or manifest nature which upset the simple rule of compensation, and
which vary greatly in individual cases. From entirely different motives
a man may, for instance, be a philanthropist, but the manner of his
philanthropy depends upon his originally inherited disposition, and the
way in which the philanthropic attitude is compensated depends upon his
motives. It is not sufficient simply to know that a certain person is
philanthropic in order to diagnose an unconscious egoism. For we must
also bring to such a diagnosis a careful study of the motives involved.

In the case of normal people the principal function of the unconscious
is to effect a compensation and thus produce a balance. All extreme
conscious tendencies are softened and toned down through an effective
opposite impulse in the unconscious. This compensating agency, as I have
tried to show in the case of the merchant, maintains itself through
certain unconscious, inconsequent activities, as it were, which Freud
has very well described as symptomatic acts (_Symptom-handlungen_).

To Freud we owe thanks also for having called attention to the
importance of dreams, for by means of them, also, we are able to learn
much about this compensating function. There is a fine historical
example of this in the well-known dream of Nebuchadnezzar in the fourth
chapter of the Book of Daniel, where Nebuchadnezzar at the height of
his power had a dream which foretold his downfall. He dreamed of a tree
which had raised its head even up to heaven and now must be hewn down.
This is a dream which is obviously a counterpoise to the exaggerated
feeling of royal power.

Now considering states in which the mental balance is disturbed, we can
easily see, from what has preceded, wherein lies the importance of the
unconscious for psychopathology. Let us ponder the question of where
and in what manner the unconscious manifests itself in abnormal mental
conditions. The way in which the unconscious works is most clearly seen
in disturbances of a psychogenic nature, such as hysteria, compulsion
neurosis, etc.

We have known for a long time that certain symptoms of these
disturbances are produced by unconscious psychic events. Just as
clear, but less recognised, are the manifestations of the unconscious
in actually insane patients. As the intuitive ideas of normal men do
not spring from logical combinations of the conscious mind, so the
hallucinations and delusions of the insane arise, not out of conscious
but out of unconscious processes.

Formerly, when we held a more materialistic view of psychiatry we were
inclined to believe that all delusions, hallucinations, stereotypic
acts, etc., were provoked by morbid processes in the brain cells. Such a
theory, however, ignores that delusions, hallucinations, etc., are also
to be met with in certain functional disturbances, and not only in the
case of functional disturbances, but also in the case of normal people.
Primitive people may have visions and hear strange voices without having
their mental processes at all disturbed. To seek to ascribe symptoms
of that nature directly to a disease of the brain cells I hold to be
superficial and unwarranted. Hallucinations show very plainly how a part
of the unconscious content can force itself across the threshold of the
conscious. The same is true of a delusion whose appearance is at once
strange and unexpected by the patient.

The expression "mental balance" is no mere figure of speech, for its
disturbance is a real disturbance of that equilibrium which actually
exists between the unconscious and conscious content to a greater extent
than has heretofore been recognised or understood. As a matter of fact,
it amounts to this--that the normal functioning of the unconscious
processes breaks through into the conscious mind in an abnormal manner,
and thereby disturbs the adaptation of the individual to his environment.

If we study attentively the history of any such person coming under
our observation, we shall often find that he has been living for a
considerable time in a sort of peculiar individual isolation, more or
less shut off from the world of reality. This constrained condition
of aloofness may be traced back to certain innate or early acquired
peculiarities, which show themselves in the events of his life. For
instance, in the histories of those suffering from dementia præcox
we often hear such a remark as this: "He was always of a pensive
disposition, and much shut up in himself. After his mother died he
cut himself off still more from the world, shunning his friends and
acquaintances." Or again, we may hear, "Even as a child he devised many
peculiar inventions; and later, when he became an engineer, he occupied
himself with most ambitious schemes."

Without discussing the matter further it must be plain that a
counterpoise is produced in the unconscious as a compensation to the
one-sidedness of the conscious attitude. In the first case we may expect
to find an increasing pressing forward in the unconscious, of a wish
for human intercourse, a longing for mother, friends, relatives; while
in the second case self-criticism will try to establish a correcting
balance. Among normal people a condition never arises so one-sided
that the natural corrective tendencies of the unconscious entirely
lose their value in the affairs of everyday life; but in the case of
abnormal people, it is eminently characteristic that the individual
entirely fails to recognise the compensating influences which arise in
the unconscious. He even continues to accentuate his one-sidedness; this
is in accord with the well-known psychological fact that the worst enemy
of the wolf is the wolf-hound, the greatest despiser of the negro is the
mulatto, and that the biggest fanatic is the convert; for I should be a
fanatic were I to attack a thing outwardly which inwardly I am obliged
to concede as right.

The mentally unbalanced man tries to defend himself against his own
unconscious, that is to say, he battles against his own compensating
influences. The man already dwelling in a sort of atmosphere of
isolation, continues to remove himself further and further from the
world of reality, and the ambitious engineer strives by increasingly
morbid exaggerations of invention to disprove the correctness of his own
compensating powers of self-criticism. As a result of this a condition
of excitation is produced, from which results a great lack of harmony
between the conscious and unconscious attitudes. The pairs of opposites
are torn asunder, the resulting division or strife leads to disaster,
for the unconscious soon begins to intrude itself violently upon the
conscious processes. Then odd and peculiar thoughts and moods supervene,
and not infrequently incipient forms of hallucination, which clearly
bear the stamp of the internal conflict.

These corrective impulses or compensations which now break through into
the conscious mind, should theoretically be the beginning of the healing
process, because through them the previously isolated attitude should
apparently be relieved. But in reality this does not result, for the
reason that the unconscious corrective impulses which thus succeed in
making themselves apparent to the conscious mind, do so in a form that
is altogether unacceptable to consciousness.

The isolated individual begins to hear strange voices, which accuse him
of murder and all sorts of crimes. These voices drive him to desperation
and in the resulting agitation he attempts to get into contact with the
surrounding _milieu_, and does what he formerly had anxiously avoided.
The compensation, to be sure, is reached, but to the detriment of the
individual.

The pathological inventor, who is unable to profit by his previous
failures, by refusing to recognise the value of his own self-criticism,
becomes the creator of still more preposterous designs. He wishes to
accomplish the impossible but falls into the absurd. After a while he
notices that people talk about him, make unfavourable remarks about him,
and even scoff at him. He believes a far-reaching conspiracy exists
to frustrate his discoveries and render them objects of ridicule. By
this means his unconscious brings about the same results that his
self-criticism could have attained, but again only to the detriment of
the individual, because the criticism is projected into his surroundings.

An especially typical form of unconscious compensation--to give a
further example--is the paranoia of the alcoholic. The alcoholic loses
his love for his wife; the unconscious compensation tries to lead him
back again to his duty, but only partially succeeds, for it causes him
to become jealous of his wife as if he still loved her. As we know, he
may even go so far as to kill both his wife and himself, merely out of
jealousy. In other words, his love for his wife has not been entirely
lost, it has simply become subliminal; but from the realm of the
unconscious it can now only reappear in the form of jealousy.

We see something of a similar nature in the case of religious converts.
One who turns from protestantism to catholicism has, as is well known,
the tendency to be somewhat fanatical. His protestantism is not entirely
relinquished, but has merely disappeared into the unconscious, where it
is constantly at work as a counter-argument against the newly acquired
catholicism. Therefore the new convert feels himself constrained to
defend the faith he has adopted in a more or less fanatical way. It
is exactly the same in the case of the paranoiac, who feels himself
constantly constrained to defend himself against all external criticism,
because his delusional system is too much threatened from within.

The strange manner in which these compensating influences break through
into the conscious mind derives its peculiarities from the fact that
they have to struggle against the resistances already existing in the
conscious mind, and therefore present themselves to the patient's mind
in a thoroughly distorted manner. And secondly, these compensating
equivalents are obliged necessarily to present themselves in the
language of the unconscious--that is, in material of a heterogeneous
and subliminal nature. For all the material of the conscious mind which
is of no further value, and can find no suitable employment, becomes
subliminal, such as all those forgotten infantile and phantastic
creations that have ever entered the heads of men, of which only the
legends and myths still remain. For certain reasons which I cannot
discuss further here, this latter material is frequently found in
dementia præcox.

I hope I may have been able to give in this brief contribution, which
I feel to be unfortunately incomplete, a glimpse of the situation
as it presents itself to me of the importance of the unconscious in
psychopathology. It would be impossible in a short discourse to give an
adequate idea of all the work that has already been done in this field.

To sum up, I may say that the function of the unconscious in conditions
of mental disturbance is essentially a compensation of the content
of the conscious mind. But because of the characteristic condition
of one-sidedness of the conscious striving in all such cases, the
compensating correctives are rendered useless. It is, however,
inevitable that these unconscious tendencies break through into the
conscious mind, but in adapting themselves to the character of the
one-sided conscious aims, it is only possible for them to appear in a
distorted and unacceptable form.

FOOTNOTES:

[Footnote 182: Paper given before the Section of Neurology and
Psychological Medicine, Aberdeen, 1914. Reprinted from the _British
Medical Journal_, by kind permission of the Editor, Dr. Dawson Williams.]

CHAPTER XI

A CONTRIBUTION TO THE STUDY OF PSYCHOLOGICAL TYPES[183]

It is well known that in their general physiognomy hysteria and dementia
præcox present a striking contrast, which is seen particularly in the
attitude of the sufferers towards the external world. The reactions
provoked in the hysteric surpass the normal level of intensity of
feeling, whilst this level is not reached at all by the precocious
dement. The picture presented by these contrasted illnesses is one of
exaggerated emotivity in the one, and extreme apathy in the other, with
regard to the environment. In their personal relations this difference
is very marked. Abstraction creates some exceptions here, for we remain
in affective rapport with our hysterical patients, which is not the case
in dementia præcox.

The opposition between these two nosological types is also seen in
the rest of their symptomatology. From the intellectual point of view
the products of hysterical imagination may be accounted for in a very
natural and human way in each individual case by the antecedents
and individual history of the patient; while the inventions of the
precocious dement, on the contrary, are more nearly related to dreams
than to normal consciousness, and they display moreover an incontestably
archaic tendency, wherein mythological creations of primitive
imagination are more in evidence than the personal memories of the
patient. From the physical point of view we do not find in dementia
præcox those symptoms so common in the hysteric, which simulate well
known or severe organic affections.

All this clearly indicates that hysteria is characterised by a
centrifugal tendency of the libido,[184] whilst in dementia præcox its
tendency is centripetal. The reverse occurs, however, where the illness
has fully established its compensatory effects. In the hysteric the
libido is always hampered in its movements of expansion and forced to
regress upon itself; one observes that such individuals cease to partake
in the common life, are wrapped up in their phantasies, keep their beds,
or are unable to live outside their sick-rooms, etc. The precocious
dement, on the contrary, during the incubation of his illness turns
away from the outer world in order to withdraw into himself; but when
the period of morbid compensation arrives, he seems constrained to draw
attention to himself, and to force himself upon the notice of those
around him, by his extravagant, insupportable, or directly aggressive
conduct.

I propose to use the terms "extroversion" and "introversion" to describe
these two opposite directions of the libido, further qualifying them,
however, as "regressive" in morbid cases where phantasies, fictions,
or phantastic interpretations, inspired by emotivity, falsify the
perceptions of the subject about things, or about himself. We say that
he is extroverted when he gives his fundamental interest to the outer or
objective world, and attributes an all-important and essential value to
it: he is introverted, on the contrary, when the objective world suffers
a sort of depreciation, or want of consideration, for the sake of the
exaltation of the individual himself, who then monopolising all the
interest, grows to believe no one but himself worthy of consideration.
I will call "regressive extroversion" the phenomenon which Freud calls
"transference" (Übertragung), by which the hysteric projects into the
objective world the illusions, or subjective values of his feelings.
In the same way I shall call "regressive introversion," the opposite
pathological phenomenon which we find in dementia præcox, where the
subject himself suffers these phantastical transfigurations.

It is obvious that these two contrary movements of the libido, as
simple psychic mechanisms, may play a part alternately in the same
individual, since after all they serve the same purpose by different
methods--namely, to minister to his well-being. Freud has taught us
that in the mechanism of hysterical transference the individual aims
at getting rid of disagreeable memories or impressions, in order to
free himself from painful complexes, by a process of "repression."
Conversely in the mechanism of introversion, the personality tends to
concentrate itself upon its complexes, and with them, to isolate itself
from external reality, by a process which is not properly speaking
"repression," but which would be better rendered perhaps by the term
"depreciation" (Entwertung) of the objective world.

