CORNELL 
 
 UNIVERSITY 
 LIBRARY 
 
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' RC 454.W5T" ""'""'''"""' 
 
 Foundations of pyschiatry [!] 
 
 3 1924 012 468 371 
 
Cornell University 
 Library 
 
 The original of tiiis book is in 
 tine Cornell University Library. 
 
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 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924012468371 
 
Nervous and Mental Disease Monograph series JNo. 32 
 
 Foundations of Pyschiatry 
 
 BY 
 
 WILLIAM A. WHITE, M. D. 
 
 WITH AN INTRODUCTION BY 
 
 Dr. STEWART PATON 
 
 NEW YORK AND WASHINGTON 
 
 NERVOUS AND MENTAL DISEASE 
 PUBLISHING COMPANY 
 
 1921 
 
Copyright By 
 
 William A. White, M.D. 
 
 Washington, D. C. 
 
CONTENTS 
 
 Page 
 
 Introduction by Dr. Stewart Paton v 
 
 Preface vii 
 
 Chapter I. Introduction 1 
 
 Chapter II. The Unity of the Organism 10 
 
 The Biological Point of View — Integration — 
 
 Structuralization — Individuation. 
 
 Chapter III. The Dynamics of the Organism 28 
 
 The Canon of Physiology (The Conflict) — 
 Ambi valency. 
 
 Chapter IV. The Stratification. of the Organism .. 41 
 The Physiological Level — The Psychological 
 Level — The Sociological Level. 
 
 Chapter V. The Region of Psychopathology 68 
 
 Chapter VI. The Nature of the Neuroses and the 
 
 Psychoses 82 
 
 Chapter VII. Therapeutics 112 
 
 Action — Objectification — Transference — Re- 
 
 symbolization. 
 
 Chapter VIII. The Social Problem 123 
 
 Elevation — Rationalization — Sublimation — 
 The Socialization of Strivings. 
 
 Chapter IX. Conclusion 128 
 
INTRODUCTION 
 
 Many of the perplexing problems in the World today are the 
 results of attempts to regulate society on the basis of what man is 
 supposed to be. 
 
 Practically very little is actually known about man as he is, 
 yet laws are drafted and adopted, and proposals to regulate in- 
 ternational relations and to direct the course of civilization are 
 made, based upon the old purely imaginative conceptions of the 
 forces shaping human character. 
 
 Ideals of social progress and hopes for international peace can 
 only be changed from visions of wishful thinkers into plans 
 capable of being realized by modifying cherished ideals to meet 
 the actual biological needs of mankind. 
 
 In this volume, for which I have been privileged to write an 
 introduction, the author. Dr. White, has pointed out what in- 
 formation is available for preparing the foundations of a science 
 of human character. He has emphasized the driving power of 
 the instinctive life, traced the genesis of impulses, and has pointed 
 out some of the prejudices and fixed ideas that are responsible 
 for so much of the chaos in the World. This presentation should 
 be useful not only to physicians interested in trying to check the 
 spread of nervous and mental diseases, that have become one of 
 the greatest menaces to civilization, but to all the great army of 
 earnest people now engaged in efforts to promote peace and to 
 reorganize society. 
 
 Stewart Paton. 
 
PREFACE 
 
 The present century has witnessed an advance in the field of 
 psychiatry which is unprecedented and has resulted in no less 
 than a complete revolution in our ways of thinking of mental dis- 
 ease. From the period, out of which we are only now passing, 
 when all mental disease was thought of as insanity and all nerv- 
 ous disease as hysteria or perhaps neurasthenia, to the present 
 with its elaborate description and interpretation of mental mech- 
 anisms and personality make-up, a tremendous step forward has 
 been taken in the understanding of the human individual of mo- 
 mentous importance, not only to psychiatry but to the practice of 
 medicine in general as well as to all those related sciences that 
 are occupied with an understanding of man. 
 
 In my previous works^ I have endeavored to cover the de- 
 scriptive aspects of psychiatry, to outline and interpret the more 
 important of the mental mechanisms and to give .the application, 
 of the facts and principles of the new psychology to certain fields 
 of endeavor, specifically psychotherapeutics and mental hygiene. 
 Such a series of works constitute an effort to develop a System 
 of Psychiatry which describes the various mental illnesses, traces 
 their causes in the underlying mental mechanisms, outlines their 
 
 1 Outlines of Psychiatry : Published by the Nervous and Mental 
 Disease Publishing Company, Washington, D. C, 1920. (8th ed.) 
 
 Diseases of the Nervous System : Written with Dr. S. E. Jelliff e. 
 Published by Lea & Febiger, Philadelphia, 1920. (3d ed.) 
 
 Mental Mechanisms : Published by the Nervous and Mental Disease 
 Publishing Company, Washington, D. C. 
 
 Modern Treatment of Nervous and Mental Diseases : Edited with Dr. 
 S. E. Jelliffe. Published by Lea & Febiger, Philadelphia, 1913. 
 
 Mechanisms of Character Formation : Published by the Macmillan 
 Company, New York, 1916. 
 
 The Principles of Mental Hygiene : Published by the Macmillan Co., 
 New York, 1917. 
 
 The Mental Hygiene of Childhood: Published by Little, Brown and 
 Company, Boston, 1919. 
 
 Thoughts of a Psychiatrist on the War and After : Published by Paul 
 B. Hoeber, New York, 1919. 
 
VIU FOUNDATIONS OF PSYCHIATRY 
 
 treatment and the principles involved in their prevention, and 
 gives the application of the principles to various related prob- 
 lems, not only of individual man but of man as a social animal. 
 
 In this work I shall endeavor to set forth these same 
 principles from a wider viewpoint, gathering them together and 
 discussing their biological, psycho-biological, and sociological 
 foundations and ramifications in a general philosophy of the 
 foundation principles which underlie an adequate approach to 
 the problems of psychiatry. This is no- less than an effort to for- 
 mulate a Philosophy of Psychiatry. 
 
 I have undertaken this broad philosophical approach to psy- 
 chiatry because of my conviction that only by an illumination of 
 the foundations of the principles of psychiatry can a full under- 
 standing of them be had and only when that is accomplished will 
 much wrong thinking about them be in the way of correction. 
 
 This method of procedure is inevitable. In any new depart- 
 ment of thought it is natural that its early stages should be char- 
 acterized by an attempt to describe the various phenomena which 
 are conceived rightly to come within its proper domain, later at- 
 tempts are made to interpret these phenomena, and lastly, on the 
 basis of these descriptions and interpretations an effort is made 
 to correlate the findings with the general principles of science 
 which have been worked out in other fields. This latter effort, 
 namely, to correlate the facts of a given field of inquiry with the 
 principles worked out in other fields which touch it more or less 
 directly, is the proper function of philosophy and is the field 
 which this book attempts to present. This is an ambitious task 
 and I can only hope to succeed in pointing the way which others 
 may follow. Because of the rapid advance in the field of psy- 
 chiatry in recent years and the realiza:tion of its value for an 
 understanding of many problems which until recently were never 
 conceived to come within its sphere, I believe that a philosophy 
 of psychiatry may be of great value at the present time. 
 
 During the period of the world war the several groups of 
 psychoanalysts in different countries were separated one from 
 another. Verbal, written and printed communications were 
 closed or rendered extremely difficult. As a result each group 
 developed along lines of its dominant trends less modified than 
 usual by the other groups with varying tendencies. The war 
 
PREFACE IX 
 
 period therefore served to accentuate the distinctive character- 
 istics in the various quarters. 
 
 In the United States, where the growth of the psychoanalytic 
 movement, and particularly the development of its relations to the 
 broader study of psychopathology, has been more free, more 
 progressive, and less doctrinal, certain fairly well defined trends 
 have come into the foregroimd, which, while not exclusively 
 characteristic, are still given much more emphasis here than 
 elsewhere. 
 
 These characteristics are sufficiently marked so that it would 
 seem proper to speak of an American School of Psychopathology 
 as distinctive from' the European groups. 
 
 In general, the features which the American School empha- 
 size may be outlined as follows: (i) The unity of the organism 
 as an energy system: (2) human behavior as a special problem 
 of energy transformation and discharge; (3) structural organ- 
 ization as an instance of the phyletic synthesis of experience, with 
 the nervous system as the chief agent in this organization : (4) the 
 principle of action patterns of discharge as integral parts of the 
 structural organization; (5) the conception that the symbol is a 
 source and a carrier of energy; (6) the ambolition of the meta- 
 physical distinction between mind and body; (7) the conception 
 of the unconscious as a container of the phyletic history of the 
 organization of the psyche in action pattern symbolization ; (8) 
 the importance of archaic symbols and their relationship to 
 somatic as well as mental diseases; (9) the belief that organic 
 disorders have their psychologic as well as their somatic symp- 
 tomatology; (10) the behef that standards of conduct are an 
 integral part of the action pattern symbolizations and therefore 
 must be included in the understanding and management of all 
 medical and social problems. 
 
 The most comprehensive expression of these tenets is to be 
 found in Jelliflfe and White's Diseases of the Nervous System. 
 This little book, Foundations of Psychiatry, is an expression of 
 the distinctive features of the American School and an examina- 
 tion into the foundation principles involved. Its function is, to 
 use an expression of one of the members of my staff, to biologize 
 psychiatry, in the sense, of course, that biology is inclusive- of 
 psychology, the humanities and the social sciences. 
 
 W. A. W. 
 
CHAPTER I 
 Introduction 
 
 The study of psychiatry has long been sepaYte from the other 
 medical specialties. Mind has been a phenomenon treated as 
 detached from consideration by the laws applicable in other 
 departments of medicine. Like all scientific disciplines, however, 
 it has been busily concerned with collecting its facts and grouping 
 them in variously arranged classifications, the facts gradually 
 increasing in number and complexity and the classifications fol- 
 lowing suite. In this process the conception of mental disease 
 types has arisen and these so-called diseases have received an 
 ever increasing accuracy of description followed by splitting up 
 into sub-types in every way analogous to natural history methods 
 of progress. Of late years, however, there has been a growing 
 tendency to seek beyond the facts of mere description and this 
 search has inevitably led to a progressively more dynamic ap- 
 proach to the problems of mental disease which has laid more and 
 more emphasis upon the processes involved in the psychoses over 
 and above the mere description of their phenomena as symptoms. 
 
 In the search for explanations, in the growth of an interpre- 
 tative psychiatry, in the change from a static to a dynamic view- 
 point, the false distinction between mind and body has gradually 
 given way to a method of approach which no longer stresses this 
 distinction but sees in the mind, the personality make-up, the final 
 expression of the total integration of the individual into an 
 organic unity, and realizes for the first time that psychological 
 mechanisms are at least analogous to those mechanisms with 
 which medicine has so long been familiar in its other departments. 
 
