THE PSYCHOLOGY OF DEMENTIA PRAECOX DR. C. G. JUNG ** PRIVATE DOCENT IN PSYCHIATRY, UNIVERSITY OF ZURICH AUTHORIZED TRANSLATION WITH AN INTRODUCTION BY FREDERICK PETERSON, M.D. PROFESSOR OF PSYCHIATRY, COLUMBIA UNIVERSITY, NEW YORK AND A! A. BRILL, PH.B., M.D. ASSISTANT IN PSYCHIATRY, COLUMBIA UNIVERSITY, NEW YORK NEW YORK THE JOURNAL OF NERVOUS AND MENTAL DISEASE PUBLISHING COMPANY 1909 1 PSYCHOLOGY DEPARTMENT Order. /7 Copyright, 1909, by THE JOURNAL OF NERVOUS AND MENTAL DISEASE PUBLISHING COMPANY - v , y \ \^\ , PRESS OF THE NEW ERA PRINTING COMPANY LANCASTER. PA CONTENTS. TRANSLATORS' INTRODUCTION v AUTHOR'S PREFACE xix CHAPTER I. Critical Presentation of Theoretical Views on the Psychology of Dementia Praecox. i CHAPTER II. The Emotional Complex and its General Action on the Psyche . . . .36 CHAPTER III. The Influence of the Emotional Complex on Association 50 CHAPTER IV. Dementia Praecox and Hysteria, a Parallel. 69 CHAPTER V. Analysis of a Case of Paranoid Dementia as a Paradigm 99 CONCLUSION 153 111 TRANSLATORS' INTRODUCTION. To Kraepeliii. belongs the credit of having introduced new life into psychiatry by his indefatigable study of his patients for long years, his keen clinical insight, and especially by an independence of thought which led him to fearlessly shatter the traditions of centuries as regards the classification of mental diseases. As a pupil of Wundt he was able to apply new methods of clinical investigation drawn from psychology. As is well known he has brought together mania and melancholia as a single disorder under the title manic-depressive insanity. This conception, vig- orously attacked at first, has probably come to stay. It is other- wise with his creation of dementia praecox, which is still strongly objected to in many quarters, chiefly because it seems to be a kind of waste basket into which are thrown all forms of mental dis- ease that cannot be tagged with another name. This disorder appears in so many guises that it is already divided into hebe- phrenic, catatonic and paranoid groups, and Kraepelin himself has intimated that in time it will be broken up into still further groups or types. It is his merit, however, to have placed before us this psychological species even if the outlines are gross and the details more or less obscure. In following Kraepelin we find that he only offers us a general and superficial view of the disease. From his description we learn that the patients are peculiar in speech and actions, that they utter numerous senseless remarks, repeat meaningless words or syllables, and that now and then they commit foolish and impulsive acts, but no attempt is made to examine the nature and origin of these peculiar utterances and actions. When we review the cases described in Kraepelin's works we find that whereas most of them show hallucinations and delusions, these are not at all of the same content or nature; the verbigerations and manner- isms, too, differ in different cases. The same similarities and divergences are to be noticed in every hospital. We recall a patient whose auditory hallucinations were attributed to a child, vi TRANSLATORS' PREFACE. and another who heard the voice of God. The mannerisms of one were characterized by a continuous rubbing on the top of his head, while another for hours described certain figures in the air. Are these diversities accidental or have they a reason? Is there any difference between Kraepelin's patient who saw a blue heart up above, and behind it quivering sunshine and another blue heart, " a little woman's heart," 1 and the patient who 2 lived by the word of God, a raven was at the window who wished to eat his flesh; or between the patient who repeated numerous times the same unintelligible sentences " one for all and all for one, and two for all and three for all," etc., 3 and the patient who speaks about " a poinard with a nuptial note " ? 4 The same questions could be asked about the manifold so-called senseless actions of patients. Kraepelin makes no attempt to explain these senseless utterances and actions. In other words, whereas he gives us an accurate, almost photographic account of the patient's general behavior, he does not enter into his psychological productions. He contents himself with noting that the patient entertains such and such hal- lucinations and delusions, and such and such mannerisms, with- out examining the causal relations. Those who work among the insane know that no two cases of dementia prsecox are alike; there is always a difference in the grouping and relationship of the symptoms, every case having its own individuality. Krae- pelin, like his predecessors, totally ignores individual psychology, a thing absolutely essential for the understanding of the psycho- sis, just as the microscope is for pathology. The present difficul- ties in classification are mainly due to a lack of knowledge of the influence of individuality without which no real classification is possible. Bleuler 5 and Jung 6 inaugurated a new epoch in psychiatry by attempting to penetrate into the mysteries of the individual influ- ence of the symptoms. They show conclusively why we have here this combination and there that combination of symptoms. In the cases described by them we see that the senseless expres- 1 Kraepelin : Psychiatrische Klinik, p. 29. 'Ibid., p. 26. 8 Ibid., p. 37. * Kraepelin: Psychiatric, Vol. II, p. 152. 5 Bleuler : Affektivitat, Suggestibility, Paranoia, Marhold, Halle. *Jung: Uber die Psychologic der Dementia Praecox, Marhold, Halle. TRANSLATORS PREFACE. vii sions and actions have their reasons. But both Bleuler and Jung 7 are only pioneers in a new field; they are not the discoverers of this terra incognita. The honor of this belongs to Breuer and Freud. In 1895 Breuer and Freud published the " Studien iiber Hys- teric," 8 in which they showed that hysterical symptoms were symbolic representations of individual experiences which were incompatible with the personality and hence repressed from consciousness. This will be best illustrated by an abstract of a case described by Freud in the aforesaid work. 9 Miss Lucy R., thirty years old, had been treated by a specialist for purulent rhinitis. Some time after she again applied for treatment; this time, however, she suffered from complete anos- mia and was almost constantly annoyed by two subjective sensa- tions of smell. She was also depressed and anergic, complained of a heavy head, loss of appetite and inability to work. As no local affection could then be found to account for these symptoms she was recommended to Freud. Besides the symptoms enumerated above Freud found distinct hysterical symptoms. She showed a general analgesia without any disturbances of tactile sensation. The nasal mucous mem- brane was totally analgesic and its reflexes absent. Freud then thought that the subjective sensations of smell and the depression were equivalents for hysterical attacks, that those odors were once objective and due to some trauma, and that they returned to memory in the form of symbols of subjective sensation. But in order to assume this theory it was absolutely necessary that the subjective sensations of smell should show such a specializa- tion as to correspond with the real object of their origin. When the patient was asked to describe the odor which annoyed her most, she stated that it was like " burned pastry." It was there- fore assumed that the odor of burned pastry was probably some actual traumatic experience. Her history was uneventful; she was a governess, having the care of two children whose mother died a few years ago, the father being a manufacturer in the suburbs of Vienna. The odor of burned pastry was taken as the ' Jung : Diagnostische Associationsstudien, Earth, Leipzig. * Breuer and Freud : Studien iiber Hysteric, Deuticke, Leipzig und Wien. * Ibid., p. 90. viii TRANSLATORS' PREFACE. starting point for the analysis. Employing the method of con- tinuous associations the patient was asked to concentrate her mind on the odor of burned pastry and then tell under what cir- cumstances it originated. After long and persevering labor she finally recalled that it occurred about two months before. It was just two days before her birthday. She was with the two chil- dren (girls) in the school room teaching them to cook when a letter was brought to her from her mother in Glasgow. The children grasped the letter, remarking that it was probably a birthday congratulation and they would keep it until her birthday. While the children were thus bickering they forgot the pastry which they were cooking and it was burned. Since that time she had perceived that odor almost constantly and it was gener- ally enhanced on excitement. When asked why she was then excited she answered that " the children were so attached to her." They were always attached to her, but just then she received a letter from her mother. When asked to explain the contrast produced by the attachment of the children and her mother's letter, she stated that at that time she had intended to go home to her mother and had a heavy heart at the thought of leaving the children. To the question why she wished to leave her posi- tion, she stated that things were unbearable. She no longer lived in harmony with the other servants because they imagined that she considered herself too proud for her position. They said many things to her employers about her and when she com- plained she was not upheld. She then decided to resign and spoke about it to her employer. He was quite friendly and advised her to reconsider it. It was while she was in that state of indecision that the incident with the letter took place. Besides that she was a distant relative to the mother of the children who on her death bed asked her to care for the children and " take the place of their mother." When she was to resign she enter- tained many scruples about breaking this promise. This apparently analyzes the subjective sensation of smell. It was really once an objective sensation and intimately associated with an experience in which there was a play of contrary affects, the sorrow at leaving the children and the mortification urging her to that decision. The letter naturally recalled the motive of this decision, because she thought of returning to her mother. TRANSLATORS' PREFACE. ix The conflict of affects raised this moment to a trauma and the sensation of smell which was connected with it remained as a symbol of it. The sense of smell is rarely made use of as a symbol, but in this case we know that she suffered from a chronic nasal affection and just then she suffered from severe coryza and could hardly smell anything; in her excitement, however, she perceived the odor of burned pastry. As plausible as this sounded there was still something lacking. Freud asked himself why this conflict of affects should have led to hysteria, why did it not remain on a normal psychological basis; in other words, what justified this conversion? Previous experience showed that in all newly acquired hysterias one psy- chological determination is invariable, namely, that some presen- tation must intentionally be repressed from consciousness and excluded from psychical collaboration. " In this intentional repression I also noticed the reason for the conversion of the sum of excitement, be it partial or total. The sum of excitation which cannot enter the psychic association thus finds the way to bodily innervation. The reason for the repression can only be a painful feeling. The repressed idea was incompatible with the ego. The repressed presentation avenges itself by becoming pathogenic." From this he concluded that in the moment of hysterical con- version there must have been one trauma which she intentionally left in darkness. There was only one interpretation. He then told her that he believed that besides her attachment for the children she also loved her employer. Hesitatingly she answered, " Yes, I believe it is true." Asked why she did not mention this before she said, " Why, I didn't know it, or rather I did not wish to know it ; I wanted to crowd it out of my head, never to think of it, and of late I was successful." After this admission all resistance was broken. She then related that during the first few years of her service she entertained no such wishes until one day when her master, a rather reserved and very busy man, talked confidentially with her concerning the rearing of the chil- dren. He was then more cordial than usual. He said that he counted on her to bring up his orphaned children and looked at her rather peculiarly. It was at this moment that she began to love him and entertain pleasant hopes. But, as this was not x TRANSLATORS' PREFACE. followed by anything else, and in spite of her long wait, he never gave her another confidential heart to heart talk, she tried " to push it out of her mind." After this analysis there was some improvement, the subjective sensation became weaker, though it had not entirely disappeared, manifesting itself whenever she became excited. The persistence of this symbol was due to the fact that besides the main trauma it also represented many side traumas, so that it was necessary to analyze all episodes connected with the main scene. It finally disappeared, only to be replaced by another subjective odor " like the smoke of a cigar." As ungratifying as this was an imme- diate attempt was made to analyze it. When asked to recall the circumstances of the origin of this sensation she was at first unable to do so, remarking that the odor could be constantly per- ceived in the house, but finally under concentration she saw a picture of a table scene. It was in the dining room at dinner, where besides the usual company there was a guest, the chief accountant of the firm, an old gentleman who was a frequent visitor and who loved the children as though they were his grand- children. While taking leave the visitor attempted to kiss the children when the host cried out, " Please don't kiss the children." " I then experienced a stitch in the heart, and as they were smok- ing this odor remained in my memory." This therefore was the second scene causing the trauma and leaving the memory symbol. But why was this scene so affec- tive? On analysis it was found that it preceded the burned pastry by about two months. It was not, however, obvious why she should have been so affected when the old gentleman was prevented from kissing the children. She stated that the father objected to strangers kissing the children, and that a few months before this episode a lady visited the house and on leaving kissed the children. At that time the father said nothing to the lady, but afterwards upbraided her for permitting it, saying that if it ever happened again he would entrust the bringing up of his children to some one else. This happened while she believed herself loved and soon expected a second confidential talk. This episode shattered all her hopes because if he could reproach her for a thing of which she was perfectly innocent he could not entertain any feeling for her. This painful incident was mani- TRANSLATORS' PREFACE. xi festly recalled when the bookkeeper attempted to kiss the children. This ended the analysis and the patient was cured. A few days later the anosmia disappeared and the reflex returned. This abstract shows very nicely how the symptoms were noth- ing other than painful psychical experiences symbolically con- verted into physical ones. The traumatic moment causing this conversion is that in which the contradiction thrusts itself on the ego and is therefore banished by it. The banishment does not annihilate the opposing presentation, but crowds it into the un- conscious. This process occurring for the first time forms the nucleus and crystallization point for the formation of a psychic group separated from the ego, around which collects everything in accord with the contradictory presentation. The splitting of consciousness in such cases is intentional; it is often initiated by at least one arbitrary act. However something else happens than the individual intends; he wishes to eliminate a presentation as though it never came to pass, but only succeeds in isolating it psychically. The traumatic moment in our patient corresponds to the time when she was upbraided by her master for allowing the children to be kissed. For the time being this episode remained without any apparent effects, perhaps it caused the depression and sensi- tiveness. The hysterical symptoms commenced later in moments which can be designated as " auxiliary " and which are charac- terized by a simultaneous flowing together of both psychical groups. The first moment in which the conversion took place in Miss Lucy was the scene at the table when the chief accountant attempted to kiss the children. This evoked the traumatic mem- ory and she behaved as though she had not entirely banished her attachment for her master. The second auxiliary moment almost followed the mechanism of the first. It is interesting to note how the symptom coming second covered the first so that it was not clearly distinguished until the former was eliminated, a thing quite usually observed in psychanalysis. The therapy consisted in forcing the union of the split-off psychic groups with the ego-consciousness. Xll TRANSLATORS PREFACE. Similar conclusions were reached by Jung on the basis of experimental psychology. 10 Jung and Riklin collected a great number of associations from normal persons with the intention of finding out first whether there exists any regularity in the reactions, and second whether there are definite reaction types. It was soon found that the process of association is an extraordinarily flighty and variable psychic process, and is under the influence of numberless psy- chical events which are beyond the limits of objective control. It was also found that attention exerts the greatest influence on the association process. It directs and modifies the associative process and at the same time can be most readily controlled by experiments. It is the delicate affective apparatus which is the first to react in abnormal physical and psychic conditions, thus modifying the associative accomplishments. It was therefore decided to investigate experimentally the following questions: 1. The laws of fluctuation in association within normal limits. 2. The direct effects of attention on the process of association, especially whether the validity of association relatively diminishes with the distance from the fixation point of consciousness. A number of educated and uneducated persons were exam- ined. A hundred stimulus words were given and the reactions noted. The reaction time was measured with a one fifth second stop watch. The second series consisted of one hundred asso- ciations plus internal distraction by means of the " A-phenome- non " (Cordes), and the third series of one hundred associations was taken by external distraction by means of a metronome. Altogether 12,400 associations were taken and were classified as follows : I. Inner associations. 1. Coordination; e. g., cherry apple, murder gallows, sea depth, father God. 2. Predicative relation; e. g., snake poisonous, war bloody, mountain beautiful, water refreshing. 3. Causal dependence; e. g., cut pain, pain tears, appetite fat, frost cold. 10 Jung und Riklin : Diagnost. Associationsstudien, Beit., I. TRANSLATORS' PREFACE. xiii II. Outer associations. 1. Coexistence; e. g., ink pen, pupil teacher, Sunday rest, table chair. 2. Identity; e. g., beautiful handsome, quarrel fight. 3. Speech motor forms; e. g., to suffer hunger, to bow head, to do right, white black. III. Sound reactions. 1. Word completion; e, g., wonder ful, friend- friendly. 2. Sound ; e. g., blanket blank, haircut cut, longing long, biting fight. 3. Rhyme; e. g., nice rice, ship trip, never clever, bone stone. IV. Remnant group. I. Mediate reactions; e.g., grass wheel hay green, Cleveland round water Miss X is a /\ /\ muddy shallow, false blond 2. Senseless reactions, where no words or associations are given. 3. Failure = no reaction, and is due mostly to emotivity. 4. Repeated stimulus word, another emotional phe- nomenon. A. Perse veration, when reaction belongs to the preceding or following association. B. Egocentric reaction; e. g., rich am I, young am I. C. Repetitions = repetition of content or style. D. Speech combinations; e. g., alliteration, same endings, etc. On examining many associations it was found that the numer- ical relations in single individuals were quite fluctuating. The main reason for this, besides the individual ones, is the intensity of attention. The fact that certain individuals react by inner associations and others preferentially by outer associations is in the first place a phenomenon of attention. Every person en- dowed with speech has manifold qualities of associations at his disposal, the association quality uttered depending on the degree xiv TRANSLATORS' PREFACE. of attention evoked by the stimulus word. Whenever the dis- traction phenomena succeeded, the result was always the same, the outer associations and sound associations gained at the ex- pense of the inner ; that is, there was a deviation to the direction of the customary and smooth, hence to the automatically obvious, or habitual speech combination. " Attention is a state characterized by muscular tension mani- fested in an association complex and furnishes the accentuated complex with the psycho-physical subsoil. The aim of the phys- ical reflection seems to be the establishing of the toned presenta- tion into consciousness. By the somatic connection the accen- tuated presentation is probably held on the height of distinctness in the stream of presentations. It becomes the ' directing ' presentation (respectively the 'directing feeling') of the others. It causes two kinds of effects: " i. Promoting effects to all associated presentations and especially to all associated in the sense of direction. " 2. Inhibiting effects to all presentations not associated, espe- cially not associated in the sense of direction. " If a non-associated presentation gains in attention, the direct- ing presentation becomes correspondingly crowded from the fixa- tion point, i. e., it loses in tone. The effects emanating from it likewise correspondingly lose in intensity and therefore the dif- ference in the liminal value of all the others is diminished. The choice in the sense of direction becomes more difficult and is more and more subjected to the law of frequency, i. e., all those asso- ciations which through habit and practice form the most frequent content of consciousness push themselves forward. The law of frequency takes the place of the directing presentation. It means that the endeavor to conceive and elaborate the sense of the stimulus word is hindered by the interposition of presentations which are already blended and automatic in speech." Whenever there is a disturbance of attention we have to expect shallow reaction types or sound associations, and, conversely, whenever we get sound associations we have to presuppose a disturbance of attention. TRANSLATORS PREFACE. XV COMPLEX-PHENOMENA AND THEIR CONSTELLATIONS. By complex we mean the sum total of presentations connected with an emotionally accentuated event. On examining the following associations, taken from an intel- ligent man of thirty-two, we note a number of peculiarities. Stimulus. Reaction. Time. Reproduction. 