The existence of two mental affections so opposite in character as
hysteria and dementia præcox, in which the contrast rests on the almost
exclusive supremacy of extroversion or introversion, suggests that these
two psychological types may exist equally well in normal persons, who
may be characterised by the relative predominance of one or other of
the two mechanisms. Psychiatrists know very well that before either
illness is fully declared, patients already present the characteristic
type, traces of which are to be found from the earliest years of life.
As Binet pointed out so well, the neurotic only accentuates and shews
in relief the characteristic traits of his personality. One knows, of
course, that the hysterical character is not simply the product of the
illness, but pre-existed it in a measure. And Hoch has shown by his
researches into the histories of his dementia præcox patients, that this
is also the case with them; dissociations or eccentricities were present
before the onset of the illness. If this is so, one may certainly expect
to meet the same contrast between psychological temperaments outside
the sphere of pathology. It is moreover easy to cull from literature
numerous examples which bear witness to the actual existence of these
two opposite types of mentality. Without pretending to exhaust the
subject, I will give a few striking examples.

In my opinion, we owe the best observations on this subject to the
philosophy of William James.[185] He lays down the principle that no
matter what may be the temperament of a "professional philosopher,"
it is this temperament which he feels himself forced to express
and to justify in his philosophy. And starting from this idea,
which is altogether in accord with the spirit of psychoanalysis,
divides philosophers into two classes: the "tender-minded," who are
only interested in the inner life and spiritual things; and the
"tough-minded," who lay most stress on material things and objective
reality. We see that these two classes are actuated by exactly opposite
tendencies of the libido: the "tender-minded" represent introversion,
the "tough-minded" extroversion.

James says that the tender-minded are characterised by rationalism;
they are men of principles and of systems, they aspire to dominate
experience and to transcend it by abstract reasoning, by their logical
deductions, and purely rational conceptions. They care little for facts,
and the multiplicity of phenomena hardly embarrasses them at all: they
forcibly fit data into their ideal constructions, and reduce everything
to their _a priori_ premises. This was the method of Hegel in settling
beforehand the number of the planets. In the domain of mental pathology
we again meet this kind of philosopher in paranoiacs, who, without
being disquieted by the flat contradictions presented by experience,
impose their delirious conceptions on the universe, and find means of
interpreting everything, and according to Adler "arranging" everything,
in conformity with their morbidly preconceived system.

The other traits which James depicts in this type follow naturally
from its fundamental character. The tender-minded man, he says, is
intellectual, idealist, optimist, religious, partisan of free-will,
a monist, and a dogmatist. All these qualities betray the almost
exclusive concentration of the libido upon the intellectual life.
This concentration upon the inner world of thought is nothing else
than introversion. In so far as experience plays a _rôle_ with these
philosophers, it serves only as an allurement or fillip to abstraction,
in response to the imperative need to fit forcibly all the chaos of the
universe within well-defined limits, which are, in the last resort, the
creation of a spirit obedient to its subjective values.

The tough-minded man is positivist and empiricist. He regards only
matters of fact. Experience is his master, his exclusive guide and
inspiration. It is only empirical phenomena demonstrable in the outside
world which count. Thought is merely a reaction to external experience.
In the eyes of these philosophers principles are never of such value
as facts; they can only reflect and describe the sequence of phenomena
and cannot construct a system. Thus their theories are exposed to
contradiction under the overwhelming accumulation of empirical material.
Psychic reality for the positivist limits itself to the observation
and experience of pleasure and pain; he does not go beyond that, nor
does he recognise the rights of philosophical thought. Remaining on the
ever-changing surface of the phenomenal world, he partakes himself of
its instability; carried away in the chaotic tumult of the universe, he
sees all its aspects, all its theoretical and practical possibilities,
but he never arrives at the unity or the fixity of a settled system,
which alone could satisfy the idealist or tender-minded. The positivist
depreciates all values in reducing them to elements lower than
themselves; he explains the higher by the lower, and dethrones it, by
showing that it is "nothing but such another thing," which has no value
in itself.

From these general characteristics, the others which James points out
logically follow. The positivist is a sensualist, giving greater value
to the specific realm of the senses than to reflection which transcends
it. He is a materialist and a pessimist, for he knows only too well the
hopeless uncertainty of the course of things. He is irreligious, not
being in a state to hold firmly to the realities of the inner world
as opposed to the pressure of external facts; he is a determinist and
fatalist, only able to show resignation; a pluralist, incapable of all
synthesis; and finally a sceptic, as a last and inevitable consequence
of all the rest.

The expressions, therefore, used by James, show clearly that the
diversity of types is the result of a different localisation of the
libido; this libido is the magic power in the depth of our being, which,
following the personality, carries it sometimes towards internal life,
and sometimes towards the objective world. James compares, for example,
the religious subjectivism of the idealist, and the quasi-religious
attitude of the contemporary empiricist: "Our esteem for facts has not
neutralised in us all religiousness. It is itself almost religious. Our
scientific temper is devout."[186]

A second parallel is furnished by Wilhelm Ostwald,[187] who divides
"savants" and men of genius into classics and romantics. The latter
are distinguished by their rapid reactions, their extremely prompt and
abundant production of ideas and projects, some of which are badly
digested and of doubtful value. They are admirable and brilliant
masters, loving to teach, of a contagious ardour and enthusiasm, which
attracts many pupils, and makes them founders of schools, exercising
great personal influence. Herein our type of extroversion is easily
recognised. The classics of Ostwald are, on the contrary, slow to react;
they produce with much difficulty, are little capable of teaching or
of exercising direct personal influence, and lacking enthusiasm are
paralysed by their own severe criticism, living apart and absorbed in
themselves, making scarcely any disciples, but producing works of
finished perfection which often bring them posthumous fame. All these
characteristics correspond to introversion.

We find a further very valuable example in the æsthetic theory of
Warringer. Borrowing from A. Riegl his expression "Volonté d'art
absolue" to express the internal force which inspires the artist, he
distinguishes two forms, viz. sympathy (Einfühlung) and abstraction;
and the term which he employs indicates that here, too, we witness the
activity of the push of the libido, the stirring of the _élan vital_.
"In the same way," says Warringer, "as the sympathetic impulse finds its
satisfaction in organic beauty, so abstract impulse discovers beauty in
the inorganic, which is the negation of all life, in crystallised forms,
and in a general manner wherever the severity of abstract law reigns."
Whilst sympathy represents the warmth of passion which carries it into
the presence of the object in order to assimilate it and penetrate
it with emotional values; abstraction, on the other hand, despoils
the object of all that could recall life, and grasps it by purely
intellectual thought, crystallised and fixed into the rigid forms of
law,--the universal, the typical. Bergson also makes use of these images
of crystallisation, solidification, etc., to illustrate the essence of
intellectual abstraction.

Warringer's "abstraction" represents the process which I have already
remarked as a consequence of introversion, namely, the exaltation of
the intellect, in the place of the depreciated reality of the external
world. "Sympathy" corresponds in fact to extroversion, for, as Lipps
has pointed out, "What I perceive sympathetically in an object is, in
a general manner life, and life is power, internal work, effort, and
execution. To live, in a word, is to act, and to act is to experience
intimately the force which we give out; experience creates activity,
which is essentially of a spontaneous character." "Æsthetic enjoyment,"
said Warringer, "is the enjoyment of one's own self projected into the
"object," a formula which corresponds absolutely with our definition of
transference. This æsthetic conception does not refer to the positivist
in James's sense; it is rather the attitude of the idealist for whom
psychological reality only is interesting, and worthy of consideration."
Warringer adds, "what is essential lies not in the gradation of the
feeling, but pre-eminently in the feeling itself; that is to say, the
inner movement, the intimate life, the unfolding of the subject's own
activity; the value of a line or of a form, depends in our eyes on the
biological value it holds for us; that which gives beauty is solely
our own vital feeling, which we unconsciously project into it." This
view corresponds exactly with my own way of understanding the theory
of the libido, in attempting to keep the true balance between the two
psychological opposites of introversion and extroversion.

The polar opposite of sympathy is abstraction. The impulse of
abstraction is conceived by Warringer "as the result of a great internal
conflict of the human soul in the presence of the external world, and
from the religious standpoint, it corresponds to a strong transcendental
colouring of all the representations man has made to himself of
reality." We recognise clearly in this definition the primordial
tendency to introversion. To the introverted type the universe does not
appear beautiful and desirable, but disquieting, and even dangerous;
it is a manifestation against which the subject puts himself on the
defensive; he entrenches himself in his inner fastness, and fortifies
himself therein by the invention of geometrical figures, full of repose,
perfectly clear even in their minutest details, the primitive magic
power of which assures him of domination over the surrounding world.

"The need of abstraction is the origin of all art," says Warringer.
Here is a great principle, which gains weighty confirmation from the
fact that precocious dements reproduce forms and figures which present
the closest analogy to those of primitive humanity, not only in their
thoughts but also in their drawings.

We should recall that Schiller had already tried to formulate the same
presentation in what he calls the naïve and sentimental types. The
latter is in quest of nature, whilst the former is itself "all nature."
Schiller also saw that these two types result from the predominance of
psychological mechanisms which might be met with in one and the same
individual. "It is not only in the same poet," he said, "but even in the
same work that these two types of mentality are found united.... The
naïve poet pursues only nature and feeling in their simplicity, and all
his effort is limited to the imitation and reproduction of reality. The
sentimental poet, on the contrary, reflects the impression he receives
from objects. The object here is allied to an idea, and the poetic power
of the work depends on this alliance." These quotations shew what types
Schiller had in view, and one recognises their fundamental identity with
those with which we are here dealing.

We find another instance in Nietzsche's contrast between the minds
of Apollo and of Dionysus. The example which Nietzsche uses to
illustrate this contrast is instructive--namely, that between a dream
and intoxication. In a dream the individual is shut up in himself, in
intoxication, on the contrary, he forgets himself to the highest degree,
and, set free from his self-consciousness, plunges into the multiplicity
of the objective world. To depict Apollo, Nietzsche borrows the words of
Schopenhauer, "As upon a tumultuous sea, which disgorges and swallows
by turns, lost to view in the mountains of foaming waves, the mariner
remains seated tranquilly on his plank, full of confidence in his frail
barque; so individual man, in a world of troubles, lives passive and
serene, relying with confidence on the principle of 'individuation.'"
"Yes," continues Nietzsche, "we might say that the unshakeable
confidence in this principle, and the calm security of those whom it has
inspired, have found in Apollo their most sublime expression, and we may
always recognise in him the most splendid and divine personification of
the principle of making an individual." The Apollien state, as Nietzsche
conceives it, is consequently the withdrawal into oneself, that is,
introversion. Conversely in the Dionysian state, psychic intoxication,
indicates in his view the unloosening of a torrent of libido which
expends itself upon things. "This is not only," says Nietzsche, "the
alliance of man with man, which finds itself confirmed afresh under
the Dionysian enchantment; it is alienated Nature, hostile or enslaved,
which also celebrates her reconciliation with her prodigal child,--man.
Spontaneously Earth offers her gifts and the wild beasts from rock and
desert draw near peacefully. The car of Dionysus is lost under flowers
and garlands; panthers and tigers approach under his yoke."

If we change Beethoven's "Hymn of Praise" into a picture, and giving
rein to our imagination, contemplate the millions of beings prostrated
and trembling in the dust, at such a moment the Dionysian intoxication
will be near at hand. Then is the slave free; then all the rigid and
hostile barriers which poverty and arbitrary or insolent custom have
established between man and man are broken down. Now, by means of this
gospel of universal harmony, each feels himself not only reunited,
reconciled, fused with his neighbour, but actually identified with him,
as if the veil of "Maïa was torn away, nothing remaining of it but a few
shreds floating before the mystery of the Primordial Unity."[188] It
would be superfluous to add comment to these quotations.

In concluding this series of examples culled outside my own special
domain, I will quote the linguistic hypothesis of Finck,[189] where we
also see the duality in question. The structure of language, according
to Finck, presents two principal types: in one the subject is generally
conceived as active: "I see him," "I strike him down;" in the other the
subject experiences and feels, and it is the object which acts: "He
appears to me," "He succumbs to me." The first type clearly shews the
libido as going out of the subject,--this is a centrifugal movement;
the second as coming out of the object,--this movement is centripetal.
We meet with this latter introverted type especially in the primitive
languages of the Esquimaux.

