
 done, usually, without realizing its true influence on the child, who, 
 
THE PSYCHOLOGY OF THE FAMILY 83 
 
 innocently, is induced to contribute its most sacred affections to 
 the welfare of the self -centered, senile adult. This -all occurs in- 
 nocently enough, but will result most disastrously, even if overt 
 sexual seductions do not occur. 
 
 The following case illustrates how the love affections, when 
 fixed upon an object in childhood, tend to force the individual, 
 when an adult, to remain conscious of the sensory images (mem- 
 ories) of the object upon which they are fixed. When the object 
 is unattainable, and the attachment too powerful to be modified by 
 the individual, the constantly recurring sensory images (as hal- 
 lucinations), if grewsome, may cause grave depression and anxiety. 
 Such intense fixations, in which the child becomes the innocent 
 slave of the transference, are usually cultivated in children by 
 adults who have strong yearnings to return to their own child- 
 hood. Children seem to be the most suitable objects to give them 
 comfort. Nearly all children, particularly if they are lonely, fall 
 easy victims to such adults. 
 
 Case AN-1. — ^A Eussian peasant girl, age thirty-seven, has 
 suffered since her childhood from depressing, horrifying, visual 
 and auditory images of her dead grandfather. 
 
 The influence of the pathological affective trend was easily 
 traced to the grandfather. He was a sad, lonely, religious old 
 man, who lived with his son, son's wife and his grandchildren on 
 a little farm in Russia. The son was irritable, selfish, domineer- 
 ing, and did not hesitate to beat his father, his wife and children. 
 
 During the patient's childhood, she says, her grandfather 
 cared for her "like a mother." Her mother was a tubercular 
 invalid. The father often starved the old man to punish him, and 
 the little girl stole bread from the family table to keep him from 
 suffering. Her love for her grandfather was stronger than the 
 fear of her father. 
 
 One day she found the old man's body hanging by the neck. 
 He had been dead for some time, and his livid, swollen face and 
 thick, black tongue made an indelible impression on the child. 
 She believed that her grandfather had taken his life because he 
 was sad. She had learned to recognize that he came to her for 
 sympathy and comfort when he felt neglected. 
 
 The child and her father washed and prepared the body for 
 burial. His discolored face ("black") she thought was, perhaps, 
 the devil's. She was seven when this experience occurred. After 
 
84 PSYCHOPATHOLOGY 
 
 this she had a long series of night terrors with ghastly dreams. 
 She tried to protect herself by wearing a rosary about her neck 
 and praying herself to sleep. For a year she slept with her 
 niother to prevent being taken away by the ghastly grandfather 
 who would appear to her (hallucinatfed) as he looked when he 
 was prepared for burial. She believed that he actually eaime for 
 her becaiTse he was lonely. (This belief in the realness of the 
 vision is characteristic of savages, psychopaths, and normal peo- 
 ple during dreams.) A year after the grandfather's death, the 
 mother died following labor. 
 
 The patient could not go to school because her eyes became 
 "sore." The night terrors continued to occur several times a 
 week and during the day she was unable to forget the sadness 
 and longing of her grandfather. Probably, the rough, abusive 
 father, by depressing her, prevented her from turning, to him for 
 love. She derived some comfort from the petting of an aged 
 woman, but was unable to enjoy the company of young people. 
 Her menstruation began at eighteen, and, with its appearance, 
 she said, the night terrors tended to disappear. At twenty-two, 
 she had grown into a strong peasant girl and emigrated to Amer- 
 ica to work as a servant. The grandfather attachment, neverthe- 
 less, persisted more or less vigorously except for brief periods 
 when something occurred to make her happy. She still inter- 
 preted her visions as her grandfather actually visiting her in 
 spirit because he was longing to take her Avith him to relieve his 
 loneliness. 
 
 When thirty-seven years of age the patient became more de- 
 pressed than usual and was unable to sleep because of the feeling 
 that her grandfather was trying to strangle her. He reappeared 
 in the garb in which he was dressed for burial, and, to protect 
 herself, she again slept with the rosary around her neck. After 
 the terrifying dream, she usually prayed the remainder of the 
 night to prevent its return. Vomiting, dysmenorrhea and the 
 feelings of abdominal weakness added considerably to her dis- 
 tress. She broke up the heads of a box of matches in a cup of millv 
 and drank it, hoping that it would cause death. After she was 
 discharged from the hospital, she stole several sticks of dynamite 
 from a mine and carried them across the state line to her home. 
 She hoped to leave no traces of her death as her grandfather had 
 
THE PSYCHOLOGY OF THE FAMILY 85 
 
 but was unable to explode the dynamite and her inquiries about 
 how it should be done led to the discovery of her plans and arrest. 
 Upon trial, she was sent to a federal prison for carrying dynamite 
 from one state to another. 
 
 During her stay in prison, she passed through two episodes 
 in which singing about going to heaven and terrors from the hal- 
 lucinations were prominent. Upon her admission to St. Eliza- 
 beths Hospital she was decidedly cowed, sad, depressed, felt 
 weak, cried, did not want to live and complained of being unable 
 to escape from her grandfather. The vision appeared constantly 
 and urged her to come with him. 
 
 She complained of dreaming about meat "all cut up," and of 
 two men bearing a dead woman away in a coffin. They were also 
 coming after her. She said that she did not want to die now, but 
 that when she became old she would destroy herself with fire so 
 that she would not leave a frightful vision of herself for some- 
 one else. 
 
 The autonotnic-ajf ective 7nechanism is the fixation of her love 
 upon the melancholy grandfather, ivho had been "like a mother" 
 to -the patient. This affective yearning reproduces the scene of 
 the grandfather's dead body. Her affections crave to have him, 
 but are unable to have him alive; hence, the affective craving re- 
 produces, in a sense, preserves, his existence in sensory images. 
 She claim^s that she looks very much like him. Site says she has his 
 facial lines and moles, etc. The affect seems to be eternally work- 
 ing ivith the dead man, trying, to resuscitate him.. 
 
 She pleads that if she could rid herself of his depressing ap- 
 peals to her she could become happy because she enjoys working 
 and is strong enough to earn her livelihood. 
 
 The grandfather apparently Avas the only one besides her 
 sick mother and an old woman who had shoAvn her consistent 
 kindness and sympathy. The patient was assigned to work and 
 treated with especial care in order to make earning a living and 
 the value of friends attractive to her. The reaction was a gradual 
 but definite fading of the grandfather images or thoughts as the 
 transference to her physician developed. She said he had gone 
 away and now she was happy. Several weeks after the vision 
 had disappeared, the patient was unwisely treated. She became 
 depressed and her troubles returned (regression of the affect). 
 She escaped one night, wandered along the railroad, contemplat- 
 
86 PSYCHOPATHOLOGY 
 
 ing suicide, but could not make up her mind. The next day she 
 was returned to the hospital in a tired, bedraggled condition. She 
 came into the ward sorry, crying and fearful that her physician 
 was going to "beat" her: This was a golden opportunity to win 
 an affective transference. A little reassurance that we were glad 
 to see her come back, a good dinner and rest in bed, won a splen- 
 did affective response from her. After this she took special pains 
 to see me when I made my morning rounds, and seemed to be de- 
 lighted when I stopped to talk to her. She'knew my Avish, from a 
 series of conferences, that the sad grandfather and the mean 
 father should lose their influence over her so that she could be- 
 come a happy woman and help us. She has now become inter- 
 ested in our ideals about working, being kind, saving money, being 
 happy, and helping everybody along. The sad, longing, tearful 
 facial expression has changed to one of happiness. She laughs, 
 heartily and works incessantly. She now has a paying position 
 in the domestic service of the hospital and regards it as the final 
 road to winning' happiness. She says that she is no longer both- 
 ered by the grandfather and has no interest in her father. She 
 is industrious and is developing into a reliable worker. 
 
 The prognosis depends upon the manner in which the trans- 
 ference is sustained by those who have charge over her. Should 
 she be treated meanly by a superior, a regression to the grand- 
 father attachment is expected to recur.* 
 
 It is generally recognized, although its mechanism and signif- 
 icance are not fully appreciated, that the father and mother, or the 
 adults who control the child in the development of its personality, 
 have a profound influence upon its affective requirements. But 
 what has not been recognized is that the adult unconsciously exerts 
 a decisive influence on the wishes of the child without the child hav- 
 ing the slightest comprehension of the existence of this influence.. 
 Further, the adult unconsciously cultivates in the child attributes 
 that please his own wishes and tends to repress in the child the 
 spontaneous interests that irritate the affections which the adult 
 has himself repressed. In this manner, a psychopathic (homo- 
 sexual) teacher or parent may ruin a child's affective disposition 
 by insiduously repressing its most vigorous and constructive affec- 
 tive cravings, particularly heterosexual love. 
 
 *About slvi months after this was written, the patient again became depressed and unliappy 
 and eloped from the hospital. 
 
THE PSYCHOLOGY OF THE FAMILY 87 
 
 The following extracts from the letter of a business man to 
 the physician in charge of his brother, who was in a serious 
 anxiety state (regression), shows how a mother's repressions 
 may cause her, in turn, to ruin her children and they, in turn, ruin 
 the grandchildren: 
 
 "Dear Sir: 
 
 "This is the second trip Gf has made to the hospital. I have taken 
 
 him there some years ago in a similar condition he is in now. 
 
 "I do not believe there is anyone that knows G 's condition better than I do, 
 
 being my brother. There were four children in father's family that lived to maturity, 
 four died in childhood. Father lived to a good old age of eighty years, and mother is 
 now living, having passed the 80th year. This would give the children a natural lon- 
 gevity, everything else being natural. Ov/r mother was a de-dowt Christian, always looked 
 upon conception or the act of conception as the great curse or cause of the human race's 
 downfall in Eden. Fo-ught marriage in the matter of her children amd advised all others 
 to steer dear of the pollution of marital union* Around our home fireside in youth, our 
 consciences were molded, and even to this day one brother 45 years old has never had 
 a sweetheart nor girl friend in his life. Both father and mother were powers in the 
 community in which they lived, but not of the leader sort, simply good citizens and re- 
 spected by all, living honest lives from without, but no doubt sinning in conscience all 
 the time if her doctrine be true. 
 
 "My sister, a beautifully sweet woman at maturity, withheld her marriage for a 
 number of years for mother 's consent, and finally married, mother simply not objecting, 
 but refused to attend the ceremony at our church. We children are all above the 
 average run in honesty, but lack a something that is essential in a human to fight the 
 world with. One would say ' ' lack of nerve, ' ' which would be right in one sense, but to 
 be more accurate, I would say, of a truth, we are all overconsoientious, so that what 
 would be passed over by a normal person, would prostrate one of us. My sister actually 
 lived the life of a Christian as near as her mind with God's help could guide her, but 
 she went down in despair and hellish torment when her daughter finally married (the 
 granddaughter) . 
 
 "Her daughter's marriage was excellent, and, though rough at the start, has 
 settled into a most contented condition now. The roughness was encountered iy Tier 
 not allowing her husiand to do family duty. 
 
 "She fought for her virtue, and, in several separations that occurred on this ac- 
 count, her mother's mind succumbed. (Sexual resistance in grandmother, mother and 
 daughter, through training; the conditioning influence of associates.) 
 
 "Fifteen years ago, for a period of five years, I, myself, made three trips to a 
 sanitarium, thought to be past hope of ever returning mentality. The cause of this I 
 frankly admit was from- being conscience-striclcen. A young girl, cousin to my wife, 
 crawled into my bed one night while wife was away from home. I quqte this truly. 
 She came to my bed and I also say I did not have a communication with her, but I do 
 say I really at the time enjoyed her company. But this could not be hid. Conscience 
 brewed till I was crazed to a point of confession direct to wife which she paid no at- 
 tention to, but to me a rip in the brain was made, and for five years I was outside of 
 
 *Italics inserted. 
 
88 PSYCHOPATHOLOGY 
 
 God's love and care, suffering the pangs of hellish torment from nothing in the world 
 that would have made a normal brain even swerve to one side. 
 
 "Just this last week, the third brother, the one that never had a girl sweetheart, 
 entered into the same condition, dementia, or something akin to it. 
 
 ' ' I returned three days ago from where I took him for rest and treatment. The 
 cause was most silly, from ordinary human standpoint, but to him it is as real as any- 
 thing can be. In a case where an inmate of a rooming house here had some girls which 
 she was using immorally, friction arose between them in the division of the spoils, and 
 the young girl preferred cha5:ge of white slavery against her housekeeper. Amongst a 
 number of witnesses, consisting of quite a few of our best young fellow citizens here, 
 bankers and lawyers, brother was summoned for the state. I thought it would kill the 
 boy, the shame and . disgrace he attached to the matter. He reported to the Federal 
 court and in the trial the woman openly acknowledged that it was her business, and she 
 was not ashamed of it and the act. None of the witnesses were called to testify. 
 
 ' ' The states attorney, however, in examining his witnesses before the trial, aSked 
 if he had ever had anything to do with the girl. He said no, and his brain is now, so to 
 speak, broken in a conscience-stricken condition, awaiting the awful penalty of perjury, 
 which, like Poe's Raven, won't leave the door. 
 
 "G 's breakdown first was occasioned by his haying promised to marry an 
 
 officer's divorced wife. His courtship, we can imagine, was mingled with trespasses, 
 but, when I found him in her grasp at the time on a leave of absence, she had him, 
 body and soul. His confession to me was pathetic, I assure you. His promise was out, 
 but she was, he found, a pervert of the first water, and his nerve was gone. I simply 
 
 took him and entered him in the hospital at once ; and he remained there bound 
 
 to his promise, but knowing it was death to consummate the marriage. The woman 
 
 married an officer in thirty days from that time, and G went out of the institution 
 
 well." 
 
 The occasion of this letter was.G 's second anxiety and de- 
 pression, which was said to be dne to his wife 's approaching labor 
 and his work as an officer. 
 
 It is a general observation to be made, if looked for, with sur- 
 prising frequency, that, ivherever we have an individual, male or 
 female, who is^conscientiously absorbed in striving to suppress the 
 sexual functions from mahing him or her aivare of their condi- 
 tioned needs, lue have a neurotic individual as the result. This 
 type of neurotic sexual abstainer must be differentiated from the 
 healthy, happy sexual abstainer who is so keenly and vigorously 
 engrossed in creating the fulfillment of a wish, through profes- 
 sional or vocational pursuits, that the creative, reproductive func- 
 tions are fully satisfied through the substitution. 
 
 The above conscientious, wretchedly trained mother, who was 
 unable to enjoy sexual intercourse because of some repressive 
 tendency, almost destroyed her children and granddaughter 
 through the pernicious, insidious suppression of their sexual 
 forces. The patient G , now a fatherj has had two very seri- 
 
THE PSYCHOLOGY OF THE FAMILY 89 
 
 ous depressions and is expected in turn, unconsciously, tlirough 
 his attitude, to influence his children so that their socialized 
 wishes will become ill adapted to meet the persistent demands of 
 the vigorous sex\ial cravings. 
 
 It Avill be seen, in the analysis of his life, that Darwin em- 
 phasized sexual selection as an important cause of variations 
 between individuals of the same species, because similarly 
 constituted males and females, struggling for the same habitat 
 and love-objects have the most persistent, and fiercest compe- 
 titions forcing the weaker to seek new objects. 
 
 The disguised competition between the males of the same fam- 
 ily, or the females, may be most serious, particularly if the mother 
 or father should be unhappily mated, and treat the child as an 
 obstacle, or substitute it for the mate. Many variations are possi- 
 ble in the father-mother or husband-wife adjustment. 
 
 The male or female child's affective cravings may become un- 
 knowingly conditioned by the persistent attitude of a parent, 
 grandparent, adult relative, brother or sister, or teacher, to re- 
 quire infantile, preadolescent, adolescent or post-adolescent forms 
 of attention from a particular person, that is, one having certain 
 affective and physical attributes. This depends upon the nature 
 of the influence and probably the child's level of development as 
 well as physiological condition when it has the experience of the 
 other person's influence. This conditioning capacity of the auto- 
 nomic cravings is as important for psychology and psychiatry 
 as the bacterial cause of disease is for medicine and science. 
 
 In Case HD-1, p. 617, the father, mother and older sister as- 
 siduously strove to keep the patient, a young woman, completely 
 dependent upon them. That is, they, with most amazing persist- 
 ence and selfishness, tried to keep her, the youngest child, a baby, 
 throughout her life. Hence, when she reached physical maturity, 
 she was utterly unable to compete with other males and females 
 for the means to gratify her cravings. Her most terrible enemies 
 were her father, mother and sister, who, despite my most vigorous 
 insistence, were unable to keep from imposing their wishes and 
 opinions upon her. With unerring fatality, she married the only 
 child of a beautiful, unhappy, neglected but self-reliant mother 
 who had made her son her hero and by cultivating a fixed affective 
 attachment in him she prevented him from being able to.love any- 
 one except his mother. He, in turn, horrified by incestuous. 
 
90 PSYCHOPATHOLOGY 
 
 thoughts and dreams that developed at maturity, courted and 
 finally married this girl, physically and mentally almos.t the di- 
 rect opposite in type of his mother, ' 
 
 This husband and wife, oppressed by the demands of the two 
 families, became incompatible, and the more infantile personality 
 collapsed. They were the offspring of highly intelligent people 
 whose heredity was apparently free from psychopathic traits and 
 "inherent taints." 
 
 The Crucifixion of Virility as a Wmlkj^^ Mechanism 
 
 The wise, severe, self-centered father and the religious, timid,, 
 obedient, mother tend to raise a son, particularly when they have 
 only one child, to have a profound mother-attachment from which 
 he becomes unable to free himself. He is completely subdued from 
 infancy by the father's power, and, held by the pitying mother's 
 love, is unable to assert his own masculine tendencies, because 
 they would claim the mother and compete with the father. Such 
 sons, despite the most desperate efforts, tend to remain miserable, 
 autoerotic personalities (Cases AN-3, PN-6, PD-35) or even be- 
 come sexually perverse because the self-sacrificial or erucificial 
 cravings take on the form of submissive oral eroticism for the fe- 
 male at first, but, usually, later, for the male (Case PD-33). When 
 the child's affections to be submissive are too insidiously cultivat- 
 ed by the mother for her own delight, since this begins at birth 
 mth nursing attentions and cleansing, the affections seem to over- 
 value the oral. and visual receptors (nursing), and olfactory and 
 anal receptors (tickling and cleansing). AVhen the affective crav- 
 ings become definitely developed in their requirements at matur- 
 ity, instead of converging upon muscular play and the external 
 organs of the pelvis and the tactile receptors there, it seems the 
 oral zone continues to be overvalued, producing an oral erotic 
 effeminate personality. (Other factors of invigoration are dis- 
 cussed in the chapter on "The Universal Struggle for Virility, 
 etc.") 
 
 This will be shomi (Cases CD-I, PD-35, PD-36, PN-6, PD-33, 
 and others), upon the study of the graver psychoses j to be the 
 fundamental determinant for the terrible fears and the dissocia- 
 tion of the personality in such individuals ; because the affective 
 cravings to win social esteem are so trained that they can not be- 
 
THE PSYCHOLOGY OF THE FAMILY 91 
 
 come reconciled to the demands of the perverted sexiial cravings. 
 The repressed, perverted cravings, overcoming the resistance of 
 the ego, force the individual to become vividly aware of distorted 
 images of past experiences (hallucinations) and these sensory- 
 images, gratifying the craving, increase the patient's anxious 
 plight and fear of becoming a degenerate. The cases show that 
 the feeling that "poison" is in the food means that the food has 
 a sexual value which is probably conditioned by the affective value 
 of nursing in infancy, being overvalued by the affective rapport 
 with the mother and the mammary gland. The timid, submissive 
 mother's wish, that the son shall obey a domineering, jealous 
 father, is gratified by the homosexual submission, crucifixion or 
 sacrifice of his virile initiative for the sake of the potency of the 
 rival. Thereby, all competition, as a virile male, for the mother's 
 love, is renounced for the sake of her mate's potency, upon the 
 mother's timid influence (Case AN-3). The one avenue left to 
 retain the mother's demonstration of love is to regress to or remain 
 her dependent (nursling). The compensation for this trend, when 
 it becomes recognized as an inferiority, is extreme arrogance and 
 hatred of the parents and a feeling of being persecuted for inferi- 
 orities; or, if the environment is favorable, a career consecrated 
 to gratifying the inspirations of the mother despite the father's 
 resistance. (See Darwin's Life, p. 208.) The crucificial adjust- 
 ment to the parents is shown in Michelangelo 's Pieta, Fig. 54. 
 
 To return to the causes of variations in family adjustments 
 or matings and their influences on the offspring. The psychopath- 
 ologist must study the family as a biological problem. The osten- 
 sible practices of the family, that is, the "good manners," as- 
 sumed for the needful purpose of misleading the neighborly gos- 
 sips, are utterly worthless data upon which to estimate the true 
 character of the family situation. Experience with numerous 
 psychopaths and their families shows that it is almost impossible 
 for a member of a family to develop a psychoneurosis or functional 
 psychosis without the family or some member being involved di- 
 rectly or indirectly, consciously or unconsciously, as a repressive 
 influence that has combined with other causes of stress to bring 
 about the collapse. 
 
 The marriage obligates the male and female to depend upon 
 one another for such displays of affection as are necessary, in 
 
92 PSYCHOPATHOLOGY 
 
 turn, to arouse vigorous autonomic functions in each, other. These 
 vigorous cravings are the forces that give the male and female 
 the power to enjoy creating the pleasant home and prosperous 
 business despite toil and worry. Wherever two people are un- 
 satisfactorily mated, that is, wherever one or the other, as a com- 
 pound stimulus, is not appropriate to arouse vigorous autonomic 
 affective cravings in the other, because these functions are condi- 
 tioned to react to quite different types of stimuli, the individuals 
 tend to become obsessed by compulsions that insist upon freedom 
 from restraint in order that the affections may attain their normal 
 requirements. Discontented, irritable and critical, a chronic per- 
 secution of the unsatisfactory mate develops until it is followed by 
 separation and divorce, or eccentric distortions and inefficiency 
 of the personalities. 
 
 In those cases where the immediate members of the two fam- 
 ilies or the religious convictions resist the divorce, a psychopathic 
 type of adjustment results, because the restless affect must be 
 repressed or diverted. Out of the dilemma, the natural wish spon- 
 taneously arises that the other might die or become sexually un- 
 faithful, which would then legally liberate the repressed craving 
 or tense aittonomie functions. When one or the other member of 
 this kind of marriage is stricken with a serious illness, both may be 
 horrified by becoming aware of the wish for death. 
 
 One occasionally 'sees such unfortunate individuals gro- 
 tesquely trying to conceal their pleasure at the prospect of free- 
 dom. 
 
 The unsuitable marriage, through forcing the affect to accept 
 that which it has aversions for, finally depresses the affective vigor 
 of the individual when it is accepted as an unchangeable obstacle 
 or resistance. Cynical people, including those who are married 
 as well as unmarried, are cynical because they have accepted the 
 world as containing nothing that can ever really gratify their love 
 cravings. Hence life becomes a bore, and spontaneous thought 
 drags along with only sufficient vigor to protect the honor, and the 
 nutritional and economic needs of the personality. For such indi- 
 viduals, the belief in a second life, Avhich is encouraged by religious 
 associates, is adopted to make life worth- living. This belief often 
 becomes the most important compensation of the individual and 
 almost a vital necessitv. 
 
THE PSYCHOLOGY OF THE FAMILY 93 
 
 The married couple that is unable to give up the struggle to 
 attain happiness through becoming attached to a satisfactory love- 
 object, often decides that a child will give it the common bond 
 of interest for happiness. This plan too frequently fails when it 
 is hoped that the child will become a mutual inspiration. It fre- 
 quently happens that one or the other of the parents, depending 
 upon whether he or she is homosexually or heterosexually inclined, 
 will cultivate the affections of the child while the other tends to 
 persecute or neglect it. In this manner, an affective fixation will 
 be innocently, gradually developed in the child at the level that 
 pleases the affective needs of the parent who has turned to it for 
 love and comfort. For the other parent, the child becomes a bonds- 
 man, because its existence enslaves, through economic and social 
 obligations, the affect of this parent. The unwelcome child may or 
 may not become aware in the future that it is a hated obstacle but 
 it will surely come to feel like any other individual whose society 
 is not desired, that something is amiss. Uncomfortable, dissatis- 
 fied, irritable, lonely, neglected, and feeling inferior, it may never 
 find anything or any vocation to inspire it. (When influenced to 
 become resentful of this mistreatment he tends to become a rest- 
 less, wandering hero, criminal, or hobo, depending upon his cour- 
 age.) 
 
 A heterosexual male and a homosexual female, or the re- 
 verse, rarely make a comfortable marriage unless they have ade- 
 quate sublimations. Heterosexual males and females, or, 
 strangely enough, homosexual males and females, who have in- 
 sight and do not suppress one another, often make comfortable 
 marriages. Children born of mismated parents, who must live, 
 day after day, until maturity, under the influence of their conflicts 
 and ungratified yearnings, do not become conditioned to have the 
 well-defined interests in life that other children have whose par- 
 ents are so mated that they do not need the child's affective at- 
 tachment to satisfy old, selfish interests. When one of the mis- 
 mated couple resigns its wish to see the children fulfill certain 
 aspirations and tacitly favors the wish of the other parent, they 
 may be saved from developing a confusion of interests. This 
 seems to be the most common adjustment adopted by mismated 
 American families. 
 
 The fact that over 30,000 cases of so-called dementia precox, 
 that is, chronic regressions and dissociations of the personality, 
 
94 PSYOHOPATHOLOGY 
 
 occur in the United States'^every year is suffieient to empiiasize ho^w 
 vitally necessary it is that the American family should become 
 organized or reconstituted on a more healthful, honest basis. The 
 vigorous movement for the enfranchisement of womanhood will 
 probably relieve one cause of adolescent fixations in the child, 
 because gradually the attitude will be developed of allowing the 
 well-conditioned affections frankly to dominate our behavior in 
 order that an honest source of gratification may be maintained, 
 if not through the husband's contribution, then through exercising; 
 the right to again choose freely. The succeeding mothers will 
 generally become progressively more resourceful and self-reliant 
 in their methods of attaining happiness. Out of this tendency, 
 however, a new, most serious difficulty is arising, if one may judge 
 from the actual dilemma of certain families, and that is a pro- 
 gressive tendency to cultivate interests which are homosexual. 
 This is due to the sexual resistance in the female, who, afraid of 
 becoming pregnant and jeopardizing her beauty and independ- 
 ence, refuses to take the risks of making herself the slave of a 
 child and becom'es frigid. She then exerts every artifice to castrate 
 psychically her mate (Cases PD-7 aaid PD-8). 
 
 It seems to be a strikingly consistent occurrence that when- 
 ever a male is unable to seek another female because of his moral 
 resistances, and his mate, holding him in this iron grip, discour- 
 ages his sexual advances through obstinate refusals, fear of pain, 
 or frigid disgust, he tends to lose his heterosexual potency and 
 often reverts to post-adolescent homosexual interests. This re- 
 version is irresistible and produces a family catastrophy because 
 the children are neglected as they become burdens when the paren- 
 tal affections diminish. 
 
 The principal factors that seem to influence the female to be 
 resistant are /ear of being dominated, the dangers of preg^^ 
 nancy and labor, pain, inconvenience, drudgery and loss of physi- 
 cal beauty caused by pregnancy, and an aversion for using 
 contraceptives, besides the fixation upon infantile sexual substitu- 
 tions, as anal, oral and urethral eroticism. 
 
 When she is homosexual the sexual attentions of the male do 
 not give her pleasure and if aggressive may even be terrorizing 
 or disgusting to her. While her husband is engrossed in the eco- 
 nomic struggle with other men, this type of woman secretly in- 
 
THE PSYCHOLOGY OF TIIE FAMILY 95 
 
 trigues with herself to practice a thoiTsand and one tricks by which 
 she can discourage his sexnal inclinations, even at the cost of his 
 vocational initiative. Following her secret dishonesty, she con- 
 stantly watches for indications of what his dissatisfied feelings 
 may prompt him to do in the matter of getting a new sexual ob- 
 ject. "With jealous petulance or the tears of invalidism, she holds 
 him in her remorseless grasp. 
 
 One of our patients (Case PD-7) has been fighting strong 
 cravings to become homo sexually submissive. He has persisted in 
 refusing to resume an interest in his wife. After several inter- 
 
 Fig. 7. — Maha-Kali, destroyer of men. 
 
 views with her, in which the usual stock of' lies had to be deci- 
 phered she finally told me the true stoiy. She maintaiiied that 
 Tier fear of having children and her husband's small salary made 
 her resistant. Her love for her physical beauty might be in- 
 cluded. Repeatedly, she had played with her husband until he 
 became sexually aroused and then refused him. He became 
 "hysterical," depressed and sullen and gradually passed into a 
 struggle against homosexual compulsions which finally caused 
 most distressing hallucinations of assault and delusions of being 
 seduced by men. Her efforts to win him back, following sincere 
 regret, have utterly failed to arouse any confidence in him. This 
 man, it must be included, had developed a weak heterosexual mar- 
 
96 PSYCHOPATHOLOGY 
 
 gin before his marriage, but it became quite evident that his wife, 
 like Delilah, had deftly castra;ted him. Her sisters, both more 
 maternal in type, regarded her resistance as the cause of the man's 
 impotence. 
 
 Case PD-8. — An undersized, effeminate man, has been re- 
 turned to St. Elizabeths Hospital several times, with always the 
 same psychopathic condition — namely, a wild flight of fancies in 
 which he believes he exercises omnipotent powers. This is inti- 
 mately associated, as a compensation, with feelings of sexual in- 
 feriority, jealousy and convictions that his wife secretly loves 
 another man. The foundation for his belief in this is unshakably 
 based upon the fact that, although she is amorous, she refuses his 
 sexual advances. She has six children, and the family's income, 
 her husband having, had three prolonged psychoses, is too meager 
 to support another child. Although sexual perversions occurred as 
 a substitute, no solution was found. The wife now siims up the 
 tragedy with the conviction that they are "mismated." She said 
 her husband was sexually unattractive to her, but she could not 
 consent to his seeking another sexual object. The patient's sister, 
 who was present at this interview, suggested to the sister-in-law 
 that she should follow her adjustnient, which was to permit her 
 husband sexual freedom if he would consent to leave her alone. 
 She said the sexual act was disgusting to her. For the jealous 
 wife this solution was impossible. 
 
 The daughter of this man, a delicate, unhappy, brooding, 
 young girl, comes to visit her father with a motherly, solicitous 
 attitude. Her future seems destined to become a tragic psycho- 
 pathic struggle. 
 
 Another very serious influence in the American family, be- 
 cause it tends to abnormal sexual repression and distortion, hence, 
 prudish resistance to- really loving the mate, is the universal ten- 
 dency in the home, church and school to taboo any childhood in- 
 terest pertaining to sex. This tends on the one hand to develop 
 secret vulgarity and perverseness, and on the other, frigid prud- 
 ishness. This is gradually changing, but is still very far from 
 normal. It seems to be vitally necessary, for society frankly to 
 express its disgust for sexual perversions, but, constructively, it 
 must come to recognize the importance of admiration and ap- 
 proval, for the sake of the individual's health and happiness, of 
 a normal 'sexual life. The tendency to sexual castration or secret 
 
THE PSYCHOLOGY OF THE FAMILY 
 
 97 
 
 autoeroticism and perverse substitutions can only he adjusted hy 
 aggrandising the maintenance of virility and removing fear of 
 normal sexual relations. Never entirely, however, will the race 
 be able to eUminate the traces of the phylogenetic influence of the 
 ape-man and his polymorphous perverse tendencies which crop 
 out in well-defined forms in the lower grade mental defectives and 
 in the preadolescent stages of childhood. 
 
 The two women who unsexed their mates, that is, through sub- 
 tle resistances forced a regression to adolescent homosexual meth- 
 ods of obtaining gratification in their husbands, are representative 
 of the pretty, amorous woman who loves herself more than she 
 
 Fig. 8. — The Egyptian god Phtha, adoring virginity "but masturbating and showing 
 oral^ eroticism. Egyptian Temple sculpture; from L'Egypte. 
 
 does her husband. She must protect herself because so soon as 
 she becomes affectionately demonstrative he becomes erotic and 
 this frightens her. When he becomes depressed and sullen and 
 homosexual she is safest. This type of woman is also to be con- 
 sidered with the opposite truly masculine type of female, who 
 has male features and voice, hypertrichosis, square shoulders and 
 smaU hips, and whose aggressiveness disposes to an uncomfort- 
 able tension unless she can dominate and fight for a social cause 
 under the pretext of liberating her sisters from the domination 
 of the "nasty man." She unconsciously, and often openly, com- 
 petes with the male for a female love-object, is a hater of virile 
 manhood and an "adorer" of "sweet men" and effeminate es- 
 
98 PSYCHOPATHOLOGY 
 
 thetes. The latter, sexually inclined to seek the affections of virile 
 males, quite gladly substitute the protection of the aggressive 
 female. This type of woman is usually quite happy when mar- 
 ried to an effeminate, or passive male who graves to be dominated 
 and protected and they even raise children with little difficulty. 
 The virile female, who needs to dominate, can not live comfortably 
 with a virile male, neither caai the clinging, dependent female live 
 comfortably with a dependent male. G-radually, the true affective 
 needs will cause irritability and impatience with the imposed 
 love-object and the child, as the bondsman, must suffer perse- 
 cution. 
 
 Another relationship of affections to be met with in the family 
 is the virile, vulgar male and the unhappy, refined, invalided wife, 
 Avho, although heterosexua,!, can not love her offensive husband. 
 His attentions worry her and his intercourse causes pain. She 
 suffers, from headaches, dysmenorrhea, and abdominal distresses, 
 while he, vaguely aware of her general attitude, forces her into 
 the alternative of submitting or permitting him to seek a mis- 
 tress. When she is unable to endure the latter she suffers from 
 one sexual act to the next, not daring to become gay because he 
 will become sexually aroused. She usually has but one or two 
 children who gradually tend to support the appeals of the sufferer 
 and hate the aggressor. 
 
 One boy, who became an impotent, unaggressive male at ma- 
 turity, at twelve, violently and openly hated his father upon hear- 
 ing his mother's sufferings when she had to submit to sexual inter- 
 course. Such reactions on the part of the son often lead to a mor- 
 tal feud between father and son, and the mother, depending upon 
 whether she wishes her freedom or not, inclines to support the 
 son's aggressiveness or induces him to submit to the father in or- 
 der to have peace. The tendency of this type of father, if he has no 
 insight, is incessantly to force the son to give (spontaneously) evi- 
 dence of his submission in hesitant movements, aresonant tone of 
 voice, and errors of judgment which give the father the desired 
 opportunity to shoAv his potency, domination and wisdom by mak- 
 ing corrections. Out of this persistent submissiveness of the pos- 
 tural tensions of the body comes the inability to assume "responsi- 
 bility or maintain initiative. Sons of such fathers and mothers 
 become unable openly to contend for the love-object because the 
 
THE PSYCHOLOGY OF THE FAMILY 99 
 
 mother has unconsciously betrayed the son's potential aggressive- 
 ness hy pleading that he shall submit to the rival^ (Case AN-3). 
 The mother wlio obtains a separation or divorce, l)y the act of re- 
 nouncing her interest in the father, greatly encourages the son to 
 feel that he is his mother's hero. He enthusiastically responds 
 with affection for her and prematurely seeks responsibility. This 
 affection, as he matures, if not effectively sublimated, will be likely 
 to express itself frankly, at first, in drc^aiiis and then in obsessive 
 cravings, in the form of sexual interests in the mother (Cases 
 PN-6, AN-3, and MD-6). 
 
 When this mother, however, marries again or becomes eco- 
 nomically independent, which means to the son that she still loves 
 .someone more, he tends to become a psychopath (Case MD-6) if 
 he is unable to find another love-object that inspires him to work 
 and struggle. Under such conditions he is actually functionally 
 inferior to other competing young men. Feeling. that all hope of 
 finding love is lost, he is forced liy the ungratified affect to waste 
 time and energy in reminiscent brooding, hence, ineffieient work. 
 
 When the mother's second marriage is also unhappy, the son 
 may become a bitter feudist if his mother tends in the least to 
 depend upon him for protection and sympathy. If she can not 
 quite go this far he leaves home as a wretched wandering hero or 
 runaway boy (in the reverse family situation the girl wanders) 
 and often enlists in the army or navy to fight. 
 
 The presence of the second and third son, or son and daugh- 
 ter, or several sons and daughters, greatly complicates the situa- 
 tion in a poorly balanced marriage, but by diffusing the attentions 
 of the parents and the child the latter is often saved. Competition 
 for affection may occur between the children of any intellectual 
 level, including twins as well. The favorite son of the virile fa- 
 ther becomes virile largely through the influence of the father 
 mshing him to propagate his name and family honor. Whereas, 
 the attached son of the dutiful, suffering mother becomes ef- 
 feminate because he is not allowed to make virile, competitive self- 
 assertions. When he does attempt it the affect struggles so fla- 
 grantly for the, mother's love that it competes with the father and 
 is instinctively attacked, or unjustifiable incestuousness comes into 
 the foreground. Often, however, religion, art, music, or science, 
 as the means of sublimation and contention, obscures the nature of 
 
100 
 
 PSYOHOPATHOLOGY 
 
THE PSYCHOLOGY OF THE FAMILY 101 
 
 the mother attachment sufficiently to make it acceptable to society. 
 Nature, however, can not always remain satisfied with the love 
 song to the subconsciously enshrined mother. Incestuous dreams, 
 indicating the trend of the affect, cause depression and anxiety. 
 The ministry is often adopted to refine the mother attachment, 
 and earnest prayers succeed frequently in sublimating the mother 
 love. This solution is more lUcely to occur when the mother, not 
 satisfied with her husband, because of her own childhood attach- 
 ment to her father, converts her son into a minister — thereby re- 
 storing the image of the holy father. Vigorous girls, having 
 strong affections for their fathers, often marry elderly men and 
 may or may not be persecuted by the vague awareness of their 
 incestuous feelings. When incestuousness frightens a woman, and 
 she reflexly tends to distort her affective interests in her family 
 in order to escape, her husband becomes dissatisfied, because she 
 can not hfelp but neglect him. 
 
 In one family, composed of a well-educated young man and 
 woman, the htisband became seriously depressed for a year fol- 
 lowing the birth of a son. The wife was frankly disappointed in 
 her husband's lack of manly self-assertiveness. He had been some- 
 what depressed by the dominations of an employer, and still ear- 
 lier, by his family's resistance to the marriage, biit when his wife 
 
 Fig. 9. — Java Temple and Legend. (Published by permission of Asia Publishing Co.) 
 
 The Java temple (Buddhist) serves as the setting for the three stone statues in 
 the dim half -ruined interior. The middle and larger one is remarkable for its posi- 
 tion. Buddha is usually represented in a kneeling or sitting posture; this image is 
 seated on a stool with both hands held as if in prayer. There is a popular legend 
 to the effect that the middle statue is Prinee Dewa Kosoumi, and the smaller statues, 
 his wife and daughter. 
 
 Onee in the fabled past there dwelt a great prinee, Dewa. His illustrious reign 
 was bright and unclouded until the pearl of his heart, his two-year-old daughter, 
 was stolen by a revengeful courtier., Everywhere he searched, but he could n'ot find 
 her. His sorrow, like all sorrows, was assuaged by time. At the end of twelve years 
 he fell in love with a very beautiful girl and married her and a child was born to 
 them. The villainous courtier now appeared and told Prince Dewa thathis wife was 
 no other than his kidnapped daughter. The prinee was horrified and wished to atone 
 for his unconscious sin. A holy man was consulted. He said that the sin would be 
 forgiven only on condition that the prince would construct a temple at Boro Budor in 
 ten days. All the artists and workmen in the country came and worked with fren- 
 zied enthusiasm to save their king. The great temple, with its galleries and hun- 
 dreds of images, was completed within ten days. But alas! One image was missing. 
 The gods in anger turned the prince and his wife and daughter to stone. 
 * The legend of this attachment of father for daughter has its counterpart _in von 
 
 Stuck 's painting of '/Der Sphinx" (See Fig. 27), showing the attachment of mother 
 for son. The Oedipus tragedy of Sophocles portrays the attachment of son for mother 
 and hatred of father, whereas the crucifixion (La Pieta) shows the attachment of 
 son for mother and his submission to the father. 
 
102 PSYCHOPATHOLOGY 
 
 neglected him in her devotion to the infant son, he regressed into 
 a helpless, suicidal attitude. A serious affective conflict developed 
 between the two. Unfortunately, this became further aggravated 
 by the wife's mother supporting her daughter rather tactlessly, 
 both being disappointed because the husband was unable to wel- 
 come his infant son. The husband and wife were both sincere and 
 quickly effected a wholesome readjustment upon the development 
 of insight through a psychoanalytic study of the situation. The 
 father readjusted and became fond of his infant son, making a 
 fine beneficent transference to him, and returned to work with 
 enthusiasm and efficiency. 
 
 The foundation of the Oedipus or Electra complex, as the 
 psychopathologis.t meets it in his practice, may be shown to rest in 
 one or the other of the parents. The parent that cultivates the 
 affections of the child conditions it so as to please his own affective 
 cravings. He is often devoted to the welfare of one child and 
 heedless of the future of the other (Case HD-lj. This occurs be- 
 cause most parents have absolutely no insight into the affective 
 mechanisms that develop the personality, either in themselves or 
 the child. Parental influence becomes particularly vicious and dif- 
 ficult to reconstruct wherever the parents have succeeded in dis- 
 guising and justifying their secret pleasure with pretext and sub- 
 terfuge. No matter how flimsy this may be, they adhere to it most 
 tenaciously when it hides pride, envy, jealousy, sloth, gluttony 
 or dishonesty. 
 
 Case CD-2, p. 572, shows how a vigorous, affectionate girl, who 
 had a strong father attachment, married a divorced, middle-aged 
 man, an obvious father substitute, despite the objections of her 
 family. The marriage was a disaster and after two daughters, 
 had reached adolescence, a divorce was procured. This sincere, 
 well-intentioned mother, struggling against her sexual needs, suc- 
 ceeded in belittling the male as an attractive object for herself. 
 But, more seriously, in order that her daughters should not be 
 self-willed and make impulsive marriages, which she always felt 
 she would not have made had her father frankly objected, she as- 
 siduously cultivated an absolute dependence upon her advice in 
 both of her daughters. The oldest dau.ghter married a man who 
 was pleasing to her mother largely because the mother be- 
 lieved she could influence him. This later became unsatisfactory 
 
THE PSYCHOLOGY OF THE FAMILY 103 
 
 because the husband began to feel the necessity of being inde- 
 pendent of the mother-in-law and urged his wife to assert herself 
 in order that she might develop the ' ' attitude of a woman. ' ' De- 
 spite the mother's disappointment they established themselves in a 
 neat secluded home which was relatively inaccessible to her sugges- 
 tions. Upon the daughter's third labor, because no maid could be 
 obtained in the emergency, the mother had to take charge of the 
 house. • She simply could not refrain from resuming her old dom- 
 ination of the family. Her daughter repressed her anger upon 
 her husband's influence and submitted to the mother. During 
 the convalescence, following a sudden conflict with her mother, 
 she passed into a psychosis in which she became crucified as a 
 hermaphroditic Christ — becoming both male and female in that 
 she believed she was masculine sometimes and feminine at others. 
 Follomng the patient's recovery this family situation was fairly 
 well readjusted after repeated conferences with the wife, husband 
 and mother. 
 
 An infantile mother, suffering neglect and yearning for a pro- 
 tector, may influence her daughter, if the only child, to develop 
 masculine traits of personality, and wlien she matures slie contin- 
 ues to be aggressive but homosexual. Because of her conditioned 
 affective cravings she in turn can only be happy when she is the 
 dominating member of the family. She becomes a type of per- 
 sonality that is unable to understand her husband if he does not 
 become submissive. Another type of woman unconsciously cul- 
 tivates submissi^'e tendencies in her son or daughter and tends 
 to dislike their virile affective compulsions when they begin to 
 show.. She excuses her selfishness with the feeling that she must 
 keep her child out of dirt and mischief and make it obey. She 
 makes "a girl" out of her son by keeping him unduly long in 
 dresses, keeps his hair long and curly, and adds an "ie" to his 
 name: as Frankie, Willie, or gives the boy a name that may have 
 an effeminate sound, as in Case PD-35. The mother of this pa- 
 tient did not love her husband and tried to develop effeminate 
 traits in her son, naming him "Lawrence," keeping him dressed 
 like a girl, hair long and curled and manners gentle and shy. Such 
 men tend to marry aggressive elderly, "manly" Avomen if some 
 influence does not give them insight and cause them to strive to 
 overcome the submissive affective trend. If they have some in- 
 
104 PSYCHOPATHOLOGY 
 
 sight, they turn heaven and earth to win their manhood and hate 
 to the killing point the unwise mother. 
 
 The homosexual father, who is "not averse to his homosexual- 
 ity, tends unconsciously to cultivate such reciprocal homosexual 
 traits in his son as please him most. The father who is afraid of 
 his homosexuality and strives to compensate by developing all the 
 masculine traits possible, hates the parent whose influence he be- 
 lieves made him homosexual, hates the dissatisfied wife who, he 
 feels, must surely be disappointed in him, and suppresses his son's 
 spontaneous virile expressions because they emphasize his own in- 
 feriorities and influence him to resume his old submissiveness. 
 
 Frequently, a debilitating disease, such as infantile paralysis 
 (Case PN-6), justifies the temptation of the mother "to raise her 
 boy like a girl. ' ' Her tears and sympathy destroy his aggressive- 
 ness and self-reliance and he becomes so conditioned (pettish) as 
 to be unable to compete with men honestly. He either resorts to 
 trickery or depends upon soliciting pity. 
 
 A flirtatious father or mother may keep a family of children 
 in an incessant turmoil, and, wherever one suffers anxiety or jeal- 
 ousy because of the illegitimate fancies of the other, the children 
 are drawn into the miserable situation, and its effects upon their 
 school record can be easily seen. When a child, having an average 
 capacity to learn, begins to fail and no physical lesion exists, either 
 a sexual trauma is disturhing the thoughts of the child or a serious 
 affective conflict is raging between the father and mother. When 
 parents arrive at the admission that the only thing that prevents a 
 divorce or separation is the welfare of the child, the child, having 
 subconsciously for the parents, the value of being an imprisoner of 
 their affections, soon begins to feel that it is unwelcome. Parents 
 usually deny such feelings, but the psychopathologist, by compar- 
 ing the attitude of parents who are genuinely happy with their 
 children, with the manner in which irritable mismated parents 
 censure and "pick on" their children, can rest assured that the 
 child is being slowly, insidiously ruined, because it is the bond that 
 represses vital yearnings. Most of our chronic lawbreakers and 
 asocial adults, thieves, pimps and prostitutes, whether mental 
 defectives or not, are chronically asocial in their tendencies be- 
 cause of the pernicious influence of mismated parents or the hatred 
 of the adults, who raised them. It is far better for the child to be 
 
THE PSYCHOLOGY OF THE FAMILY 105 
 
 raised under the consistent influence of one parent than to be dis- 
 torted in its emotional reactions by two people having conflicting 
 tendencies. It is not amazing that the affective needs of an 
 unsophisticated child should be mined by the conflicting wishes 
 of parents, siiice highly trained adults become confused and ineffi- 
 cient when their employers become incompatible and demand con- 
 flicting kinds of work. 
 
 The study of the sexual and social behavior of infrahuman 
 jy-imates shows that the male and female young, as they mature, 
 tend to compete with the adult males and females, including their 
 parents, for each other's affections. Similarly, a son of the genus 
 Homo will naturally compete mth his father for the affective fa- 
 vors of the mother, and the mother -and daughter compete for the 
 father's favors without being aware of its significance. The sex 
 regulative laws of society indicate that somewhere in the evolution 
 of the higher primitive man, the older males, as their physical 
 powers weakened, were forced to protect themselves from the in- 
 cestuous cravings of their more vigorous maturing offspring, for 
 two purposes, personal safety and control of influence in the fam- 
 ily alliances (as the subordination of son-in-law or daughter- 
 in-law) . 
 
 The resistance of the parents, forcing the young to withhold 
 the fulfillment of their childhood wishes, influences them to create 
 substitutes which are necessarily more or less beneficial to society. 
 These productions often constitute art, science, invention, etc. 
 (See Freud's Analysis of Leonardo da Vinci. Also the origin of 
 Darwin's inspiration, Chapter VI, and tlie perpetual motion ma- 
 chine of Case P-1.) Within the historic age a. growing social cen- 
 sorship has developed which has its formulation in the laws of the 
 church and state, as well as in the attitude of the family, whereby 
 the sexual cravings of the offspring are forced to seek a satisfac- 
 tory love-object outside of the family, and the youth, in turn, 
 jealous of his rights, insists that the parent shall not transgress 
 beyond the family. 
 
 The social resistance has increased since the ancient conflict 
 between father and son for the mother, or between two sisters 
 for the husband of one, or two brothers for the wife of one, or 
 two sons for a mother. The adult female as well as the child was 
 regarded by some peoples as having no rights or soul and was 
 
106 PSYCHOPATHOLOGY 
 
 bartered by the strong. Violation of her was not a crime. Now 
 society maintains laws to discourage intrafamilial intrigue. This 
 is a frank recogniti-on that within each civilized male and female 
 there may possibly become active cravings that care for the sexual 
 object without regard for any social implications. Therefore, in 
 some states, it is specifically prohibited by law for a man to marry 
 his grandmother, grandfather's wife, wife's grandmother, fa- 
 ther's sister or mother's sister, mother, step-sister, A\T.fe's mother, 
 wife's daughter, grandson's wife, wife's son's daughter, wife's 
 daughter's daughter, brother's daughter or sister's daughter. 
 
 ThroiTgh forcing the affective cravings to go outside of the 
 family in order to exercise sexual selection, society has been enor- 
 mously enriched by the intermarriage of families and the contri- 
 b\itions for esteem made by the individual competitors. The in- 
 dividuals must demonstrate their initiative, charm and potency 
 by their creations in order to win the affections that are generally 
 bestowed upon the fittest. Hence, each individual's method, 
 through profiting by the experiences of others, tends to become 
 more and more efficient and intricate, and the creations that best 
 suit the affective needs are retained while the others tend to be 
 discarded. 
 
 Wherever parents are happily mated the influence of one upon ' 
 the other arouses strong cravings to iimnortalize and perpetuate 
 the comfortable affective relationship by extending it through the 
 offspring. Hence, their consistent attitude, creating a distinct at- 
 mosphere in the home, unconsciously arouses and conditions 
 strong, consistent wishes in the child which determine its behavior 
 later, as an adult, if it finds that its methods bring it happiness 
 and esteem from its social group. If the family methods are "old 
 fashioned," or the religion is "unreasonable," the youth may suf- 
 fer and revolt. The parents who are really dissatisfied but "kejBp 
 up appearances" must have a confusing influence upon their chil- 
 dren because the affections, disguised behind the effort to keep up 
 "appearances," subtly influence the child so that its capacity to 
 socialize its affections becomes confused. 
 
 The heterosexually conditioned father or mother, who is not 
 satisfied by the mate and cultivates the love of one of the childrqji, 
 may develop vague, incestuous fantasies for this daughter or son. 
 This will surely arouse, reciprocally, a vigorous incestuous crav- 
 ing in the child. This incestuous craving in the daughter, when it 
 
THE PSYCHOLOGY OF THE FAMILY 
 
 107 
 
 is not Avell sublimated in Avomanhood maj^ become satisfied in the 
 psychosis by the fantasy of being a heavenly hride and the prosti- 
 tuted sexual object of the onmipotent fatlier. This often l^ecomes 
 extended to include all men as omnipotent man (Case HD-l). 
 This mechanism also indicates the genetic origin of the chronic 
 
 Fig. 10. — Costa Eican prehistoric ceremonial statue of erect pliallus as a God to 
 popularize reproduction. (Permission of the National Museum, Washington, D. C.) 
 
 wish to be a prostitute. Prostitutes have a favorite song in which 
 they delight in calling their patrons "daddy," and also refer to 
 the penis as "daddy," a form of phallic worship. One patient 
 fancied the penis as a god "that stood up like a little man and 
 
108 PSYCHOPATHOLOGY 
 
 wore a crown." See the erect Costa Eiean phallus as a sufEering 
 god. Fig. 10. Prostitutes often delight in being held as helpless 
 sexual slaves by some man who uses their money; also a very com- 
 mon fantasy in the erotic psychoses. Many of them are not only 
 seduced in fancy by a relative, as they cohabit with men who re- 
 
 Fig. 11. — "Pygmalion and Galatea," by Eodin. A subtly disguised form of 
 phallio worsliip which has tremendous influence in popularizing and refining the sex- 
 ual interests, thereby insuring the race against autoeroticism, prudishness, prostitu- 
 tion, perverseness, and suicide. 
 
 mind them strongly of their fathers, uncles, or brothers, but vice 
 investigations have shown that many prostitutes have actually 
 been seduced by their fathers, uncles or brothers. It also is to be 
 considered that the lower the mental capacity of the female, as the 
 
THE PSYCHOLOGY OP THE FAMILY 109 
 
 imbecile, the less she is able to sublimate her attachment to the 
 male that clothed and fed her during the preadolescent stages if 
 she has not been carefully trained to make a religions conversion. 
 Some women have strong sexual feelings for their sons which 
 they are not quite able to disguise. This may be seen in the man- 
 ner in which they show their affections and coyly display them- 
 selves to their sons more or less undressed, find excuses to travel 
 and sleep with them, but avoid their own husbands (Case PD-36). 
 (xradually, a vigorous incestuous craving is developed by this play. 
 By an adolescent boy these privileges may be enjoyed until the 
 disgust of others opens his eyes to the significance of his secret 
 behavior and wish. Suddenly, the mother finds he has developed 
 an "unreasonable" impatience and hatred for her (Case PD-35). 
 Other boys, who have been similarly raised, may not becorde in- 
 fluenced to repress the incestuous craving, but use it during adoles- 
 cence for the masturbation fancy and later promiscuously patron- 
 ize houses of prostitution, seeking one type of girl, then another, 
 to fulfill the fancy (Case PN-6). The obese matron of the house 
 of prostitution is commonly addressed as "mother," and the fam- 
 ily circle is completed by the girl's calling the lonely boy "daddy," 
 "popper," etc. The opposite solution of the incestuous attach- 
 ment is to be found in the hyper-conscientious neurotic and re- 
 ligious fanatic who strives to get everything free from sexual crav- 
 ings because his incestuous tendencies, dreams, etc., horrify him. 
 The father or mother, who has such ascetic tendencies, tends to 
 ruin the child by training it to feel that his sexual functions are 
 degrading. 
 
 It seems that parents who have incestuous interests in their 
 own parents, when not afraid of themselves, are inclined to have 
 incestuous affections for their o\Ya children. The parents who are 
 happily mated, having satisfactorily adjusted their preadolescent 
 attachments to their own parents, seem, also, by their example and 
 general attitude, definitely to condition their children to have 
 strong, well-defined affective tendencies to sublimate and mate 
 T/ell. Such children seem to know quite clearly what they love 
 most and what they can not like, and, if the children are not im- 
 posed upon by some domineering, well-intentioned adult, as a 
 homosexual or prudish teacher or relative, or are not exposed to 
 
110 PSYCHOPATHOLOGY 
 
 pernicious companions, thoy become vigorons, ethical, constructive 
 membfers of sobiety. 
 
 A well-conditioned fatlier or mother, upon the death of the 
 mate, because of loneliness, may unconsciously cultivate the af- 
 fections of a daughter or son with such insidious eagerness that 
 the youth willingly becomes the love-object. As it matures, it 
 finds all its constructive dreams are centered upon ultimately giv- 
 ing this parent happiness. Youth often becomes blindly conse- 
 crated to the selfish invalid or aged parent and when the parent 
 dies, this son or daughter faces loneliness and anxiety with little 
 chance to find a love-object. If this person then seeks for sympa- 
 thy too persistently from a relative or neighbor, he becomes a 
 burden. Our asylums contain many unmarried women who be- 
 came incapacitated after the death of a dependent parent (Case 
 MD-2), as well as the more common types who give up upon losing 
 a fostering parent. 
 
 Some of the most serious feuds between individuals for honor, 
 esteem and favor occur between sons or daughters. Avoidance of 
 this depends entirely upon the insight of the parents into the strug-. 
 gles between their children to become the favorite child and the 
 tactful manner in which they convince each child, not only by what 
 they say and do, but also by the manner in which they uncon- 
 sciously act, that they have no favorites. The psychopathologist 
 must bear in mind that it will usually be claimed by a parent that 
 all the children are treated alike, but as an actual psychological 
 fact no parent is ever able to consistently treat any two children 
 alike, because the children themselves are not inclined to act alike, 
 do not have identical attitudes or social positions and do not re- 
 quire the same attentions under the same conditions, nor while the 
 parent is in the same mood. Variations iji the attitude of parents 
 to children. usually have a trivial beginning, such as an injury or 
 illness, a triumph in school, an aptitude, a physical attribute, par- 
 ticularly a feature, such as the eyes, hair, voice, figure, etc. One 
 child may result from an accidental impregnation whereas the 
 other was sought. 
 
 Charles Darwin derived his inspiration to study biology and 
 the secrets of nature from -his mother. She was, in turn, greatly 
 influenced by her father-in-laAv. Her grandson, Francis Darwin, 
 also became a biologist. Charles Darwin, in his old age, was 
 
THE PSYCHOLOGY OF THE FAMILY 111 
 
 pleased to think that he became his father's favorite child. Most 
 parents are imable to avoid iiu consciously showing favoritism, 
 and some of the children reflexly become inspired to strive for this 
 favor while those in a disadvantageous position brood or become 
 jealous and regard themselves as relatively inferior and unwel- 
 come. The favored and censured children vary enormously in 
 their working and learning capacity, and their affective interests. 
 The feud of Cain and Abel is the classical fantasy of this rivalry. 
 We often see children suffering from fear that a brother or sister 
 or parent will die, be killed or kidnapped because of the uncon- 
 scious wish to get rid of the rival. 
 
 As a general rule, either the first, second or last child, provid- 
 ing none of the series of children happen to be born at an unwel- 
 come period or as the result of an unwelcome pregnancy, becomes 
 the favorite child during its infancy. The last child, like the only 
 child, may be seriously spoiled by the indulgent yielding of the 
 parents to his wishes, or may be seduced into remaining a "baby" 
 by the persistent " babj^f ying, " petting and general attitude of the 
 father or mother, brothers and sisters. An affective conditioning 
 results, which may seriously incapacitate the compensatory pow- 
 ers and social ingenuity of the babyfied or "spoiled" child. 
 
 The oldest child of happily mated parents enjoj''s a year or 
 two of perfect living wherein the father and mother constantly 
 seek for its favors. It becomes a monarch in which every wish is 
 satisfied, then, suddenly, its little kingdom is intruded upon by the 
 birth of the next child who usurps the mother's most tender sym- 
 pathy and her breast. Angry and jealous, it becomes irritable, 
 hates the baby, and fights to siibdue its parents. This is impossi- 
 ble and the punished child becomes a wanderer among the neigh- 
 bors. It may even try to injure the infant by gouging out its eyes. 
 If it becomes independent, the child compensa'tes for the disap- 
 pointment of the lost attentions, and learns through experience 
 that bright thoughts, funny remarks and ingenious playthings win 
 praise from the parents. With the advantages of a year or two 
 it finally outrivals the younger child and tends to keep it subdued 
 by beating it in games, in school, confiscating its playthings, 
 thoughts, creations, etc. This continues in the school and college, 
 and shows in the eagerness with which one child strives to beat 
 the record of the other. 
 
112 PSYCHOPATHOLOGY 
 
 Parents and -teachers, who indiscreetly hold np '* first" and 
 "best" and "prettiest" as incentives to greater effort in children, 
 most cruelly subject the defeated children, of which there are-, 
 manyior the one triumph, to a most depressing, humiliating pres- 
 sure, which gradually forces them to atoid competition and sub- 
 mit to the superiority of the favorite. The immunizing attitude of 
 indifference or insincerity is finally adopted by the weaker chil- 
 dren. The conquering or potent child becomes independent and 
 aggressive, but, unfortunately, learns, with great difficulty, later 
 in life, to assume second place, or a subordinated position when 
 necessary. Its competitive, selfish spirit may cause it to become 
 unpopular, particularly, if badly trained and lacking in courtesy, 
 as in Case PD-35. 
 
 The second child may be so consistently discouraged by the 
 conquests of its stronger, bigger, older, brighter brother or sister 
 that it remains "mamma's baby." When, however, it reaches 
 adolescence, infantilism is not admired and it must abandon the 
 old attachment and behavior. It now becomes fearful and jealous 
 of the admiration that the rapid advance of the older child is 
 winning from the parents, and, with a little encouragement, enters 
 upon an intense struggle to beat the school record of the older 
 brother (Case HD-14). Illness, a combination of depressing fac- 
 tors, such as the loss of a postadolescent love-object, the feeling 
 of inferiority from the persecuting memories of an adolescent 
 sexual trauma or autoeroticism, the death of the mother, failure 
 in several courses of study, etc., may finally cause a serious de- 
 pression and feeling of hopelessness, with regression to an infan- 
 tile level and fanciful, hallucinatory compensations which are 
 treated as realities. 
 
 The same tragedy may result when a son tries to beat an. il- 
 lustrious father, or a daughter tries to outshine her accomplished 
 mother or older sister, in order to stand "first" in some particular 
 person's esteem (Cases PD-35, PN-6, MD-6). 
 
 The study of the pathological manner in which parents and 
 children disguise their hatred and love, shows how often the se- 
 lection of associates, religious interests, family routine, clothing, 
 favorite studies, vocations, costumes, household furnishings and 
 the thousand and one things that make up the "atmosphere of 
 the home" are determined by the suppressed affective craving, 
 
THE PSYCHOLOGY OF THE FAMILY 113 
 
 using the qualities of the material as a vehicle for obtaining a 
 gratifying advantage. The tactless, domineering father or 
 mother, who can not direct the child to suit his or her wishes, and 
 sends the child to a Bible class, using the threats of hell in the 
 name of God to s\ibdue the child into obedience, has usually not the 
 slightest regard for its initiative or natural tendency to diverge 
 from the parent. The tragic careers of various members of a fam- 
 ily are often the climax of the life-long intrafamilial feud. 
 
 If it were feasible upon the declaration of a war actually to 
 send all men over fifty to battle first, there would be no chance 
 of declaring an international war. If the senile and arterio- 
 sclerotic males had to accept a pension and retirement from the 
 younger males and females when a certain statiTS of physiological 
 deterioration developed, there would be no need for the younger 
 people to struggle against the legal devices of economic oppression 
 in the control of the arteriosclerotic males. Then no socialistic 
 revolutions would be necessary. The arteriosclerotic, decadent 
 malcj feeling his loss of potency, compensates with those forms of 
 thought and unmodified convictions which are successful in keep- 
 ing the maturing males subdued. Their policies force the youths 
 to oppose one another and kill each other off in the, name of glory 
 for the fatherland. The general staff of the German army was 
 composed of men over sixty. New social or scientific innovations 
 are readily adopted by the growing generation while traditions 
 and precedents are sanctified by the arteriosclerotic. 
 
 Whenever an adult forces a child to do something or learn 
 something against its wishes, without justifying his demand by in- 
 ducing the child to wish to act, other than as a compensation for 
 fear, the adult, whether a sincere, devoted parent or not, dulls the 
 child's initiative and curiosity. Eepeated experiences of this sort 
 subdue the youth's aggressiveness, and opportunity is lost to his 
 competitor, who, although he may have less inherent capacity, wins 
 because he is better trained. 
 
 If the corrective infliience of our religious and social organi- 
 zations did not exist, it is quite probable that society would dete- 
 riorate into a trial and error method of seeking a satisfactory sex- 
 ual life. This is the secret method used by people at present, con- 
 sidering their illegitimate sexual practices, and is an acknowledged 
 cause of fear for the future of society by advocates of religious 
 sublimation. As in all ponderous social problems, the solution 
 
114 
 
 PSYCHOPATHOLOGY 
 
 Fig. 12. — "The Courtesan," by Eodin. (By permission of the Metropolitan 
 Museum of Art, New York.) Showing anguish and regret at sexual waste. Com- 
 pare with "The Martyr" by Eodin, Fig. 13. 
 
THE PSYCHOLOGY OF- THE- FAMILY 115 
 
 must come through the general ch^velopment of insight by the in- 
 dividuals of a series of generations. The invariable results of 
 promiscuous affective indulgence, -weakening the development of 
 the personality upon the one hand, and the rigorous imposition 
 of an unsatisfactory mating or sexual abstinence, retarding the 
 growth of the personality on the other, constitute the two great 
 parallel dangers that most healthy individuals must avoid in order 
 to make life worth living. 
 
 Fortunately, there is now developing in prudish America, 
 thanks to the insight deiived from the analytical study of the in- 
 dividual's wishes, their genesis and influence upon the personality, 
 a strong, common-sense tendency toward a more practical, less 
 
 
 
 
 
 s 
 
 ^J'v '* \ ^^K|^,^^|^^fi^M 
 
 WtKr ■■ vio 
 
 
 
 
 "^^iflttHHuj^ 
 
 XttA, y j^B^^^^^^L 
 
 
 i 
 
 ^^ .^,0!^f:"..^^^^j^tk 
 
 ■^1^ 
 
 
 
 Fig. 13. — "The Martyr," by Eodin. (By permission of the Metropolitan 
 Museum of Art, New York.) Showing agony at uncontrollable, ungratifiable sexual 
 Rravings — a martyr to social conventions and virtuous ideals. 
 
 repressive system of education. Out of this should come a frank 
 recognition of what constitutes a normal constructive sexual life 
 and what constitutes a destructive sexual life, and how one is to 
 be sustained and the other avoided. 
 
 Summary 
 
 Because the autonomic-affective cravings, in the child, alivays 
 become conditioned through the influence of associates, particu- 
 larly the adults in the family, and each experience conditions the 
 affections so that they determine the adjustment to the next 
 
116 
 
 PSYCI-IOPATHOLOGY 
 
 experience, it beoomes necessary to study the family wherever 
 a psychppathological disposition is met with in an individual. 
 Every personality constantly struggles to satisfy its wishes. 
 
 Fig. 14. — "In the Garden," by Brush. (By permission of the Metropolitan Museum of 
 Art, New York.) The contentment of a normal biologioal career. 
 
 The wishes, whether repressed or not, incessantly strive to get 
 from another individual such contributions of affection and ma- 
 terial as best satisfy their needs, and they discourage such inter- 
 
THE PSYCHOLOGY OF THE FAMILY 117 
 
 ests in others as displease them, no matter what their nature or 
 origin. If "unfair" or "unjustifiable," a compensatory control- 
 ling wish may be developed that compromises the demands so as 
 to seem fair. 
 
 It must be expected that parents who take upon themselves 
 the work of training children, unless they have most unusual in- 
 sight into their own affective cravings, will train the children to 
 gratify their own wishes and not the natural aptitudes of the chil- 
 dren. It is the easiest thing under the sun for an adult to find a 
 disguise for his wishes and induce or force the unsophisticated 
 child to make affective adjustments accordingly. It may not be 
 until maturity, when the son or daughter is compelled to strug- 
 gle and compete for responsibilities, that the impracticability of 
 the conditioned needs of his affective cravings and his methods 
 of fulfilliagthem will bring on a desperate crisis and misery, or 
 even a psychosis. 
 
 "Whenever individuals come to the physician for advice and 
 relief from anxiety which is caused by the tensions of repressed 
 autonomic cravings, it is necessary not only to bring about an ad- 
 justment of the immediate difficulty, but, in order to avoid a re- 
 currence, the foimdation for the faulty attitude must be analyzed 
 out. TJiis always, it will he found, lias been established by the con- 
 ditioning influence of associates, through actual experiences, upon 
 the affective cravings of the individual. 
 
 The natural course of the individual who has an average or- 
 ganic constitution is to develop a functional capacity that acquires 
 from its world the material that gives it a state of virility, goodY- 
 ness and happiness. 
 
 If it can not adapt itself so as to attain this state, its affective 
 requirements have been unfortunately conditioned through the in- 
 fluence of associates, particularly the adults who raised it. 
 
 I have been able to find that the happy or unhappy experi- 
 ences of a great grandfather, conditioned him so that he, in turn, 
 unconsciously, conditioned the affections of his children, and they 
 conditioned their children, and so on to the fourth generation. 
 Plenty of evidence.can be found in almost any psychopathic family 
 to show that an autoerotic manic-depressive mother's condition- 
 ing influence is a most potent determinant of the affective adjust- 
 ments of her offspring during their maturity. 
 
CHAPTER in 
 
 THE UNIVERSAL STRUGGLE FOR VIRILITY, GOODNESS 
 
 AND HAPPINESS 
 
 The, incessant pressure of social competition, as ivell as the 
 continuous metabolic needs and the cravings determined hy 
 growth, require that the capacity for virility must he consistently 
 maintained, if the state of goodness and happiness is to be approx- 
 imated for even intermittent periods* 
 
 The perfect state of existence is certainly not one of- coniplete 
 satiety, the very thought of which is as nauseating as overeating, 
 Ijut is one of freedom so that the antonomic-affective functions 
 can work, with some degree of certainty, for gratification as well 
 as the progressive refinement of their methods of working in order 
 to keep up with competition. The nature of the biological strug- 
 gle of the individual is determined by what the Avishes or auto- 
 nomic cravings need in the form of stimuli and what the social en- 
 vironment offers. The problem thus reverts to the conditioned- 
 qualities of the autonomic cravings, and, since this conditioning 
 can only occur through experiences, it emphasizes the influence of 
 associates (family, school, community, race). 
 
 The reading of the case histories, to be presented later, will 
 show essentially that the foundation of the personality is estab- 
 lished by the manner in which the autonomic cravings are condi- 
 tioned in cjiildhood. and adolescence, the nature of the autonomic 
 cravings (considered in a biological sense) and their manner of 
 
 *It is perhaps well to define what is meant by virility, goodness and happiness. 
 
 Virility is the capacity of the autonomic apparatus to compensate, when environmental re- 
 sistances tend to prevent the fulfillment of its wishes or needs, so as to overcome the resistance 
 and so modify the environment that it will gratify (neutralize) the autonomic cravings. True 
 virility applies not only to the mating competitions and overt sexual func'tidns of the individual, 
 but to his ability to coordinate his functional resources into a means (vocational) so as :.to win 
 the esteem of his love-object, overcome competition, and maintain a relatively influential social;^^ 
 place in the community, or clan. Indiflierence, timidity and inactivity are conducive to^Joss of' 
 social esteem. Fear of becoming socially inferior stimulates the compensatory striving. iP^ 
 
 Goodness is a state of feeling that is aroused when the act or sequence of acts gratifies 
 those wishes of the individual which promote his own career (egocentric) as well as the wishes 
 that promote the interests of the race (altruistic) ; the race containing the love-objects, gives rise 
 to the necessity of being esteemed by the race. In the struggle against perverse cravings, the 
 effort to establish the feeling of goodness is often extremely eccentric and* may even become 
 asocial. This idea of goodness is biological and not puritanical. 
 
 Happiness is felt as the autonomic tensions, becoming gratified, permit- the striving postural 
 tensions to change to comfortable tensions; as in the vigoroiis pursuit of a solution or result when 
 we feel confident of final success, in contradistinction to the heavy sense of depression when a 
 cause seems hopeless. 
 
 118 
 
VIKILITY, GOODNESS, AND HAPPINESS 119 
 
 adjusting to one another, determining tlie individual's struggle 
 with the social resistances and contentions of the race. 
 
 The following biological principles may be advanced as 
 absolute rules of the game which the individual is predestined to 
 play in his struggle to develop virility. 
 
 (1) Use of organs and their functions is necessary to prevent 
 the atrophy of disuse and their impotence ; and regulation of use is 
 necessary to avoid eccentric development and social inferiority. 
 
 (2) Social opportunity for use of functions and organs must 
 therefore either exist or be created for the individual- by the 
 members of the group and the individual himself. 
 
 (3) Fear, if not compensated for, tends to prevent the use of 
 those functions and affections which entail responsibilities that 
 the individual dreads. 
 
 (4) Autonomic cravings that can not be gratified cause uncom- 
 fortable ^^.sceral and postural tensions (neuroses) which tend to 
 force the individual, in order to obtain relief, to strive to obtain 
 gratification. lie usually becomes forced to repress the craving if 
 the taboos and conventions of society are severely critical of it 
 or if his restraining obligations are impassable. 
 
 (5) The conventions of society are, essentially, designed by 
 social groups to control the affective cravings of the individual. 
 The individual must suffer if the autonomic cravings have been 
 conditioned through experiences to need that which happens to 
 be tabooed by his associates whose esteem he wishes to retain. 
 
 (6) When his cravings are uncontrollable and intolerable a 
 psychosis develops to give relief. 
 
 The demented functional psychopath is the victim of auto- 
 nomic cravings which have destroyed his interest in society by 
 overcoming and distorting the affective needs for social esteem. 
 
 The perverse cravings often run a rampant career in the 
 asylum and prison and it will be seen that suicide is the final sur- 
 render of the struggle for virility and a regression to the prenatal 
 affective state. 
 
 Society tends to conserve the energies and conventionalize the 
 ■wishes of the individual in order that the interests most common 
 to the group will be assured of gratification. The majority regu- 
 lates the behavior of the minority in order that the wishes of the 
 majority will be served. The individual, on the other hand, strives 
 
120 PSYCHOPATHOLOGY 
 
 to make the social group establish interests and customs -wMcli 
 ■will permit Mm to '^i^|l|fy Ms. own autonomic cravings. Society- 
 is not safe (the martial history of the world shows this) when it 
 is forced to follow the dictations of one individual, of one auto- 
 nomic apparatus, no matter how splendidly and altruistically it 
 may be conditioned. It seems to be impossible for the indiAndi^fe;:if 
 to prevent the craving to aggrandize himself from worldng-'for 
 the personal reflections to be had from the indirect implications of 
 his laws and exhortations. Hence, the republican, the democratic, 
 and the socialistic forms of society consist of defenses or restric- , 
 tions against this fatal self -aggrandizing, autonomic tendency of 
 the individual, which has reached its highest formalizing influence 
 upon society in the absolute monarchy and papacy, and the foster- 
 ing of autocratic exploitation. 
 
 The problem for the psychopatfeelogist is always one regard- 
 ing the individual's a:ffeetions versus society's welfare. The prob- 
 lem begins with the autonomic apparatus at its birth, the predes-^ 
 tined nature of its biological career and the molding it tmdeijgfes 
 through the influence of associates, with, finally, at, maturity, the 
 autonomic cravings stxuggiing with social conventions. ,. . 
 
 Males and females are obviously hiseocual in their oTffMi&'JA-- 
 and functional attributes, with, at birth, an almost equal balance 
 of masculine and feminine {assertive and submissive, or better, 
 projective and receptipe) functions. The preponderance of traits, 
 however, tends to shift rapidly, the social influence being equal, as 
 competition contrasts their organic differences; such as size and 
 contours of bones and muscles, the lever angles of the elbow, shoul- 
 der and hip-joints for fighting, grace a,nd beauty, color of eyes, 
 hair, skin and the pitch of voice for attraction. The organic . 
 basis however, does not seem to be as influential as the functional 
 traits which are developed through the encouraging and re- 
 pressive influence of associates. This fact is to be observed right 
 and left in any social group where one may see delicate women 
 who are indomitably aggressive (projective) and powerful women 
 who are chronically submissive and receptive. Similarly, beard- 
 less men are to be seen who are socially and sexually potent, 
 always projective; and men of ponderous masculine organic con- 
 struction who are as timid, submissive and receptive as the pro- 
 verbial girl. The general tendency, among- animals and men, it 
 
VIKILITY, GOODNESS, AND HAPPINESS 121 
 
 seems, is for the aggressiveness or submissiveness of individuals, 
 who are opposing one another, to be reflexly determined in favor 
 of the one having the more powerful bluff or more justifiable 
 racial position. When the positions are quite equal, organic ad- 
 vantages decide. 
 
 In war, national morale is worth more than a temporary ex- 
 cess of cannon. The simulation of great size and power in order 
 to intimidate the opponent is used by animals, as the erection of 
 the dorsal hair, raising of the back as high as possible and making 
 violent, roaring sounds. This method is also used by the genus 
 Homo, classically portrayed in the thunders of the bully and the 
 irate screams of the infant. These compensations do not occur 
 when the individual is in terror but they occur as a defense against 
 fear. The organic determination of behavior may be theoretically 
 true for individuals having the same training, but, since individ- 
 uals are practically never trained in the smiie manner, although by 
 the same people (and outrageous intimidations and splendid com- 
 pensations are very commonly induced through the influence of 
 training or education), the influence of associates must be recog- 
 nized as the decisive factor that conditions the autonomic appa- 
 ratus to crave for, and do, the advantageous thing at the advanta- 
 geous time. 
 
 The parents' or teacher's conscious efforts to train a child to 
 do a particiilar thing, in a certain way, under certain conditions, 
 have relatively less influence upon the child than the unconscious 
 manner in which the parent or teacher attempts to train the child. 
 This is merely applying the well-known truth: It is not what is 
 said or done that pains or pleases but the affective manner with 
 ivhich it is said or done. As to how much parents or teachers are 
 responsible for their affective tensions (attitudes) when in the 
 presence of a child, is questionable, but the fact remains, neverthe- 
 less, that the influence upon the other person, of the affective in- 
 terests of which we are unconscious, goes on whether it is recog- 
 nized and admitted by us or not. This can be demonstrated in 
 our selections of words, movements, attitudes, etc., while associ- 
 ating with other people. Some people unconsciously influence us 
 to use dignified words and movements and greatly encoiirage us 
 to build up while others depress us. 
 
 It is necessary to sketch the different stages in the growth of 
 
122 PSYCHOPATHOLOGY 
 
 the bisexual personality and emphasize the manner in which mas- 
 culine, feminine, and racially perverse characteristics become dif- 
 ferentiated, developed and fixed, or discouraged. This process, be- 
 cause of its intricate variations and the manifold influences to 
 which the individual is subjected, is endless, but its more common 
 principles must be understood. 
 
 The wish or craving (no matter whether it is hunger, love, 
 hate, shame, grief, pity, or what not), when permitted free flay, 
 always strives to expose its favorite receptor to appropriate 
 stimuli in order to become neutralised, that is, to have its ten- 
 sion relieved through counter stimulation, and it alivays follows 
 the laiv of trying to acquire a maximum of result with a minimum 
 expenditure of energy. For example, when we pity the depressed 
 or unfortunate, we feel compelled to do things which will stimulate 
 a certain attitude of courage and resolution in them. This atti- 
 tude, in turn, as a counter stimulus acting upon us, relieves us of 
 feeling pitiful and enables us to become happier. This law of ad- 
 justment most consistently and automatically assures, for the au- 
 tonomic apparatus, the greatest possible use of its power for the 
 most diversified and secure domination of the environment. It 
 underlies and determines all organic evolution and functional vari- 
 ation. In proportion as a new coordination of functions, or an 
 organic structiire, can be more economically applied, the others are 
 abandoned. This applies not only in the evolution of structures, 
 such as the thumb and foot, but also to the use of vocal tones, ac- 
 cents, words, sentences, languages, customs, religious ritual, 
 machinery, theories, and scientific methods. 
 
 Families, communities, and similar social classes have many 
 similar traits, but the great variations that exist between individ- 
 uals having quite similar organic equipment are due, principally, 
 to differences in conditioning their autonomic functions through 
 experiences. 
 
 Adults, almost universally, have quite different attitudes to- 
 ward male and female children, and, although this may not show in 
 a single incident of adults associating with children, taken through- 
 out the day and in the innumerable, unconscious ways in which it 
 is demonstrated, it exerts an enormous pressure upon the child's 
 methods of becoming estimable in order to win love and admira- 
 tion. This is not only to be seen in the masculine and feminine 
 
VIRILITY, GOODNESS, AND HAPPINESS 123 
 
 ■toys and clothing nrged upon children, but in innumci-al)le pleas, 
 flatteries, criticisms, commands of the parents. 
 
 Society's expectations are so remorselessly rigid that the little 
 girl -who is raised like a boy, or the boy who is raised like a girl, 
 is foredoomed to live in a most uncomfortable, eccentric position 
 Avhich may finally amount to nothing less than a biological abor- 
 tion. This socializing pressure upon the individual has its begin- 
 ning with the infant's birth, and, by the time the child enters the 
 school, it has already developed definite aggressive and submissive 
 methods of gratifying its affections; and these, reflexly and re- 
 ciprocally, adjust to the affectivity of its associates. "When their 
 wishes conflict, individuals reflexly take advantage of each other's 
 inferiorities, fears and submissive tendencies, establishing affect- 
 ive circles that may become progressively vicious. 
 
 The growth of the personality may be divided into seven au- 
 tonomic-affective stages, which, in. certain respects, are profoundly 
 influential upon the behavior of the individual. The stages, in 
 regard to age, vary considerablj^ in different children, being in- 
 fluenced by retarding diseases, accidents, and fearful experiences, 
 as well as by the intimidating, fascinating or encouraging influ- 
 ences of associates. 
 
 The transitions from one stage to the other occur quite im- 
 perceptibly, but for the sake of convenience they may be differen- 
 tiated for Americans as follows : 
 
 Intrauterine, 
 Infantile, birth to 3 ; 
 Preadolescent, 3 to 10 ; 
 Adolescent, 10 to 17; 
 Postadolescent, 17 to 22; 
 Maturity, 22 to 45 ; 
 Decadence, 45 to — . 
 
 During the intrauterine period, the autonomic apparatus lives 
 an impersonal parasitic existence, probably exerting little influ- 
 ence upon its projicient apparatus Ijeyond a tonic effect and the 
 occasional compulsion of shifting of position in order to maintain 
 comfortable postures. Upon leaving this affective state the infant 
 is considered to have been "horn." The feeling of having died 
 or of being dead, which is so common in the psychoses, will be 
 shown to signify, often, a regression to the prenatal state, and the 
 
124 PSYCHOPATHOLOGY 
 
 suicide has this affective value. (See illustrations Requiem, Egyp-. 
 tian burial and Isle of Death, Figs. 28, 29, 30.) 
 
 The infantile period is characterized by the utter helplessness 
 and innocence of the autonomic apparatus as to the nature of its 
 environment, and its vital dependence upon the :good will of those 
 who gratify its cravings. This is the stage when the autonomic 
 functions begin to become conditioned to react with pleasant or 
 painful tensions to the presence of characteristic stimuli, as the 
 kind mother, irritable mo'ther, sadistic or masochistic father, mas- 
 culine, aggressive mother, effeminate, timid father, a jealous or 
 cruel brother or sister, etc. Naturally, the cooing voice sounds 
 and gentle smiles of the mother as secondary stimuli, at first hav- 
 ing no influence, associated with the primary stimulus of the nipple 
 and food, petting and cleansing, etc., soon condition the autonomic 
 apparatus to react pleasantly to the presence of the secondary 
 stimuli, and then to react to strange people who also give off stim- 
 uli like the mother. Liltewise, the harsh voice sounds, rough hand- 
 ling, staring eyes and irritability- of people become associated to- 
 gether, and, through their causing painful tensions, the autonomic 
 apparatus tries to avoid the influence of individuals Avho possess 
 irritating characteristics. 
 
 During the infantile stage, the autonomic apparatus seeks its 
 supreme pleasure in sucldng and emitting its excreta without 
 self-restraint. Gradually, the wishes of those who administer to 
 such needs impose restrictions upon these supreme segmental 
 pleasures of infancy, through associating the fear of punishment 
 in the form of physical injury or the loss of favor (esteem) with 
 the indulgence. The first great tragedy is experienced when the 
 sucking source of the food supply is stopped,, and it is then that 
 the foundation of the infant's belief that it is unwelcome is so 
 often quite correctly fixed, or the belief that it is a foundling and 
 the parents are foster parents. Mothers vary .enormously, largely 
 according to their understanding of an infant's affective reactions, 
 hence, according to the degree' of their love for the infant, in their 
 ability to minimize the anxiety of the infant upon being weaned 
 from the sucking stimulus. No doubt, as in all denials of affective 
 needs, the gradual change is more easily accommodated to than the 
 abrupt. 
 
 The soothing value of the sucking stimulus in the infant (sug- 
 
VIRILITY, GOODNESS, AND HAPPINESS 
 
 125 
 
 gested by Freud) is due to the affective value of the oral zone 
 as well as its association with the gratification of hunger. The in- 
 timacy of nutritional and sexual cravings is also illustrated by the 
 Costa Eican Indian's sculpture (prehistoric) and Veronese's 
 painting of ' ' Mars and Venus, ' ' p. 126. The fear of having a sex- 
 ual stimulus secretly put in the food, so often complained of by 
 oral erotic psychopaths, is due, apparently, to the erotogenic in- 
 fluence of food and sucking upon the oral zone, which must ob- 
 viously have some of its determinants in the conditioning influence 
 of nursing. 
 
 The tendency to persist in sucking in order to relax or sleep, 
 after hunger is gratified, and have "soothing feelings" (finger 
 
 Fig. 15. — Costa Eioan prehistoric ceremonial altar. Male figure sits between 
 the thighs of the reclining female who is in copulation position. She holds a large plat- 
 ter on her bosom and abdomen, one edge of which fuses with the mons veneris 
 while the mammary glands fold over the upper edge into the platter, symbolizing 
 the circle of life — nutrition and reproduction. The heads of the figures have been 
 broken off. The stone is exhibited in the National Museum, Washington, D. 0. (Eep- 
 roduced by courtesy of National Museum.) 
 
 sucking, pacifier, pipe, toothpick, fingernail and gum chewing), 
 even at the expense of causing organic deformities, supports 
 the conception that vigorous autonomic tension^ are relaxed by 
 the sucking stimulus. 
 
 The erotogenic value of some forms of kissing and the sooth- 
 ing value of others, as well as the fact of the unconquerable crav- 
 ing in the oral erotic for specific stimulation and its influence on 
 his autonomic tensions, in a manner that is similar to masturba- 
 
126 
 
 -ESYCHOPATHjOLOfiy 
 
 tion and copulation, surely, fixplainslone of. the^ causes of oral per- 
 version as a conditioned autoiipmic .over valuation in infancy, of 
 this sensory., zone. This is not physiologically mystifying' if we 
 
 Fig. 16.— "Mars and Venus United by Love," by Veronese. (By permission of 
 the Hetropolitan Museum of Art, New York.) Showing like the prehistoric GostaRican 
 copulation stone (Fig. 15), an association of nutritional and sexual interests; also 
 the sword, horse, satyr, tree, vine, old temple, armor, cupids^ and knight as sym- 
 bols associated with sexual virility. 
 
VIEILTTY, GOODNESS, AND HAPPINESS 127 
 
 consider that the sexual act is essentially a counter stinailus ap- 
 plied to a tactile zone to relieve general antonomic tensions. 
 
 Another source of soothing stimuli, if the behavior of the in- 
 fant and the pleasant reminiscences of psychopaths may be con- 
 sidered as indicative of its value, is the cleansing of the pelvic 
 skin areas after emissions of excreta. The emission of excreta, 
 besides its segmental pleasantness, becomes the infant's most po- 
 tent means of winning attention, particularly when lonely at night, 
 if the parent is not clever at avoiding its use for this purpose. 
 Many parents enjoj^ giving such attentions to infants, whereas 
 others detest it. (One not uncommonly meets with hebephrenic 
 anal erotic adult males and females who plead for cathartics and 
 enemas to be given in the way that the mother or grandmother 
 gave them.) 
 
 During the earliest infantile stage, the capacity for affective 
 reactions of hunger, love, rage and fear is present ("VVatson). But 
 a true personality does not exist. The autonomic apparatus now 
 begins to coordinate its projicient (skeletal) apparatus into an 
 instrument for dominating the environment. In this period of 
 training, parents vary enormously from intimidating the child into 
 doubting its coordinating ability, by cries of "watch out" and 
 "don't" to encouraging it to try courageously and persistently, 
 -so that it will enjoy the effort almost as much when attended by 
 failure as success. Disastrous intimidation may occur day after 
 day in innumerable forms and often with such vehement excite- 
 ment, upon sudden provocation, that almost at the onset of its 
 existence tke personality is doomed to become unable to assume 
 responsibilities without becoming tmduly tense where failu,re may 
 occur, particularly if the emotional comfort of others is dependent 
 upon it, not only in a business or athletic contest, but in copulation, 
 as ejaculatio prcecox. Upon the infant's development of sufficient- 
 functional skill, most parents, in order to be relieved of discom- 
 forts and distractions, wisely make the child take care of its- own 
 needs, particularly those pertaining to dressing, cleansing and 
 feeding. This does not always occur, however. Some mothers 
 strive to keep their children infantile forever and have been known 
 to nurse their children for over three years and babyfy and sleep 
 with their sons until after they had physically matured. 
 
 The enormous economizing of energy and time through the 
 
128 PSYCHOPATHOLOGY 
 
 child's effectual use of language (affective convergence upon the 
 iiead segment) usually wins genuine praise. But some parents 
 keep their boys and girls hesitating, whining and lisping. When 
 failure to control the emissive impulses of the pelvic segment oc- 
 curs, it is punished, more or less, by loss of favor with the parent. 
 
 The fear of losing favor and praise, later of esteem and con- 
 fidence, and of being ridiculed and ignored, stimulates the auto- 
 nomic apparatus to compensate by coordinating itself into an egois- 
 tic unity as a means of dominating the tabooed impulses of any au- 
 tonomic segment, as rectal, cystic, gastric, oral, lachrymal. Up to 
 this stage, the child is regarded as "it," as not having a personality 
 until it begins to use sentences. Some children are not given a 
 name until this stage is. reached. This recognition is gradually 
 bestowed upon the child as the compensatory strivings of its 
 autonomic apparatus become integrated into a functional unity 
 which, constantly on guard against doing something which will 
 jeopardize its struggle for the love-object's favor, learns to use 
 word-sounds to influence sources of gratification: asking ques- 
 tions, telling fancies, etc. As the social obligations become 
 more involved, and necessitate the control of physical appear- 
 ance and emissions, of hunger, anger, love, fear, grief, etc., the 
 autonomic compensations that arise to prevent the fear of failure 
 become increasingly intricate and more highly coordinated. 
 Gradually the personality becomes more and more highly organ- 
 ized and capable, until it becomes recognized by name with the 
 baby's suffix "ie," as "Willie"; but, later, if it has developed the 
 capacity of convincing aggressiven-ess, the "ie" is dropped for 
 "Will" and it earns the prefix "Mister," then, perhaps, "Sir," 
 or "Honorable," and, finally becomes known as "Shakespeare," 
 and his followers, as Shakespearean. (The hebephrenic type of 
 dissociated personality, having yielded to the regressive affec- 
 tive cravings, often feels and complains that he has no name, no 
 ancestors and no personality. One boy, anal erotic, tore his name 
 out of his clothing and said he wasn't anybody but just a "shit 
 pot." Case HD-11.) 
 
 The capacity to become conscious of self as a personality be- 
 gins to be consistently maintained by this compensating unity (the 
 ego) as it becomes able to control its asocial and unfriendly imi- 
 pulses and the socially perverse cravings and their compulsions 
 
VIRILITY, GOODNESS, AND HAPPINESS 129 
 
 to be gratified. The tendency of the ego to lose control of the seg- 
 mental cravings can be seen in the failures of the child to control 
 the wish to steal food, to suck its fingers, masturbate, indulge in 
 nocturnal enuresis, cry, scream, lie, bluff, fight, steal, etc. 
 
 The functions of self-control begin very early in the integra- 
 tion of the personality and are shown in the child's efforts to tell 
 lies in order to disguise its inferiorities and wishes. The fluctua- 
 tions of the ability to control dissociated impulses are still to be 
 seen in the painful embarrassment of children of five to seven years 
 who are occasionally unable to prevent the soiling of their cloth- 
 ing by the craving for emissions, and in the tendency to allow them- 
 selves segmental indulgences when the ego is depressed by illness, 
 loneliness, etc. Naturally this Aveakness continues during sleep for 
 several years after it has been mastered during consciousness and 
 often is the source of a persistent feeling during maturity of being 
 an inferior personality.* 
 
 The compensatory integrations, as they become knitted into 
 a unity, slowly develop the tendency to regard themselves as "I," 
 "I will," "I wish," "I am," and the body as "mine," probably 
 imitating the examples of older people. The " I " becomes the good 
 boy and the perverse craving, the bad spirit, or bad boy. As the 
 ego, or "I," matures and tends more and more to master and 
 assimilate the individual cravings of different segments into its 
 unity, by claiming them as a part of the personality, the conception 
 of the bad spirit or influence, devil, etc., simplifies into a conception 
 of perverse cravings or impulses. 
 
 With this conception of the personality as a physiological 
 mechanism, it is obvious that the accumulating force of re- 
 pressed cravings, or the weakening of the ego, through fatigue, 
 insomnia, discouragement, toxemia, etc., might lead to a dissocia- 
 tion of the wishes or power of the integrated structure constitut- 
 ing the ego and, also, how the unsophisticated ego might regard 
 the sensory disturbances caused by the repressed, dissociated crav- 
 ings as being due to another personality's hypnotic influence; a 
 form of reasoning common in sleep, psychoses, and illiteracy. 
 
 As the stage of infancy is left behind, the impres,sions of the 
 omnipotent father and kind mother, and that divine, heavenly 
 
 *The psychoanalysis of tense people has shown, in a series of cases, that the tenseness is 
 dqe to fear of making mistakes and being considered mentally inferior. T^he dread of mental in- 
 feriority in turn had its foundation in having been teased for not being able to prevent bed wet- 
 ting and soiling clothing. 
 
130 PSYCHOPATHOLOGY 
 
 equilibrium of the intrauterine existence, become immortalized ^g 
 Grod, the Holy Mother, and Heaven. The om'nipotence of infancy 
 is left behind to be sought for in another form during maturity. 
 Many of the patients who believed they were seeing "God" were 
 found, upon adequate examination, to be hallucinating their infan- 
 tile impressions of the father. The infantile stage seems to ter- 
 minate with the child's realization that it can no longer be a part of 
 the mother's personality. 
 
 The preadolescent stage of childhood (three to ten) begins as 
 the individual, now an embryonic personality, begins to compete 
 Avith all the universe for the gratification of its autonomic cravings. 
 Handicapped by its inferior organs and unskilled functions, it com- 
 pensates for the deficiency Avith day-dreams, make believe, and 
 magic, fairy fancies, bluffing, lying, etc., (the age of motor illu- 
 sions). The natural erotic curiosity of childhood, blindly censured 
 in almost every conceivable manner by prudish adults, is often 
 forced to indulge in secret play. The polymorphous, imitative cu- 
 riosity about the behavior of parents, animals, birds, insects, etc., 
 and, particularly that which causes the most excitement, naturally, 
 their sexual play, no doubt is of tremendous value as a dynamic 
 influence for the acquisition of knowledge." It surely is necessary 
 for the invigoration of the personality during its growth and ma- 
 turity. Curiosity about the possibilities of finding pleasure in the 
 environment is the grand acquisitive urge of the personality to un- 
 derstand and master the environment and the self in order to win 
 and sustain the love-object and superiority. (Upon the half -rec- 
 ognition of the manifestations of the erotic functions in the child, 
 there will no doubt appear moralizing educators, who, obsessed 
 Avith wild fears of anything pertaining to sex, Avill advance further, 
 biologically disastrous, educational schemes to castrate instead of 
 refine the sexual curiosity of school children.) 
 
 During the preadolescent age, all children, if permitted to 
 pursue a natural course of development, show, frankly, curiosity 
 in all sorts of mechanical devices and sexually significant func- 
 tions ranging throughout the demonstrations of nature; and, in 
 this promiscuous quest, a convergence of the child's affections 
 tend to become fixed upon things that enchant the love-object (as 
 Darwin's mother's curiosity about the cause of variation, in 
 
VIRILITY, GOODNESS^ AND HAPPINESS 131 
 
 plants). Around the solution of this riddle of the love-object will 
 be developed the vocational career. But woe must befall the child 
 who at this late age has no love-object to make it feel welcome and 
 inspired. 
 
 The preadolescent child's curiosity is so unsophisticated that 
 it is inclined to personify and consider secretly many polymorph- 
 ous perverse objects in an affective relationship of equality to 
 itself: such as animals, poultry, birds, insects, clothing, fetiches, 
 mechanical devices, signs, mannerisms, etc. Boys and girls of this 
 age amuse each other with all sorts of mechanical copulation de- 
 vices, such as boring, with great hilarity, into objects with sticks; 
 the breeding of insects and pets ; the adoption of various mechani- 
 cal devices and pets as the yoimg of themselves in their play fam- 
 ilies. Apparently, this is the trial and error method of differen- 
 tiating the unknown homogeneous universe into its heterogeneous 
 values and discriminating the actually, biologically useful from 
 the useless, the pleasing from the displeasing. 
 
 The convergence of interest upon the pelvis is almost infalli- 
 bly certain, because of its pleasing sensory cutaneous zones, which 
 are probably discovered throiigh the emissions and by the acci- 
 dents of play and clothing. (In regard to this, the early sexual 
 play of the infrahuman primate is characterized by its trial and 
 error method of experimenting, and is decidedly anal erotic and 
 coprophilous.) The preadolescent stage shows remarkable prog- 
 ress in the autonomic apparatus' control of the striped muscle 
 system and the development of skill in control of movement. Too 
 flattering admiration of adults easily stimulates in the child an 
 egotistical over-evaluation of the little successes and this may 
 later_ prevent the true comparison of its personal resources. 
 
 The stage of adolescence (ten to seventeen) may be consid- 
 ered to begin with the definite convergence of the affections of the 
 individual upon its pelvis in a manner that is associated Avith the 
 use of love fancies about the personality of another. (During the 
 preadolescent stage, experimental pelvic stimulation and rela- 
 tively little preliminary fancy are used.) The practice of some ex- 
 perimental masturbation is almost universal during this age and is 
 not to be considered harmful if not excessive, and if a narcissistic 
 fixation does not occur. That is, if the adolescent does not become 
 more inclined to enjoy secret sexual fancies, self-admiration and 
 
132 PSYCHOPATHOLOGY 
 
 self -stimulation than the seeking of a playmate and winning his es- 
 teem. 
 
 The stage of adolescence has a most critical influence npon the 
 maturation of the personality. In order to pass beyond. the stage 
 of infancy, and know the physiological secrets of its nature, 
 the' child, it seems, must actually experiment with itself and learn 
 the truth of its powers. This can not be adequately taught by read- 
 ing or prevented by threats of disaster ; it must be gone througli 
 -wdth, and the less secretive the easier it is for the socialized ego to 
 assimilate, control and refine these cravings. Society must, how- 
 ever, uphold the ideal of refinement and maintain adequate means 
 for this purpose, not only in schools and churches, but in play- 
 grounds, athletic games, artistic sublimations, etc. 
 
 My cases indicate that the children who masturbate alone and 
 carefully maintain the habit as a secret have by far the most dif- 
 ficulty in mastering themselves. The cause is almost obvious, 
 mechanically, because the wish to be socially estimable tends to hide 
 the inestimable, particularly the socially censured craving and its 
 fancies. Therefore, the latter tends to remain a distinctly dis- 
 sociated, unmanageable segmental craving which periodically dom- 
 inates the ego 's wish for self-control. Any force, to be controlled, 
 must be intimately associated with opposing forces, and this physi- 
 cal law, not being followed, lays the foundation for the failure to 
 control the eccentric erotic craving in maturity. 
 
 It is almost a consistent feature of psychopaths who are ad- 
 dicted to masturbation, to complain, during the psychosis or erotic 
 compulsion that they have destroyed everything in the world worth 
 living for, particularly those they should love most. We see them 
 pacing the floors, weeping and groaning, wringing and scratching 
 their hands, pulling their hair, beating their faces, (even some- 
 times amputating organs, castrating themselves, or committing 
 suicide) as a result of the terrific anxiety they suffer from the 
 fact that they have ruined their feelings of worthiness for love and 
 esteem, and have wasted the vital forces of nature through self- 
 love and masturbation. (See Eodin's "Centauress" and Michel- 
 angelo 's ' ' Captive, "p. 372, 374. ) It is also a surprisingly consist- 
 ent mechanism, though probably not a universal one, that the adO- 
 , lescents who have mutual sexual interests .which are rather freely 
 discussed with adults who understand them, have far less difficulty , 
 
VIRILITY, GOODNESS, AND HAPPINESS 133 
 
 in finally affecting the transition (transference) from indulging in 
 secret fancies about the attractiveness of members of the opposite 
 sex to actually striving to win their esteem and affections through 
 overt competitive behavior. This transference of affective inter- 
 est is vital to the growth of the personality, for it leads directly to 
 projecting the energic resources so as to fashion and master the 
 world to suit the craving; whereas, the self -loving, fanciful auto- 
 erotic individual cares little for the world except to be aggran- 
 dized and otherwise left alone to dream and brood, even though he 
 later becomes eccentric and scoffed at and finally socially ostracized 
 or confined in an asylum. The autoerotic's fancies, as vivid, in- 
 expensive pleasures, are as stimulating to him as the worldly 
 reality is to others. 
 
 The difficulties some of my cases had in mastering the auto- 
 erotic tendency, and the ease with which it is mastered by healthy 
 individuals, strongly indicate that the vigor and persistence of the 
 autoerotic cravings is greatly influenced by the intimacy of the per- 
 son who becomes the subject of the fancies, even though that 
 individual does not suspect the nature of the influence. That is, 
 when the subject of the fancies is the mother or sister, the boy has 
 more difficulty in mastering the masturbation pleasure than when 
 it is a girl neighbor. Also, the more the autoerotic fancies are 
 shared with playmates (not one playmate) the more quickly they 
 lose their value. This is also true for other fascinations and 
 causes of worry. 
 
 The autoerotic difficulty has another influence besides the pei'- 
 nicious seductiveness of the fancies, i. e., self-love resists making 
 the sacrifices necessary for heterosexual love, and is, for this rea- 
 son, regarded by the race as an inferiority. Furthermore, when 
 self-love becomes too strongly fixed in adolescence, the individual 
 can not free himself during maturity, even after mating. The over- 
 development of autoeroticism usually depends upon the suppres- 
 sive domineering influence, during preadolescence, of the more 
 powerful, skillful rival, the father or older brother, and for the 
 daughter, the resistance is in the jealous, prudish mother, aunt or 
 sister. The father, especially, when he does not love the tendency 
 towards maturity in the son and selfishly loves to remain as nearly 
 omnipotent and domineering as possible, directly, indirectly, or un- 
 consciously, attacks and suppresses the spontaneous attempt of the 
 child to win the mother's admiration and esteem. Through becom- 
 
134 PSYCHOPATHOLOGY 
 
 ing her hero in the home, at school and on the athletic field, he 
 tries to fascinate her if she loves him. The older rival belittles 
 these serious adolescent attempts and the affect becomes fixed tt' 
 the autoerotic level unless some other influence accidentally comes 
 into the life of tlie individual, as a master encouraging his ap- 
 prentice to become proficient and win love and win manhood. 
 
 I have never Jcnoivn an individual, who had fixed autoerotic or 
 perverse cravings, whose history shoived that he ivas treated in 
 his childhood like a true personality when conflicting with his par- 
 ents. Most parents seem to suffer from sexual phobia, that is, 
 their fear that the child might inquire about or discover their own 
 sexual secrets (of adolescence, particularly) unconsciously forces 
 them to protect themselves against the danger of embarrasses 
 questions l)y severely tabooing everything pertaining to sex. The 
 child is therefore forced to answer its curiosity by accepting the 
 hopelessly erroneous conceptions and wild, frivolous fancies of 
 other children, or rely upon its own imagination and experiments 
 (Case CD-3). This tendency will be seen throughout the more 
 intimate case histories to be given later (particularly Cases HD-1, 
 AN-3, CD-2). 
 
 In order to overcome the opposition of the father, boys often 
 elope from home to become chronic wanderers or engage in fierce 
 feuds with him. ( See Barye 's " Theseus and Minotaur in Battle, ' ' 
 Fig. 17. The value of this myth is interesting when the bull 
 is seen to symbolize the oppressive father.) 
 
 The postadolescent stage (seventeen to twenty-two) begins to 
 develop as the personality predominantly seeks the realities of the 
 love object and converges its interest upon the sexual career of an- 
 other of the opposite sex in a manner that is designed ultimately 
 for reproduction of self. The moment that this transition begins, 
 boys and girls tend to become serious rivals for overt demonstra- 
 tions of the esteem of members of the opposite sex, particularly of 
 their own age. 
 
 This necessitates courageous competition, steadiness, and self- 
 control in trials, and willingness to suffer from defeat as well as 
 to enjoy the glories of victory (the heroic age of athletics and self- 
 conquest, and writing and reading of romantic literature). The 
 youth who tends to seek the esteem of a person considerably older 
 (teacher), or younger, or of the same sex, is usually afraid to enter 
 
VIKILITY, GOODNESS, AND HAPPINESS 135 
 
 the general competition. My cases of anxiety at this stage quite 
 consistently showed that the attitude of a parent or some sponsor 
 was the responsible resistance that made it almost impossible for 
 the son to compete, because his diffident, self-conscious, self- 
 repressive tendencies had been already too thoroughly established. 
 A mother taught her son not to fight; "to fight is ahvays wrong," 
 and the father had no confidence in his son's powers for competi- 
 tion. Fearing the reflections upon himself of the failures of his 
 "sissified" son, he refused to give him any support. This man, 
 age twenty-six, although he felt that he was practical in his social 
 and business impulses, however, could not proceed upon his own 
 initiative because he had been trained "always to ask father," or 
 "ask mother," etc. 
 
 In the postadolescent age, parents, having sexual phobias and 
 egocentric interests, actually plot and scheme to send the boy or 
 girl to intimidating teachers, colleges, and training schools. They 
 seek the advice of "authorities," priests and physicians, and actu- 
 ally beseech them to admonish the youth to heed the interests of 
 the parents at any cost to the vital yearnings of life. The fear 
 of pain, of being considered functionally inferior, clumsy or 
 stupid, the intimidation and lack of initiative and self-reliance 
 soon make such boys or girls unable to demonstrate their biological 
 fitness to the love-object and force them into progressively per- 
 nicious affective circles. 
 
 The inclination to exhibit through tales of prowess in all sorts 
 of competitions (athletic, business, scientific, professional, etc.,) 
 is nothing more than a refinement of the lower animals' exhibition- 
 istic mannerisms when trying to win the choice of a mate or a place 
 in the herd. This attribute may be seen among birds, insects, ani- 
 mals, and seems even to be present in fish. 
 
 In one instance, a splendid type of postadolescent girl was 
 literally in a mortal struggle with her domineering, infantile 
 mother and jealous father to free herself from their restrictions 
 in order that she might become an independent personality and 
 choose her school, companions and career. A young man, an only 
 son, having a splendid physical and educational equipment, "suf- 
 fered hell" because his ambitious old parents, who had risen from 
 the farm, would not tolerate his marriage to anyone except a 
 wealthy girl. Under no persuasion could the parents be brought 
 
136 PSYCHOPATHOLOGY 
 
 to allow this son Ms emotional freedom.. The above two cases are 
 of the mild type. 
 
 The horrible biological distortion of splendid yonng males and 
 females, who must suffer most because their vital energies are 
 more vigorous than the average, occurs when parasitical parents 
 insist upon keeping them dependent, "babyfied;" "sissified," dis- 
 courage their initiative with incessant_ intriguing, pleading, beg- 
 ging, weeping, invalidism, scolding and commanding. The parents 
 continue this procedure until they actually crucify the youth's 
 vital yearnings, upon the cross of filial obedience (Cases MD-13, 
 CD-3, HD-1). Many parents, without realizing what they are do- 
 ing, will stoop to use almost any hypocritical measure, of force, 
 from the Bible and pulpit to threats of disowning, in order to con- 
 trol the son or daughter. A series of cases shows that certain 
 types of crucifixion psychoses have their foundation in this form 
 of paternal or maternal domination of the vital yearnings of 
 youth, which, if once discouraged, prostituted or repressed, may 
 never again, except perhaps under the most unusual forms of spon- 
 taneous encouragement, respond to the crises that beset the win- 
 ning of virility, self-reliance, and social esteem. 
 
 The opposition of adults to maturing youths may occur in 
 the individual's parents, or the parents of the mate. The principle 
 is the same. The unreserved love of the mate is absolutely neces- 
 sary for thorough development of virility, goodhiess and happi- 
 ness, and, without it, the struggle slowly but surely, as the age of 
 thirty is reached, becomes more and more of a burden. The social 
 responsibilities after thirty have to be met at an increasingly in- 
 volved" level or else' the individual suffers humiliation from the 
 fact that yearly he must" see the youngei", more self-reliant mem- 
 bers of the herd pass him by. 
 
 Most parents actually seem to be unable to forgive the inde- 
 pendent declarations of their offspring. This often reduces to a 
 principle of selfishness disguised by claims of duty. 
 
 The male youth who submits to the dominations of others 
 lends to remain at the autoerotic or homosexual level (adolescent) 
 and those who have been "sissified" by their parents and' asso- 
 ciates tend to become fixed homosexuals of the receptive, de- 
 pendent, submissive type. They seek for the protective friendship 
 of virile, popular males and this in its biological significance may 
 
VIRILITY, GOODNESS, AND flAPPINESS 
 
 137 
 
 finally have the same value as the love-seeking of the dependent 
 female. Anyone who has had experience with trying to assist such 
 male youths to bring about an affective readjustment, so as to 
 become normal, may testify as to the humiliations they suffer from 
 
 "Two Natures in Man," by Barnard. 
 
 "St. Michael," by Zurbaran. 
 
 'Theseus Slaying Minotaur," by Barye. "Theseus Slaying Centaur," by Barye. 
 
 Fig. 17.— Different protrayals of the struggle against homosexuality in man. (By 
 permission of the Metropolitan Museum of Art, New York.) 
 
138 
 
 PSYCHOPATHOLOGY 
 
 their sexual and social inferiorities, and their tendencies to make 
 egotistical compensations or to seclude themselves. 
 
 Virility is essentially being able, "unhesitatingly and yet with 
 effective self-control, to project the affect, at any cost of physical 
 or economic sacrifice, into the social herd and force it to reco^iC^e 
 
 ]?ig. 18.- 
 
 -Tho homosexual sigiiifleance of the centaur is shown by the left hand a 
 turbating the eupid. 
 
 its power by spontaneous submission. This does not imply that 
 the virile hero needs always to win, but, to use a pregnant expres- 
 sion of the game, he needs aliuays to play the game to the finish, 
 for all he is worth, and in a manner that will win the respect of 
 himself and admiration of his conqueror. Never can he afford to 
 be petulant, timid, self-doubting, or tmfair. The defeated but 
 good-humored rival is never vanquished, but respected and loved. 
 
VIRILITY, GOODNESS, AND HAPPINESS 139 
 
 As a social influence, he becomes more of a favorite the more grace- 
 fully he endures defeat. 
 
 Because of the tendency in both males and females of the 
 genus Homo to regress to the homosexual level whenever the com- 
 petitions and combats of heterosexual courtship or dangers of 
 heterosexual indulgence (venereal disease, pregnancy, rival's at- 
 tack or social scandal) cause fear and depression (impotence), it 
 has become valuable to know the phylogenetic determinant for this 
 universal trait.* 
 
 The behavior of infrahuman primates (Macacus rhesus, Maca- 
 cus cynomolgus, and a species of baboon) may be considered to be 
 indicative of the sexual behavior of the ape ancestors of the genus 
 Homo, and to indicate the phylogenetic influence that the civilized 
 ape (man) has still to master through the establishment of appro- 
 priate social relations. Hamilton's observations,* made under 
 practically normal environmental conditions, and my observations 
 made later in an abnormally close confinement, showed that there 
 is a persistent autonomic-affective tendency, in man and the 
 higher apes and monkeys, to revert bach to homosexual methods 
 of obtaining gratification ivhen the environmental resistances to 
 heteroseosual advances become too severe. The presence of per- 
 sistent fear producing exogenoii^s stimuli of course removes sexual 
 potency. 
 
 The behavior of the infrahuman primates, as well as male and 
 female adolescents of the genus Homo, shows that homosexual in- 
 terests precede and predominate the heterosexual interests. It 
 has been observed that matured male monkeys and apes when iso- 
 lated from females, or when prevented from courting a female by 
 a domineering male, Avill revert to homosexual play. 
 
 This reversion tendency must be seen to have its counterpart 
 in the behavior of men and women when isolated by religious or 
 social obligations or laws, as marriage to a frigid or incompatible 
 mate, over-conscientious self-repressive wishes, fear of venereal 
 diseases, scandal or prosecution, actual isolation in military camps, 
 prisons, asylums, monasteries. Men and women then tend to 
 become anxious and irritable because of the persistent autoerotic 
 
 •Kempf, E. J.: The Social and Sexual Behavior of Infrahuman Primates. The Psycho- 
 analytic Review, Vol. IV, No. 2. 
 
 *G. V. I-Iamilton: A Study of Sexual Tendencies in Monkeys and Baboons. Jour. Animal 
 l^ehavior, Vol. IV, No. 5. 
 
140 PSYCHOPATHOLGGY 
 
 or homosexual pressure which, is usually misunderstood and may- 
 lead to a psychosis. 
 
 Whenever two or more men are obsessed with cravings for the 
 affections of a certain woman, the weaker rival, who fears defeat 
 or punishment, or can not endure anxiety, or justify the pursuit 
 of his craving, tends to revert back to homosexual interests if he 
 can not find a substitute. I have seen this occur in sons who rivaled 
 their fathers for the mother's affections, in the weaker of rival 
 brothers, and in a father who believed his son had replaced him 
 in his wife's affections. The sexual cravings of man apparently 
 have only comparatively recently been subjected'to censorship for 
 incestuous fixations. A series of pernicious psychoses, presented 
 later, show that sexual reversion occurs ifthe resistances to hetero- 
 sexuality are too severe, a fact which has been utterly disregarded 
 or overlooked by most educators, ultra-moralists and sociologists. 
 
 To accuse a male of being effeminate is to insult him, but to 
 accuse a female of "having a vigorous, aggressive (masculine) 
 temperament is in this day of woman's suffrage to compliment her. 
 The first is truB the world over among all peoples. The conquest 
 of, or adequate masculine compensation for, effeminate or uncon- 
 trollable ' submissive tendencies is the underlying theme of the 
 great classical fantasies about such male heroes as Hercules and 
 Theseus. Although Hercules performed the cycle of twelve labors 
 and- was the chief national hero of Hellas, upon the slaying of his 
 friend Iphitus, in a fit of madness, he was condemned to become the 
 slave 6f Queen Omphale for three years. "While in this service 
 the hero's. nature seemed changed. He lived effeminately, wearing 
 at times the dress of a woman, and spinning wool with the hand- 
 maidens of Omphale, while the queen wore his lion's skin."* This 
 myth probably had its affective origin in the fact that when a 
 man's heterosexual ventures cause sorrow (as from syphilis, hate, 
 or the loss of a friend) he tends to a homosexual regression. I have 
 seen two poorly developed young men in homosexual panics which 
 were related to fear of venereal infection which had discouraged 
 heterosexual responsibilities and liabilities. 
 
 Theseus, the great hero of Attic legend, son of Aegeus, king 
 of Athens, and Aethra, virgin daughter of Pittheus, king of 
 Troezen (noble parentage), when sent by his mother, on passing 
 
 ♦Bulfinch, T.: The Age of Fable, vol. i, p. 147. 
 
VIEILITY^ GOODNESS, AND HAPPINESS 141 
 
 out of adolescence, to Athens, encountered many adventures on 
 the way. He performed many heroic deeds, the slaying of 
 Periphetes, called Pine-Bender, who killed his victims by tear- 
 ing them asunder between two pine trees, the Crommyonian 
 Sinis boar, Sciron, who kicked liis guests into the sea, Cercyon, 
 and Procrustes, who killed all comers by stretching them or cutting 
 them down to fit his bed. Despite this immortal virility, as he 
 passed through the streets of Athens, his curls and long garments, 
 which reached to his ankles, dreAv on him the derision of some 
 masons who were putting a roof on the new temple of Apollo 
 Delphinius : ' ' Why, they asked, was such a pretty girl out alone ? ' ' 
 In reply, Theseus took the bullocks out of their cart and flung them 
 higher than the roof of the temple, a virile, masculine compensa- 
 tion. [Postadolescent males tend to delight in exhibiting their 
 heroic deeds, sexual prowess and organic superiority (high-flung 
 bullocks) in the face of religious censorship and ridicule in order 
 to prove that they are not effeminate, as well as to win the esteem 
 of their male associates and the love-object. This heroic but 
 aborted tendency is also to be seen in the pseudo-virile demonstra- 
 tions of many forms of gambling, fighting, stealing, raping, seduc- 
 tive intrigues of males and females, the pimp's mastery of the 
 prostitute, and promiscuous patronage of prostitution. The pros- 
 titute, usually homosexual, often lives with other prostitutes to 
 dominate their affections.] 
 
 When Theseus undertook to free Athens of the scourge of 
 the Minotaur, a monster having a human body and the head of a 
 bull, to whom had to be sacrificed a tribute of seven Athenian 
 youths and seven maidens every nine years, he was guided by 
 Ariadne (meaning : "Very holy and the personification of Spring," 
 the love of a vii'gin). She gave him a clue of thread to guide him 
 through the maze of the labyrinth (social intrigues) in which the 
 Minotaur lived. After slaying the Minotaur, he carried Ariadne 
 away with him. Barye's statuette of "Theseus Slaying the Mino- 
 taur" shows the monster attacking the pelvis of Theseus with his 
 pelvis (homosexual assault). (Fig. 17.) The origin of the myth 
 as a means of gratifying affective cravings is probably in the 
 struggle against suppressive, rival males, particularly the father, 
 in order to overcome the tendency to remain homosexual, if sub- 
 missive. One timid young man frequently dreamed that he was 
 being attacked by a charging bull whose roars grew louder as it ap- 
 
142 PSYCHOPATHOLOGY 
 
 proaclied. The analysis brought out its origin in the snoring, dom- 
 ineering father with whom he had to sleep during his adolescence 
 and the increasing loudness of the roaring bull was the snoring 
 reaching a crescendo. The defeat of the father would set him free 
 from his domination, but the labyrinth of obligations and gratitude 
 bound him to his rival. The inspirations from Ariadne, lovely 
 maiden, freed Theseus from the old dependence upon his mother 
 and enabled him to free himself from the father's domination, 
 symbolized by the' Minotaur. 
 
 Pig. 19. — "Hercules and' Ompliale," from a painting by Boulanger. Masoulin'e 
 virility regresses to effeminacy and' homosexuality after slaying- a friend. Hercules 
 wore Oijiphale 'a. clothing for three years while she dominated him and wore his lion's 
 skin; the effect of shame and sorrow upon virility. 
 
 Ariadne (Spriffg) replaces the mother-attachment of ado- 
 lescence which, like Winter, must wane as postadolescence is re- 
 placed by the virility which her love stimulates. It is this inspira- 
 tion which, produced by the beauty of the pure love-object, who 
 will be the reward if he becomes a virile hero, gives him the en- 
 during ideal (continuous thread of thought) which guides him to 
 evade social intrigues and overcome opposition and inferiorities. 
 (See Fig. 20.) If the father is too severely domineering the 
 repressed affections may develop a patricidal craving. Its cul- 
 
VIRILITY, GOODNESS, AND HAPPINESS 
 
 143 
 
 mination in the patricidal act of Guiteau has its opposite solu- 
 tion in the crucifixion of the son to preserve the omnipotence of 
 the father (Cases AN-3, CD-I, CD-2) in order to please the mother 
 and also avoid incest. 
 
 Pig. 20.— "Eternal Spring," by Eodin. Trom "Art," by Eodin. (Eeproduced 
 by courtesy of Small, Maynard & Co.) The sculpture expresses the eternal vigor 
 and constructive power of uneensored heterosexual love. 
 
 This same theme runs through that wonderful modern play, 
 "The Yellow Jacket" by Hazelton, in which the kind mother saves 
 
144 PSYCHOPATHOLOGY 
 
 the infant from the jealousy of the father and then ascends to 
 heaven, becoming spiritualized npon wegling her child, which ends 
 its infancy. The young hero 's career then, till postadolescence, is 
 in the house of foster parents, a farmer, where the animals, birds, 
 fish, insects and flowers educate him (polymorphous interests in 
 nature). He emerges with an uncontrollable craving to know the 
 world and win love, and leaves home despite the pleas and tears 
 (resistance) of his parents (or foster parents). 
 
 In the world he promptly falls into the intrigues of homo- 
 sexuality which, symbolized, by the hunchback, tries to destroy his 
 virility through the seductions of a siren. When he loses her, he 
 becomes depressed, and enters into an infantile regression beside 
 the grave (memories) of his mother. While in this mental state, 
 he meets Plum Blossom, who like Ariadne, is a holy virgin who 
 loves virility, truth and heroism. Plum Blossom (Spring) now in- 
 spires him. Although he attempts suicide when her parents try to 
 keep her from him, they, upon learning of his ancestry, allow her 
 to present the youth with her slipper, the symbol of her love and 
 body, which is to become the inspiration and guide (thread), for 
 his conflicts and his prize if he conquers himself, his self-love and 
 vanity, by defeating homosexuality and evading social pitfalls. 
 
 With a mighty sword (phallus), given him by his foster father 
 (wish for his son's haature potency which many never receive) 
 and a garment, upon which is written, in her blood, his mother's 
 wish for his winning of virility, goodness and happiness (which 
 many mothers do not know enough to instill into their sons) and 
 Plum Blossom's love, as his inspiration, he sets forth to master 
 himself and the world. Gruided by a sympathetic philosopher (an 
 invigorating conception of his place in nature) he overcomes, in 
 turn, the Thunder God of fetich and tradition, the Spider and his 
 web-snares (labyrinth) of social intrigues and flattery, the Tiger in 
 the form of his jealous grandfather and jealous father (Minotaur 
 equivalent), and the freezing indifference of conventional society 
 towards the aspirations of youth. These heterosexual obstacles 
 become allied with Homosexuality's and Narcissus' seductive re- 
 sistance to the courage and self-sacrifice necessary to reach the 
 stage of true manhood. He finally learns to know himself, where- 
 upon he no longer needs the philosopher's guidance, and, entering 
 the temple wherein the Yellow Jacket of Virility is kept, he de- 
 mands it for himself from his homosexual, narcissistic brother. 
 
VIRILITY, GOODNESS, AND HAPPINESS 145 
 
 Then calling the beautiful Plum Blossom to bring her body (phys- 
 ical as well as spiritual love), he places her upon his throne, 
 maldng her slipper his scepter. Thus, he reaches true maturity 
 and bestows honor upon his family, glory to the Emperor and 
 offspring to the race. 
 
 The heroic struggles of the male youth to develop skill and 
 power, the willingness to risk pain and injury in order to main- 
 tain courage and self-confidence are of the utmost importance for 
 sexual potency. Such traits of character and the postural ten- 
 sions of the muscles of this type of adaptation stand oiit in strik- 
 ing contrast to the adaptations and postures of the narcissistic 
 youth who loves his grace and beauty, dislikes struggle and 
 competition and dreads to make an error. The normal maiden 
 reciprocates in her development by cultivating grace and beauty 
 to charm and inspire the virile 3fouth. She admires power and 
 courage and dislikes timidity and narcissism in the opposite sex. 
 If, however, she herself has developed the masculine attribute to 
 dominate, she makes a poor mate for the virile male, and, because 
 of the discomforts and competition, avoids him for the effeminate 
 male. If one will study the postures or expressions of the fea- 
 tures and bodies of the illustrations "Caryatid," "Lachrymas," 
 "Graziella," and "Falling Leaves," one sees a predominant 
 note of submissive longing for love and pregnancy, whereas in 
 the "Martyr" we see extreme suffering from uncontrollable 
 but ungratifiable eroticism depicted especially in the breasts and 
 pelvis. This condition is not unconamon to institutions for the 
 care of the insane, where the patient is sent because the family 
 abhors loss of self-control and the phj^sician is too stupid to un- 
 derstand human nature. Contrast the struggling Martyr and the 
 dying Psyche in "Cupid and Psyche," with the power, harmony 
 and virile assurance shown in "Eternal Spring." 
 
 Fear of being subjugated by the hyperactivities of an auto- 
 nomic segment is shown in "Maternity" and "The Lost Hour" 
 where the uterus is depicted as a grinding oppressive burden 
 that prostrates the body. The woman's sacrifice for maternity 
 is tremendous and requires great courage of those who fully com- 
 prehend its cost and suffering. The Caryatid shows the maiden's 
 awakening to the importance of her existence to the race and the 
 vigor of her maternal longing. A few years later this attitude be- 
 comes distorted by social intrigues, jealousies, fears and doubts. 
 
146 
 
 PSYCHOPATHOLOGY 
 
VIBILITY, GOODNESS, AND HAPPINESS 
 
 147 
 
 Fig. 22. — "Caryatid," "by Eodin. (By permission of the Metropolitan Museum of 
 Art, New York.) The vase as the burdensome uterus and longing for maternity. 
 
148 
 
 PSYCHOPATHOLOGY 
 
 tmleBs her companions have most ■annsnal regard for what is 
 worth while. 
 
 In "The Storm" we see a beautiful flight of love which, how- 
 ever, is being pursued by the storm of social disapproval, and 
 the maiden, although courageous enough to follow her hero, shows 
 a little apprehension of what is to come. The' courage in this type 
 of personality contrasts with the sullen, shut-in, brooding auto- 
 erotic maiden who indulges in innumerable sexual fancies about 
 her male relatives and neighbors, but has been trained to fear and 
 avoid an open, frank courtship because of a withering sense of in- 
 
 Fig. 23-A.— "The Storm," by Cot. 
 A love fantasy ■ pursued" by censorship. 
 (By permission of the Metropolitan Mu- 
 seum of Art, New York.) 
 
 • Fig. 23-B. — "The Ring," by Alex- 
 ander. An uneensored love fantasy. (By 
 permission of the Metropolitan Museum 
 of Art, New York.) 
 
 feriority. "The Eing" portrays the calm, justifiable contempla- 
 tion of sexual love symbolized by the ring. It contrasts with the 
 agony of the unfortunate girl martyr and the wastage of "The 
 Courtesan," or the remorse and anguish of Rodin's "Eve." 
 
 The "Madonna of the Eose" illustrates the maternal adapta- 
 tion of the religious type in which the affect is not fully 
 
VIRILITY, GOODNESS, AND HAPPINESS 149 
 
 satisfied by tlie birth of the infant because of the attachment to the 
 father, whereas the statue "Mother" shows a predominant love 
 for the infant, and "Bacchante" depicts robust, vigorous, graceful 
 joy of motherhood. 
 
 Fig. 24. — "The Madonna of the Eose, " by Dagnan-Bouveret. (By permission 
 of the Metropolitan. Museum of Art, New York.) This mother's posture, while con- 
 tented in most respects, shows some traces of longing in the features. Her costume 
 indicates a highly sublimated attachment to the father. 
 
 The group of young mothers, as fulfillments of the inherent 
 biological cravings, contrast strikingly with the ungratified long- 
 ings of the childless, the bitter anguish of those who fear the 
 
150 
 
 PSYOHOPATHOLOGY 
 
 titems, the wasters of sex, and the abnormally sexed. Art' 
 miTseums are filled with snch portrayals of the struggle to gratify 
 the inherent biological cravings; and the physician, who would 
 understand human nature and "mental diseases," must become 
 able to recognize the nature of the dilemma in his patient. The 
 possibility of functional abortion is very great in both sexes, even 
 though the individuals have a splendid organic equipment through- 
 out life. Our social ideals and purposes in education must be re- 
 adjusted in a most decisive manner to correct the evil. The aver- 
 
 Fig. 25. — "Mother," by Lewin-Funoke. (By permission of the Metropolitan' 
 Museum of Art, New York.) Showing contented motherhood and the inspirations, of. 
 child worship. "■ 
 
 age youth would eventually, like the animal, solve the riddle of his 
 place in nature if he were not misled by dogmatic ascetics and 
 biologically abnormal teachers into believing that the "fleshly" 
 cravings of his body will destroy the soul and that the "devil" 
 mysteriously encourages him to yield to their "filthy cravings." 
 Narcissistic youths are common in almost every social gather- 
 ing. They are characterized by their unusual admiration for their 
 physical and personal attributes and their inability to make the 
 sacrifices that are necessary to Avin the affections of others. 
 
VIRILITY, GOODNESS, AND HAPPINESS 151 
 
 They may make desperately grotesque, even criminal, attempts 
 to establish their potency and attain the esteem of their asso- 
 ciates, such as the narcissistic seducer of girls who brags of 
 his conquests in order to be considered potent. Considered in 
 its varied phases, it seems almost miraculous, under the present 
 
 rig. 26. — "Bacchante," by MacMonnies. (By permission of the Metropolitan 
 Museum of Art, New York.) A modern version of joyous motherhood freed from 
 religious suppression and dogmatic conventions. 
 
 idea of social and educational propriety, for parents to be able to 
 raise children who are so wisely trained that the fullness of na- 
 ture's heritage will be theirs during maturity. It seems that the 
 conglomeration of races, languages, customs, religious dogmas and 
 social ideals, which have been perniciously thrown together into 
 
152 PSYCHOPATHOLOGY 
 
 the treasure-house of primeval America has completely misled 
 the American people from the quest for true happiness. Only in 
 sporadic instances may families still be found who have not lost 
 their vision of man's true place in nature, families who have not 
 substituted economic or intellectual exhibitionism for love and 
 friendship. 
 
 The stage of maturity of the personality may be_ considered 
 to be entered upon at twenty-two, that is, about the years of com- 
 plete ossification of the skeletal apparatus and the development of 
 the ego's control of the individual autonomic segments (popularly 
 called self-control) for a full biological career, which includes the 
 capacity to derive pleasure out of the responsibilities of parent- 
 hood. It extends to the menopause in the female, and to the onset 
 of organic deterioration (sclerosis) in both sexes. During this 
 stage, both sexes, even though well developed as vigorous person- 
 alities, still retain bisexual traits and the constant possibility of re- 
 gressing (reflexly) to a homosexual level if the stresses of main, 
 taining heterosexual interests tend to cause too much anxiety and 
 sorrow. Regression often occurs even though the individual (male 
 or female) is the parent of children. 
 
 Heterosexual potency, judging from the behavior of many 
 psychopaths and normals of both sexes, varies in its vigor, and 
 is never quite secure from the possibility of disintegration in the 
 face of depressing influences, such as disease, a frigid, unldnd, 
 terrifying, neurotic or disgusting mate, hopeless economic bur- 
 dens, fear of pregnancy, or venereal diseases, social scandals, an 
 inaccessible or unresponsive love-object, death of the mate, or a 
 too fixed mother-attachment. The intrigues and usurpations of 
 power by the family of the mate, suppressing the idealized wishes 
 of the individual, often cause the regression to the lower level of 
 homosexuality, where, at least, parental sacrifices need not be 
 made. We have found, in the regression of many young wives 
 and husbands, that a domineering, jealous, scheming mother-in- 
 law or father-in-law played a most important part, as a cause of 
 the tragedy. 
 
 The disastrous influence upon heterosexual potency when the 
 autonomic apparatus has been conditioned (trained) to love sex- 
 ually the mother (her attributes, physical and personal), and can 
 not react so as to produce sexual potency when obligated to a 
 
VIRILITY, GOODNESS, AND HAPPINESS 
 
 153 
 
 wife of markedly different physical and personal constitution, is 
 often found to be the underlying cause of the male's anxiety (Cases 
 riD-l, AN-3, PN-6, PD-35, MD-6). 
 
 Fig. 27. — "Der Sphinx," by Ton Stuck. The number of young men who are 
 destroyed by incestuous love is astounding. They form a large part of the popula- 
 tion of asylums and xJrisons. The incest mechanism is symbolized by the left hand 
 about the mother's neck while the right (moral) reaches out for help as the mother 
 attachment, like a cancerous, bestial influence secretly destroys his virility and love 
 for other women. 
 
 This tragedy of the male is wonderfully expressed in Von 
 Stuck 's grewsome painting, "Der Sphinx." Here, the beautiful 
 face of the woman, whose maternal affections are shown by the 
 
154 PSYCHOPATHOLOGY 
 
 nursing mammary glands, is fondly kissing the helpless younj 
 man like a vampire. Her arms, fair to the elbows, are extended 
 behind him, and, becoming bestial, her talons are buried in his 
 back. Thereby, her selfish love, secretly ("behind his back" or 
 unconsciously to him), destroys the potency of his maturity. His 
 right (moral) hand grasps convulsively for assistance and free- 
 dom, but his left (incestuous) hand clings to her neck. Below the 
 shoulders, her body becomes bestial (incestuous) and the dark 
 cancerous shadow in the pedestal upon which she rests, symbol- 
 izes the biological disaster that threatens every man who can not 
 free himself from a physical mother-attachment and gratify the 
 needs of his affections at an esthetic level. It has been almost 
 consistently observed in the last five years that our male patients 
 who are admitted in a state of homosexual panic have profound 
 mother-attachments of an infantile, incestuous nature, and even 
 hallucinate having sexual intercourse with her during the panic 
 and despair (Case PD-34). 
 
 This mechanism, also, naturally, is to be found in the female, 
 who, because of her incestuous attachment to her father, finds all 
 other men sexually unattractive when she expresses her true sex- 
 ual interests, ■ and, when she permits her incestuous feelings free 
 play, she inclines to become impelled to submit herself promiscu- 
 ously as a prostitute to all men (Case HD-1). The report of the 
 Chicago Vice Commission shows that an astonishingly large per- 
 centage of prostitutes (over 50 per cent) were seduced by their 
 fathers or other adult male relatives, which indicates that overt 
 and secretly fancied incestuous interests have a definite relation* 
 ship to prostitution. 
 
 The physically matured males and females, who still have 
 affective attachments to homosexual experiences of adolescence 
 and "fond memories" of those incidents with their companions, 
 are not likely to become heterosexually mature. Many of them 
 become cynical and convinced that there is no such thing as hetero- 
 sexual love and never marry ; or if they do marry they find the ob- 
 ligations of the contract intolerably oppressive. As parents, they 
 have little interest in the maturation of their children and love 
 them in order to make a renewal of their own childhood. 
 
 An autoerotic narcissistic man or woman hates anything that 
 tends to .detract from personal beauty or self-indulgence, as the 
 
VIRILITY, GOODNESS, AND HAPPINESS 155 
 
 sacrifices of parenthood. He despises the drudgery of parenthood 
 withont realizing that it is because of its impositions on his self- 
 love. 
 
 Upon marriage, a subtle, if not overt struggle occurs between 
 the mates for the dominant position in the contract. The big, ag- 
 gressive wife and timid, little husband attest to the importance of 
 organic superiority in the adjustment, but the average marriage 
 does not show such organic differences. The sadistic or masochistic 
 husband and masochistic or sadistic wife will certa,inly adjust to 
 please their reciprocating cravings, no matter what influence this 
 may have upon their children, and a sadistic husband and sadistic 
 Avife, although both are cruel in their pleasures, will divorce each 
 other on the charges of the other being cruel ; but it is the common- 
 place adjustment that interests us most, because it is most predom- 
 inant. Nature places an unerring punishment upon the woman 
 who, by incessantly using every whim, scheme and artifice, finally 
 succeeds in dominating her husband. By forcing him to submit to 
 her thousand and one demands and coercions, within a few years 
 he unconsciously becomes a submissive type and loses his sexual 
 potency with her as the love-object. If he does not have secret 
 love interests which stimulate him to strive for power he finally 
 loses his initiative and sexual potency completely and must live 
 always at a commonplace level, the servant of more virile men: 
 the counterpart of the subdued impotent males of the animal herd. 
 His more aggressive, selfish mate, if periodically heterosexually 
 erotic, will become neurotic if her moral restraints are insurpassa- 
 ble, or seek a new mate whom, in time she will again attempt to 
 subdue. Never is she able to realize that her selfishness makes 
 her sexually unattractive. The psychopathologist meets many 
 such women whose husbands have evaded domination by secretly 
 depending upon the affections of another more suitably adjusted 
 Avoman. 
 
 Men and Avomen often marry to escape from autoeroticism 
 or homosexuality, an incestuous attachment to a parent, to satisfy 
 an irrepressible, subconscious curiosity, or to escape from a pain- 
 ful economic or social situation. Such adjustments are rarely 
 happy because the individuals do not have enough of those attri- 
 butes, Avhich, as stimuli, are required by the conditioned autonomic 
 functions of the other ; hence, they do not invigorate and "inspire" 
 one another. This adjustment, if accepted as final, predisposes to 
 
156 PSYCHOPATHOLOGY 
 
 loss of initiative and acceptance of the commonplace. Sncli indi- 
 viduals are able to get less than one-half of their working and crea- 
 tive capacities out of themselves and finally solve the problem 
 through secret attachments, remating or hopeless resignation. 
 
 Marriages, as cures for masturbation and irrepressible homo- 
 sexual interests, very rarely, if ever, are truly successful in either 
 relioAdng the autoeroticism or as a compensation for homosex- 
 uality. Such solutions are promiscuously advised by the ministry 
 and medical profession, when, at best, the maladjusted individual 
 is an imposition on the mate. ' Autoerotic or homosexual men and 
 women should always have a psychoanalysis and develop insight 
 before attempting to mate. Examples of the tragedies attending 
 such matings are collected in the chapters on the neuroses and 
 homosexual panics. 
 
 It is well known that excessive sexual indulgence is as perni- 
 cious and debilitating in its fatiguing influence upon the capacity 
 to win social esteem as too severe sexual restraint upon those who 
 have poorly developed sublimations. Copulation by no means can 
 be considered to be indicative of sexual virility, because it may 
 be entirely a defensive compensation against oral eroticism (Case 
 PD-10). 
 
 Throughout life each individual must maintain his virility, but 
 it will be consistently found that those who are persistent in dem- 
 onstrating their virility by "showing off," bragging with unmer- 
 ited bluffs and claims, and trying to evaluate their commonplace 
 productions above their intrinsic worth, are perniciously afraid of 
 their lack of virility. Five children, one six years of age, the 
 others about four years, were marching like soldiers. Upon asking 
 them, "How many children are there here?" the oldest child re- 
 plied "four." This compensatory attitude for organic and func- 
 tional inferiorities will be found throughout life, but in itself, must 
 not become an inferiority, like the grandiose claims of the para- 
 noiac. 
 
 The stage of decadence, organic and functional inferiority, be- 
 gins to make its appearance in the vital organs and blood-vessels at 
 about forty to fifty, and, the effect may be observable in the indiv- 
 idual's failure to compensate under stress (lack of physiological 
 recoverahility of the nerve, muscle and gland cell). The influence 
 upon the personality is to be seen in the manner in which the in- 
 dividual conserves his energy and economic resources. He admits 
 
VIRILITY, GOODNESS, AND HAPPINESS 157 
 
 there are many things he does not care to know (make effort to 
 learn). He insists upon traditions, precedents, conventions, ances- 
 tral worship, and distrusts, very naturally, social and religious in- 
 novations, invests permanently in bonds and real estate, and be- 
 gins to feel an instinctive compulsion to suppress the surging pres- 
 sure of the younger men. Men in this stage naturally push their 
 class into the law-making bodies and offices of their corporations as 
 self-conservative measures. Biologically, it is the last struggle 
 of the old bull to maintain his dominant place in the herd (family, 
 community, nation). "When the economic, military and diplomatic 
 intrigues fostered by men of this stage develop international com- 
 plications, they summon, as feudists, their heroic youths to the 
 colors and hurl armies of them upon one another to further their 
 international schemes and the domination of their economic inter- 
 ests. (The leaders of the German military machine, as well as 
 her diplomats, were preponderantly men who had advanced far 
 into the stages of arteriosclerosis and organic inferiority. One 
 may see worthy sons, who could enormously improve the family's 
 business, bound hand and foot by the arteriosclerotic father. He 
 will not yield his grip on the dominant position in the fanlily.) 
 
 Throughout the case histories to be presented in the follow- 
 ing chapters, it will be seen that the psychoses are greatly deter- 
 mined by the individual's struggle to maintain feelings of being 
 virile and esteemed despite his inferiorities. The tragedy occurs 
 when he possesses cravings to do things and obtain things that 
 are not tolerated by his associates, and which he himself regards 
 as depraved. 
 
 Many youths are to be saved from disaster just so soon as 
 parents are trained to educate their children with the object of 
 enabling them to attain the functional state of biological virility. 
 Most psychopaths are, however, the offspring of loveless mar- 
 riages, and since few people really know whether they are happily 
 mated or not until some time after marriage, the necessity of trial 
 marriages and a revision of the social obligations pertaining to 
 the sexual functions is becoming imperative, or a profound refor- 
 mation of education must come. Many male youths only suceed in 
 stopping the tendency to homosexual perversions and masturbation 
 through heterosexual intercourse; hence, usually, patronage of 
 prostitutes. As grewsome as this fact is, it can not be evaded or 
 dispersed by scorn, but must fearlessly be given consideration by 
 
158 PSYCHOPATHOLOGY 
 
 well-balanced sociologists and psychopatliologists, and not en- 
 trusted to the fanatical innovations and castrations of moralists 
 who are themselves suffering from sexual obsessions. 
 
 Prostitution, masturbation, homosexual and heterosexual per- 
 versions as a tendency to biological abortion and waste, and social 
 deterioration, are always to remain among the great problems of 
 the human race and incessantly require society's counter-efforts 
 to train the individual to enjoy living a socially constructive sexual 
 life. Society can not possibly escape the laws of nature (because of 
 the fatal tendency to autoerotic and homosexual reversion) by 
 erecting barriers against normal sexualit}^ There is but one so- 
 lution and that must lie in a profound revolution of social and 
 religious conventions and the ideals of education in order to bring 
 about a more healthful and happy career of sublimation of the 
 sex cravings with virility as the goal. 
 
 As vitally necessary as athletic and esthetic preoccupations of 
 interest are for the development of self-reliance and self-control 
 of the personality, there are many educational institutions that do 
 Jiot provide sufficient means and inducements to the school chil- 
 dren, maidens, youths, and young men and women. So far, at 
 best, many institutions that have gymnasiums encourage only the 
 more aggressive, and much smaller proportion of the pupils, to 
 cultivate control of their muscles and affective resources, and prac- 
 tically none of them give the student as much credit for developing 
 self-control and a splendid physique as they give for a course in 
 Latin. 
 
 Schools ought to be built around gymnasiums, and residential 
 communities around recreation grounds. The temple will event- 
 ually again become the sacred institution where athletic and es- 
 thetic refinement may meet to enchant and inspire the populace. 
 This aggrandized social ideal will alone be able to induce the youth 
 openly to cultivate the fundamental biological principles which are 
 most conducive to goodness, virility and happiness. Prostitution 
 and perverseness, alcoholism and drugs, are largely barometers 
 of our social system's aborting influence upon human nature. The 
 utterly bigoted manner in which professional, ascetic purveyors of 
 grace have striven to control the pressure of nature needs a sane 
 readjustment. 
 
 Humanity, no matter how it may be enshrined with eulogies 
 
VIRILITY, GOODNESS, AND HAPPINESS 159 
 
 and hales of soul, is, after all, notliing more or less than a biological 
 product. Whoever intends to understand. the profound forces that 
 compose us, which, moving like the resurging tides, force us to 
 adopt fashions of thought to please the affections, must train him- 
 self to see man as a biological problem, a refined ape that has 
 learned to wear clothing, develop a written language and use 
 mechanical means for transmitting his thoughts and forces. 
 
 Anthropological history reveals that, as an animal, man has, 
 iiniversally, acquired a trait which is not to be found in any other 
 species, and that is the capacity to use symbols and images as 
 substitutes for realities in order to acquire stimuli which arouse 
 comfortable and potent autonomic tensions. The rela,tion of the 
 symbol to the ungratified affective craving in the child, the sav- 
 age, the psychopath, and in the normal, modern man, directs our 
 attention to the difference betAveen man's affective mechanisms 
 and those of the infrahuman primate. This difference is the 
 mechanism of the suppressed, and later of the repressed, or dis- 
 sociated craving or wish. The capacity to disguise the wish, while 
 aware of its influence upon other associates, probably had its be- 
 ginning, at least as far back in the phylogenetic scale as that rep- 
 resented by the Macacus rhesus monkey. The behavior of one of 
 these monkeys, who showed sig-ns of being conscious of himself or 
 his wish to steal his companion's food, was reported in full.* 
 
 In brief, he would approach his victim by moving backward 
 toward him while at the same time he pretended to be searching 
 for food in the sawdust before him. As he drew near the eating, 
 unsuspecting monkey, he slyly glanced over his shoulder, cau- 
 tiously extended his arm backward, and, if not being watched, 
 made a quick turn of his body and full extension of his arm, grab- 
 bing the food out of the other monkey's hands. His backward 
 manner of approach, apparent pretensions of being disinterested 
 (a behaviorism very commonly used by monkeys), his hesitation, 
 and his choice of conditions for grabbing, indicated, decidedly, 
 that he was aware of the necessity of disguising his wish ; hence, 
 temporary suppression of its domination of the projicient appara- 
 tus. 
 
 Children begin to use similar mechanisms when they become 
 highly enough organized as personalities to have to solve the prob- 
 
 •KemDf, E- J.: Did Consciousness of Self Play a Part in the Behavior of This Monltey? 
 Journal of Philosophy, Psychology and Scientific Methods, xiii, No. 15, p. 410. 
 
160 
 
 PSYCHOPATHOLOGY 
 
 lem of satisfying their individual cravings, and yet retain the af- 
 fections of their masters. 
 
 The affective mechanism that would naturally follow upon the 
 development of the advantageous capacity of preventing a crav- 
 ing from jeopardizing the personality, by preventing it from con- 
 trolling the final common motor paths of the projicient apparatus, 
 would be the development of the capacity to repress it so that it 
 could, not cause the personality to think of it and be distracted 
 during a crisis. 
 
 It is this final mechanistic difference — ^namely, the capacity 
 
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 ^r^^ 
 
 -^^1 
 
 
 
 
 
 
 
 ■ '\ - > - — l-*"!'' " 
 
 sc^-- - 
 
 
 '~^ 
 
 Kg. 28.— "The Eequiem." (From Pf iater-Payne : "The Psychoanalytic Method." 
 By courtesy of MofEat, Yard & Co.) 
 
 The fantasy, of a man -who had strong suicidal cravings and wishes to return 
 to the womb of his mother. The fantasy shows the mother church isolated for him- 
 self, the tower as the clitoris, the round window as the urethral orifice, the door- 
 way as the vaginal opening, the trees as the labia, and himself floating dead on the 
 waters of labor. The hills show the thighs parted and the mens veneris. Pfister 
 showed the posture of the details to be intimately related to characteristics of- vari- 
 ous members of the family and their cravings to possess the mother. [Compare with 
 Boeeklin's fantasy: "The 'Isle of the Dead" (Fig. 29)' and "The Resurrection" 
 (Fig. 55.).] - ■ 
 
 to make affective repressions, that has probably giyen. man the 
 universal feeling that, in some certain profound, although un- 
 known, respect, he is different from lower animals. It is the re- 
 
VIKILITY, GOODNESS, AND HAPPINESS 
 
 161 
 
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162 PSYCHOPATHOLOGY 
 
 pressed wish that longs to be regarded as the hopeful soul, the su- 
 premely beautiful and most pleasing wish of all in the personality 
 of man. As a solution for his repressed cravings, repressed be- 
 cause of the distractions, sorrow and longing they produce when 
 permitted freely to cause consciousness of their needs, Man's uni- 
 versal dream of eternal heayen is created. 
 
 In the happy, virile, normal individual, this mechanism is too 
 much obscured by his general obligations, immediate schemes and 
 ambitions to be recognized, but, in the preadolescenf, senile and 
 depressed individiial, the source and nature of the craving for 
 death and heaven is revealed in its biological values. 
 
 The wishes and fanfasies of the suicidal (Cases HD-1, AN-3), 
 show that the autonomic apparatus, being discouraged and de- 
 pressed by the hopelessness of the environment and the envy of 
 its associates, and still fascinated by the Avarmth and sincerity 
 of the mother's love, craves to return to its parasitical attachment 
 to her. Boecklin's "Isle of the Dead," when studied after the 
 print "Requiem," reveals wherein the gates to the first heaven 
 are located. The "Eequiem" was drawn by one of Pfister's pai- 
 tients,* who wished, as the patient himself repeated, to commit 
 suicide in order to acquire the feeling of being again with his 
 mother. The drawing of himself as a dead man floating on the 
 waters (of labor) before the Island (mother, alone) shows the 
 mother church between four trees. If one will see the steeple of 
 the church as the clitoris, the round window in the tower as the 
 urethra, the doorway as the vaginal inlet, and the two tall (broth- 
 ers) and two short trees (sisters) as the labia, then the wish ful- 
 fillment of the sketch and the origin of the symbols, in actual ex- 
 perience becomes obvious. The wish that created the symbolic 
 sketch must be associated with the fact that he wished to return 
 to the ivomb of his mother. Case HD-1, suicidal, was in a veritable 
 panic for several weeks from the feeling that she had to return 
 to the uterus, a belief compelled by the regression of the affect. 
 One mah (aged twenty-three) was obsessed with cravings to per- 
 form cunnilingus. He had a profound mother-attachment, and 
 several times planned to commit suicide, preparing his pistol and 
 secluding himself for the purpose. When he abandoned himself 
 
 •Pfister, translated by Payne: The Psychoanalytic Method, p. 394. 
 
VIRILITY, GOODNESS, AND HAPPINESS 
 
 163 
 
 to the cunnilingus craving, he became aware of wishes to get com- 
 pletely inside of the female through the vagina. 
 
 If, now, we compare Boeklin's "Isles of the Dead" with Pfis- 
 ter's patient's "Requiem" it will l)c perceived that this profoundly 
 impressive painting has its potent influence upon the affections 
 through its symbolic value to our regressive tendencies. The isle 
 again symbolizes the lonely, isolated mother ; the great rock ridges 
 that converge behind the forest represent the flexed thighs; and the 
 forest, the pubic hair; the two pillars of the gate, the labial folds 
 about the vaginal entrance; and the entering, pure white soul in 
 the boat upon the waters (uterine) reveals the serious affective 
 origin of the unhappy Boecklin's masterpiece. The foetal posi- 
 
 Mg. 30. — The fetal position is obvious. Compare to the "Isle of the Dead" 
 (Fig. 29) and "The Eebirth" (Fig. 55). 
 
 ti6h of the Egyptian burial. Pig. 30, and that of the negress, who 
 made a series of attempts to commit suicide and wished to get out 
 of the world, as she has suspended, herself before the window in 
 the dark room, are self-explanatory. (See Fig. 62.) 
 
 If the posture of the prehistoric Costa Rican Indian's sculp- 
 tured figure (Fig. 64) is compared with the intrauterine position 
 of the hebephrenic dissociated j)ersonality, whose case is distinctly 
 that of an intrauterine affective regression under the pressure of 
 great sorrow (Fig. 65), the posture of the fetus, and the posture 
 of the motionless, eternal dreamer Buddha, the similarity of the 
 muscular tensions for their kinesthetic value is at once obvious. 
 The intimate dependence of postural tensions upon autonomic 
 
164 
 
 PSYCHOPATHOLOGY 
 
 tensions and cravings has been well established (Sherrington, 
 Langelaan, De Boer) and must be considered as indicative of the 
 true affective interests of the individual. 
 
 If this tendency to infantile or intrauterine regression persist- 
 ently occurs when the environment is too severely depressing and 
 
 Fig. 31.— Buddha — the sublimation of autoerotie self-sufl5eiency. (Compare with 
 the postural attitude of the catatonic deity, Pig. 60.) 
 
 painful, then it becomes obvious that unless man is able to find a 
 means of keeping himself happy and virile, his biological career, 
 as a species, must soon find a level beyond which it will not tran- 
 scend, because it can not endure the depression and sorrow caused 
 by the ungratified cravings. This brings us back to the use of the 
 
VIRILITY, GOODNESS, AND HAPPINESS 165 
 
 symbol and its saving, invigorating influence upon the ungratified 
 autonomic functions. 
 
 Anthropologists and psychologists have not adequately rec- 
 ognized that fetiches and idols, rituals, luck charms, and religious 
 systems have their origin in the compensatory strivings of the 
 ego to control th6 reactions of the autonomic apparatus. The 
 principle is simple enough. Every man must protect himself from 
 the incoordinations and weaknesses of muscle tone which instantly 
 are aroused by doubt of one's powers in a crisis. This self-doubt 
 or lack of self-assurance is a fear reaction. It quickly forms a 
 vicious circle because in an emergency or test self-doubt decreases 
 skill and power and this in turn, decreasing the margin of safety, 
 increases fear of failure. Sportsmen universally recognize this 
 principle. Hence the biological value of faiths, rituals, beliefs, 
 forms of thought, traditions, prayers, idols, fetiches, mannerisms, 
 which, as stimuli envigorate the man, and preventing self-doubt 
 or fear of "losing his nerve" are of the utmost importance. Ani- 
 mals, primitive man and civilized man depend enormously upon 
 bluffing as a means of keeping up courage and intimidating oppo- 
 nents. Rituals bluff the intimidations of the unknown. 
 
 Man has always had to compensate against potential defeat, 
 failure or danger, because no matter how remote, if the individual 
 is aware of it, it' remains a cause of fear and this in turn tends 
 to cause impotence. Hence, the creation of the symbol, ritual 
 and fetich as invigorating counter-stimidi which arouse com- 
 pensatory autonomic reactions which overcome the depressing 
 influence of fear and hopelessness. Man, no matter what his 
 intellectual rating may be, uses this psychotherapeutic trick in 
 some form. It is apparently necessary because, as Cannon has 
 shown, a fear producing stimulus causes a shifting of the blood 
 supply from the digestive apparatus (and the sexual organs) to 
 the organs (head, heart, limbs, lungs) which are used for defense 
 and attack. Hence, unless defensive or aggressive measures are 
 taken to remove the influence of the fearful stimulus, the nutri- 
 tional disturbances tend to become chronic, and chronic sexual 
 impotence results which might terminate the race. The sympa- 
 thetic encouragement individuals may give one another in the form 
 of praise, tokens of esteem, charms, fetiches, blessings, well 
 wishes, moral support, etc., are therefore invaluable. They be- 
 come particularly valuable in allaying the secret fears men and 
 
166 PSYOHOPATHOLOGY 
 
 women have of one another because of the envy, jealousy and in^- 
 trigues that incessantly arise within the members of the family, 
 elan and community. The primitive community's ritualistic 
 efforts to produce rain in the time of drought or to stay rain 
 in time of flood, to induce the return of the sun in winter, to 
 bring peace in time of a losing war, or relief from the ravages 
 of disease, beasts, famine, to induce sexual excitement, preg- 
 nancy, and labor, etc., are important, in that they tend to en- 
 courage reciprocity with and sjmipathy for one another. Environ- 
 mental dangers, as winter, storms, beasts of prey, are not so con- 
 stant, as trials, as the feuds between individuals of the same 
 sex and community. It is in the effort to induce the- men and 
 women of a community to renounce envy and avariciousn-egsA'ha.t 
 the Christian formalizations of religious behavior have been 
 cultivated.* 
 
 Through . relieving the fear of another's political and iwjpV; 
 mercial intrigues and homicidal plots, the biological potency of an 
 individual is increased, because the pelvic converg-fttcet of the blood 
 supply is permitted so soon as the cephalic convergence is no 
 longer necessary for defense. 
 
 Among savages, the plots and selfish intrigues were so inces- 
 sant, the necessities of life so difficult to acquire, pregnancy so 
 burdensome, and infant mortality so great, that the potent phallus 
 and its images were, by compensation, made the supreme gods of 
 ancient Man. Neither is it surprising that in sjTXibolic disguise it 
 should still continue so today, if one considers the physical and 
 personal sacrifices that are necessary to maintain the parental 
 state and provide for the needs of a family. 
 
 Another important value of the symbol as an autonomic stim- 
 ulus lies in the tendency of the invigorated autonomic reactions 
 of one individual reflexly, more or less vigorously, to stimulate im- 
 itative reactions in a friendly associate. The rapidity with which 
 imitation occurs is to be seen in the almost simultaneous leaping of 
 a school of fish, of the darting of a flock of birds, the reactions of 
 the mob or audience. The tears of the mourner or actress start 
 tears in the viewer; we admit that some smiles are welcomed be- 
 cause they stimulate imitations in us. 
 
 It is this very mechanism that also prevents many physicians 
 from using the psychoanalytic method ; because, when the patient 
 
 *Wc, however, slill make a Christian's appeal to God to defeat our enemies. 
 
VIRILITY, GOODNESS, AND HAPPINESS 167 
 
 permits the recall of his repressed emotions and memories, the 
 reflexly imitative reaction of the sympathetic physician, although 
 not usually observable in the form of overt movements, occurs in 
 the form of unpleasant postural tensions producing kinesthetic 
 images which often require considerable patience to endure. One 
 may observe that most people experience an activation of parotid, 
 lingual and labial reflexes when some one expresses a craving for 
 certain kinds of food. Although it is well known that such reflex 
 imitations occur, many psychiatrists are distressed by imitative 
 oral reactions when compelled to listen to the account of the crav- 
 ings of an oral erotic psychopath. Friends and families weep and 
 sing together, are afraid and courageous together, women feel 
 cravings to become pregnant when others are pregnant, or avoid it 
 
 
 i^H^Pk'. 
 
 ^^^fe^* ■' ^> 
 
 i 
 
 - 'j'^-' '';*'■■*■'" ;*'3^ 
 
 } ^Hj^i^jife 
 
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 1 
 
 m 
 
 
 ■■■■ 
 
 Fig. 32. — Copulation feticli from the Ivory Coast of Africa. Undoubtedly made by 
 
 a negro savage. 
 
 in groups, boys enter similar professions, children imitate each 
 other's objects of play or an adult's work, etc. Hence, when the 
 semipotent man or woman can obtain from the more virile compan- 
 ion a hint of his faith in his charm, fancies or method, or of what he 
 loves, the general tendency is to imitate the method or steal the 
 object — as fashions in dress, remedies, by-words, hobbies, ideas. 
 That which is intensely desirable to one becomes desirable to 
 many, even though it is only a misleading fancy. This is probably 
 the fundamental factor in hypnotism and suggestion and in the 
 miraculous influence of the inspired mystic who, zealously using 
 his self -invigorating charm, arouses his clan to overcome the 
 
168 
 
 PSYCHOPATHOLOGY 
 
 Fig. 33. — Azteo God wearing a robe showing a phallic border, probably to popularize 
 
 and stimulate reproduction. 
 
VIRILITY, GOODNESS, AND HAPPINESS 
 
 169 
 
 causes of fear and impotence. But it is his unshakable faith that 
 gives the other man confidence and encouragement as the inspira- 
 tions of Joan of Arc, and not the amulet or fetich. 
 
 The material, word, or movement, that may be used as a sym- 
 
 Fig. 34. — Aegean Figure of Goddess, with Serpent Attributes (about 1600 Bi. C.) 
 showing serpentine design in the costume and serpent entwined figure with coil in the 
 abdomen probably signifying pregnancy. (By permission of Metropolitan Museum 
 of Art, New York.) 
 
 bol to express the interest in the reality is as varied as language 
 itself, which, after all, consists of merely sound or sign symbols. 
 It must be recognized that almost anything that has the slightest 
 similarity of appearance or action, or contiguity of relationship 
 may be used by the affections to express their interests in the real- 
 
170 
 
 PSYCHOPATHOLOGY 
 
 Kg. 35. — "Falling Leaves," by, Merle. (By permission of Metropolitan Mu- 
 seum of Art, New York.) Fantasy of impregnation, with falling leaves symbolizing 
 the seed. 
 
VIRILITY, GOODNESS, AND HAPPINESS 
 
 171 
 
 Fig. 36. — ' ' Graziella, ' ' by Lef ebore. Maiden with net longing for maternity — ■ 
 the plan or net as the means of catching her ]over. (By permission of the Metropol- 
 itan Museum of Art, Now York.) 
 
172 
 
 PSYCHOPATHOLOGY 
 
 Fig. 37. — "Lachryma-e," by Leighton. (By permission of Metropblitan Museum 
 of Art, New York.) Woman longing for maternity. The vase rests upon the pillar 
 (phallus) while the fires burn to renew life. 
 
VIRILITY, GOODNESS, AND HAPPINESS 
 
 173 
 
 rig. 38. "Eve," by Eodin. (By permission, of tlie Metropolitan Museum of Art, 
 
 New York.) Anguish following the censored sexual act. 
 
174 PSYCHOPATHOLOGY 
 
 ity. Many psychiatrists have professed utter intolerance of the 
 suggestion that a knife, spear, wand, tree or horse should be used 
 as the symbol of the potent phallus, and yet they probably often 
 speak of a man as being "green" when they mean unsophisticated. 
 The word "screw" is commonly used to mean copulate. (See the 
 Ivory Coast fetich, Fig. 32.) A series of illustrations is given to 
 show how symbols are used in art to express the affections. The 
 same symbols are often used in dreams and fairy tales. Fig. 10 
 shows the erect phallus as a suffering man (prehistoric Costa Ei- 
 can Indian) ; Fig. 3 is an Aztec ceremonial knife, the handle of 
 which is a male in the copulation position and the blade stands 
 for the extended penis; on the same page is an African negra's 
 wand with a face carved into the glans penis, treating the phal- 
 lus and its cravings as a distinct personality. (This value is 
 also given by psychopaths, to the penis. One patient spoke of the 
 penis as a god that stood up like a little man.) Fig. 33 is an 
 early Mexican (Aztec) statue in the border of the robe of which is 
 worked the penis and testicle motive, and Fig. 34 an Aegean 
 (1600, B.C.!) statuette with the serpent wound into the border of 
 the gown, along the arms, into the head-dress, and knotted into the 
 abdomen (pregnancy) ; also the conventionalized serpent motive is 
 woven into the hem of the apron. The painting by Paul Veronese 
 of "Mars and Venus," Fig. 16, shows Mars uncovering Venus for 
 the sexual act while an infant symbolizes it by binding their legs 
 together. About Mars are many symbols of the potent phallus, 
 the horse, sword, armor, trees, grape vines and satyr. Venus is 
 also pressing milk from the nipple and looking at the infant that 
 binds her to Mars. (An identification of the nutritional and sex- 
 ual interests in the same fancy. See the prehistoric Costa Eican 
 Indian's sculpture of copulation. Fig. 15.) 
 
 The tree as a phallus, and the falling leaf as the impregnating 
 semen, is symbolized by Merle in "Falling Leaves," Fig. 35. The 
 lovelorn maiden and the infant playing near her, but still oiit of 
 sight, reveal the affective influence that created the fantasy. 
 
 The net as a web of ideas to catch the fish (infant) and the 
 lover is shown in the painting of the maiden with the net. Fig. 36. 
 
 The pillar as the phallus and the vase as the uterus, and the 
 fire (passion) that burns as they become imited, are shown in 
 Leighton's painting, "Lachrymae," Fig. 37, w^hich fantasies a 
 
VIRTLTTY, GOODNESS, AND IIAPPINESS 
 
 175 
 
 Fig. 39. — Eve. (By permission of Metropolitan Museum of Art, New York.) Eve 
 awaiting the rise of the serpent. 
 
176 PSYOHOPATHOLOGY 
 
 beautiful sorrowing woman who is suffering from an ungratified 
 wish for motherhood. This same motive is wonderfully depicted 
 in Eodin's "Caryatid," a postadole'scent maiden who is bearing 
 the burden of an ungratified uterus. The vase or bowl, as the 
 uterus, and the serpent, as the phallus, and their relationship for 
 beauty and health are immortalized in the statue of the Greek gi^ 
 dess of Health, Hygiea, Fig. 1. She is shown enabling the serpent 
 to approach the bowl. Beveridge's "Lost Hour" and "Maternity" 
 depict the bowl as symbolizing the agony of the uterus : one, the 
 imgratified uteru's, and the other, the subjugation of the woman by 
 the pregnant uterus. (An example of an autonomic segment over- 
 coming the ambitions of the ego.) 
 
 Eodin's "Martyr," Fig. 13, shows by the engorged breasts 
 and the muscular torsions of agony what may be suffered by a vi- 
 rile woman who is forced by the conventions of society to repress 
 the maternal cravings. On the other hand, Eodin's statue of the 
 wasted "Courtesan," Fig. 12, shows what may occur upon sexual 
 excess and sexual perversion. His " Centauress, " Fig. 46, shows 
 the. autoerotic female with extended hands, striving in despair 
 to escape the compulsions of the bestial pelvis, and his "Eve" 
 portrays the shame and remorse after the loveless indulgemue 
 whereas the statue of "Eve," Fig. 39, shows a beautifully mod- 
 eled and poised woman gladly awaiting the rise of the serpent 
 from the earth beneath her. 
 
 The religious joy that comes to the female upon conceiving 
 the child after a love indulgence, may be said to be portrayed by 
 Lewin-Funke's statue, "Mother," Fig. 25, and, similarly, though 
 with different sentiment, by Dagnan-Bouveret's painting, "The 
 Madonna of the Eose," Fig. 24. They represent two most pro- 
 nounced, although quite different, methods of expressing joy. 
 Perhaps Lewin-Funcke's statue, "Mother," may be considered to 
 be the more modern and expressive of a new, growing ideal of 
 maternity. 
 
 Eodin's statue, "Eternal Spring" (virility, goodness and hap- 
 piness). Fig. 20, is a marvelous portrayal of the affections, which 
 as a love mating, brings out in horrible contrast, as biological 
 abortions, modern commercialized, loveless marriages. Cot's 
 painting, "The Storm," shows a love flight pursued by society's 
 criticism. The backward glance and slight anxiety of the maiden 
 indicate that her love is not quite free from the censorship of her 
 
VIRILITY, GOODNESS, AND HAPPINESS 177 
 
 associates. Alexander's painting, "The King," Fig. 23-B, con- 
 trasts with this, showing the maiden in her home, contrasting 
 with a dream common during the erotic state, showing the destruc- 
 tion of home and loss of friends, which occurs when the woman 
 abandons herself to her passions (the wish to be abducted for 
 prostitution). She is often helpless in the arms of one conqueror 
 while others are already approaching. The wish for an abandoned 
 liaison is often portrayed in the dream by the fire that destroys the 
 home and the world ; and the anxious complaint is often made by 
 the uncontrollably erotic patient that the world has been destroyed 
 by fire. Eodin's statue of "Cupid and Psyche," Fig. 42, portrays 
 the old Greek truth that when love is denied or lost, thought and 
 inspiration (Psyche) dies. 
 
 Michelangelo's statue, "The Captive," Fig. 47, shows the 
 dual nature of Man. The youth, bound about his chest (suffoca- 
 tion distresses are often complained of while eroticism is re- 
 strained), has his homosexual, perverse craving symbolized by the 
 crouching beast (ape-dog) behind him. Barnard's statue, "The 
 Two Natures of Man," Fig 17, shows the perverse influence as 
 an imp of owl-dragon combination resting upon the prostrated 
 half of the man. (One patient saw the infantile, perversely auto- 
 erotic self before her in a dream as a black little imp.) Zurbar- 
 an's painting, "St. Michael, the Archangel," Fig. 17, expresses 
 the imperative requirement that Man shall master incest and 
 homosexuality. 
 
 The destruction of youths and maidens by satyrs, minotaurs 
 and centaurs in the fantasies of the ancient Mediterranean peoples, 
 probably has its origin in the attempt to prevent biological de- 
 struction by the tendency to revert to bestial perversions. Soph- 
 ocles' "Oedipus" was probably a profoundly thought-out pro- 
 test against the incestuous tendencies of the lower Greeks and their 
 slaves. 
 
 In contrast to the hero's slaying of the oppressor, Michel- 
 angelo's statue, "La Pieta," Fig. 54, may be used to show the col- 
 lapse of the youth when he is forced to sacrifice his vital love 
 wishes because they would conflict -with the potency of his beloved 
 father. The most common of all psychopathic tragedies is the 
 crucifixion of the son's or daughter's love because they are condi- 
 tioned to oppose the rival father or mother. (See Chapter XI on 
 catatonic and crucifixion adaptations.) 
 
178 PSYCHOPATHOLOGY 
 
 There will always be clever thinkers and zealous writers who 
 will not be able to tolerate the conception that the symbol is used 
 as a means, by the ungratified biological cravings of man, of obtain- 
 ing some relief, as in his fancies, dreams, writings, researches, psy- 
 choses, philosophies, religions, etc. But, whatever they have to 
 say in their attacks and counter-arguments, they must bear in 
 mind that often an individual reveals, by what he hates or can 
 not accept, what he has himself repressed and why he has re- 
 pressed it. This goes even deeper than conmaitting oneself to a 
 profession of faith which must afterwards be upheld in one's in- 
 terpretations of life. It goes to the bottom of the conditioned 
 cravings of the individual and his sublimation of them in order to 
 attain personal comfort and social esteem. 
 
 Virility can only be attained through the enjoyment of work, 
 play, study, fight, prayer and more ivorh. It must be maintained 
 by working for the true needs of. the autonomic apparatus as it 
 happens to be conditioned, despite all anxiety and suffering. If 
 the repressed" cravings are perversely conditioned they must be 
 readjusted by the psychoanalytic method, or adequately subli- 
 mated through striving for some scientific, artistic, religious or 
 altruistic ideal. 
 
 According to the conception of the development of the per- 
 sonality discussed in Chapters I to III, the following studies 
 of abnormal personalities, presented in Chapters VI to XIII are 
 made. Wherever the eccentric behavior can not completely be 
 explained by the manifest wishes, indications for the nature of the 
 repressed cravings have been sought. The repressed cravings, 
 when dissociated from the control of the manifest cravings, con- 
 stitute the "not me" or the foreign, "hypnotic" influence which 
 the ego must struggle against in order to keep control of its overt 
 behavior. 
 
CIIAPTEE IV 
 
 THE INFLUENCE OF ORGANIC AND FUNCTIONAL IN- 
 FERIORITIES UPON TliE PERSONALITY 
 
 An organ is relatively inferior when its structure or function 
 is not equal to the average requirements that are fulfilled by the 
 same organ or function in other members of that species. The 
 inferiority may be due to the organ being undersized, oversized, 
 diseased, or deformed, or displaced from its most advantageous 
 position, as the horns of the stag, the upper or lower mandible of 
 a bird, undescended testicles, delicate hands, or hyperthyroidism; 
 or it may be due to the excessive or inhibited innervation, as the 
 anger or fear state of the stomach while competing in polite so- 
 ciety. 
 
 A function may be inferior to similar functions of others, 
 although the organs that are used to perform the functions are 
 quite superior to the average; as inferior skill in swimming, or 
 fencing, the more rapid solving of problems by enthusiastic chil- 
 dren as compared to brooding children, sexual impotence in the 
 depressed or fearful, the inability to make love in the timid. 
 
 Organs and functions in one individual may be enormously 
 superior to the same organs and functions in others under some 
 conditions and fatally inferior under others ; as Avhen an amorous 
 person is married to an indifferent mate ; egotism and selfishness 
 wins in childhood and loses in maturity. 
 
 In every instance the inferiorities of the organ or function for 
 the requirements of the situation become emphasized when they 
 tend to cause failures in competition ; and after a few distressing 
 experiences they cause a persistent fear of failure. The fear of 
 failure in turn stimulates an autonomic compensatory striving to 
 prevent failure, forcing the development of skill and power in 
 the weak organ or an associated orgctn: as the stenographer learn- 
 ing to write "with the left hand after the right has been injured, the 
 stammerer in youth becoming the writer or orator during matur- 
 ity. When the fear of failure can not be compensated for, we have 
 an anxious neurotic patient. 
 
 179 
 
180 PSYCHOPATHOLOGY 
 
 Compensation as a physiological process is obviously a most 
 fundamental characteristic and requirement of living things and 
 is found in all living things. In fact, so soon as the powers of com- 
 pensation begin to fail, the organism or the personality begins to 
 deteriorate and finally dies. Physiological compensation to pre- 
 vent failure is to be seen in the storing of glycogen and fats 
 in the tissues to compensate for the loss of vital energies 
 due to metabolism, the development of immunity for infectious 
 bacteria, the mending of injured tissues, restoration of power and 
 vitality after disease, fatigue or fright, cardiac muscle compensa- 
 tion following valvular deficiency or hard work, the hypertrophy 
 of a kidney upon the excision or disease of the other kidney, the 
 balance of function in the endocrine glands, etc. The necessity of 
 compensation goes farther. We find it is the process of develop- 
 ing accomplishments and self-control by the personality. The 
 compensatory efforts to prevent the distresses caused by climatic 
 changes, beasts, diseases, war, hunger, social rivals, etc., developed 
 the skill and power to build houses, make clothing, invent and con- 
 struct languages, governments, machinery, create the modern 
 methods of medicine, surgery, etc. 
 
 Competition with the lower animals no doubt enormously 
 stimulated the ape-man and his offspring to develop mechanical 
 means of conquering and subjugating them in order that they 
 could not cause fear. Competition betiveen species, although often 
 a struggle for life, is by no means as severe and incessant as com- 
 petition between individuals of the same species who become con- 
 ditioned to require the sam,e objects to satisfy their autonomic- 
 affective cravings. 
 
 This fact was emphasized by Darwin as a most important 
 cause of evolution among higher animals. 
 
 Through sexual competition and the general tendency to favor 
 the fit, the less fitted or inferior are forced to diverge from the 
 favorite pursuits unless they can make adequate compensations; 
 hence most of them die or develop eccentric variations, and the 
 neuroses and psychoses are to be regarded as failures to make 
 comfortable adjustments and are eccentric biological variations. 
 It-is easy to see how the fine qualities of a species are maintained 
 through the successful natural selection of that which most thor- 
 oughly gratifies the autonomic needs of the individual. The func- 
 tionally and organically superior are so consistently favored that 
 
ORGANIC AWD FUNCTIONAL INFERIORITIES 181 
 
 ail men and Avomen are forced to develop estimable qualities unless 
 well protected by the strong and rich. The principle of natural 
 and sexual selection which has been maintained for countless gen- 
 erations, and upon which much of modern, civilized man has been 
 developed, must be recognized as the predominant determinant 
 of social adaptations whether the average individual is con- 
 sciqjis of it or not. Therefore, the organically or functionally 
 inferior male or feniale, child or adult, must make an adequate 
 compensation that will not only win in competition but also win 
 some social esteem, or always feel a pernicious sense of being 
 biologically inferior to his associates. Most people who have 
 sexual inferiorities show by their behavior and sensitiveness that 
 they are more or less consciously, incessantly on guard at trying 
 to keep their inferiorities hidden or unobtrusive. This defense 
 must be so consistently maintained that it has a most decisive in- 
 fluence upon vocational selections, places of living and working, 
 choice. of friends, mating, prejudices, forms of thought, etc. 
 
 We find that the stupid, illiterate, unclean, indecent, awkward, 
 ugly, weak, unskillful, poor, cowardly, immoral, vulgar, criminal, 
 perverse, tend to associate together in order that their functional 
 inferiorities will not be emphasized by too serious contrast with 
 the intelligent, decent, graceful, beautiful, strong, skillful, wealthy, 
 courageous, moral or normal. 
 