1. head hair 1.6" -+- 2. smooth not 4.2" love 3. to name James 3.4" no reaction 4. seeing recently 3.2" + 5. friendly very 2.6" + 6. wedding never 4.0" bells 7. to work hard 2.8" -f 8. song love 4.0" -f- 9. green hope 4.4" grass 10. definite certain 2.6" + The average reaction time in a person of his type is 2.4" ; here we find quite a number above the average. We also note that some reactions are falsely reproduced, and in association 3 a failure of reproduction. Whenever such phenomena occur they are taken as complex-indicators. The stimulus word has either consciously or unconsciously touched a complex with strong affects. Here the reason for all this emotivity is readily ex- plained by the fact that the test person was involved in an unfor- tunate love affair, and although the associations were taken years later the stimuli readily awakened the dormant complex. The associations were analyzed as follows: Association 2, smooth not love. Association 3, to name James, means Jane, the name of his former fiancee. The test person was totally unconscious of this during the experiment, but on freely associating with the word James we got Jame Jane. The subsequent associations were perseverations of the same complex. Association 4, seeing recently, recalls the fact that the test person has recently seen his former fiancee. Association 5, friendly very, is a descrip- tion of their present mutual feelings. Association 6, wedding never bells, shows his definite decision. Associations 8 and 9, song love and green hope, belong to this same episode and are quite obvious without any further analysis. We have here associations which are determined by definite constellations, inasmuch as they refer to an emotionally accen- xvi TRANSLATORS' PREFACE. tuated experience. These phenomena can be readily observed whenever associations are taken. Past experiences or complexes of strong feeling remain in the subconscious in a dormant state until they are disturbed by associations. These associations may be purely adventitious or intentional as in the experiment. As soon as stimulated they continue to manifest themselves in dif- ferent automatisms. In the experiment we have definite re- sponses which refer to the complex. In our everyday life we sometimes begin to hum a certain melody which we have not heard for years ; for a time we become, as it were, possessed by it, and on analysis we find its definite meaning. It refers to some past episode evoked by some accidental association or by a defi- nite state of mind. " The preponderant part of all our thoughts and actions is really composed of small fragments which are infinitely and deli- cately determined by numberless moments lying entirely external to consciousness. To our ego-consciousness the association process seems to be its work, in its estimation the association process is dominated by the free will and attention, in reality, however, as is so nicely shown in the experiments, the ego- consciousness is only a marionette dancing on the stage by means of concealed automatic springs." 11 Many assert that they can react of their free will and accord, but analysis shows that the reactions generally refer to their inti- mate experiences revealing just what they were endeavoring to conceal. The emotionally accentuated complex exerts a constant influence which successfully vies with the intentions of the ego- consciousness, and despite the repressing influences of the ego- complex it sends out associations about which the ego-complex has no notion. The complexes as developed by Jung are identical with the dissociated psychic groups described by Freud. Just as the com- plexes dominate our thoughts and actions, so do the repressed psychic groups assert themselves symbolically not only in patho- logical but also in normal individuals. In his excellent work, the Psychopathologie des Alltagslebens, 12 Freud shows that every- day forgetfulness, lapses in writing, talking, adventitious acts and "Jung: Diag. Associationsstudien, Beitr., IV. u Freud : Zur Psychopathologie des Alltagslebens. TRANSLATORS PREFACE. XVII mistakes are nothing but the assertion of the split-off groups which, though repressed by the ego-consciousness, continue to manifest themselves on every possible occasion in the form of symbolic actions. The same is true of our dreams 13 where our repressed wishes are realized. It is impossible to give examples here, as they would be too long for the subject in hand. These brief illustrations from the works of Freud and Jung give an intimation of the ideas expanded in this book. The author shows that just as in normal individuals and in hysteria the complex continues to play its part in dementia praecox, and as it does in dreams, the psychosis tends to actualize the repressed wishes from normal life. The otherwise known absurdities and incomprehensibilities become quite clear ; every case has its special interests and its own individuality. FREDERICK PETERSON, A. A. BRILL. NEW YORK, Jan., 1909. " Freud : Die Traumdeutung. AUTHOR'S PREFACE. This work is the fruit of three years' experimental labor and clinical observation. In view of the difficulty and magnitude of the material, my work cannot and will not lay any claims either to perfection of treatment or to perfect certainty of conclusions and statements ; on the contrary, it unites in itself all the disad- vantages of eclecticism, which perhaps to many a reader will seem so peculiar that he will call my work rather a confession of faith than a scientific book. Peu importe! What is of chief concern is that I may succeed in showing my readers how, by certain psychological investigations, I reached certain views, which I deem fit for the stimulation of the problems of the individual psychological basis of dementia praecox in a new and fruitful direction. My views are no contrivances of a roving fancy, but thoughts which matured in almost daily intercourse with my venerable chief, Professor Bleuler. I owe special thanks to my friend, Dr. Riklin, of Rheinau, for considerably enriching my empirical material. Even a superficial glance at my work will show how indebted I am to the excellent conceptions of Freud. As Freud has not yet attained fair recognition and appreciation, but is opposed in the most authoritative circles, I hope to be allowed to define my position towards him. My attention was attracted to Freud by reading some of his articles, and indeed, at first acci- dentally by his " Traumdeutung," after which I studied also his other works. To be sure in the beginning I naturally entertained all the objections which are advanced in literature against Freud. However, I thought that Freud could only be refuted by one who himself had thoroughly tried the psychoanalytic method, and who should really investigate like Freud, that is, by studying out patiently and for a long time the daily life, hysteria and dreams from Freud's point of view. He who does not or cannot do this ought not to judge Freud, else he acts like those famous men of :ience who disdained to look through the telescope of Galileo. xix XX AUTHOR'S PREFACE. Fairness to Freud does not signify, as many fear, a conditionless submission to a dogma; indeed independent judgment can very well be retained beside it. If I, for instance, recognize the com- plex mechanisms of dreams and hysteria, it does not at all mean that I ascribe to sexual trauma in youth an exclusive sig- nificance, as Freud apparently does; still less does it mean that I place sexuality so preponderantly in the foreground, or that I even ascribe to it the psychological universality which Freud postulates under the impression of the very powerful role which sexuality plays in the psyche. As for Freud's therapy, it is at best a possible one, and perhaps does not always come up to expectations. Nevertheless, all these are only side issues which completely disappear beside the psychological principles, the dis- covery of which is Freud's greatest reward, and to which the critic does not pay enough attention. He who wishes to be fair to Freud should act in accordance with the words of Erasmus: Unumquemque move lapidem, omnia experire nihil intentatum relinque. As my work is often based on experimental examinations, I hope that the reader will pardon me if he finds many references to the " Diagnostischen Associations-Studien." 1 C. G. JUNG. ZURICH, July, 1906. X J. A. Earth, Leipzig, 1906. CHAPTER I. CRITICAL PRESENTATION OF THEORETICAL VIEWS ON THE PSYCHOLOGY OF DEMENTIA PRAECOX . The interpretation of the psychological disturbances of demen- tia praecox are found in literature only in the form of frag- mentary attempts which although they at times go quite far, yet nowhere have they any clear coordination. The statements of the older authors have only a limited value as they refer now to this now to that form of mental disease which can only be indefi- nitely classified as dementia praecox. Hence one must not attri- bute to them any general validity. The first general view con- cerning the nature of the psychological disturbance in catatonia was that of Tschisch, 1 who, in 1886, thought that it was essen- tially due to inability of attention. A similar but somewhat dif- ferently conceived view was given by Freusberg. 2 He stated that the automatic actions of the catatonic are associated with a condition of reduction of consciousness which causes a loss of control over his psychical processes. The motor disturbances are only symptomatic expressions for the degree of psychic tension. According to Freusberg the motor catatonic symptoms are dependent upon corresponding psychological manifestations. The " weakening of consciousness " points to the quite modern view of Pierre Janet. Also Kraepelin, 8 Aschaffenburg, 4 Ziehen and others affirm that there is a disturbance of attention. In 1894 we meet for the first time with an experimental psycho- logical work on the subject of catatonia. It is the investigation of Sommer, " On the Study of ' Inhibition ' of Mental Proc- esses." 5 The author makes the following statements which are of gen- 1 Cited from Ehrich Arndt: Uber die Geschichte der Katatonie, Zentr.- f. Nervenheilk. u. Psych., Bd. XIV, p. 81. 1 Freusberg, 1886, Archiv f. Psych., XVII, p. 75& 'Lehrbuch d. Psychiatric. 'Allg. Ztschr. f. Psych., 1898. Allg. Ztschr. f . Psych., Bd. L. I 2 THE PSYCHOLOGY OF DEMENTIA PRAECOX. eral significance: (i) The course of ideation is retarded. (2) The attention of the patient is frequently so fixed by pictures shown him that he can only with difficulty rid himself of them. The frequent obstructions (the retardations of reaction time) are explained by Sommer by the visual fixation. 6 The condition of absent-mindedness among normal persons occasionally shows similar phenomena ; e. g., amazement and " staring into vacancy." Because of this analogy of the catatonic condition to normal absent-mindedness Sommer affirms something similar to Tschisch and Freusberg, namely, that there is a diminution of attention. Catalepsy according to Sommer is another phenomenon closely related to optical fixation and which he considers " in all cases as a phenomenon of thoroughly psychic origin." With this con- ception Sommer places himself in sharp contrast to the view of Roller, to which also Clemens Neisser unconditionally adheres. Says Roller : " The presentations and sensations which among the insane chiefly come to perception, forcing themselves into the field of consciousness, are those which have been caused by the morbid states of the subordinate centers, and when active apper- ception, the attention, enters into activity it becomes fixed and held by the morbid perceptions," etc. 7 By way of addition Neisser observes : " Wherever we look in insanity we always meet with something strange which cannot be explained according to the analogy of normal psychical activity. The logical mechanisms in insanity are put in motion not through the apperceptive or associative conscious psychic activity, but by pathological irritations lying under the threshold of conscious- ness." 8 Neisser therefore agrees with the concepts of Roller. This view does not seem to me to be without its objections. Firstly, it is based upon an anatomical conception of the psychic processes, a view against which too much warning cannot be given. What part the " subordinate centers " play in the origin "v. Leupold, who recently elaborated this symptom, names this mani- festation " das Symptom der Benennung u. des Abtastens " (the symptom of naming and touching). Zur Symptomatologie der Katatonie. Klinik fur psychische u. nervose Krankheiten, Vol. I, H. I. T Cited from Neisser's, Uber die Katatonie. Stuttgart-Enke, 1887, p. 61. 8 Ernst Meyer, too, leans towards this view which was then also held by Kraepelin. E. Meyer: Beitrage zur Kenntnis der acut entstandenen Psychosen. Habilitationsschrift. Berlin, 1899. THEORETICAL VIEWS OF DEMENTIA PRAECOX. 3 of the psychic elements, such as presentations, feelings, etc., we do not know at all. An explanation of this kind rests merely upon words. Secondly, the Roller-Neisser view seems to presuppose that beyond consciousness the whole psyche ceases. From the French psychology and from experiences with hypnotism we learn that this is not the case. Thirdly, if I understand correctly, by " pathological irritations lying under the threshold of consciousness " Neisser means cell processes in the cortex. This hypothesis goes too far. All psychic processes are correlates of cell processes, as well accord- ing to materialistic conceptions as according to the doctrine of psycho-physical parallelism. It is therefore not singular that psychic processes in catatonia should be correlates of a corre- sponding physical series. We know that normal psychical proc- esses originate under the constant influence of numerous psycho- logical constellations which as a rule are unknown to us. Why should this fundamental psychological law suddenly vanish in catatonia? Is it because the ideational content of the cata- tonic is foreign to his consciousness? Is it not the same with our dreams? And yet no one will assert that dreams originate so to speak directly from the cells without psychological constel- lations. Whoever has analyzed dreams according to the method of Freud knows what an enormous influence the constellations have. The appearance of strange ideas in consciousness with- out any demonstrable connections with former contents of con- sciousness is not an unheard of thing in either the psychology of the normal or the hysteric. The " pathological fancies " of catatonics have rich analogies in the normal and in hysterics (see further). What we lack is not so much comparative material but the key to open the psychology of the catatonic automatism. It seems to me in general rather daring to assume something toto coclo new and absolutely foreign in natural science. In dementia praecox, where numberless normal associations actually still exist, we must expect that until we shall learn to know those very fine processes which are really specific, the laws of the normal psyche will long continue to be manifest. Unfor- tunately to the great detriment of psychopathology, in which we are just beginning to agree upon our misunderstandings of con- 4 THE PSYCHOLOGY OF DEMENTIA PRAECOX . captions applied, our knowledge of the normal psyche is still on a very primitive basis. We are grateful to Sommer 9 for further fruitful studies of the associations in catatonia. In certain cases of catatonia 10 the associations flow in a normal manner only to be suddenly interrupted by an apparently totally disconnected, peculiarly-mannered connection of ideas, as will be seen by the following example: dark green, white brown, black " good day, William," red brown. These saltatory associations were also confirmed by Diem, 11 who conceives them as sudden " fancies." Sommer justly con- siders them as an important criterion of catatonia. The " patho- logical inspirations " as described by Breukink, 12 who follows Ziehen, can be readily found in every insane asylum where these authors have observed them. They are exclusively seen in dementia praecox, and especially play an important role in the paranoid types. Bonhoeffer's 13 " pathological fancies " probably refer to the same manifestations. The problem instigated by the discovery of Sommer is by no means settled, but until we become more enlightened we are obliged to group under the same head- ing the phenomena observed by various authors which are nearly all designated by almost the same name. Although from clinical experience it would seem that " pathological fancies " appear only in the realm of dementia praecox, naturally excluding the falsifications of memory which often suddenly appear in organic dementia and in Korsakow's symptom-complex, I wish to observe that in the realm of hysteria, principally in cases that never seek the asylum, " pathological fancies " often play a great part Flournoy 14 reports the most interesting examples. Similar sud- "Lehrbuch der Psychopathologischen Untersuchungsmethoden, 1899. 19 Sommer : Lehrbuch, p. 362. Recently Fuhrmann has made some asso- ciation experiments in "acute juvenile dementia" without any character- istic results. Arch. f. Psych., Vol. XL, p. 817. "Diem: Die einfach demente Form der Dementia Prsecox (Dementia simplex). Arch. f. Psych., Vol. XXXVII. "Breukink: Uber eknoische Zustande. Monatsschr. f. Psych, u. Neur., Vol. XIV. "Deutsche med. Wochenschrift, No. 39, 1904. "Flournoy: Des Indes a la planete Mars. Etude sur un cas de Som- nambulisme avec glossolalie. Paris et Geneve, 1900. III Nouvelles obser- THEORETICAL VIEWS OF DEMENTIA PRAECOX. 5 den invasions of changed psychological activity I observed in a very clear case of hysteria, 16 and recently I could again confirm it in a similar case. Finally, as I have shown, sudden disturb- ances of association by the incursion of seemingly strange con- nections of ideas also appear in the normal. 16 In the saltatory association or " pathological fancy " we are perhaps dealing with a widely disseminated psychical phenomenon, and without further discussion we can agree with Sommer that the most marked type appears in dementia praecox. Sommer, in examining the associations of catatonics, found numerous sound associations and stereotypies. By stereotypies we mean frequent repetitions of former reactions. In our exam- inations we simply name it " repetitions." The reaction time showed enormous fluctuations. In 1902 Ragnar Vogt 17 again took up the problem of the cata- tonic consciousness. He proceeded from the Miiller-Pilzecker investigations 18 by considering mainly their observations about " perseveration." The continuation of psychic processes or their correlates, even after being replaced in consciousness by other ideas, is according to Vogt the normal analogy to cata- tonic perseveration, such as verbigeration, catalepsy, etc. Ac- cordingly, in catatonia the tendency to perseveration of the psy- chophysical functions would be especially marked. But inas- much as in the Miiller-Pilzecker observations perseveration is manifested most distinctly only when no new content of con- sciousness impresses itself, 10 Vogt claims that in catatonia perse- vations sur un cas de somnambulisme avec glossolalie. Archives de Psy- chologic de la Suisse Romande, T. I, p. 102. 18 Zur Psychologic und Pathologic sogenannter occulter Phanomene. Leipzig, 1902. 16 Diagnostische Assoz. Stud., IV Beitrag. Uber das Verhalten der Reaktionszeit beim Assoziationsexperiment. J. A. Earth, Leipzig, 1906. " R. Vogt : Zur Psychologic der Katatonischen Symptome. Zentr. f . Nervenheilk. u. Psych., Bd. XIX, p. 433. "Zeitschrift fur Psych, u. Phys. der Sinnesorgane, Erg. B. I, 1901. "In conditions of distraction there is an increase of preseveration in the association experiments. See Diag. Assoz. Stud., I Beitrag, and in- teresting experiments of Stransky: Uber Sprachverwirrtheit, 1905. Mar- hold, Halle. See also the excellent work of Heilbronner: Uber Haften- bleiben und Stereotypie (Monatsschr. f. Psych, u. Neur., Bd. XVIII, Erg.- Heft), which accepts similar theoretical views. THE PSYCHOLOGY OF DEMENTIA PRAECOX . veration is only possible because no other interesting conscious process occurs. Hence it must be assumed that there is a certain narrowing of consciousness. From this we can also understand the resemblance between the hypnotic and the catatonic states. 20 The impulsive acts of catatonia are likewise explained by the narrowing of consciousness, thus preventing the intervention of any inhibition. Vogt is apparently under the influence of Pierre Janet, to whom the " narrowing of consciousness " and diminu- tion of attention is the same as abaissement du niveau mental? 1 Here then we again meet the already mentioned view, though in a somewhat more modern and generalized form, namely, that in catatonia there is a disturbance of attention, or as I prefer to express it in a more general term, there is a disturbance of posi- tive psychic function. 22 The reference to the similarity of hypnotic conditions is very interesting, but unfortunately Vogt gave us only a mere outline. Kindred views are advanced by Evensen. 23 He draws a skil- ful parallel between catatonia and absent-mindedness. Lack of ideas in a narrowed consciousness is the foundation of cata- lepsy, etc. A painstaking and detailed examination of the psychology of catatonia is the thesis of Rene Masselon. 24 The author first affirms that diminution of attention (distraction perpetuelle) is the main characteristic. He conceives attention in a very general and comprehensive sense corresponding to his French training in psychology. He says, " The perception of external objects, the perception of our own personality, judgment, the ideas of rela- 20 1 call attention here to the work of Kaiser : Differentialdiagnose zwischen Hysteric und Katatonie. Allgem. Ztschr. f. Psych., LVIII. 21 P. Janet : Les Obsessions et la Psychasthenie. Paris, 1903. Janet presents similar views in his earlier works : Nevroses et Idees Fixes, and Automatisme Psychologique. 21 According to Binet attention is " a mental adaptation to a state which is new for us." Attention et Adaptation. Annee Psychologique, 1900. n Die psychologische Grundlage der Katatonischen Krankheitszeichen. Zentralbl. fur Neurol. Psych., etc. Edited by v. S. Kure and K. Miura, Tokio, Bd. II. M Masselon: Psychologic des Dements Precoces. These de Paris, 1902. (The work of Masselon " La Demence Precoce " is rather a clinical com- pendium of the disease.) THEORETICAL VIEWS OF DEMENTIA PRAECOX . / tionship, faith and certitude disappear when the power of atten- tion disappears." As shown by this citation, much depends on attention as con- ceived by Masselon. The more general features of the catatonic condition he summarizes as " apathie, aboulie, perte de I'activite intellectuelle." A brief consideration of these three abstractions teaches that fundamentally they mean the same thing, and indeed, Masselon in his work always tries to find that word or simile which would best express the innermost essence of his correct feeling. However, scarcely any concept of human language should be so broad; indeed, there is no one who has not already been impressed by some school or system with the biased limits of meaning. We can best find out what Masselon conceives as the essence of dementia praecox by listening to the wording of some of his statements : " The habitual state is the emotional apathy . . . these disturbances are intimately connected with the disturbances of intelligence: they are of the same nature . . . the patients do not manifest any desires ... all volition is de- stroyed . . . the disappearance of desire is connected with all the other disturbances of mental activity ... a veritable weakness of cerebral activity . . . the elements of the mind show a tendency to live an individual life not being any more systematized by the inactive mind." 28 In Masselon's work there is a mixture of many things and views that he feels belong to one root which, however, he is unable to find without obscuring his work. Nevertheless, in spite of his shortcomings, Masselon's researches contain useful observations. Thus he finds a striking resemblance between dementia praecox and hysteria in the marked self-distractibility of the patient by everything possible and especially by his own symptoms (Sommer's optical fixation), and also in exhaustibility and capricious memory. German critics have reproached him for this discovery, but certainly unjustly when we consider that Masselon means only the reproductive ability. If a patient gives a wrong answer to a direct question it is taken by the German school as by-speaking (Vorbeireden) as negativism; in other words, as active resistance. Masselon, however, considers this as an inability to reproduce. When superficially considered it a Masselon: /. c., p. 62, 71, 135, 140. 8 THE PSYCHOLOGY OF DEMENTIA PRAECOX . may mean both, the divergence being due to different interpreta- tions bestowed upon this phenomenon. Masselon speaks of a "veritable obscurcissment de I' image-souvenir,' 3 he considers the disturbances of memory as " la disparition de la conscience de certains souvenirs, et I'incapacite du malade a les retrouver" The contradiction of both conceptions becomes clear without further explanation when one thinks of the psychology of hys- teria. When a hysterical patient replies during the anamnesis " I do not know, I have forgotten," it simply means " I cannot or will not say it, for it is something very unpleasant." 