In the domain of psychiatry also these two types have been described
by Otto Gross,[190] who distinguishes two forms of mental debility:
the one a diffuse and shallow consciousness, the other a concentrated
and deep consciousness. The first is characterised by weakness of the
consecutive function, the second by its excessive reinforcement. Gross
has recognised that the consecutive function is in intimate relation
with affectivity, from which we might infer that he is dealing once more
with our two psychological types. The relation he establishes between
maniac depressive insanity and the state of diffuse or extended and
shallow mental disease shows that the latter represents the extroverted
type; and the relation between the psychology of the paranoiac and
repressed mentality, indicates the identity of the former with the
introverted type.

After the foregoing considerations no one will be astonished to find
that in the domain of psychoanalysis we also have to reckon with the
existence of these two psychological types.

On the one side we meet with a theory which is essentially reductive,
pluralist, causal and sensualist; this is Freud's standpoint. This
theory limits itself rigidly to empirical facts, and traces back
complexes to their antecedents and their elemental factors. It regards
the psychological life as being only an effect, a reaction to the
environment, and accords the greatest _rôle_ and the largest place to
sensation. On the other side we have the diametrically opposed theory
of Adler[191] which is an entirely philosophical and finalistic one. In
it phenomena are not reducible to earlier and very primitive factors,
but are conceived as "arrangements," the outcome of intentions and
of ends of an extremely complex nature. It is no longer the view of
causality but of finality which dominates researches: the history of the
patient and the concrete influences of the environment are of much less
importance than the dominating principles, the "fictions directrices,"
of the individual. It is not essential for him to depend upon the
object, and to find in it his fill of subjective enjoyment, but to
protect his own individuality and to guarantee it against the hostile
influences of the environment.

Whilst Freud's psychology has for its predominant note the centrifugal
tendency, which demands its happiness and satisfaction in the objective
world, in that of Adler the chief _rôle_ belongs to the centripetal
movement, which tends to the supremacy of the subject, to his triumph
and his liberty, as opposed to the overwhelming forces of existence.
The expedient to which the type described by Freud has recourse is
"infantile transference," by means of which he projects phantasy into
the object and finds a compensation for the difficulties of life in this
transfiguration. In the type described by Adler what is characteristic
is, on the contrary, the "virile protest," personal resistance, the
efficacious safeguard which the individual provides for himself, in
affirming and stubbornly enclosing himself in his dominating ideas.

The difficult task of elaborating a psychology which should pay equal
attention to the two types of mentality belongs to the future.

FOOTNOTES:

[Footnote 183: Delivered at the Psychoanalytical Congress, Munich, 1913.
Translated from _Archives de Psychologie_, by kind permission of the
Editor, Dr. Claparède. Translator, C. E. Long.]

[Footnote 184: "The concept of energy is that which comes nearest to
the concept of libido. Libido can perhaps be described as "effect,"
or "capacity for effect." It is capable of transformation from one
form to another. The metamorphosis can be sudden, as when one function
replaces another in a moment of danger; or it can be gradual, as we
see it in the process of sublimation, where the libido is led over a
long and difficult path through a variety of forms into a different
function."--MARY MOLTZER.]

[Footnote 185: "Pragmatism," Chapter I.]

[Footnote 186: "Pragmatism," ch. i., p. 14.]

[Footnote 187: W. Ostwald "Grosse Männer," Leipzig, 1910 (11th Lecture,
"Classics and Romanticists"). See also his contribution, "A propos de la
Biologie du Savant," Bibliothèque Universelle, Oct., 1910.]

[Footnote 188: Nietzsche, "The Birth of Tragedy," trans. Wm. A.
Haussmann.]

[Footnote 189: Finck, "Der deutsche Sprachbon als Aus druck, deutscher
Weltanschauung." Marburg, 1899.]

[Footnote 190: Gross, "Die zerebrale Sekundärfonktion." Leipsig, 1902.]

[Footnote 191: Adler, "Über den nervösen Charakter." Wiesbaden, 1912.]

CHAPTER XII

THE PSYCHOLOGY OF DREAMS[192]

A dream is a psychic structure which at first sight appears to be
in striking contrast with conscious thought, because judging by its
form and substance it apparently does not lie within the continuity
of development of the conscious contents, it is not integral to it,
but is a mere external and apparently accidental occurrence. Its mode
of genesis is in itself sufficient to isolate a dream from the other
contents of the conscious, for it is a survival of a peculiar psychic
activity which takes place during sleep, and does not originate in the
manifest and clearly logical and emotional continuity of the event
experienced.

But a careful observer should have no difficulty in discovering that a
dream is not entirely severed from the continuity of the conscious, for
in almost every dream certain details are found which have their origin
in the impressions, thoughts, or states of mind of one of the preceding
days. In so far a certain continuity does exist, albeit a _retrograde_
one. But any one keenly interested in the dream problem cannot have
failed to observe that a dream has also a _progressive_ continuity--if
such an expression be permitted--since dreams occasionally exert a
remarkable influence upon the conscious mental life, even of persons
who cannot be considered superstitious or particularly abnormal. These
occasional after-effects are usually seen in a more or less distinct
change in the dreamer's frame of mind.

It is probably in consequence of this loose connection with the other
conscious contents, that the recollected dream is so extremely
unstable. Many dreams baffle all attempts at reproduction, even
immediately after waking; others can only be remembered with doubtful
accuracy, and comparatively few can be termed really distinct
and clearly reproduceable. This peculiar reaction with regard to
recollection may be understood by considering the characteristics of the
various elements combined in a dream. The combination of ideas in dreams
is essentially _phantastic_; they are linked together in a sequence
which, as a rule, is quite foreign to our current way of thinking, and
in striking contrast to the logical sequence of ideas which we consider
to be a special characteristic of conscious mental processes.

It is to this characteristic that dreams owe the common epithet of
"meaningless." Before pronouncing this verdict, we must reflect that
dreams and their chains of ideas are something that _we_ do not
understand. Such a verdict would therefore be merely a projection of our
non-comprehension upon its object. But that would not prevent its own
peculiar meaning being inherent in a dream.

In spite of the fact that for centuries endeavours have been made
to extract a prophetic meaning from dreams, Freud's discovery
is practically the first successful attempt to find their real
significance. His work merits the term "scientific," because he has
evolved a technique which, not only he, but many other investigators
also assert achieves its object, namely, the understanding of the
meaning of the dream. This meaning is not identical with the one which
the manifest dream content seems to indicate.

This is not the place for a critical discussion of Freud's psychology of
dreams. But I will try to give a brief summary of what may be regarded
as more or less established facts of dream psychology to-day.

The first question we must discuss is, whence do we deduce the
justification for attributing to dreams any other significance than the
one indicated in the unsatisfying fragmentary meaning of the manifest
dream content?

As regards this point a particularly weighty argument is the fact that
Freud discovered the hidden meaning of dreams by _empiric_ and not
_deductive_ methods. A further argument in favour of a possible hidden,
as opposed to the manifest meaning of dreams, is obtained by comparing
dream-phantasies with other phantasies (day-dreams and the like) in
one and the same individual. It is not difficult to conceive that such
day-phantasies have not merely a superficial, concrete meaning, but also
a deeper psychological meaning. It is solely on account of the brevity
that I must impose upon myself, that I do not submit materials in proof
of this. But I should like to point out that what may be said about the
meaning of phantasies, is well illustrated by an old and widely diffused
type of imaginative story, of which Æsop's Fables are typical examples,
wherein, for instance, the story is some objectively impossible phantasy
about the deeds of a lion and an ass. The concrete superficial meaning
of the fable is an impossible phantasm, but the hidden moral meaning is
plain upon reflection. It is characteristic that children are pleased
and satisfied with the exoteric meaning of the story. However, the best
argument for the existence of a hidden meaning in dreams is provided
by conscientious application of the technical procedure to solve the
manifest dream content.

This brings us to our second main point, viz.--the question of analytic
procedure. Here again I desire neither to defend nor to criticise
Freud's views and discoveries, but rather to confine myself to what seem
to me to be firmly established facts.

The fact that a dream is a psychic structure, does not give us the
slightest ground for assuming that it obeys laws and designs other than
those applicable to any other psychic structure. According to the maxim:
_principia explicandi proeter necessitatem non sunt multiplicanda_, we
have to treat dreams, in analysis, just as any other psychic structure,
until experience teaches us some better way.

We know that every psychic construction considered from the standpoint
of causality, is the resultant of previous psychic contents. Moreover,
we know also that every psychic structure, considered from the
standpoint of finality, has its own peculiar meaning and purpose in the
actual psychic process. This standard must also be applied to dreams.
When, therefore, we seek a psychological explanation of a dream, we
must first know what were the preceding experiences out of which it is
combined. We must trace the antecedents of every element in the dream
picture. For example: some one dreams "_that he is walking in a street,
a child is running in front of him, who is suddenly run over by a
motor-car_." We will trace the antecedents of this dream-picture, with
the aid of the dreamer's recollections.

He recognises the street as one down which he had walked on the previous
day. The child he acknowledges as his brother's child, whom he had seen
on the previous evening when visiting his brother. The motor accident
reminds him of an accident that had actually occurred a few days before,
but of which he had only read an account in a newspaper. Popular opinion
is known to be satisfied with this kind of explanation. People say: "Oh,
that is why I dreamt such and such a thing!"

Obviously this explanation is absolutely unsatisfactory from a
scientific standpoint. The dreamer walked down many streets on the
previous day; why was this particular one selected? He had read
about several accidents; why did he select just this one? The mere
disclosure of an antecedent is by no means sufficient; for a plausible
determination of the dream presentation can only be obtained from the
competition of various determinants. The collection of additional
material proceeds, according to the principle of recollection that
has been called the _Association Method_. The result, as will easily
be understood, is the admission of a mass of multifarious and quite
heterogeneous material, having apparently nothing in common but the fact
of its evident associative connection with the dream contents, since it
has been reproduced by means of this content.

How far the collection of such material should go, is an important
question from the technical point of view. Since the entire psychic
content of a life may be ultimately disclosed from any single starting
point, theoretically the whole previous life-experience might be found
in every dream. But we only need to assemble just so much material as
is absolutely necessary in order to comprehend the dream's meaning.
The limitation of the material is obviously an arbitrary proceeding,
according to that principle of Kant's whereby to _comprehend_ is "_to
perceive to the extent necessary for our purpose_." For instance, when
undertaking a survey of the causes of the French Revolution, we could,
in amassing our material, include not only the history of medieval
France but also that of Rome and Greece, which certainly would not be
"necessary for our purpose," since we can comprehend the historical
genesis of the Revolution from much more limited material.

Except for the aforesaid arbitrary limitation, the collecting of
material lies outside the investigator's discretion. The material
gathered must now be sifted and examined, according to principles which
are always applied to the examination of historical or any empirical
scientific material. The method is an essentially comparative one, that
obviously cannot be applied automatically, but is largely dependent upon
the skill and aim of the investigator.

When a psychological fact has to be explained, it must be remembered
that psychological data necessitate a twofold point of view, namely,
that of _causality_ and that of _finality_. I use the word finality
intentionally, in order to avoid confusion with the idea of "teleology."
I use finality to denote immanent psychological teleology. In so far
as we apply the view point of causality to the material that has been
associated with the dream, we reduce the manifest dream content to
certain fundamental tendencies or ideas. These, as one would expect, are
elementary and universal in character.

For instance, a young patient dreams as follows: "_I am standing in a
strange garden, and pluck an apple from a tree. I look about cautiously,
to make sure no one sees me._"

The associated dream material is a memory of having once, when a boy,
plucked a couple of pears surreptitiously from another person's garden.

The feeling of having a bad conscience, which is a prominent feature in
the dream, reminds him of a situation he experienced on the previous
day. He met a young lady in the street--a casual acquaintance--and
exchanged a few words with her. At that moment a gentleman passed whom
he knew, whereupon our patient was suddenly seized with a curious
feeling of embarrassment, as if he had done something wrong. He
associated the apple with the scene in Paradise, together with the fact
that he had never really understood why the eating of the forbidden
fruit should have been fraught with such dire consequences for our first
parents. This had always made him feel angry; it seemed to him an unjust
act of God, for God had made men as they were, with all their curiosity
and greed.

Another association was, that sometimes his father had punished him for
certain things in a way that seemed to him incomprehensible. The worst
punishment had been bestowed after he had secretly watched girls bathing.

That led up to the confession that he had recently begun a love affair
with a housemaid, but had not yet carried it through to a conclusion. On
the day before the dream he had had a _rendezvous_ with her.