 The failure previously to arrive at such a standpoint as this 
 has largely been the result of medical teaching. The medical stu- 
 dent, under the instruction of different specialists, has been led 
 to consider the human individual as composed of dififerent organs, 
 or systems of organs, which in each case he studied more or less 
 exclusively and with little regard for the fact that they were in 
 
2 FOUNDATIONS OF PSYCHIATRY 
 
 every instance parts of a larger whole. This attitude of medicine 
 towards the body is perfectly understandable and belongs to a 
 certain stage of progress in the development of thought. The 
 parts are first apprehended before their interrelations can becotne 
 a matter for consideration. In psychiatry, however, the student 
 is for the first time introduced to a consideration of the organism 
 as a whole, to its total as contrasted to its partial reactions. This 
 is not to say that internal medicine can not legitimately consider 
 the organism as a whole, as a unity. It can and should but in 
 psychiatry this matter of unity and wholeness is stressed for the 
 first time. The question no longer is, What is the liver, or the 
 kidney, or the stomach doing? but. What is the man doing? 
 
 This state of affairs can be simply illustrated by a social 
 analogy. Suppose the bakers should get together for the purpose 
 of standardizing the size and the price of a loaf of bread. If the 
 necessary changes to this end were inconsiderable they would not 
 attract attention, would even not be known about by the majority 
 of the people. The changes would be, to all intents and purposes, 
 local, confined to the group of bakers. Such a change is com- 
 parable to an inflammation with abscess formation of the arm, 
 for instance, without any systemic symptoms and with a minimum 
 of interference with the function of the arm. Now suppose, on 
 the contrary, that the bakers should agree among themselves to 
 materially raise the price of bread or decrease the size of the loaf, 
 or that they should strike for higher wages and for a time at least 
 stop production. Then it can be readily seen that their action 
 would cease to have only local significance but on the contrary 
 would become of great social importance. To return to the anal- 
 ogy of the abscess of the arm. If instead of remaining a strictly 
 localized afifair general infection v/ere to result the patient wotild 
 feel ill and would develop mental symptoms, for instance along 
 with the feeling of illness he would be depressed and perhaps with 
 the onset of fever he might become delirious. In other words, 
 just so soon as the abscess produces a general infection just so 
 soon does there appear a total, that is, a mental reaction; and 
 just so soon as the action of the bakers ceases to be purely local 
 does it tend to become general, that is, social. 
 
 For the most part the medical schools have laid emphasis in 
 their teachings upon the partial reactions, the diseases of the 
 
INTRODUCTION 3 
 
 several organs. Psychiatry has only recently been recognized in 
 the curricula of the medical colleges and it is the only medical 
 specialty that deals primarily with total reactions although psy- 
 chiatrists have by no means always recognized that fact having 
 not infrequently wandered very far in their search for causes and 
 explanations. Of course this is not to say that the internist may 
 not also properly approach the problem of disease as it involves 
 particular organs from the standpoint of the organism as a whole. 
 This is not only legitimate, but a very valuable, nay a necessary 
 ^ngle of approach if the problems are going to be fully compassed 
 from all sides and the internist more or less appreciates this and 
 often tries to do it. But he has almost always failed for he has 
 not taken the personality into consideration or if he has his con- 
 sideration has been hopelessly inadequate. Now psychiatry, deal- 
 ing essentially, as it does, with total reactions, that is reactions of 
 the individual as a whole, which is only another way of saying 
 mental states, is peculiarly in a position to rescue medicine, as it 
 were, from its rather hopeless quest for adequate explanations in 
 a consideration of anything short of the whole individual. The 
 whole can never be explained by the parts, no search, no matter 
 how painstaking will ever discover an idea in the section of brain 
 tissue under the microscope. The great contribution which psy- 
 chiatry has to make to medicine, therefore, is this emphasis upon 
 the importance of total reactions, and, which is largely the same 
 thing, its emphasis upon the importance of studying the phe- 
 nomena of consciousness and realizing that the understanding of 
 the individual can not be accomplished by an approach that is 
 wholly from without, so to speak, that is, that takes no cognizance 
 of the situation irom within. Happiness is at least as important 
 a goal as a urine of a certain specific gravity. 
 
 The study of consciousness, or better of mind, is too a study 
 of the most important of all the functions as well as the most im- 
 portant tool which man brings to bear upon the interpretation of 
 his problems and in eiFecting his various adjustments. It is cer- 
 tainly worth while to attempt to cultivate this instrument, to try 
 to discover its limitations, weak points, and possibilities. A prob- 
 lem as important for the physician in dealing with his own mind 
 as tool as in dealing with the mental adjustments of his patients. 
 In the chapters which follow an attempt will be made to outline 
 
4 FOUNDATIONS OF PSYCHIATRY 
 
 the important mental mechanisms, to describe the fundamental 
 laws which govern the processes of mind, in order to throw light 
 upon its ways of working. Not all of the mechanisms will be 
 examined but only those of fundamental importance a knowledge 
 of which is necessary for the adequate approach to any mental 
 problem, and those will be examined sufficiently to indicate that 
 they are processes governed by laws which are not only operative 
 in the field of the hiunan psyche but are of universal significance 
 as laws governing the distribution of energy whether jn the fields 
 of biology, psychology, or sociology. 
 
 Not only is it important in general for both psychiatry and 
 general medicine to recognize and understand the nature of total 
 reaction types of response, but it is of the greatest practical im- 
 portance for the whole field of therapeutics, otherwise thera- 
 peutic agents, pharmacological, surgical, climatic, recreational 
 or what not, are in constant and serious danger of being wrongly 
 valued. The personality make-up cannot be safely kept out of 
 consideration in any problem that effects the individual. It is 
 obviously fundamental in psychiatry, it is less obviously but 
 often equally fundamental in internal medicine, and it is often of 
 the very first significance in therapeutics. Whole fields of thera- 
 peutic endeavor are constantly receiving their stimulus from suc- 
 cesses almost if not quite wholly dependent upon their psycho- 
 therapeutic value yet the results are as constantly attributed to 
 the agent employed, usually a drug or an operation. That such a 
 serious distortion of what actually takes place is possible not only 
 spells great danger for the patient, wastes energies on the part 
 of the physician which could be employed to better advantage, but 
 is evidence of a degree of loose thinking which is sorely in need 
 of correction. From this point of view also, therefore, it is im- 
 portant to have more knowledge of the ways of working of the 
 mind, not only as it may get out of order in the patient but as it 
 may operate in the physician to distort the facts of observation 
 and even his own motives. For all of these reasons mind needs 
 to be studied in medicine, not in the superficial way of describing 
 a few types of disorders by recounting their prominent symptoms 
 in a course in psychiatry but seriously as of fundamental impor- 
 tance to the adequate understanding of the human individual, and 
 as a phenomenon which, to be understood, needs to be studied 
 from the standpoint of the broadest biological approach. 
 
INTRODUCTION 5 
 
 The conquermg of the environment is made possible only by 
 an increase in the knowledge of that environment which is, speak- 
 ing in general, accomplished by a process of becoming conscious 
 of the things which constitute the environment and of the laws 
 that govern them. Great advances in knowledge are made pos- 
 sible, among other ways, by perfecting the instruments with 
 which the environment is examined. In the course of evolution 
 the perfecting of the sense organs has brought the higher animals 
 into contact with aspects of the enviromnent unknown to lower 
 forms, while in the realm of science the perfecting of instruments 
 for enlarging the power of perception has been a notable factor 
 in bringing a constantly wider aspect of the environment within 
 the realm of perception. The perfection of the microscope, the 
 telescope, and the spectroscope are instances in point and this 
 perfection of the instruments for increasing the field of percep- 
 tion has, among other things, been along the line of correcting 
 those imperfections which produced erroneous results. The proc- 
 ess of the elimination of defects has taken place at once in the 
 realm of organic evolution, for example, the correction of the 
 defect in vision produced by the blind spot of the retina, and in 
 the fabricated instruments for enlarging the field of perception, 
 as for instance, the correction of errors of chromatic aberation 
 in the microscope. Now the human mind may profitably be con- 
 sidered as an instrument for contacting with the environment and 
 it is equally important to look to its sources of possible error with 
 a view to correcting them. This was early appreciated by the 
 astronomers who found that a series of observations of the same 
 phenomenon were not all alike. The human machine did not 
 function with absolute accuracy so that an allowance had to be 
 made for personal errors in correcting the observations — the so- 
 called personal equation. 
 
 The new psychology has discovered the same sort of thing 
 with reference to man's conduct, his beliefs, activities, observa- 
 tions and his estimates of his fellows, in fact, his whole field of 
 relations to his personal and social environment. An individual's 
 reaction in any particular situation is not alone determined by 
 the factors of the situation itself but the sum total of his previous 
 experience which relates him to it and for the most of which he 
 is quite unconscious. In other words, every situation is ap- 
 
6 FOUNDATIONS OF PSYCHIATRY 
 
 preached with a certain personal bias, a prejudice, based upon 
 what the particular nature of the previous experience may have 
 been. For example, certain religious, political, social doctrines 
 are subscribed to, professions, recreations, friends, kre chosen, 
 theories of living, philosophies are elaborated almost altogether 
 because of tendencies which lie back of consciousness and which 
 are only vaguely, if at all, in the field of awareness. In other 
 words, problems of living are approached with a bias, a prejudice 
 born of the unconscious, and lives express, among other things, 
 the reactions to these unconscious urgir^s. It is a matter of 
 common knowledge that often tendencies are at variance with the 
 individual's as well as other's interests, but never before has there 
 been an adequate appreciation of the nature of the problem of 
 bringing these tendencies under control and direction much less 
 a technique for doing so. This is precisely what the new psy- 
 chology essays and because of the tremendous importance to 
 mankind of the problems it attacks, its suggested solutions must 
 be given an adequate hearing. 
 
 The new psychology, therefore, has to do with a refinement 
 of this instrument of the mind, so that it will work better in its 
 function of relating the human machine to its environment. To 
 that end it is essential to know it through and through for what 
 it really is, rather than take it at its face value. Just because a 
 man says so and so, even though the man be as a matter of fact 
 truthful, is no reason why his statement should be accepted. A 
 man says that he really does not care for alcohol, that he only 
 takes it as a matter of sociability and he may think he is telling 
 the truth but if he is seen year after year becoming a confirmed 
 alcoholic it is realized that it is not so. In truth " actions speak 
 louder than words." 
 
 Such a man, however, may easily have fooled others into an 
 acceptance of his statement, but more important still is the fact 
 that he succeeded also in fooling himself. For after all the es- 
 sence of psychology is self-knowledge, for one must first be 
 honest with oneself if one is to succeed with others. " To thine 
 own self be true, . . . thou canst not then be false to any man." 
 