26 Very often the " I don't know " is so awkward that the reason for not knowing is quite obvious. I have given many experimental proofs to show that the defects occurring in the association ex- periments, such as want of reaction, have the same psychology. 27 It is often only with difficulty that one can decide whether hys- terics really do not know or whether they merely cannot or will not answer. Those who are in the habit of examining cases of dementia praecox in a somewhat detailed manner realize what exertion is often necessary to obtain the proper information. Sometimes one is certain that the patients know it, again it is an obstruction (Sperrung) which makes quite an involuntary impression upon one, and finally there are cases in which one is obliged to talk about an " amnesia " just as in hysteria, where from amnesia to unwillingness to talk is only a step. Finally the association experiment shows us that these phenomena exist in the normal person, though only in nuce. 2S According to Masse- lon the disturbances of memory and attention originate from the same source, though it is not clear from what source. In con- trast to this the author finds ideas that obstinately persist, which he qualifies as follows : " Certain memories which were formerly more intimately connected with the effective personality of the patient tend to reproduce themselves incessantly and "See the works of Freud, also Riklin: Zur Psychologic hysterischer Dammerzustande und des Ganserschen Symptoms. Psych.-neur. Wochen- schr., 1906. "Diagnost. Assoz. Stud., IV Beitrag. Uber das Verhalten der Reak- tionszeit beim Assoziationsexperiment u. Experimentelle Beobachtungen uber das Erinnerungsvermogen. Zentr.-Bl. f. Nervenheilk. u. Psych., Jahrgang XXVIII, p. 653. 28 Cf. Diagnost. Assoz. Stud., IV Beitrag. THEORETICAL VIEWS OF DEMENTIA PRyECOX. 9 to continually occupy consciousness . . . the persisting mem- ories assume a stereotyped form . . . thought tends to become clotted (' gerinnen ')." 29 Without attempting to produce fur- ther proof Masselon declares that the stereotyped ideas (delu- sions) are associations of the complex of personality. It is a pity that the author does not linger any longer on this point. It would be very interesting to know in what way, for example, a few neologisms or a " word salad " are associations of the com- plex of personality, as indeed these are often the only remnants through which we become informed of the existence of ideas. That the psychic life of the adolescent dement " curdles " or " clots " seems to me an excellent simile for the gradual torpescence of the disease; it designates quite pregnantly the impressions entertained by every careful observer of dementia praecox. The author found it quite easy to derive automatism (suggestibilite) from his premises. As to the origin of nega- tivism he offers but vague suppositions, although the French lit- erature on impulsive phenomena afforded him many essential facts for analogous explanations. Masselon also tried associa- tion experiments. He found many repetitions of the stimulus words and frequent fancies of an apparently quite fortuitous nature. From these experiments he concluded that the patients are unable to pay attention. A right conclusion! Masselon, however, spent too little time on the " fancies." From the main results of Masselon's work it can be seen that this author, like his predecessors, is inclined to admit a true cen- tral psychological disturbance, 30 a disturbance which sets in at the source of life of all psychic functions; that is, in the realms of apperception, feeling and desire. 81 Weygandt in his clear elucidation of the psychology of the weak-mindedness in dementia praecox follows Wundt's terminol- ogy and calls the terminal process of the disease apperceptive ' Masselon : /. c., p. 69, 261, 263. "Seglas (Legons cliniques), 1895, says the following about the un- certainty of catatonic accomplishments: There is nothing surprising when one reflects that all movement requires the previous synthesis of a crowd of mental representations and it is precisely the power to make this mental synthesis which is defective in these individuals. "Kant: Kritik der praktischen Vernunft. IO THE PSYCHOLOGY OF DEMENTIA PRAECOX . dementia. 32 It is well known that Wimdt's conception of apper- ception is a most general one. It embraces not only the Binet and Masselon conception of attention, but also Janet's idea of the " fonction du reel." 33 But we shall return to this. To show the universality of the apperception idea in the sense indicated I shall quote Wundt's own words : " The condition characterized by peculiar feelings which accompanies the clearer reception of a psychic content we call attention, the single process by which any psychic content is brought to clear conception is appercep- tion. 3 * The apparent antithesis between attention and appercep- tion is solved as follows : " Accordingly, attention and apper- ception are expressions for one and the same psychological fact. The first of these expressions we choose by preference for the ' subjective ' side of this fact to express the accompanying feel- ings and sensations ; by means of the second we designate mainly the ' objective ' results, the alterations in the quality of the con- tents of consciousness." 35 In the definition : apperception is the " single process by means of which any psychic content is brought to clear conception," much is said in few words. According to this definition apper- ception is will, sensation, affect, suggestion, impulsive phenom- ena, etc., because all these are processes by means of which " a psychic content is brought to clear conception." We do not attempt to give an unfavorable criticism on the apperceptive idea, but merely to indicate its enormous extent. It embraces every positive psychic function, especially the progressive acqui- sition of new associations; that is, no more and no less than all enigmas of physical activity both conscious and unconscious. Weygandt's idea, therefore, of apperceptive dementia expresses that which Masselon dimly felt. Nevertheless, in this we find only a general expression for the psychology of dementia praecox. It is too general to be of any force in the deduction of all symptoms. 33 W. Weygandt: Alte Dementia Prsecox. Zentr.-Bl. f. Nervenheilk. u. Psych., Jahrgang XXVII, p. 613. 13 Obsessions et Psychasthenie, Vol. I, p. 433. The fonction du reel can also be expressed in other words as psychological adaptation to the environment or acting up to reality. It corresponds to the " adaptation " of Binet, which represents a special side of apperception. "Gundriss der Psychologic, 1902, p. 249. '"Grundziige der Physiol. Psychologic, 1903, p. 341. THEORETICAL VIEWS OF DEMENTIA PRAECOX. II Madeleine Pelletier 36 examines in her thesis associations in manic flight of ideas, and in mental debility. By mental debility we understand typical cases of dementia praecox. The theoretic standpoint from which this author considers flight of ideas agrees in its essentials with that of Liepmann. 87 A knowledge of Liepmann's work is presupposed. Pelletier compares the shallow flow of associations in demen- tia praecox to the flight of ideas. The characteristic of flight of ideas is "absence du principe directeur" (absence of directing principle). The same takes place in the course of the associa- tions in dementia praecox. " The directing idea is absent and the ite of consciousness remains vague without any ordering of its elements." The only state of normal psychic activity which can be compared to mania is revery, yet revery may rather be a weak-minded than a maniacal mode of thinking. Pelletier is right in finding a great similarity between normal revery and the shallow associations of maniacs, but only when the associations ire written on paper. Clinically the manic does not by any means look like a dreamer. The author evidently feels this and finds the analogy rather more fitting for dementia praecox, which condition has been compared to that of dreams since the times of Reil (e. g., Chaslin: "La confusion mentale primitive"). The richness and acceleration of presentations in manic flight of ideas differentiates it sharply from the very stagnant slowly- coursing association type of dreams and especially from the yverty and numberless perseverations in the associations of cata- tonics. The analogy is correct only in so far as concerns the directing idea which is absent in both of these cases; in mania ;cause all presentations crowd themselves into consciousness nth marked acceleration and with strong feeling tones, 88 there- 1 L'Association des idees dans la manie aigue et dans la debilite mentale. These de Paris, 1903. Liepmann : Uber Ideenflucht, Begriffsbestimmung u. psychologische Analyse. Halle, 1904. "It is true that Aschaffenburg found a certain prolongation of the association time in manic cases. It should, however, not be forgotten that in acoustic-speech experiments attention and speech expression play a great role. One observes or measures expression of speech only, and not connections of ideas. 12 THE PSYCHOLOGY OF DEMENTIA PRAECOX . fore no attention can probably take place, 89 and in revery there is no attention to begin with, and where this is lacking the flow of associations must sink into revery. According to the laws of association there results a slowly progressive course, tending principally towards likeness, contrast, coexistence and motor- speech combinations. 40 Numerous examples can be observed daily by attentively following a general conversation. As Pelle- tier shows, the course of association in dementia praecox is con- structed upon a similar scheme. This can best be seen by an example : " Je suis 1'etre, 1'etre ancien, le vieil Hetre, 41 que Ton peut ecrire avec un H. Je suis universel, primordial, divine, catho- lique, Romaine, 42 l'eusses-tu cru, 1'etre tout cru, suprumu, 43 1'en- fant Jesus. 44 Je m'appelle Paul, c'est un nom, ce n'est pas une negation, 45 on en connait la signification. 46 . . . Je suis eternel, immense, il n'y a ni haut, ni bas, fluctuat nee mergitur, le petit bateau, 47 vous n'avez pas peur de tomber." 48 This example shows us very distinctly the type of association in dementia praecox. It is a very shallow one and carries many sound associations. Yet the disintegration is so marked that we cannot compare it to the reveries of the normal state, but are obliged to compare it to dreams. Only in dreams is such speech observed. 49 Rich examples can be found in Freud's " Die Traumdeutung." In the first contribution of the " Diagnostische Associations- studien " it was proven that diminished attention produced shal- low association types, motor-speech combinations, sound asso- ciations, etc., and inversely, the appearance of shallow associa- ** Acceleration and emotional strength of ideas are at least that which we can verify by observation. This, however, does in no way exclude the fact that there are other essential moments to consider which are, at present, inaccessible to our cognition. ** Diagnost. Associationsstudien, I Beitrag, Einleitung. 41 Assonance. Contiguite. 41 Assonance. Assonance. "Assonance. "Assonance. 41 Resemblance and contiguity, immense suggested to him the ocean, then the bateau and the aphorism which forms the shield of the city of Paris. 48 Pelletier : /. c., p. 142. "Kraepelin: Arch. f. Psych., Vol. XXVI, p. 595, and Stransky: Uber Sprachverwirrtheit, 1905, point out the same thing. THEORETICAL VIEWS OF DEMENTIA PRAECOX. 13 tion types always pointed to a disturbance of attention. According to our experimental proofs Pelletier is right when she refers to the shallow types of dementia praecox as the result of lowered attention. She calls this diminution by the words of Janet, " abaissement du niveau mental." From this work, too, it can be seen that the disturbance is again taken back to the central problem of apperception. It is to be noted that the author overlooks the perseverations, but on the other hand we are grateful to her for the valuable observation on symbolism and symbolic relations so very frequent in dementia praecox. She says : " It is to be remarked that the symbol plays a very great part in the discursions of the insane. It is encountered everywhere among the persecuted and weak- minded. It is a very inferior form of thought. The symbol mid be defined as a false perception of a relation of identity or very marked analogy between two objects which in reality pre- it only a very vague analogy." 50 This quotation shows that Pelletier brings the catatonic sym- ls into relation with disordered attention. This supposition is :cidedly supported by the fact that the symbol has since long in known as a usual manifestation in revery and dreams. The psychology of negativism, concerning which numerous publications already exist, forms a separate chapter. The symp- >m of negativism certainly ought not to be considered as some- ling definite. There are many forms and grades of negativism rhich have not as yet been clinically studied and analyzed with ic necessary accuracy. The division of negativism into active and passive forms can be easily understood. The most compli- cated psychological cases appear under the form of active resist- ance. If an analysis were possible in those cases, it would fre- quently be found that very definite motives exist for the resist- ance, and it would then be doubtful if one could still talk of negativism. In the passive form, too, there are many cases which are difficult to interpret. Notwithstanding this there are numerous cases in which one may clearly point out that even simple processes of volition are always blindly converted into their opposite. According to our view negativism always ulti- mately depends on corresponding associations. Whether there * Pelletier : /. c., p. 129. 14 THE PSYCHOLOGY OF DEMENTIA PRAECOX . is a negativism taking place in the spinal cord I do not know. The most general standpoint on the question of negativism is taken by Bleuler in his work on negative suggestibility. 61 He shows that negative suggestibility, that is, the impulse toward contrast associations, is not only a constituent part of the normal psyche, but also a frequent mechanism of pathological symptoms in hysteria, impulsive phenomena, and dementia praecox. The contrast mechanism is an independent function entirely rooted in " affectivity." It therefore manifests itself mainly in presen- tations of strong feeling as in decisions and similar things. " This mechanism protects against a rash act and forces the con- sideration of, for and against." The contrast mechanism is a counterpart of suggestibility. Suggestibility is the faculty of the reception and realization of strong feeling-toned ideas, while the contrast mechanism guards the opposite. It is for this reason that Bleuler appropriately calls it negative suggestibility. The fact that these two functions are so closely related readily ex- plains why they are met with together clinically. In hysteria we have suggestibility near insuperable contrary autosuggestion ; and negativism, automatism and echopraxy in dementia praecox, etc. The importance of negative suggestibility in every-day psy- chical occurrences explains why contrast associations are every- where enormously frequent. They are in the closest rela- tionship. 62 In language, too, we see something similar. The words which express the usual contrasts are very closely associated and there- fore mostly belong to the intimate associations of language, as, white, black, etc. In primitive languages one occasionally finds only one word for contrasting ideas. According to Bleuler a n Bleuler : Die negative Suggestibility ein psych ologisches Prototyp des Negativismus, der contraren Autosuggestion und gewisser Zwangsi- deen. Psych.-Neurol. Wochenschr., 1904. "The following express themselves in a similar manner: Paulhan: L'activite mentale et les elements de 1'esprit, 1889. Svenson: Om Kata- tonie. Hygiea, 1902. Janet: Les Obsessions, 1903. Pick: On Contrary Actions. Journal of Nervous and Mental Disease, Jan., 1904. An in- structive case is given by Josiah Royce : The Case of John Bunyon. Psychological Review, 1894, p. 143. [Jelliffe : Pre Dementia Prsecox, Am. Jour. Med. Sc. 1907. Ed.] THEORETICAL VIEWS OF DEMENTIA PRAECOX . 15 relatively mild emotional disturbance will suffice to produce nega- tivistic phenomena. Janet ("Les Obsessions," Vol. I, p. 60) shows that in persons suffering from impulsive ideas, the " abais- sement du niveau mental" suffices to liberate a play of contrasts. What, therefore, can we expect from the " apperceptive demen- tia " in dementia prsecox ! Indeed, here we really find the appar- ently irregular play of positive and negative which is very often nicely reflected in the associations as expressed in speech. 83 Hence in the problem of negativism we have sufficient evidence that this symptom too, is in close relationship with " appercep- tive dementia." The central control of the psyche is so weak- ened that it can neither further the positive nor inhibit the nega- tive acts, or the reverse may be true. 54 Let us now recapitulate what has been said. The authors thus far mentioned have essentially affirmed that diminution of atten- tion, or more generally speaking, " apperceptive dementia " (Weygandt) is characteristic of dementia praecox. The exist- ence of the peculiar shallowing of the associations, symbolisms, stereotypies, perseverations, command automatism, apathy, abou- lia, disturbances of reproduction, and, in a limited sense, nega- tivism, are all due to apperceptive dementia. That neither apprehension nor retention take part as a rule in the general deterioration, seems at first sight rather singular. As a matter of fact one can find in dementia prsecox during acces- sible moments that there exists a surprisingly good, and an almost photographic memory, which preferably takes note of the most indifferent things that unfailingly escape the notice of normal persons. 65 But just such peculiarity shows what the nature of memory is. It is nothing but a passive registration of events which take place in the nearest surroundings. But all that which requires an effort of attention passes without heed by the patient, or at most it is registered a niveau together with the daily visits of the doctor and dinner ; at least so it appears to us. Weygandt (/. c.) very nicely describes this lack of active acquisition. Ap- * Compare the analyses of Pelletier, /. c., as well as the experimental examinations of Stransky : Uber Sprachverwirrtheit. M Further works on negativism have already been criticised by Bleuler : /. c. M Kraepelin, too, is of the opinion that the apprehension is not more intensively damaged ; it is only an increased inclination to an arbitrary pro- duction of incoming ideas. Lehrbuch, VII Aufl., p. 177. 1 6 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. prehension is generally disturbed only during periods of excite- ment. Apprehension and retention, or impressibility and reten- tiveness, are for the most part only passive processes which take place in us without the expenditure of a great amount of energy, just as mere hearing and seeing when unaccompanied by attention. From Weygandt's idea of " apperceptive dementia " (Janet abaissement du niveau mental} one can in a measure deduce the origin of the above mentioned symptoms (automatism, stereo- typy, etc.) ; but we are unable from this to understand the indi- vidual multiformity of the symptoms, their capriciousness, the peculiar content of the delusions, hallucinations, etc. Many investigators have already attempted to solve this riddle. Stransky 56 examined dementia praecox from the clinical point of view. Proceeding from Kraepelin's idea of " emotional de- mentia," he asserts that by this conception two things are under- stood. Firstly, poverty or superficiality of emotional reactions, secondly an incoordination between the same and the content of consciousness dominating the psyche. 57 In this fashion Stransky differentiates the content of Kraepelin's idea, showing that clin- ically one sees more than the " emotional dementia." The strik- ing incongruity between idea and affect which we can daily observe in dementia prsecox, is a more frequent symptom during the development of the disease than the emotional demen- tia. The incongruity between idea and emotional tone forced Stransky to accept two separate psychical factors, the noopsyche and the thymopsyche. The former idea embraces all pure intel- lectual, the latter the affective processes. Both these ideas nearly correspond in Schopenhauer's psychology to intellect and will. In the healthy psyche there is naturally a constant, very fine, simultaneous, coordinated action of both factors. But as soon as incoordination steps in, it corresponds analogically to ataxia, and we then have the picture of dementia praecox with all its disproportionate and unintelligible affects. So far the 64 Stransky : Zur Kenntniss gewisser erworbener Blodsinnsformen, 1903. Jahrb. f. Psych., Vol. XXIV, p. I. 87 Jahrbuch. f. Psych., XXIV, p. 28. Idem : Zur Lehre von der Dementia praecox. Zentr.-Bl. f. Nervenheilk. u. Psych., XXII Jahrg. Idem: Zur Auffassung gewisser symptome der Dementia prsecox. Neurol. Zentr.-Bl., 1904, Nr. 23, u. 24. Idem: Uber die Dementia praecox. Wiener mediz. Presse, 1905. THEORETICAL VIEWS OF DEMENTIA PRAECOX . 1 7 divisions of the psychic functions into nod- and thymopsychic agree with reality. But "it is a question whether a trite content of consciousness manifested in the patient with an enor- mous affect seems incongruous only to us who can only most sparingly look into his soul, or is it the same for the subjective sensation of the patient. I shall make myself clear by the fol- lowing example: I visit a gentleman in his office. Suddenly he starts up enraged and swears most excitedly at a clerk who placed a newspaper on the right instead of the left side of the table. I am astonished and make a mental note about the peculiar nervousness of this person. But after a while I learn from the other employees that the clerk has done the same thing wrongly dozens of times and hence the anger of the man was quite adequate. Had I not received subsequent explanations I should have formed a wrong picture of the psychology of this person. We are frequently confronted with a similar condition in dementia praecox. Owing to the peculiar seclusiveness of the patients we see into them but little, a fact which every psychiatrist will sub- stantiate. It is therefore readily understood that many excite- ments appear to us inexplicable because we do not see their associate causes. That may even happen to us. We are occa- sionally for a time in bad humor, and quite inadequately so without being conscious of its cause. The simplest responses are then uttered in a disproportionate, emphatic, and irritable tone, tc. If even a normal individual is not always clear about the causes of his ill-humor, how little can we know when confronted with the mind of a precocious dement? On account of the evi- dent inadequacy of our psychological diagnosis, we must be very careful about the supposition of a real incoordination in the sense of Stransky. Although judging from clinical appearances there are frequent incongruities, they are by no means exclusively lim- ited to dementia prsecox. In hysteria, likewise, the incongruity is an every-day occurrence. One can see it in the very trite fact of the so-called hysterical " exaggerations," whose counterpart is the well known " belle indifference " of hysterics. We also find violent excitements over nothing, at times over something which in no way shows any recognizable connection with the excite- ment. Yet psycho-analysis uncovers the motives, and we then 1 8 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. begin to understand why the patients reacted in such a manner. In dementia prascox we are at present unable to penetrate deep enough so that the relations remain unknown, and we therefore assume an " ataxia " between noo- and thymo-psyche. Thanks to analysis we know that in hysteria there is no "ataxia," but only an oversensitiveness, which, as soon as we know the patho- genic ideational complex, becomes clear and intelligible. 