Upon reviewing this material we see that the dream contains a very
transparent reference to the last-named incident. The connecting
associative material shows that the apple episode is palpably meant for
an erotic scene. For various other reasons, too, it may be considered
extremely probable that this experience of the previous day is operative
even in this dream. In the dream the young man plucks the apple of
Paradise, which in reality he has not yet plucked. The remainder of the
material associated with the dream is concerned with another experience
of the previous day, namely, with the peculiar feeling of a _bad
conscience_, which seized the dreamer when he was talking to his casual
lady acquaintance; this, again, was connected with the fall of man in
Paradise, and finally with an erotic misdemeanour of his childhood, for
which his father had punished him severely. All these associations are
linked together by the idea of _guilt_.

In the first place we will consider this material from Freud's
view-point of causality; in other words, we will "interpret" it, to use
Freud's expression. A wish has been left unfulfilled from the day before
the dream. In the dream this wish is realised in the _symbolical_ apple
scene. But why is this realisation disguised and hidden under a symbolic
image instead of being expressed in a distinctly sexual thought? Freud
would refer to the unmistakable sense of guilt shown up by the material,
and say the morality that has been inculcated in the young man from
childhood is bent on repressing such wishes, and to that end brands the
natural craving as immoral and reprehensible. The suppressed immoral
thought can therefore only achieve expression by means of a _symbol_. As
these thoughts are incompatible with the moral content of the conscious
ego, a psychic factor adopted by Freud called the _Censor_, prevents
this wish from passing undisguised into consciousness.

Reviewing the dream from the standpoint of finality, which I contrast
with that of Freud, does not--as I wish to establish explicitly--involve
a denial of the dream's _causæ_, but rather a different interpretation
of the associative material collected around the dream. The material
facts remain the same, but the standard by which they are measured is
altered. The question may be formulated simply as follows: What is
this dream's purpose? What should it effect? These questions are not
arbitrary, in as much as they may be applied to every psychic activity.
Everywhere the question of the "why" and "wherefore" may be raised.

It is clear that the material added by the dream to the previous day's
erotic experience, chiefly emphasises the sense of guilt in the erotic
act. The same association has already been shown to be operative
in another experience of the previous day, in the meeting with his
casual lady acquaintance, when the feeling of a bad conscience was
automatically and inexplicably aroused, as if, in that instance, too,
the young man had done something wrong. This experience also plays a
part in the dream, which is even intensified by the association of
additional, appropriate material; the erotic experience of the day
before, being depicted by the story of the Fall which was followed by
such a severe punishment.

I maintain that there exists in the dreamer an unconscious propensity
or _tendency to conceive his erotic experiences as guilty_. It is most
characteristic that the association with the Fall of Man should ensue,
the young man having never really grasped why the punishment should
have been so drastic. This association throws light upon the reasons
why the dreamer did not think simply, "I am doing what is not right."
Obviously he does not _know_ that he might condemn his own conduct as
morally wrong. This is actually the case. His conscious belief is that
his conduct does not matter in the least morally, as all his friends
were acting in the same way; besides, for other reasons too, is unable
to understand why a fuss should be made about it.

Whether this dream should be considered full or void of meaning depends
upon a very important question, viz. whether the standpoint of morality,
handed down to us through the ages by our forefathers is held to be full
or void of meaning. I do not wish to wander off into a philosophical
discussion of this question, but would merely observe that mankind must
obviously have had very strong reasons for devising this morality,
otherwise it would be truly incomprehensible why such restraints should
be imposed upon one of man's strongest cravings. If we attach due
value to this fact, we are bound to pronounce this dream to be full of
meaning, for it reveals to the young man the necessity of facing his
erotic conduct boldly from the view point of morality. Primitive races
have in some respects extremely strict legislation concerning sexuality.
This fact proves that sexual morality is a not-to-be-neglected factor
in the soul's higher functions, but deserves to be taken fully into
account. In the case in question it should be added, that the young
man--influenced by his friends' example--somewhat thoughtlessly let
himself be guided exclusively by his erotic cravings, unmindful of
the fact that man is a morally responsible being and must perforce
submit--voluntarily or involuntarily--to a morality that he himself has
created.

In this dream we can discern a compensating function of the unconscious,
consisting in the fact that _those thoughts, propensities, and
tendencies of a human personality, which in conscious life are too
seldom recognised, come spontaneously into action in the sleeping state,
when to a large extent the conscious process is disconnected_.

The question might certainly be raised, of what use is this to the
dreamer if he does not understand the dream?

To this I must remark that to understand is not an exclusively
intellectual process, for--as experience proves--man may be
influenced--nay, even very effectually convinced--by innumerable things,
of which he has no intellectual understanding. I will merely remind my
readers of the efficacy of religious symbols.

The example given above might suggest the thought that the function
of dreams is a distinctly "moral" one. Such it appears to be in this
case, but if we recall the formula according to which dreams contain
the subliminal materials of a given moment, we cannot speak simply of
a "moral" function. For it is worthy of note that the dreams of those
persons whose actions are morally unexceptionable, bring materials to
light that might well be characterised as "immoral" in the current
meaning of that term. Thus it is significant that St. Augustine was glad
that God did not hold him responsible for his dreams. The unconscious
is the unknown of a given moment, therefore it is not surprising that
all those aspects that are essential for a totally different point of
view should be added by dreams to the conscious psychological factors of
a given moment. It is evident that this function of dreams signifies a
psychological adjustment, a compensation essential for properly balanced
action. In the conscious process of reflection it is indispensable that,
so far as possible, we should realise all the aspects and consequences
of a problem, in order to find the right solution. This process is
continued automatically in the more or less unconscious state of sleep,
wherever--as our previous experience seems to show--all those other
points of view occur to the dreamer (at least by way of allusion) that
during the day were underestimated or even totally ignored; in other
words, were comparatively unconscious.

As regards the much-discussed _symbolism_ of dreams, the value attached
to it varies according to whether the standpoint of causality or of
finality is adopted. According to Freud's causal view point it proceeds
from a _craving_, viz. from the suppressed dream-wish. This craving is
always somewhat simple and primitive, and is able to disguise itself
under manifold forms. For instance, the young man in question might just
as well have dreamt that he had to open a door with a key, or that he
had to travel by aeroplane, or that he was kissing his mother, etc. From
this standpoint all those things would have had the same meaning. In
this way, the typical adherents of Freud's school have come to the point
of interpreting--to give a gross instance--almost all long objects in
dreams as phallic symbols.

From the view-point of finality, the various dream pictures have each
their own peculiar value. For instance, if the young man, instead of
dreaming of the apple scene, had dreamt he had to open a door with
a key, the altered dream picture would have furnished associative
material of an essentially different character; that, again, would have
resulted in the conscious situation being supplemented by associations
of a totally different kind from those connected with the apple scene.
From this point of view, it is the diversity of the dream's mode of
expression that is full of meaning, and not the uniformity in its
significance. The causal view-point tends by its very nature towards
uniformity of meaning, that is, towards a fixed significance of symbols.
On the other hand, the final view-point perceives in an altered dream
picture, the expression of an altered psychological situation. It
recognises no fixed meaning of symbols. From this standpoint all the
dream pictures are important in themselves, each one having a special
significance of its own, to which it owes its inclusion in the dream.
Keeping to our previous example, we see that from the standpoint of
finality the symbol in this dream is approximately equivalent to a
parable; it does not conceal, but it teaches. The apple scene recalls
vividly the sense of guilt, at the same time disguising the real deed of
our first parents.

It is obvious we reach very dissimilar interpretations of the meaning
of the dream, according to the point of view adopted. The question
now arises, which is the better or truer version? After all, for us
therapeuts it is a practical and not a merely theoretical necessity
that leads us to seek for some comprehension of the meaning of dreams.
In treating our patients we must for practical reasons endeavour to lay
hold of any means that will enable us to train them effectually. It
should be quite evident from the foregoing example, that the material
associated with the dream has opened up a question calculated to make
many matters clear to the young man, which, hitherto, he has heedlessly
overlooked. But by disregarding these things he was really overlooking
something in himself, for he possesses a moral standard and a moral
need just like any other man. By trying to live without taking this
fact into consideration, his life is one-sided and incomplete, so to
say inco-ordinate; with the same consequences for the psychological
life as a one-sided and incomplete diet would have for the physical.
In order to develop a person's individuality and independence to the
uttermost, we need to bring to fruition all those functions that have
hitherto attained but little conscious development or none at all. In
order to achieve this aim, we must for therapeutic reasons enter into
all those unconscious aspects of things brought forward by the dream
material. This makes it abundantly clear that the view-point of finality
is singularly important as an aid to the practical development of the
individual.

The view-point of causality is obviously more in accord with the
scientific spirit of our time, with its strictly causalistic reasoning.
Much may be said for Freud's view as a scientific explanation of dream
psychology. But I must dispute its completeness, for the psyche cannot
be conceived merely from the causal aspect, but necessitates also a
final view-point. Only a combination of both points of view--which has
not yet been attained to the satisfaction of the scientific mind, owing
to great difficulties both of a practical and theoretical nature--can
give us a more complete conception of the essence of dreams.

I would like to treat briefly of some further problems of dream
psychology, that border on the general discussion of dreams. Firstly,
as to the _classification of dreams_; I do not wish to overestimate
either the practical or theoretical significance of this question. I
investigate yearly some 1500-2000 dreams, and this experience enables
me to state that typical dreams actually do exist. But they are not
very frequent, and from the view-point of finality they lose much
of the importance which attaches to them as a result of the fixed
significance of symbols according to the causal view-point. It seems to
me that the _typical themes_ of dreams are of far greater importance,
for they permit of a comparison with the themes of mythology. Many of
these mythological themes--in the study of which Frobenius has rendered
notable service--are also found in dreams, often with precisely the
same significance. Unfortunately the limited time at my disposal,
does not permit me to lay detailed materials before you: this has
been done elsewhere.[193] But I desire to emphasise the fact that the
comparison of the typical themes of dreams with those of mythology
obviously suggests the idea (already put forward by Nietzsche) that from
a phylogenetic point of view dream-thought should be conceived as an
older form of thought. Instead of multiplying examples in explanation
of my meaning, I will briefly refer you to our specimen dream. As
you remember, that dream introduced the apple scene as a typical
representation of erotic guilt. The gist of its purport is: "I am doing
wrong in acting like this." But it is characteristic that a dream never
expresses itself in a logically abstract way, but always in the language
of parable or simile. This peculiarity is also a characteristic feature
of primitive languages, whose flowery idioms always strike us. If you
call to mind the writings of ancient literature--_e.g._ the language of
simile in the Bible--you will find that what nowadays is expressed by
means of abstract expressions, could then only be expressed by means
of simile. Even such a philosopher as Plato did not disdain to express
certain fundamental ideas by means of concrete simile.

Just as the body bears traces of its phylogenetic development, so also
does the human mind. There is therefore nothing surprising in the
possibility of the allegories of our dreams being a survival of archaic
modes of thought.

The theft of the apple in our example is a typical theme of dreams,
often recurring with various modifications. It is also a well-known
theme in mythology, and is found not only in the story of the Garden of
Eden, but in numerous myths and fables of all ages and climes. It is one
of those universally human symbols, which can reappear in any one, at
any time. Thus, dream psychology opens up a way to a general comparative
psychology, from which we hope to attain the same sort of understanding
of the development and structure of the human soul, as comparative
anatomy has given us concerning the human body.

FOOTNOTES:

[Footnote 192: This lecture was prepared for the Berne Medical Congress,
1914, postponed on the outbreak of war. Translator, Dora Hecht.]

[Footnote 193: "The Psychology of the Unconscious" ("Wandlungen und
Symbole der Libido"). Moffat, Yard & Co.]

CHAPTER XIII

THE CONTENT OF THE PSYCHOSES[194]

INTRODUCTION

My short sketch on the Content of the Psychoses which first appeared
in the series of "Schriften zur Angewandten Seelenkunde" under
Freud's editorship was designed to give the non-professional but
interested public some insight into the psychological point of view
of recent psychiatry. I chose by way of example a case of the mental
disorder known as Dementia Præcox, which Bleuler calls Schizophrenia.
Statistically this extensive group contains by far the largest number
of cases of psychosis. Many psychiatrists would prefer to limit it, and
accordingly make use of other nomenclature and classification. From the
psychological standpoint the change of name is unimportant, for it is
of less value to know what a thing is called than to know what it is.
The cases of mental disorder sketched in this essay belong to well-known
and frequently occurring types, familiar to the alienist. The facts will
not be altered if these disorders are called by some other name than
dementia præcox.