 Instincts are bound to get expression in some way, sooner or 
 later, and if an understanding of their promptings is not possible 
 then they gain expression by some devious pathway and parade 
 
INTRODUCTION 7 
 
 as something which they are not. An instinctively cruel person 
 might be attracted to work requiring animal experimentation or, 
 on the other hand', might succeed quite as well in satisfying his 
 instinct by occupyii^ his mind in imagining all sorts of fearful 
 horrors associated with such experimentation and become a rabid 
 anti-vivisectionist. In both cases he is more apt than not to do 
 great harm because he does not approach the problem with a bal- 
 anced mind, but is more intent, unconsciously of course, upon the 
 emotional satisfaction he will derive from the contemplation of 
 suffering rather than upon the furtherance of certain researches 
 in the first instance or the doing away with suffering in the sec- 
 ond. If the individual would lead a well rounded life he must be 
 able to bring all of himself to the problems he has to deal with 
 and not have his efforts damned by a divided allegiance. In 
 order to do this he must know himself and knowing himself 
 means an ever-increasing field of himself over which he may ex- 
 tend conscious control. 
 
 Physicians must no longer be content to leave the personality 
 out of the scheme of attempts to understand illness, for if the 
 theories of the nature of the human psyche are correct then the 
 mind is the central station, the clearing house for all the activities 
 of the body, and so every physical symptom must have its rever- 
 beration in the mind of the patient and many of them cannot be 
 adequately understood unless the psychic factors involved are 
 taken into consideration. This means that he must no longer be 
 content to take the patient's own account of his symptoms as final 
 any more than he accepts a cough as final and neglects to examine 
 the various organs, lungs, heart, larynx for its explanation. 
 
 When it is once generally recognized that mental reactions 
 are as definitely determined and as reasonable as physical and 
 physiological reactions there will be a decided step forward in 
 the enlargement of the field of conscious control. 
 
 The environment need not be a matter of serious concern. 
 An increased knowledge of it and its laws and the bringing of it 
 more and more under control is the prominent fact of the present 
 day civilization. During all this period of what has been called 
 the evolution of the environment man has himself evolved and 
 that evolution has been, among other things, the result of an 
 ever-increasing extension of his field of conscious control, or. 
 
8 FOUNDATIONS OF PSYCHIATRY 
 
 speaking in more usual terms, an increase in the capacity to bring 
 the instincts under the domination of the intelligence. This is of 
 course evolution, but in the past it has been accomplished uncon- 
 sciously and only incidentally, as it were, in the attempt to attain 
 other ends. In order, for example, to attain to a position of emi- 
 nence and power in the community one had to forswear acts of 
 violence and injustice. The instincts had to be restrained, but 
 that restraint was not an end in itself but only incidental to an 
 entirely different conscious purpose. But now the program 6f 
 psychology offers instead the conscious pursuit of that which has 
 heretofore been only an incidental goal, the intelligent attack 
 upon the problem of how to bring the instincts into the best serv- 
 ice to the individual, how to run them instead of being run by 
 them. This awakening consciousness of man of himself is a 
 new instrument of civilization, a new tool, which man from now 
 on will use to fashion his destiny or until at some time in t!he 
 future another shall come to take its place. 
 
 Evolution does not alone take place by a gradual, slow, uni- 
 form progress in some given direction but by mutations, by salta- 
 tory advances, by the sudden creation of something new, some- 
 thing different. These sudden departures from the average are 
 the real creative moments of evolution. They stand for a new 
 method, supply a new instrument for dealing with reality and 
 from them as starting points evolution proceeds rapidly until the 
 possibilities of the new instrument have been pretty well ex- 
 hausted, then evolution slows down, perhaps comes almost to a 
 standstill, until nature gives birth again. Such new instruments, 
 which have made the present estate of man possible, are the pre- 
 hensile hand, language, self-consciousness. The new psychology 
 that teaches that vision must be turned within, that consciously 
 attempts to correct the error there rather than always see it with- 
 out, is a new method, a new instrument with which to attack the 
 problem of living. It matters not that man has always been 
 moving in this direction, the great new fact is that he is now be- 
 ginning, for the first time, to do so consciously. The possibilities 
 are endless and particularly at this wonderful time in the history 
 of culture, when civilization has been tried to the utmost, it is 
 important that the structure which shall be erected from the 
 primitive forces which have been loosed, shall be a better one 
 
INTRODUCTION 9 
 
 than has ever before been builded. To do this it is necessary to 
 be able to brush aside the distortions wrought by the unconscious, 
 to see through them all down to the very depths, to see the real 
 problems and not waste energy in tackling false substitutes. A 
 realization of the mechanisms by which such distortions are pro- 
 duced, by which the mental machine may fall into error, will help 
 enormously to clear vision, will extend the field of conscious con- 
 trol. This is the true self-consciousness. 
 
CHAPTER II 
 
 The Unity of the Organism 
 
 The Biological Point of Viem — Integration — Structuralization — 
 
 Individuation 
 
 The history of the development of our ideas of mental disease 
 has been conditioned by our concept of the nature of the mind and 
 its relation to the body. So long as the psyche was thought of as 
 a separate entity which inhabited the body during life and de- 
 parted at the moment of death, leaving with the last breath to 
 take its way though the window considerately left open for its 
 departure, mental disease could be thought of in like terms as 
 possession, and there was little prospect of discovering any cor- 
 relations between mental symptomatology and conditions of phys- 
 ical illness. A later parallelistic psychology was able to view 
 the two series, mental and physical, but failed to advance any 
 logical basis to account for their parallel development that was 
 more reasonable than that advanced by the elaboration of the 
 analogy of a man and his shadow. It has only been possible to 
 come to a practical handling of psychological material in propor- 
 tion to the abandonment of metaphysical speculations on the 
 nature of mind, whether material or immaterial, and upon its 
 relation to the body, and a corresponding realization that mental 
 development and increasing complexity of mind are part and 
 parcel of that development and evolution the signs of which we 
 have been accustomed to read in the bodily structure and appre- 
 ciate that they too are an expression of the organism as a whole. 
 
 The concept of the organism as a whole is by no means a new 
 one. Aristotle speaks of a "single and indivisible principle of 
 unity" as underlying the arrangement and organization of the 
 parts. But just as concepts grow in meaning with increasing 
 knowledge so the concept of two thousand years ago, while philo- 
 sophically the same, is yet based upon a knowledge of the organ- 
 ism which was relatively simple so that as we use it today the 
 
THE UNITY OF THE ORGANISM II 
 
 concept organism-as-a-whole has vastly greater depth and breadth 
 because based upon an immensely increased knowledge. 
 
 It is this concept of the organism as a whole which needs now 
 to be emphasized as a basic point of departure for an understand- 
 ing and adequate correlation of the various trends in psychiatry 
 as they are unfolding an adequate understanding of the mentally 
 sick individual. It is this point of view that needs to be devel- 
 oped, first from the biological angle; then from the angle of the 
 more definitely psychological implications; and finally by illus- 
 trating the application of the principles evolved by the- various 
 tendencies which have led up to the present hypotheses which 
 dominate present day psychiatry. 
 
 The Biological Point of View: Integration. — The special 
 creation hypothesis implied a separatistic attitude of mind 
 towards living creatures. Each living creature having come into 
 existence by a special act of the Creator it was natural that it 
 should be considered as quite apart from all other living creatures, 
 as being an individual separate and distinct from all other indi- 
 viduals. Any organic connection between living beings was ruled 
 out by the very terms of the hypothesis and correspondingly the 
 quality of each individual's separateness emphasized by implica- 
 tion. It was a great step in advance when the theory of evolu- 
 tion supplemented the special creation hypothesis and science 
 was able to trace each organism in its phylogenetic unfolding and 
 demonstrate the homologies of its various parts in the several 
 members of the series. The understanding of such relationships 
 as those between the fore limb of a frog and the pectoral fin of a 
 fish, or between the hoof of the horse and the toes of other quad- 
 rupeds was bound to make for an ever increasing appreciation of 
 the organic unity of all nature. 
 
 The separatist attitude of mind, however, by no means disap- 
 peared but tended to linger on precisely in proportion to the ex- 
 tent of ignorance of living beings. Special creation receded 
 from the individual to the species and from the species to life in 
 general and still holds the field for those phenomena for which 
 scientific explanations have as yet proved inadequate. What is 
 more important than this, however, from this point of view, is a 
 development of the separatistic attitude of mind in what has been 
 
12 FOUNDATIONS OF PSYCHIATRY 
 
 called by Ritter^ the elementali&tic, as opposed to the organismal- 
 istic, method of approach to the explanation of ibiological phe- 
 nomena. This method seeks ever to get behind the obvious phe- 
 nomena and find there some explanation. For example, the 
 digestion of carbohydrates is explained by the functions of the 
 salivary glands and pancreas ; the functions of these glands by 
 their component cells ; the functions of the cells by the functions 
 of the nucleus in part and further, plus the functions of the 
 nucleus, by chemical composition and by the physical properties 
 of colloid solutions. In other words, the functions of the organ- 
 ism are explained by the functions of its parts, the elements and 
 substances which go to make it up. This is the elementalistic 
 way of going at the problem, a method whioh is not to be dis- 
 paraged for it is an eminently proper one, but only to be con- 
 demned when used to the exclusion of the organismalistic method 
 which per contra would explain the elements by the organism. 
 Both methods are necessary, each one being the complement of 
 the other and necessarily reinforcing it. It is because the former 
 method has been used too exclusively and because the latter has 
 peculiar values for the understanding of the problems of psy- 
 chiatry that it is necessary to emphasize the organismal theory 
 in some detail and indicate its bearings upon these problems. 
 
 The organismal concept has been put forward from time to 
 time by thinkers in the various fields of science and philosophy. 
 Aristotle advanced this view. The philosopher Kant also ad- 
 vanced the concept that "the cause of the existence of every 
 part of a living organism is contained in the whole." But al- 
 though various thinkers did advance the organismal concept that 
 concept never became controlling in the efforts of science to ex- 
 plain the living organism. Science was engaged in the discovery 
 of ever more minute structural elements in the make-up of the 
 organism and so always seeking for some explanation back of the 
 facts of observation which it continually hoped would clear up 
 the problem. The discovery of the cellular structure of plants 
 and animals and the formulation of the so-called cell theory was 
 one of those events which served to reinforce the elementalistic 
 
 1 Ritter, William Emerson : The Unity of the Organism or the Organ- 
 ismal Conception of Life. Two vols. Published by Richard Badger, Bos- 
 ton, 1919. 
 