58 Knowing how the incongruity is brought about in hysteria, is it still necessary that we should accept a totally new mechanism in dementia praecox? In general we know by far too little about the psychology of the normal and hysteric 59 to dare to accept in such an untransparent disease as dementia prsecox, a totally new mechanism unknown to all psychology. One should be econom- ical with new principles of interpretation. It is for this reason that I repudiate the clear and ingenious hypothesis of Stransky. As a compensation for the above, we possess a very excellent ex- perimental work by Stransky 60 which gives us the foundation for the understanding of an important symptom, namely, the speech disorders. The speech disorder is the product of the main psychological disturbance. Stransky calls it " intrapsychic ataxia." When- ever there is a disturbance at the points of contact of the emo- tional life and ideation, as in dementia praecox, producing thereby in the normal thought the lack of orientation by a controlling idea (Liepmann), there must result a stream of thought resem- bling flight of ideas. As Pelletier has shown, the laws of asso- ciation predominate against the influence of direction. If it is a question of a process of speech there must result an increase in the purely superficial elements of connection (motor speech association and sound reactions), as was shown in our associa- 68 An hysterical woman, for example, one day merged into a deep and persistent depression "because the weather is so dull and rainy." The analysis, however, showed that the depression set in on the anniversary of a very sad and important event in the life of the patient. 88 Binet (Les alterations de la personnalite, p. 89) approximately re- marks: Hysterics are for us only subjects of choice, exagerating phe- nomena that one must necessarily find in some degree among a crowd of other persons who are not at all tainted, even slightly, by the hysterical neurosis. "Stransky: Uber Sprachverwirrtheit. THEORETICAL VIEWS OF DEMENTIA PRyECOX. lp tion experiments with distracted attention. Hand in hand with this there is a diminution of sensory connections. Besides these many other disturbances show themselves, such as an increase of the mediate associations, the senseless reactions, and frequent repetitions of the stimulus words. Perseverations show a most contradictory behavior during distractibility. According to our experiments they are increased in women and decreased in men. In a great many cases we could explain the resulting persevera- tions by the presence of a strong feeling tone. Every-day expe- rience teaches us that a strong feeling-toned idea shows a special tendency to perseverate. By distracting the attention there results a certain emptiness of consciousness 61 in which ideas can more easily perseverate than during complete attention. Stransky then studied the results of continuous speech asso- ciation under the influence of relaxed attention. His test per- sons had to talk at random into a phonograph for one minute on anything or in any way they chose. At the same time they were not to pay attention to what they said. A stimulus word was given as a starting point, and in one half of the experiments external distraction was caused. These tests brought to light interesting results. The sequence of words and sentences immediately recalled the speech as well as the writing of dementia praecox. A definite direction of speech was excluded by the arrangement of the experiment. The stimulus word at most acted for some time as a more or less indefinite " theme." Superficial connecting elements became strik- ingly manifest, corresponding to the disintegration of logical con- nections. There were numerous perseverations, or repetitions of the preceding word, almost corresponding to the repetition of the stimulus words in our experiments, and besides this there were numerous contaminations, 62 and closely connected with them neologisms or newly formed words. From Stransky's voluminous material I should like to quote * Comp. Diagnosf. Associationsstudien, I Beitrag. B. Durchschnitts- berechnungen, Abschnitt III. " Comp. Rud. Meringer and Karl Mayer : Versprechen und Verlesen. Eine psychologisch-linguistische Studie. Stuttgart, Goschen, 1895. By contamination we understand the condensation of many sentences or words into one sentence or into one word ; e. g., " I will soon him see home " is a contamination of " I will go home," " I will soon see him." 2O THE PSYCHOLOGY OF DEMENTIA PRAECOX . a few examples by way of illustrations : " On one leg stand the storks, they have wives, they have children, they are those who bring the children, the children, which they bring into the house, this house, an idea, which people have about storks, about the activity of storks, the storks are large birds with a long beak and live on frogs, frogs, f reegs, frogs, the frogs are f roogs, in the morning (Friih), in the morning they are with breakfast (Friihstiick), coffee, and with coffee they also drink cognac, and cognac they also drink wine, and with wine they drink every- thing possible, the frogs are large animals, and which the frogs devour, the storks devour the birds, the birds devour the animals, the animals are big, the animals are small, the animals are human beings, the animals are no human beings . . .", etc. " These sheep are . . . were merino sheep, from which the fat was cut out by the pound, with Shylock was the fat cut out, the pound cut out," . . . etc. " K . . . was a K . . . with a long nose, with a ramnose, with a rampnose, with a nose to ram, a ram gift, a man, who has rammed, who is rammed," etc. From these examples of Stransky's experiments it can be readily seen what laws of association the stream of thought fol- lows. It is mainly those of similarity, coexistence, motor speech connections and combinations of sound. Besides this one is struck by the numerous perseverances and repetitions ( Sommer : stereotypies). If we compare to this the sample of dementia prsecox associations which we have just quoted from Miss Pelle- tier we find a striking similarity. 63 Here, just as there, one finds the same laws of similarity, contiguity, and assonance. Only stereotypies and perseverations are lacking in Pelletier's anal- ysis, 64 although they can be plainly seen in the communicated material. Stransky also adds to these conspicuous similarities numerous nice examples taken from dementia prsecox. It is especially important that in Stransky's normal tests there "We must, however, mention that the speeches of Stransky show the unmistakable character of precipitation which is generally lacking in dementia praecox. What gives the impression of precipitation is hard to say. **As mentioned above, Sommer has already shown the sound associa- tions and stereotypies in simple word reactions. THEORETICAL VIEWS OF DEMENTIA PR.ECOX. 21 appear numerous word and sentence-conglomerations which can be designated as contaminations. 85 Example : " Especially a meat, which one cannot get rid of, the thoughts which one cannot get rid of, especially when one ought to persevere at it, persevere, persevere, severere, severin," etc. According to Stransky this conglomeration contains the fol- lowing condensed series of ideas : (a) Mutton is consumed in England, (b) This idea I cannot get rid of, (c) This is perseveration, (a?) I am to talk at random whatever comes into my mind. The contamination is therefore a condensation of various series of ideas. It is essentially to be considered as a mediate associa- tion. 68 This character of contamination can be clearly proven from Stransky's pathological examples : Question : What is a mammal ? Answer (Pat) : It is a cow, for example a midwife. Midwife is a mediate association of cow and shows the probable way of thought. Cow bears living young human beings likewise midwife. 87 Question: "What do you understand by the Holy Virgin?" Answer: "The behavior of a young lady." As Stransky rightly observes the thought probably goes as follows: Immaculate conception virgo intacta irreproachable conduct. Question: "What is a square?" Answer : " An angular quadrate." 88 By contamination we understand the condensation of many sentences or words into one sentence or into one word ; e. g., " I will soon him sec home " is a contamination of " I will go home." " I will soon see him." ** See the analysis of mediate associations. Diagnost. Associations- studien, Beitrage I, Introduction. " According to Professor Blueler, the following combination is more probable : Mammal cow- is an example -bears living young I midwife 22 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. The condensation consists of: (a) Square is a quadrate, (b) The square has four angles. From these examples it should be evident that the numerous contaminations appearing in distracted attention are somewhat similar to the mediate associations which appear under distrac- tion in the simple word reactions. It is well known that our experiments have shown that in distractibility there is moderate increase of the mediate associations. The concurrence of three experimenters, Stransky, myself, and dementia praecox, can be no accident. It proves the cor- rectness of our conceptions and is another confirmation of the symptom of apperceptive weakness, which of all the degenera- tive symptoms of dementia praecox stands out most prominently. Stransky points out that contamination has frequently pro- duced such bizarre word formations that they unfailingly recall the neologisms of dementia praecox. That a great number of neologisms are really brought about in this manner I am con- vinced. Pointing to the picture of a horse a patient remarks, 68 " This is a domestic-burden," by which he means : (a) The horse is a domestic animal, (b) The horse is a beast of burden. Based on clinical observation Neisser 69 remarked in 1898 that the newly formed words, which according to the rule as well as the roots are neither verbs nor nouns, are really no words at all but represent sentences inasmuch as they always serve to alle- gorize (Versinnbildlichung) a whole process. This expression of Neisser indicates the idea of condensation. He even goes so far as to talk directly about the allegorization of a whole process. Right here I should like to call attention to the fact that in his work " Die Traumdeutung " 70 Freud showed that there is a great 88 Given by translators as play of words, in author's example can not be translated. 89 Neisser : Uber die Sprachneubildungen Geisteskranker. Vortrag. 74. Sitzung. d. Vereins Ostdeutsch. Irrenarzte in Breslau. Allgem. Zeitschr. f. Psych., LV, p. 443. w Based on a large empirical material, Kraepelin, in his work, Uber Sprachstorungen im Traume (Psychol. Arbeiten, Bd. V, H. I), also occu- pies himself with these questions. In reference to the psychological genesis of the phenomena in question, Kraepelin's assertions show that he THEORETICAL VIEWS OF DEMENTIA PRJECOX. 2$ deal of condensation in dreams. Unfortunately I am unable to discuss in exienso the extent and extremely valuable psychologic material of this as yet hardly recognized investigator. It would lead too far. A knowledge of this valuable book is presupposed. No real refutation of the ideas of Freud have to my knowledge been advanced. I confine myself to the affirmation that dreams having already many analogies to disturbance of the associations of dementia praecox, possesses also the special speech condensa- tions in the sense of contaminations of whole sentences and situa- tions. Kraepelin too was struck by the resemblance between the speech of dreams and of dementia praecox. 71 From the numer- ous examples which I observed in my own and other's dreams, I will mention only a very simple one, illustrating at the same time condensation and neologism. One in his dream wishes to express approval of a certain situation and says: "That is fimous." does not differ much from the views developed here. Thus he says on p. 10 : " The appearance of speech disturbances in dreams is certainly very closely dependent upon the obnubilation of consciousness and the diminution in clearness of ideas conditioned by it." What Paul Meringer, Mayer and others designate as contamination, and Freud as condensation, Kraepelin names "ellipse" ("mixture of different series of ideas," " en elliptical concentration of several simultaneous series of thoughts"). Here I wish to call attention to the fact that as early as in the 8o's Forel used the expression " ellipsis " for the condensations and new word formations in paranoid states. It escaped Kraepelin that Freud had already, in 1900, treated dream-condensations in a detailed manner. By condensation Freud designates the blending together of situations, pictures, and elements of speech. The linguistic expression " contamina- tion " concerns only the blendings of speech, and is, therefore, a special idea which is subordinate to Freud's idea of condensation. The retention of the term contamination is to be recommended for condensation of speech. "Arch. f. Psych., XXVI, p. 595. Compare also Psych. Arbeiten, Bd, V, H. I, p. 79, where Kraepelin says : " It should perhaps be kept in mind that the peculiar expressions of the patients (dementia praecox) are not simple ' nonsense,' nor still less do they represent intentional productions of overbearing moods, but they are the expression of a peculiar disturb- ance of word findings which must be nearly related to those found in dreams." Kraepelin also expresses the view that " in confusion of speech, besides disturbances of word selecting and the speech expression of thought, there are even such disturbances of the process of thought which in part resemble those of dreams." 24 THE PSYCHOLOGY OF DEMENTIA PRAECOX . It is a contamination of (a) fine, (b) famous. The dream is likewise an apperceptive weakness par excel- lence, which -is especially shown by its tendency towards sym- bolism. 72 Finally there is still one more question which really should have been answered first, and that is : Does the state of conscious- ness -in' Stransky's normal experiments really correspond to one of disturbed attention? Before all it is to be noted that Stransky's experiments in distractibility show no essential changes from the experiments with the normal, consequently neither the association nor the attention in both conditions could have been so very different. But what is one to think of the disturbance in the experiments with the normal? It seems to me that the main reason is to be looked for in the forced character of the experiment. The test persons were instructed to talk at random, and that they have at times talked with great rapidity is shown by the fact that on an average they uttered from 100 to 250 words per minute, whereas in normal speech the average per minute is only from 130 to I4O. 73 Now if one talks and perhaps thinks more rapidly about indifferent things than he is accustomed to, he cannot bestow sufficient atten- tion on the associations. A second point which has to be con- sidered is the fact that most of the test persons were unaccus- tomed to the situation and it consequently influenced the emo- tional state. This may be compared to excited orators who develop a state of " emotional stupidity." 74 In such conditions I found extraordinarily high numbers of perseverations and repeti- tions. Emotional stupidity causes likewise great disturbance of attention. We can therefore take it as certain that in Stransky's experiments with the normal the attention was really disturbed, although the state of consciousness is surely not clear. We are grateful to Heilbronner for an important observa- tion. 76 By examining a series of associations in a case of hebe- ' 2 Compare above the excellent observation of Pelletier, /. c.. Uber das Symbol. TS Stransky : /. c., p. 14. "Jung: Uber Simulation von Geistesstorung. Journ. f. Psych, und Neur., II, p. 191, und Wehrlin in Diagnost. Associationsstudien, Beitrag II. " Monatsschr. f. Psych, und Neur., Bd. XVIII, Erg. Heft, p. 324. THEORETICAL VIEWS OF DEMENTIA PRAECOX. 25 y phrenia he found that on one occasion forty-one per cent., onl another twenty-three per cent, of the reaction words referred tct the patients' environment. Heilbronner considers this circum-* stance as an evidence for the fact that the perseverations are derived from the " vacuum," i. e., they are due to a deficiency of new ideas. I can confirm this observation from my own ex- perience. Theoretically it would be interesting to know in what relationship this manifestation stands to the Sommer-Leu- poldt symptom of " Benennen und Abtasten " (name and touch). New and independent views on the psychology of dementia praecox are brought forth by Otto Gross. 70 He proposes the expression dementia sejunctiva for the name of the disease. The reason for this name is the disintegration of consciousness in dementia praecox, hence the sej unction of consciousness. The idea of sej unction Gross naturally takes from Wernicke. He could just as well have taken the older synonymous idea of dis- sociation (Binet, Janet). Fundamentally, dissociation of con- sciousness means the same thing as Gross's disintegration of con- sciousness. By accepting the idea of sej unction we have only a new term of which psychiatry has certainly enough. Dissocia- tion according to the French school is a weakness of conscious- ness due to the splitting off of one or a series of ideas. They separate themselves from the hierarchy of the conscious ego and begin a more or less independent existence. 77 The hysteria doctrine of Breuer and Freud was developed on this foundation. According to the more recent formulations of Janet, dissociation is the result of " abaissement du niveau mental " which destroys the hierarchy and either favors or effects the origin of automa- tisms. 78 What automatisms are freed is most beautifully shown by Breuer and Freud. 70 The application made by Gross of this doctrine to dementia praecox is new and important. The funda- " Gross: Uber Bewusstseinszerfall. Monatschr. f. Psych, und Neurol. p. 45. Idem: Beitrag zur Pathologic des Negativismus. Psych.-neur. Wochenschr., 1903, Nr. 26. Idem : Zur Nomenklatur " Dementia sejunc- tiva." Neurol. Centr.-Bl., 1906, Nr. 26. Idem: Zur Differentialdiag- nostik negativistischer Phanomene. Psych.-neurol. Wochenschrift, 1906, Nr. 37, und 38. n See the fundamental work of Janet : L'automatisme psychologique. " Janet : Les Obsessions. ' Studien liber Hysteric. 26 THE PSYCHOLOGY OF DEMENTIA PRJECOX. mental idea of the author is expressed as follows : " Disintegra- tion of consciousness in my sense signifies the simultaneous flow of functionally separated series of associations. To me the chief point lies in the conception that the activity of consciousness is to be considered as a resultant of many synchronous psychophysical processes. 80 These citations ought to illustrate sufficiently the author's ideas. We can perhaps agree with the view that consciousness, or better, the content of consciousness, is the result of numerous nonconscious or unconscious psychophysical processes. In con- tradistinction to the current psychology of consciousness, in which beyond the epiphenomenon " consciousness " there imme- diately begins the nutritive processes of the brain cells, this aspect is really a refreshing progress for psychiatry. Gross seems to think that the psychic content (not the content of con- sciousness!) flows synchronously in single series of associations. This comparison seems to me somewhat equivocal. I think it more correct to assume successive conscious-becoming ideational- complexes which are constellated by antecedent association- complexes. The cement of these complexes is some definite affect. 81 If the connection between Gross's synchronous series is severed by disease, disintegration of consciousness results. Translated into the language of the French school, it means that if one or more association series are split off there results a dis- sociation causing weakness of consciousness. Let us not quarrel over words. Here, too, Gross returns to the problem of apper- ceptive disturbance; he, however, approaches this problem from a new and interesting side, from the side of the unconscious. Gross attempts to uncover the roots of the numerous automatic phenomena which break into the consciousness of dementia praecox with elemental power and strangeness. The symptoms of automatic phenomena in the conscious life of dementia praecox should be known to all psychiatrists. They are the autochtho- nous ideas, the sudden impulses, hallucinations, the manifesta- 80 Gross : Zur Nomenklatur, etc. 81 The pure laws of association play quite an insignificant role when I confronted with the unlimited power of the emotional constellation, just 1 as in real life where the logic of thought has no significance when con- i\^ fronted with the logic of feeling. THEORETICAL VIEWS OF DEMENTIA PRyECOX. 2/ tions of thought-influence, imperative ideas with the character of strangeness, the cessation and disappearance of thought (appro- priately designated by one of my patients as " Gedankenentzug " thought deprivation), and inspirations (pathological fancies), etc. Gross states that the catatonic manifestations are "changes of the will brought about by an agent which is conceived as external to the ego-continuity, and is therefore referred to as a strange power." They are a "substitution of the will of the' ego-continuity by a crowding in from outside of another consciousl series." We have to keep in mind that many association series' can simultaneously flow in the organ of consciousness without influencing one another. From these series in consciousness one will have to become the carrier of the continuity of conscious- ness, while the other association series are then naturally " sub- conscious," or rather, " unconscious." Now at all times there is a possibility that also in these the nervous energy swells up and reaches such a stage that one of its end organs becomes endowed with attention, which means that a joint from the uncon- scious association series pushes itself illegitimately into the con- tinuity of the dominant one. If these conditions are fulfilled, the accompanying subjective process can be only of such a nature as any psychic manifestation entering into consciousness in an unadjusted manner, and is therefore perceived by the conscious continuity as something entirely foreign. Ideas of explanation are almost inevitably added, the referred psychic manifestation (idea) originating not from the ego-consciousness, but thrown into it from without. 82 As aforesaid, the displeasing part in this hypothesis is the assumption of synchronous independent associa- tion series. Normal psychology does not furnish us with any facts on this point. Where we can best observe split-off series of ideas, namely, in hysteria, we find that the opposite holds true. Even where one deals with apparently totally separated series, one can find somewhere in some hidden location the bridge leading from one series to the other. 83 In the mind all stands in connec- tion with all, the present psyche is the result of milliards of con- stellations. ** Gross: Zur Differentialdiagnostik, etc., /. c. M Just this point I have thoroughly proved (depending on Flournoy) in a case of somnambulism. Zur psychologic und pathologic sog. okkulter Phanomene. Leipzig, 1902. 28 THE PSYCHOLOGY OF DEMENTIA PRAECOX . Aside from this slight inconvenience, I believe that I may call Gross's hypothesis a rather happy one. It tells us in brief that the roots of old automatic phenomena lie in the unconscious asso- ciation connections. If consciousness becomes disintegrated (abaissement du niveau mental apperceptive weakness) the complexes accompanying it are freed from all restraint and are then able to break into the ego-consciousness. This is an emi- nent psychological conception, and agrees in the clearest possible manner with the doctrines of the French school, with the expe- rience of hypnotism, and with the analysis of hysteria. If we weaken the power of consciousness by suggestion and produce thereby a split-off series of presentations, as, for example, in post-hypnotic commands, we find that this series reappears with a power inexplicable to the ego-consciousness. In the psychology of ecstatic somnambulists we have the typical breaking in of split-off ideas. 