I have presented my view of the psychological basis in a work[195]
whose scientific validity has been contested upon all sorts of grounds.
For me it is sufficient justification that a psychiatrist of Bleuler's
standing has fully accepted, in his great monograph on the disease,
all the essential points in my work. The difference between us is as
to the question whether, in relation to the anatomical basis, the
psychological disorders should be regarded as primary or secondary. The
resolution of this weighty question depends upon the general problem as
to whether the prevailing dogma in psychiatry--"disorders of the mind
are disorders of the brain"--presents a final truth or not. This dogma
leads to absolute sterility as soon as universal validity is ascribed
to it. There are undoubted psychogenic mental diseases (the so-called
hysterical) which are properly regarded as _functional_ in contrast
with organic diseases which rest upon demonstrable anatomical changes.
Disorders of the brain should only be called organic when the psychic
symptoms depend upon an undoubtedly primary disease of the brain. Now
in dementia præcox this is by no means a settled question. Definite
anatomical changes are present, but we are very far from being able to
relate the psychological symptoms to these changes. We have, at least,
positive information as to the functional nature of early schizophrenic
conditions; moreover the organic character of paranoia and many paranoid
forms is still in great uncertainty. This being so it is worth while
to inquire whether manifestations of degeneration could not also be
provoked by psychological disturbance of function. Such an idea is only
incomprehensible to those who smuggle materialistic preconceptions into
their scientific theories. This question does not even rest upon some
fundamental and arbitrary spiritualism, but upon the following simple
reflection. Instead of assuming that some hereditary disposition, or a
toxæmia, gives rise directly to organic processes of disease, I incline
to the view that upon the basis of predisposition, whose nature is
at present unknown to us, there arises a non-adaptable psychological
function which can proceed to develop into manifest mental disorder;
this may secondarily determine organic degeneration with its own train
of symptoms. In favour of this conception is the fact that we have no
proof of the primary nature of the organic disorder, but overwhelming
proofs exist of a primary psychological fault in function, whose history
can be traced back to the patient's childhood. In perfect agreement
with this conception is the fact that analytic practice has given us
experience of cases where patients on the borderline of dementia præcox
have been brought back to normal life.

Even if anatomical lesions or organic symptoms were constantly present,
science ought not to imagine the psychological standpoint could
advisedly be neglected, or the undoubted psychological relationship
be given up as unimportant. If, for instance, carcinoma were to prove
an infectious disease the peculiar growth and degenerative process
of carcinomatous cells would still be a constant factor requiring
investigation on its own account. But, as I have said, the correlation
between the anatomical findings and the psychological picture of
the disease is so loose that it is extremely desirable to study the
psychological side of it thoroughly.

PART I

Psychiatry is the stepchild of medicine. All the other branches of
medicine have one great advantage over it--the scientific methods can be
applied; there are things to be seen, and felt, physical and chemical
methods of investigation to be followed: the microscope shows the
dreaded bacillus, the surgeon's knife halts at no difficulty and gives
us glimpses of most inaccessible organs of vital importance. Psychiatry,
which engages in the exploration of the mind, stands ever at the door
seeking in vain to weigh and measure as in the other departments of
science. We have long known that we have to do with a definite organ,
the brain; but only beyond the brain, beyond the morphological basis
do we reach what is important for us--the mind; as indefinable as it
ever was, still eluding any explanation, no matter how ingenious.
Former ages, endowing the mind with substance, and personifying every
incomprehensible occurrence in nature, regarded mental disorder as the
work of evil spirits; the patient was looked upon as one possessed,
and the methods of treatment were such as fitted this conception. This
mediæval conception occasionally gains credence and expression even
to-day. A classical example is the driving out of the devil which
the elder Pastor Blumhardt carried out successfully in the famous
case of Gottlieb in Deltus.[196] To the honour of the Middle Ages
let it also be said that there are to be found early evidences of a
sound rationalism. In the sixteenth century at the Julius Hospital in
Würzburg mental patients were already treated side by side with others
physically ill, and the treatment seems to have been really humane.
With the opening of the modern era, and with the dawn of the first
scientific ideas, the original barbaric personification of the unknown
Great Power gradually disappeared. A change arose in the conception of
mental disease in favour of a more philosophic moral attitude. The old
view that every misfortune was the revenge of the offended gods returned
new-clothed to fit the times. Just as physical diseases can, in many
cases, be regarded as self-inflicted on account of negligence, mental
diseases were likewise considered to be due to some moral injury, or
sin. Behind this conception the angry godhead also stood. Such views
played a great _rôle_, right up to the beginning of last century,
especially in Germany. In France, however, about the same time a new
idea was appearing, destined to sway psychiatry for a hundred years.
Pinel, whose statue fittingly stands at the gateway of the Salpetrière
in Paris, took away the chains from the insane and thus freed them from
the symbol of the criminal. In a very real way he formulated for the
world the humane and scientific conception of modern times. A little
later Esquirol and Bayle discovered that certain forms of insanity ended
in death, after a relatively short time, and that certain constant
changes in the brain could be demonstrated _post mortem_. Esquirol had
described as an entity general paralysis of the insane, or as it was
popularly called "softening of the brain," a disease which is always
bound up with chronic inflammatory degeneration of the cerebral matter.
Thus was laid the foundation of the dogma which you will find repeated
in every text-book of psychiatry, viz. "diseases of the mind are
diseases of the brain." Confirmation of this conception was added about
the same time by Gall's discoveries which traced partial or complete
loss of the power of speech--a psychical capacity--to a lesion in the
region of the left lower frontal convolution. Somewhat later this view
proved to be of general applicability. Innumerable cases of extreme
idiocy or other intense mental disorders were found to be caused by
tumours of the brain. Towards the end of the nineteenth century Wernicke
(recently deceased) localised the speech centre in the left temporal
lobe. This epoch-making discovery raised hopes to the highest pitch.
It was expected that at no distant day every characteristic and every
psychical activity would be assigned a place in the cortical grey
matter. Gradually, increased attempts were made to trace the primary
mental changes in the psychoses back to certain parallel changes in the
brain. Meynert, the famous Viennese psychiatrist, described a formal
scheme in which the alteration in blood-supply in certain regions was
to play the chief part in the origin of the psychoses. Wernicke made a
similar but far more ingenious attempt at a morphological explanation
of psychical disorders. The visible result of this tendency is seen in
the fact that even the smallest and least renowned asylum has, to-day,
its anatomical laboratory where cerebral sections are cut, stained, and
microscoped. Our numerous psychiatric journals are full of morphological
contributions, investigations into the structure and distribution of
cells in the cortex, and other varying source of disorders in the
different mental diseases.

Psychiatry has come into fame as gross materialism. And quite rightly,
for it is on the road--or rather reached it long ago--to put the organ,
the instrument, above function. Function has become the dependent
accessory of its organs, the mind the dependent accessory of the brain.
In modern mental therapy the mind has been the loser, whilst great
progress has been made in cerebral anatomy; of the mind we know less
than nothing. Current psychiatry behaves like a man who thinks he can
unriddle the meaning and importance of a building by a mineralogical
investigation of its stones. Let us attempt to realise in which mental
diseases obvious changes in the brain are found, and what is their
proportion.

In the last four years we have received 1325 patients at Burgholzi;[197]
331 a year. Of these 9 per cent. suffered from congenital psychic
anomalies. By this is understood a certain inborn defect of the psyche.
Of these 9 per cent., about a quarter were imbeciles. Here we meet
certain changes in the brain such as microcephalus, hydrocephalus,
malformations or absence of portions of the brain. The remaining
three-quarters of these congenital defects present no typical changes in
the brain.

Three per cent. of our patients suffer from epileptic mental troubles.
In the course of epilepsy there arises gradually a typical degeneration
of the brain. The degeneration is, however, only discoverable in severe
cases and when the disease has existed for some time. If the attacks
have only existed for a relatively short time, not more than a few
years, the brain as a rule shows nothing. Seventeen per cent. of our
patients suffer from progressive paralysis and senile dementia. Both
diseases present characteristic changes in the brain. In paralysis there
is most extensive shrinkage of the brain, so that the cortex is often
reduced by one half. The frontal portions of the brain more especially,
may be reduced to a third of the normal weight. There is a similar
destruction of substance in senile decay.

Fourteen per cent. of the patients annually received are cases of
poisoning, at least 13 per cent. of these being due to alcohol. As a
rule in slight cases nothing is to be found in the brain; in only a
relatively few severe cases is there shrinkage of the cortex, generally
of slight degree. The number of these severe cases amounts to less than
1 per cent. of the yearly cases of alcoholism.

Six per cent. of the patients suffer from so-called maniacal depressive
insanity which includes the maniacs and the melancholics. The essence
of this disease is readily intelligible to the public. Melancholia is
a condition of abnormal sadness without disorder of intelligence or
memory. Mania is the opposite, the rule being an abnormally excited
state with great restlessness; likewise without deep disturbance of
intelligence and memory. In this disease there are no demonstrable
morphological changes in the brain.

Forty-five per cent. of the patients suffer from the real and common
mental disease called dementia præcox. The name is a very unhappy one,
for the dementia is not always precocious, nor in all cases is there
dementia. Unfortunately the disease is too often incurable; even in the
best cases, in those that recover, where the outside public would not
observe any abnormality, there is always present some defect in the
emotional life. The picture presented by the disease is extraordinarily
diverse; generally there is some disorder of feeling, frequently
delusions and hallucinations. As a rule there is nothing to be found in
the brain. Even in cases of a most severe type, lasting for years, an
intact brain is not infrequently found _post mortem_. In a few cases
only certain slight changes are present which, however, cannot as yet be
reduced to any law.

To sum up: in round figures a quarter of our insane patients show more
or less clearly extensive changes and destruction of the brain, while
three-fourths have a brain which seems to be generally unimpaired or at
most exhibit such changes as give no explanation of the psychological
disturbance.

These figures offer the best possible proof that the purely
morphological view-point of modern psychiatry leads only very
indirectly, if at all, to the understanding of the mental disorder,
which is our aim. We must take into account the fact that those mental
diseases which show the most marked disturbances of the brain end in
death; for this reason the chronic inmates of the asylum form its real
population, consisting of some 70 to 80 per cent. of cases of dementia
præcox, that is, of patients in whom anatomical changes are practically
non-existent. The psychiatry of the future must come to grips with the
core of the thing; the path is thus made clear--_it can only be by way
of psychology_. Hence in our Zürich clinic we have entirely discarded
the anatomical view and turned to the psychological investigation of
insanity. As most of our patients suffer from dementia præcox we were
naturally concerned with this as our chief problem.

The older asylum physicians paid great attention to the psychological
precursors of mental disorder, just as the public still does, following
a true instinct. We accepted this hint and carefully investigated the
previous psychological history wherever possible. Our trouble was richly
rewarded, for we often found, to our surprise, that the disease broke
out at a moment of some great emotion which, in its turn, had arisen in
a so-called normal way. We found, moreover, that in the mental disease
which ensued a number of symptoms occurred which it was quite labour in
vain to study from the morphological standpoint. These same symptoms,
however, were comprehensible when considered from the standpoint of the
individual's previous history. Freud's fundamental investigations into
the psychology of hysteria and dreams afforded us the greatest stimulus
and help in our work.

A few instances of the latest method in psychiatry will make the
subject clearer than mere dry theory. In order to bring home to you the
difference in our conception I will first describe the medical history
in the older fashion, and subsequently give the solution characteristic
of the new departure.

The case to be considered is that of a cook aged 32; she had no
hereditary taint, was always industrious and conscientious, and had
never been noticeable for eccentric behaviour or the like. Quite
recently she became acquainted with a young man whom she wished to
marry. From that time on she began to show certain peculiarities. She
often spoke of his not liking her much, was frequently out of sorts,
ill-tempered, and sat alone brooding; once she ornamented her Sunday hat
very strikingly with red and green feathers, another day she bought a
pair of pince-nez in order to wear them when she went out walking with
her fiancé. One day the sudden idea that her teeth were rather ugly
would not let her rest, and she resolved to get a plate, although there
was no absolute need. She had all her teeth out under an anæsthetic. The
night after the operation she suddenly had a severe anxiety-attack. She
cried and moaned that she was damned for ever, for she had committed
a great sin; she should not have allowed her teeth to be extracted.
People must pray for her, that God might pardon her sin. In vain her
friends attempted to talk her out of her fears, to assure her that the
extraction of teeth was really no sin; it availed nothing. At day-break
she became somewhat quieter; she worked throughout the day. On following
nights the attacks were repeated. When consulted by the patient I found
her quiet, but she wore a rather vacant expression. I talked to her
about the operation, and she assured me it was not so dreadful to have
teeth extracted, but still it was a great sin, from which position,
despite every persuasion, she could not be moved. She continually
repeated in plaintive, pathetic tones, "I should not have allowed my
teeth to be extracted; oh yes, that was a great sin which God will never
forgive me." She gave the impression of real insanity. A few days later
her condition grew worse, and she had to be brought into the asylum. The
anxiety-attack had extended and was persistent, and the mental disorder
lasted for months.