 Alfred Adler* emphasized the importance of organic inferior- 
 ities as the cause of distressing compensatory strivings. The im- 
 portant fact is that it is the individual's fear of his organic or 
 functional inferiority that forces him to make compensations which 
 later, as eccentric claims, in turn may themselves become inferior- 
 ities because of the criticisms, loss of confidence and ridicule 
 which they arouse ; as the flaunting of heroic or sexual conquests 
 by the effeminate male dandy. The inferior organ, as undescended 
 testicles or effeminate face, voice and physique in the male, is not 
 the fundamental cause of the eccentric compensation, but the fear 
 of ridicule is the cause. We find that some men, who are decidedly 
 unsexed by nature, are able to live their anomalous biological and 
 social careers quite comfortably because they have been msely 
 trained from infancy to maturity to accept their organic defects 
 and attempt no compensations which later may become causes of 
 
 *Organ Inferiority and its Psychical Compensation, Nervous and Mental Disease Mono- 
 graph Series, No. 24. 
 
182 
 
 PSYCHOPATHOLOGY 
 
 distress. On the other hand, many people are to be found who a,re 
 organically well constituted and, professionally, decidedly sldllfnl, 
 who can not escape feeling a pernicious sense of inferiority which 
 must be protected in every conceivable manner. This may be due 
 
 "Fig. 40. — Simulation of perfect man by undersized Russian immigrant, age 18, 
 illiterate. He thought the wearing of a man's suit would encourage him to grow to 
 fit it. 
 
OEGANIC AND FUNCTIONAL INFERIORITIES 183 
 
 in some instances to the prejudiced training in childhood, or an 
 unredeemable act of perverseness or cowardice, but it is necessary 
 to look for a more general cause of anxiety in certain forms of 
 functional inferiorities. It may safely be assumed that all func- 
 tional inferiorities, in vocations or hobbies, as of the mediocre sur- 
 geon or musician, in themselves, occasionally cause anxiety, but 
 this occurs ouly when circumstances place too much responsibility 
 upon the act and arouse fear of failure. Hence a form of functional 
 inferiority that interferes constantly Avith the struggle for hetero- 
 sexual virility and biological fitness must be considered to be the 
 critical factor. As such, the psychopathologist finds that tvherever 
 men or ivomen are sexually inferior to the ideals of their associ- 
 ates, due either to organic vmfitness, as masculine traits in the 
 female or effeminate traits in the male, or functional inferiority, 
 as the tendency to autoeroticism or sexual perverseness in either 
 sex, they feel a pernicious sense of inferiority from which they are 
 forced to protect themselves in some manner. 
 
 • The methods of defense for inferiority vary greatly, but may 
 be correlated into three general types. They are either (1) avoid- 
 ing competition, or (2) eliminating the inferiority, or (3) develop- 
 ^ ing a protective superiority in some other organ or function. 
 Either adjustment tends to become extreme and eccentric if the 
 fear of the consequences of the inferiority is pernicious and quite 
 continuous, whether the individual is conscious of it or not : then 
 the compensation may become so eccentric as to constitute an in- 
 feriority also! 
 
 Avoiding competition because the inferiority is ahvays re- 
 flexly contrasted with the opponent's or rival's superiority may 
 vary from the tactful avoidance of certain forms of competition to 
 the general dread of all personal contact. The latter through its^ 
 insidious influence, within a few years develops an incurable 
 psychopath; as in the seclusive, suspicious, brooding, autoerotic, 
 postadolescent boy or girl becoming the regressive hebephrenic. 
 
 Elimination of the inferiority may be solved by a severe,, un- 
 conditional aversion for anything that influences the individual tO' 
 become aware of his inferiority or by having it excised or re- 
 paired; as surgical repairs, or self-inflicted castrations for haas- 
 turbation or perversions, and catatonic adjustments. 
 
 The tendency to prevent the inferior craving from causing the 
 individual to be conscious of its existence mav become Severe 
 
184 PSYOHOPATHOLOGY 
 
 enough to be considered a psyehoneurosis, particularly when the 
 effort at repressing the inferior function, as masturbation crav- 
 ings, causes serious preoccupations of thought which interfere 
 with work. 
 
 Compensation, by developing a protective superiority in some 
 other function is, fortunately for the progress of civilization, the 
 most common method of adaptation and the most successful. The 
 successfulness of this method for the individual's needs does not, 
 however, always depend upon the fine qualities of the compensar 
 tion, as the development of literary, artistic or scientific skill, but 
 upon the fact that fear of the secret inferiority, as a potential 
 cause of failure to win social esteem, has ceased. We find men 
 Avho have made remarkable contributions to society's welfare who 
 can not even then escape from having a pernicious feeling of be- 
 ing biologically inferior to the ordinary, happy*go-lucky artisan. 
 
 When the fear of being inferior ceases, the tendency to com- 
 pensation slows up and wherever we find eccentric or unreason- 
 able attempts to win social esteem, as in the paranoiac 's or autistic 
 imbecile 's claims, we are sure to find an unavoidable fear of havi#g5 
 a certain functional inferiority recognized by others or by the in- 
 dividual himself. Inferiorities that are pernicious causes of anx- 
 iety initiate eccentric compensatory strivings, which in themselves 
 become notorious (as gaudy, loud exhibitionism, grandiloquent 
 manners, extravagant claims of wealth, honors, social recognitions, 
 unfounded claims of great inventive capacities, illegal profiteering, 
 bigamy, white-slave exploitation, sexual conquests, fanatical sex- 
 ual-religious reformations, pathological lying, stealing, etc.) The 
 inferiorities in such cases have been found to be almost invariably 
 sexual. The cases to be presented show that in every instance of 
 pernicious asocial behavior we find that the individual was suffer- 
 ing from an irrepressible tendency to crave that which was sex- 
 ually perverse or unjustifiable. Their eccentric strivings, while 
 conducive to self-control for perhaps several years, finally became 
 inferiorities because they ceased to win confidence and only 
 aroused ridicule, which soon forced the individual into a vicious, 
 affective circle that became progressively worse. 
 
 Vicious circles of compensation in vital organs for a diseased 
 or inferior organ are common enough, as in compensatory emphy- 
 sema but vicious circles of affective adjustments have not yet been 
 given their due importance. 
 
ORGANIC AND rUNCTIONAi INFERIORITIES 185 
 
 The psychopathologist and general practitioner must there- 
 fore thoroughly familiarize themselves with the mechanisms of 
 compensation in order that, as in compensatory emphysema, a 
 study of the compensation will assist them in diagnosing the true 
 nature of the individual's inferiority and his method of adjusting 
 to it. So soon as Ave deprive a man of his means of compensating, 
 by forcing him into a vocation which he dislikes, or by preventing 
 him from abandoning a position that deprives him of a means of 
 solving his affective distress, or by discrediting his creations, he 
 tends to become anxious or even panicky. He now becomes a 
 patient, complaining of distressing cardiac, respiratory, gastric, 
 intestinal, rectal, or genitourinary sensations, which we must 
 recognize as flowing from pathological tensions of certain auto- 
 nomic segments.* 
 
 These tensions are conducive to iinbalancing the reciprocal re- 
 lations of the other autonomic segments, and by their causing a 
 stream of distressing sensations, the autonomic apparatus most 
 effectually forces the individual to make a social adjustment which 
 will permit it to resume its normal methods of working. When an 
 artisan loses his right hand in an accident and complains of in- 
 somnia, loss of appetite and a "sinking feeling" in his abdomen, 
 we know that the stomach and viscera in the epigastric region have 
 assumed postural tensions that are the source of a stream of fear- 
 ful feelings. As he compensates by developing efficient skill with 
 his left hand, the dangers of failure and poverty decrease and the 
 viscera are again enabled to work at a more comfortable tension. 
 But it is the uncomfortable tension of the viscera that forces him 
 to go through the drudgery of learning to apply his left hand. 
 The development of skill must be recognized as having a psycho- 
 therapeutic value and a most decided physiological effect upon the 
 autonomic apparatus through enabling it to acquire the stimuli 
 that it needs. 
 
 The above type of case is rather simple when compared to the 
 individual whose inferiority is not a lack of skill, physical means or 
 social opportunity, but is due to an irrepressible craving for some- 
 thing or to do something which is absolutely tabooed by society, 
 such as erotic perverseness, or an uncontrollable but unjustifiable 
 
 *Such terms as "mental," ''somatopsychic"' or "imaginary" are unsatisfactory when applied 
 to such conditions. They only reveal the diagnostician's loose methods of thinking about such 
 processes. 
 
186 PSYCHOPATHOLOGY 
 
 love, hate or fear. A study of a large group of psychopathic per- 
 sonalities shows consistently that they are the victims or hosts of 
 persistent autonomic cravings ivhich are conditioned to seeh ivhat 
 they regard as perverse stimuli, such as oral or anal, incestuous, 
 homosexual, autoerotic stimuli, or illegitimate pregnancy, etc. 
 Such individuals may give up the fight for self-control and, sub- 
 mitting to the cravings, become social delinquents or dependents, 
 or hallucinate images of the necessary realities and treat them as' 
 realities; as the simulations in hysteria or the hallucinations in 
 chronic regressives and paranoics. We find many such individuals 
 in asylums and prisons as well as in society. 
 
 On the other hand, the man may strive desperately to master 
 himself and coordinate all his powers upon a compensation that 
 will bring him assurances of being esteemed and will prevent him 
 from becoming conscious of his inferiorities. It has been pointed 
 out before that this striving may or may not be valuable to civiliza- 
 tion. After some time it may tend to fail and then is pushed on 
 until it becomes hopelessly eccentric. Behind this compensation, 
 more or less subconscious and vigorous, we find the individual is 
 afraid, fearful, uneasy about losing control of himself and becom- 
 ing dominated by the dissatisfied, perversely conditioned auto- 
 nomic segment. 
 
 It is obvious that the individuals who have marked organic 
 inferiorities, (such as a girlish physique, hairless skin and soprano 
 voice in a male, or a mannish physique, facial hypertrichosis and 
 baritone voice in a female), and serious asocial cravings (for homo- 
 sexual submission in the male or female), have most terrific diffi- 
 culties in themselves and society's aversions to overcome. Their 
 struggles are terribly severe when compared to those of the indi- 
 vidual whose organic constitution is inclined to be ridiculed but 
 whose training has been so wisely managed that the affective com- 
 pensations are quite normal; or the individual who is physically 
 true to sex but is affectively perverse but kindly and tolerant and 
 does not hate his critics. 
 
 The men and women, who are constituted to be physically and 
 conditioned to be affectively true to the sexual requirements of the 
 race, have no comprehension of the anxiety their more unfortunate 
 brothers and sisters must suffer unless they themselves have had 
 experience with trying to cure them. 
 
 The normal men and women, who loved, but finally failed to 
 
OKGANIC AND J-UNCTIONAL INFERIORITIES 187 
 
 \nn their love-objects, may have some comprehension of the sup- 
 pression those people must endure who are conditioned to love 
 perversely, but they can never comprehend the terror and panic 
 such people endure when they realize that their ability to control 
 themselves is weakening and they may be forced by their own pas- 
 sions into unredeemable social and biological degradation. It is 
 not uncommon to see such men and women desperately resisting 
 the perverse erotic pressure long after a dissociation of the per- 
 sonality has taken place and they are being forced to endure a riot 
 of perverse hallucinations which are produced by the erotic affect's 
 uncontrollable seeking for gratification. The cases of benign dis- 
 sociation neuroses, (the manic depressive group) and the perni- 
 cioiis dissociation neuroses (the paranoiacs and the paranoid, cata- 
 tonic and hebephrenic dissociated types), often show these causes 
 of fear and bewildered efforts at compensation and defense. 
 
 The cause of functional inferiorities is often due to fear of 
 using a function or orgaii under certain conditions ; as fear of ex- 
 aminations or competitions even though sufficiently learned or skill- 
 ful to meet the test, fear of trying because of being considered 
 awkward, stupid, ignorant or silly, or fear of the responsibilities 
 or consequences involved in the act wh^en the safety of others is 
 dependent upon it. In heterosexual functions fear of pregnancy, 
 venereal disease, social scandals, blackmail, a rival, of being 
 jilted, rebuked, scorned, ridiculed, or of ejaculatio prsBcox, pain, 
 marriage, etc., certainly makes of the opposite sex hideous mon- 
 sters instead of attractive lovers ; hence the erotic affect is turned 
 back to the more easily maintained homosexual or autoerotic ad- 
 justment. Inferiorities due to fear of using normal organs are 
 much more easily adjusted than the homosexual fascinations which 
 have existed since childhood. 
 
 Summary- 
 Only those organic inferiorities are compensated for which 
 tend to jeopardize the biological career of the animal by being con- 
 ducive to failure in the struggle for life and sexual favor — in man 
 the struggle for sexual favor and social esteem, social esteem be- 
 ing an elaboration of the sexual interests, is to be given pre- 
 eminence, except, perhaps, during war. 
 
 The fear of potential failure stimulates the autonomic appa- 
 
188 PSYCfiOPATHOLOGY 
 
 ratus, the individual or organism as a unity or whole, to compen- 
 sate by developing, or claiming to have developed, skill and power 
 in some socially beneficial and estimable capacity. When the com- 
 pensation begins to fail as a defense, a vicious affective circle is 
 established which eventually destroys the personality if the causes 
 of fear are not rectified. This principle is the same as that death 
 of the orgaiaism follows when its physiological compensations fail. 
 In the following chapters the most prominent types of the 
 ego's compensation or adaptation to the causes of fear and the 
 various types of autonomic affective cravings that become causes 
 of fear, although most pleasing to the individual under certain 
 conditions, are illustrated by typical cases. 
 
CHAPTER V 
 
 MECHANISTIC CLASSIFICATION OF NEUROSES AND 
 
 PSYCHOSES PRODUCED BY DISTORTION OP 
 
 AUTONOMIC-AFFECTIVE FUNCTIONS 
 
 The following system is essentially based on the integrative 
 functions of the nervous system, the derangements of which pro- 
 duce the psychoses as symptoms. The same forces that build up a 
 personality when harmoniously integrated cause its deterioration 
 when unadjustable conflicts occur. It is always necessary for the 
 progress of any science to be willing to abandon an old system and 
 adopt the new if more efficient and adaptable to facts. The old 
 biology died hard in opposition to DarAvin's theory of evolution, 
 and many scholarly old physicians found the germ theory of dis- 
 ease beyond comprehension and utterly intolerable, but in each 
 struggle the more practical and rational method eventually re- 
 placed the old. Modern psychiatry is certainly in need of an 
 elastic, adaptable hypothesis, a direct terminology and method of 
 classifying its cases and problems. Should a patient have a ty- 
 phoid infection and develop nephritis and myocarditis, the clin- 
 ician would certainly add the words nephritis and myocarditis to 
 his diagnosis and again drop them as the different organs recov- 
 ered. Psychiatry must find a similar method. 
 
 The modified Ki;aepelinian system of classifying personalities 
 and psychoses fails because it is fundamentally based on a static 
 neurology, emphasizing symptoms and prognosis. Syiiiptoms have 
 been grouped into circumscribed disease entities despite the fact 
 that a large proportion of cases show symptoms which are classi- 
 fiable into two or three, or even more, groups, such as neurasthenia, 
 manic-depressive types and dementia prsecox type ; or hypomanic 
 and paranoid. About half the cases are, at one period or other, 
 atypical for the Kraepelinian divisions. Most institutions easily 
 evade this dilemma by dogmatically forcing the most suitable 
 diagnostic term onto the case for statistical purposes. If each im- 
 portant institution could be induced to give, sealed, to a central 
 
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192 PSYCHOPATHOLOGY 
 
 committee, its actual working system for classifying cases m 
 dementia prsecox, manic-depressive, paranoia, hysteria, and neu- 
 rasthenia, illustrated by cases, the differences would probably be 
 so varied that the whole system would have to be abandoned be- 
 cause the faithful assumption that symptoms are similarly ap- 
 plied and evaluated throughout psychiatry would be brutally 
 discredited. The errors in medical and surgical diagnosis are the 
 result of the failure to discover critical symptoms or the wrong 
 evaluation of the symptoms found. To this difficulty is added, in 
 psychiatry, the fact that personalities vary greatly in their auto- 
 nomic activities at different times, under different conditions and 
 under the care of different physicians ; and the same environmen- 
 tal conditions may have entirely different influences upon differ- 
 ent people, and upon the same person at different times. Hence, 
 the symptoms (as irritability) that are shoAvn under certain en- 
 vironmental conditions may not be noticeable under others, and 
 uncontrollable cravings may constitute a benign difficulty in one 
 case and a pernicious influence in another. Many cases may be in- 
 fluenced to change their attitudes toward uncontrollable cravings, 
 so that a pernicious conflict may become quite bent§ff or the re- 
 verse ; as in autoerotic or perverse cravings — one case may end in 
 suicide and another in a wild orgy, or zealous purification. The 
 strongest argument against the utility of the old system is the 
 manner in which such terms as ' ' manic-depressive " or " dementia 
 prsecox" mislead psychiatric curiosity, when there is any. In- 
 most ins'titutions the diagnosis "manic-depressive" tacitly means 
 recoverable and "dementia prascox" means incurable, no matter 
 what is done for the ease. Hence, M^hen a case, diag-nosed "cata- 
 tonic dementia prsecox," recovers, the inclination is to reconsider 
 it as a stuporous manic-depressive. The analytical study of 
 large, varied groups of cases shows that nothing could be more 
 fallacious or misleading. Remarkable, constructive, healthful re- 
 adjustments can be made if the autonomic-affective conflict can be 
 corrected and readjusted. 
 
 It seems, therefore, much more practical to use a system of 
 classifying psychopaths according to the nature of their autonomic- 
 affective difficulties and their attitudes toward them, because this 
 keeps the dynamic factors directly in psychiatric attention and 
 permits of revision as the cases change. It is adaptable, intelligi- 
 
MKCHANISTIC CLASSIFICATION OF NEUROSIS AND PSYCHOSES 193 
 
 ble, simple, and the nomenclature^ is directlij applicable to the 
 mechanisms involved. It is also comparatively easy to pick ont 
 the differentiating factors. We must not forget that the golden 
 rule in diagnosis is to htioiv what we are looking for because then 
 it is infinitely easier to find it. Hence the essential mechanistic 
 factors that make a case curable or incurable, or determine its 
 course and prognosis, are used for the terminology in the following 
 system. The psychopathologist, therefore, can only diagnose his 
 case in so far as he understands it. Under the old system the 
 promiscuous diagnosis of "dementia prsecox" is correct in over 
 half the cases (in obscure cases in medicine and surgery this is 
 fairly good practice) hence even if the physician knows little or 
 nothing about a case, he is reasonably safe becaiise over half the 
 asylum cases are "dementia prsecox types," i.e., disposed to de- 
 teriorate. 
 
 The descriptive terms, acute, chronic and periodic, are valu- 
 able for medicine and surgery and decidedly so for psychopathol- 
 ogy. Here the term, actde, is reserved to apply to cases of less 
 than one year's duration. Chronic is applied to cases having 
 had more than a year's duration or eases that have had an insid- 
 ious course for more than a year before the consultation. Periodic 
 is applied to cases that have periodic or intermittent episodes 
 or recurrences accompanying the repetition of natural phenomena 
 such as menstruation, pregnancy, the birth of a grandchild, mar- 
 riage or death of child, etc. 
 
 The most important question to be ansAvered in any case is, 
 "Is the illness likely to prove destructive or fatal?" In psycho- 
 pathology the paramount issue is, "Do we have a benign or per- 
 nicious process at work?" In the vast majority of cases, we may 
 safely hold, as an axiom, that the benign or pernicious nature of 
 the autonomic-affective conflict is determined by the ego 's adapta- 
 tion to the pathological cravings. If the ego can not accept the 
 cravings as a part of the personality, we have a pernicious mecha- 
 nism that is sure to force an eccentric, if not asocial, development 
 of the ego. If the intolerable cravings are inclined to increase in 
 vigor through natural physiological processes (gro-wi;h) and ex- 
 ogenous stimulation (as the sexual), we have a malignant process 
 that exerts an incessant pressure to influence an adjustment so 
 that gratification can be obtained. If the sexual cravings are 
 disowned by the ego and are conditioned to seek the type 
 
194 PSYCHOPATI-IOLOGY 
 
 of stimuli which were pleasing in infancy or preadolescence, 
 the destructive influence upon the personality will be greater than 
 if the cravings are postadolescent in type or fully matured, and 
 the resistance is due to an excessive prudishness. 
 
 On the other hand, apparently, no matter what the segmental 
 cravings tend to seek, if the ego is inclined to accept them as a 
 part of the personality, due to natural causes, and not due to secret, 
 mystic. or unnatural influences, the personal conflict is not so fer- 
 nicious but is rather henign, because the autonomic distress is less 
 severe and in turn the compulsion to compensatory defenses is 
 less persistent ; hence the individual does not become so eccentric 
 and asocial. Furthermore, the benign mechanism is usually ac- 
 cessible to psychoanalysis and constructive readjustment, whereas 
 the pernicious mechanism is extremely difficult to influence. Quite 
 frequently, however, patients' attitudes change from pernicious 
 adaptations to the segmental cravings to henign attitudes; as in 
 Case PD-33, an oral erotic submissive homosexual, who for two 
 years was diagnosed a typical "paranoid dementia prsecox" be- 
 cause of his convictions that the cravings were caused by secret, 
 hypnotic influences and were not a part of his personality, — caus- 
 ing most eccentric defensive behavior and compensatory, grand, 
 omnipotent, egotistical claims and fancies. Upon the development 
 of a transference to me, he asked to have his "mind read," and in 
 due course of time the ego's fear of the segmental cravings- 
 changed to a frank consideration of them, the mechanism chang- 
 ing from an apparently hopeless pernicious type to a fairly en- 
 couraging benign type. As he learned to allow the repressed dis- 
 sociated cravings frajikly to cause him to be conscious of their 
 needs, the weird, hallucinated sensory images of assault, etc., 
 disappeared and the case changed to a suppression (anxiety) neiT- 
 rosis of a benign though serious nature. As his sexual cravings 
 became more heterosexual and normal, and the oral eroticism 
 abated, the suppression neurosis and eccentric compensatory 
 striving decreased so far that he had to be discharged as socially 
 readjusted. Under the old classification he would have to be con- 
 sidered as a case of paranoid dementia pra^cox that had made a 
 social recovery. Under the following system he Avould at first 
 have been diagnosed as a chronic, pernicious, dissociation, compen- 
 sation neurosis, and, upon discharge, as a benign suppression neu- 
 rosis ivith a tendency to eccentric compensatory striving. 
 
MRCI-TANTSTTC CLASSIFTOATTON OT? NETTTiOSTS AND PSYCTTOSES 195 
 
 To emphasize : the essential moohanistic difference between a 
 henign neurosis and pernicious neurosis lies in the ego's attitude 
 toward the segmental autonomic cravings. 80 long as the patient 
 reAains the tendency to accept the personal source of the ivishes or 
 cravings ivhich cause the distress or psychosis ire have a henign 
 type; and when the patient develops the tendency to oppose or re- 
 fuse to accept the personal source of the ivish or craving, to hate 
 those ivho woidd attrihute a personal source for the craving and 
 evasively to hlame an external or im-personal cause for the diffi- 
 culty, tre have a pernicious type. Obviously, the benign attitude 
 is capable of being analyzed and corrected, whereas the pernicious 
 attitude is most difficult to rectify and influence. 
 
 The chart shows that the terms, acute, periodic, or chronic, 
 are to be prefixed to the terms, henign or pernicious, and they in 
 turn prefixed to the different types of neuroses. 
 
 The neuroses have been differentiated into five distinct gen- 
 eral types, because of the five distinct differences to be found in the 
 autonomic-affective mechanisms. It must be borne in mind, how- 
 over, that an individual may have one or more mechanisms at one 
 period just as he may have erysipelas and nephritis or become 
 healthy. ^ '<- 
 
 The suppression neuroses are characterized by the individual 
 heing, clearly to vaguely, conscious of the nature and effect upon 
 himself of his ungratifiable cravings. Similar autonomic distresses 
 may be caused by the loss of the love-object, through its inaccessi- 
 bility, as death, indifference, infidelity, or the perverseness that is 
 craved, or through the individual's becoming disgraced and unfit 
 for the love-object, as imprisoned, exiled, ostracized, etc. ; or the 
 inability to escape from one cause of fear because of a more dan- 
 gerous cause, such as the battlefield versus court-martial for 
 desertion. For this reason it is utterly imsatisfactory to use such 
 terms as "situation psychoses," "war neuroses," or "shell 
 shock." They are no more scientific and practical than the diag- 
 nosis of "automobile fracture," "fall fracture," "jump dislo- 
 cation, " " elevator sprain, " or " railM^ay spine. ' ' 
 
 The repression neuroses are characterized by the individual 
 trying to prevent the autonomic cravvn.gs from causing him to be 
 conscious of their nature or needs and influence upon his person- 
 ality. He succeeds by maintaining a vigorous, incessant, defen- 
 sive coordination (concentration of attention) of his egoistic 
 
196 PSYCHOPATHOLOGY 
 
 ■wishes upon a course that compromises, as a resultant of converg- 
 ing forces, with the repressed cravings. In battle the autonomic 
 tensions -which produce the distressing afferent sensory streaffl, 
 called fear, must be relieved. Flight niay mean life-long disgrace 
 or court-martial and shooting for desertion. Motor disability or 
 localized anesthesia, as blindness or deafness, results in hospital 
 treatment, hence the "war neurosis" is the symptom of the re- 
 pressive adaptation to the uncontrollable autonomic reaction. 
 There are certainly two distinct types of "war neuroses" — shown 
 in individuals who know that they are incapacitated by fear, admit 
 they have "lost nerve" but can not control themselves, and in- 
 dividuals who maintain that a bruise, wrench, fall, or explosion 
 caused the functional distortion that keeps them from the battle- 
 field, insisting on the other hand, that they are not afraid. 
 
 The psychological mechanism of suppression, wherein the 
 individual permits the affect to cause him to be aware of its needs 
 but prevents it from causing overt behavior, is decisively different 
 from the adaptation of repression, wherein he not only prevents it 
 from dominating his overt movements, but does not allow it to 
 make him conscious of its existence or true needs (makes himself 
 forget it). 
 
 The results or effects -of these two adaptations are distinctly 
 different, the effects being the symptoms. Their types reveal the 
 nature of the adaptation — ^whether suppressive or repressive. The 
 symptoms of suppression neuroses are mild to severe distressing 
 hypertension or hypotension of some autonomic segment or seg- 
 ments, whereas the repression neuroses show similar effects plus 
 distinct functional distortions of the projicient apparatus or sense 
 organs ; such as localized spastic or flaccid paralyses, anesthesias, 
 hyperesthesias, or amnesias, mannerisms, compulsions, unchange- 
 able preferences, persistent thoughts, etc. They are more difficult 
 to treat than suppression neuroses, because the patient's tendency 
 is to prevent the disagreeable affect from causing him to become 
 aware (conscious) of its existence, and^ the treatment essentially ^ 
 requires that he should allow it to assert itself naturally and then 
 be assimilated or used for constructive purposes. 
 
 The compensation neuroses as a division naturally follow 
 next. When the individual feels that he has cravings which arc 
 socially inferior and detrimental, and wishes to win social esteem, 
 
MECHANISTIC CLASSIFICATION OF NEUROSIS AND PSYCHOSES 197 
 
 the fear of losing social esteem and fear of the influence upon his 
 personality of' the intolerable cravings initiates a compensatory 
 autonomic reaction, which in turn compels a course of behavior 
 that is designed or adapted to acquire some form of comforting 
 social esteem. Obviously, when the asocial cravings cause persist- 
 ent, intense fear, the compensatory striving is likely to be more 
 vigorous, obsessive, eccentric and socially less adaptable, being 
 frequently designed to destroy or defeat the environmental factors 
 that arouse the intolerable cravings, as well as those opposing- the 
 compensation. Hence the eccentric compensator^^ striving is to be 
 regarded as protective but symptomatic of the fear of a secret 
 functional inferiority. 
 
 The regression neuroses are quite opposite in type to the 
 compensation neuroses in that the individual makes no effort or 
 gives up the struggle to win social esteem and biological potency, 
 regressing to a preceding, usually preadolescent or infantile, func- 
 tional level. During this sort of adaptation the asocial cravings 
 are acceptable to the ego and permitted to run a rampant course 
 of indulgences. The symptoms of the compensation neuroses are 
 characterized by striving, egotism, intolerance, grand claims, and 
 usually high tension of the striped muscles, with a general quick- 
 ening of the autonomic activities whereas in the regression neu- 
 roses we have social indifference, lethargy, apathy, slovenliness, ir- 
 responsibility, suicidal tendencies and a decided general, lowering 
 in autonomic and striped-muscle tonus. In the compensation neu- 
 roses distressing visceral tensions occur almost consistently and 
 may be serious if involving a defective vital organ, whereas in the 
 regression neuroses the individual is comfortable. 
 
 The dissociation neuroses, as the fifth division, follow logically 
 and naturally, covering that enormous group of patients who suc- 
 ceeded in keeping the undesirable cravings repressed until they 
 became dissociated and finally dominated the personality through 
 the increase of their vigor, because of stimulating environmental 
 and metabolic conditions, or the decrease of the vigor of the ego 
 because of depressing and exhausting environmental and meta- 
 bolic conditions. The dissociated segmental cravings may be 
 fought to a bitter finish, as in the paranoid adaptation, or yielded 
 to in abject fear and despair as in the catatonic, or accepted with 
 disgusting glee and abandon as in the hebephrenic and epileptoid. 
 
198 SSYGHOPATHOLOGY 
 
 They may rim a consistent course or a periodic course as in the 
 liallucinated, regressive epileptic, who has periods characterized by 
 fair judgment and self-control. 
 
 The distinctive symptoms of the dissociation neuroses are: 
 
 (1) the ego is forced to be conscious of weird, distorted images 
 (hallucinations) of past sensations (experiences) which seem to 
 gratify the dissociated affect although they horrify the ego; and 
 
 (2) the ego is dominated by unacceptable, mysterious cravings 
 worldng as obsessions, phobias, compulsions and inspirations. 
 The dissociation neuroses may or may not be further characterr 
 ized by severe visceral distress and motor disturbances, localized 
 anesthesias, amnesias, etc. 
 
 The distinctive difference between the henign dissociation 
 neurosis (hallucinated manic or depressive) and the pernicious 
 dissociation neurosis (hallucinated dementia prsecox and epileptic) 
 exists in the fact that in the henign adaptation the ego never quite 
 loses the faculty of knoAving that, after all, the most important in- 
 fluences in the psychosis are the wishes or cravings which are 
 getting satisfaction (physiological neutralization). When the 
 formerly henign psychopath begins to lose this faculty, a perni- 
 cious mechanism develops Avhich, imless rectified, will seriously 
 abort the personality. On the other hand, most serious, perni- 
 cious maladaptations may be readjusted to benign mechanisms by 
 training the patient to accept the wish-fulfillment in the psychosis. 
 
 It is a common occurrence, under the old system of classifi- 
 cation, for so-called manic-depressives to change into dementia 
 prsBCOX types. The reverse course is more uncommon, and when 
 it occurs the diagnosis of "dementia praecox" is usually changed 
 to tentative "manic-depressive." 
 
 There is often considerable disagreement about the differen- 
 tiation of paranoid, catatonic and hebephrenic tyes of dementia 
 prjecox, Avhereas under the mechanistic diagnosis the presence 
 of regressive and compensatory tendencies can easily be covered 
 by these terms. For example, chronic, pernicious, regression, 
 dissociation, compensation neurosis, covers Case HD-4, an apa- 
 thetic, anal erotic sailor who regressed to a preadolescent, irre- 
 sponsible social attitude, enjoyed the hallucinated sodomistic 
 pleasures and compensated with claims of great inventive powers 
 and omnipotence. 
 
MECHANISTIC CLASSIFICATION OF NEUROSIS AND PSYCHOSES 199 
 
 The studies of Clarke and MacCurdy and others, as well as 
 the cases included in Chapter XIII, show that certain types of 
 epileptics are really biological (erotic) abortions in which the 
 epileptic convulsion has nothing less tlian the value of an erotic 
 orgasm. These cases are characterized by regression, dissocia- 
 tion and compensation mechanisms shown in their infantile ir- 
 responsibility, hallucinations and omnipotent fancies. It is gen- 
 erally recognized that under the old classification, some cases, 
 classified as dementia prascox, develop epileptoid convulsions and 
 a typical epileptoid personality; hence the difference between 
 many epileptics and hebephrenic demeiitia prascox types is really 
 symptomatic and not mechanistic. Therefore, it seems quite ac- 
 ceptable to classify the epileptoid mechanism under the type of 
 functional neurosis tliat covers it; most cases, not showing symp- 
 toms of dissociation at first, are rather to be classified as perni- 
 cious repression neuroses. 
 
 In the table, under the heading common symptoms, the generic 
 group and the more common symptoms are detailed. The common 
 causes can not be fully given except in a semigeneric manner, be- 
 ing as endless as experience. Uuder old diagnostic terms, those 
 in most frequent use at present are listed. 
 
 The terms suppression, repression, compensation, refjression 
 and dissociation, as applied to neuroses, represent levels of de- 
 viation from the normal, but one or more terms may be applied to 
 the same case. For example, we may have a suppression neurosis 
 with or without the tendency to compensation or regression. The 
 term dissociation implies repressions that have finally overcome 
 the ego 's power of control ; hence repression need not be used when 
 dissociation is used in the diagnosis. 
 
 "When this system is fully developed the biological nature of 
 the cravings which are repressed or dissociated, will also be desig- 
 nated, as love, shame, hate, fear, sorrow, as well as the level to 
 which the regression has occurred, as adolescent, infantile, nurs- 
 ling, prenatal. 
 
 In_ conclusion the term "psychosis" is not used because, after 
 all, the sensory phenomena which we are conscious of as thoughts 
 and wishes are really integrative phj^siological processes and 'the 
 term "neurosis" is more consistent wth the integrative functions 
 of the nervous system. 
 
200 PSYOHOPATHOLOGY 
 
 This system of differentiating and classifying psychiatric 
 cases is to be considered as essentially Mologicalr It is hoped 
 that it will be fully tested and adequately readjusted. I Wke 
 found it most useful for correlatiiHf . important, essential attributes 
 of widely scattered and apparently dissimilar cases, which could 
 hardly be possible under the old systems of clasifying them. Un- 
 fortunately, it is necessary to present Chapters VI to XIII, cov- 
 ering the neuroses and psychoses, according to the old' system 
 of classification with parallel references to. the new system bpMuse 
 the old system is now in general use. It is hardly necessary, to re- 
 mark that terms designating the hyperactive condition of some 
 gland of internal secretion or the presence of an infection, toxin 
 or drug can be used by adding. "-with" hyperthyroidism, typhoid 
 or morphine intoxication to the type of neurosis. 
 
CHAPTEE VI 
 
 THE MECHANISM OF THE SUPPRESSION OR 
 ANXIETY NEUROSES 
 
 Anxiety may vary in degree from brief to continuous slight 
 visceral discomforts about the cephalic, pelvic, cardiac or epi- 
 gastric regions, to very severe general physical discomforts. It 
 may occur intermittently or endure indefinitely. These variations 
 are determined by the nature of the affective conflict. The more 
 severe forms may be characterized by vertigo, headache, a dis- 
 agreeable sense of "stiffness" in the extrinsic muscles of the eyes, 
 and at the base of the occiput and muscles of the neck, nausea, 
 vomiting, tremors, reduction of digestive capacity Avith eccentric 
 appetite, abdominal griping, diarrhea or constipation, rectal tenes- 
 mus, cystic tenesmus, dismenorrhea, amenorrhea, excessive mic- 
 turition, incontinence of feces or urine, dyspnea, tachycardia, in- 
 creased blood-pressure soihetimes, a disagreeable postural weak- 
 ness, felt particularly in the muscles of the forearm and hand 
 ("weak grip"), and those extensor muscles of the thigh ("weak in 
 the knees") and the back ("spineless") which continuously 
 oppose gravity, restlessness and insomnia, also facial apathy or an 
 overcompensatory tenseness, aresonant voice sounds, persistent 
 thoughts, and inability to create new thoughts in order to meet 
 even trivial emergencies, such as keeping business schedules, etc. 
 
 The anxiety is felt in the form of distressing sensations that 
 arise from the (anxious) postural tensions which various visceral 
 segments assume when the environmental situation contains the 
 possibility of danger or failure. 
 
 Experiments upon dogs, cats and humans by Cannon, Carlson, 
 Crile, Pawlow, and others show, upon causing fear or anger by 
 presenting a potentially harmful stimulus, reduction in the 
 capacity of the stomach to secrete digestive fluids both in quantity 
 and in digestive quality, a marked tendency to achlorhydria and 
 an increase of mucus, inability to macerate the food or to pass 
 it into the duodenum, a protective tendency to regurgitate food, 
 
 201 
 
202 PSYCHOPATHOLOGY 
 
 and a reduction in the blood supply to the stomach, intestines, 
 pelvic viscera and external sexual organs, and a generally weak- 
 ened muscle tonus and contraetibility of the viscera. The de- 
 creased secretive capacity of the salivary glands and the intestines 
 is to be included with the general inhibition of function of the 
 stomach; hence, general decrease of the assimilative and elim- 
 inative powers of tjhe digestive, apparatus. The uncomfortable 
 sensations that flow from the hypertense or hypotense visceral 
 posture have probably become necessary to compel the animal 
 to remove the environmental stimulus, or escape. , Behind the 
 patient's complaints of "indigestion," "constipation," "heart 
 burn," "stomach burn," "gastric ulcer," etc., this mechanism,, 
 as a fear reaction, should be seen at work and the complaint never 
 considered to be " imaginary. ' ' 
 
 A gradual- reduction in weight and general physical power, as 
 well as in capacity to compensate against the onslaught of disease 
 or the waste of fatigue, results if a solution is not found. 
 
 Obviously, it is vitally necessary for the organism to be able 
 to compensate when it is subjected to a painful stimulus in order 
 that the stimulus, as such, may be evaded or reconstructed. Com- 
 pensation applies to potential dangers and failures as well as in- 
 fections and injuries. 
 
 Cannon and others have shown that following a painful stim- 
 ulus, whether of a distance, or contact, or proprio-receptor, the 
 compensation takes place in the form of definite physiological 
 changes, the most important of which so far demonstrated, are the 
 following : 
 
 (1) Decrease in blood supply to the digestive system and 
 sexual organs, and a reciprocal increase of blood supply to the 
 organs that have to do with the defense and attack. (2) In- 
 crease in the sugar and adrenin content of the blood. (3) Increase 
 of the thyroid secretions. (4) Else of blood-pressure. (5) In- 
 crease in the rate and amplitude of the cardiac systole. 
 
 This physiological adaptation and compensation to sustain the 
 expenditure of energy is vitally necessary. Upon its immediate 
 and sufficient occurrence depends the organism's power to evade, 
 destroy or reconstruct the painful stimulus or situation so that 
 comfort giving stimuli may be obtained. 
 
 It should be recognized that this compensatory mechanism, 
 like all physiological functions, may react inadequately, sufficiently, 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 203 
 
 or excessively. Upon the degree of the reaction depends the na- 
 ture of the individual's adjustment, as to whether or not it is 
 timid, submissive and depressive in type, or admiirably ivell bal- 
 anced (common sense in type), or drastic and eccentric, as violent 
 anger at impleasant but banal situations. 
 
 Anxiety is felt when the compensation is insufficient or when 
 its excessiveness, being difficult to control, is also a source of 
 danger. The visceral muscle tensions and localized vasomotor 
 engorgements or anemias, that also contribute sensations which 
 constitute anxiety, are located mostly in the digestive system. 
 This may be due, phylogenetically, to the f^ct that upon the con- 
 sistent normality of the digestive functions depends the general 
 health and nutrition of the organism. The capacity to cause the 
 distressing sensations, it seems, has been gradually acquired 
 through evolution as the best means of compelling the organism to 
 act decisively and rearrange its environmental relations by remov- 
 ing the painful factors or removing itself from them, so that the 
 digestive functions can maintain their normal course -with as little 
 disturbance as possible. Then only may, eventually, the reproduc- 
 tive cravings accomplish the propagation of the race. 
 
 There has been considerable difficulty in applying this compen- 
 satory mechanism to human behavior because in most situations 
 the presence of the painful stimulus is not apparent to the observer 
 or to the individual himself, unless he has made a particular search 
 for it and is trained to recognize it as such, often it is a potential 
 or possible danger to be encountered in the future. 
 
 The influence of the mechanism of compensation is also to be 
 seen in the sexual functions, that is, in the potency of the indi- 
 vidual, because, whenever uncompensated fear comes into the 
 sexual situation, sexual potency becomes diminished proportion- 
 ately. The individual can only be considered sufficiently potent 
 when he has overcome such obstacles as indifference, poverty, 
 obscurity, ignorance, the rival's malice, expense, and social ob- 
 ligations and also has the capacity for confident, courageous but 
 refined preliminary wooing, followed by copulation with an ade- 
 quate affective climax upon seminal emission, which, in turn, pro- 
 duces relaxation. Whenever anxiety or a subtle fear reaction ac- 
 companies the sexual act, although the excitement and erection 
 may be maintained, the emission is usually precocious, and the af- 
 
204 PSYCHOPATHOLOGY 
 
 fective adjustment is unsatisfactory. A heightened irritability 
 remains, and, consequently, dissatisfaction with the sexual object. 
 The physiologiqal cause of the impotence is probably the failure of 
 adequate vasomotor engorgement of the sexual organs. This ac- 
 companies the shift of the blood supply to the head segment and 
 the defensive organs, which, in turn, is dug to the presence of a 
 fear arousing stimulus somewhere in the implications of the sexual 
 indulgence. This fact is of enormous significance to health, and is 
 underestimated by most physicians. 
 
 It is generally recognized that flushing or pallor, trembling, 
 aresonance of the vofce, stuttering, fidgetiness aiid more or less 
 confusion, complete loss of ability to talk or think coherently, when 
 one is about to address an audience, are due to some form of em- 
 barrassment of the integiptive functions. The individual feels, 
 besides the above outward signs, marked increase in the rate and 
 strength of the heartbeat, rise in the blood-pressure, and perhaps 
 nausea or incontinence of the bladder or rectum. In every re- 
 action of this sort that I have been aBle to analyze, it has been 
 shown that, even though the audience was interested, the speaker 
 was afraid that his talk would not have the desired effect. This 
 was due either to the fact that he desired too much, that is, to make 
 a "hit" or to be recognized as "brilliant," or that some one 
 was present who was felt to be secretly resistant and hostile to 
 the speaker. Both situations are the same, in that the audience, 
 because it may be indifferent or bored, becomes a painful factor 
 and causes a fear of failure reaction which is promptly compen- 
 sated for by the increased rate and strength of the heart-beat, fa- 
 cial flushing, etc. Since this, in turn, reveals the individual's anx- 
 iety and deficient power, and, becoming recognized by the audience, 
 makes the members ill at ease, it further increases the painfulness 
 of the situation by establishing a vicious affective circle between 
 the audience and the speaker. 
 
 Most speakers overcome this by the very simple little read- 
 justment of not desiring to scintillate, and, resolving to say their 
 best, humbly accept the' acknowledgment for whatever it is worth. 
 
 This mechanism applies to all situations where the degree of 
 potency- of the individual's social influence depends upon the pub- 
 lic's, or another's, response. The individual may protect himself 
 by keeping in mind an imaginary, appreciative, future generation 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 205 
 
 or an absent group as a comforting factor against the indifference 
 of the less important, pi'esent critical group. This is usually the 
 dreamer's method of escaping from reality and competition. 
 
 The anxiety that follows upon the death or degradation of 
 someone we love, or the loss of something we like, is due to the pain 
 aroused by the environment when it does not contain an object 
 upon which Ave may depend for certain protective, invigorating 
 stimuli. A comfortable readjustment occurs as soon as a satis- 
 factory situation, substitute, symbol or image is found. 
 
 Such prolonged phenomena as men working consistently for 
 years at a profession, science or art, etc., often, when analyzed, 
 show that the driving power is the compensatory striving that re- 
 sults from the subconscious but continuous fear of the possibility 
 of failure, or of losing esteem by- deteriorating to a level rela- 
 tively lower than a competitor's efficiency. The profession or 
 vocation is the individual's means of winning esteem as well as 
 safety and nourishment ; hence, anything that even indirectly per- 
 tains to the loss of esteem, as by someone becoming relatively more 
 desirable, should normally arouse a compensatory "speeding up" 
 of the autonomic apparatus — reenforeing the wish to act or "will 
 to power." 
 
 Because of this, it should ahvays he recognized that tvhenever 
 o,ny form of anxiety is complained of, the autonomic apparatus has 
 not been able to com,pensate siifficiently or has had to overcd^ 
 pensate in order to struggle ivith a hostile environment. The fail- 
 ure of compensation may be due to one of two general causes, 
 either some organic disease within the organism has prevented the 
 physiological compensation, or the requirement from the environ- 
 ment is too great, as in anxiety because of inferior skill in a seri- 
 ous, emergency resulting finally in surrender to avoid the emer- 
 gency although this entails the loss of an unreplaceable love-object 
 and a serious state of apathy. 
 
 We are especially concerned, in this chapter, with the failures 
 of compensation in individuals who are not compelled to meet an 
 obvious, extraordinary stress and do not have an organically de- 
 ficient structure; as defective adrenals, thyroid, or heart. The 
 failures to compensate adequately because of affective oppres- 
 sions are the most important for psychopathology, clinical medi- 
 cine and sociology, and are the most numerous. Therefore, they 
 
2Q6 PSYCT-IOPATHOLOGY 
 
 are given the most empliasis in this chapter. The anxiety and 
 compensations for organ igiferiority, which have heen, hereto- 
 fore considered, are the same in principle as anxiety because of 
 fear of failure. There is much serious confusion in psychiatric 
 literature regarding the failures to meet stresses. We find cases 
 discussed pro and con under such titles as constitutional infe- 
 riority, psychopathic personality, constitutional psychopathy, 
 paraphrenia, psychasthenia, neurasthenia, chronic invalidism and 
 "diseases of the will." None of those symptomatological groups 
 are satisfactory if the discussions of various contributors to the 
 literature are compared. They vary more vaguely than the 
 recommendations for feeding diabetics have varied. Obviously, 
 an arbitrarily standardized set of symptoms would have no value, 
 except to give it a name, hence a comprehensive term having .a 
 physiological basis may well be used to designate the mechanism. 
 
 The .term suppression or anxiety neurosis includes the whole 
 group of names which have just been referred to in the sense that 
 they are- all failures at physiological compensation. The abnor- 
 mal or asocial adjustment is the individual's eccentric attempt to 
 retain the prospects of maintaining a comfortable physiological 
 state. The inability to meet many painful situations honestly 
 often requires the enduring of severe, prolonged anxiety. Great 
 men must have the coiirage and fortitude to fight for a principle 
 even though it cost everything ; youth should be trained- to develop 
 this- faculty and rather than accept a disgraceful favor prefer to 
 lose or continue to suffer anxiety. This anxiety can only be en- 
 dured because of the hope of an ultimate reward. This last point 
 is of critical importance to the individual and its source lies in 
 the family training, the family and religious traits of the people, 
 and the justified hope of final gratification. The great difficulty 
 in developing this autonomic trait of character lies in the secret 
 yielding to illicit temptations or accepting half justifiable solutions 
 of a test, as the trickery to win popularity in politics. 
 
 The failure to compensate, in the organically normal, under 
 stresses that are not unusually severe, is due, as will be shown, to 
 affective suppression -or repression and its insurmountable cause. 
 
 In any crisis, the potential threat causes a fear reaction which 
 normally is immediately followed by a vigorous autonomic com- 
 pensation. This, in turn, forces the individual to adopt measure's 
 
MECI-TANISM OF STTPPRESSTON OR ANXIETY NETTROSKS 207 
 
 or actions so as to counteract the threat of injury or loss. If, 
 however, this reflex protest has, in childhood, been repeatedly pun- 
 ished, that is, if it only resulted in thereby acquiring more pun- 
 ishment, the autonomic system gradually becomes firmly condi- 
 tioned to make either an indirect or dishonest protest, or to sub- 
 mit to the threat because, from experience, punishment is then 
 loss severe. Thereby hangs the catastrophe. The capacity for 
 aggressive initiative is lost and with it goes virility. 
 
 Darwin's submission to his father, the siibmissive tendency of 
 Case AN-3 and Guiteau's father's fanatical determination to make 
 his son acknowledge submission, are simple instances of the child's 
 difficulties with the insurmountable parent and some of the adjust- 
 ments that the youth may be compelled to make. 
 
 When a father determines to "break the child's spirit," and 
 unjustly exercising his power, forces it to submit, either one of two 
 disasters results. Either the child submits and later as an adult 
 is never able to protest for its rights and compete successfully or 
 dominate in competition, can never become a leader, must always 
 work for someone, can hot assume serious business responsibilities 
 becaiTse that requires constant protesting movements against com- 
 petitive encroachment ; or the child develops an irrepressible ten- 
 dency to react with excessive hatred, that is, excessively compen- 
 sates, when irritated or resisted. The variations in the adjust- 
 ment of the struggle with an oppressive parent are largely deter- 
 mined by the attitude of the other parent giving one party of the 
 conflict moral support, hence justifying or depressing the counter- 
 attack by the child. In this manner the irreparable father-son or 
 mother-daughter feud becomes established. Sons of beautiful 
 indulgent mothers, when the latter tend to plead that their sons 
 shall submit to the all wise, irritable father, often become sexual 
 perverts and even go through crucifixion psychoses "to please the 
 father" and mother (Cases CD-I, CD-2, AN-3). Parents who do 
 not really love children, and, living for their own pleasure, force 
 the helpless child to adjust itself to unnatural interests, discour- 
 aging its initiative through indifference and suppressing it with 
 threats of punishment and moralizing opinion, gradually, insidi- 
 ously, deprive it of its power to protest against the encroachments 
 of other people upon its struggle for happiness. Hence it can not 
 develop the necessary aggressiveness which is vitally necessary 
 
208 PSYCHOPATHOLOGY 
 
 for successful love making, or the courage to compete with rivals 
 for the love-9l)ject or social esteem. Instead of wooing and com- 
 peting, it wishes to be wooed and protected; instead of becoming 
 projective and aggressive, it becomes receptive and submissive 
 and seeks to attach itself to the strong at any sacrifice — too often 
 as a sexual pervert. 
 
 The paranoid group shows that, when these individuals be-« 
 come aware of the fact that the submissive feelings are decidedly 
 depriving them of their virility, they either pass through a bitter, 
 anxious struggle and gradually compensate by the most eccentric 
 endeavors to discover the secret of omnipotence, or become incur- 
 able regressives if not fortunately protected. 
 
 In the psychology of the family it has been shown that the 
 father or mother, through'conscious and unconscious resistances 
 and coercions, cultivates the child's affective cravings to assume 
 a characteristic attitude and seek definite objects and methods 
 of expression. These methods of fulfilling the wish may or may 
 not- cause the individual, when he or she becomes an adult, most 
 distressing anxiety. This depends upon the nature of the social 
 requirements and the resistances which have to be overcome. It 
 is always necessary to bear in mind the question, "Does the in- 
 dividual suffer from an ungratified craving for a normal but in- 
 accessible object, or does he suffer from a wish for an abnormal, 
 degrading object?" The two following cases of eminent scien- 
 tists are selected to show the mechanism of prolonged struggles 
 to sublimate affective needs in highly developed personalities, 
 and the chronic anxiety endured because affective suppressions had 
 to be made, which, in turn, were due to the unmodifiableness of 
 the resistance to the affect and the fixed manner in which the af- 
 lective-autonomic cravings had been conditioned. 
 
 Charles Darwin 
 
 The Affective Sources of His Inspiration and Anxiety Neurosis* 
 
 The psychoanalytic study of these particular attributes of 
 Charles Darwin's personality must necessarily be rather abruptly 
 circumscribed. To do thorough justice to Darwin's personality 
 one ought to read everything he published and all the family and 
 
 •This paper was published in The Psychoanalytic Review, Vol. V, No. 2. 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 209 
 
 personal history that can be obtained and then present the mate- 
 rial in an analytical biography. It is hardly necessary to eulogize 
 Darwin's greatness in order to make the analytical study of his in- 
 feriorities and compensations acceptable to the hero-worshipping 
 public. 
 
 Charles Darwin's contributions to the progress of civilization 
 and welfare of humanity stand second to no man's. He has done 
 more for the liberation of human thought than the combined ca- 
 reers of Alexander the Great, Julius Caesar, Napoleon and other 
 so-called liberators, and his character needs no defense. It is of 
 great value to know how he succeeded in refining the autoerotic 
 cravings inherently active in every individual, and in sublimating 
 the father's repressive influence, thereby making it possible for 
 the affective cravings to create the long series of original re- 
 searches into the mechanisms of nature. It is quite probable that 
 no individual can be capable of consistent original thinking who 
 has not succeeded in freeing himself from the parent's resistant 
 domination. As to how much Darwin's sexual life played a part 
 in his scientific curiosity may be estimated from the fact that he 
 laid great emphasis upon the mechanism of sexual selection as 
 a determinant for the survival of pleasing attributes; hence, for 
 variations in structure and movement. He says, in his "Descent 
 of Man," that the German naturalist and philosopher Haeckel 
 was the only scientist whose writing showed that he fully appre- 
 ciated the significance of sexual selection, to which now may be 
 added the new school of psychopathologists. 
 
 Another indication of Darwin 's interest in the sexual functions 
 is to be seen in the titles of his books, such as "The Descent of 
 Man and Selection in Relation to Sex," "The Effects of Cross 
 and Self -Fertilization in the Vegetable Kingdom, " "On the Vari- 
 ous Contrivances by which Orchids are Fertilized," and "On the 
 Origin of Species by Means of Natural Selection." 
 
 In this analytical study several discussions of Darwin's sex- 
 ual life ai-e, of necessity, frankly made. No one who reads Dar- 
 win's letters can help but duly appreciate the splendid manner in 
 which he sublimated his sexual cravings, keeping himself pleasant, 
 unirritable, appreciative and grateful, which, of course, is not 
 usual for the sexually discontented. 
 
 Charles Darwin's paternal grandfather, Erasmus Darwin, 
 
210 PSYCHOPATI-IOLOGY 
 
 was a physician, poet and naturalist.* He wrote "Zoonomia, or 
 tlie Laws of Organic Life, ' ' (sif jis by^ which animals are known 
 and may be named). His feelings in regard to nature study may 
 be estimated from his introductory phrase, "The whole is one 
 family of one parent." He was a studious theorizer but not 
 very practical in his scientific work, and Charles Darwin, when an 
 elderly man, came to be disappointed in the excess of theory and 
 the scantiness of facts in his book. Like most men who devote 
 most of their love to creative thinking, he seems not to have been 
 a very practical father. This was due, also, perhaps, to a " certain 
 acerbity or severity of temper" (p. 6). His second son, Erasmus, 
 became a suppressed, psychopathic personality. The latter was 
 quiet, retiring, had eccentric, self-indulgent interests, was, in some 
 respects, brilliant, never married, and committed suicide at forty 
 while in what seems to have been a state of "incipient insanity" 
 (p. 8). 
 
 His third son, Eobert Waring, the father of Charles Darmn, 
 became a physician upon his father's command. Even though he 
 detested the work his father gave him no choice (p. 12) and, de- 
 spite his aversion for it, he developed a large country practice. 
 There are indications that Robert and his father, Erasmus Dar- 
 win, did not understand each other in the matter of profession or 
 finances, for his father "brought him to Shrewsbury before he 
 was twenty-one years of age and left him twenty pounds, saying : 
 ' Let me know when you want more, and I '11 send it to you. ' His 
 uncle, the- rector of Elsten, afterwards also sent him twenty 
 pounds, and this was the sole pecuniary aid which he ever re- 
 ceived" (p. 8), which seems to imply that although he needed 
 money he preferred to depend upon a relative. This fact may have 
 had quite a genetic influence upon his attitude, later, toward his 
 son Charles whom he rebuked for carelessly spending money 
 while at college. It is worthy of consideration that Charles Dar- 
 win, in turn, was unusually generous with his son, Francis, about 
 some of his careless debts contracted while at college. Francis 
 Darwin says : ' ' My f atlier was wonderfully liberal and generous 
 to all his children in the matter of money, and I have special cause 
 to remember his kindness when I think of the way lie paid some 
 Cambridge debts of mine — making it seem almost a virtue in me 
 
 *Darwin, F. : The Life and Letters of Charles Darwin. Information in this stndy is taken 
 from the above work, and the numbers following quotations, as (p. 6), refer to its pages. 
 
MECHANISM OF SUPPKESSTON OR ANXTETV NEUROSES 211 
 
 to have told him of thom." The attitude of Charles Darwin to- 
 ward the matter of his son's college debts stands out in striking 
 contrast to the attitude of his own father. Charles Darwin, in 
 money and business matters, was extremely careful and exact. 
 "He kept accounts Avith great care, classifying them, and balanc- 
 ing at the end of the year like a merchant. * * * His father 
 must have alloived him to believe that he wotald be poorer than ho 
 really was, for some of the diiFiculty experienced in finding a housi; 
 in the country nuist have arisen from the modest sum he felt pre- 
 pared to give. Yet, he knew, of course, that he ivould be in easy 
 circumstances" (p. 98). (The italics inserted.) From this state- 
 ment, it seems that Charles Darwin, although he knew he had suffi- 
 cient resources, was unable to use them more freely than he did 
 because he felt constrained by his father's influence to deny him- 
 self. An indication that his father's attitude had caused him no 
 little sorrow may be seen in the carefully considered manner in 
 which he made the debts of Francis seem ' ' almost a virtue. ' ' This 
 affective restraint, which Darwin imposed upon himself in order 
 to keep peace with his father, and which Avill be associated later 
 with other facts, gives us one important indication as to the mech- 
 anism of Darwin's chronic anxiety. 
 
 To return to Darwin's parents. His father was a man of 
 unusual insight into human nature, for he practiced the present 
 psychoanalytic principle of inducing an affective catharsis and 
 readjustment in his patients as a method of treating the distress 
 caused by affective suppression — anxiety. Charles Darwin says : 
 "Owing to my father's power of winning confidence, many pa- 
 tients, especially ladies, consulted him when suffering any misery, 
 as a sort of Father-Confessor. He told me that they always began 
 by complaining in a vague manner about their health, and by prac- 
 tice, he soon guessed what was really the matter. He then sug- 
 gested that they had been suffering in their minds and now they 
 would pour out their troubles, and he heard nothing more about the 
 body" (p. 12). Robert Darwin also found that the sexual forces 
 played a critical part in the attainment of happiness or misery, 
 as is obvious from the following statement : ' ' Owing to my father 's 
 skill in winning confidence, he received many strange confessions 
 of misery and guilt. He often remarked how many miserable 
 w:ives he had known" (p. 12). 
 
21 2 PSYCHOPATHOLOGY 
 
 In further characterizing his father Charles Darwin says : 
 "The most remarkable power which my father possessed was 
 that of reading character, and even the thoughts of those whom 
 he saw even a short time. We had many instances of the jDower 
 which seemed almost stopematural (p. 12). (Italics mine.) Dar- 
 win follows this comment with three illustrations. The first 
 one was how his father never, "with but one exception," made 
 an unworthy friend, and, in this instance, a clergyman, who was 
 "little better than an habitual swindler," was soon discovered. 
 The second was the loaning of twenty pounds to a complete stran- 
 ger who had lost his purse and promptly proved reliable, and the 
 third was the detection in an insane young man, who accused 
 himself of all the crimes under heaven, that he was guilty of a 
 heinous crime. "His sympathy gave him unbounded poiver for 
 winning confidence"; he was the Tnost acute observer whom I ever 
 saw"; and "the wisest man whom ever I saw\" (Italics are in- 
 serted to emphasize the superlative use of superlatives.) In order 
 successfully to conceal undesirable wishes and emotions from a 
 father having such unusual qualities for detecting them, it would 
 be necessary to repress them most assiduously from conscious- 
 ness. It is quite probable that Darwin's interest in the expression 
 of the emotions in man and animals was aroused by his father's 
 capacity to read secrets of behavior from the manner in which 
 emotions are expressed. 
 
 Eobert Darwin married Susan, the favorite daughter of Josiah 
 Wedgwood of Etruria, a very close friend of his father's and it is 
 quite probable that her esteem for her father-in-law was greatly 
 enhanced by her own father's admiration for his intelligence. She 
 seems to have had, according to a miniature and an account of her 
 by friends, "a remarkably sweet and happy face," expressive of 
 a "gentle, sympathetic nature" (p. 9). She is said to have enjoyed 
 a most benevolent regard from her father-in-law (Bettany), and 
 through this affective influence probably became deeply fascinated 
 by his poetical, scientific curiosity, and much interested in his 
 theories as to the causes of variation and evolution of life; She 
 was very fond of flowers and pets. The tameness and beauty of 
 her pigeons were the admiration of her friends. (The origin and 
 variations of domestic pigeons form a 'most important part of the 
 "Origin of Species.") The sincerity and frankness of her atti- 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 213 
 
 tilde, no doubt, gave her son Charles a distinct impression about 
 the things in life that fascinated her. She was very sympathetic 
 and seems to have had a protracted, wearisome illness Avhich 
 caused her death when Charles was but eight years of age. Her 
 charming interest in nature gave him, it seems, a fixed inspiration, 
 a wish to solve the riddle that fascinated his lovely mother. It 
 must have been her romantic fondness for flowers which inspired 
 her son to search there for the secret of her fascination, because 
 when he attended Mr. Case's school at eight, he had already begun 
 to collect "all sorts of things" — shells, seals, franks, coins, min- 
 erals, and "tried to mahe out the names of plants." (Collecting 
 was a well-developed characteristic of several of Darwin's uncles.) 
 
 The Eeverend W. A. Leighton, who was a playmate of Charles 
 Darwin at this school, remembered his bringing a flower to school 
 and saying that "his mother had taught him how hy looldng at the 
 INSIDE of the blossom the NAME of the plant could he discov- 
 ered" (p. 26). (Names are usually given in science, and also or- 
 dinarily, according to the genetic origin or dynamic nature of the 
 object — to know the secret of the name is to know the secret of the 
 child's or flower's origin.) The boy, Leighton, whose childhood 
 curiosity and inspirations Avere later considerably gratified by 
 becoming a botanist of well-known reputation, tried to discover 
 the secret. He says: "This (secret) greatly aroused my attention 
 and curiosity, and I inquired of him repeatedly hoAV this could be 
 done, but his lesson was, naturally enough, not transmissible" 
 (p. 26). 
 
 Whatever was the exact source of the fantasies exchanged by 
 the two boys, it was certainly a budding curiosity about genesis 
 (sexual), because Darwin, in his autobiography, says at sixty- 
 seven: "One little event during this year has fixed itself very 
 firmly in my mind, and I hope that it has done so from my con- 
 science having been aftenuard sorely troubled by it; it is curious 
 as showing that apparently I was interested at this early age in 
 the variability of plants! I told another little boy (I believe it was 
 Leighton) that I could produce variously colored polyanthuses and 
 primroses by watering them Avith certain coloured fluids, which 
 was, of course, a monstrous fable, and had never been tried by me" 
 (p. 27). 
 
 Why should Darwin, fifty-nine years later, with his fine in- 
 
21.4 PSYCHOPATHOLOGY 
 
 sight into the naturalness of immorality in children, write this 
 confession of an act of immorality committed at eight and apolo- 
 gize for it as a "monstrous fable" that simply would not fade with 
 time. Most unforgetable incidents of childhood which later be- 
 come painful memories are, in some manner, associated with a sex- 
 ual transgression, and it is the severity of the struggle to refine 
 the sexual interests that gives prominence to the transgressions of 
 the past, like an old scar on a highly polished surface. The self- 
 refinement tendency in Darwin is definitely revealed in his com- 
 ment, "I hope that it has done so from my conscience having been 
 afterwards sorely troubled." This eight-year-old boy^s fantasy, 
 that he could produce a variation in the colors of flowers by water- 
 ing them, was told at the age when children are inclined to wonder 
 seriously about the possible genetic qualities of their excreta, and 
 the painful attributes of the "monstrous fable" were not in the 
 story as retold at sixty-seven, but in the associations it had at 
 eight. It is quite probable that Darwin's fancy that he could cauP'" 
 variations in the colors of flowers by watering them was suggested 
 by the manner in which they gradually faded and died after he had 
 repeatedly urinated upon them (not an uncommon experiment of 
 boys), and the fancy was told as a child's recompensative wish. 
 The urinating on the flowers probably had the value of being a 
 fertilization curiosity. (See the fertilization curiosities in the list 
 of Darwin's publications to be given later.) 
 
 Whether or not Darwin's mother actiially propounded her en- 
 chanting riddle to her boy is not quite so important as the fact that 
 lie said she did, showing hoA¥ keenly his wishes relished the fancy 
 ■that she had revealed to him the one secret of life that fascinated 
 her — the secret, Avhich, if read, would reveal the origin and crea- 
 tion of life and — himself. Children from seven to ten are usually 
 passionately fond of riddles. It is the trial and error method of 
 finding the answer to the omnipresent riddle as to their origin. 
 Soon after this innocent exchange of confidences with her boy, 
 the beautiful mother died — went on a long journey into the night. 
 
 At ten, this boy was still collecting minerals mth much zeal, 
 still searching for the answer to liis mother's riddle and her wish 
 that he could know. He says, ' ' all that I cared about was a new- 
 named mineral" (p. 31). 
 
 "VVe must not forget "Zoonomia." 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 215 
 
 During- the next seven years in the classical schools, he was an 
 indifferent student, and earned the reputation of being more diffi- 
 cult to teach than the average boy. The cause of this is evidently 
 in the fact that his sponsors persisted in trying to malte him learn 
 stuff for which his affective cravings had an aversion. Criticism 
 and rebuke seemed to fail as arousing stimuli, as did also changes 
 of schools and teachers. In his autobiography, Darwin estimates 
 the value of his schooling in the folloAving sentence (p. 40) : "Dur- 
 ing the three years wliicli I spent at Cambridge (studying the- 
 ology) my time was Avasted, as far as the academical studies were 
 concerned, as completely as at Edinl)uvgh (studying medicine) and 
 at school" 
 
 The personal history of Dar^-in shows that after his mother's 
 influence nothing pleased him like the study of nature and never 
 for a day does he seem to have abandoned his quest. No doul)t 
 this adolescent speculator upoii the secret of life was subtly, but 
 decidedly, impressed by the family's I'omantic interest in the na- 
 ture of the recognition the grandfather's theories of evolution 
 ^vere winning from the great scientists of England. At the time 
 of the following critical incident, his enthusiasm about the merits 
 of his grandfather's studies was at its height. He Avas admiring 
 "greatly" the theories in the book, "Zoonomia," when acciden- 
 tally his conviction Avas fixed by the enthusiastic remarks of a hero- 
 friend. The remarks were made under those subtly impressive 
 circumstances Avhich make them irresistible because they suggest 
 an attractive solution for an uncomfortable affective conflict. He 
 and his older brother, v/pon his father's insistence, were attend- 
 ing Edinburgh University in preparation for the practice of medi 
 cine, his father's and grandfather's profession. Both boys had 
 insurmountable resistances to medicine, but the father persisted, it 
 seems, in sending them to this sort of school, because the classical 
 school had been a miserable failure. Charles DarAvin, though in- 
 spired to learn the names and secrets of biological and geological 
 objects, was utterly distressed by names and Avords in the form of 
 languages. For him, it was like marrying the wrong sister. No 
 little anxiety was felt by DarAvin's earnest father as to what his 
 son's future as a man might be, and this pressure, no doubt, made 
 the solution of a career most desirable for all concerned if it could 
 only be found. His mother had innocfintly, therefore the more 
 
216 PSYCHOPATHOLOGY 
 
 irresistibly, named her wish, for her boy's destiny, and his father's 
 Avishes, that he should study some profession, only diverted him 
 from the quest. While in this restless affective dilemma, the solu- 
 tion came in a most fortunate manner for the future of civilization. 
 
 Adolescent Darwin (seventeen) was walking with maturing 
 Dr. Grant, several years his senior. He says, in his autobiography : 
 "I knew him well; he was dry and formal in manner, with much 
 enthusiasm beneath the outer crust. ' ' (This boy had achieved one 
 of the supreme delights of a boy's life; he had overcome the re- 
 serve of his hero and was learning, through sharing confidences, 
 some of his impressions on the secrets of life and what works of 
 men aroused his admiration. In his autobiography, Darwin ex- 
 presses disappointment, even when an old man, that this hero of 
 his youth did not 'write more and develop his interests fully.) 
 "He, one day, when we were walking together, burst forth in high 
 admiration of Lamarck and his views on evolution. I listened in 
 silent astonishment, and, as far as I can judge, (paradoxically) 
 without any effect on my mind. I had previously read the 'Zoo- 
 nomia' of my grandfather, in which similar views are maintained, 
 but ivithout producing any effect on me. Nevertheless, it is proba- 
 ble that the hearing rather early in life such views mAmtained\ and 
 praised may have favoured my upholding them under a different 
 form in my 'Origin of Species.' At this time I admired greatly the 
 ' Zoonomia' — as well as Doctor Grant." (The italics and paren- 
 thesis are inserted.) 
 
 This confidential revelation, by his impressive hero, of a simi- 
 lar interest in the secrets of the evolution of life, firmly approved 
 the soundness of Darwin's sacred wish of childhood, to learn the 
 secret of nature as a geologist. Although he began his scientific 
 career as a geologist, we find as he grew older he reverted to hif 
 first wish and became more and more interested in the secrets of 
 fertilization and variation of plants and animals. Finally, he gave 
 the world the following answers to his mother's sacred riddle: 
 
 Books* 
 
 "On the Various Contrivances by Which Orchids are Fertilized by Insects," at 
 fifty-three. 
 
 "The Movements and Habits of Climbing Plants." 
 
 ' ' The Variation of Animals and Plants under Domestication, ' ' at fifty-nine. 
 
 •This is by no means a complete list ot Darwin's publications. 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 217 
 
 "The Descent of Man and Selection hi Relation to Sex," at sixty-two. 
 "The Expression of the Emotions in Man and Animals," at sixty-three. 
 "Insectivorous Plants," at sixty-six. 
 
 "The Effects of Cross and Self -Fertilization in the Vegetable Kingdom," at 
 sixty -seven. 
 
 ' ' The Different Forms of Flowers on Plants of the Same Species, ' ' at sixty-eight. 
 "The Power of Movement in Plants," at seventy-one. 
 
 Papers 
 
 "Observations on the Structure and Propagation of the Genus Sagitta," at 
 thirty-five. 
 
 "Vitality of Seeds," at forty-six. 
 
 "On the Action of Sea- Water on the Germination of Seeds," at fifty. 
 
 "On the Agency of Bees in the Fertilization of Papilionaceous Flowers," at 
 fifty-seven. 
 
 "On the Tendency of Species to Form Varieties; and on the Perpetuation of 
 Varieties and Species by Means of Natural Selection" (Darwin and Wallace), at forty- 
 nine. 
 
 "On the Agency of Bees in the Fertilization of Papilionaceous Flowers, and on 
 the Crossing of Kidney Beans, ' ' at forty-nine. 
 
 "Do the Tineina or other Small Moths Suck Flowers? and If So, What Flowers?" 
 at fifty-one. 
 
 "Fertilization of Vincas, " at fifty -two. 
 
 "On the Two Forms, or Dimorphic Condition, in the Species of Primula and on 
 their remarkable Sexual Eelations, ' ' at fifty-three. 
 
 ' ' On the Three Eemarkable Sexual Forms of Catasetum Trideutatum, ' ' at fifty- 
 three. 
 
 "On the Existence of Two Forms, and on Their Reciprocal Sexual Relations, iu 
 Several Species of the Genus Lineum, " at fifty-five. 
 
 "On the Sexual Relations of the Three Forms of Lythrum Salicaria, " at. fifty- 
 five. 
 
 "On the Movements and Habits of Climbing Plants," at fifty -six. 
 
 "On the Character and Hybrid-Like Nature of the Offspring from the Illegiti- 
 mate Unions of Dimorphic and Trimorphic Plants, ' ' at fif ty-rine. 
 
 "Notes on the Fertilization of Orchids," at sixty. 
 
 "The Fertilization of Winter-Flowering Plants," at sixty. 
 
 ' ' Pangenesis, ' ' at sixty -two. 
 
 "Fertilization of Leschenaulta, " at sixty- two. 
 
 "Fertilization of the Fumariaceae, " at sixty-five. 
 
 "Flowers of the Primrose Destroyed by Birds," at sixty-five. 
 
 ' ' Sexual Selection in Relation to Monkeys, ' ' at sixty-seven. 
 
 "The Scarcity of Holly Berries and Bees," at sixty-eight. 
 
 "Notes on the Fertilization of Plants," at sixty-eight. 
 
 "A Biographical Sketch of an Infant," at sixty-eight. 
 
 "Fertility of Hybrids from the Common and Chinese Goose," at seventy-one. 
 
 "The Sexual Colors of Certain Butterflies," at seventy -two. 
 
 "Movements of Plants," at seventy-two. 
 
 "The Parasitic Habits of Molothrus, " at seventy-two. 
 
 "On the Modification of a Race of Syrian Street-Dogs by means of Sexual Selec- 
 tion, ' ' by Van Dyck, with a Preliminary Notice by C. Darwin. 
 
218 PSYCHOPATHOLOGY 
 
 To "The Different Forms of Flowers on Plants of the Same 
 Species" he made the following significant comment: "No little 
 discovery of mine ever gave me so much pleasure as the making 
 out of the mecming of heterostyled flowers. The results of cross- 
 ing snch flowers in an illegitimate manner, I believe to be very im- 
 portant as bearing on the sterility of hybrids. ' ' (Italics inserted. ) 
 
 It would be most undesirable to leave the impression that th^ 
 affective transference to Dr. Grant, through its reenforcement of 
 his childhood wishes, alone made it possible for Darwin to over- 
 come the wishes of his father, (that he should become a physician 
 or a minister) and devote his life to the particular work which grat- 
 tified his attachment to his mother. The friendship of Prof. Hen- 
 slow, which, he says, "influenced my career more than any other" 
 (p. 44), and, of the geologists, Sedgwick and Lyell, and others, 
 besides the contributions to science which he read, furnished the 
 medium through which his inspiration could work satisfactorily. 
 The essential point is the fact that before he met Henslow, his 
 affective trends had become quite definitely fixed, and it was 
 now only a matter of finding the proper associations and material 
 with which to work. 
 
 From nineteen to twenty-two, he attended Cambridge to train 
 himself for the ministry, because, it seems, his father and sisters 
 had decided that, since he would not study medicine, there was 
 nothing else desirable. Fortunately, they were not too resolutely 
 persistent, and Darwin's yearnings were tenacious and vigorous 
 enough to endure the disconcertions of classical literature until 
 he met Prof. Henslow. Prof. Henslow, he says, was a man "whosp 
 knowledge was great in botany, entomology, chemistry, mineral- 
 ogy, and geology" (p. 44) and who later became a minister. Per- 
 haps this complex personali'ty, as a life-long friend, saved Darwin 
 from floundering under Ms father's resistance, after he had 
 started on his course. Henslow 's knowledge of biology gratified 
 the mother attachment, and his ministerial interests gratified the 
 father attachment. Later, Henslow 's inducement enabled Darwin 
 to make a neat sublimation of the father's Avishes. 
 
 At twenty-two, in Cambridge, he says : "I read with care and 
 profound interest Humboldt's 'Personal Narrative.' This work, 
 and Sir J. Herschel's 'Introduction to the Study of Natural Phi- 
 losophy,' stirred up in me a burning seal to add even the most hum- 
 
MECHANISM OF SUPPRESSION" OR ANXIETY NEUROSES 219 
 
 hie contribution to the noble structure of Natural Science. No one 
 of a dozen other books influenced me nearly so much as these two" 
 (p. 47.) (His affective needs Avere ready for the books and these 
 men, and he assimilated the scientific knowledge that helped to 
 satisfy the ardent wish of his childhood with "burning zeal.") 
 
 Darwin's affective needs resisted his father's influence that 
 he should study medicine or theology, even though he had obe- 
 diently consented, upon his father 's instigation, to become a clergy- 
 man, but they accepted Henslow's suggestion that he should study 
 geology with enthusiasm. This course satisfied the fundamental 
 wish to knoAV the names and secrets of minerals and made life sin- 
 cerely Avorth while. Had it been necessary for, say psychiatric 
 reasons, to take Darwin's life history at this time, his father would 
 probably have conscientiously said that he was not a good student, 
 Avas indifferent to the serious interests of life, a sport, ratcatcher, 
 card player, drinker, and Avaster of time, more obstinate and self- 
 willed than his brother. His brother, whom he called "poor old 
 Philos" and "poor old Ras," had, by this time, completely sub- 
 mitted to the father's wish. 
 
 In regard to the origin of the subsidiary wish to travel, which 
 also urged Darwin to make the important voyage of the Beagle, he 
 says : "early in my schooldays a boy had a copy of the 'Wonders 
 of the World, ' which I often read and disputed with the boys about 
 the veracity of the statements ; and I believe that this book first 
 gave me a Avish to travel in remote countries, which Avas ultimately 
 fulfilled by the voyage of the Beagle" (p. 31), and the voyage was 
 additionally attractive because it enabled him to answer the wish 
 of his childhood, to knoAA"- the truth of the serious claims of his 
 playmates and the author. In other words, his "Journal of the 
 Voyage of the Beagle" improved the story of traA^els AA^hich he 
 read in his childhood. 
 
 When the opportunity for the voyage of the Beagle came 
 through the kindness of HensloAv, his master in science, he says 
 his father "strongly objected, adding the words, fortunate for me, 
 'if you can find any man of common sense who advises you to go 
 I Avill give my consent' " (p. 50). This vigorous protest, no doubt, 
 was aggravated by DarAvin's past three years of sporting indul- 
 gences at Cambridge, Avhich he, himself, later characterized as 
 "time worse than wasted. " His father had often rebuked him for 
 
220 PSYCHOPATHOLOGY 
 
 his sporting proclivities, and plainly said he was seriously afraid 
 his son might become a regret to the family. Darwin's father had 
 probably not forgotten the tragedy of his brother's suicide, and 
 was at a loss to know how to influence his son. He had persisted 
 in sending him -to Edinburgh to study medicine and when he re- 
 fused to become interested he had sent him to study theology at 
 Cambridge, only to see him persistently waste his opportunities. 
 
 His son's method of wasting time and money, through sports, 
 card-playing and drinking companions, has every attribute of be- 
 ing his manner of protesting against the impatient attitude of his 
 father who was an abstainer. Their affective resistances had be- 
 come such a barrier that neither was able satisfactorily to in- 
 fluence the other. We learn that Darwin's sisters had become the 
 medium of exchange of certain opinions between father and son 
 from the fact that the father learned through his daughters that 
 his son Charles was not interested in medicine. After the father 
 had expressed his distrust of the voyage of the Beagle, Charles 
 wrote a letter declining the opportunity and promptly went on a 
 shooting trip to Maer. It was one of the interests his father ob- 
 jected to because he cared more for it than a profession. 
 
 The father's inability to see his son's zeal for scientific re- 
 search in this vitally important request, as well as in the selection 
 of an undesirable course of training for both of his sons, strikingly 
 contrasts with the persistent manner in which Charles Darwin 
 later attributed to his father the qualities of being "the wisest 
 man" he ever saw and a man having "almost supernatural" 
 powers of reading character. Additional facts, to be more fittingly 
 presented later, show decidedly that these conflicts greatly influ- 
 enced the pathological nature of Darwin's later submission to his 
 father and the over-compensation of gratitude which he developed. 
 The letters relative to the Beagle opportunity show how extremely 
 eager he was to go and how seriously he considered the oppor- 
 tunity but also how entirely, because of his affection for his fa- 
 ther, he was dominated by the latter 's opinion. 
 
 In a letter to Henslow (p. 169) he wrote, "My father, al- 
 though he does not decidedly refuse me, gives such strong advice 
 against going, that I should not be comfortable if I did not follow 
 it." 
 
 "My father's objections are these: the unfitting me to .settle 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 221 
 
 doAvn as a clergyman, my little habit of seafaring, the shortness 
 of the time, and the chance of my not suiting Captain Fitz-Eoy 
 * * if it had not been for my father I would have taken all 
 risks * * * there certainly could not have been a better op- 
 portunity. ' ' 
 
 Tn the postscript occurs a sentence that clearly reveals Dar- 
 win's utter affective dependence upon his father's approbation 
 and pleasure: "Even if I was to go, my father, disliking, would 
 take away all my energy" (p. 170). 
 
 After Darwin had resigned himself to the loss of this wonder- 
 ful opportunity, he promptly went to the home of the Wedgwoods 
 — his future father-in-law's. Apparently, there, they all talked it 
 over, for the next day he Avrote a letter to his father. It begins 
 rather timidly : 
 
 ' ' My dear Father — I am afraid I am going to make you again 
 very uncomfortable. But, upon consideration, I think you will 
 excuse me once again, stating my opinions on the offer of the 
 voyage. My excuse and reason is the different way all the Wedg- 
 woods view the subject from what you and my sisters do. 
 
 "I have given Uncle Joe what I fervently trust is an accu- 
 rate and full list of your objections, and he is kind enough to give 
 his opinions on all. May I beg of you one favour, it will be doing 
 me the greatest kindness, if you mil send me a decided answer, 
 yes or no 1 If the latter, I should be most ungrateful if I did not 
 implicitly yield to your better judgment, and to the kindest indul- 
 gence you have shown me all through my life ; and you may rely 
 upon it I will never mention the subject again" (p. 170). 
 
 One can hardly help being deeply impressed by the almost 
 tragic appeal that this young man (twenty- two) makes for par- 
 ental consent to his freedom of thought and behavior. Twice in 
 the same letter he refers to the delicate question of idleness. 
 "The time [on the voyage] I do not think, anyhoAV, would be more 
 thrown away than if I stayed at home, ' ' and ' ' I must again state 
 I can not think it would unfit me hereafter for a steady life." 
 (Such earnest pleas as this, although he was a "ratcatcher," show 
 how seriously he was interested in life, if only the controlling 
 powers would let him be free.) 
 
 Darwin's list of his father's objections reveals his attitude 
 about his inability to direct his son's career: 
 
222 PSYCHOPATI-IOLOGY 
 
 (1) "Disreputable to my character as a clergyman hereaf- 
 ter." 
 
 (2) "A wild scheme." 
 
 (3) "That they miist have offered to many others before me 
 the place of Naturalist." 
 
 (4) "And from its not being accepted there must be some 
 serious objection to the vessel or expedition." 
 
 (5) "That I should never settle doAvn to a steady life here- 
 after." 
 
 (6) "That my accommodations shorrld be most uncomforta- 
 ble." 
 
 (7) "That you [father] should consider it as again changing 
 my profession." 
 
 (8) "That is would be a useless imdertaking" (p. 172). 
 
 The objections 1, 2, 7, and S, the most important, indicate that 
 the father's resistances to naturalists' wasting time were proba- 
 bly the result -.of his economic stresses as a student and practi- 
 tioner due to his own father being a rather indifferent provider, 
 probably because of the enormous amount of time he sacrificed in 
 unremunerative theorizing about nature. Charles Darwin says 
 that his "father's mind was not scientific, and he did not try to 
 generalize his Imowledge under general laws, yet he formed a 
 theory for almost everything which occurred, ' ' which indicates that 
 some resistance prevented him from grouping his theories as his 
 own father had. 
 
 To return to the objections. Josiah "Wedgwood replied in a 
 letter to Darwin's father, in Avhich he took up each point sep- 
 arately and siTpported the wishes of his future son-in-law. The 
 answer to the first objection is interesting in that it reveals what 
 enlightened Englishmen thought of naturalists in 1831. (1) "I 
 should not think that it would be in any degree disreputable to his 
 character as a clergyman. I should on the contrary think the offer 
 honorable to him; and the pursuit of Natural History, though cer- 
 tainly not professional, is very suitable to a clergyman." 
 
 Darwin's father, fortunately, was not so obstinately cruel and 
 self-centered as to resist this final plea from his son and relatives. 
 He consented in "the kindest manner," and the enthusiasm with 
 which Darwin reacted is revealed in several letters to his friends, 
 in which such phrases as the following are to be found: "I am 
 
MECHANISM OF SUPPRESSTOK OR ANXIETY NEUROSES 223 
 
 sure it will be my fault if we do not suit" (in regard to his liking 
 liis captain). "What changes I have had. Till one [o 'clock prob- 
 ably] today I Avas building castles in the air about hunting foxes 
 in Shropshire, now llamas in South America. There is indeed a 
 tide in the affairs of men." "What a glorious day the fourth of 
 November will be to me ! Mij second life ivlll then commence, and 
 ii shall he as a birthday for the rest of my life" (p. 187) ; to Hens- 
 low, whose "protege" he liked to consider himself to be: "Gloria 
 in excelsis is the most moderate beginning [of the letter] I can 
 think of"; to his friend Fox he wrote: "Every now and then I 
 have moments of glorious enthusiasm, when I think of the date 
 and cocoa trees, the palms and ferns so lofty and beautiful, every- 
 thing new, everything sublime." When repressive influences are 
 removed the affective response immediately rises with enthusiasm 
 and exuberance. Smoky, noisy London became, for the first time 
 in his life "very pleasant," "hurry, bustle and noise are all in uni- 
 son with my thoughts ; ' ' and the crowded little ship became ' ' the 
 most perfect vessel that ever came out of the dockyard." 
 
 Darwin had a fine capacity for visualizing, which is to be seen 
 all through his letters, and there can be little doubt but that the 
 "second birth" he referred to meant that he proposed to remain 
 a naturalist, marry Emma Wedgwood and devote himself se- 
 riously to his work. 
 
 The vigor of Darwin's interest in science, as a young man, 
 certainly varied as his father's wishes forced him from the studies 
 that gratified his affective attachment to his mother, and it was 
 fortunate that his uncle was quite well aware of the family situa- 
 tion. 
 
 DarAvin writes in his autobiography : ' ' The voyage of the Bea- 
 gle has been by far the most important event in my life and has 
 determined my whole career; yet, it depended on so small a cir- 
 cumstance as my uncle (future father-in-law) offering to drive me 
 thirty miles to ShrcAvsbury, which few uncles would have done, 
 and on such a trifle as the shape of my nose" (p. 51). The captain 
 of the Beagle disliked the shape of Darwin's nose, believing that 
 it indicated weakness of purpose and energy. He, however, was 
 persuaded to accept the offer for service because of his zeal. This, 
 his father had failed to appreciate. (This complicated, decisive 
 incident is comparable to an accidental association of mechanical 
 
224 
 
 PSYCHOPATI-IOLOGY 
 
 or ehemieal devices that sometimes saves a man from a life of 
 fruitless, painful striving after an inaccessible object by giving 
 him a practical medium through which the wish may, at last, 
 struggle freely for gratification.) 
 
 Darwin, as a psychological problem, would be only half eonsid- 
 orod, if we did not include an analysis of his chronic anxiety neu- 
 rosis, which lasted over forty years, and attempt to estimate the 
 nature of his affective suppressions and his manner of dealing with 
 them, because, in many respects, Darwin's difficulties were of 
 a type that often becomes extremely destructive to the personality. 
 It is quite probable that, had his father suppressed the voyage of 
 the Beagle, it would have ruined his son (like Erasmus) because 
 the submission would have prevented the frank sublimation of his 
 mother-attachment. This mechanism, in more active form, is fre- 
 quently the most prominent factor in many dementia precox cases. 
 
 The first indications that Darwin had a psychoneurotic tend- 
 ency came out, as would be expected, upon the first strenuous de- 
 mands for adaptation when accompanied by home or love-sickness, 
 which bothered him greatly. Such symptoms as the following,; 
 occurring in a student, would lead one strongly to suspect an auto- 
 erotic difficulty that had not been completely mastered. Besides 
 cardiac palpitation and anxiety he had other neurotic symptoms. 
 
 In a letter (p. 180) written September 6, 1821, to his sister, 
 Susan, is the first significant reference to his personal difficulties. 
 The unconscious manner in which the thoughts are associated to- 
 gether is quite important. He begins with a series of requests 
 for wearing apparel, and then, when he makes the request for a 
 little book, " If I have got it in my bedroom — ' Taxidermy, ' he adds, 
 "Ask my father if he thinks there would be any objection to my 
 taking arsenic for a little time, as my hands are not quite well, and 
 I have always observed that if I once get them well, and change 
 my manner of living about the same time, they will generally re- 
 main well. What is the dose? Tell Edward my gun is dirty. 
 What is Erasmus' direction?" (Italics inserted.) 
 
 The arsenic tonic for the neurotic hands, of which he is un- 
 duly conscious while trying to make a demonstration of his best 
 qualities in order to be accepted for the voyage, is interestingly 
 associated with the queer observation, which is given so much 
 importance by the * ' always, ' ' that if he once got them well, that is, 
 
MECHANISM OF SUPPRESSION OR, ANXIETY NEUKOSES ii-!.) 
 
 under control, and changed his manner of living about the same 
 time, they generally remained -well. This sort of phrase is enig- 
 matical in almost any sense unless it reveals the manner in which 
 lie had mastered the natural onanistie curiosities of youth. The 
 associations — taxidermy, arsenic, hands, show how frankly Dar- 
 win permitted his thoughts to associate. Tonic — defective hands 
 — defective gun and Erasmus should be considered to have been 
 written in the same trend of thought. Erasmus was biologically 
 not a well-developed heterosexual type, was not creative, retired 
 while a youngs man and never married. 
 
 It is very interesting, in this connection, that, three days 
 later, Darwin again wrote to the same sister (p. 182) : "Captain 
 Fitz-Eoy first wished a naturalist, and then he seems to have taken 
 a sudden horror of the chances of having somebody he should 
 not lilie on board the vessel." In the previously quoted letter in. 
 the paragraph following the arsenic request, he says "from Cap- 
 tain Fitz-Roy wishing me so much to go, and, from his kindness, 
 I feel a predestination I shall start." (Pitz-Roy seems to have 
 been about twenty-three at this time, and the two were to share 
 quarters together. While at sea, Fitz-Roy developed a negativistic 
 , attitude toward Dar■\^^.n which almost disrupted the voyage. At 
 sixty-seven, Darwin said he "was a man very difficult to live with 
 on the intimate terms which foUoAved our messing by ourselves 
 in the same cabin" (p. 51). (This indicates that Fitz-Roy was in- 
 clined to become irritable under the strain of sexual suppression.) 
 From his autobiographic comments, Darwin apparently misunder- 
 stood Fitz-Roy 's reference to his sensuous nose as his true reason 
 for hesitating to take him on the journey. It is quite probable that 
 the astute Dr. Darwin was well aware of his son's personal diffi- 
 culties, if we consider the manner in which he read the sexual 
 difficulties of his patients, which Darwin characterized as "super- 
 natural. ' ' This may have been the true basis for the fear that it 
 might ruin him for the ministry. Homosexuality is a serious 
 problem among seameii. In the same letter, Darwin shows that ho 
 met the emergency and mastered himself completely, for he says, 
 following his comments on his successful bargain for new pistols 
 and a gun, and Fitz-Roy 's fine guns, that he would not need to take 
 arsenic. The final arrangements had then been made and the 
 slightly regressive tendency was relieved. According to some 
 psychiatric notions the neurotic and cardiac symptoms, plus a 
 
226 PSYCPIOPATHOLOGY 
 
 suicidal uncle, would have branded Darwin as a constitutional in- 
 ferior failing? to accommodate under stress. 
 
 It was not until five weelfs after his letter, in which he men- 
 tioned Fitz-Roy's uneasiness, that he bared the yearnings of his 
 soul to this stranger, instinctively assuring him that all was well 
 by the splendid sublimation that, on the day of sailing "my second 
 life will then commence, and it shall be as a birthday for the rest 
 of my life. " The nature of the fifty-two years of married life that 
 followed the voyage shows clearly how well Darwin meant exactly 
 what he said. * 
 
 No doubt Fitz-Roy and Darwin had no occasion to lose their 
 esteem for one another. The voyage lasted five, instead of three, 
 years, during which time Darwin suffered severely from seasick- 
 ness, nausea, vomiting and dizziness, but the enormous amount of 
 work he did, and the accuracy of his journal, which has been in- 
 corporated in the Harvard Classics, show how splendidly he sub- 
 limated his affective cravings. 
 
 While on the voyage he had a serious illness which his father 
 was unable to diagnose from a description of the symptoms, biit 
 it can hardly be assumed to have left a debilitating effect, because, 
 after the voyage, while working at his specimens, he wrote of his ■ 
 good health and spirits. 
 
 Dr. "W. W. Johnson,* in his article on "The 111 Health of 
 Charles Darwin: Its Nature and Relation to His Work," in which 
 he covers the symptoms and the physical stresses of the voyEg^feS' 
 and his intense method of work, concludes that the illness "was 
 "chronic neurasthenia." 
 
 Dr. G. M. Gould, in his "Biographic Clinics," reviews the case 
 of Charles Darwin, and, after discussing Dr. Johnson's diagnosis, 
 concludes that the ill health was due to "eye-strain." Both men 
 seem to have overlooked or given little importance to the anxiety 
 about his hands that Darwin complained of before the voyage or to 
 the affective suppressions that distressed him. 
 
 The indications, many of which have been collected in the fol- 
 lowing discussion, are that, 'if we will consider the nature of Dar- * 
 win's work, its affective value to him, what he anticipated it would 
 mean to civilization and the excited criticisms it would aroiise, 
 the attitude of his father, and his manner of working, it is quite 
 
 •American Anthropologist, Vol. Ill, 1901. 
 
MECHANISM OF SUPPKESSION OR ANXIETY NEUKOSES 2^7 
 
 probable that he suffered from an anxiety neiirosis due to con- 
 sistent affective suppression. The nature of the affective sup- 
 pression will be discussed after other important personal traits 
 of Darwin and the symptoms of his illness have been fully covered. 
 
 About two years after his return from the voyage of the 
 Beagle, he began to be troubled by becoming occasionally "un- 
 well." I could find no definite account of an organic disease until 
 he was an old man, and none of his physicians, including his 
 father, seemed to consider an organic lesion as the cause of his 
 illness. Many hints as to the symptoms and nature of his anxiety 
 neurosis may be found scattered throughout the biography pub- 
 lished by his son, Francis, and in his letters and autobiography. 
 Some of the more definite remarks are here collected because they 
 indicate the nature of the anxiety neurosis, and, from an analysis 
 of his compensations and methods of obtaining relief from anxiety, 
 we are enabled to acquire an insight into the nature of his affective 
 struggle and the determinants of his final course of living. 
 
 In the critical years between his return from the voyage of the 
 Beagle (twenty-seven) and his marriage (thirty) Darwin passed 
 through his final affective readjustment. He was inclined to re- 
 flect deeply on the subject of religion, read books oh metaphysics, 
 which indicates that he still conscientiously considered the minis- 
 try and "the subject was much before my mind" (p. 274), but he 
 says "disbelief crept over me at a very slow rate, but was at last 
 comj)lete. The rate was so slow that I felt no distress." During 
 these years the first important experience of becoming "unwell" 
 is recorded, and the later course of his anxiety indicates that it 
 was a reaction to his efforts to adjust himself for his career, his 
 father, and his mating. (It is important to recognize the fact that 
 individuals having too strong an affective attachment to one of 
 their parents, often experience an unfathomable anxiety when they 
 attempt to mate, because in the mating the individual tends to re- 
 press the affective interests that do not idealize the love-object, 
 and this repressed affect produces anxiety through its struggles 
 to break through the resistance so as to find its own love-object.) 
 
 He married at thirty, and lived in London, but at thirty-three 
 he retired to the restful seclusion of Down. As he grew older,, he 
 isolated himself more and more from social intercourse. Before 
 his retreat to Down he went alone on one more geologizing tour 
 
228 PSYCHOPATH OLOGY 
 
 to North "Wales, and this was the last time he tried to climb a 
 mountain. What final resolutions and emotional changes Darwin 
 experienced on this trip are not recorded by him, but shortly after 
 this he retired to Down where he became a chronic invalid and his 
 wife-mother became his devoted nurse. Francis Darwin fittingly 
 says : " N.o one, indeed, except my mother, knows the full amount 
 of suffering he endured, or the full amount of his wonderful pa- 
 tience. For all the latter years of his life she never left him for 
 a night and her days were so planned that all his resting hours 
 might be shared with her. She shielded him from every avoidable 
 annoyance, and omitted nothing that might save him trouble, or 
 prevent him becoming overtired, or that might alleviate the many 
 discomforts of his ill health. For nearly forty years [almost 
 throughout his marriage] he never knew one day of health like 
 the ordinary man, and thus his life was one long struggle against 
 the weariness and strain of sickness. And this can not be told 
 without speaking of one condition {ivife) which enabled Mm to 
 hear the strain and fight out the struggle to the end." (Italics 
 inserted.) 
 
 Another most important fact must be added because it ena- 
 bled him to play in nature study according to his wishes. His 
 economic independence was established through his father's good 
 will. It must be recognized that his wife-mother and his economic 
 independence, as a secure source of protection for his family and 
 himself, made it possible for him to endure his chronic affective 
 conflict because he could thereby avoid the aggra;vations that usu- 
 ally arise when an individual, having serious affective suppres- 
 sions, is required to adapt himself to the demands of a self-indill- 
 gent mate or the stresses of competitive business. These two facts 
 probably saved Darwin from utter ruin long before the "Origin 
 of Species" could have been published. 
 
 During the critical period of affective renunciation of ortho- 
 dox mysticism for the more serious and more sacred truths of 
 Nature, from twenty-seven to thirty, Darwin's interest changed 
 in other important respects. He discovered "imconsciously and 
 insensibly, that the pleasure of observing and reasoning was a 
 much higher one than that of skill and sport" (p. 53). He also 
 became definitely convinced of his own place innature and the sig- 
 nificance of his theory of evolution. He says (pp. 75, 76), "As 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 229 
 
 soon as I had become, in 1837 or 1838 [age twenty-eight or twenty- 
 nine], convinced that species Avere mutable productions, I could 
 not avoid the belief that man must come under the same law. Ac- 
 cordingly I collected all notes on the subject for my OAvn satisfac- 
 tion, and for a long time without any intention of publishing." 
 His cautiousness shows how clearly he foresaw the criticisms that 
 would be hurled at him because of the pain his theories would 
 arouse in others. His ability to recognize this, of course, could 
 only have come from the pain he himself experienced when he 
 quietly renounced his orthodox wishes as to the future of man. 
 His next sentence shows how clearly he apprehended the nature 
 of the illegitimate , claims orthodox minds are tempted to make 
 in the name of religious righteousness. He says, "Although in 
 the ' Origin of Species ' the derivation of any particular species is 
 never discussed, yet I thought it best, in order that no honorable 
 man should accuse me of concealing my views, to add that by the 
 work 'light would be thrown on the origin of man and his his- 
 tory.' " (p. 761). 
 
 His first child was born when he was thirty, and he says. "I 
 at once commenced to make notes on the first dawn of the various 
 expressions which he exhibited, for I felt convinced, even at this 
 early period, that the most complex and fine shades of expression 
 must all have had a gradual and natural origin." (In this re- 
 spect Freud's contribiition, that the sexual functions evolve grad- 
 ually as a variation from nutritional functions, is neither a new nor 
 a radical departure.) 
 
 It is Avorthy of consideration that Dai-Avin's father, although 
 he hated medicine, submitted and, from having "no choice," fol- 
 lowed Ms own father's profession but was unable to accept the im- 
 plications as to the origin of man that were taught by his theories 
 in "Zoonomia" (that all forms of life AA^ere "one family of one 
 parent"). Besides this resistance, he strongly wished that his 
 son Charles, after he had refused to become a physician, should 
 accept, en masse, the dogmas of the Church of England and be- 
 come a country clergyman. (This seems to have been an expres- 
 sion of opposition to "Zoonomia.") These factors indicate that 
 the father's resistance to his son's yearnings to work on the same 
 problem that had interested his grandfather had a far deeper 
 emotional determination than probably any of the family allowed 
 
230 PSYCHOPATHOLOGY 
 
 themselves to consider. That Charles Darwin's consecration of 
 himself to science was . a most sacred resolution is firmly sup- 
 ported by the zeal, patience, and care with which he worked, as 
 well as by such statements as this, in his autobiography: "I re- 
 member Avhen in Good Success Bay, in Tierra del Fuego, thinking 
 (and I believe, that I wrote home to that effect) that I could not 
 employ my life better than in adding a little to Natural Science. 
 This I have done to the best of my ability and critics may say 
 what they like, but they can not destroy this conviction" (p. 73). 
 The delicate manner in which father and son had to adjust their 
 wishes is indicated by the statement regarding the intention that 
 he should become a clergyman: "Nor was this intention and my 
 father's wish ever formally given up, but died a natural death, 
 when, on leaving Cambridge, I joined the Beagle as naturalist." 
 
 It is permissible to infer, therefore, that Darwin's consecra- 
 tion of himself as a naturalist for the welfare of humanity, besides 
 gratifying and beautifully sublimating his mother-attachment, also 
 gratified his father's desire that he should religiously consecrate 
 himself to the welfare of humanity, which is remarkably like the 
 mechanism of the sacrifice of the devoted Son Christ if we con- 
 sider certain other facts. 
 
 At thirty-three, (incidentally the year of the Crucifixion) he 
 retired from London to seclude himself for the remainder of his 
 life in the isolated, rural home of Down. That he literally wrote 
 his studies of nature with consecrated devotion is obvious from 
 his life of self-denial, the careful exactness with which he main- 
 tained his working schedule, Sundays, as well as week-days, the 
 enormous output of material, some 7,000 pages of scientific re- 
 search, the "sacredness" with which he regarded the objects of 
 his study,his humility, and the anxiety he endured lest he should 
 make a mistake or offend some one. 
 
 Probably the same biological cravings that dominate us all 
 and have insisted upon cherishing the fantasies about renuncia- 
 tion of envy by Christ in the Garden of Gethsemane, the Cruci- 
 fixion and Burial of all selfish, worldly (sporting) interests, and 
 the conversion and ascension in life through seeking truth and 
 generously tolerating censure, urged Darwin, irresistibly, onward. 
 For the sake of Maii, he endured the taunts and ridicule and curses 
 of the orthodox thinkers of his time, as Christ endured the perse- 
 cutions of the orthodox Jews nineteen hundred years ago. 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 231 
 
 It is a very serious undertaking for' a man to consecrate him- 
 self too severely to his inspirations. Comparatively rugged vul- 
 garity and mischievousness are emotional exercises that, have an 
 important balancing influence and prevent 'too consistent repres- 
 sions of affective interests of an important type as 'well as dis- 
 tressing atrophy in others. The personality tends to become psy- 
 chopathic, not unlike the seclusive, shut-in, fanciful hero Christs, 
 and many of our paranoid psychopaths, who heedlessly accept 
 their inspirations without controlling them. Observations of Dar- 
 Avin's behavior frota thirty-three until after seventy show the na- 
 ture of his anxiety. Until after his marriage, Darwin was very 
 vigorous, fond of sports, and endured physical hardships on his 
 explorations with little distress. 
 
 At forty, he wrote to Dr. Hooker, presumably his physician : 
 "Everyone tells me that I look quite blooming and beautiful and 
 most think I am shamming, but you have never been one of those." 
 And it must be remembered that at this time he was miserably ill, 
 far worse than in later years (p. 90). We are told that "his ex- 
 pression showed no signs of the continued discomfort he suffered," 
 even though, "when he was excited with pleasant talk his whole 
 manner was wonderfully bright and animated and his face shared 
 to the full in the general animation." 
 
 "Like most delicate people, he suffered from heat as well as 
 from chilliness ; it was as if he could not hit the balance between 
 too hot and too cold; often a mental cause Avould make him too 
 hot, so that he would take off his coat if anything went wrong 
 in the course of his work." (Italics inserted.) This observation 
 gives at least some insight into the delicate affective balance on 
 which Darwin's self-control swung and how quickly he overcom- 
 pensated for the fear of making a mistake or doing something he 
 might regret. He was pathologically conscientious, exceeding by 
 far the limitations of common sense. Another example of his 
 hyperconscientiousness is to be seen in his letter writing. "He 
 received many letters from foolish, unscrupulous people, and all 
 of these received replies. He used to say that if he did not an- 
 swer them he had it on his conscience afterwards. He had a 
 printed form to be used in replying to troublesome correspond- 
 ents, but he hardly ever used it" (p. 98). 
 
 Darwin's kindness and appreciation of the interests of others 
 was so remarJcably developed that it must be considered to be more 
 
232 PSYCHOPATHOLOGY 
 
 than a grateful compensation for Ms bnrdensomeness to others, 
 for we find it to have been a consistent reaction, even with un- 
 known, "nnscrnpuloiis correspondents," and his publisher, who 
 had never met him, said, "Everything I did [for Darwin] was 
 right, and everything was properly thanked for." "We also find 
 that in conversation he Avas peculiarly anxious not to become bur- 
 densome by repeating a story twice or by talking when others 
 showed impulses to do so. 
 
 The spontaneous development of such traits of hyper-appre- 
 c'iativeness may have, as a compensatory growth, a logical incit- 
 ing cause in the fear of being offensive, ungrateful and inappre- 
 ciative. The cause of this fear, however, since the soothing nature 
 of his OMU family life was almost perfect, must he looked for in 
 suppressed emotions that he had to be incessantly on guard 
 against, and which, perhaps, contributed to wearying him into in- 
 validism. 
 
 A further indication of his emotional difficulties is to be seen 
 in his habits. "After dinner he never stayed in the room, and 
 used to apologize by saying he was an old woman who must be al- 
 lowed to leave with the ladies. This was one of the many signs and 
 results of his constant weakness and ill health. Half an hour, more 
 or less, of conversation would make the loss perhaps of half the 
 next day's work. He became much fatigued in the evenings, es- 
 pecially of late years, when he left the drawing-room about ten, 
 going to bed at half -past ten. His nights were generally bad, and 
 he often lay awake or sat up in bed for hours,' suffering much 
 discomfort. He was troubled at night by the activity of his 
 thoughts, and would become exhausted by his mind working at 
 some problem which he would willingly have dismissed. At night, 
 too, anything ivliich had vexed or troitblcd him in the day would 
 haunt him, and I thinli it was then that he suffered if he had not 
 answered some troublesome person's letter" (p. 101). (Italics 
 inserted.) 
 
 This duly confirms the impression that Darwin's careful 
 gratefulness and conscientiousness were also a necessary compen- 
 sation to protect himself from anxiety and the horrors of sleepless 
 nights and uncontrollable thoughts. He dared not become conten- 
 tious or critical, because, if he did, even in little conversations, as- 
 sume the postural attitude necessary for tlie suecessfiil criticism of 
 another, the suppressed affect literally overwhelmed, his self -con- 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 233 
 
 trol and could not be checked even in the late hours of night. This 
 unfortunate man must have suffered excruciating distress in his 
 later years as his resistance weakened, but, sitting up in bed, a de- 
 fense against anxiety and fear, with his wife, who dared not leave 
 him alone at night, they shared the distress together. 
 
 That this disturbance of function had an affective basis and 
 not an organic one is indicated, not only by the fine old age he 
 reached, but by the fact that most people regarded him to be in 
 good health and shamming, and no organic lesion was found by 
 his ph^'-sicians until his last years. 
 
 "Any public appearance, even of the most modest kind, was 
 an effort for him," the marriage of his oldest daughter caused 
 undue fatigue and he was unable to attend the funeral of his 
 father. He rarely traveled and, even if he were leaving home for 
 a week, the packing had to be commenced early on the previous day 
 and the chief part of it he would do himself. "The discomfort of 
 a journey to him was, at least, latterly, chielfly in the anticipatioi}, 
 and in the miserable feeling from which he suffered immediately 
 before the start, even a fairly long journey, such as that to Conis- 
 ton, tired him wonderfully little, considering liow much of an in- 
 valid he was" (p. 107). 
 
 This sort of fatigue and weakness, due to ant'icipation, re- 
 minds one of the fatigue that is so disastrous to athletes when 
 they become overly anxious before a race or game. The extent 
 to which his anxiety might affect him when in society may be 
 gathered from this comment in his autobiography: "My health 
 almost always suffered from the excitement, violent shivering and 
 vomiting attacks being thus brought on. I have therefore been 
 compelled for many years to give up all dinner-parties ; and this 
 has been somewhat of a deprivation to me, as such parties always 
 put me into high spirits. From the same cause I have been able to 
 invite here very few scientific acquaintances." So methodically 
 did he have to live that his schedule could not be comfortably 
 varied from week-day to Sunday. 
 
 It is quite evident that DarAvin's constant problem was to 
 protect himself from anticipations and conflicts because his auto- 
 nomic-affective reactions caused severe anxiety and insomnia. It 
 is to be regretted, because of its great importance to psychology, 
 that the nature of his thoughts and dreams under such conditions 
 were not recorded. 
 
234 PSYCHOPATHOLOGY 
 
 A contributory cause of Darwin's tendency to anxiety and ex- 
 citement must be recognized in the important fact that he was a 
 sincere man and his discoveries of the laws of nature, destined 
 subtly to produce a serious change in religious practices, were se- 
 verely criticised by the rampant orthodox with probably as much 
 vindictive unreasonableness as psychoanalysis is enduring today. 
 
 The isolation of himself from the public greatly protected 
 him, but this would hardly be sufficient to insure him from the 
 fear of making a mistake or of wasting time or of offending his 
 father. 
 
 The most disastrous affects of chronic anxiety are of course 
 digestive and nutritional, and Darwin's digestive functions were 
 seriously affected. His long, thin legs showed the meagerness of 
 his powers to assiiiiilate nourishment. It seems that the most sat- 
 isfactory treatment he found was "hydropathic," and his biogra- 
 phy indicates that he must have tried many forms of treatment. 
 
 Darwin's interests in life were most decidedly eccentric if 
 compared to the interests of the average healthy scientific re- 
 searcher. He exercised little interest in business and read little 
 current literature besides his newspaper unless associated with 
 scientific work. He was very fond of novels, but his serious inter- 
 ests were devoted entirely to certain genetic problems in biology 
 and geology. He says : "My chief enjoyment and sole employment 
 throughout life has been scientific ivorTc; and the excitement from 
 such work makes me for the time forget or drives away my daily 
 discomfort" (p. 65). 
 
 His manner of working in regard to saving time also shows 
 how intensely he had compensated for the charge of being a waster 
 of time in his youth. Francis Darwin says (p. 121), as to his 
 manner of working: "One characteristic of it was his respect for 
 time ; he never forgot how precious it was. This was shown, for 
 instance, in the way in which he tried to curtail his holidays ; also, 
 and, more clearly, with respect to shorter periods. He would often 
 say that saving the minutes was the way to get work done; he^ 
 showed his love of saving the minutes in the difference he felt 
 between a quarter of an hour and ten minutes' work; he never 
 wasted a few spare minutes from thinhing that it was not worth 
 while to set to work. I was often struck by his way of working up 
 to the very limit of his strength so that he suddenly stopped in 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 235 
 
 dictating, with the words, 'I believe I mustn't do any more.' The 
 same eager desire not to lose time was seen in his quick move- 
 ments when at work." 
 
 "He saved a great deal of time through not having to do any- 
 thing twice. Although he would patiently go on repeating ex- 
 periments where there was any good to be gained, he could not 
 endure having to repeat an experiment which ought, if complete 
 care had been taken, to have succeeded the first time— and this 
 gave him a continual anxiety that the experiment should not be 
 Avasted; he felt the experiment to be sacred, however slight a one 
 it was" (p. 122). 
 
 "In the literary part of his work he had the same horror of 
 losing time, and the same zeal in what he was doing at the moment, 
 and this made him careful not to be obliged, unnecessarily, to read 
 anything a second time" (p. 122). 
 
 In regard to saving, he is said also to have used the backs of 
 his note-sheets in order not to waste paper and, because of this, 
 many historically interesting sheets were destroyed. 
 
 The above noted characteristic of saving time, energy, op- 
 portunity and material was decidedly more developed than is 
 usual for the average biological researcher. Why? What strange 
 influence could have determined this trait of character? 
 
 As a schoolboy, preceding^ during and after adolescence, his 
 father, besides others, regarded him to be more stupid and lazy 
 than the average boy and his father was honestly afraid he would 
 become a source of regret to his family. "V^Hien he came to his 
 father for consent and encouragement to make the cherished voy- 
 age of the Beagle, he was derided for utterly lacking common 
 sense; and, when he returned home, the "sensitive" father did 
 not frankly acknowledge his interest as a naturalist or his intel- 
 lectual improvement, and admit that he had been mistaken in his 
 judgment, but, compromisingly, turned to one of his daughters 
 and remarked, "Why! the shape of his head is quite altered!" 
 (p. 53). This was a phrenological observation which approved of 
 the signs of intellectual improvement in his son, but did not offer 
 a frank retraction of his former impression and create an oppor- 
 tunity for honest emotional readjustment. Darwin precedes this 
 comment in his autobiography with the significant statement, in 
 the same paragraph, "I discovered, though unconsciously and in- 
 
236 PSYCHOPATHOLOGY 
 
 sensibly, that the pleasure of observing and reasoning was a much 
 liigher one than that of skill and sport. That my mind ^§^^ de- 
 veloped through my pursuits during the voyage is rendered prob- 
 able by a remark [quoted above] made by my father, who was the 
 most acute observer whom ever I saw, of a skeptical disposition, 
 and far from being a believer in phrenology. ' ' 
 
 This revelation, an additional reason for Darwin's change of 
 interest from sports to intellectual pursuits, becomes duly si^lfi- 
 cant when we associate with it the fact that his father, when fie 
 heard from his daughters that Charles did not like the thought of 
 becoming a physician, proposed that he should become a clergyman. 
 "He was very properly vehement against my turning into an idle 
 sporting man, which he considered my probable destination. " His 
 father regarded a voyage with the Beagle as a "wild scheme" and 
 an idle, sporting adventure. The romantic circumstance in wMch 
 Darwdn's uncle testified for Darwin's sincerity of purpose, no 
 doubt, put it up to his honor not to betray his uncle's confidence, 
 and, moreover, to win his father 's approbation lest he should later 
 regret having given his consent ; hence, the gradual change of in:^|. 
 terest from worldly sports' to higher interests of reasoning as a 
 v/ish-fulfillment. 
 
 The enormous collection of observations that Darwin made 
 on this voyage verified his sincerity and diligence, but it did not 
 win frank approbation, as the father's behavior showed in the 
 first critical moment of meeting the returning prodigal, but self- 
 respecting, son. 
 
 His father, though deeply sympathetic, was too sensitive to 
 malse the complete admission that the voyage had proved to be 
 a common-sense proposition, and that he had been mistaken in 
 his judgment. Darwin 's regard for his father prevented him from 
 showing any disappointment at the evasive greetiaig upon his re- 
 turn home after five years of adventure in the obscure quarters 
 of the earth ; but, in Ms later years, his ' ' peculiar ' ' use of admir- 
 ing superlatives in regard to his father's wisdom and sympathy 
 indicate that it was probably at that time that all feelings of dis- 1 
 appointment in his father's attitude were resolutely suppressed 
 and the father was accepted as utterly unable to do a wrong. The 
 disappointment in his father's judgment was kept suppressed by 
 over- evaluating his Avisdom. Francis Darwin makes the signifi- 
 cant comment: "Charles Darwin's recollection of everything that 
 
MECHANISM OF SXIPPRESSTON OR ANXIETY NEUROSES 237 
 
 ■\vas connected Avith his father was peculiarly distinct and he spoke 
 of him frequently, generally prefacing an anecdote ivifh some 
 phrase as 'My father, who iras the ivisest man I ever knew,' " 
 (p. 10). (Italics inserted.) "His reverence for him was bound- 
 less and most touching. He would have wished to judge every- 
 thing else in the world dispassionately, taut anything his father had 
 said was received with implicit faith" (p. 10). In contrast to this 
 significant, complete acceptance of his father's word (whereby, of 
 course, all possibility of conflict of opinion or expression of doubt 
 and displeasure was removed), we find that Darwin said to his 
 daughter, as she writes it, that "he hoped none of his sons would 
 ever believe anything because he said it, unless they were them- 
 selves convinced of its truth — a feeling in striking contrast with 
 his own manner of faith" (p. 10), and a direct admission that his 
 attitude toward his father was not a healthy one, but the best ad- 
 justment that he could make under the circumstances of (1) his af- 
 fective attachment to his father, whereby he was the victim of his 
 transference, and his love for his mother and her interest, (2) his 
 economic dependence, and (3) the necessity of avoiding conflicts in 
 order that he would not be distracted from his researches. 
 
 The carefulness with which Darwin adjusted is to be seen in 
 his ' ' peculiarly distinct ' ' recollection of ' ' everything that was con- 
 nected Avitli his father," and his secret difficulties, which passed 
 unobserved by most people, may be estimated by the. following im- 
 pressions he had of his father. He was "very sensitive, so that 
 many small events annoyed and pained him much. He was easily 
 made angry, but his kindness was unbounded" (p. 18). (If not 
 made angry, is to be presumed.) Darwin's father seemed to have 
 an unforgetable memory for painful events becausCj when he be- 
 came older and unable to practice, he refused to go driving foi- 
 the reason that every road was associated with painful memories. 
 It may be repeated here that he also characterized his father thus, 
 "his chief mental characteristics were his powers of observation 
 and his sympathy, neither of which I have ever seen surpassed 
 or even equalled" (p. 11), and "the most remarkable power whicli 
 my father possessed was that of reading characters and even the 
 thoughts of those whom he saw even for a short time; some in- 
 stances of his power almost seemed supernatural" (p. 12). This 
 gives us an idea of the difiiculties Darwin must have had in main- 
 
238 PSYCHOPATHOLOGY 
 
 taining a submissive posture or attitude that kept his father com- 
 fortable, whereby he renounced all independence of thought in re- 
 lation to his father, submissively accepting his every opinion or 
 statement without reserve and as not to be questioned. 
 
 This probably explains the cause of "a fatality" of reasoning 
 which Darwin had to struggle with. When anyone makes a new 
 deduction or an original statement or theory, if it is correct, it 
 more or less reflects an atmosphere of superiority of thought upon 
 himself and, logically, an implication of inferiority of thought 
 upon other people. This is probably why lawyers, ministers, 
 scientists, artists, actors, physicians, mechanics, psychoanalysts, 
 ball-players, debutantes, cooks, i.e. established individuals who 
 compete for recognition by displaying the same powers or inter- 
 ests, have difficulty in recognizing the superiority of the new ri- 
 val's qualifications. The recognition usually comes from those 
 who are not rivals. Darwin's theories were more generally ac- 
 cepted by the younger naturalists who were training for competi- 
 tion with the established naturalists ; and the older men, who could 
 not reconstruct their work, were unable to accept the theory, pre- 
 ferring their "standing" rather than the actual truth. The feud 
 between Freud, Jung, and Adler has a similar mechanism. 
 
 With this mechanism in mind a determinant is to be seen for 
 the variation in asserting potency displayed by Erasmus Darwin, 
 grandfather, poet-naturalist and physician, and Robert Darwin, 
 physician, with theorizing capacities highly developed but not fin- 
 ished, and Charles Darwin, son, who refused to be a physician but 
 resumed his grandfather's work on the origin of species, and re- 
 wrote the theory in an improved but decidedly individualistic form. 
 
 Darwin, by his refusal to become a clergyman, had formally 
 given his father to understand that he could not accept the Church 
 of England's and his father's impressions as to man's place in 
 nature, and the expression of his views had to be most consider- 
 ately made so as not to assert himself heedlessly upon his father's 
 wisdom. Like all such adjustments between superior officers and 
 subordinates, the subordinate usually suffers from a retarding 
 tendency to misexpress himself whereby he leaves an opening'for 
 the superior to display the fact that his position is still one of 
 dominant potency. Darwin complains, "I have as much difficulty 
 as ever in expressing mypelf clearly and concisely; and this diffi- 
 
MECHANISM OF SUPPRESSION OU ANXIETY NEUROSES 239 
 
 culty has caused me a great loss of time * * * There seems to 
 be a sort of fatality in my mind leading me to put at first my 
 statement in a -wrong or awkward form" (p. 80). The wrong 
 form invites a self-assertion from another as does also the awk- 
 ward form offer a chance for more graceful display of self by 
 another. 
 
 There is considerable evidence to show that this person who 
 was always more or less in mind was none other than his father. 
 Darwin was completely independent of all other people. This 
 "fatal" tendency might have deprived humanity of his theory of 
 evolution because, although Darwin had quite clearly formulated 
 it at thirty, he did not present it until fifty-six. His father died 
 when Darwin was thirty-nine, but the death of the suppressive 
 influence does not relieve the suppressed affect so long as the mem- 
 ory is revered and cherished. It was only upon the ' ' strong advice 
 of Lyell and Hooker" (p. 70) that Darwin accumulated enough ini- 
 tiative to prepare a volume on the transmutation of species. The 
 moral support of Henslow, whose protege Darwin liked to con- 
 sider himself, and Lyell and Hooker, fortunately counteracted the 
 affective resistance to free self-expression as a naturalist, which 
 is clearly traceable to the revered father's painful manner of yield- 
 ing to the voyage of the Beagle. 
 
 Darwin compensated for the persistent paining of his father 
 by elevating him to the revered, immortal height of godliness as 
 the wisest, most sympathetic, most observing of all men. Such 
 affective attitudes toward the father, during a psychosis, are al- 
 ways indicative of renunciation of all affective competitiveness 
 with the father in order to keep peace while love is secretly claim- 
 ing for itself the mother's supreme interest. 
 
 I have seen this, frequently, distinctly illustrated in young 
 men. In a typical instance, the only son of a devoted, beautiful 
 mother was in constant anxiety lest he should suddenly die from 
 cardiac failure or strangulation. In a confidential moment, with 
 unmistakable pleasure, he said that his mother had often told him 
 that "she loved him more than she did his father. He was dis- 
 tressed -by incestuous dreams and the fact that he and his father 
 were always hostile and unable to understand one another. He 
 could 'not admit that they hated one another, and though he wished 
 to love his father he could not give up stealing his mother's af 
 
240 PSYCHOPATHOLOGY 
 
 fections for himself.' Such secret intrigue was punished by the 
 fear that he must (ought to) die and renounce his enmity. The 
 crucifixion or dying of patients, who feel that they are Christs, is 
 always attended by severe anxiety. This mechanism has been 
 observed in many of our cases. 
 
 It is evident that the affective relationship between father 
 and son had a most signi-ficant direct influence on the theory of 
 evolution which will be still further shown later. 
 
 As to the suppressed affect that distressed Darwin and added 
 considerably to his invalidism, we are given an indication of its 
 nature by his methods of obtaining relaxation ; that is, relief from 
 its pressure. 
 
 He says : ' ' Novels,- which are works of the imagination, though 
 not of a very high order, have been for years a wonderful delight 
 and pleasure to me, and I often bless all novelists. A surprising 
 number have been read aloud to me, and I like all, if moderately 
 good, and if they do not end unhappily — against which a law ought 
 to be passed. A novel, according to my taste, does not come into 
 the first class unless it contains some person whoyn one can thor- 
 oughly love, and if a pretty woman, all the better." In this tend- 
 ency to become unduly distressed by a novel in which hate and 
 misfortune triumph over love and, on the other hand, of almost 
 requiring a diet of novels in which some character won the reader's 
 love, is a strong indication that Darwin suffered from suppressions 
 of affect which, if allowed free play, might have pained him in 
 his devotion for his dominating father. This would have shattered 
 his own peace infinitely worse than slighting the letter of an un- 
 scrupulous correspondent. Rather than permit the recalcitrant 
 competitive craving free play, he incessantly suppressed it and 
 never relaxed his vigil. This was not only to keep from paining 
 those he loved, but also to protect his powers for research by 
 avoiding tbe distractions that attend arguments and dissensions. 
 He regarded himself as being "not quick enough to hold an ar- 
 gument with any one." "Unless it was a subject on which he ^sf&% 
 just then at work he could not get the train of argument ' into 
 working order quickly enough" (p. 117), which shows how deeply 
 he became concentrated on the problem that he worked on. We 
 must recognize that his self-isolation, in Down, from nearly all 
 social contact, onabled.him the more to enjoy the free play of his 
 
MECI-J^VNTSM OF SUPPRESSION OR ANXIETY NEUROSES 241 
 
 love for biological research, but the eccentric nature of the self- 
 isolation was made necessary by the ease with which he lost control 
 of himself in a conflict. This, in turn, must be recognized as being 
 largely due to the nature of the suppressed affective tendencies. 
 "When he felt strongly about * * * a question, he could hardly 
 trust himself to speak, as he then easily became angry, a thing 
 wliich he disliked exceedingly. ITe Avas conscious that his anger 
 had a tendency to m.uUij)ly itself in the utterance, and for this rea- 
 son dreaded (for example) having to scold a servant" (p. 118). 
 
 The above characteristics indicate that Darwin could not trust 
 himself to conflict with others or protest with anger because the 
 suppressed affect, that was being held back like an uncoiled spring, 
 tended to become associated with the anger of the moment and it 
 multiplied too rapidly to be controlled. In this light we can under- 
 stand why he accepted everything that his father said as final. 
 
 It is quite reasonable to give considerable value also to the 
 fact that, although Darwin had to resist his father's wishes until 
 after the voyage of the Beagle in order to gratify the affective 
 attachment to his mother, after he had fairly clearly formulated 
 his theory of evolution at thirty, about the time of his marriage, 
 it became obvious to him that the successful proving of his theory 
 lay in his finding a means for devoting all his life to study, and this 
 his father could easily give him if he were so disposed. This fact, 
 making him the source of nourishment and physical comfort, em- 
 phasized the father's omnipotence and, in his resignation to it, 
 Darwin further renounced independence of affective expressio]]. 
 In one sense this was fortunate for science and civilization, be- 
 cause it gave him more freedom for affective gratification in the 
 one direction that alone could fascinate him, but, in another sense, 
 it ruined his health and almost spoiled his theory of evolution. 
 
 The influence of this affective conflict upon his conception of 
 the origin of species and his formulation of the theory of evolu- 
 tion, which Avas to free science of many suppressive influences, is 
 most interesting. At twenty-nine Avhen he happened to read for 
 amusement Malthus' "Essay on Population," (p. 68), he promptly 
 appreciated the significance of the universal struggle for existence 
 and the survival of the fittest, not only because he had enormous 
 collections of biological data in mind Avhich Avere readily corre- 
 lated with the law, but because it was his personal experience. 
 
242 PSYOHOPATHOLOGY 
 
 This evidently was exactly the mechanism of his own triumphant 
 emotional struggle with his father's wish.* He was experiencing 
 perhaps from obscure emotional sources the enthusiasm of the 
 survival of the fittest, because his older brother, whom he affection- 
 ately called "poor old Philos" (philosopher), had yielded to his 
 father's domination and studied medicine, even though he dis- 
 liked it and retired soon after graduating, whereas he himself, 
 through his persistence and courage, had triumphed. 
 
 Most significantly, Darwin comments (p. 68): "It at once 
 struck me * * * favourable variations (mother's favorite) 
 Avould tend to be preserved and unfavourable ones to be destroyed. 
 The result would be the formation of new species." (Parenthesis 
 inserted.) "Poor old Philos" never married and in that word 
 "poor" was unconsciously expressed Darwin's appreciation of his 
 brother's silent tragedy. He continues further: "Here then, I 
 had at last got a theory by which to work, but I was so anxious to 
 avoid prejudice, that I determined not for some time to write even 
 the briefest sketch of it." As to how much excitement the reading' 
 of Malthus' "Essay on I'opulation" caused Darwin can only be 
 conjectured, but he at least felt the necessity of guarding himself 
 against "prejudice." 
 
 This cautiousness of Darwin contrasts strikingly with the im- 
 pulsiveness of Wallace, although both men, when they realized the 
 biological significance of the survival of the fittest, were decidedly 
 aided by their own personal experiences. According to the "En- 
 cyclopedia Britannica, " Wallace, "Avhile lying muffled in blankets 
 struggling in the cold fit of a severe attack of intermittent fever" 
 fin the isolated tropical Moluccas], began to thinli of Malthus' 
 "Essay on Population" [which he had read several years pre- 
 viously] and, to use his OAvn words, ' ' there suddenly flashed upon 
 me the idea of the siirvival of the fittest. ' ' The theory was thought 
 out during the rest of the ague fit, drafted the same evening, writ- 
 ten out in full in the two succeeding evenings, and sent to Darwin, 
 by the next post. (This inspiration saved his name and brought 
 him his greatest honor. It was clearly an effort to save something 
 of himself from the onslaught of disease.) 
 
 Darwin and Wallace differed in their valuation of certain 
 factors in evolution, and this can be traced to personal experience 
 and wish- fulfillment. In their joint essay, "On the Tendency of 
 
MECHANISM OP SUPPRESSION OR ANXIETY NEUROSES 243 
 
 Species to Form Varieties; and on the Perpetuation of Varieties 
 and Species by Means of Natural Selection" Darwin used the 
 phrases, "natural selection * * * Avhich selects exclusively for 
 the good of each organic being" and "sexual selection," whereas, 
 Wallace emphasized "the struggle for existence." 
 
 Even more astonishing is the fact that Darwin, before he had 
 read "Wallace, while contemplating marrying his cousin, his moth- 
 er's niece, made the scientific conclusion, which he entered in his 
 diary, that "selection loas the keystone of man's success. But lioio 
 selection could he applied to orgcmisms living in a state of nature 
 remained a mystery to me," showing clearly that this man, as well 
 as Wallace, whose scientific formulations are molding the course 
 of modern civilization, even though rigorously trying to follow 
 pure reason, were unable to avoid unconsciously founding their sin- 
 cerest conclusions upon their own most personal emotional striv- 
 ings. 
 
 Three years after his marriage, at thirty-three, he first wrote 
 a brief abstract of his theory, and at sixty-seven he made this 
 significant comment (p. 68). "At the time I overlooked one prob- 
 lem of great importance; and it is astonishing to me, on the prin- 
 ciple of Columbus and the egg, how I could have overlooked it and 
 its solution. This problem is the tendency in organic beings de- 
 scended from the same stock to diverge in character as they be- 
 come modified. That they diverged greatly is obvious from the 
 manner in which spficies of all kinds can be classed as genera, 
 genera under families, families under suborders, and so forth ; and 
 / can remember- the very spot in the road, whilst in miy carriage, 
 when to my joy (symptoms of relieved repressions) the solution 
 occurred to me; and this was long after I had. come to Down. The 
 solution, as I believe, is that the modified offspring of all dominant 
 and increasing forms tend to become adapted to many and highly- 
 diversified places in the economy of nature." (Parenthesis and 
 italics mine') What affective resistances prevented him from see- 
 ing a principle which he himself characterized as being as simple 
 as Columbus and the egg? The source of resistance may.be quite 
 surely inferred when we consider that the principle means that 
 progressive divergence is an advantage in itself, because the com- 
 petition is most severe hetiveen organisms most closely related, 
 since they require the same food and love-object, hence it could 
 
244 PSYCnOPATHOLOGY 
 
 not help hut he associated loitli the old delicate competition he- 
 tween himself and his father for his mother's affections and his 
 dependence upon the father for food, etc. The phrase about modi- 
 fied, offspring tending to become adapted to diversified places in 
 nature has an interesting example in his marriage to an obvious 
 mother-image, mother's niece, and their retirement from the Avorld 
 to the seclusion of Down, of which he says, "Few persons could 
 have Uved a more retired life than we have. Besides short visits 
 to the houses of relations, and occasionally to the seaside or else- 
 where, we have gone nowhere. ' ' It seems not even to the continent. 
 For over forty years she was his wife-mother-nurse. 
 
 In 1869, at the age of sixty, Charles Darwin, accompanied 
 by his daughter, visited the home of his childhood, years after his 
 father's death. The tenant showed them over the place and with 
 mistaken hospitality did not leave the party. As they were leav- 
 ing, Darwin said, with a pathetic look of regret, "If I could have 
 been left alone in that greenhouse for five minutes, I know I should 
 have been able to see my father in his wheel-chair as vividly as 
 if he had been there before me. ' ' (The greenhouse as nature study 
 is the point at which the father and son began a progressive di-- 
 vergence.) 
 
 "Perhaps this incident shows Avhat I think is the truth, that 
 the memory of his father he loved the best, was that of him as an 
 old man." Mrs. Litchfield, Darwin's daughter, describes hica as 
 saying with the most tender respect, "I thinlc my father was a 
 little unjust to me when I Avas young, but afterwards I am thankful 
 to think I became a prime favorite with him. ' ' 
 
 It is interesting that the wish to visualize his father so vividly, 
 "as if he had been there," was naturally inclined to recall the 
 image of him as a dependent, helpless old man, and no longer the 
 father with "the art of making one obey him to the letter" (p. 18). 
 This illustrates again the universal struggle for power that causes 
 so much pain when not handled with insight. Darwin's father 
 was actually a very sincere, kindly, sympathetic man, as his large 
 practice and the affection of his patients showed, and it was not 
 in injustice and severity that he was dominating ; that attitude usu- 
 ally justifies an open revolt on the part of the son if the mother 
 does not interfere, but it was in his conscientiousness and sincer- 
 ity of wishing that he almost ruined his son. This is the type of 
 
MECHANISM OF STJPPKBSSION OR ANXIETY NEUEOSES 245 
 
 affective bond that holds the object in the severest grip when it 
 naturally needs to break away. Like the lovely daughter who must 
 sacrifice her love for children to a dependent, defective old mother 
 and finds to her horror that she has spontaneous wishes for her 
 mother to release her by dying. 
 
 Darwin's method of working showed how keenly he humored 
 his inspirations and nursed his strength in his ascent as a man 
 of intellectual attainments. His study chair was higher than the 
 average — he had long legs — but upon the top of this he placed 
 "footstools" so as to elevate himself considerably and then neu- 
 tralized the additional height by resting his feet on another chair, 
 much to the mirth of the family. The elevated seat of learning 
 surely had a genetic influence in his work through its reenforce- 
 ment of the compensator}^ striving Avhich he had to assume in order 
 to overcome his humility and deference and the "fatality" of 
 reasoning which had become an attribute of his attitude of mind. 
 
 When his margin of energy M^as too meagre to work consist- 
 ently on other scientific problems, he could still collect facts bear- 
 ing on the origin of species. "I could sometimes do this when I 
 could do nothing else," shoAving which wish in his personality was 
 the strongest and could continue to work after the others had to 
 yield to fatigue. He says he never stopped collecting facts on the 
 origin of species. 
 
 Never for a moment after clearly conceiving his inspiration 
 did he abandon the creation of it. The excitement and difficulties 
 he experienced in controlling the affective reactions that were 
 aroused, as the secrets of nature Avere revealed to him, may be es- 
 timated by the following comment : When twenty-nine, upon read- 
 ing Malthus' "Essay on Population," in Avhich the struggle for 
 existence is emphasized, "it at once struck me that under these 
 circiimstances favourable A^ariations would tend, to be preserved 
 and unfavourable ones to be destroyed. The result of this would 
 be the formation of neAV species. Here then I had at last got a 
 theory by which to Avork ; but I Avas so anxious to avoid prejudice 
 that I determined not for some time to write even the briefest 
 sketch of it." Four years later he aloAved liintself to Avrite, in pen- 
 cil, a tliirty-five page abstract of his theory. This Avas enlarged 
 two years later into 230 pages, and his completed theory was not 
 published until some twenty-nine years after the first general 
 ■ formulation of his idea of CA^olution. 
 
246 PSYCHOPATHOLOGY 
 
 Some other peculiarities in Darwin's methods of workiii^" 
 are important for the psychologist to recognize. He says : "When- 
 ever a published fact, a new observation or thought, came across 
 me, which was opposed to my general results, it was my practice 
 to make a memorandum of it without fail at once ; for I had found 
 by experience' that such facts and thoughts were far more apt to 
 escape from the memory than favourable ones" (p. 71) (forgetting 
 as a wish-fulfillment). His watch for exceptional phenomena was 
 keen; and "my love of natural science [the medium for gratifi- 
 cation of his childhood's wish] has been steady and ardent * * * 
 This pure love had, hoAvever, been much aided by the ambition 
 to be esteemed (italics inserted) by fellow naturalists." (Reen- 
 f orcing postadolescent wishes produced by the influence of Grant, 
 Henslow, Lyell, and others.) "From my early youth, I have had 
 the. strongest desire to understand or explain whatever I observed 
 [this originated in his mother's curiosity], that is, to group all 
 facts under some general laws. These causes combined, have given 
 me the patience to reflect or ponder for any number of years over 
 any unexplained problem." (This mechanism of freely grouping 
 facts under general laws- permits the affective cravings full spon- 
 taneity of function and they are not then subdued or depressed by 
 inhibiting fears of being unwise or mistaken. The capacity for 
 spontaneous discriminations and comparisons is tremendously 
 greater than when shut in by don'ts. "I have steadily endeavored 
 to keep my mind free so as to give up any hypothesis; however 
 much beloved (and I can not resist forming one on every subject) 
 as soon as facts are shown to be opposed to it. He says that every 
 single first formed hypothesis except the one on coral reefs had to 
 be modified after a time or given up. 
 
 Darwin's magnificent courage fo think persistently and hon- 
 estly and the results of his method, as the mechanism of personal 
 improvement, is a splendid example that our American scientists, 
 holding influential chairs in research and education, should con- 
 sider. The minds of many American academic scientists seem 
 to be subtly subdued by the fear of making a mistake or of even 
 considering an hypothesis that possibly may have to be modified 
 or abandoned. This is particularly true for psychiatry and psy- 
 chology. 
 
 Darwin's attitude toward the objects of his inquiry, especially 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 247 
 
 flowers, also reveals the affect that forced the inquiry, which was 
 love. He seems to have shown no narcissistic cravings to scintil- 
 late, or hatred, prompting him to acquire a triumph in order to 
 have a potent tool for conflict, or a desire to be admired or to es- 
 tablish priority. His love for flowers led him to treat them al- 
 most as personalities. His son says: "I used to like to hear him 
 admire the beauty of a flower; it was a kind of gratitude to the 
 flower itself, and a personal love for its delicate form and colour. 
 I seem to remember him gently touching a flower he delighted in ; 
 it was the simple admiration that a child might have. He could 
 not help personifying natural things. ' ' His theory made him their 
 coequal. The actual experiences in his life in which flowers were 
 so associated as to arouse such tender affections, he practically 
 tells us, occurred in his early childhood when his lovely, gracious 
 mother revealed her curiosity about the secret of nature which 
 might be answered by looking "inside" of the flower. 
 
 Darwin, as a father and creative thinker, was a inost unu- 
 sual exception to the rule in that he proved to be a successful 
 father ; whereas, most intensive thinkers make poor fathers. The 
 career deprives the child of much needed attention. The "Ency- 
 clopedia Britannica" says four of his five sons became prominent 
 in the scientific Avorld. The honor for this, hoAvever, probably is 
 due Emma Wedgwood, Mrs. Darwin, whose Avonderful personality 
 made it possible for Darwin himself to become the creator of his 
 work. 
 
 Darwin's attitude toward his children as an educating influ- 
 ence was radically different from his father 's controlling methods 
 in that he permitted his children to develop as freely as possible, 
 thereby permitting the affective forces to exercise their fullest 
 powers. He treated his children with "unbounded patience" and 
 never "spoke an angry word to them in his life," but it "never" 
 entered their heads to disobey him. This was not their fault but 
 due to the fact that he always "respected" their "liberty" and 
 "personality." 
 
 Conclusion 
 
 The principal characteristics of Darwin that made him one of 
 the great constructive thinkers of all time are: (1) the loyalty 
 with which he cherished his mother's wish (fortunately it was 
 practical as well as ideal, which can not be said of the wishes of 
 
248 PSYCHOPATHOLOGY 
 
 most mothers). lie had to struggle with influences that ■would 
 divert him from his love-object at ten to seventeen in the classical 
 schools, at seventeen in the medical school, at twenty in a theo- 
 logical school, at twenty-two to make the voyage of the Beagle, and 
 at twenty-seven to thirty when he finally renounced all interest in 
 the last remaining restraints, orthodox Christianity, btcoming, as 
 he considered himself, an "agnostic." 
 
 As a school-boy and a student he became depressed and dis- 
 interested when he was forced by the stupidity of academic edu- 
 cators to acquire in learning what his emotions had aversions for, 
 and yet he literally glowed with enthusiasm when permitted to 
 make his own free selections of friends and literature in biology 
 and geology. His own experience demonstrated that depression 
 of compensatory adaptive capacities follovjed when an environ- 
 ment luas persistently tmfavorable to the affective needs. 
 
 In this respect the educator "s crime of forcing children into 
 prescribed courses deserves the most remorseless criticism, be- 
 cause it is still practiced today in our public schools and universi- 
 ties. 
 
 (2) The second attribute that contributed to his success was 
 the absolute freedom of his thinking and theorizing about ' ' every- 
 thing" and his humble ^^allingness to abandon any theory, no mat- 
 ter how much beloved it might be, when exceptions disproved it. 
 (When the dominant craving that the theory satisfies is not love 
 but hate, it seems to be much more difficult to admit error or to 
 risk an error.) 
 
 "He often said that no one could lie a good observer unless ho 
 was an active theorizer" (p. 126), which decidedly means that 
 since our spontaneous observations and ability to react to sublim- 
 inal stimuli, that is delicate or slight variations in the environ- 
 ment, depends upon the freedom with AvTiich the aff ective-autonomie 
 cravings may work, no one, Avho must work with material that he 
 hates, can become a good observer. This is the most common cause 
 of the tendency to dullness of thinking in most matured males and 
 females. Economic and moral obligations force the individual to 
 continue with the unpleasant work. 
 
 (3) His inherent perseverance and humility and sincerity. 
 
 (4) His patience, which was probably due to the fact that Mrs. 
 DarAvin was a perfect mother-image by birth and temperament. 
 
 (5) Freedom from economic distractions and family conflicts. 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 249 
 
 (6) The suggestions from his grandfather's theory and the 
 influence of Grant, Henslow, Sedgwick, Lyell and Hooker, that 
 counteracted his father's resistance to his becoming a naturalist. 
 
 (7) The sacredness with which he regarded his objects of re- 
 search and the religious manner in which he consecrated himself 
 to the study of nature. 
 
 The influences that conditioned Charles Darwin's affective 
 cravings so that the only thing he could satisfactorily do in life 
 was to write theories of evolution and study the secrets of nature 
 were (1) the peculiarly influential personality of his mother, due to 
 her (a) love, (&) beaiity, (c) sweetness, (d) fascination for her 
 father-in-law's work, and (e) her intuitive recognition that he Avas 
 not through with his task; (2) his grandfather's quest and theory; 
 (3) the personal influence of his postadolescent hero. Dr. Grant, 
 to which was largely contributory Darwin's affective dileimna 
 with his father, the confidential nature of the talk, his "silent as- 
 tonishment" whereby he did not lose the tension of the affective 
 reaction through talking it off; (4) Prof. Henslow's ministerial 
 and scientific interests, in Avhich personal combination of the wish 
 to please his mother as well as the conflicting wish to please his 
 father, both found a medium for gratification; (5) his uncle's in- 
 sight into the father-son conflict; (6) the voyage of the Beagle; 
 (7) the father's sensitive half -acknowledgment of pleasure in his 
 son's change of interest from sports to intellectual work; (8) his 
 father's forbearance from further conflict; (9) economic inde- 
 pendence; and (10) the unreserA^ed devotion and heroic patience of 
 his wife. When Ave think of how she deA^oted her life to his com- 
 fort and shared every one of the miserable nights Avith him dur- 
 ing his last years, the only song that DarAvin ever sang correctly 
 has a distinct interest. 
 
 AE HYD Y NOS (Welsh) 
 
 (All Through the Night.) 
 Ah! my love, how sad and dreary, 
 
 All through the night, 
 Is my heart with sighing weary, 
 
 All through the night. 
 Dearest love, couldst thou but hear me, 
 Sjirely thou wouldst, hasting, cheer me, 
 And remain forever near me, 
 
 All through the night. 
 
250 PSYCHOPATPIOLOGY 
 
 Sweetly sang beside a fountain, 
 Mona's maiden on a mountain, 
 When wilt thou from war returning, 
 In whose breast true love is burning, 
 Come and change to love my yearning, 
 By day and night? 
 
 The causes of Darwin's anxiety neurosis may be attributed 
 to Ms complete submission to his father whereby he deprived him- 
 self of all channels of self-assertion in his relations with his 
 father or anything that pertained to him. Free assertions for his 
 rights might have led to a mortal father-son conflict, because 
 both had irrepressible affective cravings that contended for the 
 idealization of the same love-object. This would, perhaps, as it 
 so often does, have terminated in Darwin becoming a paranoiac, if 
 not an invalid. His search for the secrets of nature and his 
 mother's love would then have become hopelessly aborted by hate. 
 Through the renunciation of all envy and all competitive interests 
 in life, such as ambition for priority, and the unreserved accept- 
 ance of his father 's word and wisdom, Darwin, by adroitly select- 
 ing diversions, succeeded in keeping suppressed all disconcerting 
 affective reactions, with no more inconvenience than that of pro- 
 ducing nutritional disturbances, uncomfortable cardiac and vaso- 
 motor reactions, vertigo and insomnia. 
 
 The more one analyzes personalities, the origin of their 
 wishes, their wish-fulfiUing-striving and the accidents that exert 
 a definite influence upon their successes and failures, the more one 
 realizes that many men and women are potentially, finely creative, 
 but few are fortunate enough to become associated with factors 
 that enable them, to overcome or -evade resistance. 
 
 Darwin's forty years of serious anxiety neurosis, when asso- 
 ciated with the father's brother's "incipient" insanity and suicide, 
 may invite the impression of his being a constitutional inferior 
 with hereditary psychopathic traits that forced him to devote his 
 entire time to what was then regarded as useless theorizing in 
 order that he might "grasp this sorry scheme of things entire." 
 
 I believe that Darwin's psychopathic traits were entirely due 
 to the persistence ivith which he suppressed certain autonomic 
 functions, affective cravings, in order to gratify other cravings. 
 
 The seriousness of his regret for having conflicted with his 
 father may be seen in the strange paragraph which Francis Dar- 
 
mechanism: of suppression or anxiety neuroses 251 
 
 win uses in concluding the biography of his father's life: "As 
 for myself, I believe I have acted rightly in steadily following, 
 and devoting my life to science. I feel no remorse from having 
 committed any great siii, but have often and often regretted that 
 I have not done more direct good to my fellow creatures" (p. 
 530). One can not help but think in this connection, of the un- 
 happy father who wanted a son to practice medicine with him. 
 
 Darwin's anxiety neurosis, to repeat, was characterized by 
 inability to adjust to excitement, anticipations, changes of heat 
 or cold, cardiac palpitation and vasomotor flushing, indigestion, 
 nausea, vomiting, violent tremors, insomnia, persistent thoughts, 
 inability to criticize, or to endure social contact or worry. 
 
 This anxiety continued active almost daily throughout forty 
 years, but at times his, distress became so severe that he was un- 
 able to work for several months at a time. Many forms of treat- 
 ment and a series of physicians were tried, but the most restful 
 and efficacious were hydrotherapeutic treatment and the personal 
 influence of Dr. Bence Jones, and later of Sir Andrew Clark. 
 
 AN-3 
 
 The following case, (AN-3), a well-known scientist whose dif- 
 ficulties were studied by the psychoanalytic method, Avas similar in 
 many respects ; particularly as to the influence of the lovely mother 
 and domineering, impatient, but sincere father, the necessity for 
 encouragement through becoming an esteemed man's protege, a 
 very serious emotional crisis at thirty-three, attended by most in- 
 tense resolutions for self-refinement, splendid scientific achieve- 
 ments, compensatory wish to devote all w'ork to "pure science" 
 and a persistent tendency to anxiety. Ineradicable feelings of 
 having weakened his mental powers through adolescent mastur- 
 bation were not so pronounced in Darwin. In two vital respects 
 this case was different. He was always in financially more or 
 less pressing circumstances, and though he loved a beautiful, moth- 
 ering type ,of girl, he was. unable to marry her because of the per- 
 nicious anxiety that was aroused by her approach after the crisis 
 at thirty-three. His life ended most tragically because of the un- 
 happy, unsolvable situation that finally wrapped itself irresisti- 
 bly about him. 
 
 His case is presented as a suppression neurosis, because that 
 was what he suffered from until his final crisis when he developed 
 
252 PSYCHOPATHOLOGY 
 
 a paranoid compensation. As a paranoid character with parricid- 
 al inspirations, his oase bridges over to the pernieions repression 
 compensation neurosis and in turn to chronic pernicious dissocia- 
 tion of the personality. Hence, his case, though not recapitulated 
 with the paranoia group will, however, frequently be referred to 
 in that chapter. 
 
 This man's life shows §,lso, like Darwin's, that the adult, ca- 
 reer of the individual is fundamentally determined by the family 
 situation molding the affections of youth, unless tremendous af- 
 fective adjustments are later successfully made. The patient's 
 impressions of his parents are herein used entirely, becSust^ in so 
 far as he is concerned, they reveal the nature of his adaptation to 
 them. Naturally, other people, friends and relatives, had very 
 different impressions of them. 
 
 His father, he said, was a man of "strong character," and 
 prided himself particularly on his efficiency. At eighty-one he was 
 in "full working strength." He was seemingly "never sick, nor 
 worried. * * * jje was scornful of ailments, yet full of ten- 
 derest sympathy toward acute suffering. I seem to have been 
 the one great trial to him in the family. He was genuinely con- 
 cerned about my mysterious, yet obvious, nervous disabilities; 
 though in my presence he seemed to feel only irritability, and in- 
 variably inquired, 'Well, where 's the pain?' He seemed to enjoy 
 my irritation over this." (This spontaneous association of sen- 
 tences by the patient, it will be seen later, reveals the cause of 
 his invalid adaptation to his domineering father.) "He was 
 deeply religious, always just (in intention) yet arbitrary and over- 
 bearing. * * * Never reasoned with his children or explained 
 his attitude." The patient further described his father's attitude 
 as "illogical" and "impulsive," ruling his family with puritani- 
 cal sternness and maintaining that Avhatever the situation or dis- 
 agreement "nevertheless the fact remains" that the "father" 
 should be obeyed. 
 
 "My mother seemed to be none of these things, and for this, 
 at an early age, I thanked God devoutly. I worshipped my mother. 
 But I thought she took a Avrong attitude. She would do nothing, 
 nor permit us to do anything 'to annoy your father.' " The pa- 
 tient's affective reactions to the suppressive father, if they had 
 been allowed to be frankly asserted, would probably have enabled 
 him to attain his affective independence and maturity. They were 
 
MECPIANISM OF STJPPRESSION OR ANXIETY NEUROSES 253 
 
 normally enough aroused, but the seductive attitude of his mother, 
 whom he could not pain by conflicting with his father, subtly dis- 
 armed and crucified him. (See Michelangelo's "Pieta," Fig. 54.) 
 The nature of the parental combination distorted his attitude and 
 definitely turned him upon an eccentric emotional adjustment. 
 (All the children in this family except the patient finally openly 
 revolted against the father domination and demanded the right of 
 equal and spontaneous expression of opinion and feeling. The 
 patient's brothers and sisters urged him, after he became a man, 
 to correct his father's attitude of domination and to insist upon 
 equal rights. This, the patient was never able to do, even though 
 it occupied his most serious contemplation.) He could not over- 
 come the resistance except through an uncontrollable outburst 
 due to the siunmaiion of a long series of insults, and he dared not 
 trust himself in this. 
 
 The patient's mother, according to his impressions, was a 
 beautiful, modest, retiring, girlish woman, who tended to suffer 
 silently if wronged and adjusted herself to her husband's inter- 
 ests, believing that the father's word should be law. He should 
 be master of his household, even though she could hardly endure 
 some of his selfish domineering methods. 
 
 The patient said, "At the table Ave were not to speak unless 
 spoken to, or, if we asked for anything, it miTst be done in a low 
 deferential tone. At other times when a request was made, and 
 only reasonable requests were likely to be made, it was always 
 met at first by a refusal. Later, without explanation, and after a 
 delay calculated to discipline the spirit, the reqiTest would be 
 granted." (This procedure, no doubt, greatly contributed to the 
 suppression of spontaneous emotional adjustment.) 
 
 The patient was the oldest son, and the following bitter inci- 
 dent reveals the chronically suppressive attitude of the father to 
 his first son, and the extreme steps he would take in order to hu- 
 miliate (crucify) him before the household. (It can not be as- 
 sumed that the father had any insight into the influence of his 
 suppressive attitude. His reasons were, no doubt, disguised under 
 the belief of necessary, disciplinary measures, in order that the 
 son should submit to and have respect for the word of the father.) 
 To illustrate with an incident. One day at the dining table the 
 patient, then a boy of about ten, persisted in maintaining a rebel- 
 
254 PSYGIiOPATI-IOLOGY 
 
 lious attitude about sometliing that displeased tlie father. He 
 ordered the boy's submission, and the youngster arose from the 
 table with obvious display of resistance. Thereupon, the father 
 threatened to use force, reverting to the principle of might shall 
 rule, and demanded that his son should stand with his back to the 
 table and prfess "his nose against a flower on the wall paper." 
 
 The boy now became openly defiant and refused point blank, 
 but, before he could vent his righteous indignation, his mother 
 rushed to his side and anxiously pleaded that he must "please" 
 not answer back to his father. His moral support thus gone, the 
 crisis was lost, and his anger, for the sake of his mother, had to 
 be suppressed. He submitted to the mother and, for her sake, Ms 
 personality was sacrificed to the father. The crucifixion of his 
 .affective independence seems to have been gradually completed by 
 the long pressure of this combination of influences. This is but 
 one incident illustrative of a chronic parental attitude. (At fifty- 
 seven, when the -patient reviewed this experience, he was utterly 
 unable to control his affective reactions, which were mingled with 
 violent anger, weeping and shame. He expressed astonishment 
 that, this ancient injustice should cause so much "unmanly" dis- 
 tress forty-seven years later. It certainly revealed one great 
 source of his affective tension.) 
 
 Although the above incident occurred when the patient was 
 about ten, it should be seen as illustrative of the nature of the pa- 
 ternal and maternal pressure and the reflex adaptation tendency. 
 This affective triangle, of course, had its beginning- in the early 
 childhood of the patient and, although no single truly disastrous 
 episode occurred, the continuity of the situation had its irremedi- 
 able conditioning effect. 
 
 When he was eight, the patient was sent into the country to 
 recover from depression. He was, however, unable to meet the 
 expectations of his more self-reliant cousins, and they were char- 
 acteristically disappointed in his timidity and unwillingness to ad- 
 mit his inferiority to their prowess. The situation increased his 
 depression and he was returned to his home in a condition that 
 greatly alarmed his parents. His father's "tenderness" upon 
 his return was surprising and made a distinct impression upon 
 him. In due course of time he recovered from homesickness and 
 developed "what the women of the .household called a 'lovable 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 255 
 
 disposition.' " The father recognized this cliaracteristic as that 
 of "a sissy boy," and the "lovable disposition" as "girlishness." 
 lie criticized this and objected, but the mother (as is characteristic 
 for this type of mother) defended her son "with spirit," and the 
 father "Avas silenced for a period." This encouraged the youth 
 to assert himself by criticizing his father, but the mother soundly 
 admonished him of the wrongfulness of it. He said (at fifty-seven) 
 "I think I was neither timid nor shy by nature, but I learned 
 to be silent under injustice. Later, when I should have reasoned 
 myself out of this state of mind, it had become second nature — 
 I now react to personalities of a certain type — my father's type — 
 as I have always reacted to his, from the time he took me in hand 
 for training, and I, out of consideration for my mother's feelings, 
 yielded up my independence." (This illustrates the fatal condi- 
 tioning of his power to protect himself from injustice and the 
 growth of the fatal tendency to homosexual self-sacrifice. 
 
 "The way out is simple," he commented, during the psycho- 
 analysis, "I believe — simple in method, but difficult to practice 
 because I have to deal with a long-established habit. It will be nec- 
 essary to get up a counter habit. It is necessary merely to stop 
 and think, and re-establish the independent attitude. The oppor- 
 tunity for practice is afforded many times a day, wherever I may 
 be. That is, I cringe no more, and with no more serious affect, 
 before, say, the chief of my office (if it happens to be domineering 
 in the peculiar sense I mean) than before any chance associate, 
 about whose opinion of me I really care, or should care, nothing. 
 
 "I have expierimented, and with illuminating results. Quite 
 naturally, I began wrong. The blustering manner is wrong; the 
 mollifying, conciliatory manner is wrong. Both are harmful, even 
 though they succeed. What I have really to deal with is not the 
 manner of the other fellow, which seems so terrifying, but my own 
 reaction to it. The trouble is si(,bjective. li is merely necessary 
 to have the courage of my coivardice — not try to hide it; hut to stop 
 and think. The result of this self-examination is that I get back 
 immediately to the self-possessed, critical attitude which I used to 
 assume with my father when I began to be disillusioned and be- 
 fore I had learned to fear him. I then feel at ease and good na- 
 tured. And, if a smile, or a laugh, follows, it is disarming because 
 if it obviously sincere." (The unconscious substitution of "if it" 
 
256 PSYCHOPATHOLOGY 
 
 for "it is" indicates the subconscious doubt he felt as to his ability 
 to master himself.) 
 
 The patient was inclined to teel that another reason for his 
 pathological self-conscioiisness and feelings of inferiority upon 
 his visit to his cousins and, later, their visits to his home, was his 
 inability to stop day-dreaming aiid masturbating. (Because of 
 his unusually accurate habits of thinking as a scientist, and his 
 keen analytic insight, his contribution to the psychology of auto- 
 eroticism and homosexual crucifixion is of great value.) The on- 
 set of the masturbation interests, he felt, upon long, careful retro- 
 spective consideration, to have been a logical outgrowth of the 
 suppression of love and anger. He was a very affectionate child, 
 and very demonstrative, until the unresponsive attitude of his 
 parents, which he thinks was in some respects assumed in order to 
 control him, taught him to regard "the open expression of feeling 
 as bad form— the possession of feeling, even, a weakness to be 
 covered up." 
 
 "Toward the end of this period [aged eight] I formed the 
 secret habit of inventing, in fancy, situations in which my longing 
 for affection from others, as demonstrative in its expression as 
 my own was naturally, was satisfied; and out of excessive indul- 
 gence of such fancies, the practice of masturbation developed spon- 
 taneously." The one person of all others for whom the patient 
 had an insatiable craving for demonstrations of affection was his 
 mother. This was the price she had to pay for begging him to 
 sacrifice his masculine protests against the father's suppressions. 
 Had the father not been so unfortunately disposed as to suppress 
 those interests, but rather to look for them as signs of vi|j,0rou§?a'^ 
 growth, the boy's affections would naturally have extended them-' ' 
 selves in the masculine manner of openly working to win esteem 
 and fighting for their rights instead of covertly pleading for and 
 fancying them. 
 
 The early vaguely defined fantasies of girls making love to 
 him gradually crystallized into well-defined masturbation fanta- 
 sies which Avere carefully recorded at the time of this discussion. 
 He said he would become sexually excited (this was after puberty) 
 by a certain type of modest, retiring, pretty, serious, but not deep, 
 type of slender girl, and fancy himself having a love scene. Dur- 
 ing this fantasy he would masturbate. This was followed by de- 
 spair and resolutions which, however, soon weakened as his eroti- 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSKS 257 
 
 cism became active again. At nineteen, it may be included liero, 
 when .he attempted actual sexual relations, he found that all women 
 were disgusting, and could only get satisfaction through visual- 
 izing his ideal feminine type, while the real woman became "a 
 lump of clay" that he had "fooled." After he became an adult, 
 upon one occasion, his paramour reprimanded him when she no- 
 ticed his distracted state of mind. She said: " 'I don't believe 
 you know I am here ' " ; and ' ' she was right about it. " (In follow- 
 ing this patient's biological career, I hope the reader will recognize 
 that as an.adult male he was only capable of a form of masturba- 
 tion per vagina and, what is most important, that his fancied sex- 
 ual object had, without his realizing it, all the charming attributes 
 of his mother. The mechanism of this unfortunate evolution of his 
 sexual affections has been well enough explained by the patient to 
 permit us now to study his intellectual career and his final dis- 
 astrous ending. It is of the utmost importance to appreciate that 
 the sexual functions are not merely confined to the sexual act.) 
 
 To return to the struggles of his childhood, from eight to nine 
 his health improved (father's tenderness) and his teacher credited 
 him with having "promise" and "alert intelligence." His family 
 regarded him as having a "delicate constitution" (failing to un- 
 derstand the chronic anxiety and brooding of the boy.) 
 
 At the age of nine, he was turned over to his grandmother to 
 be trained with particular attention to his undesirable timidity 
 and "girlishness." This grandmother was the "most masculine" 
 woman the patient said he ever learned to know. ' ' She derided mo 
 for my girlish sensitiveness, for my delicate coloring; that didn't 
 belong to a boy, and for certain sweet (celestial) notes in my sing- 
 ing voice that my mother, who was an expert in music, particularly 
 admired." The grandmother was proud of the fact that all her' 
 girls had been like boys, but her attitude, "although it did.no 
 harm," he said, failed to correct his shyness. "Her desire, though 
 unacknowledged, was to protect me from a harsh world," was the 
 boy's impression of her methods and she brought out no responses 
 of latent manliness. 
 
 At eleven, he was sent to a boy's boarding school, and re- 
 sponded with interest in athletics and led his class- as a student. 
 From eleven to twelve, he succeeded in distracting himself from his 
 masturbation difficulties, but at- twelve he relapsed again, so seri- 
 ously, because of suppressive influences among his playmates, that' 
 
258 PSYCHOPATHOLOGY 
 
 he despaired of ever beiiigable to master himself. (The result of 
 being completely suppressed by the first rival. His athletic inter- 
 ests and studies were seriously neglected, and he became morose, 
 sensitive, timid and decidedly shut-in.) 
 
 "The thing I was morbidly emotional about was my secret 
 habit. I was at school five years, and during the latter half of 
 this period failure to overcome it made me completely miserable. 
 An aunt — a younger sister of my mother — to whom I was de- 
 voutly attached, died during my third year at school ; and, though 
 I had by now completely rid myself of religious belief, I, never- 
 theless, suffered acutely from the mere possibility that I was mis- 
 taken, and that my blasting shame would now be made clear to 
 her. 
 
 "The longing* of the average normal man to be a boy again is 
 to me incomprehensible; the decade of youth through which I 
 passed at this time was unmitigated hell. The feeling of degrada- 
 tion, which never left me, mounted at times to a distraught con- 
 dition. During the last year in school, a stroll in the hills alone 
 on several occasions was given over to continuous prayer, to the 
 possible God, for miraculous relief." (The agonizing aftermath 
 of secret autoeroticism.) 
 
 At seventeen, he entered a university. At nineteen, an un- 
 expected crisis solved his masturbation problem for him. He of- 
 ten. regretted that he himself had been unable to master this ten- 
 dency. (Unlike the average youth he had retained the habit as a 
 secret, that is the ego had had no opportunity to assimilate the 
 'periodic segmental domination by confessing it, that is, allowing 
 it to become directly associated mth his striving for social esteem 
 by openly discussing it, which is the mechanism most boys use to 
 overcome their old mutual masturbation interests.) 
 
 The crisis occurred at dinner in a boarding house. The good- 
 natured matron wanted to reprimand the boys for eating too hur- 
 riedly. She wanted them to follow the example of our patient, 
 who ate slowly and masticated thoroughly. She, however, said, 
 "Boys, why don't you do like Mr. • — . He masturbates (for mas- 
 ticates) thoroughly." The patient's extreme embarrassment and 
 general disposition left no doubt that he was addicted to mastur- 
 bation. That night the patient's room-mate advised him to use 
 his method of self cure, namely sexual intercourse. The patient 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 259 
 
 consented, and, upon his room-mate's arrangement, began the un- 
 satisfactory sexual career of masturbation per vagina already 
 referred to. (The nature of the masturbation fancies, that is, 
 whether or not they are shared with a companion, or are secretly 
 fixed upon someone Avhose personality finally becomes offensive, 
 probably determines the outcome of the autoerotic trend. If the 
 transference, hence the fancy, is fixed upon some one who, although 
 he or she is not aware of this erotic use, persists in maintaining a 
 devoted attachment, like a mother, sister, or friend, the individual 
 will probably not be able to break up the habit until the transfer- 
 ence is greatly mitigated. ) His own comments on the masturbation 
 mechanism are so valuable that they should be recorded at the ex- 
 pense of some repetition. "The temptation to enter upon this 
 course — and the support in it, at the onset — for I doubt if I could 
 have accomplished it unaided — came at a time when I had about 
 abandoned hope of overcoming the masturbation habit. In earlier 
 years, I had looked forward to self-mastery, eventually; and to 
 marriage, as a matter of course. But I had now made marriage 
 impossible. So far as I can see, I had lost nothing of early ideals 
 and illusions. Though affecting a cynical view of life, moral con- 
 siderations Aveighed heavily still. 
 
 "In the practice of masturbation I^had employed a mental de- 
 vice, to which was due, I think, the strength of its hold upon me. 
 Masturbation itself, as I have said, had developed spontaneously 
 out of an earlier habit of creating fancies, in which an old persist- 
 ent craving for demonstrative love from others was satisfied. 
 [The "suppressed wish" had been prevented from seeking for the 
 love of another by the father's censorship.] I visualized my fem- 
 inine ideal — never quite any actual person. But these seductive 
 fancies were not deliberately created, except at the onset. I came 
 to realize that they led inevitably to masturbation. They were re- 
 sisted, sometimes for weeks. During these exceptionally long pe- 
 riods, mental dullness grew upon me ; yet failure came in the end, 
 not so much because the powers of resistance had weakened, as 
 because the increasing phantasm had become convincing, and the 
 physical act to which it led no longer appeared repulsive. The idea 
 of sexual intercourse with women, though, for a different reason, 
 was no less repugnant to me ; in the performance of the act I was 
 self-conscious and critical. But this was only for a time, until the 
 novelty of the new relation wore off. During the act, creations of 
 
260 ■ PSYCHOPATH OLOGY 
 
 fancy, coming unbidden, and more vividly real than before, eif aced 
 all. ftonacionsness of its unpleasant realities. Thus, without effort 
 on my part, the habit of masturbation was displaced. Even in 
 periods of enforced continence, there was no temptation to retiirn 
 to it. I Avas indifferent to it as a means of sexual gratification." 
 
 Before completing his studies he came under the influence of 
 a certain well-known scientist, who, although only a middle-aged 
 man then, had already made an international reputation. (I have 
 met this man, now a venerable looking gentleman, and found him 
 to have very well-developed paternal traits. The patient virtually 
 attached himself as to a foster-father, although ostensibly they 
 were just good friends.) Through the influence of their mutual 
 transference he adopted this man's science for his own career and 
 determined to devote himself to intellectual refinement and scien- 
 tific contributions. 
 
 It is probable from what has been demonstrated by young men 
 having similar difficulties, and what happened later in the pa- 
 tient's career, that this transference, or, as popularly considered, 
 this friendship, saved the patient from an early collapse mth, per- 
 haps, paranoid mental deterioration. It is worth noting, with this 
 possibility in mind, what actually happened Avhenever the trans- 
 ference was broken and the final disaster that resulted. 
 
 The patient said their friendship continued from the time he 
 was a student when "we used to live together. I mean [correcting 
 himself] I lived across the street." Then he added that he had 
 often hoped he might live with Mr. T — , and was disappointed 
 when not invited to do so, ' ' Since all his children are dead. ' ' This 
 last quotation he promptly corrected. (They are not all dead.) 
 Mr. T — had said upon one occasion that he wished his son had 
 the superfluous energy the patient had. The interest of Mr. T — 
 was truly paternal in that he not only took the patient in hand, . 
 but furnished him with funds, advised him, nursed him and bol^ 
 stored up his scientific researches with his own productions. 
 
 (Like the patient's own father, Mr. T — Avas incompatible 
 with his OAvn son, bjit adopted another "convalescent" (crucified) « 
 ypiith and made a career for him. Similar in its mechanism, the 
 patient was unable to endure his father's suggestions, but had to 
 have another matured male to advise and encourage him. These 
 characteristic tendencies of personalities to make positive and. neg- 
 ative, transferences unconsciously, reminds one of the positive and 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 261 
 
 negative valency that complex chemical molecules have for one an- 
 other. Mr. T — and the patient adopted each other in order to 
 gratify the needs for the devotions of father for son and son for 
 father. (This is a common relationship between master and ap- 
 prentice.) 
 
 His career as a scientist, which covered abont thirty-six years, 
 from twenty-one to fifty-seven, may, for the sake of brevity, be 
 sunmied up in a paragraph. Despite a long series of neurotic 
 episodes, he made several very valuable contributions to science, 
 but his supreme achievement, toward which all his scientific inter- 
 ests converged, was never completed. Even though he had col- 
 lected practically all the necessary data and formulated his hy- 
 potheses, he was never able to complete the work. The tragic 
 causes of this will be presented in their chronological order. 
 
 At twenty-two, he had his "first nervous breakdo"WTi. " This 
 was the first one of a series, all of which were essentially similar 
 in type and so characteristic that the underlying cause should have 
 been recognized by his physicians. The attacks were diagnosed as 
 "neurasthenia," because they developed gradually, usually fol- 
 lowing periods of so-called "overwork" or "malaria," and were 
 characterized by "dullness," "weakness," "irrital)ility" and ob- 
 sessive "cravings for sympathy." Gradually the craving for 
 sympathy would work into a dramatic ' ' climax ' ' and then, to the 
 surprise of all his friends, within a few days, he would return to 
 work with a rebound, as if completely refreshed and invigorated. 
 (This neurotic mechanism is, in its characteristics, decidedly an 
 aborted autoerotic mechanism.) It is also important to note that 
 he had no "neurasthenic" episode following a severe siege of 
 typhoid. 
 
 The second attack (at twenty-five) was diagnosed as "a touch 
 of locomotor ataxia" (occurred in 1881). The patient describes 
 the mechanism of the attack in the following words (it should be 
 noted that he submits to his father and makes him pay with sym- 
 pathy for the submission) : "I had a touch of locomotor ataxia. I 
 don't know that the offhand diagnosis was^ correct; I never had 
 anything like it again. I had been having malaria — well-marked 
 chills and fever. I was falling behind in my work. On good days 
 I overworked, often returning to the office at night and working 
 late. I foolishly resisted appeals from my mother to go slow^ ; I 
 went faster instead. My father tried to exercise authority and 
 
262 PSYCHOPATHOLOGY 
 
 I left home. I packed up and went to a boarding-house and sent 
 for my trunk. In my relations with my father — who had no sym- 
 pathy for my iveahness and declared that I had never grown up — I 
 always acted pettishly. We were friends only in our correspond- 
 ence — ^neither of us could stand the strain of personal contact. No 
 attention was paid to my absence, and in a few days I returned 
 home. I called for my father at his office and walked home with 
 him. I was contrite and sought to get on a footing of frank under- 
 standing. My father met me half way ; but the interview lasted too 
 long. As we entered the house and met others of the family, he 
 explained to them, laughingly, that the heat had developed in me a 
 latent hysteria; and, turning to me in sudden exasperation, he 
 advised that / learn dignity of bearing from my sisters. [The 
 son's inability to openly respond almost violently to and discharge 
 the affect of hate at this insult was years later to contribute to a 
 parricidal inspiration.] The next morning on the way to my office, 
 I found myself walking dizzily and unable to lift my feet properly. 
 [See the feet in Michelangelo's "Pieta" and Case CD-I.] I turned 
 into a barbershop and, in the chair, recovered. Later, in the office, 
 standing before one of my superiors (father image), the dizziness 
 returned. This I deliberately exaggerated, pretending to faint, 
 and, falling heavily, permitted my head to strike the floor violently. 
 My friend at once ordered a carriage and drove me home. As the 
 door closed behind me, and my mother and one of my sisters came 
 hurrying downstairs, I baAvled like a baby. At the same time I 
 pretended to be ' out of my head. ' I was helped to bed. Back of 
 this foolishness was so much real illness, I suppose, that it deceived 
 everyone. Mj father was sent for, and came immediately, bring- 
 ing with him my uncle, a physician. Both were genuinely con- 
 cerned. A sea trip, on a light house inspector's vessel was at 
 once arranged for; and, after a two weeks' rough outing, I re- 
 turned, in huoyani spirits. I continued in good health and fairly 
 good spirits for three years. Marked improvement in health, 
 after crises, characteristic. The inseparable obstacle in my Avay 
 was my own weakness of will— my yielding to domination by the 
 'base animal passions.' " 
 
 He consulted the author of "Brain Exhaustion" and ven- 
 tured the notion that he had weakened his nervous energy through 
 adolescent abuses. This author, a physician whose. opinion carried 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 263 
 
 great Aveight with the patient, fully agreed with him and pre- 
 dicted that an insidious debilitation would result. He recom- 
 mended circumcision and a prolonged rest with elaborate rehabili- 
 tating treatment. The patient was convinced that he must never 
 marry. Before seeking relief from his depression and fatigue, he 
 had handed in his resignation in a rather petulant manner. The 
 resignations were always referred, as he knew, to Mr. T — (his 
 kind foster-father) who always tolerated the younger man's 
 moodiness, sympathized with his ill health and encouraged him 
 to recover and then return to work. The patient invariably 
 reacted in a uniform way. During the previous "hysterical" epi- 
 sode he also consulted his uncle, a physician, who without asking 
 him if he had any such difficulties, informed him that no member 
 of their family ever disgraced it by masturbation. The patient 
 surmised that the author of "Brain Exhaustion" had conferred 
 with him and he reacted with increasing tenseness and sensitive- 
 ness about this old inferiority. 
 
 During the next seven years he accomplished considerable 
 scientific work, despite his general sensitiveness. lie solved his 
 sexual problem with a series of attachments to women who had 
 heen married. The lesser degree of risk influenced him in his 
 affairs, he thought. (The married woman is the most usual 
 substitution for a certain type of mother attachment.) 
 
 From thirty-two to thirty-four, he reached the high mark of 
 his career and succeeded in working into "pure science." His 
 health now was excellent ; he was vigorous, had far-reaching plans, 
 organized his work well, had splendid associations, and felt con- 
 fident that at last his personal problems were solved for all time. 
 His scientific contributions at this time were excellent and unu- 
 sually promising. His associates, who had continued to bolster 
 him up through his past crises, were well pleased mth him. 
 
 The sexual life he practiced at this time is illuminating. He 
 was stationed in a delightful university city and did much of his 
 work in the university laboratories. He lived with an elderly 
 woman and her widowed .daughter and her children. 
 