84 Unfortunately Gross leaves one question open, and that is, which are the dissociated series of ideas and what is the nature of their content? Some time ago, long before Gross wrote, Freud answered this question very brilliantly. As far back as 1893 Freud 85 showed preliminarily that a hallucinatory delirium originates from an unfulfilled wish, and that this delirium is a compensation for unsatisfied yearnings, that the person takes refuge, as it were, in the psychosis in order to find in the dream- like delirium of the disease that which was refused to him in reality. In 1896 Freud analyzed a paranoid condition, Kraepe- lin's paranoid form of dementia praecox, and showed how the symptoms were accurately determined according to the scheme of the transformation mechanism of hysteria. Freud then stated that paranoia, or the group of cases belonging to paranoia, are a defensive neuropsychosis; that is to say, that just like hysteria and obsessions, they, too, originate from the repression of painful memories, and that the form of the symptoms is determined by the content of the repression. 86 84 See especially the magnificent script examples of Helene Smith, Flournoy: Des Indes, etc. ** Uber den psychischen Mechanismus hysterischer Phanomene. Neurol. Centr.-Bl., 1893, H. i and 2. 86 For further remarks on Defensive Neuropsychoses, see Neurol. Centr.- Bl., 1896. THEORETICAL VIEWS OF DEMENTIA PRAECOX . 2Q In view of the far-reaching significance of such an hypothesis it pays to enter somewhat more fully into the classical analysis of Freud. It was the case of a thirty-year old woman who manifested the following symptoms: She imagined that her environment had changed, she was no longer respected, she was annoyed, she was watched, and her thoughts were known. Later she thought that she was watched in the evening while undressing. She also experienced sensations in her abdomen which she believed were casioned by an unseemly thought on the part of the servant girl. isions then appeared in which she saw female and male genitals. Whenever she was with women alone she had hallucinations of emale genitals, and at the same time imagined that the others saw her own genitals. Freud analyzed this case. He observed that this patient be- ved just like a hysteric; that is, she showed the same resist- ances, etc. What seemed unusual was the fact that the repressed oughts did not appear, as in hysteria, in the form of loosely connected fancies, but in the form of hallucinations, and hence :he patient compared them to her own voice. (I shall later take ie opportunity to produce experimental proof for this observa- tion.) The hallucinations here mentioned began to manifest themselves after the patient saw in the asylum a number of naked female patients bathing together. " It may be presupposed that the reason these impressions repeated themselves was because something of great interest was connected with them." She stated that she felt ashamed in the presence of these women, is somewhat forced and altruistic modesty was striking, and pointed to something repressed. Patient reproduced " a series of scenes from her seventeenth to her eighth year, during which, while bathing before her mother, her sister and her physician, she was ashamed of her nakedness. This series, however, reached back to a scene in her sixth year, when she undressed in the children's room before going to sleep without feeling ashamed of her brother, who was present. Finally it was found that for years the brothers and sisters were in the habit of show- ing themselves naked to one another before retiring." At that time she was not ashamed. " She is now trying to make up in shame what she lost as a child." 3O THE PSYCHOLOGY OF DEMENTIA PR^ECOX. " The beginning of her depression began at the time of a dis- agreement between her husband and her brother, on account of which the latter no more visited her. She was always much attached to this brother." Besides this she spoke about a moment in the history of her disease during which, for the first time, " everything became clear"; that is, during which she became convinced that her assumption about being generally despised and intentionally an- noyed was true. She gained this assurance during a visit of her sister-in-law who, in the course of conversation, gave utterance to the following words: " If such a thing should happen to me I would not mind it." Mrs. P. at first took this lightly, but when her visitor left her it seemed to her that these words contained a reproach, meaning that she was in the habit of taking serious matters lightly, and since that hour she was sure that she was a victim of common slander. The tone in which her sister-in-law spoke was especially convincing. It was, however, shown that the sister-in-law spoke about another subject before giving utter- ance to this sentence. She related to the patient that in the father's home there were all sorts of difficulties with the brothers, and added : " In every family many things happen which one would rather keep in darkness, and that if such a thing should happen to her she would take it lightly. Mrs. P. had to acknowl- edge that her depression was connected with the sentences uttered before the last one. As she repressed both sentences which could recall her relations with her brother and retained only the last meaningless one, she was forced to connect with it the sensation of being reproached by her sister-in-law; but, inasmuch as the contents of this sentence offered absolutely no basis for such assumption, she disregarded it and laid stress on the tone with which the words were pronounced." After this explanation Freud turned his attention to the analy- sis of the voices. " It is to be noted that such indifferent remarks as ' here goes Mrs. P.' ' she now looks for apartments ' were very painfully felt." The first time she heard voices was after she read the story " Heiterethei," by O. Ludwig. After reading it she took a walk on the highway, and suddenly while passing a peasant's cottage voices told her: "That is just how the house of Heiterethei looked! Here is the well and- here the bush! THEORETICAL VIEWS OF DEMENTIA PRAECOX . 31 How happy she was in all her poverty ! " The voices repeated whole paragraphs of what she had just read, but the contents were of an indifferent nature. The analysis showed that while reading she at the same time entertained extraneous thoughts and that she was excited by totally different passages of the book. Against this material analogy between the couple in the romance and herself and her husband, the reminiscences of intimate things of her married life and family secrets, against all these, there arose a repressive resistance because they were connected with icr sexual shyness by very simple and demonstrable streams of thought, and finally resulted in the awakening of old experiences of childhood. In consequence of the censorship exercised by the repression the harmless and idyllic passages connected with the objectionable ones by contrast and vicinity became reen forced in consciousness, enabling them to become audible. For example, the first repressed thought referred to the slander to which the secluded heroine was subjected by her neighbors. She readily found in this an analogy to herself. She, too, lived in a small place, had no intercourse with anybody and considered herself despised by her neighbors. The suspicion against the neighbors was founded on the fact that in the beginning of her married life she was obliged to content herself with a small apartment. The wall of the bedroom, near which stood the nuptial bed of the young couple, adjoined the neighbors room. With the be- ginning of her marriage there awakened in her a great sexual shyness. This was apparently due to an unconscious awakening of some reminiscences of childhood of having played husband and wife. She was very careful that the neighbors should not lear through the adjacent wall either words or noises, and this shyness changed into suspicion against the neighbors." On fur- ther analysis of the voices Freud often observed " a character of diplomatic uncertainty. The morbid allusions were generally leeply hidden. The continuity of some sentences was marked by strange expressions, unusual forms of speech, and, in other ways, characteristics common to the auditory hallucinations of paranoiacs. The hallucinations also showed a slight disfigure- icnt caused by compromise formation." I have purposely given the floor to the author of the first analy- sis of paranoia, a thing so highly important for psychopathology. 32 THE PSYCHOLOGY OF DEMENTIA PR.ECOX. I did not know how to abridge the ingenious demonstrations of Freud. Let us now return to the question of dissociated series of ideas. We now see what meaning Freud gives to Gross's assumed disso- ciations. They are nothing other than the repressed complexes found in hysteria, 87 and last but not least also in the normal, 88 The mystery of repressed series of ideas reveals itself as a psy- chological mechanism of general significance and of quite usual occurrence. Freud puts in a new light the problem of incon- gruity between the content of consciousness and emotional tone discussed by Stransky. He shows that indifferent, even insignifi- cant ideas may be accompanied by intense feeling tones which they take from a repressed idea. Freud uncovers a way which can lead us to the understanding of the inadequate feeling tone in dementia praecox. I need hardly discuss the significance of this. The results of Freud's investigations may be summed up as follows : Both in form and in content of the symptoms of paranoid dementia prgecox there are thoughts which in consequence of their disagreeable tone became unbearable to the conscious ego, and hence are repressed. They determine the nature of the delu- sions and hallucinations as well as the whole general behavior. Whenever apperceptive paralysis appears in a person the mani- fested automatisms contain the dissociated idea complexes the whole army of subjected thoughts become unyoked. Thus we may generalize the result of Freud's analysis. As everybody knows, Tiling, 89 uninfluenced by Freud, and based on clinical experience, came to conclusions closely resem- bling those of Freud. He, too, would contribute to individuality an almost boundless significance for the origin and formation of the psychosis. The importance of individual psychology is un- doubtedly underestimated in modern psychiatry, owing less per- haps to theoretical reasons than to the helplessness of practical psychology. One can therefore cover a great distance with OT Compare Diagnost. Associationsstudien, Beitrag V, VI, VII, VIII. "* Diagnost. Associationsstudien, Beitrag IV. "Tiling: Individuelle Geistesartung und Geistesstorung. Idem: Zur Aetiologie der Geistesstorungen. Centr.-Bl. f. Nervenheilkunde u. Psych., 1903, P. 561. THEORETICAL VIEWS OF DEMENTIA PRAECOX . 33 Tiling, at any rate, even further than Neisser 90 thought he could go. At the question of etiology, that is, at the nucleus of the problem, one must halt. The individual psychology of neither Freud nor Tiling explains the origin of the existing psychosis. In the citation from Freud's analysis we very clearly see that the " hysterical " mechanisms uncovered by him suffice to explain the origin of hysteria, why then does a dementia praecox orig- inate? We can readily understand why the content of the delu- sions and hallucinations are of such a nature and of no other; but why non-hysterical delusions and hallucinations should at all appear we do not know. Here at the basis of all there should be one physical cause embracing all the psychological ones. Let us assume with Freud that every paranoid form of dementia )raecox runs according to the mechanism of hysteria, but why is the paranoid unusually stable and resistive, while hysteria is characterized by the great mobility of its symptoms? Here we strike against a new phase of the disease. As Neisser 01 puts it, the mobility of the hysterical symptoms is based on the mobility of the affects, while the paranoid state is characterized by the fixation of the affects. This thought extraordinarily important for dementia praecox is formulated by Neisser as follows: 92 From without only a very poor assimilation takes place. The patient is able to exert less and less voluntary influence on the stream of his ideas and in this manner there originate sepa- rate groups of idea complexes of much greater volume than in ic normal. These complexes are, as to contents, connected by certain inherent personal relations, but hardly coalesce in any )ther way, so that depending on the momentary constellations it now this and now that one which more intensively determines ic direction of the continued psychic elaboration and association, fn this way there results a disintegration of the personality which scomes so to say a passive spectator of the inflowing impres- sions from the various irritative sources and an inanimate puppet for the freed irritations thus generated. The affects normally 90 Neisser, Individualitat und Psychose. Berlin, 1906. n Neisser, Individualitat und Psychose, p. 29. **To be sure Neisser only does that for paranoia, under which he can hardly include original paranoia (Kraepelin). His representations fit mainly the paranoids. 34 THE PSYCHOLOGY OF DEMENTIA PRAECOX . destined to regulate our relations to our environments and to direct our adaptation to the same, which are a protection to the organism and represent the motive powers of self-preservation, are alienated from their natural destiny. Owing to the organ- ically strong feeling tone of the delusional stream of thought, no matter what the emotional state may be, this and this only is always reproduced. These fixations of the affects destroy the ability of feeling joy or compassion and lead to an emotional isolation of the patient which runs parallel with the intellectual alienation." Neisser describes here the familiar picture of apperceptive dementia. Lack of new acquisition, paralysis of purposeful prog- ress (adapted to reality), disintegration of personality and autonomy of complexes. Finally, he adds the " Fixierung der Affecte " (fixation of affects), that is, the fixation of the emo- tionally accentuated complexes (for affects have always regu- larly an intellectual content, though it is not always known). From this he explains the emotional dementia (Masselon invented for this the fitting expression "clotting"). Following Freud, fixation of affects means that the repressed complexes (the car- riers of affects) can no more be disconnected from the contents of consciousness, they remain and so prevent the further develop- ment of personality. To avoid misconceptions I must here add that the continued persistence of a strong complex in normal psychic life can lead only to hysteria. Yet the consequent manifestations of the hys- terogenic affect are different from the symptom-complex of dementia praecox. For the origin of dementia praecox we must demand a totally different disposition than we do for hysteria. If a purely hypothetical supposition be permitted one could per- haps venture the following train of thought : The resultant mani- festations of the hysterogenic complex are reparable, while the affect of dementia praecox gives opportunity for the appearance of an anomalous metabolism (toxine?), which injures the brain in a more or less irreparable manner, so that in consequence of this defect the highest psychic functions become paralyzed. It is for this reason that the acquisition of new complexes becomes difficult or ceases altogether. The pathogenic or rather the incit- ing complex remains to the last, and the further development of THEORETICAL VIEWS OF DEMENTIA PRyECOX. 35 personality is definitely checked. In spite of an apparently gap- less causal chain of psychological events leading from the normal into the pathological, one can never disregard the possibility that in certain cases a change of metabolism (in the sense of Kraepelin) may be primary, whereby the accidental newest and last complex " clots " or " curdles," and thus inherently determines the symp- toms. Our experience does not as yet reach far enough to war- rant the exclusion of this possibility. SUMMARY OF THE FIRST CHAPTER. This anthology from the literature, in my judgment, shows quite distinctly that all the views and investigations which among themselves hardly exhibit any apparent connection nevertheless converge to the same point. The observations and intimations plucked from the different realms of dementia prsecox point above all to the idea of a real central disturbance which is desig- nated by different names, such as apperceptive dementia (Wey- gandt), dissociation, abaissement du niveau mental (Janet, Masse- lon), disintegration of consciousness (Gross), disintegration of personality (Neisser et a/.). Then there arose the idea of tend- ency towards fixation (Masselon, Neisser) and from this Neisser adduces the emotional dementia. Freud and Gross find the im- portant fact of the presence of split-off series of ideas. To Freud, however, belongs the credit of being the first to show in a case of paranoid dementia praecox the " principle of conver- sion " (repression and indirect reappearance of the complexes). Nevertheless the mechanisms of Freud do not reach so far as to explain why there originates a dementia praecox and not a hys- teria ; hence it must be postulated that for dementia prsecox there is a specific resultant manifestation of affects (toxins?) which causes the definite fixation of the complex by injuring the sum total of the psychic functions. However, the possibility cannot be disputed that the " intoxication " may appear primarily from " somatic " causes and seize the accidentally remaining complex and change it pathologically. CHAPTER II. THE EMOTIONAL COMPLEX AND ITS GENERAL ACTION ON THE PSYCHE. My theoretical propositions for an understanding of the psy- chology of dementia prsecox are in reality almost entirely ex- hausted in the contents of the first chapter, for Freud in his works on hysteria, imperative neuroses and dreams has, after all, given all essentials. Nevertheless our ideas gained on an experimental basis differ somewhat from those of Freud. Per- haps my conception of the emotional complex even oversteps the limits of Freud's views. The essential basis of our personality is affectivity. 1 Thought and action are only, as it were, symptoms of affectivity. 2 The elements of our psychic life, sensations, ideas and emotions are given to consciousness in the form of certain entities, which can in a manner be compared to a molecule, if one may venture upon an analogy with chemistry. To illustrate : I meet on the street an old comrade and imme- 1 For feeling, mood, affect, and emotion, Bleuler proposes the expres- sion " affectivity," which not only designates the affects in the proper sense but also the light feelings or feeling tones of pleasure and pain in every possible occurrence. Affektivitat, Suggestibility, Paranoia. Halle : Marhold. 1906. p. 6. 2 Bleuler says (/. c., p. 17) : "In all our actions and omissions affectivity is a much greater motive element than reflection. It is likely that we act only under the influence of pleasure and pain, and it is chiefly due to the affects connected with them that logical reflections obtain their force. Affectivity is the broader conception of which volition and effort represent but one side." Andre Godfernaux says : " The affective state is the dominating force, the ideas are nothing but its subjects. The logic of reasoning is only the apparent cause for the wheeling about of thought. Below the cold and rational laws of association of ideas there are others which conform more to the deep necessities of existence. It is the logic of sentiment." Le sentiment et la pensee et leurs principaux aspects physiologiques. Paris, Alcan, 1894. 36 THE EMOTIONAL COMPLEX. 37 diately an image is formed in my brain, it is a functional entity, the picture of my comrade X. We differentiate in this entity ("molecule") three components ("radicals"); sensory percep- tions, intellectual components (ideas, memory pictures, judg- ments, etc.) and emotional tone. 8 These three components are firmly united, so that if the memory picture alone of X comes to the surface the elements appertaining to it are regularly always with it. The sensory perception is represented by an accompany- ing centrifugal stimulation of the sensory spheres concerned. I am therefore justified in speaking here of a functional entity. Through some thoughtless gossip of comrade X, I once became involved in a very unpleasant affair, the consequences of which I suffered for a long time. This affair embraces a large number of associations (it can be compared to a body made up of a num- ber of molecules), many persons, things and events are contained therewith. The functional entity " my comrade " is only one figure among many. The entire mass of memory has a definite feeling tone, a vivid feeling of anger. Every molecule partici- pates in this feeling tone, so that as a rule it is always accom- panied by this feeling, whether appearing alone or in connection with others, and the more identified it becomes with this great union the greater is the feeling tone.* I once witnessed the following incident: I was taking a walk with a very sensitive and hysterical gentleman. The village bells were pealing a new and very harmonious chime. My companion, 'Compare Bleuler, /. c., p. 5. "Just as we are able to distinguish in every sensation of light, even in the very simplest one, between quality, intensity, and saturation, so we may speak of processes of cognition, of feeling, of will, though we are well aware that no psychic process exists to which all three qualities are not common, even if it is now one, now the other that is in the foreground." Bleuler therefore divides the " psychic forms " into preponderantly intel- lectual, preponderantly effective, and preponderantly voluntary. *This can be directly compared to Wagnerian music. The leitmotif designates (in a measure like the feeling tone) an important complex presentation of the dramatic construction (such as Walhalla, Vertrag, etc.). Whenever an action or speech incites this or that complex, the leitmotif appertaining to it immediately resounds in some variation. It is exactly the same in ordinary psychological life. The leitmotif is the emotional tone of our complexes; our actions and moods are nothing but variations of our leitmotif. 38 THE PSYCHOLOGY OF DEMENTIA PRAECOX . who generally displayed great feeling for such tunes, suddenly began to rail at it, saying that he could not bear the disgusting ringing in the major key, that it sounded abominably, that this was an especially disagreeable church and unsightly village (the village is famous for its charming location). This remarkable and inadequate affect interested me and I continued my investi- gation. My companion then began to abuse the local parson. His reason for the abuse was that the minister had an ugly beard and wrote very bad poetry. My companion, too, was talented lyrically. The affect then lay in poetic rivalry. This example shows how the molecule (the chiming, etc.) takes part in the feeling tone of the whole mass of presentations 5 of the poetic rivalry. We designate this by the name of the emo- tionally accentuated complex. Considered in this sense the com- plex is a higher psychic entity. When we come to examine our psychic material, for example, that supplied by the association experiments, we find that every association belongs, as it were, to some complex. (I refer to Contribution IV ff. of the Diag. Assoz.-Stud.) To be sure, it is somewhat difficult to prove this in practice, but the more carefully we analyze the more we find that single associations belong to some complex. Undoubtedly they are related to the ego-complex more than any other. The ego-complex in the normal person is the highest psychic instance. By it we understand the ideational mass of the ego which we believe to be accompanied by the potent and ever-living feeling- tone of our own body. The feeling-tone is an affective state which is accompanied by bodily innervations. The ego is the psychological expression for the firmly associated union of all general bodily sensations. The personality proper is therefore the firmest and strongest complex, and asserts itself (provided it be healthy) throughout all psycho- logical storms. It is for that reason that the ideas which directly concern one's own personality are the most stable and interesting ; in other words, they possess the strongest attention-tone. (Atten- tion in the sense of Bleuler is a state of affectivity. 