The history shows a series of entirely unrelated symptoms. Why all the
queer story of the hat and pince-nez? Why those anxiety-attacks? Why
this delusion that the extraction of her teeth was an unpardonable
sin? Nothing here is clear. The morphologically-minded psychiatrist
would say: This is just a typical case of dementia præcox; it is the
essence of insanity, of madness, to talk of nothing but mysteries;
the standpoint of the diseased mind towards the world is displaced,
is "mad." What is no sin for the normal, the patient finds a sin.
It is a bizarre delusion characteristic of dementia præcox. The
extravagant lamentation about this supposed sin is what is known as
"inadequate"[198] emotional emphasis. The queer ornamentation of the
hat, the pince-nez, are bizarre notions such as are very common in
these patients. Somewhere in the brain certain cells have fallen into
disorder, and manufacture illogical, senseless ideas of one kind and
another which are quite without psychological meaning. The patient is
obviously a hereditary degenerate with a weak brain, having a kink
which is the origin of the disorder. For some reason or other the
disease has suddenly broken out. It could just as easily have broken
out at any other time. Perhaps we should have had to capitulate to
these arguments had real psychological analysis not come to our aid. In
filling up the certificate required for her removal to the asylum, it
transpired that many years ago she had had an affair which terminated;
her lover left her with an illegitimate child. Nobody had been told of
this. When she was again in love a dilemma arose, and she asked herself,
What will this new lover say about it? At first she postponed the
marriage, becoming more and more worried, and then the eccentricities
began. To understand these we must immerse ourselves in the psychology
of a naïve soul. If we have to disclose some painful secret to a beloved
person we try first to strengthen his love in order to obtain beforehand
a guarantee of his forgiveness. We do it by flattery or by caresses, or
we try to impress the value of our own personality in order to raise it
in the eyes of the other. Our patient decked herself out with beautiful
feathers, which to her simple taste seemed precious. The wearing of
"pince-nez" increases the respect of children even of a mature age.
And who does not know people who will have their teeth extracted, out
of pure vanity, in order that they may wear a plate to improve their
appearance?

After such an operation most people have a slight, nervous reaction, and
then everything becomes more difficult to bear. This was, as a matter
of fact, just the moment when the catastrophe did occur, in her terror
lest her fiancé should break with her when he heard of her previous
life. That was the first anxiety-attack. Just as the patient had not
acknowledged her secret in all these years, so she now sought to guard
it, and shifted the fear in her guilty conscience on to the extraction
of the teeth; she thus followed a method well known to us, for when we
dare not acknowledge some great sin we deplore some small sin with the
greater emphasis.

The problem seemed insoluble to the weak and sensitive mind of the
patient, hence the affect became insurmountably great; this is the
mental desire as presented from the psychological side. The series
of apparently meaningless events, the so-called madness, have now a
meaning; a significance appertains to the delusions, making the patient
more human to us. Here is a person like ourselves, beset by universal
human problems, no longer merely a cerebral machine thrown out of gear.
Hitherto we thought that the insane patient revealed nothing to us by
symptoms, save the senseless products of his disordered cerebral cells,
but that was academic wisdom reeking of the study. When we penetrate
into the human secrets of our patients, we recognise mental disease
to be an unusual reaction to emotional problems which are in no wise
foreign to ourselves, and the delusion discloses the psychological
system upon which it is based.

The light which shines forth from this conception seems to us so
enormously powerful because it forces us into the innermost depths
of that tremendous disorder which is most common in our asylums, and
hitherto least understood; by reason of the craziness of the symptoms it
is the type that strikes the public as madness _in excelsis_.

The case which I have just sketched is a simple one. It is transparent.
My second example is somewhat more complicated. It is the case of a man
between 30 and 40 years of age; he is a foreign archæologist of great
learning and most unusual intelligence. He was a precocious boy of quite
excellent character, great sensitiveness and rare gifts. Physically he
was small, always weakly, and a stammerer. He grew up and was educated
abroad, and afterwards studied for several terms at B----. So far there
had been no disorder of any kind. On the completion of his university
career he became zealously absorbed in his archæological work, which
gradually engulfed him to such an extent that he was dead to the world
and all its pleasures. He worked incessantly, and buried himself
entirely in his books. He became quite unsociable; before, awkward and
shy in society, he now fled from it altogether, and saw no one beyond
a few friends. He thus led the life of a hermit devoted entirely to
science. A few years later, on a holiday tour, he revisited B----,
where he remained a few days. He walked a great deal in the environs
of the town. His few acquaintances now found him somewhat strange,
taciturn, and nervous. After a somewhat protracted walk he seemed tired,
and said that he did not feel very well. He then remarked he must get
himself hypnotised, he felt his nerves unsteady. On top of this he was
attacked by physical illness, viz. inflammation of the lungs. Very
soon a peculiar state of excitement supervened which led to suicidal
ideas. He was brought to the asylum, where for weeks he remained in
an extremely excited state. He was completely deranged, and did not
know where he was; he spoke in broken sentences which no one could
understand. He was often so excited and aggressive that it took several
attendants to hold him. He gradually became quieter, and one day came to
himself, as if waking out of a long, confused dream. He soon completely
regained his health, and was discharged as cured. He returned to his
home and again immersed himself in books. In the following years he
published several remarkable works, but, as before, his life was that
of a hermit living entirely in his books and dead to the world. He then
gradually acquired the name of a dried-up misanthrope, lost to all
meaning of the beauty of life. A few years after his first illness a
brief holiday brought him again to B----. As before he took his solitary
walks in the environs. One day he was suddenly overcome by a faint
feeling, and lay down in the street. He was carried into a neighbouring
house where he immediately became extremely excited. He began to perform
gymnastics, jumped over the rails of the bed, turned somersaults in the
room, began to declaim in a loud, voice, sang his own improvisations,
etc. He was again brought to the asylum. The excitement continued. He
extolled his wonderful muscles, his beautiful figure, his enormous
strength. He believed that he had discovered a natural law by which
a wonderful voice could be developed. He regarded himself as a great
singer, and a marvellous reciter, and at the same time he was a great
inspired poet and composer to whom verse and melody came spontaneously.

All this was in pitiable and very remarkable contrast to reality. He is
a small weakly man of unimposing build, with poorly developed muscles
betraying at the first glance the atrophying effect of his studious
life. He is unmusical, his voice is weak and he sings out of tune; he is
a bad speaker, because of his stutter. For weeks he occupied himself in
the asylum with peculiar jumping, and contortions of the body which he
called gymnastics, he sang and declaimed. Then he became more quiet and
dreamy, often stared thoughtfully in front of him for a long time, now
and then sang a love song which, despite its want of musical expression,
betrayed a pretty feeling for love's aspirations. This also was in
complete contrast with the dryness and isolation of his normal life. He
gradually became accessible for lengthy conversations.

We will break off the history of the disease here, and sum up what is
furnished so far by observation of the patient.

In the first illness the delirium broke out unexpectedly, and was
followed by a mental disorder with confused ideas and violence which
lasted for several weeks. Complete recovery appeared to have taken
place. Six years later there was a sudden outbreak of mania, grandiose
delusions, bizarre actions, followed by a twilight-stage gradually
leading to recovery. Here we again see a typical case of dementia
præcox, of the katatonic variety, especially characterised by peculiar
movements and actions. In psychiatry the views obtaining at present
would regard this as localised cellular disease of some part of the
cortex, exhibiting confusional states, delusions of grandeur, peculiar
contortions of the muscles, or twilight-states, which taken all together
have as little psychological meaning as the bizarre shapes of a drop of
lead thrown into water.

This is not my view. It was certainly no accidental freak of the
brain-cells that created the dramatic contrasts shown in the second
illness. We can see that these contrasts, the so-called grandiose
delusions, were very subtly determined by the deficiencies in the
patient's personality. Without doubt, any one of us would naturally
regard these deficiencies seriously in ourselves. Who would not have
the desire to find compensation for the aridness of his profession and
of his life in the joys of poetry and music and to restore to his body
the natural power and beauty stolen from it by the study's atmosphere?
Do we not recall with envy the energy of a Demosthenes who, despite his
stammering, became a great orator? If our patient thus fulfilled the
obvious gaps in his physical and mental life by delusional wishes, the
supposition is warranted that the whispered love-song which he sang from
time to time filled up a painful blank in his being, which became more
painful the more it was concealed. The explanation is not far to seek.
It is simply the old story, born anew in every human soul, in a guise
befitting the destined creature's highest sensibilities.

When our patient was a student he learnt to know and love a
girl-student. Together they made many excursions in the environs of
the town, but his exceeding timidity and bashfulness (the lot of the
stammerer) never permitted him an opportunity of getting out the
appropriate words. Moreover, he was poor and had nothing to offer her
but hopes. The time came for the termination of his studies; she went
away, and he also, and they never saw one another again. And not long
afterwards he heard she had married some one else. Then he relinquished
his hopes, but he did not know that Eros never emancipates his slaves.

He buried himself in abstract learning, not to forget, but to work for
her in his thoughts. He wanted to keep the love in his heart quite
secret, and never to betray that secret. He would dedicate his works to
her without her ever knowing it. The compromise succeeded, but not for
long. Once he travelled through the town where he heard she lived--it
seems to have been an accident that he travelled through that town.
He did not leave the train, which only made a short halt there. From
the window he saw standing in the distance a young woman with a little
child, and thought it was she. Impossible to say whether it was really
so or not. He does not think he felt any peculiar feeling at that
moment; anyway he gave himself no trouble to ascertain whether it was
she, which makes the presumption strong that it was not really she.
The unconscious wanted to be left in peace with its illusion. Shortly
afterwards he again came to B----, the place of old memories. Then he
felt something strange stir in his soul, an uneasy feeling, akin to
Nietzsche's--

    "Not for long shalt thou thirst, O burning heart!
    There is promise in the air,
    Winds come to me from unknown mouths--
    The healing coolness comes."

Civilised man no longer believes in demons, he calls in the doctor. Our
patient wanted to be hypnotised. Then madness overcame him. What was
going on in him?

He answered this question in broken sentences, with long pauses, in that
twilight-stage that heralds convalescence. I give as faithfully as may
be his own words. When he fell ill he suddenly lost the well-regulated
world and found himself in the chaos of an overmastering dream, a sea of
blood and fire; the world was out of joint; everywhere conflagration,
volcanic outbreaks, earthquakes, mountains fell in, followed by enormous
battles where the peoples fell upon one another; he became involved more
and more in the battle of nature, he was right in the midst of those
fighting, wrestling, defending himself, enduring unutterable misery and
pain; gradually he was exalted and strengthened by a strange calming
feeling that some one was watching his struggles, that his loved one saw
all from afar. That was the time when he showed real violence to the
attendants. He felt his strength increasing and saw himself at the head
of great armies which he would lead to victory. Then more great battles
and at length victory. He would try to get his loved one as prize of
victory. As he drew near her the illness ceased, and he awoke from a
long dream.

His daily life again began to follow the regular routine. He shut
himself up in his work and forgot the abyss within himself. A few years
later he is again at B---- Demon or Destiny? Again he followed the
old trail and again was overborne by old memories. But this time he
was not immersed in the depths of confusion. He remained orientated
and _en rapport_ with his surroundings. The struggle was considerably
milder, but he did gymnastics, practised the arts, and made good his
deficiencies; then followed the dreamy stage with the love-songs,
corresponding to the period of victory in the first psychosis. In this
state, according to his own words, he had a dreamlike feeling as if he
stood upon the borders of two worlds and knew not whether truth stood on
the right or on the left. He told me, "It is said she is married, but I
believe she is not, but is still waiting for me; I feel that it must be
so. It is ever to me as if she were not married, and as if success were
yet attainable."