THE UNITY OF THE ORGANISM 1 3 
 
 attitude of mind. Cells were considered as the ultimate ana- 
 tomical and physiological elements of living structure and or- 
 ganisms were somehow supposed to be explained as the sum of 
 these cellular units. An understanding of the structure and func- 
 tions of the cell was therefore necessary for an understanding of 
 the structure and functions of the organism. 
 
 Even the earlier investigators of cell structure, however, saw 
 the necessity of postulating some unifying principle to explain 
 the organism as a whole and realized that the living being must 
 be something more than just the mathematical sum of its several 
 parts — in this instance the cells. This concept, that there was 
 some principle of unity in the organism that was in addition to 
 any function which could be discovered in its component parts 
 has been variously expressed all the way from Aristotle to Driesch 
 who said : " The organism, we know, is a system the single con- 
 stituents of which are inorganic in themselves; only the whole 
 constituted by them in their typical order or arrangement owes 
 its specificity to ' Entelechy.' "^ 
 
 The. principle that the whole is of necessity something dif- 
 ferent from its parts is very old and must be accepted as ob- 
 viously true but in erecting this principle into something definite 
 and distinct, as distinct as any one of the parts, the old error is 
 repeated of dropping into a static formulation and failing to see 
 that what is useful in such a concept is the ability to realize that 
 the principle of unity is dynamic : that neither the whole nor the 
 parts have any separate existence: that they are but different 
 aspects of an organic unity. Driesch's entelechy is not a some- 
 thing which has been added to the parts and so constitutes them 
 a whole, it can only be a function of that whole and so a dynamic 
 aspect of the organism. 
 
 This dynamic point of view is reflected in the attempts made 
 to express this principle of unity. Thus the botanist DeBary 
 expressed it in the aphorism: "Plants make the cells, not the 
 cells plants," and the cytologist Wilson wrote: "The only real 
 unity is that of the entire organism, and as long as its cells remain 
 in continuity they are to be regarded, not as morphological indi- 
 viduals, but as specialized centers of action into which the living 
 
 2 Driesch, H., cite(l by Thompson, D'Arcy Wentworth : On Growth 
 and Form. Cambridge University Press, 1917- 
 
14 FOUNDATIONS OF PSYCHIATRY 
 
 body resolves itself, and by means of which the physiological 
 division of labor is eflfected," while Ritter' attempts to give ex- 
 pression to the same idea in the formula : " The organism in its 
 totality is as essential to an explanation of its elements as its 
 elements are to an explanation of the organism." 
 
 This unifying principle, conceived of as a dynamic function of 
 the whole is the function of integration. The word function car- 
 ries the dynamic idea and as applied to the whole organism gets 
 away from the objections to such a term as entelechy which im- 
 plies that, because it is a name, it is applied to a something, in 
 itself more or less concrete, which has been added to the parts and 
 therefore, as already indicated, smacks of the elementalistic way 
 of looking at the problem. 
 
 It is but natural that the elemental and the organismal formu- 
 lations should come to center about the cell theory because the 
 discovery of the cellular constitution of living organisms appeared 
 to be a distinct step in the direction of finding those ultimate 
 structures in which an explanation of the organism might be con- 
 ceived to rest. Although the organismal concept might not have 
 been fully grasped in all its important implications the elemental 
 was found to be sadly lacking for any real understanding of the 
 living organism. If the cell, as such, is in reality the ultimate 
 unity that the elementalist conceives it then the only difference 
 between the protozoan and the metazoan is a quantitative differ- 
 ence and a single cell of the metazoan body is homologous to the 
 unicellular protozoan. Such a hypothesis as this it seems needs 
 only to be stated and the statement carries its own refutation al- 
 though much thinking was carried on along such lines. The 
 metazoa and metaphyta are not just aggregations of cells, not 
 simply one cell multiplied by a certain number, the mathematical 
 sum of the cell units, but as Dobell says :* " The body of a proto- 
 zoan is not the homologue of a single cell in the body of a meta- 
 zoan," rather as he contends, the protozoan does not correspond 
 to a single cell of the metazoan but to the whole body. 
 
 With the advance of biological science the cell failed to main- 
 tain its place as an ultimate structural element of living matter 
 and the elementalist continued his search in regions of different 
 
 8 Op. cit. 
 
 * Dobell, C. C, cited by Ritter, op. cit. 
 
THE UNITY OF THE ORGANISM 1 5 
 
 dimensions for the explanation of life phenomena. The explana- 
 tion of the cell was sought in the functions of its nucleus and 
 finally in its particular physical and chemical constitution. Chem- 
 istry had meantime advanced and it came to be appreciated that, 
 while the cell was the center of important chemical processes 
 those processes were in the dimensional region of the colloids. 
 In fact many of the particular pictures which it had been 
 the habit to associate with living processes could now be repro- 
 duced in the laboratory by the use of colloid solutions. Leduc,* 
 for example, reproduced very accurately the karyokinetic figures 
 by the processes of liquid diffusion but Leduc's figures lacked 
 life, they were not produced as living processes so that Hopkins 
 speaking of the life of the cell from this point of view says:* 
 "Its life is the expression of a particular dynamic equilibrium 
 which obtains in a polyphasic system," but that life " is a prop- 
 erty of the cell as a whole, because it depends upon the organiza- 
 tion of processes, upon the equilibrium displayed by the totality 
 of the coexisting phases." 
 
 The same arguments might be brought to bear in dealing with 
 other elements of the organism, real or hypothetical, as they come 
 up for review as science has progressed in the process of its dis- 
 memberment. Take for example the chromosomes which have 
 come into such repute as the bearers of hereditary characters and 
 their hypothetical components, the determiners, which have been 
 insisted upon so strongly by Weismann and his school of inherit- 
 ance, and about which such a storm of argument has raged 
 apropos of the continuity of the germ plasm and the non-inherit- 
 ance of acquired characters. But applying the same formula to 
 the chromosomes we must recognize, as Ritter' very well says, 
 that they are "indispensable tools or agents of the organism 
 rather than entities, ultimate and supreme in their power over 
 the organism," and further that they " even though bearers of 
 heredity, are causally explained by the organism in the same sense 
 that the hereditary attributes of the organism are causally ex- 
 plained by the chromosomes." It is significant in connection with 
 this problem of heredity that such hypotheses as the continuity of 
 
 " Leduc, S., The Mechanism of Life. New York, Rebman Co. 
 « Hopkins, F. C, cited by Ritter, op. cit. 
 ' Op. cit. 
 
1 6 FOUNDATIONS OF PSYCHIATRY 
 
 the germ plasm bid fair to be taken out of the realm of theory 
 and discarded because of the accumulation of concrete facts such 
 as those recently stressed by Conklin.^ At least such a, signifi- 
 cance is implied in the fact that it is possible to map out, in the 
 unfertilized egg, areas which are destined to play special roles in 
 the subsequent cleavage, such as ectoderm, endoderm and meso- 
 derm. 
 
 Other concepts might be similarly dealt with. For example 
 tropisms considered as manifestations of specific chemical sub- 
 stances, heliotropism being dependent upon a hypothetical photo- 
 sensitive substance, easily comes to be used after the elemental 
 manner. Reflexes, when considered out of their relation to the 
 rest of the animal; cortical centers when considered as definite 
 concrete areas which control certain functions; and ideas, as will 
 be more fully seen later on are subject to the same criticism. It 
 is quite all right, in fact necessary, to dismember the living or- 
 ganism, pull it apart, as it were, and consider each part, each 
 function, each aspect separately with a view to defining it; but 
 when that is accomplished it is equally necessary to put the or- 
 ganism together again and observe the part the particular element 
 in question plays in the whole, living organism and unless this is 
 done the function under consideration will not have been fully 
 encompassed, will not have been seen all around, not have been 
 fully appreciated in all of its bearings, understood in its full 
 significance. 
 
 Having set forth what is meant by the organism as a whole, 
 the fact that the whole is something different from the sum of its 
 parts, and havipg indicated that the difference is due to the func- 
 tion of integration, it is necessary to indicate how this function 
 works as a function of the whole rather than as the sum of the 
 functions of the parts. The work of Child' is of the first im- 
 portance in this connection. 
 
 Structurdization. — Child sets out to discover what constitutes 
 a living or organic individual — what is at the basis of its unity 
 
 ' Conklin, E. G., Heredity and Environment in the Development of 
 Men. Princeton University Press, 1917. 
 
 8 Child, C. M., The Basis of Physiological Individuality in Organisms. 
 Science, April 14, 1916. Individuality in Organisms. University of Chicago 
 Press, 1915. Senescence and Rejuvenescence, University of Chicago Press, 
 1915. The Origin and Development of the Nervous System From a Physi- 
 ological Viewpoint. University of Chicago Press, 1921. 
 
THE UNITY OF THE ORGANISM 1 7 
 
 and the orderliness of its behavior. The structure of an indi- 
 vidual is purely a matter of anatomy, it is the orderly integration 
 of the structural elements which remains to be accounted for. 
 In other words it is not the static but the dynamic individual 
 that needs defining. After a review of the several theories he 
 discards them all, even the more recent physico-chemical theories 
 which see in chemical transportation the fundamental element in 
 physiological correlation. While chemical correlation is without 
 doubt a factor it is only possible in an already existing individual 
 in which some sort of order already maintains. Any adequate 
 theory of the individual must therefore be dynamic and deal with 
 processes rather than with structures. Contrary to the assump- 
 tion of biologists who believed that physiological individuality 
 was inherent in protoplasm and dependent upon a self-deter- 
 mined organization he sees physiological individuality as a func- 
 tion of the relation between protoplasm and its environment. 
 
 The nature of the integrating factor of relationship he arrives 
 at by assuming first a bit of undifferentiated protoplasm. Now 
 let a difference at some point in the environment act as a stimulus 
 at a given point at the surface of this protoplasm. The imme- 
 diate result is an increase in activity at this point, which dynamic 
 effect is not limited to the point of contact but tends to spread in 
 ever increasing widening waves of decreased energy much like 
 the waves which result when a stone is thrown into a quiet pool. 
 
 As the wave of activity spreads it successively acts as stimulus 
 so that the wave represents the spread of the increased activity 
 originally set in operation by the stimulus from the environment. 
 As it spreads, too, there is a constant decrement in its effective- 
 ness, so that a dynamic gradient is established, the point of great- 
 est intensity or highest rate of activity being the point of inci- 
 dence of the original stimulus. A passing stimulus -produces only 
 a passing gradient, while a long continued, or often repeated, or 
 very strong stimulus, or all combined, tends in proportion to these 
 several qualities, to establish permanent changes in the proto- 
 plasm along the path of the increased activity. The dynamic 
 gradient tends to become persistent and consists fundamentally 
 in a change in reactivity, irritability of the protoplasm. Finally 
 this dynamic, or irritability or metabolic gradient, as it really is 
 because here tissue changes go on most rapidly, becomes the start- 
 
1 8 FOUNDATIONS OF PSYCHIATRY 
 
 ing point of a permanent quantitative order in the protoplasm or 
 a physiological axis of the simplest form of individual. This 
 first order to arise is the chief, polar, or major axis, while similar 
 orders developed later determine minor axes and on the basis of 
 these is established the symmetry of the individual. 
 