6 ) "The individual presentations are connected among themselves accord- ing to the different laws of associations (similarity, coexistence, etc.). But the higher connections are grouped and selected by an affect. "Bleuler: Affektivitat, etc., p. 31, says: "Attention is nothing more than a special form of affectivity" (p. 30). "The attention just like all our THE EMOTIONAL COMPLEX. 39 ACUTE EFFECTS OF THE COMPLEX. Reality sees to it that the quiet circles of egocentric ideation are frequently disturbed by strong feeling tones, so called affects. A situation threatening danger pushes aside the tranquil play of ideas and places in its stead a complex of other ideas of the strongest feeling-tone. The new complex then appears very prominently, crowding all the others into the background. It totally inhibits all other ideas, retaining only those direct ego- centric ideas which fit its situation. Under certain conditions it can even momentarily suppress to complete unconsciousness the strongest contrary ideas. It has the strongest attention-tone. (We therefore do not say we concentrate attention on anything, but the state of attention enters into this presentation. See " Diagnost. Assoc.-Stud.," I. Beitrag, Abschnitt B. L.) Where does an ideational complex get its inhibiting or pro- moting force? We have seen that the ego-complex on account of its union with the general sensations of the body is the most stable and richest in associations. The perception of a situation threaten- ing danger excites fear. Fear is an affect, hence it is accom- panied by physical conditions, by a complicated harmony of muscular tension and excitation of the sympathetic. The per- ception has therefore found the way to bodily innervation and in this manner has immediately helped its association-complex to get the upper hand. Owing to this fear numberless general sensibilities of the body become changed, changing thereby most of the sensations lying at the foundation of the general ego. Corresponding to this the ordinary ego loses its attention-tone (or its clearness, or its promoting and inhibiting influence on other associations or other synonyms). It is compelled to give way to the stronger and other general sensations of the new com- plex. Notwithstanding this, it does not normally perish but remains as a feeble affect-ego 7 because even very strong affects actions is always directed by an affect," or better expressed, "Attention is a side of affectivity which does nothing but that which is already known of it, that is, it smooths the way for certain associations and inhibits others." T The modification of the ego-complex resulting from the setting in of a markedly accentuated complex I designate as the "affect ego." 4O THE PSYCHOLOGY OF DEMENTIA PRAECOX . are unable to change all sensations lying at the foundation of the ego. As every-day experience shows, the affect-ego is a feeble complex, and is considerably inferior to the affect-complex in constellated force. Let us now assume that the dangerous situation clears rapidly. The complex then soon loses some of its attention-tone, because the general sensations gradually resume their normal character- istics. Yet the affect continues to oscillate for a long time in its physical and hence also in its psychical components. " The knees shake," the heart continues to palpitate excitedly for some time, the face is either flushed or pale, " one can hardly recover from fear." From time to time, at first after short, and later after longer intervals, this picture of fear returns and is charged with new associations, thus exciting waves of affect-reminiscences. This perseveration of the affect, in addition to the great emo- tional force, also contributes towards the proportional increase in the number of the associations. Therefore extensive com- plexes are always of great feeling tone, and inversely, strong affects always leave behind extensive complexes. This is simply due to the fact that on the one hand strong complexes contain numerous bodily innervations, and on the other hand, strong affects can constellate many associations, owing to their strong and persistent excitement of the body. Affects may normally continue to act for a long time (in the form of disturbances of the stomach, heart, sleeplessness, trembling, etc.). Gradually, however, the^y die away, the complexes disappear from conscious- ness, and only occasionally in dreams there appear more or less hidden intimations. In the associations they continue to show themselves for years in characteristic complex disturbances. But their gradual extinction is prevented by a general psychological peculiarity, namely, their readiness to reappear in almost full force on similar or much weaker stimuli. For a long time after, there exists a condition which I should like to designate as com- plex-sensitiveness. A child once bitten by a dog will scream with This modification will, as a rule in painful affects, consist of restriction and recession of many parts of the normal ego. Many other wishes, interests, and affects have to give way to the new complex, insofar as they oppose it. The ego in the affect is reduced to its lowest, as can be seen in such scenes as theater fires and shipwrecks, where in a trice all culture disappears, being replaced by the crudest lack of consideration. THE EMOTIONAL COMPLEX. 4! fear if it observes a dog even at a distance. People who have received a painful message will thereafter open all their mail with apprehension, etc. These complex effects, which under certain conditions will extend over long periods, leads us to the consid- eration of the CHRONIC EFFECTS OF THE COMPLEX. There are two kinds to be differentiated: 1. There is a complex-action which extends over a very long period and which is often evoked by a single affect. 2. There are special chronic effects which become lasting because the affect is always in a continuous state of provocation. The first group is best illustrated by the legend of Raymundus Lullus, who, as a gallant adventurer, was for a long time enthu- siastically courting a lady. Finally the longed for billet arrived inviting him for a nocturnal rendezvous. Lullus, full of expec- tation, arrived at the appointed place and as he approached the lady who was there awaiting him she suddenly parted her apparel and uncovered her bosom eaten away with cancer. This event made such an impression on Lullus that henceforth he devoted his life to pious asceticism. There are impressions which last a lifetime. Indeed the last- ' ing effects of strong religious impressions or shocking incidents are well known. The effects in youth are particularly strong. Education, to be sure, is based on this; that is, to impart lasting complexes to the child. The durability of the complex is guar- anteed by a constantly active feeling-tone. If the feeling-tone becomes extinguished the complex, too, becomes extinguished. The persistent existence of a complex with feeling-tone has nat- urally the same constellating effect on the other psychical activi- ties as an acute affect. Whatever suits the complex is taken up, everything else is excluded or at least inhibited. The best exam- ples can be found in religious convictions. There is no argument, no matter how threadbare, that is not advanced if it is pro, on the other hand the strongest and most plausible arguments contra do not thrive ; they simply glide by, because emotional inhibitions are more powerful than all logic. Even among people of intelli- gence who have great education and experience at their com- mand, one sometimes observes a real blindness, a true systematic anaesthesia when an attempt is made to convince them of the 42 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. doctrine of determinism. How often we notice that an old unpleasant impression will, in many people, produce an imper- turbable false judgment that no logic, no matter how clear, can dislodge ! The effects of the complex extend not only over thought but also over action, forcing it continually in a very definite direction. How many people thoughtlessly practice religious rites and many other possible baseless actions, though intellectually they long since are above it all ! The second group of chronic complex-effects in which the feeling-tone is constantly sustained by actual stimuli, offer the best examples of complex constellations. The strongest and most persistent effects are especially seen in the sexual complexes where the feeling-tone is constantly maintained by unsatisfied sexual desire. A glance through the " History of the Saints," or, e. g., Zola's " Lourdes," or " Reve," will show numerous examples. Nevertheless the constellations are not always of a totally coarse and sensuous nature, often they are finer influences, marked by symbolisms acting on thought and action. I refer to the numerous and instructive examples offered by Freud. Freud presents the conception of " symptom-action " as a special act of the constellation. (One should really speak of " symptom- thought" and " symptom-action.") In his " Psychopathologie des Alltagslebens " Freud shows that apparently fortuitous dis- turbances of our actions, such as lapses in talking and reading, forgetting, etc., are due to the infringement of constellated com- plexes. In his " Traumdeutung " he points out a similar influence in our dreams. In our experimental work we have proven that complexes disturb association experiments in a characteristic and regular manner. (Peculiar forms of reactions, perseveration, retardation or loss of reaction, subsequent forgetting of critical or post-critical reactions, 8 etc.) These observations give us val- 8 Compare Jung: Experimentelle Beobachtungen iiber das Erinnerungs- vermogen. Zentr.-Bl. f. Nervenheilk. u. Psychiatric, 1905. Freud, too, says the following (Traumdeutung, 1900, p. 301): "If the report of a dream appears to me at first difficult to understand, I request 'the dreamer to repeat it. This he rarely does with the same words. The passages wherein the expressions are changed I recognise as the weak points of the dream's disguise. The narrator is admonished by my request that I mean to take special pains to solve the dream and immediately under the THE EMOTIONAL COMPLEX. 43 uable indices for the complex-theory. In selecting my stimulus words I took care to employ as far as possible words in colloquial use, principally to avoid difficulties of understanding by the subject. It would be expected that an educated subject would react easily, but indeed this is not the case. At the very simplest words there appear obstructions and other disturbances which can be explained only by the fact that the stimulus word has excited a complex. But why should it be difficult to reproduce easily an idea which is closely connected to a complex? The emotional inhibition must be cited as the main hindering cause. The complexes exist mostly in a state of repression. As a rule one deals with most intimate secrets which are anxiously guarded and which one either does not wish to expose or is unable to do so. The repression may even under normal conditions be so strong that there exists a hysterical amnesia for the complex; that is, there is a feeling of an emerging idea, of a significant connection, but the reproduction is held back by vague hesitation. There is a feeling as though one wished to say something which immediately slipped away. That which slipped away is the complex-thought. Occasionally there appears a reaction which unconsciously contains the complex thought but the test person is blind to it, and it is only the experimenter who can lead him on in the right way. The repressing resistance may also show afterward a striking effect in the reproduction test. Amnesia influences by preference the critical and post-critical reactions. These facts show that the complex has a certain exceptional position in relation to the more indifferent psychic material. Indifferent reactions follow " smoothly " and generally have very short reaction times. They are always at hand for the ego-complex to dispose of at pleasure. It is different with the complex reactions! They appear only with opposition, and often when about to appear they again withdraw from the ego- complex. They are peculiarly formed; often they are the products of embarrassment, of which the ego-complex itself is unaware, often they merge into amnesia in contradistinction to the indifferent reactions which frequently possess great stability and are reproducible even after months and years. We see, then, impulse of resistance protects the weak points of the dream's disguise, by tacing the treacherous expressions by remoter ones." 44 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. that the complex-associations are much less at the disposal of the ego-complex than the indifferent ones. From this it must be concluded that the complex takes a relatively independent position to the ego-complex, it is like a vassal who does not bow implicitly to the domination of the ego-complex. Experience also teaches that the stronger the feeling-tone of a complex, the stronger and more frequent will be the disturbances of the experi- ment. A person dominated by a complex of strong feeling is less able to react " smoothly," not only to association experiments but to all stimuli of daily life, for the uncontrollable influences of the complexes constantly exert hindrances and disturbances. His self-control (the control of his frame of mind, thought, words and actions) suffers in proportion to the strength of the complex. The purpose fulness of his actions is more and more replaced by unintentional lapses, errors, and unaccountabilities for which he himself often can give no reason. A person with a strong complex shows, therefore, intensive disturbances during association experiments, for a great number of apparently inno- cent word stimuli excite the complex. The following two exam- ples elucidate the aforesaid: CASE i. The stimulus word " white " has numerous intimate connections. The subject, however, could only hesitatingly react with "black." By way of explanation I obtained another series of reactions to " white." " The snow is white, so is the sheet covering the face of a dead person." The subject had recently lost a beloved relative. The intimate contrast " black " shows symbolically perhaps the same thing, that is, mourning. CASE 2. " Paint " excites hesitatingly the reaction " land- scapes." This peculiar reaction is explained by the following successive fancies. " One can paint landscapes, portraits and faces as well as cheeks if one has wrinkles." The subject, an old maid who sorrows over the departure of an admirer, bestows a loving attention on her body (symbolic action), thinking that by painting she will become more attractive. She adds, " One paints the face when one takes part in a theatrical performance. I took part once." It is to be noted that she took part in a theatrical performance when she was still in possession of her lover. The associations of persons with strong complexes swarm with THE EMOTIONAL COMPLEX. 45 such examples. But the association experiment is only one side of the daily psychological life. The complex- sensitiveness can also be shown in all other psychic reactions. CASE i. A young lady cannot bear to see the dust beaten out of her mantle. This peculiar reaction is based on the fact that she is somewhat masochistic. As a child her father frequently chastised her by spanking her a posteriori, which eventually caused sexual excitement. For this reason, to whatever even remotely resembles this form of chastisement, she is forced to react with marked rage, which rapidly changes into sexual excite- ment and masturbation. On saying to her once on a quite indif- ferent occasion, " You must obey," she went into a condition of strong sexual excitement. CASE 2. Mr. Y. falls in love with a lady who soon afterwards marries Mr. X. In spite of the fact that Mr. Y. knew Mr. X. for a long time and even had business transactions with him, he again and again forgot his name, so that on a number of occa- sions, when wishing to correspond with X., he was obliged to ask other people for his name. CASE 3. A young hysterical woman was suddenly assaulted by her lover during which she was especially frightened by the erected member of the seducer. She was after the incident afflicted with a stiff arm. CASE 4. A young lady while frankly relating a dream, without any apparent reason suddenly hid her face under a curtain. This striking reaction of shame was explained by the analysis of the dream which revealed a sexual wish. 9 CASE 5. Many persons commit peculiar complicated acts which at the basis mean nothing but complex-symbols. I know a young lady who when promenading wished to take along a baby carriage. The reason for this, as she blushingly admitted, was because she desired to be looked upon as married. Elderly unmarried women are wont to use dogs and cats as complex- symbols. As the aforesaid examples show, thought and action, both in general and particular, are constantly disturbed and peculiarly distorted by a strong complex. The ego-complex is, so to say, "For further examples of symbolic actions see Beitrag. VI ff. of the Diagnost. Assoz.-Stud. 46 THE PSYCHOLOGY OF DEMENTIA PRAECOX . no longer the whole personality, as alongside of it there exists another being, living in its own way and therefore inhibiting and disturbing the development and progress of the ego-complex, for the symptom-actions very frequently take up time and exer- tion which are thus lost to the ego-complex. We can readily imagine how the psyche is influenced when the complex increases in intensity. The most lucid examples are always furnished by the sexual complexes. Let us take as an instance the classical state of being in love. The lover is possessed by his complex. All his interests hang only on this complex and the things belong- ing to it. Every word, every object recalls to him his sweetheart (experimentally even apparently indifferent word stimuli excite the complex). The most insignificant objects are guarded like priceless jewels, corresponding to their value in the complex. The whole environment is considered sub specie amoris. What- ever does not suit the complex glides by ; all other interests sink to nothing, hence there results a standstill and a temporary reduc- tion of the personality. Only that which suits the complex excites affects and is psychically elaborated. All thought and action move in the direction of the complex. Whatever is not impressed into this direction, is repudiated, or is accomplished with superficiality, unemotionally, and without any care. In attending to indifferent affairs there will appear the most peculiar compromise-productions; in business letters, lapses referring to the love-complex slip in, and in conversation one finds suspicious mistakes. The flow of objective thought is constantly inter- rupted by the incursions of the complex. Many pauses of thought result which are filled in by episodes of the complex. This well- known paradigm shows clearly the influence of a strong complex on the normal psyche. We see how all psychic energy is entirely bestowed on the complex at the expense of all the other psychic material which in consequence remains unused. All the other stimuli which do not suit the complex undergo a partial apper- ceptive dementia and emotional reduction. Even emotional tone becomes inadequate. Insignificant things, like little ribbons, dried flowers, pictures, billets-doux, hair, etc., are treated with the greatest care, while vital questions are often treated laughingly or indifferently. On the other hand the slightest remark touch- ing the complex even remotely, immediately excites violent anger THE EMOTIONAL COMPLEX. 47 and painful outbreaks which may assume disproportionate dimen- sions. (In a case of dementia praecox we may note that when asked whether he is married, the patient falls into inadequate laughter or he begins to cry and becomes completely negativistic, or he shows an obstruction, etc.) Had we not the means to look into the mind of a normal lover we would have to consider his behavior that of a hysteric or catatonic. In hysteria where the complex-sensitiveness reaches a higher grade than in the normal, we lack almost all means of penetrating the mind and are obliged to laboriously habituate ourselves to enter into the feelings of hysterical affects. We totally forego this in catatonia, perhaps because we do not as yet know enough about hysteria. The psychological state of being in love can be designated as a possession-complex. Besides this special form of sexual com- plex which for didactic reasons I have chosen as a paradigm for the complex of possession (it is the most common and best known form), there are naturally many other kinds of sexual complexes which can similarly exert a strong influence. Among women one frequently finds complexes of unreciprocated or even hopeless love. In such cases one generally notes an extremely strong complex-sensitiveness. The slightest intimations on the part of the other sex are assimilated into the complex and elabo- rated with a total blindness for the weightiest arguments against them. An insignificant utterance of the adored one is construed as a powerful subjective proof. The accidental interests of the one desired become similar interests to the adoring woman a symptom-action which often rapidly vanishes if the wedding finally takes place or if the object of adoration is changed. The complex-sensitiveness manifests itself also in an unusual sensitive- ness to sexual stimuli, which especially appears in the form of prudery. Those possessed of the complex at an early age ostenta- tiously avoid everything that may call up sexuality the familiar " innocence " of grown-up daughters. They know indeed every- thing, where it lies and what it signifies, but there whole behavior is as if they never had the slightest notion of things sexual. If- the subject must be broached for medical purposes one at first believes that he is on virgin soil, but he soon finds that all the necessary knowledge implicitly exists, only the patient does not 48 THE PSYCHOLOGY OF DEMENTIA PRyECOX. know where she got it from. 10 A psychoanalysis usually finds that behind numerous resistances there is hidden a complete rep- ertoire of fine observations and subtle deductions. In a some- what more advanced age prudery often becomes unbearable, or there appears a naive symptomatic interest for all kinds of society news in which " one ought to take an interest because one is of an age when . . ., etc." The objects of those symp- tomatic interests are brides, pregnancies, births, scandals, etc. The cleverness of elderly ladies for the last is proverbial. These interests pass then under the flag of the "objective, purely human, interests." Here we simply have a transference; the complex must under all circumstances assert itself. As the sexual com- plex cannot in many cases assert itself in a normal manner, it makes use of by-ways. During the age of puberty they exist in the form of more or less abnormal fancies, frequently alter- nating with religious ecstatic phases (transferences). In men, sexuality (if not directly lived through) is frequently changed to a feverish professional activity or to some eccentricity, such as dangerous sports, etc., or to peculiar academic passions, such as a collecting mania. Women take up some altruistic activity which is usually determined by the special form of the complex. (They devote themselves to nursing in hospitals where there are young assistant physicians, etc. ) Or there may be strange eccen- tricities, affectations, " putting on airs " which shall express dis- tinction and proud resignation. The artistic predispositions are especially wont to gain by such transferences. 