Our patient here portrayed but a pale copy of the scene in the first
attack of psychosis, when he, the victor, stood before his mistress.
In the course of a few weeks after this conversation the scientific
interests of the patient again began to predominate. He spoke with
obvious unwillingness about his intimate life, he repressed it more
and more, and finally turned away from it as if it did not belong to
himself. Thus gradually the gate of the under-world became closed.
There remained nothing but a certain tense expression, and a look
which, though fixed on the outer world, was turned inwards at the same
time; and this alone hinted at the silent activity of the unconscious,
preparing new solutions for his insoluble problem. This is the so-called
cure in dementia præcox.

Hitherto we psychiatrists used not to be able to suppress a laugh when
we read an artist's attempts to portray a psychosis. These attempts have
been generally regarded as quite useless, for the writer introduces
into his conception of the psychosis psychological relationships quite
foreign to the clinical picture of the disease. But the artist has not
simply proceeded to copy a case out of a psychiatric text-book; he knows
as a rule better than the psychiatrist.

The case which I have sketched is not unique, it is typical of a whole
class for which the artist Spitteler has created a model of universal
validity; the model is _Imago_. I may take for granted that you know his
book of that name. The psychological gulf, however, between the creation
of the artist and the insane person is great. The world of the artist
is one of solved problems; the world of reality, that of unsolved
problems. The mental patient is a faithful image of this reality. His
solutions are unsatisfying illusions, his cure a temporary giving up of
the problem, which yet goes on working in the depths of the unconscious,
and at the appointed time again rises to the surface and creates new
illusions with new scenery; part of the history of mankind is here seen
abridged.

Psychological analysis is far from being able to explain in complete and
illuminating fashion all cases of the disease with which we are here
concerned. On the contrary, the majority remain obscure and difficult to
understand, and chiefly because only a certain proportion of patients
recover. Our last patient is noteworthy because his return to a normal
state afforded us a survey of the period of his illness. Unfortunately
the advantage of this standpoint is not always possible to us, for a
great number of persons never find their way back from their dreams.
They are lost in the maze of a magic garden where the same old story
is repeated again and again in a timeless present. For patients the
hands of the clock of the world remain stationary; there is no time, no
further development. It makes no difference to them whether they dream
for two days or thirty years. I had a patient in my ward who was five
years without uttering a word, in bed, and entirely buried in himself.
For years I visited him twice daily, and as I reached his bedside I
could see at once that there was no change. One day I was just about to
leave the room when a voice I did not recognise called out--"Who are
you? What do you want here?" I saw with astonishment that it was the
dumb patient who had suddenly regained his voice, and obviously his
senses also. I told him I was his doctor, whereupon he asked angrily,
why was he kept a prisoner here, and why did no one ever speak to him?
He said this in an injured voice just like a normal person whom one had
neglected for a couple of days. I informed him that he had been in bed
quite speechless for five years and had responded to nothing, whereat
he looked at me fixedly and without understanding. Naturally I tried
to discover what had gone on in him during these five years, but could
learn nothing. Another patient with a similar symptom, when asked why
he had remained silent for years, maintained, "Because I wanted to
spare the German language."[199] These examples show that it is often
impossible to lift the veil of the secret, for the patients themselves
have neither interest nor pleasure in explaining their strange
experiences, in which as a rule they realise nothing peculiar.

Occasionally the symptoms themselves are a sign-post to the
understanding of the psychology of the disease.

We had a patient who was for thirty-five years an inmate at Burghölzli.
For decades she lay in bed, she never spoke or reacted to anything, her
head was always bowed, her back bent and the knees somewhat drawn up.
She was always making peculiar rubbing movements with her hands, so as
to give rise during the course of years to thick horny patches on her
hands. She kept the thumb and index finger of her right hand together
as in the movement of sewing. When she died I tried to discover what
she had been formerly. Nobody in the asylum recalled ever having seen
her out of bed. Only our chief attendant had a memory of having seen
her sitting in the same attitude as that she afterwards took up in bed,
at which time she was making rapid movements of extension of the arm
across the right knee; it was said of her that she was sewing shoes,
later that she was polishing shoes. As time went on the movements became
more limited till finally there remained but a slight rubbing movement,
and only the finger and thumb retained the sewing position. In vain
I consulted our old attendant, she knew nothing about the patient's
previous history. When the seventy-year-old brother came to the funeral
I asked him what had been the cause of his sister's illness; he told
me that she had had a love-affair, but for various reasons it had
come to nothing. The girl had taken this so to heart that she became
low-spirited. In answer to a query about her lover it was found that he
was a _shoemaker_.

Unless you see here some strange play of accident, you must agree that
the patient had kept the memory-picture of her lover unaltered in her
heart for thirty-five years.

One might easily think that these patients who give an impression of
imbecility are only burnt-out ruins of humanity. But such is probably
not the case. One can often prove directly that such patients register
everything going on around them even with a certain curiosity, and have
an excellent memory for it all. This is the reason why many patients
become for a time pretty sensible again, and develop mental powers which
one believed they had long since lost. Such intervals occur occasionally
during serious physical disease, or just before death. We had a patient
with whom it was impossible to carry on a sane conversation; he only
produced a mad medley of delusions and words. He once fell seriously
ill physically, and I expected it would be very difficult to treat him.
Not at all. He was quite changed, he became friendly and amiable, and
carried out all his doctor's orders patiently and gratefully. His eyes
lost their evil darting looks, and shone quietly and understandingly.
One morning I came to his room with the usual greeting: "Good morning.
How are you getting on?" The patient answered me in the well-known way:
"There again comes one of the dog and monkey troupe wanting to play the
Saviour." Then I knew his physical trouble was over. From that moment
the whole of his reason was as if "blown away" again.

From these observations we see that reason still survives, but is pushed
away into some corner by the complete preoccupation of the mind with
diseased thoughts.

Why is the mind compelled to exhaust itself in the elaboration of
diseased nonsense? On this difficult question our new insight throws
considerable light. To-day we can say that the pathological images
dominate the interests of the patient so completely, because they are
simply derivatives of the most important questions that used to occupy
the person when normal--what in insanity is now an incomprehensible
maze of symptoms used to be fields of vital interest to the former
personality.

I will cite as an example a patient who was twenty years in the asylum.
She was always a puzzle to the physicians, for the absurdity of her
delusions exceeded anything that the boldest imagination could create.

She was a dressmaker by trade, born in 1845, of very poor family.
Her sister early went wrong and was finally lost in the swamp of
prostitution. The patient herself led an industrious, respectable,
reserved life. She fell ill in 1886 in her 39th year--at the threshold
of the age when so many a dream is brought to naught. Her illness
consisted in delusions and hallucinations which increased rapidly,
and soon became so absurd that no one could understand her wishes and
complaints. In 1887 she came to the asylum. In 1888 her statements,
so far as the delusions were concerned, were not intelligible. She
maintained such monstrous things as that: "At night her spinal marrow
had been torn out; pains in the back had been caused by substances that
went through the walls and were covered with magnetism." "The monopoly
fixed the sorrows which are not in the body and do not fly about in the
air." "Excursions are made by breathing in chemistry, and by suffocation
regions are destroyed."

In 1892 the patient styled herself the "Bank Note Monopoly, Queen of the
Orphans, Proprietress of the Burghölzli Asylum;" she said: "Naples and I
must provide the world with macaroni" (Nudel).

In 1896 she became "Germania and Helvetia from exclusively pure butter";
she also said, "I am Noah's Ark, the boat of salvation and respect."

Since then the disease has greatly increased; her last creation is the
delusion that she is the "lily red sea monster and the blue one."

These instances will show you how far the incomprehensibility of such
pathological formations go. Our patient was for years the classic
example of meaningless delusional ideas in dementia præcox; and many
hundreds of medical students have received from the demonstration of
this case a permanent impression of the sinister power of insanity. But
even this case has not withstood the newer technique of psychoanalysis.
What the patient says is not at all meaningless; it is full of
significance, so that he who has the key can understand without overmuch
difficulty.

Time does not allow me to describe the technique by means of which I
succeeded in lifting the veil of her secret. I must content myself by
giving a few examples to make the strange changes of thought and of
speech in this patient clear to you.

She said of herself that _she was Socrates_. The analysis of this
delusion presented the following ideas: Socrates was the wisest man,
the man of greatest learning; he was infamously accused, and had to die
in prison at the hands of strange men. She was the best dressmaker, but
"never unnecessarily cut a thread, and never allowed a piece of material
to lie about on the floor." She worked ceaselessly, and now she has been
falsely accused, wicked men have shut her up, and she will have to die
in the asylum.

Therefore she is Socrates; this is, as you see, simple metaphor, based
upon obvious analogy. Take another example: "_I am the finest professor
and the finest artist in the world._"

The analysis furnishes the remarks that she is the best dressmaker and
chooses the most beautiful models which show up well and waste little
material; she puts on the trimming only where it can be seen. She is a
professor, and an artist in her work. She makes the best clothes and
calls them absurdly "The Schnecke Museum-clothes." Her customers are
only such persons as frequent the Schnecke House and the Museum (the
Schnecke House is the aristocratic club. It is near the Museum and the
Library, another rendezvous of the aristocratic set of Zürich), for she
is the best dressmaker and makes only Schnecke Museum[200] clothing.

The patient also _calls herself Mary Stuart_. Analysis showed the same
analogy as with Socrates: innocent suffering and death of a heroine.

"_I am the Lorelei._" Analysis: This is an old and well-known song: "I
know not what it means," etc. Whenever she wants to speak about her
affairs people do not understand her, and say they don't know what it
means; hence she is the Lorelei.

"_I am Switzerland._" Analysis: Switzerland is free, no one can rob
Switzerland of her freedom. The patient does not belong to the asylum,
she would be free like Switzerland, hence she is Switzerland.

"_I am a crane._" Analysis: In the "Cranes of Ibykus" it is said:
"Whosoever is free of sin and fault shall preserve the pure soul of
a child." She has been brought innocent to the asylum and has never
committed a crime--hence she is a crane.

"_I am Schiller's Bell._" Analysis: Schiller's Bell is the greatest work
of the great master. She is the best and most industrious dressmaker,
and has achieved the highest rung in the art of dressmaking--hence she
is Schiller's Bell.

"_I am Hufeland._" Analysis: Hufeland was the best doctor. She suffers
intolerably in the asylum and is moreover treated by the worst doctors.
She is, however, so prominent a personality that she had a claim to the
best doctors, that is to a doctor like Hufeland--hence she is Hufeland.

The patient used the expression "I am" in a very arbitrary way.
Sometimes it meant "it belongs to me" or "it is proper for me";
sometimes it means "I should have." This is seen from the following
analysis:

"_I am the master-key._" Analysis: The master-key is the key that opens
all the doors of the asylum. Properly, according to all rights, the
patient should long since have obtained this key for she has been for
many years "the proprietress of the Burghölzli Asylum." She expresses
this reflection very much simplified in the sentence, "I am the
master-key."

The chief content of her delusions is concentrated in the following
words:--

"_I am the monopoly._" Analysis: The patient means the banknote
monopoly, which has belonged to her for some time. She believes that
she possesses the monopoly of the entire bank notes of the world, thus
creating enormous riches for herself, in compensation for the poverty
and lowliness of her lot. Her parents died early; hence she is the
Queen of the Orphans. Her parents lived and died in great poverty. Her
blessings are extended to them also, the dreamlike delusions of the
patient benefit them in many ways. She says textually: "My parents are
clothed by me, my sorely-tried mother, full of sorrow--I sat with her at
table--covered in white with superfluity."

This is another of these malleable hallucinations which the patient had
daily. It is one of those scenes of wish-fulfilment, with poverty on
one side and riches on the other, recalling Hauptmann's Hannele; more
especially that scene where Gottwald says: "She was clothed in rags--now
she is bedeckt in silken robes; and she ran about barefoot--now she has
shoes of glass to her feet. Soon she will live in a golden castle and
eat each day of baked meats. Here has she lived on cold potatoes...."