 The young widow, who had literary aspirations, became the 
 patient 's mistress, with her mother 's encouragement. On the other 
 hand, an associate in science had introduced the patient into a 
 refined, wealthy family and a warm friendship had developed be- 
 
264 PSYCHOPATHOLOGY 
 
 tween himself and Miss Y — (nineteen years of age). Her refine- 
 ment, restrained exuberance, enthusiasm and loveliness, and her 
 devotion to the success of his career, had, withont his clear real- 
 ization, attracted him seriously. (The account of this tragic situa- 
 tion is too important not to be given fully in the patient's own 
 words. It is essential to recognize that Miss Y — had all the attrac- 
 tive attributes of his mother. Furthermore, through Miss Y — 's 
 sympathetic influence he had "grown up," attained his place as 
 a man in science and entered upon his great life work in "pure 
 science." It is not pleasant, but extremely important, that the 
 reader should also recognize that Miss Y — , like his mother, was 
 the living embodiment of his life-long autoerotic fantasies. This 
 fact, associated with the dogmatic prediction of progressive de- 
 bilitation, is probably what made it, later, impossible for him to 
 marry. The associations of thought persisted in defiling her and 
 this he could not endure. A dream at fifty-seven, to be given later, 
 illustrates this mechanism.) 
 
 "I was able to drop much of my troublesome- burden of pre- 
 tensions, and found myself most at ease and least a conscious 
 fraud, in the home life of two or three families of cultivation and 
 refinement to which I was admitted in the university town of A — 
 where most of my activities were centered. Here, the attitude 
 toward me was so genuinely friendly, I could not very well help 
 becoming a frequent visitor. Miss Y — , nineteen years old at the 
 
 time of my arrival in A , took an enthusiastic interest in my 
 
 plans.' In addition to certain scientific work which was itself rap- 
 idly extended, with an increased force, toward what her father 
 characterized as broad- visioned development, I launched into, four 
 considerable projects, all calculated indirectly to advertise the re- 
 search in this comparatively new field. One of these called for a 
 bill before the State Legislature, and for active support on the 
 part of the university, the several scientific and technical societies 
 
 in and individuals of prominence and political influence. For 
 
 this undertaking, in particular, social backing was almost indis- 
 pensable. From the outset, Miss Y — became the most important 
 figure in the "audience" to which I looked for sustaining inspira- 
 tion. But I received from her more than approval. She took de- 
 light in what her mother called 'shameless scheming,' in 'which, 
 Avith her mother's tactful cooperation, nevertheless, the social posi- 
 
MECHANISM OP SUPPRESSION OE ANXIETY NEUROSES 265 
 
 tion of lier family was used to advance my aims. By tlie end of 
 the second year, Avheii the sudden nervous breakdown occurred [at 
 thirty-four] I had begun to find indispensalile also, not only her 
 siire intuitions as to the right course always, but her bright and 
 stimulating companionship — a new thing in my experience. 
 
 "The two years, up to this point, had been years of all-round 
 mental development. During no other period of sustained effort, 
 as I now clearly see, liave all my faculties been so variously and 
 healthfully exercised. In the recognition of this single fact, the 
 time and thought given to this circumstantial history is amply 
 justified to myself. The general verdict at the time, which it has 
 never before occurred to me to question (until the psychoanalysis), 
 that I hroJce down at last from overwork, I now believe to be mis- 
 taken. Nor do I think the collapse came because I had morbidly 
 regarded it as inevitable. Morbidness in large part had disap- 
 peared. It resulted from the concurrence of new worries that had 
 nothing to do with my work. 
 
 "In my sexual life in A — , I had been cool and sure of myself. 
 I was conscious of a growing force of character that was new in 
 kind. Under the stimulus of almost uniform success in projects 
 undertaken now solely on my own initiative, I became more and 
 more fixed in the determination to let no sentimental weakness 
 stand in my way. By the end of the first year, at a considerable 
 cost in time and money, I had provided securely, as I supposed, 
 against the calamitous possibility of being "found out." It would 
 seem that this particular fear had been pretty well allayed, and 
 that I was in a fair way to become emancipated from all of my ob- 
 sessions (sexual). Yet, in view of what actually happened they 
 appear to have been as strong as ever. 
 
 "Mrs. X — , with whom I had made this secure arrangement, 
 as I supposed, was a minister's daughter, with an ambition for 
 the stage, who had married a dramatic critic, and then given up 
 her stage ambition. For several years her husband had been a 
 consumptive, and a few months before I met her, he had died, and, 
 instead of returning to her home in the East, she had moved to A — 
 to live. Here she was joined by her mother. The mother and 
 daughter together had a small income — just about sufficient to 
 live on comfortably ; and at the time I met them, they were looking 
 for a house in — . 
 
266 PSTCHOPATHOLOGY 
 
 "It was the mother's idea that they should forego society^ 
 save rather than spend, and for a time make expenses by taking 
 two or three boarders from among the unmarried instructor class 
 in the university faculty. My rapidly developed intimacy with 
 the daughter modified this plan. I assisted in finding a house, and 
 became their only boarder, paying $100 a month. I had a 'frank 
 understanding' with both mother and daughter. It was the moth- 
 er's view that the daughter's artistic temperament demanded that 
 there should be no interruption of her sexual life. Furthermore, 
 her sexual life had been imperfect; the husband had been compara- 
 tively old as well as physically feeble. In the understanding! I 
 had been insistent on only one point ; there must never come up any 
 question of love and its obligations. I invented a girl-wife, who 
 had died in childbirth, and in whose grave love lay buried. (Ap- 
 parently this fancy about a dead girl-wife was also an unconscious 
 protective wish-fulfillment that the autoerotic fantasy should die 
 through the influence of Mrs. X — .) Mrs. X — 's mother could be 
 sentimental as well as "sensible." She called me her "poor boy" 
 and was very tender toward this affliction. Fortunately, as she 
 pointed out, her daughter, though of a warmly affectionate dispo- 
 sition, was wholly wedded to her art. We would all need to ob- 
 serve the conventions carefully. There was no occasion for social 
 attentions on my part. Then, too, the whole famtly — the children 
 as well — were in fresh mourning. Even, as the event proved, she 
 was perfectly sincere ; I had to modify my first impression that she 
 was a moral monstrosity. 
 
 "I filled the spare room in the house (by day) with a clerical 
 assistant. I was the only boarder. The older of the two children 
 in the family was under four years of age. The arrangemeutt 
 seemed ideal. Yet, within a year, my discreet household suddenly 
 revealed itself as a volcano, and blew up. 
 
 "During this year I had received an occasional rather formal 
 note of invitation from Miss Y— no intimate letters. Doubtless 
 Mrs. X had seen these notes. She had seemed intentionally to 
 avoid reference to my social engagements. They were in fact not 
 numerous. The annual foot-ball game between M — and the Uni- 
 versity of — is one of the social events in A — . Some time in ad- 
 vance of its announced date Mrs. X — asked me to take her to this 
 game. It was her first request of the kind. Her period of mourn- 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 267 
 
 ing was over. She wanted to see something again of real life. It 
 would do no harm, as she said, for me to show her now some atten- 
 tion occasionally. Her request Avas natural enough, but she showed 
 a tensity of feeling that was disquieting, even to her mother ; and 
 her manner indicated that she expected to be refused. I replied 
 that I had already engaged to take someone else. 
 
 "This was hardly true. At one time, I had planned to ask Miss 
 Y — and her mother. It seemed well, however, now to settle the 
 matter. They were out of town and I mailed my invitation. Im- 
 mediately afterward, ahead of my working program, I left town 
 myself for a routine tour of inspection. A note of acceptance from 
 Miss Y — addressed to my house as usual, was forwarded to me 
 by Mrs. X. She had opened it, without apology for doing this; 
 she had written across the top: 'I knew you were lying to me.' 
 Such action was wholly out of keeping with her ordinary behavior. 
 
 "I returned, the day of the game, on an early morning train. 
 I found Mrs. X — in her room dressing her little girl for break- 
 fast. She appeared suddenly half-demented. Her mother was 
 unable to quiet her. She picked up the child and thrust her into 
 my arms, telling her to kiss her new papa — that I was to be her 
 new papa. She derided me for 'that precious bit of fiction,' the 
 child- wife story, over which 'I, poor fool,' she said, 'have wasted 
 tears of sympathy. ' I finally announced that I should give up my 
 rooms immediately. 
 
 "I wrote out a check for an extra month's rent. TMs was 
 dramatically crumpled and throAvn at my feet, declaring I should 
 soon discover that 'hell holds no fury like a woman scorned.' She 
 sobbed hysterically in her mother's room for an hour or more 
 while I was packing up. (The behavior of Mrs. X — illustrates the 
 effects of a positive transference with its sacrifices and offerings 
 shifting to a negative transference with impulse to destroy the 
 object in order to get free from it.) 
 
 "My assistant had arrived, meantime, and I made arrange- 
 ment for immediate shifting of the work to an office. I wanted 
 him, with his gossip about a family row, to be as far away as 
 possible. I could trust Mrs. X — 's mother to do her best to avoid 
 a scandal, but was not sure that she would be successful. I left 
 a hotel address on my personal baggage (for Mrs. X — to see) ; 
 and then waylaid the expressman and changed it to another hotel. 
 It seemed not impossible that Mrs. X — might follow me. 
 
268 PSYCHOPATHOLOGY 
 
 "On my arrival at the house in the morning, I had been pre- 
 pared for trouble. I had hoped, by concessions for the future, to 
 get back to a fairer understanding. But the life I wais leading, 
 suddenly presented to me in this sordid aspect, appeared no lOTger 
 possible. I had carried off the scene with an air of righteous in- 
 dignation, which, for the moment, I had thought I actually felt; 
 but the underlying conviction was that I must prevent the possi- 
 bility of a recurrence of such scenes. / must again change my 
 mode of life radically. I was baffled, for there were other convic- 
 tions with which this was in conflict. In addition, I felt remorse. 
 After I had begun packing, the little girl had come to me with a 
 message: 'Grandma says, please don't go.' I had gone without 
 a word; and this memory rankled. It is possible, though it is a 
 mere guess, that the unconsidered act of cruelty of the gopher 
 dream, with its remonstrating children's voices (which I wrote 
 out for you some months ago)* reflects this old incident. 
 
 "I remember, as I hurried to keep the appointment for the 
 afternoon football game, I was halted suddenly by an overwhelm- 
 ing sense of panic. It was related to nothing clear, though it was 
 so sharp, like an electric .flash illuminating the whole mind, that 
 it is still clearly recalled. It had no relation, for instance, to the 
 situation immediately ahead; to that, I was looking forward for 
 relief from my repression. On the other hand, I was beginning 
 to see that in all probability the situation from which I had just 
 escaped had been brought to an absolute finish ; and in the only way 
 possible, as the event proved. The panic feeling was due, I thinl?, 
 to something old. I had been let doivn, for a time, to the level of 
 the old nervo^os instability, with its familiar perils (autoerotic). 
 It passed, however, and I regained full confidence. Strength for 
 resistance had been acquired in the vigorous and successful ex- 
 periences of the past two years. It would take a much heavier 
 blow than that of the morning to floor me now. This resilience 
 and feeling of relief I recall distinctly. It was the old rebound, 
 characteristic of my temperament. I can hereby say that I have 
 not felt any such elastic recovery of spirits on like occasions since. 
 
 "At the game, I was conscious only of exhilaration [tempo- 
 rary autonomic compensation] . I knew the coach of the University 
 team (a C — man, as I was also), had followed the training records 
 
 *The gopher dream occurred during the psychoanalysis and will be given later. ^^ 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 269 
 
 of his stars, and was well up in football strategy. I was delighted 
 to tind my companion not mif amiliar with its principles, and show- 
 ing restrained enthusiasm over the good points of play. I was in 
 a mood to note and appraise highly this versatility and strength. 
 These qualities, in a mere girl, had been of inestimable service to 
 me already ; and they were at my service further. I carried away 
 from this last meeting an abiding impression, too, of her quiet 
 joyousness and unconscious air of cultivation. Certain details of 
 sentiment here seem to he essential to this record, since they ex- 
 plain the lasting emotions. During the game, which had aroused 
 strong partisan feeling, I felt, nevertheless, that her eyes were on 
 me often, not in coquetry, nor boldly, but in kindness. Shortly be- 
 fore I had called at her house, by appointment, to take her some- 
 where ; and, while waiting for her, discovered a book with her card 
 lying on it, addressed to me. It was Barrie's "Little Minister" 
 then just out. I had taken the book with me on the trip I had jiist 
 completed. This sentence had impressed me : 'Knou-lng what he is, 
 the pride that shines in his mother's eyes, as she looks at him, is 
 about the most pathetic thing a m,an has to face, hut he would he a 
 devil altogether if it did not hum some of the sin out of him.' 
 [An interesting incident showing the significance of favorite quo- 
 tations as a means of solving great affective conflicts.] I thought 
 of this iioiv. In spite of my long course in which love had heen 
 dehased and simulated, my early illusions had remained; and if a 
 resolution can he formed suhconscioiosly , I' helieve I determined 
 there that this sin of disloyalty to ideals should he burned' out of 
 me. I could give up my sexual life. It had relieved me of stresses 
 and strains of a kind, but' it had set up others, no less unnerving. 
 In view of the contrasting experiences this one day had presented, 
 the memory of the morning' s- experience was searing. My stdind- 
 ards, or principles, had become confused^ I was glad, by this easy 
 renunciation now, to he able to pay my tribute to the sanctity of 
 women. It required no act of will, and I have used none since to 
 resist temptation; there have been no temptations. I have led a 
 wholly continent, life for twenty-three years. [The solution and 
 fixation of the sexual struggle upon a chronic course of anxiety.] 
 "At the close of the day, as the immense audience rose to 
 watch the thousands of students of the winning side pouring into 
 the field for the 'serpentine' of- victory — the supreme spectacle — ■ 
 she detained me in the seat. (Her mother, on my other side, who 
 
270 PSYCHOPATHOLOGY 
 
 had risen, paid us, seemingly, no attention.) She wanted to know 
 what was 'the trouble.' It was a surprise — an attack. Evidently 
 I had been showing traces of worry. It seemed the natural thing 
 to be entirely frank. However, I replied merely that I had given 
 up my home quarters that morning and had moved to a hotel over 
 in the city. She watched the expression of my face intently for a 
 moment, her hand on my arm. Then she started abruptly to rise, 
 turning toward her mother. As I sought to restrain her, she seized 
 my hand impulsively, pressing it against her breast. As we rose 
 together, she said, close to my ear, as if the uproar about us made 
 that necessary: 'I think I shall have to take care of you, sir.' 
 
 "Mrs. Y — could not have heard this, yet she leaned toward 
 me remarking: 'I see we shall have to make Anna your general 
 manager, Mr. — . ' It had the effect of a prepared speech. I could 
 see that she intended I should so understand it. But I had no 
 self-conscious feeling: I was watching the daughter, who was 
 blushing. She turned resolutely toward me, though answering her 
 mother: 'He has heard that already. Mamma.' And she laughed : 
 'I have told him so. He knows it.' 
 
 " (This is punishing work, though I am glad to do it. These 
 pictures are like an artist's incomplete sketches, whicli be had 
 turned to the wall as dreams that were too ambitious. I can re- 
 member them, but they seem to have meant more than I can ever 
 discover. So, with the fragments of speech, I am not trying to 
 record here what may have been implied ; yet it is these IMPLICA- 
 TIONS, which I have endlpssJy debated in mii mind, that make it 
 a sore subject). 
 
 "Miss Y — at once addressed herself with animation, and re- 
 called our attention to the brilliant scene on the football field. But 
 I was not to be diverted. It was an afternoon for light wraps, and 
 I readjusted hers about her shoulders ; then found her gloved hand 
 and tucked it into my overcoat pocket. Almost immediately, how- 
 ever, she freed it ; and leaned forward, nodding smilingly past me 
 to someone at a distance in the same tier, lightly clapping her 
 hands and pointing to the colors she was wearing — ^the colors of 
 the victors. Evidently I had startled her ; also /' felt rebuked. I 
 had been guilty of the commonplace. Yet, I persisted and sought 
 to recover her hand. In this she avoided me — and of her own ac- 
 cord replaced it securely in my pocket. 
 
 "Her father, by prearrangement, met us at the exit. He Avas 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 271 
 
 taking the ladies somewhere to a later engagement. On the short 
 return trip, we encountered acquaintances, a lively group. "We 
 drove away from the station, a party of four, and presently they 
 set me down at my hotel. I was leaving town that evening to re- 
 turn to my unfinished work. I was to be away only a few days. 
 Miss Y — stepped out with me ' to say good-bye better. ' She gave 
 me both hands gaily, swinging them apart as children do, which 
 brought us nearer. She dared this, as her father was commenting 
 on the sudden intimacy ; otherwise, I should have kissed her. As 
 I handed her into the carriage, to her parents, she turned an arch 
 look back at me over her shoulder. I was hardly responsive to 
 this gay mood. The carriage started and she smilingly raised an 
 admonishing finger, which left me thinking of her question as to 
 my 'trouble.' 
 
 "In the course followed during the next few weeks, I acted 
 on no conscious plan. Certainly I had no such craven course in 
 mind, as I made the short run that night by train to the little to-wm 
 in the foothills, which I had left in the early morning. For the 
 developments of the afternoon I had been wholly unprepared, in- 
 credible, as it now seems to me that this could be so. But I had 
 responded to them on the whole naturally ; and, on the surface of 
 my mind, at least, it was clear that I would WMrry Miss Y — . For 
 the time I could think of nothing but her loveliness. I was exult- 
 ant ; at the same time I was wondering why I Avas not really exult- 
 ing. In earher pages I have recounted the series of circumstances 
 of physical illness which brought me to a coast town Avithout reach- 
 ing a voluntary decision. [He never saw Miss Y — again. De- 
 spite repeated arrangements to do so he was unable to overcome 
 the repressions which forced him from her. The struggle is given 
 later.] 
 
 "When I set out to write this simple history, it appeared con- 
 fused and difficult. It proved to be difficult. I had to do a little 
 psychoanalysis myself. It was not sufficient to say merely that I 
 got mad and hit the other boy, though this records a physical act 
 and an emotion. It must be perceived that it is important to add 
 that he was the bigger boy, and that therefore the emotion was one 
 of reckless anger ; that I became thus violently incensed upon ap- 
 parently slight grounds; he had merely called me a "sissy;" but 
 this was a grave offense, because I felt that it was true ; and that I 
 must employ some retrospection to see why I felt it to be true. 
 
272 PSYCHOPATHOLOGY 
 
 (This example was in its essentials a true experience.) Yet it (the 
 history) has been deeply interesting; for me, emotionally, it has 
 cleared the air somewhat, I think. The incident last recorded, I 
 recognized as its climax; and I have worked np to that with in- 
 creasing reluctance, though with a growing fascination of inter- 
 est. Now that it has been told — completely, yet with compres- 
 sion — ■ I feel that all is over but the misery. In what follows, with 
 the exception of the next paragraph, there is not the same antici- 
 pation of revelations to myself. I haven't the same interest. 
 There is a succession of salient facts like milestones ahead, how- 
 ever; my uncertainty will be as to the detail required for their 
 explanation. I haven't the same sure sense as to the signifiicance 
 of detail that I have felt up to this point. 
 
 "This lack of interest, not only in detail, but in the whole 
 business [his science] , from now on, had its beginning back in the 
 
 late fall of '94, at , the sunny, lotus-eating winter resort on 
 
 the coast of Southern Florida where I had hidden myself. In sim- 
 ple English, life was not worth living. I had no thought of suicide. 
 I didn't seem to feel the situation very acutely. It was too clearly 
 settled, cut and dried and finished. There was acute feeling relat- 
 ing to the past, however. That was a dull agony that I couldn't 
 think of. It was not a sense of my own loss. That was calamitous 
 to be sure. It was remorse for what I had done to the only lovely 
 girl who had ever stooped to help me. I had not meant the cruelty. 
 I had left — after the football game, expecting, of course, to marry 
 her. I had delayed my return because of unreadiness to meet her 
 — because of the u/naccountable growing nervous debility. When 
 I finally started to return and was met with exclamations of "hag- 
 gard," etc., by my men friends, I postponed it again and made an 
 additional trip into the mountains. Here, mountain fever, mala- 
 rial fever, every physical illness that could fasten into a pretty 
 sound constitution, got me. I was crazed. I have related how I 
 finally, came to rest, like a boulder on a ragged course downhill; 
 with everyone irritably shaken off, and alone. I hadn't meant it, 
 but, I had done it. And the worst was that after all, I had meant 
 it. The situation was not-really bad at all. She had heard of all 
 the- circumstances, of course. It was merely necessary to get well, 
 go back — and explanations would not even be listened to. 'Poor 
 boy,' etc., 'I had overworked outrageously.' 'Had not everyone 
 
MECHANISM OP SUPPRESSION OR ANXIETY NEUROSES 273 
 
 said SO?' The worst tons, I didn't want to go haclc; must not. I 
 am clear now as to the meaning of my dream in rhyme in reply 
 to my mother's urging that I marry (which occurred shortly after 
 this episode) : 
 
 'You tell me I now may no longer delay, 
 
 But must lead some fair maid to the altar. 
 Ye Gods ! to the Anchorite Hills, I'm away. 
 
 I'll abode on some desert Gibraltar! 
 There, the far siren voices shall nothing avail, 
 
 There, indifferent to good and to evil, 
 I'll but swing by the tip of a prehensile tail 
 
 From a bough of the forest primeval.' " 
 
 The patient never saw Miss Y — again. Each time that he 
 made arrangements to meet her, the anxiety which was aroused 
 by the prospective situation was so severe that he was compelled 
 to avoid her. Another remarkable autonomic adjustment to the 
 situation was the fact that in the next twenty-three years he did 
 not have a seminal emission from any cause. This astonishing 
 adaptation and consecration of all his physiological resources to 
 the. sacred memory of his mother and Miss Y — (for both now be- 
 came memories), as suggested by the above quoted lines from Bar- 
 rie's "Little Minister," burned out the sin and atoned for his past 
 sexual profligacy. 
 
 To all his friends and the physicians whom he consulted, he 
 was stupidly considered to be suffering from nervous exhaustion 
 due to "overwork" and "malaria." The rest-cure was always 
 discreetly recommended as treatment. It is also important to in- 
 clude that the patient himself accepted the nervous exhaustion 
 explanation, being more considerate of his actual deficiencies, 
 and not until the psychoanalysis called for an unreserved consid- 
 eration of all the possible causes of his debility, did he actually 
 recognize that the nature of his love and his sexual life had been 
 fatal. He then dropped the "overwork" and "malaria" excuses 
 and faced his issue as squarely as its hopeless nature would per- 
 mit. This clear realization, however, came at fifty-seven, and the 
 twenty-three years from thirty-four to fifty-seven were charac- 
 terized by a blind anxious struggle with himself. 
 
 After his recovery from the distressing experience at thirty- 
 four, he resumed his scientific work despite his tendency to be- 
 
274 PSYCHOPATHOLOGY 
 
 come despondent -under stress. At foxirty-fotir, fifty-one, fifty-two, 
 fifty-five and fifty-eight he was completely disabled for work. 
 His miserable condition was diagnosed as "neurasthenia." The 
 despondent episodes lasted from several months to two years. 
 During this long period he made several scientific contributions 
 and accumulated an enormous amount of data for his chief con- 
 tribution to science, but was without the necessary inspiration to 
 synthesize his work. In following him through his positions and 
 places of work, it is worth stating that again and again he tried 
 to replace himself in the attention of Miss Y — , using many clever 
 plans. He even succeeded in having himself sent back to work 
 in the University city in which she lived (sixteen years after the 
 football game) and was invited to dinner by her brother-in4aw, 
 but unable to endure the anxiety, he broke the engagement. 
 
 At forty-four, he undertook a piece of work with his foster fa- 
 ther of science, Mr. T — , and on the last day of their work to- 
 gether he had an attack of anxiety, playing dramatically for sym- 
 pathy. He was sent to a sanitarium to recuperate and ended up 
 with a dramatic plan of committing suicide in which he went into 
 the country, taking with him some of their finest instruments, 
 which he destroyed in a log fire. He was unable, however, to de- 
 stroy himself although he had made special preparations. Then 
 he explained his behavior and offered to resign. This was not 
 accepted, but, instead, a sympathetic response was elicited from 
 his superior in charge, Mr. T — , and the patient rebounded from 
 his depression to buoyancy and hopefulness. Within a surpris- 
 ingly short time he presented a splendid scientific paper with an 
 acceptable original hypothesis, which latter may be considered to 
 be. the most difficult of all scientific achievements, and reveals the 
 influence upon initiative of a positive transference. 
 
 From fifty-one to fifty-three "general debility" from physical 
 weakness and ulcerated teeth, punctuated with brief periods of 
 "exalted" feeling, forced him into a sanitarium near Miss Y — 's 
 city. After this episode, he was unable to master himself suffi- 
 ciently to do any prolonged work. 
 
 At fifty-three, a most significant termination of an episode 
 occurred while he was convalescing at his brother-in-law's home. 
 He lived alone in the house while his brother-in-law and sis- 
 ter were away for the summer, occupying their bedroom. One 
 
mechanism: of suppression or anxiety neuroses 275 
 
 day he received a telegram which announced the unexpected re- 
 turn of his brother-in-law. (Naturally they would occupy the 
 house together that night.) The patient insists that he did not 
 think oi: this, but the situation precipitated a strange anxiety con- 
 dition with no apparent cause, and rather bewildered and excited, 
 he finally proceeded to mow the lawn "in order to be busy." He 
 soon developed a "heat stroke" and had to be sent to the hospital. 
 When his brother-in-law arrived, a day late, the patient was safe 
 from the embarrassment that might have arisen from too intimate 
 personal contact. In view of the fact that the patient and his 
 brother-in-law were congenial, this panic may be regarded as due 
 to the patient's homosexual reactions. The patient said he recog- 
 nized that he was misleading everyone, but the situation would 
 permit of no other solution, although he could not quite under- 
 stand why. While still in the hospital in a "confused" state, he 
 received an urgent letter to ' ' come at once ' ' to give an impromptu 
 lecture of scientific interest. Despite his physician's and his fam- 
 ily's protests, he left his bed and went to work. 
 
 Because he was not equal to doing exhaustive scientific work 
 he was transferred (at fifty-four) from his department of "pure 
 science" into one of considerably easier but less attractive work. 
 This transfer, to which he consented under pressure, meant the 
 ending of his dream of working in "pure science" for Miss Y — 's 
 esteem as his inspiration. His life was now clearly a failure and 
 the loss of his old position proved fatal to his sublimations and his 
 scientific career. 
 
 At fifty-five, a year after the transfer, he had another episode 
 of despondency and staged two dramatic bluffs at suicide, clearly 
 calculated to arouse sympathy. This he fully recognized at the 
 time. After several months he "recovered" and confidently 
 announced this to his aged father, but recognizedT in himself a per- 
 nicious tendency to "nervous tension." He also came to the real- 
 ization that his shamming might become uncontrollable. (He had 
 not learned to realize that the tende,ncy to sham had, since youth, 
 been ineradicable.) 
 
 Four months after he returned to work the climax of his neu- 
 rotic career developed, characterized by a clearly defined paranoid 
 inspiration to kill the man who was responsible for forcing him 
 out of "pure science." (This man had cut off, innocently, the 
 
276 PSYCH0PATH0L06Y 
 
 patient's hope of reaching Miss Y — , f^d his adjustment was so 
 similar to his old father-mother conflict that the earlier experi- 
 ences clearly conditioned the reactions to the lateB.) 
 
 The mechanism hy which this inspiration came upon him is 
 reported in some detail, hecause it is characteristic of the divine 
 inspirations of prophets, deliverers, cranhs, paranoiacs, and par- 
 ricidal inspirations. 
 
 Certain of his suppressive tendencies need to be reemphasized 
 here. The patient always had difficulty in spontaneously express- 
 ing himself when it involved any degree of anger, having been so 
 trained by his father's suppressive attitude. He always lost his 
 capacity to retaliate "under injustice" at the time of its occurs 
 rence. In his preadolescent years he had had a pleasing singing 
 voice, but it later came to lack resonance and showed very 
 plainly that chronic vocal muscle tensions had deprived his voice 
 of practically all resonant qualities, so that, although his vocal 
 sounds were clear enough, they were rather unpleasant to listen 
 to for any length of time. This, no doubt, was due to the fixed 
 postural tensions of the vocal apparatus in turn so maintained by 
 his efforts to keep the repressed affect of hate under control. 
 
 Upon formal occasions, such as scientific meetings, when he 
 was assured by the formal nature of the situation that he would 
 not be interrupted, he was able to speak with ' ' zest and freedom. ' ' 
 In informal situations where he might be suddenly interrupted, 
 this had almost always been impossible since his youth, because of 
 his father's suppressive attitude. 
 
 When the patient was offered an opportunity to accept a 
 change of work, ostensibly for the betterment of his health, in a 
 manner that he could not refuse, he recognized the undercurrent 
 intention of his director (not Mr. T — ) to get rid of him, but he 
 was unable to bring himself to speak of it. lie said he was rather 
 inclined to the temptation to ' ' sacrifice ' ' himself. After the action 
 was officially completed, the patient recognized, with no little de- 
 spair, that the great hope of his life was gone unless he could 
 transcend to heroic endeavors. He felt heeuly offended, hut did 
 not admit it to anyone. Severe economic pressure pinned his im- 
 agination to the immediate requirements of earning a livelihood. 
 To his coworkers and this chief, according to a written comment of 
 this chief, he had become "the sad case of our friend — ." It re- 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 277 
 
 quired some time for him fully to appreciate this, and the revela- 
 tion as to his social position, as such things usually develop, came 
 Avith the insignificant remark of an innocent bystander. One day, 
 in the laboratory, a young man sympathetically remarked to a com- 
 panion, not intending to be overheard, something about "the old 
 man losing his grip. ' ' The patient was unable to free himself from 
 the ringing impression it made. While brooding over this, being 
 profoundly self-conscious, he felt a distinct affective pressure to 
 have that opinion spontaneously reversed. Like a flash out of a 
 clear sky came the solution. 
 
 His department was unable to undertake an important piece 
 of work, which the patient was to direct, because the department 
 from which he had been transferred would not cooperate. (He 
 knew that his former director had lost confidence in him, hence the 
 loss of the prospects of successful cooperation.) There was con- 
 siderable general comment in the laboratories on the matter of the 
 friction between the departments, and the men in general believed 
 that this friction hindered the work. The patient's heroic inspi- 
 ration was that "the source of friction must he removed." Many 
 of the other workers had the same opinion, but, in the patient only, 
 was crystallized the inspiration that the thing to do was to kill the 
 director. (The man who had forced him out of "pure science.") 
 
 Psychoanalysis demands to know why one man, in a situation 
 common to many other men, reacts in a radically different man- 
 ner. There are logical affective determinants for this. To sum up, 
 the man he would kill was the (1) head of the service; (2) had 
 prevented him from the possibility of winning his crown as a 
 scientist, and, hence, the one chance of still attaining the final 
 realization of his biological development — Miss Y — 's love and es- 
 teem: she impersonated the ideals of his youth; (3) the head of 
 the department occupies the same psychological position to the 
 employee that the father, as a ruler, occupies in the individual's 
 youth. The father had prevented his son from "growing up," 
 from developing his virility and winning a love-object, through 
 oppressively forcing himself upon his son, as his rival. The 
 mother, had effectually blocked all his capacities to resist or over- 
 come his domineering father, because under no circumstances 
 could he pain her. Hence, at fifty-seven, when the affective ten- 
 dencies coordinated upon a course of action, it came from the 
 depths of his "soul" as an "inspiration"; clearly for him it was 
 
278 PSYCHOPATHOLOGY 
 
 his "duty" to remove the cause of friction in his struggle to 
 become a man. Logically, he must kill this director. The posi- 
 tion of his director in his emotions made him a perfect imago of 
 the hateful father, whereas Mr. T — was the imago of the kind 
 father. 
 
 The logical necessity of removing "the cause of the friction" 
 was so convincing that it never occurred to him to consider the re- 
 vengefulness of his motive. He was absolutely sure nothing in- 
 dicative of revenge or hatred was felt. The director had to be 
 sacrificed, and he felt he must do it. The patient felt that a deep, 
 calm, righteous sense of duty alone directed him in his steps. The 
 "inspiration" was nothing less than divine in its quality. With 
 surprising cunning he planned the details of the execution, and, 
 although he carried with him selected papers and letters to ex- 
 plain and justify his act, he insisted that it never occurred to him 
 that his act would arouse horror and relentless criticism of him- 
 self. Without going into the details of his method, it is sufficient 
 to say that the period of the formulation of his plans occupied 
 about two weeks of very clear thinking, and during this period he 
 felt himself to be very well and clear-headed (a symptomatic in- 
 dication that the conflicting affections had found a common path 
 for gratification). The affective turmoil had cleared up by coor- 
 dinating upon a simple procedure. Just preceding the crystalliza= 
 tion of his purpose he wrote a note to his father stating that he 
 was reorganizing Ms ivorh along the lines of his years from thirty- 
 two to thirty-four, which was distinctly a reference to Miss Y — 
 and a qualitative resumption of his old attitude to her. 
 
 He said: "I awoke with a full solution of the difficulty. It was 
 so entirely satisfactory that I gave it no elaborate consideration. 
 I would lay the matter before director — and ask him to cooperate 
 with me [italics patient's] in putting it through. In case he re- 
 fused to accept me as an intermediary, it would be necessary to 
 'remove' him. I could then take the matter ivholly in my own 
 hands. It would he necessary, because any lach of confidence on 
 his part ivould paralyse my own. I could do nothing tvith that load 
 on my shoulders. I wanted his approval as I had had it formerly, 
 tut it wasn't essential. His active disapproval, however, would 
 be blighting to my spirit." (Italics inserted.) 
 
 lie said, in retrospective consideration, that he was afraid the 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 279 
 
 director would talk to him the waj his father did and turn him off 
 without considering him seriously. The father ■usually remarked 
 about his never having grown up, and one of his greatest difficul- 
 ties was that his father never expected him to "grow up." (Fa- 
 ther's wish for son's virility was not given.) He felt compelled to 
 kill, because he must remove "the source of the trouble," the 
 source of the "friction," Avhich he allowed himself to believe was 
 the director, even though as an actual fact he knew definitely that 
 this man had himself worked conscientiously to remove the fric- 
 tion between the departments. With the readjustment of his 
 hatred he would become "free," and, as an actual physiological 
 mechanism, would no longer suffer from the affective conflict. 
 
 "I didn't dwell upon the method I should employ for his re- 
 moval. It was to be simple and effective. I should go armed, and, 
 if necessary, shoot him. It was an unpleasant alternative to think 
 of, but it seemed necessary." (See the parricidal inspiration of 
 Guiteau.) 
 
 In his fancy, after the consummation of the act, he believed 
 he would be hailed as a deliverer and a hero. With considerable 
 reluctance, and no little embarrassment, he confessed that his in- 
 spiration encouraged him to feel that his act of removing the direc- 
 tor would arouse a tremendous emotional wave throughout the 
 country, and, when he explained his deed, it would meet with vig- 
 orous approval. He would he hailed as a hero, placed in a position 
 of power, and, with the enthusiasm of the people running high, he 
 would perform great feats of national conservation which might 
 even sweep him into the presidency. He regarded this as a ridicu- 
 lous sequel, upon sober thought, but its logical growth was spon- 
 taneous. (In its essentials his inspiration was not different from 
 Gruiteau's, to be referred to later. Both would win the presidency 
 and an heiress. In both cases it was the hectic compensatory flush 
 of a losing fight to win biological potency and transcend the tyrant 
 of his youth. (See the crucifixion and Oedipus tragedies.) 
 
 He crossed the continent to carry out his plans, but fortu- 
 nately his previous nervous instability and secret departure had 
 aroused the suspicion of his friends. He was met en route by his 
 brother-in-law, to whom he confessed his plans, and, frightened 
 at himself, he re(juested to be taken to St. Elizabeths Hospital for 
 treatment. 
 
280 PSYCHOPATHOLOGY 
 
 Upon Ms admission, he was somewhat depressed, genuinely 
 alarmed at himself, and sincerely eager to get insight into his diffi- 
 culties. His refined manner and bearing were genuine character- 
 istics of the highly intelligent man. There was no mental impair- 
 ment other than the weakness and sense of impotence which usu- 
 ally follows a disastrous emotional crisis. Much of tlie material 
 elicited by the psychoanalytic method has already been included iv 
 the case record. 
 
 When his fairly well concealed hatred of his former chief was 
 brought to recognition, the patient was astonished at the hideous 
 trends that his personality had assumed. The inspired assault now 
 assumed all the attributes of a diabolically conceived murder, for 
 revenge as well as for freedom. The patient faced his guilt 
 squarely, but, as the analysis proceeded, he came more and more to 
 feel that something else had crowded him into a sordid state of 
 mind. He inclined to reiterate that his old masturbation excesses 
 had undermined his mental reserve and self-control, and that the 
 opinion of the author of "Brain Exhaustion'' was finally being sub- 
 stantiated. The pernicious belief that this debility must be his 
 ending was so persistent that it had to be anah^zed. 
 
 This necessitated a review of his sexual life and his masturba- 
 tion fantasies. Plis case was unique in that a man of his scientific 
 learning and general knowledge had had so little insight into the 
 sexual life of the male. It developed that never before had he 
 been able to discuss the subject, and, Avhen he learned-that auto- 
 eroticism had its place in the normal evolution of the personality, 
 he reacted with sorrow and regret that fortune had not saved him 
 from a life of despair and harassment by faA^oiing him A^'ith a 
 kindly bit of advice in his youth. 
 
 His hatred for his father was brought out with a review of 
 many incidents of unjust domination during the patient's youth. 
 He was unable to control his grief Avhile revicAving the father- 
 mother-self triangle and the tragic emasculation of his youth. He 
 Avas also unable to shake himself free from the fifty odd years of 
 submission. Perhaps the age of his father and economic depend- 
 ence upon him interfered considerably Avith this. The aresonant 
 condition of his voice was not permanently relieved, although he 
 recalled the father's suppressive remarlxs about liis singing; his 
 mother had delighted in accompanying his songs Avhen a boy; and 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 281 
 
 he appreciated the influence upon the vocal tones of the forbidding 
 of his spontaneous replies. 
 
 It may be summed up that despite six months of intelligent 
 effort to throAv off the father domination, he did not succeed. He 
 did, however, arrive at the conviction that the effects of his fa- 
 ther's disastrous domination had been unintentional and that no 
 one had regretted his "childish," "girlish" attributes more than 
 his virile father. He also learned to know that for him there were 
 two kinds of people — those whose attitude permitted him to ex- 
 press himself freely and those who were suppressive. 
 
 The affective dependence of the patient upon his grand, old, 
 genial master in science (Mr. T — ), and his long series of dra- 
 matic, semi-crucifixion- suicidal attempts, were so clearly alike, in 
 purpose and method, to his methods of winning expressions of 
 "tender" concern from his father, that he recognized the signifi- 
 cance of it at once. 
 
 The "heat-stroke" episode at his brothei'-in-law's house pro- 
 duced, upon its analysis, no little discomfort and complaints of a 
 "sinking feeling" when his effeminate dependence upon virile 
 males became clear. His father hated his "girlishness" and his 
 family had striven (blindly) to educate him out of it although 
 actually forcing him into the submission. It had never occurred 
 to the selfish father that he should back down, unselfishly, in 
 order to let his son occupy the throne of virility with him. The 
 patient insisted that he had "feminine" qualities, but, sponta- 
 neously, with undue earnestness and repeated efforts, he tried to 
 establish that he was not "effeminate." No homosexual relations 
 had ever occurred, and no perversions. 
 
 He dreamed of a knight in beautiful armor who appeared be- 
 fore an audience, and a penetrating light was thrown upon his 
 pelvis which revealed the genitalia of a female. He recognized 
 himself as this knight. This was a reaction to the light of psycho- 
 analysis. He also dreamed of a man singing to an appreciative 
 audience. The man had a baritone voice, but it chailged to con- 
 tralto and then to soprano. The hair became long, although the 
 mustache remained; the breast was a man's but the manners were 
 a woman's. The singer showed embarrassment, then distress, and, 
 finally broke down in tears. The audience sympathized with him. 
 The patient awakened "in strong agitation," and recognized the 
 singer as himself. At one time he had had a pleasing baritone 
 
282 PSYOHOPATHOLOGY 
 
 voice. He never shaved Ms mustaclie in order not to look effem- 
 inate. 
 
 Two insurmoimtable obstacles finally stopped the psycho- 
 analysis, in that it seemed profitless to continue it. (In the light 
 of further experience with this type of case this must be regarded 
 as a mistake.) One was his love for Miss Y — and the other was his 
 well-founded uneasiness lest he should become a public dependent, 
 because, at fifty-seven, he was losing ability and had no economic 
 resources. 
 
 ,Miss T — appeared in many of his dreams and always urged 
 him that the past "makes no difference," but that he should re- 
 turn to work and succeed. Miss Y — still appeared to him as she 
 was at nineteen, although now she was over forty. She had never 
 married, and lived a comfortable but lonely life (probably still 
 hoping for his return, judging from her expression of interest in 
 the patient through her brother-in-law, sixteen years after he had 
 disappeared). Tier ivealth and lils poverty, he felt, made a union 
 impossible. 
 
 The cause of his inability to return to Miss Y — , after the foot- 
 ball game, was explained b}' a dream. He had been reading 
 Bank's "Myth of the Birth of the Hero," and previously ana- 
 lyzed out the origin of his masturbation fantasies in his mother, 
 but, strangely enough, he was unable to appreciate that Miss Y — 
 had the physical and personal features attributed to his mother 
 and the girl of his autoerotic fancies and heterosexual rela- 
 tions when the woman accused him of thinking of some other 
 person. He dreamed, "the unfriendly part of myself was throw- 
 ing lantern-slide illustrations on a screen and lecturing that 'all 
 women are the same' (meaning voluptuous). He showed a skele- 
 ton, obviously feminine, and superimposed a series, 'startlingly 
 familiar to me,' of feminine figures of 'all the women I have 
 known.' The figures, nude and Avith living flesh tint, were super- 
 imposed almost exactly, illustrating the point. Then the speaker 
 triumphantly excl aimed 'the composite,' and tiie audience stirred 
 as if with pity or indignation as he showed a figure appealingly 
 beautiful, composed of a thousand figures, dream conceptions that 
 I thought of during sexual intercourse. The figure turned to mar- 
 ble, and the audience recognized that it was unreal and the lectur- 
 er's purpose was defeated. Then, to convince the audience, the 
 light was made softer, and a single figure began to appear, and 
 
MECHANISM OF SUPPRESSION OR ANXIETY NEUROSES 283 
 
 it was tmmistakably living. As the illumination grew stronger, 
 and glowed, I recognized it, my bonds were broken, and I smashed 
 the instrument." 
 
 This dream reveals its true significance when we recall that, 
 for him, all women, except one type, were essentially the same in 
 their sexual unattractiveness, unless he enriched them with fancies 
 about a certain type. The similarity of this girl of his sexual fan- 
 tasies to Miss Y — tended to associate them together in his mind, 
 but he was saved from the vulgar desecration by having her turned 
 into marble. When he was about to ask Miss Y — to marry, the 
 "commonplace" associations of thought, the result of his past in- 
 dulgences, so horrified him that he was unable to approach her as a 
 lover. Even twenty- three years of bitterness and sexual absti- 
 nence did not "burn" out the fixed mental tendencies as Barrie's 
 phrase suggested they would. 
 
 The psychoanalysis stopped at about the point where, figura- 
 tively, he smashed the source of light in the dream, in that he could 
 not face the last fact and consider why he remained attached to 
 Miss Y — but would always have to avoid her. The solution of his 
 problems came, arousing genuine enthusiasm, through a dream 
 in which he made a financial success by commercializing his scien- 
 tific knowledge. He now laid his plans upon a practical basis, and 
 urged that his freedom be restored with such common sense and 
 judgment that he was permitted to perfect his plans for earning 
 a livelihood. If successful, he might then approach Miss Y — , he 
 fondly hoped. 
 
 In the meanwhile he had more than recovered his physical 
 strength and weight, general bearing and emotional resources for 
 work. He and the chief, whom he had planned to assassinate, had 
 become very friendly. All of his friends in science, to whom he 
 submitted his plans, more than approved of their value and prac- 
 ticability, so that the patient was discharged as socially recovered 
 eight months after his admission. His old master in science again 
 responded with encouragement and financial support. 
 
 For seven months he worked on his business project and de- 
 pended upon Mr. T — for encouragement and financial support. 
 It finally became evident that the project would fail, and, because 
 of family obligations, his patron was forced to intimate that fur- 
 ther loans would be unfair to his heirs. This, of course, plainly 
 
284 PSYCHOPATHOLOGY 
 
 said that, after all, blood relatives are to be given preference and 
 he must stand alone (breaking the transference). 
 
 This preference and his poverty, in addition to his inability to 
 get employment in the service in which he had previously Avorked, 
 finally precipitated a catastrophe. Under conditions that indicated 
 premeditation he shot himself in the head in one of the laboratory 
 rooms which was under the charge of the man he had once been in- 
 spired to ' ' remove. ' ' He left the following significant note : 
 
 "Apologies are due, but the Director knows that some sacri- 
 fice is necessary, somewhere, sometime, to make the connection." 
 (Italics inserted.) 
 
 As enigmatical as this seems to be, it is quite transparent if it 
 is recalled that he was inspired to remove this man in order to 
 "remove friction," and also in order that he might have a fair 
 chance of still winning Miss Y — . His life-long worry about ado- 
 lescent masturbation, his bitter resolutions to purify himself and 
 make himself worthy, the loss of the encouraging influence of his 
 master in science, who counteracted the depressing influence of his 
 skeptical father and director, the hopeless attachment to Miss 
 T — , his economic poverty, even though relatives were willing to 
 give him a home, and his mother's persistent influence establish- 
 ing the pernicious tendency to sacrifice himself when his affec- 
 tions were opposed to authority, probably were the principal de- 
 terminants that converged upon the sacrificial suicide, a renuncia- 
 tion of all competitive interests, and an eternal regression to his 
 mother. True to his childhood inspiration, of which he often de- 
 voutly told his mother, that nothing could ever separate him from 
 her, he finally had to give up the struggle to establish his own 
 biological integrity and independence. 
 
 Had the patient fulfilled his impulse to kill the director, he 
 Avould probably have fortified his position with all the logic, fan- 
 cies and inspirations of the true paranoiac and suffered as a mar- 
 tyr. He had brought his old correspondence for this purpose. 
 The jury would probably have given the verdict of insanity, be- 
 cause of his long series of neurotic episodes and acquitted him of 
 a very intelligently planned crime, and an inspired act, that was 
 committed in order, to "remove friction." This homicide would 
 have been due to a desperate effort of the repressed and misdi- 
 rected affect to break throiigh the insurmountable resistance and 
 
MECHANISM 01? SUPp-RESSION OR ANXIETY NEUROSES 285 
 
 save the personality. This is essentially the mechanism of all 
 inspired and compelled acts: to break away from the repressing 
 influences and attain affective freedom. 
 
 The causes of this man's svppression or anxiety neurosis (di- 
 agnosed as "locomotor ataxia," "malaria," "neurasthenia," 
 "delicate constitution," etc.) wore obviously the inability to com- 
 pensate and remove the repressive influences in the persons of his 
 father and others which were preventing him from developing 
 virility and escaping from autoeroticism and feminine submissive- 
 ness. The manner in which the repressed affect finally converged 
 upon a desperate, eccentric inspiration in order to win freedom 
 and attain potency will be seen, in the chapter on the paranoiac, to 
 be the mechanism of pernicious repression and compensation. 
 
 This parricidal compulsion is the opposite of the crucifixion 
 and sacrifice to the rival father. Both acts are founded upon the 
 suffering another's love, but become differentiated into parricidal 
 or sacrificial solutions by the hatred or love of the father for the 
 rival infant and later for the adolescent. This in turn depends 
 upon whether or not the father himself has difficulty with the ten- 
 dency to homosexual reversion or is a well-established beneficent, 
 virile, heterosexual type and does not mind the aggressions and 
 claims of his son becaiise he will "grow up" and perpetuate the 
 father to the third generation. 
 
 Suppression Neuroses in War 
 
 The manifold problems besetting the army surgeon, under the 
 caption "shell shock," arising from the stresses of a military cam- 
 paign, and the shocking powers of modern artillery, have produced 
 an enormous number of maladaptatiohs which are to be correlated 
 into two fundamental groups: {a.) the cases attending organic 
 injury and (&) the cases of affective suppression or repression. 
 Either type may occur with or without predominant symptoms of 
 autonomic distress. 
 
 The cases of organic injury include both the gross hemor- 
 rhages and thrombi, as well as the molecular intraneuron dis- 
 turbances due to violent cephalic auditory concussions. Probably 
 most cases of internal organic molecular injury Avhich cause ab- 
 normal variations of behavior are to be easily differentiated from 
 the affective derangements, because they belong to the cerebellar 
 ataxic, cerebral anmesic and aphasic types. The treatment in 
 
2S6 PSYCHOPATHOLOGY 
 
 such cases is essentially rest, physical recoiistT-uction, and reedu- 
 cation. 
 
 The affectively distoited, howc'voi-, Ix'cause of their irrespon- 
 sibility and pernicious influence upon the morale of their com- 
 rades, form a more serious problem for the medical officers. The 
 essential factor is that the terrified autonomic apparatus reflexly 
 forces the individual into a useless adaptation in order to es- 
 cape from pain and danger. These adaptations consist usually 
 of the disuse of motor or sensory functions (as motor paral- 
 yses of limbs or larynx; hyperesthesias or anesthesias, as irrita- 
 bility, blindness, deafness, anosmia) or the distortion of motor 
 functions, as in spastic contractions and imitative postures. 
 
 This group of functional cases, complicated and highly indi- 
 vidualistic in their personal qualities, is best treated by giving 
 each patient sufficient personal attention to establish a transfer- 
 ence from the patient. Then the physician is able to influence him 
 with suggestions. The hypnotic type of suggestion can only be 
 made after an affective transference has been established, other- 
 wise no state of rapport exists. Suggestions under light ether an- 
 esthesia, no doul)t, must have a similar affective foundation and 
 the transference determines, by its vigor, the posthypnotic degree 
 of successfulness of the suggestion. 
 
 The soldier who generally suffers least from battle is the man 
 whose affect craves most to fight for the cause of his people. This, 
 however, is determined by the nature of his love for his people and 
 their principles. His sacrifice to save them is rewarded by propa- 
 gating their cause and winning their love and social esteem. In 
 the following repression neuroses it will be shown that the indi- 
 vidual who is subconsciously autoerotic or sexually indifferent 
 to the future Avelfare of his race, as the indulgent homosexual (not 
 the sublimated), has usually the least capacity to make severe 
 sacrifices for the cause of his people. 
 
 MacCurdy's studies of shell shock, as an analytical con- 
 tribution to our taiowledge of the individual character in rela- 
 tion to shell shock, establish the prevalence of abnormal biological 
 (sexual) types among these cases. It has repeatedly been stated 
 by French, English and German writers that psychoneuroses aris- 
 ing in a military campaign contain nothing new in principle from 
 the cases found in civil life, which is essentiallv true. 
 
MECHANISM OF SXJPPRESSTOK OK ANXIETY NEUROSES 287 
 
 My impression, based upon a review of the literature collected 
 by F. E. Williams in "Neuropsychiatry and the War," and four 
 years of analyzing psychoses in soldiers and sailors in St. Eliza- 
 beths (Government Hospital for the Insane), is that the functional 
 maladaptation that renders an individual useless for a military 
 campaign is a profound biological adjustment to avoid the causes 
 of fear. The causes of fear are usually (1) potential death and 
 physical injury, or (2) an uncontrollable subconscious craving to 
 commit submissive homosexual perversions because of the sexual 
 isolation. 
 
 The autonomic state of fear is in itself extremely distressing 
 and a grave test of the compensatory capacities of the autonomic 
 apparatus (adrenal, thyroid, hepatic, respiratory, cardiac, vaso- 
 motor, renal, digestive). A disease process in any of the divisions 
 of the autonomic apparatus or undue fatigue from exertion and 
 insomnia predisposes to a failure of compensation and the mainte- 
 nance of aggressive resistance to the hostile or seductive environ- 
 ment. The individual who has undergone an eccentric deviation of 
 the psychopathic type, in order to avoid being forced by military 
 command or social obligations to compete with the causes of fear, 
 usually is unable ever again to meet those stresses Avith sufficient 
 confidence to make him feel reasonably sure of compensating suc- 
 cessfully, unless protected by a profound transference or love for 
 his people or some one representing them. 
 
 The psychopathologist must therefore make a neat discrimina- 
 tion between ordering the soldier, after his readjustment, into a less 
 dangerous environment, in order to save him from breaking 
 down again, or returning him to the^ battle to sustain and 
 propagate, eventually, the ideals of his people. It is needless 
 to emphasize that the acquirement of most unusual insight into, 
 human nature is absolutely essential for the successful practice 
 of psychotherapy. In this respect the medical profession has ut- 
 terly failed to encourage its better equipped members to give psy- 
 chopathology serious attention and understand the significance of 
 anxiety and its ranges from a mild malaise to terrific panic. 
 
 Restatement 
 
 The two foregoing cases of chronic anxiety are, after all, not 
 unusual types of cases. They were differentiated principally, in 
 
288 PSYCHOPATHOLOGY 
 
 Darwin's case, by an n.nqnalified submission which, is rarely snc- 
 cessfnl (his adjustment conld only have been successful because 
 of his' economic independence and his wife's marvelous devotion), 
 and, in Case AN-3, by the severity and remarkable perseverance of 
 the struggle against hopeless odds for an impossible goal. The 
 psyehopathologist meets with almost innumerably varied causes 
 of anxiety, but, in one factor, they are all the same — the anxiety 
 is due to the suppressed or repressed affect trying to force its 
 way through the egoistic resistance in order to ohtain relief or 
 gratification. Hence, whenever a patient describes his physical 
 symptoms and the latter indicate undue tension, both the nature 
 and the cause of the suppressing and suppressed affect must be 
 sought. The cause of the suppression is egoistic and environ- 
 mental, that is, due to the obligations required by the individual's 
 associates, as the wife, children, employer, commander, or priest, 
 as the initiator of a conflicting fear and wish for esteem. Although 
 the suppressed affect may be love, fear, hate, shame or grief, the 
 anxiety is due to the inability to get relief and get rid of the affect. 
 The most common forms of affective craving which society 
 requires the individual to suppress, and which constitute the most 
 serious personal conflict, are autoerotic or homosexual love, incest, 
 hatred and fear. They are all rather easily recognized and ad- 
 mitted when the physician has the confidence (transference) of the 
 patient and the patient has not made a complete repression and 
 affective convergence upon a functional defence or sublimation, 
 physical or ideational. The physical distortions constitute the 
 solution, and like the fancies or ideas, are the product of a per- 
 sistent kinesthetic sensory stream which is sustained by the con- 
 verging affect (repressed and repressing) becoming fixed in the 
 adjustment of the conflict. Such maladjustments may in turn be- 
 come the foundations of further distortions, thereby enormously 
 complicating the personality. The mechanism of the repression 
 neuroses will be presented in the next chapter, and the manner in 
 which the psychoses are elaborations of the psychoneurotic ad- 
 justment is given considerable attention in order that the discus- 
 sion of the latter may logically follow. 
 
CHAPTER VII 
 
 REPRESSION OR PSYCIiO-NEUROSES 
 
 Their Mechanisms and Relation to Psychoses Due to Repressed 
 
 Autonomic Cravings 
 
 The true repression neuroses, which exist in the form of spe- 
 cial phohias and definite compulsions, which are not common to the 
 individuaPs social group, and the eliminations of the use of special 
 functions or organs (as anesthesias and paralyses), contain a dis- 
 tinct, additional mechanism from that which is found in the pure 
 suppression or anxiety neuroses. In the latter, distressing tensions 
 of different segments of the autonomic apparatus occur (chiefly 
 gastrointestinal and cardiorespiratory) Avhich, in turn, disturb the 
 reciprocal adjustments of the other important segments, such as 
 the sexual or renal functions. These disagreeable tensions are 
 always due to threatening factors within the personality or in the 
 environment which cause fear reactions (such as shame, grief, dis- 
 gust, fear of censure, persecution, injury or failure, etc.). Dis- 
 tressing hypotensions of viscera (sinking feelings) are due to the 
 failure of the autonomic apparatus to compensate. (In many in- 
 stances, defensive compensation tends to increase the punishment 
 or threat, as when a parent, teacher, mate, or an employer demands 
 abject submission.*) When the autonomic apparatus tends to 
 overcompensate in a painful situation, the individual is distressed 
 by the hypertensions of visceral segments. The individual, in the 
 anxiety neuroses, becoming afraid of his ability to control him- 
 self, tends to avoid the situation, as in Darwin's seclusiveness be- 
 cause of the tendency to become unduly distressed by social gath- 
 erings, but he does not obscure its true nature from himself by 
 fooling himself into believing that the distress is caused by an 
 extraneous influence. 
 
 So soon as the individual, in order to avoid recognizing the 
 painful factor in the situation, attempts to give it a pleasing, fic- 
 
 *Aninials and birds often use the meciianisin of complete submission in order to avoid the 
 punishment that may come if anger is shown; as the puppy lies on its back exposing its throat and 
 abdomen to the other dog's domination. 
 
 289 
 
290 PSYCHOPATHOLOGY 
 
 titious value, then what "usTially proves to be an impractical dis- 
 tortion occiirs ; as the devoted mother, who, refusing to recognize 
 the lies in her son's explanations of his misbehavior because that 
 would be too painful, overcompensates with some foolish' indul- 
 gence. Such adjustments eventually place the individual at a pro- 
 gressively increasing disadvantage if he must struggle with com- 
 petitors in order to retain his social and economic position. 
 
 In the repression neuroses, the indiAddual suffers from a func- . 
 tional distortion bepause the autonomic segment, giving rise to 
 affections which would claim a hazardous object or course of be- 
 havior, is kept repressed by a vigorous compensatory coordina- 
 tion of the remainder of the organism (the ego) upon some asso- 
 ciated interest or function. This adjustment controls the activities 
 of the final common motor paths (Sherrington) ; as in the case of 
 mysophobia-, or in the functional disuse of a limb (paralysis) or 
 sense organ (anesthesia). 
 
 Obviously, any defective adaptation of this nature to an emer- 
 gency more or less reduces the individual's capacity to master the 
 environment, hence, to compete for social influence and esteem. If 
 the adaptation involves the aggressive self-assertions that are 
 necessary for effective competition, such as taUdng in a resonant 
 voice directly to the point, and makes it impossible to functionate 
 with due impressiveness and Avithout posing, the individual's effi- 
 ciency is enormously reduced. One finds that very capable men, 
 who are too timid, must accept subsidiary positions because they 
 can not endure the embarrassment that is aroused by the possibil- 
 ity of failure in competition. 
 
 Such adjustments and repressions do not necessarily in them- 
 selves make an individual unhappy. They may, however, make it 
 impossible for him to compete for a mate or a responsibility. One 
 finds everywhere worthy men and women, who desire nothing so 
 much as parenthood, chronically avoiding everything pertaining 
 to sex ; hence, whenever the sex interest begins to assert itself, the 
 subject is avoided, and not even the preliminary stages of "making 
 love" are attempted. The scene that promised much is tactlessly 
 ended, and for months the memory of it is cherished and wondered 
 at because of what might have been. But no further progress is 
 made. 
 
 Individuals, who grow into this biological type, are incapaci- 
 
REPRESSION OR PSYCIiONEUROSES 291 
 
 fated by sexual repressions and absurd compensations. Tliey are 
 usually started in childhood through the influence of some prudish 
 adult who labors under the mission of eliminating everything that 
 pertains to or stimulates a sexual interest. 
 
 The concentration upon a substituted interest, by which the 
 intolerable wish is kept repressed and the compensatory trend is 
 also gratified, may assiime the constructive course of making some 
 particular creation or investigation, or the destructive course of 
 merely eliminating some vitally necessary function or affection. A 
 great deal is being said about hysterical conversions and conver- 
 sion mechanisms. The term conversion was adopted by Freud (see 
 case of Miss Lucy E — ). lie confusingly assumed that "psychic 
 energy," without explaining what is meant by it, becomes con- 
 verted into a physical distortion or functional derangement such 
 as a paralysis. This conception, so generally used in articles on 
 psychoanalytic studies of neuroses, seems to be, upon careful con- 
 sideration, incomprehensible as a biological phenomenon. It is 
 not only confusing but imnecessary. There surely can be no dif- 
 ference in principle between the making of different overt move- 
 ments, say in making sounds and signs with the hand or vocal 
 organs, and preventing their being made. The innervations neces- 
 sary to maintain postures and functional paralysis require auto- 
 nomic reenforcement just as m^uch as skillful movements require 
 it. Functional anesthesia, or hyperesthesia of any receptor field, 
 is in principle the same as the commonplace phenomenon of direct- 
 ing attention. It is entirely a matter of affective, or rather auto- 
 nomic resistance to, or craving for, the stimuli ivhich are received 
 hy the particular sense organ. It is nothing less than a reductio ad 
 absurdum to assume that repressed anger can be "converted" into 
 a physical distortion. The repressed affect, or rather the hyper- 
 tense repressed autonomic segment, simply forces the assumption 
 and maintenance of a fixed attitude, stereotyped function or an 
 idea, which requires as constant innervation and affective reen- 
 forcement as the performance of countless movements to attain an 
 end ; as in the handwashing of the following case of mysophobia, or 
 the case of functional paralysis of the leg, or Darwin's life long 
 compulsion to solve the riddle of the evolution of life and the origin 
 of species. The functional variations in the innumerable psycho- 
 paths to be met with in the practice of medicine are determined by 
 
292 PSYCHOPATHOLOGY 
 
 the manner in.wMcli the affect has been conditioned and repressed 
 and has compensated and its stimuli have been associated with 
 avoidable or unavoidable factors in the environment. 
 
 Compidsions and obsessions are the same in principle, in that 
 behind the compulsion to perform a certain act, or the obsession 
 that something might occur, when performing a certain act, is the 
 fear of the possible conseqiiences if such acts are not always per- 
 formed. The difference between compulsions and phobias usually 
 lies in the manner in Avhieh the patient or physician regards the 
 difficulty. For example, in the case of mysophobia the compulsion 
 to wash the hands was a compensation for the fear of being ' ' con- 
 taminated" by dirt, germs, feces, etc. The fear of fecal contami- 
 nation, however, was based upon the craving or love for anal- 
 autoerotic fancies and sensations. The compiilsion or phobia was 
 always emphasized by the patient. The erotic craving, however, 
 was always concealed with the utmost determination. The delusion 
 and hallucination as the result of vivid sensations caused by the 
 persistent struggle of the repressed affect to get gratification, are 
 actually the result of the obsessive craving compelling the individ- 
 ual to be conscious of the specific sensations because they are, in 
 some manner, associated with the stimuli that might gratify the 
 affect. Phobias are usually due to fea/rs of having tabooed crav- 
 ings : therefore, what is the repressed wish or craving and the 
 secret experience in which some such indulgence actually occuredf 
 
 A dependent old mother is obsessed with the fear that her 
 daughter wishes her to die. This gives rise to compensatory 
 behavior which is designed to make the daughter wish that she 
 should live. The foundation of the fear about the daughter 's wish 
 is the fact that she prevents the daughter from marrying and 
 usurps her affections for herself. The daughter, being forced to 
 repress her wishes for maternity, which naturally tend to remove 
 the obstruction, the dependent mother, compensates with feelings 
 which compel her to renounce all social engagements that may give 
 rise to the possibility of an offer of marriage. 
 
 Behind compulsions or obsessions is the fear of yielding to a 
 repressed, intolerable, secret v)ish of which the individual has suc- 
 ceeded in keeping himself unconscious by concentrating. on a sub- 
 stitute. This substitution usually becomes very much involved, 
 be'cause of its eccentric nature, with the adaptations that are 
 
EEPRESSION OR PSYCHONEUROSES 293 
 
 necessarily required in the day's -work. The patient never comes 
 for relief from the repressed wish, but desires to be relieved 
 of the \exhaiisti-ng--dj;ains necessary to maintain the substitution. 
 The medical profession, until Freud worked out the mechanism of 
 the compulsion, was as helpless in the solution of the mechanism 
 of compulsions as academic psychology. 
 
 Simple phohins, such as fear of Avater, fire, automobiles, bee- 
 tles, spiders, foods, strangers, etc., are often conditioned auto- 
 nomic reactions due to the accidental association of the object, as 
 the mouse, with a primary fear producing stimulus. The primary 
 cause, say the frightful story of a sadistic nurse told in childhood 
 is no longer recalled by the patient, but the presence of a mouse 
 still causes a repetition of the panic of childhood. 
 
 All cases in ivhich the repressed affect is resisted by the per- 
 sonality, causing a functional distortion, should he considered as 
 repression neuroses. The individual who has repressed the affect 
 and refuses to regard it as a part of his personality, is logically 
 subjected to a mysterious, persistent, pernicious influence from 
 which he can never escape, and this force is potentially liable 
 through a summation of repressions or exhaustion of the ego to 
 produce a serious dissociation of the personality. Undue stresses 
 (diseases, exhaustion, insomnia, failures) Aveaken the controlling 
 AAdshes which are striving to retain social esteem. 
 
 The following patients, Avho illustrate these mechanisms, are 
 divided into two groups. Those who striA'e persistently to elimi- 
 nate or castrate the functional or organic inferiority in order to 
 get rid of a craAang, and those AA^ho strive to simidnte a function or 
 condition which pleases the otherAvise ungratifiable craving. The 
 elimination types of psychoses and neuroses seem to be more 
 malignant than the simple simulation, types, because in the latter 
 the affect often obtains gratification, that is, is neutralized and 
 the craving ceases. 
 
 There is a distinct functional difference betAA^een the repres- 
 sion neuroses and acute dissociations of the personality marked 
 by hallucinations. The degree and persistence of the dissociation 
 process varies enormously. 
 
 In the following Case' PN-1, the patient was compelled to 
 wash herself almost incessantly in order to obtain relief from the 
 fear and shame of being "contaminated" by feces. The feeling 
 
294 PSYCPIOPATHOLOGY 
 
 that she was contaminated had its origin in an anal anto erotic 
 catastrophe of which, because of the embarrassment it caused, she 
 had to keep herself unconscious ("forget it"). 
 
 Case PN-1 was a young woman, unmarried, with a high school 
 education and considered to be a likable, capable girl by her 
 friends. She was Avell able to earn a living, and apparently suc- 
 cessful, when there developed quite suddenly an intense mysopho- 
 bia, (fear of being "contaminated by dirt"). 
 
 The history of the onset showed that she had been inclined to 
 conceal her emotions, and was, secretly, very erotic. The im- 
 portant feature in her case was the incessant compulsion to wash 
 her face, hair, hands and body, but chiefly her hands, because she 
 believed she was "contaminated." All her interests in her family 
 and friends were completely subordinated to this craving to get 
 clean. 
 
 She had to quit work and spent practically all her time wash- 
 ing and drying herself. When the distracted parents and sisters 
 tried to stop her, she became "wild," pleaded, begged, cried, 
 fought, and became panicky until they permitted her to resume 
 the washing. A few minutes after she felt herself to be clean, 
 she would again be compelled to use soap and water and would 
 consume an entire bar of soap at a washing if permitted. She 
 finally had to be sent to the state hospital in order to protect her 
 from the obsessive craving. 
 
 The sole topic of interest to her was that she had been ' ' con- 
 taminated" by filth and could never get clean. Her conversation 
 showed that there was no intellectual impairment. She would 
 give no explanations about when or how she had become "con- 
 taminated. ' ' 
 
 Wlien washing herself, she rubbed the skin surface with highly 
 rapid, short, brisk strokes. Her almost breathless eagerness and 
 the flushed, excited face, and expression of rapturous delight sug- 
 gested a strangely erotic excitement in the contamination. She 
 sought no relief from the compulsion to wash and would gladly 
 have devoted her life to this obsession — an interesting form of 
 biological .abortion. (Her behavior, or affective state, was not 
 characterized by the disgust that one would expect when removing 
 filth from the skin.) 
 
 Her compulsion, after more than a year's duration, was con- 
 sidered incurable by the physicians she consulted. Almost daily 
 
REPKESSION OR PSYCHONEUROSBS 295 
 
 brief talks and earnest suggestions about her welfare had no mit- 
 igating effect upon the craving to remove the "contamination." 
 Without my realization, however, of what was transpiring^ this 
 young woman, about my age, Avas responding to my interest in her 
 welfare by making a transference to me. (This case was worked 
 out in 1911 after reading Freud's Studies of Hysteria. I now 
 feel sure that only the development of this transference made the 
 later grewsome analysis possible.) 
 
 The transference developed to a state that made her feel an in- 
 terest in other possibilities of living. I was then learning the 
 technique of psychoanalysis, and success with another case was 
 creating an interest among the patients. This led Case PN-1 to 
 seek the intimate conversations of a psychoanalysis. 
 
 The essential points of the origin of the feeling of having 
 been contaminated, were easily uncovered, but, as she broiTght 
 them out, she vigorously denounced me for "putting the thoughts 
 into her mind." (I was extremely careful to avoid making any 
 other suggestion than that whatever we were considering at the 
 time would surely remind her of more details. In this sense I did 
 suggest that she would recall the memories of a painful experience, 
 but in no sense did I suggest what it would be.) 
 
 She uncovered her secret autoerotic fancies with considerable 
 resistance and embarrassment, but her confidence in the sincerity 
 of the procedure enabled her to recall the delicate secret of her 
 love fancies about her cousin and a playful scene with him. 
 
 This led, in turn to the critical scene in the kitchen. She vis- 
 ualized herself washing dishes, and her sister working near by. 
 She was having difficulty in washing some object and her fancies 
 indicated that she was in a decidedly erotic mood. Despite the em- 
 barrassment, she honestly revealed that she was menstruating at 
 the time and was wearing a cloth made from her father's under- 
 wear. Then she added the significant fact that the thoughts of 
 this cloth had aroused more pleasure than she had realized, and 
 in her erotic mood she felt a desire to allow her bowels to evacuate. 
 
 Despite her sister's presence, before she realized the preca- 
 riousness of her state of mind, she yielded to the erotic pleasure, 
 beca,use, as she said, the passing of the feces would "feel good" 
 (substitution for phallus). 
 
 Immediately following the evacuation, which she was inclined 
 
296 PSYOHOPATHOLOGY 
 
 to urge was mfluenced by diarrhea, slie fotind herself in an ex- 
 tremely embarrassing situation. She fled to the toilet and in un- 
 dressing her hands became contaminated with feces. ; 
 
 Her guilt and shame were greatly aggravated by the dre|d 
 that her sister might guess the truth of the incest. The sister 
 seemed to accept the affair as an accident, but the mortified Sri 
 could not be convinced. The shame from the erotic fancies about 
 the father and the cloth could not be completely repressed from 
 consciousness, and the struggle to get clean by washing, which she 
 was doing at the time, persisted as a defensive, persistent, obses- 
 sion. 
 
 With the recall of the semirepressed material, her mortifica- 
 tion and anxiety became serious. She upbraided me for havinf^; 
 brought the thoughts to her mind and had to be placed in bed 
 because of becoming suicidal. "Whenever she saw me, her anxiety 
 waxed into a crescendo. This continued for several weeks and 
 I now feel its long duration was due to my inexperience Avith the 
 transference under such conditions and my inability to advise her 
 properly. 
 
 Unfortunately, I was unable to complete the analysis and help 
 her to free herself from the secret father attachment because of 
 leaving the hospital service. Several months later, however, I re- 
 ceived a letter from her that explained the outcome. In it she ex- 
 pressed gratitude for having been cured. She had returned to work 
 and was enjoying excellent health. 
 
 The incessant compulsion to remove every possible trace of 
 "contamination" was obviously a desperate effort to wash the 
 erotic guilt away. This sense of guiltiness was persistently forced 
 into consciousness by the repressed erotic cravings for the father, 
 which had suddenly been transformed from a secret pleasure 
 into a terrible burden, because the whole truth might be sur- 
 mised by the sister, who probably vaguely knew more than she 
 would allow herself to realize. 
 
 This type of anal autoerotic personality, with the father as 
 the affective object, will probably develop into a gravely psycho- 
 pathic personality having terrific affective difficulties and distress- 
 ing feelings of being socially inferior unless she is helped to estab- 
 lish an adequate affective readjustment. The cleansing obsession 
 in her case might be compared with the behavior of a young homo- 
 
REPRESSION OR PSYCHONEUROSBS 297 
 
 sexual soldier, very tense, inaccessible, and hostile, who would 
 stand for hoiirs before the window with his month wide open to let 
 the sun shine into it. 
 
 The above case was essentially due to a persistent attempt to 
 eliminate an intolerable affective craving and the sensory im- 
 pressions (memories) aroused by it. The following case was also 
 characterized by a series of elimination procedures in which the 
 patient used the mechanism of repressing (forgetting) the affec- 
 tions and memory impressions that pertained to a painful expe- 
 rience, because it was her only means of escape from a distressing 
 situation. The extent to Avhich the elimination of inferiorities 
 may be developed is astonishing. It often includes the most radi- 
 cal of major operations if an unsophisticated surgeon can be 
 found, who sluggishly conceives the personality to be an organic 
 mass whereby his scalpel becomes the supreme truncheon of the 
 universe and he its irrepressible wielder. Panhysterectomies, 
 ciirettages, circumcisions, thyroidectomies and gastroplastic oper- 
 ations are not uncommon sequelae of the patient's effort to refuse 
 to recognize the repressed affective cravings, particularly hate, 
 envy, jealousy and love. 
 
 Case PN-2* was a slender, dark-complexioned girlish look- 
 ing woman, of medium height, twenty-one years of age, who was 
 admitted to a state hospital for the insane because she could not 
 control her "hatrish feelings" and "jerking spells." 
 
 During the admission proceedings, she sat quietly in an incon- 
 spicuous chair, her head lowered so that the brim of her hat con- 
 cealed most of her features. When she looked up, she timidly 
 lifted the hat just high enough to permit her eyes to peer beneath 
 the edge. She smiled at almost every remark addressed to her, con- 
 trasting strangely with the uncontrollable feelings of hatred of 
 which she complained and indicating compensatory efforts to hide 
 those feelings. Her husband gave the usual brief account of her 
 illness, but carefully hid his feelings of personal responsibility, 
 displaying no intimation of insight into her condition. However, 
 he was very solicitous of her welfare. 
 
 The patient's life on the ward for the first few days was un- 
 eventful. She adjusted herself fairly well to the companionship 
 and society of other patients, accepting the routine requirements 
 
 *This case was reported in the Journal of Abnormal Psychology, April, 1917, as: "A Study 
 of the Anesthesia, Convulsions, Vomiting, Visual Constriction, IJrythema and Itching of Mrs. V. G." 
 
298 PSYCHOPATPIOLOGY 
 
 and finding some light work to perform to curtail the periods of 
 idleness. 
 
 "When her ear was pricked, in order that a blood specimen 
 might be taken, she submitted to the ordeal without any signs of 
 uneasiness until the blood was being cleaned off. Then, suddenly, 
 she became embarrassed, and seemed to be very uncomfortable, 
 but said nothing to the physician (conditioned repressed affect). 
 
 One morning, after this incident, when I made my ward 
 rounds, I found her. standing before a window, seemingly very 
 much embarrassed. The muscles of her body were jerking vigor- 
 ously and she explained when I approached that she hated ' ' that 
 man more than any one in the world." (She referred to the phy- 
 sician who made the ear puncture and whom she had just seen 
 pass the building.) She could not explain why she hated him; 
 he had not hurt her but had been kind and careful, she said ; but, 
 nevertheless, when she saw him, she felt an intense hatred. 
 
 Within a few days after her admission, the "jerking spells" 
 or "hatrish feelings" recurred so frequently that she was seldom 
 without them. She complained, pitifully, that, despite her efforts 
 to control herself, even the slightest commands of the nurses af- 
 fected her. Such impersonal orders as the call of the patients to 
 attend dinner caused her to feel intensely embarrassed and resis- 
 tant, even though, as she expressed herself, she knew better. 
 
 She told me of one of her reactions when she was in the grove 
 with her ward. "She [the nurse] called us .in a very pleasant 
 voice [to come to the ward] , but it affected me so deeply that in a 
 second, my thoughts Avere in a whirl. I came in, and went to my 
 room and cried. All those bitter thoughts back in my childhood, 
 rushed through my mind. I could see them all, like a flash, pass 
 in a string, and it made me feel so bitter I cried, and then went to 
 sleep. But today I feel better." 
 
 It was observed that practically all of the muscles of her body 
 "jerked," that is, became involved in convulsive movements dur- 
 ing many of these episodes. The recti abdominis were included 
 in the large group of muscles which were involved, but not until 
 later was it ascertained that their activity was conditioned by a 
 distinct experience. With the attacks, there would often be inter- 
 vals when she would beat herself and dig her nails into her palms. 
 She was afraid that she might injure herself or others. She did 
 not hallucinate or lose consciousness. 
 
KEPRESSION OR PSYCUIONEUROSES 299 
 
 Upon examination, without a perimeter, it was found that her 
 visual field for colors was marliedly constricted for the right eye 
 and practically normal for the left. 
 
 The patient did not react to heat, cold, touch, or pain, except 
 sometimes when it was strongly suggested that she could feel the 
 stimulus, over the right side of the face and neck, right shoulder, 
 arm, trunk, and leg. She also practically gave no response to 
 .stimuli over the posterior surfaces beloAV the waist. The left side 
 varied considerably at different times, but, on the whole, the sen- 
 sations were normal over the left half of the face, shoulder and 
 arm, except over the hand and a narrow strip which ran down 
 the left side of the body and leg to the ankle. Stimulation of the 
 hands and feet yielded no response. She had never complained of 
 loss of sensation, had no idea of its duration, and seemed to be 
 surprised at the discovery. 
 
 On the extensor surface of each forearm, about midway be- 
 tween the elbow and wrist, was an irregular, blotchy, slightly 
 raised erythematous surface. Each area was about as large as the 
 finger surface of a woman's hand. These areas itched consider- 
 ably at times, and she insisted that it was a skin disease which she 
 had had for more than a year and did not worry about, and which 
 bad nothing to do with her illness. 
 
 Her subjective complaint consisted of "hatrish feelings," 
 "jerking spells," and nausea, caused by red fruits and vegetables. 
 This nausea became so intense that she vomited when she ate red 
 fruits or vegetables (conditioned affective reaction). 
 
 To sum up her symptoms, she had (1) uncontrollable periods 
 of intense hatred and jealousy, for, principally, her husband, 
 mother-in-law and her grandmother; (2) periods of jerking of 
 practically all her voluntary muscles; and (3) an independent 
 jerking of her abdominal muscles; (4) anesthesia for her right 
 face, chest, arm, side of body and leg, and back below the waist, 
 with later hyperesthesia of the right upper face; (6) constriction 
 of the field for color vision in the right eye, pai"ticularly red; (7) 
 nausea and vomiting caused by red fruits and vegetables; (8) 
 erythematous blotches on the extensor surface of each forearm, 
 and (9) periods of intense itching over these surfaces. 
 
 Her parents died when she was two years old. She was 
 adopted by a neighbor whom she was very fond of and always 
 
oOO PSYCHOPATHOLOGY 
 
 regarded as her mother. This woman taught her the Catholic 
 faith, gave her a comfortable home, and provided for the usual 
 childhood education. She was probably an excessively petted 
 child. She was taught by her foster-mother to fear and avoid a 
 certain "mean" old lady. Unfortunately, this old lady, who was 
 her grandmother, caught her on the street when she was about ten 
 years old and kidnapped her despite her cries and protests. From 
 that day on, she lived very unhappily with this grandmother. 
 
 The patient always believed that the shock of the kidnapping, 
 her great fear and hatred of her grandmother, reenforced by the 
 long years of unhappiness, caused her to become abnormal. As a 
 child of her foster-mother she had been petted, spoiled and given 
 every comfort and attention. After she was kidnapped, she was 
 always miserable; scolded, whipped, lonely and unhappy. She 
 had to sleep alone upstairs, and frequently, terrified, she sneaked 
 to the head of the stairs where she cried herself to sleep. She was 
 often punished for this, but the punishment did not stop the fear. 
 After her grandfather died, \er night terrors left her. 
 
 Other than the constant exposure to the unintelligent domina- 
 tion by a much older, unsympathetic personality, her life was un-, 
 eventful until the period of her engagement and marriage. 
 
 The grandmother was an earnest Catholic, but the patient, 
 as she said, felt very little interest in that faith. The persistent 
 old lady had no patience for such girlish irresponsibility and 
 planned out the young woman's course in life without considering 
 her wishes. She selected a young Catholic man to be her grand- 
 daughter's husband and, at what seemed to be the propitious time, 
 announced her engagement to him through the medium of the news- 
 papers. But this selection, like most of her grandmother's ideas, 
 was quite different from what the young woman desired. This 
 young man, she said was a flirt, and was known in the neighbor- 
 hood as an immoral man. For some reason that she did not quite 
 understand, she liked him, and often fancied herself the object 
 of his flirtations, but she was never able to love him. 
 
 She was in love, she thought, with a young Protestant and, 
 despite her religion and her grandmother's horror, determined to 
 niarff him. The grandmother was not sure of their intention, but 
 suspected it, and determined to forestall their purpose by an- 
 nouncing her engagement to the Catholic and this precipitated a 
 
REPRESSION OR PSYCHONEUROSES 301 
 
 crisis. The next day the patient denied the engagement and a 
 furious debate between the two women resulted. The grandmother 
 would not permit her fiance to see her, but kept her in the house 
 and sent for the parish priest. She said the two people tried to 
 convince her that she would make a mistake if she should marry 
 the Protestant. In the afternoon, the patient was locked in her 
 bedroom by the grandmother and informed that she would be kept 
 there until she promised to marry the Catholic. (The remaining 
 details of the scene which developed while she was in the room 
 were forgotten by the patient and will be described later as part 
 of the psychoanalysis.) 
 
 Later in the afternoon, the patient managed to escape from 
 the house and stayed with her future sister-in-law. A few days 
 later she married the Protestant. (It may be best to note here 
 that this sister-in-law had been subject to violent "jerking spells" 
 since the birth of her first child. The muscles involved were 
 principally the abdominal, according to our patient's statement.) 
 
 Soon after this a neurosis became apparent and developed 
 rapidly. A sequence of unhappy experiences in an environment 
 that was peculiarly suited to expose her to a series of most un- 
 pleasant conflicts, soon proved too much for the patient. 
 
 Her husband's parents lived alone on a farm which they had 
 occupied for years and the young couple Avere to take complete 
 charge of all its details and live with the old people. This proved 
 unfortunate, because the mother-in-law could not give up her 
 dictatorship of a household that she had dominated for years. 
 The young wife was in perpetual conflict with her. She was, in 
 reality, exposed again to her perplexing grandmother problem in 
 the person of the mother-in-law. The long needed freedom from 
 restraints and criticism was not to be her good fortune. 
 
 She soon became convinced that she was not regarded Avith 
 much favor by the older woman, and believed that her husband 
 favored his mother in their conflicts, which he actually did. 
 
 The psychoanalysis, that is, the recall in detail of the sensory 
 images (memories) of the experiences that determined her patho- 
 logical condition required about eight weeks of almost daily con- 
 ferences averaging more than an hour to an interview. The recall 
 was like unraveling a tangled skein of yarn. Part of the details 
 of one experience, then part of another were recalled until most of 
 the unpleasant experiences and their influences were readjusted. 
 
302 PSYCHOPATHOLOGY 
 
 The "jerking spells" and "hatrisli feelings" bothered her 
 most, and naturally, her discussion of her troubles, at first, cen- 
 tered about their description and onset. She attributed much 
 of her trouble to the fact that several months after her marriage 
 she was badly frightened by a report from the neighbors that an 
 insane man was coming through the woods towards their house. 
 The next day their barn caught fire. Although she was men- 
 struating, she ' ' ran about a mile ' ' to call some neighbors and while 
 on her way, it occurred to her that her mother-in-law might enter 
 the barn to liberate the horses and be burned up. She at once ran 
 back to the house and found that an excited crowd of neighbors 
 had gathered and the barn was in ruins. She recalled how she 
 cried when she saw the remains of a pet colt and also how she 
 and her sister-in-law prepared dinner for the neighbors. When 
 they entered the kitchen, her "head flew back" and her "jaw set." 
 For several weeks, she seemed to be unable to recall any other de- 
 tails of this scene. Later, when the house caught fire, and when 
 the wheat field burned, she again had unusually severe convul- 
 sions. 
 
 Details of more trivial conflicts about the condiiet of the farm, 
 etc., seemed to force themselves into the foreground and neces- 
 sarily had to be readjusted. Her jealousy of the mother-in-law 
 became very evident, and her incapacity to meet this condition 
 troubled her greatly. Gradually, she developed a determination 
 to meet her family problems on another basis than hatred. This, 
 of course, she was unable to carrj'' out, but her attitude had the ef* 
 feet of enabling her to study her troubles more intimately, and she 
 no longer evaded her own responsibilities in the psychoanalysis. 
 
 Then, quite unexpectedly, memory details or images of a for- 
 gotten traumatic experience came to the surface and proved to 
 contain the conditioning stimuli of her very distressing gastric 
 sensorimotor reactions to feel nauseated when red fruits or vege- 
 tables were placed on the table for the meal. When she ate the 
 re"d fruits or vegetables they were quickly emitted again. The 
 traumatic incident amounted to the following: 
 
 In June, a few months after her marriage, she found her 
 mother-in-law on the porch before breakfast, seeding cherries for 
 canning. The patient, who was trying to take charge of the house- 
 hold, made preparations to help seed the fruit. The mother-in-law 
 refused her assistance. The yoimg woman persisted, venturing 
 
REPRESSION OR PSYCHONEUROSES 303 
 
 the information that she was not unwell because her mother-in- 
 law believed that when fruit was canned by a menstruating woman 
 it Avould spoil. Although her menstrual period was due, she did 
 not realize, until later, that the cause of its delay was pregnancy. 
 
 For several minutes she was unable to recall anything further. 
 Finally, she added, "Then I went in to breakfast with my hus- 
 band and tried to take my anger out on him, but I got no satisfac- 
 tion." Here, another break in the recall occurred. "Then," she 
 resumed, "I ate a little breakfast and my mother-in-law brought 
 in some cherries. I gave my husband mine, with the remark that 
 I guessed they were all right since he picked them. I left the table 
 and vomited up the food. I did this for everything I ate after 
 that, until my baby was born. The reason I was so angry was be- 
 cause we had contracted to run the farm for half, and I thought 
 I should have something to say." (She discussed this scene with a 
 free adjustment of anger for the mistreatment.) 
 
 (Cannon has shown that anger or fear arousing stimuli cause 
 a marked disturbance of the gastric sensorimotor and secretory 
 functions ; and the sensation or feelings produced by the reaction 
 constitute, in large part, the emotion of anger, a mechanism anal- 
 ogous to the peripheral origin of hunger. The anger and fear re- 
 actions of the stomach, both seem to be unsuitable for the recep- 
 tion of food.) When the patient was still further aggravated by 
 the triumphant mother-in-law (primary stimulus) offering the 
 cherries (conditioning stimulus,) and her husband supported his 
 mother, the patient was left no outlet through which to express her 
 anger and make a comfortable readjustment. She had to control 
 herself, that is, suppress the affect. Anger tends to remove the 
 stimulus from the receptor and not to accept it, m.uch less to swal- 
 low it as food. She succeeded in rejecting the cherries, which had 
 become part of the mother-in-law's interests, but the rage status of 
 the stomach was unlit to retain the breakfast, and caused feelings 
 of nausea. The stomach emitted the food, and it seems that so long 
 as she was unable to make a normal affective adjustment to either 
 the conditioning or the primary stimuli, they both tended to arouse 
 reactions of hatred and gastric aversion. When she did make an 
 affective readjustment to the experience, it seems that, concomi- 
 tantly, the gastric reflexes were no longer conditioned to react 
 with aversion to the red food. The readjustment seems to have 
 been in the lowering of the postural hypertension of the stomach 
 
304 
 
 PSYCHOPATI-IOLOGY 
 
 and its tendency to emissive, reversed peristalsis when certain 
 foods -were being forced upon it. 
 
 The continuation of the vomiting was probably later reen- 
 forced by the aversions to food which occur frequently as a psycho- 
 genetic phenomenon in pregnancy (perhaps nourish|g(|*an unwel- 
 come fetus), because throughout her pregnancy the patient said 
 she vomited nearly all the food she ate, and merely the sight of 
 red fruit on the table caused vomiting ; whereas, after her labor, 
 the red fruits only caused nausea, unless they were eaten. She 
 became so emaciated that later she was unable to nurse her infant. 
 
 The tendency to react with aversion to all red fruits and veg- 
 etables, besides cherries, was probably reenforced by a traumatic 
 experience of several months previous, because, when she had 
 made an emotional adjustment to the cherry incident and allowed 
 the hatred freely to attack the unjust husband and mother-in-law, 
 she, much to my surprise, included the pathologist. She could 
 not explain why she included him, until it occurred to her that she 
 felt her first hatred for him Avhen he removed the blood-stained 
 (red) cloth from her ear after making a puncture to take a blood 
 specimen. To this she added: "I thought he did just as he 
 pleased," which seemed to be an insignificant phrase, but later 
 proved to be an important lead. 
 
 Her agitation and hatred continued for the next twenty-four 
 hours and was, later in the day, accompanied by a general con- 
 vulsive jerking of her muscles which continued throughout the 
 night. 
 
 The episode of the cherries occurred after the barn fire, and 
 the vividness of its affective impressions had probably covered 
 up the details of the more important barn fire episode. Now the 
 fire episode bothered her again, and she made considerable prog- 
 ress in the recall of its details, but could not quite get all of it — 
 the most pertinent fact in the scene. 
 
 She visualized the fire scene in greater detail. She recounted 
 how the excited crowd and the women, particularly the mother-in-^ 
 law, noticed her excitement and trembling, and told her to keep 
 quiet or she would have "spells" like her sister-in-law (sugges- 
 tion). She could not recall what happened next, but she was able 
 to recall from the time her head "flew back," etc., when the men 
 entered the kitchen. One of the men was Mr. li — -. He was pres- 
 
REPRESSION OR PSYCHONEUROSES 305 
 
 ident of a home insurance company that had insured the bam. Al- 
 though she seemed to be unable, with persistent effort, to recall 
 what transpired between the suggestions of the women and the en- 
 trance of Mr. li — , she was able to develop the scene from the time 
 of his entrance until her convulsions. She could see herself trying 
 to pour the coffee, but her hands trembled so violently that her sis- 
 ter-in-law took the pot, and " I broke down. ' ' She fell back into a 
 chair. The men seized her arms, to keep them from jerking, and 
 then her face began to jerk and her jaws set. Then, her entire 
 body became involved in a conviilsion from which she did not re- 
 cover until the next day. She had been apprehensive lest she 
 should be like this sister-in-law (as suggested) and now she had 
 her malady. 
 
 Her husband paid her a visit at this stage of the analysis, 
 and both were delighted with the improvement. She said her 
 ''mind felt free and open," and she now understood why she had 
 attacks in the presence of a croivd or a fire (conditioning of the 
 convulsions). But, it soon became evident that she was not so well 
 aff she thought. The fire scene was again studied and she recalled, 
 more elaborately, the details of the excited crowd running about 
 with water, and that Mr. H — wanted to know who was the last 
 person in the barn, and that she thought the people believed that 
 the son of the insane man, who had been in the w^oods the night 
 before, had set fire to the barn, because the children reported hav- 
 ing seen him running away from the fire. The patient heard Mr. 
 H — ■ telephone for the sheriff, supposedly to arrest the suspected 
 man. The recall of these impressions worried her, and she ex- 
 pressed herself to the effect that "yesterday I felt so good and 
 now I feel as if something wants to come out and can't." 
 
 She seemed unable to recall anything further and was very 
 m.uch agitated. With suggestions that she would see more details 
 of the tire, gradually other fragments of the scene were recalled. 
 She now saw the excited Mr. H — with two cups of water trying 
 to throw them on the fire, and when he entered the kitchen door- 
 way she started to tease him about it, but something changed her 
 mind. After several minutes another fragment was added,. She 
 saw her husband's brother, J., walking behind Mr. H — . They 
 were having an earnest conversation, and then she remembered 
 that she was afraid J. was talking about her husband. That 
 morning, she heard J. say that he had always expected a fire be- 
 
306 PSYCPIOPATHOLOGY 
 
 cause her husband would not stop carrying matches when in the 
 barn. "Mr. H — had a mean look in his eye, and I thought J. 
 had told him about my husband. This is what changed my mind, 
 and I stopped him to see what 'he was going to do," 
 
 No further recall was effected although we tried hard for 
 fifteen minutes. Then came this "strange thought." Airs. T — , 
 an old lady, set fire to her barn when she smoked in it, and j\Ir. 
 H — • refused to pay her the insurance." 
 
 With this fragment, it seemed obvious that the patient held 
 a secret which Mr. H — should knoAv, and was afraid that the in- 
 surance would be lost if he knew it. I insisted that she knew 
 something that no one else knew, but she seemed to be unable to 
 recall anything, and was obviously feeling very uncomfortable. 
 She seemed to be lost in study; then, suddenly, an expression of 
 decided pleasure swept over her features. "I knew that my hus- 
 band watered the colt after everybody left the barn that morning, 
 and 1 thought he might have fed it some hay and dropped some 
 matches. This, 1 was afraid Mr. H — would find out." She seemed 
 to feel relieved and said that a weight had passed from her. 
 
 The tendency to liave "jerking spells," seemed entirely to 
 disappear now and she regarded herself as cured. Several days 
 later, however, she complained of back pains, and, when the ex- 
 amination was made, much to my surprise, she developed strong 
 rhythmical jerks of the recti muscles of the abdomen which easily 
 could be seen through her clothing. Two days later, a jealous pa- 
 tient made offensive statements about her and her physician, and, 
 following this conflict, the recti muscles resumed a rhythmical jerk- 
 ing whicli lasted about thiity-six hours. Several hours of inter- 
 views did not yield the slightest information relative to its re- 
 pressed cause. Her difficulties Avitli the patient had to be dealt 
 with before further progress was possible. The incident empha- 
 sized the importance of keojiing patients who are to be psycho- 
 analyzed in a congenial environment and free from inquisitive 
 or critical people. 
 
 The remainder of the psychoanalysis will be given as com- 
 pactly as possiltle l)ecause of the limited space, and the traumatic 
 experiences will be related in brief instead of in the fragmentary 
 manner of the recall. She was finally able to place the first attack 
 of abdominal jerking as having occurred about two weeks after 
 
REPRESSION OR PSYCHONEUROSES 307 
 
 her marriage, and, later, she recalled that it was two days after 
 her marriage instead of two weeks. 
 
 The difficulty developed as follows : The night following her 
 marriage was spent in revelry. The next night, the boys carried 
 her husband away, and the following afternoon, her husband and 
 his mother paid a visit to her grandmother, despite the patient's 
 objections. She refused to accompany them and this disregard 
 for her feelings associated the grandmother and mother-in-law 
 and husband against her. This disappointed her greatly, and she 
 was left alone in a very miserable state of mind. Her state of 
 feeling was probably that of intense indignation and hatred for 
 the grandmother. She said she was lonely and cried. She had 
 no friend and no one to depend upon. She knew nothing about 
 the sexual life of woman, and was afraid of becoming pregnant 
 without someone to take care of her. Her sister-in-law's attacks 
 of "jerking" followed the birth of her first child and the patient 
 believed it was the result of poor treatment. This reenforced 
 her fears of pregnancy. In the recall she visualized herself lying 
 on the bed in a very morose frame of mind. She had started to 
 menstruate that day and that night she expected to sleep with her 
 husband. She was disgusted with her condition, and felt deeply 
 disappointed in her husband's and his mother's attitude toward 
 her grandmother. She had expected them to take up her quarrel. 
 She even regretted her marriage, and thought that perhaps she had 
 made a mistake. She recalled her resolution to depend upon her 
 sister-in-law and that when she arose from the bed she felt better 
 but her abdomen jerked. (It always seemed to me that a critical 
 incident was overlooked here, unless the following sextial trans- 
 gression occurred in the afternoon and that night, also.) That 
 night, she said, her husband "did just as he pleased" despite her 
 unhappy mental state and resistance. The recall of this imposi- 
 tion seemed to complete the details of the repressed traumatic 
 experience. Her anger at the pathologist who "did just as he 
 pleased," when he removed the blood-stained cloth, seemed also 
 to be explained. Later on, she met the pathologist again and said 
 that she no longer hated him, although this conditioned reaction 
 had persisted for weeks. The final explanation which she was 
 able to give for the abdominal jerks did not seem definitely sat- 
 isfactory as a traumatic episode, although feelings of shame and 
 
308 PSYCHOPATHOLOGY 
 
 hatred were given free play. It must be included that because 
 of her disappointment in her hnsband's loyalty to her, she was in 
 no mood to make love to him. Whatever details were missing 
 seemed to be unimportant, because the convulsions entirely disap- 
 peared, including the tendency to squint her eyelids closely to- 
 gether and avoid looking at anyone frankly. Her husband had 
 noticed this shifting glance on a previous visit and had asked her 
 about it. 
 
 It is perhaps necessary to repeat that she recognized heat, 
 cold, touch and. pain stimuli over the left |.||,lf of her face, left 
 breast and arm, upper back and posterior arm surfaces, and a 
 narrow strip along her left side and left leg. The right side of 
 the face and body was almost completely anesthetic, except that, 
 sometimes, upon strong reenforcing suggestions that she could 
 feel the stimulus, she reacted. The face and breast lines of demar- 
 cation were definite, but the other borders varied several inches at 
 different times. It is rather striking that she never complained of 
 areas of anesthesia, and maintained that she had never known of 
 their existence until I discovered them in the routine physical ex- 
 amination. 
 
 The time and manner of the onset of the anesthesia was quite 
 a dilemma. The anesthesia seemed to be a discovery for her, and 
 she did not seem to have the slightest idea how it might have oc- 
 curred. 
 
 In a sense, the associations of thought that led up to the re- 
 call of the painful experience were influenced by me in that I in- 
 sisted that through the areas of skin which she avoided the recog- 
 nition of, she had met with an unpleasant experience. But, the 
 actual details of the recall, I am sure, were not changed by sug- 
 gestions, because, when in our groping for the experience, I told 
 her that I believed it must have occurred as a result of her hus- 
 band's impositions, she maintained that she did not believe it had 
 any relation to that experience, and gave it little consideration. 
 
 After a great deal of searching, I rather vigorously insisted « 
 that she would recall some things that Avould lead us back to the 
 time of the experience. After considerable wandering of the vis- 
 ual images, which she recalled, the scene of the engagement con- 
 flict with the grandmother came into the foreground. She ex- 
 hausted the details of the unpleasant announcement of her en- 
 
REPRESSION OR PSYCHONEXJROSES 309 
 
 gagement, and the scene shifted to her imprisonment in her bed- 
 room. Here, a^ gap in her ability to remember occurred, and she 
 was not able to recall, for some time, the slightest detail of herself 
 in the room. Then she added the fragment that she dressed pre- 
 paratory to .eloping from the house. After some time, she added 
 further that she changed from winter to spring underwear. Here, 
 the resistance became so strong that she was unable to make fur- 
 ther progress. 
 
 I had devoted so much time to the analysis of the repressed 
 causes of the anesthesia that I again felt constrained to make a 
 suggestion, in order to hasten the recall of the details of the ex- 
 perience. Obviously, the traumatic experience occurred when she 
 was nude, and, since the door was locked and she was alone in the 
 room, and the odd distribution of the anesthesia roughly included 
 about all of that surface of the body which one would see while 
 standing in a three-quarters pose before a mirror, I suggested that 
 something happened while she was posing before the mirror. 
 Had this anesthesia been merely a wish-fulfillment of the malinger- 
 ing type to gain an object, as is still ordinarily believed to be the 
 case in hysteria by many plwsicians, this patient could have es- 
 caped further analysis and all personal responsibility simply In^ 
 accepting my suggestion. But it Avas not correct. It was not in 
 her power to change her functions by merely wishing. She replied 
 that although she did not know what was the true explanation of 
 the anesthesia, the suggestion I made did not seem to be right. 
 
 The psychoanalysis now was interrupted for a week by other 
 obligations. When she entered the room to resimne the analysis, 
 she announced rather triumphantly that her sensation had re- 
 turned without the analysis. Much surprised, I asked why she 
 thought this. She said she could no longer wash the dishes. (Be- 
 cause she did not mind hot water, having been able to endure hotter 
 water than the other patients, she had been delegated to wash the 
 dishes, but now the water burned her hands.) I tested her with a 
 pin and found her to be very sensitive where previously she had 
 been anesthetic. The hypersensitiveness seemed to be as patho- 
 logical as the anesthesia had been, and it soon proved that she had 
 recalled most of the traumatic experience which was incident to the 
 anesthesia, but had not adjusted to it. She had been ashamed of 
 the' experience and had repressed the affect. • 
 
 In brief, while locked in the bedroom, she had had a good cry 
 
310 PSYCHOPATHOLOGY 
 
 and time to think things over. She must either marry the grand- 
 mother's choice (Mr. A — ) or escape. She was facing the crisis 
 of her life under most confusing circumstances. She was not ab- 
 solutely sure she loved the Protestant (Mr. G — ) but she had more 
 confidence in him than in A — . She was inclined to elope and 
 marry Gr — , and, while in this vacillating frame of mind, she 
 changed clothing. She recalled that while she was undressed, the 
 postman whistled his announcement of having mail for the house. 
 She was expecting a letter from A — in which he would declare his 
 feelings about the marriage. She liked him because he was bold 
 with women and knew more about the world than Gf — who was 
 quiet and more retiring. Then she recalled that she parted the 
 curtains slightly and looked out of the window to see whether or 
 not the postman was coming into their yard. She watched him 
 go around the house and remained at the Avindow for some time 
 lost in sexual fancies about A — , and whether or not to elope with 
 G — . She did not hear the grandmother come upstairs, and sud- 
 denly was aroused from her sensuous day dream by the grand- 
 mother pushing a letter under the door. She was startled and 
 deeply embarrassed because of her guilt, her nakedness, sensuous 
 (autoerotic) fancies, and secret planning to elope. She thoteglit 
 her grandmother was opening the door, but the old woman went 
 away without doing so or saying anything. (The recall of the 
 surprise came only after great resistance and mortification.) 
 
 The patient explained that she was nude when she was sur- 
 prised, except for the curtain that she was peeping through. It 
 covered one side of her face, shoulder, breast and arm, and a strip 
 along the side of her body to the ankles. Anesthesia for the rest 
 of the body seems to have resulted from a pathological effort not 
 to be conscious of the nudeness. When I asked why her back was 
 not affectM, she replied that, perhaps it was because she Avas not 
 ashamed of her back. (Naked backs are permitted on the stage 
 and in society.) 
 
 Her reactions to heat, cold, touch and pain stimuli now be- 
 came normal, except for a small area of anesthesia involving the 
 upper right face about the eye, cheek and upper lip. As an ex- 
 planation for this, she comparatively easily recalled a scene in 
 which A — caught and kiss.ed her despite her resistance. The anes- 
 thetic area was where he kissed her. The repressed affect was 
 shame and indignation. 
 
KEPRBSSIOJSr OR PSYCHONETJKOSES 311 
 
 Up to this time, the patient consistently maintained that the 
 two similar blotches of erythema on the extensor surfaces of each 
 forearm resulted from an incurable skin disease that she had had 
 for a year or more. Although she had excellent insight into her 
 neurosis, she would not consider the blotches on her arms as any- 
 thing but a skin disease. She had gained in Aveight, and was now 
 in excellent physical condition. Hours of exposure to the sun in 
 the park had tanned her forearms a very noticeable brown, but the 
 areas of capillary dilatation did not tan, remaining decidedly paler. 
 
 She was now compelled to scratch her forearms; at times 
 she almost scarified her skin. The itching now occupied most 
 of her attention and she complained that she could not go into 
 the park because the grass caused her arms to itch. This feature 
 influenced her to study the difficulty. I thought the itching and 
 capillary dilatation were determined by one experience, since it 
 seemed part of the same skin area, although she scratched more of 
 the arm than the surface of the blotches. 
 
 Her associations, suggested by the symptoms, brought up a 
 visual picture of herself working in the garden Avith her mother- 
 in-laAv. It was very hot and, because of her poorly nourished con- 
 dition and pregnancy, the mother-in-law ordered her to go into the 
 house. They had been pulling a weed that had caused her skin to 
 itch. She felt that the mother-in-law Avas trying to command her, 
 and she refused and retired to the shade of an apple tree. She 
 visiialized herself standing there, rubbing her itching arms and 
 feeling very angry. The mother-in-law persisted, and she finally 
 submitted and retired to the house. She hated the mother-in-law 
 for bossing her, but repressed her feelings. She now made 
 a comfortable, affective readjustment to this experience by a frank 
 discussion of her mother-in-law, and the itching disappeared, but 
 the blotches of skin did not tan. 
 
 The queer distribution of the blotches of erythema suggested 
 the grip of someone's hands to me, which I discussed when I 
 showed them to another physician, and the patient probably re- 
 membered this, although, at the time, she did not agree Avith me. 
 
 The associations of thought may possibly have been influenced 
 by that conference, but I believe it is impossible for a patient to 
 relieve a repression symptom by telling a lie or substituting an 
 irrelevant experience. She visualized herself in a room with her 
 mother-in-law, announcing that she was going to harness the horse 
 
312 PSYCHOPATHOLOGY 
 
 and drive to town. The domineering mother-in-law opposed this, 
 and a conflict resulted. The patient started to leave the house, and 
 her mother-in-law grabbed her by the forearms. The patient 
 jerked loose, and the tightly compressed fingers slipped off, leav- 
 ing the dilated capillary blotches where the fingers had compressed 
 the skin. The recall of this experience was accompanied with its 
 repressed affect of hatred, and she expressed herself freely about 
 the forgotten experience. In each of the instances of repressing 
 her hatred, she gave as her reason her utter dependence upon 
 the mother-in-law and her fear of offending her. 
 
 Unfortimately, the patient was discharged about a week later, 
 and I was unable to observe that the pale blotches tanned as much 
 as the remainder of the arm, although they were quite brown in 
 comparison to their former condition and had practically disap- 
 peared. The erythema and itching had completely disappeared. - 
 
 It was necessary for the patient to get some insight into her 
 serious tendency to repress her strong affective reactions of ha- 
 tred and grave persistent feelings of inferiority. She was decid- 
 edly immature in her self-reliance. She believed her grandmother 
 had ruined her life by the kidnapping and mistreatment, and in- 
 sisted that she had never had a childhood sexual trauma. (At the 
 time of this psychoanalysis, the psychogenetic importance of the 
 autoerotic and homosexual strivings was not realized and so they 
 were overlooked. I would now regard her as a seriously sup- 
 pressed, jealou.s, autoerotic girl.) 
 
 She recalled that she did not like a certain girl and her 
 brother, after she had grown up, although they were her play- 
 mates when children. She finally associated with this dislUie a 
 scene of her childhood, Avhen an attempt was made by this boy 
 to perform sexual intercourse with her and his sister. He was 
 considerably older and he, with his sister, who was abou.t her age, 
 enticed her to submit to the play. While they were in the act, 
 her foster-mother surprised them and whipped her. More serious 
 than the whipping, she caused the child to feel that she had lost all 
 respect for her. 
 
 This sexual trauma can not be considered the foundation of her 
 neurosis, but it probably played a part as a determinant of her 
 tendency to react in a repressive manner to her conflicts, and 
 tremendously accelerated the tendency to be timid and react with 
 shame for even trivial mistakes. The long years of domination 
 
REPKESSION OR PSYCPIONEUROSES 313 
 
 by an unsympathetic grandmother, following ten years of petting 
 by her foster-mother, her tendency to nurse her hatred and even 
 enjoy it, associated with her serious ignorance of the sexual life 
 of woman, were probably more influential. She married to escape 
 a domineering grandmother who never permitted her to assert 
 herself and, most unfortunately, became associated with a still 
 more domineering mother-in-law and an immature husband who 
 could not give up his mother. The psychoanalysis of the ease can 
 not be considered finished nor the patient cured of her psycho- 
 pathic tendencies. 
 
 Three years after the psychoanalysis, she wrote in reply to 
 an inquiry, that none of the symptoms which were analyzed, re- 
 turned, but she had had a- psychotic episode since her discharge, 
 the details of which were not learned. She had to return to the 
 household of her mother-in-law and from what has since been 
 learned from such cases (Cases HD-1, CD-2, HD-3) the situation 
 is not encouraging. 
 
 Probably this patient's tendency to make one affective re- 
 pression after another and, in nearly every instance, that of lia- 
 tred, was largely the result of her affective isolation in her grand- 
 mother 's house. Her ' ' hatrish feelings ' ' often caused her to enter- 
 tain revengeful fancies, which, undoubtedly, she really enjoyed and 
 then regretted. (These fancies Avere her only avenue of escape 
 from the unusually inflexible, painfiil environment. ) 
 
 That her personality never developed beyond the autoerotic 
 level was probably due to the consistent repressive influence of 
 the dominating grandmother, who assiduously imposed a censor- 
 ship upon most of her spontaneous, girlish, social interests, and 
 forced the child, with threats of punishment, to suppress her emo- 
 tions. 
 
 She really married to escape from her grandmother, and, un- 
 fortunately, moved into the house of her mother-in-law. Because 
 of her long training to repress her affections, to be economically 
 dependent, to have a grossly apprehensive misunderstanding of 
 the sexual life of woman, her inferiorities became the instruments 
 that bouud her to the older woman. She dared not retaliate and 
 offend her mother-in-law, for fear of being neglected in her preg- 
 nancy and labor. 
 
 In this case, in each instance of affective repression that left 
 objective, functional derangements, the affect was the natural re- 
 
314 , PSYCHOPATHOLOGY 
 
 sponse to an irritating situation ; that is, a healthy response to the 
 situation, but was repressed because of some form of fear of the 
 consequences if she should permit her feelings free play. In each 
 instance, the initial affective reaction, whether shame or hatred, 
 may be looked upon as a normal reflex response to certain fea- 
 tures in a definite situation, and these features may he regarded as 
 the primary stimulus of the affective reaction. Associated simul- 
 taneously with the primary stimulus, were stimuli (secondary fea- 
 tures) that had previously been indifferent, in so far as affective 
 reactions were concerned. To illustrate this, let us take the itching 
 or erythema symptoms. 
 
 The dominating mother-in-law, with her affective attitude and 
 Avords, was the primary stimulus of the natural reaction of hatred 
 in the patient. The itching of the skin from an irritating weed 
 which was occurring at the time, or the capillary dilatation of the 
 skin from compression and friction of the fingers, was a normal 
 reaction to stimuli which were heretofore indifferent to causing 
 reactions of hatred. Through the accidental association, as siWiul- 
 taneous stimuli, of the primary affective stimuli and the indiffer- 
 ent secondary stimidi, {the latter were causing the next most 
 vigorourS, disagreeable sensations at the time), the affective re- 
 actions of hate became conditioned to react to these secondary 
 {skin irritating) stimuli. Therefore, whenever the autonomic ap- 
 paratus was stimulated by things that had similar qualities to the 
 secondary (grass) stimuli, they aroused the repressed hypertonic 
 aiTtonomic-affeetive reactions (hate) to greater activity. This 
 continued so long as the affective tensions were repressed and un- 
 adjusted. In turn, the repressed hate affect increased and reen- 
 forced the normal skin reactions to the associated stimuli, maki:&g 
 the reactions persist for undue periods of time. The memories of 
 the experience were repressed (forgotten), and the individual re- 
 acted with hatred and itching when in the grass, without knowing 
 that it was caused by the grass. Later, when she recognized that 
 the grass aroused the itching, it did not enable her to stop the re- 
 actions.' In each instance, after the repressed affect was allowed 
 to have free play and an adequate affective readjustment to the sit- 
 uation AA^as made, the pathological influence of the secondary or in- 
 different stimuli, as well as the objective symptoms, disappeared. 
 
 Bechterew first pointed out, and has been supported by the 
 studies of Watson and Lashley, that, Avhen the primary stimulus 
 
REPRESSION OR PSYCHONEUROSES 315 
 
 of a motor or secretion reflex is associated simultaneously for a 
 number of times Avitli an indifferent stimulus, then the reflex will 
 become conditioned to react to the indifferent stimulus. This 
 seems to be the mechanism of the conditioned repressed affect ex- 
 cept that when the affective reenf orcement is vigorous enough, one 
 simultaneous association may be sufficient. 
 
 Bechterew further pointed out that, Avhen reflexes become 
 thoroughly conditioned to certain stimuli, this conditioning, simi- 
 lar to the reactions to primary stimuli, may be the basis for asso- 
 ciating other secondary stimuli so that the reflex will be condi- 
 tioned by them also ; thus its reactive capacity spreads. 
 
 The affective reactions of hatred and their tendency to injure 
 the cause of the hatred were repressed by the fear of doing some- 
 thing which would be regretted. The conflicts were always in- 
 tense and acute, necessitating vigorous efforts to repress from con- 
 sciousness the memories that aroused the hatred or shame. The 
 successful repression depended upon the patient's ability to force 
 immediately the conflicting cravings to converge Urpon a compro- 
 mise {coordinate all her attention upon a sid)stitute), and this 
 substitute ivas, very naturally, that content of consciousness ivhich 
 was next in vividness at the moment of the affective conflict. 
 
 This case seems to offer an explanation of the phenomenon of 
 so-called visual constriction; namely, because of the affective re- 
 sistance only the more sensitive receptors which lie nearest the 
 macula transmit sensory reactions of sufficient intensity to over- 
 come the affective (autonomic postural) resistance and cause con- 
 sciousness of their activity. 
 
 The stimuli that arise from objects in the peripheral field, as- 
 suming the intensity of the light waves to be equal, since they must 
 play upon the less sensitive receptors, cause subliminal reactions 
 and do not overcome the affective resistance. Therefore, only the 
 colors directly before the eye are seen. The affective resistance 
 may become so vigorous that complete anesthesia or blindness may 
 result, and ordinary color stimuli may not be able to break through 
 the resistance. Postures increase or decrease the reactivity to 
 stimuli', the reactivity being determined, it seems, hy luhether or not 
 the exogenous stimuli are allied or are antagonistic to the proprio- 
 ceptive activities aroused through the posture. 
 
 In the case of Miss Lucy R — , Freud says: "The hysterical 
 form of defense, for ivhich a special adaptation is required, con- 
 
316 PSYCHOPATHOLOGY 
 
 sists in converting the excitement into physical innervation. The 
 gain brought about by this process is the crowding out of the un- 
 bearable presentation from the ego consciousness, which, then con- 
 tains, instead, the physical reminiscences produced by the conver- 
 sion, in our case, the subjective sense of smell, and suffers from 
 the effect which is more or less distinctly adherent to these rem- 
 iniscences. ' ' 
 
 It is necessary to briefly restate the manner in which Miss 
 Lucy E — developed the persistent olfactory image of cigar smoke 
 which annoyed her almost incessantly. 
 
 She loved her master's children, and having encouraged her- 
 self to expect the love of her widowed master, she was shocked, 
 when, one day, he unjustly threatened to discharge her if stran- 
 gers were again permitted to kiss his children. A few months 
 later, when she was coincidently suffering from an ulceration of 
 the ethmoid, after dinner an elderly guest attempted to kiss the 
 children. The impetuous master shouted, "Don't kiss the chil- 
 dren!" and she "experienced a stitch in the heart, and, as the 
 gentlemen were smoking, the odor remained in my memory. ' ' 
 
 The violent words of the master were sufficient as a primary 
 stimulus of reactions of fear, because of the previously threatened 
 discharge, to force a repression of her affections for the children 
 and master, since it was not possible in the situation for a gover- 
 ness to permit the naturally anxious expression of her injured 
 affections for the children and her master. Because of her af- 
 fective attachment, her position had a vital value for her. She 
 held the attachment by a slender thread in the hands of an impetu- 
 ous master who had already threatened to break it if a certain al- 
 most unavoidable trivial incident should occur again. In his dis- 
 cussion, Freud does not seem to think that the fear of the dis- 
 charge was a justifiable cause for the affective repression, but' 
 that a degree of moral courage was lacking in his patient. I can 
 not at all agree with Freud's feelings. It seems to me that the 
 patient's affective attachment (maternal) to the children made her, 
 unfortunately, but normally, a weakling in the face of a discharge 
 and their loss. 
 
 Now, to return to the "conversion" mechanism. It seems to 
 me that the conception of conversion is not satisfactory as an ex- 
 planation of the biological process, and the "special" defensive 
 
REPKESSION OR PSYCHONEUEOSES 317 
 
 adaptation of "converting the excitement into physical innerva- 
 tion" is a biological riddle. Jnst how Freud understands that 
 excitement may be converted into a physical innervation is not 
 comprehensible to me. Furthermore, it seems that this conversion 
 conception is the keystone of Freud's important, but not satis- 
 factory libido concept. It seems that the persistent olfactory 
 image of tobacco smoke, complained of by Miss Lucy R — ■, was an 
 example of the repressed affections becoming conditioned to react 
 to an ordinary painful stimulus — the irritating cigar smoke, and 
 this sensory image was made to persist by the repressed affections 
 trying to force a recognition of their needs. They had been of- 
 fended by the impulsive master and wanted him to become solicit- 
 ous, and thereby renew the transference. 
 
 In the instant of that conflict, the love for the children and 
 the master was repressed because of fear of appearing indecent, 
 and the repressions continued until Freud released them by analyz- 
 ing away the cause of the fear. In order to make the repression, 
 and avoid showing anxiety about losing the objects of the affection, 
 jeopardizing them still further, the autonomic-affective ap- 
 paratus reflexly coordinated all its available forces upon the con- 
 trol of the final common path of adaptation. This was associated 
 with the next most vivid, similarly painful, sensory reaction of that 
 .moment — ^namely, the cigar fumes which were coiricidently ir- 
 ritating the diseased nasal membranes and causing discomfort. 
 
 The reflex adaptations to the nasal irritation, because of their 
 simultaneous activity, became associated with the normal affective 
 reactions to the primary stimulus of anxiety — namely, impulsive 
 master. When Freud analyzed away the fear and permitted the 
 repressed affections to make an adequate readjustment to the atti- 
 tude of the master, then the olfactory sensory images lost their 
 vividness and took their normal place in the sensory experiences 
 of the personality, because the repressed affect no longer existed 
 to force them into consciousness. 
 
 The persistence of the abnormal conditioning of the reflex is 
 due to the reenforcement by repressed affections, and the reen- 
 forcement disappears so soon as an adequate affective readjust- 
 ■ ment is made. 
 
 Fear of allowing the primary affections, whether of shame, 
 fear, hatred, grief or love, to malce adequate adjustments, tends to 
 make a psychopath of any individual; that is to say, when the affec-. 
 
318 PSYCHOPATHOLOGY 
 
 tions of a personality are repressed, their functions are abnormal, 
 because they are prevented from acquiring a natural adjustment. 
 In their struggle to acquire gratification they persist in causin|-.: 
 awareness of thoughts or images of past experiences which happen 
 to be associated with what they need. Using this fact the psycho- 
 therapist is able to bring about the recall of the repressed affect. 
 
 The effort to eliminate from the personality an affective crav- 
 ing that caiises embarrassment or sorrow is usually performed by 
 "forgetting it"; that is, keeping it repressed so that it can not 
 cause one to become conscious of it. This does not actually elim- 
 inate it from the personality, as man, until very recently, so 
 naively believed it did. It merely forces the repressed affect to 
 work its way into consciousness through a compromising disguise. 
 Often this substitute is anything but pleasant to the ego, but the 
 repressed affect being too vigorous to be further repressed or de- 
 nied, the individual may become desperate and attempt to have 
 the difficulty excised by the surgeon or do it himself. The indi- 
 vidual becomes inclined to do this, particularly if the repressed 
 affect causes a functional distortion of some sort and a plausible 
 excuse can be found for the operation. For example, a girl, who 
 can not control her masturbation cravings and has dysmenorrhea, 
 frequently consents to a series of uterine rectifications such as 
 curettages and replacements, and, logically, winds up with a hys- 
 terectomy if the surgeon is suggestible and without insight. 
 
 All such repressions of functions are, more or less, forms of 
 abortion or castration by which the personality tries to make itself 
 estimable, and the castration, in turn, may be regarded as a form 
 of crucifixion, or sacrifice of a part of the personality for the best 
 interests of society. 
 
 The castration or elimination of the disagreeable tendency 
 may be so neatly disguised that the martyr feels himself to be 
 divinely sanctified thereby and enjoys the fruits thereof indefi- 
 nitely. The following case* illustrates the manifold values of such 
 an act to the patient : 
 
 Case PN-3. — Patient, aged twenty-seven, was admitted to the 
 Johns Hopkins Hospital to be treated for a "sore knee." For the 
 past fourteen months, he had been walking with crutches which 
 he made for himself. At the age of tAventy-three, he had the first 
 
 *This case was reported in The Psychqanalytic Review, 1915, Vol. II, No. 2. 
 
EEPRESSION OR PSYCHONEUROSES 319 
 
 period of soreness of the knee, lasting tliree months, and a second 
 period lasting three weeks. At twenty-six, the present difficulty 
 began. On inspection, both knees appeared to be the same except 
 for a general atrophy of the soft parts of the left knee as well as 
 a very marked atrophy of the muscles above and below the knee. 
 The patient wallied with crutches and made no attempt to bear 
 weight on the left leg. This seemed to be merely on account 
 of fear of using the knee, and not because it was painful. As the 
 patient flexed or extended the leg, nothing abnormal Avas felt in the 
 joints. There was no tenderness on palpation, and sensation was 
 normal. X-ray examination was negative. The physical status, 
 otherwise, was also negative, except for some constriction of the 
 visual fields. He had the usual diseases of childhood, with no af- 
 ter effects and attended school successfully until seventeen, then 
 Avorked in his father's workshop for two years. He had always 
 been very religious. At twenty, he entered college. At twenty- 
 one, he developed a facial paralysis of an apparently functional 
 type. 
 
 At that time the patient was a student at college and while on 
 police duty at one of the football games he became involved in a 
 clash of words with a trespasser and seemed to have suffered some 
 humiliation. A review of the emotional conflict is given almost as 
 the patient discussed it. 
 
 The quarrel, he says, made him compare himself with his an- 
 tagonist. He felt spiritually superior to the man, but thoiight that 
 his masturbation had weakened him physically, and that the man 
 showed his inferiority openly while he kept his own, personal weak- 
 ness concealed. He had been struggling to overcome the auto- 
 erotic tendency by making a confession, but had been afraid to eon- 
 fide in others because he might lose their respect. The conflict 
 emphasized the debilitating influence of his secret self-love and 
 aroused a strong compulsion to expose his sins. During the game, 
 and during this state of emotional conflict, one of the players was 
 knocked unconscious. The patient was impressed by the open, up- 
 turned eyes and expressionless face, which, to him, meant honora- 
 ble defeat. 
 
 That evening, he could not close his eyes. He recalled rubbing 
 his face, but could not tell whether it was paralyzed or not. The 
 next morning, he noticed that ho could not laugh with the stu- 
 dents in the classroom, and thinking that his face was SAVoUen he 
 
320 
 
 PSYCHOPATHOLOGY 
 
 consulted a physician. He was advised to r,emain in school and 
 subjected to a course of electrical treatment. ' The right side of 
 the face began improving in a week or so, but the left side re- 
 quired about eight weeks for recovery. The patient interpreted 
 his conflict, as follows-: 
 
 In the patient's terminology, his "second mind" wished to lay 
 open his weakness as an explanation for his defeat, but his "outer 
 mind" would not permit this because of fear of ridicule, so his 
 two minds compromised on the way of showing the defeat as ex- 
 emplified by the expression of the unconscious football player. 
 The neurosis was a timid method of exposing and controlling the 
 autoerotie cravings and the adjustment was influenced by shame 
 because of his masturbation and defeat which was compelling a 
 radical adjustment, and fear of losing social esteem if he betrayed 
 liimself. 
 
 In Januaiy, his father injured his knee and had to be confined 
 in a hospital for seven weeks. In August (at twenty-three) the 
 ]iatient's first knee episode occitrred. He had been working in a 
 kneeling position, laying flooring. For a day or two, he had been 
 afraid that he might get a sore loiee like his father's. Then his 
 knee developed peculiar feelings and "wanted to stay in a bent 
 position," and, finally, could not be used. For ten weeks, his 
 physician treated the Imee vdth iodine. He gradually became able 
 to walk, then used a cane. The knee became quite normal until 
 the foll()\\ing June wlion he bent it, accidentally, "farther than it 
 had over been liont since the previous illness." This second pe- 
 riod of soreness lasted three weeks. 
 
 He then improved and had no further difficulty until at twenty- 
 six, when he dropped a piece of iron on his knee. He felt some 
 pain which, however, disappeared after a brief period. A few days 
 later tlic knee again felt sore and, after that, for the next four- 
 i^'vu months, lie had either been in bed or used crutches. 
 
 The patient characteristically maintained a most striking men- 
 tal attitude of serene, sanctified composure while enduring the sup- 
 posed suffering. He gave one the impression of being deeply 
 pleased with his solution, saying that he felt God wanted him to 
 suffer for his sins (crucifixion for mother attachment). 
 
 He had been in the surgical service of the hospital for three 
 weeks and had, no doubt, been impressed by the thorough physical 
 examinations and negative diagnosis. Eepeated and enforced sug- 
 
REPRESSION OR PSYCHONEUROSES 321 
 
 gestions that lie could walk were responded to with but little effort 
 and much complaint of the great difficulty. After a second com- 
 plete mental and physical examination had been made, the case 
 was discussed with the patient. Great emphasis was placed on his 
 negative physical state. I insisted that the cause was emotional, 
 and advised him to talk frankly and restrain no feelings about 
 the matter. He replied, mth little hesitation, that he was worried 
 about masturbation, which had continued since he was eleven or 
 twelve years of age. With more resistance and circumlocution, 
 he told that the objects of his erotic fancies were his neighbors, 
 his sisters and, finally, after some hesitation, Ms mother. He 
 said his affections were "filthy" because they were so associated 
 with his mother. He had been impressed by his mother's care of 
 his father during his illness, and now, during his own illness, she 
 had been unusually solicitous for him. Because of his incestuous- 
 ness he must suffer for his sins, either in this world or in the next. 
 When asked if he cared to explain why the left knee had been 
 affected instead of the right, he replied that he believed it might 
 be because his heart was the seat of his affections and it was on 
 the left side, and that he had a left-sided varicocele which he be- 
 lieved was caused by masturbation. 
 
 The "sore knee" formed an adequate castration as an ex- 
 piation for incestuous masturbation, but it was also a means of 
 religious compensation and simulation of his father's illness. 
 Further, he successfully solicited his mother's affections in an- 
 other way. After the analysis the patient walked back to his bed 
 without crutches, something he had not done for fourteen months. 
 His attempt, however, was accompanied with loud breathing and 
 facial distortion as if he were in tremendous pain. He afterwards 
 stated that he felt no pain at the time, but could not prevent mani- 
 festing outward indications of his struggle. With encouragement, 
 he rapidly recovered the use of his leg without any special treat- 
 ment, despite the marked muscular atrophy and plantar sensitive- 
 ness from disuse. 
 
 A few weeks after his discharge, he returned, bringing a 
 friend who was also depressed and anxious because of autoerot- 
 icism. This man responded promptly after a full discussion and 
 adequate affective readjustment. Within a few days he changed 
 from a morose, brooding, timid individual into a happy, grateful, 
 earnest fellow with considerably more confidence in himself. 
 
322 PSYCHOPATHOLOGY 
 
 The following cases further illustrate the mechanism of elim- 
 ination or castration of perverse erotic cravings. 
 
 Case PN-i was a sailor, twenty-four years of age, who for 
 six weeks had almost incessant compulsive feelings inciting him 
 to smash his head into a wall or dive from a height. 
 
 His receding chin, high palate, irregular teeth, deficient en- 
 amel and facial development indicated some mental inferiority. 
 He gave an indefinite account of having had fits in childhood. At 
 nineteen, he enlisted in the Navy and served almost four years. 
 After 'a visit to his home, his difficulties began. He had always 
 been seclusive, shut-in, inclined to brood, indulge in alcoholics, 
 and was disposed to respond sullenly to the social advances of his 
 mates. They called him ' ' punk. ' ' 
 
 Soon after his admission to the hospital he complained of hav- 
 ing an intense dull, persistent pressure in his head, which com- 
 pelled him to strike his head against objects and even to plunge 
 head foremost into the wall. In his desperation, his record states, 
 he plunged from the second story, cut his throat, and made nu- 
 merous efforts to pound his head. When he was admitted, he had 
 two deep scalp wounds, several minor facial bruises, and a scar 
 over his throat. He had to be watched constantly, and for several 
 days had to be tied in bed. Despite these precautions, he con- 
 tinued his vicious attempts to kill himself and succeeded in bat- 
 tering his head and face on the bed. 
 
 When I addressed him as Mr. — , he looked surprised, and, 
 after several repetitions of his name, gruffly demanded to know 
 whom I was calling "Mister." When I replied that I had ad- 
 dressed him, he showed unmistakable scorn for himself. After 
 a little persuasion, he said he was not fit to be called "Mister," 
 and was not fit to be talked to. He reluctantly gave the informa- 
 tion that the pressure in his head was caused by worry and he 
 felt he deserved it for his wrongs, for which he was punishing 
 himself. After several brief visits, he was finally induced to 
 confide his difficulties. Eecent masturbation, and his seclusive- 
 ness, contributed to his feelings of being "not fit to live." But the 
 reason he "must die," etc., was due to his having masturbated his 
 young sister, a child, while on a recent visit to his home. The 
 details of the occurrence were such that its reality was hardly to 
 be doubted. When he talked of it, it drove him into a state of ut- 
 most desperation, and little hope "w^as entertained for a solution. 
 
REPRESSION OR PSYCHONEUROSES 323 
 
 Several days later, in talking it over, he said that the whole 
 affair was so unnatural that he wondered if it were not a dream 
 or imagination. Within a few days, his suicidal compulsion dis- 
 appeared, and he rapidly readjusted to a more comfortable state. 
 About two months later, when I questioned him to learn his method 
 of adjustment, he reluctantly discussed his difficulties and said he 
 thought (doubtfully) that probably it was a dream. It was con- 
 sidered advisable to stop questioning him, because of the ominous 
 uneasiness he commenced to show when we started into the details. 
 
 Since then, he made an attempt to drown himself and has be- 
 come very sullen, irritable and inaccessible. His behavior is es- 
 sentially that of a most desperate elimination or castration com- 
 pulsion to escape from the perverse cravings. 
 
 Case PN-5 was a sailor aged nineteen. Shortly after hi^ en- 
 listment, he developed a grave self -mutilation and suicide compul- 
 sion. 
 
 He had always been unduly protected by his mother, and Avas 
 inclined to be timid and seclusive. He had a very odd face, al- 
 most ludicrous because of his very long chin which extended down 
 in front of his throat instead of forward like the usual prognathous 
 jaw. This deformity made him the "goat" of all his companions' 
 wit, driving him into seclusion. 
 
 He had been addicted to secret masturbation from adolescence 
 until after he entered the Naw. This vice greatly increased his 
 feelings of inferiority but was unkno-wni to others before the psy- 
 chosis. He resented the nagging of his mates, which began with 
 his first day, and, finally, they "stampeded him." His mother 
 had always prevented him from fighting, but the unbearable tor- 
 menting compelled him to protect himself. He unwisely posted 
 a challenge which was taken up by a man selected by the crowd. 
 Before a jeering crowd of boys, he was soon knocked down by his 
 opponent, and then held there by the crowd while they pummeled 
 him. His social standing was, of course, hopelessly lost, and a 
 tremendous regression with suicidal compulsion developed. He 
 felt that he had ruined himself and was obsessed with a violent 
 hatred for his physical inferiorities. He cut veins in his wrists 
 and leg that day and later made a series of attempts to strangle 
 himself by hanging, and by twisting a towel around his neck. This 
 behavior continued for three weeks. 
 
324 PSYCHOPATHOLOGY 
 
 Upon Ms admission, it was necessary to watch him constantly 
 because of his self -mutilation compulsions. 
 
 When I saw the patient, the day following his arrival, he was 
 lying in bed with his face buried in a pillow. The nurse reported 
 that he had just tried to strangle himself. Unlike the previous 
 case, he responded almost immediately to a friendly advance, and 
 rolled over to answer a question, showing an earnest desire to be 
 helped. Gradually, after cautious inquiry, he was able to give an 
 account of his troubles. He began with his feelings of being unfit 
 to live, stating that he had ruined himself because of his ' ' selfish- 
 ness" and " seclusiveness. " (Complaints nearly always charac- 
 teristic of the autoerotic.) He then cautiously complained of hav- 
 ing had a series of horrible dreams; such as sliding across the 
 floor of a great hall, a feeling that he could not stop and was 'tigte; 
 ing to hell;" noises, sudden sounds, such as slamming of doors, 
 bugles, bands, etc., made him feel "dizzy," and have "sinking feel- 
 ings in the abdomen." He could not explain why sudden sounds 
 should affect him unless it were that they had some relation to the 
 bugle call (to face roll call). 
 
 The wrist scars, which were small, indicated rather timid ef- 
 forts to commit suicide. Something about his manner suggested 
 that he was pleased to have me notice the wrist scars and, with a 
 little encouragement, he, described his effort to hang himself, ad- 
 ding that he was sure one of the efforts, which he described in de- 
 tail, would have been successful had he not fainted just as he was 
 going to jump from the bed after tying the noose. (Having 
 "fainted," he fell upon the bed.) 
 
 He gave the impression of desiring to punish himself for 
 something, but not really to commit suicide. After some hesita- 
 tion he brought out the obvious cause, masturbation. In detail, 
 he discussed his autoerotic interests and selfishness. He gave, as 
 his opinion, expression to the belief that he would have cured 
 himself if he had followed the methods of other boys, but his "re- 
 spect for girls" prevented him. 
 
 "When he confessed his masturbation tendencies, he showed 
 intense affect and seemed to be grateful for the opportunity to 
 ' ' talk it over. ' ' He believed that it had caused his weakness, short- 
 ness of breath, and feelings of inferiority. 
 
 The next day, he made another attempt to strangle himself, 
 but, on the whole was much more quiet. We talked over the im- 
 
REPRESSION OR PSYCHONEUROSES 325 
 
 pression his odd features made on his friends and the inability 
 of his friends to keep from laughing at him. We concluded that, 
 under all conditions, it was disastrous for him to take offense when 
 people laughed at him because their retaliations were nearly al- 
 ways focused on his facial inferiority. Only one solution was pos- 
 sible. We agreed that his face was certainly odd and, naturally, 
 the cause of mirth ; so why should he not become a humorist and 
 enjoy the fun? It was strongly emphasized that he could turn his 
 deformity into a valuable asset if he became tolerant and good 
 natured. Several days later, he was found copying cartoons. He 
 showed considerable interest in the idea of developing a sense of 
 humor and became interested in studying the value of Mark 
 Twain's humorous methods to make things easier. 
 
 During his self -mutilation period, he had no hallucinations. 
 When discharged, he was much more congenial and apparently 
 normal, but his dear mother had again enveloped him in her shield- 
 ing arms, and his self-consciousness showed that he had yielded 
 to her petting and solicitations. 
 
 Case HD-15 was a Russian soldier, aged twenty-four, single, 
 uneducated and, apparently, a mental defective. At venereal in- 
 spection this patient Avas found to have inserted a safety pin 
 through the corpus spongiosum of his penis for the purpose of 
 "curing wet dreams," as he expressed himself. He also said, 
 several times, that he would amputate his penis to cure himself. 
 When admitted to St. Elizabeth's, he gave the impression of un- 
 dergoing a marked deterioration of the personality. 
 
 The following case is typical of the castration which is usually 
 characteristic of a pernicious dissociation of the personality. 
 
 Case PD-16 was a soldier who had given fourteen years of 
 "excellent" service. He had lived what he regarded as a normal 
 sexual life for a soldier. For years he had been a periodic alco- 
 holic. 
 
 At thirty-two, he decided to get married to a divorcee twelve 
 years his junior. One night, a few weeks previous to his marriage, 
 he became intoxicated with another soldier, and went to the latter 's 
 home, going to bed with him ' ' to sleep it off. ' ' (During his psycho- 
 sis he was obsessed with feelings that homosexual relations of 
 some sort may have been perpetrated upon him that night. He 
 also felt that he was accused of having seduced the man's young 
 daughter. ) 
 
326 PSYCHOPATHOLOGY 
 
 A few nights after this episode, he left for a distant city to 
 get married. He was still intoxicated and having dangerous audi- 
 tory hallucinations when he started. Voices said, "We'll get him 
 sure this time" and threatened to cut his throat, etc. While en 
 route, he became panicl?y, and jumped through the window of the 
 moving train. Other than some contusions, he escaped injury 
 and borrowed a pocket knife, with which he cut his wrists and 
 throat and stabbed himself over the heart. None of the wounds 
 were severe. (They were not unlike the wounds of the crucifixion 
 and are to be regarded as compulsions to self -purification.) 
 
 After two weeks in a hospital he resumed his journey and 
 married. He had always entertained fears that his fiancee would 
 "not be straight and decent," and, on one occasion, criticized her 
 for permitting the attentions of a superior officer. 
 
 About a month after the marriage, he began to show irri- 
 tability and have suspicions of his wife. This tendency gradually 
 developed and, about a year after marriage, he began to complain 
 of enemies. He now openly condemned his wife for infidelity and 
 restricted her freedom. 
 
 Then followed a series of changes to different cities to avoid 
 his enemies, who his wife (a very suspicious individual) believed 
 were trying to "break us up." He reverted to alcoholism, and 
 developed persistent, vigorous self -denunciatory hallucinations of 
 an auditory nature which included charges of homosexual degen- 
 eracy, seduction of a little girl, and the murder of a woman. He 
 had some insight, attributing the hallucinations to "imagination," 
 but he could not avoid reacting to them for several years. 
 
 During his marriage, he was virtually impotent, and only at 
 times was he able to perform as much as ejaculatio prsecox. His 
 general attitude during his hospital confinement Avas one of con- 
 tinuous brooding and denial of the hallucinated charges. Four 
 years after the onset of the psychosis, the hallucinations had sub- 
 sided sufficiently to render the discharge of the patient feasible. 
 
 In this case, the cutting of the wrists (like the hands in 
 others), in order to shed blood, "to let out the bad blood," has a 
 castration (Case PN-5) and crucifixion significance. Christ's 
 hands and feet were punished by nailing them to a cross. The 
 repressed affect was accusing the ego of being a pervert and his 
 desperate efforts to eliminate it were the violent castration efforts. 
 
REPRESSION OR PSYCHONEUEOSES 327 
 
 In the following case of intense struggle to prevent the oral 
 erotic homosexual cravings from forcing the heterosexual emascu- 
 lation, the patient will be seen to be continually tottering on the 
 verge of yielding to the crucifixion and dying, to attain the rebirth 
 as the best possible solution for his distress. 
 
 Case PN-6 was a male clerk, aged twenty-four, unmarried, who 
 had persistent feelings of ' ' dying, ' ' accompanied by choking, gasp- 
 ing, sniffling, and an abdominal tic. The symptoms were about 
 three years old. 
 
 The patient's father was a stern old soldier, a firm believer 
 in discipline, systematic work and fortitude. 
 
 The mother, about twelve years younger than her husband, 
 was a quiet, pretty, affectionate little woman, rather timid, sug- 
 gestible, and decidedly lacking in firmness. They had two chil- 
 dren. The daughter, a good-looking, aggressive girl, with con- 
 siderable business capacity, was about four years older than the 
 patient. 
 
 The patient was the only son. At four, his legs were badly 
 paralyzed by anterior poliomyelitis. At six, he was able to walk, 
 and at seven, started school. Because of his disabilities, he 
 had only finished the second year of high school at nineteen. He 
 quit in order to earn money but could not be considered an in- 
 tellectual defective. 
 
 His mother said she "raised him like a girl," always gave 
 him everything he wanted, and could not resist his pleas, because 
 of her pity for his deformity. His behavior was that of a very 
 badly petted, spoiled child who realized that under almost any 
 circumstances he could do as he pleased. Throiigh his infirmities, 
 he held his affectionate little mother as his confirmed slave. (For 
 more than a year, I tried every persuasion and argument to con- 
 vince the mother that she must allow her son to become independ- 
 ent of her, but marble would have been more plastic.) The stern, 
 gruff father tried to coimterinfluence this effect eariy in the boy's 
 life, but succeeded only in increasing the son's triumphant attach- 
 ment to his mother. The daughter usually supported the son in 
 his clashes with his father. 
 
 The boy was unreliable, did not hesitate to lie, or take any 
 advantage of a situation to satisfy his self-indulgent whims. De- 
 spite his deformities, he was very narcissistic. He always de- 
 
328 . PSYCIIOPATHOLOGY 
 
 pended upon his sister to secure positions for Mm, and, because 
 of his unreliabihty, she finally found it necessary to have him work 
 in the same office with her in order to keep him out of trouble. 
 
 This patient was peculiarly erotic and it seems that all his 
 sincere interests were sexual and self-indulgent. As a boy, he had 
 almost unrestrained access to the privacy of his mother and sister, 
 and secretly utilized their attractions in his autoerotic fantasies. 
 They never discussed the sexual problem Mith him. His masturba- 
 tion was unusually excessive until nineteen, when he went to work 
 so that he could have a "good time." At six, he had a fellatio 
 experience with a boy playmate, and was severely punished for 
 this by both of his parents. Other sexual experiences occurred 
 with children of both sexes, and at nineteen, he had his first actual 
 heterosexual experience, after which, until his panic, he spent 
 nearly all his earnings on prostitutes. He considered himself to 
 have unusual sexual powers because of his chronic eroticism. 
 
 At nineteen, he also had a homosexual experience with a boy of 
 his age, Avhile traveling with him. Both anal and oral perversions 
 occurred. 
 
 At twenty, when his family was absent from the house; he 
 abandoned himself to his eroticism in a most unusual and sig- 
 nificant manner. 
 
 He described himself in the episode as having casually strayed ■ 
 into the kitchen (where his mother prepared the food) during an 
 erotic mood, when it occurred to him that he might perform fel- 
 latio on himself. One suggestion for this was traced back to a 
 companion's remark aboiit a contortionist while at a circus. With 
 considerable effort, he succeeded. He states that he never made 
 a second attempt, but this does not minimize the high proportions 
 to which he had developed his autoeroticism. The accessibility of 
 his mother and sister for the stimulation of his secret fantasies 
 tended unduly to cultivate his eroticism, as will be seen later. 
 
 No immediate psychotic effects resulted from this behavior, 
 biTt it surely must have contributed to his secret feelings of in- 
 feriority, for, when he became twenty-one, he complained to his 
 mother of being unlike other young men and that he would never 
 be able to become "a man." 
 
 He proposed marriage to a girl of his age, for the sole purpose 
 of learning how girls regarded him. He was much encouraged 
 Avhen she was inclined to accept his proposal. 
 
REPRESSION OR PSYCHONEUROSES 329 
 
 He was deeply attached to his sister, and seemed to regard 
 her as a life-long protector. lier engagement caused considerable 
 anxiety, but at her marriage he was, in his own words, "at my 
 best." 
 
 Almost six months after her marriage, his psychoneurotic dif- 
 ficulties began. Significantly, he could never give a clear account 
 of the time of the onset or what his personal difficulties were at the 
 time. (This extremely important part of the case history was 
 never cleared up, although appeals were made to his parents for 
 accurate data.) 
 
 The parents were both inclined to feel that the throat diffi- 
 culties began at nineteen, and were first noticed after a vacation. 
 He had visited a prostitute who had "choking spells," but he 
 maintained that no perversions occurred. The choking began sud- 
 denly, while drinking water. He felt that he was dying from 
 strangulation, and that evening complained to his mother, "I can't 
 keep my mouth open. I'm afraid I can't drink water." The pa- 
 tient created so much excitement that several physicians Avere 
 called by the distracted mother. He describes his behavior at the 
 time as "very nervous, could not read, had to be alone or would 
 just go wild. Could not talk to anyone or read sister's letters." 
 
 Several months later, one positive blood "Wassermann reac- 
 tion was obtained, otherwise no physical signs were found that 
 might have a relation to the choking and fears of "dying." The 
 diagnosis of his phj^sicians was "hysteria." 
 
 A series of intravenous salvarsan injections was given for 
 the positive Wassermann reaction, and with the third injection (so 
 the patient said three years later) his abdomen began to jerk vio- 
 lently, and an attack of vomiting followed, which latter is not un- 
 common after salvarsan injections. This jerking stopped suddenly 
 with the next injection, just as his physician "said it would." 
 For two years, the abdominal symptoms did not return, but the 
 choking and fear of "dying" persisted. The patient developed 
 the habit of pulling at his larynx, and persistently massaged his 
 throat to stop the sensations of strangling. Almost two and one- 
 half years after the onset (age twenty- three), the patient had most 
 of his thyroid excised, because the x-ray showed an enlargement 
 that indicated compression of the larynx. 
 
 He was terrified by the ether and complained of dying while 
 passing under its influence. He later stated that the vision of a 
 
330 PSYCHOPATHOLOGY 
 
 devil trying to jab Ms harpoon into him terrified him, but, finally, 
 he submitted to the devil. The physician who was present said the 
 patient had to be prevented from masturbating when 'he became 
 delirious. The strangling symptoms were not materially relieved, 
 and, within a few months, became more severe than before. As 
 the patient recovered from the ether, the abd-eminal "jerldngs" 
 returned with the vomiting. The abdominal tic has persisted more 
 or less vigorously to the present writing. The contractions were 
 clonic in type, and occurred at the rate of 15 to 20 a minute. The 
 rate was, at times, almost rhythmical, but, on the whole, arhythmi- 
 cal, and the contractions varied greatly in vigor, according to his 
 emotional state. To control the abdomen, he developed the habit 
 of pulling on his belt, and was rarely seen without his hand on his 
 belt. The abdominal tic and the strangulation feeling accompanied 
 one another. 
 
 Then followed a long series of panics and consultations with 
 numerous physicians. He could never rest assured that there was 
 no serious danger of "dying," and, in all the interviews, he often 
 repeated the same inquiries, despite tiresome insistence that noth- 
 ing could be found to justify such suspicions. The patient most 
 persistently tried to find physical causes for his troubles so that 
 he might also have them removed (castration compulsion) by a 
 surgeon. He wrote: "When I wake in the morning after a rest- 
 less sleep, the- first thought that enters my mind is, whether I 
 "will live to see the day out. My breath becomes short as soon 
 as I get on my feet, and my abdomen starts jumping. The only 
 way I can manage to get a satisfactory breath is to open my 
 mouth as wide as possible and gap it in. I yawn continually, 
 all day. When these spells come on, it is almost impossible to 
 be still. I waU?: the floor until some relief comes. When I have 
 these nervous spells, the hardest part to bear is the awful smoth- 
 ering sensation in the throat. The nerves seem to bunch all to- 
 gether in the throat, causing same to feel like something is press- 
 ing the windpipe closed. I become very much alarmed and think 
 sure that every breath is the last. Then, all of a sudden, a calm 
 will come over me, and the throat will sort of relax, and the breath 
 will come natural again. I notice the most discomfort at meal 
 time. It is very difficult to swallow my food on account of the 
 jumping and smothering sensation which, if not already taking 
 
EEPEBSSION OR PSYOHONEXJROSES 331 
 
 place, will commence inmiediately after being seated at the table. ' ' 
 
 He usually ate from his plate placed on the top of the icebox 
 in the kitchen. Because of his discomforts when seated, a very 
 definite tendency to go into a panic at meal time existed, and, 
 when later he became a patient on the Avard, he usually attracted 
 considerable attention by excitedly jumping up from the table to 
 keep from choking. 
 
 He was admitted to St. Elizabeths Hospital for treatment at 
 twenty-four years of age. From the outset, he was dishonest and 
 could not quite be depended upon. He came voluntarily for a 
 psychoanalysis, but the benefits he derived could not be considered 
 of much value. He always maintained a bluff about his case, and 
 had an irrepressible craving for sympathy. He was virtually an 
 affective parasite. He had no delusions or feelings of being per- 
 secuted, and no hallucinations, although he frequently showed con- 
 siderable fear of insanity. His mental capacity, other than the 
 distractions of anxiety, showed no impairment. He was always 
 neat, and inclined to -be stylish. He could not be induced to work, 
 would mingle with the patients, was unduly curious about the 
 affairs of other people, inclined to be petulant and quarrelsome, 
 and easily dissatisfied unless he received special attention. His 
 associates quickly learned to doubt his statements. At night, he 
 bolstered himself up so as to go to sleep in a sitting position, but, 
 in the morning, he always found himself lying flat in bed. During 
 sleep, all symptoms and discomfort disappeared. 
 
 His general attitude toward his abdominal difficulties is ap- 
 parent in his discussions : "I am convinced in my conscious mind 
 that this jerking is caused by the '606' being too strong. I did 
 not have syphilis, so this medicine had nothing to fight and af- 
 fected my nerves. My father was unable to trace syphilis in our 
 family. ' ' (His parents were horrified when the physician advised 
 treatment for syphilis, and his fattier severely rebuked him for 
 disgracing the family. The value of the above reasoning, to shift 
 the responsibility upon the physician, is apparent.) 
 
 Another determinant for his abdominal troubles was revealed 
 in the teasing of his sister and brother-in-law. They called the 
 cause of the "jumping" abdomen, " Yosabel," and playfully teased 
 him about being pregnant. 
 
 The mother wanted a grandchild, but the daughter was "too 
 selfish" to have children, the patient believed. When his ab- 
 
332 PSYCHOPATHOLOGY 
 
 dominal trouble first began he complained that "something was 
 kicking in there to come out." In discussing the pregnancy value 
 of the difficulty, the patient wittily remarked, "Four injections 
 ought to be enough to cause pregnancy." It should be noted hero 
 that at the time of the injections, the patient had developed quite 
 an attachment for the physician. 
 
 Previous to the strangulation crisis, a homosexual seducer of 
 boys paid frequent visits to the patient's office in order to per- 
 suade the patient to live with him. He represented himself as hav- 
 ing plenty of money, but Avas lonely and felt sympathetic because 
 of the patient ^s deformity. He said he wanted to give the boy a 
 home where he would not have to work. The patient stoutly main- 
 tained that no relations occurred, although he regarded the situa- 
 tion as tempting. 
 
 The strangulation and "dying" feelings at times caused 
 panics and the abdominal jerks often became so violent that he 
 had to keep his belt pulled tight. Several times in these "dying" 
 states, I urged him to lie on a couch, and encouraged him to let 
 himself go. During such states, he had to hold tight to some ob- 
 ject to counteract the feeling of "falling" and "dying." He was 
 never able to let himself go. He usiially rolled and writhed about 
 on the couch, suffering constantly, making sucking movements with 
 his lips, complaining of choking and having violent abdominal 
 movements. Twice, he described himself as having violent com- 
 pulsive homosexual fet^lings during these tantrimis. A little ward 
 incident spoke vokimes. An older, very active, red-headed soldier, 
 of decidedly scrappy appearance, was inclined to pity the patient. 
 This, man was also a patient because of his anxiety and jealousy 
 about his wife. One evening, he took the patient on his lap and 
 called him "honey," etc. To this, the patient commented, "I felt 
 so peaceful and contented it frightened me. I felt like a girl 
 would, and I jumped up. That Avorried me awful. ' ' The effect on 
 the older man ma^- be guessed from his behavior, when a little 
 later he made frank, but playful, homosexual advances to another 
 patient. 
 
 The patient gradiially l)ecame aware of his homosexual sub- 
 missiveness and himself found evidences of it in his jokes and the 
 selection of companions, etc. "The feelings (repressed) say, 'let 
 yourself go, you '11 be happy if you '11 die. ' They say, I am ' scared, ' 
 and I say, 'liar, it is not so.' There is too much manhood in me 
 
REPRESSION OR PSYCHONEUROSES 333 
 
 to give up to being a fruiter." At other times his feelings would 
 tell him that he would not actu.ally die, but would pass through 
 a climax. His manhood only would die and his mother and sister 
 would lose their love for him. "If I could just throw myself on 
 the floor and die, I believe I would feel better." (This method 
 of "dying," etc., is a very conunon phenomenon in the graver 
 psychoses.) 
 
 He was very much inclined to treat "Yosabel" as another 
 personality within himself that was trying to destroy his manhood. 
 When talking of it, he said, ""When we are by ourselves." The 
 case could not be psychoanalyzed satisfactorily, because of his con- 
 stant bluffing. After he told me of his sexual career and his self- 
 indulgent fellatio, he, with pseudo boldness, declared he was not 
 homosexual, because if he had such inclinations, he would go 
 right ahead since it was his OAvn business. Later, he was con- 
 stantly worrying lest he should become homosexual. When in a 
 panic he had dilated pupils, staring eyes, dyspnea, tachycardia, 
 insomnia, and fear of death. He would gasp and cry and beg for 
 help and encouragement, etc. During these states, he grasped his 
 belt or clothing like a drowning man and clung desperately. (The 
 fear of the heterosexual ego being overcome by or yielding to the 
 homosexual cravings.) 
 
 Behind all this symptomatic difficulty and distress was the 
 feeling that his father wanted him to die (crucifixion) so that 
 he could have his wife for himself. He tallied of his father's 
 jealousy, denunciations and violently expressed wishes that his 
 son should die because of his worthlessness. The mother usually 
 counteracted this by saying that her love for her son was greater 
 than that for her husband, but that she had to take care of the fa- 
 ther. (Back of this mortal feud between father and son was a timid 
 little wife-mother who weakly tried to keep things smoothed over 
 between husband and son. See Michelangelo's Pieta.) 
 
 During one of his more severe "dying" episodes, he reviewed 
 his difficulties with his father, permitting his anger free play, 
 finishing with his father's denunciations about the syphilis. The 
 intensity of the compulsion "to die" seemed to be greatly relieved 
 by a series of protests against the domineering attitude of his 
 father. A reaction of regret followed in which he mourned the 
 fact that he should have such violent hatred for his father. 
 
 His almost unrestrained attachment for his mother and sister 
 
334 PSYCHOPATHOLOGY 
 
 was evident in a long series of dreams about light-haired girls 
 and women (mother and sister were light-haired) and several 
 rather romantic sexual dreams in which his mother or sister made 
 love to him. He commented that it was strange that when he was 
 awake he should be attracted by dark-haired girls and in his sleep 
 nearly always dream of light-haired women. 
 
 He developed a "funny little habit" of drinldng out of his 
 hands because it tasted better than the cup and relieved his tend- 
 ency to become strangled. 
 
 The intensity of the symptoms gradually became lessened, and 
 he made a fairly consistent transference to me, but would not give 
 up his mother attachment. This Avas expected, because his mother 
 could not give up her unhappy, crippled boy. 
 
 His sexual interests in his mother were never analyzed. To 
 this he stoutly refused to give any consideration even though he 
 came to an interview much embarrassed by a frank, vivid sexual 
 dream about her. 
 
 In due time, he was discharged as improved. He had re- 
 gained considerable confidence in himself, and was determined to 
 become a man and "make good" despite his difficulties. For 
 several months, he occasionally came to see me to show how well 
 he was succeeding. He was always well dressed and made a goodf 
 appearance, but was still uneasy. 
 
 "Every time I try to appear at my best, this thing comes up 
 in my throat. 'Tosabel' gets after me whenever I try to do my 
 best, but I am putting up a fight, all right, but it has not won 
 yet." The striving and bluff were still obvious. He was having 
 "a good 'time to forget his troubles" and saying nothing. Before 
 long, a panic developed. He had been discharged from a series of 
 jobs for insubordination. For three weeks, he said, he loafed. 
 His mother said he could not get work. Finally, his father or- 
 dered him to leave home and refused to give him a loan to start on. 
 
 He came to me discouraged, depressed, with all his symptoms 
 reaggravated. (The repressed cravings become dominant when 
 the ego is discouraged.) He hoped I would find him an easy road 
 to travel. He was advised to go it alone, and, half-heartedly, 
 promised to do so. A few days later, the mother informed me that 
 he had bravely started out (with her strings tied to him), and that 
 if he did not get along well she had assured him he would always 
 be welcome in her home. Within a few weeks, he was back. He 
 
eepkessiojst or psycitoneueoses 335 
 
 still calls me up to be reassured that he will not die from the 
 throat sensations.* 
 
 This man has, obviously, very grave oral erotic affective re- 
 pressions, and trudges along on the precipitous edge of dementia 
 prsecox, that is, profound dissociation of the personality. 
 
 The struggle to become virile, good and happy through the 
 elimination of the distressing cause or the deficiency (the perverse 
 affect and its interests), has its corollary in another type of strug- 
 gle—namely, to compensate for the deficiency through the simula- 
 tion of a compensatory state Avhich atones for the deficiency. It 
 is important to recognize the difference for the psychotherapeutic 
 procedure and the prognosis, because the elimination or castration 
 type of mechanism, unless the tendency becomes checked, may 
 develop into a pernicious type of dissociation with progressive 
 deterioration. The preceding cases illustrate this feature. 
 
 In the shmdation type, the affect creates the postural and sen- 
 sory image of what it needs in order to attain comfort because the 
 reality is unattainable, as in the simulation of pregnancy, or of 
 paralysis (Case PN-3). In the latter, the suppressed affect will 
 often permit the free use of the inhibited or misused part so soon 
 as a monetary compensation for the injury is made by the of- 
 fender, as a railroad company. In one case, the simulation was so 
 transparent that after handsome damages were collected a lamin- 
 ectomy had to be performed despite a normal spinal column and 
 spinal cord. This, apparently, socially justified the recovery 
 which promptly followed. The neurologist and surgeon permitted 
 the patient to evade the responsibility for the* simulation of 
 paralysis. 
 
 The following case of simulation is presented as typical of 
 the rather startling behavior of such cases, which, however, usually 
 have an excellent prognosis, unless the deficiency which is compen- 
 sated for is utterly intolerable, as in Case PN-7, who protected 
 himself from fear through the defensive use of his foot. 
 
 Case PD-17 was a white, married woman, aged thirty-four, 
 who passed through a sexual panic with simulation of labor, and 
 also hallucinated sexual assaults by two female relatives. 
 
 Her father- was "dull" and her mother, "nervous" and 
 "eccentric." They lived unhappily together, and the patient, as 
 a child, suffered from their quarrels. A paternal uncle was in- 
 
 *Two years after this was written I received a letter from him stating that he had recovered 
 because he had learned to be a man. 
 
336 PSYCHOPATHOLOGY 
 
 sane. A brother had three manic-depressive episodes, presuma- 
 bly related to his wife's alcoholism; and two other brothers sepa- 
 rated f-rom their wives because of infidelity. 
 
 The patient had jaundice, spasms, mumps and "kidney trou- 
 ble" when a child, but seemed to be a healthy woman. 
 
 Although she learned very well in school, she had to quit at 
 eleven because her parents refused to supply her with clothing. 
 As a child, she persistently tried to become a Catholic in order 
 to go to confession with her playmates. 
 
 Her skin was darkly pigmented, and the mother obtained much 
 of her revenge through calling her a "nigrified bitch," "black 
 bitch," and "black nigger." Her playmates often provoked her 
 into fights by calling her "Jew," "Italian," and "crazy Susie." 
 (These names were hallucinated in the psychosis.) 
 
 (The sister-in-law, who was supposed to be immoral, and who 
 called her "Indian," appeared in the psychosis as a sexual as- 
 sailant. ) 
 
 The' patient began to menstruate at eleven, and early developed 
 maternal interests. At fifteen, she "fell in love," donned long 
 dresses, and eloped to get married, but the impulsive plan mis- 
 carried. . , 
 
 At twenty -two, she married an artisan of twenty "for a 
 home," to evade her abusive mother. Her married life was not 
 happy. Her first child was healthy, but the second pregnancy was 
 aborted and this resulted in a separation. Family relations were 
 finally resumed, whereupon she became infected with gonorrhea. 
 This increased her sexual indifference for her husband. Her hus- 
 band, soon after, lost one of his legs in an accident and her house- 
 hold attentions became drudgery. 
 
 Her husband's mother and she were bitter enemies, and this 
 added considerably to the incessant family turmoil. Eestless and 
 amorous, she was forced to find an affective solution. 
 
 At thirty-four, about one year before the psychosis began, she 
 affiliated with a Baptist congregation. She became an ardent 
 worker, but was infatuated with the minister. "When he failed to 
 make satisfactory responses, the dissatisfied affect caused her to 
 suspect that he was making sarcastic references to her in his ser- 
 mons and the congregation was gossiping about her. Six months 
 previous to the crisis, her. physician noted "some mental disturb- 
 
REPKESSION on PSYCHONEUROSES 337 
 
 The excitement began suddenly, apparently after a conflict in 
 which her mother-in-law figured prominently with accusations 
 about her character. She believed that her own mother had poi- 
 soned her, her husband's breath poisoned her, and that the medi- 
 cine for her pharyngitis was poison. She rapidly developed fan- 
 cies of being a little girl (regression) and refused to listen to her 
 friends. Although she wore her house dress she fancied it to be 
 an Indian costume, fixed her hair to hang unbraided and tied a 
 handkerchief around her neck. 
 
 She went to a Catholic hospital for help, and then became 
 "unconscious" from a "shock." A nun, she said, tried to calm 
 her and, upon hearing her story, said something about having a 
 baby, which, the patient thinks, influenced her, but was only an 
 excuse for what was inevitably coming. Because she was unable 
 to control herself or attend to her household duties, and was re- 
 sponding to hallucinations with weeping and singing, she was 
 brought to St. Elizabeths Hospital. 
 
 Upon her admission, aged, thirty-five, she was very much con- 
 fused and excited by the hallucinations and erotic cravings. Her 
 wide-open, appealing eyes and submissive, yearning facial expres- 
 sion were classical of the Madonna, although she was short, obese 
 and darkly pigmented. No important physical lesions were found. 
 
 Within a few hours after admission, she attacked several 
 women and charged them with trying to "cast influences" over 
 her. For several days, she retained her excreta. Although very 
 apprehensive in the presence of women she seemed to be relieved 
 from fear in the presence of a man. 
 
 (I believe that the unrestrained nature of her transference 
 and confession was an important influence in preventing a pro- 
 longed psychosis. The reasons for this impression will become 
 more obvious as the material of the confession and the patient's 
 faith in its therapeutic value becomes manifest.) 
 
 She persisted in getting under thehed, removed her clothing, 
 and kept the ward in confusion. She was secluded, and continued 
 her general erotic behavior for the next seven days. Then she 
 seemed to gain considerable control of herself after several frank 
 discussions of her wishes, which are recorded because of their im- 
 portance. 
 
 During the period of greatest confusion and activity, she 
 pleaded frequently that she wanted "to die." "I have been poi- 
 
338 PSYOHOPATHOLOGY 
 
 soned," she would say. "I have been tortured and tortured every 
 night. I know I have never had nothing like this before. My 
 whole body was to be cut up and wrapped in some filth and thrown 
 into a slop-cart. I will be glad to die to get out of my trouble. 
 This morning, -when I sent for you, I didn't knf)w what was the 
 trouble. Feels lUce labor pains." 
 
 Examiner: "Why do you have feelings of labor pains?" 
 
 Patient: "I couldn't tell. I can't remember. My mind was 
 upset when I came here. It's drawing — some kinds of drawing 
 pains, just like it 's pulling your heart-strings down. I haven't had 
 any movement of the Ijowels — I am full of food. I don't know 
 when I was sick last. I don't know how long I have been here 
 [six days]. I don't know wliether I have been here a month. I 
 know some of the girls have been acting so funny, and everything 
 has been going wrong, and I do not know what the cause is. I 
 have just been poisoned today A^ith something put in the soup, so 
 they told me [hallucinated] . That gets me giddy in the head, and 
 then I feel like I am thick around the neck, get stiff, a pulling on 
 the nerves. I don't feel it is ni}- husband's cause [fault]. They 
 all say that I am going to have a baby. They said I was going to 
 have a baby today [hallucinated]. 
 
 ' ' They shut me up like a maniac. There are no conveniences, 
 no vessels, or no drinking water. I feel like I am not treated right 
 [contracts her muscles]. I feel like they are poisoning me. 
 [Trembles all over and writhes in bed, saying: "Oh, my!" Her 
 body was badly beaten and bruised from throwing herself about 
 in the bed.] I liave stood that poison so long. ' ' 
 
 She placed her hands on her abdomen, and said: "It feels 
 like those drawing labor pains. It might be some convulsion pains 
 from poisons. AVe had soup today, and some of the people were 
 sick. There is food in my stomach for many days, and I don't 
 think the child would be healtliy if it were a child." 
 
 She asked me, with great anxiety, to close the door, because 
 she was afraid a "grey-haired Avoman'' might enter her room. 
 She said she could hear her voice. "They might cut me up," she 
 said. "They might throw me through the window and put me in 
 the slop-cart. [Smiles.] That [the voices] makes me go just like 
 that. [She made her arms tremble.] She is downstairs now. 
 They are just having a picnic out of me, and I "will do anything 
 
EEPRESSTOK OB PSYOHONEUROSES 339 
 
 they tell me. [Refers to her autosuggestibility.J I smell the odor 
 of some kind of disinfectant. ' ' 
 
 That morning, she complained, with anxiety, about a "woman 
 downstairs" who was terrifying her. She said: "She has called 
 me everything — ^bitch, black bitch, and names that meant I was 
 low." (The reader must always bear in mind the fact that the 
 hallucinated voice is produced by the dissociated cravings.) 
 
 I asked her if " doi^mstairs " had another meaning, and she 
 replied: "Below and Hell, torment, murder, death, everything 
 ugly and danger to me," revealing the moral direction the per- 
 verse dissociated affect was forcing the ego. 
 
 She complained that she could not understand why she should 
 have labor pains when she really could not be pregnant, and, at 
 times, she spoke of her pregnancy as "imagination," but she 
 seemed unable to stop it, and would quickly slip back into accept- 
 ing the feelings to mean a real labor. This indicated that at times 
 she was able to almost control the dissociated aifect. 
 
 The necessity of holding to her admission that her troubles 
 were imaginary was earnestly maintained, but all criticisms were 
 carefully avoided, and in her replies she made the following state- 
 ments : 
 
 Examiner: "What can a Avoman do Avhen she is having such 
 imaginary labors ? ' ' 
 
 Patient: "She will never get Avell of the insane." 
 
 Examiner: "What else will she do?" 
 
 Patient: "She will die." 
 
 Examiner : "Is there anything else ? " 
 
 Patient: "If she tries to stop it [hesitates, but acts as if go- 
 ing to continue] . . . ." 
 
 Examiner: "How do you think she can stop it?" 
 
 Patient : " I don 't knoAA^ ' ' 
 
 Examiner : ' ' How do you stop anything like that ? ' ' 
 
 Patient : ' ' Trying. ' ' 
 
 Examiner : ' ' When are you going to try ? ' ' 
 
 Patient: "When I get out of this — ^unhappiness — trouble." 
 
 Examiner: "Tell me all about it." 
 
 Patient : "It seems just like someone had me on their mind — 
 minister — ^I don't know. I was going to church, and I tried hard 
 to believe and be right, and it seemed like this party would just 
 
340 PSYCHOPATIIOLOGY 
 
 look at me sideways and talk directly to me. He was minister of 
 — it just struck me to the heart. I admired him iirst as a minister, 
 and thought he was a nice man. I used to like his virtue, but after 
 he commenced to be sarcastic I kind of didn't care for his sermon. 
 I thought I must be guilty of sin" (secret orotic wishes). 
 
 She confessed to having had "drawing feelings of love" for 
 him, and now was suffering froui "disappointment and sin," and 
 she admitted that her troul)les may lie "imagination." (Here she 
 began to writhe and groan.) "Oh, my! I don't know what I am 
 going to do! These girls are ah\'ays plotting and thoy are making 
 fun of me ! ' ' 
 
 Her labor pains aud general lichavior wore evidently a com- 
 pensatory simulation J relieving the "disappointment" of the sex- 
 ual cravings for the minister. 
 
 She said: "I tried hard not to think of it [lovo]. I thought 
 I was wrong. I had to drive the feelings away." She followed 
 with tlie complaint that it had been "a week" since she had def- 
 ecated and "everything is mixed up in me." This retention of 
 her urine and faeces made her "get big," and it was "something 
 like labor, ' ' and made her think " of a child. ' ' 
 
 "When she was not tossing, and contracting her abdominal mus- 
 cles, and groaning, she smiled pleasantly and tried to lie agreeable. 
 After her confidence was won, she became quite inclined to assume 
 the responsibility for lier condition, which was the encouraging 
 sign of a health^" solution, and I asked hor what she was going to 
 do about it. She replied: "I don't know. If I could just get out 
 of this placo. [She was afraid of being considered insane.] This 
 misery just started a little last night. For two or three nights I 
 have not had a passage of urine I held it so long. I could not 
 got anybody to como to the door. Last night they let me out but 
 I could not do it, and this morning — Oh, doctor! Please see if 
 you can't get mo somotliing for this. [She seemed to be in great 
 pain, and tossed about in the Itod.] I feel like I am just clogged 
 up inside by keeping my urine and passage back. I don't know 
 what it is. I believe I could get relief if I had a passage. I don't 
 know what it is. Maybe somebody has poisoned me. I don't 
 know — imagination or what." The transference to me was mak- 
 ing it possible for her to see the wish-fulfillment. 
 
 The next day she removed all her clothing and stood nude 
 
KEPRESSION OR PSYCHONEUROSES 341 
 
 before the window. She pounded on the screen, and tried to force 
 an opening. She said she saw a light in a nearby building and was 
 trying to reach it becaixse "it meant passion." The nurse put her 
 to bed and, when I entered the room, she was lying quietly, 
 stretched out on her back, eyes closed, trying to appear as though 
 she. had not noticed me. With a little persuasion, she opened her 
 eyes and began to talk. She repeatedly protruded her tongue, 
 covered with foamy saliva, during the conversation and, in reply 
 to my questions, she explained that this meant "passion." She 
 continued to groan, and to contract her limbs and abdominal mus- 
 cles the way she did the day before. She complained that she could 
 not "make water flow." At first, she seemed to mean urine. To 
 make certain, I asked to what water she was referring, and she 
 explained that she meant the waters of labor, and again spoke of 
 her "imagination," about having to have a child by the minister. 
 
 She complained bitterly of having "impure thoughts," and 
 that she was unable to control herself. She said her thoughts were 
 "degrading" and "wrong." She was fighting against them be- 
 cause something was pulling her away from her husband. "It 
 grips my wrists," she said. [Rubs her Avrists.J "I can feel it — 
 feels like electricity drawing me to some other person. ' ' 
 
 From the time of her admission, she had complained of being 
 afraid of an " old grey-haired Avoman ' ' who looked like ' ' a witch. ' ' 
 She heard and saw this woman, described her as naked, trying to 
 get into her bed to perform sexual acts on her with "her mouth." 
 For this reason she was afraid of the women when they entered 
 the room and attacked them. 
 
 While speaking of the woman calling her "black bitch, negro, 
 foreigner," she complained that her mother never wanted her, 
 and, accused her of being a "nigrified bitch." She believed she 
 was "marked" because of this. 
 
 What she called "impure" and "degrading" thoughts, she 
 said, were influenced by an alcoholic, immoral sister-in-law, "be- 
 cause if you sympathize too much with a person it will make you 
 like them." (Quite a profound psychological observation.) This 
 sister-in-law, she hallucinated, was also trying to make a homo- 
 sexual assault on her like the old woman. 
 
 The patient was now extremely erotic and vividly hallucinated. 
 The sputum on her tongue was shown repeatedly, and she pleaded 
 
342 PSYCHOPATHOLOGY 
 
 pitifully that she was unable to control herself. She explained 
 that her husband had repeatedly practiced eunnilingus on her and 
 induced her to practice fellatio on him. She said that is what 
 she meant by " It is all mixed up inside [placing her hands on her 
 abdomen] and the phlegm comes from down here." 
 
 The patient's anxiety about her perverse eroticism was un- 
 questionable. She was terrified and begged to be saved from in- 
 sanity. 
 
 The next day she was not quite so confused. She said: "I 
 think my mind is purer and I feel better." She wept bitterly, and 
 felt ashamed, because "I did not act right here. I took my cloth- 
 ing off and was so stupid. ' ' Her eroticism had greatly subsided, 
 and, although she still had hallucinations, they were not vivid 
 enough to cause her to yield to them, except to cry and plead for 
 help. 
 
 She now wanted to tell me about her sexual difficulties, in 
 order to get control of herself, because a confession, she ,|h#i.fpt, 
 would help her. (See Case CD-8.) She said she had loved a man 
 of her age and allowed him sexual privileges, then she married 
 her present husband to save her honor. This distorted her entire 
 life, and explained the origin of the dissatisfaction with her hus- 
 band and her cravings for the minister. 
 
 Five days later, she had improved sufficiently to review her 
 psychosis. It was deemed advisable so that she would understand 
 herself. (Some of her explanations of the impulses to conmiit per- 
 versions were extremely pertinent.) Eelative to the "phlegm" on 
 her tongue, she said: "They (voices) accused me of drawing 
 phlegm, like passion [placed hand on abdomen] lihe a hahy taking 
 nourishment from the breast." 
 
 These hallucinations indicated that the origin of the affective 
 craving of "drawing phlegm" (like a baby taking nourishment 
 from. the breast) and sucking to satisfy "passion" or sexual 
 hunger was actually related to a nursing craving hence the 
 struggle to resist the degrading sexual qualities of poison in 
 the food. When patients fear there is poison in the food, they 
 usually mean a sexual ingredient, and this feeling about its pres- 
 ence in the food tends to satisfy the orally conditioned sexual 
 craving which is associated with the food hunger, perhaps, because 
 practically the same physiological functions were used to satisfy 
 both cravings in infancy. Both cravings seem to have a common 
 
EEPRESSION OR PSYCHONEUEOSES 
 
 343 
 
 root in the infant's affections when food is taken from the breast 
 (Case PD-13 and Costa Riean Indian sculpture of copulation). 
 
 She said, retrospectively: "I heard voices around me say 
 I was going to have a baby. I seemed to be in a dream, and I 
 forgot all about my husband. It seemed I was going to marry 
 Dr. V — . When the girls put me in a continuous tub I heard voices 
 say: 'You can't tell me she isn't a Southern water nymph.' I 
 thought a crowd of actresses were coming up from the South. I 
 was preparing for the stage. It seemed that after I came here, 
 there was a lady, Avho was built like my brother's wife, came near 
 me, and it frightened me. I said I would strike her, and once I 
 got her by force. [She attacked several women.] I thought she 
 was going to use her mouth on me. [Groaned, and appeared very 
 anxious.] I am hearing voices now call me a bitch, a dirty dis- 
 eased somebody. I am rotten. I must dirty the bed. Believe I 
 did once." The psychopathologist must see behind this talk the 
 erotic craving to be "rotten" and "dirty." 
 
 The patient told another physician, who was not familiar with 
 my notes, that she felt an old woman would come in the night and 
 put something into her rectum. She heard the woman's voice tell 
 her to put her finger into her rectum and she would see her picture, 
 so she covered her finger with a sheet, and, after inserting it, saw 
 ' ' a picture of a nigger on it. ' ' She said that a voice told her she 
 would see Christ and that she herself was the Christ Child Jesus. 
 Someone cut up the bodies of her people, and she was blamed for 
 the crime. 
 