 This matter of symmetry has been largely discussed in the 
 past. Spencer in his Principles of Biology^" has devoted a great 
 deal of space to it and concluded that it was a function of the 
 relation of the animal or plant to its environment. For example, 
 an animal moving through the water will, by that very fact, ex- 
 pose its forward end to the operation of forces quite different 
 from those to which the other end is exposed and so it tends to 
 become different. Thus begins a polar differentiation which re- 
 sults, other things remaining equal, in radial symmetry. Now if 
 one surface is already uppermost and the other lowermost a 
 further differentiation will ensue resulting in a bilateral sym- 
 metry. This is precisely the state of affairs and the result which 
 Child sees when he points out the results of a stimulus applied 
 to an undifferentiated bit of protoplasm. There results what he 
 calls a dynamic gradient which gradient if maintained ultimately 
 becomes one of the axes of the individual, all of which are ar- 
 ranged in various degrees of subordination to the major axis. 
 It is such an arrangement about a major axis which is the funda- 
 mental fact of the physiological individual, according to Child, a 
 conclusion reminiscent of Spencer, who considered the individual 
 as "any center or axis that is independently carrying on that 
 continuous adjustment of inner to outer relations which consti- 
 tutes life."" 
 
 Briefly set forth these are the methods of experimentation 
 which Child used. They are significant for the purposes of this 
 exposition because they serve to write large the stated conclu- 
 sions and to make their fundamental soundness more evident. 
 
 The experimental work was done for the most part with 
 fresh-water planarians, particularly the Planaria dorotocephda, 
 P- tnaculata, and the P. velata. The experimental animals were 
 subjected to immersion in solutions of various strengths of potas- 
 sium cyanide. If the solution is strong enough to kill without 
 
 "Vol. II. 
 
 11 Principles of Biology, Vol, I. 
 
THE UNITY OF THE ORGANISM I9 
 
 acclimation but still not so strong but that the diiferences in sus- 
 ceptibility may appear clearly, it will be found that death begins 
 at the head and proceeds posteriorly and that the lateral margins 
 die before the median region, thus proceeding along the axial 
 (metabolic) gradients ; and as between different groups of worms 
 disintegration begins earlier and proceeds more rapidly in the 
 younger than in the older worms, that is, in the worms having 
 the highest rate of metabolism. The susceptibility therefore 
 varies directly as the metabolic rate. 
 
 If a concentration of cyanide is used which does not kill the 
 animals directly but permits of a certain degree of acclimation it 
 will be noted that the relation between the survival time and rate 
 of metabolism is the opposite of that when the solution kills. 
 Under these circumstances the younger animals, that is, those with 
 the higher rate of metabolism, live the longer, while it is the 
 older who die first. Here again the degree of susceptibility corre- 
 sponds to rate of metabolism. 
 
 Such is the nature of the experimental work which demon- 
 strates the existence of a dynamic gradient and which thus re- 
 futes the hypothesis that the unity and the order in an organism 
 is dependent upon the transportation of substances, in other 
 words, consists in chemical correlations. Rather the correlation 
 is dynamic and dominance is dependent upon transmitted change 
 or excitation from the region of highest metabolic rate — the head 
 region. The nature and the accumulation of substances in the 
 different pajts of the body are, therefore, not dependent upon 
 their transportation, but upon their relative stability in relation 
 to the metabolic rate of the particular part. In general only the 
 most stable substances can accumulate in regions of high meta- 
 bolic rate, while substances of less stability may exist where the 
 rate is lower so that each level, so to speak, of the gradient comes 
 to be characterized by certain substances, and qualitative differ- 
 ences in the different parts of the gradient arise, characterized by 
 specific substances. As Child well says, chemical transportation 
 cannot account for the origin of the individual, because some sort 
 of an individual, as such, must exist, having some sort of orderly 
 relation between its parts, before chemical correlation between 
 those parts can take place. From this point of view, therefore, 
 hormones which have sprung into such prominence in the last 
 
20 FOUNDATIONS OF PSYCHIATRY 
 
 few years become of secondary importance relatively to the 
 nervous System, which in its relation to other parts is " the final 
 expression of relation whjch is the foundation and starting point 
 of organic individuation.^* 
 
 It has already been pointed out how and why an animal tends 
 to develop diflferences in the different parts of the body because 
 of, and dependent upon, the different relation of these parts to 
 the environment. How, for example, a uniform bit of protoplasm 
 by the mere fact of its movement through water would develop a 
 difference in the extremity which came first and most intensively 
 in contact with the environment — ^the head end. To put it dif- 
 ferently — a mass of protoplasm without an axis becomes the 
 recipient of a stimulus. The first result of such a stimulus^' 
 would be an increase in the metabolic rate at the point stimulated 
 and this change in rate would tend to radiate from that point like 
 the waves on a pond from the point where a stone has! been 
 thrown in. Immediately the bit of protoplasm has an axis, the 
 important characteristic of which is that the metabolic rate is 
 highest at the point of the application of the stimulus and tends 
 to decrease in direct proportion to the distance therefrom. The 
 limit of effectiveness of the transmission varies in accordance 
 with the strength of the stimulus and the nature of the transmit- 
 ting material (protoplasm). The bearing of this matter of the 
 effectiveness of transmission, or rather the distance of trans- 
 mission, upon reproduction is very well shown in the case of the 
 Planaria dorotocephala}* This flatworm undergoes from time 
 to time a species of agamic reproduction by fission. The rear end 
 of the body (posterior zooid) fails to be controlled by the an- 
 terior end, attaches itself to the ground as the worm crawls for- 
 ward, and holds fast while the forward end tries to go ahead. 
 The substance between gets thinner and thinner and finally 
 breaks. The posterior zooid, now separated from the control of 
 the anterior end, proceeds to develop a head of its own and to 
 become a complete worm. 
 
 To revert to the transmission of energy from the point of 
 stimulation. If the same character of stimulus is repeatedly ap- 
 
 i!! Individuality in Organisms, p. 48. 
 
 13 Individuality in Organisms, p. 30 et seq. 
 
 1* Senescence and Rejuvenescence, Ch. VI. 
 
THE UNITY OF THE ORGANISM 21 
 
 plied to the same portion of the animal; if, for example, the 
 animal keeps thrusting the same part of its body forward into 
 the environment, then the protoplasm along the lines of the trans- 
 mission of energy from the stimulus will tend to organize into a 
 chemico-physical equilibrium with the rate of energy change. In 
 other words substances will tend to accumulate at the different 
 levels of the gradient which are in dynamic equilibrium with the 
 energy transmission at those levels — the gradient becomes or- 
 ganized. 
 
 Not only is the principle of the organization of the gradient 
 visible in the processes briefly outlined in this illustration, but 
 another principle of as great importance comes out with equal 
 clearness, namely, that structure is organized function, or, as 
 Bergson would perhaps put it, structure is the organization of the 
 past, or, organization is the structuralization of function or of 
 the past. From this point of view the nervous system, as a struc- 
 turalized dynamic gradient or as an organized system of relations 
 between the parts of the organisms, is given a new meaning. 
 
 Now of course as Child has very well shown in the simpler 
 organisms, an individual has many gradients. Among the sim- 
 pler individuals these are expressed in the various axes of sym- 
 metry. Among the higher animals each organ would have a 
 dominant gradient of its own and probably many subordinate 
 ones, while the total interplay of forces in the individual can be 
 visualized as playing along the axes of these multitudinous gra- 
 dients, now reinforcing, now inhibiting, according as their energy 
 rate is mutually assimilable or not, all of this great number of 
 gradients held in an orderly organization because of mutual rela- 
 tions of dominance and dependence and all in the last analysis 
 under the final domination of the gradient of highest metabolic 
 rate, which in turn is dominated by its region of highest meta- 
 bolic rate — the head end. 
 
 From this presentation it is easy to see how erroneous is the 
 ordinary way of thinking of the dominance of the head end of 
 the body. It is quite usual to think of the psyche, for example, 
 as if it were a concrete entity which made its entrance upon the 
 stage at some particular point in evolution — ^the only question is, 
 just when? Many people may say that an animal cannot reason, 
 has no soul (psyche), or even that children have no souls or are 
 
22 FOUNDATIONS OF PSYCHIATRY 
 
 only little animals, while in the Orient, as is well known, woman 
 is supposed to be without a soul. Aside from these rather crude 
 ideas, however, there seems to be a wide feeling that evolution 
 has taken place, so to speak, by a series of superpositions and 
 that finally a head and then a psyche were added (evolved). 
 From the presentation thus far it will be seen how far this is 
 from the truth. There never was an organism, no matter how 
 simple, how far down the line of evolution, but had a head end. 
 The organism did not first develop as a group of organs and then 
 develop a centralized control and coordination of these organs, 
 but the development of the centralized control and coordination 
 went along with the development of the organs. A moment's 
 consideration will serve to convince one that this must have been 
 so, inasmuch as the function of the various organs is in large 
 part to serve the organism as a whole. No such service could 
 be rendered without .organization, and centralized authority is 
 the basis of organization. The history of the head end, the head, 
 the psyche then reaches as far back as the history of life itself, 
 in fact is coterminous with that of life. All the forces which 
 have been operating to produce the developed organism have also 
 been operative in producing the developed head control. More 
 will be learned of the significance of this fact later in the discus- 
 sion of more specifically psychological problems. 
 
 Here is a setting forth of evidence, based upon observations 
 and experiments, which tends to show not only that the organism 
 is a unity but how that unity has come about, the forces which 
 that unity expresses, the nature, in dynamic terms, of the relation 
 of the parts to the whole and of the whole to the parts, how or- 
 ganization develops and as it develops becomes structuralized. In 
 the light of such an hypothesis such formulations as Sach's law" 
 that "growth determines division and not division growth" ac- 
 quires added significance. It can be understood why it is that, 
 as Whitman so well says," " physiological unity is not broken by 
 cell-'boundaries," and that "comparative embryology reminds us 
 at every turn that the organism dominates cell-function, using 
 for the same purpose one, several, or many cells, massing its 
 material and directing its movements and shaping its organs, as 
 
 1' Cited by Ritter, op. cit. 
 '■' Cited by Ritter, op. cit. 
 