The wish-fulfilments of our patient go even further. Switzerland has
to furnish her with an income of 150,000 francs. The Director of the
Burghölzli owes her 80,000 francs damages for wrongful incarceration.
She is the proprietress of a distant island with silver mines, the
"mightiest silver island in the world." Therefore she is also the
greatest orator, possesses the most wonderful eloquence, for, as she
says, "Speech is _silver_, silence gold." To her all the beautiful
landed estates belong--all the rich quarters, towns and lands, she
is the proprietress of a world, even a "threefold proprietress of
the world." Whilst poor Hannele was only elevated to the side of the
Heavenly Bridegroom, our patient has the "Key of Heaven," she is not
only the honoured earthly queens Mary Stuart and Queen Louise of
Prussia, but she is also the Queen of Heaven, the Mother of God as well
as the Godhead. Even in this earthly world where she was but a poor,
ill-regarded homely dressmaker she attained fulfilments of her human
wishes, for she had taken three husbands from the best families in
the town and her fourth was the Emperor Francis. From these marriages
there were two phantom children--a little boy and a little girl. Just
as she clothed, fed and feasted her parents, so she provided for the
future of her children. To her son she bequeathed the great bazaar of
Zürich, therefore her son is a "Zur," for the proprietor of a _Bazaar_
is a "Zur." The daughter resembles her mother; hence she becomes the
proprietress of the asylum and takes her mother's place so that the
mother is released from captivity. The daughter therefore receives the
title of "Agency of Socrates," for she replaces Socrates in captivity.

These instances by no means exhaust the delusional fancies of the
patient. But they will give you some idea, I hope, of the richness
of her inner life although she was apparently so dull and apathetic,
or, as was said _imbecile_, and sat for twenty years in her workroom,
where she mechanically repaired her linen, occasionally uttering a
complex of meaningless fragments which no one had hitherto been able to
understand. Her odd lack of words can now be seen in another light; they
are fragments of enigmatical inscriptions, of fairy-story phantasies,
which have escaped from the hard world to found a world of their own.
Here the tables are ever laden, and a thousand feasts are celebrated in
golden palaces. The patient can only spare a few mysterious symbols for
the gloomy dim shores of reality; they need not be understood, for our
understanding has not been necessary for her for this long time.

Nor is this patient at all unique. She is one of a type. Similar
phantasies are always found in patients of this kind, though not always
in such profusion.

The parallels with Hauptmann's Hannele show that here likewise the
artist has shown us the way with the free creation of his own phantasy.
From this coincidence, which is not accidental, we may conclude that
there is something common both to the artist and the insane and not to
them alone. Every human being has also within himself that restless
creative phantasy which is ever engaged in assuaging the harshness
of reality. Whoever gives himself unsparingly and carefully to
self-observation, will realise that there dwells within him something
which would gladly hide and cover up all that is difficult and
questionable in life, and thus procure an easy and free path. Insanity
grants the upper hand to this something. When once it is uppermost,
reality is more or less quickly driven out. It becomes a distant dream,
and the dream which enchains the patient wholly or in part, and often
for life, has now the attributes of reality. We normal persons, who have
to do entirely with reality, see only the products of disordered fancy,
but not the wealth of that side of the mind which is turned away from
us. Unfortunately only too often no further knowledge reaches us of the
things which are transpiring on that other side, because all the bridges
are broken down which unite this side with that.

We do not know to-day whether these new views are of universal or only
of limited validity; the more carefully and perseveringly we examine our
patients, the more we shall meet cases, which, despite apparent total
imbecility, will yet afford us at least some fragmentary insight into
the obscurities of the psychical life. This life is far removed from
that mental poverty which the prevailing theories were compelled to
accept.

However far we are from being able to understand fully the
concatenations of that obscure world, at least we may maintain, with
complete assurance, that in dementia præcox there is no symptom which
can be described as psychologically baseless and meaningless. The
most absurd things are in reality symbols of ideas which are not
only generally understandable, but also universally operative in the
human heart. In insanity we do not discover anything new and unknown,
but we look at the foundation of our own being, the source of those
life-problems in which we are all engaged.

PART II.[201]

The number of psychoanalytic investigations into the psychology of
dementia præcox has considerably increased since the publication of my
book upon the subject.[202] When, in 1903, I made the first analysis
of a case of dementia præcox, there dawned on me a premonition of the
possibilities of future discoveries in this sphere. This has been
confirmed.

Freud first submitted a case of paranoid dementia to closer
psychological investigation.[203] This he was enabled to do by means
of an analytic technique perfected through his rich experiences with
neurotics. He selected the famous autobiography of P. Schreber,
"Denkwürdigkeiten eines Nervenkranken." The patient could not be
analysed personally, but having published his most interesting
autobiography all the material wanted for an analysis was to be found in
it.

In this study Freud shows out of what infantile forms of thought and
instincts the delusional system was built up. The peculiar delusions
which the patient had about his doctor whom he identified with God
or with a god-like being, and certain other surprising and really
blasphemous ideas, Freud was able to reduce most ingeniously to his
infantile relationship to his father. This case also presented similar
bizarre and grotesque concatenations of ideas to the one I have
described. As the author himself says, his work confines itself to the
task of pointing out those universally existent and undifferentiated
foundations out of which we may say every psychological formation is
historically developed.[204] This reductive analytical process did not,
however, furnish such enlightening results in regard to the rich and
surprising symbolism in patients of this kind as we had been accustomed
to expect from the same method in the realm of the psychology of
hysteria. In reading certain works of the Zürich school, for example,
Maeder,[205] Spielrein,[206] Nelken,[207] Grebelskaja,[208] Itten,[209]
one is powerfully impressed by the enormous symbol-formation in dementia
præcox.

Some of the authors still proceed essentially by the method of analytic
reduction, tracing back the complicated delusional formation into its
simpler and more universal components, as I have done in the preceding
pages. One cannot, however, resist the feeling that this method hardly
does justice to the fulness and the almost overpowering wealth of
phantastic symbol-formation, although it does undoubtedly throw a light
upon the subject in certain directions.

Let me illustrate with an example. We should be thankful for a
commentary upon "Faust" which traced back all the diverse material of
Part II. to its historical sources, or for a psychological analysis
of Part I. which pointed out how the dramatic conflict corresponds to
a personal conflict in the soul of the poet; we should be glad of an
exposition which pointed out how this subjective conflict is itself
based upon those ultimate and universal human things which are nowise
foreign to us since we all carry the seeds of them in our hearts.
Nevertheless we should be a little disappointed. We do not read "Faust"
just in order to discover that also we are, in all things, "human, all
too human." Alas, we know that but too well already. Let any one who
has not yet learnt it go for a little while out into the world and look
at it without preconceptions and with open eyes. He will turn back from
the might and power of the "too human," hungrily he will pick up his
"Faust," not to find again what he has just left, but to learn how a man
like Goethe shakes off these elemental human things and finds freedom
for his soul. When we once know who was the "Proktophantasmist," to what
chronological events the mass of symbols in Part II. relates, how it is
all intimately bound up with the poet's own soul and conditioned by it,
we come to regard this determination as less important than the problem
itself--what does the poet mean by his symbolic creation? Proceeding
purely reductively, one discovers the final meaning in these universal
human things; and demands nothing further from an explanation than that
the unknown and complicated shall be reduced to the known and simple. I
should like to designate this kind of understanding as _retrospective
understanding_. But there is another kind of understanding, which is not
analytic reduction, but is of a _synthetic_ or _constructive_ nature. I
would designate this _prospective understanding_, and the corresponding
method as the _Constructive method_.

It is common knowledge that present-day scientific explanation rests
upon the basis of the causal principle. Scientific explanation is
causal explanation. We are therefore naturally inclined, whenever we
think scientifically, to explain causally, to understand a thing and
to regard it as explained whenever it is reduced analytically to its
cause and general principle. In so far Freud's psychological method of
interpretation is strictly scientific.

If we apply this method to "Faust" it must become clear that something
more is required for a true understanding. It will even seem to us
that we have not gathered the poet's deepest meaning if we only see in
it universal foregone human conclusions. What we really want to find
out is how this man has redeemed himself as an individual, and when we
arrive at this comprehension then we shall also understand the symbol
given by Goethe. It is true we may then fall into the error that we
understand Goethe himself. But let us be cautious and modest, simply
saying we have thereby arrived at an understanding of ourselves. I am
thinking here of Kant's thought-compelling definition of comprehension,
as "the realisation of a thing to the extent which is sufficient for our
purpose."

This understanding is, it is true, subjective, and therefore not
scientific for those to whom science and explanation by the causal
principle are identical. But the validity of this identification is open
to question. In the sphere of psychology I must emphasise my doubt on
this point.

We speak of "objective" understanding when we have given a causal
explanation. But at bottom, understanding is a subjective process upon
which we confer the quality "objective" really only to differentiate it
from another kind of understanding which is also a psychological and
subjective process, but upon which, without further ado, we bestow the
quality "subjective." The attitude of to-day only grants scientific
value to "objective" understanding on account of its universal
validity. This standpoint is incontestably correct wherever it is not a
question of the psychological process itself, and hence it is valid in
all sciences apart from pure psychology.

To interpret Faust objectively, _i.e._ from the causal standpoint, is as
though a man were to consider a sculpture from the historical, technical
and--last but not least--from the mineralogical standpoint. But where
lurks the _real meaning_ of the wondrous work? Where is the answer to
that most important question: what aim had the artist in mind, and how
are we ourselves to understand his work subjectively? To the scientific
spirit this seems an idle question which anyhow has nothing to do with
science. It comes furthermore into collision with the causal principle,
for it is a purely speculative constructive view. And the modern world
has overthrown this spirit of scholasticism.

But if we would approach to an understanding of psychological things we
must remember the fact of the subjective conditioning of all knowledge.
The world is _as we see it_ and not simply objective; this holds true
even more of the mind. Of course it is possible to look at the mind
objectively, just as at Faust, or a Gothic Cathedral. In this objective
conception there is comprised the whole worth and worthlessness of
current experimental psychology and psychoanalysis. The scientific mind,
thinking causally, is incapable of understanding what is ahead; it only
understands what is past, that is, retrospective. Like Ahriman, the
Persian devil, it has the gift of After-Knowledge. But this spirit is
only one half of a complete comprehension. The other more important half
is prospective or constructive; if we are not able to understand what
lies ahead, then nothing is understood. If psychoanalysis, following
Freud's orientation, should succeed in presenting an uninterrupted and
conclusive connection between Goethe's infantile sexual development and
his work, or, following Adler, between the infantile struggle for power
and the adult Goethe and his work, an interesting proposition would have
been solved--we should have learnt how a masterpiece can be reduced to
the simplest thinkable elements, which are universal, and to be found
working within the depths of everything and everybody. But did Goethe
construct his work to _this_ end? Was it his intention that it should be
thus conceived?

It must be sufficiently clear that such an understanding, though
undoubtedly scientific, would be entirely, utterly, beside the mark.
This statement is valid for psychology in general. To understand
the psyche causally, means to understand but half of it. The causal
understanding of Faust enlightens us as to how it became a finished work
of art, but reveals nothing of the living meaning of the poet. That
meaning only lives if we experience it, in and through ourselves. In so
far as our actual present life is for us something essentially new and
not a repetition of all that has gone before, the great value of such
a work is to be seen, not in its causal development, but in its living
reality for our own lives. We should be indeed depreciating a work like
Faust if we were only to regard it as something that has been perfected
and finished; it is only understood when conceived as a becoming and as
an ever new-experiencing.

Thus we must regard the human psyche. Only on one side is the mind a
Has Been, and as such subordinate to the causal principle. On the other
side the mind is a Becoming that can only be grasped synthetically or
constructively. The causal standpoint asks how it is this actual mind
has become what it appears to-day? The constructive standpoint asks how
a bridge can be built from this actual psyche to its own future?

Just as the causal method finally reaches the general principles of
human psychology by the analysis and reduction of individual events,
so does the constructive standpoint reach aims that are general by the
synthesis of individual tendencies. The mind is a point of passage and
thus necessarily determined from two sides. On the one side it offers a
picture of the precipitate of the past, and on the other side a picture
of the germinating knowledge of all that is to come, in so far as the
psyche creates its own future.

What has been is, on the one hand, the result and apex of all that
was--as such it appears to the causal standpoint; on the other hand, it
is an expression of all that is to be. The future is only _apparently_
like the past, but in its essence always new and unique, (the causal
standpoint would like to invert this sentence) thus the actual formula
is incomplete, germlike so to say, in relation to what is to be.

To get any conception of this expression of what is to be we are forced
to apply a constructive interest to it. I almost felt myself tempted
to say, "a scientific interest." But modern science is identical with
the causal principle. So long as we consider the actual mind causally,
that is scientifically, we elude the mind as a Becoming. This other side
of the psyche can never be grasped by the exclusive use of the causal
principle, but only by means of the constructive standpoint. The causal
standpoint reduces things to their elements, the constructive standpoint
elaborates them into something higher and more complicated. This latter
standpoint is necessarily a speculative one.

Constructive understanding is, however, differentiated from scholastic
speculation because it imposes no general validity, but only subjective
validity. When the speculative philosopher believes he has comprehended