 "I got to da,ncing and hollering out of the window like an 
 Indian. Hollered for people in Baltimore. Thought the Washing- 
 ton people thought I was colored and were all against me. These 
 Protestants and Catholics were fighting. Whenever I do wrong," 
 I feel better when I can confess it, and the sisters (nuns) are so 
 nice tome." 
 
 She continued to be distressed and anxious because the crav- 
 ings to perform sexual perversions could not be subdued. During 
 this conference, she was inclined to lapse into a distracted state, 
 but would respond promptly to questions. 
 
 Two weeks after her admission, she commented : "I thinli my 
 mind is purer and I feel better." She adapted herself well, was 
 not so distressed about her former behavior, and asked for work. 
 
344 PSYGHOPATHOLOGY 
 
 She pleaded to be permitted to return to her husband, and made 
 profuse promises about never leaving him again. 
 
 Her dreams, during the acutely erotic period of her psychosis, 
 were quite in harmony with the hallucinatory trend, such as dreana- 
 ing about marrying her physician, and of being in bed with a man ; 
 that someone telephoned to her that she did not have a husband ; 
 and that she was going to be married to the husband of another 
 woman. Another time she dreamed she was nude before him, and 
 he was studying art, etc. 
 
 During the acute stages of her psychosis, she yielded to the 
 erotic cravings and interpreted the environment largely to satisfy 
 them. She would laugh, cry, groan, fight, pray, plead, sing, dance 
 or be silent for periods or talk freely. Her conversation was not 
 coherent, and there was a little distractibility, referring to things 
 in the environment. It showed in the promiscuous subjects of 
 her eroticism. 
 
 During the acute stages of her psychosis she also seemed to 
 be disoriented for time, place and person, but when her attention 
 was held, she proved to be quite oriented, althoTaglt she frequently 
 made mistakes before she arrived at the correct date, etc. Her 
 memory for remote and recent events was accurate, biit the special 
 memory tests were not so well done, and the calculations were in- 
 accurate. About two weeks after admission, she was able to per- 
 form the usual tests well enough. 
 
 Unfortunately, she was discharged by the court twenty-five 
 days after her admission, before she had completely recovered. 
 Her insight was good, and she understood the wish-fulfillment in 
 her behavior. She was inclined to feel that in some respects the 
 psychosis did her good. 
 
 During the past two years, the patient has conducted herself 
 quite efficiently, with, perhaps, a better appreciation of her hus- 
 band. 
 
 In the above case, the simulation of pregnancy and labor was 
 brought about by the dissatisfied affect which, obviously, craved 
 a definite relationship with the minister (father). On the whole 
 she was not desperately averse to the repetition of perversions, 
 but was terrified by the hallucinations of the mother. 
 
 In some cases, the simulation of an attitude or state may be 
 made at the sacrifice of an important organic function or personal 
 interest, and the sacrificed function may mislead the observer to 
 
REPRESSION OR PSYCHONEUROSES 345 
 
 consider this in itself to be an elimination process, when, in reality, 
 it is decidedly a simulation process made necessary in order to 
 eliminate a far more grave, although more obscure affective crav- 
 ing. 
 
 In the following case (PN-7) the soldier simulated a disease, 
 "the bends," and crippled his leg in order to protect himself from 
 the terrifying effect his anal erotic cravings had upon him. 
 
 That one individual should become terrified when he becomes 
 erotic, whether perversely or not, and another elated, seems to be 
 decidedly a result of the influence of associates, particiilarly the 
 esteemed associates who create in the individual through endless 
 suggestions and pleas, from infancy to senility, a conscientious re- 
 gard for what is estimable and justifiable. 
 
 Case PN-7 shows the marked distortions an individual will as- 
 sume to escape the causes of fear when due to uncontrollable per- 
 verse eroticism. 
 
 The patient was a tall, broad shouldered, lanky soldier and 
 coal miner who was sent to St. Elizabeths Hospital for dementia 
 prsecox and a hysterical contracture of the right leg. He had also 
 been diagnosed as having cerebral syphilis. He was tAventy-six 
 years of age, unmarried, and had spent most of his life in the 
 coal mines and on the Ohio Eiver as a roustabout. He believed 
 that he was the only child of his parents, but did not remember 
 them and could give no information about his early childhood. His 
 education was extremely meagre, and he gave the impression of 
 being a high-grade moron. When asked to give the difference be- 
 tween water and ice, he said: "One is water and the other ice." 
 
 He denied having had any diseases. His blood M^as double 
 plus for one Wassermann test and negative for another. His 
 spinal fluid was negative for one examination and showed 14 cells, 
 double-plus protein, negative Wassermann and negative Lange 
 tests upon another examination. A neurological examination was 
 negative for all signs of any form of cerebrospinal syphilis. He 
 had indulged freely in alcoholic beverages for years, but did not 
 show physical signs of their excessive use. ' 
 
 He quit the coal fields for reasons that he would not discuss, 
 and enlisted in the army in January, 1915. Six months later, ac- 
 cording to the Army Medical Eeport, while in the Hawaiian Is- 
 lands, he returned to the post and claimed that he had been struck 
 
346 PSYCHOPATHOLOGY 
 
 from behind and knocked unconscions. He was put nnder arrest 
 for being drunk and carrying a revolver. Following the alleged:; 
 attack, the patient went on sick report complaining of pains in 
 the right testicle, right thigh and abdomen. Upon examinait, 
 tion, no evidence of tranma could be found. (The reports are con- 
 fusing on this point. The first report says the patient suffered 
 from a severe contusion sustained in a fight. Then the diagnosis 
 was changed to cerebral syphilis, and later, to dementia praseox. 
 The patient's stories were also contradictory and confusing.) He 
 waUced with the thigh in an abducted position for several days, 
 and his physicians expressed the belief |^t his symptoms were af- 
 fected. He was observed to walk across the room in a normal man- 
 ner, but within a few days the right knee was raised almost to the 
 level of the hip-joint and extended before him, while the li^^Jwas 
 flexed closely upon the thigh and the foot carried below the left 
 buttock so that the foot practically covered the anal region. (See 
 Fig. 41-A.) The muscles were held fixed, except upon defecation 
 and sleep, when the foot was let down to rest behind the left 
 loiee. He usually walked by shifting sideways on the left leg, 
 twisting the foot from heel to toe over the floor. Later, he walked 
 with crutches. An x-ray pictiire of the hip showed the joint to be 
 normal; at least, no signs of necrosis or infection could be made 
 out by the x-ray examiner. No trophic disturbances were found, 
 and no changes for sensation or tenderness could be elicited. 
 
 Unfortunately, a description of his behavior and mental status 
 •during the acute stages of the illness were not given in the report. 
 The medical officer said that he showed "mental deterioration" 
 within a short time after his admission. A true deterioration, how- 
 ever, had not occurred. The patient was only panic-stricken and 
 was unable to cooperate; also being illiterate, his state of mind 
 was misunderstood. 
 
 In the beginning of his illness he had been assigned to an 
 open ward, but became morose, suspicious and surly. Although 
 no one in authority advised a surgical operation, he became ex- 
 cited, threatening, abusive and profane, in order to keep the physi- 
 cians and nurses away from him. He could not be reassured, and 
 had to be assigned to a private room. (Such behavior always sug- 
 gests a homosexual panic.) He closed the Avindows, covered his 
 head with a sheet and leaned against the door to keep it closed. 
 He refused to eat and would not explain why. 
 
KEPRRSSION OR PSYCHONEUROSES 
 
 347 
 
 He was not accessible and never admitted that he had hal- 
 lucinations, but replied to questions concerning them with, "They 
 don 't bother me any more. ' ' 
 
 Mg. 41-A. — Spastic distortion as a defense against anal erotic cravings. 
 
 Ten months after the onset, he was admitted to St. Elizabeths 
 Hospital. Certain characteristics of the patient's attitude were 
 
348 PSYOHOPATHOLOGY 
 
 very striking. He trusted no one, and always watched everybody, 
 particularly when they approached him from behind. He would 
 not make friends, tended to isolate himself, had a perplexed, anx- 
 ious facial expression, and did not want to be cured. He said 
 if his leg should be brought down, "I'll go mad." He was very 
 anxious to be discliarged "not in line of duty" and avoid any 
 form of treatment. (When a soldier is discharged for an illness 
 or injury which is not in line of duty he is not entitled to a pen- 
 sion.) Throughout his stay, he asked this monotonous, stereotyped 
 question: "When can I get my discharge, sir? I am all right. 
 It's not in line of duty, sir. They read it [record] to me that way." 
 If he had the opportunity he never failed to add, with anxiety, "I 
 do not want a pension, and since this happened out of line of 
 duty and I was not in the service very long and I am an expense 
 here, I want to be discharged, and you can put it on the records 
 that I do not want to claim a pension — if I could have been cured, 
 the doctors in Honolulu would a done it, sir." It should be re- 
 called that he resisted the doctors in Honolulu. 
 
 His story of the injury Avas as follows : "I was in town drink- 
 ing a few glasses of beer with some friends and was going along 
 the street (in a park) wlien I heard someone come up behind me 
 with a police officer on horseback. From what the police said they 
 knocked me unconscious and boat me up. Tlioy hurt my left ear 
 [while in the hospital he had otitis media] and side and my right 
 hip. My leg dragged afterwards and it was in the Avay, so it 
 drawod up this way. I couldn't iTse it while it dragged. If it 
 comes down (now) it would be in the way. 
 
 "My trouble's Avith my right hip. Came from my right tes- 
 ticle. It hung doAvn and it affected mo all through here [places 
 hand on right inguinal area] and my leg draAved up." 
 
 When the testicles, Avhich appeared to be normal, Avore pal- 
 pated the man Avas decidedly emltarrassod and uneasy. He feigned 
 great tendoriiess and resisted the examination. 
 
 No A^aricocole or hernia on oitlior side Avas found, although 
 he insisted that ho had a riglit A'aricocole. Physical examinations 
 of the abdomen and sci-otum av(m-o found to be negative. 
 
 Wliy this able-bodied man should light against being treated 
 for so serious a deformity as ho had, seems inexplicable upon any 
 other ground than that it Avas a necessary, desperate solution of 
 a graA'o affectiA^e difficulty. He had carried his leg in this position 
 
REPRESSION OR PSYCHONEUROSES 349 
 
 for ten months, but repeated, emphatic warnings of possible, in- 
 curable changes in his hip and knee-joint did not influence him 
 to seek treatment. He would not consider it under any circum- 
 stances. 
 
 He worked indiistriously, was well oriented, and interested in 
 most things, and tried to find favor with the physician-in-charge 
 so that he would be given a parole. He was consistently inacces- 
 sible and elusive so that only fragments of information could be 
 gathered. He admitted to Dr. D. C. Kalloch that he had heard 
 unnatural voices calling him vile names, and said that he may have 
 been thinking of someone committing a sexual assault upon him on 
 the night of the supposed injury, but did not want to talk about it. 
 
 During a later interview, he thought that ' ' may be the police- 
 man affected my hip with compressed air." This statement fol- 
 lowed his explanation that he had never had relatives who had a 
 similar affliction, but he had seen several men Avho had had "the 
 bends" from compressed air. This was while he worked on the 
 coffer-dams in the Ohio Kiver. 
 
 The fancy that the policeman had caused "the bends" with 
 compressed air was significant. But, what did the policeman on 
 horseback and the compressed air sj^mbolize? And why did "the 
 bends ' ' take on this convenient form which he would not allow to 
 be treated! The answer is possibly to be found in the use of sim- 
 ilar symbols by other cases, and in his general personal makeup. 
 The policeman on the horse symbolized the centaur that had as- 
 saulted Mm, and the compressed air that he injected was a seminal 
 equivalent. Case HD-1 described a horse on which a policeman 
 rode as being "nearly all penis," and Case PD-32 often sits on 
 her foot to protect her amis from a secret underground device 
 that sends shochs into her anus, and is operated by her sister and 
 brother-in-law. 
 
 The patient said he had never masturbated at any period of 
 life. For a boy, carelessly raised in the coal-mining towns of 
 West Virginia, this is so improbable that it must be considered a 
 defensive misrepresentation of his sexual life. Since he told read- 
 ily about his experiences in houses of prostitution, the impression 
 was given that he had the usual pride about heterosexual ex- 
 periences, but was very uneasy about his homosexual life. 
 
 When the universality of masturbation was explained, and its 
 usual harmlessness emphasized, he replied, "If you can't get me 
 
350 PSYCHOPATHOLOGY 
 
 one way you'll get me another." But lie did. not trust nie far 
 enough to disclose the true causes of his anxiety. 
 
 He would not relate his dreams, so this avenue to his fears was 
 not open. 
 
 The foot was carried over the anus and he so consistently 
 watched for suspicious signs of approaching danger and was so 
 easily startled, that the defensive value of the foot attracted at- 
 tention. His panicky resistance to treatment, the hallucinations 
 that had accused him of being a degenerate, and the fear that he 
 would "go mad" if the foot was displaced, indicate that he was 
 protecting himself from anal erotic, homosexual cravings. His 
 explanation that he had been ''knocked unconscious" by the as- 
 sault is a phrase typical of anal erotic submissions, as Cases 
 PD-34, PD-33 shoAv. ' 
 
 One other feature of the case must be given consideration, and 
 that is tlie pain he endured wlien he so severely flexed his knee. 
 He explained it was done because "the leg_ dragged from the hip 
 and was in the Avay. ' ' The pain was endured in order to escape 
 more terrible panic. The consistent maintenance of its position 
 gives a measure of the persistence and gravity of the fear. Sug- 
 gestions that Ave Avould correct the leg after giving ether caused 
 him to become decidedty anxious. 
 
 His sensitiveness and embarrassment upon digital examina- 
 tion of his scrotum was unquestionably a homosexual reaction, as 
 was his tendency to isolate himself from other men. The sugges- 
 tion of so using the foot for a defense probably had, for one de- 
 terminant, its origin in the cases of "bends" he had seen from 
 compressed air. 
 
 The possibility of error in the diagnosis that the position of 
 the foot was a defense against an anal erotic predisposition must 
 be admitted, but the more important fact, for AA-hich the case is 
 presented — ^namelj^, that tJie extensive serious physical distortion 
 was reflexly assumed by the man and maintained indefinitely in 
 order to escape the affective state of fear, is definitely established. 
 It is probable that so soon as he escapes from the causes of fear, 
 he will gradual^ resume the use of his leg. 
 
 Sixteen months after the onset, he eloped in an unimproved 
 condition. The trend of tlie psychosis seemed to have become fixed 
 upon the physical distortion he had maintained, and this in itself 
 was the reason for not pushing his case. To have deprived him 
 
REPRESSION OR PSYCHONEUROSES 351 
 
 of Ms "defense," without having his confidence, ■would probably 
 have thrown him into a more serious panic. 
 
 The peculiar phrases about being "made unconscious," or 
 "knocked unconscioiis," or "temporarily senses taken away" 
 (Case PD-34), are strikingly used by patients to describe their 
 experiences when passing through a sodomistic experience. It 
 stands out in quite marked contradistinction in my cases to the 
 oral erotic complaint of being ' ' crucified, " or " dying. " I do not 
 believe that it is distinctly pathognomonic of the type of erotic 
 panic, but I am sure that in my study of erotic panics the anal 
 erotic and oral erotic individuals have quite different ways of 
 
 A. B. c. 
 
 Fig. 41-B. Tensions of facial muscles to control eroticism. 
 
 A. Shows tensions of facial muscles at 16. No conflict apparent. Narcissism 
 highly developed. 
 
 B. Shows strong incessant tensions of facial muscles indicating great difficulty 
 in keeping himself unconscious of his sensuous lips. Age 23. 
 
 C. Two years later. Obsessed with oral eroticism he bit out the parts of his lips 
 that had a sensuous significance. The biting occupied several days and occurred while 
 in a desperate panic trying to get pure thoughts and eliminate the eroticism. 
 
 meeting their difficulties, and these methods, as symptoms, have a 
 diagnostic value. "When both forms of eroticism are present the 
 distinction is not so clear. 
 
 Attention to this variation was first directed by Case PD-34, 
 so-called paranoid dementia prjecox, who repeatedly described 
 his experiences of being made "unconscious" by secret powers, 
 and then subjected to sodomy. During these states, his behavior, 
 according to his history, was not unlike that of some epileptics 
 when they become erotic. 
 
 Summary 
 
 The elimination of an organ or function, or a craving, and the 
 memories aroused by it, is always made in order to escape from 
 a situation which is made intolerable by the existence of the crav- 
 ing. This craving, in itself, may be pleasant or unpleasant, as an 
 
352 PSYCHOPATHOLOGY 
 
 illegitimate love or hatred. A true eliinination naturally can not 
 be made. The individual only, represses (forgets) the wish so that 
 it can not maJje him conscious of its needs. 
 
 The simulation of an organ, function or object is made in 
 order to gratify an irrepressible affective craving. It is usually 
 not so malignant as the elimination mechanism, although, because 
 of its eccentric nature, it may lead to the social ostracism of the 
 individual; as the claims of undue prophetic powers or the simu- 
 lation of pregnancy. 
 
 Because either mechanism may become the foundation of ec- 
 centric adjustments and ridicule, they are to be regarded seriously, 
 and the individual needs assistance in order to make the necessary 
 affective readjustment and obtain insight. 
 
 The surgeon, in particular, should train himself so as to have 
 at least sufficient insight into these mechanisms to prevent being 
 used for the castration of some repressed affective craving through 
 the excision of some important organ. Many a surgeon has had 
 to close a distended abdomen, which was complained of in a man- 
 ner that indicated a distressing fibromatous uterus, but was in 
 fact distended as a simulation of pregnancy. 
 
 The repression of an affective craving is aluays due to the 
 fear of the social consequences of permitting the craving to seek 
 gratification. The repression is made by coordinating all the 
 jeopardized cravings of the ego for social esteem upon some sub- 
 stituted line of behavior in order to keep the repressed affect from 
 causing the individual to become conscious of its needs. The sub- 
 stitution, for this reason, is usually seized upon reflexly and is 
 largely made up of those things of which the individual was quite 
 vividly and coineidentally conscious at the time the crisis occurred. 
 For this reason an overemphasized physical lesion, such as an 
 ulcer, a fracture or an organic inferiority, should be suspected by 
 the psychopathologist to be the means of maintaining the repres- 
 sion of some unjustifiable affective craving such as love, fear, hate, 
 shanie, envy, avariciousness, etc. 
 
 Since there is no line of demarcation between the psycho- 
 neuroses, compulsions and obsessions, and the graver psychoses 
 and dissociations of the personality, we may now consider the in- 
 fluence of repressed affections with elimination and simulation 
 tendencies in the dissociations and regressions and eccentric com- 
 pensations (psychoses). 
 
CHAPTER VIII 
 
 MANIC-DEPEESSIVE PSYCHOSES AS BENIGN COMPEN- 
 SATION OR REGRESSION NEUROSES, WITH OR 
 "WITHOUT DISSOCIATION OF 
 PERSONALITY 
 
 Elimination or Simulation for Wish-FulflUment in Affective 
 
 Crises 
 
 Two general types of elimination mechanisms in the benign 
 regression neuroses (depression psychoses) are to be recognized: 
 those complicated with anxiety and those ivitlvout anxiety. 
 
 The depressed individual suffers from inhibition of the auto- 
 nomic-affective sources of energy, particularly love, so that his 
 powers for work are reduced more or less beloAV his usual capacity. 
 This inhibition procedure, it seems, may be due (1) to ceaseless 
 preoccupation of thought in order to control a perverse or asocial 
 affective craving, or (2) to a subtle, regressive affective tendency 
 toward the nursling's heaven, in which the covetous and com- 
 petitive interests of the individual are renounced because of the 
 hopeless nature of his conditioned infantile love cravings. This 
 renunciation or abandonment of the struggle for virility must not 
 be regarded as being due to sopie obscure inferiority or weakness, 
 but rather to the inaccessible nature of the loye-object for which 
 the affective craving must struggle if it is to struggle at all ; as, for 
 example, an unresponsive or unfaithful love-object to discourage 
 maturing and an infantile fixation upon the mother to pull back. 
 
 In both types, the resources of personal energy for earning a 
 livelihood are much reduced. In anxious depressions, where the 
 individual has plenty of energy, usually more than normal, the 
 ability to do an ordinary day's work is reduced because the affect 
 is striving for a fixed, decidedly different object, and the striving 
 is very distressing in itself, because of its uncontrollableness. 
 
 The nature of these dissatisfied affections is extremely im- 
 portant. It may be a disguised craving for masturbation or un- 
 justifiable sexual indulgence. 
 
 353 
 
354 PSYCHOPATH OLOGY 
 
 The anxious struggle for self-control is essentially e^mwa- 
 tive in the sense that the individual strives to castrate or eliminate 
 the persecutory affective craving from the personality. In the 
 type -without anxiety, by giving up the object, the genetic stimulant 
 of potency is lost, and, according to the Ancient Greeks, when 
 Cupid or Eros (Love) flies away, Psyche dies. 
 
 Fig. 42. — "Cupid and Psyche," by Eodin. (By permission of Metropolitan 
 Museum of Art, New York.) When love flies away the mind, that is, inspiration, 
 dies. (Compare with "Eternal Spring," Fig. 20.) 
 
 In the following case, it will be seen that the woman strove 
 desperately to avoid becoming pregnant, because she thought a plot 
 to impregnate her had been organized. It is hardly necessary to in- 
 sist that no such absurd plot existed, or that she was not being mis- 
 treated. What then was the foundation for her belief that a plot 
 to impregnate her existed? Her case shows that her sexual crav- 
 
MANIC-DEPRESSIVE PSYCHOSES 
 
 355 
 
 ings were demanding impreg-nation and, because the reality was 
 unattainable, they created bodily sensations of such vividness that 
 the patient felt and believed she was pregnant. Like Eodin's 
 "Centauress," the prudish ego strove desperately to escape from 
 the horrifying machinations of the erotic pelvis and eliminate its 
 cravings from the personality. 
 
 Case MD-1 was a tall, slender, rather delicate, refined but 
 prudish woman of fifty-two when she developed a, grave anxiety 
 state with obsessive feelings of being pregnant, destitute, and the 
 subject of world-wide gossip. For years she had been a teacher 
 
 Fig. 43. — Posture of regression to intrauterine attitude, love is gone and life is not 
 
 worth the struggle. 
 
 of physiology and nature study. Her menopause had occurred at 
 fifty. 
 
 Two aunts, two first cousins and the son of a cousin were pa- 
 tients in an institution. Two sisters were neurotic, one finally com- 
 mitting suicide. The son of the latter is considered to be unre- 
 liable and had a "nervous breakdown." 
 
 The parents taught their children to religiously avoid every- 
 thing pertaining to sex. Hence, the sexual interests of everyday 
 life of other people were always horrifying to these gentle ladies. 
 The atmosphere of their home was always very puritanical and 
 everything was sacrificed for family pride, even though the family 
 was at times almost destitute. 
 
35G PSYCHOPATHOLOGY 
 
 All the children had delicate physiques and little endurance. 
 They ^vere well educated and two of the three daughters taught 
 school. The third daughter became the secretary of a business 
 man. 
 
 AVhen the patient was twenty-five she became engaged, al- 
 though she was not strongly attached to the man. AVhile the en- 
 gagement was dragging along her younger sister returned home 
 after a miserable year of married life. This sister's husband was 
 known to have interests in other women, and she left him although 
 she was six months pregnant. 
 
 The tragic situation of this "beautiful'' younger sister was 
 
 such that the patient broke her engagement and resolved to pro- 
 tect the unhappy girl and never marry. After the child was born, 
 the sister obtained a divorce. She would accept no alimony and 
 would not permit the father to contribute to the support of the 
 child. They were living with the mother at the time, and the aver- 
 sion of the three women for the child's father was very intense. 
 The court unfortunately permitted him to see his son. To pre- 
 vent him from touching the child, the grandmother always held 
 him on her lap, and to make the situation doubly secure, they are 
 said to have taught the child not to walk on the floor barefooted 
 so that when his father called, the boy obediently sat on his grand- 
 mother's lap in his bare feet and would not go to the father. 
 
 The two sisters taught school and raised the boy according to 
 their puritanical conceptions of propriety, with emphatic aver- 
 sions for those fundamental cravings of nature, which had be- 
 come grossly emphasiiied by the sister's misfortune. Affairs 
 moved quite smoothly until the boy was about sixteen when the 
 irrepressible father, Avho seems to have entertained no little aver- 
 sion for his son's associations, threw the women into a panic by 
 offering the boy a large sum in cash, a liberal education and an 
 automobile if he would leave his mother. The temptation at- 
 tracted the boy and in order to avoid it, the women took him into 
 a distant state, where they sent him to college. The father fol- 
 lowed the boy and the mother again changed his school. He failed 
 as a student and developed a depression. His mother took him to 
 a summer resort to hide him from the father and she herself de- 
 veloped a serious anxiety state. During her confusion she is re- 
 ported to have misidentified her son as her husband. The attitude 
 
MANIC-DEPRESSIVE PSYCHOSES 357 
 
 of the son made it appear that he was inclined to accept his fa- 
 ther's offers as soon as he became twenty-one. No inducement, 
 moral suasion, or affective attachment of the two women, who had 
 virtually sacrificed their lives for him, seemed to counterbalance 
 his father's temptations. The mother solved the anxious situa- 
 tion for herself ten months after the depression, by taking gas. 
 
 The patient, who was at work and suddenly called home in 
 the emergency, entered the room first and removed all direct evi- 
 dence of suicide. The coroner's verdict of suicide was made de- 
 spite her denial of any interference. She always maintained that 
 she had not perjured her testimony, but probably the affair con- 
 tributed quite an element to her obsessive feelings during the psy- 
 chosis of having "told a lie." 
 
 A year later, the patient's nephew went into his father's office 
 but continued to live with his two old maiden aunts. His tendency 
 to return home at all hours of the night indicated an estrangement 
 from puritanical morals. The patient, now a woman of fifty-two, 
 persisted in her hope of holding him and never retired at night 
 until the boy had gone to bed. Thus she made her silent prayer 
 and protest night after night, but in vain. 
 
 The increasing anxiety, loss of sleep, decreasing efficiency as 
 a teacher, and almost total lack of funds, finally produced a col- 
 lapse a few months before the nephew became twenty-one. It was 
 expected at the time that he would abandon his aunts when he 
 became of age. 
 
 The patient's psychosis now developed rapidly. After a brief 
 period of restlessness, insomnia and inability to teach, she seemed 
 to become obsessed with the feeling that everything was lost, be- 
 cause her inability to think in the schoolroom would necessitate 
 her resignation and her meagre funds would soon be exhausted. 
 She asked to be sent to St. Elizabeths Hospital for treatment, 
 but before she was removed from the home she made two attempts 
 that indicated strong suicidal impulses. She had tried for several 
 weeks to induce sleep by a large variety of old home methods, but 
 without relief. 
 
 During the greater part of the stay at St. Elizabeths she was 
 in a continuous anxiety state, the affective causes of which she 
 succeeded in concealing for some time. She irritably complained 
 of insomnia, restlessness, "brain-fag," "my head doesn't work," 
 etc. 
 
358 psychopathOlogy 
 
 Her description of the onset of the psychosis revealed consid- 
 erable insight. "I had not slept much and was walking around the 
 house restlessly. All of a sudden there was a swish, as though a 
 lot of people were rushing toward me, gathering' in around me try- 
 ing to cover me. I said, 'I have no clothes on.' I Avas frightened 
 and resisted. This confusion of my mind began the evening before 
 when I asked for something sharp. It is all rather hazy in my 
 mind, but I remember repeating over and over : ' Scissors are not 
 very sharp.' I was in that state of mind that I wouldn't get well, 
 that I could never sleep, that I could never work again. Nothing 
 hut had thoughts came to me, and scissors was all that was near 
 me." She complained of a temporary "change of speech" and in- 
 ability to address her pupils which, however, was probably a func- 
 tional disturbance, since no organie lesions were ever manifested. 
 
 She gave the examining physician no insight into the "bad 
 thoughts," and cleverly evaded giving any other information than 
 that she was destitute and her life seemed hopeless. Her irritable 
 resistance was quite typical of the anxious, self -critical individual. 
 When a physician asked if anything worried her, she answered, 
 "Yes, madame," and irritably added, "ask me what it is, please." 
 Then she answered her own question with: "Lack' of money." 
 (This, obviously, was true in so far as it went, but was wholly in- 
 sufficient, although she persisted in trying to make it the sole 
 cause of worry.) 
 
 She said she had always been a "practical woman," "a good 
 mixer," fond of people, and made friends with her sex freely, but 
 encouraged no attentions from men. In the past ten years, besides 
 her work as an advanced high school teacher of nature study and 
 physiology, she taught a Simday school class. In discussing her 
 engagement, with a woman physician, she exhibited unusual em- 
 barrassment for a spinster of fifty- two. After her sister's mis- 
 fortune, she literally mothered the unhappy girl and her child. 
 Her description of this unfortunate sister revealed a deep sympa- 
 thy for her. 
 
 Throughout the psychosis, when her attention could be held, 
 she showed fair ability to perform intelligence tests, was always 
 well oriented and had an excellent memory. Later, when she com- 
 plained of confusion and inability to think, it was found to be 
 relative to her failure, to build up a defense for herself, to hide 
 from herself her sexual cravings. She said, in answer to a ques- 
 
MANIC-DEPRESSIVE PSYCI-IOSES 359 
 
 tion about her failure to marry : "MmsU tell jon that? I know 
 in work of this kind [psychiatric] it is necessary for you to ask 
 such questions and there is often a physiological reason for a 
 woman breaking as I did last Sunday morning, because she should 
 have been married." 
 
 After she was admitted to St. Elizabeths Hospital she was 
 agitated, anxious, wrung her hands, picked at the bed clothes, and 
 held on to other people desperately. Her facial expression showed 
 grave anxiety, as if she were under terrific tension, and her 
 breathing was rapid and heavy. She said, spontaneously, "Oh! 
 why did you do it? No one can help me. I must work it out, 
 work it out — work it out — ^work it out — I must work out my own 
 salvation. I've got to do something. I must work. Everyone is 
 talking about me. There is nothing for me. My body is full of 
 poison. I've got to get it out — soak it out." 
 
 She almost incessantly sought water "to soak" herself in, 
 and cathartics to remove this "poison." When in the tub she 
 made frantic efforts to get her hgad under the ivater. For several 
 weeks, she also tried numerous schemes to escape, and her beha- 
 vior suggested that something in her surrov/ndmgs terrified her. 
 The night following her admission, she dashed to a window and 
 screamed to the physicians, ' ' Everybody is dying, the whole world 
 is poisoned." In her efforts to escape, she made numerous as- 
 saults upon nurses and patients. 
 
 Her intense anxiety increased until it became most grave, and 
 her constant restlessness, general weakness, and great fear looked 
 ominous. She Seemed to feel that all conversation of the patients, 
 every word and movement, had a secret meaning which was di- 
 rected at her. "What do all these people mean?" — ^I don't know 
 what things mean," etc., were phrases she anxiously repeated to 
 everyone around her. 
 
 She refused to sleep alone in a room because she believed a 
 man visited it at night, and to protect herself she tried innumera- 
 ble ways of keeping awake. 
 
 She was literally swept off her feet by the sexual upheaval. 
 This poor, dignified, puritanical lady stood aghast with anxiety 
 and astonishment at herself. She could not reconcile herself to 
 accept an attitude of irresponsibility for the strivings of nature, 
 even though she was a teacher of nature study and physiology. 
 
360 PSYCHOPATHOLOGY 
 
 It was not difficult to understand why she thought everybody 
 was talking about her and the people considered her to be an "im- 
 moral" woman. Nature did not stop here. Before long, she was 
 observed to study her abdomen and complain of getting large. 
 Then came the desperate appeal for help because she felt con- 
 vinced that she was pregnant. She said she could feel it. (The 
 erotic cravings were forcing a simulation or imitation of what was 
 denied them, although at the same time she strove desperately to 
 eliminate them from being a part of herself.) 
 
 For several weeks, she carried about with her sheets of paper 
 covered with disconnected worda and pencil drawings collected to 
 prove that she had never had sexual intercourse, and that she 
 could not be held responsible for her pregnancy, which she now 
 regarded as absolutely real. 
 
 Her behavior was typical of the individual who is desperately 
 trying to hide a secret. Daily, she anxiously asked the nurses and 
 physicians if she had talked in her sleep, or if she had said any- 
 thing that she should not have said. If anyone happened to open 
 a letter nearby, she begged to know its contents to make sure it was 
 not about her. 
 
 At almost every interview, she consumed a great amount of 
 time demanding assurances that a woman who had passed her 
 menopause and had never had sexual relations could not be preg- 
 nant. "With it would come her insistence, however, that she must 
 be pregnant, because of the peculiar abdominal sensations. She 
 was sure she had been made the victim of an " experiment. ' ' Her 
 fantasies about the nature of the experiment were varied, but the 
 most persistent were those of "poisons" in the food and the "con- 
 tinuous bath." 
 
 At times, she asked: "What makes me have such fancies?" 
 but no explanation was convincing. Neither could she understand 
 the significance of her compulsion to make amorous advances to 
 the physician, such as trying to touch his hands, get her cheek 
 against his hand as it lay on the table, slap her abdomen, shift 
 her body restlessly, smile, make flirtatious glances, etc. Althougfiv 
 she tried to control herself by holding her hands behind her back 
 and keeping herself in a rigid position in her chair, within a few 
 moments she unconsciously would be making advances. The pa- 
 pers she carried contained numerous coitus and phallic symbols, 
 such as little half-circles Avith arrowheads entering the convex 
 
MANIC-DEPRESSIVE PSYCHOSES 361 
 
 surface, and squares pierced by long, pointed cigar-shaped figures 
 that originated from two circles, representing the testicles and 
 penis. Under no circumstances would she discuss the general sub- 
 ject of the sexual life of woman, and stoutly maintained that, even 
 though she was a teacher of physiology and nature study, she 
 laiew nothing of the sexual life "of woman or anytMng!" 
 
 I thought an opportunity had arisen when she referred to a 
 "horrible woman" who had been admitted in a confused state a 
 day or so after labor. But I was not ingenious enough to influence 
 her resistance, perhaps because the erotic pressure was too severe. 
 She usually said: "I don't care what they say, I have never had 
 an experience, but I think I might have * * * The continuous 
 bath equalizes blood; there are two kinds of blood, long tedious 
 wait, birth of a child and rearing of a child." Continuous meant 
 "on and on and ON!" 
 
 The shghtest variation in her clothing, food, walks, nurses, 
 etc., were suspected of being signs of a plot. 
 
 Although brief periods of relaxation and playfulness oc- 
 curred, the patient's anxiety about gossip and her pregnancy per- 
 sisted with the same monotonous expressions. Two months after 
 her admission, during an interview in which we were trying to 
 unravel the causes of her persistent feelings of having told a "lie" 
 and having had an "experience," she suddenly wanted to know 
 whether or not her nephew was suspected of having had improper 
 relations with her. Without waiting for an answer, she became 
 frantic at the thought. This association increased her futile, in- 
 numerable efforts to gather facts to prove that she had never had 
 a sexual experience. No persuasion or reason could shake the 
 obsessive fears. 
 
 A most unfortunate but unavoidable situation now arose. She 
 was summoned to court for the crime of being insane and the pros- 
 pect of a legal inquiry into her sanity (moral record) drove the 
 patient into a panic. Her persistent sensations of being pregnant 
 were too real to permit her to consider the sensations and images 
 as gratifying a wish. She had no way of proving that she had 
 never had sexual intercourse and in despair she repeated to herself 
 as she tried to study out a defense : "I don't think the person was 
 in the room. There is where I got in the lie part. I can never prove 
 it. I can never prove it. I don't want to go to court--I Avill have 
 to go tomorrow and I can never prove it. ' ' 
 
362 PSYCHOPATHOLOGY 
 
 She "would not permit me to see her notes because she was 
 ' ' trying to laake things come out right. ' ' The effort to prove her 
 morality now became tAvisted into tryingHo prove that she never 
 said she had had sexual relations with her nephew, fi^^^obsessed 
 with the feeling that she had admitted such interests! ''"'"^ 
 
 She became very negativistic and resisted being fed, dressed 
 or undressed, bathed or entertained, and yet begged for help to 
 remove the "poison." Her attitude toward the patients and nurses 
 gradually changed from that of a refined, polite woman to a 
 combative Amazon who went about pulling women's hair, striking 
 them in the face and spitting on them. Sometimes she would be 
 sorry for her behavior and apologize because she could not control 
 herself. 
 
 It was absolutely impossible, it may be repeated, because of 
 her lifelong prudery, to persuade her to accept the sexual pressure 
 as a natural part of herself. "Never!" was her answer. This 
 was not a part of herself. It must be caused by poisons, experi- 
 ments, etc. She found numerous plots being woven about her 
 which, however, she never systemMised (hence she is not to be re- 
 garded as a paranoiac). She seemed to lose her identity, asking, 
 "Wlio am I? What do all these people mean? What do all these* 
 signs mean?" (like putting fingers to the nose, rubbing hands, etc.). 
 She asked in anxious astonishment if now she had to be "every- 
 body," because she was two or three people. When she struck 
 and spit on women, it made her feel that she was a man. (The 
 spitting on women was associated with her striking them and 
 probably symbolized the male's emission. (This bisexual state 
 probably was also expressed in the feeling that she was "every- 
 body.") 
 
 About the sixth month after the onset of the illness, she tried 
 to "represent" everybody and everything as if she were responsi- 
 ble for the universe. She retained enough judgment to realize the 
 absurdity of this, but affective cravings compelled her to go on, 
 and she often became aware of herself trying to "represent" peo- 
 ple, colors, objects, etc., and work out "meanings" of everything 
 she heard or saw. She fairly shouted, "I can't explain two peo- 
 ple coming in at once [as two people passed her in the hall] and 
 you think I know those things and I don't, because I have had no 
 experience in that line. [Sexual significance of two people passing 
 through a doorway.] I never could do anything with numbers. 
 
MANIC-DEPEESSIVB PSYCHOSES 
 
 363 
 
 Nobody wants mimbers and numbers and NUMBERS! Go on, 
 forever and ever, continuous bath!" 
 
 She had now become God of everything. With horror, she 
 said: "They say I said I had fifty babies, and [indignantly] I 
 never had one. I don't represent the loorld! If I could just get 
 that out of my head. One of these people said that I had to be 
 every animal in the Avorld." (The fantasy of being every animal, 
 then going a step further and acting it out, is due to the vigor of 
 the erotic wish and its polymorphotis striving for gratification.) 
 She frequently and spontaneously tried to disprove that she 
 "knew" everybody, or was "greater than God." (The conflict 
 
 Pig. 44. — Mother earth as Madonna; goat nursing Hercules; and she-wolf nursing 
 Eemus and Komulus. (From "Ancient Pharmacy," by Hermann Peters.) 
 
 between the ego, the socialized cravings to be estimable, and the 
 perverse segmental pelvic compulsion is well illustrated by her 
 attitude.) 
 
 By the eighth month, this tendency had changed into quite a 
 manic type of craving for unlimited potency, and yet she wept at 
 her impulsive vulgarity and profanity— an interesting contrast to 
 the perfect manic who abandons herself to the erotic flight with 
 pleasure. The fifty years of puritanical training and refinement 
 could not yield so lightly to the erotic flight (showing the influence 
 of associates in the conflict). 
 
 She rubbed and picked her skin like the autoerotic patient, but 
 denied masturbation. During the erotic period I observed her to 
 
364 PSYCHOPATHOLOGY 
 
 grab her finger and, unmistakably, make the mastnrbatory move- 
 ments of the male, without apparently being aware of it. At the 
 time, she was talking to me about her inability to understand the 
 meaning of things. (The resistance to understanding; "the m^^^*x. 
 ing" always indicates a defense to keep from recognizing certain 
 attributes of the repressed wishes.) 
 
 The tenth month after her admission, she was discharged upon 
 the request of her sister, and, several months later, was reported 
 to have recovered and resumed her Avork. She never gained suffi- 
 cient insight into her condition, but apparently adjusted, as such 
 cases usually do, upon the subsidence of the erotic pressure. 
 
 The sexual upheaval seems to have developed as a desperate 
 affective struggle to keep her own and her sister's life work intact. 
 The fancied pregnancy with "long, tedious wait, birth of a child 
 and rearing of a child" was, it seems, a compensating measure for 
 the restoration of the deserting boy for which the family had been 
 sacrificed. During the latter part of her psychosis, the nephew 
 became twenty-one and joined his father but retained considerable 
 interest in his aunts, and this enabled the patient to become recon- 
 ciled to his necessities. Some information was obtained about a 
 year after she had resumed her work as a teacher, which indicated 
 that the sexual pressure had not completely subsided and her abil- 
 ity to work was not up to the old standard. 
 
 This refined, prudish woman's frantic anxiety was due to her 
 compulsion to escape the influence of her sexual cravings which 
 had become highly aroused at fifty-two. Her psychosis was de- 
 cidedly characterized by efforts to eliminate the affective cravmg;, 
 This type of case contrasts definitely Avith that manic type which 
 has similar affective (sexual) cravings, but abandons itself to the 
 glories of the erotic flight. A series of these cases is presented 
 later. 
 
 The symptoms of the anxious erotic state, such as scratching, 
 piclcing, rubbing shin areas, pulling out threads, hair and hits of 
 skin, rubbing sputum into the skin, hair, clothing or furniture, and 
 sometimes eating it again, seem to he caused by autoerotic self- 
 impregnation cravings as is demonstrated by the following cases. 
 
 Case MD-2 was a slender, delicate little woman of forty-two, 
 admitted because of anxiety and depression intensified by hallu- 
 cinations. 
 
MANIC-DEPRESSIVE PSYCHOSES 365 
 
 Her father's sister was "nervous," and her married brother 
 committed suicide after years of alcoholism and brooding. His 
 wife was insane. 
 
 The patient was a timid, shy, undersized child. She learned 
 easily at school and later became a capable dressmaker. 
 
 She had scarlet fever and typhoid without apparent compli- 
 cations. Upon her admission she had a rectovaginal fistula. 
 
 When three years old, she reacted with undue terror to a 
 small boy who teased her with a mask. She was found several 
 hours later asleep behind a barrel where she had hidden. 
 
 Because of her smallness and timidity people humored and 
 petted her, and according to her estimation of herself she became 
 whimsical and selfish. After several years as a stenographer she 
 became a dressmaker, which was her occupation until her illness. 
 As a young woman, she was pretty and enjoyed the admiration of 
 men, but she was too timid. She was not asked to marry until 
 thirty-six, and this offer came from an intimate friend of her 
 brother. The friendliness of her brother for the man apparently 
 gave her enough assurance to make love. 
 
 During the engagement, she was induced to visit an assigna- 
 tion house several times. Later, her fiance abruptly broke the en- 
 gagement, left the community, and married. The patient appar- 
 ently adjusted to this distressing shock, but became very seclusive, 
 rarely indulging in social functions, and devoted most of her time 
 to sewing and supporting her mother. The mother became a bur- 
 den; suffered from a malignant condition of the lungs which fi- 
 nally terminated in a fatal hemorrhage. The patient was present 
 at the time, and the experience contributed materially to her psy- 
 chosis. Because of her mother's age and feebleness, the patient 
 was forced to devote herself to her care and repress her own crav- 
 ings for masculine affection and maternity. 
 
 After her mother's death, she gave up housekeeping and be- 
 came an itinerant dressmaker. Her friends regarded her as 
 "neurasthenic" and "nervous." She complained freely of nu- 
 merous bodily discomforts, and finally resorted to "electrical 
 treatment." About this time, she happened to see her old fiance 
 and talked about his coming back to induce her to renew the en- 
 gagement. 
 
 Her moroseness, brooding and anxiety gradually increased 
 
366 PSYCHOPATHOLOGY 
 
 after this, ■until the mood seemed to reach a climax two years later 
 in a well-defined struggle against strong erotic cravings. Most 
 of the period of anxiety w^as spent in St. Elizabeths Hospital. 
 
 She was sent here because she cried and worried about her- 
 self, complained of "burning up inside," (a common expression of 
 feeling erotic), and being choked by accumulations of froth in her 
 throat. At the time of her admission, menstruation occurred every 
 two or three weeks, lasting four to five days, accompanied by 
 slight pelvic pains. 
 
 When admitted, she was in accurate touch with everything, 
 and had considerable insight into her condition. Later, she became 
 suspicious of certain women, but was never confused or stupid. 
 Her hallucinations became so vivid that she treated them with the 
 utmost seriousness as reality. 
 
 She complained that her "nerves were all to pieces," and, al- 
 though she could think clearlj^, she was under a continuous 
 "strain." "I just imagine someone was after me, but it is only 
 my imagination. ' ' She complained of numerous disagreeable sen- 
 sations; such as impleasaut odors, taste of carbolic acid in her 
 mouth, electricity passing through her body, "qiiivering sensa- 
 tions" and feelings of "breaking apart," burning up inside, feel- 
 ings of undue weakness, and stiffness in the back of the head and 
 neck, sour stomach, etc. 
 
 She made friends readily and, because of her coyness, became 
 a pet on the wards. Her behavior, in a general sense, for the 
 three years following her admission, was a continuous anxious 
 struggle with the erotic cravings. 
 
 Soon after she was admitted, she was obsessed with the de- 
 sire to make a confession and, indiscriminately, asked people to 
 listen to her because she wanted to convince them that she was 
 "not bad." The pressure of persistent sexual cravings became 
 apparent soon after her arrival, and her method of adjustment 
 was an uncompromising battle to free herself from them. 
 
 ' ' I have a secret to tell you. I know it mil mal?:e me feel bet- 
 ter to tell someone," she anxiously pleaded. "I have always been 
 virtuous and have done much church work, so don't think I am 
 bad. At the sanatorium, they treated me as though I wasn't 
 moral, and this present trouble is the reaction to that treatment. 
 [Here she confessed the nature of her relations with her fiance.] 
 Frequently, I have been under a terrible nervous tension, and. 
 
MANIC-DEPRESSIVE PSYCHOSES 367 
 
 when I was thirty-eight, it seemed unbearable, although I am in- 
 nocent and good, I felt that [sexual cravings] had something to do 
 with it, and I quit using a syringe." (Here was an indication of 
 an autoerotie secret trend.) 
 
 Such confessions were made promiscuously with apparently 
 no relief from the obsessive feelings that people considered her 
 to be immoral. It became clear later that- the cause of such per- 
 sistent suspicion was due to her irrepressible eroticism. The 
 desire to make confessions soon changed to reticence and a tend- 
 ency to be seclusive and resistant. When taken to the dining 
 room, she would become "too weak" and complain that she could 
 not eat. She swallowed a portion of her dental plate in order "to 
 die." Her facial muscles were tensely contracted and she seemed 
 to be afraid of everybody. For weeks, she secluded herself in bed, 
 and turned her face to the wall. Here, she would moan and mum- 
 ble self -denunciations to herself. She passed through a tube-feed- 
 ing stage at this time and, later, begged to be fed with a spoon, be- 
 cause she was too weak to feed herself. (Infantile regression.) 
 
 She sought attentions, and then became resistant when her re- 
 quests were about to be attended to, as if she were afraid of her- 
 self or some ulterior motive. Occasionally, she surprised us by 
 a queer, timid interest in the dresses of the women, usually saying 
 something pleasant about them. Several months later, she com- 
 plained that she had to wear the old clothing of the people and they 
 wore her good dresses. About a year after her admission, audi- 
 tory hallucinations became so vivid and persistent that they almost 
 completely dominated her behavior (a complete dissociation of the 
 personality had developed). She would never frankly discuss her 
 hallucinations, but their significance may be inferred from the 
 answers she would make to them. "You did not, you did not 
 see me in there. [Eeplying to auditory hallucinations accusing 
 her of having been somewhere.] I did, I did [shouts], I did not 
 see the paper. [Groans.] They are trying to make me say [looks 
 at me and groans] I was not any such thing. You know I was not. 
 I was not a colored woman, I was not. ' ' 
 
 "Dr. Kempf, when did I ever meet you?" she begged pitifully. 
 (Voices accused her of having had clandestine meetings with me 
 as well as negroes, foreigners, etc., etc. When she was admitted 
 to my office she resisted because she did not want to be alone in 
 
368 PSYCHOPATI-IOLOGY 
 
 a room with, a man. Such attitudes alvays reveal the nature of 
 the struggling repressed affect.) 
 
 "Wliat are they trying to malie me believe? What are they 
 trying to make me do? I wasn't [gasps ^nth astonishment and 
 replies to the hallucinations angiily], I wasn't a spy. I was no 
 such thing. I did no such thing, stop snoring. Oh, Grod ! My con- 
 science! They are trying to make me say I have been to places 
 where I have not been." (Later, she said these "places" meant 
 clandestine meetings with negroes, and living in negro houses.) 
 
 At this time, she was too much preoccupied ■\^ith her halluci- 
 nations to pay attention to my questions. ' ' Oh ! If I could only 
 prove — [Avails] * * * Three million people are saying [hesi- 
 tates], they say I am doing wicked things. [Grits her teeth.] My 
 father knows I am not doing — [does not finish]. This habit of 
 not saying the last word was a characteristic persistently exhibited 
 in her statements, showing a striking, perhaps prognostically sig- 
 nificant, hesitancy aboiTt absolutely giving credence to the halluci- 
 nations. 
 
 Su.ch little remarks as the following, occurring in an attitilde 
 of extreme anxiety, we thought, were flashes of insight, indicating 
 that despite the long persistence of the eroticism, and its hallucina- 
 tory gratification, she would ultimately make, a good recovery. 
 She ceased wailing and groaning for a moment, and, looking up 
 A^ith a pleasant little smile, she said, "They say I am talking to the 
 Devil." (Kef erring to me.) 
 
 She continued quiet for a moment, then suddenly again she 
 began, "Oh! Oh! Tliey are trying to make me say awful things. 
 Oh — h ! Colored people are trying to make me. Oh ! Doctor ! Hoav 
 can people throw the voice into me like that and make me say 
 such things? Don't! Don't! Don't! let me say such things!" 
 (Begging pitifulh'.) For hours at a time she Avould hold her lips 
 together to keep from saving this something. (One woman pa- 
 tient on the ward has frequently tlirust wire through her lips to 
 join them together so that she could not be made to say things by 
 "the voices." Another woman on one of my wards bit a hole 
 through her lip by continually grasping and holding the lip with 
 her teeth for several months in order to prevent the voices from 
 making her speak. The latter Avoman made a social recovery.) 
 
 At times, the patient had brief rests from hallucinations and 
 
MANIC-DEPRESSIVE PSYCHOSES 369 
 
 usually would, quickly become interested in lier surroundings, ask 
 intelligent questions and then, suddenly, again burst into crying 
 and protesting about the voices. This condition has coi;tinued for 
 a period of over four years and varied little, except in intensity, , 
 from one day to another. 
 
 Details of her complaint are included here to illustrate that, 
 in her case, the chronic piching of the shin was, in reality, an 
 aborted form of mastu,rbation, and the picking up of tiny hits of 
 material and eating them was accompanied hy impregnation fan- 
 tasies. She picked the skin and scales from her face, neck and 
 scalp, arms, and hands, and continued this despite all efforts to 
 prevent it, or to control herself, for over two years. " If I pick this 
 ear [left], they say I will tell one story, and if I pick this ear 
 [right], I tell another. Now [seriously], I am not such a fool. 
 They say, 'Don't pick your ear with your left hand.' Why do they 
 tell me it is wrong to pick my earl Everybody does such things. 
 I am not wicked. Do you see what they are saying now? They 
 say I am in a room behind closed doors. [She was in the office 
 with me. She almost continually picked at her ear, and fre- 
 quently picked up little flakes, specks and threads and put them 
 into her mouth. At times, the picking of threads became so 
 persistent that she gradually destroyed her clothing.] They 
 say T did these things. I did not do any such thing. I never 
 touch myself [masturbation]. Oh, God! I did no such thing." 
 (Cried.) It should be recalled that she quit using a syringe be- 
 cause it might have meant something sexual, even though it was 
 necessary because of the fistula. 
 
 In reference to the flakes of skin and small bits of clothing, 
 etc., she asked the following question: "Why do they say that 
 these are prizes? You know Avhen I leave here those voices will 
 say those flakes on the floor come off me. Everything in this 
 building comes off me. ' ' The voices spoke of the little crusts from 
 her scalp as being "alive." She would constantly eat them, and 
 the relationship of the living specks probably had an intimate 
 association with the talk she heard about having "1,000 children" 
 and being "1,000 mothers," and "love caused all the troubles." 
 
 "Someone says they are going to put flint in what I eat. Gets 
 you afire [passion]. I wish I could go where it is a cold climate 
 for this kind of trouble. I don't think you ought to have heat for 
 this kind of trouble." She often refused to sit on the chair be- 
 cause it passed "electricity" into her. 
 
370 PSYCHOPATHOLOGY 
 
 The. heat of sexual passion, the burning of the body or of the 
 ear,' the picking of the ear and the eating of the living flakes were 
 all intimately associated with her intense eroticism and.impir%=-: 
 nation cra-vings. ' 
 
 "Oh, God! What do they make me say? [Wept bitterly.] They 
 say I am colored and am like colored people." A negro did some 
 janitor work about the house, and she hallucinated accusations of 
 admitting him to her room. "They" called her "black," "col- 
 ored," "nigger." "They" took her out of her room at night and 
 exposed her to. sexual indignities and "put a gown on me and made 
 me into' ah east." (Cehtauress.) She was fearful of the colored 
 patients who worked on the ward, and avoided them whenever pos- 
 sible. 
 
 She shouted a reply to the hallucinations: "No, I am not 
 going into the tombs!" And then to me, wailing, and wringing 
 her hands in. despair : ' ' They say I am going into the tombs ! I 
 never had such thoughts lintil that man came into my life. Every- 
 body has' come to him and put a claim onto me. God knows I am 
 not a character like that." (Prostituted to every man, to become 
 the mother of every thing.) 
 
 Two and one-half years after admission, she became wretched 
 because the voices accused her of having caused (wished) the death 
 of her mother becausje, at the time of her fatal hemorrhage, she 
 did hot try to save her, although she had removed the blood-clot 
 from her mother's mouth in order to prevent strangulation. 
 
 Bier resistance was usually given expression in the following 
 manner : 
 
 "I never had such thoughts, and can not understand why I 
 must say them now." Gradually, however, she was induced to 
 say them despite the horror and anxiety they caused, arid this 
 seemed toJessen the tension (Cases HD-1, CD-8, CD-9). When 
 she began to improve, she was given some old clothes to mend. 
 Three years after admission, she objected, saying that she should 
 not be given dirty old clothing to mend when they were trying to 
 get her skin "nice and clean with the baths." (Her skin had grad- 
 ually been permitted to heal, which was an indication of slowly 
 waning autoeroticism.) 
 
 ■ As the pressure of the eroticism decreases, her self-control 
 increases, and at present (four years after her admission) she is 
 decidedly more comfortable, neat, industrious, and often cheerful, 
 
MANIC-DEPRESSIVE PSYCHOSES 371 
 
 but not altogether free from the hallucinations. Her prognosis 
 might be excellent if she were economically independent. Her 
 
 rig. 45. — "La Pensfee," by Eodin. (By courtesy of Small, Maynard & Co.) 
 This symbolizes t.lie purity of the soul imprisoned in the body as the rock. (Compare 
 with "The Centauress," by Eodin, Fig. 46.) 
 
 psychosis may be regarded as an erotic gratification, with the 
 erotic craving dissociated and disowned by the ego. 
 
372 
 
 PSYCHOPATHOLOGY 
 
 The autoerotic significance of the chronic, coinpulsive skin 
 picldng and ruhbinrj is even more definitely shorvn in the following 
 case. 
 
 Case MD-3 was an unmarried woman, thirty-six years of age, 
 who was never able to devote hersolf seriously to any endeavor 
 because of her unhappy family relations. She has been in an ex- 
 
 Pig. 46. — "The t'rutaurosti, " by Bodin. Showing the personality struggling 
 in despair to escape from the bestial sexuality of the pelvis. This anguish is typical 
 of unpreventable masturbation in growing and adult males and females. (The pelyis is 
 also shown as bestial in von Stuck 's "Der Sphinx," Pig. 27.) 
 
 trenie state of anxiety, and has, for several months, because of her 
 eroticism, been wailing and screaming for help, begging piteously 
 to be saved from hemg locked in a room, or' shut within a (fancied) 
 stone wall. She tried incessantly to run away, and often smashed 
 
MANIC-DEPRESSIVE PSYCHOSES 373 
 
 the windows to malce openings "in the walls" in order to feel more 
 free. She would stand upon her toes and make rapid jumps into 
 the air, trying to escape from the rising forces that she felt were 
 engulfing her. She begged to be transferred to the second floor 
 "because it was higher up" (again the striving "centauress"). 
 See Fig. 46. 
 
 Throughout the first year, she bored holes into her scalp with 
 her finger. At times, in erotic desperation, she used the rounded 
 ends of hair pins, etc. Her facial expression, because of the pecu- 
 liarly contracted miiscles reminded one of the contortions aroused 
 by the strong scratching or rubbing of an intensely itching patch 
 of skin. On one occasion, when this boring of holes into her scalp, 
 with a rotary motion of her finger, became so intense that she had 
 to be put to bed to control her, she became frenzied "with eroticism. 
 
 Another woman, who had rubbed all the hair from her scalp 
 so that she was perfectly bald, occupied a bed in the same ward. 
 The patient forced herself into this woman's bed calling her a 
 "man," and it was with difficiilty that she Avas removed. Then 
 she began an unusually unbridled, vicious attack upon her own 
 genitalia, masturbating without restraint and regardless of all the 
 women on the ward ; stuffing pieces of cloth, and other things, into 
 her vagina. 
 
 The association of skin picking and masturbation cravings 
 was here clearly shown and we have come, upon further investiga- 
 tion, to regard undue skin or scalp rubbing and picking as symp- 
 tomatic of auto eroticism. 
 
 The erotic beast that was pulling her down to the perdition 
 of the fiery pelvis ("the bowl of hell") has incessantly clung to 
 her for two years. Her strivings to get above it probably deter- 
 mined the scratching (masturbation) to become shifted as high as 
 possible (the top of the head), a compromise between the erotic 
 craving and the desperate compensatory defense to be saved by 
 the transfer upward. 
 
 In her compensatory fancies now, she is "the purest girl in 
 the world," and says she lives in heaven among the clouds, far 
 above the "wicked world," and is "destined for brighter skies." 
 
 The impulsive smashing out of windows was a wild effort to 
 free herself from suffocating, restricting sensations as she became 
 engulfed by the rising tide of eroticism. (See Michelangelo's 
 
374 
 
 PSYCHOPATHOLOGY 
 
 "Captive" and Eodin's "Centauress.") She pleaded to be saved 
 from the walls that were closing in upon her, and smashing the 
 window was an impulsive effort to break through those walls. 
 
 Fig. 47. — "A Captive," by Michelangelo. (By courtesy of Small, Maynard & 
 Co.) Similar in theme to "The Centauress" (Fig. 46) and "La Pens6e" (Fig. 45), 
 by Eodin. This theme portrays humanity as hopelessly captive to the primitive and 
 infrahuman ancestry from which it has arisen. 
 
MANIC-DEPRESSIVE PSYCHOSES 375 
 
 ig«iu s 'Captive," Fig. 47, is bound tightly about the 
 chest, and behind him, at his feet, crouches a hideous dog-ape, 
 his erotic self. Eodin's "Centauress" tries to free herself from 
 the pelvis like the "purest girl in the world" who can not actually 
 get free from her autoeroticism. 
 
 The significance of rubbing the sputum in the hair, which is 
 a common compulsion associated with anxiety, was definitely il- 
 lustrated by an erotic young woman who grabbed at a physician's 
 genitalia, then spit into her hand and rubbed it into her hair in 
 almost one movement ; also by many oral erotic men who spit in- 
 cessantly about the wards, feeling that the mouth contains semen 
 from a secret assault. (See also Case PD-17 using the sputum 
 as semen.) 
 
 The persistence of the auto erotic tendency after maturity 
 seems to be caused largely by the sitppressive influence of another 
 personality who, as the resistance, prevents the love-dffect from 
 asserting itself freely in corn-petition for the affections of a love 
 object while the personality is growing up. 
 
 Case MD-1 became greatly relieved from the autoerotic pres- 
 sure of her love as soon as her nephew's attitude assured her that 
 he, her love-object, was not going to forsake her entirely. It is a 
 common experience in psychoanalysis that as an altruistic trans- 
 ference becomes established the patient's erotic affect becomes 
 diverted to winning the esteem of the analyst — the love object — 
 through creative work, thereby escaping masturbation. Cases 
 AN-3 and HD-1 show more distinctly the mechanism of the affect- 
 ive cravings following an autoerotic course in which the exogenous 
 resistances to winning a love-object are accepted as insurmount- 
 able, and yet, also show how the affect tends to abandon th-e auto- 
 erotic course so soon as an encouraging avenue for heterosexual 
 striving becomes again apparent through the establishment of a 
 heterosexual transference. 
 
 Case MD-4 is presented because it illustrates how the exog- 
 enous resistances may become permanently insurmountable. The 
 world offers not the slightest enticement for this patient to strug- 
 gle with it again ; hence the affective craving reverts to the auto- 
 erotic course in which she becomes her owm love-object and remains 
 fixed, showing no perceptible change in its activity for an indefi- 
 nite period. (Now nine years.) 
 
376 PSYGHOPATIiOLOGY 
 
 Case MD-4 is that of a patient characterized by a chronic 
 state of anxiety because of auto- and oral-eroticism. 
 
 This patient's paternal grandmother was considered to be in- 
 sane becatise of her temper. Her maternal grandmother's half- 
 sister was insane; her mother's second cousin killed himself, '^ild 
 his wife and her mother had "suicidal melancholia." The patient 
 had one sister who was an opium habitue, a brother who was an 
 alcoholic, and another brother who was very "nervous." 
 
 The patient learned to give herself sexual pleasure when 
 nine years of age by sitting on the edge of the chair in school. 
 She was considered to be a bright, affectionate girl by her friends. 
 At twenty, she became engaged, her engagement lasting five years, 
 during which time she yielded to her fiance's sexual advances. She 
 earned a living by doing office and house work. For social and 
 religious pleasure she sang in a church choir. She said she never 
 married biit lived a "double life." She did not consider herself 
 to be a prostitute, but was unable to resist the temptations^of men. 
 
 At thirty-nine, she was sent to St. Elizabeths Hospital be- 
 cause of an anxiety state. Upon admission, her symptoms con- 
 vinced her physicians that she was pregnant, and full preparations 
 were made for the labor. In due course of time, the symptoms of 
 pregnancy proved to be Avish-fulfilling simulations. After a year 
 or so of anxiety and sexual worries she was . discharged as re- 
 covered. 
 
 At fifty-three, she was readmitted, because of a chronic anxi- 
 ety state. Her mental capacities were never impaired except for 
 prolonged, consistent coordinations of attention. She was unable 
 to keep quiet or relax, and usually paced the floor, wrung her 
 hands, and bemoaned her troubles as follows : " Oh ! Fate ! Fate ! 
 0, God ! Take me ! This isn't making me any better ! I have ,§0%-: 
 to go back to the same old thing ! — walking up and down the ward ! ' 
 I can't sit here any longer! I'd like to have the courage to Idll 
 myself! — ^biit I haven't! I'd rather get well than die! But if I 
 can't get well, I can't stand this misery! I have been begging 
 and pleading with them to explain what has happened to me ! And 
 why this trouble came over me ! Oh, Grod ! I am the sickest pa- 
 tient in the world ! I am the worst patient in the world ! ' ' 
 
 She "worried because her salivary secretions were "dried up" 
 and her menstrual functions had ceased, which, she insisted, was 
 caused by the mercury she had taken in the form of calomel. She 
 
MANIC-DEPRESSIVE PSYCHOSES 377 
 
 complained of not being able to taste food or drink, and that she 
 had an indescribable sensation in her throat which made her des- 
 perate and could not be relieved. She shouted profane and obscene 
 phrases at the top of her voice to get relief, she said, from this 
 sensation. 
 
 About eight months after her admission, she complained bit- 
 terly of having huo balls of hair in her throat. She said she rolled 
 up strands of her o^ra hair and swallowed the balls in order to 
 kill herself, but they would not go down. She insists that they are 
 sticking in her throat and must be removed even though it neces- 
 sitates cutting her throat. Careful laryngeal examinations did 
 not change her complaint, and. she could not be dissuaded from 
 this conviction. 
 
 This incessant anxiety, including the biting of her finger nails, 
 restless pacing, profanity, and chronic complaints about her miser- 
 ableness, the dried up secretions and itching throat have continued 
 for nine years, up to the present time. 
 
 When fifty-seven, I made the following observations: She 
 complained almost constantly about the two balls of hair in her 
 throat, frequently palpated an enlarged submaxillary gland, which, 
 she said, was one of the balls, and wanted to have her throat cut 
 or an operation performed to remove it. She begged to be relieved 
 of the distressing: sensations in her throat, and seemed to think 
 that it had something to do with the dual life she had lived. She 
 spontaneously added that she was sure her troubles could not be 
 caused by sexual cravings, because she had passed her menopause. 
 Then she further added that she was in the habit of masturbating 
 twice nightly ' ' to let the nervousness out ' ' so that she could sleep. 
 
 She also brought up her past sexual life and her inability to 
 resist the temptations of men, adding that, when her menses 
 stopped (menopause), she felt certain that she was pregnant and 
 made elaborate preparations for a child (simulation). 
 
 The discussion of the above experience, including her regard 
 for herself as a dual personality, was followed by explanations 
 of the throat trouble. She said she couldn't control herself and 
 felt compelled to scream her denunciations of God, and wanted to 
 know why she shouted : "If I had it I would bite it off !" In the 
 same hoarse, wailing tone of voice, she followed by saying that she 
 swallowed pins, nails, glass, sticks, hair, ' ' anything ! ' ' The morn- 
 ing of the interview, she swallowed a large screw and broke up 
 
378 PSYCHOPATHOLOGY 
 
 curtain sticks swallowing the splinters. She did these things, 
 she said, in order to kill herself ; and tried to make herself ' ' crazy, ' ' 
 since, "Crazy people are happy because they do not know any- 
 thing. ' ' 
 
 Her chronic masturbation is utterly uncontrollable, and the 
 degree of anxiety gives some measure of her inability to- cope with 
 the situation. The oral cravings are clearly explained in the 
 phrase: "If I had it I would bite it off," and the swallowing of 
 hair-balls, sticks, pins, screws, and many other things are com- 
 pulsions to satisfy the craving with substitutes ; the two hair-balls, 
 having an oral self -impregnation value. 
 
 A similar mechanism of oral impregnation is shown by the 
 case of a man about thirty-five years of age who had a historj'^ 
 that very strongly indicated oral erotic homosexual practices in 
 the past and complained that a swollen submaxillary gland was a 
 testicle put into his throat by the secret religious societies that 
 persecuted him. 
 
 Discussion 
 
 In the states of anxiety presented above the individuals of 
 both sexes tried to eliminate the erotic affective cravings, which, 
 despite their desperate struggles to control them, produced sen- 
 sory disturbances that sim/idated the desired object and tended to 
 satisfy the craving. That this mechanism of simulation occurs in 
 the dream, delusion, hallucination and fantasy will become evident 
 as other cases are presented. 
 
 The prognosis of anxiety states, due to repressed autoerotic 
 cravings, is very good as a rule, if the individual's personal in- 
 terests and economic resources are sufficient to assiire him of a 
 reasonably attractive living, otherwise the resistances may be too 
 great for the autoerotic personality to overcome, as in the pro- 
 tracted case, MD-4. 
 
 The autoerotic cravings seem to be enormously reduced when 
 an altruistic transference is established between the patient and 
 someone who represents a high degree of social-moral integrity, 
 particularly a physician or minister. 
 
 In the treatment of such cases, the individual's previous rec- 
 ord as a worker or day-dreamer should be clearly estimated, be- 
 cause, in proportion as he was previously inclined to obtain hap- 
 piness throu.gh work, the prognosis is good. 
 
MANIC-DBPEESSIVE PSYCHOSES 379 
 
 The nature of the resistance and the isroticism is to be given 
 the utmost importance in estimating the degree of malignancy of 
 the affective craving. The more it is bound up with other affective 
 ties, such as esthetic and nutritional interests (beautiful mother), 
 the more difficult it becomes for the individual to free himself. 
 When the object of the autoerotic fancies is the father or mother, 
 they are, as a rule, much more difficult to readjust than when they 
 are attached to a sister or brother, and are still easier to readjust 
 if the fixation is upon a stranger or friend. The patient always 
 suffers pain when the love-object has to be unconditionally aban- 
 doned, and quite serious depressions may follow until an adequate 
 altruistic and esthetic, as well as attractive creative interest, is 
 established. The degree of shock to be expected from abandoning 
 the love-object is to be measured by its value to the personality, 
 i. e., Avhether it is perverse in its attributes or not. It seems that 
 a sexual object that deserves a halo because of its exquisite, in- 
 trinsic worth, is far easier to sublimate than one that is associated 
 with grewsome, disquieting memories, because an inherently beau- 
 tiful sexual object contains inherently also the wish that the win- 
 ner of its affections shall become beautiful. Therefore, the lover, 
 rather than endure the pain of unconditional resignation of his 
 interests, willingly strives to live so as to become superior in a 
 field of work which may yet be conducive to mnning the esteem of 
 the love-object. 
 
 Depression Without Anxiety 
 
 Another entirely different type of depression occurs, often 
 as the sequel to the abandoned, erotic flight. These cases are es- 
 sentially different from the restless, anxious, agitated, striving 
 types in the attributes of being almost motionless, mute, retarded, 
 indifferent, dreamy; they must be clothed, nursed, cleansed and 
 fed. This' is essentially a more or less complete affective regres- 
 sion to the intrauterine level, in that the affective cravings of the 
 individual have lost all acquisitive interests in the affairs of every- 
 day life. Such conditions can be diagnosed almost on sight. The 
 degree of regression may vary to any infantile level in the same 
 individual, at different times. 
 
 Case MD-5, that of a kindergarten teacher, was an excellent 
 example of affective regression follo-wdng an erotic flight with 
 fancies about her father and brother. 
 
380 PSYCHOPATHOLOGY 
 
 Her father and an annt were insane. 
 
 She was a badly spoiled, willful, stubborn child, and had 
 many of the self-secluding attributes of the secretly auioerotic 
 personality. At eighteen, she had a "love affair," and reacted to 
 its disappointments with a psychosis that lasted six months 
 (manic-depressive) . 
 
 At twenty-three, the second psychosis occurred, lasting nine 
 months (manic-depressive). 
 
 At twenty-eight, the third psychosis lasted one year (manic- 
 depressive). 
 
 At thirty-three, the fourth psychosis lasted two years and six 
 months (manic-depressive). 
 
 At thirty-nine, the fifth psychosis lasted three years and six 
 months (manic-depressive). 
 
 At forty-six, the sixth psychosis lasted two years. During this 
 psychosis I observed her behavior throughout the erotic striving 
 (manic phase) and the affective regression to an infantile state 
 (depressed phase). That she was in an extremely erotic state dur- 
 ing the first seven months was very obvious from her behavior. 
 She was incessantly active, trying to bring some event about, • 
 dressed and undressed herself repeatedly, and was fond of exhib- 
 iting herself. She talked a great deal aboiit love, heard "false 
 voices" call her "baby dear," and suddenly attacked a male phy- 
 sician to show him that she was "innocent." She said his eyes 
 made her feel excited. She misidentified the woman physician as a 
 man when she examined the patient's heart, and accused the 
 woman physician of making her feel "passionate." Masons tried 
 to initiate her into a secret. She insisted that she Avas "innocent 
 and pure minded" and ignorant of all sexual things. (Secrets. of 
 the initiation.) ' 
 
 .Her father, she said, was the "holiest man on earth" (God), 
 although he had been "very passionate and cruel" to her mother. 
 "I never look into the eyes of a man; but a woman, that is differ- 
 ent." She claimed that she was her brother's wife and the mother 
 of his child, and denounced her sister-in-law for being a usurper. 
 
 After seven months, she became depressed, retarded in 
 thought, disinterested, mute, had to be clothed and fed, and usu- 
 ally sat on a radiator cover in the toilet, where, with her head to 
 one side, she would Avhisper incessantly to herself but would an- 
 
MANIC-DEPRESSIVE PSYCHOSES 381 
 
 swer no questions. Quite characteristically, she held some little 
 object in her hand and sat, mute, dreaming, indifferent. We 
 seemed unable to change this affective state for eleven months. 
 Then she developed pneumonia, and following the crisis, began to 
 show an interest in her treatment. She recovered rapidly and 
 after a week or so of rather hyperactive interests became "nor- 
 mal," making her usual adjustment. She would not discuss her 
 persona! problems and was discharged as "recovered." No doubt 
 she will again have periods of uncontrollable eroticism.* 
 
 During the depressed state, she decidedly renounced all but 
 the most infantile interests in life, and seems to have made a com- 
 plete submission to the mother, becoming wholly dependent (in- 
 fantile) upon her; whereas, during the erotic state, her behavior 
 and stream of tallc showed that her fantastic amours were woven 
 about her "holy" father and brother, becoming her mother's rival. 
 The persistent craving to hold some little object in the hand, such 
 as food, bread (bread of life), a box, ad infinitum, usually mieans 
 that the hand symbolises the uterus. (See Rodin's "Hand of 
 God," as the power that makes the world and life; and also Case 
 P-1 — perpetual motion machine.) 
 
 In order to emphasize that this type of depression, which is 
 simply and essentially an affective regression, and is not at all 
 like the anxiety-depression which is due to intolerable eroticism, 
 the following case is included. 
 
 Case MD-6 was a bright, interesting, impulsive sailor of 
 seventeen who was admitted to St. Elizabeths Hospital three 
 weeks after his enlistment in the navy. 
 
 His mother, an unusually beautiful, girlish, animated woman, 
 married at eighteen, a man twenty years older. The patient was 
 her only son, and early showed his heroic attachment to his 
 beautiful, unhappy mother. His father was lethargic, submis- 
 sive, impotent, unambitious and, after several years of indiffer- 
 ence and neglect, the boy's parents separated. In school he was 
 an indifferent pupil because of the distractions caused by his 
 discontented parents. Soon after adolescence he insisted upon 
 leaving school and earning a livelihood for his mother. As a child 
 he strove to relieve the distresses of his mother by immediately 
 becoming a man without waiting for the training and growth neces- 
 
 *One year later this patient was readmitted in a very erotic condition. 
 
382 
 
 PSYGHOPATHOLOGY 
 
 sary to make manhood possible. Because of Ms premature manly 
 attitude and "big" claims, his lack of preparation (inferiorities) 
 exposed him to merciless teasing from his playmates. 
 
 He had all the acquisitive interests of the average healthy 
 
 Fig. 48. — "The Hand of God," by Rodin. Insert at top of picture shows "The 
 Birth of the Greek Vase," by Eodin. (By permission of the Metropolitan Museum 
 of Art, New York.) Both themes use other parts of the body to symbolize the uterus 
 and uterine labor. (Compare to "Perpetual Motion," ITig. 51.) 
 
 boy, but was decidedly overburdened with his aspiration to be- 
 come his mother's hero and protector. 
 
 The first quite serious depression followed the defeat of an 
 
MANIC-DEPRESSIVE PSYCIIOSES 383 
 
 athletic team for -whicli he was manager. He soon readjusted 
 and enlisted in the navy. His illy substantiated braggadocio, 
 which compensated for the inferior attributes that retarded the 
 realization of his heroic ambition, exposed him to numerous chal- 
 lenges from the other young aspiring heroes and, instead of ad- 
 mitting his deficiencies, he battled stoutly for all his claims until a 
 dramatic climax occurred. About a week after his enlistment his 
 mother happened to step into the training quarters while he was 
 being surrounded for a hazing. He broke down for a moment and, 
 like the fable of the Libyan Antaeus in the grasp of Hercules, 
 sought his mother's support. She, however, chided him to take 
 his defeat like a man. He seemed to react with keen disappoint- 
 ment in himself. Within a few days he overcompensated and 
 claimed to be the most expert fighter, sailor, tree-surgeon, organ- 
 izer, and champion in the world, challenging everybody to contests. 
 He rapidly developed and expanded into a hero of unlimited ac- 
 complishments, sought fights, destroyed things in order to remake 
 them {a confused effort to overcome a r:esistance) , became an in- 
 ventor, was noisy, incessantly active and difficult to control. In 
 this compensatory striving he elevated his family to distinguished 
 social heights, his father significantly becoming Jesse James, the 
 robber, and he becoming the pugilists, Jeffries and Jack Johnson. 
 He damned and challenged eVerybodj'" in his overly compensated 
 struggle against his inferiorities. During this period he* mastur- 
 bated heedlessly and was inclined to expose himself. He did not, 
 however, pass into the extreme manic state. 
 
 This compensatory striving lasted about six months. Grad- 
 ually he quieted down and, by the eighth month, had subsided 
 into a retarded, disinterested attitude, feeling "sad" and regard- 
 ing himself to be friendless and neglected (the renunciation of 
 becoming his mother's hero had begun). 
 
 He secluded himself, showed no interest in anyone, and was 
 utterly indifferent to his mother's visits and conciliatory appeal 
 to make a man of himself. He became very fat, slept most of the 
 time and could not be induced to talk. He, however, attended to 
 his personal needs. 
 
 By the twelfth month he began slowly to resume some interest 
 in the world, and by the fourteenth month had again developed a 
 "normal" interest. His discharge as "recovered" occurred dur- 
 
384 PSYCHOPATHOLOGY 
 
 ing the sixteenth montli. lie never lost contact with his environ- 
 ment and apparently never was hallucinated. 
 
 One year later (age nineteen) he was readmitted because he 
 was unable to work, felt dull, had headaches and felt no love for 
 anything. He had tried several positions but was unable to be- 
 come interested in any of them. When readmitted he explained 
 that his grandmother could not take care of him and his mother 
 had to be away from home because of her work. For three months 
 he remained indifferent, seclusive, unresponsive, and spent most 
 of his time lying about on settees. This time he was more sullen 
 and inclined to brood, whereas in his previous depression he was 
 decidedly sad. His attitude indicated that he was suspicious and 
 perhaps had auditory, accusatory hallucinations. 
 
 By the fourth month he was more willing to work and his af- 
 fective readjustment progressed without intermission. One year 
 after his readmission he was again discharged because his work 
 and general attitude seemed to warrant giving him serious respon- 
 sibilities. 
 
 This boy's acquisitive interests and ambitions are decidedly 
 guided by the "love" attachment to his mother. She has become 
 an efficient, independent business woman, and tries to make him 
 realize that his place in nature is to take care of himself and not 
 his mother. He, however, is unable to free himself from the crav- 
 ing to become either his mother's hero and protector, or her nurs- 
 ling. His inaccessibility and tendency to keep his longing a secret 
 make his affective difficulties very serious. 
 
 The Mechanism of the Manic-Erotic Flight 
 
 It seems, and this conception is very helpful in understanding 
 the behavior of the liappy type of manic adjustment, that in the 
 manic (erotic) flight the individual enjoys the unrestrained de- 
 lights of a divine amour with the heavenly love-object of infancy. 
 (Daughter-father and son-mother.) Wlien the wish for this love- 
 object is renounced as shameful and incestuous, the individual 
 deprives himself of the chief source of stimulating energy and in- 
 spiration for sublimation. The affective attachment to the mother, 
 ivhen suhlimated, drives him on to become virile and good in 
 order to create in maturity situations and images which will gratify 
 the childhood love. When this wisli is renounced or betrayed, life 
 
MANIC-DEPRESSIVE PSYCHOSES 385 
 
 becoming an onerous burden, the affections tend to regress to the 
 state of dependence upon the mother which existed before the 
 weaning or even before the parturition. 
 
 The following cases of divine rapport and erotic flight with 
 the father's image are presented to illustrate this mechanism more 
 definitely. The symptoms of this affective state are typical. 
 
 The affective craving (erotic) often transcends all resistances, 
 in a sudden manic flight, when some failure that discourages the 
 struggle for social esteem occurs and weakens the restraining 
 Avishes of the personality. The individual quits the struggle of 
 refining the erotic cravings and, with unrestrained expressions 
 of delight, abandons himself to the affective flood and the orgy of 
 fancies and wild, weird self-indulgence. 
 
 Case MD-7 was a patient who, during the first three months of 
 her psychosis, abandoned herself to an almost continuous stream 
 of vivid auditory, visual, olfactory, tactile, and kinesthetic sen- 
 sory disturbances Avhich were so vivid as to be accepted as reality 
 (commonly called hallucinations). Her delusions, hallucinations 
 and dreams, because of their content, were evidently produced by 
 the same affective cravings. She was unable to resist a compul- 
 sion to be incessantly active in her talk and movements, doing in- 
 numerable things in rapid succession. She was married, twenty- 
 eight years of age, large, well developed, and in excellent physical 
 condition. Other than her lactating breasts from nursing a four- 
 teen-months' old child, her physical examination was negative. 
 
 Her family history indicates probable neuropathic deter- 
 minants. Her paternal grandmother died at forty with convul- 
 sions during labor. Her sister had convulsions during her last 
 period of childbirth. Her father was inclined to alcoholism. 
 
 The patient is the oldest of six children. She enjoyed ex- 
 cellent health during her childhood, entered school at six, learned 
 easily, and finished the eighth grade with her class. She was 
 bright, and apparently always happy, with the exception of times 
 when she worried about her father's alcoholism and tried to re- 
 form him. She always delighted in considering herself to be her 
 father's favorite, even preceding her mother. 
 
 After her school years she worked as a clerk, spending most 
 of this money for clothes and amusements. She says she had many 
 "sweethearts," which is probably true, because of her loquacious 
 personality and good appearance. 
 
386 PSYCHOPATHOLOGY 
 
 At nineteen, she married, an unskilled workman of twenty- 
 five. Despite the fact that she had a quite comfortable home, was 
 very fond of her social life, desired good clothes, entertainment, 
 and a married life that would enable her to continue her habits 
 of living, she married a man whom, for a long period, she did not 
 admire and was never quite sure that she loved. Her mother 
 discouraged the marriage because the man was an unambitious, un- 
 skilled workman. The patient said she realized this and hesitated 
 for some time, but finally her desires became too strong and she 
 preferred to overlook his deficiencies. She thought perhaps she 
 loved him a-njwaj ' ' and would help him to succeed. ' ' Also : "He 
 was a man who would not become interested in other women," and 
 one whom she "could control." The latter wishes were probably, 
 unconsciously, very important determinants of her selection, re- 
 flecting her difficulties with her own sexual tendencies. 
 
 The first two pregnancies resulted in miscarriages. Five 
 years after marriage, her first child was born. The second child, 
 which she nursed for fourteen months, until her psychosis, was 
 born three years later. 
 
 Unfortunately, both husband and wife were uninstructed in 
 sex hygiene. Their sexual desires were uncontrolled and, after the 
 first two years of nightly intercourse, her husband's powers failed. 
 This occurred gradually and insidiously. The first two congenial 
 years were succeeded by disappointment, irritability and unrest. 
 The patient could not be satisfied with the houses she lived in, 
 and moved frequently, trying one type of house after- another to 
 find a comfortable home (symptomatic. of the unsatisfactory hus- 
 band). She finally openly expressed suspicion of her husband's 
 fidelity, because of his impotence which she attributed to indif- 
 ference. She tried to obtain evidence of his infidelity, but could 
 not. Frequent quarrels occurred and she reacted with repugnance 
 and hatred for him. She became proud, and sighed for "high 
 ideals." The husband, she thought, recognized that she had "finer 
 feelings" than he had. She talked about her sexual difficulties 
 with her intimate friends who, she thought, encouraged her to 
 find another man. She said that her "stfong character pre- 
 vented her from turning out bad"; besides, she "was afraid 
 of venereal diseases." She felt that her husband was not good 
 enough for her; that he was a failure, unambitious, lazy. She 
 took a non-alcoholic proprietary remedy for ' ' female trouble, ' ' but, 
 
-MANIC-UEPIIKSSIVE rSVCIfOSES 387 
 
 tlie day before her psychosis began, she took several doses oi' an 
 alcoholic proprietary remedy. 
 
 This craving for sexual gratilieation, and her irritability and 
 discontent with the now socially imposed unsatisfactory sexual 
 object, increased, and not knowing how to prevent the excessive 
 genesis of sexual cravings, her difficulties became serious. 
 
 During this period she frequently dreamed of being divorced. 
 (That this wish prompted her reasoning and acts and much of the 
 psychosis can be seen throughout her behavior.) 
 
 Four years before the psychosis she unknowingly moved next 
 door to Mr. L — who had been a girlhood "sweetheart." "He 
 married after I married," she often repeated to assure herself 
 that he once wished to marry her. She looked for and found many 
 "signs" that indicated a return of his old love for her. She 
 convinced herself that his wife was weak like her husband, and 
 that this man was discontented and desired a separation. 
 
 She found many trivial reasons for having him in her house. 
 He was a plumber. She thought the stove was not suitably placed 
 in the kitchen and unshed to have it transferred into the dining- 
 room. Although her husband had previously set up the stove, 
 she wished to have it done better. She wished Mr. Ij — to set it up. 
 It is also interesting that she encouraged Mr. L — to visit her, 
 and, upon one occasion, gave him some lilg bulbs (pure love). She 
 foun'd many excuses for calling at his store, but, just previous to 
 the psychosis, he renounced all interest in her.* 
 
 The affective craving now quickly overcame the controlling 
 ego. She charged her husband with infidelity, and wishing to kill 
 her because of her secret guilt (projection as a defense). She ac- 
 cused him of openly being negligent, a poor provider, not bath- 
 ing often enough, of not consulting a physician for his impotence, 
 etc. She was convinced that she made a mistake when she mar- 
 ried, just as Mr. L — had made one. She thought a satisfactory 
 solution could be obtained through tAvo divorces and a remarriage. 
 
 Several days before the onset of her psychosis, she told her 
 mother that Mr. L — ' ' has conquered everything. ' ' A day or so 
 later, she showed her brother the meager food supply for the table 
 and complained of starving. That afternoon, while she was play- 
 ing the piano, she noticed a hearse and funeral passing the house 
 
 *Twci years later she admitted that L was the father of her second child. 
 
388 PSYCHOPATHOLOGY 
 
 She exclaimed : "Oh, look! Jack [her husband] is dead!" Her 
 brother stated that previous to this he thought her behavior nor- 
 mal. Following this incident she became very talkative and dif- 
 ficult to influence. That night, she lighted up the entire house 
 and raised all the blinds so "everybody could look in." She 
 wanted "everybody to see that nothing wrong was going on in her 
 house." (That she had no secret wishes.) 
 
 Within a few hours she was in a tremendous erotic flight. 
 The next day she was committed to the hospital, 
 
 A personality of this type may be thought of by some in a 
 moralizing sense, but one does not see how it can be understood 
 from any other than a biological viewpoint. The patient had an 
 uncontrollable tendency to erotic fancies and erotic cravings which 
 she did not realize the significance of nor understand how to 
 control. Because of her inadequate outlet, she became the host 
 of intense sexual cravings constantly tending to place her in an 
 environmental situation which might permit tjlaeir gratification. 
 This was shown, (positively) both by wishing prostitution and 
 finding the "signs" of discontent and desire in Mr. L — , remar- 
 riage, etc., and (negatively) by getting rid of the restricting, in- 
 hibiting influences, through the delusion of her husband's death, 
 the divorce, and the dreams, and later the hallucination. 
 
 The same day that she was admitted to the hospital, she stood 
 in the street and shouted to the neighbors that L — was her.hus- 
 b'and and the father of her second child. The reality of this father- 
 hood was later verified. Her ideas about the pseudo-marriage 
 were wish-fulfilling. 
 
 When brought to the hospital, her sexual cravings dominated 
 the personality. She was very talkative and happy, rejecting the 
 unsatisfactory husband as "untrue," "a thief,'' "a tramp," "no 
 good," "unclean," etc. She had learned this in the past seven 
 (impotent) years, and now had to leave home "to please God," 
 and the hpspital was like "heaven." The positive expressions of 
 the sexual cravings revealed themselves in the delusion or fantasy 
 that she "was a bride because everybody treated her so nicely." 
 "It is God's Will, and God's Will must he done." She frequently 
 shouted L— 's name, wanting him brought to her because he was 
 the father of her child and her husband, etc. She persistently 
 maintained that she would' not remain in the hospital. If the 
 nurse barred the windows, "Love will find a way." ■ 
 
MANIC-DEPRESSIVE PSYCHOSES 389 
 
 For the next two montlis, she was unable to accommodate Jier- 
 self to her surroundings. She had great difficulty in following 
 out the simple routine of the ward, could not endure the slightest 
 inhibitions, and her threshold of consciousness for all the extero- 
 ceptors was so lowered that she constantly reacted to everything 
 in her environment. She was subjected to an almost continuous 
 stream of wish-fulfilling, vivid, olfactory, auditory, visual, tactile 
 and kinesthetic sensory images (hallucinations), and compulsions 
 to do what the voices said. "What makes this magnetism in my 
 throat? It feels like it makes my lips move. I don't know what 
 compels me to say things. It must be Satan. I say it must be 
 witchcraft — my lips move and speak words that I do not think — 
 are not — not — what I want to say. Now, that — that fullness comes 
 in my throat. [Places fingers over larynx.] It wants to say things 
 I don't mean." (Benign dissociation of the personality.) 
 
 She explained many of her sensations, muscular spasms of 
 the throat and pains in the scalp, through claiming that magnetism, 
 hypnotism and x-rays were tearing her brains out. "If they have 
 me strung up on some mechanical thing that makes that — my 
 father was a good mechanic — he was a good man. * * * There 
 are two sides to everything. There is a right side and a wrong." 
 She referred to the persecutory, sexual, or wrong side as "they," 
 and the right, defensive side as "my," "myself," the social self, 
 which wished to do "right," "be honorable," "virtuous," as her 
 pastor, religion, parents, friends, taiight her to be. At times, 
 she referred to the persecutions and compulsions as "they," or 
 as her "inward emotions. ' ' (This case lirought out the mechanism 
 of the struggle of the ego with the uncontrollable cravings. ) 
 
 The ego was in constant conflict with the deeper, more unmodi- 
 fied sexual cravings. The latter were continually forcing her to 
 be conscious of sensory images which she tried to suppress, dis- 
 own, or segregate as impersonal, etc. l^Haenever the patient and 
 physician became en rapport, that is, when the physician was no 
 longer an exogenous stimulus of the repressive social-moral crav- 
 ings, the sexual cravings were permitted to seek satisfaction 
 through the use of very transparent symbolism, and even this 
 disguise would be flung aside before the patient seemed to be con- 
 scious of it. Then she usually reacted Math embarrassment, apol- 
 ogies and pleas for assistance and self-understanding. 
 
390 PSYCHOPATHOLOGY 
 
 Because of her numerous psychomotor expressions duriag this 
 period, only a brief review can be given here. Judging from the 
 material which was analyzed, every act, phrase of speech and 
 dream during the entire feriod had a predetermim,ed\ influence. 
 Such cases convince one that there is no such thing as an unde- 
 termined, ahsurd, or nonsense expression in a psychosis. 
 
 As the patient expressed herself, "I remember all that has 
 happened since I came here in this building : Visions, dreams, pic- 
 tures, love, sweethearts of the past, politics, religion, fraternities, 
 health subjects, opinions of cleanliness, schooldays, music, studies 
 of people, nations, United States, the government and its di:fferent 
 branches, inventions, infringements, occupations, growth of chil- 
 dren, etc." 
 
 "I feel as though I am writing for the motion picture authori- 
 ties or theater managers. [Exhibition cravings. The biological 
 value of exhibitionism during the mating season in animals is ob- 
 vious.] I can not understand why this thought appears to me as if 
 by some unknown source. Politics, faith, organizations, fraternal 
 orders, music, pictures, beautiful scenery and lovely visions are 
 continually coming before me." She frequently complained of 
 posing for the "movies," and being on the stage. She said the 
 Knights of Columbus — her former physician was a member — and 
 the Masons showed her their secrets. She said that her father 
 was a Mason, and seemed to have some very intimate relation with 
 her. The secrets of the Knights of Columbus were about the birth 
 of a child, and they would teach her "to get into a corner on the 
 floor and put her head down like a child coming into the world." 
 At the same time, she thought she was posing for a moving pic- 
 ture show. {A secret society's persecutions or influences, when 
 analysed, seem, invariably, to mean ungratifled cravings for ex- 
 hibitionism, and the acquisition of sexual experiences.) 
 
 Her visions, "moving pictures," were seen on the nearby 
 buildings. Besides others, slie saw a wedding ceremony visualiz- 
 ing herself being married to L — . Her husband was seen standing 
 near, but he seemed to have been divorced. At other times, she 
 saw herself being married to her physician, pastor, and "many 
 old sweethearts. ' ' She often saw the images of the pastor, physi- 
 cian, President, father, brother, and others, in the form of por- 
 traits. They "smiled very sweetly" and she seemed to be mar^ 
 
MANIC-DEPRESSIVE PSYCPIOSES 391 
 
 ried to them. She said she had "visions of every young man I 
 ever kept company with," and usually added, "They can not say 
 I am not a virtuous girl." The pastor appeared to her and 
 seemed to be proud of her goodness. She traveled in strange 
 lands, Alaska, Australia, England, Germany, and others. The 
 electric lights in the ceiling seemed to be the source of pictures 
 and magnetic influences. She saw people in the light having sex- 
 ual intercourse, and hid her head under the mattress. It made her 
 angry and she scolded and fought at the visions, but could not 
 avoid them. Shafts of light descended from the electric light and 
 passed into her. She was sure that it was a form of sexual in- 
 tercourse. One night "they produced an abortion" and she saw 
 the "afterbirth in five pieces." She said that her mother had 
 five girls and one boy. At another time, she gave birth to ten 
 children. 
 
 Voices of "foreigners" shouted at her from the street. They 
 called her "Violet," and threw white love powders through the 
 window (vaginal symbol). "They had wonderful odors like the 
 pines of Australia, menthol, chloroform, or olive oil" (common 
 semen symbols), which made her sleepy. The voices would say: 
 "Violet does not love me. Whom does she love? She has beautiful 
 breasts. I said: 'Go away from me,' and would fight back at 
 them." Her boy friends, she explained with pleasure, used to 
 tell her that she had violet-blue eyes. "They" would hang up red 
 lights on the building (sexual wishes), which made her angry and 
 she would shout at them to take down the red lights, because they 
 meant immorality, and hang up blue lights and white lights — 
 blue for the truth and white for morality (social wishes), or, 
 at least, hang up blue and white lights with the red (the com- 
 promise). Throughout the psychosis, its content was the product 
 of the conflicting sexual cravings and socially conditioned control- 
 ling compensations. 
 
 She frequently remained nude, and was so destructive that 
 nothing could be kept in her room except a mattress. Everything 
 else she tore up and tried to remake into something. The mat- 
 tress, she, at times, thought was a man to have sexual relations 
 with. At other times, she called it a Masonic chart and, while 
 lying on it, would have love dreams about her father. She shaped 
 the "chart" into a bell, and called it the "Liberty BelL" She - 
 also tried to adjust it in the "tomb of the room," and "pushed 
 
392 PSYCHOPATHOLOGY 
 
 it up the hole," the register. Everything she could obtain she 
 would push into the register, such as blankets, books, papers, etc., 
 so that the people upstairs would get them. She complained that 
 she had to work with great speed. This register she associated 
 with her lover's work, and laughed explosively when she spoke 
 of the register as a grave. This tomb (womb) was a symbol in 
 her fancies like the window. She formed stars with the sheets 
 and blankets, and "matched and compared blankets." Her fa- 
 ther often called his children "his stars." She compared herself 
 with her sisters — as her father's favorite. 
 
 During the period of eroticism her psychomotor expressions 
 through speech, writing, and actions were extremely disconnected, 
 and followed each other rapidly, showing symbolical, similarity, 
 contiguity, and sound .associations. She hoarded, with purpose, 
 numbers of papers and debris "to remake," "create." She read 
 religious magazines and the Bible, played hymns on the piano 
 and sang, when permitted. She wrote numerous essays about 
 "Barrooms and Red-light Districts," "The Struggle Between Vir- 
 tue and Vice, " " Right and Wrong and Their Victims, ' ' etc. Her 
 efforts at writing essays illustrated the psychotic' s abortive at- 
 tempts to keep suppressed the sexual cravings, keeping conscious- 
 ness free of them through the process of projecting an attack 
 upon the exogenous temptations of the -sexual cravings, such as 
 barrooms, red lights, prostitution, etc. 
 
 Despite the confusing flood of irrelevant sensory images which 
 the patient was conscious of, she was oriented, for time, place and 
 person, and seemed to realize that she was in an abnormal mental 
 state (benign dissociation neiirosis). Her memory for remote and 
 recent events was excellent, and she was able to do the intelligence 
 tests well. When she tried to calculate she had to take consider- 
 able time, and explained that it was due to her confusion. 
 
 A fragment of her stream of talk, which was taken by Dr. 
 Anita Wihon, is presented, because what at first glance seems a 
 senseless confiision of phrases, upon analysis reveals all the mo- 
 tives which caused the dissociation of the personality. The phrases 
 which a;re -particularly indicative are printed in italics. 
 
 Q. "What year is this?" 
 
 A. "This is leap year. Everything has a lovg tail irith a 
 comet to it. I have everything here and they belong to Dr. — . All 
 those keys, they are all maniacs together. Your hair may be curly, 
 
MANIC-DEPRESSIVE PSYCHOSES 393 
 
 but it will he stiff ivhen my fattier gets on the stand. The fathers 
 and mothers will show the little kids something. Now don't leave 
 my pastor out." (Parental secrets, childhood sexual curiosity.) 
 
 Q. "What month is it?" 
 
 ^. "I think it is October. [Correct.] I don't know. I only 
 knoiv the sun, moon and stars. I never saw a calendar. I never 
 saw the time. Keep them all. I don't care. 
 
 ' ' My saviour comes to me through my dreams. King George 
 gives them to me. I went up in a flying machine. He smiles at his 
 girls. I can see him night and day. That's my husband, George." 
 
 Q. What is the day of the month?" 
 
 ^. "I don't know. Black lip, black tip, any old way. This is 
 all a silly mess." 
 
 Q. "^Vhat place is this?" 
 
 A. "I don't know. It is my husband's hospital or it will be. 
 Someone pulled my hair. I could feel it. [Hallucinates. Looks 
 at nurse.] Did you do it? Kill me if you want to. He'll send a 
 light doivn to the grave to warm me from that light over there. 
 (Probably referred to an electric light from which, at night, beams 
 entered her body in simulation of sexual intercourse.) 
 
 "He loves me. There is my son, my man in the moon, he loves 
 me. I am not a criminal. You are my sister, one of the sweetest 
 I ever had. What I have done, I have done for love. I don't ex- 
 pect it in return. They will have to give it to me if theA' have to 
 go to hell for it. Red lights, bhie lights, any old lights." 
 
 Q. "Are you happy or sad?" 
 
 A. "I am happy and sad. A combination. I am happier now 
 that I have done my duty. I'll live forever and turn into a ivhet- 
 sfone. Then I'll be crucified and the man will save me because he 
 loves me. I am not ashamed. ' ' 
 
 Q. "Why were you brought here?" 
 
 A. "To be a monkey, a baboon, anything you choose." 
 
 Q. "Were you ever like this before?" 
 
 A. "Oh, yes! Many times. They have tried to come between 
 me and my luck and the right hand and the left' hand, above and 
 behind. It did make me worried before. I dealt with them ac- 
 cording to law.* You are one of them [laughs]. Preach for the 
 war!" 
 
 Q. "Is there anything the matter with your mind?" 
 
394 PSYCHOPATHOLOGY 
 
 A. "No, my mind is as clear as crystal. They never thougiit- 
 I acted crazy. I noticed my husband acted queer. I tried to hide 
 his misdemeanors and wrong acts. I don't like to betray Ms se- 
 crets. I expected to redeem him. [His impotence.] The pastor 
 and the President are all my sweethearts [father-image], but my 
 husband is not to go to Alaska, clothes, furs, wraps, money, right, 
 right, left, left, between, between, travel, travel, follow, follow, fol- 
 low." 
 
 Q. "Do you sleep well?" 
 
 A. "When I feel like it I sleep and when I wake I carry on 
 hell ! Everything belongs to me, this building and my room. He 
 just keeps me here for himself " * * * [Prostitution fantasy.] 
 
 "I never have a good sleep for I dream all the time. Last 
 night I sat up all the night looking out of the window watching 
 moving pictures. They sent Dr. — to purgatory. You are trying 
 to get my Dr. ■ — away from me, but it'll take more than keys or 
 string hea/ns. 
 
 "There was no vulgarity in any letters that were written to 
 me. Everyone knows my history. There is nothing crooked about 
 me, hut they picture all sorts of things [sexual] about me in 
 these moving pictures. They had me doing acrobatic [sexual] 
 stunts at the Bureau of Engraving [where her father works] . He 
 and George too were shooting them for ine. Both of them are 
 BuSdMsts trying to i/nfringe on other people's patents * * * ." 
 
 Q. "Does everyone treat you well?" 
 
 A. "No, they treat me like the devil. The nightfall girls, they 
 steal money at the Bureau. Agnes, who lived with me. They got 
 me drunk and brought me into the streets. I wasn't happy with my 
 husband, but I was with someone else." 
 
 "I had lots of enemies. I don't know why. Lots of girls were 
 after George — ^but he loved me best and his ivife couldn't help her- 
 self * * * . 
 
 "They take away my bed and give me a Masonic chart to 
 sleep on. I have prayed all the time to help them. They are all in 
 love Avith me * * * Everyone is my sweetheart. ' ' 
 
 If we analyze the already transparent phrases in italics we 
 find that the sexual cravings utilize sensory images of her sweet- 
 hearts, father, and pastor with xmrestrainod promiscuity. 
 
 For example : 
 
MANIC-DEPRESSIVE PSYCHOSES 395 
 
 "This is leap year," the year in ^vhich women are popularly 
 said to have the privilege of proposing, or offering themselves as 
 love-objects; "Everything has a long tail with a comet to it," 
 she later said, meant the male genitalia; "I have- everything here 
 and they belong to Dr. — , all those keys; "Everything" meant 
 sexual desire and the female genitalia, "Those keys" meant male 
 genitalia, and "all" expressed her excessive eroticism; "Your 
 hair may be curly, but it. will be stiff when my father gets on the 
 stand : " It -will be stiff, etc., has an obvious meaning. 
 
 "The fathers and mothers will show the little kids some- 
 thing," expressed her childhood sexual inquisitiveness. "I only 
 know the sun, moon and stars," meaning her father, mother, and 
 their children; a "calendar" and "time" (piece) are sexual sym- 
 bols. Associated with her sexual desires for her father, she says : 
 "My Saviour comes to me in my dreams. King George gives them 
 to me. I went up in a flying machine." Her "Saviour," who 
 saves her from her erotic discomfort, is King G-eorge. "King" 
 means ' ' father, ' ' and ' ' George ' ' is the name of the man she wishes 
 to marry, and who, she insists, is the father of her child. 
 
 "They had me doing acrobatic stunts at the Bureau of En- 
 graving [where her father works]. He and George, too, were 
 shooting them for me." Here "shooting" is an intercourse sym- 
 bol. ' ' Both of them are Buddhists, " " Buddhists ' ' being evidently 
 subconsciously derived by her from "Buddy," her pet name for 
 her brother, who was also one of her sacred "lovers" contending 
 for her charms. 
 
 "I'll give my brother to his sweetheart." She often asso- 
 ciated her brother's first name with her lover's last name. She 
 was also her brother's sweetheart in dreams and in childhood. 
 
 "He wants me to put that pencil there for him, too [taking 
 pencil and putting it on a I'ackJ. He tells me what to do." Such 
 spontaneous acts are oxpi'ossions of the same motives. From the 
 context, the pencil and rack have value as sexual symbols (one 
 object being mechanically the receiver of another is all that seems 
 to be necessary for such symbolic use when people are erotic). 
 
 "Safety-pins and white-ways." Her pastor talked to her 
 about the safety of leading a white life, and said that she was in 
 safe hands. "There shall be no patents infringed upon." Her 
 father had lieen cheated out of a patent. "When asked what she 
 
396 PSYCHOPATHOLOGY 
 
 meant by the phrase "keys or string-beans," she langhed and 
 said she had not been married for nothing, she conld not tell, she 
 was "too modest." She talked considerably about "Buddhists," 
 .although she knew nothing about them. Her associations to 
 "Buddhists" later were "Buddy," "Brother," "Wilfred," 
 "Bud," "Love," "Great Love," * * * 
 
 She talked a great deal about a "conflict over religion and 
 politics," and associated Protestant, Catholic, and Republican to- 
 gether, explaining the meaning as herself, Protestant; physician. 
 Catholic; father, Eepublican. With religion and white-ways, she 
 assaciated politics, red lights, immorality, etc. 
 
 She spoke of "nightfall girls" who live crooked lives, prefer 
 night to day, etc. G. H. was stamped on her bedding. She read 
 it " C. H. " and said it meant ' ' Charley J — , ' ' her teacher while in 
 the sixth grade. 
 
 Prostitution was shown in the phrases: "To be a monkey, a 
 baboon, anything you choose," "I'd go anywhere for Jesus," "He 
 just keeps me here for himself." [She often said that her lover 
 sent her here.] "I have lots of company and fellows," "I don't 
 know what they are trying to keep me here for, unless they are 
 making money on me," and, "The nightfall girls * * * got 
 me drunk and brought me into the streets. ' ' 
 
 The desires for exhibitionism were expressed in such phrases 
 as, "They had me doing acrobatic stunts" and "they picture all 
 sorts of things about me in the moving pictures." 
 
 There was some tendency towards homosexual expression in 
 her dream of seeing a nurse trying to influence her "to do wrong" 
 while she was nude. 
 
 During the erotic flight, masturbation occurred with little ef- 
 fort at concealment and, without restraint or shame, she indulged 
 in unbridled sexual fancies about her father, pastor, brother and 
 physician, she became, in fancy the "Bride of Christ," married 
 to "God," and seemed to be wonderfully happy. She luore her 
 hair long, had a classical "Madonna" countenance, and felt herself 
 to he a "Heavenly Bride." 
 
 During the first three months, she believed that her hallucina- 
 tions were actual experiences caused by other people and that she 
 had been "hypnotized," "electrified," "experimented upon," etc. 
 The persistence and intensity of such sensory images, and their lia- 
 
MANIC-DEPRESSIVE PSYCHOSES 397 
 
 hility to recur, diminished iritli the subsiding eroticism.- Gradu- 
 ally, she learned to doubt their reality, and her sensory disturb- 
 ances were rather regarded as a "mystery." 
 
 During this period she Avas somewhat sad and complained that 
 the other patients talked about her, persecuted her, and caused her 
 to have the mysterious feelings. She wished to know if it was pos- 
 sible to have telepathic communications, etc. 
 
 As the activity of the sexual cravings further subsided, she 
 no longer thought of Mr. L — as her husband but as a lover to be 
 met in heaven, and again recognized her real husband but dis- 
 liked him. 
 
 Her dreams, she said, were ahvays very beautiful and pleas- 
 ing. They bore an intimate and striking relation to the hallucina^ 
 tory content. 7/ one studies her dreams as lialhtcinatory sensory 
 disturbances occurring during sleep, or dormant periods, we may 
 understand hoiv the same conflicting ^vishes produce halhwina- 
 tions, delusions and dreams. (This is true for many of the other 
 cases and a general principle of human behavior.) She dreamed 
 about her father, that he loved her and would help her. She had 
 some papers in her hand, and he said: "Don't worry, little daugh- 
 ter, I will try to get these papers pushed through as quickly as I 
 can." Upon another occasion, she similarly dreamed that her 
 physician stood by her bed and talked to her, saying, "Don't 
 worry, little girl, I'll take care of you." When relating this cir- 
 cumstance, she further said: " Then I felt a liking for him. Then 
 I had a feeling for him. ' ' 
 
 She also dreamed that one of the nurses was trying to in- 
 fluence her for sexual purposes. At another time, several weeks 
 after her dissociated state had almost disappeared, she dreamed 
 that a white hand, a wax figure, like a man whom she did not 
 know, approached her bed and said, "Peace, little one!" The 
 person then told her to make the bed. Still later, she dreamed 
 about her lover but would not tell it because her conscience both- 
 ered her. 
 
 "I dreamed last night that my brother was kissing and caress- 
 ing me and then led me to meet and be introduced to a gentleman 
 by the name of Andrews. I also felt the clasp of his hand as he 
 shook hands with me upon introduction. This was only a dream, 
 but, upon one occasion, 7 had the pleasure of seeing the vision 
 of a man with an artificial wax hand, who held a dove in one hand 
 
398 PSYCHOPATHOLOGY 
 
 and clasped my hand Avith the other, telling me to go and make 
 up his bed in a joking, jolly way, then disappearing. When asked 
 to associate with the wax figure, she replied: "I could not tell 
 that. It is too ernbarrassing. I might later on. I never did any- 
 thing wrong [masturbation] . I always assured myself that it was 
 necessary" [laughing boisterously]. Because the hand was so 
 frequently associated with the father, and "Peace, little one," 
 etc., the masturbation and its fancies were justified as a necessity 
 and evidently were associated with the "father" fancies. 
 
 Her struggles to control herself showed, as she became less 
 erotic, in her essays, songs and religious-moralizing and attempts 
 to eradicate sexual temptations. Eeligious music and literature 
 (working for God and Christianity) seemed to effect the most 
 adequate affective sublimation through their social-moral satis- 
 f actoriness as well as constituting an indirect sexual outlet through 
 striving to please a distant lover, as God, the Heavenly Father of 
 infancy. Later, she inckided her children in this sublimation, and 
 dedicated them to the "Glory of the Heavenly Father." This 
 concentration of the autonomic-affective cravings upon a eertlfel 
 course of behavior and content of consciousness has also the emo- 
 tional economy of preventing direct sexual excitation. 
 
 This patient made a transference to me and from that time it 
 was comparatively easy to control her. She rapidly gained in- 
 sight. "The mystery" of "the experiments" that she had under- 
 gone (the sensory images forced into consciousness by the af- 
 fective needs, despite her efforts to inhibit, "block" them out) 
 rapidly cleared up. 
 
 When analyzing some of her visions, the patient asked if I 
 were a law^'er or congressman, and then added that she believed 
 I was a lawyer and not a doctor. When asked why she thought 
 this, she replied that I must be a lawyer gathering evidence to 
 help her obtain a divorce. 
 
 In the above phenomenon, the very active sexual cravings, 
 striving to acquire an adequate love-object, distorted her concep- 
 tions of the environment through forcing her to become conscious 
 of additional sensory images which caused her to perceive her 
 physician as a lawyer. Through him, the affect could realize an 
 opportunity for gratification, through divorce and remarriage. 
 
 Another example of this mechanism occurred when, during 
 the analysis, the patient clearly recognized that her difficulty was 
 
MANIC-DEPRESSIVK PSYCHOHKS 399 
 
 sexual: her love for Mr. L — , and tlie fact that he was unattainable. 
 She became very anxious, complained of cardiac pains, and then 
 hallucinated, visually Mr. L — standing by her. She claimed that 
 she could see him and said she was relieved to feel that he was so 
 near. She refused, at this time, to give him up. 
 
 When her love was about to he deprived of its object, the 
 cardiac anxiety, as part of the fear reaction, resulted and had to 
 he relieved by vivid sensory images of her lover, in which she saiv 
 and felt his presence, and which she gladly accepted as realities. 
 {This instance first showed, the value of the hallucination for keep- 
 ing autonomic segments comfortable.) 
 
 We maj^ apply this same interpretation to the psychosis as 
 a whole. In brief, the sex cravings discarded the unsatisfactory, 
 Impotent husband. Sensory images ("imaginations") were sup- 
 plied by the sex cravings to compensate for the acts and words 
 which Mr. L — would not actually administer. "When, through Mr. 
 L— 's personal objections to her attentions, he became unattain- 
 able, a tremendous, uncontrollable, compensatory flight of fancies 
 occurred which prevented distressing teusions of the autonomic 
 apparatus. The conflicting cravings caused an acute dissociation 
 of the personality and the consciousness of a vast stream of sen- 
 sory images and delusional concepts. These sensory images 
 seemed to involve all the recent to the remote sensory impressions 
 of extero- and proprioceptors which, at one time or another, had 
 played a direct or indirect paft in gratifying her love cravings. 
 
 As is usual in such cases, the cravings forced, in more or less 
 retrogressive order, the recall of all the retained sensory inmges 
 of the . experiences that might be adequate until the most impres- 
 sive and fundamental, accessible for reproduction, were reached. 
 Hence, the array of former lovers and marriages, her ' ' beautiful ' ' 
 love visions and dreams on "the chart," the voice, "Peace, little 
 one, I will protect you," etc., all associated with the "Heavenly 
 Father," "minister," "physicians," "President," and "king"; 
 all men as one in that the supreme qualities of one man are always 
 -sought for in all the men she meets. Thiis is the dominating wish 
 of the prostitute" s trial and retrial method of seeking for him. 
 
 It is a' moral imposition, and biologicaly wrong, to say 
 that fundamentally we have an "incest complex" determining this 
 psychosis. The problem of acquiring an adequate stimulus for the 
 gratification of the sex cravings luas most important. The sensory 
 
400 PSYCHOPATHOLOGY 
 
 images and delusional concepts, -which principally made up the 
 content of consciousness during the dissociated state, Avere forced 
 into consciousness despite all resistance of the socialized wishes 
 which are habitually active at the level producing the conscious 
 reactions of the ego. 
 
 The nature of these sensory images showed several interesting 
 characteristics : 
 
 1. That they all, at one time or another, seem to have stim- 
 ulated sexual cravings or reactions which later became associated 
 with sexual cravings; in other words, the sexual cravings were 
 conditioned by definite experiences. 
 
 2. The images of sensations, which had been experienced 
 throughout the developrtient of the personality, were subject to 
 re-presentation in consciousness, and were utilized by the sexual 
 cravings to obtain neutralization. 
 
 3. The re-presentation seems to have been effected in a more 
 or less retrogressive order xmtil the sensory images of the early 
 childhood and infantile period were utilized, which, at one time, 
 probably caused the most intensive pleasure reactions of the or- 
 ganism — namely, sensations from the father. (His favorite; 
 hence, her favorite.) 
 
 4. The sense of REALITY of the visions (hcdlucinations) de- 
 peiided.upon the persistence and intensity of these sensory images. 
 They were so persistent and intense that the ego could not dif- 
 ferentiate their reality from the new sensations of the environment 
 until they could be suppressed from consciousness for periods of 
 time which were long enough to enable the patient to react to the 
 functional difference of persistence and vividness between sensory 
 images and actual sensations of external objects. Then her "vi- 
 sions," "experiences," etc., became a "mystery" to her, and this 
 mystery disappeared as she became able to recall the origin of the 
 sensory images and their cravings through a psychoanalysis. 
 
 She was discharged as recovered after four months, the 
 autonomic-affective cravings having completely resumed their 
 habitual systems of adjusting themselves and reacting to the en- 
 vironment. She fully appreciated, accepted in consciousness, her 
 sexual striving, and has concentrated all her efforts upon religion 
 and raising her children. It is, however, too much to expect a 
 personality, biologically so constituted, to endure the meager grati- 
 fication of her excessive needs as provided Ijy an impotent hus- 
 
MANIC-DEPRESSIVE PSYCHOSES 401 
 
 band. She still frankly entertains wishes to discard her obliga-, 
 tions. Four years since her discharge the family problem remains 
 unsolved and now she desires a divorce. 
 
 This case is typical of a common type of acute benign dissocia- 
 tion of the personality. The patient's psychosis showed clearly 
 that hallucinations and dreams are alike in that they both are con- 
 stituted of sensory images forced into consciousness by the same 
 suppressed cravings which are striving for gratification. The dif- 
 ference seems to be entirely one of intensity and duration of oc- 
 currence. Patients often speak of the varying . intensity of their 
 hallucinations. This is well known to be characteristic of dreams, 
 and patients often refer to their hallucinatory states as dream 
 states. Delitrsions are concepts caused hy the association of wish- 
 fulfilling though misleading sensory images with new sensations. 
 Such associations of sensory images and sensations, producing 
 concepts, are utilised by unshcs to give them a means to attain an 
 object for gratification. The associated sensory images, in pro- 
 portion as they are utilized by the cravings or wishes, indicate the 
 personality's tendency to avoid the realities of its environment. 
 Cravings strive to discard from the environment, from conscious- 
 ness, and from the personality all sensations and sensory images 
 that are not needed to neutralize their uncomfortable tensions; 
 as in irritability at distractions and controversies, speech de- 
 fenses, diversions, etc. 
 
 The ego succeeds in controlling its undesirable cravings, and 
 suppressing them from consciousness, by coordinating itself upon 
 certain common paths of behavior. Such interests only are main- 
 tained as tend to gratify hy compromise, as a resultant, both the 
 socialized and sexual cravings of the personality. 
 
 "Worries about secret societies, mysterious influences, religious 
 societies, personal influences, hypnotism, etc., mean that the ego 
 can not entirely free itself of the influence of undesirable crav- 
 ings of a sexual nature. Either such undesirable cravings must 
 find another object or the patient must become conscious of them 
 through psychoanalysis in order to get rid of the delusion, hal- 
 lucination, etc. No amount of reasoning or argument, reeducation 
 or habit formation has the slightest effect upon the struggle of the 
 repressed affect. 
 
 In this erotic (manic) flight, the patient enjoyed, without re- 
 straint, all the repressed sexual interests of her life, including a 
 
402 PSYCHOPATHOLOGV 
 
 divine liaison with.- her "Heavenly Father." She had no difficulty 
 in finding an excuse for yielding to the "father," whereas the 
 more catatonic patient (Case CD-2, to be presented later) had 
 considerable difficulty. Although the latter case ^Iso submitted to 
 the "father," it was not so glorious a flight, being more of a 
 crucifixion, with anguish, pain and joy. 
 
 This form of psychosis, in which the images of the loved and 
 hated objects are simulated without restraint, thereby -enabling 
 the repressed affections to attain thorough gratification, always 
 has an excellent prognosis for that episode. 
 
 As to whether or not another psychosis will follow, depends 
 largely upon good fortune in acquiring a satisfactory sexual 
 solution. 
 
 The above case (MD-7). consulted me two years after her dis- 
 charge. She said she had had excellent health, enjoyed work, but 
 was dissatisfied and needed advice. Her husband continued to de- 
 liver milk at night, and slept during most of the day. She had no 
 companionship. He was always tired out, was impotent and indif- 
 ferent. She .felt incessant cravings for pregnancy and was in- 
 clined to claim the right of free love. She wanted only the slight- 
 est justification from a physician for this adjustment and then she 
 could happily go her way. Such advice, of course, the physician 
 can not give. He must 'not say "iio" or "yes," because, as a re- 
 pressive influence, he maij cause a disaster, such as a psychosis or 
 suicide, and, as an immoral encouragement, he ivould betray the 
 social obligations -of his profession. It is not an uncommon expe- 
 rience to have patients, who desire but a hint of medical appro- 
 bation, bluff and darnn the physician violently for his silence. It 
 is probable more exasperating to these imfortunate people, be- 
 cause they feel certain the physician knows what release from 
 inhibitions they need. 
 
 Case MD-8 showed an interestirtg- manic (compensatory) type 
 of wish-fulfillment which subsided when thie 'love-object Avas re- 
 acquired. 
 
 She was a frail little woman, twenty-nine years of age, 5 ft. 
 tall and weighed only 81 lbs. Her father was, from her descrip- 
 tion, a man of great fancies, but provided a meager home. To her, 
 he was a "man among men" [Godliness]. 
 
 As a child she was small and delicate, and had only advanced 
 to the seventh grade when she quit school at seventeen. 
 
 She was her father's "pet," and her attachment to him Avas 
 
iMAA'K'-UKPHK^iSIVK I'SVCI lOSIOS 40.'! 
 
 probably increased by liis habit of taking lier to bed with him on 
 "cold" nights. He died when she was fourteen, but she felt no 
 anxiety because she believed that he had only gone on a journey. 
 She Avas always addicted to day-dreaming, and colored her 
 meager comforts Avith rich fantasies of love and happiness. At 
 twenty, she married. Her husband's name was George Washing- 
 ton J — . 
 
 Her first two children lived, but the next three pregnancies 
 ended in miscarriages, Avhich probably were largely the result of 
 her frail physique. Witli the second miscarriage, she was re- 
 ported to have been "hysterical" for several weeks, in which state 
 she thought her sister's child was her own. Upon the occasion of 
 the third miscarriage, she developed a more pronounced psychosis, 
 in whicli her Avishes Avere better gratified. Her husband had be- 
 come an alcoholic in the preceding four years. She believed that 
 he was losing interest in her and secretly freqiienting the "red- 
 light district." This added consideralily to her anxiety about her 
 physical Aveakness and greatly influenced the compensation. 
 
 She felt that her last infant was not dead, and again tried 
 to claim her sister's infant as. her oaa'u. She accused her sister 
 of stealing her infant and, although it Avas tAvo months old, main- 
 tained that it was but twelve days old and too small for its cloth- 
 ing. She played that she was a certain famous divorce, a charmer 
 of men, and dressed in her nine-year-old daughter's clothing. She 
 said her children had been taken from her by "conjury," other- 
 wise, the last child would have l^een born on Christmas Day. 
 Therefore, she was "The Divine Virgin Mary, Mother of the 
 Christ. Child. " When she opened the Christmas turkey, the intes- 
 tines looked like snakes, and she cast them out of her house as a 
 sign that she Avould cast Avickedness out of the Avorld. The day 
 before Christmas, she saAv a picture of a red devil on the door of 
 a "Jew store," probably an adA^ertisement, and entering the store 
 she gave the proprietor a lecture. She said it seemed that she 
 Avas unable to get away from that store (the devil). The police 
 sent her to the city hospital. The acute stages of her psy- 
 chosis lasted about six weeks, during which she liA^ed the char- 
 acter of "The Virgin Mary" and became the "Queen of Wash- 
 ington." She carried herself with- ludicrous dignity and compo- 
 sure for a frail, little, ignorant woman, and with remarkable self- 
 assurance talked like a ruler of the Avorld. She let her hair hang 
 
404 PSYCHOPATHOLOGY 
 
 loose, characteristic of the "Heavenly Bride," sang songs of in- 
 spiration, such as "Lead Kindly Light," and danced about the 
 ward, threw open the windows and talked to people (halluci- 
 nated). She picked out patients on the ward, and gave them 
 her sisters' names, said her father had destined her to become 
 the Virgin Mary, recalling that upon his death she felt something 
 great was in store for her. 
 
 While lying in bed, she said five small lights, like "little 
 wings," (she had five pregnancies) flew around her head, and 
 the room became brightly illuhiinated. She then felt a "great 
 change" and thought of the Virgin Mary and her halo. When the 
 light entered her eyes, she had feelings described as "inspiration 
 and knowledge," remarking that she had never had a college edu- 
 cation. It also meant her sins had been forgiven. She spoke of 
 herself as Mary Magdalene, because of her sexual relations before 
 her marriage, and named her five children, assuming that all were 
 alive, after five saints. She was called "The Blessed Mother," 
 "Queen of Angels," "Queen of Saints," "Gate of Heaven," 
 "Morning Star," "Help of the Wealf," "Eefuge of Sinners," and 
 was ' ' The Head and Euler of the Universe. ' ' 
 
 She maintained that she was to be married to "The Presi- 
 dent" and the King of England. She reasoned it out with great 
 conviction, as follows: She was to be married to George Wash- 
 ington (her husband's name was George" Washington J — ), who 
 was the Father of the Country and the first president, so that 
 might mean "The President" or it might mean King George of 
 England. Her next son was to be named George Washington. 
 She would rule Washington, and therefore desired to be boss of 
 her ward, starting many fights with the nurses to establish her 
 position. 
 
 The fact that her name was Mary, and her child would have 
 been born on Christmas Day, was her strongest reason for the 
 wish-fulfilling conviction that she was "The Divine Mary." Her 
 husband was not divine, but she had the power to make him divine. 
 She frequently substituted the word father for husband. 
 
 Her fantasies were almost unlimited, as is characteristic of 
 such compensatory strivings to prevent the anxiety that is caused 
 by the reality of her inferiority and cravings. An extract from her 
 essay on flowers illustrates, a strikingly symbolic method of com- 
 pensating for a distressing physiological inferiority. For some 
 
MANIC-DEPRESSIVE PSYCHOSES 405 
 
 time, she felt that "something was ahead" of her and prevented 
 her husband from being affectionate. She said she vv^anted more 
 affection than he could give her. 
 
 Her fantasy is entitled ' ' The Imaginary Dream of Dreams to 
 be Outclassed by the Song of Songs. ' ' The synopsis given by her 
 is as follows: "First of all, I imagine myself among the tall 
 stately wall flowers. [She was 5 ft. high and weighed 81 lbs., 
 and wall flowers, are the neglected girls at the dances.] They 
 prove a success in some instances. Then, I am attracted by the 
 buttercup and the daisy, but, almost too quick to realize it, I am 
 entirely overwhelmed by the forget-me-not [she repeatedly used 
 the expression 'father-'forgot-me-not'] which shows itself in many 
 ways: First of all, as it appears in the garden of my dreams, 
 as two tiny, yet dazzling, young flowers. [She had two stillbirths. 
 The third fetus was eight months and developed, living for twenty- 
 three days.] Next, I see it in a vision as a kiss-me-at-the-garden- 
 gate. It has changed somewhat, but in my dream it is as a lilac 
 which of tentimes I tries to bud and blossom ahead of Jack Frost. 
 (Her physical debility thrice wilted her budding flowers, produc- 
 ing, she thought a consequent indifference in her husband which 
 rendered her desolate;) 
 
 "Now, I am almost awake [reconstituted]. I have June roses 
 placed before me in many bright colors, but the one I love best 
 is the pink bud .of the daily rose. The storms of the summer only 
 fade her to blossom again and again till she is at last a calm, 
 grand beauty." (Despite the storms that tend to rob her of her 
 womanhood, she has become the calm, grand beauty that she im- 
 personates on the wards.) She has effected a satisfactory adjust- 
 ment, and says: "Now, I fall back and find myself among the 
 brightest flowers, the gayest, gladdest, the best of all. In my 
 lonesome pathway are three bright red poppies. They each lift 
 their bright heads in contrast, but the center poppy, all at once, 
 takes a notion to leave his brother poppies and flourishes wonder- 
 fully in the sunlight [the erection of the phallus] till father-fox- 
 glove [her father attachment] overtakes him in his desperate 
 struggle to leave his own beautiful garden. 
 
 "With all the earnestness of her desire, mother-lily was al- 
 most too worn out by the chilly blast to welcome her own red poppy 
 back again. But, as she always trusted father-forget-me-not with 
 all her treasures, she was quite sure he had some object in trans- 
 
406 
 
 PSYCHOPATHOLOGY 
 
 planting liis own bright poppy again. So, little by little, mother- 
 lily opened her petals' until she was almost as bright as ever," 
 (With the failure of her husband's affections, she had regressed 
 to her memories of her dead father for comfort, See Fig. 49, of 
 
 Fig. 49. — "Die Hoffnung, " by G. v. Bodenhanseii. Hope as a young woman 
 standing in the graveyard of buried wishes and memories reaches out for the revival of 
 life, symbolized by the spring flowers. Compare themes of Aesculapius (Fig. 87) and 
 Hygeia (Pig. 1). 
 
MANIC-DEPEESSn'E PSYCHOSES 407 
 
 Hope in the graveyard yearning for the return of the flowers 
 and life. 
 
 With the onset of her fantastic psychosis, her husband became 
 very repentant and, literally, he wept and sang Avith her. He was 
 genuinely sorry for his negligence, and his clumsy, but earnest at- 
 tentions seemed to induce her to abandon the heavenly compensa- 
 tion for his neglect and be satisfied again with reality. 
 
 She was discharged, apparently, making a satisfactory re- 
 covery eight weeks after her admission. 
 
 In this case the fantasies aaid hallucinations decidedly com- 
 pensated for her physical defects as well as for the unsatisfactory 
 mate. In the preceding case (MD-7), of a woman who had all the 
 physical attributes necessary for a virile maternity, no compen- 
 satory fantasies for personal physical defects were noted in her 
 psychosis. 
 
 Manic Compensation for Inferior (Perverted) Eroticism 
 
 There is another type of manic compensation for eroticism 
 that is not a simple, pleasing orgy of wish-fulfilling fantasies, but 
 is decidedly more complex and is a hostile compensation for the 
 fears caused by tahooed erotic cravings. These cases affect bold- 
 ness and bluff so vigorously that the physician usually becomes 
 intimidated and does not recognize the patient's underlying fear. 
 
 Case MD-9 is an unmarried woman of sixty, who has for three 
 years been trying to dominate her environment by claiming to be 
 "the Lord," "God Almighty," the "King," "President," "Sec- 
 retary of the Navy," and so on. She proclaims that she is the 
 maker of a cannon that shoots 6,000 cannon balls which will de- 
 stroy everything and shoot into the uterus of her physician, who is 
 a "she devil." She threatens to cut off. anyone's head who comes 
 near her, damns everybody, and does it with such vicious emphasis 
 that she makes one feel decidedly like leaving her alone. 
 
 With hair flowing, gowa often exhibitionistically adjusted, ex- 
 ophthalmic stare, stern masculine countenance, mannish voice, and 
 hypertrichosis, she makes a formidable impression. 
 
 At about thirty-four, she -had a serious depression, lasting 
 seventeen months, following the death of a sister. 
 
 At fifty, she had a manic attack, lasting a year. During this 
 attack, she claimed to be a divine healer, "God," and her own 
 
408 PSYCHOPATHOLOGY 
 
 healer, thereby not needing a physician to treat her. She talked 
 in similar, threatening, monotonous phrases, nsnally repeatiitg 
 each one six times. She was very suspicions, afraid of poison, 
 would not bathe herself, and allowed no one to approach or touch 
 her, or to turn the lights off, etc. 
 
 At fifty-four, she had a similar psychosis which lasted about 
 eight months. 
 
 At sixty, she had the fourth attack, and her behavior was de- 
 cidedly like that of the other manic episodes. During this last 
 attack, she began as a manic, then she became somewhat depressed, 
 and then again resumed a manic compensation. 
 
 During the manic states, her stern countenance, threatening 
 demeanor, exophthalmic stare and fear of disrobing or bathing, 
 betrayed the fact that her erotic cravings were not to be the homo- 
 sexual aggressor as her behavior on incomplete observation had 
 suggested. She really wanted to be just the opposite, even though 
 she talked of performing most gruesome sexual assaults, such as 
 shooting into the womb of her physician with a cannon and similar 
 devices. "When her sister or friends visited her, she drove them 
 from the room because they made her fearful. She said, sternly, 
 that those who came to her room were Roman Catholics who had;, 
 come to torture her. 
 
 During the erotic state, she was not happy and elated, hut, 
 fearful of herself, was compensating and combative. When the 
 truly aggressive homosexual female becomes erotic, she tries to get 
 in touch with women and endeavors to exhibit herself, and must 
 therefore be closely guarded and watched to prevent her from 
 making sexual assaults, like one case, who, while in an erotic aban- 
 donment, tried to rape her woman-physician. Another homosex- 
 ually aggressive woman who confessed to having repeatedly "made 
 love" to a married woman, performing cunnilingus, when admit- 
 ted to the hospital, because of a state of helpless apathy follow- 
 ing the death of her paramour, was quite willing to be examined 
 and had to be watched constantly to prevent her from establishing 
 herself with the younger women. 
 
 The^ fearful patient never shows happiness and joy, and the 
 happy patient is never fearful The physician must learn to dif- 
 ferentiate the pseudo-happy, who betray themselves by their tense- 
 ness and the ease unth which they are offended, from the truly 
 happy, who are delightful patients even though mischievous. 
 
MANIC-DEPRESSIVE PSYCHOSES 409 
 
 The following stern type of threatening pronunciamento is- 
 sued to the world always means a counter attack to protect the self 
 from a repressed fear, which, in turn, subsides as the erotic crav- 
 ings for perverse submissions subside : 
 
 "September, October, November, 1915. 
 
 "I am the Acknowledged Lord God Almighty, The Supreme 
 Ruler of the Universe. I am The First Attending Physician of" 
 * * * * [her name] . This was followed by a long series of re- 
 peated claims of power and conjugal relations Avith kings and 
 other prominent men to keep from recognizing her affections for 
 women. By being her own "attending physician" she could re- 
 fuse the examinations of the women physicians. 
 
 This mechanism of manic compensatory striving is also found 
 in men. 
 
 Case MD-10 was a passenger steamship captain who failed as 
 a skipper soon after changing command from a freighter to a pas- 
 senger boat. He was forced to resign, and promptly developed 
 a compensatory manic psychosis in which he finally transcended 
 to grandly potent heights, became God, tried to produce and quiet 
 storms, was a king and made dukes and princes out of his at- 
 tendants and a castle out of his hospital. He constantly displayed 
 his physical power and tried to bluff everybody. He became de- 
 structive, uncontrollable, noisy, had flight of ideas, and was filthy 
 and erotic. After several months, he became fixed upon a grand 
 attitude, and since then, for four years, has poured out, in a clas- 
 sical flight of ideas, an almost incessant pronunciamento to God 
 and the people. 
 
 With hoarse voice, bedraggled appearance and haggard coun- 
 tenance, he looks upward, towards the right, and talks almost in- 
 cessantly. This man's behavior was distinctly a compensation 
 for fear of his cravings, and, thoiigh witty and inclined to laugh, 
 he was not truly happy, but was trying to hide a disappointment. 
 He does not like to be touched by men. 
 
 The following case (MD-11) thoroughly demonstrated the com- 
 pensatory value of uncontrolled (manic) religious striving in its 
 relation to the inferior, homosexual erotic craving. His behavior 
 also showed the influence of the two great, constant, affective 
 trends of the personality, the sexual and social, as they struggled 
 with each other to control the man's behavior. His reaction to 
 
410 PSYCHOPATHOLOGY 
 
 men, {fear), was considerably less than in the sea paptain and yet 
 it Avas quite an evident influence in his behavior. His joy was not 
 unrestrained, as in the case following this one, and it was evident 
 that he could not freely associate with men because of the fear 
 of becoming overtly erotic when too closely approached by them. 
 
 No little controversy has arisen since Bleuler's article on 
 Schizophrenia over the ambivalent value of an individual's fancies. 
 It seems that they are the accepted resultant of opposing wishes 
 ajid must, .more or less, satisfy both of the antagonistic cravings ; 
 as -the. relative vigor of different affective cravings changes, the 
 fancies and symbols are changed by the affect. 
 
 This patient (CaseMD-11) shows the ambivalent value of 
 symbols and the value of the religious method in combating eroti- 
 cism. His eroticism seemed to have acquisitive interests in an 
 enormous variety of objects, and, to protect himself, he cultivated 
 interests in a large variety of oppo sites. 
 
 His personal history up to the time of his psychosis shows 
 an inability to control his affective cravings. He had one sister 
 who was "hysterical at times." His parents said he was a 
 "bright," "good" boy and learned very well in school although 
 he quit at fifteen because of a conflict with his teacher. He worked 
 at numerous jobs and finally ran away from home, wandering 
 through the West doing odd jobs: 
 
 At nineteen, he enlisted in the U. S.' Army and eventually was 
 courtmartialed for selling two rented "Royal" typewriters. He 
 seemed to fancy the name "Royal." After two years in prison he 
 was discharged. 
 
 While he lived in California, and during his stay in a Cali- 
 fornia prison, he was considerably influenced by an itinerant mis- 
 sionary and his wife, who, judging from their letters, were inclined 
 to fanatical flights of evangelism. ' The patient was very suggesti- 
 ble, self satisfied, easily excited and' inclined to be seclusive. 
 
 A few months after his discharge (at twenty-four) he enlisted 
 in the Marine Corps and four months later was sent to St. Eliza- 
 beths Hospital. 
 
 His psychosis began rather suddenly and its general nature 
 continued while in this hospital. He had some feelings of being 
 persecuted by a corporal. Soon after his admission he had to be 
 isolated because of his tendency to interfere with everyone and 
 
MANIC-DEPRESSIVE PSYCHOSES 411 
 
 upset the routine of the Avard service, furniture, etc. He was vir- 
 tually in a chronic state of ecstasy which lasted about four months 
 and gradually shaded off into an attitude of ecstatic letter writing 
 and mischievousness. About the tenth or eleventh month he 
 quieted down sufficiently to be paroled. 
 
 Unfortunately he could not be induced to review the material 
 of his psychosis and was inclined to excuse himself Avitli the admis- 
 sion that he had been "very lively." Mentally, he was quite clear 
 and capable of doing the intelligence tests whenever he tried. 
 
 The preeminent traits of his psychosis are given in the follow- 
 ing rather detailed account to illustrate the strong autoerotic and 
 anal erotic cravings which the patient had, and the numerous de- 
 tails in which they were showm. 
 
 In the room in which he was isolated was a dark grey woolen 
 blanket and a sheet. He tore the dark blanket into shreds, saying 
 all dark or black things belonged to the devil. He pointed to the 
 shreds Avith triumphant glee. Although it was rather cold and 
 snowing, he had destroyed the warm blanket and wrapped himself 
 up in the sheet. He wore white underwear, and the sheet as a cas- 
 sock. When I entered he was pounding on the window guard and 
 shouting something about the "beautiful white snoir." 
 
 (From the start he classified almost everything on either the 
 deA''il's side or God's side and counted the devil's things with his 
 left hand and God's with his right. Only a few examples can be 
 given here. White objects belonged to God and black things be- 
 longed to the devil, and his incessant industry in gathering and 
 classifjdng such things throughout his excitement indicated the 
 vigor of the affective forces that he was trying to control.) 
 
 God was "first and last and last and first." With this he 
 pounded on the shutters and stepped from one side of the windows 
 to the other and explained that there were two parts to the window 
 and two parts to the first and last. He noticed m}^ head and play- 
 fully^ shouted: "You have a bald place on one side of your head 
 and one on the other, that is two." "There are tiro, North Amer- 
 ica and South America, wliich haA-e ])ocn cut in tAvo. There are 
 three countries in North America, Canada, United States and 
 Mexico, but the United States is in betAveen, so there are two 
 not three." He told of stealing two "gold" dragons and the tA\^o 
 "Royal" typeAvriters. The gold dragons, he said, lie took home 
 
412 PSYCHOPATHOLOGY 
 
 to look at because they represented the devil and he wanted to 
 show that he was not ashamed to look them in the face. (This 
 occurred when he was abont nineteen or twenty.) When younger 
 he wrote "two black hand" letters to "millionaires" to get 
 money. He spoke repeatedly of "two not three" and always tried 
 to change things like the three countries in North America to two 
 in order to get "two not three." The reason for this he explained 
 in the interview. 
 
 The wonders of two were further elaborated in the Son and 
 Holy Ghost, two testicles, man and woman; and "three" often 
 was associated Avith "three in one," "God the Father, God the Son 
 and God the Holy Ghost," "three in one oil," "two testicles and 
 one made three in one, and if that was piit into a man it made 
 three in one." 
 
 He related a parable. "God sent down the rain to make the 
 grass green and the cattle ate the grass. This was converted into 
 beautiful, ivTute milk and people drank the milk. But why do they 
 raise hlach umbrellas when it rains, isn't that funny? Can you 
 explain it? The people drink this nice, white milk [spoken with 
 great ecstacy] and kill the cattle and eat them. Then God turns 
 this into semen and man puts this semen into woman and they bear 
 children. Man and womaii, that is two. But the devil tried to 
 make the man put the semen into another man's mouth or his — 
 [would not say anus]. That is three in one." (When I entered 
 the room I noticed a cluster of fecal spots on the corner of the 
 sheet. They had been made bv the patient covering his finger Avith 
 the sheet and thrusting the finsrer into his anus. There were no 
 feces in the room. He slyly tried to hide this sign of his anal 
 eroticism shortly after I entered.) 
 
 The above parable, which this ecstatic prophet related, proved 
 to contain the secret of his behavior. He was extremely anal erotic 
 — and autoerotie, and was "fighting the devil," his eroticism. 
 
 (Why he wanted everything white and not black (pure and 
 not erotic) and "two not three" (female and not male) was now 
 obviously because his anal erotic cravings were forcing him to seek 
 submission to pederasty. The above data were gained by taking 
 the trouble to spend an hour or so with him and encouraging him 
 to talk about whatever he pleased in order to get at his own story 
 of his troubles.) 
 
 A few days later, he demanded a Bible with a "Avhite cover" 
 
MANIC-DEPRESSIVE PSYCHOSES 
 
 413 
 
 and a "white sailor's suit." He would not wear the black stock- 
 ings or black slippers and iisnally tried to put both hlacJc slippers 
 on his left foot. He usually sat with his right leg crossed over his 
 left and\ said he kept "the devil" under his left foot. 
 
 His stories of his struggles with the devil included several 
 experiences in childhood. When he was a boy he saw the devil wha 
 
 Fig. 50. — This man struggled for years witli an uncontrollable eroticism and 
 finally effected this solution. Dressed in white (purity) with his hands gloved in 
 white, he is a prophet of the Lord and talks his new religious system to all who will 
 listen. 
 
 was a "great black man," (probably a negro), and frightened, he 
 ran to his mother for protection. She told him to raise his right 
 hand to God and God protected him. "Whenever he raised his 
 right hand the devil could not harm him. The devil had followed 
 him all his life. When at home "a little nigger, who was a slick, 
 little devil, just worshipped me and followed me everyv\^here. He 
 
414 rs Y C HOPATHOI.OGY 
 
 used to slap me on the back and ask me when I was going to give 
 him some." (EeferrM to perversions.) 
 
 "Black cats and black dogs often ran in front of or behind 
 me and were devils in disguise * * * The North fought the 
 South to get rid ol the black, ' ' and when he was stationed in Nor- 
 folk he was harassed liy negi'oes. With unrestricted expres- 
 sions of glee he told of how he beat the brains out of a bla,ck snake 
 when he was a boy. For some time he would go through mystic 
 movements to keep the crows from coming to the ground. Later 
 on he spent hours wa-tching the crows and blackbirds and tried 
 to remove a woman's black furs. He explained that if the devil 
 got him he would be ruined, but he had saved himself by his un- 
 bounded religious zeal. This sort of behavior continued for about 
 four months. 
 
 Another physician relates the following experiences with the 
 patient. The patient stated that during his boyhood days there 
 was a colored (black) boy who had a rather bad reputation for 
 engaging in fights and he tried to stab the patient in the back, and 
 while in California, a colored (black) boy tried to get the patient 
 to commit sodomistic acts ("stab in back" and sodomy are often 
 equivalent). When questioned about having done this, the patient 
 inunediately opened the Bible, which he always carried with him, 
 and started reading. He refused to discuss the subject directly, 
 but began a detailed account of the destruction of Sodom and the 
 transformation of Lot's wife into a pillar of salt. 
 
 He said that he came from God and was speaking the voice 
 of God, and later in the psychosis he became the Christ and his 
 family became a "wonderful" family. 
 
 fie had to be watched constantly to keep from removing his 
 clothing and running nude aboiat the ward. He spelled most of 
 the words he used by counting each letter 9f the word with a 
 touch of the finger to the thumb and numbered each letter accord- 
 ing to its respective place in the alphabet, such as A-1, B-2, M-13, 
 X-24, etc. (He had started his letter coimting interests before his 
 admission and later was considerably influenced but outdone by 
 Case CD-8. 
 
 Two days before I saw the patient he told another physician 
 (counting the letters on his right hand) that "smart, white and 
 angel" (five letters each) were God's words and (counting the 
 five letters on the left hand) that "crazy, black and devil" were the 
 
JIAN'IC-DKPKKSSIVK I'SVCM I ( )SI':S 41') 
 
 devil's words. "Wondering'' had nine letters, "three three's," 
 the first three were God the Father, Son and Holy Ghost, and the 
 second three meant ' ' a quail and two cuckoos, ' ' Avhich means ' ' the 
 penis and two testicles." This shoM^ed that God made man and 
 breathed the breath of life into him and the l)reath of life was the 
 semen. The third three were the red, Avhite and blue of the IT. S. 
 flag. (At this point in his ecstatic explanations he began to re- 
 move his clothing in his erotic excitement. ) 
 
 The following are abstracts of a stenogram taken one week af- 
 ter his admission: "There's God — three little simple letters — ■ 
 that's G-O-D [ecstatically counts letters on right hand]. The 
 devil says if you have your J-E-S-U-S, I will have my D-E-V-I-L. 
 And God loves the beautiful birds in the Heavens that fly above. 
 There's Q-U-A-I-L [counts on the right hand]. Well — the devil 
 says, if you have your quail that whistles [whistled Bob White four 
 times] in the lone, beautiful woods of nature, I Avill have my quail 
 too — that's Q-U-A-I-L [counts on the left hand] — that's sodomy, 
 sodomy, sodomy. [He often referred to the penis as "quail"]. 
 You remember when Sodom was destroyed 1 Sodom was destroyed 
 by fire and Lot and his wife and two daughters, three of them al- 
 together, were fleeing. God said : ' When you flee from that city, ' 
 he said, 'don't look back,' [back, anal interests]. Lot's wife looked 
 back and she became a pillar of salt, she became white, w-h-i-t-e, 
 and salt, s-a-l-t. That 2-2 is what f And the devil says if you have 
 your sugar, s-u-g-a-r, which is w-h-i-t-e, I will have my side, which 
 is b-1-a-c-k. The devil fights against the white before every side 
 you take. If you have your little red bird, he says I will have my 
 red birds too. The red birds means whores — red-light district. 
 li-E-D and I will ha^'e a b-a-t. ' ' 
 
 His fascination in counting letters had no limit and the lively 
 persistence of the tendency, like all such compulsive activities, 
 showed the tremendous affective pressure behind it. 
 
 Upon one occasion he started an interview with a brief dis- 
 cussion of hands and later returned to it throwing considerable 
 light on the compulsion to associate his left hand with the devil 
 and eroticism, and his right hand with God and religion. 
 
 "Does God give us these hands for nothing? God gave us 
 these hands. You see it takes these hands to do the work of the 
 brain. It takes these haiids to build buildings. It takes these 
 hands to put on our clothes. Isn't that right? Everything comes 
 
416- PSYCHOPATHOLOGY 
 
 right through my hcmds. If my hands were cut off I don't know 
 wiiat I could do * * * You can't make no children throughly our 
 hands; you have to [hesitates] that one has to go into one." 
 
 (A similar interest in counting was complained of by another 
 patient who said that he was compelled to count everything,- such 
 as houses, windows^ trees, words on a page, periods on a page, pic- 
 tures on the wall, etc., and this followed his fascihatidhfor count- 
 ing the movements of his hand when masturbating. The palielrt' 
 (MD-11 ) found an A in the lines of his hands which meant A stood 
 for Almighty. (The negro (P-1) heterosexually impotent, made 
 a perpetual motion machine and suspended the apparatus from 
 a wooden hand, which, he said, created everytfeliig. This might 
 be equivalent to saying, everything runs through the hands.) 
 
 The association of "everything comes right through my 
 hands" and "you can't make no children through your hands" 
 indicates the erotic fascination for his hands which he had to 
 struggle with. Like the "three in one" interests and the promis- 
 cuous numbering, all go back to autoerotic interests in the male 
 genitalia, masturbation, and anal eroticism. Oral erotic inter- 
 ests were shown in the phrase the ^ ' semen is the breath of life ' ' 
 fa phrase used by several patients who swallowed their semen to 
 restore "the breath of life" while in that peculiar state of erotic 
 "dying" (Case PN-6). 
 
 As to whether this man hallucinated or not is questionable. 
 He never formed systematic delusions about anyone, but frequently 
 attacked men whom he felt to have carnal influences over him. 
 
 He reconstructed his family into a holy family, his father be- 
 came God, and he and his brother became Jesus and the Savior. 
 He wrote numerous letters about this and drew fanciful signs of 
 crosses, with the word God and his name together. His fancies 
 about being with God ran as follows : 
 
 He said he had been downstairs and picked up two pieces of 
 ice. He put one down the back of his neck and dropped the other 
 on the floor. This piece broke into four pieces. The fourth piece 
 meant "the coming forth of Christ." The piece put down the back 
 of his neck meant that Christ carried the Cross on his back. 
 
 His divine potency was often revealed in fancies like the fol- 
 lowing: His father used to cut switches from a peach tree and 
 whip him. He laughingly said this tree died. Then his father 
 cut switches from a little pear tree and this tree also died. "Then 
 
MAjSriC-DEPKESSIVK J'SVCIIOSHS 417 
 
 lie cut switches from a large pear tree and I cut the top out of this 
 tree and it became loaded with pears." (Laughed.) 
 
 Last year there was a great drought. "I went to tlie Pacific 
 Coast and when I returned to the ^Middle AVest the rain just poui'ed 
 down. [Laughed.] And this rain produced much gi-ain and 
 fruit." 
 
 "j\[y brother jumped off a hmiber pile which i-epresented a 
 tree top, and hurt his left foot. Now he steps over his left foot 
 with his right A\hen he walks. He is a tailor now and an awful 
 good seAver." He explains this story as follows: "God is repre- 
 sented by a tree — is a tree — makes the trees. My brother steps 
 over the left foot with his right. The left is evil, the right means 
 good. My brother is a fine sewer. Did not Grod 'seAv' the grain?" 
 The experiences Avith his brother's foot probably cnndilioved the 
 mannerism of placing the right foot on the left when sitting. 
 
 Several Aveeks later, Avhen he attended the clinic,- he stepped 
 upon the stage, and, picking up a glass of Avater, drank some and 
 then poured a few drops on the center, large chair, then a fcAv 
 drops on the right chair, and last, a fcAv on the left. He then 
 pinned a "gold" (brass) pin on the right side of the middle chair. 
 
 He looked into the Bible for tlie "second chapter of the Acts," 
 in Avhich he said reference Avas mado to the second coming of 
 Christ (himself). 
 
 To prove that he Avas the Son of God, he asked the people to 
 let him shoAv hoAv he could "driA-e steel through flesh Avithont 
 hurt." To demonstrate this, he Avould permit needles to be jabbed 
 into his tongue or skin Avithout Avincing. "Christ made the Ncav 
 Testament, the Son. I am the brother to the Christ. Christ is 
 brother to me — tAvo in one, and three in tAvo, and one in three." 
 He and his crippled brother, to Avhom he Avas deeply attached, 
 were Jesus and SaA^or together. 
 
 He was the "Star of the East" and fondly signed his aggran- 
 dized Christian name as folloAvs : 
 
 N E LI A N 
 NaAw-Prison-Royal-]\Iarines-^\.]raighty-Xavy 
 
 (No pris-) Armies 
 
 (on. ) 
 
 The first letters of tlie Avords spell XPRMAN and refer to 
 important experiences decreed liy divine fate. 
 
418 PSYCHOPATHOLOGY 
 
 He was never, in a true panic, but inclined to iight and dom- 
 ineer. He expressed no delusions about his food and gained 
 ■weight. Gradually, after the fourth month, his ecstasy abated, 
 and he swung back to his normal interests, but was not inclinepl to 
 discuss them. After sixteen months, he was discharged as recov- 
 ered sufficiently to take care of himself. Although he was very ap- 
 preciative for his recovery, his refusal to study his sexual life and 
 the psychosis, and the fact that it had no reconstructive value, in- 
 clined us to expect that similar episodes would recur. 
 
 The large number of symbols for the erotic cravings asso- 
 ciated with symbols for the religious social interests are so simple 
 they need no discussion. 
 
 Since this case record was prepared for publication, this pa- 
 tient has been readmitted (thirty-one months- after discharge). 
 His general attitude of suspiciousness and smiling, egotistical self- 
 confidence, and his eccentric convictions, are unchanged. While 
 serving with the American Expeditionary Forces in France, he 
 was arrested for refusal to salute when the casket bearing a line 
 officer passed in funeral procession. Confinement in a guard house 
 was followed by an erratic counter attack upon military authority, 
 and desertion. His arrest was followed by a manic episode which 
 lasted about three months. 
 
 Because of the tenseness and combativeness of the above pa- 
 tient, besides his sensitiveness and inaccessibility, further com- 
 pensatory erotic strivings are to be expected. 
 
 In his autoanal eroticism he did not renounce all self-control 
 with quite the abandon of the follomng case. 
 
 Case MD-12, a Costa Rican boy, eighteen years of age, also 
 claimed to be God, and tried to destroy everything and remake 
 it into something more pleasing, as a compensatory reaction to his 
 eroticism and the additional stress of making himself comfortable 
 in a strange land. He was never threatening, did not avoid touch- 
 ing men, but rather persisted in having his arms affectionately 
 about someone, laughed rapturously, and claimed the whole world 
 was his. 
 
 For two months, he abandoned himself to an analerotic and 
 masturbation orgy. Nude, he laughed, sang, shouted, destroyed 
 everything in his room, beckoned for homosexual play to the male 
 nurses and physicians, dressed himself in shreds of blankets like 
 a savage, painted the walls, floor, his face, and body with excreta. 
 
MANIC-DEPRESSIVE PSYCHOSES 419 
 
 ate his excreta, and with his thumb in his rectum he shouted with 
 glee that he was God and the whole world. When asked who his 
 father was,- he shouted, laughing at his wit, ' ' I am no father, I am 
 everything!" With his finger in his rectum, like the serpent swal- 
 lowing its tail, he became a complete biological universe in him- 
 self. 
 
 Incessantly active, going at a terrific rate, he lost weight de-' 
 spite a ravenous appetite — the appetite is an indication that fear 
 is not active in the psychosis. 
 
 By the fourth month, the eroticism had subsided and he made 
 an excellent recovery without signs of depression. This : boy was 
 allowed to go the limit, and quickly recovered, whereas, had he 
 been moralized, bound down, scolded and hampered, he might 
 never have been able to regain control of himself. 
 
 The importance of fear of the influence of the erotic cravings 
 as the cause of the manic compensation must be recognized, be- 
 cause such cases are to be quite differently treated. Intelligent 
 efforts have to be. made to win the patient's confidence in order 
 that he will recognize what he is fearful of, whereas the happy, in- 
 dulgent erotic is best semi-isolated and left to do as he pleases. 
 
 A man of refinement and extensive business experience, who 
 was in a wild, combative, noisy (manic) state, naked in his room, 
 with a"'^'dead line" drawn on the floor, defied all his attendants 
 and physicians to. approach. They were trying to induce him to 
 submit to a hypodermic injection. Cursing and raging and sweat- 
 ing, he paced the floor like a raving tiger at bay. The physician 
 in charge of the case considered it to be a manic excitement; think- 
 ing of the patient in Kraepelinian terms he scoffed at the idea that 
 the man was fearful of an assault. 
 
 This attitude continued more or less vigorously for several 
 days, until a little common sense and patience won the man's confi- 
 dence, whereupon his attention was successfully directed to the 
 fact that he had been in a rage because he was frightened, and then 
 to what was causing his fear. 
 
 It seemed that the mere recognition of the fact that the cause 
 of his fear was within himself, besides the transference to the 
 physician, helped him to adjust himself within a few days. He 
 soon showed confidence in his treatment. 
 
 The happy, elated, erotic flight gives far better results ivhen 
 the patient is alloived absolutely free play in order that all his af- 
 
420 PSVCirOPAT]IOLOGY 
 
 fective cravings may satisfy themselves, even at any cost to Man- 
 kets and extra cleaning of floors and walls. 
 
 In business, nothing can be done with a man until you allay 
 his foars and -win his confidence. The same applies to the psycho- 
 path. 
 
 Restatement 
 
 There are two distinct types of regression or depression psy- 
 choses, and tivo distitict types of conipeusation or manic psy- 
 choses. The distinctive difference in the mechanisms is the affec- 
 tive complication of fear which is absent in one type and an 
 important factor in the other type. The type of psycliosis which 
 is free from fear usually runs the shortest course, is less severe in 
 its physiological stresses, is less complicated, and, since it does 
 not distort the affective functions, it offers a better prognosis. 
 
 The complication of fear, when it occurs in the manic state, 
 is shown by the patient's distrust of the treatment, aloofness to 
 personal contact, eccentric or diminished appetite, and extrava- 
 gant claims and demonstrations of power (for defense) ; whereas 
 in the depressed, -anxious patient, almost every unknown thing' in 
 the environment causes fear of inquiry or seduction. On the other 
 hand, the psychotic who is not afraid, delights in being touched, 
 loves attention, has a good appetite, and A\'ill recover from the af- 
 fective dissociation so soon as the uncontrollable craving is satis- 
 fied and temptations to live a constructive social life are sufficient 
 to induce sublimating. 
 
 Throughout the cases to be presented one consistent fact is 
 present: the individual resorts to almost any limit of behavior or 
 self -mutilation to control the content of consciousness. The des- 
 perate extent to which such struggles may be carried will be seen 
 to be the most stril^ing feature of the paranoid type. 
 
 In the preceding group of cases the patients were quite well 
 aware of the wishfulfiUing value of the psychosis and as such the 
 cases were benign in type. 
 
CHAPTER IX 
 
 THE psvchopath:ology of paranoia 
 
 As Pernicious Repression Compensation Neurosis; the Particular 
 Nature of Its Biological Inferiority and the Eccentric Com- 
 pensatory Struggle to Develop Virility and Win Social 
 Esteem. 
 
 In the chapter on the struggle for viriUti/, (/oodiiess and hap- 
 piness, the tendency to consider sexual siibmissiveness and de- 
 pendence as an inferiority A\'as shown to have its origin as far back 
 in the phylogenetic scale as the higher monkeys. This indicates 
 hoAv, long ago, the ancestors of the genus Hudio fought and strove 
 to develop the state of virility. In man the feeling that sexual 
 perverseness is an intolerable functional inferiority is more or less 
 prevalent throughout the world but most so among' the Caucasians. 
 
 Whenever two individuals compete for social influence, the 
 superior organs and functions of one individual emphasize the in- 
 ferior attributes of the other. The sjiecies, race, or clan tends to 
 support the organically and functionally superior individual, and 
 tends to neglect the inferior rival because tlic superior, most 
 often, promises the gratification of society's needs. This is prob- 
 ably due to the reproductive interests of the species, because only 
 through maintaining to the utmost the biological potency of Iwtli 
 sexes is its future secure. It is obvious that this attribute is per- 
 petuated through inherent transmission liy the individuals of the 
 species which best meet the struggle. This tendency to conserva- 
 tion of useful attributes is expressed in the form of dread and 
 liafred, among the. more civilized peoples, for all tendencies to 
 incest, masturbation, perversion or biological waste. Therefore, 
 the individual 'who, liecause of the ]^eculiar nature of bis organic 
 constitution or the conditionutg of his affective cravings, can 
 only obtain autonomic-affective potency and comfort through 
 some perverse indulgence, or who is only potent when invigor- 
 ated l)y some pervei-se stimulus, is sti-ongly, unshakably felt to be 
 
 421 
 
422 PSYCHOPATHOLOGY 
 
 inferior, and he himself can not escape the feeling of being racially- 
 inferior. 
 
 The feeling of being inferior seems to be ineradicable so long 
 as a potentially uncontrollable tendency to vary from the biolog- 
 ical demands of the race exists within the personality. The psy- 
 chosis varies according to the manner of the individual's efforts, 
 to free himself or herself of the inferiority, and the manner in 
 which he strives to compensate in order to attain sexual potency 
 and social esteem. The efforts to compensate vary according to 
 the life long influence of the individual's associates. Many sexu- 
 ally abnormal and organically inferior individuals are quite com- 
 fortable so long as they associate Avith similar types of people and 
 avoid competing with sexually normal people. 
 
 The painful influence of organic inferiorities, such as being 
 hairless, effeminate, soprano voiced, sexually undersized in males, 
 in the struggle for social esteem and personal influence is obvious 
 to any sophisticated adult. In this chapter organically normal 
 but affectively inferior types will be given most consideration, be- 
 cause it is obvious that the organically inferior, if also affectively 
 inferior, must have a more severe struggle. 
 
 The nature of the sexual inferiority and mechanism of com- 
 pensation is brought out in each case. It may be" well to add that 
 the convictions expressed herein are not based solely upon the 
 cases which are presented, but upon the examination and intimate 
 study of nearly two thousand males and females, of nearly every 
 educational level and vocational interest, and from most of the 
 races that immigrate to this country. The nature of the individ- 
 ual 's inferiority and manner of compensating has also been inves- 
 tigated in the various developmental stages from infancy to senil- 
 ity, under quite an extensive variety of social influences. 
 
 The paranoiac, who crystallized the converging data which 
 were rapidly accumulating, will be presented ' first, because his 
 "perpetual motion" machine symbolizes and reveals' his functional 
 inferiority and the protective compensation in one creation. To 
 this case are added the remarkably similar, but more tragic, strug- 
 gle of another ignorant negro, and the strivings of an American 
 college graduate, and an American sailor. 
 
 Because of the variations this inferiority may assume, it is 
 necessary to follow these cases with a comprehensive variety of 
 cases so that the physician and psychologist may learn to know 
 
PSYCHOPATHOLOGY OF PAKANOIA 423 
 
 what the eccentric variations may mean after he has learned to 
 recognize them in his practice. 
 
 This patient (P-1), noAv in St. Elizabeths Hospital, is a tall, 
 slender, rather clever, bnt imedncated, light skinned negro, abont 
 forty-one years of age. He has an effeminate, conciliatory man- 
 ner of speaking. There is no history of insanity in his ances- 
 try. His education consisted of sfeveral years, each of a few 
 months, in a country school, and what information he was able 
 to acquire from newspapers, current magazines, the Bible and a 
 few books. 
 
 Gonorrhea was the only serious disease he acquired after he 
 became an adult. 
 
 "When the patient was twenty, his father, Avho was a minister, 
 died, and it devolved upon him to raise his 3''ounger sisters with 
 his mother. He talked of this work with considerable pride, and its 
 influence formed an important part of the material of his psycho- 
 sis. (He believed that he had successfully raised his father's 
 children, that they had married happily, and in his psychosis he 
 felt that he could elevate the negro race out of its lowly social 
 position.) 
 
 At the age of twenty-five he married a very light mulatto of 
 nineteen. The negro traits Avere so little in evidence that she 
 could have easily passed as a Caucasian. She was a bright, ener- 
 getic woman, inclined to accommodate herself to all of her hus- 
 band's dominations. "I had to obey him as if I was a child," she 
 said. She had two miscarriages during the early years of their 
 marriage. Aside from this, she never Avas pregnant. 
 
 His work, after his marriage, was mostly that of doing odd 
 jobs until several years ago when he became the janitor of a thea- 
 tre. His employer, who Avas a Jcav, became an important figure in 
 his psychosis. 
 
 He only occasionally drank liquors until about one year before 
 his first, admission. During this last year, he drank excessively, 
 and, because of his inefficiency, lost his position as janitor. 
 
 As a personality, during the early years of his marriage, he 
 was kindly disposed and rather suggestible, but suspicious and 
 inclined to be jealous. He was a good provider, but a poor saver. 
 He had no close friends of his OAvn sex. His wife said "he Avould 
 turn on the men" when they came to Adsit him in his home. When 
 drinking, he associated with men. He was always jealous of his 
 
424 PSYCHOPATH OLOGY 
 
 Avife, and objected to the least attention she gave men. Years 
 after the incident occurred, he denounced her for giving his 
 brother a kiss of welcome Avhen he came to their house for a visit. 
 This jealousy became more marked in the last two years, and fre- 
 quently Avhile drunk he abused and struck his wife. 
 
 During the years in Avhich he so jealously watched his wife 
 to prevent her from being unfaithful, he secretly visited other 
 Avomen. 
 
 The onset of his troubles, the patient says, occurred suddenly. 
 But, this complaint dates about a Aveek after he had completed his 
 "tabernacle." lie says it began Avhile he Avas trying to have in- 
 tercourse Avith his Avife; lie felt a "live substance" Avithin his 
 Avife. It AA^as "a man child" and "snatched" his penis and "bent 
 it" and took his "poAver" from him; but the latter was due, ho 
 added, to his "run-doA\m condition." A feAV minutes later, "vi- 
 sions came." He saAv that his Avife had been AA-ith a man, his former 
 employer (the JeAv), and he accused her of it. Because of his ex- 
 citement at this time he had to be sent to a city hospital. 
 
 Among his visions, about Avhich he AA-as at first extremely cau- 
 tious, he saAv a snake on a square rock aiid killed it l:)y throwdng 
 a stone at it, and (Avith emphasis) he "cut its head clean off." 
 (Destruction of sexual temptation.) Then smoke and fire came 
 out of it and the smoke frightened him as it floated upAvard around 
 him. 
 
 Unfortunately, an account of his behaAdor Avhile in the hos- 
 pital on this occasion is not obtainable, except that he was diffi- 
 cult to manage, had seA^eral fights, and resisted AA^hen baths Avere 
 administered to him. He Avas discharged after eight days upon his 
 promise of good behaAdor. He gradually became more egotistical 
 and dignified in manner, dressed in a ministerial garb, and 
 wore a broad black felt hat. He carried himself Avith an atti- 
 tude of exaggerated self-importance, was overbearing in contro- 
 versies, defiant, sensitive and dictatorial. He eanphasized his 
 discussions with quotations from the Bible and later developed 
 the habit of giving numerous references to books, chapters, 
 and verses of the Bible Avith an atmosphere of authority and 
 benevolent tolerance for anyone Avho appeared to be ignorant of 
 the meaning of his references. He impressed one as being ex- 
 tremely sensitive about something and yet Avell pleased Avith his 
 superiority and the grand compensation he had effected. 
 
PSYCHOPATHOLOGY OF PATtANOIA 42.") 
 
 lit' accused his ^vil'o of liavin"' soci-etly liad two illcf^itimatc 
 children while he was confined in the hospital the first time. One 
 child was black and he was the father of it, but the other was white 
 and the son of his Hebrew employer. These children Avere dis- 
 posed of secretly, but one Avas to become Jesus Christ. He kept 
 a record of his wife's time Avhile at work away from the house. 
 When she failed to return from her Avork at a certain hour, he ac- 
 cused her of infidelity and later he accused her of keeping secret 
 relations Avith her landlord, the President, etc. He often blamed 
 her for his oayu difficulties and repeated tliat she had taken all Ms- 
 powers from him by taking "the blood" out of him. This com- 
 plaint, at times, he Avordcd differently, stating that AA'hen he had 
 intercourse Avith her he came in contact A\'ith "something alive " 
 and that he "found strange blood" and this took his power. (For 
 a year or so before the sloAvly develoiiing paranoid attitude had 
 reached an asocial degree, he had become impotent — that is, could 
 not perform the sexual act satisfactorily to himself, and most of 
 the time not at all. This developed gradually and seemed to be 
 closely related to his irritability and increasing haughtiness.) His 
 wife states that he had ahvays been "very ciuick." She has main- 
 tained that no abnormal practices occurred. The history of the 
 patient's impotence Avas not obtained until the second admission. 
 He had completely coAved her into secrecy and made her promise 
 to reveal nothing about their sexual difficulties. 
 
 As a patient, he was defiant, arrogant and sensitive about dis- 
 cussing his personal difficulties, but upon encouragement he re- 
 vealed that he considered himself to 1)e a prophet, directed by God, 
 to teach the Gospel and build a model of the "tabernacle" Avhich 
 Avas also "perpetual motion." He intrenched himself in the Bible 
 and projected a chronic attaclf upon the immorality of the Gen- 
 tiles. The feAv ideas that he confided to us indicated that he had 
 elaborately systematized delusions about the practice of circum- 
 cision by the JeAA^s, Avhich seemed to have a profound significance 
 to him, and in the interim l)etween liis first and second admissions 
 he had himself circumcised. 
 
 He arrogantly insisted that no one had the right to ask him 
 about his affairs, and warned the examiner about the danger of 
 asking too many questions. 
 
 Like all paranoiacs, he consistently liated anyone Avho at- 
 
426 PSYGHOPATHOLOGY 
 
 tempted to question him about anything that might lead to infor- 
 mation about his deficiencies or errors, but promptly became fond 
 of anyone who would listen to his fancies about his potential deeds 
 of the future. For such unhappy, tense, striving individuals, 
 every hint of giving esteem or recognition of their efforts as a 
 social necessity to the herd is ravenously accepted. It seems to 
 relieve that profoundly fixed, unmodifiable feeling that they are 
 inferior to their fello~WTnen. 
 
 The only hallucinatory experiences admitted by the patient 
 were always consistently limited to that of having had a vision of 
 a serpent on a rock which he killed and which appeared again, and 
 the auditory experience of hearing God's voice tell him to build 
 "the first tabernacle." 
 
 He never expressed ideas of being hypnotized or under the 
 influence of anyone. He was, however, inclined to be uneasy at 
 night, but adroitly concealed this. He did not seem to worry 
 about having his food poisoned. While in the hospital, he tended 
 to isolate himself, and complained of being annoyed by the attend- 
 ants. He always carried his Bible and enjoyed being seen with 
 it. On the whole, he was easily managed if his wisdom and pro- 
 phetic knowledge were not questioned. 
 
 His fancies about being the prophet of a new religion, and 
 probably being a second Christ or Father of Christ were highly 
 elahorated and almost inexhaustible. Some of his arguments to 
 prove this were like the following: When he became guardian of 
 his father's minors he lost his father's pension certificate, and the 
 new pension certificate had for its last three numbers "666." 
 "This number can l^e found in the Bible, Revelations, 13th chapter, 
 18th verse." ("Here is msdom. Let him that understand et^i 
 count the number of the beast : for it is the number of the man ; 
 and his number is Six hundred threescore and six.") 
 
 He claimed the distinction of being the only man that had built 
 a correct model of the tabernacle, and that its dimensions had been 
 revealed to him by a young priest. He said his revelations were 
 inspirations to him, and he absolutely pinned his faith on God's 
 wisdom which was "different than man's wisdom." 
 
 This "tabernacle" was "the first church, perpetual motion," 
 which is "the force" that makes the world move, that mingles 
 the blood of the races, and referred to the mingling of the blood of 
 the white and black races. (One of his grandfathers was white. 
 
PSYCHOPATHOLOGY OF PARANOIA 427 
 
 his wife had well-marked Caucasian traits, and he believed" that a 
 Jew was the father of an illegitimate child by her.) His discus- 
 sions of this ^"sp-called tabernacle were difficult to follow. He 
 strongly maintained that he had no preconceived idea of what he 
 was doing, but was compelled to- build it according to ' ' revela- 
 tions." When he discussed this creation, he used the following 
 phrases: "Wisdom has built her foundations. She has builded 
 her seven pillars. She has mingled her urine. She has killed her 
 beasts — my father said, 'My son, I can not do that without re- 
 course to my mother.' " "My" was a misplacement for "your" 
 mother, and in this instance indicated Ms incestuous attachment. 
 
 During an examination, he showed a photograph of this ' ' tab- 
 ernacle," which he had taken for publication. The model is. shown 
 standing in a room, and on the Avail on the right side was hung a 
 large picture of his mother, and on the left, a similar type of pic- 
 ture of himself. (It should be noted that his "perpetual motion" 
 was placed between himself and his mother, and one should recall 
 the above error of "recourse to my mother.") 
 
 A detailed description of the machine which I had the oppor- 
 tunity to examine would be tedious, but the principal features of 
 its mechanism will be described here, because they revealed the 
 man's affective difficulties, what he unconsciously strived to at- 
 tain, and the machine's biological significance. In building what 
 was "revealed" to him, he unconsciously constructed and substi- 
 tuted an image of the very biological qualities that he had func- 
 tionally failed to develop. 
 
 In other words, this creation or "model," and his psychosis 
 was the goal of an aborted biological career, some of the deter- 
 minants of which had their sources in his early life, far deeper 
 than the levels of activity of which he would ever again likely be- 
 come aware. 
 
 The "model" (see Fig. 51) about 5 ft. high is constructed of 
 pine boards, pieces of boxes, cast-off spiral springs, a lamp oil 
 container, and other like material which he had gathered from va- 
 cant lots and alleys. It consists of two large compartments — name- 
 ly, a large square frame (A) upon which is erected a pyramidal 
 frame (B). From the apex of the interior of this pyramid is sus- 
 pended a "hand" or "arm" (1) which he whittled out of pine. To 
 this "hand" is attached a long, coiled spring (2) which holds up a 
 vessel (3) which was at one time the oil container of a lamp. The 
 
428 
 
 PSYCHOPATI-IOLOGY 
 
 Fig. 51. — Copulation, f eticli by impotent negro paranoiac. He said lie was in- 
 Kpired by God to build "the flrst church" -or "perpetual motion." A, pyramidal 
 frame; ,B, square frame; 1, hand; 2, long, coiled spring; 3, oil lamp; 4, sand bags; 
 5, horizontal board ; 6, bed spring; 7, lever; S, wlu-el; 9, "chorubs. " 
 
rSYC'Il()l'ATll()I.()(iV Ob' I'AIIANOIA 42!) 
 
 lower end of this y('ss(4 is attached to a horizontal lioard (5) and 
 this board rests upon two old l)ed springs (6). AVhen this board 
 (5) is pressed doAvn it stretohos the long spring alcove and com- 
 presses the l)ed springs underneatli ; lience it is bobbed u]) and down 
 for a short while from one jmsli oC the hand. To keep tiie inachiiie 
 at rest, he fancies that it is necessary to weight the board (5) with 
 two liags of sand (4) wliich he removes in order to operate the ma- 
 chine. 
 
 Several other springs are fastened to various parts of the 
 rcpiare frame, and they ccmtribute to tlie "perpetual motion." Two 
 other features of interest are the "four cherubs" (9) and the four 
 "wheels within wheels" (8) which are inside the square frame. 
 A cherub Avas made out of a broomstick with a hole bored through 
 the upper end. A piece of rope was passed through the hole and 
 both ends wound once in the same direction around the stick, and 
 then tied to th(> opposite ends of a horizontal board. The broom- 
 stick ran through a hole in the center of this board, and the board 
 itself is made to slide up and clown the stick liy the springs. Eais- 
 ing and lowering tlie board would slightly wind and unwind tlie 
 rope and cause the stick to bore slightly. The winding of the rope 
 was not mechanically correct to make tlie stick revolve, but the 
 attempt had the same value. He said he obtained the idea of the 
 "cherubs" when he was sixteen years old. A cousin taught him 
 how to bore holes in bricks. He commented : "I made up my mind 
 then that if perpetual motion ever came, it was to come that way." 
 He would give no inkling- of whei-c he had obtained the name 
 "cherub," but tried to give the impression that it was a revela- 
 tion (heavenly infant). 
 
 The mysterious "wheels within wheels" were solid, clumsy 
 structures of wood. The tA\o inner wheels were cross sections of a 
 barber's pole and still showed red and aluminum stripes. He 
 called these the "American Glory." The wheels were revolved 
 slightly by large levers (7) that were attached to the horizontal 
 board (5). 
 
 He pointed to the interior of the scpiare frame and remarked 
 that here "the blood of the world is mixed." When I asked to 
 be shoA\Ti more definitely where it occurred, he avoided an answei' 
 and smiled at my stupidity. 
 
 To return to the significant oil can suspended from the long 
 spring, he said that it was "the manna — it came to me to put sand 
 
430 PSYCHOPATI-IOLOGY 
 
 into it, ' ' and he told of his pleasure in watching the sand ran out 
 as the "perpetual motion" made the "manna" move up and doAvn. 
 He also spoke of the sand as the "manna." 
 