THE UNITY OF THE ORGANISM 23 
 
 if cells did not exist, or as if they existed only in complete sub- 
 ordination to its will, if I may so speak." " Every organ is com- 
 pelled to follow the morphological plan of the organism."^^ To 
 stick to the cell as a fair example of a structura,! unit Qhild'te 
 point of view makes understandable the statement of Wilson:^* 
 " The only unity is that of the entire organism, and as long as its 
 cells remain in continuity they are to be regarded not as morpho- 
 logical individuals, but as specialized centers of action into which 
 the living body resolves itself, and by means of which the physio- 
 logical division of labor is effected." 
 
 Already in this effort of Child's to explain the dynamic foun- 
 dations of the individual organism there begins to emerge some 
 idea of what that group of phenomena stands for, to which the 
 collective term mind is given. Each individual organism is or- 
 ganized and structuralized on a plan that of necessity integrates 
 all its parts, and what is of the greatest significance for our pur- 
 poses, integrates them under the domination pf a head end, that 
 is, a dynamic locus wherein are concentrated those activities to 
 which, later in the course of evolution, the name of mind is given. 
 Before approaching this specific psychological problem, however, 
 it will be well to consider briefly somewhat more of what is 
 meant by the term individual. 
 
 Individuation. — Up to this point it has been attempted to 
 show that the organism as a whole is something different from 
 the mathematical sum of its parts, either structurally or function- 
 ally; and that that difference is dependent upon the function of 
 integration. It has also been attempted to show how such a func- 
 tion of the whole operates by the establishment of dynamic gra- 
 dients which become organized and laid down in structure — ^the 
 structuralization of function. It will now be indicated how these 
 processes are much more specific than have thus far been implied 
 and that as a matter of fact their specificity tends always in the 
 direction of individuation whereby not only related forms tend 
 to resemble each other in the general facts pf their structure and 
 function, but that they tend also to differ from one another to an 
 extent that constitutes each an individual, in certain respects dif- 
 ferent from all other individuals, and how as they proceed along 
 
 IT Ritter, op. cit. 
 
 18 Cited by Ritter, op. cit. 
 
24 FOUNDATIONS OF PSYCHIATRY 
 
 the pathway of evolution to ever more complex beings the indi- 
 vidualistic functions of integration and structuralization become 
 ever more pronounced. 
 
 Integration and structuralization by virtue of the nature of 
 the forces integrated and structuralized take on specific char- 
 acters so that while a frog, a horse, a human being all are living 
 organisms they are more than that, they are specifically a frog, a 
 horse, a human being and as such can be readily recognized and 
 distinguished one from the other. It is to this tendency to more 
 specific differentiation that the term individuation applies, a proc- 
 ess the increasing specificity of which in the higher organisms, 
 such as man, differentiates each member of the species as distinct, 
 because different, from every other member. 
 
 This tendency to individuation is already in evidence in pro- 
 toplasm. Attempts to fuse protoplasm of different species gives, 
 conclusive evidence that at least such fusion is more possible be- 
 tween nearly related forms. Although the evidence is not final 
 it is sufficient for discarding the general term protoplasm so far 
 as it implies identity of constitution in different forms of life and 
 speaking instead of protoplasms.^® When it comes to the more 
 highly specialized cells, such as the egg cells, there can be no 
 doubt. As Conklin puts it:^" "Furthermore, from its earliest to 
 its latest stage an individual is one and the same organism; the 
 egg of a frog is a frog in an early stage of development," or as 
 Ritter puts the same thought :" " it is the attributes of a horse as 
 a horse, and not as an animal generally, that elicits our particular 
 interest in the horse. Zoology rightly understood is preeminent 
 among all the sciences as the science of particulars." 
 
 The process of individuation makes for ever greater speci- 
 ficity the higher the organism in the scheme of evolution. The 
 differences between many of the unicellular organisms is much 
 less obvious than those between the higher organisms. Take for 
 example the matter of the reflex. Sherrington very well says -.^^ 
 "the reflex reaction cannot be really intelligible to the physiolo- 
 gist until he knows its aim," and he adds " and he can know its 
 
 19 Ritter, op. cit. 
 
 2» Cited by Ritter, op. cit. 
 
 " Op. cit. 
 
 22 Cited by Ritter, op. cit. 
 
THE UNITY OF THE ORGANISM 25 
 
 aim only by considering it in the light of the organism's entire 
 complex of normal activities; i.e., in accordance with the con- 
 ception of the organism as a whole." What this means in the 
 way of individuation is well expressed by Ritter^^ in respect to 
 reflex action, as follows : " A vast mass of evidence makes it 
 almost certain that a dog's scratch-reflex is different from a cat's, 
 and both are different from an ox's, a frog's, and so on." And 
 in discussing how the dog's reflex can be explained, for example, 
 what chemical changes can be called upon to account for it he 
 says that "since the reflex is an indubitable reality, there is no 
 escape from the conclusion that something other than the original 
 inorganic simples must have intervened between these simples 
 and the reflex," and adds, "the dog is what has intervened be- 
 tween the chemical simples and the reflex." " A dog, and a dog 
 only, is able to cause oxygen, carbon and the other elements to 
 reveal those particular scratch-reflex powers. The dog comes in 
 as a sine qua non to the production of, and hence to the causal 
 explanation of, the particular group of activities under considera- 
 tion." The principle here, as elsewhere, is that "analysis alone 
 is incapable of interpreting, of understanding organic beings. 
 No natural object which in its nature is more distinctively syn- 
 thetic than analytic can be understood by knowledge-processes 
 which are more analytic than synthetic."^* 
 
 The great organized task of individuation has been the pro- 
 duction of species but the specificity of the process has extended 
 to still further refinements in the production of subspecies, of 
 variations, and finally it comes to its most cwnplete fruition in 
 the individual as such. The production of the individual, as dis- 
 tinct from all other individuals, grows out of the fact that the 
 life history of each organism must of necessity be to some extent 
 different from that of all others no matter how closely related 
 they may be nor how similar their environment, and it is on the 
 basis of just these differences that these peculiarities of each in- 
 dividual are based which make it different from all others. 
 
 This process of individuation is seen ever3rwhere going for- 
 ward constantly.''^ The increasing recognition of the individual 
 
 23 Op. cit. 
 2* Ritter, op. cit. 
 
 25 Ross, E. W., Individuation. The American Journal of Sociology, 
 January, 1920. 
 
26 FOUNDATIONS OF PSYCHIATRY 
 
 is one of the important aspects of social evolution: the principle 
 of " self-determination " is the cry of the smaller countries for 
 individual recognition: in the Roman family the child was com- 
 pletely subordinated to the will of the father, now the child, or 
 individual, has certain rights conceded to it and they are safe- 
 guarded by the law : a state religion offered little chance for in- 
 dividual expression, the religion split up into a number of camps 
 to suit all tastes, and now each person is conceded the privilege 
 of entertaining such religious views as he individually may 
 prefer: in the Middle Ages the peasant was a part of the estate 
 and the compensation for his labors was a place to live and food : 
 now each worker is paid in money and it is left to individual taste 
 when and how he shall live : at present one of the elements in the 
 cohtroversy between capital and labor is the demand by the latter 
 that labor shall not be considered as a commodity, the laboring 
 man insists upon being dealt with as an individual: the feminist 
 movement emphasizes the desire of the women no longer to be 
 dealt with en masse, as women, but, freed from legal disabilities, 
 considered as individuals and accorded all those advantages and 
 privileges which they can secure as a result of their efforts and 
 the free exercise of their abilities: the same tendencies toward 
 individuation can be traced in many other directions, for instance, 
 in the general medical aphorism, "treat the patient, not the dis- 
 ease," which must be emphasized over and over again to coun- 
 teract the tendency to treat the disease as such without a sufficient 
 appreciation of just how the individual patient is reacting to it: 
 in the same way there is a growing tendency of criminology to 
 advocate dealing with the criminal rather than with the crime, 
 to search out the individual factors and by an understanding 
 and appreciation of them perhaps being able to work out some- 
 thing constructive in the life of the offender: in psychiatry, too, 
 the tendency is towards an even greater individualizing of the 
 patient until in the treatment by psychoanalysis there is, perhaps, 
 the most exquisite individualizing of the patient in the whole 
 field of medicine. 
 
 These principles will be traced further in the dynamics of the 
 living organism. 
 
 In this chapter there have been developed three principles 
 which govern the organism in the course of its growth, develop- 
 
THE UNITY OF THE ORGANISM 2 7 
 
 ment, and evolution. While the study of the parts of the or- 
 ganism is not decried as such it has been shown that no ade- 
 quate understanding could be reached unless it was considered 
 as a whole and that by such a consideration certain new factors 
 entered into the problem which modified the conception that 
 regards the functions as manifested by the parts. This added 
 factor is the function of integration and in the dynamics of this 
 function of integration the hypothesis of Child has been put for- 
 ward to show how the process of integration became structural- 
 ized along the lines of dynamic gradients. It has further been 
 indicated how the function of integration, tending always to 
 become- structuralized, tends also to an ever increasing individua- 
 tion of organisms whether that individuation be considered from 
 the structural, physiological, psychological or social point of 
 view. A further elaboration of these principles will show how 
 they are fundamental to an understanding of the psyche and the 
 problems of mental disease. 
 
CHAPTER III 
 
 The Dynamics of the Organism 
 
 The Canon of Physiology (The Conflict)— Ambivalency 
 
 In the last chapter it was shown that the organism is not a 
 mere aggregation of parts but that it is something more, namely, 
 it is an integrated whole. It will now be attempted to point out 
 how that whole works, or at least call attention to those factors 
 upon which its working efficiency depends and which are per- 
 tinent to the aim of this book. In other words, an attempt will 
 be made to show the moving factors in the integrated whole of 
 the organism, the factors which make it dynamic. 
 