11 One very fre- quent manner of transference is hiding the complex by means of a contrasting frame of mind. This manifestation is frequently seen in those who are constantly endeavoring to banish a chron- ically irritating sorrow. Among these one generally finds the best wags, the finest humorists whose jokes however are spiced with a grain of bitterness. Others hide their pain under a forced and convulsive cheerfulness, which, on account of its boisterous- ness and artificiality (lack of emotion) allows of no ease in society. Women betray themselves by an unbridled aggressive 10 Freud expresses himself in a similar manner. Compare also the case in Beitrag VIII, Diagnost. Assoz.-Stud. u Freud calls this transference " sublimation " : Drei Abhandlungen zur Sexualtheorie. Deuticke, Leipzig und Wien, 1905, p. 76. THE EMOTIONAL COMPLEX. 49 gayety, the men by sudden disproportionate alcoholic and other excesses (also fugues!). These transferences and simulations may, as is known, produce real double personalities, which have long excited the interest of writers with a psychological trend (see Goethe's " Zwei-Seelen-Problem," and among the modern writers Herman Bahr, Gorki, et a/.). "Double personality" is not a mere literary term, it is a fact in natural science of general interest to psychology and psychiatry, especially when it mani- fests itself in the form of double consciousness or dissociation of personality. The dissociated complexes are always differ- entiated by peculiarities of mood and character, as I have shown in a case of the kind. 12 It happens not seldom that the transference gradually becomes stable and at least superficially replaces the original character. Every one knows people who when judged by their exterior are considered very gay and entertaining. Inwardly, or under cir- cumstances seen in private life, they are sullen grumblers nurtur- ing an open wound. Frequently the true nature suddenly breaks through the artificial investment, the assumed blithesomeness suddenly disappears and we are then confronted with a new per- son. A single word, a gesture, striking this wound, shows the complex lurking within the soul. Such imponderabilities of human emotional life must be borne in mind when we enter with our coarse experimental methods into the complicated mind of the diseased. In association experiments with patients who suffer from marked complex-sensitiveness (as in hysteria and dementia prascox) we find exaggeration of these normal mech- anisms; hence their description and discussion will require more than a mere psychological apergu. "Jung: Zur Psychologic und Pathologic sogenannter okkulter Pha- nomene. Leipzig, 1902. Comp. also Paulhan : La simulation dans le caractere. CHAPTER III. THE INFLUENCE OF THE EMOTIONAL COMPLEX ON ASSOCIATION. How the complex manifests itself in association experiments we have discussed a number of times, and the reader is therefore referred to our earlier publications. We must, however, return to one point which is of theoretical value. We frequently meet with complex reactions which are built up in the following manner : (to kiss to love 3.0" burn ing 1.8" to despise someone 5.2" tooth teeth 2.4" friendly amiable 4.8" dish fish 1.6" The first reaction of the three examples contains the complex (in i and 3 we deal with erotic references and in 2 with an injury). The second group of reactions shows a persever- ating feeling-tone from the preceding reactions, as can be readily seen by their slightly prolonged reaction time and their super- ficiality. As explained in the first contribution of the " Diagnost. Assoz.-Stud.," associations like tooth teeth belong to the motor- speech combinations, burn ing to word completion and dish fish to rhyme combinations. When attention is distracted, there is an increase in motor-speech combinations and in sound reac- tions, as was positively shown from the results obtained in dis- traction experiments. Whenever there is a diminution of atten- tion there is an increase in the superficial associations and their value diminishes. Therefore, if during an association experi- ment without any artificial distraction there suddenly appear striking superficial associations, one is justified in supposing that a momentary diminution of attention has taken place. The cause of this is to be sought in an internal distraction. According to instructions the subject is supposed to fix his attention on the 5 INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 51 experiment, if his attention decreases, that is, if without any external reason the attention is turned away from the meaning of the stimulus word there must be an internal cause for this dis- tractibility. We find this mostly in the antecedent or in the same reaction. There appears a strongly emotional idea, a complex, which on account of its strong feeling tone, assumes great dis- tinction in consciousness, or when repressed sends an inhibition into consciousness, and in this way either suspends for a short time the effect of the directing idea (attention to the stimulus word) or simply diminishes it. The correctness of this suppo- sition can usually be proven without any difficulty by analysis. 1 The phenomenon described is therefore of practical value as a complex-indicator. Of theoretical value is the fact that the com- plex need not be conscious for the subject. From the repression it can send an inhibition into consciousness, thus disturbing the attention ; in other words, it can check the intellectual functioning of consciousness (prolongation of reaction time), or can make it impossible (errors), or can diminish its value (sound associa- tions). The association experiments merely show us the details, whereas clinical and psychological observation show us the same phenomena in gross outlines. A strong complex, such as a tor- menting grief, hinders concentration ; we are unable to tear our- selves away from the grief and direct our activity and interests into other channels. When we make an attempt to do this, " to drown our sorrow," we succeed perhaps for a short time, but we are able to do it only " half-heartedly." Without our knowing it at the time, the complex prevents us frdm giving ourselves up entirely to our tasks. We undergo all possible inhibitions, dur- ing pauses of thought (deprivation of thought in dementia prae- cox) there appear fragments of complexes, which just as in association experiments, produce characteristic disturbances in intellectual functioning. We make mistakes in writing according to the rules of Meringer and Mayer, 2 we produce condensations, perseverations, anticipations, etc., and especially Freud's errors, which last reveal by their content the determining complex. 'For the technic of the analysis see Diagnost. Assoz.-Stud., VI and VIII Beitrag, and Jung: Die psychologische Diagnose des Tatbestandes. Jurist.-psych. Grenzfragen, 19x16. 'Versprechen und Verlesen etc., Stuttgart, 1895. 52 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. Our lapses in talking are at critical points, that is, the words we say have a complex significance. We make mistakes in reading because we think that we see in the text words of the complex. Frequently the complex words appear in the peripheral field of vision 3 (Bleuler). In the midst of our diversions we are sur- prised to hear ourselves sing or whistle a certain melody, the text of which can only seldom and with effort be found, and is a com- plex constellation; or we continue to murmur a word, frequently a technical term, or any foreign word, which also refers to the complex. Sometimes we may be dominated by an obsession, a melody or word continually thrusting itself into our mind. Here, too, are complex constellations. 4 Or we may draw lines on paper or on the table, complex signs which are frequently not difficult to decipher. Wherever the complex disturbances refer to words we find displacements by sound-similarity or phraseological com- binations. I refer here mainly to Freud's examples. 5 I mention the following from my own observations: To the stimulus word " lawn " a gentleman reacts with the peculiar association " broker." The analysis readily shows that he was contemplating some transactions with a loan office " pawn- broker." 6 The word-automatism, " Bunau-Varilla," 7 by free associations gave the following series : " Varinas-Manila Zigarillo Havana cigar." It was because I forgot my matches that I resolved not to throw away the butt of my cigar, so as to light another good cigar with it. The word " Bunau-Varilla " appeared just at the moment when I was about to throw it away. A boy who won a prize for passing a brilliant examination in arithmetic continues to chant for hours the word " rithmication."' 3 The greatest distinctness lies in the point of fixation where, too, is the greatest attention, hence for the peripheral field of vision attention is diminished, and the inhibition for the unsuitable is less than in the point of fixation, therefore in this location it is easier for repressed complex- fragments to manifest themselves. * See examples in Beitrag IV Diagn. Assoz.-Stud. Compare also the mediate associations Beitrag I, Abschnitt B. III. * Psychopathologie des Alltagslebens and Traumdeutung. "Given by translators as play of words, in author's example can not be translated. 7 Beitrag I, Diagnost. Assoz.-Stud. ' [Example given by translators. The example in the German text does not lend itself to translation. Ed.] i INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 53 These examples serve to illustrate that which Freud treats con- clusively in his " Traumdeutung," namely, that repressed thoughts disguise themselves in similarities, be it in speech similarities (sound), or similarities of optical pictures. For the latter forms of displacement dreams afford the best examples. Those who reject Freud's analysis of dreams can discover rich substitutes in melody automatisms. At a merry entertainment some one remarked that if a person marries he should marry a proud lady. A gentleman present who recently married a woman noted for her pride began to softly whistle to himself the melody of a familiar street song. I immediately asked this gentleman whom I knew well to tell me the text of this melody. I received the following answer: "What I whistled just now? Oh that's nothing, I believe I heard it often in the streets but I do not know the words." I insisted that he should recall the words which I knew well, but he was unable to do so; on the contrary he assured me that he never heard these words. The text reads as follows: " Meine Mutter hat gesagt : Nimm dir keine Bauernmagd." (" My mother has said do not take a peasant maid.") During an excursion, a young lady accompanied by a gentle- man whose proposal she soon hoped for quietly sang the Wed- ding March of Lohengrin. A young colleague who just finished his doctor's thesis had to whistle for half a day Handel's " Lo the conquering hero comes crowned with glory," etc. An acquaintance who was happy over a new and lucrative posi- tion betrayed himself by the following melody which obsessed him : " Are we not born for glory ? " A colleague meeting a nurse during his rounds, who was sup- posed to be pregnant, immediately afterwards finds himself whistling : " There were once two royal children who loved each other so much." I do not wish to increase unnecessarily this collection of melody automatisms, every person can daily make the same observation. We learn from this another method of disguise of the repressed thought. It is well known that whistling or singing is a frequent accompaniment in those occupations where the full attention is not required (Freud), the rest of the attention can therefore 54 THE PSYCHOLOGY OF DEMENTIA PRAECOX . suffice to produce a dreamy movement of complex-thoughts. The conscious activity, however, prevents the complex from becoming clear, hence it can only show itself indistinctly, and this eventually happens in the melody automatisms which contain the thought of the complex in a general metamorphosed form. The resemblance lies in the situation or in the frame of mind ; as, " Lo the conquering," etc., Bridal March, " There were once two royal children, etc.," or in the expression (" My mother has said, etc."). The complex-thought in these cases was not clear to consciousness, but manifested itself more or less symbolically. How far such symbolic constellations can go is best seen in the wonderful example of Freud in his " Psychopathologie des All- tagslebens." From the sentence " Exoriar aliquis nostris ex ossibus ultor" Freud was able to trace back to the forgotten word "aliquis" [a liquis liquid fluid blood miracle of S. Gennario ] the thought of a much overdue period in the be- loved. I shall quote a similar example from my own experience in order to corroborate Freud's mechanisms. A gentleman wishes to recite the familiar poem (" Ein Fichten- baum steht einsam ") "A pine tree stands alone, etc." In the line " he felt drowsy " he becomes hopelessly stuck. With the words " with white sheet " he forgot everything. This forgetting in such well known verse seemed to me rather peculiar and I let him reproduce what came into his mind with the words " with white sheet." The following series resulted : " White sheet makes one think of the cloth for the dead a linen cloth with which one covers a dead person (pause) now I think of a near friend his brother died quite recently he is supposed tc have died of heart disease he was also very corpulent mj friend is corpulent, too, and I thought it might also happen tc him probably he does not exercise enough when I heard oi this death I suddenly became frightened, it could also happen to me, as we in our family are predisposed to obesity my grand- father also died of heart disease I too find myself somewhat too corpulent and have therefore within the last few days begun treatment for reducing fat." From this example it can be clearly seen how the repression draws out of consciousness symbolic similarities and chains them to the complex. This gentleman unconsciously identified himself with the pine tree which was enveloped in a white sheet. INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 55 From this fact it can also be assumed that he wished to recite this poem as a symbolic act in order to effect a discharge of his complex excitement. Another preferred realm of complex- constellation is the joke of the pun type. There are persons who possess special talent for this and among whom I know some who have very strong complexes to repress. What I mean I should like to show in a simple example which may serve as an illus- tration. At a gathering there was a gentleman who made many good and bad puns. While oranges were being served he made the following pun : "O rangierbahnhof " (shunting station). Mr. who obstinately disputed the complex theory, called out: " You see, doctor, here you could again suppose that Mr. X. thinks about a journey." Mr. X. embarrassingly replied: " That is really the case; lately I thought much about travelling, but :ould not get away." Mr. X. thought particularly about a jour- ney to Italy, hence the constellation through the oranges, a num- ber of which he recently received from a friend in Italy. To sure, at the moment of pronouncing the pun the meaning of it was totally unknown to him, for the complex constellation is, and must remain, obscure. Dreams, too, are constructed according to the nature of the examples mentioned, that is, they are symbolic expressions of repressed complexes. In dreams we find very fine examples of symbolisms used for expression. 9 As is known, Freud finally advanced the dream investigations on a way towards progress. Let us hope that psychology will soon take cognizance of this fact. It would profit immensely by it. As for the conception of expression by means of symbolisms in the psychology of demen- tia praecox, Freud's " Traumdeutung " is epoch-making. In view of the importance of symbolic expression in dementia prge- cox it will not appear superfluous if I add another to the dream analyses reported in Contribution No. VIII of dream analyses. A friend 10 related to me the following dream : " I saw how horses were hoisted by thick cables to indefinite heights. One of them, a powerful brown horse which was tied *See examples in proof of this in Beitrag VIII, Diagnost, Assoz.-Stud. "I am well acquainted with the personal and family relations of this gentleman. 56 THE PSYCHOLOGY OF DEMENTIA PR^ECOX. up in a belt and dispatched upward like a package, especially took my fancy. Suddenly the cable broke and the horse dropped to the street. I thought that it was surely killed when, all at once, it started up and galloped away. At the same time I noticed that the horse was dragging along the heavy trunk of a tree, and I wondered how, in spite of that, it could advance so rapidly. Evidently it became skittish and was liable to do some damage. Then a rider on a small horse came along and slowly rode towards the unruly horse which also assumed a somewhat slower gait. Nevertheless, I feared that the horse might run over this rider when a cab came along and paced in front of the rider, thus bringing the horse to a still slower gait. I then thought now all is well, the danger is over." I then took up the individual points of the dream and asked my friend X. to repeat to me whatever came into his mind at each point. The hoisting up of the horses recalled to him the idea of hoisting horses on a sky scraper and indeed they seemed to be covered up just like horses that are lowered into mines to work. X. recently saw in a periodical the picture of a sky scraper in process of building where the work is done at a dizzy height and at the same time thought that it was hard work that he would not care for. I then attempted to analyze this strange picture of hoisting a horse into the air. X. stated that the horse was tied around by a belt just as they used to tie horses which they lowered into the mines. What particularly struck the dreamer in the picture of the periodical was the work at such a dizzy height. The horse in the mines must also work. Perhaps the expression for mines (Berg-Werk, literally translated moun- tain-work) gave origin to the two thoughts of the dream, " mountain " expressing height and " work " expressing labor. I therefore asked X. to concentrate his mind on the word " mountain " and tell me the associations following it. He immediately remarked that he was a passionate mountain climber and especially about the time of the dream he had a great desire to make a high ascent and also to travel. But his wife felt very uneasy about it and would not allow him to go alone. She could not accompany him, as she was pregnant. For the same reasons they were obliged to give up a journey to America, whither they had planned to go together. They then realized that as soon as INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. $7 one has children it becomes more difficult to move about and one cannot go everywhere. (Both are very fond of travelling and formerly travelled much.) The idea of relinquishing his trip to America was especially unpleasant to him, as he carried on com- mercial transactions in that country and always hoped that per- haps by a personal visit to the country he would benefit commer- cially. On this hope he built many vague plans for the future, rather lofty and flattering to his ambition. Let us briefly summarize that which has been so far said. Mountain can be interpreted as height. To ascend a mountain = to get to the top. Work = labor. The underlying sense of this may be " By labor one gets to the top." The height in the dream is especially plastically produced by the " dizzy heights " of the sky scrapers which designated America, where my friend's ex- pectations lie. The picture of the horse which is evidently asso- ciated with the idea of labor seems to be a symbolic expression for " hard labor," for the work on a sky scraper upon which the horse was hoisted is very difficult, as is also the work which is accomplished by horses lowered into mines. In colloquial lan- guage we have such expressions as " work like a horse " and " harnessed like a horse." By disclosing these associations we gain a certain insight into the sense of the first part of the dream. We have found the way which apparently leads us to very intimate hopes and expecta- tions in the dreamer. Let us then assume that the sense of this part of the dream signifies, " By labor one gets to the top." The dream pictures appertaining to it can easily be taken as symbolic expressions for this thought. The first sentences of the dream read : " I saw how horses were hoisted by means of thick cables to an indefinite height. One of them, a powerful brown horse which was tied up by a belt and dispatched upward like a package, especially took my fancy." This seems to contradict the analysis which is that by labor one gets to the top. To be sure one can also be hoisted up. In this connection X. recalls how he often looked with disgust upon those tourists who had themselves hoisted up to the high summits by the "flour sack" method. He never needed anybody's help. The various horses in the dream are therefore others who were unable to get to the top by their own effort. The expression \ 58 THE PSYCHOLOGY OF DEMENTIA PRAECOX . " like a package " seems also to express some contempt. But where in the dream is the dreamer himself represented? Ac- cording to Freud he must be represented and indeed he is gener- ally the chief actor. He is undoubtedly the " powerful brown horse." A powerful brown horse resembles him firstly because it can work much, then the brown color is generally described as " a healthy reddish brown color " such as mountain climbers are wont to have. The brown horse then is probably the dreamer. It is hoisted up like the others the content of the first two sen- tences seem to be exhausted to the last point. The hoisting up of the dreamer is not clear, it even contradicts directly the applied sense " through work one gets to the top." It seemed to me of special importance to find out whether my supposition that the brown horse represents the dreamer was really confirmed. For this reason I asked him to concentrate his attention on the passage " I remarked that the horse dragged along a big trunk of a tree." He immediately recalled that for- merly he was nicknamed " tree " on account of his powerful stout figure. My supposition was therefore correct, the horse had even his name attached. The trunk on account of its heaviness en- cumbered the horse, or at least should have done so, and X. wondered that in spite of that it advanced so rapidly. To ad- vance is synonymous with to get to the top. Therefore in spite of the burden or encumbrance X. advances and indeed so rapidly that one gets the impression that the horse is skittish and may perhaps cause some misfortune. On being questioned X. stated that the horse could have been crushed by this heavy trunk if it had fallen, or the force of this moving mass could have thrust the horse into something. These associations exhausted the fancies of this episode. I therefore began my analysis from another point, that is, at that part where the cable broke, etc. I was struck by the expression " street." X. stated that it was the same street in which his business was where he once hoped to make his fortune. One deals here with the hope for a definite career of the future. To be sure it came to nought, and if it would have come to anything it would have been due not so much to his position or his own merits as to personal influences. Hence we get the explanation for this sentence, "The cable broke and the horse dropped INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 59 down." It symbolically very properly expresses the disappoint- ment. He did not fare like many others who get to the top without any trouble. The others who were " preferred " to him and got to the top could not begin to do anything of value for " what could a horse do up there ? " They were, therefore, in a place where they could not do anything. The disappointment over his failure, was, as he stated, so great that on one occasion he was almost desparing of his future career. In his dream " he thought " that the horse was " killed " but soon he verified with satisfaction that it rose again and galloped away. He therefore could not be subdued. Here apparently commences a new part of the dream which probably corresponds to a different period of his life, if the interpretation of the preceding part be correct. I asked X. to fix his attention on the horse galloping away. He states that for a moment in his dream he saw another but very indistinct horse appearing near the