 When the picture of this "perpetual motion" machine with 
 the pictures of himself and mother was shown and described by 
 him, the diagnosis of heterosexual impotence with striving to com- 
 pensate was made, although the foregoing information about his 
 sexual life had not yet been, obtained because of his resistance. 
 Later the diagnosis proved to be correct. It was based upon the 
 following interpretation of the behavioristic symptoms which were 
 "inspired," that is, compelled by the affections in their struggle 
 to find a solution of their needs. 
 
 The "manna," which is a divinely given food in the Bible, he 
 made to pour out of the can as it moved up and doAvn, on the end 
 of the long spring, inside of the pyramidal space. This is sym- 
 bolic of the semen emitting from the glang penis while in the mo- 
 tions of copulation. He called the emission "manna" (holy or 
 divinely bestowed food), which reveals the unconscious pleasure 
 he derived from the crude symbolization of his nursling oral erotic 
 hunger. Several of iny cases treated their oral eroticism with 
 most fervent religious ecstasy. This is the grand compensation 
 for, a most serious biological inferiority. The constant pressure 
 of his homosexual cravings are the cause of a constant fear that 
 he might be considered a degenerate; hence, the eccentric striv- 
 ing to be acclaimed as great. The pyramidal frame in which the 
 "manna" etc. (penis) moves is the vagina, and the large square 
 frame beneath it, in which the "cherubs" and "wheels within 
 wheels" work and the "blood of the world is mingled," is the 
 uterus. The hand, which he spoke of as the power that made every- 
 thing, significantly holds the spring and the emitting can which sug- 
 gestively associates with masturbation. The "manna" and oral 
 erotic cravings recall Freud's grouping of the food hunger and the 
 earliest and most important zones for the soothing of love cravings 
 of the infant to be in the mouth. 
 
 The two bags of sand, which he placed on the machine as 
 weights to keep it quiet and removed in order that the machine 
 might run, were made with extra labor. When I asked why he 
 did not use bricks or stones as weights, he replied that he had to 
 make it as it was "revealed" to him. If one follows the lead from 
 sand in the container, then the sand in the bag becomes manna, or 
 
PSYCHOPATHOLOGY OF PARANOIA 431 
 
 semen, and the substitution value of two bags of sand as testicles 
 completes the generic significance of the "first tabernacle." 
 
 The patient would not accept this archaic model of his own 
 sexual functions in this light, because that would destroy his ritual 
 and compensation. He has enshrouded it with an atmosphere of 
 sanctified mystery. To remove this archaic mystery would deprive 
 him of all his means of defense, evasion and compensation.- So 
 long as the paranoiac deals with his sexual troubles in religious 
 terms, he may talk freely ; he may even, with the ignorant, develop 
 in them an attitude of awe which gives him at least a social sense 
 of potency as a personal influence. His wife believed in his pro- 
 phetic powers and the wonderful machine for some time. He hates 
 me for pointing out its sexual significance. 
 
 The defensive value of the paranoiac 's grand fancies may be 
 further illustrated in the case of a well-trained physician, who, 
 after several periods of excitement and panic, finally distorted, 
 in his effort to establish himself comfortably, everything he 
 heard or saw, in order to place himself in an awe-inspiring, om- 
 nipotent light. He called all the people about him Caesars, Cic- 
 eros, kings, philosophers, etc., and addressed them as such with 
 most gracious, princely bows and greetings to express his admira- 
 tion. But, in turn, he demanded to be recognized as Napoleon, and 
 dressed accordingly. He wrote a language, at immense cost of 
 time and labor, which he would have the world adopt. This lan- 
 guage would malie him the premier thinker of his time. He ac- 
 quired several magnets and induction coils with which he worked 
 by the hour to send telepathic messages and direct the affairs 
 of the world. These most extravagant efforts at establishing his 
 place in the sun really isolated him, because no one could se- 
 riously consider his fancies. To this he accommodated by simply 
 maintaining that his associates were too stupid to understand him. 
 Nevertheless, so long as he could keep himself believing that what 
 he upheld was reality, he was safe from his homosexual submission 
 cravings. 
 
 The above negro maintained that there were "two kinds of 
 wisdom," God's and Man's. The wisdom of Man was worldly 
 and did not understand the revelations. His wisdom was Ood's, 
 therefore, sv/perior to Man's. 
 
 That he was afraid of homosexual cravings is indicated by his 
 effeminate traits, and is supported by the fact that he had culti- 
 
432 rSYCTTOPATirOLOGY 
 
 vated no male friends, but rather, as his ^vif e put it, would turn 
 on a man so soon as they became friendly. His responses to his 
 male associates could not be endured when friendliness was too 
 freely shown. Always in tlie background of his mind lurked a 
 fear, a distrust of men, a subconscious fear of his own weakness. 
 The mental dissociation (hallucinations) and tendency to panic 
 depended upon the intenseness of the homosexual cravings. 
 
 When I saw "the model,''' he had it covered with, a white 
 (purity) cloth, and on it were tacked several large pieces of card- 
 board. One piece was the discarded cover of a writing pad on 
 which was printed in large type the words, "LEGAL CAP — EX- 
 TEA FINE." A newspaper abstract of Lincoln's Gettysburg 
 address and a long sheet of legal cap covered with written 
 quotations from the Bible were also tacked on the model. He dis- 
 played it with great pride, and explained its nature with consid- 
 erable tremor of the facial muscles (symptomatic of great affec- 
 tive pressure). 
 
 The air of profound religious mystery with which he on- 
 shrouded the whole effort had quite convinced his wife that her 
 Imsband had performed a wonderful deed. The great, amount of 
 noise and motion from so little effort was sufficient to itJiake her 
 believe in "the perpetual motion." But the religious fervor of 
 her husband was beyond her understanding, and she was inclined 
 to warn him against his overenthusiastic demonstrations. His 
 sincerity decidedly contradicted malingeriitg' or affectation. He 
 was desperately sincere in his efforts to become potent. 
 
 It is not surprising that his wife should have believed in his 
 sanity and the perpetual motion machine. After he had created 
 it and taken photographs to a newspaper, got an editorial on per- 
 petual motion, tried to have his machine patented, written numer- 
 ous wild letters to government officials, full of vulgar, perverse 
 phrases purporting to be religious, dressed like a minister, and 
 claimed himself to be a prophet inspired by God, a jury, in a trial 
 as to Ms sanity, gave as their verdict, that he ivas sane. 
 
 He believes that the last days of the Gentiles have come and 
 liis people are to be led into their rightful dues by him. 
 
 The perverse nature of his letters is best illustrated by one 
 which he wrote to the President denoimcing the American flag., 
 saying that it should be destroyed and the flag of a menstruating 
 
PSYCHOPATHOLOGY OP PARANOIA 433 
 
 woman substituted. (Since that letter, lie lias had no chance witli 
 a jury.) 
 
 Almost daily, he writes letters Avhich are filled with an inco- 
 herent collection of biblical references and phrases. He clips head- 
 lines of murders, scandals, abortions, thefts, embezzlements, etc., 
 from the ncAvspapers and marks them Avith biblical references 
 which, he seems to feel, prophesied the event. He adjusts to the 
 fact that he is not believed, by pointing out a biblical phrase about 
 the prophet not being heeded at first. His voluminous output of let- 
 ters and arguments serves one valuable purpose, in that, by con- 
 trolling the content of conscionsness Avitli such interests he does 
 not feel his sexual difficulties. He often Avrites on his letters: 
 "Were it not for the pleasant fields of Holy AVrit, I might de- 
 spair." His invention of "perpetual motion," he says, is finished, 
 and he refers to it as a final achievement, a goal which he has 
 reached. 
 
 Argmxient, persuasion, and reasoning have no influence with 
 him. He can not and Avill not forsake his fancies. He promptly 
 damned me when I advised him that work would be good for him. 
 
 This man became heterosexually impotent at a period closely 
 related to his systematization of delusions about his wife's infi- 
 delity. He has never been satisfactorily potent in the sense of hav- 
 ing the power to perform sexual intercourse Avith due affective 
 gratification, being capable only of ejaculatio prsecox. He is so 
 constituted in the reactions of his sexual reflexes as to feel vaguely 
 Avhat the normal biological goal should be, and his striAdngs to 
 reach this level are ceaseless. 
 
 Upon the other hand, his feminine manners of self-expression, 
 the shunning of friendly^ masculine associations, the tendency to 
 guard his room at night, the conviction that a "man child" in the 
 uterus of his wife destroyed his potency, and his thoroughgoing 
 pleasure in the disguised "manna" sjonbol, indicate a fairly well- 
 covered but pressing tendency to drop back to the biologically 
 more easily maintained submissive homosexual level. His hetero- 
 sexual possibilities are surely seriously inhibited because of their 
 conditioned specific requirements — namely, the mother. In pro- 
 portion to the limitations imposed by this fixed conditioning, the 
 possibilities for ever making a biologically satisfactory mating are 
 reduced to the barest possible accident. There are many colored 
 
434 PSYCHOPATHOLOGY 
 
 wpmen seeking mates, but very few are likely to meet the require- 
 ments of the necessary and too strictly limited prototype. The af- 
 fective determinants for this fixed condition of his reflex systems 
 can only he worked out through an analysis of his experiences with 
 his associates. 
 
 At present, he claims that he has become an apostle, must 
 gather about him 'tnany wives, establish a religion, and guide his 
 heavenly flock. 
 
 This negro's "perpetual motion" is only complete when pla- 
 carded with prophecies and religions writings and intimately 
 placed between himself and his mother. In its energizing, inspir- 
 ing effect upon him, it should be recognized as having the same 
 affective valne that the painting of Mona Lisa and her smile had 
 for Leonardo da Vinci. Freud's anafysis of da; Vinci's personal- 
 ity, showing that the yearning and mother fixation were consider- 
 ably gratified by the inspired painting of a certain type of smile, 
 clearly brought ont its significance to the creator. 
 
 That the inspired ' ' first tabernacle ' ' in which ' ' the blood of the 
 world is mixed," and whence all men and women are creatsd, 
 should be suspended from a hand,' is as poetical and remarkable 
 in its conception as Rodin's "Hand of God." A comparison of 
 the two figures shows the refinement in symbolic expression that 
 training, education and social influence exert iipon the creative 
 yearnings. 
 
 The inspirations of this negro, as striving to compensate for 
 grave biological malfunctions, lead directly into another group of 
 cases, who, as individuals compelled to make consecrated striv- 
 ings, feel themselves directed to come to the Nation's Capital. 
 
 A Chicago negro* (Case P-2), who had been arraigned before 
 the police court for carrying a dangerous knife and being "qneer" 
 and a "little off," was discharged by the conrt after a careless 
 mental examination. His neighbors recognized that he was a " re- 
 ligious fanatic," but regarded him as harmless. In January, 1915, 
 he mailed a letter io a " Prince Johannes L. Menelik, Adis abbeba 
 Abyssinia," which was returned unopened. It was an appeal that 
 Prince Menelik should recall the African people and teach them his 
 (this prophet's) religion. He said : "The traitors and betrayers of 
 the black race are black men and white wpmen." (A mixed pair 
 
 *This case is taken from a Chicago newspaper, in which the crime was featured in bljainug 
 headlines. 
 
PSYCHOPATHOLOGY OF PAEANOIA 435 
 
 lived next door to him.) He wrote numerous religious messages 
 on the walls and curtains of his house, such as "The Lord has 
 made me the Saviour of all Africans in America, and now I shall 
 recommend all that are worthy imto my Heavenly Father, the 
 Great God of all Creation. The Lord has given me the spirit to 
 judge the quick and the dead. 
 
 "I must die in this land, that I may carry my reports unto 
 Almighty God concerning the land of the United States. I am 
 the spirit of the Almighty God. ' ' 
 
 For about two years, the negro had been seclusive and deeply 
 interested in his religious strivings. He built a crude, wooden 
 model of nn electric generator and designed other contraptions, 
 such as switchboards, etc., which probably had a similar value to 
 Case P-l's perpetual motion machine. 
 
 The reference to the pernicious mixture of black men and 
 white women is also similar to the "place where the blood of the 
 world is mixed" and also the suspicions about the relations of his 
 wife and his employer. Both were religious prophets and deliver- 
 ers of their people. The electric generator, like the perpetual 
 motion machine, indicates that the cause of impotence which he 
 vras trying to overcome was also causing great anxiety. He col- 
 lected a rifle, shotgun, loaded mimerous shells with vicious slugs 
 and armed himself for an assault, Avhich indicates that the erotic 
 pressure of the repressed affect and his fears Avere influencing a 
 desperate compensation (See Case PD-11). 
 
 One morning (June, 1916), this dangerous fanatic ran amuck 
 and killed four people, and wounded five others, and not until his 
 house, which he had barricaded, was blown up with dynamite, were 
 he and his wife finally shot by the police. 
 
 The tragic sequel of suppressed erotic attachments between 
 females is illustrated by the following instance: 
 
 Two well-educated, wealthy young women, who had developed 
 an unusual intimacy, registered under assumed names in a hotel. 
 They retired to a booth in the restaurant where they dined. Late 
 that evening they simultaneously shot each other in the head. Ac- 
 cording to the Press, a note was left saying, "We have experienced 
 perfect love for each other and can not bear the thought of separa- 
 tion. So we will end it all." In such instances as this, the act 
 can hardly be regarded as any other than the expression of an 
 aborted erotic climax. 
 
436 PS\'( : I H) PAT 1-IOLOG V 
 
 An eccentric compensation of tlie paranoid type that may be- 
 come disastrous is illustrated by the following case: 
 
 This man (Case P-3) was sent to St. Elizabeths Hospital by 
 the police department because he was acting suspiciously. He had 
 complained to the police that people on the street and at his board- 
 ing house were making "threatening remarks" al)ont him. These 
 suspected remarks were related in some manner to the fact that 
 the War Department had discouraged him in his ambition to per- 
 fect a great cannon which would have more power than any other 
 because the rifling would lie abolished, thereby decreasing the 
 friction to the shell. 
 
 He was unmarried, tliii-ty-two years of ago, a graduate of a 
 polytechnical school and a designer of tools for a large manufac- 
 turing company. In this work, ho had been A^ery successful and 
 drew the highest salary in his department. 
 
 His coworkers, like his classmates, considered him to be ec- 
 centric because he applied himself too severely to his work and 
 never encouraged friendly advances from anyone. As a student, he 
 had striven constantly to be the foremost in his class. Shortly 
 after beginning work, he said, an elderly man in his office took a 
 "fatherly" interest in him. This man, who was notorious for his 
 vulgar stories, urged him to live a more active sexual life on the 
 grounds that it would do him good. He thought the old man had 
 noticed his irritability, tenseness and asocial tendencies, and sin- 
 cerely tried to help him. 
 
 The patient was neat, efficient and conscientious, and a capable 
 tool designer. He was, hoAvover, inclined to assume an attitude of 
 superior knowledge, was dissatisfied, unduly self-aggrandizing, 
 and morose. TTe was openly proud, and usually talked, even in 
 ordinary conversation with one person, in a loud, deliberate tone 
 of voice, which, with the studied enunciation of unusual words, 
 sounded strikingh' as if lie were speaking formally to an audience. 
 The large number of unique words which he used to express a sim- 
 ple thought was unusually impressive. 
 
 His opinions nearly ah^-ays contained an egocentric turn, and 
 distinctly indicated that he obsessively felt the necessity of ad- 
 vancing his self-importance. He enjoyed arguments, he said, but 
 tried to do all the talking. 
 
 For several years he had been interested in designing an enor- 
 mous cannon upon the principle of using a smooth bore in order 
 
PSYOHOPATHOLOGY 03? PARANOIA 437 
 
 to reduce the resistance to the discharge caused by the rifling 
 which is used in modern artillery. He hoped to obtain the neces- 
 sary rotation of the projectile through a new means of producing 
 the explosion. This, he thought, he had theoretically demon- 
 strated and, at his own expense, he spent three months review- 
 ing the files in the patent office in order to secure a patent for his 
 design. 
 
 He secured an interview at the War Department, where he 
 was discouraged and, at the same time, flattered, on the grounds 
 that such an instrument would be too expensive to be practical. 
 This, he repeatedly said, "brought me to earth." For several 
 days he seemed to be unable to adjust himself to the disappoint- 
 ment and, without insight (until later), he unconsciously compen- 
 sated for his loss by developing feelings that roomers in the house 
 were planning to raid his trunk in order to steal the plans for an- 
 other government. He also heard "remarks" about himself, such 
 as "there lie goes" (as if he were important), and "something 
 was said" about the progressiveness of the German Army and 
 that he was suspected of furnishing the Germans with plans of his 
 gun. This compliment to his mighty gun was obviously restoring 
 the fulfillment of the wish that the War Department had so pain- 
 fully disappointed. 
 
 Fortunately, he was intelligent enough to become suspicious 
 of himself and not assume the absolute certainty of "the re- 
 marks." He realized that his long hours of Avorry, poor appetite 
 and loss of weight might have fatigued his powers of self-control. 
 To make sure of himself, he talked it over with a policeman who 
 induced him to accept hospital treatment. 
 
 Upon his admission, he was appreciative, accessible and pleas- 
 antly accepted advice about rest and hygienic living. He told the 
 impersonal side of his interest in a powerful cannon with so much 
 detail that he eonfiised himself as well as the physicians Avith his 
 abstract mathematical theories. 
 
 His proud carriage, cultiA^ated grandiloquence, tendency to re- 
 vert to a fixed subject, rather slight figure, sparse facial hair, 
 strained sobriety, undernourished condition (indicating the sever- 
 ity of his striving) and the obvious wish-fulfillment in the delusions 
 all coincided with the significance of the long-continued effort 
 to create an instrument of great potency. 
 
 The diagnosis on the above information was ventured that the, 
 
438 PSYCHOPATHOLOGY 
 
 man was anxious about his heterosexual potency and was striving 
 to establish it. {TJie term, sexual potency, is used in a broader 
 sense than merely potency for mechanical intercourse, for it also 
 includes estahlishing the capacity to obtain affective gratification.) 
 
 Several days later he was led to discuss his sexual life freely. 
 He denied having masturbated at any time, and was, I am quite 
 sure, ignorant of the practices of homosexuals. He stated that 
 he had occasionally had sexual intercourse with prostitutes upon 
 the advice of a physician, but, finding it an unsatisfactory ex- 
 perience, made strong efforts to repress any sexual inclinations. 
 Then, he elaborated further and explained that one reason he had 
 had for visiting prostitutes was that he felt encouraged when they 
 (in answcn- to his questions) told him that his penis was as large 
 as that of the averas'o man. He said he Jiad been afraid since 
 his adolescence thatlie was sexually undersized. 
 
 The symbolic value of the mighty cannon as a compensation 
 for his undersized penis and impotence was immediately grasped 
 by tlio patient. The grandiloquent style, which worked havoc in 
 its tendency to isolate him from friendly associations, was de- 
 fended as an "old habit." That he used it as an instrument for 
 social domination he admitted. Interwoven with this confession 
 of the tendency to sexual compensation, he confided his story of 
 disappointment in love as an explanation of why he had never 
 married. The girl's father had at one time discouraged the match 
 because of his salary, and, irritated by her attitude, he had proudly 
 determined to make a great success for himself. 
 
 The permanent value of this insight into his struggles can 
 not be estimated here, but an indication of what it might be worth 
 was shown by his rapid readjustment to a sociable, more unselfish 
 attitude, with a genuine, unforced tendency to be amused at him- 
 self for his absurd striving. He frankly rebuked himself for his 
 stilted pride about his love affair. Before he was discharged he 
 intimated that he intended to apologize to the girl for his attitude. 
 He abandoned the big cannon fancies and considered the "suspi- 
 cious remarks ' ' to have been imaginary. 
 
 This patient may be regarded as typical of the so-called 
 "cranks" who feel compelled to come to Washington and present 
 the nation with "inspired" advice or a discovery having great 
 potential possibilities. The uniform revelation of sexual inferi- 
 ority in the accessible cases of this type, which we have received at 
 
PSYCHOPATHOLOGY OF PARANOIA 439 
 
 St. Elizabeths Hospital, strongly reenforces the impression that 
 probably most individuals of this type are striving to overcome 
 definite pernicions sexual inferiorities of which they are fearful. 
 
 Throughout the above three cases runs the well-defined inflii- 
 ence of both the sexual inferiority and the eccentric compensatory 
 striving for potency and social esteem. The foundation of the lat- 
 ter exists in the repressed affections, and finally succeeds in direct- 
 ing itself by an "inspiration," Avhich, although radical and 
 destructive, may be irresistible. The actual mechanism ' of the 
 "inspiration" is most clearly demonstrated by the repressions 
 and inspirations of Case AN-3, which is worth reviewing in this 
 connection. The extent to which such cravings may influence the 
 individual is brought out in the cases of J. Wilkes Booth and 
 Gtiiteau. 
 
 It seems highly desirable, with the knowledge of the parricidal 
 type of inspiration of Case AN-3, to review the personalities and 
 acts of Booth and Guiteau. An unprejudiced account of Czolgosz's 
 personality, unfortunately, is not accessible. 
 
 In Case AN'-3 many facts show that the man became "in- 
 spired" to kill his director because the latter, through transfer- 
 ring him from working in "pure science," prevented him from 
 ever possibly solving his biological obsessions thereby compensat- 
 ing for the inferiorities of masturbation and the sexual affairs 
 that caused the loss of his love-object, who was a mother image. 
 The director, by his act, unconsciously became the equivalent or 
 image of the domineering, hateful father who had disastrously sup- 
 pressed the patient's youthful, vital, spontaneous aspirations, 
 Avhich necessarily needed encouragement and freedom of function- 
 ing in order that the personality should later develop to a com- 
 fortable, healthful maturity, and overcome its homosexual and 
 autoerotic tendencies. This case is of the utmost value, in that it 
 explains the origin of the inspiration that the suppressive superior 
 must be killed in order that the freedom of manhood might be 
 realized; hence, the reader should be familiar with it. 
 
 The cases of Booth, the assassin of Lincoln ; Guiteau, the as- 
 sassin of Gdrfield ; and Czolgosz, Avho shot McKinley, were not 
 considered from this point of view by the psychiatrists who ad- 
 vised the court; hence, essential details arje lacking which would 
 convincingly fix the impression that these "men were all obsessed 
 with inspirational compulsions to "remove" the suppressive fac- 
 
440 PSYCHOPATHOLOGY 
 
 tor, father-image. There is sufHcient reliable data, however, to be 
 had in W. W. G-odding's "Two Strange Cases" and A. M. Hamil- 
 ton's " Eecollections of An Alienist," to make it worth while to 
 reconsider these crimes from this new point of view — ^namely, 
 that the preadolescent affective repressions finally tried to destroy 
 the repressing influences in order to attain freedom from sexual 
 inferiority and acquire the functions of maturity. 
 
 In the following brief reconsideration of these parricidal acts, 
 the limitations of space make it possible to bring out only those 
 points which support the impression that probably most parricidal 
 and treasonable acts are the result of preadolescent repressions 
 of primary emotions'. They were repressed by the doniineeri^g 
 attitude of someone who, through the powers inherent in their con- 
 trolling position, as father, mother, guardian, teacher, older, 
 brother or sister, aborted or distorted the affective career of the 
 individual. The history of Case AN-3 shows that affective re- 
 pressions may be so constituted that the individual will never be 
 able to achieve a comfortable solution during maturity, unless he 
 obtains insight. He is doomed to become noted for his eccen- 
 tricities, irritability, neurotic episodes and paranoid struggles. 
 
 Guiteau (Case P-4), according to Godding,* came from a very- 
 pathological family. His paternal grandparents had eleven chil- 
 dren, of whom one died of cancer and perhaps six died of pul- 
 monary diseases, probably "consumption." Two other children 
 were insane at one time, and a third was considered to be insane 
 by her acquaintances. 
 
 The paternal grandfather was thought to believe that one 
 might attain a mental state of such purity that it Avould immor- 
 talize the body, and this conception was apparently a conviction of 
 Guiteau 's father. 
 
 Guiteau 's father was knowii to be an imusually persistent, in- 
 tensely religious type of man, and "intensely honest and sincere" 
 as a business man. "In his ecstasy he believed that by prayer and 
 the laying on of hands lie could himself raise the sick to health, 
 and that he might attain, yea, had already attainecj,. to a union 
 with Christ, in whicli he should live forever on earth" in his 
 natural bodily state. He became an ardent member of J. H. Noyes ' 
 Oneida Community. He believed insanity was caused by a dia- 
 
 *"Two Strange Cases." 
 
PSYCHOPATHOLOGY 01? PARANOIA 441 
 
 bolical possession and that superior virtue could cast it oixt. Ac- 
 cording to his daughter, who described his methods of domination 
 over his son, his father "would whip him, and after he had 
 punished him would say, 'Now say pail': and he Avould say 
 'quail' every time" (Godding). Such sitaations between the fa- 
 ther and son are never anything but hopeless hatred in which the 
 father is determined to force the son into abject submission; and 
 the son, physically inferior, must endure the punishment, but con- 
 quers through his contradictory " wilfuUness. " The boy's grand- 
 father, Howe, said he was the smartest Guiteau he knew of (God- 
 ding) and bequeathed him $1,000 for his education. Guiteau 's fa- 
 ther, however, regarded him as a worthless, disobedient "devil's 
 seed." 
 
 AVhen liis father married the second time, like many unhappy, 
 brooding children, Guiteau ran away from home at the age of thir- 
 teen. After his crime at forty he said he never knew amotlua-'s 
 love, his mother having died from a protracted illness when he was 
 a child. 
 
 It seems that the youth and father were so deeply incompatible 
 that they were rarely able to approve of one another's work. "It 
 would seem that his father neglected and flogged him by turns," 
 and the following quotation from a letter of the father to his son 
 reveals his utterly uncompromising attitude toward his son. 
 (Such an attitude between any two people who are unable to avoid 
 one another must almost inevitably lead to a disastrous climax.) 
 
 The letter read : ' ' Soon after your mother 's death our family 
 became somewhat scattered. I was much away from home, and 
 gradually for the want of fidelity on my part, you became more 
 and more insubordinate, for the want of proper discipline and re- 
 straint, until I lost all, or nearly all, the control of you, which 
 I had the right, and ought to have exercised as your father. In- 
 deed, my discipline Avas absolutely loose, etc." (Thus, the father 
 had to justify his abnormal domination of his son.) 
 
 As a youth, Guiteau was considered to be egotistical, un- 
 friendly, restless, brooding, irritable, cowardly, and, according to 
 North, upon one occasion, attacked his father from behind ivhile he. 
 was seated at the table. 
 
 Judge Porter, in closing the argument for the prosecution of 
 Guiteau for Garfield's murder, spoke a deeper truth than he per- 
 
442 PSYCHOPATHOLOGY 
 
 haps realized when he said: "The spirit in which at forty he 
 fired at Garfield [from behind] loas the spirit in ivhich at eighteen 
 he struck his father from behind." 
 
 There is no doubt that the father was absolutely obsessed with 
 a bitter hatred for his son, which worked under the ethical disguise 
 of driving the devil out of him and only resulted in hopelessly con- 
 fusing the son's affective interests in life. 
 
 At eighteen, he entered a school at Ann Arbor, but as usual, 
 Avas unable to obtain his father's approbation for this preparatory 
 interest in life. He seemed unable to become attached to anythin^|!|i' 
 definite, probably because of his father's persistent negation and 
 resistance. He was unable, on the other hand, to leave his father 
 alone or his father, to leave him alone. While his son was at 
 Ann Arbor, the father, who had joined the Oneida religio- 
 socialistic community, sent him their literature, which resulted in 
 the son finally abandoning college to devote his life "to Christ" 
 and this community, being, as he wrote, "attracted here by an 
 irresistible power, which I was not at liberty to disobey." 
 
 After five stormy years in the communitjr, he abandoned it 
 "to give Jesus Christ a daily paper, 'The Theocrat.' "_ While 
 in the community, Guiteau's eroticism and egotism caused his fa- 
 ther and Mr. Noyes no little anxiety to prevent him from cor- 
 rupting their teachings with licentious interpretations. From 
 what followed later, it is apparent that "The Theocrat" was an 
 attempt to supercede his father and the founder of the community. 
 Because he had, no funds or preparation upon which to base or sup- 
 port his newspaper project it seems to have been nothing more 
 than a wild self-aggrandizing fancy. His uncle Maynard thought 
 "he was going as crazy on religion as ever his father was."- The 
 newspaper project fizzled out and he returned meekly to the com- 
 munity only to leave in a few months, now openly hating his father 
 and Noyes, the leader, and writing vindictive open letters about the 
 licentious practices of the community. 
 
 From this time, in 1866 (aged twenty-four), until the shoot- 
 ing of Garfield, he worked as a newspaper reporter, studied law, 
 lectured on theological subjects, and wrote a book on "the second- 
 coming of Christ." The book shows that he had strong affective 
 repressions that were interested in a rebirth, a second coming forth 
 of Christ, which was himself. 
 
PSYCHOPATHOLOGY OF PARANOIA 443 
 
 As a lawyer, he never won a case, and as a theologian and 
 politician he scarcely made a living. He was immoral, a plagiarist, 
 dishonest, bigoted, unfriendly, crooked and a dead beat. He 
 tried to blackmail the Oneida Community and boosted numerous 
 wild business projects with no success. He was utterly unable 
 to control his impulsive cravings and reach a comfortable, efficient 
 affective state. He was divorced for adultery by his own procure- 
 ment, dismissed from the Chiirch on charges of gross immorality, 
 and "his life pleaded guilty to all the sins of the Decalogue except 
 profanity, smoking and drinking" (Godding). 
 
 Evidence was given at his trial (1881) that at thirty (1872) he 
 had said in a discussion that he would someday gain notoriety, if 
 not by good then by evil, and shoot some public man as Wilkes 
 Booth had. (Guiteau was twenty-three when Booth shot Lincoln.) 
 The statement at the time M^as regarded as a bit of nonsensical 
 braggadocio, but was damaging evidence nine years later. 
 
 From thirty-five to thirty-seven he entered the lecture field 
 of theology and left behind a trail of board bills and incoherent 
 harangues on the second coming of Christ, quitting finally after 
 he "had worked the inspiration out of him." 
 
 In 1880 (aged thirty-eight), he attached himself to a Ee- 
 publican campaign committee in New York, wrote an inconsequen- 
 tial speech on "Garfield against Hancock" and gave one or two 
 addresses to negro meetings. During the campaign, he remained 
 a faithful hanger-on at the Republican campaign headquarters. 
 
 Even before Garfield Avas elected, he wrote about marrying an 
 Austrian heiress and asked to be sent to the Austrian mission, 
 basing his claim for consideration "on the principle of first come, 
 first served." After the election, he repeated the request, and, 
 on the day after Garfield's inauguration, he arrived in Washing- 
 ton. His method of forcing himself upon the attention of Presi- 
 derit Garfield by pressing' his way into his private office during a 
 conference, handing him a printed copy of his speech -with his 
 name and request written on it, should at once have called atten- 
 tion to the eccentric, persistent, egotistical attitude of the man. 
 
 Godding 's review of the behavior and character of this man 
 up to this time leaves lio doubt but that the man was probably 
 sexually petverse and certainly 'inclined to wild' flights of unrea- 
 sonable' conduct due to his obsessive inspirations and unbounded 
 
444 PSYCHOPATHOLOGY 
 
 paranoid egotism. Godding appeared for the defense and testi- 
 fied belief in Ms insanity, and later wrote a review of the case 
 of Guiteau in which he justified his opinion. A. "W. Hamilton tes- 
 tified that Guitean Avas a malingerer and, half a century later, 
 in his " KecoUections of an Alieniest," he repeated his opinion. 
 "Without entering into a controversy as to whether or not he 
 malingered, Guiteau 's history shows that something prevented him 
 from becoming a reliable, constructive member of society, and tjxai 
 he had wild religious inspirations, M^as extremely selfish, egotis- 
 tical and dishonest, and was sexually a very inferior type of man. 
 For the psychopathologist, this is sufficient evidence to show that 
 the man was a psychopath because of affective repressions and not 
 because he planned to be so. 
 
 His book on the second coming of Christ indicates his in'- 
 terest in a future happier rebirth. The heiress, whom he wrote 
 President Garfield about, was a Sunday-school teacher whom he 
 had seen but never spoken to. However, true to the paranoiac 's 
 estimation of his love-object, he believed she would marry him if 
 he was appointed. This belief, of course, held the President not 
 only responsible for Guiteau 's honors and economic position, but, 
 also, in so far as Guiteau seemed to feel, for his marriage to an 
 heiress and the rehabilitation to a happy state of his heretofore 
 misguided, wretched life through the "second coming" of himself 
 as a Redeemer. 
 
 Similar to Case AN-3, the pressure of poverty was forcing 
 him to a desperate solution. In March, 1881, he wore the last 
 year's summer clothing and appeared in a Senator's office in san- 
 dal rubbers, without stockings. This may also have had a re- 
 ligious significance. 
 
 A few weeks later, Secretary Blaine sharply told Guiteau 
 "never speak to me again on the subject of the Paris consulship." 
 This attitude placed a hopeless barrier between him and the Aus- 
 trian mission or the Paris consulship. While brooding over this, 
 the rupture occurred lietwoon Garfield and the New Yoi'k "stal- 
 warts." Garfield had appointed Blaine and Avas responsible 
 through other appointments for wliat the New York Eepublicau 
 stalwarts claimed was the ruin of the party, the empowering of 
 the Democrats, and the ruin of the country. Garfield, and not 
 Blaine, Guiteau seemed to feel, Avas responsible for the refusal ; 
 and Arthur, the Vice-President, he thought, Avould treat him AAdth 
 
PSYCH OPATllOLOCn- Ol-' TAIIANOIA 441) 
 
 more consideration. Tlie logical solution would be the "removal" 
 of President Garfield and the placing of Vice-President Arthur, 
 "a friend," in power, the liberation of the Republican party from 
 betrayal, and the saving of the country from the Southern Demo- 
 crats. This removal of Garfield Avould, therefore, arouse the grati- 
 tude of the American people. He A\'ould be liandsomely rewarded 
 and the spirit of the Hood-tide might even sireep him transcen- 
 dentalli/ into the presidency. By a miraculous turn of events he 
 would attain the fittest place in tlic social herd and his struggles 
 would be eternally solved. 
 
 No evidence is to be had that, in this hour of fancied triumph, 
 he thought of the damnatory repressions and prophecies of his 
 father. Other men in their hour of triumph are often briefly con- 
 scious of their old, hateful enemies, of old deficiencies and strug- 
 gles, and w^eep with joy. The conception that the "removal" of 
 Garfield Avas the thing to do was significantly clarifying in its affec- 
 tive value, feeling it to be an "inspiration from God," that is, from 
 the deepest levels of the unconscious. In a psychological sense, 
 it relieved the affectiA'c repressions of his youth just as Case 
 AN-3's inspiration did, by destroying the cause of the repressions. 
 
 There is no doubt that at this time there were many disap- 
 pointed politicians who were hoping that something "legitimate" 
 Avould interfere Avith Garfield's career. The point I A\dsh to em- 
 phasize is that Guiteau's aborted affections, due primarily to 
 the repressive influences of his tyrannical father, combined with 
 liis destitute economic and political position, which did not give 
 enough material AA'ith Avhich the old repressed craA'ings might 
 Avork, his sexual perverseness, and the half-suppressed animosity 
 in certain quarters against Garfield, the ruler (father eqiiiva- 
 lent), determined and inspired the nature of his act. Guiteau's 
 affective constitution made the act of shooting Garfield prob- 
 able when he was forced into a submissive position by Secre- 
 tary Blaine's attitude. The soundness of Blaine's attitude, and 
 ihe utter irresponsibility of Guiteau for the position he demanded. 
 Lad no special significance for the repressed affections. 
 
 About the first of June, Guiteau's conflicts and struggles Avere 
 solved by the "inspired" idea — "the remoA^al" of Garfield. His 
 manner of carrying out the scheme of the assassination may be 
 abbreviated. He planned it for several weeks and, on one occasion, 
 succeeded in getting near Garfield Avith a loaded pistol, but the 
 
446 PSYCHOPATHOLOGY 
 
 helpless dependence of Garfield's invalid wife clinging to his arm 
 influenced him to postpone his act. Mrs. Garfield, "the first lady 
 of the land," probably aroused to an influential extent the old im- 
 pressions of his invalid mother. He could not destroy this re- 
 sistance to his wishes (father eqiaivalent) in her presence. 
 : In July, 1881 (aged thirty-nine), he approached his unsuspect- 
 idg- victim from behind and fired two bullets into his back. He 
 had made careful preparations to protect himself from the mob, 
 and had prepared an heroic appeal "To the American People" 
 to explain his act and win their approval. His stupid selfishness 
 and litter lack of insight into the true value of his act convinced 
 Godding that he never expected to be tried. He only prepared for 
 flight to the jail to escape the mob. 
 
 His "Address to the American People," dated June 16, 1881, 
 nearly three weeks before the assassination, says: "I conceived 
 the idea myself and kept it to myself. I read the newspapers care- 
 fully for and against the administration, and gradually the con- 
 viction settled on me that the President's removal was a political 
 necessity, because he proved a traitor to the men that made him, 
 and thereby imperiled the life of the Eepublic. [Guiteau believed 
 he had helped to make Garfield president.] In the President's 
 madness he has wrecked the once grand old Republican party, and 
 for this he dies." (Similarly, Case AN-S felt that his former di- 
 rector was causing the ruin of his department.) 
 
 Two days after the above address, he wrote in a letter : 
 
 "The President's nomination was an act of God. 
 
 "His election was an act of God. 
 
 "His removal is an act of God's. 
 
 "(These three specific acts of the Deity may furnish the 
 clergy with a text). 
 
 "I am clear in my purpose to remove the President. Two 
 points will be accomplished. It will save the Republic and create 
 a demand for my book, 'The Truth.' (On the second coming of 
 Christ, the Redeemer. — See page 10. ) This book was not written 
 to make money, but to save souls. In order to attract public at- 
 tention, the book needs the notice the President's removal Avill 
 give it." 
 
 Had these letters and the man's ideas become known before 
 the act, he would surely have been sent as insane to the Govern- 
 
PSYCHOPATHOLOGY OF PARANOIA 447 
 
 ment liospital for the Insane. At present, he would be classified 
 as a paranoiac. 
 
 After the assassination, the man elaborated his defense and, 
 characteristic of the egotistical paranoiac, he maintained that 
 "Grod and one man are a majority," he being God's inspired man. 
 
 The fact that Guiteau sincerely believed his assassination of 
 the President would make him a popular hero also showed his utter 
 lack of judgment and insight, and his insanity. His feelings told 
 him that if he removed the oppressing influence in his life he would 
 attain his biological potency. In a man whose altruistic and 
 egocentric interests balance well, this is a truth. "Ye shall know 
 the truth, and the truth shall make you free. ' ' But, in a patholog- 
 ically distorted personality, the struggle for truth and freedom 
 and its inspiration are liable to have disastrous consequences. 
 
 It is probable enough to deserve consideration that Guiteau's 
 "inspired" destruction of an innocent man, who had become 
 through his office and political relations a father equivalent, would 
 never have occurred had Guiteau's affective functions, in his 
 youth, not been so pathologically abused and repressed by a sin- 
 cere, but unnatural father. He was never able to attain a state 
 of comfortable affective composure and maturity. The affective 
 value of his crime to him is to be measured hy his dreams of what 
 it would bring — a consulship in Paris (his ancestors were French 
 Huguenots), an heiress and, perhaps, the Presidency. This would 
 be a complete domination of the social herd and give him its 
 approbation of his fitness, which would rectify his ineradicablp 
 sense of biological inferiority as a " devil 's seed, ' ' which had been 
 present since his youth. The second coming of Christ as a com- 
 pensation for his sexual perversions needs no further comment. 
 
 The case of J. Wilkes Booth (Case P-5), who assassinated 
 President Lincoln, can only be briefly. discussed to show that the 
 sincere, but tyrannical, oppressive attitude of the father, Junius 
 Brutus, was one of the important determinants of the act, and 
 "Sic Semper Tyrannus" had a deeper significance than a refer- 
 ence to the most democratic and fair minded Lincoln. 
 
 Booth's father, according to A. W. Hamilton* was excitable, 
 licentious, unbalanced and cruel. In his acting, when he played 
 the character of an assailant, he did it with such sadistic delight 
 
 •"Recollections of An Alienist." 
 
448 PSYCIIOPATHOLOGY 
 
 that lie was often cruel and cut his adversaries upon the stage "in 
 sheer wantonness and bloodthirstiness." He surely had a re- 
 pressed hatred for some oppressor in his youth, for as an adul^ 
 he had an uncompromising hatred for oppression and, yet, he 
 himself did not hesitate to take a brutal advantaige^. of others. 
 The youngest son, J. Wilkes, was named after an English agitator, 
 and the oldest son, Junius Brutus, was named after his father and 
 the deluded Roman liberator, an assassin. 
 
 As a boy, J. Wilkes Booth was unstable, suspicious, morose, 
 had fits of melancholy, was waj'ward, and one time ran away 
 from home (a protest against its tyraimy) and joined the pirate 
 oystennen of Chesapeake Bay. At other times, he was gentle, 
 winning and lovable. In school, he learned with, difficulty, and 
 later doted on sentimental verses, Avhich he was fond of recit- 
 ing. His morbid, brooding periods, as in most young men, were 
 probably due to sexual difficulties which are usually later com- 
 pensated for as inferiorities. 
 
 He compensated by being vain and grandiose. He was in- 
 clined to be dissolute and dissipated. At times, he had a speech 
 impediment that may, possibly, have been pathognomonic of the 
 nature of his personal deficiencies. 
 
 After he shot President Lincoln, he is reported ,to have leaped 
 upon the stage with a bowie-knife in one hand and a smoking pis- 
 tol in the other shouting: "Sic Semper Tyrannus — ^Virginia is 
 avenged ! ' ' This dramatic manner displayed his grandiose, self- 
 exhibitionistic cravings. There is more than a coincidence in the 
 father's selection of names for his sons and the assassination of 
 Lincoln. The name Brutus always suggests the assassination of 
 CsBsar, and the father's sadistic bloodthirstiness on the stage was 
 caused by the craving to attack some person superior to him. The 
 morose J. Wilkes, oppressed by the father, unconsciously became 
 fertile soil for this suggestion. It is believed that a gang of an- 
 archistic plotters iTsed him for tbeir tool, but his affective repres- 
 sions made their suggestions acceptable and pleasing. 
 
 (The writer does not hold that every case of severe affective 
 repression in youth, due to the father's hatred or a father equiv- 
 alent's, will lead finally to a parricidal or treasonable compulsion. 
 It is only held that such affective repressions produce a revolu- 
 tionary character, which, if given an appropriate repressive set- 
 ting during maturity, will then converge upon the parricidal act. 
 
PSYCHOPATHOLOGY OF PARANOIA 449 
 
 Without the rather specific type of affective repression in his 
 youth, he would be invulnerable to parricidal suggestions later on.) 
 
 The sexual inferiority may not become plainly evident, the in- 
 dividual indulging in a series of wild heterosexual experiences, 
 until the social or vocational obligations or a failure in a mating 
 attempt emphasizes its presence. There may follow then a des- 
 perate effort to compensate in some particular manner which is 
 designed to attain social esteem. The repressed affect, as in the 
 following Case PD-1 may finally become dissociated from the ego 
 and be considered by the individual as a foreign power or person- 
 ality which is trying to coerce him into most perverse forms of be- 
 havior. This dissociation may become chronic and endure for 
 many years, in the following case, over fifty, without causing an 
 otherwise marked deterioration of the personality. The compen- 
 sating fancies may also become very eccentric and, in turn, arouse 
 society's suspicions and ostracism, or they may win unusual hon- 
 ors, but fail to relieve the repressed perverse craving. 
 
 In Chapter I it was emphasized that for the psychopathologist 
 the individual case is always a problem of repressed or suppressed, 
 and suppressing autonomic cravings. The repressed craving per- 
 sists in its efforts to solve the resistance. The nature and inten- 
 sity of the two opposing forces determine, as a resultant, the 
 behavior of the individual and caiise the symptoms or distress. 
 The repressed affective cravings and the resistance are al- 
 Avays complicated and can not be summed up in a word, but in 
 their persistence, intensity and requirements, they have well- 
 defined characteristics that enable the psychopathologist to clas- 
 , sify them. 
 
 When the affective cravings require acts and objects that 
 would irrevocably stamp the individual as being perverse or de- 
 graded, and they are intolerable to him, the individual makes in- 
 tense efforts to repress the cravings and compensate for them so 
 as to attain biological fitness and win social esteem. The repres- 
 sive-compensatory striving is necessarily intimately associated 
 with the repressed craving Avhich remains active although sub- 
 merged. The intensity and nature of the affective cravings, there- 
 fore, determine, fundamentally, the intensity and nature of the 
 compensatory strivings. Since both forces must be satisfied 
 through the individual's behavior, symbols are often substituted 
 for reality, as a compromise. The compensatory achievements, as 
 
450 PSYCHOPATHOLOGY 
 
 one would expect, are Tisually all the patient cares to tell the phy- 
 sician. The rest he wishes to remain nnconscions of and hates to 
 have recognized. 
 
 When the repressed cravings become too vigoroiis to be con- 
 trolled, the conflict often results in a serious dissociation of the 
 personality. In the completely dissociated pernicious sta:tes, the 
 individual maintains that the hallucinations and other sensory 
 disturbances are caused by some personal influence that is wholly 
 foreign to his own personality. The physician must be constantly 
 on his guard so as not to accept this explanation by the patient. 
 The point may well be emphasized here that, the degree of convic- 
 tion with Avhich the patient maintains that sensory disturbances 
 are produced by some foreign, mystic, or personal influence, and 
 the degree of systematization of his compensatory defense, indi- 
 cate the degree of dissociation and its destructive prognosis. 
 
 The repressed cravings ihay become continuously very active, 
 forcing a constant problem for control upon the patient, or they 
 may be intermittently active, depending largely upon the environ- 
 ment, forcing an intermittent volcanic type of psychosis. 
 
 The following Case PD-1 shows clearly the nature of the- af- 
 fective craving he had to struggle against, its surprising persist- 
 ence, and a most remarkable compensatory striving and castration 
 defense. 
 
 Captain • Avas born in 1834, in Ceylon, India. His parents 
 
 were missionaries with strong religious convictions. The mother 
 died when the patient was six, and, at fourteen, he was brought 
 to America to be educated. (He said, when an old man, the wild, 
 naked children of Ceylon made a vivid impression on his mind as 
 a child.) 
 
 He had no other serious diseases than septicemia and typhoid 
 at twenty-eight, from which he made a good recovery. 
 
 At twenty-nine, he graduated from Yale Medical School, and 
 entered the Army at the close of the Civil War. He had, up to 
 this time, shown excellent capacities as a student and physician, 
 and for his services during a cholera epidemic on Governor 's Is- 
 land, New York Harbor, he was brevetted by the Government. 
 
 At thirty-two, while at Governor's Island, he began to carry 
 a revolver, which seems to have been the first overt indication of 
 uneasiness. He was engaged to a New York girl at this time, 
 
rSYCTIOPATllOLOGY 01'" PATIANOTA 451 
 
 and her mother strongly opposed the marriage, fmally causing the 
 engagement to be broken. (He would make little comment on this 
 affair except that he did not really love the girl because a man who 
 had had "forty or fifty" sexual affairs with women could not feel 
 love. He considers himself -to have l^een extremely licentious iTp 
 to this time, and is inclined to be pleased to exaggerate the sexual 
 activities of his twenties.) 
 
 Later, he Avas stationed in an army post where he devoted 
 considerable time to painting A\'ater-colors, but lost interest in 
 his work as a surgeon. The course of his behavior in the years 
 immediately foUomng his unhappy engagement gives the impres- 
 sion that he passed through serious emotional disturbances. He 
 became more and more irritable and suspicious. Then he had a 
 "severe sunstroke" attended by "some mental disturbances." 
 
 He finally challenged an officer to a duel because he believed 
 the man was the leader of a movement to persecute him. 
 
 At thirty-five (1869), he was ordered to St. Elizabeths Hospi- 
 tal for observation and treatment. The meagre records of that 
 period give the diagnosis of ' ' homicidal and suicidal mania, ' ' but 
 include no account of his behavior or the content of his psychosis. 
 From later evidence, it is certain that he was struggling to repress 
 homosexual cravings. 
 
 He has always been reluctant about discussing this period of 
 his psychosis, but, recently (1917), he gave the information that 
 he felt himself to have been persecuted by secret societies who 
 exposed him to sexual indignities at night. Because of this, he 
 violently protested, and tended to attack anyone Avho had a sinis- 
 ter effect upon him. This desperate state of mind lasted about 
 one year, when gradually, he changed his attitude about the offi- 
 cer he had challenged to a duel and admitted he had been wrong. 
 He studied everybody at this time to understand his own perse- 
 cutions, and finally concluded that "they" (not referred to any 
 one in particular) had some secret power with which "they" were 
 tiying to force him to submit to licentious practices. He was dis- 
 charged after eighteen months, as a social recovery. This action, 
 however, proved to be a mistake. 
 
 At thirty-seven, he left America for England to escape the 
 persecutions, spending most of this time "sight seeing" in Lon- 
 don, He had entirely lost interest in his medical work. In Eng- 
 
452 PSYCHOPATHOLOGY 
 
 land, the persecutory cravings grew worse, and he developed the 
 conviction that while asleep he was often taken from his room 
 and later returned after being subjected to sexual indecencies. 
 He believed that many young women used him for sexual purposes 
 and among them were "some of the first ladies of England's no-, 
 bility. ' ' He fondly, blindly aggrandized himself with these dreams 
 and fancies and cherished the names of many prominent English 
 people as having been attracted to him sexually. 
 
 He firmly believed that he heard "remarks" and read articles 
 which "proved" that women spoke of his penisi as being the "big- 
 gest thing in the world." He received several pamphlets with 
 some such title, which, although they were not on a sexual subject, 
 he insisted, subtly referred to him in that light. 
 
 The nature of such cherished fancies as a compensation for 
 the terrifying homosexual undercurrent, which he was struggling 
 against, is so obvious it needs no discussion. The important fea^ 
 ture in this case is the extraordinary nature the compensatory 
 fancies finally assumed and how they themselves became an ad- 
 ditional pathological influence in his life. 
 
 The seductive dreams were as vivid as the real experience 
 could have been, and the patient suffered keenly from them. He 
 tried to obtain passports for France to escape the persecutions. 
 At night, he guarded his rooms, or often wandered the streets 
 to keep from sleeping, always carrying a loaded revolver. The 
 inevitable disaster finally came, as is usual under such conditions, 
 by merely the addition of a suitable, though innocent factor. 
 
 One night, before a passport was secured (aged thirty-eight), 
 he shot an innocent man. The following account of the episode 
 was received many years later from the criminal asylum in which 
 he was confined after his trial. It can be accepted as reliable in 
 its essentiar points. 
 
 "He had been tried at K — , shortly before his admission, on 
 a charge of murder, and acquitted on the ground of insanity. His 
 offense consisted of shooting Avith a revolver and killing a man 
 in the Belvedere Road about 2 :30 a.m. The man was on his way 
 to work at the time when he was shot. Captain—; labored under 
 the delusions that persons, who were unknown to him, entered his 
 bedroom during the night, for the purpose of annoying him ; and, 
 in order to punish his supposed tormentors, and, also, for the pur- 
 pose of proving to ' his friends that he was right in saying that 
 
PSYCnOPATHOLOGY OF PARANOIA 453 
 
 persons did really enter his room, he took a loaded revolver to 
 bed with him, intending to shoot one of his tormentors in his bed- 
 room. ' ' 
 
 ' ' One night, he awoke with a start, and fancied he saw a man 
 at the foot of his bed. He took the revolver from under his pillow, 
 intending to shoot the man, but, he says, the man was too quick 
 for him, and ran out of the house. Captain — followed, and, think- 
 ing that a man whom he saw in the street was the man who had 
 been in his bedroom, he fired at him repeatedly, and killed him. 
 Captain — is still insane, and still has the same delusions respect- 
 ing persons coming into his sleeping room at night. His bodily 
 health is moderately good. " (Dated April 25, 1910.) 
 
 After his commitment to the English Asylum (1872, aged 
 thirty-eight), his case did not materially change. 
 
 The almost nightly hallucinatory experiences continued 
 throughout the next thirty-eight years in that asylum. Visual, 
 auditory, gustatorj'', and other sensory disturbances tended to con- 
 firm his beliefs in the persecution. "Remarks" by the people 
 around him convinced him that they were familiar with his ex- 
 periences. 
 
 He fought against the homosexual dreams, but enjoyed the 
 heterosexual dreams, and considered both forms to be real ex- 
 periences, not dreams. At sixty-five or so, he began to seek relief 
 from the visitations of the women, and finally, passed through a 
 religious conversion in which he "accepted Christianity." He 
 tried every possible means, as he sincerely thought, to save the 
 young women, and, finally, "conscientiously" amputated his penis 
 (aged sixty-eight.) He secretly performed the act with a pocket- 
 knife after taking due surgical precautions. (This defensive elim- 
 ination gave him no relief from the erotic cravings.) 
 
 At^ghty-threp, in discussing the act, he said, earnesth^: "I 
 cut it off because of the enormous size of it. I cut it off for a real, 
 considerate reason, because it was so attractive to others. It was 
 not a haphazard sort of thing, but seriously considered to protect 
 young women." He explicitly added that it was not done to pre- 
 vent masturbation. 
 
 During this (forty years) period of almost nightly hallucina- 
 tory experiences of a type that certainly results from serious erotic 
 cravings which work independently of the ego, and into which 
 he had no insight, he made a long series of brilliant contribu- 
 
454 PSYCIIOPATIIOLOGY 
 
 tions to the Oxford Dictionary, Ijecoming recognized by the 
 ■university as a lexicographer of most unusnal ability. He was ac- 
 corded, under dramatic circumstances, an honorary visit by the 
 editor, and received complimentary mention from newspapers and 
 magazines. Besides his literary interests he painted and learned 
 to play the flute. 
 
 At seventy-seven, he was transferred to the United States and 
 admitted to St. Elizabeths Hospital. Upon admission, his phj's- 
 ical condition was excellent, and his mental integrity surprising. 
 At eighty-four, he is still an ardeiit reader and a serious thinker. 
 His tall, slender, stooped figure, his keen eyes, finely cut features 
 and white lieard distinguish him as a scholar. 
 
 Upon several occasions (aged eighty-two, eighty-three and 
 eighty-four), he told me of his experiences and his life history. 
 Each time, the story was about the same as the above in its essen- 
 tials and corresponded with the hospital records. 
 
 At present, he barricades his door each night, to prevent the 
 entrance of abductors, by leaning chairs upside down against it, 
 so that if it should be opened their fall would awaken him. He 
 says his experiences usually follow a deep sleep. He may or may 
 not be awakened by his abductors, but finds himself in some un- 
 usual place, such as a strange house, on a boat, in a carriage, etc., 
 where he is forced to submit to the sexual play of women, mostly 
 young, and even of little girls. He carefully avoids including men, 
 but admits that men also visit him. (It is noteworthy that he will 
 not permit men to enter his room at any time, and rarely speaks 
 to the men on his ward, but is ahvays pleasant to women.) He 
 speaks of his experiences as occurring "like a dream," but makes 
 the firm insistence that they are real, and ventures proofs that he 
 hears "remarks" made on the ward about hoAv his keepers mahe 
 moneij out of him. He has noticed that the bottoms of his pajamas 
 have been soiled, whieli pTf)vos that he has been led through the 
 grounds. At times, ho becomes agitated abo;it his tormentors, and 
 complains bitterly. Ui)<)ii sudi occasions he has threatened to com- 
 mit suicide if not relieved. He says they have a metal funnel A\'hich 
 they use to poiir food down his throat and engorge him until hir 
 stomach overflows. They also "peck at my eyes" and "hammer 
 my finger-nails." At times, his delusions become quite fantastic. 
 Upon one occasion, he described his tormentors as pir/mips Avho 
 hide in the ceiling and cracks in the floors to acts as scouts for 
 
PSYCHOPATHOLOGY OF PARANOIA 45.5 
 
 the people of the underworld. Sometimes at night he runs panic- 
 stricken and yelling ont of his room, because "they" are trying 
 to carry him away. He particularly emphasizes the food which 
 he says is often pumped into him in great quantities and is often 
 contaminated with excreta to punish him. He can taste the ex- 
 creta the next morning, and tends to attribute all spontaneous or 
 unpleasant physical sensations, such as inflammatory conditions 
 of his larynx or nasal passages, to the practices of his enemies. 
 When he had a mild otitis media he attributed it to the "scoun- 
 drels ' ' using an electric battery on him. 
 
 He does not fancy that he is a Christ or an apostle, but be- 
 lieves that Chapter II, Book of Mark, refers especially to his case, 
 and Christ "must have foreseen" his trials, which indicates feel- 
 ings of an unusual relationship between himself and Christ. 
 
 (When I explained to him that cases having similar hallu- 
 cinatory experiences were quite common, but that the younger men 
 usually became so severely disturbed by the experiences that they 
 were unable to adjust themselves, he gave the opinion that he had 
 been saved through a deep acceptance of Christianity. "Book of 
 Mark, Chapter II," he says, "was Avritten as though Christ had 
 foreseen all this abominable stuff which I have been receiving" 
 (referred to excreta in his mouth). With solemn conviction he 
 said the chapter meant "nothing can enter into them from without 
 to defile the body. It must start from Avithin and it always seemed 
 to meet my case. I'll say it was a great consolation to know that 
 there was nothing in the world could enter man except that which 
 came out from him. They are angr}- with me because I would not 
 lie down with them. I endure it for Christ's sake." 
 
 He discusses his experiences with striking conviction and firm- 
 ness, and his reasons are expressed in scholarly English. He feels 
 that he has given the subject of his persecutions years of careful 
 study and has concluded that a secret society abducts him bodily 
 Avhen he is in a profound sleep. This subject, he treats as if it were 
 a scientific problem. 
 
 He frequently comments that it is strange that attractive 
 Avomen should continue to pursue him since he has grown old 
 (eighty-four) and has amputated his penis. This amputation does 
 not stop them, and this, he reluctantly, solemnh^ confides, is prob- 
 fihly due to the "persistance of the priapism" though his penis is 
 "only one- third of its former gize," 
 
456 PSYCHOPATHOLOGY 
 
 At present (eighty-five), he is more inclined to dwell on the 
 persecutions of men than women, and frequently he comes to nay 
 office for assistance. Recently, he has begged to be castrated so as 
 to prevent women and men from abusing him. He often directs me 
 how to make investigations for him, and slyly adds that I should 
 notice the "manner of the reply more them what is said." He 
 feels at present he is being prostituted by the ward attendant, and 
 often threatens to assault patients for their supposed persecutions. 
 
 To sum up, he was raised, until fourteen, among the savages 
 of Ceylon by a very religious father. From about twenty to thirty- 
 two, he was promiscuously erotic, and, upon the failure of his 
 engagement, become impotent, irritable, asocial and suspicious, 
 and finally, passed through a homosexual panic. Although he ap- 
 parently recovered and was discharged from an asylum, the hallu- 
 cinatory sexual difficulties persisted, and, to escape their supposed 
 causes, he traveled about the United States and England. Finally, 
 in a nocturnal panic, at thirty-eight, he shot an innocent passer-by. 
 From thirty-eight to eighty-five, he has lived in asylums and con- 
 tinued to experience the hallucinatory sensory disturbances of 
 homosexual and heterosexual form, but predominantly the former. 
 The man was probably heterosexually impotent, of undersized sex- 
 ual development, and suffered from ejaculatio prsecox. He com- 
 pensated with fancies about being sexually, unusuallj^ potent. De- 
 spite these hallucinatory and persecutory difficulties he became a 
 world-famous lexicographer. 
 
 At sixty-eight, he amputated his penis to save the (halluci- 
 nated) women and children, and, at eighty-five, he begs to have his 
 testicles excised for the same purpose. He believes he is intimately 
 associated with Christ and is religious, but has no mission. 
 
 His most annoying sensory disturbances, due to excreta in his 
 mouth, definitely indicate the oral eroticism he has struggled 
 against. As an interesting sublimation he made a wonderfully re- 
 fined contribution to the origin and'use of words. 
 
 His attitude, at eighty-five, to control his eroticism, is similar 
 to his attitude at thirty-two. Probably the congenial nature of the 
 asylum in which he lived made his classical sublimation possible, 
 because his superintendent (father-equivalent) turned over a well- 
 equipped library to him and had a personal pride in his pr'oduc- 
 tions. 
 
 No skeptic, no matter how orthodox and conservative, can read 
 
PSYCHOPATHOLOGY OF PARANOIA 457 
 
 the above cases witliotit feeling some respect for the seriousness 
 of the struggle which males and females are forced to undergo 
 when their sexual affections become fixed upon homosexual objects 
 and perverse mannerisms. The decisiveness and chronic persist- 
 ence of the dissociation of the personality of this brilliant philol- 
 ogist is unquestionable. His homosexual and perversely oral 
 erotic cravings, Avhich obtain gratification through hallucinated 
 forms of sensory disturbances are unquestionable, and his anxiety 
 and tragic struggle, ending with self -castration, must be accepted 
 as a biological (sexual) struggle to save himself. 
 
 Before pursuing the mechanism of the acute panic with acute 
 dissociation of the personality, which, in turn, leads directly into 
 the nature of the biological struggle of the so-called dementia prse- 
 cox group, it is probably worth while to illustrate with further 
 cases other ways in which men and women struggle against the 
 homosexual cravings, and desperately strive to establish comfort- 
 able heterosexual powers. 
 
 Some men fight for years against homosexual tendencies, and 
 finally marry, in an effort to save themselves. Such marriages, 
 as a rule, end disastrously upon the patient's experience showing 
 that he is heterosexually impotent. He may develop feelings of 
 having been betrayed by his A^dfe, and justly or unjustly blame 
 her for having caused his impotence through the infidelity of her 
 "wishes. The usual cause, which he refuses to recognize, is, how- 
 ever, his self-love and homosexuality. It is certain that men are 
 often psychically castrated by frigid, homosexual women (Cases 
 PD-7, PD-8) and, though ''impotent with one mate, may enjoy a 
 comfortable potency Avith an appropriatelv constituted mate. Tn 
 such cases, it goes without saying that a remarriage is almost 
 necessary. Such cases should be differentiated from fixed homo- 
 sexuality. 
 
 Some males, who have a very small margin of heterosexual 
 potency, and lose it soon after the novelties of the marriage be- 
 come commonplace, secretly try almost every conceivalile expe- 
 dient to reach the coveted biological goal. Many are doomed, how- 
 ever, because of the conditioned nature of their autonomic func- 
 tions and lack of insight, never to quite reach a comfortable po- 
 tency, and, if hatred for their more potent rivals should develop, 
 the individuals become incurable. 
 
 A salesman (Case PD-5), about thirty-five, who had kept him- 
 
458 PSYCHOPATHOLOGY 
 
 self popular with a certain "buncli of sports," not realizing, it 
 seems, that he was living a crudely sublimated homosexual exist- 
 ence, finally married an attractive young and inexperienced 
 woman. His behavior immediately following this marriage showed 
 that it was hastily consummated to ward off a possible disaster 
 from the cumulative effects of whiskey and his perverse eroticism. 
 The plan failed. 
 
 Within a few months, the man began stimulating himself to re- 
 tain his potency, taking whiskey to bed with him. Upon several 
 occasions, he attempted sexual perversions (this tendency is char- 
 acteristic of apes when sexually fatigued), and, finally, he ex- 
 ploded with an outburst of jealous invectives a,bout his Avife's 
 betrayal of his affections, although he had no justifiable grounds 
 for the suspicion. He became dangerous, but, before a tragedy 
 occurred, he was sent to a hospital. He rapidly developed a homo- 
 sexual panic in which he hallucinated homosexual assaults and 
 thought himself a sort of ' ' white slave " in a house of homosexual 
 prostitution. 
 
 After several months of anxiety and hallucinations, he began 
 most intense efforts to control the homosexual compxilsions, devel- 
 oping a compensatory system of telepathic communications and an 
 omnipotent social-reform scheme that would be backed up by a 
 wealthy aristocracy. He made strenuous efforts to regain his 
 health, and, finally, emerged a very tense, sullen, suspicious, de- 
 lusional man, decidedly dangerous. His wife had to seek a di- 
 vorce, and he, after the eccentric attempt to master himself, has 
 regressed to a mother dependence, where he apathetically dreams 
 but Avill not work. (His marriage was a desperate attempt to 
 save himself from disaster.) 
 
 The following cases illustrate variations of the marriage at- 
 tempt to escape from homosexual tendencies. A college professor 
 (Case PD-6), aboiit thirty-five years of age, had to leave his uni- 
 versity because of unfounded feelings of being persecuted by the 
 college president. He felt the president had evidence about his 
 practices of heterosexual perversions. To escape "persecution," 
 he went to a foreign country to study, but only brooded over his 
 wretched condition. 
 
 An inspirational type of solution began upon seeing an at- 
 tractive, refined young foreign woman in a cafe. Without intro- 
 duction, he proposed to her through letters to her parents, and, 
 
PSYCHOPATHOLOGY 01*' PARANOIA 459 
 
 after a series of letters they actually became engaged, even though 
 by the time the engagement was consummated he had returned to 
 America, had passed through a homosexual panic, and attempted 
 suicide. At the time of the acceptance of his proposal, he was 
 being treated in a hospital for an elaborate system of paranoid 
 delusions of persecution centered about his former president. The 
 feelings that he should be persecuted were intimately attached to 
 the feeling of being sexually perverse. The impulsive engagement 
 was a desperate attempt to solve his dilemma through marriage. 
 
 The following cases illustrate the same mechanism : 
 
 Case PD-9 was a tall, strong, wiry man about forty-four years 
 of age. He had served since his eighteenth year in the army and, 
 through efficiency, attained the rank of sergeant major. He also 
 received an honor from Congress for conspicuous bravery during 
 an engagement in the Spanish-American War. As a soldier his 
 record was "excellent." 
 
 The patient's father was a chronic alcoholic, and one brother, 
 he said, had "mental trouble." 
 
 Dissatisfied with his home and school, he settled his troubles 
 by eloping at fifteen. He maintained himself quite well by work- 
 ing at odd jobs until eighteen, when he enlisted in the U. S. Army. 
 
 He had several gonorrheal infections, and, at thirty-two, had 
 a chancre followed by skin eruption Avhich was diagnosed as syph- 
 ilitic and treated as such. He maintained that because of syphilis 
 he had postponed his marriage. 
 
 He thought people had imagined him to be a "moral pervert" 
 since his twenty-fifth year. When about thirty-two, he had a homo- 
 sexual experience and an anxiety type of psychosis, the nature 
 of which he would not disclose, although it was serious. He read- 
 justed well enough to keep his difficulties concealed, although the 
 course of events indicates that at no time was he really ever free 
 from homosexual cravings. Like many such men, he was an al- 
 coholic. 
 
 At forty-four, he mai'ried a Avoinan -whom he had known casu- 
 ally for several years. This was a sudden change in his course 
 of living, and it surprised those who knew him. 
 
 Just previous to his marriage, he had complained of feeling 
 weak, tired and forgetful. He went to a Western city on a fur- 
 lough, evidently to recuperate, and married, hoping to solve his 
 sexual i^roblem. He felt that he was being "hypnotized" by some 
 
460 PSYCHOPATHOLOGY 
 
 people while in this city, but would not explain what their in- 
 fluence was. When he returned to his company, a friend, he said, 
 informed him that the woman he married had a questionable repu- 
 tation. The charge, he said, became "fixed" in Ms mind. He be- 
 came morose, seclusive, and constcmtly brooded about Ms sexual 
 difficulties. Impulsive feelings developed, accompanied by voices 
 which prompted him to commit murder and suicide. The murder 
 probably meant that of his wife. He shunned and accused her 
 of immorality without facts to substantiate his beliefs. Auditory 
 and visual hallucinations bothered him in the form of what he 
 called "telepathic communications" and "dreams." He was not 
 absolutely sure of their reality, and dragged out a long period of 
 indeciision as to whether or not he should obey the voices. 
 
 He slept insufficiently because of his anxiety and dreams, one 
 of which is quite typical. He dreamed of a death-chamber in 
 which he saAV his wife in a red dress, and on the wall Avas written : 
 "This is the life." 
 
 When he was admitted to the hosp'ital, his homosexual eroti- 
 cism had become so active that he believed poison was administered 
 in Ms food, and electricity was forced into his body from batteries 
 in the wall. He spit almost continuously in order to keep his 
 mouth purged, because, he said, it was the only way he had of 
 clearing himself of sexual perverseness. (He was experiencing 
 vivid gustatory sensory disturbances. ) 
 
 He became retarded, suspicious, and very cautious about his 
 answers, and decidedly fixed in Ms emotional reactions. He had 
 no sense of humor, never smiled, and talked in a low, serious, omi- 
 nous tone of voice. His features were tensely set, lips compressed, 
 and his eyes stared into space. Frequently, the upper eyelid be- 
 came so much retracted as to expose the sclera above the iris, 
 decidedly the exophthalmic stare. He was inaccessible, on the 
 defensive, had no insight, and was inclined to feel that the homo- 
 sexual struggle was forced upon him by others. He gave the gen- 
 eral impression of being a desperate man. Pertinent questions 
 were met Avith a sullen, threatening stare, and he usually walked 
 away or refused to answer. 
 
 He'said that his Avife tried to poison him with strychnine, and 
 her kisses turned his lips "to ice." He Avas reserved and very 
 formal in his behavior Avhen she visited him. 
 
 He was always neat, seclusive, and wanted special privileges 
 
PSYCHOPATHOLOGY OP PARANOIA 461 
 
 in order that he might treat his illness in his own way. He com- 
 plained that some force was making him think of his "whole past 
 life" (Regression of the love affect after mismating). The 
 thoughts w^ere unpleasant, and, by frequently jerking his head, he 
 found he could get relief and think of something else. He said: 
 "I can think of you or any person and it seems to stop it." 
 
 He felt a force "drawing at the heart" as if something 
 ' ' pulled on it. " Then he added, " I feel drawn toward you. ' ' ( Dur- 
 ing another interview, he spontaneously left' his chair and lay 
 down on a bed. He seemed to expect some procedure to follow 
 this. He did this, he said, because he felt that it was wanted of 
 him. ) He gave every evidence of having to make a desperate ef- 
 fort to control poAverful submissive homosexual cravings. 
 
 He indifferently performed the intelligence tests with many 
 mistakes of memory, indicating marked preoccupation. He was 
 accurately oriented for time. Later, he performed the intelligence 
 tests very well, apparently being better able to coordinate his in- 
 terests better. 
 
 His general attitude was characterized by sullen indifference 
 to advice. He tried to smooth over his difficulties with his wife, 
 and refused to discuss his past suspicions about her infidelity, 
 but stubbornly maintained that he believed she ^vas faithful. He 
 usually seemed willing, and at times glad, to see her, but his pre- 
 occupied manner of staring at her indicated that all Avas not going 
 as smoothly as he tried to make the physicians believe. His be- 
 havior varied from fairly efficient cooperation with the ward-work 
 to periods of anxiety, resistance and refusal to cooperate and to 
 eat. 
 
 He complained bitterly of the electrolier and batteries in the 
 wall shooting electric currents through him and burning his skin. 
 He persistently asked for medicine to cure a weakness caused 
 by dreams — namely, frequent nocturnal emissions without an 
 erection. 
 
 This erotic difficulty and defensive tension subsided after sev- 
 eral months. Later, he explained the cause of his behavior, as 
 follows: "I was considerably mixed up. I imagined that little 
 pieces of stone and plastering which I -saw near the baseboard on 
 the wall were electric magnets, and that these had an influence on 
 me and kept charging me with electricity." During this period of 
 "electric shocks," etc., he frequently had nocturnal emissions, but 
 
462 PSYCHOPATI-IOLOCiY 
 
 was not observed, to masturbate. He said, further, tvith convic- 
 tion, that he noAV regarded, the voices he had. heard and his ideas 
 about his wife as "imaginary" and due to a "mental derange- 
 ment." He was given a parole and permission to direct his af- 
 fairs to soine extent, but not allowed to visit the city with his wife. 
 He promptly eloped, but returned two days later of his own ac- 
 cord. His brooding continued, and again he eloped several weeks 
 later, returning again because he had become confused. He re- 
 fused to cooperate, and tried to convince us that he loved his wife. 
 
 At no time ivere we able to persuade him to talk over his per- 
 sonal problems. Fourteen months after he was admitted, he made 
 a final elopement, and persuaded his former commander to give 
 him some occupation. Because he threatened to, commit suicide 
 if forced to return to the hospital, and upon the assumption of" 
 responsibility by his commander, he was discharged. He refused 
 to live with his wife, convinced of her infidelity and sent her back 
 to her family. (He impressed his commander as being "normal" 
 despite this knowledge of his grave homosexual difficulties. Be- 
 cause of the secret nature of his struggle, the tendency to become 
 confused by hallucinations, and his desperate efforts to fight off 
 his homosexual cravings, we felt that the prognosis was bad. 
 
 His wife was a quiet, patient, healthy woman, submissive to 
 his demands and eccentricities, and wholly without insight into 
 the nature of his struggle. She reported that he had always been 
 potent,' and he claimed as much, but the content of the psychosis 
 and his behavior make their statements unacceptable. (It has 
 been a general experience that the statements of men and women 
 under such conditions are usually not reliable.) 
 
 The tragic ending of such desperate struggles is well illus- 
 trated by the following case : 
 
 Case PD-10 was a man twenty-three years of age, married, 
 rather iTuder sized, but well muscled, very active, had a well-formed 
 head and face, and liked to be considered handsome. He Avas fond 
 of displaying his cleverness and worldly knowledge, and made a 
 determined effort to be considered a man of the world by his asso- 
 ciates. He looked very much of a " dandy. '.' 
 
 His family history contained no indications of an inherent 
 psychopathic taint. He was a healthy, active- boy, learned well 
 at school, and was fond of sports, but girls made him "nervous." 
 As a student, he was indifferent, and left high school to work as 
 
PSYCHOPATPIOLOGY OF PAHANOIA 463 
 
 a stenographer. At twenty, he attended night school, but aban- 
 doned this at the end of a year with an indifferent record. He 
 spent all his earnings as a sport and frequenter of the red-light 
 district and certain saloons. He considered himself to be a hard 
 worker, which was not substantiated by actual endeavors, but, be- 
 cause he was always on the lookout for a scheme to get rich quick, 
 he felt himself to be superior to the other clerks. (A not uncom- 
 mon method of overcoming the inferiorities of poor ability is to 
 be extravagant. This is the most usual compensatory mechanism 
 of the rich inferior male or female.) 
 
 As a clerk in a government department, he was inclined to be 
 inconsistent and suspicious of the other employees. He dressed 
 in advanced styles of clothing and lived what he considered to be 
 an "active life." 
 
 When twenty-one, he, secretly, without a license, married a 
 girl of seventeen. During his psychosis he boasted that his mar- 
 riage was the result of his seduction of the girl on a picnic. This 
 affair he dangled like a scalp on his belt as a token of his virility. 
 "A girl has no chance Avhen a good man is at the helm," was his 
 comment on the affair. She was an unusually pretty, stylish, but 
 simple, maiden Avho had been infatuated with the dashing brag- 
 gadocio of the man. She mistook his ready wit and boastfulness 
 for promising ability. About six months after the unlawful mar- 
 riage, he corrected his crime by marrying the girl according to the 
 requirements of the law. (This should be regarded as a reaction 
 of fear, although he -made the plea of having done this out of pity 
 for her.) From this time on, he fared badly, drank excessively, 
 and insulted and abused her shamefully. He often abandoned 
 his wife on the street to "pick up" a street- walker. He w^as ut- 
 terly unable to endure the restrictions of this marriage. 
 
 Their sexual - relations were excessive, practically daily, de- 
 spite the resistance and distress of his wife. He stated that it 
 was not an unusual thing for him to have sexual intercourse and 
 then masturbate "to get. relief," or to patronize several houses 
 of prostitution, have intercourse with several women and then re- 
 turn to his Avif e. His boast was that he had ' ' so much power "that 
 he could "not get enough." He held this up as a flaunting proof 
 of his heterosexual virility at the time that he was in a panic about 
 . becoming a sexual pervert. 
 
 He had been drinking excessively since seventeen, and once 
 
464 PSYCHOPATHOLOGY 
 
 "swore off" because of a tendency to deliritim. Despite the dan- 
 ger and entreaties of his wife, however, he returned to his old 
 haunts. One night, he was accosted by a homosexual prostitute, 
 and permitted him to practice fellatio upon the payment of a 
 dollar. Later, he boasted of this to his companions and made it 
 a point to prove that he himself was not homosexual. From his 
 quotations of their comments, he seems to have been recognized 
 by his companions as homosexually inclined and defensively trying 
 to establish a recognition of his manhood. A strange man in a 
 hotel one day complimented him on being a "handsome boy," and 
 this suggested that he ought to have his nose operated on to im- 
 prove his looks. Just before the onset of the psychosis he had his 
 teeth treated by a dentist, and later the electrically operated drill 
 played a prolific part in his hallucinations. Also, the dentist him- 
 self became an hallucinated figure in his struggle and worked on 
 his mouth. He had delusions of his wife's infidelity practically 
 from the time of his marriage, and accused her of having had sex- 
 ual relations with her uncle. He abused her violently, and de- 
 nounced her with most unbridled profanity. 
 
 About three weeks before his admission to St. Elizabeths 
 Hospital, he visited a friend's house and there acted "queerly." 
 He familiarly looked over the house and went into the bathroom, 
 while the guests were chatting in a nearby room, and removed his 
 clothing. He made homosexual advances to his host and believed 
 that his host wanted him to have sexual intercourse with the host- 
 ess. His insane state was recognized, and his friend* put him 
 to bed, but later allowed him to return home. Several days la1;er 
 he "felt mean" while in a cafe and smashed up furniture, raised 
 a row, and tried to fight. He was then in a homosexual panic, 
 and hallucinated several of the men planning an assault upon him. 
 He was sent to a receiving hospital, and for several weeks con- 
 tinued in an uncontrollable jampage similar to that which followed 
 when admitted to St. Elizabeths Hospital. 
 
 Upon admission, he refused to give any history of himself or 
 to discuss his mental state. Any questions were answered with, 
 "It is none of your damned business. If you want to know about 
 that you can find out the best way you can. You are not going to 
 learn it from me." Direct questions were. resented, and he fre- 
 quently threatened to assault the examiner. He was well oriented, 
 said he was happy, and refused to consider thathe was mentally 
 
PSYCHOPATHOLOGY OF PABANOIA 465 
 
 deranged. Although he was experiencing prolific, unpleasant hal- 
 lucinations, he refused to admit them for several months. He 
 would not relate his dreams. The simple intelligence tests were 
 performed quite acciTrately, and several times he asked for some- 
 thing more difficult in order to show his mental efficiency. He 
 elaborated the memory test story and, throughout the examina- 
 tion, made many plays of wit and showed considerable tendency 
 to a flight of ideas not unlike the classical manic stream of talk. 
 He strove constantly, desperately, to convince everyone that he 
 was a strong man. 
 
 On the whole, he was inaccessible, and would not reveal his 
 troubles. Unlike the typical manic, however, he had hallucina- 
 tions and reacted to them, investigating them as realities. He 
 grimaced, and displayed his square jaw by thrusting his lower 
 teeth beyond the upper. He stared defiantly into the faces of the 
 physicians, and smashed his fist into his palm (same as Case 
 PD-34) to emphasize what he had to say. This behavior was con- 
 sidered to be a desperate effort to convince the men about him 
 that he was not a weakling: Later, this proved to be true. The 
 desperate necessity was probably not caused by a threatening or 
 hostile attitude of the hospital attendants, but it was caused 
 by a terrible fear of being considered inferior. He could not dis- 
 tinguish the sensory disturbances (hallucinations) from external 
 reality, and this caused his fear. He felt some secret power was 
 exerted over him by the men about him which was pressing him to 
 commit oral erotic perversions ; and this power (which, of course, 
 was within himself) he fought to a desperate finish. So vivid were 
 the hallucinations this caused (visual, auditory, gustatory, tactile 
 and kinesthetic) that he was unable to recognize the causes as a 
 part of his personality. In fact, the sexual cravings had become 
 dissociated from the social self and Avere pursuing their own 
 course. 
 
 Within a few days, he fixed the whole cause of his cravings 
 iipon a certain patient, and assaulted him at every opportunity. 
 He tried to dominate the ward with his displays of power and ag- 
 gressiveness, which, in a certain measure, intimidated the other 
 patients, and must have relieved his fears to an extent. He de- 
 stroyed property wantonly, and his clothing became disheveled 
 and untidy. His language was extremely vile, even for his envi- 
 ronment. 
 
463 PSY.CHOPATPIOLOGY 
 
 When his pretty, timid, young wife visited him, he made her 
 sit on a bench in one end of the hall while he placed himself 
 squarely before her and glared down upon her. He tried to intim- 
 idate her, and would not allow her to look anywhere except directly 
 at him. The passers-by, he said, came near them because they 
 kneAV that she wanted to flirt. He was determined to stop it, and, 
 upon several occasions, struck her, accusing her of lying to Mm 
 when she denied his accusations. He did not seem to feel the 
 slightest sympathy or sorrow for her when she cried and pleaded, 
 but, charged her, again and again, with being prostituted to her 
 uncle. 
 
 For four months, he maintained a general attitude of univer- 
 sal distrust and hatred, upon the one hand, and fear of plots and 
 assaults, upon the other. The following pathetic letter by his wife, 
 written to him at this time, shows the nature of the mating and 
 how he projected his infidelity upon her. 
 
 "Dearest Boy: 
 
 "Your letter received this morning, but, dear, you know very 
 well that I will not be able to do what you ask me in your letter. 
 In the first place you have not asked Mr. — about the rent coming 
 to you, and in the second place I would not know how to go about 
 taking this matter to court. I tell you what you do, you write me 
 a letter and enclose a note addressed to Mr. — , telling him to let 
 me have the rent money due you, and sign your name to it, then 
 I will take the note up to him and see what he will do about it. 
 You can tell him that I am in need of the money, but, dear, write 
 him a nice note, because you will gain more by being nice than by 
 being so mean. 
 
 ' ' Sweetheart, you certainly do say mean things in your letters 
 to me. Now I guess you think that I would sue my aunt for open- 
 ing my letter ; my how foolish you are to talk that way. Do you 
 think for one minute that I would sue my aunt for opening that 
 letter? Why you must think I am crazy. Then you are always 
 talking about who I am living with, you speak of my uncle as 
 though he was an awful person. Instead of do-wning my people 
 as you do, you ought to uphold them and thank them for the kind- 
 ness they have shown toward us, since we have had this trouble. 
 They are good people and they treat me very nice, and you know 
 they are good, but I do not know and can not understand why you 
 say such mean "things about them, that are not the truth. Now, 
 
PSYCHOPATHOLOGY OF PAEANOIA 467 
 
 darling, try to speak more kind of people than you do, and you will 
 
 find out that it will pay in the end. Now do what I told you about 
 
 the note to Mv. — , dear. I have some cigarettes for you, and if I 
 
 see — I will send them oiit by him, because you know they will not 
 
 allow me to come out to see you on account of Avhat happened the 
 
 other day, and it's all your fault too, dear; now I will not be able 
 
 to see you for about a month, or until the doctor lets me know 
 
 when I can come over. Why don't you be good, dear, for I am 
 
 sure (by the way the doctor talked) that if you behave yourself, 
 
 you will get out in a short time, but you are everlastingly getting 
 
 into fights. Now try to be good dear, and try to believe more in 
 
 God, for I am sure this will help you along a great deal. I hope 
 
 you are well, sweetheart, and try to be as happy as possible, and 
 
 I will tell you again to he good. With lots of love and kisses, I 
 
 remain, ^^ ^ . -r. ,, 
 
 ' Your lovmg wife. 
 
 For four months he was openly hostile to everyone. 
 Gradually, his eroticism subsided sufficiently for him to feel more 
 kindly towards the physicians, and he made advances to obtain 
 privileges. It was for privileges only that he discussed his case. 
 He only admitted having hallucinations in order to gain the favor 
 of the physicians and not to obtain insight, and was surprised to 
 learn that the hallucinations he heard could not be heard by the 
 physician. For several Aveeks, he could not believe this, and asked 
 innumerable questions and cross-questions about their electrical 
 machines. He became curious about the hallucinations, as such, 
 and began to look for explanations of them. The electrical ma- 
 chine, he believed, was the dentist's instrument boring the steel 
 burr into his teeth. His attitude towards his wife also changed, 
 and he became lavishly affectionate in order to coerce her into 
 pleading for a parole for him. He tried to keep her from becoming 
 aware of his true difficulties and the fact that he had been insane. 
 He never fully trusted anyone, and gave his confidence guardedly. 
 The incentive for this was his wish for discharge, his general mis- 
 information about the rules of the hospital, and his shame. He 
 thought patients were discharged only when the physicians be- 
 lieved they were able to control themselves. 
 
 He at first made most persistent demands for a parole, and 
 backed it up with threats and profanity. Later, he adopted the 
 method of incessant begging, a decidedly common attribute of the 
 
468 PSYCHOPATHOLOGY 
 
 spoiled child. It was surprising to see his astqnishment when he 
 first learned that his auditory hallu^cim-ations were not heard\ hy 
 others. It seems probable that this revelation was largely due to 
 his general ability to grasp things quickly and the unusual rapid- 
 ity with which the hallucinations waned, perhaps largely the result 
 of the alcoholics. 
 
 The electric machine that had tortured him so persistently, 
 he decided, was an "imagination" that he had carried over from 
 his experiences with the dentist a short time before the onset of 
 his psychosis. The fact that he could place all the blame for his 
 psychosis on alcohol was very valuable to him,, and he seized this 
 opportunity for shifting the responsibility. . But, when it came to 
 explaining why his hallucinations and difficulties were so thor-^ 
 oughly sexual, why he was afraid of being hypnotized and forced 
 to commit oral perversions, he had some difficulty. (Alcoholics, as 
 a rule, will not admit the homosexual fears after the hallucina- 
 tions have stopped.) 
 
 When he learned that homosexuality and oral erotic cravings 
 were considered to be the probable difficulties that caused his fears, 
 etc., he advanced his sexual history to prove that it could not be 
 true. One experience that he laid great emphasis upon was the 
 recorded experience with the homosexual prostitute. (See also 
 Case PD-33.) The fact that the man had practiced fellatio upon 
 him, he believed, was evidence of his masculine superiority and 
 virility. He included an accoimt of how he had told this ex- 
 perience to his friends, and how they had considered it a great 
 joke. However, he was not satisfied with' his insight, and 
 persistently sought to learn more about himself. He seemed in- 
 clined to believe that perhaps he was homosexual, relating how 
 strangers in hotels had accosted him. He thought it was strange 
 that men whom he did not know should compliment him upon his 
 good looks and try to entertain him. The significance of this im- 
 pressed him, and he finally wanted to know if an act of eunnilingus 
 upon his wife meant that he was oral erotic. Later, he admitted 
 that he repeatedly did this, and yet maintained that he was not oral 
 erotic, although, when he spoke of his cravings, he performed most 
 flagrant impulsive movements with his lips and tongue. At this 
 time, he threatened to assault a patient whom, he insisted, talked 
 about him and his wife. This seemed to indicate Jiow much he 
 
PSYOHOPATHOLOGY OF PARANOIA 469 
 
 "was occupied with a solution of his oral erotic inferiorities and 
 the memories of it. (People, as a rule, feel, when ideas can not be 
 repressed from consciousness, that observers can read their minds 
 by the effects emotions have on features, etc.) As his eroticism 
 subsided, he talked more freely, and no longer seemed to be 
 afraid. He had fair insight, but often asked for assurances that 
 he would not have another similar experience. He seemed to 
 be ominously desperate about tliis, but his behavior on parole 
 and his attitude toward his wife was such that the physicians ' con- 
 ference of the hospital yielded to their entreaties for a. month's 
 leave (five months after admission). {A series of these cases have 
 demonstrated thoroughly that vie)!, ivtio are oral erotic, who are 
 inclined to feel that their wives are unfaithful, and cure themselves 
 anxious about their abilitij to copulate with due affective relief, 
 are most unreliable men. When they also have fears of homosex- 
 ual reversion, they must be consideredi as potentially suicidal and 
 homicidal.) 
 
 This young man was strongly homosexual and oral erotic, as 
 well as autoerotic. Through the influence of associates, he learned 
 that these ' ' unmanly ' ' traits were easily hidden by demonstrations 
 of sexual prowess with prostitutes and young girls. Seductions 
 indicated that ' ' a good man was at the helm. ' ' (One wonders how 
 many girls are seduced by young men homosexually inclined, 
 who make conquests merely to boast of them.) His unusually fre- 
 quent acts of intercourse were the expressions of most desperate 
 compensations to become heterosexual and overcome the fears at- 
 tending homosexual reversion. Highly narcissistic, he could not 
 love his wife, or any other woman. Novel forms of excitation 
 probably made it possible for him to copulate, but sooner or later 
 he would have to face the true nature of his biological constitution. 
 
 Several weeks after he left the hospital, he was found lying in 
 a park, dying from a very large dose of bichloride of mercury. A 
 note in a pocket contained the following to his wife: "I have 
 stood the suffering as long as I could. Goodbye." 
 
 Case PD-11, a soldier, aged thirty-seven, unmarried, had been 
 tense and uncomfortable since he was twenty-nine. He drank ex- 
 cessively, and was unable to solve his affective conflicts. For sev- 
 eral years, he felt convinced that his comrades thought he was a 
 sexual pervert. "Signs" and "remarks," which he interpreted 
 
470 PSYCHOPATHOLOGY 
 
 as having a secret reference to Ms troubles, goaded him into des- 
 peration. He felt that certain men were persecuting him, and 
 planned to kill "four or five" of them. One morning he entered 
 the squad room with a loaded rifle and killed two men before he 
 could be stopped. 
 
 During his stay in this hospital,, he has felt that his attendants 
 and physicians persecute him for having secret sexual inclinations, 
 and has repeatedly assaulted attendants and nurses for having 
 such influences upon him. 
 
 The desperate mental straits that men and women get into 
 when the primary affective cravings, pertaining to nutrition or 
 sex, are resisted, hardly needs further elaborate illustration. ..On 
 the other hand, the nature of the underlying affective cra^Mg^; 
 that cause the desperate act are worthy of further analysis, be- 
 cause the variations of behavior must be understood so that the 
 underlying difficulty will become apparent to the psychopathol- 
 ogist. 
 
 Throughout the above group of cases an immodifiable, hio- 
 logically inferior, terrifying, sexual craving is evident, and the ec- 
 centric striving, as a compensation, made in order to win social 
 esteem, as ivell as to insure the feelwig of biological fitness, is cer- 
 tainly obvious. In the above group, homosexual inferiorities were 
 predominant. In the following case, the autoerotic source of wild 
 compensatory fancies is quite definite. 
 
 The following patient's (Case PD-12) account of the develop- 
 ment of wild compensatory fancies about studying " electrons, " 
 "molecules," etc., to solve the great riddle of the universe, and of 
 himself, in order to develop potency, shows that compensatory 
 striving is also typical of the autoerotic. It protects him from the 
 fears of social persecution so often arising from such wastage: 
 
 "Began the act of masturbation at thirteen, which continued 
 until seventeen, when I sought a room in my mother's house, and 
 in which I stayed until eighteen. During the period of confine- 
 ment I was beset with the delusions that everyone I heard speaking 
 was deriding me. Not only did I think this of my own relations, 
 but of everyone I heard speaking. My resentment finally centered 
 on the "Odd Fellows" who had forcibly ejected me from their 
 hall one afternoon. I thought that I would find great satisfaction 
 in destroying their property, so attempted to burn down their hall, 
 and on being examined by physicians was sent to the Matteawan 
 
PSYCI-IOPATHOLOGY OF PAKANOTA 471 
 
 State Hospital where I was confined nntil twenty-one, wlien I was 
 discharged as cured. During the first part of my confinement 
 there I was troubled mth the same delusions. On leaving that 
 institution my mind acted in a weak and wandering state which I 
 could not control. I had numerous positions, but tlie condition of 
 my mind prevented me from holding any of them but for a short 
 time. But I found that I was gradually becoming stronger, and 
 could better concentrate my mind as the years went by. I enlisted 
 in the army, where, having access to the library, I became inter- 
 ested in scientific ideas. I spent all my wages for books on the sub- 
 jects of Chemistry, Astronomy, Morphology, Electrons, Atoms and 
 Molecules, which I shidied\ for three years luith the idea in mind 
 that I tvoidd discover some ivovderfid facts imlinown to the other 
 men ivho did not use Electrons, Atoms and Molecules for a base to 
 start from. During this period, I was masturbating about twice 
 a week. When I was discharged, I soon became convinced that I 
 was mentally living in a world of theory, but decided to finish my 
 books so I reenlisted in the army. I studied for eight months, when 
 becoming startled at unknown fears and intense pains in the head, 
 accompanied by fiutterings in the back part of the head when evac- 
 uating the bowels, I became frightened. I commenced to study my 
 mental condition. I looked back over the years of masturbation ac- 
 companied by intense study, so became convinced that my mind 
 Avould shortly fail me. I determined that my only relief was to 
 seek the noise of the city streets, so I deserted. For three days I 
 was intoxicated, which helped me to completely forget my troubles. 
 But I found that I was still possessed of a Avandering mind and a 
 peculiar quick temper. I would hold a position for a short time 
 only. I commenced to experience pains in the head when it seemed 
 to me that the sidewalk was moving sideAvise. I consulted one old 
 soldier friend who advised me to surrender myself to the military 
 authorities, which I did. My friend stipulated that I should behave 
 as a prisoner and that if found being afflicted with lung trouble I 
 would be sent to Fort Baird, New Mexico. But as three examina- 
 tions showed no signs of lung trouble, I determined to secure a 
 medical discharge from the army by shamming insanity which I 
 did successfully. I told the doctor I was possessed of a knowledge 
 concerning electrons, atoms and molecules as would enable me to 
 change the present existing conditions and bring on the millemiium. 
 I accompanied these verbal assertions by exaggerated nervous 
 
472 PSYCHOPATHOLOGY 
 
 stimulations which completely fooled the doctor, as expressed by 
 his eyes. This continued for two months, when to my surprise, 
 I was brought to "Washington under the impression that I was com- 
 ing to the Walter Reed General Hospital for observation." 
 
 When this patient was brought to St. Elizabeths hospital he 
 soon claimed that he had malingered insanity in order to escape a 
 prison sentence. He made the confession of malingering, saying 
 he would rather go to prison than to remain here, because he was 
 afraid the associations with patients would again make him insane. 
 He had very little confidence in his mental stability, and begged to 
 be sent to prison. 
 
 He declared the material he had used to give the impression 
 of insanity had been picked up at Matteawan from other patients 
 and from his own experience there. It consisted mostly of claims 
 of auditory hallucinations, fear and very grandiose fancies about 
 omnipotent, heroic deeds -wdth electrons and molecules, and the 
 destructions of an enemy's, fleet, etc. 
 
 While he was a patient here he was sociable, helpful, clean and 
 generally well behaved. The intelligence tests indicated consid- 
 rable inability to concentrate on facts and think accurately. 
 
 The Paranoid Mechanism of Compensation in the Female 
 
 The paranoid mechanism of compensation in the female seems 
 to be similar to the male in that fundamentally there is an overde- 
 veloped homosexual craving that has existed since adolescence, 
 which, however, has often not been truly appreciated by the indi- 
 vidual. Through the influence of some experience or overt auto- 
 erotic and homosexual play, the woman becomes fearful of her 
 inability to control herself and tries to show that she is not auto- 
 erotic or homosexual, but is fond of men and very attractive to 
 them. Within due time the fear of being recognized as homosex- 
 ual becomes covered over by the obsession, a wish-fulfilling con- 
 viction, that men are passionately fond of her and resort to every 
 means to seduce her. 
 
 These patients, as a rule are remarkably clever and tell an 
 astonishingly logical story built up of deductions from, however, 
 the wish-fulfilling "meanings" in the suspected person's "re- 
 marks" and "manners." 
 
 My experience with a series of such women, several of whom- 
 are reported (Cases PD-28, PD-36), is that if the male physi- 
 
PSYCHOPATHOLOGY OF PARANOIA 473 
 
 cian is not critical and carefully refrains from expressing any 
 donbt about the defensive delusional system, which is not often 
 easy to do, he will soon find that the woman will strive to force 
 herself to establish a transference to him which in a short time will 
 be difficult to control (contrasting with the truly heterosexual type 
 who make a natural transference). He will also find that these 
 Avomen usually are much more inclined to trust men physicians 
 and will not, if possible, allow a woman physician to examine or 
 prescribe for them. 
 
 Their records also show, if married, that they have been 
 frigid, vain, self-indulgent, and often secretly autoerotic, and not 
 until they become fearful of their affections for other women do 
 they plunge into a system of heterosexual fancies. In this respect 
 they strive to compensate like the homosexual man. 
 
 It seems to he a consistent fact, remarkable if so, that the con- 
 slstently aggressive homosexual male and female, iieither one, are 
 inclined to become paranoiacs and panic-strickeu , developing 
 m-erely anxiety neuroses and periodic manic flights of abandon- 
 ment, but those ivho can not control cravings to submit to sexual 
 assa^dts, develop a delusional system in ivliich everytliing in the en- 
 vironment that tends to stimulate the compulsion to be submissive 
 is resented and attacked. 
 
 The mechanism of compensating for an inferiority, l^eing 
 characteristic for all forms of animal life and probably every cel- 
 lular division of each animal, not only shows in the psychoses when 
 a functional inferiority causing fear is present, but also when the 
 individual has a functional inferiority due to disease. The fol- 
 lowing cases of paresis and an arteriosclerotic old man show how 
 the compensatory claims a]:ise as a defense against fear. When 
 this inferiority is increased by disease, reducing the margin of 
 reserve power, the compensation may become more eccentric. It 
 is quite probable that only those paretics compensate who become 
 afraid when they begin to feel their potency diminishing. 
 
 Case GP-1 was a government clerk, aged twenty-seven, 
 recently married, who had all the clinical and laboratory findings 
 of paresis. He acquired syphilis seven ^^ears before his admission, 
 and received vigorous an ti syphilitic treatment. His physician con- 
 sented to his marrying, although a few weeks previous to giving 
 this advice the patient developed a slight ptosis of one eyelid. 
 
474 PSYCHOPATflOLOGY 
 
 Soon after his marriage he complained, after copulating, of 
 having to work unduly long in order to have seminal emissions, 
 and worried about the cause of this weakness. Three weeks after 
 his marriage he became depressed, felt that he was going blind, 
 and reacted to auditory hallucinations that were trying to make 
 him commit sexual perversions. They also told him he was goii^ 
 blind in one eyes 
 
 He developed a classical compensation type of psychosis with 
 a grand euphoria and a consistent goodhumored, halfserious hy- 
 peractivity, colored with chronic plays of wit. He constantly built 
 great electrical machines in his fancy, with which he could explode, 
 magazines of powder at great distances by mere turn of the hand. 
 These fancies gave him great pleasure. He told of a fight he had 
 with an attendant, in which, by the power of his mind he took hold 
 of the man's little finger and threw him. 
 
 He fancied that he could hypnotize any girl by looking at her, 
 and, with his eyes, make her fall in love with him. This was a dis- 
 tinct compensation for distressing sexual impotence, although the 
 impotence was probably caused by cerebral syphilis ; and the hyp- 
 notic power of the wonderful eyes replaced the ptosis. 
 
 Case GP-2 was a sailor, aged twenty-nine, divorced, who 
 had many clinical and all the laboratory findings of paresis. 
 Pie was hyperactive, made numerous incoherent productions, 
 Avrote many unintelligible letters and constantly tried to establish 
 his potency as an inventor. He believed that syphilis of the brain 
 was the cause of his incoherent speech, feelings of weakness and 
 tremors. Through exercise and incessant work, he tried to repair 
 his loss of skill and strength. One morning, while confused and 
 stuporous, following a convulsion, he rushed up to me from his 
 bed, crying and begging for protection^froni men who, he explained 
 unmistakably, were trying to subject him to an oral sexual assault. 
 From the facts, that he was isolated in a room, had been muttering 
 and cursing the assailants, and later treated the affair as an " im- 
 agination," and that he was recovering from a stupor following 
 convulsions, we regarded the panic as the result of vivid halluci- 
 nations, in which oral erotic cravings played a predominant part. 
 The tendency to homosexual regression caused fear which was com- 
 pensated for by the vigorous, wild striving to be potent. 
 
 Case AS-1 was a man over seventy years of age, who had 
 many signs of a cerebral arteriosclerotic deterioration process. He 
 
PSYCHOPATHOLOGY 01? PARANOIA 475 
 
 always persisted in demonstrating Ms fancied great strength and 
 inventive ingenuity, and described, with indefatigable detail, the 
 wonders of a powerful drill for "boring into rock," which he was 
 going to build. 
 
 The rock suggested the resistance to sexual potency, and the 
 drill Avas the all potent phallus, which brought up the question: 
 Why should an old man, on the verge of his grave, persist in this 
 striving? What was he afraid of? He answered this question as 
 soon as we inquired about his comforts and safety, not about his 
 sexual difficulties. 
 
 He immediately begged for protection from a young man who 
 slept near him. He described the man 's behavior in a manner that 
 convincingly showed that he himself had submissive erotic inclina- 
 tion toward his neighbor and was blaming the young man for the 
 difficulty. The old man was afraid of himself and so was recon- 
 structing his potency in fancy as a defense. His hyperactivity and 
 demonstrations of power were compensations. 
 
 Case MD-8 illustrates a compensatory mechanism in the fe- 
 male due to organic inferiority. 
 
 Summary 
 
 It is apparently a sound principle in psychopathology that, 
 whenever an individual presents an eccentric claim for prowess, 
 inventive power, creativeness, or undue potency in some artistic, 
 professional, social or mechanical field, without reasonable foun- 
 dation in reality, he is overcompensating for inferiorities of which 
 he is fearful. 
 
 Organic and functional inf erioritieis that do not cause anxiety 
 ("sensitiveness") or fear are not compensated for. 
 
 Conversely, when an individual wishes to acquire or avoid the 
 attentions of someone, or develop some project, he compensates 
 with work, the endeavor relieving the fear of possibility of failure 
 to gratify the wish. 
 
 The paranoiacs and paranoid types arc, always individuals 
 who are biologically inferior to the requirements of the race. 
 They are not able to establish a comfortable heterosexual potency 
 and are constantly forced to struggle in order to control homo- 
 
476 PSYCHOPATHOLOGY 
 
 sexual perverse cravings of which they are fearful, and which they 
 usually refuse to recognize as a part of themselves. 
 
 My experience with these unhappy people is that the prognosis 
 depends upon the development of insight, and this, in turn, de- 
 pends upon the absence of hatred and the ability to avoid system- 
 atizing an attack upon those who make them conscious of their un- 
 desirable cravings. 
 
 The paranoiac is functionally so conditioned and his cravings 
 are so repressed that he can almost but not quite reach hetero- 
 sexual virility. The near approach to potency compels him to 
 strive incessantly to reach it. 
 
CHAPTER X 
 THE PSYCHOLOGY OF THE ACUTE HOMOSEXUAL PANIC 
 
 Acute Pernicious Dissociation Neuroses 
 
 The confirmed paranoiac avIio systematizes delusions of per- 
 secution and the paranoid individual who does not systematize 
 his delusions of persecution, the individual who passes through an 
 acute homosexual panic and recovers, and the homosexual individ- 
 ual who becomes dissociated and deteriorates, are dissimilar, 
 largely because some make fortunate positive transferences which 
 ameliorate the fear of inferiority and stop the tendency to erotic 
 deterioration, whereas the others, who make negative (hatred) 
 transferences, drive themselves into a progressively eccentric 
 social position which establishes a vicious affective circle and a 
 pernicious dissociation of the affective forces which constitute the 
 personality. Chapters IX, X, XI, XII and XIII contain studies 
 of these different types of adjustment. 
 
 The mechanism of the homosexual panic (panic due to the 
 pressure of uncontrollable perverse sexual cravings) is of the ut- 
 most importance in psychopathology, because of the frequency 
 of its occurrence wherever men or women must be grouped alone 
 for prolonged periods, as in army camps, aboard ships, on explor- 
 ing expeditions, in prisons, monasteries, schools and asylums. 
 
 The perverse sexual craving threatens to overcome the ego, 
 the individual's self-control, because the affections for winning 
 social esteem have been pushed into an eccentric adjustment. The 
 weakness of the ego is usually due to fatigue, debilitating fevers, 
 loss of a love-object, misfortunes, homesickness, the sediTctive 
 pressure of some superior, or erotic companions. As the individ- 
 ual tends to become eccentric and irritable he is teased and goaded 
 by his associates. He then loses his social influence and develops 
 a feeling of being inferior and disrespected. The goading is the 
 reflex reaction of the herd to get the individual into line with the 
 needs of the herd. The herd can not afford to be biologically 
 misled. 
 
 477 
 
478 PSYCHOPATHOLOGY 
 
 * 
 
 The fear of inferiority arouses a more intense compensatory- 
 striving, wMch, because of its eccentric nature, further increases 
 the nagging. The vicious affective circle gradually becomes a per- 
 secution and the erotic individual, as the perverse sexual cravi^^| 
 tend to force him into further jeopardy, becomes panic-stricken. 
 
 The perverse affective craving causes delusions about, and 
 hallucinations of, situations, objects and people which tend to 
 gratify the craving. The pressure of the perverse craving occurs 
 despite the social honor and social future of the individual. Hor- 
 rified, he is swept off his feet into a hell of hallucinated tempta- 
 tions and demons of destruction. 
 
 The physiological reactions of fear to a painful contact stimu- 
 lus are quite like the fear reactions to horrible, painful hallucinated 
 stimuli. The mechanism of the terrifying dream, like the halluci- 
 nation, is first an affective disturbance due to the repressed auto- 
 nomic tensions becoming released by the relaxation of self -con- 
 trol, as in sleep. During sleep, indigestible food would cause 
 increased gastrointestinal striving. This produces consciousness 
 of distressing sensory images which may coalesce into a horrible 
 perception, like the black dots forming a picture (to^ repeat the 
 simile used in Chapter I), and this horrible visual or kinesthetic 
 image, in turn, cati^s the fear reaction. The next stage would 
 be to compensate by awakening, by flight or counter-attack. When 
 the erotic.hallucination is felt to be an external reality and no de- 
 fense is found, pamic ensues. 
 
 The panic may be more or less serious, lasting from a few 
 hours to several months, and the metabolic disturbances attend- 
 ing such dissociations of the personality, because of the autonomic 
 reactions due to fear may be very serious. 
 
 The autonomic reactions to fear, whether endogenous (as car- 
 diac incompensation) or exogenous in, origin, are, ivhen the com- 
 pensatory striving can he made, increase of blood-pressure and 
 pulse rate, increase of adrenin and thyroid secretions, increase of 
 blood sugar and decrease of the digestive and assimilative capa- 
 cities of the digestive apparatus, decrease of heterosexual potency, 
 and marked increase of trial and error movements of the skeletal 
 apparatus for the purpose of escape — ^heiice, restlessness, irrita- 
 bility, insomnia, etc. 
 
 When the compensatory striving to retaliate or escape in- 
 creases the liability to punishment, a tendency to loivering of 
 
ACUTE HOMOSEXXJAL PANIC 479 
 
 blood-pressure, irregularliy of pulse, difficulty in respiration cmd 
 a tendency to assume the catatonic attitude seems to follow; as in 
 young monkeys, puppies, terrified soldiers, niid catatonic patients. 
 
 Obviously, since work and play are necessary to prevent the 
 atrophy of disuse of tissues and functions in the normal, long per- 
 sistence of panic or anxiety, besides the tendency to abnormal 
 endocrinous functions, may be expected to cause marked physio- 
 logical and, later, permanent structural changes. Gradually, a 
 deteriorating or destructive autonomic-affective vicious circle is 
 established, which, because the powers of adaptation and social 
 competition are greatly reduced, deprives the individual of the 
 capacity to regain self control, social esteem, reassurance and bio- 
 logical fitness. Intercurrent diseases and seclusion in asylums 
 further reduce the compensatory capacities of the dissociated per- 
 sonality. This is not dissimilar to the Aricious circle of disease and 
 inactivity upon the normal. "What normally active individual 
 would dare to endure the deteriorating, monotonous type of activ- 
 ity forced upon the individuals incarcerated in prisons and asy- 
 lums? 
 
 A series of cases is here presented to show that the cause of 
 the anxiety and panic is the uncontrollable, perverted segmental 
 craving struggling with the socialized affective cravings, the ego, 
 in the same personality. The latter can only acquire gratification 
 by doing the things that win social esteem. They constitute the 
 ego and are spoken of as "I," "me," "myself." Naturally, when 
 the sexual cravings can not be controlled they become disowned 
 by the ego as a foreign influence, and the ideas and visions, or 
 sensations they cause, are treated as being due to a foreign influ- 
 ence. Hence, when another individual, whose characteristics hap- 
 pen to coincide with the conditioned needs of the dissociated sexual 
 cravings, thereby stimulating them, comes into the patient's en- 
 vironment, the patient feels he is being "hypnotized." Often 
 such men and women attack the innocent person or yield to the 
 hallucinated assault; or even do both. When the patient says 
 someone is "throwing voices" into his head, making him hear 
 voices or have visions, making him have a peculiar taste in his 
 mouth, putting poison in his food, shooting electricity into his 
 body, hypnotizing him, going to kill, crucif}^, initiate him, or make 
 him join a society or religion, or steal his manhood, etc., it has 
 been found that the patient is telling the physician that he has lost 
 
480 PSYCHOPATHOLOGY 
 
 control of Ms sexual cravings ivhich are forcing him to offer him- 
 self as a sexual oiject. When the patient insists that a certain 
 person is performing this mysterious ritual or power over him, 
 it may be accepted that in some manner this particular person is 
 either sexually attractive to him or is very intimately associated 
 with someone who is sexually attractive. 
 
 The prognosis of such cases, it seems, depends largely upon 
 the extent of the defensive systematization of the delusions, and 
 whether or not the patient is reacting with hatred. The presence 
 of hatred should always he considered as dangerous under such 
 conditions and almost sure to prevent the develop'inent of insight. 
 
 The true significance of "poison" in the food was a riddle 
 until the following patient showed us that it probably, usually, 
 meant semen. A further careful investigation of the meaning of 
 "poison," "filth," "dope," "drugs," "stuff," "something in the 
 food," "cream," "powder," "saltpeter," in a series of over 200 
 cases, established the probability that in every instance in which 
 a patient seriously complains that food has a mysterioiTS, or hyp- 
 notic, or erotic influence upon him, it is due to the fact that the 
 food acts as the stimulus of pernicious oral erotic cravings. This 
 insight naturally has led us through a simple approach to the very 
 foundations of the patient 's emotional cravings and the heretofore 
 obscure causes of this type of psychosis. 
 
 We have found that the patients who can be influenced to quit 
 fighting the recognition of oral erotic cravings — this does not mean 
 submission to them — fare better than the patients who struggle 
 desperately to eliminate them and attack everything that arouses 
 the craving. 
 
 In order to make it unnecessary to refer again to the facts 
 that explain the meaning of "poison," etc., in the food, or of im- 
 pulsive suicidal assaults upon the head, mouth and throat, or swal- 
 lowing extraneous material, the reader is asked to note -partic- 
 ularly the factor of oral, homosexual eroticism and the delusions 
 about being persecuted for having such perverse cravings in the 
 following series of cases. 
 
 Case PD-13 was an egotistical, taciturn, rather well-built, but 
 undersized, German, with small features, and lips which were 
 tightly compressed into a cynical, indulgent smile. He was twenty- 
 eight and unmarried when admitted to the hospital. He had never 
 been able to adapt himself comfortably to any society and had at- 
 
ACUTE HOMOSEXUAL PANIC 481 
 
 tended school irregiilaiiy, liad a poor education, was fond of play- 
 ing truant, and frequently was arrested for vagrancy, serving two 
 sentences of thirty days and one oL' six months. lie Avorked in 
 bicycle-repair shops, and at similar odd jobs, until he was twenty- 
 four, but was unable to submit to the dictations of an employer, 
 feeling that it referred to some inferiority. 
 
 At twenty -four, he drifted into the army and earned a fair 
 record during his first enlistment. There, he was operated on for 
 appendicitis, and later for hernia. Neither experience seriously 
 disturbed him. He denied venereal infections and was not inclined 
 to be alcoholic. He saved no money, giving some aM'ay to men who 
 Avere "down and out" and patronized prostitutes when "nature, 
 called for it." Otherwise, he cared very little for women. 
 
 He was inclined to brood, made no friends, was very seclusive 
 and sullen. He felt that his companions talked about him and 
 avoided him because they thought he was "a silent worker." (He 
 meant homosexually, oral-erotic.) 
 
 At twenty-eight, his feelings of persecution due to the re- 
 pressed eroticism assumed the proportions of a fernicious repres- 
 sion compensation neurosis or paranoid psychosis. He became 
 more seclusive and would talk to no one, feeling himself to be re- 
 garded as "no good in the army." He fancied that "broken 
 pills" had been put into his pudding and coffee, and complained of 
 this as mistreatment. He said that at one time he acted as if he 
 was asleep and heard his companions make such remarks about 
 him as "fluter," "silent worker," "start him working," "he will 
 be in Washington in the insane hospital soon." 
 
 He was finally confined in the Post hospital because he was 
 suspected of taking money from a store-till. A fcAv weeks later, 
 he was sent to St. Elizabeths Hospital at "Washington, D. C. 
 
 The mental examination showed no actual impairment. He 
 was well oriented, understood his environment, his memory was 
 accurate, and he easily passed the special intelligence tests. The 
 physical examination revealed no organic inferiorities. 
 
 His psychosis seemed entirely to be constituted of a struggle, 
 with intense homosexual cravings. He believed that he had been 
 sent to this hospital as a punishment and that the men here re- 
 garded him to be a sexual pervert. His auditory hallucinations, 
 accusing him of homosexual desires, worried him continually. He 
 believed the accusations were made by other patients and isolated- 
 
482 PSYCHOPATHOLOGY 
 
 himself accordingly. He was depressed and at times wept bitterly. 
 At other times he was quite indignant and threatening. He walked 
 erectly, held his head up, and looked defiantly at his physicians and 
 associates. He usually smiled in a very tolerant, superior, self- 
 satisfied manner, as if he knew something that made him superior 
 to most men. 
 
 He complained mostly about the food, and was fed with diffi- 
 culty. ' ' They ' ' put pills and powder in his coffee ; it was ' ' ground 
 up so that it would dissolve. ' ' He said the milk in the coffee was 
 "too thick." "It ivas not cream, it ivas too fat." His ideas 
 about the coffee were very similar to the ideas he entertained 
 at the army post. A few days later he cautiously revealed his true 
 feelings about the pills in his coffee at the army post. This was 
 told with mingled embarrassment, weeping and affectionate smil- 
 ing. .The questions had to be guardedly phrased so as not to of- 
 fend him or lose his confidence. He finally revealed his craving 
 for the ingredients and that it made him "feel better," relieving 
 his depression. He said the coffee and pudding contained some- 
 thing "richer than cream, richer than milk,." It would make him 
 "feel hot" when he ate it, and he had to open "two windows" to 
 "cool off." He added, in his discussion of this, that later he had 
 to go to the toilet but could not pass feces because "it was too 
 hard." (Two windoAvs evidently referred to two orifices ; in order 
 "to cool off," to be relieved — namely, oral or anal. An erotic 
 woman begged for cold water because she was "hot.") 
 
 He would not say definitely what this coffee contained, but 
 felt sure it made him "dream off." His smiles and tendency to 
 become affectionate when he described the "richer than cream" 
 were unmistakably characteristic of the homosexual advance. 
 (Such men can not be held morally responsible for having such 
 autonomic cravings, but they are responsible for their adjust- 
 ments to them.) 
 
 He said he would like some more of it because it did him 
 "more good than anything else," and made him "feel much bet- 
 ter." 
 
 During this renunciation to his sexual feelings for men, he 
 wept bitterly, and showed how easily he might lose control of his 
 cravings. He said : "Somebody might make me do something, biit 
 I would not do it if I knew it. ' ' He continued to mal?:e homosexual 
 advances with this statement and talked of his inability to control 
 
ACUTE HOMOSEXUAL PANIC 483 
 
 himself. When he realized that he was making advances unre- 
 servedly, he cried and tried to assert some self-control, with the 
 statement, "I am not so low as that." I was careful to ask only 
 simple questions, basing each one on the content of his preceding 
 statement so as not to suggest an opening to him, but it seemed 
 that my insight into his struggle was sufficient for him to make 
 a frank exposure of his difficulties. After he expressed his resist- 
 ance to his sexual cravings in the phrase, "I am not so low as 
 that," he followed it up with another advance and then with agita- 
 tion, ' ' If you want to, take me out and shoot me and be done with 
 it." After this conversation he frequently sought further inter- 
 views and regarded me with affection and as a protector. This 
 soon changed to peevishness Avhen- 1 was unable to give him fur- 
 ther attention. 
 
 In the meantime he was neat and seclusive, spent most of 
 his time in day-dreams, often laughing heartily to himself. He 
 was paroled several times, and did some indifferent work in the 
 laundry, but, because of his egotism and sensitiveness, he had to 
 be removed. 
 
 For several months he compensated for his feelings of infe- 
 riority and unpleasant hallucinations by most extravagant claims 
 of being "God" and very powerful (potent). Otherwise, he could 
 not be induced to discuss his troubles Avith anyone, but prophesied 
 that we would soon know all about him. He became very arrogant, 
 and often demanded his discharge. He Avrote numerous letters 
 containing incoherent phrases referring to his omnipotence and 
 self-importance. Unfortunately (sixteenth month) he eloped from 
 the hospital. The following letter was received from him about 
 a month later: "Sii* — Am writing in regard to clothes and rest 
 of funds, $5900 due to me while I been in U. S. Army from 5th 
 December 1914, discharged 13th July 1915. Hoping to hear from 
 you soon." (Signed.) « 
 
 Other sensory disturbances than auditory and gustatory were 
 never complained of or indicated. 
 
 When he eloped, he had no insight into the hallucinated sen- 
 sory gratification of his affective cravings, but believed other peo- 
 ple were responsible for them. He was regarded as a paranoid 
 type of pernicious dissociation of the personality. 
 
 After this patient's revelation of the significance of "poison" 
 and "dope" in the food, and the cravings.it satisfied, an entirely 
 
484 PSYCHOPATHOLOGY 
 
 new interpretation of the resistance to food, which is common in 
 many psychotics, became necessary. We now were able to under- 
 stand why many panic-stricken patients had to be tube-fed. The 
 food and month were intimately associated Avlth the erotic crav- 
 ings and the forced feeding constituted an assault : to some, pleas- 
 ant, to others, horrible. Some resist the feeding desperately 
 whereas one woman starves herself in order to be tube-fed and 
 reacts to the tubing as a sexual orgy in which she masturbates if 
 not restrained. 
 
 Case PD-14 had an alcoholic father; his mother had had 
 "fainting spells." Because of his limited mental capacities, he 
 attended the ungraded schools until twelve years of age, then 
 worked as a helper in many different trades, and enlisted in the 
 navy at seventeen. 
 
 About fifteen months after his enlistment, his psychosis began. 
 The interesting feature in his psychosis was the panic, because of 
 inability to control himself. He suddenly submitted to the homo- 
 sexual cravings, and put white paste into his m,outh, insisting that 
 some person's hypnotic influence forced him to do this. 
 
 When he was admitted to St. Elizabeths Hospital, having 
 practically readjusted, he discussed the panic with great reluc- 
 tance. When he spoke of the details of his experience, he again 
 became agitated, and only controlled himself with the greatest 
 effort. He insisted he had been "doped" and a scheme had been 
 "framed up," on board ship, which he resented bitterly. 
 
 He was well oriented upon admission, his memory was accu- 
 rate, and he performed the intelligence tests quite well, althoiagtv' 
 his answers were frequently rather simple and insufficient. 
 
 At the time of his psychosis, he was in love with a girl and 
 planning to marry. He naively displayed the girl's picture to his 
 companions and promptly became the butt of unpleasant "kid- 
 ding ' ' which, on one occasion, resulted in a fight. 
 
 His fair, pink, girlish complexion, scanty facial hair and shy 
 manner of expressing himself were effeminate attributes. Several 
 times, some of his shipmates made homosexual advances to him, 
 and he probably felt uncomfortable about their impressions af his 
 masculinity. For several weeks before the acute panic, he worried 
 about his health (anxiety) and tried to get into "the sick bay" be- 
 cause of feelings of dizziness, weakness, fear of falling, and a tend- 
 ency to become confused (common symptoms of failure to con- 
 
ACUTE HOxMOSEXUAL PANIC 485 
 
 trol the erotic affect). The first tune he went to the sick bay, he 
 said, a "red-headed" attendant told him that if be didn't quit 
 ' ' pulling his penis something would go wrong with him. ' ' He said : 
 "I let this sink deep into my mind; I had been dreaming a lot 
 about my girl and may have masturbated while in my sleep." He 
 had tied his hands at night to preA'ent himself from masturbating. 
 (Fear of the segmental craving.) 
 
 During this episode he complained of the usual anxiety symp- 
 toms: Pain in the stomach, vomiting, depression, weakness and 
 crying. Despite this, he was sent back to duty in two days. The 
 physician made a diagnosis of "hysteria." About three weeks 
 later, a serious panic developed. He remembered the following 
 ' ' remarks, ' ' which had something to do with the ' ' frame up. ' ' 
 
 He said the day he drew his pay he was feeling uncomfortable. 
 One of the sailors, he thought, significantly remarked : " ' Sign it 
 for all you're worth ! ' The pay check said 18, and I told him to look 
 again and he found it was $27!" That afternoon, they stored 
 "brightening paste" (a white metal polish) in a storeroom and it 
 made him feel sick, but he could not explain why brightening paste 
 should sicken him. (His later impulse explains this.) He said he 
 felt "so dizzy" he could hardly take a bath. (Fear of sexual 
 temptation.) That evening, he joined some sailors in a game of 
 poker, during which his "queer feelings" made him sure that 
 "something" was going to happen to him. He gave his money to 
 a companion for safe-keeping and then sought help from an officer, 
 who, it seems, passed him up. He retired to his hammock, but 
 could not sleep. Finally, he went to the toilet "to get relief," and 
 on the way he passed a bulletin-board on which he saw the names 
 of all the men with Avhom he had previously played poker. Their 
 names were posted to receive ' ' registered mail, ' ' and his name was 
 not on the list. (He was not a truly registered, thoroughbred 
 male. ) This convinced him that a ' ' frame up ' ' was being planned 
 against him and caused his "queer" (sexual) feelings. He tore 
 the names off the board, and. the officer sent him to the sick bay. 
 Here he felt that "odors, like ammonia, were blown into the room 
 by a fan. ' ' He became panic-stricken, was afraid they were plan- 
 ning to kill him or put him through a series of initiations. He 
 cried, resisted all attention, talked confusedly, and could not be 
 controlled. He was finally put to bed, but insisted upon examining 
 everything in the room. He tried to find the cause of the odors, and 
 
486 PSYCHOPATHOLOGY 
 
 found a box of brightening paste. He sKonted, "This is the 
 stuff ! ' ' and bit into it. The taste was unpleasant, and he scattered 
 the remainder over the ward. He was caught and put into the 
 ' ' strong room, ' ' where he now cried, shouted, cursed and called for 
 the "red-headed attendant." When the man came, he threw his 
 arms around him and begged for protection. He said he thought 
 his penis was all" shrivelled up" {castration) , and that they were 
 trying to do "something, pull something over his eyes." He con- 
 tinued to be excited, incoherent, confused, and was unable to be- 
 come reconciled to his confinement. After he readjusted he al- 
 ,ways became agitated and wept when he discussed this experi- 
 ence, and is still firmly convinced that he was " doped "^and 
 subjected to a sexual assault of some sort. The panic and depres- 
 sion lasted about a week. 
 
 He never gained insight, but explained the eating of the 
 paste as an impulse. Physically, he was a well-developed young 
 man, but the scarcity of his facial hair, his transverse pubic hair 
 and soft voice indicated his effeminate make-up. He M^as fond 
 of other male patients, and was observed to sit on the bed with 
 another man and kiss him. 
 
 His panic was clearly terror at his own homosexual eroti- 
 cism which he could no longer control or understand. 
 
 While in this hospital he was neat, well-behaved, sociable, and 
 worked on the ward. He was discharged at the end of the third 
 month as a social recovery with partial insight. He declared he 
 was going to marry and make a man of himself. The prognosis is 
 considered poor. 
 
 Case PP-15 was an illiterate Eussian Jew, aged thirty, mar- 
 ried, who served in the U. S. army one and one-half years as a pri- 
 vate. 
 
 He said his father was ' ' crazy. ' ' 
 
 This man was well developed, physically, but gave a history 
 of syphilis, had a positive blood reaction (Wassermann), but nega- 
 tive spinal fluid and no neurological symptoms of intracranial 
 syphilis. 
 
 He was sent to St. Elizabeths Hospital as a case of ' ' catatonic 
 dementia prsecox." His psychosis was a classical homosexual 
 panic. 
 
 At twenty-six, several years after his marriage, he began to 
 
ACUTE HOMOSEXUAL PANIC 487 
 
 practice cunniliBgus, and there is some indication that homosexual 
 perversions may also have been practiced. 
 
 The onset of the psychosis, according to the army medical re- 
 port, was "snb-acnte with insomnia, confnsion and depression." 
 This was followed by a state of panic, hallucinations and a "hys- 
 teria form of attack. ' ' 
 
 During the panic, he knew he was in the army hospital and 
 could give the time of day, but not the day of the week. His mem- 
 ory for most past experiences was quite detailed and accurate. 
 He calculated fairly well. 
 
 He made numeroiTS efforts to strangle himself and to take 
 poison (emphasizing the throat and moiTth). He was afraid of 
 being killed, and believed that poison was put in the food. He 
 resisted the food for three days, and could be fed only after 
 considerable persuasion. 
 
 V'oices called him a Eussian spy, and hallucinations convinced 
 him that his death was being planned. When a blood specimen 
 was taken he fought fiercely and had to be anesthetized in order 
 that the spinal puncture might be made. He resisted all the rou- 
 tine ward measu.res, and was afraid of the approach of men pa- 
 tients, male nurses and physicians. He was constantly trying to 
 escape from his "tormentors" and impending "death." 
 
 On one occasion, during an interview, he threw himself about 
 in his chair, and finally, allowed himself to slide to the floor with 
 his muscles rigid. He remained there stretched out, eyes closed, 
 and mute, for several minutes, simulating "d3ang." (This usu- 
 ally means an offer of sexual submission.) 
 
 He repeated questions four or five times, and whispered to 
 himself but gave few, irrelevant answers. After several weeks 
 of panic, he lapsed into a mute state and became indifferent to 
 everything, had hallucinations, whispered, and responded with 
 mysterious signals to the dissociated affect. 
 
 He was in this inaccessible state wlien admitted to St. Eliza- 
 beth's three months after the onset. He was apprehensive, very 
 much afraid of everyone, and would stand about or hide in the 
 corner of a dark room. He seemed to be disoriented, repeated 
 questions, rubbed his hands, said he was sick, and suspiciously 
 resisted all efforts to take care of him. 
 
 He gradually improved, liecame more accessible, and showed 
 considerable insight, denied hallucinations, but complained of 
 
488 PSYCHOPATHOLOGY 
 
 "bad dreams." About tbe sixth month of his psychosis, he went 
 through another panic which lasted about four weeks. It, for- 
 tunately, was more accurately observed. It seemed to have been 
 initiated by an erotic dream; because, about three o'clock one 
 morning, the patient awakened everyone on his ward with shouts 
 of terror and pleas for help. When the physician entered the 
 room, he jumped from the bed, fell on his knees and begged to be 
 saved. He shouted something about being killed, but was too ex- 
 cited to give any information. Finally he succeeded in telling Dr. 
 James Hassell that, for several nights, he had been unable to sleep, 
 and on this occasion, as the clock struck three, he began to shout; 
 "I am a fool!" (in Polish) and to count: "One, two, three," re- 
 peatedly. Snakes appeared all about him, and he became panic- 
 stricken. (He said he had always been very much afraid of 
 snakes, rats, rabbits and toads, and later attributed it to older 
 children frightening him with such things when he Avas a child. 
 He had had similar nightmares when on board ship.) 
 
 On the i?,ight of the panic, a snake approached with its head 
 raised, "about six inches," with mouth open, making hissing 
 noises. It jumpe_d at him and bit him in the chest. His brother 
 and sister also appeared in the hallucinations. 
 
 The panic gradually subsided and he resumed an interest in 
 work, recovering his composure after four weeks. 
 
 A young man, very well versed in abnormal psychology, was 
 afraid that he might develop dementia prsecox because of his oral 
 homosexual compulsions. He related a dream in which a snake 
 bit him inside of the mouth, causing considerable anxiety (fea,r of 
 an oral infection). Another young man who incessantly boasted 
 of his physical powers, his dangerousness, love for blood and mur- 
 der, and tried to keep the other patients bluffed to protect himself 
 from his homosexual cravings, dreamed, with anxiety, that a snake 
 coiled around his neck and strangled him. (See p. 603.) 
 
 In the fable about Man's Fall from Paradise, a snake was the 
 seducer, and, in religious writings and sexual stories snakes, bats, 
 dragons, rats and. owls are often used to symbolize sin, death and 
 sexuality. (See Fig. 52.) 
 
 The feelings, of inferiority in this man were due to oral-erotic 
 homosexuaLcrayings, and the anxiety and panics were due to th6 
 cravings becoming uncontrollable. When the Eussian recovered, 
 he worshipped his imif orm and s'trutted about the hospital grounds 
 
ACUTE HOMOSEXUAL PANIC 
 
 489 
 
 like a "dandy," making a classical compensation of egotistical 
 self -admiration. 
 
 Case PD-18 was a soldier, twenty-eight years of age, unmar- 
 ried. He had served five years in the U. S. army. 
 
 Abont six months before his admission, he made the rounds 
 of gastroenterologists to be ti'oated for "catarrhal gastritis" and 
 
 Fig. 52. — Cover of magazine, by Erte. Sexual fantasy showing the phallus symbolized 
 by great birds, bunches of grapes and a serpent; with passionate submission. 
 
490 PSYCHOPATHOLOGY 
 
 "acute duodenal ulcer," because of abdominal pains and a "turn- 
 ing stomach." He also complained of "gonorrhea of the rectum," 
 and that the soldiers were calling him a "masturbator," "bas- 
 tard" and "degenerate" (referring, as usual, to submissive oral 
 and anal eroticism). 
 
 He was held in an army hospital for observation to determine 
 whether or not he was "a malingerer, hysterical, or really ill." 
 
 About three weeks before his admission to St. Elizabeths 
 Hospital he escaped from the hospital in his gown and bathrobe, 
 and was later found in a state of panic. He complained that his 
 "stomach and bowels are on fire," drank large quantities of warm 
 water to induce vomiting, was inaccessible and very difficult to 
 control. He was sent to St. Elizabeths Hospital about six months 
 after his first complaints began. 
 
 Upon his admission, he went to bed, covered himself com^ 
 pletely with blankets and turned his face to the wall. When ques- 
 tioned, he at first refused to answer but later accompanied his re- 
 plies with violent motions of his body. Pounding the wall with his 
 hands, he shouted, "they call me a dope, a thick-headed Irishman, 
 and this and that ! ' ' When he talked of his ' ' terrible pains ' ' in the 
 abdomen, he viciously jabbed his fingers into his abdomen, grabbed 
 his tongue with his fingers as if to pull it out, and tried to seize the 
 physician's stethoscope. His voice was sharp, high-pitched and 
 whining.. 
 
 Later, when he talked to me, he said : ' ' Somebody chokes me ; 
 they do everything in the little room ; they throw me away ; words 
 come out of my mouth; I can't help it, and people tell me lots of 
 things, and I have to tell it over again; nobody likes me. I feel 
 queer ever since I have been in a warm climate, have feelings that 
 cause my troubles and can't help it. The troubles are in my head 
 and I can 't help it. [Shook his head vigorously.] They say I killed 
 Major — and Captain — and could not help it. I ran out into the 
 snow. [Referred to his elopement from the hospital.} They were 
 after me — I was calling them names — they forced me — pulled me 
 out, said T did this and that ; [cried] said I had all kinds of dis- 
 eases, venereal diseases, said I done everything — one fellow told 
 all aroimd the company that I had a venereal disease of the rec- 
 tum, and he said that I said things about the Major — said the 
 Major was giving me salt enemas and eggnogs." 
 
 He frequently asked for a priest, because he had "to die," 
 
ACUTE HOMOSEXUAL PANIC 491 
 
 and when the priest arrived, he insisted the man was not a priest. 
 
 His behavior indicated auditory, visual, gustatory, and other 
 hallucinatory disturbance of sensation. He wa§ disoriented and 
 misinterpreted almost everything to be related to his erotic crav- 
 ings. 
 
 When patients approached him, he made noises, grimaces, 
 manneristic movements, threatened or attacked- them or secluded 
 himself. He complained of being afraid, and often resorted to 
 making as much noise as possible to intimidate his environment. 
 (A method common to birds and animals.) He Avas very untidy 
 and destructive, and, occasionally, drew his finger across his throat 
 as if he meant to cut it, saying, "Cut it off!" 
 
 He would often lie on the floor half-clad and beat his head and 
 face with his fists, expectorate and repeat that there was some- 
 thing in his head, and that he could not control his thoughts. 
 
 The eroticism of the patient was clear enough. The fear of 
 gonorrhea -of the rectum fromanal eroticism and gastric disease 
 from oral eroticism, his attachment to the officers and fancies 
 about the Major giving him salt enemas and eggnogs (seminal 
 equivalents) are distinctly symptomatic of his cravings. His 
 method of beating his head, because of inability to control his 
 thoughts, shows the desperate manner in A\'hich he was fighting to 
 control himself. 
 
 Suicides in such conditions, usually by cutting the throat, 
 hanging, or plunging on the head, are quite common. I know of 
 two young men who killed themselves by several days of terrific 
 pounding of their heads and bodies ; another by plunging from an 
 elevation onto his head, fracturing a spinal vertebra; another by 
 shooting himself; and another, by taking bichloride of mercury. 
 These men seemed to reach a stage in the affective struggle when 
 intolerable sensory disturbances about the erotic region coinpelled 
 an annihilation at the cost of everything. ( Such cases, demanding 
 castration of the erotic zone, under pretext of distressing pain- 
 fulness, often gravitate to a surgeon.) 
 
 Case PD-19 was a rather slender man of medium height, 
 twenty-four years of age, and unmarried. He enlisted in the navy 
 with the ostensible intention of improving his knowledge of certain 
 kinds of machinery. His physical condition showed certain in- 
 feriorities. His facial hair was very scanty, and the bones of his 
 
492 PSYCHOPATHOLOGY 
 
 face, while not small enotigB. to be distinctly effeminate, were not 
 as heavy as the average male's of his age. 
 
 He had never shown a social interest in girls. Several times 
 he had patronized prostitntes when on shore duty. 
 
 Several months after his enlistment, he suspected' that some- 
 one was putting different "chemicals" and "medicine" in his 
 beer. This "dope" or "jnnk" made him feel "dopey" and have 
 "swimming in the head." He heard whisperings on the streets 
 "like anybody would," such as, "He is not guilty! Don't believe 
 it!" He did not get excited about the names he heard "those peo- 
 ple" use, such as s. b., c. s., etc., because he "did not know who they 
 meant." 
 
 Whieh he had tonsillitis, the doctor, he said, swabbed out his 
 throat with "margarine oil" and whispering voices said: "He 
 wouldn't have anything to do with it," etc. 
 
 Later, the food became "rotten." Someone "put filth in it." 
 He could see "white stuif " in the bread. This filth he smilingly 
 described as "come" (semen), when he was asked more definitely- 
 concerning it. This "stuff" made him sick at the stomach, caused 
 vomiting, anxiety, and inability to worJc. 
 
 About this time, he noticed that his "tools" had been tam- 
 pered with. ' ' The ripper " (a type of chisel for cutting tubes) had 
 its edges turned and instead of cutting into the tube would "slip 
 off." 
 
 "The expander" (a cluster of three rollers to be inserted into 
 a tube so that when a cone-shaped pin is driven between the rollers 
 they spread apart and expand the tube) was also "tampered with" 
 and would not work. ' ' The tools would kink over every time you'd 
 go to use them. ' ' 
 
 After his admission he adapted himself to the" ward routine, 
 was neat, not worried, sociable, and gave the impression of rather 
 enjoying the auditory hallucinations and his perverse sexual in- 
 clinations. The trouble with his tools symbolized his actual hetero- 
 sexual impotence. The fancies about the treatment of his throat 
 with "margarine oil" and the "come" in his food gratified his 
 oral erotic homosexual cravings. 
 
 He discussed these things with sm,iles and laughs, showed no 
 embarrassment, and seemed to make no effort to compensate for 
 feelings of defieienc}^ which was in striking contrast to the des- 
 perate compensations of other men. 
 
ACUTE llOMOSEXUAI. PANIC 493 
 
 Impregnation fancies were not obtainable at the time of the 
 examination, bnt were rather to be expected. 
 
 Case PD-20 was an illiterate, irresponsible soldier, aged 
 twenty-four. 
 
 The patient's father was a chronic alcoholic and psychopathic 
 personality. Twice, he suddenly disappeared, deserting his chil- 
 dren. 
 
 The patient said he was not able to learn very well, and only 
 reached the sixth grade in school. He was a shiftless worker and 
 never earnestly tried to develop skill in any mechanical art. He 
 wasted all his earnings in carousals and alcoholics, Avas seclusive in 
 his social tendencies and at times lived the hobo 's life. 
 
 He never shoAved an interest in women for social purposes. 
 His sexual career included perversions when he was about six 
 years of age, and numerous anal perversions with adult males in 
 the last few years. He also patronized prostitutes and practiced 
 sexual perversions. He contracted gonorrhea, but not syphilis. 
 
 The present psychosis began two years after his first enlist- 
 ment in the U. S. Army. His indifference and "queer, silly" be- 
 havior caused him to be confined in the Post hospital. The report 
 of his behavior at the Post hospital says that when he tried to 
 think, he wrinkled his forehead, said he felt happy sometimes 
 but usually had ' ' the blues ' ' and felt ' ' homesick. ' ' 
 
 He complained of restlessness and insomnia, had auditory, 
 visual and olfactory hallucinations, and other distressing sensory 
 disturbances. The voices called him a sexual pervert, etc., and the 
 auditory image of the voice of a man named M — , saying "I'll 
 shoot that s. b.," frightened him. He believed he had been given 
 a "hypodermic injection," which made him feel "dead." (Possi- 
 ble reaction to a hypodermic.) When, however, the spinal punc- 
 ture was made, he said with anxiety, "It is all off," he was going 
 to die. "They accused me of going doAvn on different fellows — of 
 having improper intercourse with women and by rectum with 
 men." He admitted sodomy and masturbation but denied oral- 
 erotic acts. He believed his sins were unpardonable and that he had 
 to suffer accordingly. He had sensations of choking that made 
 him very uncomfortable, and during these states he sometimes saw 
 "flashes of light in the sky." 
 
 He smelled "drugs" on the bed-linen and, believing that "poi- 
 son" had been placed in the food, refused to eat. Feeling that he 
 
494 PSYCHOPATHOLOGY 
 
 ought to be shot or hanged, he regarded everyone with suspicion 
 and dread. 
 
 His insight was not encouraging. He maintained that there 
 was nothing wrong with his mind and the other patients were 
 all sane. He would not discuss the symptoms of his cravings and 
 their influence on his thoughts. 
 
 His memory for remote and recent events was reliable. He 
 was well oriented and passed most of the intelligence tests when 
 lack of knowledge did not make it impossible, but he showed very 
 little interest in current events, being absorbed in his feelings of 
 persecution ■ and degeneracy. He apparently made little or no 
 effort at a religious or social compensation. His general knowl- 
 edge was very meagre. Seven months after the onset of his con- 
 fused meutal state, his eroticism subsided and he was dischargeii 
 as socially recovered, having become able to work when not too 
 erotic. 
 
 His physical status showed no stigmata of degeneracy and his 
 hair distribution and general physical make-up was masculine in 
 type. 
 
 Case PD-21 was a soldier, twenty-three years of age, unmar- 
 ried, who enlisted at seventeen and served five years when he be- 
 came panic-stricken. 
 
 His maternal grandmother was insane, probably cerebral ar- 
 teriosclerosis. One maternal uncle was "thought to be insane," 
 and his father was a chronic alcoholic. 
 
 Although he attended school from six to fourteen, he advanced 
 only to the fourth grade, about the ten-year level. He said he 
 learned with great difficulty. 
 
 At twelve, he left home because of his alcoholic father's abuse. 
 His father caught him in the act of masturbating, which increased - 
 their animosity. Besides this, he said, he stole $13.00 from his 
 father and denied it under oath in court, which denial, later, greatly 
 worried him. 
 
 At seventeen, after several years of crude labor, he enlisted in 
 the army and served as a private until the onset of his psychosis. 
 
 In the army, he indulged in alcoholic debauches and became 
 infected with syphilis from a prostitute. The psychosis appar- 
 ently developed some time after this, but was probably related to 
 his worries about it. One day, he was observed to be talking to 
 himself in a curious manner. He complained that one of the ser- 
 
ACUTE HOMOSEXUAL PANIC 495 
 
 geants intended to "blow np the stables" in which he had been 
 sleeping and, with manifest anxiety, said the sergeant worried 
 him by his frequent inqiiiries about the locks on the doors of the 
 stable, commenting in a confused way "this got on my mind and 
 I thought he was crazy. ' ' 
 
 The earliest hallucinatory experience which referred to feel- 
 ings of homosexual assault was probably his statement that "the 
 horses got loose" and he heard "chains rattling." The psychosis 
 soon developed more frankly. He complained at the hospital that 
 he had a cough and, in a few days, that he had a ' ' sticky substance 
 in the mouth between the teeth" Avhich he removed with his fin- 
 gers. He could ' ' smell ether, ' ' which doped him, and thought that 
 "my manhood had been taken from me." "They would cut my 
 testicles out to stop my masturbation [and] prevent me from hav- 
 ing intercourse with women. I tried to stop it but did not have 
 quite enough will power to stop altogether — ^I was afraid it would 
 make me crazy." 
 
 Coincident mth his delusions and hallucinations, he became 
 confused, depressed, retarded and mumbled continimlly to himself. 
 He would stand in one position for hours and repeat his mumbled 
 phrases about the sergeant, horses, blowing up stables, etc. "The 
 voices reminded me of my step-brother and my stealing money." 
 Later, the voices said : ' ' Give him all he wants. ' ' He refused to 
 eat (probably because of poison — semen symbol— in the food) and 
 was afraid to sleep because of his feelings of impending sexual as- 
 sault. He frequently examined his genitalia to find the place of 
 a supposed operation and seemed to be puzzled by the absence of 
 signs. He asked the examining physicians at St. Elizabeths and 
 at Fort Oglethorpe about the operation on his testicles. (Castra- 
 tion.) He complained that "the voices" (hallucinations) called 
 him "everything except a man." 
 
 His general behavior was that of a depressed, confused man 
 who was in profound state of fear and tended to make a catatonic 
 adaptation to the hallucinated assault. He understood the other 
 patients to be "posing" and doing "queer things on purpose." He 
 had no insight for several months, and for some time was dis- 
 oriented for time, place and person. Upon admission, he per- 
 formed simple intelligence tests poorly, but, several weeks later, 
 the intelligence tests were better performed and his recall for re- 
 mote and recent experiences was accurate and fully detailed. (In- 
 
496 PSYCHOPATHOLOGY 
 
 telligence tests are only valuable for showing how mneh the ego is 
 preoccupied with the irrepressible erotic affect.) 
 
 He gradually adjusted himself to the hospital environment 
 and assisted in the ward work. After several brief relapses he 
 was finally given duty in the dining-room and later a parole of the 
 grounds. 
 
 The patient was a tall, slender, pale man with no physical 
 defects. His thin, firmly compressed lips, and his brief, staring 
 looks, indicated his tension and fear. 
 
 His blood reacted positively to the Wassermann test, but two 
 spinal fluid examinations and all physical signs were negative. 
 
 Probably because of his mental development he never attained 
 satisfactory insight into his condition other than that he had ' ' im- 
 agined" his troubles and had worried about his masturbation. He 
 showed no aggressive tendencies to a grand potential compensa- 
 tion or social-religious censorship of immorality. He was dis- 
 charged as a social recovery seventeen months after his admission. 
 
 The prognosis apparently depends upon a fortunate location 
 in a community of simple requirements, avoidance of serious re- , 
 sponsibilities and the control of his autoerotic tendencies. Be- 
 cause this depends so largely upon other sources than himself, the 
 prognosis is poor. 
 
 Case PD-22 was a patient who had enlisted in the navy at 
 twenty-one, after he had been unable to find other satisfactory 
 employment. After three years of "good" service he apparently 
 quite suddenly developed a psychosis. He had had several infec- 
 tious diseases, but had not been excessively alcoholic. Like most 
 sailors he had patronized prostitutes and had had an "affair" 
 with a married woman. 
 
 A classical panic began one morning after a "shore leave" 
 with a companion. He had several times taken shore leave mth 
 this man and, on this particular night, they had taken "several 
 drinks together" and spent the night in a boarding house, occu- 
 pying the same bed. 
 
 (The medical certificate, which accompanied the patient, 
 stated that he had a record of sodomistic relations which, later, 
 the patient stoutly denied.) 
 
 The patient said that he and his companion returned to the 
 ship the next day and after they were on board he noticed an aver- 
 sion in his companion's attitude toward him. He overheard him 
 
ACUTE HOMOSEXUAL PANIC 497 
 
 make remarks about "the blond queen of the deck" and having 
 been ashore with the blond queen (the patient was the only blond 
 in that part of the ship) and that "she was on the stuff." That 
 morning when he attempted to urinate, he said, "I could not do it 
 because it ran backward into my stomach." He believed that his 
 companion had "doped" him and performed some sexual act upon 
 him which had destroyed his sexual powers. He reasoned that 
 he must have been doped because he could not remember anything 
 of a sexual nature that might have transpired but was certain 
 that a sodotnistic assault had been attempted because of his de- 
 ranged sexual powers and the talk that he overheard. 
 
 He said that he challenged his companion to a fight to show 
 how much of a man he was, but the sailor avoided a conflict 
 by declaring that his remarks about the blond queen referred to 
 the Jew plumber. Later in the day, he became panicky when he 
 found that his testicles were "all shrunken up" and his "penis 
 looked small and drawn up." That night, while in his hammock, 
 he thought he overheard several sailors plotting against him, and 
 one of them said : ' ' Give him a couple of shots of dope. ' ' 
 
 The fear of "lost manhood" was decidedly increased by the 
 belief that he would now become a sexual pervert (oral erotic). 
 He said his companion boasted freely that he had caused two 
 other men to leave the navy "by putting up jobs on them." One 
 of them deserted and the other fellow bought himself out. 
 
 The period of worry and panic was comparatively brief, which 
 may have been due to the frankness mth which he confessed his 
 troubles to the ship's medical officer. About two weeks later, he 
 had a sexual dream which he could not recall, except that it was 
 accompanied by a nocturnal emission. This dream and the tend- 
 ency to have spontaneous erections seemed to have been a most 
 important basis for the return of his self-confidence. 
 
 After several weeks of confinement in a naval hospital, he was 
 admitted to St. Elizabeths Hospital, but was no longer worried 
 about his heterosexual powers. He never developed insight into 
 the episode and always maintained that he probably had been the 
 victim of "a job," which he disciissed with grief and anger (sim- 
 ilar to Case PD-14). 
 
 Physically, the patient was a rather slender man, about 5 feet 
 9 inches tall, weighing about 140 lbs., with blond hair, fair skin and 
 
498 . PSYCHOPATHOLOGY 
 
 scanty facial hair. His sexual organs appeared to be well devel- 
 oped. 
 
 Five months after his admission, he was disehaygeii because he 
 was apparently able to take care of himself. 
 
 This man gave one the impression of being a rather simple 
 type of personality, in the -sense- that -he expressed his wishes 
 bluntly, was sincere, and had a limited capacity for sublimation 
 and adaptation. He said: "I would rather die than become a 
 c. s.," and this probably expresses the prognosis best if his hetero- 
 sexual margin is as limited as the homosexual psychotic episode 
 indicates. Either attempts at suicide, or, as he expressed himself 
 before his discharge, "I'd rather go crazy before I'd become a 
 e. s.," indicate his probable final .adjustment. The fear of the 
 shrinking penis becoming invaginated into the abdomen was ap- 
 parently due to an uncontrollable effeminate . attachment to his 
 companion. 
 
 Case PD-23 was an unmarried soldier, twenty-six years of 
 age, whose psychosis began rapidly after his second enlistment. 
 
 At thirteen, he left school to earn money, because the curric- 
 ulum was uninteresting to him. He stammered seriously. At 
 twenty-three, he enlisted in the army and was discharged at the 
 expiration of his service with the character "good." Duriiig the 
 last few months of this service he was court martialed for alcohol- 
 ism. 
 
 He worked at a soda fountain for a short time, but was unable 
 to keep his position After several months of loafing and quarrel- 
 ing with his father, he reenlisted in the army at the age of twenty- 
 six. 
 
 His sexual history began mth unsatisfactory heterosexual re- 
 lations at fourteen, which continued more or less. frequently until 
 a few months before his psychosis. He contracted gonorrhea twice, 
 but never acquired syphilis. His alcoholic indulgence, could not 
 be considered excessive, and he was not a drug habitue. He 
 smoked cigarettes excessively and wasted his money. 
 
 Soon after his reenlistment, he became irritable and apprehen- 
 sive. His bed was in the barracks and he had to retire in company 
 with other soldiers. This environment, associated with his homo- 
 sexual cravings, made sleep impossible and he soon became panic- 
 stricken. He blamed the catise of his fears upon his associates, 
 which, though probably unknown to the associates, was partly 
 
ACUTE HOMOSEXUAL PANIC 499 
 
 true. The fear increased quite rapidly. A few days later, he de- 
 clared that someone was trying to get into bed with him. He after- 
 wards stated that this followed an evening of listening to tales 
 of sexual prowess by the older veterans. He tried another bar- 
 racks, with no relief, and several nights later insisted that someone 
 tried to inject cocaine or morphine into his arms, legs, or penis 
 (castration fears), and tried to get into bed with him. "Thought 
 it was the doctors or something. Must have been dreaming or 
 something. Thought it was somebody one minute and then knew 
 no one was there the next minute." The next night he took his 
 bayonet to bed with him with the intention of "getting" anyone 
 who bothered him. He now believed that he was not wanted in 
 the company, that the men called him "c. s.," cursed him, "pulled 
 their noses" and made other signs of disgust at him. He tried to 
 escape from the island with the intention of deserting but was 
 transferred to the hospital ward, and after one night, the homo- 
 sexual obsessions became more serious. 
 
 He believed he had "killed the captain" and wanted to see 
 the chaplain, believing that he Avas to be shot. Many of the simple 
 things in his environment began to act mysteriously, such as the 
 clock, etc. He. talked of committing suicide, and would frequently 
 kneel and pray. Later, he referred to himself as Jesus Christ; 
 said that he was to be killed by God ; that he had killed his father 
 and the captain, and often referred to a murder that he had com- 
 mitted. 
 
 "When admitted to St. Elizabeths Hospital, though in excel- 
 lent physical condition, he had visual, auditory, cutaneous, olfac- 
 tory and gustatory sensory disturbances of the hallucinatory 
 type, Avith the usual supplement of delusions. He thought he 
 had been sent to the hospital by God, and pointed out a pa- 
 tient as God and an attendant as his brother. He felt "sad" 
 and "everything" worried him. "I want to do the right thing, 
 but I can't. When I try to do the right thing I am doing wrong, 
 and everything I should do." (He frequently added unqualified 
 words to his sentences.) 
 
 He heard bells ringing, people shouting, steam blowing, tasted 
 poison in his food, smelled "all kinds of odors," saw people whom 
 he knew to be dead and was sure they had come to life, particularly 
 his grandparents and mother (ancestors). Thought that he, Jesus 
 Christ, had killed his father, who reappeared in a hat and cape 
 
500 PSYCHOPATHOLOGY 
 
 looking like a priest (See Case PD-27). He contimied to feel that 
 lie was being stuck with needles, that cocaine, a "green fluid," 
 and morphine, were injected into him, and a "brain machine" was 
 turned on his head. 
 
 His dreams were terrifying and very similar to his hallucina- 
 tory experiences. "I dreamed I was going down, was burned out, 
 grabbed an electric light, thrown in water, was walking, running, 
 I don't know what else I didn't do." . 
 
 During this period he was suicidal, depressed, apprehensive, 
 seclusive and careless with his clothing. He performed the usual 
 intelligence tests with some difficulty. This markedly dissociated 
 mental state continued for about six months, after which a gradual 
 affective readjustment began. He never became entirely con- 
 vinced that his strange experiences were not real, as they dimin- 
 ished in intensity, his doubt increased. He finally made a com- 
 plete readjustment and social recovery with fortunately no mani- 
 fested tendencies to project a social or religious reform move- 
 ment. No obsessive counter-attack upon the environmental temp- 
 tations of the now fairly well repressed homosexual cravings was 
 projected. He remained, however, very sensitive, tense, refused 
 to discuss his difficulties, and s'eemed to be extremely determined 
 to maintain his level of social fitness. 
 
 The prognosis is apparently poor just in so far as his homo- 
 -sexual cravings tend to break through his concerted efforts to 
 control them. That he will be able to maintain a biologically sat- 
 isfactory heterosexual adjustment is very unlil?:ely, and his homo- 
 sexual cravings being intolerable, a later sustained chronic disso- 
 ciation of the personality with consequent deterioration, because 
 of the future hallucinatory gratification of his homosexual needs, 
 will probably be the ultimate course of his biological career. 
 
 Case PD-24 was a well-developed, ignorant male negro, about 
 thirty-nine years of age, married twenty years, who became panicky 
 because of his homosexual eroticism. He had no insight, and ex- 
 citedly complained of his difficulties as follows : 
 
 "My time was up some time for some two years to have me 
 on exhibition before Congress 304 years ago for real delegatesi — 
 for reputation as well as for anything else — they did not Avant me 
 to drink at the bar. They put things in my food and made me 
 feel bad at the stomach. It smelled like something that had been 
 in the ground — smelled like guano fertilizer. They tell me it came 
 
ACUTE HOMOSEXUAL PANIC 501 
 
 from animals — sometimes they shoot stuff into yonr ears and make 
 yon dumbfounded, and they pull it out; sometimes they put pic- 
 tures on your eyes and change them, pull them back. [Pushes 
 his eyes hard with his fingers and says it takes the pictures away. J 
 
 "The electricity runs from the shoulder and arm and feels 
 like pins in you ; they are trying to break me down and are forcing 
 me to have friction. 
 
 "Through sleight-of-hand they touch it [penis] and draw your 
 breath. They play it and said I played it with racehorses and 
 children, boys and girls ; they take your nerve from you and you 
 naturally fall. [Fail, when he tries to perform the sexual act.] 
 I thinlc they have lots of luck, interfering with a man and 
 his wife, but I don 't do anything about it. ' ' They make him feel 
 weak and "faintified like." "It seems as if somebody throws this 
 at you with a sling-shot and put so many horse-power into you. 
 [They pump him full of air.] This cold air pressure and warm 
 air pressure fills your stomach, and I have to belch it and it has 
 to go away. They would learn me how to bend over and it would 
 go away. They move you from one side to another [bends from 
 left to right] and this takes the blood. It would drop from up here 
 [places hand on chest] to do^wTi there [places hand on buttock] and 
 it would make you cold and weak. ' ' 
 
 He spoke of his auditory hallucinations as having a "tele- 
 phone" in his ears and his visual hallucinations as "pictures." 
 
 Almost daily, when he could reach a physician, he complained 
 of aches and pains and tried to show the scars from the tortures of 
 the night before. 
 
 Often at night, he pounded on the door and called for help. 
 He would usually be in a panic because of his terrifying sensory 
 hallucinations, such as having holes pounded into his abdomen, 
 dramng sensations at his heart and umbilicus, and pounding elec- 
 tricity into his head. Sometimes he tied a handkerchief about his 
 head because of head pains, and another time he pasted a piece of 
 paper over his abdomen and asked for treatment for a hole there. 
 
 The voices talked of making a "hermaphrodite" out of him. 
 
 He was quite frank about his hallucinations, but had no in- 
 sight into his eroticism. His efficiency for simple manual labor 
 was not impaired, and he worked very well. Alcoholism as an ad- 
 ditional exciting factor was excluded. 
 
 Case PD-25, a marine having about two years service, un- 
 
502 - PSYCHOPATHOLOGY 
 
 married, about twenty-three years of age, was in a constant anxi- 
 ■ety state because "voices in the walls" told him that they were 
 going "to operate" on him and remove his "kidneys" so that he 
 could not have children. 
 
 Case PD-26 was the only son of an overworked, uneducated 
 mother who suffered from neglect and the need of the simple com- 
 forts necessary to make life worth living. He was a typical "mam- 
 ma's boy," seriously pampered, effeminate, dainty in manners, 
 tenor voice, and generally submissive in his make-up. 
 
 He was an ordinary seaman in the navy when a typical homo- 
 sexual panic developed in which he was obsessed with fears that 
 men plotted to sexually assault him. He had to be tube-fed, and 
 when he resisted, and his arms were forcibly drawn beTiind him, 
 he had a "vision of Jesus Christ and the Thieves on the Cross," 
 feeling that he was being crucified as one of the thieves. Later, 
 he realized that it was ' ' imagination. ' ' 
 
 The following patient (Case PD-27) was a white sailor, single, 
 aged twenty-seven, medium sized, earnest in disposition, but very 
 naive and simple in his general attitude. His mother 's father was 
 a cocaine habitue and his father was an alcoholic. Upon his ad- 
 mission, he was very repentant and somewhat depressed. He 
 wrote the following story of his life, which contains an excellent 
 description of the causes of his anxiety, the repressed cravings, 
 the psychosis and the reconstructive tendency. (Following the 
 letter is appended some information about his boyhood which 
 explains his difficulties more completely.) 
 
 "I was always aloude to race and play with everybody, and 
 would prefer larger boy's work, but didn't know at the time, hav- 
 ing jest come from the country. The first two years of my- city 
 life taught me how to masturbate, and smoke cigaretts and chew 
 tobacco. I went to School steady, and got along fine in the lower 
 grades, but, as I grew older, kept slipping behind, umtil finally, 
 after reaching my fifteen year, I got discouraged and hounded my 
 mother and father to let me go to work. And I did, at the same 
 time, I was given permission to smoke in the house. So between 
 Master Bation and cigaretts, my school life was ruined. I worked * 
 in the shop two years, enlisting in the Navy at eighteen as an Ap- 
 printise Seaman, changing my rateing to that of coal-passer, and 
 made the cruise around the world with the Atlantic fleet. I was 
 discharged ordinary, as I had a bad record from overstaying leave 
 
ACUTE HOMOSEXUAL PANIC 503 
 
 and didn't save any money. My dowTifall was bad women. I am 
 not, never was, and never will be a drnnkard. I have been drunk, 
 but never took any pleasure in it. I Avent home and went to work, 
 with intentions of staying out of the service, but through women, 
 I lost my job and was told by my father I had better go back to the 
 Navy, and I went. 
 
 "While at the Norfolk Navy Yard, I was going to see a bad 
 woman, and got in with her very thick. This company run along for 
 over two years, and I tried to stay away from her at times, but she 
 seemed to call me back. While on my thirty-day furlough, I took 
 her out of the hoiise she was living in, and lived with her for a few 
 days before going to Guantanamo. I Avorried right from the time 
 we left the Navy Yard, for I was afraid she would do wrong before 
 I could get back ; also I had lied terrible, about being married, and 
 she was with very nice people. Then I remembered, too, that her 
 husband was to be let out of jail. And she had two suits of clothes, 
 liiy watch and chain, Honorable Discharge button, and I liked to 
 worried myself to death. And then I received a letter from the 
 man that rented the rooms we had, telling me that she had gone 
 and owing him a bill of $8.70, and took everything with her. 
 
 "Well, I just went to pieces altogether. I prayed to God to 
 put me in touch with her some way or another. I sent telegrams 
 and asked God to connect us up some way, so I could find out where 
 she was and everything. ^[This is a good account of a dissatisfied, 
 affective craving and the hallucinated gratification which it pro- 
 duced.] Then I got to thinking more and more about her husband, 
 and finally got to hearing her talk and also hearing her husband 
 talk and that he was with her. And some nights, she would get 
 beat to death, and other nights she would get cut to pieces. I 
 imagined everything horrible that could happen to her at the hands 
 of that husband. And I told the Hospital Apprintice about it and 
 he took me to the Hospital and on the 24th of Dec. I was put on 
 board the Jupiter. She left on the 29th, and I went to the Hospital 
 again. Now, it was coming up on the Jupiter I got to thinking of 
 home and I got a letter from home right after gifting to Norfolk. 
 And then it seemed that the woman was killed by her husband for 
 the last time and that he also killed himself and went to heaven and 
 hell, coming to the Norfolk Hospital to kill me by cutting my heart 
 out. He also brought the God of Hell with him. I had to go to Hell 
 for being a ma'sturbator, murderer, never told God the truth. * 
 
504 PSYCHOPATHOLOGY 
 
 "And, then there was an angel came to me and told me that 
 'I conld go to Heaven if * * * .' Then my little sister #3111 
 Jesus Christ came to save me. The dog is dead, so its spirit came 
 along with my sister. There was something strange about that. 
 The girl's [his mistress] right name was May White, and m. a 
 prostitute she went under the name of "Eose Brown." The dog 
 was a bitch, and she was brown and white, the brown hair was 
 very rough and coarse and unnatural, but the white hair was as 
 soft as silk. [May White was beautiful to him and he loved her, 
 but Eose Brown was coarse and a prostitute.] 
 
 "One day [when a boy] when I first got; the dog, I put my 
 finger in her womb, thinking of trying to do her wrong, but 
 couldn't, so I masturbated myself instead. Now, by wronging my 
 dog, I wronged this girl, and was the cause of her bfefomi^ a 
 prostitute. I can't say just how this happened, but will say this 
 much [similar affective attachment for his dog and mistress and 
 association of the two together in the hallucination] — 'Grod's 
 Will will be done on earth as it is in Heaven. ' I am writing things 
 as they came to me, as near right as possible. I was told [auditory 
 hallucination] that whenever I smoked a cigarette, I was burning 
 up my little sister, for I had said I wouldn't smoke them any more. 
 It seemed to me that they had a certain way of doing things and 
 saying things to bring about every move, like a good lawyer fi^Bt- 
 ing a case before a judge and jury, and I do honestly believe that 
 the powers of the Holy Ghost were working on me. 
 
 "I also received some knowledge about going to New York to 
 a Mission House run by the Salvation Army. Also to go to the 
 Brooklyn Bridge, Brooklyn Side, to the President's Office, and 
 ask for a pocket-book containing $10,000, to be used for mission 
 purposes on the Bowery of New York City. This mission is the 
 one I went into drunk one night and was taken sick, leaving a ter- 
 rible mess behind me for some poor soul to clean up. As near 
 as I can understand it I am on trial for my life, and this is where 
 I think it comes in [the reconstruction, but very pathological.] 
 That I will go to Heaven if 'I do as I'm told, and obey the Lord 
 our God.' As I have been letting the Devil lead me instead, and 
 now it has come to a show down, and I feel that I have been put 
 threw this thing for a purpose. It seems like a 3rd degree to me, 
 and I think I have a hiffh duhf to perform before I' leave this earth. 
 ' "I saw one vision at the Norfolk Hospital. It was a very big 
 
ACUTE flOMOSBXUAL PANIC 505 
 
 Tabernacle at Chicago, and it was full of people. They were seated 
 like people at a circus, and I saw myself in the center standing 
 in my shirt sleeves with my fists doubled up, and the spirit of 
 Our Savior was behind me. I don't know what I was saying, biit 
 I think those things Avill be put in my head as I go along. I'm 
 reading the bible and learning things that I never dreamed of be- 
 fore, for us children at home were not brought up by Church par- 
 ents. I also have a letter to prove that my sick sister has felt 
 this same Heavenly Power. And I also say, truthfully, that I 
 was taught the Lord's Prayer, and also this one: 'The Lord is 
 my Shepherd, I shall not want. lie leadeth me threw green 
 marshes. He is the story of my soul.' I never remember of hear- 
 ing it before. And the other, I couldn't find my way. threw it 
 before I went to the Norfolk Hospital if I tryed. 
 
 "The $10,000 is another strange thing. When I was about 
 Fourteen years old and carrying newspapers, I found an old 
 cigarette button with the picture of a very pretty young lady on 
 it, Avhich, of course, must have been an actress, and I thought a 
 good deal of it, and carried it in mj coat pocket for a long time. 
 And, as near as I could understand, that money was lost by her 
 at the time of her death. It was in a Pocket Book, and the money 
 is in cash, and is being held by the President of the Brooklyn 
 Bridge. Now, doctor, I've told you about all there is, and I hope 
 it will be the last time, for I wish to be done with it. 
 
 "I also wish to go home, and then I will be contented and 
 happy once more. I would never be happy again, with all this on 
 my mind. I wish to unload it on my mother and father. I also in- 
 tend to go to a Priest and confess my sins, to be reconciled with 
 God, and then threw the help of the Church, I will know just what 
 to do. I have told the truth as near as I can judge, and I hope that 
 you doctors won 't hold me here very long, for I am anxious to find 
 out if there really is any truth in this matter or not. Perhaps I 
 have been chosen by Our Lord to perform a Cirtain duty, and I 
 Avish to go and find out. ' ' 
 
 The affective reconstruction after his panic and collapse has 
 many elements of efficiency, willingness to work and endure fail- 
 ures, but he finishes mth an admission that he feels that he is 
 called upon to be a disciple of Christ, and, as an absolution for his 
 sinfulness, God will direct him ; meaning, of' course, complete sub- 
 
506 PSYCHOPATHOLOGY 
 
 mission to the obsessive compensation for inferiority, but on 
 probably pathological lines. 
 
 During his psychosis, he wonld stand immovable for long 
 periods and look at the wall while he was having hallucinations 
 pertaining to Jesus, his little sister, a dog, Grod, etc. 
 
 Several times during one panic, he dived head first into fur- 
 niture and was restrained "vvith considerable difficulty. (Unfortu- 
 nately, the history sent with the patient did not record the details 
 of this excitement.) While in the Naval Hospital he heard his 
 mistress' voice calling, "Come back!", gratifying the affective 
 attachment to her. 
 
 His discussion of himself reveals the origin, in past experi- 
 ences of many distinctive wish-fulfilling sensory disturbances of 
 Avhich he complained. This woman looked "something like my 
 little sister." "Jesus Christ looked like a man -with a hood on, 
 and it came tight across his chin." "The little girl was supposed 
 to be the little sister that was born when I was seven or eight years 
 old. She only lived two weeks. All I remember of that baby 
 sister is my brother had her wrapped up in blankets before the 
 fire. The dog was like a big mastiff. I had a dog on my mind, sir. 
 I thought the world of that dog. There was a family moved in 
 next door to us. They were from the West and they had two dogs. 
 One was a martin pointer. She was given to me. [His descrip- 
 tions of his relations with the dog showed his erotic adolescent 
 affection for her. J My father got disgusted and gave her to the 
 dog-catcher one day while I was in school. Of course, I was cut 
 up by it. At G — Hospital I asked several times for the dog's 
 picture. That (God) was my own father. I believed my Father 
 in Heaven sent me here for that purpose to keep me from destruc- 
 tion, because he was God to me. ' ' 
 
 He gradually became clearly oriented, sociable and indus- 
 trious, but somewhat depressed and very repentant. He was dis- 
 charged in excellent physical condition and appeared to be quite a 
 comfortable personality, with, however, a dangerous tendency to 
 cultivate moralizing inspirations in order to become fit for social 
 
 esteem and complptely repress his erotic cravings. 
 
 * * * * 
 
 It is hardly necessary to include additional cases of homo- 
 sexual panic that originated in prisons, monasteries and colleges. 
 The case of the physician (Case PD-1) who later became a bril- 
 
ACUTE HOMOSEXUAL PANIC 507 
 
 liant philologist and the panic of a university professor (Case 
 PD-6) show that irrepressible homosexual cravings are not charac- 
 teristic of the ignorant or mentally defective. Under appropriate 
 sentimental conditions, homosexual cravings probably may become 
 aroused in most males and cause very serious disturbances of self- 
 control, developing at times into nothing less than a psychosis. 
 
 In women, anxiety and even panic, with a well-fixed feeling 
 of inferiority and delusions of persecution systematized about 
 other women, show that the same mechanism of irrepressible 
 erotic cravings may also occur in the female when she has sub- 
 missive cravings for assault. I have never seen an aggressive 
 homosexual female or male in a panic. The anxious homosexual 
 female usually feels safer when her physician is a male. 
 
 Case PD-28 was a young unmarried white woman of twenty- 
 five, who was struggling to pull herself together after a grave 
 long continued dissociation of the personality. She related the 
 following dream and impressions of her physical examination. 
 
 She dreamed: "I think I was dying and something with 
 wings stood over the bed. It was black and I heard the noise. I 
 said go away, go away. Somebody had me by the hair and said : 
 ' I '11 make a cripple out of you like Mrs. L. ' I yelled and twisted 
 and it seemed as if somebody was holding me." (The patient had 
 an obsessive tendency to pull the hair of old Avomen patients.) 
 
 She discussed the dream and finally began to tell with marked 
 affect and weeping, her misinterpretations of the work' of the 
 woman physician who made her physical examination. ' ' She did 
 something to me Hke Mrs. L. — she stuck me in the thigh. She said 
 I want to show you a little invention of my OAvn. She put a towel 
 over my face and asked me what she had in her hand. I said it 
 was a bottle of perfume. ' ' ( The wish-fulfillment in these peculiar 
 delusions becomes transparent when we see that "the bottle of 
 perfume" here symbolizes a fragrant narcotic and "the little 
 invention" in her hand becomes the desired phallus which, how- 
 ever, would cripple her womanliness. The symbolic value is more 
 evident in the following.) 
 
 The patient said her left leg then became paralyzed and she 
 protested, "You destroyed something you can't replace [virgin- 
 ity]. You can't try that holy mother business on me." * * * 
 "She drove something into me with a tadk hammer. I nqver 
 wanted a girl. ' ' She said she never wished for sexual love from a 
 
508 PSYCHOPATHOLOGY 
 
 girl and then drifted immediately into the subject of her great love 
 for her sister Ann. She said she cried every night and complained 
 that she had no one to sleep with. 
 
 She believed she gave birth to a child by the twilight sleep 
 method (narcotic), and insisted that the people found a dead 
 child in the house. 
 
 This patient, while she was afraid of women, trie.d to misiden- 
 tify a male physician as her lover and made many flirtations ad- 
 vances to him. 
 
 Case PD-29 was an intelligent, married woman, forty-three 
 years of age, who gradually elaborated a system of persecutory 
 delusions which she centralized about her neighbors and a neigh- 
 bor's wife in particular. 
 
 At thirty-four, she married a man of seventy. She had known 
 him since her childhood, when he was a man of fifty with children 
 considerably older than herself. When she was ten, her father was 
 killed by the husband of his paramour and probably a compensa- 
 tory association between her future husband and her father became 
 established. 
 
 The patient was very religious, conscientious, friendly, and 
 satisfied with her home. She felt that her married life was satis- 
 factory until about three years ago (aged forty) when she noticed 
 that the neighbors made "remarks" about her and seemed to 
 laugh rudely whenever she appeared. This feeling, that common 
 gossip was made about some secret relating to her life, grew into 
 a firm conviction, and for three years she gathered an enormous 
 collection of incidents where "looks," "remarks," "laughs," 
 "signs," etc.,, proved it. For about tAvo years she secretly nursed 
 her suspicions, but finally, unable to further restrain herself, she 
 confronted her husband with a surprising but convincing arrayal 
 of incidents to prove that her neighbors were slandering her and 
 making charges that she was a "bad woman." 
 
 Without going into her characteristic paranoid story of elec- 
 tric currents, searchlights, ridicule, plots, gossip, mind-reading, 
 suggestion, etc., the case may be abbreviated to a record of a year 
 of anxious consultations with physicians and a few months in a 
 sanitarium. Her behavior was characterized by weeping and fear 
 of persecution but no anger and no retardation of thought or 
 ability to work. 
 
 She showed, symptomatically, every indication of being an 
 
ACUTE HOMOSEXUAL PANIC 509 
 
 amorous woman who was making a desperate effort to suppress 
 her eroticism. She had spontaneously confessed to her husband, 
 with great anguish and embarrassment, her masturbation prac- 
 tices during the past few years, but this was not sufficient to re- 
 move the feelings that she ought to be punished and that the 
 woman neighbor was to instigate the punishment. 
 
 Upon her admission, although she was at first rather reticent, 
 her mental integrity was found to be excellent, and, gradually, as 
 her confidence in the physician became established, she told most 
 but not all the history. 
 
 Her difficulties, on the whole, seemed to be, at first, natural 
 for an amorous woman at forty, being persistently sexually ex- 
 cited by an equally erotic but impotent man of eighty. 
 
 After a few conferences, she, apparently without reservation, 
 told the details of difficulties which contained facts that made 
 it possible but not probable for the neighbors to learn of her mas- 
 turbation, through hearing certain characteristic noises through 
 an open window, and her confession to her husband, which was 
 made in a very loud voice because of his deafness. 
 
 Following a common sense, frank discussion of how such prac- 
 tices might be gossiped about by herself if she discovered another 
 woman doing the same, she admitted that she had been too quich 
 and severe in blaming her neighbor for her troubles and not hold- 
 ing herself to an honest account. (This method of adjusting the 
 attitude of a paranoid state never works, unless the physician 
 has the thoroughgoing confidence and transference of his patient 
 and is able to induce his patient to see the reversed side of her 
 belief that she is hated — the fact that she despises herself for hav- 
 ing abnormal sexual cravings.) 
 
 Later, a more complete confession of her autoerotic difficulties 
 and a readjustment of her interests along socially wholesome lines 
 removed all traces of anxiety, and she seemed to become a very 
 much relieved, grateful woman. Her most distressing fear, that 
 neighbors were planning to have her arrested and punished by 
 the police seemed to become adjusted when she no longer felt a 
 sense of secret guiltiness. Previous to this time she wept bitterly 
 and complained with great fear that the police were going to arrest 
 her. As is usual in such cases, arguments and persuasion had not 
 been sufficient to shake the apprehension. Not until she related 
 how the woman who lived on the other side of a thin partition 
 
510 PSYCHOPATHOLOGY 
 
 had followed her about from room to room, "keeping opposite to. 
 her," and made remarks to others, when the patient turned on the 
 water or scrubbed the floor, that she was going to masturbate, did 
 the patient succeed in seeing the mechanism of her cravings. This 
 revealed the disguised interest of her eroticism, a masturbatory 
 sexual interest in the woman neighbor and its attending feeling, of 
 being inferior to her. 
 