 A biological discussion of the dynamics of the living organism 
 would commence with its inorganic and non-living constituents, 
 the strictly physical problems that are involved in determining 
 the forms of parts — morphology — such as the influence of stresses 
 in fixing the structure of the skeleton, such matters as surface 
 tension, adsorption osmosis, torsion, diffusion, viscosity, etc. 
 Only a sufficient pause will be made in the discussion of such 
 matters as to indicate that the same principle, which it is wished 
 to emphasi2se because of its importance to the matters at issue, 
 underlies these manifestations at the physical level as underlies 
 certain phenomena at the higher physiological, psychological, and 
 social levels. This principle, which has been variously expressed, 
 is known as the theorem of Le Chatelier^ and seems to be really 
 an expression of the law that action and reaction are equal but 
 in opposite directions. This theorem is that " a system tends to 
 change so as to minimize an external disturbance." The boughs 
 of a tree bend to the wind in proportion to its strength, when the 
 wind is strong the bending is great, when the wind lets up the 
 boughs straighten : in firing a cannon there is a recoil : if an elec- 
 tric current is passed through a solution a counter current is 
 formed which tends to reduce the electrical stress: in the struc- 
 
 1 Bancroft, W. D., A Universal Law. 
 
 28 
 
THE DYNAMICS OF THE ORGANISM 29 
 
 ture of bone the arrangement of the bony trabeculae follows the 
 theoretical pattern of a stress-diagram,* the ossification taking 
 place along the lines that take up, absorb, the stresses : pieces of 
 metal habitually stressed in certain directions tend to so rearrange 
 their parts that they offer greater resistance, the particles which 
 lie obliquely to the lines of tension and pressure are displaced 
 while those that are parallel or perpendicular to it remain in 
 place,' for example, a piece of tow can support but little weight 
 but when carded and all its fibres are arranged parallel to one 
 another, it makes a strong cord. The principle here is that force, 
 operating in any direction, has to overcome resistance, little or 
 great, in proportion to the strength of the force, and that the 
 push and the resistance are in opposite directions and tend to 
 equalize — action and reaction are equal and in opposite direc- 
 tions: the pendulum swings an equal distance in each direction. 
 This is the principle of the conflict and the conflicting forces 
 being in opposite directions give an ambivalent character to every 
 such situation, the principle of ambivalency. 
 
 The application of this principle to inorganic nature might 
 be illustrated extensively to show how it served to explain the 
 processes continuously going on therein. How, for example, 
 any group of particles must of necessity immediately be thrown 
 out of equilibrium by the mere fact that any incident force nec- 
 essarily affects the different particles differently because of their 
 different distances from the point of application of the force and 
 their different orientation towards it. A piece of hot metal, in 
 cooling, tends to cool more rapidly at the surface than at the 
 center. The illustrations, however, will be confined to the living 
 organism and recall what has already been set forth in the pre- 
 vious chapter in describing Child's hypothesis of the laying down 
 of dynamic gradients. The illustration there given was a stim- 
 ulus applied to an undifferentiated bit of protoplasm. Such a 
 stimulus produced an area of increased activity at the point of 
 application which spread in waves of decreased energy along 
 lines of least resistance. Such a dynamic gradient tends to be- 
 come permanent in proportion to frequency and strength of the 
 stimulus and finally to be laid down in structure like the trabec- 
 
 2 Thompson, D'Arcy Wentworth : On Growth and Form. Cambridge 
 University Press, 1917. 
 ' Thompson, op. cit. 
 
30 FOUNDATIONS OF PSYCHIATRY 
 
 ulae in the shaft of a long bone. Such a gradient then becomes a 
 permanent part of the structure and by virtue of its presence 
 tends still further to multiply the differences with which the 
 organism responds to incident forces. Complexity makes for 
 increasing complexity on the principle of what Spencer called* 
 the "multiplication of effects." This principle has been called 
 the canon of physiology and is expressed by Fredericq as fol- 
 lows :° " A living being is adjusted in such manner that each per- 
 turbing influence provokes to activity a compensating apparatus 
 which brings about its neutralization and the repair of the dam- 
 age." Animals in a cold climate develop thick suits of fur to 
 prevent the radiation of heat: desert plants, when the supply of 
 water is scant, develop a considerable growth of hairs which im- 
 pede the circulation of the air and thus lessen the rate of evapora- 
 tion: the submerged leaves of aquatic plants do not develop the 
 supporting framework of aerial leaves: an irritant in the eye is 
 washed out by an increased secretion of tears, in the gastro- 
 intestinal tract by vomiting and purging : plants and trees that 
 have been seriously injured tend to reproduce, produce flowers: 
 hunger prompts the finding of food to neutralize the uncom- 
 fortable feelings. 
 
 Kempf has more recently reformulated these same principles' 
 to apply more s.pecifically to the psychological level in terms of 
 cravings as motives for conduct which tend to produce behavior 
 calculated to neutralize — satisfy — the craving. Fear prompts 
 those activities that lead to safety : anger causes behavior calcu- 
 lated to overwhelm the enemy : the desire for money brings about 
 conduct calculated to acquire it : the desire for food causes con- 
 duct looking to its procurement : love prompts the acquisition of 
 the loved object : lonesomeness causes the individual to seek com- 
 panionship : pain induces the sufiferer to seek relief. 
 
 At a still higher social level the same principle is at work. A 
 shortage of labor causes a rise in wages with a consequent mi- 
 gration of laborers until the industrial tension is neutralized: a 
 shortage of any commodity causes the price to rise and thus at- 
 tracts more persons to undertake its manufacture thus increasing 
 
 * First Principles. 
 " Cited by Thompson, op. cit. 
 
 ° Kempf, E. J., The Autonomic Functions and the Personality. Nerv- 
 ous and Mental Disease Monograph Series, No. 28. 
 
THE DYNAMICS OF THE ORGANISM 3I 
 
 production and neutralizing the tension: increased production 
 causes prices to fall and the stimulus to production being less the 
 production falls off until demand and supply are more nearly 
 equal: illness produces a demand for doctors: the demand for 
 doctors produces a demand for medical schools : the demand for 
 medical schools produces a demand for teachers: the demand 
 for teachers produces a demand for endowments to pay their 
 salaries, etc., each new factor operating as both a satisfaction of 
 a demand and a creator of a new demand on the principle of the 
 multiplication of effects already alluded to. 
 
 Every dynamic situation, therefore, can be resolved into two 
 component factors, namely, a force tending to produce motion in 
 a given direction and a force opposed to it tending to produce 
 motion in the diametrically opposite direction. Such a situation 
 occurring in a living organism is termed a conflict, and the two 
 opposing forces are designated as ambivalent opposites. It is 
 important to inquire into the operation of this principle more 
 particularly as it applies to the human individual and especially 
 as it expresses itself in his psyche. 
 
 It has already been briefly indicated how these principles 
 make for the elucidating of certain facts of structure — morphol- 
 ogy. In the realm of physiology they are again found operative. 
 In the phylogenetically oldest portions of the nervous system, the 
 autonomic or vegetative nervous system,' this principal of am- 
 bivalency is laid down as a basic factor in its organization. 
 The sympathetic and autonomic nervous apparatus operates in 
 constant antagonism. This is typically seen in the innervation of 
 the heart, the sympathetic increases cardiac action, the autonomic 
 inhibits it. Similarly in other functions, the autonomic increases 
 the secretion of sweat, the sympathetic inhibits it; the autonomic 
 increases intestinal secretion, the sympathetic inhibits it and so 
 on with other functions. Further, these divisions of the nervous 
 
 ^ The nomenclature of this portion of the nervous system is somewhat 
 confusing. It has all been referred to as the sympathetic and as the auto- 
 nomic nervous apparatus. The usual terminology refers to the thoracio- 
 lumbar outflow as the sympathetic and the vagus, mid-brain, and sacral 
 outflow as the autonomic or the para-sympathetic. Dr. Jellifife and I pre- 
 fer to call it all the vegetative nervous apparatus and divide it into two 
 parts,' the sympathetic and autonomic (see JelliflFe and White, Diseases of 
 the Nervous System). 
 
32 FOUNDATIONS OF PSYCHIATRY 
 
 system are activated by the secretions of the endocrine glands, 
 the hormones of the thyroid, thymus, adrenal, pituitary, pineal, 
 pancreas, gonads, so that there is a complicated system of op- 
 posed activating and inhibiting mechanisms consisting of the 
 endocrine glands, the hormones, and the vegetative nervous ap- 
 paratus. In this dynamic equilibrium of the organism Ritter' 
 sees a "ceaseless play of constitutively antagonistic forces and 
 structures" especially clearly illustrated by these "cooperative 
 antagonisms " at the level of the vegetative nervous system and 
 which he aptly likens to "the performance of the tight-rope 
 walker, which depends on numberless balancing activities. Let 
 the performer be really motionless in every part for one instant, 
 and he falls." 
 
 At the psychological level this principle of conflict and am- 
 bivalency is equally in evidence. There is a constant back and 
 forth swing between opposite paths of conduct, the so-called 
 " parallel path of opposites," illustrations of which are constantly 
 in evidence in everyday acts. A given craving, hunger for ex- 
 ample, prompts the getting of food but the individual has no 
 money with which to purchase it. Stealing offers as a means of 
 solving the difiSculty but the social taboo and the possibility of 
 arrest and punishment act as hindrances to such a method of pro- 
 cedure. If the individual has credit he may have time and op- 
 portunity to earn the necessary money. If, on the other hand, 
 the craving is very great and insistent it may be a sufiScient stim- 
 ulus to overcome all objections to stealing. In both instances the 
 individual is torn between two lines of conduct, right and wrong 
 — ambivalent opposites — and finally yields to the motive which at 
 the moment is the stronger : he goes to work if he is not too hun- 
 gry and the social instinct dominates, or if the hunger is too great 
 he steals. 
 
 It is the same with all activities, though not quite as obviously 
 as in this illustration. Every ideal stirs to activities which would 
 bring it to pass, but at the same time there are tendencies in the 
 opposite direction, they may be grouped for present purposes 
 under the generic term laziness, tending to of3fer resistances which 
 interfere with doing the necessary things, and the resulting con- 
 duct is what it is because one or the other dominate the given 
 
 8 Op. cit. 
 
THE DYNAMICS OF THE ORGANISM 33 
 
 situation at the particular moment. The wish is to become emi- 
 nent in some particular direction, eminence means hard work for 
 an extended period of time, but it is more agreeable to play. The 
 wish is for riches, riches mean work and sacrifice, it is easier to 
 put off the decision to work. Belief in honesty, virtue, truth are 
 tempted, and so man weaves his way in the maze of adjustments 
 which his daily life demands of him, pushed and pulled, now in 
 this direction, now in that, his resulting actions depending upon 
 the strength or the weakness of his desires and aspirations, his 
 attractions and repulsions. 
 
 When it is realized that instincts and emotions are the oldest 
 aspects of the psyche, and that the oldest part of the nervous sys- 
 tem, the vegetative, controls the visceral phenomena which give 
 them expression, trembling, involuntary emptying of bowel and 
 bladder, movements of the pupil, horripilation, alterations in the 
 rhythm of respiration and heart beat, secretion of sweat and 
 saliva, caliber of blood vessels, it can be seen how these oldest 
 forms of reaction have been laid down in structure and how inti- 
 mate is the correlation between the nervous system and the 
 psyche at these levels. 
 