brown one ; this, too, dragged the trunk and started to gallop away with the brown one, but it soon became very indistinct and disappeared. As shown also by the late reproduction, this horse seems to be under a special repressing influence and hence important to the dream. X. there- fore dragged the log with some one else and this person must have been his wife with whom he is harnessed " in the yoke of matrimony." Together they pull the trunk. In spite of the burden which encumbers his progress he gallops away. This again expresses the thought that he can not be subdued. The galloping horse recalls to X. Welti's painting " Eine Mondnacht " (a moonlight night) which represents galloping horses on a cor- nice among which one very distinct fiery horse is mounting. In the same picture there is the representation of a married couple lying in bed. The picture of the galloping horse (which at first galloped with another) leads therefore to the very suggestive painting of Welti. Here we get a very unexpected view into the sexual nuance of the dream, whereas we thought we saw only the complex of ambition and future career. The symbol of the horse which until now showed only the side of the hardworking domestic animal now assumes a sexual significance which is specially confirmed by the horse scene on the cornice. There the horse is the symbol of the passionate impulsive desire which without any further discussion can be identified with the sexual 6O THE PSYCHOLOGY OF DEMENTIA PR^ECOX. desire. As shown by the above-mentioned recollections, the dreamer feared that the horse would fall or that the force of the moving trunk might thrust it into something. This vis a tergo can readily be perceived as X.'s own impetuous tempera- ment which he feared might sometimes force him into many thoughtless acts. The dream continues: Then a rider on a small horse came along and slowly rode toward the unruly horse which also assumed a somewhat slower gait. His sexual impetuosity is bridled. X. states that the rider by his dress and from his gen- eral appearance resembled his superior. This fits the first inter- pretation of the dream. His superior moderates the rash pace of the horse; in other words, he hinders the too rapid advance- ment of the dreamer because he is his superior. Now we have to search for the further development of the sexual thought. Perhaps there is something behind this peculiar expression, "a little horse." X. states that the horse was little and pretty like a child's toy and recalls to him an incident of his youth. While still a boy he noticed a woman far advanced in pregnancy, wear- ing hoops. It was then the style. This appeared to him very comical and he asked his mother whether this woman wore a horse under her dress. (He thought of horses worn at carnivals or circuses which are buckled to the body.) Since then, when- ever he saw a woman in a pregnant state, it recalled to him this childish hypothesis. His wife, as we mentioned above, is preg- nant. Pregnancy was also mentioned above as a hindrance to travelling. Here it bridled the impetuosity which we were obliged to designate as sexual. This part of the dream appar- ently means that pregnancy of the wife imposes restraints on the husband. Here we have a very clear thought which is evidently intensely repressed and extraordinarily well hidden in the meshes of the dream. It is composed entirely of symbols of the upward striving conduct. Pregnancy, however, does not seem to be the only reason for the restraint, for the dreamer feared "that the horses may in spite of all overrun the rider." But then we have the slowly advancing cab which moderated still more the gait of the horse. On asking X. who was in the cab, he recalled that there were children. The children therefore were apparently subjected to some repression, as the dreamer recalled them only INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 6l on being questioned. In the vulgar expression known to my friend it was " a whole car full of children." The wagon with the children inhibits his impetuosity. The sense of the dream is now perfectly clear. It reads as follows : The pregnancy of the wife and the problem of too many chil- dren restrained the husband. This dream fulfills a wish as it presents the self-restraint as accomplished. At first sight the dream, just as all others, seems senseless, but when its first stratum is uncovered it already shows distinctly the aspirations and the disappointments of an upward struggling career. In- wardly, however, it hides a most personal question which must be accompanied by many painful feelings. In the analysis and treatment of this dream, I omitted to refer to the numerous recurring analogous combinations, the similarity of pictures, and allegorical representations of phrases, etc. A careful examination of the reported observations shows that they contain the characteristic features of mythological thinking. I only wish to point out that the ambiguity of the individual pic- tures of the dream (Freud's overdetermination) simply shows the obscurity and haziness of thought in dreams. The pictures of the dream belong to one as well as the other complex of the waking state, although both complexes are sharply separated in the waking state. Due to a deficiency of the discriminating ability in the dream both complexes may at least symbolically flow together. This manifestation is perhaps not clear without further expla- nation, but we can readily deduct it from our former premises. 11 Our experiments in distraction confirm our supposition that in "For the fusion of simultaneously existing complexes we may find some corroboration in the elementary fact not unknown in psychology (Fere in La pathologic des emotions, mentions it by way of intimation) that two stimuli simultaneously existing in two different sensory spheres, reinforce or respectively influence each other. From researches with which I am at present occupying myself, it seems to show that a volun- tary motor activity is visibly influenced by a simultaneously existing auto- matic activity (breathing). From all that we know of complexes they are continued automatic incitements or activities. Just as they influence the conscious activity of thought so do also the complexes act upon one another formatively, so that every complex contains elements of the other, a thing which may psychologically be designated as fusion. Freud from a different point of view calls this Uberdeterminierung (overdetermination). 62 THE PSYCHOLOGY OF DEMENTIA PRAECOX . diminished attention, thought is rather superficially connected. The state of diminished attention expresses itself in a decrease of clearness of ideation. Whenever the ideas are not clear their differences, too, are not clear; hence our sensitiveness to differ- ences is naturally diminished, for it is nothing but a function of attention or clearness (synonyms). Therefore there is nothing to prevent the mistaking of one idea ("psychic molecule") for another, although normally they are clearly defined. The experi- mental expression for this fact is the increase of mediate asso- ciations produced by the distractibility. (See Beitrag IB of the " Diagnost. Assoz.-Stud.") It is known that the mediate associa- tions of the association experiments (especially in a condition of distraction), are generally nothing else than a displacement of an intimate connection by phrase or sound. (For example, see Beitrag I. Intr. "Diagnost. Assoz.-Stud.") On account of the distraction the psyche becomes uncertain in the choice of expres- sion, and has to be satisfied with all sorts of errors in the speech and acoustic systems, thus resembling a paraphasic. 12 We can readily assume the external distraction in our experiments to be replaced by a complex which displays its autonomous effect beside the activity of the ego-complex. We have discussed above the resulting association phenomena. Whenever the com- plex becomes excited the conscious association becomes disturbed and superficial, due to an escape of attention (or inhibition of "Kraepelin (Uber Sprachstorungen im Traume, Psychol. Arbeiten, Bd. V, H. i) is of the opinion that the proper formation of a thought is hindered by the encroachment of a distracting by-idea. On p. 48 he expresses himself as follows : " The common feature in all these observa- tions (Dream paraphasias) is the displacement of the basal thought by the entrance of a by-association for an essential link of the chain of presenta- tions. The derailment of speech or of thought to a by-association is due in my opinion, to lack of distinctness in the ideas." Kraepelin further asserts that " the by-idea causing the displacement of thought was dis- tinctly a narrower and more significant idea which suppressed the more general and more shadowy one." Kraepelin calls this symbolic manner of derailment " metaphoric paralogia " in contradistinction to the purely " displacing " and " derailing paralogia." The " by-associations " are mostly perhaps associations of similarity at all events we deal here very fre- quently with such it is therefore easily understood how the paralogia has the character of metaphor. Such metaphors may give the impression, as it were, of an intentional disfigurement of the dream-thought. In this point Kraepelin is not very far from Freud's ideas. INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 63 attention) to the a parte existing complex. During the normal activity of the ego-complex the other complexes must be inhibited else the conscious function of the directed association would be impossible. We therefore see that the complex can only indi- rectly reveal itself by indefinite symptomatic association (sym- bolic actions), all of which show a more or less symbolic char- icter. 13 (See all examples mentioned above.) The effects eman- iting from the complex must in the normal be weak and obscure jecause they are not in possession of their full attention which is taken up by the ego-complex. Therefore in the experiment on distraction the ego-complex and the autonomous complex must be directly compared to both psychic activities, just as in the experiment most of the attention is bestowed on the writing and only a fraction on the association, so in activity most of the attention lies in the ego-complex while the autonomous complex receives only a fraction of it (provided the autonomous complex is not abnormally excited). It is for this reason that the autonomous complex can think only superficially and vaguely, that is, symbolically. Its productions (automatism, constella- tions) which it sends into the activity of the ego-complex and into consciousness must be created in a similar manner. We shall here give a brief analysis of the symbolic. We use the symbolic in contradistinction to the allegoric. Allegory is an intentional interpretation of a thought reinforced by emblems, while symbols are only indistinct by-associations of a thought, causing more vagueness than perspicuity. Says Pelletier : 14 " The symbol is a very inferior form of thought. One can define the symbol as a false perception of a relation of identity or of a very great analogy between two objects which in reality present but a "Stadelmann (Geisteskrankh. u. Naturwissensch., Miinchen, 1905) in his regretably affected manner of representation, says : " The psychotic furnishes the partially or completely deranged feeling of his ego with a symbol, but unlike the normal he does not compare this feeling with other processes or objects, but it is stretched to such an extent that the pic- ture which he has brought in for comparison he allows to become a reality, a subjective reality which in the judgment of others is a delusion." " The genius finds the necessity of forms in his inner life which he pro- jects outwardly, and whereas the symbolized associations in the psychotic become delusions, in the genius it only manifests itself as a somewhat exaggerated experience." 14 L'Association des Idees dans la Manie aigue, etc. These de Paris, 1903. 64 THE PSYCHOLOGY OF DEMENTIA PRAECOX . vague analogy." Pelletier also presupposes that for the origin of symbolic association there must be a deficiency in power of discrimination. Let us now apply these reflections to the dream. At the onset of sleep there is the suggestive imperative, "you wish to sleep, you don't wish to be disturbed by anything." 15 This is an absolute command for the ego-complex which subdues all associations. But the autonomous complexes as shown above are no more under the direct control of the ego-complex. They allow themselves to be pushed back quite far, and to be reduced, but not to be completely lulled to sleep. For they are like small secondary minds having their own affective roots in the body and by means of which they always remain awake. During sleep the complexes are perhaps just as inhibited as during the waking state, for the imperative call to sleep inhibits all side thoughts. 16 Nevertheless, just as during the noises of the day and in the waking state, so they succeed from time to time in presenting to the sleeping-ego their pale, apparently senseless, by-associations. The complex thoughts themselves are unable to appear, as the inhibition of sleep-suggestion is especially directed against them. If they are able to break through the suggestion, that is, if they can come to the full possession of attention, of course sleep immediately ceases. We see this very frequently in the hypnosis of hysterics; the patients sleep a short time, then they suddenly 15 Of course this is only a figurative expression for the sleep obsession, or sleep instinct (see Claparede : Esquisse d'une theorie biologique du sommeil. Archives de Psychologic, Tome IV, p. 246). Theoretically I agree with the point of view formulated by Janet : Par un cote le sommeil est un acte ; il demande une certaine energie pour etre decide au moment opportun et pour etre accompli correctement." Les Obsessions, I, p. 408. Like every psychic process, sleep probably has its special cell chemism (Weygandt !). In what it consists no one knows. Considered from the psychological side it seems to be an autosuggestive phenomenon (Forel and others utter similar views). Thus we understand that there are many transitions from the pure suggestive sleep to the organic sleep obsession which gives the impression of a poisoning by some meta- bolic toxin. 18 The instinctive sleep inhibition can be expressed psychologically as "desinteret pour la situation present" (Bergson, Claparede). The effect of the " desinteret " on the association activity is the " abaissement de la tension psychologique " (Janet) which as afterwards described manifests itself in the characteristic association of dreams. INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 65 become awakened through fright from some thought-complex. Insomnia in many cases is due to uncontrollable complexes against which the energy of the auto-suggestion of sleep can no more be effective. If, however, by proper means we reinforce the energy of such persons they are again able to sleep, because they can restrain their complexes. But restraining the complex means nothing more than the withdrawal of the attention, that is, its distinctness. Hence in their thought the complexes depend only on a small fraction of distinctness and because of deficiency of discrimination they manifest themselves in rather vague and symbolic expressions and become mingled. A real censorship of dream-thoughts in the sense of Freud we need not admit. The inhibition emanating from the sleep-suggestion perfectly suffices to explain all. In conclusion we must mention another charac- teristic complex-effect, that is, the inclination to contrast-associa- tion. As was fully shown by Bleuler (see Chap. I) psychic activity tending towards an aim must be accompanied by con- trasts. This is absolutely necessary for proper coordination and moderation. From experience we know that every decision is accompanied by the association of contrasts. Normally we are never impeded by contrasts, they only induce reflection and are useful for our actions. But if for any reason the energy is impaired, then the individual readily becomes the victim of an opposition between positive and negative, inasmuch as the feeling- tone of the decision suffices no more to overpower and restrain the contrasts. We see this very often wherever a strong complex absorbs the energy of the individual. The energy being dimin- ished, the attention for everything not belonging to the complex becomes superficial, and the associations lack a firm course. As a result we get on the one hand shallow associations, and on the other the contrast can no longer be suppressed. Sufficient exam- ples can be found in hysteria where one deals entirely with con- trasting emotions (see Bleuler's works) and in dementia praecox where we deal with emotional and speech contrasts (see Pelle- tier's work). Stransky experimentally found speech contrasts in his forced talking. A few general remarks will be made on the manner and course of the complex by way of addition to Chapters II and III. Every emotional event becomes a complex. If it does not meet 66 THE PSYCHOLOGY OF DEMENTIA PRAECOX . an already existing kindred complex it is only of momentary significance, and gradually sinks with lulled emotional tone into the latent mass of memory where it remains until a kindred impression reproduces it. But if an emotional event meets an already existing complex, it reinforces it and for some time assists it in gaining the upper hand. The clearest examples of this kind are to be seen in hysteria, where apparently insignificant things may lead to strong emotional outbursts. In such cases the impression touched either directly or symbolically the rather loosely repressed complex and in this manner called forth a complex-storm, which, in view of the unimportance of the event, appears entirely disproportionate. The strongest complexes unite themselves with the strongest emotions and impulses. We must therefore not be surprised at the fact that most complexes are of an erotic-sexual nature (as are also most dreams and hysterias). Especially in women where the sexual is the center of psychic life there hardly exists a single complex not in relation to sex- uality. The significance of sexual trauma for hysteria univer- sally assumed by Freud probably rests on this circumstance. At any rate, sexuality should always be kept in mind during psy- chanalysis which does not, however, mean that all hysterias are exclusively traced to sexuality. Any strong complex may call forth hysterical symptoms in those predisposed, at least so it seems. I do not mention here all the other kind of complexes, as I have already attempted to sketch the most frequent kinds. 17 It is for the interest of the normal individual to free himself from any obsessing complex which impedes the further proper development (adaptation to environment) of his personality. Time generally takes care of that. Frequently, however, arti- ficial aid must be invoked so as to help the individual rid himself of an obsessing complex. Transference we have learned to know as a very frequent help. One is wont to grasp at something new, especially something which strongly contrasts with the complex (masturbatic mysticism). An hysteric can be cured if one is able to produce a new complex which will obsess her. 18 Soko- " Arch, f iir Krim.-Anthropol., 1906. 18 Hysteria makes use of all sorts of detailed measures in order to pro- tect itself against the complex, such as conversion into bodily symptoms, disassociations (splitting) of consciousness, etc. INFLUENCE OF EMOTIONAL COMPLEX ON ASSOCIATION. 6/ lowski 10 expresses himself in a similar manner. If one succeeds in repressing the complex, there remains for a long time a strong complex-sensitiveness, that is, there is a marked tendency to recrudescence. If the repression was produced by compromise- formation there exists a lasting inferiority, a hysteria, in which only limited adaptation to the environment is possible. If the complex remains entirely unchanged which, to be sure, is possible only when there is most serious damage to the ego-complex and its functions, we must then speak of dementia praecox. 20 Of course, I speak here only from the psychological side and only affirm what one may find in the psyche of dementia praecox. The view expressed in the above sentence in no way excludes the idea that the inveterate persistence of the complex may be due to an internal poisoning which may perhaps have been originally liberated by the affect. This assumption seems probable because it is consonant with the fact that in most cases of dementia praecox the complex is in the foreground, while in all primary intoxications, such as alcoholic, uremic poisoning, etc., the com- plex plays a subordinate role only. Another fact which speaks for my supposition is that many cases of dementia praecox begin with striking hysteroid symptoms, and only during the course of the disease do they " degenerate," that is, only during the course of the disease do they merge into the characteristic stereotypy or senselessness. It was for this reason that the older psychiatrists spoke directly of degenerative hysterical psychoses. We may, therefore, formulate the above conceptions in the following manner : Considered from without we see the objective signs of an affect. These signs gradually (or very rapidly) grow stronger and more distorted so that to ingenuous observation it finally becomes impossible to assume a normal psychic content and one then speaks of dementia praecox. A more perfect chemistry or anatomy of the future will perhaps sometime be able to demon- strate the objective metabolic changes belonging to it, or the toxin effects. Considered from within, which, of course, is only 19 St. Petersburger Medic. Wochenschr., 1895. *A similar? idea, which, however, is unfortunately almost choked by its weedy exuberant conception is uttered by Stadelmann, Geisteskrankh. u. Naturwissensch. Miinchen, 1905. 68 THE PSYCHOLOGY OF DEMENTIA PRAECOX . possible through complicated analogical conclusions, we observe that the subject can not psychologically free himself from a cer- tain complex. Because he continually associates with this com- plex and allows all his actions to be constellated by it, there must result a certain reduction of personality. How far the purely psychological influence of the complex reaches in such case we are unable to say at present; we may, however, suppose that the toxin effect plays an important part in the progressive degeneration. CHAPTER IV. DEMENTIA PR^ECOX AND HYSTERIA. A PARALLEL. To write an exhaustive comparison between dementia praecox and hysteria would be possible only if we knew more thoroughly the disturbances of the association activities of both diseases, and especially the affective disturbances in normal individuals. At present we are far from this. What I intend to do here is to recall the psychological resemblances based on the preceding dis- cussions. As a later treatment of the association experiments in dementia praecox will show, an antecedent comparison between dementia praecox and hysteria is necessary in order to under- stand the manifestations of the associations in dementia praecox. i. THE DISTURBANCES OF THE EMOTIONS. The more recent investigators of dementia praecox (Kraepelin, Stransky and others) group the emotional disturbances about the central point in the picture of the disease. On one side one speaks of emotional dementia, and on the other of an incongruity between ideation and affect (Stransky). I do not speak here of terminal dementia as seen in the terminal stages of the disease which can hardly be compared to hysteria (they are two totally different diseases), but I limit myself to the apathetic conditions during the acute stages of the disorder. The emotional apathy so striking in many cases of dementia praecox has a certain analogy to the " belle indifference " of many hysterics who describe their complaints with smiling serenity, thus giving a rather inadequate impression, or speak with equa- nimity about things which should really profoundly touch them. In Contributions VI and VIII of the "Diagnost. Assoz.-Stud." I endeavored to point out how the patients apparently speak unemotionally about things which to them are of the most inti- mate significance. This is especially striking in analyses where 69 7