 The case assumed an encouraging turn after several very free 
 discussions of this wish and of her methods of disguising her 
 wishes. Her transference to me after I had been made aware 
 of her worst traits, no doubt gave her firm feelings that she still 
 must have some goodness in herself. Fortunately, while becom- 
 ing aware of the fact that she was accusing the woman neighbor 
 of being guilty ,of what she herself wished her to do, which caused 
 her to feel no little shame at her hyprocrisy, this woman paid her 
 a friendly visit at the hospital. 
 
 This spontaneous visit helped to satisfy the patient that her 
 suspicions had been entirely due to her own misbehavior. She- 
 made an excellent adjustment and openly showed her penitence 
 and gratitude. Here was a very serious case of paranoia of over 
 three year's duration that apparently made a comfortable adjust- 
 ment through a psychoanalysis. 
 
 The patient was carefully forewarned that she must not con- 
 sider her sexual problem at an end. It was difficult to foresee 
 how a woman of such amorous disposition, with a strong resistance 
 to illicit sexuality and an impotent, erotic, aged husband, would 
 succeed in keeping herself comfortable. 
 
 About nine months after her discharge, following her hus- 
 band's dangerous illness, which implied the possibility of free- 
 dom she again became erotic. Although she succeeded in pre- 
 venting masturbation, she could not avoid the belief that her 
 neighbors suspected her of such misbehavior. This soon became 
 elaborated again into fears of persecution and secret influences. 
 
 She voluntarily returned to the hospital, depressed, anxious, 
 erotic, and preoccupied with a stereotyped stream of thought. Al- 
 though she had had insight into the wish-fulfilling mechanism of 
 her fancies, such as being considered a "whore," she was now 
 too erotic to understand herself. ' She however, had confidence in 
 our insight, saying she believed she was understood. 
 
 She refused all personal attention, and food, had to be con- 
 
ACUTE HOMOSEXUAL PANIC 511 
 
 fined to bed, given general hygienic attention and reassured re- 
 peatedly that she was safe. Within a month the erotic tensions 
 and cravings again subsided and the tendency to become appre- 
 hensive at sudden sounds (electric elevator, locking doors, rat- 
 tling carriages, etc.) disappeared. 
 
 Ten weeks after her admission she became accessible and 
 confessed that the fear of her neighbors was due to her uncon- 
 trollable sexual desires. She now became pleasant, confiding, 
 wanted to work, was no longer suspicious and resumed her general 
 social interests. In the twelfth week she had insight and claimed 
 to have recovered. She seemed to be "normal" and did not re- 
 lapse. Eighteen months later she was still in excellent health and 
 quite happy. 
 
 This patient is nnliJce the usual anxious depressive in that she 
 systematized her delusions of persecution and is unlihe the usual 
 paranoiac in the absence of hatred and haugJitiness as a defense 
 for her inferiorities. 
 
 The tendency to homosexuality surely in males has a dual de- 
 termination. Not only are homosexual associations attractive, but 
 there is an insurmountable affective (fear) resistance to hetero- 
 sexual potency which becomes aroused by the amorous approach of 
 the female. Through some affective mechanism, she, like the ser- 
 pent-headed Medusa, freezes his soul. Her sexuality horrifies 
 instead of fascinates. 
 
 Anxiety and depression may develop rapidly after a hetero- 
 sexual failure in this type of male. Such reactions are often 
 characterized by suicidal impulses due apparently to an irresisti- 
 ble regression to the mother. The patient feels that she can not 
 give him up, and he, being unable to free himself, in order to be- 
 come devoted to another woman, finds life is not worth living. 
 
 Case PD-30 was a soldier, unmarried, aged twenty-seven. He 
 had a meagre education and came from the poor peasant class of 
 Eussian Poland. 
 
 He emigrated to America at seventeen, and Avorked in coal 
 mines for five years. At twenty-two, he enlisted in the U. S. Army, 
 because the mine had closed. His army record was free from mis- 
 demeanors except alcoholism. He was a tall, dull, sluggish fellow, 
 slow to comprehend, and gave the general impression of not hav- 
 ing the mental capacity of the average man. 
 
512 PSYOHOPATHOLOGY 
 
 lie had become interested in the adopted daughter of a board- 
 ing-house keeper, and had been inclined to spend much of, his time 
 in their house. She was a rather pretty, delicate little girl, -with 
 small symmetrical features and blue eyes, but decidedly inferior 
 mentally. She had been unable to attend school regularly, g,nd 
 had such stigmata as very defective, poorly aligned teeth. In her 
 general attitude toward the patient, she was very erotic, and 
 openly made sexual advances to him. She considered herself to 
 be engaged and, later, despite his defects and the gravity of his 
 psychosis, she was determined to marry him. 
 
 For several months previous to his psychosis, the patient had 
 been depressed" by the misfortunes of his mother. She lived in 
 the Polish war area, and nothing could be learned about her fate. 
 
 Four weeks before his attempt to commit suicide, he was fur- 
 ther depressed by influenza. One day, he left the hospital mthout 
 permission and went to his girl's home. Here he solicited petting 
 for several hours, and she occupied a bed with him, she said, 
 only to comfort him. He believed, however, she had other in- 
 terests. He became very erotic, but, as he expressed it, "didn't 
 have the nerve." He said these temptations had been offered 
 frequently, and he had never been able to go ahead because he 
 lost courage. On this particular occasion, he left the house about 
 1:00 a.m., and procured a pint of whiskey. He felt, he said, 
 "knocked crazy," and went to a hotel. There, he drank the whis- 
 key, turned on the gas and went to bed with the intention of dying 
 because he was "no good." He was found by an hotel employe 
 almost asphyxiated, but recovered later without any serious phys- 
 ical effects. 
 
 At the hospital, he became very erotic and masturbated openly. 
 He talked incessantly about being "rotten inside," and "knocked 
 crazy, ' ' would not rest in bed, pounded his head against the wall, 
 rolled around on the bed and floor. He heard his mother's voice, 
 a,nd dreamed of her calling him. He believed that in some man- 
 ner his mother called him, and he often repeated: "My mother ^ 
 wants me to come back home." (Regression to the mother be- 
 cause of inability to surmount the obstacles to his potency.) 
 
 During his excitement, he was confused, and muttered to him- 
 self frequently, but was generally oriented, and rememb^ered most 
 things, although he was unable to hold his attention on any sub- 
 
A.CUTR HOMOSEXUAL PANIC 513 
 
 ject. His stream of talk Avas diseonnocted and could not be fol- 
 lowed. 
 
 He passed into a depression after a few days, and complained 
 that he Avas burned up inside, had no blood, was "rotten," "no 
 good," "nerves were bad," and people called him "crazy," and 
 "weak." He had headaches and could not walk or do any work. 
 He tried to control himself but rather periodically masturbated 
 and then declared that he wanted to die, because he could not con- 
 trol himself. He had completely given up, and was a very de- 
 jected, wretched man. 
 
 He considered his whole life to have been a failure and fre- 
 quently talked to himself and to us about his girl, saying he wished 
 to marry her, but could not make himself consent, masturbating 
 instead. 
 
 He was kindly disposed toward the other patients, but re- 
 garded himself as hopelessly unfit. His depression continued for 
 three months, after which he gradually extended his interests to 
 the games, ward work, and finally worked on the grounds. 
 
 His heterosexual failure may be summed up as largely due to 
 his attachment to his suffering mother, and the imfitness of the 
 "sexual object, as well as autoeroticism. "At the hospital, I wor- 
 ried myself nearly dead so I could come back to my mother. ' ' His 
 attempt to suffocate himself Avith gas in the closed room Avas, it 
 seems, the' regression to the uterus. This man had never had sex- 
 ual intercourse Avith women and could not establish his biological 
 potency, but this is not to be attributed to his mental deficiency. 
 
 Case PD-31, a A'ory Avell-trained, efficient laA^^^er, a descendant 
 of a proud old New England family, reacted in a manner very sim- 
 ilar to this ignorant Eussian peasant, to a Avoman^s sexual ad- 
 A^ances. True to the teachings of the NeAv England conscience, he 
 had been trained drastically to suppress any interests that per- 
 tained to sex. 
 
 He had never married, and had never shoA^m an overt sexual 
 interest in women. While visiting at the home of an old friend, 
 this man's Avife made unmistakable sexual advances to him. They 
 had been "Platonic friends" for years. The act, he said, so em- 
 barrassed and "disgusted" him that he tried to commit suicide, 
 locking himself in a room and turning on the gas. He Avas found 
 unconscious. Confusion and disgust were the only explanations 
 he offered for his act. He related this experience to me at the 
 
514 PSYCHOPATHOLOGY 
 
 time when he was obsessed with his sexual difficulties. He gave 
 the history while seeking relief from an anxiety that made it 
 reliable. The obsessive persistence of the sexual cravings had 
 forced him to stop his work. Although over forty, he derived 
 most unusual pleasure from any sort of conversation about the 
 sexual question, and must be regarded as sexually undeveloped, 
 because of his inability to perform the sexual functions of the 
 mature male. This fiact he attributed to puritanical moraliz- 
 ing on the part of his parents and relatives. His attempt to die, 
 like the Eussian peasant's, was the equivalent of an. intrauterine 
 regression to the mother. (These two cases become strikingly 
 interesting when associated with Boecklin's fantasy, "The Isle of 
 Death," Fig. 29, and the "Eequiem," Fig. 28, as a regression, a 
 suicidal fantasy.) 
 
 The acute dissociation of the personality, in both sexes, may 
 become chronic and run a protracted course, varying from several 
 weeks to many years, with final recovery, or may become perma- 
 nent without further deterioration, as in Case PD-1, or pursue a 
 course of progressive deterioration depending upon the negative 
 nature of the transference and adjustment to the erotic pressure. 
 
 It seems that a persistent vigorous, pernicious counter-attack 
 of hatred becomes directed against the conventions of society 
 and particularly against those to whom social obligations bind the 
 patient (parent, offspring, mate, employer), because they are re- 
 pressing influences. This finally results in loss of social adapta- 
 bility. ' 
 
 Summary 
 
 The acute homosexual panic may well be considered a distinct 
 stage in the psychoses. It may be diagnosed as readily as paresis 
 by certain cardinal symptoms: (1) panic and the autonomic reac- 
 tions which accompany grave fear; (2) the defensive compensation 
 against the compulsioit to seek or submit to assault; (3) the sym- 
 bols used by the erotic affect and the disturbances of sensation 
 it causes. The latter are complained of as visions, voices, electric 
 injections, "dopy" feelings, "poison" and "filth" in the food, 
 seductive and hypnotic influences, irresistible trance states, cruci- 
 fixion, etc. It is necessary to estimate the significance of the symp- 
 toms of panic in a neutral environment and the significance of the 
 various symbols used. 
 
ACUTE I-IOMOSBXUAL PANIC 515 
 
 The prognosis of a homosexual panic in a soldier or sailor 
 is usually favorable for that episode, but the future of that in- 
 dividual is most insecure unless he obtains insight and a fortunate 
 sexual adjustment. In a series of several hundred cases which 
 have been recognized in the past six years, most of the cases 
 recovered. The recurrence of panic, later, among men who se- 
 cretly reenlisted in some branch of the government's service and 
 were returned to St. Elizabeths Hospital, as well as the return, 
 several years later, of men who had profoundly deteriorated after 
 having been discharged as social recoveries, shows that the recur- 
 rence of panic results from inability to control the tendency to be- 
 come perverse, i. e., biologically abnormal. This abortive tend- 
 ency seems eventually to become dominant and incurable and the 
 chapters on the causes of variations in chronic pernicious dissocia- 
 tion neuroses or dementia prascox are composed of cases that are 
 selected to show why one type becomes paranoid (compensates), 
 another, catatonic or submits, and another, hebephrenic, or an- 
 other case may show attributes that indicate a tendency to cover 
 the whole regressive cycle and not be distinctive of any of these 
 classical divisions. 
 
CHAPTER XI 
 
 THE PSYCHOPATHOLOGY OF CHRONIC PERNICIOUS 
 DISSOCIATION OF THE PERSONALITY WITH DE- 
 FENSIVE liATRED, ECCENTRIC PARANOID 
 COMPENSATIONS AND DETERIORATION 
 
 (Paranoid Dementia Prseeox) — Clironic, Pernicious, Dissociation, 
 Compensation Neuroses 
 
 Why should one man or- woman who suffers from an acute 
 dissociation of the personality make a relatively rapid recovery 
 and another case run a protracted chronic course without de- 
 terioration, and still another individual deteriorate? To assume 
 that the variation is due to differences in the social stresses the 
 individuals had to meet, and to greater so-called constitutional 
 or nervous instability, is about as accurate and satisfactory as to 
 tell a scientific engineer that a hoiTse was blown over becaiise its 
 foundation was unstable. The answer can hardly be based upon 
 one factor or attribute, but must consider the nature of the re- 
 pressed affective cravings, the nature of the compensatory striv- 
 ing, as to how eccentric, systematic and persistent it is, how much 
 hatred there is in it, and how persistent are the resisting social 
 obligations that force the repressions to be continued and prevent 
 a transference from being established. 
 
 In those cases where an affective readjustment occurs quickly, 
 we often fiind that the patient has been greatly assisted by the 
 friendly affection (positive transference) for some other person, 
 a relative, friend, patient, nurse or physician. Attention was di- 
 rected to the influence of the transference of affection to another 
 person, which, in turn, stimulates a desire to work so as to retain 
 the person's esteem, by several of our cases, particularly HD-1, 
 PD-33, CD-3 and a seriously depressed young male Hebrew whose' 
 psychosis began upon the suicide of a boyhood friend and whose 
 recovery began, he said, when he "found a friend." 
 
 Case MD-13 reported in full by Dr. Dooley,* definitely crystal- 
 
 *The Psychoanalytic Review, Vol. V, No. 1. 
 
 516 
 
CHRONIC PARANOID DISSOCIATION 517 
 
 lized the realization of tlie importance of affective transference 
 for recovery from dissociation of the personality. This attractive 
 young Avonian had been unable to control or to sublimate her 
 vigorous sexual cravings. Secret masturliation and the repressing 
 influence of a pernicious, infantile mother who, obsessed with the 
 tendency to obsti-uct the maturation of her daughter by suggesting 
 all sorts of fears about the uterine pains and trials of maternity, 
 gradually forced her to divert her sexual cravings from refining 
 themselves for a mate to substituting autoerotic fetiches, etc. 
 
 She repeatedly submitted to Avild, erotic, infantile, self-indul- 
 gent flights of behavior only to emerge discouraged and feeling 
 hopelessly inferior and unfit to win social esteem. Quite trans- 
 parent advances made spontaneously to me on my ward rounds, 
 indicated that probably a carefully directed influence might greatly 
 help her to master her eroticism and influence her to turn it into 
 constructive channels to win my interest. She reacted splendidly 
 to a suggestion made while she was depressed, after an erotic 
 flight, that I was sure she could take up the "responsibilities of 
 womanhood. ' ' The next day she wrote me a letter containing a 
 most sincere appreciation of my interest and encouragement. The 
 existence of a vigorous transference between us soon became no- 
 ticeable to those who were familiar with the case. Fortunately, 
 through Miss Dooley, the patient found a medium of reaching me 
 (my esteem). She made an excellent recovery after an elaborate, 
 skillful psychoanalysis by' Miss Dooley, and when she returned 
 to the hospital for her discharge, now a student in a university, 
 she asked to see me. "With splendid womanly reserve, and yet a 
 pleasing expression of gratitude, she said slie wished to thank me 
 for the interest I had taken in her, and for the "transference" 
 that had been established between us while she was ill, making the 
 psychoanalysis possible. She said it had enabled her to make an 
 analysis of her difficulties, through associating her transference 
 to me with the work of my assistant. 
 
 Case PD-33, presented below, further illustrates the influence 
 of a transference upon recovery from chronic dissociation of the 
 personality. The dissociations of the personality that run brief 
 courses when the repressed affect overcomes the controlling ego- 
 istic affect, the latter having been weakened and depressed by 
 disease or a hostile environment, are usually brief, due to the suc- 
 cessful evasion of the depressing influence in the environment. 
 
518 PSYCHOPATHOLOGY 
 
 This occurs when the panicky, homesick soldier is sent to the 
 hospitalas a preliminary step for discharge. He escapes danger 
 and the nagging , of his companions, and the friendly nursing 
 encourages or stimulates the depressed socialized wishes to assert 
 themselves and regain control of the content of consciousness. 
 The patient, feeling more hopeful, recovers through the influence 
 of the prospective discharge and the prospect of winning his love- 
 object. 
 
 The following case (PD-33) ran a chronic pernicious course 
 and, although the patient strove desperately to understand him- 
 self, he was unable to understand the influence of his homosexual 
 cravings. The psj'^choanalysis brought about considerable insight, 
 promising recovery in this case of so-called "paranoid dementia 
 prsecox. ' ' 
 
 He had been diagnosed as a case of paranoid dementia prsecox 
 and generally regarded by his physicians as utterly hopeless be- 
 cause of his systematized delusions of persecution, auditory hal- 
 lucinations and oral sensory disturbances, his arrogance, danger- 
 ous assaults, and persistent masturbation. Aboiit six months after 
 his admission, he begged to have his "mind read" so as to learn 
 whether or not he was "crazy" or actually being "hypnotized" for 
 sexual purposes. 
 
 He was an uneducated Russian -peasant of German parentage. 
 His mother was "peculiar," and had been confined" in an institu- 
 tion for the insane. His sister was also insane. He had no dis- 
 eases that left injurious effects. He attended the Russian schools 
 from six to twelve and advanced with his classes, althoiigh he 
 felt little interest in his studies. He considers himself to have 
 been a "wild boy" and difficult to control. 
 
 He ran away from home to work as an apprentice, and had 
 to be persuaded to return. (This type of impulsive solution of 
 an unpleasant environment was later frequently repeated by the 
 patient.) 
 
 At seventeen, he emigrated alone to the United States despite 
 the wishes of his parents. Until twenty-three, he maintained him- 
 self fairly comfortably in New York and other cities by working 
 as a general utility man in stores, and as a plumber's apprentice. 
 He was very restless, and Wandered from one job to another. He 
 said: "I used to work in a place; all of a sudden get tired of 
 work there and leave it for another place. / seemed all at once 
 
CHRONIC PARANOID DISSOCIATION 519 
 
 to take a dislijc^^ to the people and quit." {This characteristic 
 fickleness is significant of inability to find a satisfactory love- 
 object, and later showed that homosexual fears determined the 
 shifting about as a defense.) 
 
 At twenty-three, he enlisted in the U. S. army, and served for 
 about two years. Then he impulsively purchased his discharge 
 and visited his mother in Europe. After a few months he became 
 restless and returned to the United States. He reenlisted in the 
 army and was sent to the Philippines. After twenty months of 
 service (aged twenty-six) he again bought his discharge and re- 
 turned to the United States. The second time, as he explained with 
 great detail to justify Ms actions, Avas the result of "unfair" 
 work imposed upon him by his captain. (The charge, unsupported 
 by facts, of being discriminated against is often significant of wn,- 
 due affections that are not being recognised by the persecutor.) 
 After several months of restless work at odd jobs, he enlisted as 
 a federal prison guard. His struggle to control himself became 
 intense, and he persisted in blaming others for Ms emotional diffi- 
 culties. 
 
 A few weeks after he began his duties as a federal prison 
 guard, the loss of self-control reached the proportions of a grave 
 dissociation of the personality. He said he "got into the habit 
 of being mad all the time." He objected to being imposed upon 
 and placed on duty in the "worst cell house." Other men, he 
 thought, began calhng him "bad names," and he frequently ob- 
 served them talking about him. He tried to escape this unpleasant 
 situation by asking for a transfer, but the affective storm broke 
 before this could be arranged. Distressing auditory hallucinations 
 accused him of being a ' ' pervert, ""c.s.,""s.b.," etc. One night, 
 he hallucinated an assault in which ' ' someone was cutting me, ' ' and 
 this precipitated a panic. He attempted suicide by drinking sul- 
 phuric acid, because men considered him to be an oral sexual per- 
 vert. {The analysis of a series of such impulsive acts shows that, 
 ■unconsciously , the act often satisfies the repressed cravings.) Af- 
 ter a period of treatment in a hospital he became more self-com- 
 posed, and was considered to be fit for duty. (His physicians evi- 
 dently had no insight.) Several months of duty with depression 
 and worr3^ followed, but his anxiety and tenseness becoming per- 
 sistent, because "men looked at me in a peculiar way" and "dis- 
 liked me," he was sent to St. Elizabeths Hospital. 
 
520 PSYCHOPATHOLOGY 
 
 Before discussing Ms psychosis as it developed further, it 
 will be of interest to bring the history of his sexual life up to the 
 same chronological period. He avoided, with denials and refusals, 
 a frank confession of his sexual life until nearly six months after 
 his admission to St. Elizabeths Hospital, although persistent at- 
 tempts were made to obtain the history. Without it, his difficulties 
 in the prison and the army Avould be wholly unintelligible. Not 
 until he had repeatedly consulted me about his difficiTlties, after 
 begging for a psychoanalysis, did he finally venture to tell the 
 true story of his sexual experiences. It was imniediately obvious 
 that this had a most important bearing upon his distress and feel- 
 ings of being persecuted. 
 
 (In all such cases, the only physicians who are at all likely to 
 obtain a true history of the sexual career of the patient, are those 
 who convince the patient by their personal attitudes, not words, 
 that they appreciate the nature of his struggles. ) 
 
 He gave his history of masturbation, including an account of 
 the usual struggle to overcome the tendency, -with little embar- 
 rassment. This was consistent with the facit that he had been 
 masturbating freely during the psychosis and excused it as "a 
 necessity." His sexual history also inchided numerous hetero- 
 sexual experiences, attachments to several mistresses and an in- 
 fection of syphilis at twenty-seven, for which he received some 
 treatment. His debauches were visually accompanied by alcoholic 
 indulgence. Finally, with great embarrassment^ he confessed the 
 nature of his relations with his mistress AA'hile he was employed at 
 the federal prison. During an alcoholic ( ?) debauch he performed 
 cunnilingus. 
 
 He insisted that she must have drugged him and deprived 
 him of self-control. After this act, which he said occurred only 
 once, he became more sensitive and worried. He lost his potency, 
 Avhich seems to be a common sequel in these cases, and this gravely 
 depressed him. He believed that his associates had caught on to 
 his perversions. This partly explained his notions that they were 
 maldng remarks about him, in that he regarded himself to be 
 sexually abnormal. 
 
 About two weeks after his admission to St. Elizabeths liospi- 
 tal, he discussed the anxiety period at the prison, stating that he 
 thought it had been caused by "imaginations," showing some in- 
 sight; but at the same- time, he insisted that the men in St. 
 
CHRONIC PARANOID DISSOCIATION 521 
 
 Elizabeths Hospital were voir talking about him, considering him 
 to be a pervert, and were making sexual advances to him. Prac- 
 tically the same difficulties which he now said were "imaginarji" 
 at the federal prison, he insisted were a reality here. The reader 
 should bear in niind that during the following six months he would 
 give no account of his past sexual behavior. 
 
 He had a slight gonorrheal discharge and his blood Wasser- 
 mann reaction was plus-minus. His physical condition was other- 
 wise negative except that he complained of being "cold," 
 "drowsy," "dizzy," "doped," and was afraid he would "die in 
 a funny way." He was a man of medium height, square-shoul- 
 dered, and very well developed. He had a large head, good fea- 
 tures, a heavy distribution of hair and well-developed masculine 
 physical traits. He held his head up stiffly, was proud, rather 
 defiant in his stare, inclined to be arrogant and combative, and 
 never showed a friendly disposition to nien. 
 
 He Avas decidedly depressed, sullen, worried, apprehensive 
 and suicidal. At every opportunity, he stopped the physicians and 
 nurses to say, "I want a chance to go back to my outfit and prove 
 to them that I am all right." He persistently told his troubles 
 with great detail, and tried to jiistifi/ his reasons for believing 
 that he was being persecuted. He often added that, because he 
 could not see why he should live, he would kill himself. 
 
 When he talked to the physicians or nurses he Avas extremely 
 arrogant, and aUvays wanted them "to understand" that he Avas 
 as good as they were. He "impulsively" attacked other patients, 
 and, one time, while lying sullen and brooding on a couch, and a 
 physician bent over him to ask hoAv he felt, he struck the physi- 
 cian in the face, shattering his glasses. He Avould giA^e no ex- 
 planation for this act. It looked "impulsive," but later he ex- 
 plained that he thought homosexual insinuations AA^ere meant by 
 the question of "hoAV he felt." 
 
 During this period he Avas disoriented for time and person, 
 and answered the intelligence tests poorly. Ho ]5aid no atten- 
 tion to questions or eA^cnts in his environment tliat did not touch 
 his personal difficulties. 
 
 He said: "lani not happy oi' sad, but just mad, because of 
 the dirty tricks they haA-e plaA'ed on me. I imagine everybody is 
 looidng at me. I am supposed to be sometliing I am not." 
 
 His delusions of persecution Avere mostly clal)orati()iis of lial- 
 
522 PSYCHOPATHOLOGY 
 
 lucinatory experiences wMcli consisted of auditory, olfactory, 
 visual, gustatory and cutaneous sensory disturbances. 
 
 He felt that "dope" was being used upon him, which made 
 him do "funny things" (oral erotic acts). Sometimes when he 
 closed his eyes he saw "stars" and "angels." At times he heard 
 "beautiful music" and had a "queer taste" in his mouth. He 
 heard voices accuse him of being a c. s., s. b., etc. 
 
 His dreams, he said, were "funny ones." "Sometimes I 
 dream I am flying from one roof to another, and sometimes I 
 dream my tongue is as big as an elephant's and my body is all 
 dried up." His sleep, he believed, was disturbed by someone giv- 
 ing him "dope," and he felt like fighting everybody. 
 
 His insight was interesting, in that, despite his confusion and 
 panic, he said, "I imagine all the time that people are talking 
 about me." (His use of the doubting word, "imagine," indicated 
 that he was still conscious of sensory images which were the 
 foundation of perceptions that so qualified the hallucinated sen- 
 sory disturbances as to cause some doubt about their reality and 
 influenced him to admit that perhaps he himself created many of 
 his troubles.) Sometimes. he said, "I am a little off in my mind." 
 
 His judgment, however, about his difficulties and their solu- 
 tion was very poor, and followed purely reflex lines of defense. 
 He wanted the doctors to "look up my past," to "let me go back 
 there and prove I am all right." Attempts at explaining the 
 necessity of his being treated in the hospital only aroused the per- 
 sistent question: "Why should I be locked up?" He paid no 
 attention to persuasion and advice. 
 
 The progress of the case was slow and changed but little dur- 
 ing the first month. He continued to be sullen and extremely 
 tense, becoming startled at the slightest sound. He was, however, 
 not agitated, and did not complain of having committed sins, so 
 typical of the more simple depression. 
 
 The first suicidal attempt was made about two Aveeks after 
 his admission. He tried to strangle himself with his belt but, 
 fortunately, it broke. His explanation was that people would not 
 let him alone and he wanted to die. 
 
 After the second month he became more sociable and in- 
 terested, and was assigned to work in the douche room. Although 
 he still had the same hallticinations, he was not "so panicky, but 
 more combative. About the fifth month, his work had to be stopped 
 
CHEONIC PABANOm DISSOCIATION 523 
 
 because he began openly to accuse different men of making sexual 
 advances to him. 
 
 At this time he was very erotic, and one morning he in- 
 dignantly demanded the protection of his physician. With great 
 bitterness, he insisted that while asleep some men had forced him 
 to submit to an oral sexual assault. Despite the most earnest 
 persuasions, he could not be made to doubt the reality of this 
 vivid dream experience. Fear of sexual assault by men continued 
 almost nightly for the next two months. During this time, he slept 
 very little and used many precautions to protect himself from the 
 (hallucinated) assaults. He barricaded the door of his room with 
 all the furniture available, and kept chewed paper in his mouth, 
 Avhich, he thought, would catch the semen and prove that he had 
 been mistreated while asleep. Unfortunately, one morning, he 
 found a hair in the paper, and this firmly convinced him that his 
 hallucinations were realities. Conversations or questions had 
 "double meanings." One night, the attendant legitimately asked 
 him if he wished to have a sheet. The patient interpreted it to 
 mean something "to spit in," and promptly assaulted the attend- 
 ant. He Avas sure he heard the attendant saj'^ he had chancres in 
 his throat. [Numerous incidrnis of this tupe might be included 
 in this case record to ilhtstrafc hoiv persistently the individital in- 
 sists that the cause of his distressing, irrepressible sensations is 
 someone in the enviroiim.ent, in order to avoid becoming conscious 
 of the true nature of his segmental cravings. However, in the 
 sense that the autonomic functions (homosexual cravings) re- 
 spond to the seductive stimuli (a certain type of man) despite his 
 efforts to prevent it, the patient is perfectly right in his statement 
 that he is persecuted by the man, although the latter is unaware 
 of it. J 
 
 During this period of homosexual eroticism he masturbated 
 several times a week, because, as he reasoned, he "felt passionate 
 and it had to have an outlet. ' ' 
 
 Despite these difficulties, he was given work in the laundry. 
 He insisted that people there also talked about his sexual behavior, 
 and soon he decided a certain woman employee was making over- 
 tures to him to perform cunnilingus. Although he would fight and 
 threatened to kill a man when he suspected homosexual advances 
 were being made, he was willing to indulge in heterosexual per- 
 
§24 PSYCHOPATHOLOGY 
 
 versions, lie tried to induce the woman to go into a nearby closet 
 for that purpose. He again had to be confined. 
 
 Then he was 'employed in the green-house, but was quite .use- 
 less because of his arrogance. He constantly tried to demon- 
 strate his superiority, did little work, argued incessantly, and an- 
 noyed the employees. 
 
 He accused attendants of smacking their lips as an invitation 
 to "go do-wm," and often threatened an attack. Any smacking of 
 lips, smile or inquiring look at the patient was resented as a refer- 
 ence to his sexual difficulties. 
 
 During the latter part of this period of eroticism, the patient 
 asked for the ' ' mental treatment. ' ' He naively wanted to be " hyp- 
 notized so the bad thoughts could be stopped." He reasoned, plac- 
 ing the cause characteristically in an impersonal light, that it was 
 due to "bad blood." He also begged for Avork "to keep my mind 
 imder control." This was his own solution and, being excellent 
 mental hygiene, had to be given every consideration despite his 
 perverseness. He became determined to get his discharge, the need 
 for which was surely biological, being created by the redevelopment 
 of heterosexual cravings which now began to remanifest them- 
 selves. 
 
 Although he was disappointed because he could not be hypno- 
 tized, he decided he wanted to have his ' ' mind read. ' ' He now, for 
 the first time, told the important details of his sexual life and the 
 act of cunnilingus. Because of his vocal difficulties and illiteracy 
 the remainder of the time Avas devoted to helping him to understand 
 that he thought men had homosexual thoughts about him, because 
 he had homosexual cravings for them and was trying to hide 
 them. At first, this was met with considerable indignation, but 
 his transference was well enough established to permit me to talk 
 plainly. He soon substituted me for the physician in charge of 
 his ward and the superintendent (father equivalent), Avhom he had 
 previously insisted used him for sexual purposes. He learned 
 to recognize the element of irresponsibility^ for homosexual feel- 
 ings (feelings should not lie mistaken for overt conduct), and 
 naively learned to talk of this as his "bad blood." 
 
 He discussed his sexual feelings at first in the following man- 
 ner. "I feel as if a girl was like a piece of cake — it is my imagina- 
 tion, but mv character Avotild not alloAV it. I Avas that Avay Avhen 
 I was a little kid." 
 
CITRONTC PAKANOin DTSSOCTATTON iy2.) 
 
 He maintained that eunnilingais was not so depraved as fel- 
 latio, but not until later was it possible for him to discuss his 
 reasons for this belief. "If I would allow myself to do that [fel- 
 latio] to cure myself [it is surprising how often the belief is ox- 
 pressed by patients that l)y allowing the cravings to commit the 
 act, a cessation of the craving would result], it Avould not cure me 
 — [because] — my character will not let me go so low. I would 
 jump out of the window or down a stairs afterwards. It looks like 
 the harder I try the more it is against me. I feel dizzy and chills 
 in me and it makes me drowsy. When a person feels that way he 
 does not care to live. — Now, if I must die, for God's sake make 
 Drs. "W. and H. not do these things when I am asleep." (He was 
 in earnest.) 
 
 He gradually became aware that he was afraid to sleep be- 
 cause of his erotic feelings and dreams, and this led to his ex- 
 planation that he really lost control of himself in 1912 while in 
 the Philippines when he complained of the captain's mistreatment. 
 He said, with insight, "I had the feelings for years, bvf did not 
 knoiv luhat it ivas." (This explains the whole trend of his be- 
 havior, irritability and repeated elopements, and sudden change 
 of associates.) 
 
 As the analysis and insight progressed, this uneducated man 
 began to feel that he Avas no longer homosexual, and had as much 
 interest for normal sexual relations with women ' ' as anyone. ' ' At 
 the time of the onset of the psychosis, he said, he was able to per- 
 form the act, but had no desire. He now disappeared from the 
 hospital. Two days later he returned with the explanation that 
 he eloped to see if he could make a "good enough impression" to 
 get employment, and also test his sexual powers with women. He 
 insisted that he had enjoyed sexual relations, and his affective 
 tone showed considerably less tension. He was still sensitive, 
 however, walked stiffly, Avith head and shoulders back, held his 
 chin high, and pursed his lips, but not so intensely as formerly. 
 
 Eepeated studies of his social difficulties as they occurred, and 
 their relation to his eroticism, enabled him to improve his insight. 
 He felt proud of his conquest of masturbation, and considered his 
 homosexual feelings as only a "small part" of himself which he 
 no longer heeded to worry about. 
 
 His homosexual cravings had considerably subsided, and with 
 them, as always happens, the sensitiveness and compensatory ec- 
 
526 PSYCHOPATHOLOGY 
 
 centric strivings disappeared. The arrogant posture was not so 
 evident. He no longer complained of persecutions, and tried to 
 make friends. He talked about his future prospects, and deter- 
 mined to get married and "ijiake a man of himself." The patient 
 ■was discharged as a social recovery ten months after his admis- 
 sion — now adjusted as a benign suppression neurosis. 
 
 It was highly necessary to forewarn him of a possible return 
 of his homosexual feelings if his wife should prove to be an un- 
 satisfactory mate. (He seemed to appreciate this, and declared 
 he would not make accusations should it occur. This, however, 
 would be too much to hope for, should the homosexual regression 
 recur. The prognosis depends, it seems, entirely on his capacity 
 to make an adequate heterosexual transference.) 
 
 Unfortunately, at present, there is no means of preventing 
 such eases from marrying, or of knowing whether or not the diffi- 
 culties will return with the stresses attending marriage. This 
 man's anxiety, compensatory arrogance and feelings of persecu- 
 tion had increased as his sexual cravings turned to homosexual 
 interests and decreased as they turned to heterosexual interests. 
 Should he marry, and his mate become a heterosexual obstacle, 
 instead of an attraction, he mil probably again have feelings, of 
 persecution as his repressed affections turn back to the easier 
 outlet of homosexual submission (See Case PD-9). 
 
 The following case (PD-34) ran a more protracted course. 
 His compensatory strivings were more eccentric and violent, but 
 he finally adjusted sufficiently to permit discharging him as having 
 made an affective readjustment sufficient to control himself and 
 earn a living. In his case, an important variation from the pre- 
 ceding case occurred, in which, he at times submitted with con- 
 siderable pleasure to the dissociated perverse affect. 
 
 His father died at sixty -three of a cerebral hemorrhage (?), 
 and his mother, who "was out of her head at times," died at forty- 
 seven of carcinoma of the uterus. The patient was born in Con- 
 stantinople, in 1887. He was the second child, and had most of 
 the diseases of childhood with no serious effects. His blood (Was- 
 sermann) reaction was positive for syphilis to several tests, but 
 no signs of a cerebral form of syphilis could be found. He also 
 had had gonorrhea. He was educated in several mission schools 
 in Turkey, and learned to speak English fairly well. He emi- 
 grated to the United States at seventeen, and worked at numerous 
 
CHRONIC PARANOID DISSOCIATION 527 
 
 jobs until twenty-one, when \w enlisted in the army. His reasons 
 of "unfair treatment" for leaving many of his positions indicated 
 that his general suspiciousness and irritability were due to a dis- 
 satisfied affective craving. 
 
 His sexual experiences during childhood were very promis- 
 cuous, including masturbation and considerable overt curiosity 
 about his mother. He never felt moral resistances to heterosexual 
 indulgence. His career as a soldier lasted two years. He had 
 several courtmartials and was difficult to control. When brought 
 to St. Elizabeths Hospital (at twenty-three) he was very hyperac- 
 tive, with flight of ideas, Jiallucinations, marked suggestibility, 
 fairh' clear orientation, memory accurate, mental faculties well 
 controlled for brief periods, but no insight. He was proud, ar- 
 rogant, suspicious, loud, domineering and yet afraid. He was al- 
 ways very hypochondriacal and wanted treatment for cancer of 
 the brain, (condensation of father's and mother's diseases), weak 
 alrteries, weak muscles, floating kidney, tobacco heart, appendicitis, 
 syphilis of the larynx and inability to see with his right eye when 
 he used his left eye (to see good because of evil). His complaints 
 indicate that he had vivid auditory, visual, olfactory and other 
 sensory disturbances of the hallucinatory type, into which he had 
 no insight. He complained of seeing "parts of the body, as a lung, 
 a leg, a foot, etc.," but added: "You know they are not there, 
 don 't you ? They are only thoughts, maybe. ' ' 
 
 When asked if he heard voices, upon admission, he said : 
 "Certainly, it is my mother talking to me. Yes, mother. About 
 nine — 2 C. C. " Voices accused him of sexual perversions and, 
 particularly, of oral erotic homosexual cravings. To protect him- 
 self from the homosexual cravings, he constantly moved about the 
 ward, talked loudly, accused others of following him, and had 
 numerous fights to protect himself from the "hypnotic influence" 
 of others. 
 
 During the first few months, because of his activity, com- 
 bativeness and inaccessibility, little could be learned about his hal- 
 lucinations, except through his letters and spontaneous discus- 
 sions which showed that his difficulties were very similar to those 
 he complained of throughout the following four years. 
 
 During the acute stage of his illness "all" his "relatives" 
 appeared to him (visions). His mother appeared as a "consoler 
 and adviser." He had sexual relations with her, "as natural 
 
528 PSYCHOPATHOLOGY 
 
 intercourse." • She "felt affectionate, loving one like I would 
 when I was a child, but when it was all over it seemed like a 
 dream." To this he spontaneously added, if his mother now tried 
 to coerce him into a sexual act he would resist it. He commented 
 further : ' ' My mother has suggested to me to know what it is to 
 feel gorgeously, in the gorge [placed hand on larynx], to have 
 sexual intercourse in this manner" (oral). He said all' his life 
 he had to struggle against such compelling- feelings in order to 
 retain his "manhood." 
 
 About the sixtli month he began to describe his hallucinations, 
 and within the next four years he developed an elaborate system 
 of explanations for them to which he persistently adhered until 
 the sixth year of the psychosis. 
 
 : He usually wandered about the ward talking to himself, mak- 
 ing many gesticulations and mystic movements with his hands and 
 eyes to communicate with and control the telepathic messagfes he 
 was receiving. He had numerous fights to stop patients and at- 
 tendants from "working on" him, and wrote a series of pitiful 
 letters to the superintendent. They characteristically Show the 
 nature of his homosexual struggle and the transference to the 
 father image. 
 
 The following abstracts from a letter written by the patient 
 to the superintendent about four years after bis admission shoAv 
 the chronic persistence and the nature of his affective struggle: 
 ' ' Am dropping you a few lines to let you knoAV that I am awfully 
 displeased about your actions as you are constantly tormenting 
 me by giving me surplus pains all .over my body. [In the light 
 of present psychiatric knowledge, the foregoing sentence ivoiold be 
 sufficient to make- a diagnosis of repressed submissive homosexual 
 cravings.] 
 
 "1 have written you particular letters about infidelism, ma- 
 sonic secrecies and all that. Am positive of everything and not a 
 bit scared to tell you that you are the cause of my surplus worry, 
 tormentations and sorroAV. 
 
 "You are the Masons that's augmenting the pain of these 
 sores [ulcers] and my appendices as well, for you are constantly 
 keeping after them and you are irritating them all the time. I 
 have pleaded and am pleading again and again, telepathically and 
 correspondingly, to stop all this foolishness as I have enough of 
 it, for I can stand it no longer. I am a hitman being lilte your- 
 
CHRONIC PARANOID DISSOCIATION 529 
 
 selves and have feelings like yourselves. So please consider a lit- 
 tle about what you are doing to a person who has never bothered, 
 hunted or harmed you in any way. 
 
 "I have been considering this for the past two years and four 
 months — I have done my utmost to have you stop the frequency 
 of the 'nightly emissions' but haven't succeeded yet. What on 
 earth is the matter with you? Are you after my life pretty bad? 
 I have used six bottles of medicine for such 'nightly emissions' 
 but to no avail. Do you mean to tell me that I am so weak as all 
 that? You are the 'Masons' that's halhicinating us in my dreams 
 and deceive me while helpless and make me dream off. I feel so 
 weak at the present from the consequences that I can not sit down 
 and write a letter without feeling pains in my back, kidneys and 
 along the spine. [Nocturnal and precocious emissions are often 
 the cause of worries about having a weak brain and spine.] 
 
 " It is a dirty shame. Only twenty-four years old. One thing 
 that I have noticed and it has been exercised on me for a long 
 while, it's the wish of some of your employees that has a lot to 
 do with my sufferings. [Herein are revealed the feelings that lead 
 to fights, delusions of persecutions and defensive murder. This 
 patient, however, was passive enough in his reactions to make him 
 fairly safe if treated pleasantly, as the following quotations show.] 
 
 "If you wish to let me know your presence at any time or any- 
 where give me some secret signs of the harmless hind, to make a 
 poor v/nfortunate lad lihe me happy." (Willingness if pleasantly 
 treated.) 
 
 On the basis of his somatic disturbances he wrote many 
 characteristic essays about such subjects as: "Immigration," 
 "Darwin and His Theories of Evolution," "Christianity and In- 
 fidelism," "Masonry and Its Deeds" or "Freemasonry and Rosi- 
 cVucianism, ' ' and a series of erotic love letters to girls. 
 
 (All psychotics are exceedingly introspective and inclined to 
 note their trivial, odd, sensory disturbances as well as the more 
 persistent, unpleasant tensions like the scalp tensions, spastic and 
 griping alimentary conditions, etc. Such normal incidents as in- 
 crease in rate and strength of the cardiac systole, when the patient 
 has to appear before a conference of physicians, are often attrib- 
 uted to the annoying "wireless influences" of the Masons, etc.) 
 
 In an essay on Masonry he pinned a newspaper clipping 
 about the training of Jesuit priests, identifying the two as similar 
 
; J 
 
 530 PSYCHOPATHOLOGY 
 
 mysterious bodies. For him the Masons were "The ranking, 
 highest order and founded by "Solomon the King," "The Wise 
 (paternal attributes). He commented: "Through some mysteri- 
 ous way, like the inventions of the present day, the secrecies of 
 Masonry were discovered or founded by the f orementioned King, 
 which it undoubtedly shows the supreme mentality possessed [by] 
 him, as the secrecy of life and its particulars." {The secret so- 
 cieties are Relieved to hnoiv the secrets of life and logically are sus- 
 pected hy the patient of Imowing the secret ivish in his difficulties.) 
 
 Since the erotic feelings and hallucinatory experiences', are 
 compulsive and force themselves on the individual, he feels him- 
 self to be held as "a victim for sexual purposes, a white slave, or 
 a novice before the shrine, to be initiated into'the mysteries of sex 
 and life. 
 
 Four years after his admission he gave the following inter- 
 view. (He was extremely tense and emphatic. He shouted his 
 statements and often smashed his fist into the palm of his hand 
 to derhonstrate, he said, his vigor and manhood, and indicated what 
 he would do if "foul play" was contemplated. His personal style 
 was stilted and arrogant, and he used numerous polysyllabic words 
 with little regard to their meaning.) In the interview, he said: 
 
 ' 'T was temporarily insane when I first came here. I saAV many 
 pictures of ianatoiny, such as hands, feet, heads, different kings, 
 angels, -the. German Emperor, the Sultaii of Turkey, etc. My idea 
 has been' that secret lodges could interfere with a man's career. 
 It may be my imagination, hallucinations caused by mental strain. 
 I had'false hearing. I was called unpleasant and insulting names. 
 People said they would "pump me out," told me I was immoral, 
 a pervert and associated with prostitutes. I have no tendencies 
 that way. [He was, however, very immoral.] I have seen it when 
 a soldier and outside of the service. People have tried to seduce 
 me and when they would not get me to concentrate my rtiind on 
 these things they called me bad names. I have had to struggle 
 against these things and at times it has been hard to control my 
 thoughts. " 
 
 With intense feeling, he shouted, as T sat at the desk: "I see 
 you are trying to get at Masonic secrets and by coercing my mind 
 you think to impress those feelings on me hut it can not he done 
 unless I am fouled." 
 
 The patient then continued as follows : 
 
CHRONIC PARANOro DTSSOCTATTOW 531 
 
 "I might, however, be led into a trap and tlie object accom- 
 plished through love. This can be done. For example: If a 
 mother, sister or sweetheart were to concentrate sufficiently on 
 one's mind and thus produce the desire — I never had the love for 
 man that a woman has. I have had men practice immoral rela- 
 tions with me, but I have given the part up, and, although it gives 
 me feelings of love, I can control myself except when I am fouled. 
 I have worried and fought against it for I know it is against my 
 manhood. I can demolish [smashes his fist into his palm] the feel- 
 ing [in himself] if there is no dodge in it. They will have to fight 
 it [demonstrates his willingness to fight], but as I said before it 
 can be done if two or three people concentrate on me. [This was 
 a frank admission of his submissive homosexual make-up and he 
 identified it in nature to be like the love of a woman for a man.] 
 
 "They say once a pervert, always a pervert now. If I as a 
 child did it, yoti fouling me, do you mean I would do it now? But, 
 if I did it after a certain age, then I say, once a pervert, always a 
 pervert. This feeling is an instinct. It belongs to a woman, but 
 I have to fight against it. If this feeling were transferred to me I 
 must resist it. If not, I lose my manhood. ' ' (This man had iror'ked 
 out this mechanism of the repressed wisli himself and his case is 
 used here because of this.) 
 
 A few days later he wrote a letter under the caption : ' ' FOUL 
 PLAY— MASONIC SECRET ORDER— CONTINUED SODOMI- 
 ZATION," in which he tried to explain how an individual could 
 be influenced into sexual perversions against his will and why he 
 feels that secret societies are responsible for this. The following 
 is an extract: 
 
 "I shall remind you of the present 'Masonic order* which, 
 after having had the experience of knowing the abnormality of 
 the secrecies,! was put to a test by relations as a verification and 
 a proof of absolute supreme order, hy having a desire for 'So- 
 dome,' ordered to feel affectionate against my will, toivards an- 
 other's and, had temporarily senses taken aivay; in other words, 
 rendered helpless, to prove the efficiency, supremacy, and ul- 
 timately, the positiveness of the order." (This is equivalent to 
 stating that when his anal eroticism became severe it ultimately 
 became so "positive" and "supreme" that it temporarily over- 
 powered him, taking his senses away. This is an interesting case 
 of segmental domination of the final common motor paths despite 
 
532 - PSYCHOPATHOLOGY 
 
 the ego's resistence.) lie continued: "Similar to this, I have had 
 other things proven to me by parental consent which helped me 
 cast doubt aside, when only a young lad and a scholar, about secret 
 organizations and their standing, the 'Masonic' being the ranking. 
 The facilitations through these secrecies, have enabled others to do 
 as wanted and even play foul through its charmful order, which 
 seems to control ivill poiver temporarily until the acoomplishing of 
 an act." 
 
 The ivords in italics reveal that the soitrce of the "secret 
 power" is in .the repressed, dissociated, affective craving. _ Its 
 "charmful order" controls "the ivill-poiver temporarily-' wntil the 
 accomplishment of an act residting in-the gratification of the per- 
 verse erotic hunger. This, then, because of inaiility to transfer the 
 craving to such zones and stimuli as ivill mahe the act an enduring 
 memory pleasure, becomes, instead, a memory source of remorse. 
 His inability to control his autonomic erotic reactions to certain 
 types of men convinced him that these types of m.en possessed a 
 secret of n>ature and could Ivypnotize him against his will; hence, a 
 secret society. Masonry, etc. As a general rule, this "hypnotic" 
 power is. felt to be an attribute of the father-imago , as the superin- 
 tendent, director, president, "highest" secret society, etc.; that is, 
 the potent or powerful males ivho are in authority for society. 
 
 Gradually this patient became less dangerous and irritable 
 as he learned to control his homosexual cravings against the "hyp- 
 notic" influence of his associates. He quit fighting, and was given 
 freedom of tlie grounds. For a year or more his arrogant efforts 
 to elevate himself to a level of equality with the physicians and 
 officers were quite a nuisance. He talked to himself a great deal, 
 and usually referred to the hypnotizing "They" in whatever he 
 said to the physicians. He made playthings, such as cigar and 
 cigarette holders, which were probably oral substitutes for phallic ■ 
 symbols, because he had, at the time, active, oral erotic interests 
 which he was. gradually forcing to use sjinbols. 
 
 Five years after his admission, he still believed that he could 
 be made the victim of "foul play," but that it would be more diffi-, 
 cult than heretofore. By the sixth year, he had cultivated so 
 much self-control that his feelings of persecution had largely dis- 
 appeared and he became decidedly less arrogant. Six years after 
 his admission, he was discharged to the care of a relative as im- 
 proved. He still struggled with homosexual cravings and held 
 
CHRONIC PARANOID DISSOCIATION 533 
 
 Masons responsible for his difficulties and "constipation." He 
 was no longer combative, although sensitive and egotistical. 
 
 m * * * 
 
 The above case shows clearly enough hoAV the perverted sexual 
 cravings, when they become dissociated and acquire gratification 
 through wild perversions or through hallucinations, become the 
 foundation of the conviction that surely a mysterious foreign 
 power is controlling the ego. 
 
 The factor of this man's anal eroticism and its capacity to 
 take his senses away, make him unconscious, Avill be referred to 
 in the chapter on the anal erotic group and their convulsions and 
 stupors. 
 
 The mechanism of the paranoid personality who chronically 
 blames others for his hallucinations and sensory distress because 
 of the dissociated affective cravings is one of the most important 
 problems in psychopathology. Since no two cases are alike, vol- 
 umes written upon this mechanism would not exhaust it. That a 
 perverse affective craving should be struggled mth and repressed 
 because of its intolerable tendencies, is quite obvious, and that it 
 should become dissociated and uncontrollable when the superim- 
 posed, controlling, socialized affective interests, which are cul- 
 tivated in order to keep the content of consciousness pleasing in 
 the struggle for social esteem, become fatigued or depressed, is 
 also a simple, acceptable explanation. But this again brings up 
 the more intricate and important problem : How does an affective 
 craving become perverted? How does it become conditioned to 
 crave the use of abnormal stimuli and abnormal erogenous zones? 
 These questions take us at once into the influence upon the child 
 of secret loves and hates of the parents, those inaccessible intra- 
 familial feuds about which only the most astute observer ever ob- 
 tains evidence. 
 
 Such cases as the folloAving bring out the conditioning influ- 
 ence upon the child's biological career which results from too in- 
 timate relationship with homosexual or abnormally biased parents 
 or relatives. (Cases HD-1, AN-3.) 
 
 (For the past five years I have had opportunities to study 
 the parents of this boy as well as the patient, Case PD-35.) 
 
 Case PD-35 has a father, who is an impulsive, suspicious, 
 easily rattled, persistent, wiry, little Jew. At thirty-three, he 
 
534 PSYCHOPATHOLOGY 
 
 married a pretty Jewess of twenty-four. She was 0ways ■unu- 
 sually prone to anxiety states, liad frequent seizures of "palpi- 
 tation of the heart, "was rather eccentric, proud, prudish, inclined 
 to keep herself aloof and fond of showering fastidious attentions 
 upon her child. 
 
 She had three children, two of whom died in infancy. The pa- 
 tient is her only living child. The maternal grandmother was 
 also given to "nervous spells" and was "too devoted" to the 
 grandson. He usually spent the summers of his boyhood with her. 
 The father's brother, an unmarried man of rather secretive 
 character, whom the patient styled as beini^Jmore of a woman than 
 a man, and who, the mother said, was a "crank on children," 
 slept with the patient since his early childhood. The boy was al- 
 ways very fond of this uncle who showered him with attentions 
 and little gifts. 
 
 At birth, the patient weighed 3 lbs. The mother stated thkt 
 the unusual devotion of the grandmother, who "carried him in 
 her bosom,", saved him. He was a very delicate, tense child and, 
 from four to thirteen, was often nursed for his headaches. Al- 
 though he had measles, typhoid at fourteen, and a mild nephritis, 
 he become strong, well developed, though medium sized, tense, 
 energetic, and apparently without a physical defect, at twenty- 
 three. 
 
 The mother and grandmother devoted all their attention to the 
 cares and whims of the child, always dressed him "in white," kept 
 him spotlessly clean, selected playmates for him, never allowed him 
 to go barefooted, humored and flattered him assiduously, tailgkt 
 him to be' egotistical, selfish and to crave dominance above every- 
 thing. When the question about his going barefooted Avas askedf 
 the mother replied with a strange, cultured poise of feelings : "No 
 indeed! You never found a neater boy.' The doctor wanted me 
 to put him on a sand pile, but I never trusted him with "anyone. 
 He was so delicate * * * * ■ I never allowed a maid to take 
 care of him alone at any time * *' * Even his own shadow 
 would frighten him when he was a child and I had to explain it 
 to him. * * * jjp -^ag always afraid of being locked up and 
 disliked closed doors and gates." These statements, given with 
 unmistakable efforts at self -exoneration, show the chronic course 
 of suspiciousness, anxiety and foolish pride to which the child had 
 been exposed, throughout its life. (The psychopathologist must 
 
CHRONIC PARANOID DISSOCIATION 535 
 
 suspect an unwelcome child in such instances, the aversion being 
 overcompensated for.) 
 
 The boys called him "Toney" because of the scrupuloiis tone 
 of his dress and teased him at every opportunity. He had numer- 
 ous fights to protect himself and his "screams of 'mamma' could 
 be heard for blocks." 
 
 "His health never permitted him to take an examination," 
 his parents conscientiously maintained, until he entered high 
 school. Because of his headaches, etc., he was nursed on espe- 
 cially prepared foods and humored by the four adults of the house- 
 hold. This ruinously anxious mother was utterly unable to foster 
 fortitude and patience in her son. The father had to whip him 
 "once" because of his obstinacy. 
 
 At ten, he learned to masturbate, and the family's anxious 
 solution, upon the advice of the grandmother, was to encourage 
 him to visit prostitutes (aged fourteen). This was accomplished 
 through the guidance of older boys. 
 
 Throughout the patient's childhood he Avas nursed, humored 
 and never permitted to take his place in the boy's world. At 
 puberty he Avas engineered by the ambitious parents into an older 
 crowd so that at sixteen he had interests that made him compete 
 with young men of twenty. 
 
 During'high school he was extremely ambitious and the pride 
 (jf the household. He did well as a high school student, although 
 he had considerable trouble with his arithmetic at first. His his- 
 tory gives the impression of intense striving to keep ahead of his 
 associates. ' He was a "great reader" and took particular interest 
 in medical ioohs, although he never considered medicine as a pro- 
 fession. (From what developed later the boy was trying to solve 
 his sexual problem.) 
 
 At seventeen, the boy started his business career as a bank 
 clerk. He progressed very well, but his scheming, striving selfish- 
 ness, general suspiciousness, and tricky inquisitiveness soon made 
 him very unpopular and the butt of considerable nagging and dis- 
 favor. He was sensitive, irritable and arrogant, and unable to 
 niak'e friends although he made acquaintances very readily. He 
 had developed no capacity for gratitude, sincerity, self-sacrifice, 
 devotion, or humility. 
 
 His chronic feelings of inferiority, for which he desperately 
 strove to compensate, were pathognomonically revealed in a seem- 
 
536 PSYCHOPATHOLOGY 
 
 ingly trivial incident. He was attending a night law school (aged 
 twenty-one) when, he said, the lecturer "looked at me when he 
 talked about delusions. ' ' (This should have indicated worry about 
 his self-control.) The feeling that he might be abnormal bothered 
 him persistently and he discussed the lecturer's remarks with 
 great seriousness at home. 
 
 His mother was a very pretty, girlish looking woman who de- 
 lighted in stylish clothing. This worried the son and in his vig- 
 orous protests were poorly concealed suspicions that she was 
 dressing to attract the attention of men. The patient's resistanoe 
 to the mother's dress seems to have begun at about thirteen and 
 has always persisted. It has since become evident that it is due 
 to a sexual interest in her. When seventeen, he happened to be 
 with his mother in a woman's store when the clerk complimented 
 the mother on her yoiithful looks and added the rather conomon re- 
 mark that the mother and son looked more like sister and brother. 
 The patient reacted immediately with intense indignation at what 
 he considered an insult to his mother. He was horrified at the sug- 
 gestion that she looked nearly as young as himself and might be 
 mistaken for his girl. The iniportance of this revelation of his 
 sexual attachment to his mother was completelv overlooked at the 
 time. He became very erratic in his demands that his mother 
 should dress in plain, severe, clothing, preferably black. 
 
 When nineteen his anxiety about his mother's morals reached 
 a climax. He seems to have been literally obsessed -with thoughts 
 and fears about her sexual life and was constantly A\'atching for 
 clues. He accused her of exposing her legs needlessly to his uncle 
 (father's brother). One night, just after he entered his home, he ' 
 saw his mother, dressed in negligee, standing in the bathroom. As 
 he hurried up the stairs she turned the light out. Just across the 
 hall stood his uncle in an open bedroom. The situation absolutely 
 convinced the boy that he had surprised his mother in a compro- 
 mising situation with his uncle. With bitter invectives, he chafed 
 her A\'ith immorality. The father, who was do-wmstairs, entered 
 into the scene and tried to plead A^dth the patient, but no evidence 
 or reasoning could shake his absolute conviction. He charged his 
 father with stupidity. Previous to this incident, the members of 
 the family had noticed the patient's increasing exhibition of jeal- 
 ousy Avhen his mother became affectionate with his father or uncle. 
 This uncle was "like a father" because he contributed to the fam- 
 
CHRONIC PARANOID DISSOCIATION 537 
 
 ily maintenance; and although his mother suggested it, tlie son 
 would not permit the uncle to leave. 
 
 The next evening his mother broiled a squab for the patient to 
 win his favor. He tasted it, and then, cunningly, this young Ham- 
 let asked her to eat it. Not appreciating the situation, she gave 
 the squab to his father, whereupon the patient furiously de- 
 manded that his mother should eat the bird and not the father, be- 
 cause it was "poisoned." He emphatically declared that he could 
 see through his mother's plot. She had poisoned the squab to kill 
 her son and husband in order to marry her huisband's brother. 
 
 From that time to the present, eight years later, he has been 
 unable to change that conviction. He has accumulated iramerous 
 "signs" and "remarks" that showed his- mother did not love him, 
 but cared more for his uncle. He has become a veritable melan- 
 choly Hamlet, brooding over his incestuous love for his mother 
 and her infidelity to him and his father. 
 
 ^Vhen his mother an,d uncle cleaned the house together, when 
 his father became ill, and Avhen his uncle called him "the king," 
 he interpreted these affairs as convincing signs that something 
 was ominously wrong. He consulted several physicians about his 
 health, and reported to his mother that a physician said his blood- 
 pressure was high. He said she "sighed" so peculiarly at this 
 that it meant she had given him up. During this period, he visited 
 his grandmother and, while swimming, struck the back of his head 
 in a dive. His neck was painfully wrenched and his grandmother, 
 in applying heat, blistered it. Later, when in a panic, he com- 
 plained about pains in the back of his neck which may have had 
 an association to this accident. He rubbed the back of his neck 
 constantly during the panic. 
 
 The patient's suspicions and anxiety were sho^vn in his work 
 also. He had advanced from a bank messenger to paying teller 
 and seems to have exercised no restraint of his ambition to push 
 ahead. During his banking career he worked in three institutions, 
 from one of which he was dismissed for prjdng into a private 
 secretary's papers. (Extending the family's secret intrigue.) 
 
 He fancied that he had discovered a scheme among some 
 bankers to consolidate several banks and in the course of the oper- 
 ation he was to lose his position. His assistant was given a raise 
 of salary and promoted over him. This convinced him that he 
 was in disfavor. On one occasion he assaulted a clerk for making 
 
538 PSYCHOPATHOLOGY 
 
 "remarks," and could not forget a tannt made by another clerk 
 that he would become a cashier soon. He fancied that he had 
 learned a secret about his employers' business which would jeop- 
 ardize them if it became known and they were determined to get 
 rid of him. His pride, fastidiousness, insistence upon dominating, 
 and suspiciousness, increased his unpopularity. 
 
 The story of his sexual career should also be brought up to 
 this age (twenty). From fourteen he had been encouraged by his 
 grandmother, mother and father to visit prostitutes because of 
 their horror for masturbation. His mother believed she had some 
 control over his behavior because he confided some of his experi- 
 ence to her. At twenty, while on a vacation, he became involved 
 in a scandal with some married women, one of whom tried to com- 
 mit suicide. He is reported also to have forced himself upon 
 another woman and barely avoided being arrested. "Just out of 
 curiosity" he had induced several prostitutes to perform fellatio 
 upon him, but he denied all other sex p.erversions. About four 
 months later he entered the Phipps Psychiatric Clinic upon his 
 own judgment ' ' to find out if I am crazy or not. ' '' He complained 
 of "pains in the head," "uncertainty," "no confidence in myself," 
 "feel that I have delusions." "Don't know, may be I was told." 
 He said that at times he felt "bkie." He complained that "stiff- 
 ness" of the eyes and spasms of the muscles at the base of the 
 skull occurred when he looked at people. He frequently would 
 thrust his head forward and stretch his neck, because it felt as 
 if it might "fly back:" He was inconsolable about his heart, 
 blood-pressure, the contraction and dilatation of his pupils, pains 
 in the "top of his head," "base of the brain," and "in the back," 
 etc. 
 
 He was extremely curious about the record of his case and the 
 physical examination, trying to discover clues of a plot against 
 him,. and whether or not his physical condition showed signs of 
 collapse. His physical condition other tlian the anxiety symptoms 
 was excellent, except for a small inguinal hernia and hyperactive 
 reflexes. 
 
 He gave a complete history of his life, including his difficulties 
 as a bank clerk, the "remark" of the teacher in the law school, 
 and an account of the intrigues of his wretched home life. He was 
 not sorry for his miethical curiosity and significantlv justified 
 himself with his motto, "If there is anything I don't know I am 
 
CHRONIC PARANOID DISSOCIATION 539 
 
 going to know it." He emphasized a personal cliaracteristic that 
 he was proud of — ' ' Never took anything off anybody. ' ' ( Compen- 
 sation for inferibrity.) 
 
 Plis description of his lioine life revealed the brooding, melan- 
 choly Hamlet. liis mother, he felt, did not love him or his father 
 but favored his micle. He was sure she was immoral and his ex- 
 perience with women was such that he said he could not trust any 
 of them. He was unable to love women and his home was ruined by 
 secret intrigues. 
 
 He complained about having been raised "like a hothouse 
 plant," being unduly "self-conscious," and "bashful." This 
 was in sticking contrast to his actual disposition of audacious in- 
 quisitiveness and impudence. For a year previous to his seek- 
 ing treatment he had refused to speak to his mother or uncle 
 and openly considered his father a stupid weakling, Avhile his 
 mother came from "a shrewd family." 
 
 I-Iis dreams were significant in their revelations of the oncom- 
 ing failure, such as often dreaming of falling off tlie world; of 
 being compressed between two big balls or worlds that carried 
 him up and down; of slipping off a curb and "nearly jumped out 
 of bed trying to catch myself," and a series of incestuous dreams 
 Avith emissions. 
 
 Although he Avas decidedly ambitious and Avorked hard he 
 had no "poAver," no self-confidence and could not concentrate 
 his attention. The mental test shoAved an inability to remember 
 test phrases as well as he should and simple Calculation tests con- 
 tained several mistakes. He recognized the deficiency and anx- 
 iously interpreted it as a sign of mental collapse. He denied hal- 
 lucinations. 
 
 The tendency to panic and delusional interpretation of en- 
 vironment soon became evident. Within a feAv days after his ad- 
 mission, through a cunning system of questions, he tried to dis- 
 cover whether or not two patients on the ward were physicians in 
 disguise put there to watch him. A few days later he had elabor- 
 ated this into imagining that he was surrounded Avith plotters and 
 his death was imminent. 
 
 Although the patient had applied Avith genial smiles and 
 friendly advances to find out whether or not he Avas going insane, 
 behind the mask of genial cooperation was a complicated delu- 
 
540 PSYCHOPATHOLOGY 
 
 sional system of three years' elaboration of Ms intrigue and 
 hatred. 
 
 I had personal charge of this case, and although we had at 
 first regarded it as a mild anxiety state we soon became convinced 
 that grave difficulties were involved, possibly he was a case of 
 so-called paranoid dementia prsecox. But what was paranoid de- 
 mentia prsecox? That the patient was suffering from an intense 
 mother-attachment was obvious, but how should it be handled and 
 what was the significance of his chronic fear 1 Although the homo- 
 sexual panic was recognized, no one had insight into the mecha- 
 nism of the homosexual panic at that time, and 'the necessity of 
 cultivating a ' ' transference ' ' of affection from the patient, so that 
 he would feel safe, was not understood. 
 
 "Within a week after his admission he had become panic- 
 stricken. We were plotters intriguing for his death. He thought 
 the bath was arranged to dro-wm him, the tonics and foods con- 
 tained poisons, he would be destroyed while he slept, etc. He fre- 
 quently examined and rubbed his hands and feet because they 
 were ' ' dying. ' ' He would rub thenj vigorously to keep up circu- 
 latioii and often jumped out of bed and went through vigorous 
 deep-breathing exercises to save his life. (Michelangelo's "Cap- 
 tive," Fig. 47.) He would. not lie down in the tub and when or- 
 dered to do so, screamed and pleaded for mercy. His rapid breath- 
 ing and pulse rate, tense facial expression, dilated pupils, general 
 muscular tremors, insomnia and refusal to eat, indicated the se- 
 riousness of the panic. He came into the physician's office crying 
 from the pain in a tender spot on his neck which was in about the 
 location of the blister made by his grandmother. He constantly 
 rubbed this surface. When he became interested in other subjects 
 the pain tended to disappear. No inquiries into his fear of castra- 
 tion or actual homosexual assault were made at this time, although 
 the course of the anxiety, a year later, indicates that the patient 
 was passing through a classical fear of castration because of in- 
 cestuous cravings. 
 
 The patient gradually became more quiet and asked to be 
 pardoned for his excitement. He pleaded to see his parents, and 
 earnestly solicited their love, as if they had hated and abandoned 
 him. He also asked for religious attention. His confidence, how- 
 ever, could not be gained. To his parents he was beseeching, but 
 
CHRONIC PARANOID DISSOCIATION 541 
 
 he had no confidence in them and was inclined to be ii'ritable and 
 rude as soon as they resisted his demands. 
 
 No further insight into the case was obtained at this time ex- 
 cept that an associatioji test showed his difficulties. To the stimu- 
 lus word "friendly" he reacted after twenty -five seconds with 
 "my father," and the next time said "everybody"; to "mother" 
 after eight minutes he responded "dear"; to "duty" after twelve 
 seconds, "obligation"; to "threaten" he gave no association and 
 the second time reacted Avith "to promise." 
 
 About three weeks after his admission it became evident that 
 he was interested only in one thing — his dismissal from the hos- 
 pital. He shrewdly won some confidence by disclaiming further 
 fears of being poisoned in the hospital and by becoming very 
 obedient. His restlessness, inability to amuse himself, or read, 
 the firmness of his refusal to go home, his plan to visit a relative 
 in the country, indicated that all was not well. He was removed 
 from the hospital by his father despite our advice. For six months 
 he now lived fairly quietly with some relatives in a distant state, 
 but would not live with his parents. Gradually he began to com- 
 plain that the Masons subjected him to strange sensations. He 
 worked in a real estate office, but had to quit because of his inability 
 to work accurately. Upon Ms discharge, his employer "made the 
 remairk," "If you ever get another job," which, he said, meant 
 the Masons had schemes for his destruction and would keep him 
 from working. 
 
 The patient's submissive homosexuality now came frankly 
 into the foreground as his most pressing difficulty. He had been 
 sleeping with his cousin, a physician. One night he charged this 
 cousin with perpetrating a sexual assault upon him during sleep. 
 His foundation for the charge was a peculiar taste in his mouth. 
 He also believed he had been infected with gonorrhea and syphilis 
 in this manner. To escape from the Masons he made an intricate 
 trail through. several cities and then stopped at a " 'Masons* Ho- 
 tel." That night "every sound" indicated an oncoming assault 
 or an initiation. All night long he remained in his room (9th floor) 
 in a panic expecting the Masons to rush into his room. He pre- 
 pared the window so that he could jump if the door was opened. 
 (His behavior suggests an explanation for some impulsive leaps 
 from windows by panic-stricken travelers in hotels.) 
 
 After this he returned to his home "frightened to death, tor- 
 
542 PSYCHQPATHOLOGY 
 
 tured to death, by Masons." Everybody "eyed" him. He found 
 that several of his uncles iver-e Masons and his mother's father had 
 been a Mason. On one occasion he approached his mother with, 
 "Did yon ever take a Mason's degree?" His mother replied that 
 she had taken some sort of Masonic degree when she was twelve 
 years old. At this he cried out, "My God, can't you help your 
 own son?" The Phipps Psychiatric Clinic now was fancied as an 
 institution of Masonry in which, he had received a Masonic degree. 
 
 One night his mother, while lying in bed, suddenly became 
 aware of him standing over her. He said: "Mother, you have got 
 me hipped [hypnotized]. I can't get my mind off you." She was 
 terrified_by this arid a lively scene developed as the frightened 
 family tried to shut him into a room. 
 
 He was then sent to a sanatorium and the physician, he said, 
 put "poison," "spue" (semen) into his food and wanted him to 
 marry an immoral woman. The physician, he fancied, tried to 
 hypnotize him and promised to release him if he would perform 
 fellatio. He eloped from the sanatorium in a panic and was 
 committed to St. Elizabeths Hospital. (The cause of the panic 
 and delusions must be seen in the patient himself — in his uncon- 
 trollable homosexual cravings.) 
 
 Upon his first admission, age twenty-two, eight months after 
 leaving the Phipps Clinic, he was depressed, inaccessible and in- 
 cessantly worrying about property and money which he claimed 
 belonged to him (the inheritance he would probably receive upon 
 the death of his father). He had no insight, was certainly experi- 
 encing annoying sensory disturbances, and made numerous hypo- 
 chondriacal complaints. 
 
 He was well oriented, shrewd, performed the intelligence tests 
 well and his physical condition was excellent. A month after his 
 admission he convinced the jury that he was not insane and was 
 discharged. 
 
 Immediately upon his return home he complained of Masons 
 talking about him in the house. He threw the hysterical family 
 into an uproar and four days later was recommitted to St. Eliza- 
 beths Hospital. . He was suspicious, surly, asocial, seelusive and 
 would not work. 
 
 He has been here continuously for six years since the second 
 admission and his behavior shows that a pernicious dissociation 
 of the personality is now going on. Only the striking features in 
 
CHROlSriC PARANOID DTSSOCIATTON 543 
 
 his behavior in the past six years need be recorded to show the 
 persistent influence upon his reasoning of the dissociated perverse 
 affect, i 
 
 About a year after his admission, I joined the staff of the 
 St. Elizabeths Hospital The patient promptly concluded that my 
 coming was -a scheme for further persecution. Although he had 
 been very xeticent about his sexual difficiilties to other physicians, 
 he was quite readily induced to tell the story of the sexual persecu- 
 tions that were disguised 1)y the social persecutions which he 
 characteristically preferred to talk about. 
 
 He said the hospital was a religious institution in which 
 Catholics, Jews and Masons were initiating him into a religious 
 ritual. They made him masturbate (which he did with little 
 effort at concealment), were making a c. s. out of him, and were 
 trying to give him syphilis in the "hach." For the impotent in- 
 feriorities he compensated with schemes worth vast sums of 
 money, wrote numerous letters to prominent men. begged his 
 father to give everything away to the Masons so that he would be 
 freed, made an emblem of toilet paper which he wore in his but- 
 tonhole as a sign that he had been initiated into the great secret 
 (anal erotic interests). 
 
 He schemed incessantly and accumulated numerous "signs" 
 and "remarks" to convince himself that he was surely being de- 
 prived of his sexual powers and freedom by Ms uncle. He could 
 hardly be persuaded to talk of anything else than his property, 
 money from his father's insurance, his Masonic uncles, etc. Usu- 
 ally his discussions wandered aimlessly, being unable to talk con- 
 sistently about anything except to disguise his troubles. Fre- 
 quently he stopped to whisper to himself. 
 
 When he came into the consultation room he asked me sud- 
 denly if I proposed to hypnotize him as Dr. — had and make 
 a c.s. out of him. Several weeks later he deliberately ventured that 
 he was willing to become a pervert if this was necessary for his 
 freedom. (The wish-fulfilling influence of the uncontrolled homo- 
 sexual cravings are to be seen throughout his delusions of perse- 
 cution. ) 
 
 He finally confided that he was controlled by a stronger will 
 which masturbated him and forced him to submit to oral perver- 
 sions. (The dissociated atfect.) He was sure that this could 
 , happen because snakes could hypnotize birds. He said the Catho- 
 
544 PSYCIiOPATHOLOGY 
 
 lies hated the Jews and were using him to degrade, the Jews. 
 Johns Hopkins Hospital was controlled by Catholics because a 
 large statue of Christ stood in the entrajice. Since he had been a 
 patient there, he had been admitted and initiated, and perhaps 
 there was "more than one Jesus Christ." The Jews were called 
 ' ' Christ killers. ' ' While he was talking of himself as- a Christ he 
 spoke of Dr. — (who is a large man of about fifty). He de- 
 scribed Dr. #» as trying to make him submit to a sexual assatilt 
 and in it he made a significant error; "then I begged him not 
 to let me — I mean not to inake me doit. He kept me from eating 
 and tried to weaken my will." (The oral-erotic act often has 
 the significance of a religious act, a crucifixion of the rival son to 
 the virile father. Its expression is submission of the Jew to 
 Catholicism, of the son to the father. Homosexual perverts some- 
 times speak of their oral-erotic submissions as a crucifixion. Bio- 
 logically, this is quite true. ) » 
 
 A few days later he described how he was being "slept on" 
 by "someone" who was "getting old and needed strength to keep 
 young." He said: "It is too bad this old man did not use many 
 young men to get strength from each one and not ruin one young 
 man, who had his whole life before him, by sapping his strength 
 and ruining his mind and physical condition internally." He 
 described himself as being "sapped" by the old man as a fountain 
 of youth. He said he was being slept with day and night and could 
 feel electricity being drawn from him and from the air around 
 him. It is "static electricity" and this is "life." "Life is neces- 
 sary to prolong life" and because the "germ of life" was being 
 "sapped" out of him he was losing strength. He would not ex- 
 plain ' ' the germ of life, ' ' but Avhen asked where it came from, he 
 said ''the semen." His fancies about this procediire were that the 
 germ was obtained by using him in a mysterious sexual manner, 
 that his money was also being taken and with this complaint he 
 referred to himself as being like Christ. 
 
 When he was asked to describe the uncle that was "sapping" 
 his strength, although he gave the name of an older uncle, he de- 
 scribed the uncle he had slept with for eighteen years. (The idea 
 of sapping of the strength during sleep is not an uncommon one. 
 Among the laity one may hear the belief expressed that an older 
 person saps the strength of a younger person when they sleep 
 together.) The patient complained that this arrangement in his 
 
CHRONIC PARANOID DISSOCIATION '545 
 
 boyhood was a mistake. His homosexual attachment to the uncle, 
 whom he accused of having coerced his mother, was evident. This 
 uncle had ' ' always been like a father. ' ' He really had two fathers. 
 
 This was the high tide of the psychoanalysis and was reached 
 after a few weeks of consistent painstaking effort. Then came the 
 over-transference. He said I was able to hypnotize him and -the 
 delicate affective rapport miscarried. We were never able to dis- 
 cuss the influence of this interest in me and the progress of the 
 analysis was arrested. No doubt this was largely due to my in- 
 ability to handle the transference which is usually a most difficult 
 thing to do if the patient will not try to sublimate and the physi- 
 cian is inexperienced. 
 
 For a year or more previous to this analysis, he had com- 
 plained of being masturbated and orally seduced by hypnotic 
 powers, etc., and spit continuously, in any direction and on any- 
 thing. His face was chapped and raw from the constant applica- 
 tion of a wet towel over his mouth to keep out * ' something. ' ' He 
 used great quantities of tooth paste to keep his mouth clean and 
 would not explain to us why he persisted in these prophylactic 
 measures. Usually, as he paced about the ward with the wet 
 towel over his mouth, he cursed and muttered, to himself his re- 
 sentment of the abuse. At last, the exiplanation was given in a 
 violent condemnation of his father, who, he ■ said, permitted a 
 woman, who wore black futs, to urinate in his moiith. A girl who 
 played with him in childhood Was sitting oh his face^ he said, and 
 men subjected him to oral seductions. He chewed inordinate quan- 
 tities of tobacco and smoked cigarettes incessantly to get rid of 
 a taste that distressed him. He usually had his trousers unbut- 
 toned and frequently inserted his- finger to scratch his genitalia, 
 which were also the field of persistent unpleasant sensations. 
 Probably castration fancies played a part in this because he com- 
 plained of haAdng had his potency ruined. 
 
 His parents' fear of him, when he was at home, was appar- 
 ently justified, because, about three years after the charges of 
 infidelity were made, he insisted that his father should examinfe 
 his mother because he had shot his mother and the girl who had 
 lived in their home when he was a boy. 
 
 He also felt that he should shoot the uncle and a boy friend. , 
 He would not discuss his experiences with these people. 
 
 To the physician he denied his delusions and hallucinations, 
 
546 PSYCIIOPATITOLOGY 
 
 but repeatedly told his father that the roof of his mouth was being 
 ruined and "urine was poured in by the quart." "I am dreaming 
 all the time. They are' bleeding me to death" (castration). 
 
 His -verbal attacks upon his father were wholly unrestrained. 
 He called him almost everything vile and accused him of living 
 with prostitutes, etc. 
 
 He had an occasional tic, jerking his back as if something 
 sharp were being thrust .into him, but would never discuss this, 
 usually only muttered and cursed to himself when it occurred. 
 
 Although very neat and tidy heretofore, about the fourth year 
 of his psychosis he became very careless and tore up his clothing. 
 When the excitement of war swept over the country he became an 
 army and naval officer, financier, diplomat, etc. He sleeps poorly 
 and at night tends to wander about the ward trying to escape 
 from persecutors. 
 
 He has passed through several brief panics in which he feels 
 he is being murdered and has made several desperate attempts to 
 escape. On the whole, he is a very unreliable patient. 
 
 At present he insists that his father and mother are dead, 
 that he is a lawyer, army officer, Mason, animal, everything. He 
 mutters to himself and has but one interest — to escape from hi^ 
 sexual tormentors. Lately he begged for fat tablets.- He wanis 
 enough to increase his weight to ' ' two or three hundred pounds. ' ' 
 (This has been found in other patients to be a reconstruction wish, 
 to counteract nocturnal emissions.) 
 
 He is very tricky and schemes constantly, but his general be- 
 havior shows marked disintegration of the personality. 
 
 At no time has he tended to be grateful, courteous or appre- 
 ciative. He is completely self -centered, lazy, proud, sensitive, sus- 
 picious, egotistical and hallucinates most of the time. 
 
 Some notes about "the voices," Avhich he wrote on an en- 
 velope a year and a half after his commitment, indicate the fixed 
 affective value of his hallucinations. They say, "if you ever get 
 another job, " " crazy, " " a rich wife, " " a good-looking girl, " " can 
 I be as witty as anyone else," "can I screw a girl and give satis- 
 faction," "be an inventor," "I am different from other people," 
 ' ' I can 't think, " " Be a study nature, " " How do your eyes feel 1 ' ' 
 "ydii don't want to work," "Man or monkey," "I can't make 
 friends," "You are afraid you won't get a good job," "you know 
 too much," "A pain in the back of my neck," "Love me," "I am 
 
CHUONIC PAUANOTD DTSSOGTATTON 547 
 
 jealous," "you are liippoed," "No reputation to lose," "you made 
 me love you, I didn't want to do it." 
 
 The patient lias no insight into his personal deficiencies and 
 concentrates all his efforts in maintaining that he is normal but 
 misunderstood and mistreated. 
 
 His crucifixion for the invigoration of his uncle, his fancies 
 about the death of his father and the immorality of his mother, tlie 
 heterosexual, incestuous interests in his mother, his inability to 
 love other women, and the sexual submissiveness to old males, 
 gives us considerable insight into the affective cravings of the 
 classical paranoid form of progressive disintegration of the per- 
 sonality. {There is occurring in this man a pernicious sexual 
 abortion, a biological growth, from ivhich he is striving desperately 
 to save himself.) An assumption of constitutional inferiority or 
 a toxin need not be made to explain this man's dementia. Should 
 anyone become conditioned to love and hate what this man loves 
 and hates, he could hardly be expected to avoid insanity. 
 
 Repressed hoinosextoal cravings may also cause a chronic dis- 
 sociation of the personality of the female. This woman (Case 
 PD-36), whose case is here briefly reported, had hallucinatory 
 sensory disturbances that indicated strong homosexual cravings 
 and a heterosexual attachment to an old man. She would not 
 permit a woman physician to ask her intimate questions or make 
 a gynecological examination, whereas she was inclined to become 
 quite friendly with men physicians. 
 
 This patient had several years of college training and was 
 teaching school when she became engaged. She married at twenty- 
 nine, after a two years' engagement which had been broken several 
 times. She placed the responsibility of the marriage upon her 
 husband's persistence and forcefulness and said it was noj; due to 
 her infatuation for him. When she accepted her husband's pro- 
 posal of marriage she was inclined to regard it as an agreement 
 merely for the sake of an engagement. 
 
 Later he forcibly persuaded her to write out her resignation 
 as a school teacher. They were soon after married, without prep- 
 aration. The night before the marriage she was depressed and 
 cried. She said she could not understand her reactions because 
 she should have felt elated. 
 
 (In this critical decision, forcing herself into an unsuitalile 
 biological career, she yielded to persuasion because she had lit- 
 
548 , PSYOHOPATHOLOGY 
 
 tie or no definite heterosexual interests, and yet felt that she 
 should have. Her spontaneous reactions were depression and 
 aversion for the man.) 
 
 From the outset she never occupied the same bed with him 
 and not often the same room. She demanded arrangements 
 whereby she could live apart from him. When the first child was 
 born, the second year after the marriage, she chara;cteristically 
 transferred her affections to the child and ignored her husband. 
 This adjustment became even more eccentric after the birth of the 
 second child. 
 
 The pathetic story of their mismated relations and the pa- 
 tient's sexual aversion for her husband is told best by extracts 
 from a letter from her husband to her physician : 
 
 "As to my relations with her since our marriage, while they 
 were always friendly, I can not say much about her for she chose 
 to live away from me most of the time during the past sixteen 
 years — during all those years she preferred to live in W — while 
 I remained in Cuba. When I was in W — she went out in the coun- 
 try and the year of my coming to Porto Eico she spent in North 
 Carolina. Her claim was the tropics injured her health. Her trip 
 to North Carolina was upon the advice (she said) of a physician 
 who feared lung trouble. I do not think there was anything in 
 that, but it was easier to accede to her wishes than to deny them, 
 or to cross her in her desires. She came with me to Porto Eico, 
 but only remained six months. The number of times I have set 
 up housekeeping and sold out my furniture kept me broke and 
 frequently in debt. For seven years I did not see my family— her 
 letters fell off to about six a year; — there was less and less affec- 
 tion shown in her letters to me. In May, 1913, I was a very sick 
 man and went to M — . * I wrote to my wife to join me there (I had 
 not seen her for seven years as stated), but she did hot do so. 
 Finally, I went to W — where she was. Though the house was 
 small and crowded, I was able to obtain a hall bedroom next to 
 hers, where I was flat on my back. During that time she never 
 came near my room, but contented herself with sending the boys 
 to inquire about me. Later, we all went to a country place, where 
 I remained until the middle of September. She insisted upon a 
 room, with the boys, at the other end of the house from me. Ex- 
 cept at dinner we seldom met to speak. She cherished animosity 
 toward me and seemed to think that I was back of her troubles. 
 
CHRONIC PARANOIP DISSOCIATION 549 
 
 present and past. I am sure that nobody who knows me and has 
 Avatched my life during the past sixteen years can possibly be- 
 lieve that I care or have cared for anybody but her. The life I 
 have been obHged to lead has all been because of her, but with the 
 hope that she would eventually return to live and share my life 
 as a wife should. [The only explanation of his ivife's behavior 
 that occurred to him was that she believedi him to he unfaithful. 
 Neither understood the hopelessness of her homosexuality, and he 
 waited for years hoping that she would return to him.] As to her 
 character no one can make me believe that she was ever otherwise 
 than pure and sweet, notwithstanding that I found numerous en- 
 dearing Tetters from an elderly (male) friend. I hope and pray 
 for a change that will make a cure in her case with our eventual 
 reunion. That is all my life has amounted to for all the years that 
 have passed since 1899. Anything that -will give her comfort and 
 the greatest happiness wherever she is, is my principle purpose in 
 life." 
 
 Apparently only a divorce, as soon as the incompatibility be- 
 came apparent, could have saved the happiness of these two peo- 
 ple from this tragedy. 
 
 The patient guarded her children prudishly from their play- 
 mates, who, she insisted, were trying to teach them immorality. 
 For nearly two years she managed to keep the youngest child out 
 of school to protect it from immorality. She lived in the same 
 room with the children and slept with the younger boy about whom 
 her obsessive fears of immoral seduction were most persistent. 
 
 Her delusions of persecution became so persistent and promis- 
 cuously referred to others, "particularly unmarried women and 
 bachelors," that finally she had to be relieved of her children's 
 care and sent to a sanatorium. 
 
 Now she misidentifies strangers for old acquaintances, weaves 
 about them persecutory designs and hallucinates homosexual as- 
 saults perpetrated upon her at night by older women. She says 
 they break down her abdominal organs and put their knees into 
 her abdomen, etc. (This compares interestingly with the ideas 
 about old men in the previous case, and the hallucinations of Case 
 PD-17.) 
 
 She has often dreamed two dreams. She said: "I try to 
 climb a long hill to a church on its top and I never seem to get 
 there. And I dreamed this after I Avas married also. 
 
550 PSYCHOPATHOLOGY 
 
 "I also dreamed of having Billie [son] in a baby carriage, 
 trying to push it np the hill and I couldn't. It always seemed that 
 some day I would see that church." 
 
 The frequent dreams of trying to climb a long hill (ascend 
 to the biological levels necessary for maturity) indicate the 
 autonomie-affective indifference to her married life, and the ef- 
 fort to protect her children from the sexual immorality, which 
 she is compelled to feel they must endure, reveals her preadoles- 
 cent sexual fixation. That older women are gradually killing her 
 by weakening her reproductive organs shows the preadolescent 
 sexual cravings from which she can not free herself. Such cases 
 have a very poor prognosis unless handled with insight early in 
 life. 
 
 Her feelings of persecution still persist. She is irritable,, 
 quarrelsome, insolent, haughty, and scornful of all her associates 
 and physicians. They are- her inferiors. Thereby, sheovercom- 
 pensates in her attitude for her grave, unmodifiable biological de- 
 ficiencies. She lives in a world of fancy and distorts any reality 
 to suit her wishes, hates her husband and refuses to consider any 
 attentions that indicate a design to return her to him. Such 
 women, dreading their homosexiiality, often develop the convic- 
 tion (compensatory) that the immorality and vulgarity of their 
 husbands deprives them of love, or that, because of their fancied 
 charms, men persecute them with invitations and seductive inten- 
 tions. 
 
 The most important determinant of the 'malignancy and in- 
 curability of the psychopath's methods of thinking is hatred. A 
 conception that is formulated in order to permit hate to obtain 
 gratification is more difficult to change than any other. This is 
 due to the fact that the hater can not admit inferiority or error 
 to his opponent, that being a form of submission and acceptance 
 of the opponent's righteousness and superiority. Hatred does 
 not tend to accept a situation, but is so constituted that it must 
 modify or destroy it; hence, if a faulty conviction is established 
 gratifying hatred there is lil^ely to be a serious eccentricity in the 
 adjustment to reality. 
 
 Society soon becomes afraid of, or at least loses confidence 
 in, the man who chronically hates, and the tendency, if the hatred 
 
CHRONIC PAEANOID DISSOCIATION 551 
 
 is quite volcanic and asocially eccentric in its demands, is to iso- 
 late the individual. 
 
 The individual begins in infancy and preadolescence with a 
 pathological overvaluation of one of his parents, usually son- 
 naother, daughter-father, which is generally due to the excessive 
 affection (hate or love) of the parent for the child. Because of 
 the overlove for the parent the individual becomes unable to love 
 any other person of the same sex unless it is an image; hence, 
 there is no autonomic sexual invigoration, in case of the son, upon 
 marriage or flirtation with an otherwise attractive female. She 
 only arouses tensions, anxiety and a tendency to precociousness 
 of sexual adjustments 
 
 The paranoiac 's love for his mother, although often attended 
 by incestuous dreams, is, in reality, fundamentally the love of the 
 nursling, and is decidedly dependent, submissive and receptive. 
 In comparison to this profound submissive disposition, essentially 
 feminine^ the projective, independent attitude of the virile male 
 may be considered. 
 
 The submissive cravings of the oral erotic male are of the 
 nursling type, making him a wretched man unless he can find a 
 love-object that gratifies this tendency. The need of a love-object 
 is characteristic of all types of males and females, and irritability 
 and cynicism is the natural reaction when society fails to produce 
 it. The male, however, can not admit his submissive cravings un- 
 less he is willing to admit himself to be biologically^ perverse and 
 inferior, and accept the relentless social condemnation that must 
 be directed upon him in order that the species may conserve its 
 integrity and future. 
 
 According to their adjustments there are three classes of this 
 submissive type: (1) those who indulge and abide meekly by the 
 consequences; (2) those who struggle directly, intensely to over- 
 come the cravings ; and (3) those who succeed in finding wholesome 
 distractions and sublimations in science, philosophy, religion, art, 
 etc., and keep themselves unaware of their homosexual tendencies. 
 
 It is the second type that makes the asocial compensation. 
 Despite his good intentions, his effeminate receptive cravings re- 
 act to the presence of the virile, projective, assertive male, and 
 reflexly he develops a love reaction. This frightens him because 
 he soon has vague premonitions as to the liiological dilemma it 
 will lead to and, fearful of the virile man's personal influence, he 
 
552 PSyCHOPATHOLOGY r 
 
 defends himself. Most men despise the receptive cravings (to be 
 petted and fondled by males) in particular when this leads to ridi- 
 cule. The unfortunate individual, feeling persecuted by the possi- 
 bility of discovery, counteracts with anger and hatred of every- 
 thing that may humiliate him, particularly the one whom he loves. 
 The patient strives to master the unequal battle at this un- 
 compromising level, and becomes an eccentric nuisance or a men- 
 ace, and is sent to an institution. Now, truly persecuted, he shifts 
 his charges to the people that confine him and escapes admitting 
 the biological inferiority to himself. The cravings for submission 
 to virility's petting and flattery insidiously develop, even though 
 
 Pig. 53. — Tensions of facial muscles showing desperate Striving as a defense against 
 ■ fear of becoming effeminate and homosexual. His final solution was suicide. 
 
 repressed, until they become uncontrollable and force the individ- 
 ual to become aware of hallucinated forms of sensory gratification. 
 Treating the hallucinations as realities, the individual becomes 
 hopelessly entangled within himself and his personality is grad- 
 ually destroyed. 
 
 The ideal way to rear a male to become a paranoiac is to be- 
 gin with a devoted, religious, prudish mother and a self -centered, 
 all-wise, domineering, irritable father. The mother, within a few 
 years, develops in her son, beginning from infancy, an insatiable 
 receptive dependence upon herself. This becomes the foimdation 
 of the later ineestuousness. His attachment makes him a rival 
 of his father, who, because he must dominate, and because he has 
 
CHROWIO PARANOID DISSOCIATION 553 
 
 the enormous advantage of experience and power, becomes a sup- 
 pressive factor. The son tends to revolt and assert himself to 
 overcome the father's advantages and achievements that attract 
 his mother. An intrafamilial feud threatens, but the devoted, hor- 
 rified mother intervenes and instinctively pleads that if the son 
 loves her he must not oppose his father. He is thereby forced to 
 renounce his ambitious craving to become his mother's hero, and 
 crucified instead, he becomes her baby; a realm of ownership 
 wherein the father can not enter. 
 
 This triangular adjustment continues comfortably until the 
 son, maturing, is forced to leave home and compete with other 
 males. Having lost his capacity to initiate spontaneous assertions 
 of his interests, through voice and deed, he is forced into submis- 
 sion by his competitors and gradually finds his associates are forg- 
 ing ahead. Then he learns that he is regarded as a coward and ef- 
 feminate. Horrified, he compensates desperately, but eccentric- 
 ally, because he^ can not' compete frankly. Gradually, unless very 
 fortunate, his eccentricity defeats him. In the meanwhile his love 
 craving, to be protected and flattered, makes him miserable be- 
 cause he can not find comfort and a suitable love-object. Tired 
 and distracted, he regresses and is swept off his feet by the hal- 
 lucinations that gratify the perverted love cravings. 
 
 One of my paranoid patients, who" had struggled for years 
 against the nursling's form of receptive cravings, finally aban- 
 doned himself to them and performed cunnilingus. While in the 
 act, he was astonished at becoming aware of strong Avishes to 
 get inside of the female. (See Boecklin's "Isle of the Dead," 
 Fig. 29.) Cunnilingus is usually abandoned for fellatio, and al- 
 though such males derive comfort and relaxation from the aban- 
 doned attachment to virile males, they tend later to make eccen- 
 tric compensations as a defense against the persecutions of their 
 inferiority. The compensation then is to invent or discover om- 
 nipotence at any cost (Cases PD-1, HD-4, PD-10). 
 
 It is reasonable to expect that the male or female, beginning 
 with a well-disposed bisexual equipment, if wrongly trained, will 
 have greater difficulties in maintaining a well-balanced social ca- 
 reer whereby the predominant autonomic cravings may be grati- 
 fied. 
 
 It is also to be expected that wherever the capacity to make as- 
 sertions or projections is imposeid upon and weakened by a resist- 
 
554 . PSYOHOPATHOLOGY 
 
 ant jealous father or mother, later, when the man marries, if the 
 mate is also inclined to be resistant, he mil be gradually forced 
 back upon a dependent, submissive homosexual basis and concomit- 
 antly lose his power to project himself upon the interests of others. 
 This probably explains the phenomenon of the striving male, 
 who, making an impulsive marriage to establish his potency, finds 
 himself growing impotent after the novelties of the female disap- 
 pear (Cases PD-9, PD-10). In some types he becomes dominated 
 by her, craving to be mothered ; and, gradually becoming submis- 
 sive, he, in turn, becomes fearful and paranoid or avoids responsi- 
 bility when opposed by men. 
 
 Sununary 
 
 The fearful homosexual as a paranoiac strives incessantly to 
 reach a state of socially estimable biological potency (hetero- 
 sexual) which, however, he can not quite- maintain because he is 
 "conditioned" heterosexually to be stimulated by a tabooed love#.i: 
 object, or is socially obligated to depend upon a frigid mate and 
 is prevented by " overconscientiousness " from seeking another, 
 or he is so conditioned by adolescent experiences and infantile 
 submissions that certain types of males fascinate him and he can 
 not overcome this. The catatonic, it will be shown, gives himself 
 up to the repressed cravings and permits them to satisfy them- 
 selves through whatever they wish or tend to cause him to hallu- 
 cinate. He or she becomes "crucified," "dies," is "reborn" 
 and again grows up. The hebephrenic is not so inclined to em- 
 phasize death and rebirth, but regresses to a childhood or infan- 
 tile, excretory erotic level and tends to live in that playful, irre- 
 sponsible affective state indefinitely. 
 
 The determinants for these variations are due, it seems, to the 
 nature of the influence of dssociates, during the growth of the per- 
 sonality, conditioning the needs of the autonomic-affective crav- 
 ings. The nature of the social-economic resistenees to be overcome 
 in order to make life worth living no doubt greatly depresses those 
 individuals who have poorly developed heterosexual inclinations. 
 
 The dissociation of the personality and the tendency to per- 
 nicious deterioration, characteristic of the so-called paranoid type 
 of dementia prtecox, are due to the chronic, perverse eroticism and 
 the persistent fears of becoming influenced to yield to sexual as- 
 
CHRONIC PARANOir DISSOCIATION 555 
 
 sault or onanism. The hatred with which they counter-attack the 
 social conventions which oppress them, and the friends and rela- 
 tives who are forced to oppose them, establishes a vicious circle 
 from which they become unable to extricate themselves. 
 
 In the paranoid type the craving for crucifixion is quite con- 
 sistently found to be active, but in the catatonic the crucifixion is 
 often actually acted out in some modified, symbolic ritual. The 
 crucifixion in the psychosis reveals the strong cravings for sexual 
 submission as a biological sacrifice. 
 
CHAPTER XII 
 
 THE PSYCHOPATHOLOGY OF CHRONIC, 'PERNICIOUS 
 DISSOCIATION OF THE PERSONALITY WITH. 
 CRUCIFIXION AND CATATONIC ADAP- 
 TATIONS TO THE REPRESSED 
 CRAVINGS 
 
 (Catatonic Dementia Prsecox) — Chronic, Pernicious, Dissociation, 
 
 Regression Neuroses 
 
 The catatonic adaptation occurs in acute as well as chronic 
 anxiety and panics, and is an adjustment to the cause of sexual ex- 
 citement and fear: a reaction not alone characteristic of men and 
 ■women. I have observed it' in monkeys as an adjustment to causes 
 of fear and sexual excitement. The catatonic adaptatiom to causes 
 of fear alone may be observed in animals, birds, fish and insects, 
 and the assumption that a toxin or cerebral lesion is the cause 
 of the catatonic attitude, or even the catatonic's stupor, has fla- 
 grantly failed to consider the phylogenetic origin of this adaptive 
 mechanism in man. 
 
 The observations that monkeys use the catatonic adjustment 
 to causes of fear were reported,* with considerable emphasis upon 
 two factors that seemed to influence the adjustment : the confine- 
 ment, preventing flight, and the sexual excitement, craving for 
 manipulation by the older monkey even though that monkey was 
 ordinarily reacted to as a cause of fear. He ustially punished the 
 young monkeys severely whenever he could reach them, and on the 
 occasions of the catatonic adjustments he roughly examined the 
 eyes, face, teeth, gums, and genitalia of his submissive, plastic ob- 
 jects while they were erotic. These two facts, the'inability to es- 
 cape and the sexual desire to be manipulated, make a most inter- 
 esting correlation with the same facts present in every catatonic 
 psychopath — especially the erotic craving to be subjected to ma 
 nipulations, ' ' initiations, " " crucifixions, ' ' etc. 
 
 The following selected cases shoAA^ that the mechanism is es- 
 
 *The Psychoanalytic Review, Vol. IV, No. 2. 
 
 55G 
 
CHRONIC CATATONIC DISSOCIATION 557 
 
 serrtially that of an irrepressible sexual craving, which, becoming 
 dissociated from the personality, tJie ego, is considered by the 
 individual to be a foreign personality. This dissociated sexnal 
 craving, becoming nncontroUable, produces hallucinatory forms of 
 sensory disturbances of being sexually manipulated and assaulted. 
 The patient continues in his submissive, more or less non-resistant 
 attitude until the erotic cravings are gratified by the hallucina- 
 tions. As the eroticism subsides the individual is able to resume 
 his habitual social interests, and his friends, no longer uncon- 
 sciously arousing the erotic autonomic reactions, again have an 
 affective influence upon him which they can understand and of 
 which he is not afraid. 
 
 The catatonic adjustment in males is due, except upon rare 
 occasions, to the fact that the dissociated sexual cravings are per- 
 verse and require the reception of homosexual attentions. In the 
 female, however, they may be due to an unusual resistance to nor- 
 mal heterosexual cravings, the resistance being insurmountable be- 
 cause the patient has been taught. by those she loves that any 
 wish pertaining to sex is horribly licentious or disgraceful. In 
 this respect the asocial significance of the eroticism seems to be 
 about the same. 
 
 Case CD-I passed through a remarkable catatonic crucifixion. 
 The underlying affective attachment to his beautiful mother was 
 not so much due to her prudish resistance to his becoming hetero- 
 sexually free as it was due to the loyalty and devotion to her wel- 
 fare, which she unconsciously cultivated. The father was not a 
 domineering parent, we were informed, but Avas kind and devoted 
 to his son's welfare. Eivalry is often disarmed by kindness and 
 it is more likely, from what transpired during the psychosis, that 
 the son was iinable to free himself from a religiously sanctified 
 overlove for his mother. In turn, the. tendency to use his fiancee 
 as a subject for masturbation fancies made^ him feel that he had 
 been guilty of unworthy wishes that must be purged from himj 
 eliminated (like Case AN-S). 
 
 The patient was the only child of a beautiful, devoted, girlish 
 mother. His father was unusually chummy with him and taught 
 him many of the tricks that delight a boy, such as building toys, a 
 canoe, how to camp, play games, etc. The family situation seems 
 to have been delightful throughout the patient's boyhood. His 
 
558 PSYCHOPATI-IOLOGY 
 
 heredity contained no psychopathic determinants. Except for -one 
 convulsion in infancy, and mild attacks of measles and scarlatina, 
 the patient was physically robust. He was interested in aagiiny out- 
 door sports. 
 
 His career in school showed that he did very well except for a 
 failure in mathematics when he tried to enter the Naval Academy. 
 His youth was considered as the reason of the failure. 
 
 When seventeen, his father died unexpectedly. The mother 
 and her son finally adjusted themselves to the situation, which 
 was very difficult because of their affective dependence upon the 
 father. The patient immediately entered a business firm and 
 learned to manage his mother's estate. For three yea.rs he did 
 ordinarily veil and seemed to enjoy the responsibilities of taking 
 caj-e of his mother. She devoted herself to the comforts of her son 
 and literally idolized him because "he was a perfect brick." 
 Friends of the family recognized the affections and devotion of 
 mother and son as an unusually happy solution of the family 
 problem. They both fondly cherished the memory of the man 
 who had devoted his life to their happiness. 
 
 Descriptions of the patient's personality given by the mother, 
 fiancee and several friends, as well as a series of kodak pictures, 
 gave unquestionable evidence as to his excellent social qualities. 
 He seems to have been a favorite in his set, fond of athletics, par- 
 ties, business, was an e:5j;cellent mixer, very good-natured, witty and 
 likable. All accounts of his character corroborated the impres- 
 sion that he was a good-humored, robust young fellow. None of 
 his friends considered him to be sensitive, timid or irritable, al- 
 though I pressed, the issue hard because of the unusual nature of 
 the psychosis occurring in a man with such excellent social qixal- 
 ities. He was not inclined to spend his money foolishly and in- 
 dulged in no compensatory debauches. 
 
 At twenty, he became engaged to a delightfully frank, inde- 
 pendent, self-reliant iindersized girl of about his age. Despite his 
 very unusual height (six feet, six inches) he seemed to enjoy the 
 jokes at the expense of their physical disparity. Although he 
 was apparently not sensitive about his height he seems to have 
 given it some consideration, because his mate was undersized and 
 he particularly enjoyed the novelty of being bossed by this little 
 woman. 
 
 At twenty, he enlisted in. the State Militia and enjoyed the 
 
CTTRONTC CATATONIC DISSOCIATION 559 
 
 military work but his friends wore inclined to think that he 
 treated this work too seriously. A few months later the troops 
 were suddenly ordered to the Mexican border. The rush of prepa- 
 rations and the possibility of war threw everything into a whirl 
 of excitement. Just preceding this event, the patient had boon 
 worried by a hazardous business deal. 
 
 The young couple decided to announce their engagement on 
 the eve of the departure of the troops and the patient had it pub- 
 lished so that it read like a military order. Their friends re- 
 garded the unique announcement as a clever idea and the patient 
 himself seemed to think of it as a bit of fun. At the same time, 
 his fiancee worried about his being "too serious" about his mili- 
 tary work. She protested that he was more engrossed and worried 
 than his companions. He, however, seemed unable to regard the 
 situation in any other light than that of an extremely serious 
 event, which indicated an unusual affective pressure. 
 
 The officers, with whom he was a favorite, noticed that ho 
 tended to become confused Avith the details of his work and tlie 
 patient also expressed concern at his inability to make things come 
 out right, but objected when others offered to help him. This ap- 
 parently mild, but persistent, tendency to confusion was not rec- 
 ognized as the onset of a grave .affective disturbance and he was 
 hurried off to the border with the troops. 
 
 The above is the story of the man's behavior as any friend 
 or physician might have learned of it and is the essence of the 
 observations of the family. No other etiological factors, they em- 
 phatically maintained, were to be considered. The psychiatrist, 
 however, can not afford to rest contented with the socialized half 
 of the patient's career. If he permits himself to-be misled he will 
 never obtain insight into the actual problems involved in the ease. 
 The following information was obtained from the patient after 
 the psychosis was well started, but since it concerns his behavior 
 preceding the psychosis, it is brought in here in order to empha- 
 size the significance of the military form of announcing the en- 
 gagement and, later, the characteristics of the psychosis. The 
 patient had one heterosexual experience at fifteen which can only 
 be regarded as a sexual experiment. His masturbation career be- 
 gan at adolescence with other boys, but later, when it usually is 
 stopped by most boys, he secretly continued the practice under 
 the self-assurance of its being a physiological necessity. TTiis 
 
560 PSYCHOPATHOLOGY' - " ' i 
 
 justification probably spared him from being timid and sensitive. 
 This practice occurred usually after he had retired. On some oc- 
 casions it followed after he awakened from erotic dreams. Usu- 
 ally the autoerotic escapades followed amorous situations with 
 his fiancee. These episodes, however, as usual, were finally fol- 
 lowed by remorse and a determination to make amends for the mis- 
 behavior. The announcement of the engagement as a military or- 
 der (sacred order from the government), just before the troops 
 were going away to a probable war, contained an indication that 
 the play of wit disguised the yearnings to attain a state of grace 
 which had been lost through sexual misuse of the sacred love-ob- 
 ject for masturbation fantasies (Cases AN-3, HD-1). This effort 
 at self-redeinption came strongly into the foreground after the 
 psychosis had progressed for several months. (It seems, from 
 my cases, that the paranoid type feels the necessity for self-re- 
 demption, but does not get relief because he does not allow the 
 affect to carry him through whatever it craves, like the catatonic.) 
 
 From the onset the difficulty in carrying out orders increased, 
 and by the time the train reached the border the patient was in 
 a grave state of confusion. He struggled desperately to control 
 himself against compelling feelings to remove his clothing. The 
 compulsion, however, mastered him within a few days, and in his 
 confused condition he tried repeatedly to remove his clothing be- 
 fore the men, with the compulsion (within himself) to go through 
 a sacrificial form of initiation. "I was very self-conscious about 
 the publicity of my engagement. I was numb all over as if there 
 was no force in me, and then, for a minute, I would get clear and 
 know everything. In San Antonio they [hallucinated] led me to 
 believe that my mother and girl were dead. I spoke to them all the 
 time. I don't know why. Over a year ago Tabout the time of the 
 engagement] I went to the doctor because one testicle was lower 
 than the other. It had been injured in a football game and I de- 
 veloped varicocele. ' ' He also intimated that perhaps circuincision 
 was necessary, and that masturbation had had something to do 
 with the varicocele. 
 
 A friend who was in his troop on the border described the pa- 
 tient's behavior, showing that he soon passed into a hallucinatory 
 panic during which he fled into the desert, poorly clad. He w^as 
 found in a haggard, desperate, terrified condition. He expressed 
 particular terror for the soldiers' knives. 
 
CHRONIC CATATONIC DISSOCIATION 561 
 
 When the company surgeon examined him, he said of someone 
 who passed, "Do yon see that man? He has my face." When 
 a physician passed throngh the room, he said, "That man had a 
 frown on his face and now I have it and can't get rid of it." {This 
 marhed fendlency to imitate and passively submit to almost any im- 
 pression was later cotifrolled hy a catatonic resistance to the feel- 
 ing that we desired him to yield. It is absolutely essential to recog- 
 nise that the desire to be manipulated was in the man, and was 
 really the erotic affect seching a solution. If the reader can ac- 
 cept or understand such things, the remainder of the psychosis 
 becomes transparent.) 
 
 A few days after the onset of the panic he was sent to the St. 
 Elizabeths Hospital. Upon his arrival he was haggard, ex- 
 hausted, confused and tended to be disoriented and hallucinated. 
 There were relatively lucid intervals that lasted for several hours, 
 but he was never entirely clear. He persisted in confessing that 
 he had committed numerous crimes and perversions that involved 
 his friends and family. He had particular difficulty in understand- 
 ing the behavior of the other patients, and constantly read secret, 
 seductive meanings in the movements of everybody. The letters 
 written during the next few weeks varied greatly in continuity of 
 expression, and none of them were altogether free from errors. 
 
 For a week or so he seemed to improve, and asked to work in 
 the dining room in order to get his thoughts on other subjects. 
 For some unascertained reason he soon became too confused to do 
 any work and tended to lose touch with everything. He would 
 stand for hours in one place or follow people around a few steps 
 and keep asking unfinished questions about the meaning of things. 
 
 He complained of cardiac, respiratory and gastrointestinal 
 distresses: believed that he had syphilis, leprosy and infantile 
 paralysis. When he was a child his parents passed through an 
 infantile paralysis scare. 
 
 Another patient, who was sent with him from the border, 
 passed through a state of very erotic, symbolic dying, and for 
 several days yelled lustily to be "saved." It was very difficult 
 to restrain him from trying to render assistance to this man. He 
 was unable to comprehend the man's condition and felt strong 
 compulsions to save him. 
 
 The patient was polite and well mannered throughout his 
 psychosis. Even in his most confused states the influence of re- 
 
562 PSYCHOPATHOLOGY 
 
 fined habits could plainly be seen in Ms courteous manner of ask- 
 ing for or refusing assistance. 
 
 In the third week after admission his confusion increased. 
 He explained in detail the nature of the thoughts and hallucina- 
 tions that distressed him. Various patients seemed to make signs 
 to him, indicating that he must submit to them sexually, voices 
 talked about his masturbation, a childhood oral erotic experience, 
 and accused his mother and fiancee of being prostitutes. He cHed, 
 clenched his fists and, with intense affect, exclaimed: "I want to 
 show them it is not so !" His medical record showed that he made 
 many sexual references to these same subjects while on the border. 
 He would not fight hack at the fancied persuasions of the men and 
 expressed confidence that they would be unable to hypnotize him, 
 although, he said, the men were stronger sexually and more mas- 
 culine than he was. Several times he fought, he said, in order to 
 be killed. His persecutions ivere not systematized, were not fixed 
 •upon any particular individual, and there was no hatred in his de- 
 fense. These facts encouraged us to give a good prognosis to his 
 people. 
 
 He eoinplained that everything in his life was coming back to 
 him with a double meaning of sexual and immoral significance. 
 He complained bitterly of this, and seemed to worry about the 
 cause of it, but could not understand that it was due to his own 
 uncontrollable emotions. 
 
 Voices (hallucinated) told him that his testicles were to be 
 removed (castration) and he could not understand why "they" 
 should speak of him as being Jesus Christ (biological crucifixion). 
 
 The crucifixion craving soon dominated everything, and he 
 had to be isolated because he persisted in removing his clothing 
 and being crucified. His stream of talk now became unintelligi- 
 ble. During his isolation he masturbated extremely frequently, 
 assumed the coitus position on the floor, and, on one occasion, when 
 I entered the room, he was manipulating his genitalia, and, with a 
 confused, wondering facial expression, he pleaded timidly, "I can't 
 please my' father innocently." The setting was conclusive evi- 
 dence as to its significance — namely, a crucifixion of his virility 
 and a sexual submission to the father as a solution of the mother 
 attachment. 
 
 "They," he believed, put poison into his medicine, and called 
 him c. s., fairy, s. b., bastard, snake, woman, etc. He said he had 
 
CHKONIC CATATONIC DTSSOCTATTON 5G3 
 
 to go through a strange initiation of religious, sc^crct significaijce, 
 etc. ir.e fulfilled this craving later b}' acting it out in detail. 
 
 His memory for remote events was surprisingly good during 
 the niore lucid intervals if he could be induced to answer questions, 
 but recent events, however, were rather haz}' and inaccurate. Dur- 
 ing the early part of the psychosis he did the mental tests fairly 
 well and could repeat six numbers backward. The ethical ques- 
 tions were answered very well. He complained of retardation of 
 thought until he talked a while. Then his thoughts came more rap- 
 idly. 
 
 From the fourth A\'eek to about the thirty-fifth week, except 
 for a brief interval, his personality was markedly dissociated, and 
 he seemed to be unable to prevent himself from submitting to the 
 hallucinations. He muttered to himself constantly, and persisted 
 in certain mannerisms. During the first few weeks he wept bit- 
 terly at his plight and considered himself to be disgraced but he 
 later abandoned himself to the affective wave that swept the ego 
 under. He complained that he could not understand why he was 
 not ashamed when he talked about his masturbation, etc. 
 
 During the masturbation period he refused all food, vomited, 
 complained of headaches, extreme weakness, and his condition 
 became alarming because of the extreme emaciation. For two 
 weeks he had to be tube-fed. Then he adopted a female nurse 
 whom he usually insisted should feed (mother) him. Several 
 weeks later he began to eat ravenously. 
 
 About the tenth week he became decidedly negativistic and 
 assumed a catatonic attitude that endured more or less consist- 
 ently until about the thirty-fifth week. During this catatonic per- 
 iod he used manneristic expressions and symbols, and entertained 
 classical crucifixion fancies. He also informed the nurse that he 
 had given birth to a child, and actually simulated labor pains. 
 Then followed the birth of many children. When, during this ap- 
 parently profound stupor, he protested that his nurse was killing 
 his child, he spoke the nurse's correct name. He said his body 
 was destroyed, bones broken, he died, was female and male in one, 
 had all the thoughts of the world to care for, etc. He would be 
 absolutely mute for several days, then Become talkative and witty, 
 masturbate, and then lapse into mutism again. This cycle was re- 
 peated so frequently that a neighboring, bed-ridden, alcoholic pa- 
 tient was able to describe it accurately. His dull stare, dilated 
 
564 PSYCHOPATHOLOGY 
 
 pupils, -haggard face, small rapid pulse, emaciation, negativism 
 and confusion, indicated the degree of his stupor. 
 
 Without going into details of the numerous symbolic expres- 
 sions, the record of the catatonic period may be abbreviated to 
 make clear its affective value and how it led to the manner of ad- 
 justment.. In the early part of the catatonic state his fiancee nursed 
 him. He responded sufficiently for her to take him into the 
 grounds for several hours daily, although he would say very little. 
 Then his mother joined the party, began to fix his clothing and as- 
 sert her motherly interests in his welfare. His response was a 
 startling regression. His fiancee had succeeded in inducing him 
 to leave his bed, shuffle about and look at things, but, when his 
 mother insisted upon mothering him, he regressed to a nursling 
 level. They were sitting on a bench when she persisted in fixing 
 his clothing despite his motions and signs that she should not do 
 so. He relaxed and slid from the seat to the floor, lying in a heap. 
 The mother and fiancee had to be sent home and the patient became 
 confined to bed in a catatonic, infantile affective state for several 
 months longer. The reaction was an eloquent confession of his 
 infantile dependence upon his mother and the disastrous influence 
 it was having on his mental integrity. 
 
 Most of the patient's mannerisms were intelligible as gratify- 
 ing the crucifixion craving. During the catatonic period he per- 
 sisted in assuming a position which was very similar to the posi- 
 tions of Christ in the paintings of "The Entombment" by Eaphael 
 and Carracci and the sculptured "Pieta" by Michelangelo (see 
 illustration). The most important features being the position of 
 the crucified feet which he persisted in maintaining despite all 
 efforts to make him walk. He believed that the scars on his feet 
 had been made by the crucifixion. His attitude toward his mother 
 and fiancee was in many respects like that of Christ- toward his 
 mother and Mary. Magdalen. The dead Christ seemed to be acted 
 out by his postures. Later, when he began his "reconstruction" 
 under the nursing of his fiancee he spoke to her about "our" 
 difficulties as though she were going through a purification proc- 
 ess with him. 
 
 When he was bathed he insisted that he was not dirty and sin- 
 ful and did not need it. At other times he protested that he should 
 not be touched because he contaminated everyone. He usually 
 looked at people with his left eye and kept the right eye closed or 
 
CHRONIC CATATONIC DISSOCIATION 
 
 565 
 
 Fig. 54. — "La Pieta," by Mielielangelo. The loving, son of the too-devoted 
 mother becomes the instinctive , rival of the father. If he is unjust to wife and son, 
 the son develops parricidal impulses. If he is unjust to the son and the mother is 
 loyal to her husband, the son tends to become a wandering hero (hobo). If he is domi- 
 nated by a severe, just father and pitied by a timid mother, he becomes crucified and 
 sacrifices himself to Ms father's glory and potency. He often "dies," descends into 
 the hell of invalidism arid infantism, and is nursed and petted by the mother. Often 
 before the sacrificial regression, he seeks a mother substitute in Magdalen, the prostitute, 
 who having a reciprocal father attachment sympathizes with him and often marries 
 him. (Compare Figs. 28, 29, 55.) 
 
566 PSYCHOPATHOLOGY 
 
 kept both closed. When alone for a considerable length of time 
 he opened both eyes and looked about. He crossed his fifth fingers 
 Tinder the fourth or passed the thumbs between the second and 
 third (see Fig. 6) and held up the right hand to the level of his face 
 and supported the right elbow with the left hand, somewhat like 
 statues of the Infant Christ. (His mother said that when he 
 played football he used to keep his fifth fingers crossed imder the 
 fourth for luck.) Wlien his tray was offered he refused to eat, but 
 when it was taken from him he begged for it, saying he was hun- 
 gry. 
 
 He resisted all efforts to attract his interest, talked very lit- 
 tle, and with his eyes squinting, fingers crossed and arms flexed 
 he shuffled about. His feet were almost useless. He talked about 
 the Jew in himself — said "she is inside" and caused his mastiir- 
 bation. 
 
 About the ninth month of the catatonic period his fiancee re- 
 turned to nurse him out of his condition. She was a charming lit- 
 tle M^oman, imbued with a mother spirit and thoroughly convinced 
 that her inspiration would induce him to take a new interest in 
 life. I had been in close touch with the progress of the psychosis 
 but was unable to win the patient's confidence. Somewhere he 
 had learned something about fransferevce, and while in his cata- 
 tonic moods he talked about it but complained that my personality 
 was too strong and he felt hypnotized by. my presence. This 
 clearly indicated the vigor of the submissive homosexual interests 
 and the value of the superimposed catatonic defense. He felt 
 too unsafe to trust himself. With his fiancee the situation was 
 .very different. A heterosexual transference is eagerly sought by 
 such patients, particularly if it can be refined. 
 
 Upon her first appearance he reacted with interest, and within 
 a few days was out on the grounds for short walks. The patient 
 began to speak of himself as being in a stage of ' ' reconstruction ' ' 
 and maintained that "psychology only" could help him. Fortu- 
 nately, his fiancee was splendidly open-minded and frankly inter- 
 ested in the affective development of the personality. She soon 
 became a reliable medium through which I could influence the' ad- 
 justment of the patient. That he was going to recover was mani- 
 fested by his rapid gain in weight and his ability to talk about 
 impersonal affairs. The critical problem was how to prevent him 
 from repressing the memories of the psychotic episode. It was 
 
CHRONIC CATATONIC DISSOCIATION 
 
 567 
 
 vitally necessary to the future of his personal integrity that he 
 should retain the memories of his psychosis as a part of his per- 
 sonal experience so that he would not lose sight of the wish-fulfill- 
 ment in it. Only in this manner of qualifying the wishes with his 
 other interests could sound emotional balance and judgment be 
 expected to result. 
 
 His fiancee, upon my recommendation, read Hazelton's play, 
 "The Yellow Jacket," and White's "Mechanisms of Character 
 Formation." She grasped the mechanism of the family romance 
 and realized her part in the psychotic fantasies. She seemed to 
 
 Fig. 55. — "The Resurrection or Eebirth, " from a painting by Raphael and Perugino. 
 
 have no hatred, jealousy or prudery Avhich might act as repressive 
 factors upon the patient, and her splendid sense of humor stood 
 her in good stead. It made the reconstruction decidedly easier. 
 The patient resisted the reading of ' ' The Yellow Jacket ' ' for sev- 
 eral days, but finally consented and became interested. 
 
 During the first few weeks he was like an infant learning the 
 ways of life (rebirth). See Fig. 55 of the resurrecting Christ. 
 He would not step on the lawn, cross the street, or go iii unusual 
 directions without asking permission of his escort. Numerous 
 other little adjustments Avere noted by Miss A — , and both seemed 
 
568 PSYCHOPATHOLOGY 
 
 to delight in joking abont his infantile manners. Gradually, and 
 yet quite rapidly, he began to assert himself, and would often 
 ask her if she noticed his progress. Soon tramps into the country, 
 then trips into the city followed. Within several weeks after she 
 began to nurse him they went to the bathing beach, theatres, etc. 
 The patient's tendency to avoid things that pertained to his old 
 affective status showed in his refusal to eat in a basement cafe. 
 The basement cafe, being "low down," was still "immoral," al- 
 though the hotel iii which it was located, he said, was all right. 
 
 Even though the patient tramped and played with consider- 
 able zest, bought his clothing with good taste and entertained a 
 guest in a downtown hotel for dinner, when he returned to his 
 ward he quickly lapsed into his catatonic attitude, shuffling gate, 
 peeping eye, and hand mannerisms. He was convinced that a hyp- 
 notic force on this particular ward overpowered him so soon as 
 he stepped into it' (conditioned autonomic affective reaction). The 
 suggestible nature of the catatonic state and autohypnotic trance 
 surely have very similar mechanisms and contradict the presence 
 of a toxin or cerebral lesion as a cause of catatonic dementia 
 precox. 
 
 This tendency disappeared entirely after he was transferred 
 to another ward. He was proud of his readjustment, took firm 
 hold of himself, and applied for occupation in the dairy. His de- 
 voted mother could restrain herself no longer and insisted upon 
 returning to her son in order to take him home with her. The in- 
 sight he had acquired into the debilitating influence of her mother- 
 ing enabled him to grasp the critical nature of the situation, and 
 he met it firmly. He wrote her a letter in which he emphasized 
 that he was mastering himself and intended to become the head of 
 the family, and that he did not wish her to visit him. 
 
 Nearly one year after his admission he was discharged as re- 
 covered. He had fair insight, but was inclined to use witty little 
 defensive remarks about his case, and dodged an analytical review 
 of his psychosis." 
 
 His pretty, little, self-confident mother-fiancee surely exerted 
 a fine reconstruction influence over her charge. She was inclined 
 to have ",edlds on her lungs" and coughed affectionately as she 
 nursed and enticed him to exert a manly interest in life for her. 
 The coughing had, I am sure, unconsciously for her, an inciting 
 influence upon him to take a protective interest in her efforts. She 
 
CHRONIC CATATONIC DISSOCIATION 
 
 569 
 
 glowed with enthusiasm over her success. During the first few 
 weeks he significantly, referred to himself and his fiancee as being 
 "in the dark" and that they were finding a way out. 
 
 Now the patient seems to be the master. The fondness of the 
 mother (Mary) and the fiancee (Mary Magdalen) for one another 
 and the son made the solution considerably easier than it could 
 have been had the slightest rivalry existed. 
 
 The many strange fancies, such as the food passing out of the 
 
 Mg. 56.— Seal of Lichfield Cathedral, 
 England. 
 
 3?ig. 57. — Window of Dumblane Abbey, 
 England. (From Buskin's works.) 
 
 back of his neck, of his being closed in a tomb for months like an an- 
 cient Egyptian, of being deserted by his "ancestors," and that 
 loud sounds of bells and knocks should be made for mysterious 
 reasons whenever anyone touched him, etc., can not be included 
 for want of space in the discussion of the case. 
 
 The crucifixion and submission "to please" the father, the 
 dying, burial, resurrection or rebirth as a purification of the 
 homosexual and incestuous fancies, the reconstruction and new 
 adjustment to meet the obligations of life, were obviously made 
 
570 PSYCHOPATHOLOGY 
 
 to free himself from the abnormal affections which prevented him 
 from loving his fiancee. The psychosis, as a means of affective 
 readjustment in order to become able to love like a virile man-, 
 seems to have been necessitated in order that he might free him- 
 self- from his mother-attachment, father-submission and secret 
 autoeroticism. 
 
 The patient's inability to grasp the personal sources of the 
 affective regression — the cause of the dissociation — and to analyze 
 the various situations so as to appreciate the wish-fulfillment and 
 his own responsibilities in the psychosis, are a very important de- 
 fect in his adjustment. He had, however, fair insight into his af- 
 fective make-up and the nature of his family romance. 
 
 The catatonic adaptation as a defense after he became unable 
 to control the homosexual cravings to be crucified was obvious in 
 this case. The rapidity with which he assumed the catatonic atti- 
 tude when he felt that he was losing control of himself, or aban- 
 doned it when environmental conditions made him safe, gives fur- 
 ther support to the instinctive nature and defensive value of the 
 catatonic adjustment. During the catatonic attitude the erotic 
 cravings were permitted freedom through fantasies, hallucina- 
 tions and overt acts, and yet, the individual was fairly safe from 
 bursting into a wild orgy of sexual perversions, although he could 
 not prevent the masturbation. I have seen perverse outbursts oc- 
 cur in other catatonic cases. 
 
 The patient's mother, fortunately, had no repressions to main- 
 tain, nor feelings of having betrayed her son 's welfare for herself, 
 so she was very amenable to suggestion and cooperated Avith, our 
 wishes, yielding her own interests to the patient's welfare. Moth- 
 ers who have selfishly appropriated a son's powers to further 
 their own interests in life literally become hostile to any line of 
 readjustment or any psychotherapeutic measure that recognizes 
 their selfishness. They are not able to escape the feeling that they 
 secretly wronged the son and yet very few are able to admit it 
 frankly. The mother in this case had not consciously adopted her 
 son for a lover as an adjustment to her social obligations ; hence, 
 she had no feeling of guilt to hide. She resigned her interests 
 for the welfare of the patient's manhood, Avhich surely made his 
 readjustment and self-assertions much easier, and enabled him 
 finally to marry his fiancee one year after the psychosis. 
 
 The fundamental principle of the "golden rule" of Chris- 
 
CHRONIC CATATONIC DISSOCIATION 571 
 
 tianity, "Whatsoever ye would that men should do to you, do ye 
 even so to them," is the renunciation of envy, of hatred, and the 
 sort of selfishness that tends to destroy or subjugate the other 
 man's independence and resistance. The attitude of many par- 
 ents, because they can not be comfortable imless they dominate 
 their children, often forces the son or daughter to sacrifice his 
 or her most intense yearnings in order that the anxious or selfish 
 parent may be happy. The natural reaction when the affections 
 are resisted is to overcome or remove the resistance. But the 
 parent who takes advantage of the solemn religious impressive- 
 
 rig. 58. — Drawing of a vulva, and its symbol, the doubly-pointed ellipse. 
 
 ness of parental authority disarms the son or daughter when 
 the parent is really loved. The son, as in the preceding case, 
 or the daughter, as in the following case, is forced to choose 
 between two great affective cravings, which finally results in a 
 crucifixion, or renunciation of the competitive vital craving un- 
 less a compromise can be established, as in Darwdn's case. 
 This is the biological significance of the crucifixion of Christ and 
 becomes intelligible as a biological phenomenon when this ancient 
 and catholic fantasy is compared to the emotional sacrifices of 
 some of our catatonic patients reviving the potency of the dying 
 god or father. ' 
 
 The anger in the following case had to be repressed when it 
 produced a crisis. The renunciation of the anger and the submis- 
 
572 PSYCHOPATHOLOGY 
 
 sion to the parent played an interesting part in the crucifixion 
 behavior. 
 
 The family situation in this ease also illustrates the manner 
 in which a personal difficulty in a parent influences the affective 
 development of the children and possibly the grandchildren. 
 
 The mother of this patient (Case CD-2) married at eighteen. 
 She became the second wife of a man of forty despite the objections 
 of her parents and the marriage developed into a very unhappy 
 mating. The patient's mother was obviously a girl of strong af- 
 fective compulsions who could not be easily guided. After her 
 daughter 's psychosis, Avhen it became necessary to study the nature 
 of her influence upon her daughter, she said that if her father had 
 definitely protested against her marriagp she would have given 
 the man up. But her father only objected to the inequality of 
 their ages and pointed out the difficulties to be expected. (Ob- 
 viously the daughter wanted the father to make stronger claims 
 for her future than the father-image, the man she finally married.) 
 
 Two children grew up from this mating and both of them are 
 decidedly subdued, dependent girls. They and their friends have 
 often remarked that they never learned to think for themselves 
 because their mother always thought for them. 
 
 The mother explained to me that her unhappiness, which re- 
 sulted from her determination to solve her own problems when she 
 was a girl, constantly influenced her to train her daughters to 
 depend upon her for trivial as well as important decisions. 
 
 She assiduously, jealously, cultivated this dependence in them,' 
 in order that when they became young womenj temptations would 
 not induce them to act impulsively. She is an aggressive, energetic 
 woman, large and vigorous, with quick wit and an unusual capacity 
 to forge ahead even if it involves serious personal retractions on 
 the part of her children. Her natural physical endowments sup- 
 ported her obsession to control her children in that she was large 
 and strong. 
 
 Her husband was an irritable, rather violent, selfish man 
 who did not hesitate to strike his daughters to satisfy his anger 
 though the act was an injustice. This finally produced a very un- 
 happy relationship between himself and his eldest daughter, the 
 patient. She seems to have been forced into a persistently sub- 
 dued, discontented attitude toward her father. The father finally 
 left his family and lived alone in the West until his death. ■ 
 
CHRONIC CATATONIC DISSOCIATION 573 
 
 The patient's development into Avomanliood was not impaired 
 by diseases and her education was snffieient to meet her social de- 
 mands. Her .personality at maturity Avas, however, much too sub- 
 dued and retracting. She had developed the fatal speech tendency 
 of starting to say something and then automatically stopping, 
 usually at the point where listeners show by the usual movements 
 of the head and eyes that they have surmised what she wants to 
 say. Almost invariably, she stopped as if expecting the listener 
 to finish the thought. The development of this serious habit, which 
 was fatal to maldng affective adjustments (considering speech as 
 the preeminent method of affective expression) was easily trace- 
 able to the overly eager dominant mother, who, as her son-in-law 
 had observed, had the habit of stealing her daughter's speech and 
 finishing it for her. 
 
 At twenty-one, with her mother's approval, she married a 
 rather tense, energetic, somewhat eccentric, but kindly man. The 
 patient was unduly ignorant of the sexual life of woman and ex- 
 perienced no little anxiety until her mother sanctioned sexual re- 
 lations by verifying the husband's claim that they were normal. 
 The husband recognized the suppressive influence of the mother 
 upon her daughter and tried to influence or train her to become 
 more self-reliant and independent. The first eight years of their 
 married life were happy and very satisfactory. About eighteen 
 months before her psychosis her father died, a recluse in a far 
 Western city. His death caused the young woman no little re- 
 morse, which she concealed. She felt that she might have made her 
 father's life more comfortable had she been more forgiving of his 
 abuses. 
 
 The patient 's first two pregnancies caused no distress and the 
 third pregnancy, which was welcome and occurred some time after 
 her father's death, was in most respects, except for "dreadful 
 dreams," a source of happiness. Her friends and relatives com- 
 mented on her unusual "madonna-like" appearance during this 
 pregnancy. The labor and convalescence were uneventful until a 
 sudden affective upheaval occurred four weeks after the labor. 
 
 A few weeks before the labor the cook left unexpectedly and 
 the patient's mother had to join the family and take charge of 
 the house in the emergency. She managed the household accord- 
 ing to her own methods, although on certain essentials of house- 
 keeping the mother and daughter persistently disagreed. The pa- 
 
574 PSYCHOPATHOLOGY 
 
 tient's husband had always had a strong aversion for anything 
 that savored of being infested with "germs" and required .that 
 the foods, particularly the milk, should be carefully handled. The 
 mother felt that the germ phobias of the young couple were rather 
 extreme and was inclined to say so. Similar differences of opin- 
 ion were held about the best methods of controlling the children. 
 The vigorous mother, who had always handled her daughter's af- 
 fairs as if they were her own, could not refrain from exerting a 
 constant pressure that gradually forced her convalescing daughter 
 back into the old, submissive, dependent attitude. The submis- 
 siveness because of her convalescent state and the sense of ob- 
 ligation to the mother, for taldng care of the house in the emer- 
 gency, greatly weakened the daughter's resista;nce. 
 
 The climax came when the patient was unexpectedly called 
 upon to resume her household duties, because her mother had be- 
 come ill. The patient found most of the household disarranged 
 and the irritation reached a point where it could no longer be 
 restrained when, upon opening the ice-box, she found a piece of 
 foul smelling meat that h0,d been carelessly left there. The pa- 
 tient lost control of herself and a vigorous, angry upheaval fol- 
 lowed. She was unable to adjust herself or to criticize her ill, 
 well-meaning mother. The independence she had laboriously' de- 
 veloped during the eight years of her marriage, had been wrested 
 from her by the sincere, but tactless, inconsiderate woman who 
 would have only dependent, infantile daughters. (Compare Dar- 
 win and the sincere but domineering attitude of his father, and 
 Case AN-3.) 
 
 The patient's excitement and inability to control herself 
 frightened the household, and the husband and physician were 
 sent for. Attempts were made to smooth things over, but, in 
 order to avoid being rude to the mother, the situation could not 
 be handled in the natural manner of letting the daughter win a 
 personal triumph. The mother should have found some excuse 
 for having to go on a journey in order to give the daughter a 
 chance to make an affective adjustment and let things calm down. 
 Unfortunately, however, an affective vicious . circle had been es- 
 tablished. The patient was too distracted to manage the house, 
 and the mother, the cause of the distraction, now felt, character- 
 istically, that she had to stay and retain control of it. This neces- 
 sitated forcing herself upon the patient despite its inadvisability. 
 
CHRONIC CATATONIC DISSOCIATION &/[) 
 
 Nothing but unusual luck and insight could now have prevented 
 the final break from occurring. The physician and family wanted 
 a cook to take charge of the kitchen, and the mother wanted a 
 nurse. They finally compromised by getting a nurse! 
 
 For several days the patient was very apprehensive of some 
 terrible disaster occurring to herself which was due, as the symp- 
 toms showed later, to the repressed affect vigorously trying to 
 make an adjustment. The last vestige of self-control was broken 
 when her husband, who had been dozing on the patient's bed, 
 awalfened in fright at some sudden disturbance. The husband's 
 startled manner of awakening frightened the patient and she be- 
 came unable to control her apprehensions, which Avere already 
 colored by vivid imaginations, such as being assaulted by German 
 soldiers who had captured Washington. The next morning she 
 was completely out of touch with reality and walked off her bed 
 as if in a dream, falling heavily to the floor. At this time "she 
 said something about being bad." 
 
 She was taken to a sanatorium on Easter Sunday, and after 
 several weeks, was brought to St. Elizabeths Hospital. She clung 
 desperately to her husband as if she Avere doomed to lose him and 
 everything. She recalled during the analysis that while at the 
 sanatorium she looked over some pictures of priests and thought 
 of herself as being like one of the priests who was effeminate look- 
 ing. (This bisexual interest should be compared to the bisexual in- 
 terests of the previous case.) 
 
 Upon her admission, about two months after the onset, she 
 was disoriented, poorly nourished, showed hyperactive reflexes, 
 small pulse, rate about 100 per minute, facial and finger tremors, 
 profuse sweating of the face; sometimes a Von Grsefe's sign was 
 present, thyroid was not enlarged, urine was not abiiormal. She 
 was disoriented and could not iinderstand or adapt herself to the 
 simple needs of the hospital situation. Because of her extremely 
 disconnected and unintelligible, retarded phrases no intelligence 
 tests could be made. There was no flight of ideas. Her behavior, 
 however, was a clear revelation of what the uncontrollable affect 
 was trying to accomplish. 
 
 She believed that she had died, but her husband would not let 
 her go. (She clung to him when admitted. His affective attach- 
 ment to her was genuine.) She carried her head in the position 
 of the crucified, dying Christ on the cross; her facial expression 
 
576 PSYCHOPATHOLOGY 
 
 reminded one decid'sdly of the agony in Christ's face as depicted- 
 in many paintings of scenes before the crucifixion, and her eyes 
 were uplifted in religious fervor. She would stand in one position 
 for hours in the dormitory and move her head from left to right 
 and back again with inexhaustible monotony. While in bed, dur- 
 ing this stage, she was observed to lie with her head fallen back on 
 the edge of the bed, her arms dropped in some lose position about 
 the head and her pelvis going through the gyratiojis of copulation. 
 The nurse reported that when she dressed herself after the phys- 
 ical examination she tucked her skirts inside of her drawers like 
 a boy. (Again the bisexual.) 
 
 The baths were interpreted as mysterious sexual practices per- 
 formed by the nurses and she was always frightened by the ordeal. 
 One of the physicians was thought to be the Virgin Mary, "God" 
 talked to her, and she believed that she was in "heaven. ' ' She per- 
 sisted in having her hair hang loose (a surprisingly common pleas- 
 ure of heavenly brides). She never tallied except when asked 
 questions and then answered in broken phrase^ that could not be 
 connected with anything in the environment, as: "The voice said 
 that it mustn't. It said it musn't talk all the time— that was God's 
 voice. He told me to try to make some excuse. He said I must try 
 one way or another. He said I must not untie everything. ' ' She 
 said something frequently about drinking water, and frequently 
 washed and examined her hands. She spoke of herself as "she" 
 and said she had been "quite naughty" — "I didn't do all — ^I didn't 
 try to take away all the paints that were on me, etc. ' ' 
 
 When taken out on the porch she would let herself collapse 
 on the floor as if utterly helpless. When asked how old she was, 
 she answered: "I am two hours," and Avhen asked for the year, 
 she gave the year of her birth. 
 
 She showed numerous infantile traits, such as pitch of voice, 
 manner of replying, would not attend to her excretions and had to 
 be spoon-fed. After the crucifixion she became mute and passive 
 for several weeks, during which time she was disoriented but 
 recognized her relatives. About three months after the onset she 
 began to improve, her mannerisms disappeared, and she gained 
 considerably in weight. She was glad to see her mother and hus- 
 band, and begged to be taken home. The process of reorientation 
 and reconstruction progressed gradually. 
 
CI-inONIC CATATONIC DISSOCIATION 577 
 
 About six montlis after the onset she -was able to take care of 
 herself and her room and knit for the soldiers. 
 
 The patient was now well oriented and recovering rapidly, so 
 that it was deemed advisable to begin an analytical study of her 
 difficulties in order that she should have a reasonable amount of 
 insight. She had no difficulty in recalling the important features 
 of her illness which Avere essentially relative to the crucifixion, 
 death of her personality and the rebirth. At first she was inclined 
 to excuse herself on the ground that she had been exhausted by 
 child-bearing and had not regained sufficient strength to resume her 
 household diities. She remembered the essential details of her ill- 
 ness, the hallucinations and her fancies, but was inclined to evade 
 them in order to be discharged until she recognized the therapeutic 
 object of an analytical review of the content of the psychosis. 
 
 The father and mother situation had to be handled tactfully 
 until she had brought out the details of her psychosis and her life. 
 
 The father appeared (hallucinated) in the disguise of elderly 
 women. She said, that when he appeared in the reception room, 
 "He or she said [laughs], 'It was up to me to make him happy.' 
 He said: 'I hope you can do it, son Harry' and 'Welcome, son 
 Harry.' " In the dormitory, "He, she or It [laughs] was taken 
 out of the room and she looked at me and said: 'You will be 
 sorry some day.' This puzzled me to know what I should do to 
 restore happiness. T^lien I determined to stick it out and hear 
 ivhat I had to hear, the Lord's voice said: 'Well done, thou 
 faithful servant. ' ' ' She spontaneously identified the Lord 's voice 
 as her father's. (This sort of resignation to the dissociated affect 
 is typical of the catatonic.) 
 
 The sin that she felt she should suffer for she insisted was the 
 feeling that she had wronged her father by not trying to make his 
 life happy even though he had abused her. The general attitude 
 of the patient was such that when she said the sins did not refer 
 to masturbation, the point was dropped. 
 
 That her father should call her Harry, was due to the fact 
 that this was her nickname with some playmates Avhen she was a 
 child. 
 
 That her father should be associated with women and be 
 spoken of as "he, she or it" was probably due to the fact that 
 she not only craved to be crticified for her fa.ther's sake, but also 
 for her dominating mother's. The mother's attitude was so 
 
578 PSYCHOPATHOLOGY 
 
 subtly ingratiating and yet domineering, that she would almost 
 have had to be destroyed as a mother if the patient were to free 
 herself from its terrible influence and win- her own womanhood 
 and personal independence. 
 
 It was this protest, which had always been curtailed because 
 she could not control its expression, that finally burst forth when 
 she found the decaying meat in the ice-box and was again subdued 
 through the anxious mother's, the husband's and the physician's 
 pleas for self-control in order to avoid illness. 
 
 The various sensory disturbances that gave elaborate color 
 to the crucifixion need not be discussed, because the submissive 
 value of the crucifixion solution of the affective dilemma is clear 
 enough. It saved the ideal family as she wished the parents to 
 have, it, and her personal integrity was crucified for the selfish 
 wishes of her parents. 
 
 Why should this patient have become masculine ("son 
 liarry") during her stuporous state? Christ and the young priest 
 had marked effeminate traits, as do many crucified heroes; and 
 males who go through the crucifixion, complain of becoming effem- 
 inate and even of losing all masculine attributes. The renunciation 
 of all. competitive sexual interests, in order that the rival parent 
 shall dominate, may perhaps be compensated for by the develop- 
 ment of a complete sexual cycle within the self. The female, devel- 
 oping masculine traits, and the male, developing feminine traits, 
 are protected, like Buddha, from the more virile members of their 
 sex who would dominate them. This conjecture is based upon ob- 
 servations of the completely autoerotie who are physically of one 
 sex and fancifully develop the attributes of the other sex, thereby 
 perfecting the autoerotie cycle. Some of our autoerotie patients 
 complain of being male at one time and female at others. 
 
 A series of analytical studies were necessary before the pa- 
 tient was able to talk over the father situation without losing con- 
 trol of herself. (When a patient tends to lose control of herself 
 while discussing a painful relationship or experience, she must, 
 by all means, be left to her own adjustment.) When she was disJ* 
 charged this situation had not been satisfactorily mastered, but 
 it had to be foregone because of the pressure to get her Jiome. 
 
 The attitude of the mother and husband was surprising, in 
 that they both spontaneously and independently asked for advice 
 because they felt that they had domineered the patient's emotional 
 
CllUONIC CATATONIC DISSOGIATTON 579 
 
 adjustments. It was easy to trace the mother's desire; to con- 
 trol the daughter's personality to her own disastrous marriage. 
 The illumination caused no little sorrow, but it was very helpful in 
 furthering a readjustment on her part so as to encourage her 
 daughter's independence. Not too much can be expected from peo- 
 ple who have a lifelong established attitude toward another in- 
 dividual. Nothing short of a severe affective reaction can force 
 a readjustment that will make the situation comfortable for the 
 suppressed. The necessity of permitting the patient the joys of 
 exercising her own judgment was vigorously presented to the hus- 
 band and mother. Experience has taught that only with very in- 
 telligent, unselfish people can new relations l^e permanently ad- 
 justed without suspending all contact with one another. 
 
 The patient returned to her home with sufficient insight to 
 insist that her family must submit to some of her interests and 
 that she was going "to run the ranch." She was not tense in this 
 request and quite good humored about it. Her mother and husband 
 were very glad to make the adjustment. The prognosis depends 
 largely upon the length of time that this arrangement can be main- 
 tained. The patient said that upon her marriage she resolved to 
 raise her children so that they would not be suppressed and de- 
 pendent upon her. A tendency gradually to go to the other ex- 
 treme of not controlling the children sufficiently must be intelli- 
 gently guarded against in such cases. 
 
 It may be added that the patient's younger sister now en- 
 gaged, is struggling to overcome or avoid the domination of her 
 ingenious mother. Fortunately, the mother has learned to con- 
 sider the efforts of the unmarried daughter in a fairly impartial 
 light and is trying to force herself to be less domineering, but she 
 finds that it causes her no little anxiety when the daughter seems 
 about to make even a trivial mistake. 
 
 It is valuable to note that the revered, respected memory of 
 a domineering individual may exert a suppressive influence during 
 the psychosis although that individual is no longer in the environ- 
 ment and may even be dead, as in the case of the above patient's 
 father. 
 
 The following case (CD-3) of catatonic adaptation to an ir- 
 repressible erotic craving also shows how the erotic affect pro- 
 duced hallucinations of what it craved and how the hallucinations 
 terrified the patient. 
 
580 PSYCHOPATHOLOGY 
 
 The patient's maternal grandmother liad some form of chorea 
 ("St. Vitus' dance") and was considered to be a very irritable 
 woman. The patient's mother was married at seventeen to an 
 artisan. The marriage was unhappy because, as the patient 
 thought, her mother had a refined, artistic temperament and her 
 father, who was considerably older, was rough, slow and "not 
 finely tempered." Her mother had a series of "uterine abcesses" 
 after the birth of her children and finally developed "arthritis de- 
 formans." Even during her youth, the patient felt that sexual re- 
 lations, although she had an ill-defined notion of what they were 
 like, were the cause of her mother's unhappiness and illness. The 
 mother surely had insurmountable difficulties Avith her sexual af- 
 fections, because, when her daughter was twenty she had not yet 
 learned to realize that the menstrual functions were normal. The 
 mother was never able to answer the sexual questions of her chil- 
 dren, but met them with reactions of embarrassment and discom- 
 fort. (Such reactions on the part of the parents usually distort 
 the child's control of the sexual cravings.) 
 
 This ascetic tendency seems to have been a family trait, be- 
 cause the patient's cousin left her husband within a few days after 
 her marriage, and the patient's sister and mother both suffered 
 severely from anxiety because of the sexual experiences a,ttending 
 marriage. The patient's sister was even afraid that she mifht 
 become pregnant when dancing with a man, and the patient her- 
 self would not learn to dance because she believed the man's touch 
 during the dance might impregnate her. One can easily imagine 
 the eccentric effects upon a girl's adjustments to society and love- 
 making that such conceptions might cause. 
 
 The patient, the last child, was healthy, vigorous and of a 
 naerry disposition until she became a woman. Her mother liked 
 to call her "the lucky child," because she was born in an easy 
 labor. She won a scholarship in a normal school, taught for sev- 
 eral years and at thirty-one was appointed to a social worker's 
 organization because of her unusual -textbook information on so- 
 cial subjects, acquired after long, intensive study. As a practical 
 social worker she did very well until her psychosis began to de- 
 velop. Her physical constitution, except for mwistrual difficulties 
 which developed after twenty, was very good. 
 
 "During all the patient's girlhood she was the prey of her 
 mother's tales of woe and reacted with resolutions to give her 
 
CHRONIC CATATONIC DISSOCIATION 581 
 
 mother some comfort when she should become able to earn a liveli- 
 hood. The daughter's womanhood was usurped by the mother's 
 invalidism. The patient was inclined to be overly ambitious, and 
 made exacting demands upon herself as a student and social 
 worker. She always showed impatience toward her "slow" father 
 and tended to compensate for his deficiencies, as well as to protest 
 against his causing her mother to suffer. She did not like the rich 
 relatives of her mother, but, on the other hand, prided herself on 
 her intellectual capacities (a compensation). 
 
 The nature of the mother's moodiness and irritability neces- 
 sitated her removal to a sanitarium for years at a time, and this 
 completely drained the family's finances and the patient's earn- 
 ings. 
 
 When the patient was about twenty she taught young chil- 
 dren and then began to realize that some of her pupils knew more 
 about the sexual life of woman than she did, and, as she expressed 
 herself after her psychosis, she resigned because of this and took 
 up other work. At twenty, she first realized that menstruation, 
 etc., was not an indication of a shameful defect in womanhood. 
 (Her mother's depressing, prudish attitude had given her this im- 
 pression.) 
 
 At twenty-three she became engaged to a man several years 
 older than herself, but was never quite able to make up her mind 
 to marry. For the next ten years she was neither able to break 
 the engagement nor fulfill its obligations. The principal causes 
 of fear of marriage were sexual ignorance and her mother's, sis- 
 ter's and cousin's unhappy experiences. She planned her house 
 and furniture which was strikingly like her mother's, but was un- 
 able to consummate the final act. 
 
 In her studies for social service (at twenty-eight) she came 
 upon literature that partly explained the sexual life of man and 
 woman and the diseases peculiar to sex. Here, according to her 
 statements, the discussion of the clitoris and masturbation aroused 
 her excitement and curiosity, which she hept secret. This led to 
 sexual experiments and masturbation episodes preceding her men- 
 struation, and it finally grew into a very serious autoerotic diffi- 
 culty. 
 
 At thirty-one she entered the social service. Her work was 
 characterized by periods of efficiency with periods of irritability, 
 headaches, dysmenorrhea, psychoneurotic disturbances and slug- 
 
582 ' PSYCHOPATHOLOGY 
 
 gish thinking. For two years her friends and relatives recognized 
 her growing irritability and seclusiveness, but saw nothing in her 
 behavior that indicated to them an undne change of personality. 
 
 The secret autoerotic indulgences were no doubt considerably 
 augmented by the fancies and amorous pleasures with her fiance, 
 which had naturally groAvn out of a ten years' engagement. 
 
 By thirty-three, the autoerotic trend developed into serious 
 proportions and symptoms of its undermining the integrity of 
 her personality began to show in the form of chronic, neurotic 
 disturbance^. Her "hands broke out in red spots, swelled and 
 became so painful" that she had to consult her physician. He 
 failed to recognize the affective, autonomic significance of this and 
 sent her to a skin specialist who also failed to grasp the patient's 
 difficulty, but gave her an ointnaeht, diagnosed it as a "case of 
 nerves" and "handled the case very lightly." "Two or three 
 days" later she "began to feel weak" amd stopped at a certain 
 sanatorium for hydriatric and massage treatments. She ' ' fainted ' ' 
 while in the bath, and this "alarmed" her because, as she said, 
 "I had alwajys said that when I fainted it meant a serious sick 
 spell." From that time, she later 'said, she felt a "clutching in 
 the back of the head. " (A very common symptom attending affec- 
 tive conflicts in which fear plays a part. Perhaps it is due to a 
 spasm of the muscles of the scalp and the posterior spinal occipital 
 muscles which naturallv become tense when a defense becomes im- 
 minent, as. may be easily observed in dogs and cats.) She said of 
 the onset of the psychosis: "One day in the office a sharp pain 
 like the prick of a pin struck me on the left side of the back of the 
 head and came out of the right eye. I at once thought of cerebral 
 hemorrhage (brother had a cerebral hemorrhage) and started for 
 Miss — . I became delirious, and after rambling for over an hour, 
 came to and heard Miss — saying 'You're sick.' I insisted that I 
 was not ill, but allowed Miss — to persuade me to go home. The 
 next morning I felt as though I were tied do-vim to my bed. After 
 several efforts I decided to go to the sanatorium for a treatment. 
 I told Dr. — about the clutching in the head, and she advised me 
 to spend several weeks at the sanatorium. I did so, and after 
 three weeks decided to go home. T was at home but a day when 
 my brain seemed to stop working; the clutching had stopped biit 
 I could not think. I managed to write a short letter to Mr. — 
 [fiance] telling him that I believed I was about to have a spell 
 
CHRONIC CATATONIC DISSOCIATION 583 
 
 of typhoid fever, and requested liim to take charge of my business 
 affairs. The next morning I attempted to write a check, but could 
 not complete the last word — 'association.' " 
 
 (She. had, during a ten years' engagement, been unable to say 
 the last word consenting to marriage and the sexual act. Through- 
 out her psychosis she repeatedly hunted for something that she 
 said would complete her life. She would never complete a puzzle 
 or game, she said, because there was something incomplete in her 
 life. Later she decided that this was fear of heterosexual rela- 
 tions.) 
 
 She returned to the sanatorium for "treatment" and had a 
 "tenable screaming spell." "I had a loose bracelet on the arm 
 and it seemed to hecome so tight that I wds afraid I ivas being 
 choked although it ivas on my arm." [The reader will bear in 
 mind the arm and its relation to masturbation, and the tight brace- 
 let, choking, and oral eroticism, l)ecause much of the content of 
 the psychosis Avas later colored with oral impregnation fantasies, 
 which, of course, had their origin in infantile and preadolescent 
 cravings.] 
 
 "That evening a message ran up my spine and into the back 
 of my head. It said something like, 'You are going to become vio- 
 lently insane liy tomorrow morning. You will require the serv- 
 ices of several nurses and the best care, for you will be very ill. 
 If you go to the T — Sanatorium (her mother had been there seven 
 years) at once, where it is quiet and you will have the best of 
 nursing, you will recover, but not until every effort is made to 
 keep life in your body." [This wish-fulfilling "message," por- 
 tending unbridled abandonment to the erotic affect with final puri- 
 fication, was probably retrospectively elaborated, but in a general 
 sense it tells the truth about the undercurrent affective cravings 
 which now were allowed to dominate and sweep her into a grave 
 psychosis of the catatonic, dissociation type.] 
 
 "At 5 o'clock [a.m.] I was screaming to get out of the place, 
 thought I could not bend my knees, that I had arthritis. I had 
 often wondered if I vwvld get the disease my mother had." This 
 excitement, as is usual in such cases, was ushered in by religious 
 ecstasy and then came the lapse into" unconsciousness. ' ' (The pa- 
 tient often referred to herself as being "unconscious," but after- 
 wards said she really meant a "helpless dream state.") 
 
 Unfortunately, the patient now actually developed measles, 
 
584 PSYCHOPATHOLOGY 
 
 and the skin rash, convinced her that she had syphilis (her broth- 
 er's disease). She was now in an affective state that tended to 
 assimilate everything that was destructive to the personality. Her 
 only brother had had cerebral syphilis and committed suicide 
 several years after he had what was probably a cerebral hemor- 
 rhage (at twenty-six). The erotic affect apparently was interested 
 in the experience that was naturally associated with syphilis. 
 
 Within a few days the affective storm reached the propor- 
 tions of a "delirium" and an unbridled orgy of masturbation fol- 
 lowed. Vivid sensory disturbances of the hallucinatory type gave 
 plenty of color to the situation. She destroyed the brown hot- 
 water bottles because they were "nigger babies" and cherished 
 the white hot- water bottle as her infant, and had "babies, babies, 
 babies, twins and triplets." "I masturbated most vigorously and 
 when I cleaned my death (her error for teeth) I rubbed the necks 
 of the teeth hard and long and then screamed with pain." (This 
 is an interesting association of masturbation with teeth; ) 
 
 The erotic flights were usually followed by several days of 
 remorse and then repeated. "I could hear everything that went 
 on and imitated these patients in their vile habits. I knew I was 
 doing it but could not stop. ' ' 
 
 During the analysis, a year later, she retrospectively de- 
 scribed her fancies about the red light in the hall, the male patients, 
 the red-light district, and that she had become a white slave who 
 had to submit to long lines of men. These autoerotic hallucina- 
 tions were vivid enough to cause her to attempt to jimip from the 
 window. (She later recognized their erotic source to be Avithin 
 herself.) 
 
 During the period of fancies, the fiance and father also were 
 believed to take possession of her. She had to submit to many 
 forms of sexual equivalents, including electricity, knives, razors, 
 drugs, injections, poisoned foods, etc. During the less erotic in- 
 tervals she realized what her behavior had been and a serious 
 tendency developed to mutilate herself, even destroy herself in. 
 order to destroy the masturbation "devil" (castration). 
 
 After a period of several months (about six) she regained 
 some control of herself and was permitted to return home, upon 
 her persistent begging. She was finally permitted to return to 
 work, but, after a day or so of trying, she found that she was un- 
 able to think about her work. Some wild attempts at suicide with 
 
CHRONIC CATATONIC DISSOCIATION 585 
 
 self-accusations of degeneracy followed. She was then sent to 
 the Phipps Psychiatric Clinic where she was treated for about ten 
 weeks and then 'transferred to St. Elizabeths Hospital, where she 
 remained about nine months, when she was discharged as recov- 
 ered. 
 
 Her behavior during these eleven months and her final re- 
 adjustment throws considerable light on the mechanism of the 
 autoerotic-catatonic forms of dissociation of the personality. Un- 
 til the latter part of her psychosis, the reconstructive period, 
 she was not truly accessible and cooperative. Although she would 
 talk about herself, more or less, she was unable to consider the 
 nature of the intense straggle she was having with her autoerotic 
 cravings. Therefore, the physicians were unable to bring the 
 genetic determinants of the autoerotic interests to the surface. 
 
 (I am indebted to Prof. Adolph Mej^er and Dr. E. ^Y. Hall for 
 the summary of her behavior while she was under their care in the 
 Phipps Psychiatric Clinic. The following is an abstract of the 
 summary. ) 
 
 Upon her admission the patient had to be "coaxed" to enter 
 the hospital. She was rather tense and nervous, and spoke of her- 
 self as eating and sleeping and living "like an animal." She com- 
 plained of a clutching sensation in her brain, that she desired to 
 expose herself, was vulgar, etc. She talked considerably about her 
 personal difficulties, but in a fixed, stereotyped manner, and per- 
 sisted in asking to be discharged. She seemed to be sad and de- 
 pressed, was poorly nourished; picked her face and chewed her 
 nails, refused food because it represented the blood of her rel- 
 atives ; and complained of being hypnotized and unable to pull 
 herself together and to think clearly. "I must have simple food 
 without seasoning; the season heats my blood and the heated 
 blood melts my brain." The electric switches and- signals af- 
 fected her; her flesh was being dried up and her body ^vas being 
 destroyed. (Before her admission she complained of having be- 
 come so degraded as to eat the dirt in the streets.) On the wards 
 she persisted in washing the floors, walls, etc., and would eat the 
 scraps from the other patient's trays. - 
 
 She complained of having lost all self-control, and wanted to 
 be chained to the bed to regain it. Her talk contained a note of no 
 little prognostic importance, in her tendency to repeat that she 
 could regain it with the proper treatment. "I can ne-^'cr get up. 
 
586 PSYCHOPATHOLOGY 
 
 I am bound down by sin," was a complaint made during a time of 
 erotic abandonment. She begged to be given something that would 
 make her " vomit ' ' and "tear me to shreds. " She complained that 
 her hands and mouth were dirty and that she was dirty inside. 
 
 This behavior varied more or less with manneristic postures, 
 tense attitudes and considerable expression of fear and then a re- 
 turn for several hours to the ward interests and light work. She 
 seemed to be well oriented, despite her hallucinatory experiences 
 and distractions. During the last few days of her stay at the 
 Phipps Clinic she maintained a stooping posture because "some- 
 one is holding me down." She also retained saliva in her mouth 
 and refused to respond to simple requests. 
 
 For several days after her admission to St. Elizabeths Hos- 
 pital her behavior continued about the same. She resumed her 
 head-knee posture, continued mute, retained saliva, and showed 
 decided flexibilitas cerea. At times, Avith persistent urging, she 
 could be persuaded to dress herself. (Her analytic retrospective 
 discussion of this period, which is probably quite accurate, because 
 her memories of her behavior were accurate enough, showed that 
 she was still imitating her mother's illness, arthritis deformans, 
 as well as assimilating everything of a degenerative sort in her en- 
 vironment, but nothing constructive.) Elaborate, vi^dd sensory 
 disturbances of the hallucinatory type contributed greatly to her 
 confusion. 
 
 During her panic she developed the fancy that the physician 
 was experimenting on her with injections of semen which, to her, 
 accounted for the cessation of menstruation. 
 
 She complained to me that she could not hold the "sticky" 
 fluid (saliva) in her mouth, as if she believed it was necessary. In 
 her retrospective analysis she brought out many fancies that she 
 had about foods, such as custards, and yellow colors that "dis- 
 gusted" her. The custard she identified with semei'' and like the 
 "sticky" saliva, it throws considerable light on the tendency to 
 hold sali^'a in the mouth as part of the impregnation fancy. Her 
 knowledge of semen she said, had been gathered through reading. 
 (Saliva, nasal secretions, pus, greases and soaps are not uncom- 
 monly identified by patients as being semen.) 
 
 During this impregnation stage the patient's behavior was 
 more or less consistent in her unshakable tendency to pursue her 
 own course. This condition lasted about four months. Most of 
 
CHROlsriC CATATONIC DISSOGlATlO^i 587 
 
 the time she was confined to bed and tube-fed. She resisted every 
 attention, kept her eyes closed, lips protruded and pressed to- 
 gether, and retained large quantities of saliva. She was unclean, 
 thin, haggard, ugly, and seemed to be in more or less of a stupor. 
 This, however, was not a true stupor, since she was later able to re- 
 member most of her experiences during this stage. (Later, during 
 the retrospective analysis, she explained the meaning of some of 
 her postures. The reason for holding her hands above her head and 
 digging her fingers into her palms was to keep from masturbating. 
 (See Fig. 46, Rodin's "Centauress.") During this period she real- 
 ized that she ivas deriving sexual pleasure from her fancies and 
 hallucinations. She yielded to this form of mental masturbation 
 with the justification that she was "experimenting," but later 
 realized that she was unable to control herself. These fancies were 
 probably in the form, as she expressed it, of acting out "every 
 character" that she had ever read of. 
 
 We felt we fully appreciated the erotic significance of her 
 catatonic dilemma and that the vigor of the autoerotic cravings 
 made it impossible for her to relinquish her bizarre adaptation 
 to control them. During one of her "stuporous states" in which 
 she had not tallied for several weeks and had to be confined 
 to bed becaiise of her extreme emaciation, rapid pulse, general 
 weakness and confusion, I asked her if she was enjoying her fan- 
 cies. A distinct wincing of the facial muscles revealed her sur- 
 prise that anyone should understand her, and, when the ward 
 physician came in, this "stuporous" patient got out of bed and 
 insisted upon having her clothing. She said she could stay here no 
 longer and "must go home." 
 
 The treatment was essentially of a threefold nature. The 
 hydriatric and dietary treatment to build up her exhausted physical 
 condition, and a preconceived plan of helping her to realize that her 
 personal difficulties were understood, but were not censured, and 
 that they were to be overcome because other interests in life were 
 more attractive and important to humanity. According to the 
 patient's behavior and her expressions of gratitude later, this last 
 step in the reconstruction started with a transference to Dr. Anita 
 Wilson, which was followed by efforts to win her approbation. 
 Before discussing the reconstruction, in order to bring out the 
 value of the psychosis to the patient as a gratification of the erotic 
 affect it should be given some further description. So long as the 
 
588 PSYCHOPATHOLOGY 
 
 imitative tendencies continiTed she was the play-object of several 
 patients who had sadistic trends that dovetailed with her maso- 
 chistic cravings. She wanted to eat dirt, and one of the patients 
 had to be watched to be prevented from feeding her cockroaches, 
 flies, etc. Despite supervision she gulped down primes, seeds, 
 great quantities of food, etc., like an automaton. She stole keys, 
 buttons, light switches, steam valves from the radiators, and 
 smeared herself with black grease to keep the electricity out of 
 her body. At other times she sought the electricity. Her bones 
 were broken, eyes destroyed, flesh burned, and she believed that 
 she died, lived among her dead relatives (misidentifying patients 
 as such), and endured the torments of hell (intrauterine regres- 
 sion). The details of these hallucinatory and fancifuh experiences 
 would fill a volume. She was finally reborn after due purification. 
 The reconstruction of the new life became manifested rather sud- 
 denly, and she progressed up to the point of being able to work, 
 then something occurred that discouraged her and she again re- 
 gressed to a state of helplessness. After a few weeks she reacted 
 again and improved up to a certain point. She now began to write 
 the story of her life for me, but the sentences were poorly associ- 
 ated. She talked most about having had brain syphilis and that 
 she was recovering from it. My first intimation of her transfer- 
 ence to me came with her reaction to a rather simple but firm ex- 
 pression of belief that she never had syphilis. She rather joyously 
 abandoned the notion of syphilis, I thought, in order to believe 
 what I believed, and felt encouraged because now she could get 
 "absolutely well," as she expressed it. She attributed the onset 
 of the recovery (fifteen months after the first visit to the sanator- 
 ium) as being due to the resumption of menstrual function, which, 
 of course, must be, in turn, attributed to the benefits of hygienic 
 treatment and the disappearance of anxiety through weaning her 
 from her autoerotic interests. 
 
 The review of her psychosis and her emotional problems pro- 
 gressed rapidly, but it was nearly two months before she was able 
 to speak the word "masturbation." Her defense for her illness 
 shifted from brain syphilis to exhaustion from overwork, mother's 
 sufferings, etc. Finally, however, we were able to deal quite 
 frankly with the autoerotic cravings and she recognized that the 
 compiilsive feeling that she "must work" was a form of fighting 
 her fear that she might lose control of herself and relapse again. 
 
CHRONIC CATATONIC DISSOCIATION 589 
 
 For some time she complained of crainpin^' pains in tlie right 
 arm, but these disappeared as the anto(ux)tic trend waned. The 
 selfisli pleasures of autoerotieisra wore pretty vigorously dealt 
 with, and she responded with more enthusLastie and genei'ous feel- 
 ings toward the interests of humanity. It must be emphasized 
 here that her fiance's attitude gave her consideral)lo encourage- 
 ment, lie felt himself to be obligated to her, and would consider 
 no other adjustment than marriage. His reasons for this feeling 
 of duty were not investigated. We emphasized, however, that her 
 fitness to marry depended entirely upon the nature of her recov- 
 ery and insight. 
 
 The analysis did not succeed in completely bringing out the 
 value of the infantile gratifications in the psychosis. She summed 
 it up pretty well, however, in the analysis of the dream that pre- 
 ceded the onset of the autoerotic orgy, namely, of climbing a hay- 
 stack, and then sinking "down, down, down, and coming out on 
 the left side," moaning that she considered it to presage a moral 
 fall because of inability to control herself. During her illness she 
 thought her disease affected the right side. She would not accept 
 things from the right side, she said, but tliis was not altogether 
 true. She said her illness benefited her greatly, and now she could 
 begin life all OA^er again. "My case Avas like a prolonged night- 
 mare. ' ' 
 
 The patient's recovery was, on the whole, rapid and unevent- 
 ful except for several periods of mild anxiety that arose when un- 
 pleasant situations threatened to stop the psychoanalysis. These 
 situations, which perhaps would have caused a patient in private 
 practice to discharge her physician, were, however, readjusted 
 when she was given an opportunity to express her resentment to 
 the significance of her affective relationship to the father and 
 mother. This caused such vigorous resistance, which was unfor- 
 tunately supported by an unsophisticated confidant, that the an- 
 alysis had to stop there. The conditioning of the wish to become 
 ill like her mother was never brought to the surface. (She be- 
 lieved the mother's illness was due to the father's sexual incon- 
 siderateness, and during the first part of the psychosis she hallu- 
 cinated herself in possession of the father. This, however, could 
 not be analyzed.) 
 
 The patient gained rapidly in weight, strength and mental 
 
590 PSYOHOPATJIOLOGY 
 
 efficiency, aiid was discharged as recovered twenty-oiie months 
 after the onset of the illness. 
 
 Within a few months she returned to work and has since been 
 doing unusually well as a social worker. One year after her dis- 
 charge she was married, and several months later again resumed 
 her social work. She now feels satisfied with her marriage, but 
 has had no children as yet, because she feels the interval of re- 
 covery has not been long enough (two years). 
 
 This case is so transparent that it needs little discussion. 
 She was trained by a mother, who had herself been trained to 
 suppress her sexual emotions, to be fearful and ashamed of her 
 sexual functions. The resistance was so vigorous that she could 
 not love or marry, and when the erotic pressure excited by fancies 
 and courtship, finally dominated, it was diverted to autoerotic 
 fancies instead of heterosexual realities. A grave dissociation 
 of the personality with destructive erotic abandonment finally re- 
 sulted. The affective readjustment required, in order to be 
 healthy, insight and the practice of affective gratification char- 
 acteristic of normal, happy people. 
 
 This patient might have made a social recovery without psy- 
 choanalytic treatment, but it is certain that she would have so ad- 
 justed as to be eccentric, tense and sensitive about her autoerotic 
 inferiority, which would have always exerted a serious pressure 
 upon her. 
 
 It seems that a psychosis depends largely for its periodicity 
 or continuity upon the nature of the affective pressure that the in- 
 dividual is trying to control. The chronic type of psychosis is 
 naturally associated with a chronic affective pressure which forces 
 the individual into a sustained eccentric, asocial position, whereas 
 the periodic type is associated Avith periodic exacerbations that 
 may subside and be very well adjusted. 
 
 The following case (CD-4) shows that crucifixion psychoses, 
 also, may vary in their activity as the erotic pressure varies. 
 
 The psychosis of CD-4 was characterized by two years of in- 
 tensive striving in order to establish his biological potency ; 
 marked by periodic exacerbations of homosexual panic, serious 
 dissociation of the personality, with hallucinatory disturbances of 
 all sensory fields, no insight, and a tendency to make a grand re- 
 
.CimONK! CATATONIC IHSSOCrATlON 591 
 
 ligious compensation for social uplift. He A\as constantly invent- 
 ing machinery and eccentric devices, with some success, "to con- 
 serve energy." This, it will be seen, was clearly a desperate com- 
 pensation for seminal wastage-. 
 
 The family history revealed no neuropathic or psychopathic 
 traits. His mother died Avhen he was three weeks old. At birth 
 he was considered to be a "weakling and not expected to live." 
 He never had a wet nurse. He had none of the serious diseases 
 of childhood, and no gonorrhea or syphilis. Upon admission his 
 blood test was negative for syphilis. 
 
 He did not learn to walk until he was three years old, but, 
 otherwise, his mental development and education showed no re- 
 tardation. Because of an unusual interest in machinery he suc- 
 ceeded, after six years of assiduous self-training and apprentice- 
 ship, in securing (at twenty-four) the rating of a first-class ma- 
 chinist. He derived unusual pleasure from improving machinery, 
 and, in several instances, made successful inventions, which are 
 now used by the Navy. 
 
 His sexual career was characterized by addiction to secret 
 masturbation from the years of nine to twenty. As usual be- 
 cause of secret autoeroticism he was unable satisfactorily to 
 transfer his affections, although he made anxious, "helpless" 
 efforts to do so. When twenty, his father tardily warned him 
 about the dangers of masturbation, and, as a criticism, praised 
 the physical fitness of the Zulus, who, he said, abstained from all 
 sexual relatioi:is until they reached the age of twenty-five. This 
 deeply impressed the patient and, during his psychosis, he tried 
 to develop the physical standard admired by his father. At 
 twenty-one, he married a girl of his age despite the protests of her 
 father. They had five children. The first was still-bom, the sec- 
 ond died of "marasmus" at five, the third died at four months 
 from "intestinal trouble." The other two children are living. 
 The weakness of the three dead offspring confirmed the patient's 
 notion of being a physically inferior man. 
 
 During the first year of his marriage, he practiced sexual in- 
 tercourse almost every night, usually resulting in ejaculatio 
 precox. He attributed his inability to perform coitus adequately 
 to his weakness at birth and his former masturbation. Apparently, 
 he had no insight into the requirements of sexual hygiene and 
 self-control. 
 
592 PSYCI-IOPATHOLOGY 
 
 The sexual relations were unsatisfactory to his wife as well 
 as damaging to his self-confidence, and caused them no little dis- 
 appointment in one another. 
 
 While stationed away from liis family, he became very erotic 
 and indulged in promiscuous sexual relations with Avhite and 
 colored prostitutes, including instances of fellatio on the part of 
 his sexual object. 
 
 The patient was holding a responsible position as machinist in 
 a United States port at thirty-eight, the time of the onset of his 
 psychosis. His family was comfortably provided for and his po- 
 sition assured. He was, hoAvever, intensely interested in social- 
 sexual reforms, and devoted much of his time to teaching a Sunday- 
 school class. He worked out an endless chain plan for buying 
 churches, and planned several civic reform movements, and an 
 ambitious 4th of July celebration. 
 
 His Avife noticed that for some time previous to this celebra- 
 tion he had tended to be extravagant with his money. He slept 
 only a feAV hours at night, and was "constantly on the go." He 
 tried to induce the entertainment committee to invite the President 
 to the 4th of July celebration, and became so enthused over the 
 prospect, that he had to be restrained because he made wildly 
 enthusiastic speeches on the streets. 
 
 The onset of the psychosis was characterized by gradually in- 
 creasing insomnia, constant activity, poor appetite, and uncon- 
 trollable "inspiration." He Avould write speeches and articles for 
 publication throughout the night, and his wife, he said, was unable 
 to induce him to stop these "abnormalmental practices." 
 
 His associates and superior officers felt that the patient was 
 egotistical, and was flagrantly trying to aggrandize himself. "He 
 was very talkative, claimed to be an unusual genius in art, to have 
 musical talents, to be a social reformer, an inventor of marine 
 machinery, and to know a great deal about medicine and every- 
 thing else." At times he maintained an attitude of affected re- 
 serve, was irritable, and inclined to outbreaks of anger. He be- 
 lieved his mind "was keener than it had ever been before." He^ 
 was obsessed Avith ^the desire to talk about the fall of Adam and 
 Eve because of their sex relations "for lustful purposes." These 
 talks were irrepressible, and to men and women, in fact, to anyone 
 Avho listened, he said: "We want to be Christians, we Avant to 
 understand the Bible in the beginning or we won't understand the 
 
CHRONIC CATATONIC DISSOCIATION 593 
 
 rest correctly. ' ' The original sin, he said, was sexual intercourse 
 for pleasure. Sexual intercourse should be for the idea of con- 
 ceiving a child. He advised the nurses frequently: "If you want 
 to really know if the man is truly in love, look him in the eye, ask 
 him if he really wants to do that to have a child by you, and, if he 
 does, it is love, and, if he does not, it is lust." (His sexual ex- 
 cesses for which this was a compensation should be kept in mind.) 
 
 Sexual intercourse for lust, he said, was the cause of the fall 
 of Adam and Eve, and he believed, during the early period of his 
 psychosis, that this was the trouble with humanity and he himself 
 must correct it. (Two years later, when he discussed this subject, 
 he said: "Now, I think it was not that, but it was sex perversion. 
 The 24th and 25th verse of the 2d chapter and 1st verse of the 4th 
 chapter seem to confirm the idea that it was not sexual intercourse 
 but sexual conversion, I mean sexual perversion that caused the 
 downfall of man. ' ' 
 
 Upon his admission to St. Elizabeths Hospital he was in 
 good physical condition, well developed, very strong and active. 
 He had good features and appeared to be more intelligent than 
 the average, enlisted seaman. His memory for most details was 
 remarkably accurate. He was well oriented despite his excitement 
 and the frequent hallucinatory vividness of the sensory disturb- 
 ances of all his major receptor fields. He felt compelled to do 
 many odd things, some of which will be described later, and com- 
 plained bitterly because he was unable to keep from lying. When 
 he improved, one of his triumphs was the ability to tell the truth 
 again. 
 
 He expressed himself as being decidedly happy and optimistic, 
 and acted accordingly; but, at times, he wept bitterly and com- 
 plained of being depressed. He insisted that nothing worried him, 
 which is quite typical of the so-called manic type, and yet he tried 
 desperately to obtain freedom and exercise in order to save himself 
 from "moral degeneration," about which he was very anxious, 
 even though he maintained that "nothing" worried him. 
 
 Insight was lacking in the sense that he never, even when dis- 
 charged, would consider that he had been insane. His "nervous 
 system was run down" and, as he said: "I realize I need rest 
 and quiet," was about the extent to which he would consider his 
 difficulties. His powers were concentrated upon the sole object of 
 establishing his biological fi.tness and self-control at any price of 
 
594 PSYCHOPATHOLOGY 
 
 reality. Because his "memory was even a little keener than ever 
 before," he made the not uncommon contention that he could not 
 be insane. He performed the intelligence tests fairly well.' 
 
 Throughout the first few months of his siay in the hospital, ,he 
 denied his hallucinatory experiences and was not frank. He re- 
 fused to eat and wanted to fast, but would not explain its signifi- 
 cance (religious). For several months, he incessantly tried to 
 convert patients to accept his religious views, because he believted 
 that sexual perversions had caused the downfall of Man. He be- 
 lieved he was inspired by Christ and twice cultivated a beard like 
 Christ's, walked about with eyes uplifted in a soulful manner, 
 tried to heal the sick, and save the damned. The remark of a 
 woman visitor that he looked like Christ, elated him. He said, 
 ' ' In my efforts to lead you and others back to Christ, I have taken 
 him into my life so much that if I grew a beard and proclaimed 
 myself as the Christ that is expected, it would be believed by 
 many, especially after my beard had grown out. A woman told 
 someone that I looked like Christ, and, besides, by taking him into . 
 my life, I have acquired some of his qualities." (See the photo- 
 graph of another patient who simulated Christ, Fig. 59). 
 
 The patient expended tremendous energies in writing. He 
 was almost indefatigable in the exposition of his version of the 
 biblical story of Adam and Eve. He made lavish claims of being 
 an inventor (creator) of battleships, guns, machinery, and, in fact, 
 anything that struck his fancy. He wanted to patent several of 
 his inventions and would willingly have spent all his income to 
 further these fancies. Strikingly enough, but as is characteristic 
 of the impotent and almost pathognomonic, his inventions were 
 always about the conservation of energy and utilization of all the 
 waste (reconstruction for the wastes of masturbation), with the 
 ultimate hope of perfecting perpetual motion (omnipotence.) 
 
 His religious fancies were intimately interwoven with his in- 
 ventions and indicated their common root. He originated a system 
 by which a community could accumulate money, build a churchy 
 and have sufficient funds left to start a second nucleus for a church- 
 building fund "like an endless chain" (perpetual motion). 
 
 During this prolific period of fancies, he was very courteous 
 and delighted with anyone who would listen to him. At the same 
 time, he was decidedly displeased with his "wife and Avrote numerous 
 
CHRONIC CATATONIC DISSOCIATION 595 
 
 indignant letters, some frankly shoAving suspicions of her fidelity 
 and the renewal of the desires of her father to get rid of him. 
 
 About the sixth month of the psychosis the repressed, erotic 
 cravings could no longer be controlled or disguised. (It is in- 
 teresting to note that he never was sensitive about his tendency 
 to homosexual perversions.) He had been allowed limited freedom 
 of the grounds because of his harmlessness and his courteous 
 agreeable manner. For several weeks previous to the following 
 climax he had been secretly entertaining vivid erotic fancies about 
 another male patient. He fancied that this man was making "pas- 
 sionate love" to his wife, and he must go home and "save them 
 from themselves." He must "interfere and forgive them for 
 almost giving way to their feelings." This man seemed particu- 
 larly admirable to him at this time. A few nights later, while lying 
 in a dream state in a bathtub, he responded to these erotic 
 thoughts, and, jumping out of the tub, rushed into his room, ex- 
 claiming: "I love you! I love j^ou!" The erotic pressure soon 
 precipated a climax. (The fancy about loving the same woman is 
 often the meeting point of homosexuals.) 
 
 During this period he dreamed of being shot, burned, etc., and, 
 one night, that his house was burning in a great fire and his wife 
 and children were being destroyed. This dream, and its after- 
 images, were so vivid that he believ^ed it to be a reality and became 
 panic-stricken. He rushed about the ward looking for evidences 
 of the fire, and tried to telephone to his wife in New Orleans to 
 find out if it was true. The most pressing assertions that informa- 
 tion had been received from his home and that everything was all 
 right would not quiet him. He fought the attendants desperately 
 and tried to jump from the windows in order to escape. His 
 anxiety was intense and, while still worrying about the fire, the 
 next night, he evaded the attendants and sneaking iiito the bath- 
 room filled the tub and flooded the compartment. For several days 
 he continued to have hallucinations about his suffering wife, heard 
 God calling him and was unable to eat, sleep or rest because of his 
 anxiety. [Several months later, he explained that the panic had 
 resulted from increased weakness and seminal emissions with 
 dreams of great fires and loss of self-control, because he had per- 
 mitted his beard (Christ's) to be shaved off. He insisted that a 
 saving strength grew in the hair. J He called different nurses 
 "wife," and usually saved part of his food for his "wife." He 
 
596 PSYCHOPATPIOLOGY " 
 
 considered himself to be doomed to die and "go to God," and that 
 he had to save the world (crucifixion). He temporarily improved 
 in his general behavior after this panic. 
 
 Abont the seventh month his parole of the grounds was re- 
 turned and, for a month, he restrained himself fairly well, until 
 the eroticism again dominated his behavior (eighth month). He 
 became noisy, talkative and bothersome, wandered about, usually 
 alone, would run up and down the steep hills to develop his en- 
 durance (like the Zulu) and indulged in a variety of unique ex- 
 ercises. He was always eager to compare his superior strength 
 with that of other men, and delighted in taldng punishment when 
 boxing. (This disguised his biological inferiority in one sense, 
 and, also, pleased his sexual cravings to be punished.) He said 
 when a certain man hit him in the chest, "it caused an erection." 
 In harmony with this, he begged the physicians to experiment on 
 him. (This compares strikingly with the panicky homosexual who 
 is afraid of being experimented upon.) He tried to prove that his 
 body was able to overcome any deleterious substances that might 
 be introduced into it. He ate all sorts of leaves and seeds, and 
 finally "produced a climax by drinking sewer water from a ravine 
 because "it was full of germs. ' ' His method was to dip his fingers 
 into the slime and lick them off. (In such erotic states, patients 
 often believe that fellatio or cunnilingus will relieve them. The 
 germ-laden sewage as a semen equivalent is obvious. Some pa- 
 tients drink from the hoppers.) 
 
 The uncontrollable craving that forced this impulsive act 
 frightened him and, although he ate sand "to scour" himself out, 
 he returned to the ward and anxiously sought a cathartic and bath. 
 He completely submerged himself in the tub and drank inordinate 
 quantities of water, exclaiming, enthusiastically, that he was able 
 to force the water directly through his bowels while he was sub- 
 merged. (The feminine sexual cravings were apparently being 
 gratified by this archaic submerging in water and emitting water, 
 germs and sand, as a parturition.) While in the tub he had in- 
 congruous fancies about a rebirth. A few days later, while still » 
 in this mental state, he ate a red poinsettia's leaves. Then he 
 felt inspired to eat "root and branch," whereupon he devoured 
 the stalk, chewing it down to the ground. Highly excited, he now 
 fell upon his knees and, as he said, "tried to go down on a man and 
 invited the man into a room." This behavior was attended Avith 
 
CHRONIC CATATONIC DISSOCIATION 597 
 
 the most uncontrollable affective disturbances of weeping, resig- 
 nation, agitation and trembling. 
 
 By the ninth month this excitement again subsided, and a 
 depression with indifference, retardation and inactivity developed. 
 He frankly accused himself of being a "degenerate," and wrote 
 numerous self-accusatory letters to his wife. He would stand for 
 hours in one place, and showed great affect when he talked of his 
 general condition. 
 
 Gradually he resumed some interest, although he was con- 
 fused and still considered himself a degenerate. One morning a 
 steam pipe blew out in the hall and he hallucinated his son's voice 
 calling in distress to his mother. He was sure an accident had 
 happened at home and not only on the ward. (The feelings that 
 desired a disaster to the family were always fought against by the 
 patient. The sexual cravings which would destroy all the resist- 
 ances within the personality, in order to have free play, caused the 
 fancied destruction of the family ties as the destruction of the re- 
 sistances that opposed homosexuality.) 
 
 The feeling of unworthiness continued throughout the ninth 
 to the fourteenth month, although he was no longer retarded. He 
 compMned of being a miserable sinner because of his acts of de- 
 pravity, but would never confess what they really had been. 
 Whether or not he really committed fellatio, which he was in- 
 clined to say he might have done in his confusion, he never ac- 
 tually admitted. During this time he believed he had two fathers " 
 and mothers (probably heavenly and earthly) and again grew a 
 beard and renewed his fancies about being "like Christ." Be- 
 cause of his sincerity, courtesy and harmlessness his parole was 
 renewed. He started many enterprises about the grounds, but 
 never finished anything. Gradually his efforts became more prac- 
 tical and he became less self-assertive. Upon his own application 
 and our consent he was given a position in a machine shop. 
 
 In the twenty-seventh month, as the result of persistent beg- 
 ging, he was permitted to go to work in a nearby munitions fac- 
 tory. He worked very well there, but was simply unable to keep 
 from coming in conflict Avith his foreman and other supervisors be- 
 cause he delighted in displaying his inventiveness, and criticised 
 right and left by suggesting improvements. He worked on a lathe, 
 and soon discovered an improvement by which he could increase 
 its capacity two, and later, threefold. This little infringement 
 
598 PSYCHOPATHOLOGY 
 
 upon the foreman's ingenuity (and social potency) aroused the 
 .latter 's animosity and, true to human nature, he tried to squelch 
 the patient's enthusiasm. This resulted merely in the patient's 
 utilizing another outlet^a man higher up. 
 
 From the improvement, however, of the machine, the patient 
 expanded from the practical to the absurd and insisted upon giv- 
 ing advice about remodelling all types of machinery and, in fact, 
 the entire place. lie was always kindly disposed about it, but ir- 
 repressibly insistent. He was discharged as a "nuisance" from 
 the factory three weeks after he started working. 
 
 During the next year he "experimented" and claimed to have 
 found methods of curing insanity. He freely advised the physi- 
 cians and incessantly urged- them to heed him. During the day he 
 wandered about the grounds looking for an outlet for his restless 
 energies. He cultivated a small plot of ground and raised vegeta- 
 bles and flowers, but allowed the garden to become weedy before 
 the season was through. Later, he gathered together large pieces 
 of cast-off machinery, and, at immense labor, dragged them to a 
 pit in the woods, dug a well, built a furnace and constructed a 
 bellows, engine, firebox, etc. He expended unlimited energy in this 
 pursuit with the ultimate object of creating an engine that would 
 utilise all its power and waste nothing. It was an approach to the 
 perfect engine like the state he ceaselessly strove to establish in 
 himself. (Compensation for the waste of masturbation and his im- 
 potence—Cases P-1, PD-12, CD-8.) 
 
 Although most of his plans miscarried, because he was too 
 ambitious and had no means, he derived great pleasure out of his 
 little successes. (If given suitable opportunities, these indefati- 
 gable workers, with their prolific imagination, practical experience 
 and humanitarian motives, might make invaluable contributions 
 to civilization.) 
 
 The following spring (thirty-second month), he abandoned 
 this work and devised a scheme for selling subscriptions to maga- 
 zines and developing a "big business." He still retained his re- 
 ligious fancies about himself, but was finally persuaded again to 
 have his beard shaved off, not however, until he felt absolutely 
 sure that the dreams of fire and nocturnal emissions would not 
 return. He had facetiously maintained that he wanted to see the 
 reactions of his wife to his beard. The fact that no erotic exac- 
 erbations occurred this time with the loss of the beard did not 
 
CHRONIC CATATONIC DISSOCIATION 599 
 
 cause him to change his general attitude about its value to his 
 virility. 
 
 In the thirty-fifth month he was allowed to visit his wife after 
 emphatic warnings to avoid sexual excesses and worry in case of 
 precocious emissions or impotence. lie was discharged thirty- 
 seven months after his admission. 
 
 Althoiigh his general intelligence was unimpaired when he 
 was discharged his obsessive striving revealed the persistence of 
 the underlying fears. liis compensatory trend, his inventiveness 
 (creativeness) and religious-social reforms are absolutely neces- 
 sary to him in order to avoid another, collapse and further homo- 
 sexual difficulties. It gives him something definite to work for. 
 His affective career is essentially an incessant biological struggle. 
 With encouragement, and a healthful heterosexual attainment, he 
 may yet succeed in becoming a useful member of society. 
 
 Several months after his discharge, he wrote for adAdce about 
 an erotic dream that resulted in masturbation and was followed 
 by a "hideous sound" of "angry voices" (the old protest of na- 
 ture). 
 
 The man never showed anal erotic interests or hatred, and 
 had no systematized delusions fixed upon particular individuals. 
 
 Here was a clear case of prolonged masturbation in youth, 
 persistent eroticism, excessive sexual indulgence with ejaculatio 
 prsecox, nocturnal emissions, and, finally, a regression to homo- 
 sexual cravings, which were compensated for by tremendous striv- 
 ings not to only create machinery that would conserve and use all 
 its energy, thereby eliminating the sins of waste, but also to re- 
 form the sexual life of the herd. This patient was never analyzed. 
 His behavior attracted considerable attention from the hospital 
 staff and the foregoing data was freely given by the patient. 
 
 Surely, upon impartial consideration, the crucifixion and the 
 submission to the sublime father can have no other than a pro- 
 found biological significance, and a long established phylogenetic 
 foundation in the infrahuman ancestors of man. 
 
 I have observed frequently that monkeys (Macacus rh-esus), 
 when sexually fatigued and indifferent, ^YiY[ become highly excited 
 and erotic at the screams and panic of an intimidated monkey that 
 is being persecuted by another. This persecuted, terrified monkey, 
 if it can not escape, usually assumes the sexual position and its 
 persecutor generally ends by copulating with his viftim, where- 
 
600 PSYCHOPATHOLOGY 
 
 upon the other previously indifferent monkeys, also having be- 
 come excited engage in copulating with one another. The primi- 
 tive man no doubt was 'greatly invigorated and sexually excited 
 by persecuting and maltreating his captives. Their terror and 
 pain, the gushing blood and dying gasps were sanctified by reli- 
 gious ceremonies and the erotic reactions culminated in the fruits 
 of numerous pregnancies. We still have the symbolic sacrifice of 
 the lamb and the attainment of divine grace in religion. 
 
 In man, the popular debauches and assassinations, and tor- 
 tures by beast and brute, as occurred in the Eoman ampitheatre, 
 and the public festive murders of the French guillotine, as well 
 as the dog-fights, cock-fights and prize-fights of today are popular 
 because of their erotogenic influence. Almost daily one may read 
 of the mutilation and murder, by some group of brutal assailants, 
 of an unhappy man, woman or child who is really crucified for 
 their lust. On the other hand one actually meets men and women, 
 who, erotic and uncontrollable, seek such mutilation and, not be- 
 ing able to acquire it at the hands of others, inflict it upon them- 
 selves, associating with it religious, crucificial fancies. Such acts 
 are not rare in the history of any asylum for the insane. 
 
 The above man's desire to be "experimented upon" is similar 
 in its value to the desires of the three following "Christ" who 
 prayed ardently to be crucified, one of whom excised one of his 
 testicles. The physician (Case PD-1) also, who became a brilliant 
 philologist at fifty, amputated his penis to save humanity, and at 
 eighty-five still begs to have his testicles removed for the same pur- 
 pose. Christ's public crowning of thorns, carrying of the cross 
 through the city's streets, the lashing and crucifixion, as a festival 
 that excited and pleased the mob, restless under the impetus of the 
 awakening Spring, should surely be compared as a biological phe- 
 nomenon to . the bloody sacrifices of the Mexican and Peruvian 
 Indians, the Egyptians and ancient Asiatics, as well as the erotic 
 attacks of the infrahuman primate and the ape-man upon their 
 victims. 
 
 It' is necessary to understand the behavior of man, including 
 his most sacred and tabooed rituals, in a biological light or it can 
 not be truly understood at all. 
 
 Case CD-5 was an uneducated Russian immigrant Avho was 
 sent to St. Elizabeths Hospital after having excised one of his 
 testicles. He said he did it to stop masturbating, but his behavior 
 
CHRONIC CATATONIC DISSOCIATION 601 
 
 otherwise showed unmistakable religious fanaticism and the de- 
 sire to be crucified. He tried to raise a beard like Christ, and his 
 prayers and uplifted eyes, ecstatic crucifixial countenance, his tears 
 and impulsive giggles, revealing pleasure at the physician's ap- 
 proach on the ward, showed, as he persisted in attempts to bow 
 and kiss the physician's hand, not only his appreciation, but also 
 an intense desire to subject himself to the physician's domination. 
 The homosexual eroticism of this was suspected at first, but later 
 it became confirmed when we had to watch him continually to pre- 
 vent him from getting into homosexual embraces with other erotic 
 men. 
 
 Case CD-9 was a well-built, submissive-looking Bavarian, age 
 twenty-nine, unmarried. His crucifixion cravings and penitent at- 
 titude were frankly due to his sexual "sins." 
 
 When a child he spent several years in a monastery, received 
 a common-school education in Germany, and gave the impression 
 of being a man of fair mental capacity and not a mental defective. 
 
 He worked in a brewery and consumed an average brewer's 
 amount of beer daily, but his psychosis had no characteristics of 
 alcoholism. About three years before his admission he passed 
 through several months of anxiety and prayer because of sexual 
 perversions that he had committed. The psychosis for which he 
 was sent to St. Elizabeths Hospital was very similar in it charac- 
 teristics to the former period, and had endured for two years be- 
 fore his admission. Although he had resumed work in the interval 
 between the two psychotic periods, it is quite probable that the 
 disease process was one psychosis, the behavior being very simi- 
 lar. 
 
 The striking characteristics of his behavior were the almost 
 incessant kneeling, folding of hands, bowing of head, elevation of 
 wide-open, ecstatic eyes, and fervent praj'^er to be freed from sin. 
 He regarded almost all men who came near him as priests and de- 
 voutly made the sign of the cross, prayed for forgiveness, and if 
 anyone stood before him for a few moments he usually tried to 
 kneel, kiss the man's hand and begin a confession of freed sins. 
 (See Fig. 77.) 
 
 He practically lived on his knees and prayed incessantly with 
 sincere fervor and appeal, frequently weeping bitterly with copious 
 flow of tears. In due course of time a severe bursitis developed 
 over each patella for which he had to be confined to bed. Here he 
 
602 PSYCHOPATHOLOGY 
 
 continued to fold his hands and pray. Frequently he made crosses 
 with his thumb on his forehead, lips or chin, and breast, and often 
 placed the hand of "your highness" on his head for a blessing. 
 Frequently he bowed his forehead to the floor and kissed the floor. 
 
 He frankly told almost anyone what his sins were, in usually 
 the following style and with most sincere feeling : "I make myself 
 too much trouble. My mother is not well off [sick]. I wish to 
 make my confession. I cursed marly times. I was bad many times 
 when I was a little boy." Here he confessed to a list of childhood 
 oral and anal erotic acts upon his younger brother and a pet dog. 
 That the oral erotic tendencies persisted is certain, because of 
 frequent practices of cunnilingus since he became an adult. "I 
 worry over this. It is my fault. I had no right to do it. ' ' 
 
 His ideas about the hospital were significant. It was a place 
 "to create good men and ladies." (Such statements usually offer 
 a reliable prognosis because the feeling of having been made a 
 "good" man would eventually dominate the anxious personality 
 if he was not interfered with or mishandled.) He frequently 
 "saw" Christ and insisted one of the patients was the Christ who 
 had come to save him. 
 
 When he spoke of Grod and Christ he said: "Many times I 
 was not satisfied and prayed on everything he gave. I have a feel- 
 ing that I can not look at what your highness is writing. ' ' He was 
 inclined to become panicky, with all the symptoms of great fear, 
 such as blanched face, cold-beaded perspiration on the forehead, 
 wide staring eyes, trembling, and inability to attempt to escape. 
 He felt that he was going to be killed, burned and crucified. 
 
 He would not eat "because all trouble and fight — curses and 
 trouble come in my head when I eat. ' ' He felt that this was caused 
 by a poison in his food. "I said to my good mother once, 'I guess 
 you poisoned my spoon.' I had a feeling to help my mother, I 
 want to be a child of you and the U. S." (Eagerness to make a 
 transference.) 
 
 He complained most persistently that he had a snake in his 
 throat. This, associated with his expectant, pleased, yet anxious 
 attitude toward "dying," and pleasing his "dear God" (cruci- 
 fixion), and his passive supplications to men, with vivid feelings 
 of being oral erotic, made it obvious that strong submissive homo- 
 sexual cravings were the cause of his anxiety. The anguish about 
 dying and pleasing his "dear God" were crucifixion pleasures. 
 
CHRONIC CATATONIC DISSOCIATION 603 
 
 The intelligence tests were unsatisfactorily responded to, but, 
 although he at times seemed to be confused, retarded and dis- 
 oriented, when answers were patiently insisted upon, we frequently 
 found that he Avas not disoriented and relatively not so confused. 
 
 His effusive smiles, when given some attention by the physi- 
 cians, showed his great pleasure and his happy transference to the 
 ' ' highness. ' ' 
 
 About four months after his admission he began to improve in 
 that he took more interest in his environment and it was quite easy 
 to convince him that we believed work was as necessary as prayer 
 to save his soul. He became a diligent worker and gi*adually an 
 incessant worker. When he was discharged seven months after 
 his admission, he was pleased with his "cure" and said that God 
 had forgiven him. 
 
 The phallic significance of the hallucinated snake was most 
 clearly demonstrated by Case CD-6, a married soldier, thirty-three 
 years of age, who was in a homosexual panic A\'ith predominant 
 crucifixial tendencies at the time of this observation. He refused 
 nourishment and withdrew from any contact A\'ith men. He said, 
 "They have switched the keys on me here. It looks to me in this 
 moving picture thing [visual hallucinations are often called by this 
 name] that someone is putting a job on me. It seems as though 
 someone is trying to poison me. It seems the carpets [red] are 
 poisoned. There has been a lot of cigarettes and poisoning going 
 on here in the U. S. The snakes have made greater discoveries on 
 us than doctors. Snakes understand us better .than we do them. 
 They have a great idea of business. Siiakes keep their forbidden 
 fruit better than anyone also. Forbidden fruit is a poison for 
 edible purposes. I am poisoned by forbidden fruit. There are 
 many snakes here in B-4. Battlers. I see their poison. It loohs 
 like semen. They give me snake poison, sem-en, here. They want 
 to land us all in the forbidden fruit country. The nurse here has 
 been poisoned. She was dead and was captured by snakes and 
 brought back to life. * * * j'he snake poison comes from the 
 human body through the penis. I think snake poison vvjvld give 
 me life." 
 
 The patient accompanied the above complaint with many ef- 
 forts to stop the hypnotic influences of the physician whose pres- 
 ence filled him with sensations, electricity, etc., and caused feelings 
 of weakness, loss of sexual poAver, etc. 
 
604 
 
 PSYCHOPATHOLOG Y 
 
 Before this man collapsed in a state of homosexual panic he 
 made a wild effort to save himself by claiming great creative 
 powers, inventive faculties and prophetic inspirations. During 
 this state of grand compensation he bitterly accused his wife of 
 sexual infidelity. 
 
 During his panic he Avas not disoriented and could coordinate 
 sufficiently for simple mental tests. 
 
 Pig. 59. — Simulation of Christ to please the father and sublimate homosexual 
 
 cravings. 
 
 The following case (CD-7), (see Fig. 59), came to Washing- 
 ton, to advise the President how to stop the war. He said he was 
 inspired by his father, and the voice of God to fulfill a mission as 
 Jesus Christ. He also associated himself with the biblical heroes, 
 Joseph and David. This man had not passed through his cruci- 
 fixion at this time, but hinted that this would come when he became 
 thirty-three, his present age. 
 
 The long, flowing hair, carefully groomed beard, almost line- 
 
CHRONIC CATATONIC DISSOCIATION G05 
 
 less face, wide-open, uplifted eyes, and fixed, sanctified, appealing 
 facial expression contrast strikingly, in a biological sense, with the 
 face of the virile, hard-working, average American or the tense, 
 egotistical paranoiac. This man's vaulting ambition, claiming 
 spontaneously to have been his "mamma's most beautiful baby" 
 and his father's favorite son, his egotism about being named after 
 a former president of the United States, and the fact that he never 
 has competed for the love of a woman, gives the psychopathologist 
 an insight into the disguised self-love of the neo-Christ. Afraid of 
 pain, too proud to be defeated or admit error, averse to vulgar 
 virility, and infinitely narcissistic, he is hopelessly doomed to live 
 as a biological' al)ortion that must surmount all obstacles with 
 fantasy instead of work. 
 
 One of the most astonishing atonements for having been sex- 
 ually perverse, hence, biologically, a betrayer of the aspirations 
 of the human race, is in the record of the following' case. Although 
 confronting almost hopeless odds in the form of sexual perverse- 
 ness this man after many months of the most bitter anguish and 
 despair, accompanying a most eccentric indefatigable compensa- 
 tion, actually succeeded in restoring himself to a constructive so- 
 cial attitude. The purifying purpose of his desperate striving 
 Avas always clear to him and he revealed it without reservation. 
 
 The brilliant sublimation made by the physician (Case PD-1) 
 in his struggles against perverse affective cravings (oral), making 
 many of the finest contributions on the classical use of words to 
 the Oxford Dictionary, may well be compared to the "inspired" 
 philological interests of this illiterate soldier (Case CD-8) who 
 passed through a terrific emotional struggle to free himself from 
 the influence of similar, but more overt polymorphous, perverse 
 affective cravings. 
 
 This soldier-miner (Case CD-8) had a meagre education and 
 "could not make sense out of some of the studies." He referred 
 to his father as a "severe father" but did not hold him responsible 
 for his difficulties. His father was insane for several months at 
 fifty-six. 
 
 The patient was raised on a farm, and worked in coal mines 
 from fourteen to twenty-two. From twenty-two to thirty-three he 
 served in the army and made a "good" record. He was a large, 
 powerful man, rough and inclined to rowdyism. At thirty-two he 
 was returned to the United States from the Philippines to be 
 
GOG PSYCHOPATHOLOGY 
 
 .treated for pulmonary tuberculosis. At thirty-three he was dis- 
 charged from the service for disability. He had been an alcoholic 
 and had had gonorrhea. 
 
 A few months later he was sent to a state hospital as insane 
 and soon after transferred to St. Elizabeths Hospital. 
 
 The patient frankly complained that his sexual life was the 
 cause of. his insanity. As "a child on the farm he had played sex- 
 ually with pigs, dogs, sand holes, children, boys and girls, and 
 masturbated excessively. Although he made several attempts to 
 marry, each affair was disrupted by compulsions to avoid the 
 woman. During his life in the army he indulged in sexual de- 
 bauches with men and women, and said that during one drunken 
 episode he submitted himself to a dog for the amusement of others. 
 During his psychosis he considered himself tp have been a "rec- 
 tum subject," meaning anal erotic. 
 
 About a year previous to being returned to the United States 
 he felt that certain men exerted hypnotic influences over him, 
 made him have perverted dreams, and were planning to control 
 him. 
 
 When he was admitted to St. Elizabeths Hospital he was an 
 anxious, miserable, despairing man, who stood about on the ward 
 weeping and begging to be saved from insanity. Distressing, hal- 
 lucinated voices urged him to submit to perversions and crucifix- 
 ion, and he wrote numerous letters begging an opportunity to 
 make "a confession." Unfortunately this opportunity was -not 
 arranged, until a compensatory self -purification reaction had been 
 considerably elaborated. 
 
 The anxiety and weeping rather abruptly changed to an atti- 
 tude of inspired writing and talking that was quite characteristic 
 of a religious fervor. 
 
 His attitude about making an unreserved confession was as 
 follows: "This life is lived to publish to the world to show them 
 that the publishing of their sins is forgiveness. If you have a sin 
 and hide it in your life that worries you, and if you let other peo- 
 ple share, it that makes them just as much a sinner as you are, and 
 they are your equal. If you are ashamed}^ to look him in the face 
 you feel that he is your superior. By confessing to the rest of the 
 world you make them all the same thought and same idea as you 
 are." (This was entirely the patient's own conception and his 
 own method of solving his difficulties. It was surely a vital fac- 
 
CHRONIC catatonic; dissociation 607 
 
 tor in his recovery because it permitted a free affective readjust- 
 ment.) 
 
 The change came, he said, when he believed that he was "lost." 
 "They were ticking off in my mind" through electrical devices, 
 and then "revelations" as to what he should do came to him. 
 
 The patient was tacitly encouraged to go ahead and given 
 means to carry out the dictation of his feelings. To anyone who 
 listened he poured out, without the slightest disguise, the details 
 of all his crime and misbehavior. The sorrow and contrition for 
 his wrongs was sincere and pitiful, although his story was full of 
 disgusting details. 
 
 For seven months- he worked incessantly on a "scientific" 
 system according to the dictations of the "hypnotic" influences. 
 He thoroughly worked over all his perverse sexual acts and many 
 little details, through a language system of his own invention by 
 which he proved that the misdeeds had been performed to test him 
 out, just as Christ, he said, had committed all the sins of the world ; 
 and through his "scientific language" he proved that he was a 
 "perfect man," "Christ," "the Son of God," "a redeemer," had 
 "a perfect mind" and could not be made insane. He saved all 
 his writings and accumulated a veritable library of note books. 
 From scrawls and writings on scraps of paper he refined his sys- 
 tem into note-book records and then aspired to typewrite them. 
 It was a sincere contribution to the redemption of mankind and 
 himself. 
 
 The "perfect language" was created by numbering each let- 
 ter in the alphabet as a-1, b-2, c-3, m-13, o-15, etc. Then by taking 
 an unpleasant word that referred to his depravity, as "crazy" he 
 found its number by adding up the numbers of each of its letters 
 as c-r-a-z-y equal 3-18-1-26-25 equals 73. Now any other word 
 that equaled 73 was its equivalent ; p-e-r-f-e-c-t equals 73. There- 
 fore, "crazy" equals "perfect." Therefore, there is no such 
 thing as being crasy. Then by substituting pleasing equivalents 
 for unpleasant words he proved that his depravities had an entirely 
 different meaning, that he was a "perfect man" and had invented a 
 "perfect language." He rewrote the Bible and created an enor- 
 mous dictionary for his new language. His additions were not 
 always accurate and gradually many new coined words were added 
 until the entire system was worked over into something like the 
 following example: 
 
608 
 
 PSYGHOPATHOLOGY 
 
 Zaalo- 
 
 -55-1 
 
 Monday- 
 
 Zahlo- 
 
 -56-2 
 
 Tuesday 
 
 Zaclo- 
 
 -57-3 
 
 Wednesday 
 
 Zadlo- 
 
 -58-4 
 
 Thursday 
 
 Zaelo- 
 
 -59-5 
 
 Friday 
 
 Zaio- 
 
 -60-6 
 
 Saturday 
 
 Zasrlo- 
 
 -61-7 
 
 Sunday 
 
 "This is a perfect alphabetical and nu- 
 meral system; each word and number is 
 written on perfect science. Every letter is 
 perfect in its place. Every word and name 
 of its number is written on its equal. The 
 author of this system can perfect the Eng- 
 lish language and use it as a basis to write 
 a perfect language on a scientific basis that 
 will be adaptable for all modern sciences, 
 so that no word can be misinterpreted. Do 
 people wish this work done? I will do this 
 work if given a chance." 
 
 It is only possible to give a brief account of how he proved 
 himself to be a "perfect man" and was now Christ on earth for 
 the third time. The man had been struggling with obsessive crav- 
 ings to become the object of homosexual perversions and upon his 
 admission begged to be saved. The solution that saved him was 
 the inspiration that he was to be crucified and would be reborn a 
 perfect man. He frequently set the date for his crucifixion, but the 
 climax would never quite appear. When presented to a class in 
 psychiatry, which he greeted as jury, he described his language 
 system, and brought out the details of his life that proved his di- 
 vine origin, but before he could finish he broke do-^'iTi, buried his 
 face in his hands, and weeping bitterly, he announced that "to- 
 night I will be crucified." The severity of his anguish made it 
 necessary to take him back to the ward. 
 
 The following is a brief abstract of one of his innumerable 
 dissertations to prove the mystery and magic of his birth : 
 
 "I was born on my mother's birthday, which is the 15th of 
 March, the third month in the year. My father was born on the 
 fourth of March and was one of the 12 apostles, and I was born on 
 the 15th of March, which makes three fives, which is 30, and when 
 my mother was 19 years old I was born. My father makes me the 
 twelfth apostle and the first, second and third of March makes 
 me 15, which makes three fifteens, which is 45. 
 
 "When Jesus was to come back to the earth he was to go 
 through all kinds of trials and tribulations and was to be a soldier 
 in the army which I was on three full enlistments, ten years being 
 the same number. And I was a musician in three different com- , 
 panies of the army. That is thirded, and everything that I ever 
 did ivas thirded. That is the important events, which I will give 
 you. On my father's farm there is 15 coal hatches which gets the 
 three fives again, and my father and mother (together) have three 
 eyes and I have two, that makes five eyes. Now my father has two 
 
CHRONIC CATATONIC DISSOCIATION G09 
 
 good legs and I have two good ones and my mother one good one, 
 the ankle of the left leg being defective, which makes five good 
 legs. NoAV my father has two good arms, my mother two good arms 
 and I have two scars on my left arm, which makes my left arm 
 affected and will be in accordance with the Bible, which makes 
 five good arms. There is yonr three fives again. ■ Take the Eoman 
 V for the number five at the time of Jesus Christ was on earth 
 and my father has one good eye and two feet, Avhich makes V; and 
 also three "cornered. Take my two eyes, now there's a scar over 
 this one and two good feet and that gives me three corners and 
 the Roman V. Take my mother's two eyes and her one good foot, 
 her left ankle being affected, makes her the third Eoman V. This 
 is the three fives, which is thirded always. Our house on the farm 
 is the letter L, which is the 12th letter in the alphabet and gets the 
 twelve apostles, and the word twelve spelt gets 87, which is (equiv- 
 alent to) the truth — 87. Now my first name is Charley — Charley 
 Milton, Charley is the equivalent of 'first' and Milton is the equiv- 
 alent of wisdom, and is the equivalent of 'message' — that is 'the 
 first wisdom message. ' " (The fancy of the holy family is obvious.) 
 
 At great length he showed that "everything I ever did was 
 thirded" and being "thirded" meant something similar to being 
 given a divine heritage. He worked out his various sexual ex- 
 periences to show how they occurred in threes. H(^ referred to 
 his sexual affairs with his sister, when tliey were children, as 
 having "to third her." Three as a symbol for the male genitalia 
 is commonly used and had this value for him. He said this was 
 his third time on earth and a time of great power whereas the 
 second time was his ' ' dark time, " " secret time ' ' and meant weak- 
 ness. Tivo is usually the symbol of femininity and passivity. 
 
 All his sexual activities, he belieAT'ed were for the purpose of 
 extending his omnipotence and they included "mental intercourse" 
 with "all kinds" of animals, insects, etc. Mental intercourse, he 
 said, meant imaginary sexual intercourse. 
 
 He was in "direct communication with God at times. At 
 times it seems like the voice is far aAvay. It sometimes sounds like 
 my mother's voice. I am in connection with her spiritually or 
 something that way. ' ' His mother was the Virgin Mary, his fa- 
 ther was one of the apostles and all three together were God. His 
 brothers and sisters were not blood relations to him and he ex- 
 
610 
 
 ESYCHOPATHOLOGY 
 
 pected to marry. a sister who was dead, saying she had only gone 
 away. 
 
 His discussions almost always included something about "dy- 
 ing ' ' and the completion of his ' ' life of mystery. " His discussions 
 of dying and crucifixion were always accompanied by strong feel- 
 ings of anguish and weeping. It was to be the consummation of 
 Ms career and final purification. 
 
 For six months he wandered about among the patients weep- 
 
 Pig. 60.— -Posture as God of omnipotent power in a catatonic dissociation neurosis. 
 The similarity of posture to the ancient Egyptian statues is obvious. 
 
 ing and preaching. The lining of his clothes and the pockets were 
 stuffed with papers and notebooks. He also claimed to be a greal: 
 inventor and planned to make Washington the capital of the world 
 and place the treasiiry in the" basement of the capitol. (He had 
 claimed to be a "rectum subject" and anal erotics often accumu- 
 late and hoard all sorts of trash. The meaning of the inspiration 
 
CHRONIC CATATONIC DTSSOCMATION 611 
 
 of ti-easuro in tlio basement, in the light of anal erotic misers is 
 obvious. There is a common vulgar term applied to both stinginess 
 and constipation.) 
 
 By the end of the seventh month he had completed ' ' the alpha- 
 betical langiTage and numeral system ' ' and discarded his earlier 
 scribblings saying that he had been ' ' crazy, ' ' and his claims about 
 being "thirded," etc., were "nonsense." He still maintained, 
 however, that he could cure insanity and that he was Christ. He 
 seemed to feel considerable doubt about this, showing it in his 
 reluctance to discuss it. By the ninth month he gave up his lan- 
 guage system as also being absurd, and renounced all claims of 
 being Christ. He explained that while on the athletic field he had 
 overheard two patients arguing with each other to prove that they 
 were divine, and conchided that if men as insane as these two men 
 were, claimed to be Christ, he rnust doubt the sanity of his own 
 claims. [It is highly important tO' consider that this man had lived 
 for six months with a series of men who claimed +o be Christs 
 (asylum wards contain many of them) but he always passed them 
 up as impostors and firmly believed he alone was the Christ. This 
 is about the attitude of each case toward the other. The absurdity 
 of the claim is only appreciated after the eroticism wanes.] Dur- 
 ing all these months he was undergoing a profound affective up- 
 heavel, Avith tremendous cravings to be crucified by the "severe 
 punishment father, ' ' accompanied by strong sexual feelings in his 
 dreams and visions for his mother and dead sister. From his be- 
 havior and general composure it was obvious that his creativeness 
 was now subsiding with his eroticism. He now reached a state of 
 affective composure in which he could see himself as others saw 
 him. He was already giving up his cravings to be crucified when 
 he overheard the argument of his companions, hence he was able 
 to accept them as "insane." 
 
 By the eighth month he announced that he was curing himself 
 by "will-power," baths and careful living. Within a few months 
 after he gave up the Christ beliefs lie expressed doubts about the 
 existence of a God, etc. 
 
 By the tenth month he had developed considerable insight 
 without assistance, but persisted in feeling that he could cure any 
 case of insanity by the method with which he had cured himself. 
 His insanity, he still believed, was caused by a plot. 
 
 In the eleventh month he eloped and after a few weeks re- 
 
G12 PSYCITOPATHOLOGY 
 
 turned voluntarily to get a discharge. He had started to work m 
 the mines. 
 
 He was discharged as a social recovery (about one year after 
 his admission). He had now also given up the feeling that he had 
 been the victim of a plot to ruin him, and added, that he now real- 
 ized that his homosexual cravings and feelings that his eoMraies 
 Avanted him to perform homosexual acts began nearly two years 
 before he was sent to an institution for mental diseases. 
 
 "When I asked him to write an impression of his experiences 
 he sent me a tablet containing some of his fantasies. On the cover 
 he had written "pure, unadulterated insanity." This was his 
 final estimation of his "perfect language" and his philosophical 
 system. It had served a serious purpose and was then cast away. 
 He considered himself to be soundly cured, was unashamed of his 
 past and no longer (?) perversely conditioned. He believed that 
 his sexual feelings for women were normal. 
 
 The following are some of his impressions of his experiences 
 at self -cure: 
 
 "This is not to give you the impression that I think this is 
 wisdom but the worst kind of foolishness. But when I came here 
 I determined to make a study of insanity while treating myself 
 and I have as good an idea as a man can have of the cause, for I 
 have suffered every symptom of insanity that can pass through 
 a man's mind * * * i have learned a great lesson and I am 
 in no danger of ever becoming insane any more for I have erased 
 these ideas from my mind as fast as I would get disappointed by 
 them, and I have learned the truth at last. ' ' 
 
 Unfortunately there is no means of following this man's ca- 
 reer for the next few years. 
 
 This patient, while he was most erotic and polymorphously 
 perverse, saved himself by struggling day and night, in his own 
 waif, with some tacit encouragement, to prove himself to be a 
 "perfect man." He received no psychoanalysis and needed none. 
 He simply poured out everything "that came to mind," in order 
 to be relieved. 
 
 When his affective readjustment was made he resumed the 
 usual interests of the average uneducated man. 
 
 One of the most important features of his attitude differen- 
 tiated his struggle from other cases who have similar difficulties 
 — he showed no hatred as a defense for his deficiencies when others 
 
CHRONIC CATATONIC DISSOCIATION 613 
 
 scorned Mm. When he was recovering, and the Government with- 
 drew his pension, because of the nature of his disability, he ac- 
 cepted the loss without resentment. His accessibility and sincere 
 sorrow perhaps made it possible for him to make a comfortable 
 affective readjustment despite the odious personal distortions 
 from his heinous perversions. 
 
 At no time did he show a flight of ideas or serious distracti- 
 bility. He had been sexually perverse all his life and from thirty- 
 three to thirty-four (about the age of the crucifixion of Christ) 
 he passed through a tremendous affective readjustment and came 
 out of it reborn in his attitude toward life and freed (!) from the 
 influence of ' ' the devil. ' ' 
 
 The last case in the above group showed no flexibilitas cerea 
 or other forms of submission ; nor the opposite, the unreasonable 
 resistance and fear of the acceptance of authority required for ad- 
 ministrative routine and physical examinations ; characteristics of 
 the catatonic, dissociated personality. He did, however, have an 
 insatiable desire to submit (exhibit) the detailed history of his en- 
 tire life to all who would listen, no matter who they were. He 
 also desired to be crucified, become relwrn and purified, so that , 
 essentially his case lielongs to the catatonic crucifixion group. 
 
 Summary 
 
 The catatonic 's variation of adjustment from the paranoid's 
 struggle is due to the manner in which the individual reacts to 
 the irrepressible, uncontrolled sexual craving which he feels to be 
 asocial and perverse. This variation, in turn, is not explicable, 
 upon the assumption of an inherent difference or a particular cere- 
 bral or physiological (toxin) difference. It is explicable, hoiuever, 
 by the manner in which those affective cravings irhich constitute 
 the ego, the socialized self, resist the sexual cravings. The method 
 of training and the impressions from associates and the environ- 
 ment determine the nature of the ego's resistance, hence the varia- 
 tions of adjustment, i.e., whether or not the individual will struggle 
 against his asocial craving like a paranoiac or submit like a ca- 
 tatonic. 
 
 The catatonic has, usually, a much better prognosis because 
 the surrender to the uncontrollable dissociated cravings gives 
 them some opportunity to obtain gratification and. become neu- 
 tralized by the wish-fulfilling (hallucinated) sensory images. 
 
614 PSXCHOPATHOLOGY 
 
 Naturally the catatonic 's resignation to the terrific affective 
 (erotic) pressure that floods his mind with an interminable series 
 of weird, horrible hallucinations and compulsions to yield to un- 
 fathomable symbolic rituals, which the affect creates out of the 
 ordinary ward routine, not only confuses but terrifies the indi- 
 vidual. The crucifixion of himself or herself is truly a resignation 
 of all competition with the parent and usually a profound biologi- 
 cal submission and self-sacrifice. 
 
 I am inclined to believe that the phylogenetic foundation for 
 the catatonic 's tendency to submit and be crucified i-s based upon 
 the tendency of the higher monkeys and apes to submit themselves 
 as sexual objects to stronger males and females for the physical 
 protection and food favors which in turn are bestowed upon the 
 sexual object. The terror of the weaker monkey, as he yields to his 
 unavoidable master, is, in the symptoms of panic, remartefbly 
 similar to the panics of male and female patients while they enter- 
 tain convictions that they "must die," "-wfill be initiated," "will 
 be crucified, ' ' etc. 
 
 In all catatonic states the undercurrent affect that forces the 
 adaptation is the uncontrollable erotic craving. It is the erotic 
 craving that distorts the individual's sense of social proportions 
 and material values and converts the community ard the objects 
 on the ward and the routine behavior of strangers into solemn, 
 hypnotic, mystic rituals and weird sexual symbols. 
 
CHAPTER XIII 
 
 PSyCHOPATHOLOGY OF CHRONIC, PERNICIOUS DISSO- 
 CIATION OF THE PERSONALITY AVITIi liEBE- 
 PHRENIC ADAPTATIONS— PREDOMINANCE 
 OP EXCRETORY EROTIC INTERESTS 
 
 (Hebephrenic Dementia Praecox) — Chronic, Pernicious, Dissocia- 
 tion, Regression Neuroses 
 
 It is perhaps well to reemphasize that there are no absolute 
 lines of demarcation between any of the functional psychoses. 
 Abnormal variations of behavior which are due to affective distor- 
 tion are to be regarded as varieties of biological abortion. The 
 predominant affective variations and symptomatic traits that 
 characterize the different types are due to the conditional needf< 
 of tlie auto)W)iiic cravi)igs and ihc ef/oistic, affective resistances 
 to these needs. Hence, catatonic and paranoid individuals may 
 be expected to show some distinctive traits which determine the 
 nature of the psychopathic abortion. The paranoid and catatonic 
 types have more highly organized cravings to become normal ma- 
 tured personalities than the hebephrenic. This seems to be due, 
 essentially, to the manner in which the autonomic affective crav- 
 ings have been conditioned to strive for the special stimulation of 
 particular sensory zones, without which stimulation the individual 
 tends to become irritoMe and depressed. The nature of the indi- 
 vidual's social strivings is influenced by the persistent pressure 
 of these fundamental cravings. 
 
 The predominance of fascination for the excreta and the anal 
 and urethral zones in the typical hebephrenic is astonishing. All 
 children pass through an age, from birth to aboiit ten, when the ex- 
 creta and their creation are among the great vague mysteries of 
 the universe. This fascination may continue, secretly, throughout 
 life. Among the most intimate and confidential secrets of many 
 adults is still to be seen a profound fascination for the marvelous, 
 recreative powers to be found in the excreta of man and animals. 
 
 615 
 
616 PSYCHOPATHOLOGY 
 
 It is not ■ancommon to see country people maintain, with ab- 
 solute conviction, that cow dung, sheep and horse manure have 
 especial curative powers for the diseases attending old a,ge, for 
 snake-bites, bee-stings, rheumatism, nephritis, etc. The learned, 
 classical treatises of medicine written two hundred years ago by 
 eminent, scholarly gentlemen, literally teem with eulogies of purg- 
 ing, and the value of animal excreta when concocted with wines, as 
 marvelous remedies for rheumatism, deafness, failing vision, etc. 
 This fascination for the excreta is still traceable in the mainte- 
 nance of fashionable spas and watering-places where the odorif- 
 erous emissions from the bowels of the earth are enshrined in 
 festively decorated buildings that almost assume the proportion 
 of temples. That such institutions are valuable is not to be de- 
 nied. They are helpful so long as the constipated wish urges the 
 bejewelled onward to seek the aggrandized symbol of the shrine 
 that fascinated childhood. 
 
 It is not astonishing, then, if considered in a biological light, 
 that the genus Homo, when depressed and wretched because of 
 the ungrateful nature of the social system, should regress to the 
 balmy fancies that cheered the loneliness of childhood. There is 
 one period in every person's life when it may master all its social 
 surroundings and reap unlimited attention, no matter how lonely 
 it may be, nor how engrossed other people are, and this is by im- 
 pulsively excreting in the years of childhood when it is unable to 
 cleanse itself. Then, usually the child obtains thorough attention. 
 
 Hence, when a depressed, lonely, brooding, psychopathic 
 young man, timidly, childishly, approaches his physician each 
 morning for the administration of a generous cathartic and cau- 
 tious inquiry leads him to tell, with unmistakable smiles of pleas- 
 ure, how his mother xised to look after these needs with enemas, 
 we have revealed one of the conditioned cravings that constitute 
 the very foundation of his personality. 
 
 The following cases are selected for their preadolescent 
 style of behavior during the psychosis. A predominant num- 
 ber, not including the first case, show unquestionably that during 
 the psychosis the anal zone and its emissions dominated all other 
 interests in life. 
 
 The material of the following psychosis is presented in a 
 chronological order although much of this data was collected 
 
CHRONIC HEBEI'HRENTC DISSOCIATION 617 
 
 through the psychoanalysis and was not obtained through the ordi- 
 nary method of asking questions for a case history. The chrono- 
 logical report has an advantage in that it is simple and reveals 
 the course of the evolution of the personality into a psychopatho- 
 logical adaptation to specific environmental influences. The most 
 difficult feature of presenting such cases is in revealing the wish- 
 fulfilling value of the hallucination, phobia, etc., without making- 
 monotonous, repetitious discussions. If the reader will bear in 
 mind the influence of the aiitonomic cravings for gratification 
 (AAishes), this value of most delusions, etc., will become obvious as 
 the case unfolds. 
 
 In order that the biological struggle and collapse of this pa- 
 tient (HD-1)* may be given its proper setting it is necessary to 
 include brief character studies of the people who Avere most inti- 
 mately associated Avith her. Her father was an engineer, and 
 through many years of hard, consistent work attained a high rank 
 in his profession. In his later years he was very conservative and 
 saving to the point of being stingy. This was probably the result 
 of fear of becoming destitute, due to a chronic gastritis and general 
 feebleness. He persistently talked to his children about being pre- 
 pared for misfortunes and old age. He loved his children, but 
 tended to conflict with them because of his prudish resistances to 
 an ordinary freedom of their general interests. Despite his care- 
 fulness about his money he made some poor real estate invest- 
 ments, which became a point of counter-attack later by his son-in- 
 law. He owned some houses in a distant city which, for a time, the 
 renters converted into houses of ill-repute. (This fact later con- 
 tributed considerable reality to his daughter's psychopathic fan- 
 cies.) 
 
 In nis home all topics that had any sexual suggestions were 
 most severely tabooed. He criticized his daughters for indecency 
 when they sat with their legs crossed, and objected to seeing them 
 dressed in kimonas. This suggested to the patient that he had 
 sexual feelings toward his daughters when he saw them in kimonas 
 and was inclined to think of their sexual difference when they sat 
 with their legs crossed. Because of his reserve and obstinate tend- 
 ency to hold on to his old conceptions his children had great dif- 
 
 *This case was reported in The Psychoanalytic Review, Vol. VI, No. 1 ("The Psychoanalytic 
 Treatment of Dementia Prsecox"). 
 
618 PSYCHOPATHOLOGY 
 
 ficulty in realizing their own wishes or enjoying the freedom of 
 their companions. 
 
 In his later years he depended upon his oldest daughter to 
 manage his affairs, and was persistently inclined to make a baby, 
 of his youngest daughter, the patient. He was sensitive and un- 
 happy about one of his sons, who had revolted against his domina- 
 ting teachings. The other son and two daughters had very little 
 or no important influence upon the psychosis hence are not men- 
 tioned further. 
 
 At the time of the patient's illness the father was about sev- 
 enty, and an invalid from a chronic gastritis which necessitated 
 long periods of convalescence in hos|)itals. 
 
 The patient's mother- was a "nervous," kindty, home-loving 
 woman, tall and heavy, diabetic and extremely fond of eating. All 
 her children were inclined to eat excessively. She encouraged her 
 oldest daughter to be unusually self-reliant and persistently trained 
 her youngest daughter to be dependent upon her in every way, and 
 introduced her, when a young woman, to visitors as her "baby." 
 She encouraged the other children to shop and manage housekeep- 
 ing affairs, but would not trust the patient with any responsibilities 
 or allow her any initiative. She was usually displeased with this 
 daughter 's tastes and whatever she bought. She trailed her to be 
 dependent for advice about the style and material of her clothing, 
 what dresses to wear for the day, how to act, whom to talk to, etc. 
 She was consistently ver}^ emphatic and domineering in her con- 
 flicts with the patient, although tolerant of her other daughters. 
 
 Like her husband she severely tabooed all matters pertaining 
 to sex and never tolerated her children's intimate confidences. 
 She died of nephritis and diabetes about six months after the 
 onset of her daughter's psychosis. 
 
 Their oldest son remained wayward and irresponsible for 
 many years after his adolescence. He gambled, drank, would not 
 work," delighted in being considered a sport and was a soiirce 
 of anxiety and shame to his parents and sisters. The early years 
 of his manhood were devoted to an immoral revolt against his par- 
 ent's influence. 
 
 The oldest daughter, A — , was decidedly aggressive, large, ro- 
 bust, active, self-reliant, fond of business and executive responsi- 
 bilities, but inclined to be selfish and domineering. It was with the 
 greatest difficulty that she could allow her youngest sister to win 
 
CHRONIC HEBEPHRENIC DISSOCIATION 619 
 
 in any conflict of opinion. Because of the attitude of her parents 
 and her age she naturally dominated the smaller, younger sister 
 and became imbued with a pleasing sense of superiority and per- 
 sonal responsibility for her welfare. When the patient announced 
 her engagement, A — became intensely angry and said that she 
 could never forgive her sister for leaving her. Undoubtedly the 
 masculine temperament of A — had been pleased by cultivating 
 dependence in her sister and it caused no little anxiety when she 
 had to give up her superiority. 
 
 Three other people played an intimate part in the develop- 
 ment of the psychosis; the patient's husband, and his father and 
 mother. 
 
 Her husband's father Avas also an engineer. He was a younger 
 man than the patient's father, with a better training, but had not 
 yet had time to surpass the older man in financial and business 
 standing. Under the surface of ostensible goodwill a keen rivalry 
 developed between the families, to show which father was the bet- 
 ter, wiser man. This quarrel developed most naturally out of the 
 desire to demonstrate that each family practiced the better way of 
 living, in order that the new family should adopt the better prac- 
 tices. 
 
 The husband's father had always been. a free spender and fond 
 of gay parties. He never worried about misfortunes and old age. 
 His business kept him away from home a great part of the time 
 and his wife had to depend mostly upon her only child for com- 
 panionship. 
 
 She was a beautiful woman, with a trim, girlish figure, small 
 feet, neat ankles, attractive personality, dressed in good taste, 
 traveled extensively and had a wide range of general interests. 
 She carefully groomed her figure and dieted to keep herself look- 
 ing attractive. She was inclined to have anxiety states and occa- 
 sionally retired to sanitariums for a rest. In her travels over the 
 globe to join her husband her son Avas her companion and hero. 
 
 He was also an engineer, very ambitious, tense, earnest, sin- 
 cere, fond of being heroic, obviously spoiled by his overindulgent 
 mother, and at times was irritable and impulsive without realiz- 
 ing it. He was slender, medium sized, and at thirty had the 
 figure of a wiry, active boy of twenty. He, like his parents, be- 
 lieved in enjoying life today and letting tomorrow take care of it- 
 self. He liked to spend his money for parties and play but frowned 
 
620 PSYCHOPATHOLOGY 
 
 upon people who "gormandized" and was openly disgusted with, 
 such habits in his wife and her relatives. 
 
 Just how these two families became interested in each other 
 is unknown. To get a true perspective of their conflicts as they 
 were waged over their common battle ground, a timid, unsophis- 
 ticated, poorly trained girl, it will be necessary to study the de- 
 velopment of the personality of this girl. 
 
 She was the youngest of the children. At birth she was con- 
 sidered to be a "blue baby," the causes of which apparently dis- 
 appeared. 
 
 Other than a series of boils when an infant her health was 
 excellent until sixteen when she had chlorosis attended by a mild 
 chorea. Otherwise she was never seriously ill. 
 
 Her play interests included about everything in their proper 
 time, such as dolls, games, dresses, friends, swimming, sailing, 
 horseback riding, dancing, parties, etc. From twelve to fourteen 
 she was quite a tomboy and delighted to wear a boy's hat and 
 "cuss" like her oldest brother, who was her star. This occurred 
 about the time he openly flaunted his misdeeds at the family's 
 prudish conservatism and was an effort on the part of the young 
 girl to express her dislike for the restraints that held her in bond- 
 age. 
 
 Her home training and education were sadly unfitting for the 
 cultivation of self-reliance and efficiency. 
 
 Her father, mother and sister seemed to have irrepressible 
 desires to keep her the "baby" of the family, and she was not 
 only not encouraged to grow up, but was actually inhibited from 
 doing anything of a serious nature for herself. 
 
 She was dressed, petted and pampered, and given no choice 
 in the designing or purchasing of her clothing. Her efforts in 
 this direction were suppressed as "poor taste." 
 
 She was trained to ask advice about every little wish and to 
 constantly depend upon her mother and eldest sister. Even when 
 she became an adult and married, the three older women were un- 
 able-'to restrain their habits of advising and bossing her. 
 
 Most of the time she enjoyed this, and became a lazy, rather 
 obese type of girl. Initiative and responsibility became a burden 
 to her, and she was inclined to treat her irresponsibility as a joke. 
 At times she feebly revolted against the pernicious influence and 
 
CHRONIC UEBEPHKENIU DISSOCIATION (')2i 
 
 tried to free herself, but the persistence of the older women and 
 her unreliable experience easily infiueiicod her to yield. 
 
 Her education Avas carelessly planned and indifferently car- 
 ried out. She was sent to public and private schools with no con- 
 tinuity of training. Subjects axovc taken up and never finished. 
 She was pemiitted to loaf at home during her school days on whim- 
 sical little pretexts of not feeling well. 
 
 Because of the prudishness with which her parents raised her, 
 almost every little interest that might have a sexual bearing was 
 rebuked and had to be developed in the child's secret fancies. She 
 had no adult or older companion in whom she could confide her 
 fancies and whose opinions she might assimilate to qualify. her 
 o•v^m. 
 
 When about four years old while walking with her parents she 
 became excited by the appearance of a bull. They were shocked by 
 her curiosity and questions about the bull's scrotum. The embar- 
 rassed parents told her to look at something across the street and 
 gave the child the impression that her curiosity was unnatural and 
 shameful. (The affective influence of this experience came out 
 in the psychoanalysis and played a part in the fancies of her psy- 
 chosis.) 
 
 Their attitude so emphasized the object of her curiosity that 
 she never forgot it. In diie time she felt an exciting but 'secret 
 curiosity in the sexiial behavior of cats, chickens, dogs, horses, 
 etc., which was forbidden by her parents, but she could not help 
 a secret enjoyment of these things. A woman's breasts while 
 nursing a cMld embarrassed her so that she had to hide her curi- 
 osity. When a little girl she demonstrated her pleasurable inter- 
 ests in excreta by chasing some visitors with a filthy stick. Her 
 mother failed to comprehend the situation and punished the child, 
 but did not make her feel- sorry for her behavior, rather leaving 
 her curious about the excitement she had created. 
 
 A few years after she entered school she saw a strange word 
 written on the walls of an outbuilding. (The word was a common, 
 vulgar term for sexual intercourse.) When she reached home she 
 innocently asked her mother about the meaning of the word in the 
 presence of visitors. Again the situation was too much for her 
 mother's resourcefulness and the child was surprised at the ex- 
 citement she created. 
 
 A number of such incidents indicate the vigor with which the 
 
622 PSYGHOPATHOLOGY 
 
 child was trying to understand a secret that conld so easily cause 
 so much embarrassment. 
 
 When she was nine years old a boy of about her age tried ' ' to 
 spoon" with her and this caused so much excitement that she in- 
 voluntarily urinated in her clothing. This made her the butt of 
 almost endless teasing among the children and placed in 'their 
 hands an instrument of retaliation that she could not immunize 
 herself against. 
 
 Even when she was a child she was not allowed the natural 
 pleasure of sitting on her father's or her older brother's lap. It 
 was not long before she realized that this restriction was because of 
 something pertaining to her sex. Her father told his daughters 
 that it was indecent for girls to sit with their legs crossed, and 
 this so emphasized the factor of sexual difference that she became 
 obsessed with an impulse to look at men when they sat with their 
 legs apart, particularly fat men. Her father was a rather short, 
 heavy man. (In regard to this compulsion during the psychosis, 
 she complained of being unable to control her eyes from glancing 
 at men in street cars, etc.) 
 
 Her father's feelings, when he saw his daughters in kimonas, 
 were frequently expressed by his saying that it made him sick at 
 the stomach. (This, surely, associated together her father's sex- 
 ual feieliiigs and sick stomach and substantiated one of her most 
 unshakable convictions during her psychosis, which will be referred 
 to later.) 
 
 She was taught to be unduly modest and careful about her 
 person without due appreciation of the reasons for it. She never 
 ''spooned" with boys, and, when her older brother, flaunting the 
 evidence of his postadolescent conquests and experience, demon- 
 strated to her how he mad"e love to the girls, she was painfully 
 embarrassed by his behavior and believed he was making sexual 
 advances to her. She learned that he frequented houses of prosti- 
 tution and this gave material for further wild, secret fancies. 
 
 When her oldest sister began to menstruate she found some 
 indications that this sister was passing through a most unusual ex- 
 perience and ventured to ask her mother about it. Again the well- 
 intentioned mother failed to grasp the tremendous significance of 
 her child's curiosity and after vigorously scolding- her sent her to 
 her room. This profound secret of nature shared by her mother 
 and sister, and denied to her made her feel that she lived in a pale 
 
CHRONIC TTEBEPITRBNIC DISSOClATrON 623 
 
 beneath them and really outside their li\'('s. From that time on 
 she was unable to throw off a sense of personal inferiority and 
 neglect. 
 
 At sixteen she was sent to a convent school, but only remained 
 a few months because she thought the girls did not like her. They 
 teased her inconsiderately because of her naive, frank questions, 
 her unsophisticated beliefs and the case with -which she was 
 embarrassed and fooled by vulgar stories told by the older girls. 
 She learned to believe that the nuns put drugs in the food to stop 
 the menstruation of the girls. The nuns gave her medicine to 
 correct her amenorrhea. It happened that she was asked, when 
 returning from the toilet, if she had passed anything and she inno- 
 cently replied ' ' only a little wind. ' ' Some older pupils overheard 
 this and the teasing by the girls became unbearable. She left 
 school presumably because of chorea, but at the time she was 
 worried about masturbation and feelings of inferiority. 
 
 She lost confidence in herself and learned )wt to ask questions 
 because they might reveal her thoughts. This unfortunately cut 
 off the principal means of acquiring the knowledge necessary to 
 correct her archaic conceptions of her sexual life. 
 
 She had learned to masturbate l)y using the bed clothing in 
 some manner and was inclined to believe that the other girls did 
 not like her because of her habits. 
 
 Some gossip about a white woman Avho lived with a negro made 
 a deep impression upon her, and she felt that this scandal in some 
 manner was really talked about for her benefit. From her father 
 she learned that women sometimes lived with men without being 
 married, and around this she wove doubts about the legitimacy 
 of her parentage and whether or not she was actually a member of 
 the fainily. She became verj^ curious about an old Dutch picture 
 of a man and woman in a room. She wanted to know if they were 
 married and her father suggested that they might be brother and 
 sister. The sexual possibilities of such situations excited her im- 
 agination normally enough hut secretly. 
 
 Wlien she was about seventeen the family employed a colored 
 servant who had once been a maid in a house of prostitution. The 
 girls found in her an inexhaustible source of information which 
 their curiosity could not resist. She described scenes of beautiful 
 girls, dressed in stylish clothing, living a comfortable, lazy life, 
 
624 PSYOHOPATHOLGGY 
 
 and being visited by married men, etc. The fascinated girl won- 
 dered what such a house must be like, and the serva.nt, to find an 
 example, suggested that the houses might look like one they were 
 living in. After this the red lamp shade, the dark halls, the ki- 
 monas, her father's mysterious behavior, etc., took on the atmos- 
 phere that might be found in a house of prostitution. The servant 
 said the matron of the house was called "madam" and her father 
 called her mother "madam," etc. Girls that were attractive to 
 men became "objects of wonder to her and she eagerly studied them. 
 This probably had a relation to her tendency to mimic people 
 Avhich she cultivated to an unusual degree. 
 
 Her sexual fancies, though more or less recurrent, were not 
 vigorous enough at this time to cause anxiety. She had many 
 social interests, such as dancing, games, SAvimaming, boating, etc., 
 to keep her occupied and quite happy. She was very affectionate 
 and sincere, and enjoyed a reputation for her sense of humor and 
 ability to mimic her friends. While she was growing into physical 
 womanhood and living the emotional life of a child, not even being 
 allowed to go into the city alone, her sisters became self-reliant, 
 efficient young women. The eldest sister was capable of conduct- 
 ing business affairs and managing her grandmother's estate. This 
 contrast greatly emphasized her immaturity and she regarded her- 
 self as a simpleton. Her mother often spoke of her as an "enigma 
 to herself" and the patient thought she was "slyly'' referring to 
 her stupidity and masturbation. 
 
 At twenty-one she married after an engagement that was in- 
 teresting because of her worry about and utter inability to make 
 up her mind as to what behavior would be proper for an engaged 
 girl. When her fiance tried to put his arm around her and kiss 
 her she reacted with so much embarrassment that he had to be 
 contented Avith holding her hand. He was also unable to solve this 
 delicate situation because of his own rather naive conceptions 
 about propriety and decency. 
 
 She was still influenced by her brother's past demonstrations 
 of how he spooned with girls, and interpreted her fiance's petting 
 as a sexual advance. 
 
 The first serious shock came after a quarrel with her fiance. 
 She refused to see him, and he sought the company of other girls, 
 including a prostitute. He had considered the engagement broken 
 and plunged into a series of carousals. 
 
Cl-IRONIC I-IEBEPHRENTC DISSOCIATION 625 
 
 Later the quarrel was satisfactorily adjusted and prepara- 
 tions were made for the marriage. A few days before the wed- 
 ding her fiance felt obsessed to make a confession of his misbe- 
 havior and inferiorities, including his long struggle with mas- 
 turbation. He wanted help and sympathy because of his feelings 
 of unfitness in the hour of his marriage. 
 
 The unexpected realization that her hero Avas not virtuous 
 and true, overwhelmed her with confusion. Her first impulse was 
 to cast him off but the expectations of her friends, the nearness of 
 her wedding, her sense of being equally inferior and her affection 
 for huu prevailed. She suppressed her resistances and married 
 him without talking over her dilemma with anyone. (During her 
 psychosis she said that she felt she gave up something when she 
 married under those conditions, and after that crisis she went 
 backward while her, husband went forward. She doubted the legal- 
 ity of her marriage during the psychosis.) 
 
 She knew nothing about the sexual life of woman until after 
 her engagement when she made her mother tell her about the 
 origin of babies. The revelation Avas shocking and she hated her 
 mother for having always deceived her. Despite her ignorance, 
 the sexual experiences did not distress her. On the other hand 
 they did not fully satisfy her curiosity. From another, entirely 
 unavoidable quarter, very serious difficulties now arose. 
 
 Her husband Avas a rather boyish type of personality. It 
 should be recalled, he was the only child of a pretty, devoted 
 mother. His wife in many fundamental respects Avas quite the op- 
 posite type of woman. His mother kneAv the world, groomed her- 
 self, dieted, AA^as trim and neat, had good taste and Avas self-reliant. 
 His wife was inclined to be lazy, overeat, Avas fat, Avore loose, com- 
 fortable shoes, dressed in poor taste, could not design or buy 
 clothing, had a limited range of interests, and had never gone any- 
 where alone. She AA^as AvhoUy dependent upon him. 
 
 He was greatly troubled hx his difficulties and "asinine 
 thoughts." He could not understand Avhy he should be so much 
 affected by certain physical attributes in a Avoman, such as small, 
 dainty feet, hairless body, firm breasts and small stomach, and 
 why he should so highly prize them. (Conditioned autonomic-af- 
 fective cravings.) Ho realized that they Avore the attributes of his 
 mother, but AA'hy should his Avife's large, soft breasts, rather full 
 abdomen, fat feet, and hairy ankles bother him Avlien he tried to 
 
626 PSYCHOPATHOLOGY 
 
 make love to her ? His lieterosexual potency was being severely 
 tested by the inappropriateness of bis wife^s physical make-up as 
 an adequate stimulus for the invigoration of his conditioned auto- 
 nomic sexual reflexes. After the novelty of his sexual object and 
 the excitement attending, the first year of married life had worn 
 away, the biological problem became a serious one. (My impres- 
 sion of his problem, considering his type of personality and general 
 physical make-up, and the biological difficulties attending such 
 situations, is that it always will.be a source of irritation.) 
 
 These conditioned functions of his sexual reflexes made him 
 furious with himself. Although he was usually affectionate and 
 sincere, he became irritable and impatient with his wife. He 
 thought the sexual difficulty was an indication of sexual weakness 
 due to boyhood masturbation. Ejaculatio prsecox supported this 
 belief. He tried persistently to induce his wife to diet and take 
 exercises to reduce her abdomen and breasts. For a time she com- 
 plied and also removed the hair from her ankles, but when he be- 
 came impatient and critical she became negligent and resistant. 
 
 He reacted to her general unsophistication by taking her 
 to clubs, cafes, parties, teaching her to drink cocktails, smoke 
 cigarettes, play tennis, etc. He sincerely wished to make a chum 
 out of her and was fondest of her when she was like a tomboy, 
 but also she had to "mother him." Physically she was not con- 
 structed to be an athletic girl because of her broad pelvis and 
 obesity, but temperamentally she was delighted by such efforts. 
 
 I am sure that since his adolescence he had been aware of his 
 sexual fixation upon his mother because of incestuous dreams, and 
 in his striving to so train himself that he would escape the horrors 
 of incest, he married nearly the opposite type of woman. He 
 dreamed of having sexual relations with his mother both before 
 and after marriage and his horror was nothing less than intense. 
 He said he prayed to God to be spared from such terrible thoughts. 
 "When he learned the biological significance of the dream he was a 
 deeply relieved man. For these reasons and his previously noted 
 strivings, I am sure he sacrificed many naturally delightful inter- 
 ests to escape the feelings of incest. After his marriage, when his 
 conditioned sexual reactions made it evident to him, by their in- 
 difference to the stimuli to which he had bound himself, he desper- 
 ately strove to train his wife to become as nearly like his mother as 
 possible, in order to save his heterosexual potency. (Later in the 
 
cnnoxic hebephrenio oissociATioisr G27 
 
 case -will be f oiind a sigiiifieant comment of his wife upon a remark 
 he made to her about homosexuality among men.) 
 
 She learned to travel alone and tried to keep house. She was 
 sincere in her work as a Avif e and looked forward to home building. 
 Unfortunately her husband's work necessitated his traveling about 
 and her living a great part of the time with her mother, or her 
 husband's mother. This prevented her becoming independent. 
 The wife's relatives persisted in trying to reform her husband, and 
 his mother tried to reeducate her son's wife. Her husband's 
 salary was barely ample to keep things going smoothly, and yet 
 the patient, by denying herself, managed to save several hundred 
 dollars in two years. 
 
 Her father was displeased with his son-in-law's behavior and 
 the latter reacted by gambling and carousing. The reactions of the 
 son and the son-in-law to the father were strikingly similar. The 
 two families naturally made the patient their common battle 
 ground because she was suggestible and unsophisticated. Her 
 family felt no compunction about criticising the behavior of her 
 husband. She remained faithful to her husband, however, and 
 tried to give up the habits of her family as "old fashioned," 
 "selfish," "gormandizing," etc., and convince herself that his rel- 
 atives knew better how to live. 
 
 When they were not quarreling they were happy and optimis- 
 tic about the future, but they were unable to make a thoroughly 
 satisfactory adjustment to their family differences and biological 
 difficulties. He showed his displeasure by threatening to leave 
 her if she lost her beauty, if she did not groom herself, and if she 
 did not write to him daily. 
 
 Until she became pregnant the situation permitted enough 
 physical freedom to prevent her disappointments from becoming 
 oppressive. Her sexual life, of course, was not satisfactory with 
 her irritable husband, and some prodromal indications of the 
 nature of her adjustment appeared before she became pregnant. 
 She tended to become apprehensive when she happened to be alone 
 in the house with a man serv^ant. She apprehended that he might 
 make sexual advances and AA^orried because she Avouldn't know how 
 to repulse him if he did ; that is, control her sexual wishes. 
 
 During her pregnancy she masturbated and reacted with feel- 
 ings of unfitness and shame, but compensated by reading select 
 literature to cultivate in her child, through prenatal influence, a 
 
628 PSYCHOPATHOLOGY 
 
 love for the beautiful. Despite her apprehension she was, how- 
 ever, delighted with the prospects of having a child. After labor 
 when she came out of the etherisalion she wanted to knoiv if her 
 baby was "marked." She said something about its being marked 
 by a chicken. (Chicken is a common name for a girl of the 
 streets.) During her convalescence after the labor, the nurse, 
 perhaps because she was unconsciously guided by the patient's 
 affective reactions, persisted in telling her all the sexual details 
 and scandals she knew; particularly that masturbation caused 
 insanity and that she must protect her son from masturbation. 
 Her sister reenforced this train of thought by giving, as her con- 
 viction, that masturbation was a symptom of insanity, and when 
 she asked her doctor about masturbation in boys, his conmient 
 corroborated her sister 's statements. 
 
 Her mother had often told her she was "an enigma to her- 
 self ' ' and she. believed that this meant being ' ' queer, ' ' and was 
 now magnified into meaning ' ' slightly insane. ' ' She felt that her 
 mother was responsible for her masturbation, because she failed 
 to educate her properly. (Such bitter reproaches are quite com- 
 monly made to parents by children for improper education.) 
 
 Her husband was indifferent to the infant. He showed much 
 more pleasure in the baby of a friend. The patient felt keenly ' 
 the unwelcomeness of her child and his threats about leaving her 
 soon proved to be fertile suggestions, indeed. Her inability to 
 control the sporadic outbursts of autoeroticism troubled her in- 
 tensely, and her efforts to educate her child so that he would not 
 masturbate, became an obsession. She expressed it to her friends 
 in thoughts about raising her baby to be "good." The father 
 of the baby was rather indifferent about naming it and in her 
 fancy her unnamed infant grew into a foundling. 
 
 Not long after the birth of the child she became obsessed with 
 the feeling that she had served an allotted purpose in the family 
 and was no longer wanted since the birth of the child. 
 
 It is quite possible that the collapse of the patient might have 
 been avoided even at this late stage had her husband been able to 
 love her. This perhaps would have given her firm feelings of hav- 
 ing attained a worthy place in nature, and if the two families had 
 been less critical of her manner of mothering her child. At the end 
 of the fifth month she was unable to nurse her baby and both her 
 
CHRONIC HEBEPHKENIC DISSOCIATION 629 
 
 mothers inconsiderately emphasized the failure by telling her of 
 their own ability to nurse their babies for a year. 
 
 The two families conflicted right and left about the way to 
 raise their only grandchild, and the timid, inexperienced young 
 mother was swept off her feet. Her husband's mother insisted 
 upon plenty of fresh air for the baby and her mother protested 
 that the child was freezing. When her husband happened to be 
 in a nearby city, his mother insisted that she neglected him because 
 she did not go to see him; and her mother objected to the visit 
 because she would be neglecting the baby. The patient said, "You 
 would have thought the child was her own." Unfortunately she 
 lived in her mother's house, occupying the upper floor. Most of 
 the time she was without a servant and the necessary physical ex- 
 ertions were too severe. Her husband reacted to her anxiety 
 about the education of the child by vigorousl}' criticising the "gor- 
 mandizing" tendencies of her relatives and insisted that his son 
 should have the freedom and interests of the modern child and 
 some day drink a cocktail with his father. The patient no longer 
 had confidence in the integrity of her husband, and this only ag- 
 gravated her obsessive fears that her baby must become sinful. 
 
 After a careful study of all the participants in this family 
 disaster, I was unable to find that the patient had, at this time, 
 a single adult who felt an encouraging sympathy for her efforts 
 to become a woman according to the dictates of her own feelings. 
 
 She regarded herself as a failure as a wife and a mother, and 
 an object of shame to her family. She read "The House of 
 Bondage" at this time and in her faaicies she became the woman 
 who had to go down, down the social scale until she reached the 
 gutter. 
 
 Her sexual obsessions were now met l)y a sincere, frightened, 
 but pooi'ly balanced effort of her husband to educate her. He 
 rather instinctively felt that her ignorance was the foundation of 
 her difficulties. Unfortunately, the book on sexology that he gave 
 her was filled with vigorous moralizations against the depravities 
 of masturbation and perversions. Its effect was the formation of 
 an unshakable conviction that she was a degenerate because of 
 her masturbation and certain sexual impulses which she was try- 
 ing to suppress. She concluded that she was an outcast or should 
 be one, that she was unfit to raise her baby, and people could see 
 the degeneracy in her. 
 
630 PSYCHOPATHOLOGY 
 
 Her mother remarked one day about how wonderful it was 
 for her to have a baby that she could call all her own. The ' ' all 
 her own" she interpreted to mean a fatherless child and the baby 
 was regarded as a foundling. (It is evident that the erotic affect 
 was influencing her interpretations so as to discourage the efforts 
 to remain estimable.) 
 
 She frequently told her family that she wished she were dead 
 and these ominous wishes were not apprehended. She had un- 
 accountable fits of crying and depression for which she would 
 give no explanation. When her people talked about the European 
 War, she construed it to mean figuratively that she was a German 
 and all the others were Allies against her. 
 
 About a year after the birth of her child she began to talk 
 about her husband remarrying so soon as she was dead, and she 
 looked at him with a "queer sort of smile." She mshed that she 
 and her husband and baby were dead. She could not be pacified. 
 She began to speak of her masturbation openly and thought peo- 
 ple sneered at her as if she passed disgusting odors. She tried 
 to make her eldest sister promise that she would raise the child 
 carefully and teach him to love God when she married her hus- 
 band. She said- it was a case of survival of the fittest. Her sister 
 could not understand this talk and was horrified with being charged 
 with longings to have her sister's husband. The patient told this 
 sister of her masturbation fancies, and accused her of having in- 
 fluenced her in this. 
 
 She was very erotic at this time and had quite a series of 
 dreams of having sexual intercourse with different married men 
 whom she knew, and when her husband had intercourse with her 
 she felt that she was his mistress. One dream that impressed her 
 was about not being sexually satisfied. This eroticism gradually 
 became so persistent that during her waking states she could not 
 suppress it and the resulting fancies soon replaced the realities 
 of her environment. She insisted upon reexamining the marriage 
 license. 
 
 She now believed that she was no longer the daughter of her 
 father, but a girl kept in a house of prostitution conducted by her 
 father, and all the men talked of her beauty because of their 
 sexual interest in her. (The sexual value of beauty and the dan- 
 gers of becoming ugly had been emphasized by her husband long 
 before.) Nearly everything now had a "double meaning" and 
 
CHRONIC HEBEPHRENIC DISSOCIATION 631 
 
 she read into the conversations she heard, subtle references to her 
 secret sexual cravings. 
 
 When her mother suggested that she should give the baby's 
 old clothing to a negress who was going to have a baby, it meant 
 that she herself was going to have "a little black Jesus," and she 
 now became the white woman ^vho had lived with a colored man 
 and had years ago aroiised so much curiosity during her adoles- 
 cence. 
 
 She begged her htisband not to leave her and prayed- that 
 God would protect her son when she was gone. She would not 
 allow her husband to touch her. She said he held his lips stiffly to 
 keep from laughing at her and put his fingers to his face to hide 
 his smiles. She believed people were lying when they talked about 
 her. She found a copy of the "Police Gazette," which she said 
 had pictures of her in tights, and her husband was not able to con- 
 vince her that he had not exposed her. 
 
 She was afraid to take medicine because it contained poison, 
 and she thought her urine was sticky (sugar). (Her mother had 
 diabetes.) 
 
 Her fancies, anxiety and irritability increased rapidly, and 
 one day she threw the household into a panic by drinking tinc- 
 ture of iodine to commit suicide. She was now completely out of 
 touch with her family and upbraided them all for deceiving her 
 and making a prostitute and degenerate out of her. 
 
 She was taken to a sanatorium and this environment became 
 at once converted into a house of prostitution conducted by "Dr. 
 Bull," the first syllable of the physician's name. All the inmates 
 and herself played an active part. She fancied herself the mistress 
 of the physician in charge. When the men talked about "billiard 
 balls" it meant testicles. She believed that she Avas doped at night 
 and was subjected to sexual assaults through her mouth. She spit 
 and vomited frequently to cleanse herself and complained of having 
 sexual difficulties like her father. His chronic gastritis, she said, 
 was put on and he Avas merely hiding his sexual perversions. She 
 had to be watched day and night because of her numerous at- 
 tempts to strangle herself, stab herself in the head with pins and 
 pencils, drink drugs, etc. 
 
 One day she ran into the bathroom and locked the door. She 
 tore up her dress, and tried to strangle herself Avith the strips 
 before the nurses could break the door open. When they caught 
 
632 PSYCHOPATHOLOGY 
 
 her she fought violently and, half choking, she gasped : " I know 
 just what happened, you dirty devil. My husband told me about in- 
 tercourse through the mouth." As she was taken to her bedroom 
 she reacted mth the horror that Avould naturally have attended an 
 actual assault o£ this nature. 
 
 From that time on (for six months) she insisted that she had 
 been sexually assaulted and ruined the way her father had been 
 ruined. In her many tirades about her supposedly brutal treat- 
 ment in that sanatorium she completely neglected the fact that 
 she had strangled herself. Unfortunately, the nurses were not 
 able to resist the temptation to joke about this, and during the 
 remainder of her stay they delighted in playing upon her sexual 
 fears and curiosity with weird stories of immorality, which mate- 
 rial suited her affective cravings. 
 
 Throughout this erotic tide, however, the patient made a piti- 
 ful effort to be "pure" and "good." She was almost constantly 
 in an anxiety state about her exotic fancies and helplessly tried to 
 suppress them. She bit her fingers and pinched her skin, paced 
 the floor and tried to keep from sleeping in order to prevent mas- 
 turbation. 
 
 As a quite unusual feature in the setting, for several months 
 she consistently criticised herself for everything she did. She 
 spoke of herself as vain, overbearing, selfish, deceitful, lying, 
 stupid ; said her parents should have punished her, etc. 
 
 When her mother died she refused to believe it and did not 
 grieve. 
 
 Fourteen months after the birth of her son and about two 
 months after the attempt at suicide, she was transferred to Saint 
 Elizabeths Hospital where she remained for eight months. 
 
 It is only possible to relate the more important incidents in 
 her behavior while in the hospital and the underlying "cravings that 
 influenced her. Except for a slight cervical tear, her physical 
 condition was excellent upon her admission. 
 
 When she was not disinterested in the physician's efforts she 
 could perform the intelligence tests very well. Her letters were 
 always neatly written and full of affection and worry about the 
 future of her child. 
 
 She wrote to her husband as if he had divorced her. In a 
 pathetic letter she wrote: "I feel that the whole — family, while 
 maybe believing in God, are AvhoUy without religion and are very 
 
CHRONIC HEBEPHREIsIC DISSOCIATION 633 
 
 ungodly, and as they allowed .me to i^row np in sin, never made 
 me go to Sunday-school, nor so much as taught me the Lord's 
 Prayer, I hate to think that my Babe is in their power. And I 
 very much fear that the sins of his father and mother will be 
 visited upon him and that those sins will be encouraged in him. 
 
 "Time and again I've prayed and hoped that Baby Boy [as 
 yet he has no name] would know the pinch of poverty inasmuch 
 as it would bring him nearer his God and cure him of hardness 
 of heart toward his fellow beings. I have an idea that one [her 
 maiden name] was only a meditan of propagation and after the 
 birth of that haby was to be cast off. The baby will one of these 
 days be 'comfortably off' and I'm quite sure he'll not be taught 
 charitableness at all but miserable greed Avill be fostered in him. 
 
 "About my Baby Bo^^ I plan and dream and hope for him, 
 plan and hope that I can go back to him and teach him to be a 
 good Christian. With all this planning the miserable thought 
 comes over me that he is to live his life without me." 
 
 (The obsessive fears about the ruin of her son can be read 
 throughout this letter as well as her pathetic struggle to avoid the 
 disaster.) 
 
 The feelings of sin, being cast off, the godlessness of her fam- 
 ily and the ruin of her child were her most dominant fears foi'' 
 several months, all beliefs being due to the erotic affect getting 
 rid of the social obligations that inliibited its freedom of getting 
 gratification. 
 
 Among the people she met were the names Manor, SaA\n'pr, 
 Gay, Childs, and Slicer, which she pieced together to mean "Man- 
 her," "Saw-her," "Gay," "Slice-her," "Childs" (children). 
 "Man-her" meant sexual intercourse, etc. 
 
 She repeatedly asked the nurses if they thought she was a 
 hopeless case, believing that she had been confined in the govern- 
 ment institution for life. She was very pleasant and tractable 
 for several weeks and took care of her own room. At this time 
 she was quite playful and her fancies did not seem to be more 
 archaic than so far described. 
 
 Her husband came to visit her and most strikingly persisted 
 in being advised even in detail as to what to say to her. He was 
 very unhappy and took upon himself the entire responsibilitv of 
 her depression and anxiety. He was secretly drinking Avhiskey, 
 smoking cigarettes to excess, unable to sleep, and was constantly 
 
634 PSYCHOPATHOLO&Y 
 
 resenting the criticisms of her relatives. He was willing to do any- 
 thing to regain her confidence. His first few visits were eantionsly 
 conducted and she reacted with an encouraging interest in him. 
 
 She began to talk about her hallucinations- and dreamed that 
 her nurse was explaining them away and that she had gone home. 
 She talked a great deal about the immorality of her family and her 
 masturbation to the patients and nurses, and was- constantly on the 
 lookout for anything that pertained to sex. She was surprisingly 
 frank and showed no embarrassment about her secrets. She said 
 she had always been reticent about her secrets and now she was 
 going to tell them to everyone. (See compulsion, Case CD-8.) 
 This satisfied the feeling that the whole world should know, the 
 dread of which is complained of when the patient resists the com- 
 pulsion. 
 
 For several days she could not be induced to come into the ex- 
 amination room. She said she thought I was a good man, but 
 she was afraid of me. Finally I won her confidence and she 
 learned to depend upon me for assurance and encouragement. She 
 was like a child in her acquisitive interests. 
 
 For some unaccountable reason, about six weeks after her ad- 
 mission, she slumped to a still lower method of gratifying her 
 cravings. Her husband had been visiting her regularly and be- 
 coming tired of her childish reasoning threatened to leave her, if 
 she did not try to get well. She also learned about his drinking 
 whiskey. Those were probably the causes of the regression. 
 
 "When she was transferred to St. Elizabeths Hospital from 
 the sanatorium she became encoiiraged and adjusted to a higher 
 level of interest, but now she regressed to her prostitution feel- 
 ings and this hospital also became a house of prostitution. For 
 several days she brought up the fancies of the sexual assault at 
 the sanatorium and now explained her vomiting as the result of 
 having a diseased stomach like her father's (which she imagined 
 to be caused by fellatio). She said she had not known of such be- 
 havior until her hiTsband unwittingly told her about such im- 
 morality among some types of men. She repeatedly remarked that 
 she thought it was ' ' so disconnected and funny" when her husband 
 added ''no one cou.ld make me do such a thing." Fox some time I 
 was unable to get the Avish Avhich was causing these persistent wor- 
 ries. She persistently maintained that she was horribly assaulted 
 Avhile half dazed from the strangulation. Finally she commented 
 
CHRONIC HEBEPflRENIC DISSOCIATION 635 
 
 that she wondered if it was not a fancy, but then added that she 
 was sure she had been assaulted. Although she wavered, she was 
 not quite ready to give it up as a reality. 
 
 The pathological mechanism became clear to me during this 
 interview, but she was not able to control her eroticism. Her hus- 
 band's sexual failure during the last months of her pregnancy 
 and since the birth of her child, she felt, was responsible for her 
 uncontrollable eroticism. The sexual pressure made her mastur- 
 bate and her husband's advances only irritated her. At this stage 
 of the analysis she asked unusually simple, heedless sexual ques- 
 tions of almost anyone wlio would listen to her, and unblushingly 
 remarked before the ward full of people, almost innumerable times 
 during the day, that she was ' ' a masturbator ' ' and her family had 
 put her in an insane asylum for it. The naive abandonment 
 and persistence with which these remarks were made seemed to me 
 to be the production of an obsessive craving and not an effort to 
 explain her confinement. 
 
 She finally became aware of the feelings which prompted this 
 behavior as she talked about her husband's impotence and how 
 he only irritated her. Now, she said, she got her sexual pleasure 
 ont of talking promiscuously on the ward about sexual things and 
 did so at every opportunity. At this time she dreamed that she 
 was driving a carriage and was delighted Ijecause she could turn 
 it around in such a small space (turn facts around). It will be re- 
 called that she had allowed the erotic affect to turn around the facts 
 about a supposed sexual assault in the sanatorium, divorce, prosti- 
 tution, the immorality of her family, etc. Although she now 
 grasped the curious Avish-fulfiUment of her innumerable questions 
 and assertions about sexuality, she could not yet accept the wish- 
 fulfillment in the fancied oral sexual assault. (It is interesting to 
 recall here her tendency to ask naive sexual questions in child- 
 hood.) 
 
 She delighted in calling herself a "bad woman" and smil- 
 ingly asked if she ought to conmiit suicide. 
 
 The manner in which ordinary things in her environment took 
 on sexual values may be illustrated by a few notes from her letters 
 to me. 
 
 "I got so I could not read my prayers without seeing some- 
 thing vulgar in them. 'Forgive our trespasses,' a Avoman (nurse) 
 
636 PSYCHOPATHOLOGY 
 
 used to accent the passes. I thought it was very queer and she laid 
 such, stress on it that I thought it meant something sexual. 
 
 " 'He leadeth me by his own hand.' Nurse said 'hands' in- 
 stead of hand and I thought it meant something about masturba- 
 tion. 
 
 " 'The incorrupt tree brings forth incorrupt fruit.' Then I 
 realized I was wicked and my baby would be bad. 
 
 "When I asked the nurse if I could ever see my people, she 
 said, ' Stop whorrying so. ' She put an h in worry which meant 
 I was bad" (whore). 
 
 She would sleep in a certain position to see if she would 
 awaken in the same position. She was afraid she was being mis- 
 used during her sleep. 
 
 "I used to plan to commit suicide, but I would say to myself 
 'no I mil wait until tomorrow, I have, too much curiosity now.' 
 Used to talk abqut curiosity in my sleep." When the physician 
 called to see her she thought she would kill herself because he 
 intended to misuse her. Then she decided that she would wait 
 until she was taken to the "bad house" because she wanted to see 
 what a "bad house" was like. 
 
 -During this discussion she said: "My! if all this energy and 
 curiosity was used for something else I ivould he hrilliant." (The 
 influence of twenty years of repression and deferred satisfaction 
 for her curiosity was unquestionably a determinant of this sexual 
 curiosity.) With this exclamation she spontaneously brought up 
 her childhood shame and embarrassment that prevented the learn- 
 ing of the truth about sex. She had not even been permitted to 
 watch a baby nurse. This treniendous sexual curiosity, despite 
 all resistance, was now being satisfied at any cost, even though 
 she could not get rid of her feelings of shame. When she forgot 
 herself she was happy and playful, but when her duties of woman- 
 hood were emphasized she reacted to her eroticism with shame and 
 fear. 
 
 In the ninth week of her confinement she passed into a more 
 serious anxiety state. She brought a page of a Sunday newspaper 
 to me on which was a full-page feature about a minister who had 
 disappeared and awakened later to find himself a sailor in the 
 New York Bowery. The article was illustrated with pictures of 
 a minister, a sailor and a group of women, etc. She said I had 
 published this and gave me an excellent demonstration of what 
 
CJIRONIC IlEBEPIIRBN^lC DISSOOIATION G37 
 
 she could say -when she was angry. She said that it referred to 
 her love affair with a choir boy and her feeling that now she had 
 to become the mistress of a conmion sailor. (She had had fancies 
 about a sailor.) 
 
 She felt that her situation was hopeless and lier family was 
 using this means of making money out of her. 
 
 Now she lost all the reconstructive ground and insight she had 
 gained. She became confused, had to be confined to bed, com- 
 plained that she had been doped, felt stupid and seemed unable 
 to remember anything. She tried to find a place to hang herself 
 and made an attempt to stick a hatpin into her head. She refused 
 food, could not sleep and had the persistent feeling that she must 
 leave the hospital and walk the streets as a prostitute, and asked 
 innumerable times a day if she must go into the street. 
 
 Her father came to see her at this time and she noticed his 
 agitation and grief. She turned her cheek to him to be kissed 
 (their mouths were unclean) and paid no attention to his questions. 
 She stared at him stupidly, repeated at intervals, "I must be 
 queer," "It is the queerest thing." Then she tried to leave him 
 in the building and go in the street; was not interested in the pic- 
 tures he brought of her baby and only begged that he would be 
 well taken care of because she had to die. 
 
 I was at a loss to understand this sudden, profound confusion 
 and anxiety of the patient. The newspaper story did not seem to 
 be sufficient for such regressive changes. A few days later from 
 a repentant husband I learned what had happened. 
 
 The patient's mother willed all her property to the father 
 and this necessitated the signature of the heirs including the pa- 
 tient and her husband. Her husljand had carried the will about 
 for several days trying to decide whether or not he should sign 
 it. Finally in his dilemma he brought up the whole family con- 
 flict again and threshed it out with the patient. He lost his tem- 
 per despite explicit instructions to be careful, and told the patient 
 that he thought her mother was insane Avhen she made such an 
 unjust will. They were attending a patients' dance when this 
 occurred and she changed in a few minutes from a state of hope- 
 fulness and promise to one of serious confusion and inaccessi- 
 bility. 
 
 This lasted nearly two weeks, but gradually she became more 
 cheerful. She talked about herself as a "clinging vine" and said 
 
638 " PSYCHOPATHOLOGY 
 
 she could not beat her "hoodoo number." She complained of 
 "feeling dazed, like in a dream," that "everything had a sexual 
 meaning, even the Bible." She asked about her father and sister 
 but showed no interest in her husband. She dreamed that her 
 hitsband and sister and baby were' waving good-bye to her and 
 she wanted to know if it meant that she must remain here. 
 
 About the twelfth week she made strong efforts to stop her 
 eroticism and tried to stay awake at night to prevent herself from 
 masturbating because she was afraid it occurred during her sleep. 
 She now cried because her mother was dead and begged to go home 
 to her father, sister and baby, but showed no interest in her hus- 
 band. In her dreams one of the older women physicians became 
 her mother and during the day she spoke of their similarities. 
 
 She sexualized nearly everything she heard and seemed to 
 feel that the patients were all put here to annoy and persecute her 
 for her wrongs as a masturbator and prostitute. She worried 
 about a ward patient who was deformed by a polyneuritis, because 
 it meant that she would become that way when "they" were fin- 
 ished with her. Another patient's bruised lip referred to her 
 mouth. The perfume of the spring flowers meant something about 
 the right way to live. The hard pillows meant a hard, bitter world. 
 For weeks she correlated everything, it seemed, into groups of 
 good and bad, right and wrong. She greeted her father with more 
 affection, but protested, when he called her his ' ' baby, ' ' that she 
 wanted him to call her a woman. He could not quite do this but 
 called her his "girl." This disappointed her. She needed to be 
 recognized as a woman and her family would not respond. She 
 was trying hard to get well. 
 
 She dreamed at this time about someone carying a sign with a 
 Latin word on it and when she tried to read the word it changed 
 to "rore" (whore). The man carried it before her to make her 
 miserable and she refused to read it because she wanted to sup- 
 press her sexual thoughts and get- well. This dream worried her 
 greatly because she could not get rid of the word it suggested. 
 She was utterly unable to tell me about the word. Later this word 
 persisted like an obsession and stopped the analysis and progress 
 of the case until she frankly discussed it. 
 
 Although she went to dances and understood the moods of 
 other patients she was troubled by a strange sense of unreality. 
 
CHRONIC HEBEPHRENIC DISSOCIATION 639 
 
 She wanted to know if certain other patients were not herself, 
 and if she had been doped or jnst had "a spell." 
 
 These faint glimmers of insight that flashed out now and then 
 gave us the most encouragement for her future. 
 
 In the fourteenth week the family difficulties -were again forced 
 upon her by an impulsive outburst by the husband, sister and 
 father, and tliis time it gave impetus to an affective regression 
 that finally carried her into the intrauterine affective attitude. 
 
 Her face looked confused, she stared blankly ahead of her, 
 smiled and cried and frowned almost at the same time. She said 
 someone was trying to talk to lier from below and kept her in a 
 perpetual state of anxiety. ITer hands had to be bandaged to 
 keep her from picking the skin off and she was given bromides and 
 packs to quiet her. 
 
 During this anxiety her eroticism apparently asserted itself 
 at a much more infantile level as her sensations and delusions indi- 
 cated. The patients talked about the food. It horrified her be- 
 cause they meant she had a "queer appetite" and had abnormal 
 sexual desires. They noticed that she was "passionate," and 
 putting wax on the floors was done to remind her of her sexual 
 desires. When my pencil broke in taking notes of what she said, 
 she immediately said it was a sign that I was going to quit her 
 case. She said she wS,s to be made "crazy with the heat," "had to 
 burn," etc. A Mrs. Wilbur was to leave the hospital and she be- 
 lieved it meant that she herself had to leave and "will-burn." 
 
 She was having auditory hallucinations and charged the 
 women with hypnotising her and reading her thought ^^ hecause she 
 could not control her wandering sexual thoughts. In a few days 
 she became very stupid and drowsy and hallucinated grewsome 
 experiences with negroes 
 
 She said she did not know why she wished these things to 
 happen to her, but she thought she would be "burned," "buried," 
 "crushed in a box that would grow smaller and smaller," that 
 hot irons or the floor brush would be put into her vagina, etc. 
 Horses, bulls, negroes, "morphrodites with three penises and large 
 breasts," her husband with two penises, her father, brother, 
 mother and sister would have intercourse with her. The police- 
 man's white horse as he rode by was "awful." "The horse was 
 nearly all penis." She had become a "morphrodite " and would 
 have intercourse with herself and use a horse's penis. "When 
 
640 PSYCHOPATHOLOGY 
 
 you sp.eak I think I speak. I am trying to do everything." She 
 believed she was "everybody." Her father was hallucinated as 
 having sexual relations with her and when she told me about it 
 she added the experience of her childhood when she was four 
 years old and wanted to know about the bull. (This weaves in 
 with Dr. Bull's sanatorium.) "With great anxiety, she said, "To- 
 day the nurse threw the cat out and I thought it meant me." When 
 the nurse brought' her a postage stamp, corset, stocking, box of 
 powder, a whisk broom, etc., it meant that she took everything 
 and was "poor white trash. ' ' 
 
 She identified herself with the manure on the lawn and was 
 afraid to use the toilet because she would pass out with the feces. 
 She frequently commented about people's shoes and said they 
 
 Fig. 61. — "Leda and the Swan," by Michelangelo. The Swan as Jupiter, the father, 
 disguises the incestuous fixation of the sexual cravings. 
 
 reminded her about "passing wind." At this time there was a 
 very noticeable fecal odor about the patient. 
 
 At brief intervals she improved enough to run the floor pol- 
 isher and the long handle became a penis that tried to have inter- 
 course with her. She complained of being ' ' t-y-d. " (" T-y-d ' ' was 
 her pet name for her baby's genitalia). 
 
 She would come into the examination room scowling and whis- 
 pering to herself, "Who am I, am I somebody else?" When I 
 drummed my fingers on the table, she said ' ' rats gnamng, hither, 
 thither anon. ' ' She watched every move I made and even such 
 trivial things as the movements of my pencil made her submit to 
 
CHRONIC HEBEPHRENIC DISSOCIATION 641 
 
 its influence. (I do not think that this was a bromide delirium 
 because her memory was not actually confused and I could get 
 her to explain the meaning of the symbols, although the bromides 
 must surely have added to her feelings of unreality.) 
 
 She felt that slic teas a kleptvmaniac and associated the nu- 
 merous things she supposed she had accumulated with sexual curi- 
 osity and recalled hoiv she had stolen little things ivhen she was a 
 child. (Here a definite relationship existed between kleptomania 
 tendencies and the gathering of sexual symbols. This behavior 
 has been observed in other patients.) She was to gather all the 
 trash and dirt in the world and build a degenerating world which 
 would contrast with the beautiful world. "I think I steal all the 
 time and take delight in hoarding up trash. I think I yell out 
 dirty words about bowel movements" (hoarding, miserliness and 
 anal eroticism). She showed the restless, picking symptoms of 
 the anxiety depression and believed she had lost her soul because 
 she could not control the sexual fancies. 
 
 During this period she frequently referred to the hot box 
 (hot-air cabinet) with great anxiety, and begged to have the hot- 
 air bath discontinued. For several weeks she gave me so few 
 fragments about this particular fear that I did not understand 
 it. Gradually her fragmentary phrases were pieced together. The 
 hot-air cabinet, she said, was a "hot box" in Avhich she was to be 
 suspended and drawn up in the fetal position and to float "on 
 her side" in her own urine and feces and would be "whirled- 
 around and around. ' ' She would be cut open and worms put into 
 her, snakes would crawl through her, old rags would be sewed up 
 in her, and she would be smothered. The walls of the hot box 
 would contract around her and she would get smaller and smaller. 
 
 She also dreamed at this time about being smothered in the 
 "hot box," and a little white girl haying her mouth open for sex- 
 ual intercourse. The infantile determinant for oral eroticism 
 (nursing), is obvious in the little white girl and the afl'ective re- 
 gression (Case PD-17). 
 
 During the most vivid period of her intrauterine fancies she 
 had to be dressed and fed. She would curl up under a blanket, 
 and paying no attention to anyone, Avould laugh and giggle to her- 
 self for hours at a time. 
 
 While in this state she happened to see a cat eat the umbilical 
 cords of its young. She worried about the cat eating its young 
 
642 
 
 PSYOHOPATHOLOGY 
 
 and worked herself into a panic abont having eaten her baby. A 
 severe panic about having circnmcised, eaten and killed her infant 
 continued abont three weeks. She was sad and cried as if her baby 
 were really dead. (The identification is made here of the entire 
 baby with the baby's penis which actually was circumcised. Later 
 the identification of the penis as a baby came out frankly and the 
 
 Fig. 62. — Affective regression to intrauterine attitude in suicidal negress; who sus- 
 pended herself for weeks" in a blanket before the window. 
 
 feeling that she had eaten her baby became recognizable, as an 
 oral erotic wish-fulfillment.) 
 
 When I asked, "Why do you thinli you ate your baby?" she 
 gave me to understand that she did not "hate" her baby. The 
 burdensome baby was disposed of in her dreams and hallucina- 
 tions in the form of abortions. 
 
CHRONIC HEBEPHRENIC DISSOCIATION 643 
 
 At this stage of her psychosis she developed a mild nephritis 
 and otitis media which reacted readily to treatment. The ice bag 
 on her ear felt like a "horse's hoof" and she gave birth to a baby 
 from the ear Avhich was discharging pns. When I stooped over 
 her to examine her ear she watched my pnpils to see what kind of 
 a girl she could see there. It gave her an indication of how I looked 
 upon her. She said the light glinted in my eyes like a Japanese 
 sword and the impression was used to suit her. wishes. 
 
 She saw her sister crushed and her brother doubled up and 
 stuffed into a tower, which made her feel glad. She thought she 
 threw her infant down a shaft and burned it to death. She felt 
 that she walked on babies and something held them up to her. 
 She would walk about the ward and hold her hands behind her as 
 if dropping something. Later she explained that she was dropping 
 babies behind her and giving birth to a great number. She thought 
 the nurse directed unborn souls and old people into the clouds. 
 
 When the urinals were Avashed out they glistened in the sun 
 and looked to her as if they were filled with a fluid lilce ' ' glycerine 
 [meaning semen] from horses' eyes." 
 
 When she was in bed she would lie half exposed and as a 
 man approached she made little movements to uncover herself (to 
 submit herself)' and yet looked at him in great fear. 
 
 She would lie in bed in a half-reclining position as if about to 
 get out, and her facial expression, dilated pupils, dry lips and fixed 
 stare showed her anxious, perplexed state of mind. She seemed 
 to be terrified and complained of seeing most "awful things," de- 
 scribing a huge round muscle, "slick all over," with two "stubby 
 legs like an elephant's legs" sticking out of it, lying on the floor. 
 "When I tried to ascertain the meaning of this very unusual visual 
 hallucination she talked -about "hot box." For many weeks she 
 was unable to give any further clue of what it meant. * ' Hot box ' ' 
 obviously meant uterus to her but why it should be seen lying on 
 the floor, and of such immense size with two "stubby legs" like 
 "an elephant's legs" sticking out of it, I could not imagine. (Par- 
 ticular care was taken to ask no suggestive questions about this.) 
 
 During this period when she Avas allowed to be up and dressed 
 she often dashed to a front window to look at something. This 
 behavior was considered as "queer" and "silly" by those in 
 charge of her until we learned, after no little effort, that she 
 thought she saw her baby in the form of a white parrot hanging 
 
()44 PSYCHOPATHOLOGY 
 
 from the bough of a tree. lier dashes across the room to watch it, 
 she said, were to see if it changed its position and whether it was 
 real or not. Her feelings about its reality were so convincing to 
 her that she worried about this considerably, often asking ques- 
 tions about a parrot and her l)aby, and later when she had the 
 freedom of the grounds she examined this "parrot" and found a 
 white rag hanging on the bough. 
 
 Although her case looked very discouraging her dreams re- 
 vealed affective trends that suggested a reconstruction. She 
 dreamed that she saAv her sister pick up a girl who had slipped 
 (herself). 
 
 About the eighteenth week she began to show more interest 
 in her family and some of the patients. She again b&^aii to feed 
 and dress herself and crochet for her baby. She wrote affection- 
 ate letters to her husband and wanted him to send her candy. 
 
 She now entered upon what may be regarded as the recon- 
 struction. Her affective cravings had apparently regressed to the 
 intrauterine level and after a due period the craving for her child 
 and family began to dominate her behavior again. 
 
 She adjusted rapidly, took walks, studied birds, went to 
 dances, frolicked with the patients and became very hopeful. Un- 
 doubtedly she would have made a social recover}- without assist- 
 ance and wQuld have regarded her experience as a protracted night- 
 mare, but she would not have developed insight witliout the psycho- 
 analysis. 
 
 She became very skillful at analyzing her hallucinations and 
 dreams which threw significant light upon the behavior of similar 
 cases. 
 
 In the twenty-first week she went to the city and shopped. She 
 visited an art museum and that night dreamed of Napoleon (such 
 a statue is in the museum) in meditation. To this she sponta- 
 neously brought out the pleasures of uninterrupted dreaming and 
 fantasy. 
 
 Now she put her fancies about her father in the proper light. 
 She did not think now that he was immoral, because the type of 
 liis friends proved his Avorth; but during her illness she fancied 
 that if he were "bad" she might as well have sexual relations ^v^.t\\ 
 him, and even hallucinated that she did. (This instance shows how 
 tlie affect influences the estimation of social values in order to find 
 gratification.) She begged for her watch and wedding ring and 
 
CHRONIC HEBEPHRENIC DISSOCIATION 645 
 
 wanted to be a wife again. Her acquisitive interests attained an 
 excellent range, and her emotional reactions to her companions 
 were more refined, but she was still very unstable. 
 
 She still had erotic dreams and would have to awaken to keep 
 from masturbating. Her social interests were decidedly homosex- 
 ual. She delighted in dancing with certain women, dreamed of 
 being in continuous tubs with them and being tempted to mastur- 
 bate by them. 
 
 About the twenty-third week she had progressed so far that 
 her nurse took her out to visit her family. I had carefully in- 
 structed her husband, his mother and her eldest sister that under 
 absolutely no circumstances must their petty grievances be thrust 
 upon the patient in any way. These kindly, well-meaning people 
 promised faithfully to cooperate. They had been thoroughly 
 frightened by the regression. 
 
 With her husband I had given consideralile study to his sexual 
 problem, his irritability, and his mother fixation. Also his antag- 
 onism to her father. But human nature is not plastic when it has 
 its own struggle. She was at home only a few hours when the 
 family quarrel about spending money and the way to live came 
 into the foreground. The eldest sister was simply unable to al- 
 low the patient to become independent and assert herself while at 
 home. The latter tried to movp some of the furniture about and 
 criticised some of the decorative arrangements. A conflict was 
 promptly precipitated. The eldest sister regarded herself as hev 
 father's housekeeper and would not tolerate interference. She 
 Avanted to be her father's favorite and the patient foresaw an 
 unfair division of the estate, which was also her husband's fear. 
 She returned to the hospital angry and worried. Her father and 
 sister, she said, were scheming to cheat her out of the property, 
 did not want her, and the whole problem of caring for her child 
 without funds was resurrected. Much of the ground we had gained 
 was lost, but she did not give up this time. She began to quarrel 
 with the other patients, and derived especial delight out of "cuss- 
 ing." She used pi'ofanity liberally for almost everything, and was 
 very much like a tomboy in her vulgarity and heedlessness. (This 
 cussing method of adjustment she had learned from her brother 
 at twelve.) 
 
 At this tirne, while visiting the zoo with her nurse, a negro fol- 
 lowed them and exposed liimself. The nurse beramc excited, but 
 
646 PSYCHOPATHOLOGY 
 
 the patient had so far regained control of herself that she coolly 
 took charge of the situation. 
 
 Her husband visited her frequently and she responded to his 
 encouragement by making plans to renew her housekeeping. At 
 the same tirfle, however, she complained of a dangerous undercur- 
 rent of laziness and longing to be protected by her mother. She 
 dreamed frequently about her dead mother and complained that 
 she did not feel quite right about resuming the duties of a wife 
 because, at times, she feared another "nervous breaJidown" (that 
 is a relapse to autoeroticism). 
 
 She dreamed : "I saw mother in a white wrap and I came out 
 of the bath (waters of birth). I said look at these funny marks 
 on me. Mother said not to worry, they were the result of boils 
 when I was a baby. ' ' 
 
 "When she told the above dream, she added : ' ' The marks were 
 on the abdomen and looked like childbirth — ^wonder if I -could ever 
 wear a straight-front corset again [reduce abdomen]. When I 
 was about fourteen, mother introduced me to an officer. She intro- 
 duced my sister first like a woman and then introduced me as her 
 'baby.' I cried and it put the bosh on it right there because I 
 wan.ted to be a woman. It seemed as if I took the cue and followed 
 it since. I'll tell you one thing, I was disappointed when mother 
 didn't make a fuss over me in the dream." Then she explained 
 that her husband had recently told her of a girl friend who had 
 gone to a maternity hospital. 
 
 Another infant would be a serious biirden and her dread of it 
 now naturally became quite pronounced. A f^.w days later, she 
 dreamed: "Someone and I were going through a poor district 
 [her poverty] making investigations, and upon looking over a 
 fence saw any number of pink and white, bright-faced young 'uns 
 probing the bony hip of an old horse. The children were having 
 a very good time and because they were, at the expense of the old 
 horse, I rapped them smartly on their wrists with a stick. That 
 dream seemed to fade and it got on toward dark and W— [hus- 
 band] and I were coming home through a field. Near a barbed* 
 wire fence we both espied what looked to be a covered telephone 
 wire^spotted black and red — but upon inspection W — exclaimed, 
 'By Jove, it's a worm, queer thing — sort of a glow worm of some 
 kind. ' It seemed to be about 100 ft. long and not so large around 
 as one's little finger." 
 
CHRONIC HEBEPHRENIC DISSOCIATION 647 
 
 The above dream revealed the wish for children, but also the 
 dread of maternity at the expense of the bony old horse. She was 
 like the broken down old mare, and this particular symbol of her- 
 self recurred in quite a series of dreams. 
 
 She continued to be afraid to sleep because of the dreams. At 
 night the sexual images tended to become vivid, and she resorted 
 to means of keeping awalce to avoid them. • During th'fe day she 
 was busy enough to crowd out the unpleasant imagery. 
 
 She now spontaneously resurrected the fancies of the sexual 
 assault in "Dr. Bull's" sanatorium. This time she gave an aston- 
 ishing explanation of the craving to strangle herself and jab pen- 
 cils and pins into her head, etc. She reviewed the scene in detail 
 and then said the assault might have been imaginary. "The, 
 strangling might have had the same effect as putting my finger 
 do-\vn my throat. ' ' She explained that she felt the same affections 
 for her husband's penis that she did for an infant and felt impulses 
 to submit to the wish. This horrified him and he vigorously tried to 
 impress upon her how degrading men thought oral erotic women. 
 She now recalled that when she had the obsession of having eaten 
 her baby, that baby was associated with "t-y-d" and penis, which 
 explains the influence of the oral craving of which she was fearful. 
 The oral erotic cravings had compelled her to strangle herself, put 
 her fingers into her throat, stick pins and pencils in her head, eat 
 wasted food (symbolic of the censored phallus), chew up a ther- 
 mometer, drink, tincture of iodine, and eat her baby in fancy, etc. 
 The genesis of this affective craving was now intelligible as the 
 reaction to her husband's enticing and then repressive attitude, 
 which he corroborated. 
 
 Following this adjustment the patient emphasized her fear 
 that she talked in her sleep. She was afraid people would under- 
 stand her "awful thoughts." She giggled and laughed, and yet 
 worried about a certain awful thought. She felt that she fmisf 
 tell it to someone to free herself of its exasperating presence, 
 and yet said ; " I can not tell it. I would simply die. It got so that 
 it identified itself with masturbation and got worse than ever." 
 The thoughts were about a word (previously referred to as hav- 
 ing occurred in a dream) she had seen in an outbuilding when 
 about eleven. As a child, she thought of it with pleasant fancies 
 when at home in the toilet. She innocently told her mother about 
 her fancies and was whipped for indulging in vulgar thoughts. 
 
648 PSYCHOPATHOLOGY 
 
 After such impressive reactions of her mother she was unable to 
 forget it. Before this she had not realized the triTe import of her 
 behavior. 
 
 Although her sexual thoughts were troubling her constantly 
 (she was trying to get rid of them) she was unable to tell me about 
 that word, and its persistence stopped the progress of the analysis 
 until she told her husband. It was the vulgar word for sexual 
 intercourse. 
 
 After this the tendency to self-repression greatly decreased 
 and her confidence in her relations with her husband increased. 
 
 She dreamed (twenty-eighth Aveek) : "My husband and I 
 seemed to hav^ a house. [They were planning to go housekeep- 
 ing.] We were coming across a field and saw horses dying. One 
 had something like a big lump or tumor on his brown side. Some 
 horses were in agony about the war. They lay with their legs 
 drawn up. (She explained the legs drawn up as the fetal position. 
 "War, farnily wars, and maternal problems were still her difficul- 
 ties.) 
 
 A few nights later she dreamed: "I was back of a peculiar 
 house on a terrace. A child and I were trying to climb down steps 
 and we got to squabbling and wrestling. I was thrown on my back 
 and she landed into me pounding me in the stomach" [pregnant 
 uterus] . 
 
 The relief and comfort she derived after telling her husband 
 about the obsessive vulgar word probably encouraged her to con- 
 fer the following secret which made her dread to sleep "with him, 
 fearing that she might talk in her sleep about it^ — namely, that 
 during her pregnancy she had fancied herself carrying the baby 
 of an old suitor, and this reenforced her feelings of infidelity. 
 After this confession to him her relations became still happier and 
 less restrained. At the time that she told me of this she also dis- 
 cussed the masturbation fancies during her pregnancy and it is 
 quite probable that the fancies about the old suitor, which made 
 her foel guilty of infidelity, mado her feel that her husband was 
 laughing at her with scorn. At this stage of the psychoanaly|is 
 she dreamed that she gave birth to a "young-un" but it was a 
 miscarriage. She now explained the old horse dreams as old nags 
 and she was. "nagged to death," which was the meaning of the 
 nags in the fetal position dying because of the war. "The one 
 that looked like it was carrying a colt stood on tottering legs * * 
 
CHRONIC HEBEPIIKENIC DISSOCIATION 649 
 
 I was nagged to death with a big, fat, lieavy baby and I did not 
 Avant to go through it again." 
 
 Now the glycerine fancies and the horses' eyes of the psychosis 
 were brought up and she explained them. "My sexuality ivas noi 
 satisfied and it just took hold of everything. I wondered how if 
 ivould he to have sexual contentment. I courted it in my dreams 
 and hnew it h^it it wasn't in me to stop. I remember when I ivas 
 lying with my head on my nurse's hnee I determined not to commit 
 masturbation, but I ivould have anything for happiness, so I let 
 my imagination go and it got bigger and worse all the time. When 
 I was indifferent to people my mind was rank and tvhen I paid at- 
 tention to people my thoughts got better." She explained the gly- 
 cerine as a sticky fluid and "when I was in the sanatorium tlic 
 nurse told me about saving sexual fluid in a bottle and trying to 
 make AA^omen pregnant Avith it. [The horses' eA^es blinked as her 
 
 eyes blinked Avhen she was sexually excited.] I read 's book 
 
 on 'Advice to Young Men' and he said something about not marry- 
 ing a girl Avho Avould secretly jDeep through a curtain at bulls and 
 cows having intercourse. There AA'ere cattle near our house and 
 my sister and I used to Avatch them, but Ave never mentioned tlio 
 Avord 'bull' in our house because it Avas vulgar." 
 
 During her psychosis she had complained of her hands being 
 hot, and now she explained that it Avas associated with her mastur- 
 bation during pregnancy. 
 
 As the psychoanalysis progressed she spontaneously explained 
 the origin of the great round muscle lying on the floor with th(> 
 "stubby feet sticking out." When she AA-as pregnant she Avas 
 fond of playing Avith the uterus and feeling the kick of the baby's 
 feet through the abdominal wall. They felt "stubby, like an ele- 
 phant's foot." Her distressing thoughts about having torn her 
 infant to pieces were associated also Avith the fears of her labor. 
 She had learned that sometimes this Avas done in labor and Avor- 
 ried about the probabilitA' of haA'ing to undergo a similar expe- 
 rience. 
 
 Seeing her baby as a Avhite parrot Avas explained as folloAvs: 
 When her husband was stationed in Cuba he sent her souvenir 
 cards decorated with parrots. She was afraid she had become 
 pregnant after he returned and by taking medicine to establish 
 her menses she believed that perhaps she had had a miscarriage. 
 (The baby on the bough Avas an abortion.) The popular asso- 
 
650 PSYCHOPATHOLOGY 
 
 ciation of cliattering, imitative babies as parrots must also be in- 
 cluded here. 
 
 The affective value of many of the grewsome hallucinations 
 that had distressed her for many weeks now became clearly appar- 
 ent. They were the productions of a biological struggle to castrate 
 or abort the uterus and its contents in order to save the remainder 
 of the personality from destruction. She stood on "tottering 
 legs" and had been "nagged to death" over her maternity by her 
 inconsiderate families. 
 
 The patient made remarkable progress in the recall and anal- 
 ysis of the content of her psychosis and the understanding of her 
 affective cravings. (It is almost a universal tendency in the grave 
 psychoses for patients to "forget" all the disagreeable details 
 they possibly can and smooth their difficulties over only to find 
 that with the next stress the repressed affections break through 
 Avith more disastrous effects than ever.) 
 
 To make sure that her insight into her conflicts and tendency 
 to regression was clear I asked her to write oiit her estimation of 
 her case, part of which is quoted here. "One part of me would 
 say, 'see what you've done! You'll be punished for this!' And 
 would thoroughly frighten the other part of me and perhaps it 
 Avas the self-scolding that started 'the make-believe-you-don 't- 
 know, make-believe-you'-didn 't-do-it. ' One part took great delight 
 in the scolding and beating the other part around the bush. And 
 the second part was fond of dodging and scheming and getting 
 aAvay from the scolding and making the get-away caused the fool- 
 ish giggles I think. I would preface everything with ' Oh, wouldn't 
 it be funny if such and such a thing could and would happen — (for 
 instance if there could be an old Mother Time and I could be she) 
 or if I could be Mrs. Gargantua and eat the world up. ' But being 
 'Mother Time' would mean that I'd have to go on unceasingly, 
 forever and forever — through all eternity — then having come to 
 the end of eternity would have to start all over again, for there is 
 no end to eternity and I'd be so tired. Had this in mind when I 
 remarked that I seemed to do my best to jump from the frying 
 pan into the fire. ' ' (This was an occasional remark she made while 
 having the fancies of returning to the intrauterine state.) 
 
 Her general attitude was now so satisfactory that she was 
 permitted to go home and return several times a week for the psy- 
 choanalysis. Several days after she had been living with her 
 
CHKONIC HEBEPHEEKIO DISSOCIATIOK 651 
 
 husband in her father's honse she brought the following dream 
 and its analysis, which she made herself. 
 
 Dream : I was chasing around a high granite house looking 
 for a broom to sweep the pantry with. The great pillars made 
 dents like rooms. When I found the broom it Avas worn out. 
 
 Analysis: Chasing around the house meant seeking sexual 
 gratification. The new broom [laughed frankly] sweeps clean — 
 my husband came home after working all night. Was like an old 
 broom, all worn out. 
 
 The patient's nurse was discharged (thirty-seventh week), she 
 was given complpte freedom to do as she pleased. From the time 
 the patient returned home, her sister had conflicted with her when- 
 ever the patient asserted her independence. During this conflict 
 the nurse was retained for an extra month becaiise the patient's 
 sister was in an anxiety state, about the patient possibly commit- 
 ting suicide. The sister insisted to me, with a vigorous display of 
 anger, that she had to "protect her responsibilities" and did not 
 "care a hang" what the patient did about it. 
 
 A few days later the patient had to oppose her hiTsband's 
 mother, who was trjdng to influence him to change his work. The 
 importance of making the first year of her return to the household 
 one of sincere welcome and comfort had been carefully discussed 
 with her husband and he generously agreed to adapt himself to his 
 wife 's wishes. I hoped by this measure to make him feel also that 
 as a woman his wife 's interests were to be considered preeminent 
 to his mother's. 
 
 Unfortunately his mother could not accommodate herself to 
 their plans and strongly opposed them. The patient dreamed: 
 "W — 's mother was saying good-bye on board a ship on a long 
 gang-plank and embracing W — . I had been waiting for W — and 
 I thought it a good time to get away and I ran down the plank to 
 get away." She brought the following analysis mth the dream. 
 His mother wanted him to take a position in a foreign country. 
 (This would have been very undesirable for the patient.) "You 
 see before I married I expected to work out things for myself but 
 his mother is an old "but-inski," and so when I ran away from 
 them and the baby Avas drowned I escaped my troubles." The 
 night of the above dream she also dreamed that she saw her sister 
 and her baby drowning in a shower bath. 
 
 This incessant, miserably petty struggle betAveen the two fam- 
 
652 I'SYCHOtATHOLOGY 
 
 ilies and her husband did not cease. Although the exasperating 
 persistence with which the older people tried to work out this 
 young woman's plans was finally slightly checked, it has by no 
 means, within two years, assumed the proportions of sensible con- 
 siderateness. 
 
 About two months after the discharge of the nurse the pa- 
 tient's fears were realized and she became pregnant despite pre-' 
 caution. Although she was urged by some members of the fam- 
 ily to submit to a hysterectomy and be contented with one child, 
 she decided the matter for herself and made it plainly understood 
 that she was delighted with her prospects for another child. All 
 she wanted was a fair amount of consideration for her wishes 
 and material needs. 
 
 During this period, when her relati-\-es were again trying to 
 mold her against her desires and her husband could not free him- 
 self from the direct influence of his mother, she had several dreams 
 of being on the stage and at work, and had strong wishes to sever 
 her relations with his family. 
 
 Two years later: This patient has two fine children and is 
 trying to work out her life plans to her heart's desire, despite the 
 resistances that she has to deal with. ^Tien she began to recover 
 from her psychosis her husband spontaneously promised to ab- 
 stain from gambling and alcoholics, but now he has resumed taking 
 an occasional drinlc which disappointed her but not grievously. 
 
 When I discharged her she seemed to be uncomfortable about 
 two things — inability to find a religion that was not free from 
 dogma and hypocrisy, and a feeling that her education was not am- 
 ple. She made a special visit to ask me if I believed in a personal 
 God. My indefinite reply, made with the object that she should 
 formulate her conception for herself, I have always regretted. It 
 was, I have always felt since, the one point in the psychoanalytic 
 procedure where I should have crystallized things for her so that 
 she might feel optimistic. My position in her life, due to the al- 
 truistic traiisrci-enco, made this essential, but I had not quite 
 grasped the full importance of its sublimating value in her case. 
 
 Her husband has not changed sufficiently to make me feel as- 
 sured about the solution of their mating problem. Although he 
 is attentive, sincere and "faithful to her, and she is a devoted, af- 
 fectionate woman, he shoAvs a constant undercurrent of criticism 
 and displeasure about her diet, tendency to become heavy, dressing 
 
CHKONIC HEBEPHEBN30 DISSOCIATJON 653 
 
 carelessly and lier personal style, lie can not renounce his at- 
 tachment to his mother and his work does not permit him to have 
 a psychoanalysis. 
 
 Her feelings of inferiority about her education had to be given 
 serious consideration. Her education had been badly supervised 
 and her conception of her fitness as a woman was not at all com- 
 mensurate with the magnificent affections of a practical nature 
 which were natural to her. She had become more of a woman in 
 her sympathies and insight than the average social light. Her in^ 
 sight into the affective mechanisms of those about her was unusu- 
 ally keen, and yet gracious and not critical. Among her friends 
 she was delightfully amusing despite her feelings of inferiority. 
 To meet this inferiority, upon advice, she read biographical 
 sketches of famous women and reacted A^dth the conviction that 
 much of her suffering had been due to her suppressed, censured 
 existence. She determined to join the movement for woman's 
 emancipation. This was very encouraging and, although I could 
 not frankly urge as much to her, forseeing her husband's resist- 
 ance, I explicitly insisted to him that he must not suppress this 
 but shonld support her. He quite agreed Avith me, but a year later, 
 iipon a visit to their home, I found that he had been unable to com- 
 ply. He had suppressed this most encouraging adjustment and 
 Avas tending even to further remodeling pressure with no little 
 irritability. 
 
 Two years after her discharge, despite the critical pressure 
 of her people, she was asserting herself according to her oa\ti 
 judgment. She met their arguments Avith the unshakable convic- 
 tion that first of all she must use her own judgment because her 
 physician had insisted upon it and she did not care what they 
 had to say. She could not please everyone, and no matter what 
 happened, she kncAV that her physician respected her personal in- 
 tegrity and sincerity. 
 
 Possibly this reliance upon me Avill gradually force the fami- 
 lies to quit criticizing by discouraging them. I feel that in such 
 problems the patient's considerations must come first. 
 
 The manner in which she managed her second pregnancy and 
 conducted herself and household is very encouraging, although 
 she has openly stated that if any hopeless family estrangement 
 should ever occur she would commit suicide. 
 
 The committing of suicide Avould of course be equivalent to a 
 
654 PSYCHOPATHOLOGY 
 
 final regression to the eternal mother : the intrauterine regression 
 was the most predominant interest during the period of dissoeia* 
 tion of the personality. (See the "Isle of the Dead" by Boecklin, 
 Fig. 29. The suicide's effort is to return to the ancient state of 
 intrauterine dependence.) 
 
 The mental confusion, that is, the flood of distressing delu- 
 sions and hallucinations through which she passed, was caused 
 by the repressed affect becoming uncontrollable and dissociated. 
 The distressing elements in the content of consciousness, such as 
 the abortion and prostitution fantasies, horrifying as they were, 
 were nevertheless wish-fulfilling. 
 
 Her psychosis may be regarded as an episode of confusion in 
 her biological struggle. The nature of the affective dissociation 
 and regression, as revealed by the hallucinations, was quite charac- 
 teristic of the so-called dementia prsecox type. The nature of her 
 recovery and insight I believe was entirely due to the psychoanal- 
 ysis, which, in turn, was dependent fundamentally upon the nature 
 of the transference that she required. 
 
 It is important for the physician to recognize when a patient 
 is tending to make an affective regression to a lower integrative 
 level, because nothing but an adequate transference can prevent it. 
 When the person upon whom the patient is most dependent for 
 sympathetic encouragement can not respond to the situation, be- 
 cause of death, marriage, selfishness, unconscious resistances, or 
 disinterestedness, it is necessary that a physician be engaged 
 whose personality and insight are so constituted as to enable the 
 patient to develop intelligently an affectionate transference to the 
 physician, which, however, must plainly have only an altruistic 
 purpose. 
 
 The following cases are typical of the mechanism of affective 
 regression to an infantile level because the conflicts attending ma- 
 turity were too severe and the form of transference conducive to 
 maintaining mature interests is lost. 
 
 Case IiD-2 is a slender little woman of thirty-eight, unmar- 
 ried, who had a common school education and later worked as a 
 domestic. She developed a psychosis at twenty-six, two years 
 after her mother's death. The psychosis was characterized by a 
 sudden onset, long period in bed, the refusal of food, passing of 
 excreta in bed, indifference, hallucinations, feelings of inferiority, 
 and a tendency to adopt her nurse as "mamma" and follow her 
 
CHRONIC HEBEPHRENIC DISSOCIATIOK 
 
 655 
 
 constantly about the ward like a child. She talked of her worries 
 about her mother and her ability to communicate wdth her parents 
 in "heaven" (wish-fulfilling hallucination). The nurse and a 
 woman physician were adopted as mothers by her. 
 
 Mg. 63. — Regression to intrauterine attitude and dying followed hj reconstruction 
 
 to this early childhood level. 
 
 She developed the facial expression and affective attitude of 
 a little child. Eleven years after her psychosis (age thirty-eight) 
 she still claims to be a baby, uses baby words, baby pronunciation 
 
656 PSYCPIOPATHOLOGY 
 
 and carries a large Teddy bear about witli her. day and night. 
 (See Fig. 63.) 
 
 She says, in a baby's voice, that she has always been a baby 
 and never grew up. Although one brother is younger than she, 
 she says he was never the baby. She tells with pleasure that she 
 is now awaiting the time of her death when she "will be Avith 
 mamma in heaven." 
 
 No physical anomalies Avero noted upon examination. Her 
 memory and general orientation are excellent. 
 
 Case HD-3 was a very affectionate, attractive girl who had 
 many friends and a wide variety of social interests. ^Vhen she 
 was nine years old, an older brother coerced her into sexual play 
 and the moral compensations later became the foundation of undue 
 aversions for functions pertaining to sex. 
 
 At twenty she married an effeminate man of about her height, 
 five years older than herself. He had a strong affective attach- 
 ment to his mother, was rather erotic, tense and inclined to be 
 irritable. He regarded her as sexually frigid althoiigh willing. 
 She resented his tendency' to favor his mother above her and an 
 uncompromising situation developed in which she and the mother- 
 in-law avoided speaking to each other for a year or longer. 
 
 The patient was a sincere Catholic and protested when her 
 husband insisted upon an abortion the first time she became preg- 
 nant. She finally took some "pills" for this purpose, which, how- 
 ever, were ineffective and the fetus was delivered vnth instruments 
 at full term but only lived nine days. Her reactions of remorse 
 were serious, but finally she succeeded in smoothing the situation 
 over, although she held herself responsible for the death of the in- 
 fant because of the drug. 
 
 Fourteen months later she gave birth to her second son and 
 seemed to improve finely until the eighth day when she showed 
 considerable anxiety about something Avhich Avas not understood. 
 On the ninth day she began to talk about her first infant (died 'on 
 ninth day) and mentioned its nanio. She had premonitions that 
 something serious was going to happen and asked to see her 
 mother-in-law. Unfortunately an understanding AA^as not only not 
 effected, but the situation Avas, as usual, decidedly aggravated. 
 (The physician probably did not grasp the serious incompatibility 
 alwavs to be found in tAvo Avomen avIio demand the first considera- 
 
CHRONIC HEBEPHRENIC DISSOCIATION 657 
 
 tions of one man, even if he is the son of one of the women. The 
 mother-in-law mnst step back or the situation is hopeless.) 
 
 The patient now became confused and rapidly developed a 
 delirium. She said she mnst sacrifice herself and added something 
 abont "the devil." She seemed to be obsessed with feelings of 
 sinfulness and confessed the sexual transgressions of her brother 
 for which she seemed to feel she AA'as responsible. She had another 
 secret. She said her husband was the Father, Son and Holy Ghost, 
 and Grod was the Father and she A^-as the Virgin Mary. She called 
 frequently for her first infant. 
 
 She was finally admitted to St. Elizabeths Plospital in a very 
 toxic, delirious condition. She tossed restlessly from side to side 
 iu bed, tongue coated, breath foul, eyes staring, and was unrespon- 
 sive to questions. At times she rubbed her hand along the wall 
 and then kissed it. She had to be tube-fod, was disoriented, and 
 persisted in misnaming the nurse. A few days after admission she 
 began to talk incessantly. The stream of thought Avas disconnected 
 and not influenced by the environment but tended to refer to her 
 affective disappointments, her husband, and persistent feelings 
 that she had to leave him. In the continuous bath she spoke of 
 snakes, bedbugs, negroes, and thrcAV the pilloAv out of the tub, 
 because it was a "negro." She wrote several letters filled Avith 
 vulgar sexual phrases, references to feces and her love for the 
 nurse. 
 
 The delirium continued for nearly a month, during which she 
 gave birth (simulated) to tA^dns, tAA^o boys, instead of one child (a 
 compensation for the dead child). 
 
 Then she improved gradually, became oriented, helped to 
 nurse other patients and seemed to be readjusting A^ery Avell, al- 
 though she still had hallucinations. Unfortunately her narcissistic 
 husband did not vnderstand her, he really could not be made to un- 
 derstand her, and could not give her the affectionate consideration 
 she required, because of his mother-attachmevt. He tried to be 
 Jiind, but ivas stiff, proud, insistent, even haughty, and was unable 
 to develop the slightest comprehension of his affective influence in 
 the situation. He AA^as adAased not to Adsit his wife, but his unrea- 
 sonable persistence had to be yielded to occasionally although it 
 Avas regarded as an ominous risk because she so frequently asked 
 her nurse to tell her the truth about whether or not she might get 
 Avell. She Avas afraid she never could, Avhich Avas regarded as an in- 
 
658 PSYCHOPATHOLOGY 
 
 dication of the perniciousness of the regressive reaction to her hus- 
 band's attitude. She was, however, playful and kind. The crisis 
 came at an unguarded moment. A profound affective regression 
 occurred and she has remained fixed in this condition for nearly 
 four years. 
 
 Her husband would never share his responsibility for the epi- 
 sode. He used the defensive phrases that people usually use when 
 they want to avoid responsibilities. He simply forgot most of the 
 things he said while they were in the hospital parlor together. He 
 said he did not notice anything unusual about her behavior. "V\Tiat- 
 ever disappointment the patient experienced, she returned to the 
 ward and cried like a broken-hearted girl. She soon passed into 
 an excitement, destroyed her clothing, rubbed saliva over her arms, 
 put food into her mouth, spit it up and ate it again, became mute 
 and masturbated excessively. Later the frequency of the mastur- 
 bation subsided and she assumed the fetal position under blankets 
 which she placed on the floor (mother earth). She would not lie 
 in bed. She preferred dark rooms and when anyone entered she 
 rolled over and over. On the open ward she turned ' somersaults 
 over the furniture, exposed herself, and crawled into dark corners. 
 She has remained almost consistently mute since the episode in the 
 parlor. 
 
 She was fond of resting her hack against the electric light 
 switch and turning on the light. Sometimes she assumed the fe- 
 male sexual position on the floor and then assumed the male sexual 
 position and imitated coitus : she usually left her slipper in the 
 office when she started to leave. On one occasion, when asked to 
 write out her troubles because she would not speak, she drew an 
 eagle among the clouds for me and when she handed back the pen- 
 cil, cleaned it off as if it had been soiled by her hands. 
 
 For several days at a time she had periods when she crawled 
 about on all fours, barked and grunted like an animal. She Avould 
 not eat in anyone's presence and mixed her foods into a homoge- 
 neous mass on the floor and only ate part of it. She also played 
 with her excreta and rubbed urine into her hair. (Excretory 
 erotic interests were very active.) 
 
 She grabbed her sister's wrist watch and swallowed it. It 
 was recovered later and then she tried to swallow her nurse's 
 watch. (Probably a pregnancy substitution, as the ticking, watch 
 may symbolize an animated object. One is inclined to feel that the 
 
CHRONIC HEBEPHRENIC DISSOCIATION 
 
 659 
 
 affective craving to have the first child return was partly gratified 
 by this as well as by fancies of its rebirth.) 
 
 The patient was finally taken to her home for several months 
 and nursed, but failed to respond. 
 
 Since her return to the hospital she Avill not wear clothing, 
 but tears her dresses, wraps them around her body. like a blanket, 
 
 Fig. 64. — Prehistoric Costa Biean sculpture showing squatting, ape-like posture 
 with genitalia displayed to the foreground. Compare with squatting postures of 
 hebephrenic deteriorated types on next page. 
 
 sits on the floor for hours with her head buried in her arms and her 
 knees pulled up to her chest — a very common dementia prsecox 
 position in which such patients freely play with their pelvic ori- 
 fices. It is also a position very common to apes and savages. (See 
 Fig. 64, a decidedly fetal position.) 
 
660 
 
 P.SVGHOl'ATHOI.OGV 
 
 She now calls her nurse "mamma," and occasionally talks in a 
 playful, childish voice, sings childish songs about school days, begs 
 to be loved, petted and fed, but most of the time she is mute, de- 
 structive, plays with excreta and masturbates openly. 
 
 She complains of having died and says her baby was killed on 
 a railroad track. 
 
 Kg. 65. — No. 1 shows the primitive ape-like posture with erotic facial expres- 
 sion. No. 2 shows a similar bodily posture with significant differences in posture of 
 the arms and head which is more like the affective attitude of intrauterine regression. 
 While in this mood patients often insist they are dead. 
 
 Previously she menstruated regularly every two weeks, but 
 since the psychosis the menstrual functions have been inactive. 
 Her prognosis is hopeless, I believe, not because of her present 
 affective disposition, but because of the insurmountable resist- 
 ances in her husband and his mother to the affect readjusting at a 
 
CHRONIC HEBEPHRENIC DISSOCIATION 
 
 661 
 
 higher, independent level. Her religion and the law prevent a 
 divorce which' might permit the repressed affect an opportunity 
 to adjust itself along more constructive lines. 
 
 The following group of hebephrenic dissociated personalities 
 has been selected to illustrate further the influence upon behavior 
 and character formation of the repressed, dissociated anal erotic 
 
 JTig. ti6. — Ape posture in excretory erotic liobeplirenio dementia prseoox — a dis- 
 sociation neurosis with regression to infantile level and abandonment to pelvic 
 segmental cravings. 
 
 (sodomistic) cravings, and the fascination for the excreta. The 
 peculiar stupor which patients are inclined to develop while in an 
 anal erotic tension is decidedly worth more detailed investigation 
 in selected cases. Two of the preceding cases showed marked 
 interests in the excreta, but the following group showed predomin- 
 ant interests of this nature Avhen in the depths of the psychosis. 
 
662 PSYCHOPATHOLOGY 
 
 As the obverse corollary to the hoarding of the seclusive anal 
 erotic miser, who must accnmnlate material in order to prevent the 
 visceral anxiety that comes on when he f eel-s that he may lose his 
 wealth and possibly not be able to provide the alimentary tract and 
 its outlet with sufficient stimuli, we have the case of compulsive, 
 anxious cleansing to remove the guilt of the incestuous anal erotic 
 craving (Case PN-1), and the opposite types, who delight in ac- 
 cumulating debris, reducing their clothing to loose rags, and 
 spending their time in trying to defecate. At the same time the 
 latter type have very active sodomistic tendencies toward their 
 companions. The typical miser and the mysophobic patient are 
 self-centered and seclusive, whereas this other anal erotic type is 
 more inclined to companionship and revelling in waste and debris, 
 hoboism and irresponsibility. 
 
 Case HD-4 was a large, well-muscled, almost brawny, sailor, 
 6 ft. tall, weighing about 180 lbs. He was twenty-six years old, 
 unmarried, and had never had a love affair with a female. He 
 had a large masculine figure, no deformities, and a heavy distri- 
 bution of hair. His genitalia were well developed and no stig- 
 mata or indications of physical inferiority of the gross type were 
 detected. His forehead gave the impression of being a little lower 
 than normal, because the scalp grew closer to the eyebrows than 
 usual. His head, however, was actually of good height and breadth. 
 He was an excellent example of that group of men who are physi- 
 cally better sexed than the average man, but, becaiTse of their af- 
 fective development, are not truly matured males. 
 
 He had had no serious diseases except gonorrhea. Syphilis 
 was denied, and his blood (Wassermann) reaction was negative. 
 He had been inclined to delight in alcoholic debauches, and had 
 one scar over the left hip from a stab wound received in a Mexi- 
 can gambling house brawl, and another from a bullet wound in the 
 leg acquired in a saloon fight. (When drunk, he was inclined to 
 become brutal and quarrelsome, which is rather a significant in- 
 dication of old repressions of hatred.) 
 
 The family history (inadequate) obtained from the patient 
 revealed no neurological or psychopathic determinants in his he- 
 redity. 
 
 The patient was born in a rural district of Tennessee in 1888, 
 developed normally as a child, and had no serious illnesses. He 
 attended a southern eoimtry school intermittently until sixteen 
 
CHRONIC HEBEPHRENIC DISSOCIATIOH 663 
 
 years of age. This gave him a meager education. As a pupil, he 
 was indifferent. 
 
 He worked on a farm with his father and conflicted frequently 
 with his parents Avho evidently did not understand him. This was 
 disposed to make him brood and sullenly resent their impositions 
 and punishment. 
 
 lie refused to Avork with his father because of their quarrels 
 and obtained little sympathy from his mother. With uncontrol- 
 lable affect of grief and facial tremors he commented, when a pa- 
 tient, upon her, as follows : ' ' My mother had no use for me when 
 I was a child. She loved my brother and sister * * * Tliey 
 [not a reference to parents] used to get her under control and she 
 would whip me. * * * j have no use for my mother and would 
 not go home if she were living." 
 
 At seventeen, he ran away from home and travelled with a 
 circus as an assistant to an animal trainer. He wandered about 
 the Southwest for several years working as an unskilled laborer, 
 earning from $40.00 to $90.00 a month. At twenty-one, he enlisted 
 in the navy and served for three years, receiving an honorable 
 discharge as a third-class gunner's mate. 
 
 At this time he inherited $1800.00 from liis parent's estate 
 which was totally lost when a boarding house which he had es- 
 tablished, was destroyed by fire. This misfortune discouraged him 
 seriously and for several months he wandered about the Pacific 
 coast doing odd jobs in lumber camps, judging from his behavior, 
 apparently in a very abnormal frame of mind. 
 
 During this period of anxiety he reenlisted in the Navy, (aged 
 twenty-five). As he expressed himself, he was "afraid that they 
 would break me down and get me into trouble." "They," he said, 
 followed him over the Pacific coast. He was actually undergoing 
 a grave biological struggle into which he had no insight. 
 
 Three months later while on board ship he was observed to be 
 acting "queerly" and spending much of Ms time reading oriental 
 books of mystery. A few days later, he threatened to shoot some 
 of his companions whom he accused of persecuting him. He tried 
 to obtain a revolver for this purpose and attracted the attention 
 of the officer in charge. "When questioned by the medical officer 
 he broke down completely and, with uncontrollable affect, ex- 
 plained that he, himself, was a "beast." He also repeatedly 
 told his comrades that he was a "moral degenerate." (Evidently 
 
664 PSYCHOPATHOLOGY 
 
 the "they" who would "break him down" had succeeded despite 
 his pathetic, earnest attempts to transcend them by reading orien- 
 tal books about the development of occult mental powers. The 
 "they" were his irrepressible homosexual cravings as will be 
 shown later.) 
 
 He was sent to a naval hospital, and became panic-stricken 
 because "someone" had told him that he was to be "hung." Be- 
 cause of his feelings of impending punishment, he tried to escape. 
 After several weeks of terrifying hallucinations, he gradually be- 
 came indifferent to work and spent his time in listless day dream- 
 ing. He talked freoly about his super-human powers to anyone 
 who would listen and now elaborated them without reserve. 
 
 He was admitted to Saint Elizabeths Hospital (aged twenty- 
 six) about seven months after his personal difficulties had devel- 
 oped to the degree of a psychosis. In its essential characteristics 
 the psychosis had not changed after the acute stages of the panic. 
 
 Upon admission, he performed the routine intelligence tests 
 very well. (This accomplishment reqiiires control of attention and 
 fairly accurate recall of details for past and recent experiences, 
 but very little education.) 
 
 The patient showed clearly, by his affective reactions and 
 fancies, that he was seriously troubled by grave, personal deficien- 
 cies. Their nature became apparent later in the study of his case. 
 He derived great comfort out of his fancies that he was a super- 
 man. Those who feigned to believe him, he liked, those who 
 doubted him, he tried to convince of his powers, and those who 
 criticised him were hated. It pleased him greatly if one paid some 
 attention to his fancies, abstracts of which from a series of talks 
 are given with some detail here. (The fancies, through the tend- 
 ency to develop the opposite in order to hide the painful weakness, 
 often indicate the personal deficiency (Case MD-11). 
 
 "Every so often someone is born with these [his] powers, 
 which are controlled by the spirits that rule the universe, and a 
 person so gifted is compelled to iTse his powers or else he is put to 
 death. [Death, meaning the destruction of the virile traits of the 
 personality, is very commonly so used by such patients.] If, on 
 the other hand, they use these poAvers, they are condemned to a 
 life of trouble. ' ' 
 
 "I was father of all the people. [Omnipotence and perpetual 
 power fantasy.] I built the Panama Canal, naval hospital at Brem- 
 
OHROSriO HEBEPHRENIC DISSOCIATION 665 
 
 erton, including ships, maciiinerv, big guns, and about everything 
 in the world. ' ' He was fond of talking about his (fancied) friendly 
 relations with the commanders of various vessels and how they 
 Avere awed by his superhuman wisdom. He said he had studied 
 "metapathiwn [metaphysics] ivhich ieaches a man to contract un- 
 seen forces and coinmimicale with 'people," 
 
 He was convinced that there was no need of his again trying 
 to overcome the mysterious, all powerful forces which were trying 
 to "pull me down," "break me down," and anyone who tried to 
 lielp him, he said, was in danger of becoming the same way. With 
 a marked display of affect and sincere pleading, he liesought me 
 to give up his case and not try to help him, because if I did I would 
 surely become like himself. He had developed, after several 
 months, a strong transference to me, and this anxiety was quite in- 
 dicative of the undercurrent homosexual feelings that were react- 
 ing to my personal interest in his difficulties. 
 
 "A man has got to get where he don't realize his surroundings, 
 but at that time I would be in a helpless state. When a man tries to 
 concentrate his mind to get into a higher form of life, that is when 
 thejj try to harm you in many ways * * * * jj d^ j,,^,, eovhJ 
 irorh himself up hic/h enough lie could co)iirol himself." (Com- 
 pensate sufficiently. ) 
 
 (The above comments, when theii became inlelliciible, proved 
 to be most significant and revealed lus biological difficulty, shoiving 
 in a sense the insight, that if a man could develop himself to a high 
 enough biological level, he could cotiirol liimself from the tevdency 
 to relapse to adolescent and preadolescent sexual interests. This 
 man's hint led to the investigation of the secret of the paranniac's 
 grand compensation, presented in the chapter on the 2^aranoid type 
 — namely, his struggle to reach a biological level that at times he 
 can vaguely feel but can not qiiite attain because of the conditioned 
 sexual cravings.) 
 
 For five months, he was indifferent to the other people about 
 him, many of Avhom were sailors of his own age. He rarely quar- 
 relled with anyone and was not sensitive about his honor. He was 
 rather sluggish and enjoyed himself best when lying on a bench 
 ■with his face covered, lost in dreams. He worked well on the ward 
 so long as urged and flattered. AH his discussions were giA^en with 
 an attitude of deep confidence in his wisdom. 
 
 The attempts to convince him, made by the Avard phA'sician, 
 
666 PSYCHOPATHOLOGY 
 
 that he was not being persecuted were met by vigorous assertions 
 that his difficulties were real. The defense was often accompanied 
 by marked agitation. He felt his case to be beyond help and never 
 seemed to vary from this opiiiion. Because of this he was consid- 
 ered to be incurable. 
 
 Further than relating fa,ncies about his omnipotence and per- 
 secutions he was not inclined to be accessible. There was consider- 
 able repetition and rambling in. his discussions which are included 
 in the history in as intelligible a sequence as possible. 
 
 The "absurd, discouraging" ideas of the patient, as some of 
 the physicians were inclined to call them, which he discussed with 
 so much conviction, later proved to he figuratively or symbolically 
 true, although not literally so, as the patient himself had main- 
 tained them to be at the first. They contained the biological se- 
 cret of his life, into which he had to gain insight in order to make a 
 more practical adjustment. 
 
 For several interviews the frequent inquiries into his difficul- 
 ties yielded nothing more than heroic fancies and expressions of 
 the following type, but they were usually accompanied by marked 
 aifect: — 
 
 "When I was twelve I was in Tennessee. A man named -?;fa^- = 
 had his legs cut off when in Saint Louis. He was only ten 
 
 or eleven. He was a nice lad. They tried to do something with 
 him but could not. Then I gave him his leg back. I thought of 
 this just a few days ago. " (Perhaps a figurative castration fan- 
 tasy which may be conipared with the definite castration fantasy 
 given later.) 
 
 The following example of his mysterious fantasies was woven 
 into his account of his confinement in a hospital: "When the 
 guard who had taken me to the hospital had returned to his ship 
 I was there. They asked me how I managed to get back so soon 
 and I told them I had returned to the ship by wireless while they 
 had to use the train." When asked to explain what he meant by 
 getting back by wireless, he said: "I used the word 'wireless' 
 merely as a figure of speech, but I meant that I was already on 
 the ship. Although I had gone to Uldah, California, I had Tiever 
 left the ship." 
 
 As in all such cases it is useless to attempt try correct such 
 glaringly inconsistent statements.' It only provokes indignation 
 and further inconsistent statements when the physician attempts 
 
CHROKIO HBBBPHEBNIO DISSOCIATION 667 
 
 to force the patient to recognize his falsifications. A more suc- 
 cessful method seems to be to patiently listen to the seemingly in- 
 exhaustible supply of fancies, and, as the patient gains more con- 
 fidence in his physician's purpose, more intelligible personal sto- 
 ries are related. He often told various physicians and patients at 
 this time that if he could concentrate his mind more thoroughly he 
 would have enough power to pass oiit through the roof and trans- 
 fer himself instantly to any distant land. This naturally aroused 
 no little impatience in busy members of the staff, and their severe 
 but well meant criticisms of his "nonsense" insulted the patient 
 and he soon learned to keep his fancies and diflficulties to himself. 
 
 "When he found his fancies were listened to with patient so- 
 briety he felt encouraged to elaborate those about mental concen- 
 tration and astral flight. Although disconnected, they give at least 
 an impression of the numerous unintelligible difficulties to be met 
 with before the truth will out. 
 
 ""When a man thinks — they claim when he lives this lower 
 life they call that thinking. I '11 try to explain it differently. Sup- 
 pose a man has three bodies, a material body, an astral body and a 
 spiritual body. It is hard to maintain this body without food. 
 My enemies try to make me live this body [the material]. The 
 spiritual body is one no one can explain. The astral body is an 
 imaginary body, is not material, but it is a body, that is just about 
 all [everything] ; there is no limit to space or time. You are just 
 as old as God, as anyone else. ' ' 
 
 The spiritual body was passed by with the remark, "No one 
 can explain. ' ' The discussions of the material body revealed that 
 he felt it to be controlled by "they," "those people," "my ene- 
 mies," which try to "keep me down, — ^make a brute out of me." 
 He escaped from these unhappy cravings by developing, through 
 "concentration," the "astral body" or bodies which were onrni- 
 potent and omnipresent, if estimated by his fancies of their deeds. 
 
 He avoided, for a long time, discussing freely the unpleasant 
 difficulties of ' ' the material body ' ' or the lower self, and delighted 
 in the omnipotent traits of his astral self. 
 
 "When I quit thinking I can he made to do anything." He 
 often referred to this state as being made "mentally thick" (stu- 
 pid.) "You see, to do that, I must forget everything. After I 
 make myself strong I cannot be influenced. ' ' He often talked about 
 the "concentrated" or astral state's achievements in the past. 
 
668 PSYCHOPATHOLOGY 
 
 Eidieule of it had taught him not to attempt any further explana- 
 tions. He earnestly claimed that at one time he could make several, 
 even a dozen, astral bodies, and delighted in relating their potent, 
 heroic achievements, such as building canals, ships, railroads, etc., 
 but, particularly, detailed accounts of their heterosexual conquests, 
 and the plan to get married because then "they" would let him 
 alone. (The number would be astonishing if the males and fe- 
 males were knoAvn who marry with the desperate hope that hetero- 
 sexual intercourse will free them from homosexuality and mastur- 
 bation. Sadly enough, physicians are frequently inclined to rec- 
 ommend such procediires under pathological conditions.) 
 
 During the conference in which the fancies about the value of 
 the marriage of the astral self was discussed he made his first con- 
 fession of his past heterosexual difficulties, although the difficulties 
 of the material self had been quite frequently referred to. Pie 
 told of his attempts to have sexual relations with a prostitute and 
 how "they" (the mysteriously destructive forces) fought him and 
 made it difficult for him to ' ' concentrate and have an erection. ' ' He 
 finally succeeded in having sexual relations, but felt no pleasure 
 or passion, as he expressed it. He said he made this effort because 
 if ho got into trouble people would think that he had tried to live 
 rigM. (Heterosexual potency and the higher life.) 
 
 From that time on, the patient's transference was such that 
 he allowed me to remind him of Avhat he actually meant by coji- 
 centrating to attain omnipotenco and live a higher life. As this 
 insight developed he tended to abandon his wild fancies about the 
 astral self. 
 
 Patients who persist in their striving and hope to attain 
 heterosexual potency delight in fancies about promiscuous hetero- 
 sexual conquests. This ignorant sailor gave a detailed account, 
 with great pleasure and earnestness, of how, Avhen he Avas fifteen, 
 college girls lived in a house for his pleasure, and tried to make a 
 "Brigham Young" out of him. (This was probably a recasting of 
 his old masturbation fancies.) 
 
 The patient usually showed considerable affect, and even anx;^ 
 iety, when he discussed the process of his mind "getting thick" 
 and ' ' forgetting everything. " " They keep fighting me all the time. 
 If I were discharged [from the hospital] they would keep right 
 after me, get me restless [erotic] and get me into a state of not 
 thinking. Then one is Aveak and they use him. I have never had 
 
CHRONIC HEBEPHRENIC DISSOCIATION 669 
 
 rest. That lias been the one thing in the world that I have been 
 looking for. Now I am as helpless as a babe. These people make 
 me live the life of a brute." 
 
 "When a man tries to do well they fight him so much that they 
 tear his mind up and wear him out." He complained of his strug- 
 gles to live the higher life (heterosexual), but that sooner or later, 
 when he tvas not on his guard, he luould suddenly become "thick" 
 and "mean" and while in this state of covfitsion lie would he com- 
 pelled to commit sodomij. 
 
 During the analysis ho related this dream: "Trees, fruit trees, 
 chestnut trees in full bloom in June. Snow all over the trees 
 [trembles]. ^Vt that time they were going to use me and I awak- 
 ened." (To be used meant for homosexual purposes.) 
 
 His discussion is given here in part : "The snow destroys the 
 crops, is cold." (He was unable to practice coitus and was unable 
 to feel passion.) When "they" use him, he said: "They make me 
 quit thinking and confuse me with ideas of sodomy." He main-, 
 tained he did not realise ivhnt he was doing at such times and could 
 only give a vngtte, account of what happened. His description of 
 his behavior, although colored trith fanci('s, teas decidedly like the 
 behavior of some confused epileptics while suffering hallucina- 
 tions and fears of being assaulted. 
 
 When his accounts of his sodomistic tendencies became less 
 guarded, he said, with great agitation, that he was not only forced 
 to live like "a brute" but also something Avas trying to make a "c. 
 s." out of him. Unfortunately, just as he was confessing these 
 difficulties, the discussion was interrupted by a knock on the office 
 door. I was not again able to obtain a reference to his oral erotic 
 difficulties although he frequently discussed his anal eroticism. 
 
 After I succeeded in having the pleasure principle recognized 
 in his homosexual submissions and aggressions, he became less 
 inclined to shunt the responsibility onto an impersonal "they" 
 and accepted the inclinations as his own. This seemed to be the 
 most important step toward a more healthy readjustment of his 
 conflict, which, however, I believe, never entirely disappeared and 
 may be expected to recur later in life Avith grave mental conse- 
 quences. 
 
 The following fancies, at first seriously given reveal the mech- 
 anism of the compensator}' striving to avoid this cause of fear. 
 He discussed the inclination of the second cruise men (old sailors) 
 
670 PSYCPIOPATHOLOGY 
 
 on his sHp to kiss the soft skinned, effeminate boys who were in 
 the crew. Then he told of how he himself transformed "a lady" 
 (effeminate boy) into a blue jacket, and kept "her" for some time 
 on board ship, practicing sodomy with "her." 
 
 The pleasure fancy was expressed as follows : "She said, 'they 
 put me here for you to use me so you wouldn't get into trouble.' " 
 He was fond of giving imaginary quotations about being called 
 "father" by his sexual objects. He quoted them as saying Avith 
 awe, "Father can do anything." With this phrase he frequently 
 diverted to heroic stories about making wonderful machinery, etc., 
 or vanquishing an enemy. He had an enemy in sailor C — who was 
 at one time a drinking companion and probably a paramour. He 
 
 tallied with great affect about a quarrel with C and af how he 
 
 smashed a plate over his head. Then he put the pieces together 
 and the fellow called him "God" and "Father" and marvelled at 
 his great powers and ability to "do anything." 
 
 ' ' People have always called me father all over the world * * 
 Hate, fear and worry are the worst enemies of man. I know they 
 will be forgiven, when I know enough to let the devil let me alone. 
 I know the spirits. I know Mother. She is mother to the world. 
 She is in heaven. She is everyone's mother, not that one I had on 
 earth," (said with emotion). 
 
 This patient's fancies about having superhuman power when 
 he could concentrate, Avere intimately based upon his struggle to 
 establish heterosexual potency and be socially respected. His 
 strivings to escape from the influences of the "they" which make 
 him homosexual, commit sodomy, etc., were his biological struggle 
 to develop adult male sexual attributes. Whatever conditioned the 
 homosexual fixation was not analyzed, but is indicated in the fol- 
 lowing : 
 
 When his sexual difficulties were frankly considered in the con- 
 sultations, he talked of influences to which he had not properly ad- 
 justed when an adolescent. "I used to go to bed Avith my trousers 
 on, so I could not put my hand on my privates. At night, they used 
 to fight me. They would malfe me think of haAdng intercourse with 
 women. ' ' This account of his early difficulties may be more or less 
 true, but at least it established the "they" as a personification of 
 his sexual cravings. 
 
 To the masturbation discussion he added the fancy, perhaps 
 partly true, that when fifteen he helped a man to escape from the 
 
CHRONIC HEBEPHRENIC DISSOCIATION 671 
 
 eommunity. "They" were trying to make a masturbator out of 
 him, and if he did not quit they would cut his testicles out. Later, 
 they cut out his testicles but healed him up. (The self -cure of 
 masturbation by castration is not imcommon.) Upon another oc- 
 casion he related the same story about this man and included that 
 his grandfather had warned him not to associate with the fellow 
 because he was a "c. s." "They," however, made him associate 
 with the man and he "cured" the fellow by teaching him to "con- 
 centrate his mind." 
 
 During the psychosis he would not recognize his brother's let- 
 ters and was inclined to regard him as dead. He gradually re- 
 sumed an interest in his family and the realities of life. He 
 disposed of his fancies as something he would no longer discuss 
 because it Avas "foolish," although at times he intimated that he 
 still tended to solve his troubles through mental concentration. 
 
 Seventeen months after the onset of liis panic he Avas dis- 
 charged from the hospital as a social recovery, because of his con- 
 genial attitude and the fact that by Avorking he demonstrated his 
 ability to take care of himself. 
 
 This man's explanations of his mental state of becoming 
 "thick" (confused) by the pressure of the anal erotic cravings and 
 his tendency to get into fights and become "a brute" possibly 
 throws a significant light on some types of epileptic personalities. 
 It is Avell known that epileptics may become A-ery abusive and cruel, 
 and even commit horrible erotic crimes, while in the epileptic con- 
 fusion. 
 
 A variety of reactions to anal eroticism are given here be- 
 cause they indicate that the fall and the conATilsions in some cases 
 of idiopathic epilepsy are related frankly to anal-rectal eroticism. 
 
 Case HD-5, considered to he a hebephrenic type of dementia 
 prcecox, had been seen submitting himself to sodomy with affec- 
 tions that made his anal eroticism unmistakable. One day when I 
 entered the Avard I saAv him standing alone near the center of the 
 living room. His eyes were staring, out of focus, his face showed 
 profound perplexity and his body seemed quite rigid. I advanced 
 and greeted him, but he did not seem to see or hear me. Suddenly, 
 his muscles stiffened, he swayed backAvard and fell at full length 
 on the floor in an epileptiform type of seizure. Although dazed, 
 he did not completely lose consciousness and got up within a few 
 seconds. Physically, this man's condition was excellent. He had 
 
672 PSYCHOPATHOLOGY 
 
 occasionally approached me, trying to show, in a confused mum- 
 bling voice, that he was willing to do something, and seeming to 
 feel that I wanted him to do something. His perplexed emotional 
 state was largely due to an intense affective pressure (anal erotic) 
 .and the fall signified submission. He was several times ca%|iifin 
 sodomistic submission to other homosexual patients. 
 
 The inference as to the significance of the moral fall will cer- 
 tainly seem iinreasonable to those who have not made a definite 
 study of these particular phenomena; hence, the following case is 
 added to support the inference that such states of becoming "men- 
 tally thick, ' ' as Cases HD-4, PD-34 described their states, are due 
 to the autonomic-affective influence of this form of erotic tension. 
 
 Case HD-6, a sailor, about twenty-five, had passed through a 
 period of confusion with hallucinations. He was a dull, sluggish 
 type of fellow who had not fared well as a sailor. He seemed to 
 be dazed and sat about in stupid wonder at the behavior of the 
 other patients. His face looked dull, congested, and showed no 
 emotional response. No replies which were relevant to questions 
 could be elicited. He persisted in complaining that on board ship 
 he had not been considered a good f elloAV, and that now he wanted 
 to do whatever Avas wanted. Despite efforts to divert him, Avhen 
 his genitalia were examined, he persisted in lowering his trousers, 
 stooping over and turning his buttocks toward us. His mental 
 state of being dazed and bewildered Avas quite similar to that of 
 Case HD-5. 
 
 Case PD-34: (p. 526) protested for four years against the se- 
 cret powers that took his "senses temporarily aAvay" and forced 
 him to submit to sodomy (segmental cravings AA^thin himself). 
 
 The fall, if in a proper affective setting in the dream and the 
 psychosis, signifies sexual submission, and the conAnalsion, if it 
 then occurs, seems to be the orgasm and is as genuine as if it oc- 
 curred as the result of adequate irritations of the primary eroge- 
 nous zone. 
 
 A big, uneducated Swede ahvays greeted me with a smile Avhen 
 I arrived on the ward. If given an opportunity he usimlly asked in 
 a smiling way, (a pleasure and not a hatred smile), Avhy I Avanted 
 to hypnotize him. (I had no sucli interests in the patient.) These 
 approaches Avere later followed by complaints of suffocation dis- 
 tresses and feelings of "dying." (See Michelangelo's "Cap- 
 tive.") The climax came one day Avhen I AA^as on the AA^ard. He 
 
CHKONIC HEBEPHRENIC DISSOCIATION 673 
 
 fell in a heap on the floor and "died." lie had to be put to bed, 
 and when I examined him he told me, with indications of no little 
 pleasure, that I was causing him "to die." The erotic nature of 
 the man's affective state could hardly be mistaken. A few days 
 later he looked upon me with beaming pleasure and seemed to re- 
 gard me with awe, as if the procedure had had some wonderful 
 significance. 
 
 The above case was considered to be both oral and anal erotic 
 and is presented to point out the significance of the fall and the 
 "dying" in certain cases. 
 
 Case HD-7 was a boy, soldier, Avho, when a class in psychiatry 
 surrounded him on the ward, became agitated. He had been in a 
 state of protracted confusion and decidedly destructive for several 
 Aveeks. He threw liimself at full length, face down on the floor and 
 Avept violently, blurting something to "God" about having given 
 up his ' ' soul. ' ' I-Iis confused erotic state, was typicah Two days 
 later some members of the class who were observing him, allowed 
 him, upon his confused, stiipid insistence, to enter the room of a 
 sick man. With much confusion he tried to show affection to the 
 sick man, exposed his penis and tried to undress. Such compul- 
 sions are common in this type of erotic state. 
 
 Case HD-8 was a sergeant in the army who resigned because 
 he believed that the men were trying to induce him to submit to 
 homosexual advances. '\^Tien admitted to the hospital he was very 
 erotic. When in the presence of patients or physicians he fre- 
 quently accused them of trying to tempt him, even though no un- 
 usual demonstration of personal interest in him was made. 
 
 In the examining room he complained of the attitude of the 
 physicians toward him aiid spoke of himself as being like Christ. 
 When the physician handed him a pencil to write he refused it and 
 accused the physician of having evil intentions because he handed 
 the pencil to him with the sharpened end pointed toward him. He 
 said the pencil should have been handed lengthAvise to him. 
 
 Later, he again accused the physicians of having sexual de- 
 sires for him, and turning his back, spoke of himself as being 
 Jesus Christ and said to them, ' ' Get behind me, Satan. ' ' 
 
 This anal erotic man was a constant source of dissension 
 wherever he was placed. He had no 'insight, and AA^as inclined to 
 blame others for his difficulties. (In its mechanistic sense, this is 
 of course true because his autonomic-erotic functions react to the 
 
674 PSYCHOPATHOLOGY 
 
 presence of certain types of men and he becomes embarrassed and 
 unoomfortable, perhaps anxious, and if very erotic, may even be- 
 come panicky upon loss of self-control.) 
 
 Case HD-9 was a patient on my wards in the Cleveland State 
 Hospital. He was extremely untidy, would wear almost no cloth- 
 ing, or old torn clothing, leave his shirt and trousers unbuttoned, 
 and keep the buttons torn o:ff (typical costume of the anal erotic). 
 He would spend hours at a time in the lavatory seated on the hop- 
 per. If the door to the toilet was locked, or he was prevented from 
 access to it, he would quickly get into a panic and Beg:; pitifully to 
 be allowed to enter. 
 
 Defecation was the one grand pleasure of his existence. Most 
 of his waking time was spent in making innumerable visits to the 
 watercloset. The expression of his full, dull, apathetic face ;g||ye 
 one the impression of stupidity and indifference to all other in- 
 terests, and a marked dementia. 
 
 Case HD-10 is recorded because of the striking indications of 
 unusual anal and nasal itching, her mannerisms, feelings of per- 
 secution, her intense hatred, cruelty and stealing. 
 
 She was admitted from a federal prison at twenty-three be- 
 cause of her violent temper and feelings of persecution by the pris- 
 on authorities, who, she insisted, were plotting "to shoot her" 
 and "cut her throat." 
 
 She was sent to prison twice for increasing the denominations 
 of money orders. Her father and mother are reported to have 
 been alcoholic and the patient has been a prostitute and an alco- 
 holic. 
 
 Since her admission, her general attitude has not changed. 
 Occasionally, she has made desperate attempts to carry out her 
 threats to kill people. 
 
 Her general demeanor was most grotesque. She usually 
 combed her rather short, curly, thick, shaggy hair so that it stood 
 out from all over the head in great twining masses like the caput 
 of Medusa. Her facial muscles Avere contorted in a snarl and she 
 nearly always spoke with a high-pitched, sneering, mocking voice 
 to everyone. Her nose was usually swollen, very red, pitted, and 
 she habitually rubbed and picked it. The skin of the face around 
 the nose was also congested, looked toughened, and her cheeks and 
 lips usually were spotted with large acneiform eruptions. 
 
 She walked with stiff, deliberate, step and was not inclined to 
 
CHRONIC llEBEPJIRENrC DtSSOCIATJOSr 675 
 
 move out of the way for anyone. She dressed very grotesquely 
 and adorned her legs with gaudy colored ribbons and strips of 
 cloth. She often walked along with one hand on her buttocks, 
 scratching herself, and Trequently used tlie phrase, "Kiss my ass." 
 
 She never smiled, but scowled and fi-owiied, rarely spoke ex- 
 cept to swear and threaten. She was considered to be a dangerous 
 Avoman, particularly homicidal. On one occasion, she attacked the 
 nurse and attempted to stab her in the throat Avith a safety pin. 
 One day, she smashed a window, crawled through it and jumped 
 from the second floor to the gronnd to escape. 
 
 To bluff the nurses and physicians, she threatens in a hideous, 
 sneering voice, "I'll kil — 1 you, I'll kil — 1 you! You don't believe 
 it, do you ? I '11 crush your skull ! ' ' 
 
 Sometimes she A^ciously throws the furniture about to make 
 a noise, exposes herself before the men passing the ward, spits at 
 people and is a constant source of trouble. She is also inclined to 
 be dirtjr in her toilet. 
 
 She accuses the girls of trying to assault lier sexually and 
 -often threatens to protect herself. She is very erotic, and be- 
 lieves the nurses cause it. She has made no friends in a year and 
 a half and still believes the authorities are planning to slioot her, 
 cut her throat, hang her, etc. 
 
 This case decidely demonstrates the delight in cruelty and 
 hatred that may be shoAvn by an anal erotic. 
 
 Case HD-11 Avas a newly enlisted seaman, age nineteen. When 
 thirteen his mother divorced his father and remarried Avhen the 
 boy was seventeen. He could not adjust himself to his step-father 
 who was an alcoholic. From his thirteenth to eighteenth year he 
 was very Vestless, brooding, and dissatisfied, and unal)le to hold a 
 position. He Avorked as a messenger boy and general helper until 
 his eighteenth year AA^hen he hoboed his Avay to Florida (Avandering 
 hero). 
 
 Here, he enlisted in the navy, because he was destitute, and 
 about one month after being placed on the training ship, he had 
 to be sent to St. Elizabeths Hospital because of a serious dissocia- 
 tion of the personality. Physically, he Avas a AA^ell-developed 
 healthy boy.- 
 
 When he arriAJ-ed at the hospital, he AA^as disoriented for time 
 and place, and could not tell hoAv he had enlisted or give a satis- 
 factory account of his last few days on the training ship. He 
 
676 PSYCHOPATHOLOGY 
 
 watched his environment with wide, staring, wonderi^Beyes Md 
 seemed unable to comprehend the meaning of the beha:vior of the 
 physicians and the patients Jbout him. He talKed in disconnected 
 phrases about having seen "spooks" at home, "saw aw&^V in his 
 house and "heard chains rattling^" which frightened him. He 
 said he had seen his father or a man who' "looked exactly" like 
 his father. He said fie "hngged the man" and the "man fed me 
 and gave me some candy. ' ' He acted as if he believed he Itaid seen 
 his father and had a confused notion about expecting something 
 further to happen in relation to his father. 
 
 On the ward, he would stand about in the way of the workers 
 and seemed unable to comprehend what they were doing. He 
 asked to be put "on shore" and seemed to feel that he was on a 
 ship. He complained of being "all stopped up," that he had not 
 defecated for "six days" and had eaten "the wrfsig f ood. " He 
 complained that when he tried to defecate something prevented 
 him. He said the "boys call me chicken and kid me about corn- 
 holing me (sodomy) and they call me shitpot." He was very sus- 
 picious of everyone and reluctant to tell me about his case. He 
 was having auditory hallucinations and other vivid sensory dis- 
 turbances. When asked, using his phrase, if he had been "corn- 
 holed," he said not unless they had "chloroformed" him. He be- 
 lieved that this might have occurred. He admitted having had 
 such sexual relations with his brother when a boy. 
 
 He continually felt of his abdomen and looked confused as if 
 trying to understand some strange sensation there. The only ex- 
 planation he would give was that he was "all stopped up." He 
 almost continually fumbled at his clothing and tried to remove it, 
 would open the buttons on his blouse, and when I told him to dress 
 after finishing an examination of his abdomen, he partly dressed 
 himself and then forgot about his unbuttoned clothing, but sat 
 staring into space. When he was reminded of his negligence he 
 showed a little surprise at his f orgetfulness and buttoned his cloth- 
 ing further, but still left the buttons in front of his trousers open. 
 This behavior was decidedly like the behavior of Case HD-6. 
 
 He was completely distracted by cravings to defecate and his 
 tendency to keep his clothing open was concomitant with, and 
 surely related to, his obsessions about defecation and sodomy, be- 
 cause they occurred in the same consistent affective setting. 
 
 He gradually became destructive, and on the fifth day, he 
 
CHKONIC HBBEPHKENIC DISSOCIATION 677 
 
 tore the pockets out of his trousers and worked for hours pulling 
 out the threads of the lining on which his name was stamped, also 
 rubbing the cloth against the furniture to erase the name, insisting 
 that it was not his name (regression to the nameless, wandering 
 hero ) . 
 
 Although he was given cathartics, he persisted that he could 
 not defecate, insisting that some strange influence bothered him 
 when he went to the toilet. He tried to trade his clothing for the 
 clothing of others in order to get another name. 
 
 He practically tore the lining out of his clothing and ripped 
 the uppers of his shoes into shreds so that they fitted his feet very 
 loosely. Finally he traded them to another patient for a pair of old 
 worn out slippers (typical behavior for this erotic type). He be- 
 came very slovenly, worried about having been subjected to sod- 
 omy and his feelings of an enlarging abdomen. He walked so 
 that his abdomen was protruded forcefully, a distinct effort to 
 have a pregnant abdomen. 
 
 About the seventh week he taUced a little more freely about 
 his troubles. His memory was accurate for remote events and was 
 more detailed for recent experiences. He was noAv oriented but 
 had no insight. He performed the intelligence tests quite well, 
 but complained that voices bothered him. 
 
 He said his own voice sounded queer. He frequently assumed 
 the attitude of prayer, and said, "I Avanted to get out of this build- 
 ing. I have been praying hard enough. I don't Avant to be drown- 
 ed." He hallucinated accusations of sexual perversions, of rap- 
 ing his sister, being a spy, of having electricity shot into his body, 
 etc., and insisted that he had been "nearly dead." 
 
 He complained frequently that "this patient in my stomach 
 talks to me all the time and mixes me up. "Water or something 
 moves up and doAvn in here [his abdomen] . It might be a rupture 
 or something." He said it took him all over the country and 
 showed him many things and talked "plainly" to him. He would 
 not talk freely about it because it might get him into trouble. He 
 seemed to believe that the feelings were the result of some form of 
 pregnancy and explained it by "someone stuck a stick of dyna- 
 mite in there," and stuck needles into his "back." 
 
 I happened to be sketching a man's face on a piece of paper 
 and he burst out laughing. He explained that the voice said, 
 "The face is more of a man than I am." 
 
678 PSYOHOPATHOLOGY 
 
 (The tendency to pull off buttons from clothing, to loosen, de- 
 stroy and remove clothing, tear shoes into shreds and only wear 
 loose, torn shoes or socks is apparently an effort to find and get 
 free from the resistances to defecation. This is probably analogous 
 1o those Balkan Avomen who open the doors and windows of their 
 houses in order to induce an easy labor.) 
 
 He later felt compelled to remove his clothing and without ex- 
 planation stood about naked. He persisted in fondling certain 
 other patients and became extremely persistent in getting: into 
 physical contact with them. He had a particular attachment to 
 another patient who had similar difficulties and frequently halluci- 
 nated someone trying to perform sodomy on him. 
 
 Four months after his admission he tied a rag around his left 
 leg so that the band covered an old scar. About two inches above 
 this he tied a very stout cord. After I had examined the scar he 
 rebound the leg with the rag which he had ripped from the bottom 
 of the white sailor's trousers he wore. As he replaced the bandage 
 belabored and grunted and spat until he had it tied as tight as 
 possible in order he said, ' ' to keep the air out. " 
 
 As he showed me the scar he explained that when seven years 
 old, while whittling on a tree with Ms father's pocket-knife, he ac- 
 cidentally cut his leg. He said lie nearly bled to death and now 
 he believed the knife had cut a "leader," which has never been 
 right since. The supposed defect of this leader he demonstrated 
 with movements of his foot, as follows : "See! My toe drops and 
 it drags around when I put my shoe on. It has never been right 
 since. Tt has been leading me around ever since. I almost bled to 
 death, and my left leg is weak. My whole left side is weak, There 
 isn't enough blood in it." "While he talked in this manner he ma- 
 nipulated his toe and spoke of its weakness, saying it had no blood. 
 Almost at the same instant, as if the two subjects were intimately 
 associated in his mind, he opened his trousers and drew out his 
 penis, which was edematous and swollen. A deep groove around 
 it showed where he had tied a string. He said he tied a "green 
 string" arotmd it the night before, "because there isn't enough 
 blood in it." He talked of the penis as being Aveak, and when I 
 asked about his testicles, he replied, "They are all right, if I have 
 any" (castration). 
 
 All during the conversation he continued to spit over his right 
 shoulder. When asked why he did this, he said that after he had 
 
CHRONIC HEBEPHRENIC DISSOCIATION 679 
 
 cut his leg, "everybody in town spit around everywhere and the 
 Avhole town became dirty. Before it happened nobody was allowed 
 to spit on the streets." 
 
 He interpolated the following remarks during the demonstra- 
 tion: "I guess the blood is still on the ground there. My father 
 was good to me then [began to cry] and [pettishly] we had cows 
 and chickens and turkeys. I was my father 's boy. My brother got 
 typhoid fever after that. ' ' He said he wanted to die and felt that 
 his body Avas dying. 
 
 Referring to the cutting incident, he said: "I never grew up 
 after that. I have had to lean ever since." (On the ward he is 
 very fond of leaning against his chums.) 
 
 He talked about his father with deep sorrow, and tears came 
 into his eyes. He said his father and mother were never happy 
 when he was at home and always quarrelled. (Their separation 
 and divorce was never adjusted to by him.) 
 
 The nature of this boy 's affective disposition is to be inferred 
 from his feelings about being pregnant, the result of sodomistic 
 relations. Whether such acts occurred is not so important as the 
 fact that the affective cravings have restored the hallucinated 
 father to him and in the same dissociated, confused mental stat<^ 
 he is pregnant as the result of a symbolical "stick of dynamite," 
 needles stuck into his back, etc. 
 
 The lonely, unhappy father means the boy is lonely for him, 
 and the submissive extreme to which his love has gone is evident 
 from the vivid impregnation feelings. The loss of blood refers to 
 his impotence, the voice in his abdomen said the pencil sketch of a 
 man's face was more of a man than he was, and the tying up of 
 the penis and leg were restorative attempts. The green of the 
 string was probably a virility fancy, the edema enlarging the 
 penis. ! ' f '''■ '' 
 
 Fourteen months after his admission this boy had shown no 
 important changes. No record of convulsions has been made. 
 
 The tearing off of all bindings and buttons from the clothes 
 and shoes in order to have everything loose has been found to be 
 consistently symptomatic of a certain type of anal erotic patients 
 who seem (Case H.D-9) to feel rectal sensations that presage com- 
 pulsive defecation. Even though they are unable to defecate, the 
 vigor of the sensory disturbances absolutely convinces them 
 
680 PSYCHOPATHOLOGY 
 
 that the crisis might occur at any moment; hence, they become 
 uneasy when restricted. 
 
 Case HD-12, aged twenty-one, had served two years in the 
 navy when he acquired syphilis and reacted with delusions of per- 
 secution which seemed to have an obscure foundation. 
 
 As a boy he had been indifferent in school and disinterested in 
 his studies. At sixteen he ran away from home, inducing his 
 parents to consent to his joining the navy. 
 
 Ten months after an infection of syphilis (no active lesions of 
 the nervous system were indicated by physical signs or the spinal 
 fluid), he complained of feeling weak, unable to work, and seemed 
 to be confused. 
 
 Two months after the tendency to confusion began he devel- 
 oped a mental state which in its characteristics was not unlike an 
 epileptoid confusion in that he showed no toxic symptoms, was 
 difficult to control^ could not be influenced, seemed to be disoriented 
 and misinterpreted everything, apparently fearing that he was to 
 be killed or subjected to a mysterious initiation which he could not 
 understand. 
 
 The third month after the onset of the psychosis he was ad- 
 mitted to Saint Elizabeths Hospital. He called the physician 
 ''father," said he wanted to become "a priest," and from his 
 behavior it was evident that tlie whole environment had been dis- 
 torted into an initiation ceremony. He looked under furniture, be- 
 hind doors, etc., for secret signs, and studied people quizzically, as 
 if they had a mysterious significance. 
 
 His replies to simple questions were prompt, but very often 
 irrelevant and incoherently broken, up. When asked if he was 
 married, he replied, "No, no, doctor; but my mother and father's 
 married ; but I 'm not married. ' ' He seemed to think that he had 
 been made a naval officer, and stupidly talked aboiit himself in the 
 third pers'^n, as: " [name], as they generally call me; he is good; 
 he ought to be on one of the big ships; he's good; he's a good 
 man." 
 
 He had no insight, was disoriented for a time, partly knew 
 where he was but, when not stimulated by questions, lapsed into a 
 state of mind wherein almost everything became misidentified, and 
 yet he was able to take care of his personal needs. 
 
 He believed he had been given cocaine ; heard voices accusing 
 him of murder, masturbation, sodomy, and other misconduct. He 
 
CHKONIC HEBEPHEEKIC DISSOCIATION 681 
 
 reacted to the erotic pressure by persisting in trying to prove him- 
 self to be innocent. He had the nsnal beliefs of being subjected to 
 electrical devices, etc., etc. 
 
 Much of the time was spent in kneeling, praying, and crossing 
 himself, because he thought he had been chosen a "son of God." 
 He thought the sodomistic subjugation made him impotent. He 
 paced the floor, held his head and wrung his hands, but not in true 
 grief. His eyes were decidedly uplifted, and his facial expression 
 was the classical crucifixion type. He said he dreamed the sky was 
 full of floating angels but he could see only their heads and wings. 
 
 He delighted in confused castration fancies. ' ' I told them 
 [voices] to cut me open and take my balls out. There are a lot 
 of women inside who want to throw a child over on the navy. I am 
 a pretty good fellow, but I don't want to take men. I am different 
 than all the men in the world. I am in all the lodges. ["Weeps.] 
 I'll get married if you say so." He frequently approached a phy- 
 sician to say, as if it Avere expected of him, that he would never 
 get married. 
 
 This was only intelligible from what followed in the sense 
 that he was resisting his feminine cravings to marry a man. 
 
 He always slept in a corner bed, with his back to the wall, and 
 watched the men so that they could not secretly perform sodomy 
 upon him while he slept. He had a characteristic Avalk, passing 
 along through the Avard for several steps, then turning to look 
 down close behind him, as if sensory disturbances jnade him feel 
 that someone Avas approaching him. Such back and anal sensa- 
 tions persisted more or less vividly for about ten months, as his 
 behavior indicated. 
 
 One day he approached me asking if I Avere a detective and 
 adding. ' ' I am carA''ed from here to here. ' ' (Passing his hand from 
 anus to scrotum.) He further added that he had difficulty in pass- 
 ing feces and was "all choked up." During most of this period, 
 frank sodomistic interests and fancies occupied his entire time. 
 He could not be interested in anything. Although he Avas tractable 
 and almost "harmless," he occasionally got into fights with those 
 whom he suspected, and he seemed to enjoy his bruises. 
 
 Whenever I met him on the ivard he AA^ould come up to me, 
 grinning and shaking his head oddly, to say that he was not sure 
 that anyone had performed sodomy on him, but that he Avould 
 Avatch out for them. He frequently said, "I guess I just imagine 
 
682 PSYCHOPATHOLOGY 
 
 it"; then doubtingly, "But I don't know"; "I'll watch out for 
 them. ' ' With this he usually walked away smiling and pleased. 
 
 During this long period the affective cravingf-worked up into 
 several crescendoes, and during such states he was wholly dis- 
 oriented, confused, went about, characteristically, with loose, un- 
 buttoned clothing and torn shoes and had to be isolated because 
 he removed his clothes. Also, characteristically, he made love to 
 a patient having similar affective interests. 
 
 This man's cravings are to be regarded as unchangeable. 
 Tattooed pictures on his arms revealed the fixed nature of his af- 
 fective make-up. They were done in red, black and green. On his 
 right arm, upper, were a large flag,. shield, eagle, and sun rising out 
 of the waves, and on the opposite side, a setting sun. On the lower 
 right arm were a crucified Christ on the cross, a double shamrock 
 and a large dagger passing through a bleeding wound. On the 
 lower left arm was the bust of a sailor, shield and anchor, and an 
 anchor mth sailing ship, wreath and flag. Most of these were 
 symbols of his patriotism. The crucifix pleased his crucifixion 
 cravings, and the dagger in the bleeding wound also satisfied his 
 masochistic anal erotic cravings. (He described his anus as being 
 widely "split" open.) 
 
 During his less confused states his conversation ran about as 
 follows: "Eckinrode's horse — it got out in the night and some- 
 thing happened to it, and I am like that horse [centaur] * * * I 
 got so low down I didn't have anything until I came out of my 
 mother — they can crucify'' me if they want to — they can fool around 
 and fool around, and a Chinese woman can have a Chinese baby in 
 two weeks — ^I guess they'll make a Chinese baby but of me." 
 
 Nineteen months after his admission he was discharged as im- 
 proved upon the request of his relatives. He was in excellent 
 physical condition, regarded his difficulties as " imaginations, " 
 had very little insight, showed no tendency to irresponsible be- 
 havior, was decidedly indolent and useless. He was, however, need 
 and courteous. 
 
 The probable outcome of such cases as the above, because of 
 their great unlikelihood of finding a satisfactory environment, 
 may be inferred from the career of the following man : 
 
 Case HD-13 is a Russian Jew, a peasant, who immigrated to 
 the United States, at the age of ten. Illiterate, wanderer, soldier, 
 unmarried; pyschosis began at twenty-four. Twelve years after 
 
CHRONIC HEBEPHRENIC DISSOCIATION 683 
 
 his second admission the following behavior was observed. (The 
 second admission was made three months after his discharge as 
 improved after a four months* confinement during his first psy- 
 chosis.) He is well oriented, with memory accurate, considerable 
 insight, an incessant reader, lazy and irritable. He prefers white 
 shoes to black and will not wear black ones if he can avoid it (Case 
 MD-11). Keeps his shoes unlaced, clothing loose, unbuttoned, 
 torn, suspenders hanging down, trousers half-unbuttoned, belt 
 loose, pockets full of debris and papers for which he ahvays has 
 some plausible use. 
 
 He is very irritable, quarrels a great deal, often injures him- 
 self when he gets angry and has made innumerable half-serious at- 
 tempts to commit suicide ; threatens to do so openly, and yet states 
 that he hasn't "nerve enough." He has often cut his wrists A\dth 
 pieces of glass, cut his throat, and tried to hang himself. 
 
 He says he ' ' masturbated to kill himself, ' ' and complains that 
 when patients "sneer," "sniff" or "cough" at night it hypnotizes 
 him and makes him masturbate. In a recent conversation about 
 his difficulties, he said that when he worked in the laundry and had 
 to handle the sheets he thought about ■v^'hat was in the sheets and 
 "everything got yellow" and it made him weak. He went on to 
 say with this, that he had seen his grandmother sharpen a candle 
 and insert it into the rectum of children when they were consti- 
 pated, and his mother made a paste of mud and urine when he 
 stepped on a nail and applied it to stop the bleeding. (Here were 
 vivid impressions of childhood related to the difficulties which fol- 
 lowed.) 
 
 He complained in this same trend of conversation that one 
 patient used to excite him by blowing on his arm with his mouth 
 against the skin, imitating emission of gas from the rectum. An- 
 other fellow excited him by sniffing and hawking. The yellow 
 color of the wall on one ward "affects" him so that he has to in- 
 sert his finger into his rectum, etc. 
 
 There is here a distinct relation in his loosened, slovenly 
 clothing, hoarding debris, and torn loose shoes, to constipation, 
 rectal sensations and excitement when patients sniff (odors). 
 
 He complains of being hypnotized and rendered helpless by 
 others, and when he feels such influences he gets wildly excited 
 and threatens to attack his persecutor. 
 
684 PSYCHOPATHOLOGY 
 
 Case HD-14 is a young man, aged twenty-two, unmarried, who 
 has been having grand mal attacks since seventeen. 
 
 The personality of the father in this #^P was clearly a de- 
 termining influence in his son's life. He was a "literary man" ; al- 
 though comfortably established financially, he was extremely 
 stingy, dressed shabbily, and was decidedly careless about his toi- 
 let, apparently deriving considerable pleasure from slovenliness. 
 
 On the other hand, his religious enthusiasm was excessive in 
 its zeal and most dogmatic. His fervor was born of hatred of all 
 that seemed to him to be evil, and a few minutes * conversation, in 
 which he freely expressed his fervid religious convictions in the 
 presence of his son, thOTialighly showed what a profoundly repres- 
 sive influence they had subtly exerted upon the son (causiu^Unvol- 
 untary tremors in the boy's face during the conversation) under 
 the disguise of Truth, God and Eeligion. 
 
 The fearful boy had conscientiously striven to suppress all 
 overt sexual interests on the one hand, and on the other, he assid- 
 uously responded to his father's appeals to Jaggra^iidize Grod, f^^fe- 
 eousness, etc. >■ . ^. ;..=;:,;- 
 
 The patient was the overly petted "baby" of the family and 
 learned to regard his father with great fear and reverence. 
 
 As a child he Avas inclined to play alone and rather timidly 
 joined in play with older boys. In school he was "bright," and 
 usually attended classes a year or so ahead of his age. At thirteen 
 he had "strange sensations in the right ai'm." 
 
 All overt sexual interests characteristic of the average boy 
 were denied. He insisted that masturbation had never occurred, 
 and that he never listened to the "smutty" stories and jokes of 
 his playmates. 
 
 He became decidedly out of touch with his companions, and, 
 because of his resistance to their sexual curiosity he was consid- 
 erably ridiculed. 
 
 He graduated from high school a year earlier than the aver- 
 age age and entered a university with ostensibly bright prospects, 
 but was decidedly a self-suppressivo, socially eccentric youth Avho 
 found the average social interests of college life to be "shallow," 
 irreligious, sinful and unattractive. He did not realize that this 
 was due to his training, but egotistically considered it to be due to 
 the inferior interests of Ids associates. 
 
 An older brother, a much more congenial personality, whom 
 
CHRONIC HEBEPHRENIC DISSOCIATIOK 685 
 
 the patient tried to surpass as a student, became, probably be- 
 cause of his merits, the pride of tlie famih'. The patient had al- 
 ways tried to surpass him as a student and in religious fervor, but 
 in the first year at college lie began to lose interest in study and 
 seemed to suffer excessively from homesickness (regression). 
 Among the embarrassing, urgent problems to be met at this 
 time was the interest of a schoolmate Avho persisted in showing a 
 personal attraction and expressed a desire to sleep with him. 
 This boy's interests were coarsely sexual and caused considerable 
 excitement for the patient. No overt sexual behavior transpired, 
 but the affair increased the guilty unattractiveness of the world. 
 
 The first serious convulsion occurred aljout one month later 
 (aged seventeen), but apparently had no especial reference to the 
 behavior of his companion. The convulsion started significantly 
 with the cry, "Oh! mamma," and developed into a grand mal type. 
 It showed, decisively, his affective dependence upon his mother, 
 and may be regarded as the turning crisis, marking the renuncia- 
 tion of the world and the beginning of a pernicious regression to 
 the mother. 
 
 Collegiate interests became burdensome and, after two years 
 of struggling, he returned home to regress gradually into more 
 and more of a "baby." 
 
 The convulsions increased in frequency and general severity, 
 occurring more frequently at night. They Avere often accompanied 
 by periods of confusion lasting from several hours to several days. 
 Confused periods also occurred Avithout convulsions. On one occa- 
 sion he found himself wandering at night several miles from his 
 home on a country road. He could not recall when he started 
 or how he got there. 
 
 Four years after the first convulsion, in one period of con- 
 fusion, he believed he was Christ, the Son of GTod and a Redeemer. 
 He assumed "queer" attitudes, removed his clothing, and talked 
 about "doing something, accomplishing something," and broke 
 up some of the furniture in the room. 
 
 He progressively became more irritable, violent, obstinate, 
 petulant, selfish and egotistical. To his father, who sternly com- 
 mands him during his confusions, he meekly submitted. 
 
 The frequency of his convulsions varied from one a week to 
 one a day or so. 
 
 Five years after the onset, aged twenty-two, he had become 
 
686 PSYCHOPATHOLOGY 
 
 very egotistical, uncongenial, irritable, suspicious, was unable to 
 take part in conversations or social interests, had to be petted 
 and condoned, regarded all general interests as a waste of time, 
 and spent most of his time in day-dreaming. He talked in a very 
 slow, labored manner, that made one wonder if he would be able 
 to finish his thought, expressed himself emphatically and unshak- 
 ably, believed that he was "divine," and had a sublime mission 
 on earth. 
 
 He did not wish to be considered as having a mental disease, 
 but only consulted physicians because his father insisted upon -it. 
 
 As a subject for psychoanalysis he was inaccessible because 
 lie insisted in devoting all of his time to the discussions of the di- 
 vine personal state that he had reached. During one play at dis- 
 cussion, he said with profound sobriety, "This thing will kill me 
 or I will be God.'.' 
 
 He was in love, he said, with a neighbor's daughter. She was 
 then twelve, but he would wait for her because by her ways he 
 could tell that she loved him. 
 
 Since I never saw him in a state of confusion, a description of 
 his behavior and an inference as to the nature of his affective 
 striving under such conditions can not be given. But, from his 
 anger, suspiciousness, and determination to protect himself, it is 
 obvious that he becomes afraid of some craving or influence. 
 
 He learned to speak of himself as becoming a divided person- 
 ality during these attacks. Like all such cases, the source of con- 
 flict and fear was in himself, and his repressed affections persisted 
 in trying to do something that made him fearful of the conse- 
 quences and responsibility. "What they persisted in doing may be 
 inferred from several dreams and a comparison of his symptoms 
 with those of similar, more accessible, instances of behavior. 
 (The above group of cases, however, is not truly epileptic al- 
 though related in certain fundamental cravings.) He frequently 
 dreamed about privies and his father or some friend of his father 
 meeting him there. 
 
 A most significant dream was the following: It was Sunday 
 (God's day) and he was driving an auto with his mother as "a 
 companion (he had never driven an automobile) and they were 
 passing along an asphalt street. He became aware of the pres- 
 ence of a large hole in the asphalt on the right side of the street. 
 In the hole lay an old, dead mule that "looked more like an ass 
 
CHRONIC HEBEPHRENIC DISSOCIATION 087 
 
 than a mule." This seemed to stop his machine, but his friends 
 appeared to pass "right on over the mule giving me many unavail- 
 able suggestions." (The analysis, which aroused the patient's 
 indignation, showed its importance, when to "asphalt" the pa- 
 tient associated "ass felt," and to the mule in the hole, "ass in a 
 hole," then "ass hole.") 
 
 The dream continued: Finally a young lady (with more 
 money than she needs) suggested the street cars and we started 
 home. She pulled out a purse Avith ten times the cash I had. I 
 refused to accept her offer until the whole party placed itself, 
 individually, on the level with the dead mule Avhich was left some 
 ten blocks behind. 
 
 The patient's, difficulties with money (father's penuriousness), 
 and his mother-attachment (the two, together, in the automobile), 
 and the infantile affective pleasure in the anus, which he could 
 not pass over (repress) as others had, seemed to be extremely 
 pertinent revelations as to the nature of his repressed affective 
 cravings. He could not accept the social and sympathetic in- 
 terests of his friends until they met him on the level of anal in- 
 terests (ass-in-hole), because he could not understand them. The 
 above dream, he thought, was accompanied by a mild convulsion. 
 
 Later, he dreamed while sleeping with his mother that his 
 mother was ' ' tickling ' ' his anus. He said he ' ' suffered painfully, ' ' 
 and yelled out, "G — damn it ! Mother, wliy don't you quit tickling 
 my ass ? ' ' 
 
 Upon another occasion he dreamed that his mother took a 
 small dose of powder, after he refused it, "just to see the effect." 
 
 He related numerous other dreams, some plainly sexual (mas- 
 turbatory only) ; others more obscure, which were not apparently 
 associated with anal and fecal interests. The above quoted dreams, 
 however, have a vastly greater significance in their setting of re- 
 pressed, uncongenial, extremely egocentric, affective interests, 
 than they would have in a personality having extensive affective 
 interests in earning a living and making others happy. 
 
 His suppressed hatred and jealousy of his brother and father 
 prevent him from becoming a frank competitor for his mother's 
 love by working for it. He, however, takes a short cut to gran- 
 deur by becoming a zealous Son of God (outdoing brother and fa- 
 ther), and creates his own world in which he enjoys the petting 
 
688 PSYCHOPATHOLOGY 
 
 and fostering of his mother. At twenty -two he still slept with 
 her, justified as an invalid, helpless boy. 
 
 The convulsions often began with tingling and jerking^ of his 
 right arm,. and by vigorously rubbing the arm the progress of the 
 attack was sometimes checked. Such arm symptoms are, as is 
 well known, extremely frequently an expression of repressed mas- 
 turbation functions. 
 
 The patient's penurious, hoarding interests Were nicely illus- 
 trated by his notebook in which he recorded facts about his 
 thoughts and behavior. To it, he had tied a pencil with a very 
 clumsy excess of string which he laboriously wrapped about the 
 pencil and tablet, each time he finished a notation (hoarding). 
 
 No important physical defects, that could be related to his 
 disease, were found upon extensive, highly specialized, efficient ex- 
 aminations, except that he had the fat, stuffed, dull face of the 
 advanced epileptic. 
 
 His mental labors show a decided deterioration of spontaneity 
 and efficiency, and a growing concentric affective restriction upon 
 himself. 
 
 His symptoms indicate that, eventually, he will become Qod 
 and the Universe at the total loss of everything that makes life 
 worth living. 
 
 Case HD-17 was a salesman of mediocre ability and very much 
 inclined to shift from one position to another. At thirty-six he 
 had "typhoid" which was attended by a psychosis of which no 
 satisfactory account could be obtained. 
 
 At forty-one he was admitted to Saint Elizabeths Hospital 
 because of feelings of being persecuted which were reenforeed 
 by well-systematized delusions of a bizarre nature. He believed 
 he had been "overcome by the heat" on July 4 (year of his ad- 
 mission), and dated his troubles from that experience. Upon his 
 admission he tried to justify his feelings of being persecuted by a 
 Yery lengthy, detailed, involved discussion which Avas constructed 
 out of fantasies. The principal featiire of this system was that a 
 detective watched him because he owed money. 
 
 In a general sense there was no impairment of his mental 
 faculties unless prolonged, accurate coordination was required. 
 
 ■About one month later he admitte'd auditory halkicinations 
 and thought "the whole world knew everything" by means of a 
 fancied recording dial in the superintendent's office. He was very 
 
CHRONIC HEBEPHRENIC DISSOCIATION 689 
 
 suggestible, and laughed or cried frequently about his troubles. He 
 devoted most of his time to delivering orations from the veranda, 
 lecturing on ' ' any subject. ' ' Electricity was played on him and he 
 became "the Son of God on earth" with unlimited power and abil- 
 ity as the mouthpiece of God. He coined many words and preached 
 incessantly. 
 
 Seven months later he said he must have been "very crazy" 
 in the past and tried to explain the most common of his original 
 Avords, such as " telephonalizations, " as analyzations of wireless 
 and telephonic communications, and "vonedating," as telephoning 
 from the soul which had been ignited by electricity and voices that 
 were located in his abdomen. He secretly tried to remove the voices 
 with a mustard plaster, producing a severe blister. 
 
 His insight into his condition was about as follows: "About 
 a year ago I became voiced. I had a crawling, nagging or eating 
 sensation about my navel which was very annoying. I thought 
 it was a tapeworm. Later on I Avas standing waiting for dinner 
 and something crawled up from the floor and took full possession 
 of my person and I felt as though the voice came out. My mother 
 ahvays called me Willie and it said, 'Is this "Willie?' and I said 
 'Yes.' It said, 'You know Avho this is?' and I said, 'No.' It said, 
 ' This is Jesus Christ talking to you. ' I kneeled right down in the 
 hall. It was a very exhilarating feeling. And then I went to 
 dinner — then the voice came out in full, saying, ' This is my beloved 
 Son, Jesus Christ,' and this took me from the table. After a test 
 of faith this voice cussed me and called me vile names because 
 I would not pray every second. The voices Avould say, 'That is 
 an evil thought and I am going to punish you for it. ' Then they 
 would shock me with electrical strokes. These nearly tore my in- 
 sides out. They worked through the rectum, privates, eyes, nose 
 and the organs, also the A^eins. I believe the blood is carbonated 
 in the glands just like carbonated AA-ater, and if kept up Avill cause 
 mortification of the human body. ' ' 
 
 He never doubted the reality of these sensations and con- 
 stantly begged for treatment. He was quite suggestible, Avell 
 behaved and not destructiA^e. At the end of the third year he 
 eloped and succeeded in maintaining himself fairly Avell for nearly 
 one year Avhen he Avas readriiitted iipon his OAAm request. 
 
 He discussed his condition this time as follows: "When I 
 was here before my head cracked, my ear bones rattled and they 
 
690 PSYCHOPATHOLOGY 
 
 were all dried up. I asked Dr. S — if I could drop olive oil in my 
 ears, and by Jove it cured it. I keep a little olive oil 'at home. I 
 decided to get some tallow and I made a cake and put it right here 
 [epigastrium]. I believe the soul is right here and I believe it 
 helped. The devil is using the "fridation" process on me and it 
 constitutes the drying up or waste of the anatomy of man ; sapping 
 the Kfe out of him — the germing cells are cut down by the mag- 
 netic influence in the blood and it dries up the life cells." (Oils 
 as semen.) 
 
 (This was definitely related to his sexual impotence and feel- 
 ings of being castrated. He used oils to cure himself and restore 
 the losses due to "fridation.") 
 
 This patient's solution of his difficulties was made along the 
 following lines. "I believe honestly we have the devil right in us. 
 We are double. When the devil becomes overmagnetic we fall 
 insane. I am not properly balanced, but I take care of it like you 
 would. After two years and a half I struck a refined intellectvM 
 atmosphere to go on and make the best of it and death would 
 solve. ' ' 
 
 Since this second year of his second psychosis he has main- 
 tained an atmosphere of personal aggrandizement and talks with 
 an affected enunciation. During his second admission he also had 
 feelings of infidelity about his wife, and he wrote numeroiis letters 
 charging her with being pregnant and later spoke of her as a poor 
 little girl "crucified" by a scoundrel. 
 
 Eighteen months after his second admission and nearly six 
 years after the onset of his psychosis, he has made a fairly com- 
 fortable adjustment to his difficulties. He reasons that "the 
 devil" causes his persecutions, and by tiTrning his mind along "re- 
 fined" channels of thought he has improved considerably. He is 
 congenial and ostensibly interested in his wife. He is, however, 
 lazy and seems to have difficulty in working steadily, usually re- 
 quiring tonics and a man's sympathy. 
 
 He gives the impression of being harmless and one feels no 
 difficulty in talking freely to him about his problems. Hatred is 
 not evident in his reactions, but he is too suggestible and plastic 
 in his adaptations to assume responsibilities and readjust. 
 
 Another patient, who passed through a psychosis and 
 panic because of fear of being destroyed and sexually misused, 
 finally recovered and returned to work. A few years later he vol- 
 
CJUIONIG IIEBF-PJIIIENIC mSSOGlATlON fiOi 
 
 untarily sought admission to St. Elizabeths Hospital He said 
 his genitalia Avere disappearing and his rectnm was changing into a 
 vagina. He Avas decidedly pleased and livod his belief, devoting 
 his time to erotic fancies about his hermaphroditic nature, not 
 caring to return to society, Irat probably better pleased with tlie 
 men on the wards. 
 
 Case HD-16 was a soldier, divorced, alcoholic, and a hobo.. 
 His left eyeball had been enucleated, loft face badly scarred and 
 right arm amputated in accidents. 
 
 At one time he was a well-developed man Avith masculine fea- 
 tures and resonant voice. 
 
 He Avas sent to St. Elizabeths Hospital because of his imfit- 
 ness to remain in the Soldiers' Home. He says: "I represented 
 the Spirit of American Service, the Navy Service and the Depart- 
 ment of Justice, through a method of transfiguration, the purity of 
 the Church represented in it." (Grand compensation.) 
 
 On the Avard he often shouted "get out of my stomach," and 
 rubbed his left hand on the right side of his abdomen. AVhen 
 asked about the trouble, he said it was a "composition put in by 
 magnetism through a transfiguration," and "a divorced woman, a 
 AA'hore," is trying to get inside. 
 
 He said he had been bothered considerably more than usual in 
 the past ten months or year. He earnestly asked the physicians 
 to feel his abdomen and note the movements in it. Sometimes he 
 insists that there is something "aliA^e" in his "stomach." 
 
 When the remark Avas passed that ten months Avas a long 
 time to carry anything there, he looked decidedly pleased and 
 smiled effiisively. When asked Iioav he acquired it, he thrcAv back 
 his head and looked upAvard and smiled knoAvingly (as if it came 
 from Grod). 
 
 He will not frankly state today that he is pregnant, but he is 
 pleased by such fancies, and characteristically rubs his abdomen. 
 "Wliile making this note he suddenly denounced in vigorous lan- 
 guage the "diA'orced Avhore" Avho is trying to get into his ab- 
 domen. 
 
 Dissociated anal erotic cravings do not ahvays cause a pro- 
 gressive deterioration of the personality, even though they cause 
 intense hatred and violent outbursts of rage. 
 
 Case PD-32, a strong, healthy, Avell-deA-eloped, energetic, un- 
 married woman of thirty-six, rather suddenly developed halltici- 
 
692 PSYCHOPATHOLOGY 
 
 nations and delusions al)out a religious initiation wMeli were at- 
 tended by considerable excitement. The tendency to an affective 
 dissociation had been developing for some time, but the crisis 
 did not occur until the day previous to starting on a vacation, 
 which was looked forward to with considerable feeling, because 
 of a secret liaison that was to occiir with it. Then followed a year 
 of sexually indulgent fancies in which she cohabited with Christ, 
 God, was taken through ' ' the Holy Land, ' ' was persecuted and tor- 
 tured, "skin turned to rubber," insides were removed, saw the 
 world destroyed, etc. She finally adjusted with a fixed conviction 
 that an older sister and her husband had discovered a mysterious 
 means by which, in disguise, they had opened up the ground under 
 the surface and, following her about wherever she went, subjected 
 her anal-rectal and vaginal tracts to incessant tortures. 
 
 For four years she has resorted to many wild schemes to in- 
 sulate her pelvis from exposure to the tortures, and spends hours 
 literally damning and berating with vulgar epithets this sister 
 and her husband who would make a prostitute out of her. She 
 has frequently inserted her finger into the rectum to find out 
 Avhether or not it has been destroyed, sits on her foot to insulate 
 it (Case PN-7) from contact with the furniture, and begs daily 
 that the government will dig down into the earth and remove 
 "Sharewould" or " Cherrywould " and his wife and destroy their 
 instruments with which they make her suffer "hell on earth." 
 
 Besides the persistent anal and rectal sensations, she has also 
 vivid auditory hallucinations of this coiiple taunting and sadis- 
 tically torturing her. She has attempted to commit suicide and 
 pleads pitifully to be cremated when she dies so she will not be tor- 
 tured in her grave. 
 
 Despite this, she is neat, clean and an excellent worker and 
 during periods is pleasant and sociable. There has not been the 
 slightest change in her case within the last four years. That the 
 anal sensations are secretly pleasing to her is indicated by the unu- 
 sual attentions she gives to her defecation, and, previoiTS to the 
 psychosis, her practice of cleansing her moiith, taking a purgative 
 and then following it with an enema. 
 
 This woman is not inclined to indulge in play and does not 
 show the hebephrenic pleasure in destruction and waste which 
 self-indulgent patients of this sort show. Daily she : submits 
 to the "hell" and lies on her bed, cursing and weeping, and talks 
 
CHRONIC HEBEPHRENIC DISSOCIATION 693 
 
 back vigorously to the voices of the two people while they subject 
 her to tortures of her pelvis and throat. This is so vivid as an 
 experience that she can not differentiate it from the persistence 
 and vividness of sensory disturbances caused by external realities. 
 She regards another woman who makes similar complaints about 
 her father being under the ground, etc., as insane. 
 
 Summary 
 
 The hebephrenic type of dissociation of the personality, like 
 all dissociated states, is due to the affective cravings working 
 for certain types of stimuli which they need and conflicting with 
 other cravings which try to do something entirely different to ol)- 
 tain gratification. The ego that wishes to develop itself, work, 
 win social influence and esteem becomes depressed and lonely 
 through fatigue, lack of affection, and a sequence of painful expe- 
 riences. During the period of retraction and loss of initiative the 
 repressed segmental cravings dominate the personality and are re- 
 garded as a foreign influence. The dissociation of the ecjo and self- 
 control enables the perverse affect to urge the behavior that pleases 
 this affect most; hence, the 6170 beeonics helpless and is swept 
 into a world of infantile dreams and anal erotic play. The re- 
 pressed segmental cravings may then seek for what please them 
 most. Since they seek what they have been conditioned to need 
 through the pleasant experiences of infancy and earl}- childhood, 
 they tend to restore the ancient experiences in imagery. Hence, 
 the levels to which the regression occurs and the degree of the 
 dissociation largely, if not entirely, depend upon the stage of the 
 growth of the personality when serious aff'ective repressions be- 
 gan to be made and what tabooed objects and sensory zones are 
 especially craved. 
 
 It is natural that, if a large proportion of the affective crav- 
 ings of the personality are fixed upon infantile or perverted in- 
 terests, the personality will not be able to adjust comfortably to 
 the customs, requirements and objects which society demands 
 should be used by the matured of the species in order that the sex- 
 gan to be made and what tabooed objects and sensory zones ar(> 
 especially craved. 
 
 The rampant vulgarity and destructiveness of the hebephrenic 
 ai'"e, with astonishing frequency, concomitant with, hence, probably 
 
694 
 
 PSYCHOPATHOLOGY 
 
 urged by, the same affective cravings. Predominant anal, fecal, 
 urinal and sodomistic interests are characteristic of children ahd 
 immature apes and monkeys. The diagnosis of this biological 
 state of the genus Homo, when well defined, can often be made on 
 sight. 
 
 The typical hebephrenic type of dissociated personality is to 
 
 Pig. 67-A. — Crochet work of patient having a preadoleseout incestuous attaeli- 
 nient. Througli creating such fancies of herself with her parents and childhood 
 surroundings she restores images of past experiences which aroused and gratified 
 the affect. Dr. Arrah B. Evarts reported this creation in The Psychoanalytic Eeview, 
 Vol. V, No. 4, showing the significance and affecti-\'c ^alue of the figures and details. 
 (See also Fig. 67-B.) 
 
CHRONIC HEBEPHRENIC DISSOCIATION 695 
 
 be differentiated from tlie typical catatonic and paranoid types 
 in that during the psychosis there is little or no interest in re- 
 turning to a mature level or in earning social esteem by doing 
 socially constructive things. This feature, however, is not so con- 
 sistent, as a characteristic, as the gross preadolescent and infantile 
 forms of play which they indulge in. The prognosis is usually 
 
 Pig. 67-B. 
 
 poor because the autonomic-affective cravings would rather re- 
 main infantile than strive for the responsibilities of maturity. 
 They tend again to regress to the hebephrenic level, after having 
 
696 
 
 PSYCHOPATHOLOGY 
 
 temporarily resumed an interest in earning a living, and the second 
 regression, if not the first, is nsnally permanent. 
 
 The anal-erotic patient, when giving vent to his pleasures, 
 is far more destructive than the oral erotic, and this destructive- 
 
 Fig. 68. — ^Eegression to iafaiicy, thereBy escaping the trials of an unhappy marriage 
 and the responsibilities of raising her family. ^ 
 
 ness, when not used as an intimidating defense, is an important 
 diagnostic symptom. 
 
 The anal-erotic mysophobia, presented in the chapter on the 
 psychoneuroses, showed that anal eroticism, when it causes fear 
 
CHRONIC HEBEPHRENIC DISSOCIATION 697 
 
 and no dissociation of the ego, may become the foundation of a 
 compulsion to cleanliness. Miserliness is a compensatory defense 
 against the fear of food poverty. 
 
 The behavior of the anal- ( rectal f) erotic patient is character- 
 ized by the fact that he is not only unable to control his thoughts 
 and loses his powers of adaptation and social orientation when the 
 affective pressure becomes too vigorous, but certain very charac- 
 teristic adjustments are made which seem decidedly different from 
 the oral-erotic patient's. During an intense emotional conflict an 
 individual's capacity for adaptation and orientation is greatly re- 
 duced; hence, confusion is only a general characteristic of affec- 
 tive conflict, but the particular acts, which the uncontrollable anal 
 erotic persists in doing, are highly indicative of the nature of the 
 craving. 
 
 The anal-rectal erotic persistently destroys the binding ap- 
 pliances of his clothing and shoes (as buttons, ties, etc.), re- 
 moves his clothing, loves debris and filth, and his face assumes, 
 for prolonged durations, the dull perplexed, often congested as- 
 pect of defecation strivings. He usually has marked submissive, 
 sodomistic interests in the "father" or a substitute (in one case a 
 grandmother), and the defecation is frequently treated like a cre- 
 ■ ation or parturition (Cases HD-11, PD-17). Not infrequently, the 
 condition is attended by grand mal types of epileptoid convulsions 
 which occur during the perplexed hallucinated erotic state of mind, 
 and the patients complain of becoming ' ' mentally thick, " " senses 
 taken away," etc. 
 
 It is possible that some of these cases are truly epileptic in 
 character, or better, that some cases of idiopathic epilepsy, so- 
 called, belong to this group, as case HD-14 indicates. This possi- 
 bility is certainly worth extensive psychopathological research. 
 
CHAPTER XIV 
 
 RECONSIDERATION OF THE CONDITIONED AND RE- 
 PRESSED AUTONOMIC AFFECTIVE DETER- 
 MINANTS OF ABNORMAL BEHAVIOR 
 
 Anyone, who is seriously interested in human behavior and 
 its normal and abnormal, or social and asocial, variations, upon 
 reading the difficulties and struggles of the cases discussed in 
 the preceding chapters, will see the necessity of formulating a 
 conception of the forces of the personality, which will enable us 
 to deal intelligently with the variations of behavior that may occur. 
 
 The conception that all affective craviBLgs (a,ll emotions, 
 wishes, feelings, sentiments) originate in the peripheral sensa- 
 tions caused by muscular tensions and vascular tumescence, or 
 detumescence, in different segments of the autonomic apparatus, 
 gives us an insight into those functions of the personality which 
 are fundamentally and intimately related to metabolic changes 
 and organic structures. These affective-autonomic tensions or 
 cravings, constituting the ivish to do, to be, to have,, etc., compel 
 the organism to expose the favorite receptors of the craving so 
 that they may receive from the environment those stimuli which 
 have the quality, through counter stimulation, of arousing auto- 
 nomic reactions, Avhich, in turn, neutralize the undue autonomic 
 tensions and restore a state of comfortable autonomic tonus. 
 Through this principle, the constant tendency of the everchanging 
 environment and metabolism to cause a state of autonomic ten- 
 sion and unrest is relieved, more or less, by a compensatory effort 
 to reestablish a state of autonomic comfort. 
 
 This gives us a loorldng conception of the principles upon 
 which, and the forces out of which, the personality is constructed. 
 The personality's intricacy and variability are accounted for by 
 the manifold segmental cravings which are all active at the same 
 time, one or several dominating now, and others surging into dom- 
 inance later : some struggling to get into contact with the environ- 
 ment, and others struggling to maintain an established contact 
 
 698 
 
RECONSIDEEATION OF DETERMINANTS OF BEHAVIOR 699 
 
 and trying to keep repressed the antagonistic cravings so that they 
 can not interfere with the use of the projicient apparatus. 
 
 From birth, the autonomic apparatus, having been forced to 
 abandon its parasitical attachment to the mother, begins its strug- 
 gle of coordinating its projicient (skeletal) apparatus into an 
 efficient instrument, Avith progressive refinements of self-control 
 and skill of adaptation, in order to keep up with the standards 
 of its rivals and the race. Upon the nature of the skillful coor- 
 dinations and the conditioning of the cravings depends the exis- 
 tence of its biological potency (of social influence and fitness, 
 commercial or professional prowess and sexual power). 
 
 The inherent capacity of differcnit autonomic segments (gas- 
 tric, cardiac, etc..) and of the affective cravings (as food-hunger, 
 fear, anger, etc.,) to react at first to primary stimuli and then 
 become conditioned to react to associated stimuli, rapidily trains 
 the personalitv to develop special acquisitive and avertive tenden- 
 cies toward different objects and customs in society, literature, 
 commerce, art, science, religion, mating, etc., etc. 
 
 The conditioning of the autonomic apparatus to react so as 
 to produce pleasure-giving sensations upon the acquisition of cer- 
 tain classes of stimuli, and unpleasant sensations upon being ex- 
 posed to the presence of other stimuli, is the very foundation of 
 the differences in interests and aversions that arc to be met in 
 everyone. This inherent attribute of tlic autonomic-affective ap- 
 paratus, in relation to character formation, places an enormous re- 
 sponsibility upon rxpcyieiirc and ediirafion, and emphasizes the 
 most important problem of all, the influence of the family, the 
 school, the church and community upon the biological forces of the 
 personality. The reading of the preceding cases makes one se- 
 riously doubt the fitness of the present educational system and its 
 puritanic ideals, the present expositions of religion and social law. 
 and of the average parent to train a child, so that during maturity 
 the individual will have sufficient affective vigor to maintain the 
 state of virility, goodness and Kap'piness despite the stresses and 
 worries which attend responsibilities and competition. 
 
 ^\Tien any of the different autonomic-affective cravings be- 
 come conditioned so as to need certain stimuli to be applied to 
 certain sensory zones, constituting interests that are perverted 
 or asocial, then these cravings become a serious, if not a grave, 
 menace to that personality and cA^en to the race. When such 
 
700 ' PSYCHOPATHOLOGY 
 
 cravings become overstirmalated and uncontrollable, and, because 
 of their vigor, or because of the weakness of the opposing, con- 
 trolling wishes of the ego, due to fatigue, discouragement, toxins, 
 etc., then the personality faces a crisis : grave, often, because the 
 cravings, which are urging the commitment of perverse or dan- 
 gerous acts, are jeopardizing the personality's social fitness. The 
 individual, horrified and fearful, struggles desperately, eccentri- 
 cally, even frantically against this endogenous force. It is not sur- 
 prising then that the pelvis and the devil are so often believed to 
 be allied as one, and that this uncontrollable craving is regarded 
 as a foreign influence, a hostile, hypnotic power, threatening the 
 peace and safety of "the soul," which is secretly introduced into 
 the personality through the diabolical schemes of a secret society, 
 an associate or a parent, and must be eliminated or destroyed at all 
 costs. The fear and anxiety, which the obsessive craving causes, 
 may become intolerable. This /ear is not a strange or unexpected 
 freak of evolution, however. It is obvious that humanity, by 
 becoming afraid of and hating biological inferiority- and perverse 
 waste, succeeded in avoiding it best. The individuals who procre- 
 ated young naturally trained them to approximate most nearly such 
 requirements as contributed most to the further development of 
 the race, by their example and affective influence. Thereby was 
 fostered the tendency to become apprehensive of Inological per- 
 •verseness and to regard it as an inferior attribute in an individual, 
 because it tended to mislead the resources of the race. That the 
 failure of an affective craving to acquire its needed Stimulus should 
 arouse uncomfortable autonomic tensions and sensations was the 
 sole means the autonomic apparatus had of compelling the profi- 
 cient cellular masses to work, endure fatigue, pain and destruction 
 in order that the autonomic craving might be relieved. Those in- 
 dividuals, who do not feel uncomfortable when the craving is not 
 gratified, naturally become careless and retrogressively less able 
 to compete with the sensitive members of the herd. In turn, they 
 become isolated and tend to die oif without procreating or raising 
 their young. 
 
 The general method of controlling a perverse craving or infe- 
 rior attribute is to get as far from it, as a cause of fear, as possi- 
 ble ; hence, tend to develop opposite interests. -The asocial or per- 
 verse craving, as a functional inferiority, must be compensated for 
 in some m&nner in order to acquire sufficient social esteem and 
 
RECONSIDERATION OF DETERMINANTS OF BEI-IAVIOR 
 
 701 
 
 social influence to feel safe. This is natural and invaluable. 
 Throughput animal life wo find that inferiorities, oi-ganic or func- 
 tional, due to disease or injury, have to be compensated for at a 
 level far too deep to be considered to he instinctive; as in the de- 
 velopment of antibodies to counteract infection, phagocytosis, car- 
 diac compensation for valvular deficiency, muscular hypertrophy 
 
 Fig. 69. — Masculine compsiisation in a woman. Following the mother's inter- 
 ference with her mating she developed a psychosis in which she solved her unhappi- 
 ness by becoming male, the priest of an elaborate new religion and philosophy. Her 
 attitude is that of aggressive homosexuality. She made the costume. 
 
 to compensate for fatigue, or hunger to compensate for the deteri- 
 orations of metabolism. Similarly the autonomic compensations 
 (adrenal secretion, adequate vasomotor changes, glycogen in 
 the blood, increased cardiac rate and systole, and appropriate 
 motor tensions) occur reflexlj^, preparatory to attacking the cause 
 
702 PSYCHOPATHOLOGY 
 
 of fear ; as bluff in the face of danger (the arched back and erect 
 hair of the apprehensive dog or cat, or the lond profanity of the 
 bully), the creation of machinery to compensate for physical in- 
 feriority in our competition with climate and space, or with an en- 
 emy : producing out of Demosthenes, the stammerer, Demosthenes, 
 the orator. 
 
 Physical competition in battle, games, mating, commerce, tends 
 to reveal the relative inferiorities of the competitors as well as 
 their superiorities. The presence of an inferiority, organic (as 
 color) or functional (as stammering), requires either an ade- 
 quate compensation or a withdrawal from competition. In com- 
 mercial and political struggles for social esteem and social influ- 
 ence a tactful withdrawal is often more practical than a fight to 
 the finish, but in mating there is but one solution, either -win or 
 lose the love-object. Naturally, also, the presence of a pernicious 
 fear, while competing for a mate, is in itself an inferiority and ex- 
 poses the individual to severe tests of self-control. If the founda- 
 tion of the fear is a specific functional inferiority, as autoeroti- 
 cism or homosexual perverseness, or incestuousness, or a criminal 
 record or scheme, the competition for the mate not only necessi- 
 tates unusual compensations, but also concealment of the inferior- 
 ity, and even repression of an adverse craving, so that it can not 
 cause awareness or consciousness of its presence. This repression 
 of the perverse wish is always attended by more or less defensive 
 tension, sensitive pride, and anxiety; hence the mild neurosis as 
 a disturbance of autonomic comfort. 
 
 Whenever the segmental autonomic-affective craving meets 
 with an unmodifiable resistance, the individual begins to feel un- 
 comfortable from the autonomic pressure. He can not sleep well, 
 is restless, does not think consistently, loses appetite, becomes irri- 
 table, etc., symptoms of the autonomic-affective pressure using 
 the trial and error method of finding a weak place in the resistance 
 and obtaining control of the final common motor paths of adjust- 
 ment. If the struggle is hopeless because of unchangeable ethical 
 and moral obstacles, as the inability to marry because of obliga- 
 tions to a parental invalid, or the attitude of a frigid mate, or the 
 inability to retaliate against a nagging, superior officer, a depres- 
 sion of the autonomic apparatus develops which may vary from a 
 mild malaise to severe loss of power to coordinate acts and 
 thought for a future purpose (as so-called paraphrenia, etc.). 
 
RECONSIDERATION OJ? DETERMINANTS OF BEHAVIOR 703 
 
 Dissociation of the personality is essentially due to the re- 
 pressed craving (a state in which the craving is not permitted to 
 produce consciousness or aAvareness of its needs) overcoming the 
 wishes to be socially estimable and proper, and despite the ego's 
 resistance, causing behavior and sensations which tend to gratify 
 its needs. 
 
 The discovery of the existence of the repressed craving (for- 
 gotten wish in the "nnconscions"), and of its subtle influence upon 
 human behavior and the content of consciousness (thought and 
 judgment), is the great contribution to knowledge by Sigmund 
 Freud. If the experiences of psyehopathology in the use of this 
 discovery are a reliable criterion of its value, it will become an 
 important contribution to the progress of civilization. 
 
 Sherrington, in his work upon the integrative functions of the 
 nervous system, showed how two neurones, converging upon a 
 third which is efferent to them, may be stimulated to inhibit or 
 suppress one another or to reenforce one another. This mecha- 
 nism applies not only to individual neurones but to segmental 
 groups when acting as a unity against antagonistic cravings or 
 wishes, as they converge upon the use of a limb, or group of limbs, 
 or the special exposure of a receptor or group of receptors. The 
 same principle exists in the struggles „of antagonistic cravings 
 with the ego to dominate the final common motor paths of adjust- 
 ment and direct our overt behavior. As the vigor of the conflicting 
 wishes varies, incoordinations may occur; hence, errors in move- 
 ment, execution of work, and wish-fulfilling mistakes. Conversely, 
 the occurrence of an error under ordinary conditions, as a slip, fall, 
 unintentional self-inflicted injury, mistake in speech or writing, 
 swallowing food into the larynx or biting the tongue, is indica- 
 tive (symptomatic) of the repression of an affective craving or 
 wish having been made at the moment of the incoordination. 
 
 Similar in mechanism is the misinterpretation or misrepresen- 
 tation, in that the cause of either is usually traceable, if explain- 
 able at all, to the direct or indirect fulfillment of a wish (grati- 
 fication of a suppressed autonomic craving). The craving not 
 only causes the seeking for a satisfactory stimulus, but, moreover, 
 through the reflex maintenance of characteristic postural ten- 
 sions of the striped muscle apparatus, forces the individual to be 
 conscious of a kinesthetic stream of sensory images which tends 
 more or less to relieve the craving. It is this autonomically 
 
704 PSYCHOPATHOLOGY 
 
 aroused stream of hinesthetic imagery, wMch,. ivJien combined with 
 sensations produced by exogenous stimuli playing upon the extero- 
 ceptors, produces the ivish-fulfilling delusion, dream and hallucina- 
 tion, or misinterpretation of the behavior of others. This meclian- 
 ism applies as well to the ■wish-fulfilling errors of substitutiorL or 
 elimination, as in misspelling, misreading, misselecting, even 
 though they may be disastrous to the ego. The dream is a minia- 
 ture, transitory psychosis occurring when the capacity of the or- 
 ganism to remain coordinated as a unity is lost (as during fatigue, 
 toxemia, sleep). The psychosis occurs when the repressed auto- 
 nomic-affective cravings, through summation, or depression of the 
 ego, become too vigorous to be controlled by the repressing crav- 
 ings and becoming dissociated, cause hallucinations (auditory, 
 visual, tactile, olfactory, gustatory and hinesthetic sensory dis- 
 turbances) which tend to gratify the dissociated affect. The 
 individual hears himself called a pervert, because the dissociated 
 affect has perverse needs, or he dreams (hallucinates in sleep) 
 that his absent or dead mother is present, becaiise he is home- 
 sick, or that he is drinking water when he is- thirsty, because he 
 wishes to sleep and will not get up, etc. 
 
 The symbol, image,. feiich, ritiial, -fancy, fairy' tale, novel, or 
 psychosis, etc., is adopted by the affect ivhcn it can not obtain 
 the reality. The image or symbol,' being associated with the re- 
 ality by the similarity of some of its qualities or the accidental con- 
 tiguity of its special or temporal position, seems to relieve the af- 
 fect to a marked degree. When the affect can not acquire what it 
 needs, uncomfortable tensions or anxiety (fear) are felt, and the 
 use of the symbol or fetich, relieving this anxiety, has a marked 
 physiological vahoe in that it prevents the adrenal, thyroid, cir- 
 culatory, hepatic, and pulmonic compensatory striving from be- 
 coming excessive. Hence, religious symbolism, ritualistic formu- 
 lations of faith, fetichistic administrations of grace, artistic fan- 
 cies, mystic rites, etc., all have a great value in the restoration of 
 biological potency until the environment, climate, social jeopardy, 
 disease process, or bereavement, change sufficiently so that the 
 autonomic cravings may again acquire the reality. The ritual of the 
 medieval northern Europeans inducing the return (rebirth) of the 
 Sun, thereby increasing the food supply and decreasing privations 
 and restoring potency, has a psychotherapeutic value. It seems 
 to me that this conception of the physiological nature of the per- 
 sonality and the theory of neutralizing affective cravings, alone, of 
 
RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 
 
 705 
 
 all the tlieories advanced, gives the (uithropologist, behaviorist 
 and psychologist a satisfactory explanation of the compensatory 
 origin of folk lore, song, language, mysticism, art, religious ritual, 
 hallucination, etc., in primitive a/rid civilized man. Obviously, rit- 
 uals and fetiches ichich tend to stimulate sexual potency, despite 
 the depressing fears of the m.ate's indifference, economic stress, 
 political oppression, religious dogma and social intrigues, are to 
 be highly favored, not only by the savage, but by the modern 
 civilised man and ivoman, as ivell a\s the psychopath. 
 
 It is but natural tliat, when a fearful, oppressive, unpleasant, 
 or disgusting stimulus enters into tlie love or mating situation, 
 
 Fig. 70. — African feticli place; a tree and two stones. 
 
 before the erotic state is well established — the blood-supply be- 
 coming reflexly shifted from the pelvic and gastrointestinal organs 
 to the organs of defense, as the limbs, head, heart and lungs, pro- 
 ducing more or less sexual impotence, — the individual tends to seek 
 a fetich, drug, companion, play, or ideal, which, as a counterstimu- 
 lus, tends to restore his potency or feelings of power and general 
 reassurance. 
 
 Only with this understanding of human nature do the psycho- 
 pathic deviations from the requirements of the social herd become 
 intelligible as truly biological phenomena. 
 
 The intimate influence of the affective-autonomic activities 
 
106 
 
 PSYCI-IOPATHOLOGY 
 
 upon the postural tensions of the striped muscle apparatus, hence, 
 the kinesthetic stream and in turn, the content of consciousness, 
 has been shown in a variety of cases besides the classical exam- 
 ples of anger and fear used by Darwin. 
 
 The proud, arrogant, egotistical paranoiac displays his af- 
 fective compensation in his carriage, walk, play, conversation, work 
 and conflicts, and a little study of his case shows that he strives to 
 free himself from a persistent sense of personal inferiority due 
 to his secret autoerotic or homosexual tendencies. In such exam- 
 
 Fig. 71. — Terrific striving to become omnipotent as a defense against fear of homo- 
 sexuality and impotence. 
 
 pies we find a complete similarity in the man's general muscular 
 tone and the trend of his thought. 
 
 On the other hand, the individuals, who finally yield- to their 
 perverse erotic cravings and resign themselves to live at the level 
 of non-resistance to it, may be found on the wards by the hundreds 
 as so-called chronic dementia prseeox types. A study of these peo- 
 ple shows that they are preoccupied with an incessant stream of 
 lurid, weird polymorphous perverse sexual thoughts and sensa- 
 tions, ajid a most grotesque, primitive estimation of their places 
 in the social herd. Their slovenly appearance and characteristic- 
 ally relaxed,, si ouchy carriage reveal the marked indifference of 
 
IIECONSIDEIIATIOX Ol-" PHTBIUII iVANTS 01'' BK.IIAVKIR 
 
 ro7 
 
 the erotic affect to social esteem, and the sensuous, postural tonus 
 of the striped muscles, as the source of the kinesthetic stream, co- 
 incides with the erotic Avish-fulfiUing content of consciousness. 
 (See Figs. 65, 66.) A more easily defined relationship of the pos- 
 tural tonus of the projicient apparatus to the affective craving and 
 the content of consciousness is to be seen in the catatonics' gro- 
 tesque postures and mannerisms, as compelled by the dissoci- 
 ated affect and their literal interpretation by the ego (see cases in 
 Chapter XII). One may become aware of these mechanisms in 
 
 Pig. 72. — Charaeteristie postural tensions of striped muscle system revealing 
 affective cravings. (1) Depressed, intrauterine state of regression with sufficient 
 adaptability to walk when forced. (2) Paranoid adjustment, showing expectation 
 of assault from Behind,- probably sodomistie. (3) Hebephrenic excretory erotic in 
 characteristic dress and defecation position; face shows pleasure at fancies. This 
 photograph, taken, in ari American State Hospital shows the primitive method of 
 herding the dissociated personalities into groups without regard for the individual's 
 repressed or dissociated cravings. 
 
 himself if he will learn to analyze his dreams wliile the dream 
 process is active. Ordinarily, the dream is taken at its literal face 
 value during sleep, whereas by learning to analyze its symbolic 
 values, one learns to recognize that the grotesque dream imagery 
 decidedly portrays the incongruous relations of the affective ten- 
 sions. We often feel incongruous postural tensions when, we have 
 forgotten to do some important thing. These tensions indicate 
 
708 
 
 PSYCHOPATHOLOGY 
 
 that a wish to do some certain thing has been repressed and is 
 trying to work. 
 
 The quickness with which a change of postural tonus of the 
 striped muscles is compelled by an affective change, is to be seen 
 in the innvimerable, undesirable, little accidents that occur every 
 day as the result of a brief relaxation of some postural grip that 
 holds the body or an object in place against the influence of grav- 
 
 !Fig. 73. — This biological result is typical of the dironio oral erotic dissociated 
 
 personality. 
 
 ity, such as slipping, or dropping a razor or cigar as the result of 
 being momentarily distracted by the necessity of making a repres- 
 sion of an affective reaction which, if allowed free play, might 
 be embarrassing. 
 
 The psychologist, psychopathologist and physiologist must 
 
BECONSIDERATION OF DETERMINANTS OF BEHAVIOR 709 
 
 learn to recognize that his affections or feelings, as he becomes 
 aware of them, consist of a stream of sensations which have so 
 coalesced as to be reacted to as a characteristic feeling, and 
 this craving constitutes the anger, hunger, fear or love. For exam- 
 ple, in anger, the hypertensions in the epigastric region, the 
 thoracic inflation, increase of cardiac vigor, tumescence of the 
 muscles for attack, as chest, arms, legs, neck and face, are popu- 
 larly expressed by the phrase, "itching for a fight." When fear 
 is also a part of the reaction, the face may be blanched and tense 
 instead of congested, as "white with rage," signifying that the in- 
 dividual has become afraid of his ability to control the compul- 
 sions of anger and his responsibility. 
 
 The delusions and hallucinations about the behavior of other 
 people are not due, essentially, to the actions of these people, but 
 are the result of the individual's own, autonomically determined, 
 wish-fulfilling, kinesthetic sensory stream so coloring his impres- 
 sions of the meaning of the behavior of others as to produce the 
 misinterpretation. Naturally, when the delusion is accepted as an 
 accurate representation of the behavior of others, the delusion it- 
 self becomes the cause of elation or anxiety. Thus a vicious circle 
 of adjustment develops. 
 
 On the other hand, only those individuals are hiologically well 
 adjusted, ivhose sexual affections are so conditioned that, in their 
 striving for gratification, they reenforcc the ego's struggle for 
 social esteem. 
 
 The affective difficulties of the cases presented lead to a most 
 important conclusion, which, if correct, calls for a significant, more 
 biological readjustment of our social, educational and religious 
 ideals. It is, namely, that no individual can have a psychosis or 
 anxiety neurosis so long as he can maintain his sexual potency 
 ivithout jeopardising his needs for social esteem. 
 
 If he or she maintains sexual potency at the price of social 
 esteem, a social delinquent results. If sexual potency is sacri- 
 ficed for the sake of social esteem, an anxioty neurosis develops 
 unless the sexual affections can be thoroughly sublimated. Such 
 sublimation is rare and most difficult except for some philosophers, 
 scientists and social workers of the modern and ascetic religious 
 schools. (Teaching and the ministry come iinder the social forms 
 of sublimating the erotic affect.) 
 
 If the sexual cravings Iiavo to be kept repressed in order to 
 
710 PSYCHOPATHOLOGY 
 
 protect the struggle for social esteem, a psychosis is very likely 
 to occur, -whether the erotic affect is perverse or not, when the 
 power to control the self is weakened by disease, injury, discour- 
 agement, etc. : whereas the social virility of an individnM is enor- 
 mously increased ivhen reenforced by estimable, refined, condi- 
 tioned sexual cravings. 
 
 Mechanisms of Neuroses and Psychoses 
 
 The psychopathologist must answer two questions in every 
 case: (1) how long Avill the psychosis last? and (2) what will be 
 its effect upon the personality? My experience is that one's an- 
 swer is best guided by an estimation of the ego's attitude toward 
 the ungratified unavoidable cravings and the nature of these crav- 
 ings. If the ego is inclined to accept or recognize that the source 
 of the neurosis or psychosis, that is, the visceral distress, preoc- 
 cupation of thought, hallucinations, etc., lies in his emotions, crav- 
 ings or ' ' feelings ' ' getting gratification or striving to get gratifica- 
 tion, we have a benign mechanism that is curable. If the ego per- 
 sists iai treating the cravings as foreign to his personality, per- 
 haps a part of his body but not a part of himself, or the result of 
 the secret work of an enemy, Grod or society we have a pernicious 
 mechanism that is incurable unless the attitude of the ego can be 
 changed to a benign one. This often can be brought about through 
 cultivating a transference of affection from the patient. 
 
 The duration of the neurosis or psychosis seems to depend 
 ixpon the means the affective cravings develop for obtaining grati- 
 fication and this is largely determined by the attitude of the ego 
 and what the environment can offer. Each case is decidedly dif- 
 ferent and as intricate as only humanity can be. One can not 
 afford to be too sure of the prognosis of pernicious cases. 
 
 The symptoms produced by the autonomic-affective conflict, 
 while often important because of the distress and vicious circle of 
 preoccupation which may result, are after all, not so important as 
 the attitude of the ego toward the cravings and what the cravings, 
 are. For this reason, unlike the older psychiatries, wherein most 
 of the space was given to describing symptoms, attention has been 
 mostly directed to the wishes or cravings of the individual and 
 how his resistance distorted their seeking for relief and their ef- 
 fects upon his comfort and the content of consciousness. 
 
RECONSIDERATION 0]? DETERMINANTS OF BEHAVIOR 711 
 
 There are, it seems, four types of adjustment to the disturbing 
 pressure of an autonomic-affective craving: (1) yielding to the 
 craving at any cost of self-control and social esteem; (2) eliminat- 
 ing it from the ego by repressing it and keeping it repressed so 
 that it can not cause awareness of its needs, as in the functional or 
 organic castrations; (3) simulating conditions that tend to gratify 
 the craving, as in selfish fancies, dreams, imitations of pregnancy, 
 use of symbols; or (4) sublimating the love or hate by creating 
 socially estimable images -which are related to the true object of 
 the affect, as creating artistic, scientific, religious, philosophic, or 
 social works. 
 
 In the suppression anxiety neuroses we meet with distressing 
 sensations originating in the persistent tensions of some segment 
 or segments of the autonomic apparatus. This is usually due to 
 the inability to make the overt adjustment which is necessary to 
 acquire the conditioned affect's object and thereby its neutraliza- 
 tion; therefor the persistent increased cardiac rate and vertigo, 
 gastric anemia, and visceral hypotension associated with feelings 
 of weakness and inability to think clearly and accurately in a 
 crisis that threatens failure and loss of a love-object. 
 
 In the repression neuroses the individual represses the cause 
 of his anxiety (makes himself forget it), whereas in the anxiety 
 neuroses he is more or less aware of the cause but will not give it 
 its due value in his personality, as disguising his love or hate. 
 In the repression neuroses (phobias, compulsions, obsessions, func- 
 tional distortions) the repression of a wish or craving is main- 
 tained by a vigorous coordination or converging of the remainder 
 of the autonomic apparatus (which, acting as a unity, constitutes 
 the ego) upon a substituted or compromised line of behavior, 
 thereby preventing the intolerable craving from causing aware- 
 ness of its needs and jeopardizing the futiire of the whole organ- 
 ism. This is similar to concentration of interest in order to pre- 
 vent distractions Avhen trying to study, or work, or play golf, hide 
 a guilty or scheming wish, etc. 
 
 In the adaptations to vigorous cravings and critical situations 
 we find two general types of compensation and two types of re- 
 gression adjustments. The manic either abandons himself with- 
 out reservation to the enjoyment of the erotic craving and becomes 
 a jovial, amusing, mischievous, autoerotic player, or he develops 
 a wild, threatening, bluffing over-compensation, because he is 
 
712 PSYCHOPATHOLOGY 
 
 fearful of being unable to control bis perverse sexual cravings. 
 The depressives are either types ■\vbo renounce all competitive 
 interests in the world, give up hope of Avinning the love-object 
 through the striving methods of maturity and regress to an 
 infantile, or intrauterine mother dependence; or, autoerotic, they 
 struggle anxiously, desperately to escape the obsessing cravings 
 of the pelvic segment. The determinants for these variations of 
 adjustment to the tabooed affect, psychoanalysis of these cases 
 shows, are based upon the influence of the individual's associates. 
 
 There are no well defined lines of demarcation between psycho- 
 pathic adjustments to intolerable or ungratifiable cravings upon 
 Avhich to erect very satisfactory nosological classifications of the 
 different adaptations as true diseases; hence, it is much more 
 practical to speak of cases according to the affective mechanisms 
 which are involved. 
 
 For example, the term dementia pracox i§ of necessity used 
 here because it has been popularly adopted as a division for classi- 
 fying people who show certain behavioristic traits, affective trends 
 and physiological symptoms. Through a loose usage of its origijtipl 
 purpose, the classification of certain psychopathic personalities, 
 the term dementia prcecox has been gradually, indiscreetly a;ccepted 
 as being a definite disease entity, and the classification of the per- 
 sonality as a dementia precox type has become adopted as the 
 diagnosis of a specific disease process. Because of the absence of 
 definite etiological factors, this has reduced the psychiatrist to 
 the sad plight of having to define what is meant by dementia prce- 
 cox in terms of the symtoms which he has grouped imder the name. 
 This circular method of reasoning from symptoms to name and 
 from name to symptoms, while it satisfies the court's and jury's 
 demand for logic and the custodial psychiatrist's need for short, 
 convenient names in order to pigeon-hole his cases, is diverting 
 the major part oE psychiatric curiosity from its task of working 
 out the particular pathology of each individual. 
 
 The general lack of confidence and respect by the medical and 
 surgical profession for the psychiatrist is due, largely, to his psy- 
 chotherapeutic inefficiency^ and circular mode of presenting his 
 eases, characteristically obscuring the unrecognized etiological fac- 
 tors behind the assumption of tmdefinable inherent or constitu- 
 tional defects. The profession's critical attitude is having, how- 
 ever, the effect of forcing the psychiatrist to present his case in 
 terms of its etiological factors or admit that he does not under- 
 
RECONSIDERATION 01'' DETEII.MI XAXTS OK BEHAVIOR 713 
 
 stand it. The necessity for etiological factors lias changed the in- 
 terest in making wholesale, statistical, group studies to more prac- 
 tical, intensive, analytical studies of individual cases. The indi- 
 vidual, analytical method is not only clearly revealing many of the 
 psychopathological mechanisms which cause the functional psycho- 
 ses, but, almost equally important, it is decisively establishing the 
 fact that these mechanisms, constituting the disease process, are 
 all that need to be known, or used for the diagnosis, treatment and 
 presentation of cases. Necessarily, the old symptomatologieal 
 classification of psychopathic individuals has become scientifically 
 useles, except where lack of knowledge of the affective mechanisms 
 still makes it a convenience. 
 
 The study, or history of a case should include, besides an ac- 
 count of the environmental setting and an estimation of the indi- 
 vidual's intellectual, social, economic, vocational and esthetic-moral 
 development, an account of the psychopathological processes which 
 are involved : as the attitude of the ego in the coijflict, ivhether be- 
 nign or pernicious, the nature of the affective repression, acute or 
 chronic (love, hate, fear, shame, sorrow) ; the degree of the affec- 
 tive regression (as adolescent, preadolescent, infantile, intrauter- 
 ine) ; the type'of affective dissociation, recent, chronic, progres- 
 sive, fixed (as obsessions — persistent feelings and thoughts, de- 
 lusions, hallucinations, compulsions — mannerisms and acts, pho- 
 bias, confusion, delirium) ; the presense or absence of functional 
 simulations or eliminations, recent or chronic (as wish-fulfilling 
 postural tensions for their kinesthetic value, anesthesias, hyper- 
 esthesias) ; the presence or absence of compensations, if pres- 
 ent, whether recent, chronic, progressive or fixed (harmless, dan- 
 gerous grandiose) ; the degree of insight into the wish-fulfilling 
 influence of the cravings involved in the maladaptation process; 
 the symptoms of autonomic reactions (condition of hair, skin, 
 pupils, eyes and their extrinsic muscles, muscle tonus, pulse 
 rate, blood-pressure; glycemia, glycosuria, areas of vasodilation 
 or vasoconstriction, and spastic or flaccid visceral postural ten- 
 sions — pleasant or unpleasant — and degree of activity of glands 
 of external and internal secretion). 
 
 When some such procedure is followed, a comprehensive cap- 
 tion like dementia pnecox obscures the nature of the biological 
 adaptation or psychosis, and its particular dynamic factors. 
 
 The progressive biological deviations from the norm, dreaded 
 by the social herd, which are due to uncontrollable autonomic 
 
714 PSYCHOPATHOLOGY 
 
 cravings, an nnmodifiable environmental resistance, and the re- 
 quirements for social esteem, vary greatly from mild feelings of 
 anxiety and inferiority with eccentric compensations to prevent 
 detection, as in the suspicions or paranoid type, to the arrogant, 
 eccentric, domineering, sensitive, grandiose paranoiac and the 
 paranoid dissociated (dementia prsecox) type. 
 
 In the pernicious dissociation neuroses (dementia prsecox 
 types, paranoid, catatonic or hebephrenic) or the benign dissocia- 
 tion neuroses (the hallucinated manic and depressive types) the 
 repressed affect has broken away from control by the ego and is 
 causing hallucinations of what it needs. The ego in turn may ac- 
 cept and enjoy them or fight desperately to stop them. In the 
 paranoid dissociation neurosis the repressed intolerable cravings 
 have become dissociated, and, producing vivid sensory disturbances 
 (hallucinations) are understood by the desperately striving ego to 
 be the voice and influence of a foreign personality. Utterly with- 
 out insight, the personality may or may not undergo a pernicious 
 deterioration, depending upon the degree of hatred, and the con- 
 ditioned nature of the love affect for infantile or adolescent types 
 of experiences, such as excretory or oral erotic play with certain 
 associates. 
 
 The catatonic adaptation is a renunciation of resistance and 
 submission to the dissociated cravings, which, usually, becoming 
 gratified by the hallucinated experiences, gradually subside and 
 permit a reconstitution of the personality along its preceding habit- 
 ual lines of behavior. (The mechanism of the catatonic 's "pro- 
 longed nightmare" is probably not unlike the erotic dream which 
 causes fear but gives sexual relief.) 
 
 The hebephrenic, having an affective fixation at the infantile, 
 or preadolescent polymorphous perverse level, usually predomi- 
 nantly excretory and anal erotic, finds life to be productive of the 
 greatest happiness in that irresponsible state. The affective re- 
 gression is to be regarded as an escape from the anxiety and vigi- 
 lance necessary to maintain fitness for social esteem, by resuming 
 a previous, irresponsible affective attitude, usual!}' a dependence 
 upon the mother. 
 
 The delirium is to be recognized as the loss of the organism's 
 capacity to maintain the compensatory nervous integrations which 
 acting as a unify control the proj'icient apparatus {overt behav- 
 ior) so that some hyperactive segment may not dominate avd com- 
 
RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 715 
 
 pel behavior which might jeopardise the entire personality. The 
 hypertense autonomic segments and their nngratified cravings are 
 able, during the delirium, to dominate and cause awareness or con- 
 sciousness of images of previous sensory impressions (hallucina- 
 tions) which are, in some manner, related to the needs of these 
 cravings. The hallucinations may seem to be utterly irrelevant 
 and incongruous, but, upon analysis, will be found to be intimately 
 related to the atf active needs. The delirious, alcoholic homosexual 
 may frankly hallucinate an impending sexual assault by a potent, 
 dominant male, or its equivalent, by hallucinating being crushed 
 by a gigantic engine, or overcome by beasts. 
 
 This is not a strange or ridiculous symbolism. One needs but 
 to recall that politicians, big business men, athletes, generals, ar- 
 mies, fate, etc., are often compared to steam rollers or gigantic 
 irresistible monsters, and symbolized as such in cartoons. This 
 certainly reveals that the individual members of society have simi- 
 lar affective reactions in regard to them, or the cartoon would be 
 meaningless. 
 
 Explanations of delusions, say about having been shot with a 
 pistol in a certain spot in the chest (Southard, Franz) are not 
 satisfactory when based upon the finding, at autopsy, of a fresh 
 pleural adhesion near this spot. The conclusion that the adhesion 
 probably caused a piercing type of pain and therefore the mentally 
 deranged individual thought it was due to a pistol shot, is not 
 sufficient, because, although the lesion may explain the patient's 
 tendency to localize the supposed shot, it does not, in the least, ex- 
 plain why she specifies a pistol shot instead of a stab wound, or 
 pleurisy. 
 
 Such delusions, if explainable at all, will be found upon an 
 adequate analysis to be determined by the conditioned nature of 
 the ungratified affective cravings of the individual. 
 
 Determinants of the Prognosis of Affective Distortions 
 
 The ever recurring question as to the prognosis of the psycho- 
 sis, as a biological divergence, may be given some consideration 
 here. Distresses, confusions and psychoses, which are solely due 
 to affective maladjustments can not always be given definite prog- 
 noses. Sometimes most astonishing, efficient readjustments are 
 made, which, even though occurring in an apparently hopeless sit- 
 
716 PSYCHOPATHOLOGY 
 
 nation, may endure for the remainder of the individual's career. 
 As a general rule, however, when certain affective tendencies ap- 
 pear persistently in an individual, the prognosis is proportionately 
 discouraging, particularly if there is hatred, or- fear of external or 
 environmental reality. 
 
 In proportion as fancies, delusions and hallucinations are 
 secretly pleasing and detract from the cultivation of efficient in- 
 terests in environmental reality, the prognosis is poor. 
 
 Individuals, who use eccentric compensatory strivings in order 
 to establish a sense of social fitness and obscure the feeling of in- 
 feriority, and maintain them at all costs, are not likely to acquire 
 insight and readjust, particularly if the eccentricity attracts so- 
 ciety's criticism and in itself becomes an inferiority. 
 
 Wherever an individual persists in making an eccentric claim 
 of unusual potency in art, science, commerce, mechanics, religion, 
 etc., ivhich is not fov/nded upon reasonable facts, fear of the tend- 
 ency to become heterosexually impotent is indicated. This type of 
 male or female's future depends largely upon the capacity to toler- 
 ate the cause of the fear (usually homosexuality) and sublimate it. 
 
 The earlier in the career that the affective cravings become 
 fixed and dependent upon a parent, the less affective capacity or 
 energy seems to be possessed for the fulfillment of the responsi- 
 bilities and independence of maturity; hence, less stress and dis- 
 appointment can be endured. 
 
 The probable difficulties of a psychopath, in adjusting to a 
 perverse craving or functional inferiority, may be inferred fairly 
 reliably from the comfortableness and success of his previous 
 social adjustment and the sincerity with which he seeks to control 
 himself. When such individuals o])enly haie those who resist their 
 eccentric struggle for potency and social infiuence, they tend to 
 establish a vicious social circle for themselves. When an indi- 
 vidual hates another, reactions seem to be aroused in himself that 
 tend to prepare for a counter attack by his rival or victim. These 
 compensatory tensions are disagreealile and, in turn, are reacted 
 to, reflexly, by others, although the latter may not become clearly 
 aware of what is occurxing. Thus the paranoid individual soon 
 finds himself cultivating, unconsciously, a fertile field from which 
 to gather remarks, signs, etc., which indicate that he is disliked, 
 distrusted, despised, and, in turn, soon actually becomes distrusted 
 and avoided, establishing a vicious affective circle. 
 
nECONSIDERATIOK OF DETEEHINANTS OF BEPIAVIOU 71.7 
 
 It seems, as a general rule, tliat paranoiacs are not able to 
 re-establish a comfortable relationship with society if they tend 
 to systematize their delusions, fix them upon sohie definite person 
 or event, hate the resistance to their struggle for virility, and fear 
 their OAvn inferiorities. 
 
 Psychoses which are duo to intvafamilial feuds, arousing and 
 maintaining vicious affective circles, often disappear when an af- 
 fective readjustment is permitted, as upon the death of the oppres- 
 sor, or upon the severance of repressive obligations through di- 
 vorce. Most intrafamilial feuds are too intricate and involved and 
 of too long standing to permit of a solution through a sincere recog- 
 nition of the mechanism by the members of the family. In the 
 wealthy we often find an earnest, prosperous grandfather, and a 
 perverse, dissolute, unproductive grandchild. In such cases it 
 often happens that while the vigorous, virile grandfather built the 
 foundation of Ms family and established its economic resources, 
 he also unwittingly established an affective situation which was 
 destined finally to abort his descendants. 
 
 Psychoses which are due to periodic, erotic upheavals or pe- 
 riodic regressions have a better prognosis than the chronic erotic 
 or regressive. 
 
 The histories of psychopaths show, again and again, that the 
 foundation of the abnormal or eccentric tendency is established in 
 childhood through the influence of associates, and that psycho- 
 pathological adjustments in a parent tend to influence the child to 
 make abnormal adaptations and when the child matures its off- 
 spring also become the victims of an abnormal influence. The de- 
 velopment of insight through educational measures, more than 
 anything else, promises to reduce the tendency to assume an 
 abnormal attitude toward the fundamental inherent autonomic 
 cravings of the personality. Because of the changes incident to 
 the development of knowledge, severe conflicts with many tradi- 
 tions and religious conceptions and the social conventions must be 
 expected. The pressure of the restless, dissatisfied autonomic- 
 affective apparatus can no longer be lulled by platitudes and 
 preachments and dogmas, and the social readjustment, as a biolog- 
 ical process, is becoming irresistible. 
 
 A detailed discussion of the symptoms and mechanisms in the 
 eases presented in the chapters on the different types of neuroses 
 and psychoses was avoided in the case histories for the sake of 
 
718 PSYCHOPATHOLOGY 
 
 brevity and clearness of presentation of the cases. It is impor- 
 tant, however, that some explanation of the mechanisms and symp- 
 toms be made. Theories or explanations are valuable as working 
 hypotheses in so far as they actually explain what actually occurs. 
 
 All the cases presented are alike in that we have people strug- 
 gling with strong affective cravings which are trying to get con- 
 trol of the individual or the environment in order to acquire the 
 stimuli which will neutralise or gratify them ; and because they are 
 resisted they cause distressing tensions of certain parts of the 
 body. Many ask the question that seems to arise naturally from 
 the case material, "Why do all neurotics and psychotics have sex- 
 ual difficulties?" This should be followed by the question, "Why 
 do people who have sexual difficulties tend to become neurotics or 
 psychotics?" These questions are very much like asking, "Why 
 do all cardiac incompensations develop general muscular weak- 
 ness, or all paretics have syphilis?" The answer would be that it 
 is the inherent nature of the forces involved to produce certain 
 mechanisms, and so the ego and its struggle Avith its sexual crav- 
 ings, when the cravings are ungratifiable and vigorous enough, 
 causes distress and distortions of behavior. The ego rarely has 
 to struggle continuously with the other primary emotions because 
 they are not taboo. 
 
 Under unusual conditions (as in the army or navy) we see 
 irrepressible hatred of an unavoidable superior or irrepressible 
 fear of an unavoidable cause causing neuroses or psychoses. They 
 clear up, however, when the cause is removed. 
 
 It seems that the erotic cravings may be (predominantly, not 
 entirely) balanic, vaginal, iirethral, oral, anal, or autoerotic. The 
 latter type, occurring in an individual who is his own lover and love 
 object, is quite different from the other types which must have 
 love objects that are not a part of the personality. 
 
 It is certain that we may have a neurosis or psychosis in an 
 individual who is normally heterosexual. By normally heterosex- 
 ual is meant individuals whose sexual cravings need the re- 
 sponses of the opposite sex and when free play of the sexual cravr 
 ings occurs a form of sexual intercourse results that relieves the 
 autonomic tensions and gratifies love, may reproduce their kind, 
 and gives a sound feeling of biological and social fitness. Case 
 MD-1 struggled against such cravings because of prudishness and 
 Case MD-7 abandoned herself to the cravings, obtaining in this 
 
RECONSIDERATION OE DETERMINANTS OV BEHAVIOR 719 
 
 manner what they needed because of her impotent husband and 
 her fears of immorality, syphilis, betrayal and abandonment. 
 
 Both were women. Men are not so likely to have neuroses 
 from ungratifiable heterosexual cravings because the social taboo 
 is fortunately not (yet) as severe and punishing as it is against 
 the female. When his autonomic tensions and sexual cravings, 
 however, tend to force him to yield to an abnormal (autoerotic or 
 perverted) means of getting relief because the resistance to a 
 normal means is insurmountable then the signs of tensions and 
 distress begin to show. The type and seriousness of the neurosis 
 or psychosis is the type of conflict that is waged between the ego 
 and the erotic cravings. 
 
 The manner in which the erotic cravings are gratified is de- 
 termined by the same laws that determine how stomach cravings 
 for food shall be gratified. That is to say, if we punish or threaten 
 to punish a young or old dog, horse, any animal, man or woman, 
 often enough when trying to get food in a certain way (the 
 younger and more timid the animal or person, or the more violent 
 and certain the punishment, the less often need it be applied) the 
 fear of pain will force the development of some other means of 
 getting gratification. This other means is determined throughout 
 animal life by the nature of the organic equipment (motor and 
 sense organs). The small horned stag is subdued during the rut- 
 ting season, the timid youth is subdued by his more courageous ri- 
 val or the suggestions of his prudish parents and remains auto- 
 erotic. The monkey, elephant, or stallion, upon being subdued by 
 man and placed in captivity, masturbates. When the monkey is 
 isolated from the female he becomes homosexual; and so when 
 youth is placed in captivity by moral preachments, prudish par- 
 ents, fears of disease, pangs of conscience, all depriving him of a 
 heterosexual outlet, he finds his sexual cravings trying to get 
 homosexual or autoerotic gratification. If his organic equipment 
 is effeminate, or her equipment is masculine and unattractive to 
 the opposite sex, the fear of punishment and ridicule upon seeking 
 heterosexual means is increased. 
 
 The sexual hunger mechanism, like the food hunger mech- 
 anism is extremely simple. It tends to follow the line of least 
 resistance and requires controls and reenforcement to overcome 
 dangers and become refined. Society must recognize this and in- 
 stead of despising and discouraging heterosexuality it should 
 
720 PSYCHOPATHOLOGY 
 
 encouage and promote the development of heterosexual potency 
 in order to prevent biological abortions . through fear of the re- 
 sponsibilities of heterosexuality — ^pregnancy, labor, parenthood. 
 Many of -the preceding cases show that as the sexual cravings 
 become normal (heterosexual) 'the panic and fear of homosexual 
 submission T,vith perversions (the psychosis) decreases. (See 
 Cases P-3, PD-14, PD-15, PD-20.) This" should be sufficient warn- 
 ing against heeding moralizing fanaticism, under whatever dis- 
 guise it may appear — religious, academic, medical, esthetic, etc., 
 which would place too severe obstacles, laws and conventions 
 against heterosexual living. Particularly is this likely to be over- 
 done wherever men or women are congregated together in large 
 numbers, as on board ship, in army camps, colleges, prisons, con- 
 vents, monasteries and asylums, because it is certain that a large 
 proportion of the males or females will become obsessed by the sex- 
 ual cravings tending to revert to masturbation or homosexuality. 
 On the other hand, heterosexual license, Ijesides increasing ve- 
 nereal disease, is decidedly conducive to degeneration of the per- 
 sonality and inability to love (PD-1, AN-S). Life is a serious 
 game which requires courage, fortitude, and common sense to play 
 it well. 
 
 Significance of Symptoms of Affective Conflicts 
 
 The most difficult features of a person's behavior to describe 
 in words that will give the reader the desired impressions are the 
 postural tensions of the patient's limbs, body and facial muscles. 
 It requires genius to convey an accurate idea -with draAvings, paint- 
 ing or sculpture, hence description by words, far more difficult, is 
 beyond reach of the average psychiatrist. Photography is perhaps 
 the best method and avoids the tedious descriptions of behavior 
 and emotions that once burdened psychology and psychiatry. (See 
 following pages.) 
 
 The postural tensioiis of the striped muscles reveal the nature 
 of the ego 's struggle with the repressed affect to the observer who 
 is familiar with their significance. The cravings for oral or anal 
 erotic submission and the attitude of the ego can often be differen- 
 tiated by the postural tensions. Autoerotic anxietj'-, autoerotic 
 abandonment, infantile regression, paracidal or manic compensa- 
 
RECONSIDERATION OF DETERMINANTS OK BEHAVIOR 
 
 r2i 
 
 Fig. 74. — Note the posture of tlie hands and rigidity of the body. This postural 
 interest in the hands is usually a defense against autoerotieism. This patient seized 
 u, knife and attempted to amputate his penis. 
 
 Fig. 75. — The postural tensions of the facial muscles show silly, unrestrained abandon- 
 ment to autoerotic cravings. 
 
722 
 
 PSYCHOPATHOLOG Y 
 
 tions, and defensive postures to keep from becoming conscious of 
 undesirable cravings or inferiorities are often self-explanatory 
 when one has had clinical experience with the predominant types. 
 
 ITig. 76. — The postural tensions of the facial muscles show anguish and despair. The. 
 cause was secret autoeroticism. 
 
 rig. 77. — Compulsion to prayer as a defense and purification against oral eroticism. 
 
 The ego's attitude toward the use of the different sense or- 
 gans of the body also reveals the nature of the affective struggle. 
 Anesthesias and hypesthesias mean an affective resistance to 
 
RECONSTDEUATIOSr OF DETERMINANTS OF BEirAVrOU 72'.] 
 
 Fig. 78. — Joyous abandonmoiit to anal and autoeroticism. 
 
 Fig. 79. — The face shows intense Fig. 80. — Postural tensions of facial 
 
 hatred. This individual is the victim of muscles show extreme terror and emaci- 
 intense anal erotic cravings. ation. At this time she had the convic- 
 
 tion of having teen the subject of 
 sodomy, apparently a wish-fulfilling de- 
 lusion. 
 
724 PSYGHOPATI-IOLOGY 
 
 the sensations that might be received through using a particular 
 sense organ. These sensations may be aroused by stimuli in the 
 environment or memories, that is images, of past sensory experi- 
 ences which the ego might become conscious of. So-called visual 
 constriction of hysteria, deafness for certain sounds, areas of an- 
 aesthesia for contact stimuli, anosmia, etc., are due to affective re- 
 sistance or fear of using the sense organ because that would force 
 the recall of a painful memory or sensorj'' images of experiences 
 that caused distress. (See Case PN'-2.) 
 
 Amnesias, circumscribed for an experience or the details of a 
 period of life, are, physiologically, forms of anaesthesia. The ego 
 
 Pig. 81. — Tlio tensions about the mouth show tremendous striving as a defense 
 
 against oral eroticism. 
 
 resists making movements and assuming postures which would 
 stimulate the proprioceptors (kinesthesis) and external sense or- 
 gans which in turn would reproduce a sensory image of the pain- 
 ful experience. Thus the patient prevents himself from becoming 
 conscious of the experience, hence the amnesia is a valuable form 
 of adaptation. Partial memories are similar to hypesthesias. 
 (See Case PN-2.) 
 
 Hyperesthesias and paraesthesias are caused by an excessive 
 craving for the sense organ and its stimuli. Persistent memories, 
 delusions and hallucinations are forms of hyperesthesias caused 
 by the ungratified affect striving to get gratification despite the 
 resistance of the ego. (See Cases PN-2, PN-1, PN-7, MD-1, MD-2, 
 
RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 725 
 
 A. 
 
 Fig. 82. 
 
 D. 
 
 A. Tensions of facial muscles showing perplexity and fear caused by anal 
 erotic cravings. 
 
 B. Facial tensions showing fear — anal erotic cravings. 
 
 0. Facial tensions showing slight suspiciousness but general tendency to seek 
 seduction — cause anal eroticism. 
 
 D.. Facial tensions showing extreme suspiciousness. 
 
726 
 
 PSYCHOPATHOLOGY 
 
 HD-1,, CD-I.) Fear of injury, for example, lowers the resistance 
 to the sense organs that indicate the approach of an avoidable 
 cause of injury. The painful or hypersensitive vagina is often 
 caused by fear or repressed hatred lowering resistance to the pain 
 sense organs there. The delusion or hallucination often gratifies 
 erotic or hatred cravings although it terrifies the ego just as the 
 stomach hunger cravings often force the eating of waste or dan- 
 gerous food or getting into situations that terrify the eg'o. (See 
 Cases PD-33, PD-35, CD-6.) 
 
 The theory that delusions or hallucinations are caused by the 
 misinterpretation of an external situation or the peculiar condition 
 
 Fig. 83. — (A) Facial tensions show weak striving to control fearful oral erotic crav- 
 ings. (B) Facial tensions showing despair at uncontrollable eroticism. 
 
 of the environment is not acceptable. (See Case HD-1.) What 
 actually occurs in the delusion or hallucination is that the individ- 
 ual's perceptions and conceptions are made up, as a synthesis, of 
 the sensations of which he is conscious. The sensations now m 
 from the three great sensorj?- divisions, exteroceptive, enterocep- 
 tive and proprioceptive. Now the inflow from the exteroceptors 
 may be qu.ite alike for a group of people and each member's con- 
 ceptions may be more or less alike in general but decidedly differ- 
 
EECONSIDBEATION 01? DETERMISTANTS OF BEHAVIOR 727 
 
 A. 
 
 B. 
 
 Fig. 84.^ Tensions of facial muscles showing desperate striving (hate) to control 
 
 dissociated perverse erotic cravings. 
 
728 
 
 PSYCHOPATHOLOGY 
 
 ■ 
 
 ^ -0"^ 
 
 ^ 
 
 >^. 
 
 
 ^H 
 
 ■^ ^ 
 
 ^^1 
 
 
 "^ 't'V*79^B^^ti^^^H 
 
 I^M 
 
 ^^K "^^WfP** 
 
 tji^^^^^^^^^^^^D 
 
 ^^^^H 
 
 Im^ 
 
 
 H^H 
 
 Pig. 85. — Elimination or eaatration of eyeball as a defense against eroticism. 
 
 Pig. 86. — Facial tensions and posture of eyes express the "contrite virgin" — 
 the result of tremeadous compulsions to prove innocence following a sociarseandal 
 that forced her into the position of an immoral intriguer. Striving to forget (make 
 herself unconscious of the sexual wishes and memories). 
 
RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 729 
 
 ent in important details, as the testimony of observers or wit- 
 nesses of a crime always shows. This difference in the significance 
 of what was seen or heard is due to the differences in the kinaes- 
 thetic stream or stream of sensations flowing into consciousness 
 from the proprioceptors and enteroceptors. Hence it is more ac- 
 ceptable to say that any individual having the same flow of sensa- 
 tions from the internal sense organs and external sense organs 
 would think the same things ; that is to say, would have the same 
 delusions or hallucinations. The difference between delusional 
 and rational inividuals lies in the proprioceptive activities, that 
 is, hyperesthesia of certain proprioceptive fields and anesthesia of 
 others, in turn, aroused by postural muscle tensions, in turn deter- 
 mined by the repressed and ungratified affective cravings trying 
 to get what they need. Therefore in psychotherapy we endeavor 
 to induce the patient to become conscious of his repressed affective 
 cravings and the wish fulfilling value of his delusions and halluci- 
 nations, just as men lost in a desert would not hesitate to explain 
 why they could not resist the craving to drink urine, or water which 
 they knew to be poisoned by alkalies. 
 
 Paralyses (s-pastic and flaccid) are compelled by the repressed 
 affect in order to escape from a distressing situation, escape from 
 the distressing memories or sensations of a situation, or they are 
 the best available means of getting sensations that will gratify the 
 affect in a hostile or unresponsive environment. (See Case PN-3, ' 
 PN-7.) Convulsions and tics, as clonic-spastic motor tensions, 
 also are caused by the affect to acquire similar results — relief or 
 neutralization. (See Case PN-6.) Fear of the enemy in front 
 and court-martial behind, if unendurable and uncontrollable will, 
 as soon as fatigue or toxemia sets in, force a reflex postural ad- 
 justment in the soldier which will permit escape from the cause of 
 fear. Hence the war neuroses as repression of fear or perverse 
 eroticism neuroses. 
 
 Dreams, fancies, myths, tales, stories, novels, poetry, paint- 
 ing, sculpture, music, drama, delusions, hallucinations, religious 
 ritual, forms of faith, scientific research and theories, philosoph- 
 ical and social systems, laws and ministrations of justice are the 
 result of forms of behavior urged by the affective cravings trying 
 to get gratification through solving the environmental resistance. 
 In order to understand the significance of a man's fancies as 
 forms of reasoning, look for wish-fulfillment and how it gratifies 
 
730 PSYCHOPATHOLOGY 
 
 his struggles for potency and social esteem and avoids the fear of 
 failure, loss, pain, etc. 
 
 Fear, panic, terror, anxiety, uneasiness, douht, apprehension 
 are all degrees of fear of failure to gratify the affect, avoid pain 
 or control the perverse affect. 
 
 Apathy, lethargy, "loss of will power," loss of muscle tone 
 or energy are failures to compensate to the cause of fear and an 
 unconscious submission to an insurmountable environmental re- 
 sistance. (Case AN-3.) 
 
 Phobias seem to be of two types, one is due to the fear reac- 
 tions being conditioned to be aroused by stimuli that are associ- 
 ated with a former dangerous or fearful experience which may or 
 may not have been forgotten. (Case AN-1.) The associated stim- 
 uli may also be symbolized, as the fear of open spaces due to fear 
 of losing the mother's attachment. The other type of phobia is 
 the fear of a suppressed, persistent wish bringing about an indul- 
 gence or an event or getting joy out of an event; such as the death 
 of a father, mother, mate or child who has become an obstruction 
 to obtaining a love-object. (Case PN-1.) 
 
 Compulsions and obsessions naturally arise as confipensations 
 to keep the intolerable or unjustifiable wish repressed, that is, pre- 
 vent it from causing consciousness of its needs or efforts ; such as 
 the compulsion to maintain innumerable protective appliances 
 about the house or of performing a ritual each day in order that 
 a certain person -will not be killed. (Cases PN-1, P-1.) The unrea- 
 sonable dread of the person being killed is due to the wish for 
 relief from that person's unconscious obstruction of the affective 
 cravings, usually love. 
 
 Mannerisms, fetiches, ritioals are methods of repressing from 
 consciousness ("banish out of mind" or "banish the thought") 
 thoughts or environmental conditions that tend to cause fear of 
 loss of potency (particularly fear of yielding to perverse or auto- 
 erotic cravings) and on the other hand to stimulate heterosexual 
 potency. (Cases MD-8, MD-2, MD-3, MD-11, P-1.) 
 
 Manias or cravings such as kleptomania, mania for lying, for 
 causing others to hate one another, injure one another, or love one 
 another, are means of getting erotic gratification through bringing 
 about events that may establish an opportunity for or that actually 
 cause the orgasm. (Case HD-1.) In surgical clinics we often find 
 erotic females and males who periodically become obsessed with 
 
RECONSIDERATION OF DETERMINANTS OF BEHAVIOR 731 
 
 cravings for minor or even radical major operations, entailing even 
 the loss of large parts of vital organs. The operation and excision, 
 being equivalent to a sexual submission or labor and birth, attended 
 by affective readjustments which are equivalent to a sexual or- 
 gasm, force such people to seek for and submit themselves repeat- 
 edly to the ordeal. When erotic affect runs a rampant course, 
 the visceral tensions, hence visceral areas of tenderness and pain, 
 become unendurable. The simulations of tumors and visceral an- 
 omalies are often amazingly real and may mislead the most skill- 
 ful diagnostician. 
 
 The obvious defense against irresistible cravings is the elim- 
 ination from the environment of all things that might arouse them. 
 This mechanism gives rise to an enormous number of chronic ec- 
 centric social reformers. (Cases P-1, CD-4.) Psychopaths often 
 solve their conflicts with repressed cravings in this manner. 
 Asylums are full of them. The more practical and harmless, 
 though not less obsessed and inspired, biologically anomalous re- 
 formers must be controlled or avoided because of their persistent, 
 unconscious tendency to mislead the race in its ciiltural develop- 
 ment. They are compelled to make life easier for their own con- 
 flicts and being biologically abnormal are potentially misleading 
 for the biologically normal. 
 
 The influence of secret cravings and secret memories of past 
 indulgencies upon the behavior of the psychopath is the same as 
 upon the normal child and adult. They all feel, because of many 
 minor experiences of the sort, that others recognize their efforts 
 to conceal something shameful. The next stage is the persistent 
 dread that people will shun them because of trying to conceal 
 something and this may develop into the belief that people can 
 read their minds and steal their thoughts. This develops the com- 
 pensatory defense or claim of the psycopath that he can read the 
 minds of others, even building up a defensive philosophy on this 
 conviction. 
 
 Fear of croivds usually means a repressed craving for exhibi- 
 tionism or a secret violation of the laws of the race and fear of the 
 anger of the race. - 
 
 Fear of death, dying, crucifixion or stdcide often results from 
 ungratified sexual cravings that are trying to get gratification 
 through the act. (Cases PD-30, PD-31.) Such fears also may 
 mean an uncontrolled regressive tendency of the affective cravings 
 
732 PSYCHOPATHOLOGY 
 
 to return to an intrauterine attachment to the mother. ( Case HD- 
 1.) Dying means returning to a state of existence similar to that 
 which was lived before birth. In many religions , it signifies a 
 reidentification with divinity. 
 
 Cravings to steal, lie, rape, sedivce, nmrder, to be cruel, brutal 
 or sadistic are often caused by the erotic affect trying to get fur- 
 their excitation in order to become potent enough to obtain grati- 
 fication. 
 
 Cravings to be beaten, punished, cheated, misled, seduced, 
 raped, persecuted, bullied, injured are often caused by erotic 
 cravings to submit to and be overcome by a powerful, brutal, ir- 
 responsible force and are often shown in the psychosis as the cause 
 of delusions and hallucinations of having had such experiences. 
 (Cases PD-33, PD-34, PD-35.) 
 
CHAPTER XV 
 PSYCIiOTIlERArEUTIC PRINCIPLES 
 
 All neuroses and psychoses which are due to uncontrollable or 
 ungratifiable affective cravings have a common psychotherapentic 
 problem which resolves into a question either of diminishing the 
 vigor of the uncontrollable autonomic tension and its craving or 
 of increasing the vigor of the ego (the socialized cravings), so that 
 the latter may dominate the final connnon motor paths (overt be- 
 havior) and thereby control the undesirable craving. 
 
 The psychoanalytic method is primarily interested in reducing 
 the vigor of the uncontrollable craving, whereas the suggestive 
 and hypnotic methods, reeducation and rest cures, etc., endeavor 
 to reconstitute and reenf orce the ego so that it will be able to con- 
 trol the cravings which tend to jeopardize the individual's efforts 
 to retain social esteem. Both methods have splendid merits which 
 a prejudiced advocate of either one would be likely to neglect in 
 the other. 
 
 There are types of cases, particularly where unmodifiable in- 
 trafamilial feuds are involved, which may become aggravated by 
 a psychoanalytic procedure. On the other hand, there are more 
 cases which can only be cured through psychoanalysis and which 
 only receive a meagre, temporary benefit from the suggestive 
 smoothing-over process. There is, moreover, a critical stage in 
 many psychoses that is highly favorable to a psj'choanalysis, but 
 is often missed and lost because the physician in charge inclines to 
 favor the rest-cure and suggestive method at the wrong time. 
 
 The suggestive method of treating the psychopath rarely, if 
 ever, effects a permanent cure, whereas the psychoanalytic method 
 often effects remarkable, apparently permanent cures. The lat- 
 ter method has not, however, been used long enough to justify 
 absolute confidence in its capacity to effect permanent cures, even 
 though the results are, so far, most encouraging. 
 
 The suggestive method depends for its success upon the con- 
 vincingness of the personality of the physician and his ability to 
 
 733 
 
734 PSYOHOPATHOLOGY 
 
 win the patient's confidence; that is, a transference of affection 
 from the patient. Most suggestion therapeutists refuse to recog- 
 nize this fact, but insist that they merely win the patient's confi- 
 dence through the administration of impressive therapy and op- 
 timistic suggestions. Early in the history of hypnosis a form of 
 magnetic influence was assumed to be possessed by the hypnotist, 
 but this is now recognized by the psychoanalyst to be nothing more 
 than the winning of a positive transference of affection, love. 
 
 The psychoanalytic method of treating the psychopath is often 
 stupidly objected to on the grounds of expense of time and lack 
 of foreknowledge of practical results, and being useful only "in 
 selected cases," because it "may do more harm than good." I 
 have often heard these ultra-wise platitudes, which are as appli- 
 cable to surgery or internal medicine, pronounced with conviction 
 by physicians who had neither experience in psychoanalysis nor an 
 unprejudiced interest. One usually sees men maintain this atti- 
 tude as a justification for neglecting to conscientiously read 
 psychoanalytic literature for the welfare of their patients, or, be- 
 cause their own affective repressions mal^e them unable to endure 
 the tensions which would be aroused in themselves when listening 
 to a patient's difficulties which are other than organic and imper- 
 sonal. 
 
 It must be admitted that the psychoanalysis of a case may 
 result in a suicide, serious panic, or wild, homicidal outburst. But, 
 it must also be consistently admitted by the opposition to psycho- 
 analysis that the mistakes of medicine have buried their thousands, 
 and surgery, their tens of thousands. Because tuberculosis, car- 
 diac diseases, nephritis, pellagra, cancer, syphilis, etc., require 
 indefinite time and great labor, and cancer is often ineradicable, 
 should these cases be abandoned? The same unapologetic answer 
 to men who would advocate the neglect of such patients is not 
 too severe for men who strive to bring about the disfavor of the 
 psychoanalytic method. 
 
 The viciousness of the attacks upon psychoanalysis is so ut- 
 terly ill-founded and unjustifiable that it automatically directs at: 
 tention to the source of the prejudices in the personalities of these 
 critics. One man, a surgeon of national reputation, has written 
 severe attacks upon the psychoanalytic method without a justify- 
 ing study of the literature. At a medical society meeting in which 
 he presented an interesting theory on the pathology of dementia 
 
PSYCHOTI-IERAPEUTIO PrJNCIPLES 735 
 
 prsecox, he said, when informed that I desired to discuss the physi- 
 ology of the emotions in relation to the pathology of dementia 
 prsecox, that he did not care anything abont the emotions, and, 
 further, that since he was an older man, it was only courtesy that 
 I should withhold my discussion. So, to please his personal preju- 
 dice, science and fairness had to be aborted. Later, I learned that 
 his prejudice was, at the least, related to repressions which were 
 intimately associated Avith a psychopathic tragedy in his family. 
 
 Another instance was that of a young physician, who, because 
 of marked bisexual physical anomalies (organ inferiorities) was 
 subjected to no little unpleasant ridicule by his classmates. He 
 wrote a paper denouncing the psychoanalytic method and the con- 
 ception that sexual inferiority was a cause of anxiety. It was 
 founded upon a gross mixture of misquoted data and fancy. The 
 only critic of psychoanalysis who can be considered at all reliable 
 by the medical profession is the man who has himself practiced 
 psychoanalysis and did not have to abandon it because of Ms own 
 affective discomforts. Similar qualifications would, at least, be 
 required of the critical surgeon or internist upon equivalent ques- 
 tions pertaining to surgery and therapeutics. 
 
 Another prejudice that is often hurled at psychoanalysis is 
 a professed abhorence for the "transference." Itis condemned as 
 immoral and unethical to have a patient develop an affectionate 
 regard for the physician. As ridiculous and inconsiderate as this 
 hypocritical attack has been, it can not help but be amusing when 
 considered in the light of the fact that few, very few, physicians, 
 surgeons, gynecologists, obstetricians or priests have not had to 
 solve the problem of the unhappy individual developing an affec- 
 tion for them. Also any fair-minded physician or minister will ad- 
 mit that much of his success is due to the fact that he is able to 
 control the patient through winning his confidence and affection. 
 The psychoanalyst has been merely honest enough to recognize 
 this fact at its true affective and therapeutic value, and, desiring 
 that his patient should become a self-reliant, independent person- 
 ality, regards it as his duty to educate the patient as to the signif- 
 icance of the transference. Many physicians find it decidedly 
 profltahie to keep the yearning neurotic attached to them even 
 though they realize that their impressive examinations and thera- 
 peutic methods are practiced for the sole purpose of humoring the 
 patient. This type of physician is, naturally, the thinker AA^ho ab- 
 
736 PSYCHOPATHOLOGY 
 
 hors a frank consideration of the mechanism of the transference 
 and therefore feels it his mission to attack the psychoanalyst Avho 
 uses it honestly. 
 
 To. return to the two general psychotherapeutic methods of 
 treatment of neuroses and psychoses and the principles upon which 
 they are based. It must be recognized that an important part of 
 successful therapy in which drugs, mechanical devices and surgieal 
 intervention are used, is due to the comfort the patient derives 
 from being nursed and attended to by a matrtre personality for 
 whom the patient has great fondness, respect and a;dmiration. This 
 encouraging; invigorating influence counteracts the patient's tend- 
 ency to become depressed and yield to the attack of disease, the 
 neglect of a mate, parent, son, or daughter; or the probability of 
 economic failure due, in turn, to the patient's inability to summon 
 sufficient courage and resourcefulness to save himself. It is, in 
 brief, an expression of the infantile tendency to seek the moral 
 support and sympathy, during stress, of the more potent father 
 or mother. This is to be -seen in the tendency of the forlorn and 
 discouraged to make fathers and mothers out of their physicians, 
 priests and nurses. In other words, the autonomic coordinations 
 that have been built up to win social esteem are the first to dis- 
 integrate under pressure of misfortune or disease. This failure 
 of the ego is to be seen in the symptoms of depression and the 
 hypochondriacal complaint. The weaJmess and confusion of the 
 ego is complained of as "I feel," "I am," "I can't," "can you 
 help me?" or "please help me," etc. 
 
 Considering the personality as a mechanism of primary mani- 
 fest wishes plus subsidiary wishes (as the manifest e^o) be'conodng 
 superimposed, through compensation to avoid fear of failure upon 
 the repressed primary segmental wishes plus suhsidary wishes, the 
 fact that an injury, shock, stress, disease or drug tends to weaken 
 or fatigue the wishes of the ego and permits the repressed wishes 
 to force themselves into, control of the final common motor-paths 
 becomes intelligible ; as compulsions or obsessions cause persistent, 
 uncontrollable streams of thought and behavior. These, in turn, be7 
 ing intolerable to the ego, arouse more or less anxiety, complained 
 of as disagreeable visceral sensations. Why should the functional 
 integrations which constitute the ego, the "I," "me," "myself," 
 become disintegrated by fatigue, drugs, toxins or injuries instead 
 of the repressed craving? The explanation lies in the probability 
 
PSYCHOTHERAPEUTIC PRINCIPLES 737 
 
 that the integrations constituting the ego are only compensatory 
 integrations which are developed to enable the organism to act 
 as a unity and maintain biological fitness. This is necessary be- 
 cause individual autonomic segments tend to compel adjustments 
 which may be punished, or may be dangerous, as indiscriminate 
 evacuations, reckless indulgences, thievery, selfishness, cruelty, ly- 
 ing, sexual perversions, etc. The wish for the death of a child that 
 binds the individual to an unattractive or impotent mate must be 
 compensated against in order to control it, because it is reenf orced 
 by the sexual affections which urge the removal of the child. 
 The delirious son, who, during a typhoid intoxication, hates and 
 attacks (verbal) his father and will only permit his mother to 
 nurse him, is an illustration of the old repressed craving of child- 
 hood for the mother's love attacking the rival (father) who claims 
 her attention. 
 
 When talcing anesthetics, it is not uncommon to hear patients, 
 as they lose self-control (become unable to coordinate for the pur- 
 pose of retaining social esteem) burst forth into a heedless ex- 
 posure of their most carefully guarded secrets and repressions. 
 
 In vino Veritas is the same in principle as from delirhim comes 
 truth. The delirious alcoholic, who is on the verge of collapse from 
 the fear of assult by serpents, beasts, giants, fiends, engines, is 
 the victim of his homosexual cravings to be sexually overcome by 
 a potent male. The delirious female, who, following parturition, 
 becomes the bride and love-object of God (the father), is the vic- 
 tim of the repressed wish of childhood, to become the love-object 
 of her father. 
 
 The rational therapeutic procedure, in all cases where the func- 
 tional integrations of the ego are too depressed and weakened to 
 control the segmental craving, is to eliminate the toxin and restore 
 the organic vigor of the individual first. 
 
 ■This is best done by protectvng the patient from causes of fear 
 and anxiety while reconstructive measures are used. If the pa- 
 tient is enjoying an incestuous liaison, careful nursing and pa- 
 tience with the most careful avoidance of censure, even if mastur- 
 bation should occur, is necessary. This behavior will nearly al- 
 ways stop as the repressed cravings of preadolescence become 
 gratified. The danger lies, not in the self-indulgence, but in the 
 stimulation of horror by the criticisms of sanctimonious prudes. 
 The patient, in my experience, will sooner or later beg relief from 
 
738 PSYCHOPATHOLOG-? 
 
 the compulsion. Then comes the stage of the psychoanalytic pro- 
 cedure (Cases CD-2, HD-1, HD-4, PD-33). 
 
 So long as the delirious patient can he kept happy and fear or 
 hate is avoided, the prognosis is good if organic destructions do 
 hot occur. 
 
 The best methods of restoring the patient's capacity to con- 
 trol his overt behavior, foUowiitig the loss of self-control during 
 disease, injury, stress, or shock, are principally rest in bed, good 
 food, sunlight and fresh air, eliminative and tonic drugs, and con- 
 genial, sympathetic nursing. Sedatives may be cautiously admin- 
 istered for insomnia when the patient is anxious, but not when 
 happy. It is far better to let the patient go the limit of his whims 
 if he feels compelled to do so despite persuasion. Hydrotherapy, 
 mechanotherapy, electrotherapy, massage, and delightful (play) 
 occupations are always valuable in restoring vigor and distracting 
 the patient from the conflict. 
 
 The capacity to control repressed cravings varies enormously 
 for different individuals and for the same individual at different 
 times. This capacity seems to depend upon such complex factors 
 as fatigue, toxemia, misfortimes, the summation of the repressed 
 cravings, the efficiency of the compensatory strivings, and the en- 
 couragement the latter receive from individuals upon whom the 
 patient is dependent for affection (friendship). The establish- 
 ment of the altruistic transference is essentially the foundation of 
 suggestive therapeutics and faith cures. Suggestions have no 
 value unless made Avhen the patient is in an impressionable (re- 
 ceptive) attitude toward the physician {en raport). The sugges- 
 tions made when- the patient is feeling obstinate, or, more techni- 
 cally, negativistie, often arouse compulsions to do the opposite. 
 
 Freud first appreciated the significance and mechanism of 
 transference, and cautiously warned against its indiscriminate cul- 
 tivation, because suggestions, under such conditions, might influ- 
 ence the patient to' attempt to do what pleased the physician even 
 though it would be unsatisfactory. This is the great danger in 
 suggestive therapy and is not usually recognized because the dif- 
 ficulties suggestions cause do not often follow immediately and are 
 not attractive to the erring physician. 
 
 It is a matter of ordinary common sense to recognize that no 
 physician would care to expose his secret personal inferiorities 
 to another physician if the latter had merely a technical interest 
 
PSYCHOTHERAtEirTlO PRINCIPLES 
 
 739 
 
 in the case and no friendly sympathy for the difficulties, or if he 
 entertained secret aversions for them. The physician should not 
 expect a refined woman to reveal autoerotic or prostitution crav- 
 
 Fig. 87. — ^Aesculapius as the restorer of virility and happiness like Hygiea enables 
 the serpent to feed and drink from the dish. 
 
 ings, or a man to confess, or even to recognize, that he is suffering 
 from homosexual cravings without first winning the patient's con- 
 fidence and respect. Neither may the medical profession expect a 
 
740 PSYCHOtATHOLOGY 
 
 physician, who fears a tendency to regress to homosexual cravings 
 and has no insight, to become able to psychoanalyze a male patient 
 having similar difficulties, or ever to give an unprejudiced opinion 
 for or against the case. The mechanism of the transference would 
 prevent it. The physician's sympathy for a distressed patient 
 eventually makes him aware of his own abnormal difficulties as the 
 patient relates the details of his inferiority. If this becomes un- 
 endurable, the physician's defense shows in the form of some 
 disgust-expressing mannerism, intonation of voice, or sarcastic 
 cast of a question, or a siTperior self -installation in the advice. The 
 physician who has really mastered himself and has clear insight 
 into his own inferiorities and defensive compensations, and does 
 not have to keep concealing them from the patient, can psycho- 
 analyze the patient; but just so soon as he becomes preoccupied 
 with his own difficulties, the psychoanalysis becomes automatically 
 stopped by the patient becoming uneasy or inquisitive. It is neces- 
 sary to feel a sincere interest, not a mawkish sympathy, in the 
 welfare and difficulties of the patient, and absolute freedom from 
 personal resistances, or it is not justifiable to undertake the psy- 
 choanalysis of the case. In fact, the disastrous consequences of an 
 experimental psychoanalysis are comparable to the tragedies of 
 major surgery Avhen practiced by a tyro. However, psychoanaly- 
 sis is so important that it must be learned and practiced by spe- 
 cialists, and understood by the profession. 
 
 The psychoanalytic procedure becomes valuable in most cases 
 just in proportion as the patient spontaneously desires to under- 
 stand his difficulties and is willing to talk over whatever may per- 
 tain to them. So soon as he shows resistance, in the form of in- 
 dignation or a tendency to change the subject, it is important to 
 await the disappearance of the resistance before urging further 
 inquiries or recollections. No matter what the difficulty of the in- 
 dividual, it may be analyzed so long as he spontaneously desires 
 it. The essential aim of the psychoanalyst is to enable the patient 
 to become conscious of the repressed craving and to permit it to 
 say what it wishes without restraint of the affect. This permits 
 the assimilation of the repressed affect into the ego; that is, theo- 
 retically, the dissociated or repressed akttonomic functions are 
 thereby enabled to become integratively associated with the auto- 
 nomic functions which constit^de the ego, as a part of the ego in its 
 common strivings. 
 
PSYCHOTHEEAPEUTIC PRINCIPLES 741 
 
 When the distresshag tensions of the repressed segmental 
 autonomic functions and their obsessive influence are relieved, the 
 neurosis disappears; the individual's compulsion, by a "foreign 
 influence" to perform an intolerable act, no longer exists. The 
 personality, thereby becoming integrated into a imity, becomes 
 able to coordinate itself much more efficiently for the pursuit of 
 its social career, and the autonomic segments are able to freely 
 cause awareness of their needs. 
 
 The psychosis (Case PD-33), when this stage of reconstitution 
 or reintegration of the personality is reached, often changes to a 
 suppression neurosis, in which hallucinations and delusions no 
 longer exist, biit a tendency to anxiety may remain. Further psy- 
 choanalytic procedure usually enables the patient to make a com- 
 plete affective readjustment and a final selection of his social- 
 biological career. He either becomes able to renounce his envy for 
 his father or brother or, if the distress is due to an obsessive or 
 perverted love, he becomes able to make a decisive social readjust- 
 ment and sublimate his love craving by concentrating his interests 
 upon altruistic work which he feels will please his love-object, as 
 the father, mother, physician. 
 
 The psychoanalytic procedure is essentially a therapeutic pro- 
 cedure if adequately carried out. The recognition of the signif- 
 icance of the repressed craving or the recall of the forgotten con- 
 ditioning experience is, however, not sufficient. The therapeutic 
 result occurs in the form of relief from the autonomic tension 
 upon permitting the affect free play ; that is, by allowing the hyper- 
 tense autonomic segments to dominate the speech motor-apparatus 
 and thereby make a common adjustment with the great tendencies 
 of the remainder of the autonomic apparatus. This greatly re- 
 duces the necessity for disguising compensations, as the hiding 
 of anger or fear when again meeting an old embarrassing situa- 
 tion. 
 
 The necessity of speaking seems to be due to the fact that in 
 modern civilization the prime weapon of social offense and de- 
 fense is speech. From infancy, the individual should be, and usu- 
 allv is, encouraged to speak according to the dictates of his feel- 
 ings ; hence, the socialized ego is developed about the autonomic af- 
 tive use of the speech apparatus (much of the content of conscious- 
 ness being constituted of word sound and sign images) . It is often 
 in the struggle to speak, or to keep from speaking, according to the 
 
742 PSYCHOPATHOLOGY 
 
 dictates of the affect, tliat the causes of much of the discomfort 
 and preoccupation rest. When we are prevented from speaking 
 to satisfy our justifiable anger, we become obsessed with uncom- 
 fortable laryngeal and thoracic tensions in the presence of the as- 
 sailant or, conversely when we have impulsively betrayed our 
 secrets through yielding to the wish to speak, we often feel infe- 
 rior and uncomfortable. The therapeutic value of the confessional, 
 in which the feeling of having betrayed the struggle for social 
 esteem by a sinful act is removed by the penitent confession of the 
 act or thought to one who is loved and respected, lies in the affec- 
 tive readjustment that follows. 
 
 Patients are often considerably benefited by writing out their 
 difficulties ; but not until they become able to speak of them without 
 effort at self-control and yet without anxiety, do they really master 
 their reactions to society's conventions. 
 
 In a book of this nature, wherein psychopathological mecha- 
 nisms are studied in detail, it is not suitable to consider the tech- 
 niqae of psychoanalysis. There are at present a series of excel- 
 lent monographs to be had on the subject, and the reader is re- 
 ferred to them. Freud, Jung, Pfister, and Jelliffe have given 
 us excellent presentations of the psychoanalytic method, and the 
 writings of Dubois, Janet, Prince and Sidis, Weir Mitchell and 
 Dercum present well the suggestive method of psychotherapy. 
 
 Psychoanalysis is essentially based upon inducing the patient 
 to permit, through, free association of thought, the repressed af- 
 fect to cause him to become conscious of its influence and needs. 
 This is often very difficult, because, when once repressed, the reflex 
 tendency is to avoid reexperiencing painful or embarrassing situ- 
 ations or memories of them, particularly when the individual is 
 confronted by a critic or censor. Psychoanalysis, as such, does not 
 occur until the spontaneous, free association of thought is made by 
 the patient, and it is just in this fact that most experimentors with 
 psychoanalysis blunder, and defensively assuming themselves to be 
 qualified in such psychotherapy, having read an article or so on the 
 subject, they attack it as nonsense or dangerous. Psychoanalysis, 
 like surgery, is an extremely important therapeutic measure when 
 carefully used by a duly trained physician. Often it is necessary 
 to conduct the psychoanalysis through a medium, because the pa- 
 tient is unable to trust himself or herself to the psychoanalyst, or, 
 more frequently, the psychoanalyst is not able to endure the pa- 
 
PSYCHOTHERAPEUTIC PRINCIPLES 743 
 
 tient's transference, because of his personal difficulties ; both situa- 
 tions preventing the patient's spontaneous associations of thought. 
 
 In Case CD-I, the patient's fiancee induced him to confess his 
 troubles and inferiorities to her, and she, in turn, discussed them 
 with me. In this manner, I was able to direct his study of himself 
 until he developed considerable insight into his psychosis. In Case 
 HD-1, when certain experiences were recalled, the patient was un- 
 able to discuss them with me even though they worried her con- 
 stantly, but she obtained relief from the obsession through telling 
 her husband. I have frequently used men and women physicians 
 as mediums for the analysis, because I was either unable to manage 
 the transference, or the patient could not disregard some personal 
 attribute about myself that acted as a censor, being conditioned to 
 associate it with a previous censor. The use of a fiance or mate 
 for the analysis is only safe ivhen the healthy viate is actually in 
 love ivith the patient. This is a rare situation, the fact that the 
 mate does not love often being a factor in the psychosis. 
 
 The hallucinations, delusions, creations, and dreams, wlien the 
 wish-fulfilling attributes can be analyzed out, are by far the most 
 satisfactory means of getting at the needs of the repressed affect 
 and the compensatory striving. Word association tests are often 
 valuable, but are inclined to encourage guessing upon the part of 
 the physician. It is never profitable to tell the patient your im- 
 pressions of his difficulties, because he is almost sure to use Avhat is 
 said, if it is wrong, as a defense, or a means of evading responsi- 
 bility. In conclusion, few physicians can expect to become good 
 psychopathologists or psychoanalysts, because the work requires 
 an unusual freedom from prejudice and sound self-control with 
 an earnest, vigorous desire to assist the prejudiced, the depressed 
 and the perverted to readjust so as to become able to live construc- 
 tive, comfortable lives. The work requires often an unusual sym- 
 pathy for and insight into human nature in the face of the most 
 odious revelations of feeling that may possess humanity. 
 
 Responsibility of Penal Institutions and Asylums 
 
 In regard to the management of patients we have found in 
 Saint Elizabeths Hospital that confused males who are fearful of 
 their ability to control their cravings to submit themselves to 
 homosexual seductions are greatly relieved by being attended or 
 
744 PSYCPIOPATHOLOGY 
 
 supervised by a female. The more maternal she is in her personal 
 attributes the more successful her infliience. The narcissistic or 
 homosexual type of female nurse is of little value in such cases. 
 The patient apparently does not feel confidence in her presence 
 because he can not trust her sympathy. Similarly, the female pa- 
 tient who is in a panic because of fear of homosexual assault will 
 attack (defensive) female physicians and nurses when they ap- 
 proach her, but will show signs of relief when attended by a male 
 physician. 
 
 On the other hand, male and female patients who are actually 
 heterosexually erotic (they must be discriminated from the indi- 
 viduals who affect heterosexual interests in order to hide their 
 homosexual difficulties), often become difficult to control when a 
 nurse or physician of the opposite sex supervises their treatment. 
 
 In all cases of dissociated personalities, as soon as the organic 
 functions are vigorous enough to endure work, the patient should 
 be given individual attention and persistently induced to work and 
 play, with the idea of getting back into the social herd. The tend- 
 ency to show this interest comes, more or less vigorously, in most 
 cases of dissociation of the personality, and, if it is not judiciously 
 heeded by the physicians and nurses, the tide of affective interest 
 in reconstruction may again regress and the case become incurable 
 (Case HD-3). It is just in this principle of psychotherapy that 
 most state institutions are deplorably inefficient. The reconstitu- 
 tion of the dissociated personality should be the principal interest 
 of the medical and nursing staff of the state institution and oc- 
 cupy most of their time and Avork. At present, despite the impos- 
 ing demonstrations of crafts at the meetings of the psychiatric 
 societies, the practice of reconstitution and insight into its princi- 
 ples is far from being truly efficient and intelligent. This is prob- 
 ably due to the fact that special work of this nature would require 
 considerable increase of expense to the state until it is Avell es- 
 tablished, and it requires years to overcome inherent institutional 
 prejudices. After the preliminary expense, however, an enormous 
 yearly per capita expense would probably be saved by the reduc- 
 tion of the number of chronic and confined cases. Every institu- 
 tion that is maintained by the state or a society for the compulsory 
 confinement of patients is obligated by the nature of its trust to 
 provide a means for the patient's return to society and respect- 
 able self-sustainment there. 
 
PSYCHOTHEKAPEUTIC PRINCIPLES 745 
 
 Not -until every institution has erected a vocational depart- 
 ment in the most imposing architectural structure on its grounds 
 and maintains an adequate vocational bureau, the sole business 
 of which is to secure employment for its efficient members in the 
 factories, shops and fields of the people of the state, can the physi- 
 cians, lawmakers and custodians of the state be considered to have 
 fulfilled their obligations to its mentally diseased citizens. We 
 have shut our eyes to the tremendous obstacles and prejudices the 
 psychopath must overcome to regain the confidence of the people. 
 The conviction of having lost social esteem is most seriously de- 
 pressing to his ego. 
 
 It is also of the utmost importance, because money is the most 
 practically useful of all encouraging instruments for Avinning social 
 esteem, that the state shall pay its patients according to the work 
 they do, and establish a bureau for selling their products. In this 
 manner, above all others, will the patient regain confidence in his 
 ability to win social esteem and a means of maintaining his per- 
 sonal independence. The additional intricacy of institutional 
 management, under such conditions, can not be justifiably consid- 
 ered as a hindrance, because returning the helpless individiial's 
 status to that of social usefulness is the first duty of the physician 
 and the administrative department of the institution. 
 
 These innovations would have a direct bearing on the sexual 
 lives of the confined men and women. It is an incontrovertible fact 
 that most males and females, normal or abnormal, when perma- 
 nently sexually isolated and prevented from sublimating the sexual 
 cravings, revert to homosexual perversions or masturbation. At 
 present, society confines the criminal and the insane to reform or 
 cure him, but in actual practice, by depriving him of the privilege 
 of improving himself and his resources through remunerative 
 work, forces him to degenerate to an even lower sexual and social 
 level. The confined should be encoiiraged to earn money, and 
 master themselves, instead of being herded together, dressed in 
 misfit, slouchy garments, and forced to entertain themselves with 
 brooding and autoerotie fancies. It is certainly impossible for 
 society to offer any man sexual inducements of any sort, but it is 
 vitally important that society should not put up barriers which pre- 
 vent the individual from entertaining a reasonable hope that some 
 day he may win a love-object and therefore he should keep himself 
 fit, because this alone keeps him from degenerating. 
 
746 PSYCHOPATHOLOGY 
 
 The solution of the progressive tendency to cultivate abnormal 
 variations in human behavior, that is, more specifically, asocially 
 conditioned and biologically perverted autonomic cravings, is in 
 the organically normal, a matter of influence of associates, hence, 
 is, broadly, an educational problem. The psychopathologist must 
 recognize that all individuals (pairents, teachers, playmates, un- 
 known members of the community, writers, actors, etc.) who, in 
 any manner, induce the individual to adopt or avoid certain social 
 interests or methods of self-expression, through any method that 
 influences him either consciously or unconsciously, are his associ- 
 ates. For example, certain orders of monks have isolated them- 
 selves in monasteries and are supposed to live there a voiceless 
 existence to counterinfluence the speech sins of people whom they 
 have never seen or known. 
 
 The Biological Castration Influence of Present American Educa- 
 tional and Social Tendencies 
 
 In America, it is a common observation that the ;general bio- 
 logical careers of the last three generations are markedly different 
 from one another in certain critical respects. Particularly is this 
 true for the play interests, the manner of self-display and the 
 interest in children. The present tendency is decidedly toward 
 a radical increase in self-exhibitionism in the form of multifarious 
 changes in styles of clothing, despite its enormous waste of energy 
 and economic resources. The increasing craving for newspaper 
 recognition and social notoriety, prompting a wider and wider 
 range of mingling with associates for novel entertainment, and 
 a mania for automobiles, magazines, novels, movies and social- 
 political affiliations, are resulting in a decided decrease of interest 
 in reproduction of the species; offspring per pair having been 
 greatly reduced despite the enormous increase of power in con- 
 trolling the forces of nature. This is essentially the result of at 
 least two great social factors. One is the tendency in America 
 of placing children under the direct influence of non-reproductive 
 teachers who are either homosexual or too self -centered to be 
 able to marry and reproduce, or who do not dare to have chil- 
 dren because of the certainty of being ostracised as teachers with 
 the loss of the privilege of practicing their vocations and earning 
 a livelihood, or who have no sincere interest in teaching or in the 
 social development of the child. 
 
 In New York City, the trustees of the New York schools in- 
 
PSYCHOTHEEAPEXJTIC PRINCIPLES 747 
 
 delibly impressed upon hundreds of thousands of school children 
 their disfavor of motherhood by their attempt to remove a teacher 
 ■who had asked for several months' leave of absence in order to 
 give birth to a child. This single act, of the wise fathers of edu- 
 cation, will probably, by its subtly implied sentiment, counterin- 
 fluence years of propaganda directed against race suicide. It is 
 not what is said or done, but the affective attitude with which 
 people do things, that impresses the youth despite all platitudes 
 and explanations. Ascetic males and females, whether covered 
 with cassock or not, stand as diverting examples of biological non- 
 reproduction if their lives are comfortable. The unmarried, the 
 mainstay of the American public school system, can not avoid, be- 
 cause of their eternal examples, becoming a sterilizing influence 
 upon the species. For the woman, if she will maintain the appear- 
 ance of social propriety, the tendency in children toAvard a certain 
 degree of a:ffective convergence upon the pelvis, which is vitally 
 essential for a successful parenthood in the future, is a desecration 
 of her ideals of decency. She is compelled, unconsciously, to de- 
 fend her ideals in order to protect herself from feeling that she is 
 functionally inferior. The homosexual males, many of whom be- 
 come teachers, by upholding intellectual development to the youth 
 as the only ideal of the race, support the movement to steriliza- 
 tion. Hence married teachers, who are parents, offer the best 
 solution. 
 
 The child, surrounded in its growth, from preadolescence to 
 maturity, by ascetic trainers of its biological career, can not help 
 but become conditioned to crave a career which would be decidedly 
 imposed upon by the sacrifices and distractions of parenthood. 
 On the other hand, supporting this influence, is society's rush for 
 the accumulation of money and pleasures and the inane tendency 
 to estimate the individuals' social capacities by the clothing they 
 wear, the words they use, and the money they spend. The child 
 is naturally a distracting menace to social climbing and self-indul- 
 gence, and, as such, is decidedly unwelcome. The direct effect of 
 these conditions is to be seen in our large cities, where one may 
 walk for blocks in the residential districts occupied by middle-class 
 and wealthy American couples and see very few or not any chil- 
 dren at play. These people, as mates, have become conditioned to 
 have for their chief interests in life, the struggle to earn and spend 
 money in order to maintain a popular social standard. 
 
748 PSYCHOPATHOLOGY 
 
 The ultra-rich, many women of which class have very few 
 children and rarely nurse any of them, are largely preoccupied 
 with social intrigues and anxiety iieuroses. 
 
 We have the ascetic minister's preachment for unlimited fam- 
 ilies (he, not having to endure the pains and privations of such 
 ordeals, can enjoy preaching them), and the overly burdened 
 Avoman's demand for the right of birth control, pleading that unless 
 life is made worth living for herself it can not be worth giving birth 
 to children who are doomed to social and functional inferiority. 
 
 Out of this biological chaos of commercialized, loveless mar- 
 liages and sterilized ideals are produced the insane and the crim- 
 inal. Already more money must be spent upon the state 's asylums 
 and criminal institutions than is spent upon her institutions for 
 higher education. The disease, for it is actually a social tendency 
 to functional abortion, is too deeply rooted and intricate to be 
 rectified by anything but an unusually profound, persistently main- 
 tained, general social readjustment. The existence of the child, 
 the affections of the child, and the racially constructive biological 
 career of the individual during maturity must become the religious-, 
 social ideal of humanity. Less energy must be devoted to the glor- 
 ification of religious fantasy and economic display, and, in its place, 
 the virility, goodness and happiness of the individual must be 
 directly, frankly worked for and jealously guarded from being mis- 
 led by asceticism or exploitation. Otherwise, the American people 
 can not readjust to a normal biological course and the heritage of 
 the continent must pass on to the more primitive European im- 
 nligrant. 
 
 The most practical methods for bringing about a healthy 
 readjustment must be solved by the people through the serious, 
 impartial reconsideration of social and religious ideals and con- 
 ventions. 
 
 Since an enormous proportion of psychopaths and criminals 
 are the offspring of loveless marriages, and, since many people, 
 because of the prudish or vulgar manner in which they are raised, 
 often can not knoAV Avhether or not they actually love each other 
 until sometime after trying marriage, either trial marriages and 
 easy divorces must be practiced or the entire educational system 
 must be readjusted, including teachings and teachers, so that stern 
 biological facts may take precedence over half -religious fantasies. 
 Social conventions must be reorganized for furthering the pro- 
 
PSYCHOTHERAPEUTIC PRINCIPLES 749 
 
 gressive refinement of the biological career of the individual. Only 
 a generation ago it was considered a moral crime for a physician 
 to advise an abortion in order to save the life of the mother, or 
 for the mother to take an anesthetic during labor. It is now be- 
 coming evident that the physician must assume the responsibility 
 of advising divorces as well as marriages, for wretched people 
 who are mismated. This must be done to protect the suppressed 
 individual as well as to save the affections of the child. When 
 granting a divorce the court shoiild never expose the child to two 
 conflicting parental influences. This is almost certain to so con- 
 fuse the affective interests of the child that when it becomes an 
 adult it will not be able to find its place in nature. 
 
 A new movement is to be seen in the general encouragement 
 of domestic science in our public schools, the institution of more 
 courses in biology, nature study, athletic training and attractive 
 self-expression in voice, movement and crafts, and the dilatory 
 attempt to teach the truths about the sexual functions. In colle- 
 giate education, however, we still find the ascetic, biologically ab- 
 stracted professor teaching vague notions about a castrated ethics 
 instead of defining for the youth a clear ideal of the most efficient 
 means for realizing a healthful, virile, refined biological career. 
 
 The autonomic functions of the youth should be so conditioned 
 (trained) that they may vigorously, frankly seek for and create 
 such social conditions as will most thoroughly gratify their vital 
 affective needs. The implications of such striving by the individ- 
 uals of the herd must necessarily be such as to bestow upon the 
 race and the individual himself the most constructive and health- 
 ful influences and the most satisfactory sense of virility, goodness 
 and happiness. We must not forget that we, as animals, lived in- 
 finitely longer as apes than ape-men, and less time as men. We 
 have only recently learned to Avear clothing, use comforting sym- 
 bols and create media for the transmission and transmutation of 
 the forces of natiire. We must recognize that the sexual affections 
 are still the greatest constructive forces of the personality if prop- 
 erly conditioned and adjusted, but also that they may become the 
 most insidiously, irresistibly destructive if perverted or uncondi- 
 tionally repressed. This statement is based upon the personal 
 study of more than two thousand psychopathic and criminal per- 
 sonalities of many nationalities and intellectual levels. 
 
 Much has been written as to the utilitarian value of art, lit- 
 
750 PSYCHOPATHOLOGY 
 
 erature, religious ritual, and communistic forms of worship. Some 
 maintain that purity in music, art, literature and religion requires 
 that their motifs and expression shall not be measured by their 
 utility but shall transcend all other human interests and be created 
 to please feelings ("Soul") that have no relationship to the striv- 
 ing emotions. For such sickly claims for art, etc., the author has 
 no comment except that the view seems to contain the same pleas- 
 ure principle as the compensatory autoerotic fantasy, the senti- 
 mentalist accrediting the fantasy with a transcendental value after 
 having disguised its previous affective value for himself. 
 
 The utilitarian view of the artistic and religious sublimations 
 is supported by the fact that the loss of a love-object (through 
 death, desertion or disinterestedness) causes, in proportion to its 
 affective value, more or less severe autonomic tension and dis- 
 comfort, which is greatly relieved by finding or creating a substi- 
 tute. The creation of substitutes for unattainable love-objects 
 or to perpetuate the perishable memories of the love-object essen- 
 tially constitutes art and religious ritual. The comforting value of 
 pastoral scenes and lyrics to the bereaved or tired autonomic func- 
 tions, or the invigorating influence of martial music and heroic 
 figures for the oppressed, or the social and moral justification of 
 decisive actions can be seen throughout artistic creations and 
 rituals. Just as the individual's creation pleases the needs of the 
 greater number it becomes immortalized. The savage's fetich and 
 weird incantations have a splendid psychotherapeutic value in 
 invigorating the autonomic functions that tended to become de- 
 pressed by the insidious influence of unavoidable dangers (lurking 
 animals, diseases, droughts, floods, storms, the night, death, ster- 
 ility, tribal intrigues, slavery, etc.). In our present social system, 
 that besets civilized man with the incessant dangers and tempta- 
 tions of social intrigues, any communistic or religious ritual, or 
 philosophy, as masonry or Catholicism or monism, or any art, as 
 the drama of Shakespeare or the sculpture of Rodin, which tends 
 to cultivate similar ideals in the people, furthering the brother- 
 hood of man, has a tremendous psychotherapeutic value. 
 
 When the value of art and song and ritual, as stimuli to the 
 striving autonomic apparatus, is considered, then we appreciate 
 that civilization could not possibly "be maintained for even one 
 generation without such creations. American civic centers will 
 not be half developed until the supreme interests of the different 
 
PSYCHOTHERAPEUTIC PRINCIPLES 751 
 
 types are given overt expression in athletic stadiums, civic thea- 
 tres, art galleries, music halls and gardens, parks and libraries. 
 
 The solid convergence of the affections of the people upon 
 constructive esthetic interests has a tremendous influence in pre- 
 venting social situations that are conducive to distrust, hatred and 
 intrigues, or sexual perverseness and social degeneration." An 
 overconvergence of the puritanical type, because eventually this 
 course tends to become repressive and sterilizing (my cases show 
 that it gradually tends to biological abortion after a few genera- 
 tions), is certainly as disastrous as exploitation and dissolute 
 wastage. Man, in his eternal struggle to transcend his former 
 state and progressively refine his nature, must neither cut himself 
 off from, nor waste, the sexual affections that made his existence 
 and personal development possible. 
 
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 Frink, H. W. : Morbid Fears and Compulsions, Moffat Yard & Co. 
 Hart, H. : The Psychology of Insanity, Cambridge, University Press. 
 HiTSCHMANN, E. : Freud 's Theories of the Neuroses, Moffat Yard & Co. 
 HiGiEB, H. : Vegetative Neurology, Nervous and Mental Disease Monograph Series, 
 
 No. 27. 
 Holt, E. B. : The Freudian Wish, Henry Holt & Co. 
 
 Hug-Hellmuth, H. von: A Study of Mental Life of the Child, Nervous and Mental 
 Disease Monograph Series, No. 29. 
 
 *For a more extensive bibliography of papers and publications on subjects pertaining* to 
 psychoanalysis, see Tridon's Bibliography in his book on Psychoanalysis. 
 
 753 
 
754 BIBLIOGRAPHY 
 
 Kkaft-Ebbing : PsyohopatHa Sexualis, Eebman Co. 
 Janet, P. ; Major Symptoms of Hysteria, Macmillan Co. 
 
 Jelliffe, S. E. : The Technique of Psychoanalysis, Nervous and Mental Disease Mono- 
 graph Series, No. 26. 
 Some Notes on Transference, Journal of Abnormal PsyeiiiBliip^ viii, No. 5, p. 302. 
 The Bole of Animals in the Unconscious, Psychoanalytic Review, 1917, viii, No. 3. 
 Psychotherapy and the Drama, New York Med. Jour., September, 1917. 
 Jones, E. : Papers on Psychoanalysis, William Wood & Co. 
 
 Jung, C. G. : Psychology of Dementia P'rsecox, Nervous and Mental Disease Mono- 
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 Analytical Psychology, Moffat Yard & Co. 
 Kempp, E. J. : The Autonomic Functions and the Personality, Nervous and Mental Dis- 
 ease Monograph Series, No. 28. 
 Lay, W. : Man's Unconscious Conflict, Dodd, Mead. 
 
 McCuBDY, J. T.: A Clinical Study of Epileptic Deterioration, Psychiatric Bulletin, 
 1916, ix. 
 War Neuroses, Psychiatric Bulletin, 1917. i. 
 Maedeb, a. E. : The Dream Problem, Nervous and Mental Disease Monograph Series, 
 
 No. 22. 
 Pfisteb, O. : The Psychoanalytic Method, Moffat Yard & Co. 
 PtaNCE, M. : Psychotherapeutics, Eichard G. Badger. 
 POTNAM, J. J. : Human Motives, Little, Brown & Co. 
 
 Eank, 0.: The Myth of the Birth of the Hero, Nervous and Mental Disease Mono- 
 graph Series, No. 18. 
 Bank, C, and Sachs, H. : The Significance of Psychoanalysis for the Mental Sciences, 
 
 Nervous and Mental Disease Monograph Series, No. 23. 
 RiCKLiN, E.: Wish Fulfillment and Symbolism in Fairy Tales, Nervous and Mental 
 
 Disease Monograph Series, No. 21. 
 EOBIE, W. F. : Eational Sex Ethics, Eichard G. Badger. 
 
 Sherbington, S. C. : Experiments on the Vascular and Visceral Factors for the Genesis 
 of Emotion, Proceedings of the Eoyal Society, Ixvi. 
 Postural Activity of Muscle and Nerve, Brain, xxxviii, part III. 
 Integrative Action of the Nervous System. 
 
 On the Proprioceptive System, Especially in its Eeflex Aspect, Brain, xxix, No. 4. 
 SiLBEEEE, H. : Mysticism and Its Symbolism, Moffat Yard & Co. 
 Stekel, W. : Die Sprache des Traumes, Wiesbaden, 1911. 
 Teidon, a.: Psychoanalysis, Heubsch. 
 
 Von Beci-iteeew, V. M. : La Psychologie Objective, Chapt. IX. 
 Watson, J. B. ; Psychology, J. B. Lippinoott Co. 
 Wall, 0. A. : Sex and Sex Worship, C. V. Mosby Co. 
 
 White, W. A. : Outlines of Psychiatry, Nervous and Mental Disease Monograph Series, 
 No. 1. 
 The Mental Hygiene of Childhood, Little, Brown & Co. 
 Principles ,of Mental Hygiene, Macmillan Co. 
 Mechanisms of Character Formation, MacmiUan Co. 
 White, W. A., and Jellii'I'E, S. E.: Diseases of the Nervous System, Lea & Febiger. 
 
INDEX 
 
 Abdominal distress, 98 
 Adier, 181 
 
 Adolescent period, 131 
 Affective adjustments, 61, 66, 314 
 conflict, 104 
 dependence, 89 
 progression, 68 
 reactions, 314 
 reformation, 227 
 regression, 68 
 state, 27 
 Alcoholism, 325, 423, 469, 493, 674, 691 
 as a defense, 463, 471 
 brutality with, 662 
 Amnesias, 724 
 Amulet, 169 
 
 Anesthesia, 49, 297, 308, 722 
 Anger, 24, 25, 241, 303, 709 
 Anxiety, 24, 56, 201, 700, 704, 730 
 chronic, 224, 251, 287 
 symptoms, 201, 485, 538 
 Apathy, 730 
 
 Apperceptive capacity, 63 
 Apprehension, 500, 575, 730 
 Arrogance,- 518, 526, 527, 530, 535 
 Art, 65, 174 
 
 utility of, 750 
 Asocial tendencies, 104, 748 
 Assaults, 465 
 Association test, 514 
 Asylums, 743 
 
 inefficiency in, 744 
 Athletic interests, 158 
 Autoerotic cycle, 563 
 Autonomic affective stream, 52 
 apparatus, 6, 21 
 
 as asocialized unity, 55 
 mechanism, 9 
 pressure, 702 
 
 adjustment to, 711 
 segment, 21 
 
 pathological tensions of, 185 
 Aversion, 304 
 
 Beard, 594, 595, 597, 598, 604 
 Beating head, 322, 491, 506, 512 
 Beohterew, 9, 10, 36 
 Behavior, 69, 74 
 Benign compensations, 353 
 
 mechanism, 710 
 Biological crucifixion, 562 
 
 principles, 119 
 Birth control, 748 
 
 Bisexuality, 120, 362, 501, 563, 575, 576, 
 
 578, 639, 691 
 Bluffing, 165, 407, 465, 491 
 Body, 7 
 Booth, 447 
 Boring into scalp, 373 
 
 Case history, 713 
 Cannon, 9, 23, 202, 303 
 Carlson, 23 
 
 Castration, 293, 322, 325, 330, 450, 453, 
 600 
 as cure of masturbation, 671 
 disguised, 318 
 fancies, 678, 681, 690 
 fear of, 486, 495, 497, 499, 502, 544 
 psychic, 94, 96, 457 
 Catatonic adaptations, 
 as a defense, 570 
 cause of, 566, 614 
 in monkeys, 556 
 prognosis in, 613 
 
 reconstruction after, 566, 576, 588 
 transitory nature of, 568 
 stupor, 564, 587 
 Centauress, 370, 373, 587 
 Charm, 167 
 
 Christ, 416, 499, 544, 562, 673, 685, 689 
 bisexual, 578 
 
 simulation of, 594, 601, 604, 607, 611 
 Classification, 190 
 Clothing, 
 
 careless, 500, 546 
 grotesque, 675 
 
 loose, 662, 674, 676, 677,, 682, 683 
 meaning of, 678 
 Compensation, 1, 38, 69, 70, 165, 180, 184, 
 203, 268, 292, 730 
 asocial, 551 
 autonomic, 701 
 for impotence, 425, 604 
 for sexual inferiority, 438, 449, 458, 
 
 550, 596, 664 
 for waste of masturbation, 598 
 in arteriosclerosis, 475 
 in paresis, 473, 474 
 moral, 656 
 
 sexual excesses as, 463 
 psychoses, 420, 711 
 Compensatory striving, 53, 78, 245, 383, 
 
 449, 470, 516, 552, 592 
 Competition, 180, 243 
 
 755 
 
756 
 
 INDEX 
 
 Complaints, 202 
 bad blood, 326, 524 
 bad dreams, 488, 500 
 blood carbonated, 689 
 body destroyed, 563 
 bones broken, 563, 588 
 brain fag, 357, 582 
 burning, 366, 490, 513, 588, 639 
 cardiac distress, 51, 561 
 choking, 327, 329, 332, 366, 490, 493, 
 
 583, 632 
 confusion, 487, 561 
 constipation, 616, 676, 683, 692 
 contamination, 294, 564, 586 
 crying, 485, 547, 563, 601, 606, 630, 
 
 692 
 depression, 485, 487, 493, 547 
 dizziness, 485, 492, 521 
 dope, 484, 492, 497, 521, 631 
 dying, 327, 332, 493, 521, 540, 563, 
 
 602, 672 
 
 electricity, 366, 396, 460, 461, 467, 501, 
 
 508, 544, 603, 607, 677, 689 
 eyes destroyed, 588 
 falling, 332 
 gasping, 327 
 gastric discomfort, 81, 366, 485, 489, 
 
 492, 500, 561 
 hair in throat, 377 
 hatred, 297 
 
 headache, 513, 563, 581 
 homesickness, 493 
 hot blood, 585 
 hot hands, 649 
 hypnotic influence, 396, 479, 484, 518, 
 
 527, 542, 566, 585, 603, 606, 
 
 639, 672, 683 
 inability to work, 492, 582 
 initiation, 479, 485 
 injections, 493, 500 
 insomnia, 357, 460, 478, 487; 493, 546, 
 
 592, 702 
 itching, 299 
 anal, 674, 687 
 nasal, 674 
 jerking, 297, 330 
 poison, 338, 359, 460, 480, 487, 562, 
 
 631 
 queer feelings, 485 
 respiratory distress, 330. 561 
 restlessness, 357, 478, 493, 702 
 shock, 337 
 sinking feeling, 281 
 stiffness of neck, 338, 366, 538, 582 
 strangling, 330 
 torture, 338, 692 
 vomiting, 299, 485, 492, 563, 631 
 weakness, 485, 501, 529, 563, 582, 595, 
 
 603, 678 
 Compulsions, 289, 292, 730 ' 
 
 cleansing, 292, 294, 359, 662 
 initiation, 560 
 prostitution, 399 
 to eat plants, 596 
 
 Oonfpulsions^-Cont 'd 
 
 to lie, 593, 730 
 
 to remove clothing, 337, 340, 391, 560, 
 672, 673, 676, 678 
 Conditioned cravings, 11, 400, 625 
 Conditioning, 36, 37, 314, 533, 699 
 Confession, 366, 561, 601, 606, 634, 657 
 
 recovery through, 612 
 Confusion, 495, 559, 637, 654, 657, 680 
 Consecration, 230, 434 
 
 content of, 3'3, 35, 50 
 
 control of, 420 
 
 nature of, 31 
 
 of self, 13, 32, 128 
 Constitutional inferiority, 80, 206, 250, 
 
 547 
 Conversion mechanisms, 5, 291, 316 
 Convulsions, 297, 685, 688, 729 
 Craving, 9, 22 
 
 acquisitive-assimilative, 24 
 
 allied, 28 ' 
 
 antagonistic, 28 
 
 autonomic affective, 24,' 698 
 
 emissive-avertive, 24 
 
 for manipulation, 556, 561 
 
 for social esteem, 53 
 
 incestuous, 105. - 
 
 neutralization oii 122 
 
 segmental, 21, 54 
 Crile, 33 
 
 Crucifixion, 90, 103, 254, 285, 333, 449, 
 596, 602 
 
 as an atonement, 320, 326, 608 
 
 as sexual submission to the father, 
 562, 569 
 Cruelty, 662, 675 
 Cutting wrists, 323, 326 
 
 D 
 
 Darwin, 208 
 
 Death (see complaints) 
 
 significance of, 664, 732 
 DeBoer, 30 
 Decadence, 156 
 Defective heredity, 80 
 Defense mechanisms, 315, 588 
 
 bluffing, 465, 491 
 
 compensation, 392, 408 
 
 insanity, 498 
 
 wit, 568 
 Degeneration, 745 
 
 Degradation, 258, 341, 585, 597, 640, 663 
 Delirium, 66, 584, 657, 714, 734 
 Delusions (see complaints'), 66, .292, 401, 
 704, 715, 726, 729 
 about food, 500, 585 
 
 broken pills, 481 
 
 cream, 480, 482 
 
 dope, 480, 492 
 
 drugs, 480, 492 
 
 filth, 455, 480, 492 
 
 flint, 369 
 
 poison, 480, 487, 493, 540, 602 
 
INDEX 
 
 757 
 
 Delusions — Cont 'd 
 
 powder, 480, 482 
 saltpetre, 480 
 spue, 542 
 stuff, 480, 492 
 of assault, 452, 454, 486, 495, 497, 
 501, 541, 639, 689 
 anal, 692 
 
 oral sexual, 631, .632 
 of death, 575, 660 
 of infant, 660 
 of love objects, 560 
 of eating infant, 642 
 of mate's infidelity, 386, 433, 460, 464, 
 
 595, 604, 690 
 of persecution, 519, 539, 549, 665, 674, 
 688 
 by secret societies, 530, 541 
 systematization of, 717 
 unsystematized, 562 
 of reference, 359, 469, 508, 521, 524, 
 
 530, 543, 630, 683, 731 
 Tvishfulfilling, 388 
 Dementia prEeeox, 192, 712 
 catatonic, 714 
 hebephrenic, 714 
 paranoid, 516, 518 
 Depression 
 anxious, 353 
 without fear, 379 
 Destructiveness, 693, 696 
 Disgust, 25 
 
 Dissociation, 4, 12, 129, 339, 449 
 chronic pernicious, 516 
 mechanism of, 693, 703 
 significance of "they," 65, 664, 670 
 Drama, 729 
 
 Dreams, 66, 397, 704, 729 
 anal erotic, 686 
 homosexual, 453, 645 
 incestuous, 539, '626 
 of abortion, 642, 648 
 of compression, 539 
 of death of relatives, 651 
 of failure, 539, 589 
 of fire, 595 
 of freedom, 652 
 of maternity, 646, 648 
 of pregnancy, 648 
 of recovery, 634, 644 
 of striving, 549 
 oral erotic, 488, 522, 641 
 seductive, 397, 452 
 sexual, 529, 630, 651 
 terrifying, 500 
 wishfulfilling,_ 387 
 Drug habitue, d9 
 Dynamic mechanism, 9 
 
 E 
 
 Eating dirt, 585, 588, 596 
 Eccentricity, 70, 71, 440, 475, 716 
 Education, 746 
 careless, 621 
 
 Ego, 11, 78, 477 
 
 development of, 52, 128 
 Egoistic unity, 13, 29 
 Egotism, 436, 441, 448, 482, 489, 546, 
 
 592, 686 
 Ejaculatio prtecox, 127, 326, 591 626 
 Electra complex 102 
 Elimination 69, 293, 318, 335, 351 
 
 of an inferiority, 183 
 
 of functions, 289 
 
 of organs, 728 
 
 of perverse cravings, 322, 480 
 Emaciation, 563 
 Embarrassment, 204 
 Epileptiform seizure, 671 
 Epilepsy, 684 
 Erotic flight, 584 
 Eroticism (see perverse eroticism) 
 
 anal, 296, 346, 412, 418, 616, 661, 669, 
 671, 672, 673, 696, 697 
 
 auto, 97, 133, 136, 375, 470, 509, 570, 
 585, 628 
 
 oral, 327, 376, 378, 455, 468, 481, 492, 
 497, 523, 528, 543, 545, 596, 
 602, 632, 647 
 determinant of, 342, 641 
 
 polymorphous perverae, 606 
 
 reaction to, 345 
 Errors of speech, 544, 584 
 Erythema, 299, 311, 582 
 Esthetic interests, 158 
 Excreta 
 
 in infancy, 124, 127 
 
 interest in, 131, 615, 640, 657, 658, 
 661, 674, 676, 681, 692 
 
 potency of, 616 
 Exhibitionism, 396, 560, 585 
 Experience, 77 
 
 P 
 Fairy tale, 704 
 Faith, 165, 167, 729 
 Falling as submission, 672 
 Family adjustments, 91, 111, 533 
 
 conflicts, 629, 749 
 
 feuds, 110, 117 
 
 intrigue, 106 
 
 mother-in-law domination, 301 
 
 parental domination, 86, 256, 572, 
 579, 618 
 
 prudishness, 87, 514, 621 
 
 rivalry, 619 
 
 sister domination, 619 
 Fantasy, 704, 729 
 
 enjoyment of, 587, 686 
 
 symbolic truth of, 666 
 Father attachment, 82, 102, 154, 380, 
 679 
 
 imago, 532 
 Favorite son, 99 
 
 Fear, 1, 24, 25, 51, 165, 204, 287, 289, 
 317, 430, 730 
 
 biological value of, 700 
 
 of assault, 408, 435, 495, 499 
 
758 
 
 INDEX 
 
 Fear — Cont 'd 
 
 of consequences, 314 
 
 of crowds, 731 
 
 of failure, 58, 179 
 
 of heterosexual relations, 583 
 
 of inferiority, 478 
 
 of moral degeneration, 593, 633 
 
 of sexual craving, 470, 472, 627 
 
 of sleep, 359, 647 
 
 physiological reactions to, 478, 582 
 Feminine functions, 120 
 Fervor, 684 
 
 Fetich, 39, 165, 169, 704, 730, 750 
 Final common motor path, 13 
 
 control of, 28 
 
 segmental domination of, 531 
 Flexibilities cerea, 586 
 Flight of ideas, 527 
 
 analyzed, 392 
 Forced feeding, 484, 563 
 Forgetting, 246, 318, 351, 650, 658 
 Foundling, 628 
 
 Freud, 5, 16, 291, 315, 705, 738 
 Frigidity, 78, 94, 457, 656 
 
 in homosexual female, 548 
 Functional traits, 15 
 
 G 
 Godding, 440 
 Goodness, 118, 748 
 Grandfather attachment, 83, 85 
 Grandiloquence, 436 
 Grief, 25, 317 
 Guiteau, 440 
 
 H 
 
 Hallucinations, 66, 91, 292, 704, 726, 729 
 affective value of, 399, 650 
 auditory 
 
 accusatory, 367, 481. 490, 499, 519, 
 522, 527, 562, 677, 680 
 
 bells, 499, 569 
 
 castration, 562 
 
 mother's voice, 527, 609 
 
 music, 522 
 
 shouting, 499 
 
 steam blowing, 499 
 
 telephone, 501 
 gustatory, 366, 522. 541, 545 
 of sexual assalilt, 335, 464, 519, 523, 
 
 549, 639 
 olfactory, 366, 391, 485, 493, 495, 499 
 visual, 
 
 angel, 522 
 
 dead relatives, 84, 499 
 
 father, 577 
 
 flashes of light, 493 
 
 infant, 643 
 
 pictures, 390, 501 
 
 snakes, 424, 488 
 
 stars, 522 
 wishfulfilling, 390, 503, 597 
 Hamilton, 447 
 Hamlet's tragedy, 537 
 
 Happiness, 118, 748 
 
 Hatred, 72, 112, 315, 317, 675, 716 
 
 prognostic importance of, 516, 550 
 
 suppressed, 687 
 Headaches, 98, 535 
 
 Heavenly bride, 107, 396, 407, 576, 692 
 Hebephrenic adaptations, 615, 693 
 
 reconstruction after, 644 
 Hereditary taint, 80 
 Hoarding, 641, 662, 683 
 Holt, 21 
 Homicide, 452, 470 
 
 attempted, 277, 674 
 
 double, 435 
 Homosexual cravings, 481, 484, 507, 547 
 Homosexuality, 136, 511 
 
 in infrahuman primates, 139 
 
 in men, 511, 595, 601, 670 
 
 in women, 94, 507, 508, 645, 701 
 
 readjustment of, 525, 532 
 
 submissive, 531, 551, 602 
 Hunger, 23 
 
 Hyperesthesia, 49, 724 
 Hypertension, 23, 27, 51, 289 
 Hypesthesia, 722 
 Hypochondria, 529, 538 
 Hypotensions, 27, 289, 730 
 Hypnosis, 733 
 Hysteria, 315 
 
 I 
 Images, 159, 704 
 Imitation, 166 
 
 in catatonic, 561, 586 
 Impotence, 46, 98, 152, 165, 326, 433, 
 
 668, 705 
 Impregnation fancy, 586 
 Incest, 109, 152, 536 
 
 fantasy, 106, 527, 584, 622, 639 
 Infantile period, 124 
 Infantilism, cultivation of, 572, 618, 646, 
 _ 684 
 
 Inferiority, compensation for, 71, 404, 
 422, 543 
 defense for, 183 
 functional, 179, 183, 187 
 organic, 179, 181, 186 
 sexual, 422 
 Influence of associates, 76, 554, 572, 613, 
 699, 717, 746 
 repressive, 86 
 unconscious, 121 
 Inhibition, 
 of speech, 573 
 of writing, 583 
 Insanity as a defense, 498 
 Insight, 522, 639, 650, 654 
 Insomnia (see complaints), signiflcance 
 
 of, 647, 702 
 Inspiration, 434, 443 
 paranoid, 275 
 parricidal, 439, 445, 448 
 
INDEX 
 
 759 
 
 Inspiration — Coiit 'd 
 
 religious, 426 
 
 as a defense, 504 
 
 towards social sexual reforms, 592, 
 731 
 Inspired act, 284 
 Intoxications, 65 
 Intrauterine period, 123 
 Intriguer, 59 
 Introspection, 529 
 Inventions, cannon, 436 
 
 drill, 475 
 
 electric generator, 435 
 
 language, 431, 607 
 
 perpetual motion, 427 
 
 to conserve energy, 591, 598 
 Irritability, 440, 451, 478, 498, 535, 550, 
 581, 592, 683, 686 
 
 significance of, 702 
 Isolation, 745 
 Itching (see complaints), 311 
 
 James, 5 
 
 Jealousy, 687 
 
 K 
 
 Kinesthetic imagery, 34 
 Kissing, 125 
 Kleptomania, 641, 730 
 Kraepelinian classification, 20, 189 
 
 Lange, 5 
 
 Langelaan, 14, 30 
 Latcliley, 36 
 Laws, 729 
 Laziness, 620 
 Learning, 50 
 Lethargy, 730 
 Literature, 65 
 Love, 13, 25, 112, 317 
 sublimation of, 72 
 
 M 
 
 Madonna, 337, 396, 403 
 
 Manias, 730 
 
 Manic compensation, 384 
 
 happy type, 384, 419 
 
 fearful type, 407 
 Manna, 430 
 Mannerisms, 528, 563, 576, 586, 730 
 
 of eyes, 564 
 
 grabbing tongue, 490 
 
 grimaces, 491 
 Marriage, 91, 155 
 
 as a, defense 328, 457, 458, 459, 462, 
 554 
 
 fear of, 581 
 
 loveless, 748 
 Masculine function, 120 
 Masochism, 596, 600, 732 
 
 Masturbation, 78, 158 
 cycle, 563, 584 
 fantasies, 256 
 incestuous, 321 
 in cliildren, 131, 132, 622 
 in men, 259, 322, 324, 463, 470, 485, 
 496, 513, 518, 520, 559, 591, 
 683 
 in women, 367, 373, 377, 396, 509, 581, 
 584, 6"" ' ^ 
 Maturity, 152 
 Mechanistic classification, 190 
 Memory, 49 
 
 Menstrual disturbances, amenorrhea, ■'588 
 660 
 dysmenorrhea, 84, 98, 318, 581 
 Mind, 7 
 Miser, 662 
 
 Misinterpretation, 703 
 Misrepresentation, 703 
 Mosso, 23 
 
 Mother, attachment 81, 82, 99, 152, 244, 
 321, 327, 381, 434, 502, 534, 
 542, 557, 625, 685 
 domination of 572, 579 
 invalidism of, 58 
 infantile, 103 
 hostile, 570 
 Muscular tensions (see postures), 21, 28, 
 
 698 
 Music, 729 
 
 Mutism, 379, 563, 586, 658 
 Mutilation, 323, 420, 584, 683 
 Mysophobia, 292, 294, 662 
 Myths, 141, 729 
 
 N 
 
 Narcissism, 150, 154, 605 
 
 in husband, 657 
 Nausea, 302 
 Negativism, 563 
 Neurasthenia, 206, 261 
 Neuroses 
 
 benign, 195 
 
 compensation, 196 
 
 dissociation, 197 
 
 pernicious, 195 
 
 regression, 197 
 
 repression, 195, 289, 293 
 
 suppression, 195, 206 
 in war, 285 
 Neutralization, 23, 698, 704 
 Night terrors, 84 
 Nocturnal emissions, 546, 595 
 Novel, 704, 729 
 Nursing, 738 
 
 O 
 
 Obsessions, 292, 730 
 chewing tobpceo, 545 
 cleanliness, 294 
 
 of mouth, 545 
 language reform, 607 
 of sin, 633, 657 
 sexual, 629 
 
760 
 
 INDKX 
 
 Obsessions — Coat 'd 
 
 ■vnlgar word, 647 
 
 wishfuffilling, 472 
 Odors, 391, 630, 683 
 Oedipus complex, 102 . 
 Omnipotence, 409, 418, 431, 436, 483, 
 610 > ! > 
 
 as defense for impotence, 427, 664 
 striving for, 494, 706 
 Onychophagy, 377, 585 
 Organism as a unity, 22, 28 
 Overwork, 265 
 
 P 
 Painting, 729 
 
 Panic, 268, 325, 361, 455, 540, 560, 595, 
 730 ' > ) 
 
 homosexual, 514 
 
 mechanism of, 477, 479 
 prognosis, 480, 514 
 -symptoms of, 540, 602 
 Paresthesia, 689, 724 
 Paralyses, 319, 346, 729 
 Paranoia, 421, 475, 510, 552, 706 
 Paranoid mechanism, 449, 533 
 
 in female, 472 
 Paraphrenia, 206, 702 
 Parricidal compulsion, 285, 440 
 Pathological liar, 59 
 P'awlow, 10, 36 
 Pellaeini, 23 
 Penal institutions, 743 
 Pernicious mechanisms, 710 
 Perpetual motion, 427, 594 
 Personality, 74, 736 
 
 stages of deyelopment, 123 
 Perverse eroticism (see eroticism), 158, 
 478 
 atonement for, 605 
 cunnilingus, 162, 342, 368, 487, 520, 
 
 553, 602 
 fellatio, 328, 342, 468, 538, 592, 634 
 sodomy, 493, 661, 669, 676 
 and convulsions, 671 
 and stupor, 531, 667 
 unrecognized, 525 
 Phallic worship, 107 
 Philosophy, 729 
 Phobias, 289, 293, 730 
 
 sexual, 549, 580 
 Play, 744 
 Poetry, 729 
 
 Postadolescent period, 134 
 Postural tension, 21, 30, 67, 315 
 P'osturar tonus, 708 
 Postures, 31, 701, 720 
 crucifixion, 564, 575, 681 
 dying, 487 
 
 facial, 465, 573, 605, 639 
 fetal, 355, 641, 642, 658, 659, 660 
 kneeling, 601, 681 
 of eyes, 308, 460, 594, 601, 605, 681, 
 
 728 
 of feet, 350, 564, 692 
 
 Postures — Gont 'd 
 
 of hands, 556, 601 
 
 of lips, 322, 368, 460, 480, 496, 525, 587 
 
 of vocal muscles, 490, 676, 690 
 
 meaning of, 587 
 
 sexual, 562, 576, 658 
 
 standing, 495, 506, 561, 597 
 
 stooping, 586 
 
 submissive, 98 
 
 walking, 674, 681 
 Potency, 145, 1S2, 422 
 
 and social esteem, 409 
 
 striving for, 668, 705 
 Prayer, 165 
 
 Preadolescent period, 130 
 Premonition, 583, 656 
 Preoccupation, 353, 563 
 Prognosis, 710, 715 
 Frojicient apparatus, 6, 21, 29 
 Proprioceptors, 23, 33 
 Prostitution, 107, 154, 157, 399 
 
 cravings, 396 
 
 fantasies, 107, 584, 624, 630 
 
 homosexual, 464 
 Psychasthenia, 206 
 Psychic energy, 24 
 Psychoanalysis, 67, 733, 734 
 
 essential aim of, 740 
 
 experimental, 740 
 
 of benign dissociation (manic), 385 
 
 of catatonic dissociation, 577 
 
 of chronic paranoid dissociation, 518 
 
 of hebephrenic dissociation, 644 
 
 of paranoia, 508 
 
 of repression neurosis, 301 
 
 of suppression neurosis, 251 
 
 technique of, 742 
 Psychopathic personality, 206, 748 
 Psychopathology, 1 
 Psychoses, 704 
 
 in heterosexual individuals, 718 
 
 periodicity in, 590, 717 
 Pulling threads, 364 
 
 E 
 
 Eapport, 286, 738 
 Reality, 66, 400, 704 
 Rebirth, 567, 576, 588, 596 
 
 as a purification, 569 
 Receptors, 23, 32, 
 Recreation, 158 
 Reeducation, 733 
 Regression, 162, 353„ 384, 420, 461, 634 
 
 infantile, 367, 576, 637, 654 
 
 intrauterine, 379, 514, 641, 642, 658 
 
 to homosexuality, 94, 95, 97 
 
 to nursling, 553, 564 
 
 types of, 711 
 Religion, 72 
 Religious compensations, 409," 414, 424, 
 
 435, 442, 592 
 Religious symbolism, 704, 729 
 Repressed wish, 5 
 
INDEX 
 
 761 
 
 Eepression, 4, 12, 61, 160, 711 
 
 successful, 315 
 
 symptoms of, 72, 73 
 Resistance, 291, 702, 740 
 Rest cures, 733 
 Restlessness, 702 
 Retardation, 495 
 Retention, 
 
 of feces, 337, 340 
 
 of saliva, 586 
 
 of urine, 340 
 Revelations, 427, 607 
 Ritual, 39, 165, 704, 730 
 Rubbing, 
 
 saliva, 364, 375, 658 
 
 sealp, 373 
 
 skin, 264, 540 
 
 urine in hair, 658 
 
 S 
 Sacrifice to parents, 110, 254, 285, 571 
 Sadism, 600, 732 
 Schools, 158 
 Scientific research, 729 
 Screaming, 540, 583 
 Sculpture, 729 
 Seclusiveness, 500, 542, 582 
 Secret power, 461, 465 
 
 society, 390, 401, 455 
 Seduction, 732 
 
 as a compensation, 463, 469 
 Selection, 243 
 Self-control, 128, 158, 738 
 Self cures, 671, 690 
 Self-redemption, 560, 607 
 Sensitiveness, 257, 424, 475, 500, 533, 
 
 535 
 Sex taboo, 96, 718 
 Sexual curiosity, 130, 621, 635 
 
 ignorance, 573, 581, 624 
 
 interpretations, 633, 635 
 
 phobia, 134, 135 
 
 reversion, 139, 140 
 
 selection, 89 
 
 trauma, 104 
 Shame, 25, 312, 317 
 Shamming, 275 
 
 Sherrington, 8, 14, 21, 22, 28, 290, 703 
 Shock, 624 
 Simulation, 121, 293, 321, 335, 344, 351 
 
 of dying, 487 
 
 of father's illness, 320 
 
 of mother's illness, 583, 631 
 
 of parturition, 335, 338, 563, 643, 657 
 
 of pregnancy, 360, 376 
 in male, 332, 677, 691 
 Skin picking, 369, 373, 585, 639, 674 
 Soaking, 359, 596 
 Social systems, 729 
 Somersaults, 658 
 Speech, 741 
 
 errors of, 544, 584 
 
 hesitating, 573, 686 
 
 Speech — Cont 'd 
 
 stereotyped, 585 
 
 sneering, 674 
 
 cautious, 460 
 
 mumbling, 495, 563 
 Spitting, 460, 491, 545, 631, 678 
 Stories, 729 
 Struggle for existence, 241 
 
 esteem, 128, 187, 709 
 
 sexual favor, 187, 702 
 Stupor, 661 
 
 associated with sodomy, 551, 667, 672, 
 673 
 Sublimation, 72, 456, 709, 745 
 Submission, 250 
 Sucking, 124, 332 
 Suggestibility, 527 
 Suggestive therapy, 733 
 Suicide, 284, 323, 480 
 
 as a regression, 512, 513, 653 
 
 as a solution, 84, 469, 498 
 
 attempted, 584, 631, 683, 692 
 by poison, 487, 519 
 by strangling, 487, 522 
 
 cutting throat, 491 
 
 fantasies, 162 
 
 hanging, 491 
 
 impulsive leaping from windows, 541 
 
 plunging on head, 322, 491 
 
 poison, 491 
 
 pounding head, 491 
 Summation, 62 
 Superiority, 424 
 Suppression, 4, 12, 61, 205, 711 
 
 of sexual functions, 88 
 Surliness, 542 
 Survival of the fittest, 241 
 Suspicion, 458, 460, 463, 542, 686 
 Swallowing objects, 377, 480, 486, 588, 
 
 596, 659 
 Sweating, 575 
 Symbols, 19, 39, 159, 166, 704, 715 
 
 ambivalence of, 410 
 
 erotic, 403, 405 
 
 of evil, 414, 488 
 
 of immorality, 339, 568 
 
 of impotence, 492, 669 
 
 of infants, 584 
 
 of parturition, 643 
 
 of pregnancy, 658 
 
 of purity, 411, 413 
 
 phallic,- 174, 438, 488, 602, 603, 640, 
 679 
 
 seminal, 391, 480, 484, 491, 492, 586, 
 596, 603, 649, 690 
 
 sexual, 41, 381, 424, 430, 488, 584, 631 
 
 T 
 
 Thought, 6, 34 
 Tic, 546, 729 
 abdominal, 327 
 
762 
 
 INDEX 
 
 Timidity, 312 
 
 Transference, 67, 286, 398, 509, 517, 587, 
 654 
 
 altruistic, 378 
 
 danger in, 738 
 
 heterosexual, 566 
 
 mechanism of, 56 
 
 negative, 267, 477 
 
 positive, 267, 274, 477, 516 
 
 prejudice against, 735 
 Tremors, 540, 575 
 
 Vascular tumescence, 698 
 Virgin Mary, 403, 657 
 Virility, 118, 138, 178, 279, 748 
 Visuarconstriction, 299, 315 
 Vocational department, 745 
 Vomiting, 84, 304 
 Vulgarity, 693 
 
 W 
 
 War neuroses,, 285, 729 
 Watson, 10, 13, 36 
 Wertheimer, 33 
 Will, 6, 24, 57, 129 
 
 diseases of, 206 
 power, 58, 205 
 overcome, 532 
 loss of, 730 
 Wish, 35, 129, 698 
 
 dissociated, 56 
 
 for death, 630 
 
 fulfillment, 63 
 
 neutralization of, 12'' 
 
 peripheral origin of, 27 
 Work, 744 
 
 remunerative, 745 
 
 Yellow, 586, 683