 Later in the course of evolution there come the development 
 of ideas, the more intellectualistic aspect of the psyche, and 
 knowledge is opposed to instinct bringing it under control and 
 direction. Now the individual with a definite idea of a goal to 
 be reached is able to so control his instinctive promptings as to 
 succeed or, if he fails, then there are the resulting regrets for 
 something definitely conceived which has been lost. The feelings 
 and the ideas at the psychological level are but the expression in 
 psychological symbols of the physiological changes that are tak- 
 ing place at lower levels. The complex mosaic of the psyche is 
 part and parcel of the organism as a whole, one aspect of its 
 many-sidedness, and there, seen in its symbols, if they can be read 
 aright, is but a representation of all the things that the organism 
 as a whole is trying to accomplish, albeit at a higher develop- 
 mental level. 
 
 Verily the organism is an integrated whole, all of its parts 
 attuned to function in accord, and when the action systems are 
 set to any particular task all the machinery is brought into ad- 
 justment for its accomplishment and the psychological rever- 
 berations express in symbolic language the motif. 
 
34 FOUNDATIONS OF PSYCHIATRY 
 
 There is in the Congressional Library an heroic mosaic -of 
 Minerva. It is made of little squares of marble of various colors, 
 all fitted together in such a vi^ay as to produce the resulting figure. 
 If any particular bit of marble were removed it would be found 
 to have certain dimensions of length, breadth, and thickness and 
 its removal would leave a vacant space of the same size. But 
 the organism is not such a mosaic. It is a living, functioning, 
 dynamic thing each part of which is related in its activities to 
 every other part and no portion of which can be removed, dam- 
 aged, or altered in any way without reflecting the change in all 
 the other parts. All the organic functioning parts of the human 
 organism are related and find their final and highest expression 
 in symbolic patterns which set forth the tendencies of the or- 
 ganism as a whole in what are called psychological terms. But 
 the symbolic pattern is itself a living thing so constructed as to 
 shift its parts in intimate harmony with the whole and in its con- 
 stant shiftings and changes to reflect that whole. It therefore 
 reflects and expresses in symbols the coriflict, and these symbols 
 express over again the opposite tendencies which are struggling 
 for control. Conflict and ambivalency are fundamental and nec- 
 essary concepts with which to approach the realm of the psyche 
 in its various manifestations. 
 
 This way of thinking of the living organism does away at 
 once with the necessity, at least for pragmatic purposes, of in- 
 quiring into the nature of mind as something apart from the body, 
 although of course such a question may still present as a legiti- 
 mate subject for metaphysical discussion. Mind and body as 
 separate entities belong to the elementalistic way of looking at 
 things and, as has already been indicated, hark back to medi- 
 aevalism. It is no longer permissible to think of mind as some- 
 thing which is added somewhere in the course of organic evolu- 
 tion. The addition of the relatively more complex and controlling 
 functions in the process of development and evolution is riot com- 
 parable to the superposition of brick upon brick in the building 
 of a house, rather such added functions grow out of what has 
 previously developed. Living beings by virtue of the very fact 
 that they are living and are organized show the existence of 
 organization in the laying down of gradients, and the main gra- 
 dient shows from the very first a dififerentiation into a head end. 
 
THE DYNAMICS OF THE ORGANISM 35 
 
 These developmental gradients are but the organized interrela- 
 tions of the several parts of the organism laid down in the struc- 
 ture of the gradient. In other words, the various adjustments 
 which the organism is called upon to make in its relation to its 
 environment, its functions, are integrated and laid down in the 
 structure of its several dynamic gradients: "We must seek for 
 the integrating factor in the relation between living protoplasm 
 and its environment."* This integrating factor has already been 
 traced to the stimulus and the changes following its incidence. 
 The nervous system is "the final expression of relation which is 
 the foundation and starting point of organic individuation."" 
 
 It is quite evident that, from this point of view> it is not only 
 no longer permissible to think of the psyche as something which 
 has been added in the course of evolution, but that the history of 
 the psyche, far from being a relatively short one as compared to 
 the history of the body, as ordinarily conceived, is of necessity of 
 equal length. Just as the potentiality of the later developed 
 heart, lungs, liver, stomach, kidneys- were included in the early 
 simple processes of ingestion, digestion, egestion and circulation, 
 so also were the potentialities of the later manifestations of 
 psychological activity included in those simple forms of response 
 which included the conduct of the organism as a whole, such as, 
 its seeking for food, avoidance of danger and conjugation. 
 
 This concept of the psyche which makes its development con- 
 temporaneous and coterminous with the development of the in- 
 dividual as a whole and all-inclusive in its centralized relation to 
 the different parts, makes its inclusion in any study of the indi- 
 vidual necessary if that individual is to be really understood and 
 any adequate attempt made to reconstruct in thought the indi- 
 vidual from the point of view of the dynamic factors which have 
 produced the end result, for example, as seen in the patient who 
 applies for help. 
 
 It is then the primitive, phylogenetically older, archaic types 
 of reaction which are served by the oldest parts of the nervous 
 system, the vegetative, and the motor sets which are conditioned 
 at this level are those of the smooth or involuntary muscle and 
 the glandular apparatus. Later in the course of evolution there 
 
 8 Child, op. cit. 
 
 1" Child : Individuality in Organisms. 
 
36 FOUNDATIONS OF PSYCHIATRY 
 
 arises the phylogenetically very much younger portion of the 
 nervous system, the cerebro-spinal or sensory-motor, consisting 
 largely of the neuro-muscular apparataus as ordinarily thought 
 of, that is, in the main, the pyramidal tract system and the volun- 
 tary musculature. This apparatus is calculated to bring about, 
 with far greater nicety, the motor responses that so relate the 
 organism to its environment as to make possible the securing of 
 stimuli which will neutralize the instinctive cravings. The dis- 
 tinguishing features of this more recent development of the nerv- 
 ous system, the cerebro-spinal, are the distance receptors which 
 function as analyzers of the environment and as a result of such 
 analysis condition relatively exact responses to its several 
 qualities. 
 
 Recent studies have indicated that in the striped muscle there 
 is a double system of innervation which so relates the autonomic 
 apparatus (vegetative nervous system, smooth muscle, and endo- 
 crine glands) and the cerebro-spinal neuro-muscular apparatus 
 (the projicient system) as to insure their working in harmony. 
 These studies tend to show that the sarcoplasmatic substance of 
 striped muscle is analogous, if not identical, with the smooth 
 muscle substance and is innervated by the v^etative nervous 
 system, while the anisotropic disc system is the developmentally 
 more recent portion and is innervated by the cerebro-spinal nerv- 
 ous system. This double innervation of the voluntary muscu- 
 lature makes it responsive to the activation of the autonomic 
 apparatus through the vegetative nervous system serving in the 
 way as an integrating factor used as a mechanism for pressing 
 the cerebro-spinal neuro-muscular apparatus, with its much wider 
 capacity for adjustment and response, into the service of the 
 organism's instinctive demands and also providing a higher mech- 
 anism for their control and regulation. The instincts which have 
 at their command the autonomic apparatus and its interoceptors 
 bring about certain motor sets which are expressed in various 
 forms of visceral and postural tonus. Hunger produces, at this 
 level, the periodic contractions of the stomach which are regis- 
 tered in the psyche as a desire for food so long as they continue. 
 The projicient apparatus, with the aid of its exteroceptors, can 
 initiate responses calculated to expose the stomach receptors to 
 neutralizing stimuli — food — and thus cause the craving to dis- 
 appear. 
 
THE DYNAMICS OF THE ORGANISM 37 
 
 It is in connection with this later developed nervous apparatus, 
 the cerebro-spinal, that there comes into existence those later 
 functions of the psyche to which are given such names as judg- 
 ment, will, voluntary attention, and which are subserved by ideas 
 in contradistinction to feelings which are the psychological rever- 
 berations belonging to activities more characteristic of lower 
 levels. The cortex is thought of as the organ or rather group of 
 organs through which these higher aspects of the mind gain ma- 
 terial expression, if not exclusively then at least it is here that 
 they get their most pronounced emphasis when the process of 
 str.ucturalization of these psychological functions is going forth. 
 
 From the point of view thus far developed the organism ap- 
 pears as a hierarchy of functions, each functional level con- 
 trolling or inhibiting those that lay beneath and in turn being 
 controlled or inhibited by those apove. This way of thinking is 
 useful if not taken too literally and if at the same time it be real- 
 ized that the various levels are spoken of as such and named only 
 for pragmatic purposes and that they are by no means separated 
 by well-defined boundaries. On the contrary each higher level 
 represents the working out more accurately of the problems of 
 the lower, a virtual unfolding and development of the lower 
 levels. At the same time the analogy must not be limited to two 
 dimensions because many functions go forth parallel to one an- 
 other and represent different aspects of adjustment at practically 
 the same level as for example the digestion of starches by both 
 the salivary and pancreatic secretions. 
 
 In addition to all of these processes which make for higher 
 development there are, in any complex organism, processes of an 
 opposite nature also in evidence, namely processes of a degenera- 
 tive nature which still further complicate the total picture. These 
 processes now deserve some attention and following out the work 
 of Child, already referred to, will be illustrated by the results of 
 his experimentation. He has called the process dedifferentiation 
 to distinguish it from the process of development which he terms 
 dififerentiation. 
 
 Child is not altogether willing to admit with Lillie, Loeb, 
 Driesch, Schultz and others that development in animals is a re- 
 versible process. Inasmuch, however, as the complexities which 
 have been built up by the process that he calls differentiation can 
 
38 FOUNDATIONS OF PSYCHIATRY 
 
 be torn down by dedifferentiation he believes the process of 
 development is regressible. Differentiation is progression, and 
 dedifferentiation regression, but perhaps through stages very dif- 
 ferent from the stages of progression, therefore the term re- 
 gressible is preferable to reversible. This matter of the rever- 
 sibility of development will claim attention from time to time. 
 It seems certain that Child is right in his position that develop- 
 ment is not reversible and that therefore the term regressible is 
 preferable. This question touches the whole problem of the law 
 of recapitulation. The recapitulation hypothesis is extremely 
 useful and suggestive, offering analogies which are very helpful 
 in aiding the understanding of certain types of phenomena but it 
 seems obvious that although it may be assumed that the human 
 individual reproduces in the course of his development the 
 various stages through which the race has progressed and that 
 the imbecile boy correspondingly is arrested at a stage analogous 
 to the level reached by certain savages still the imbecile boy is 
 not a savage after all; he is very different from the savage and 
 there are no savages comparable to him. The process of differ- 
 entiation and development is not reversible even though useful 
 analogies may be drawn to lower stages of development. The 
 human embryo, for example, is never a fish even though it has 
 gill slits, nor is it at all like a fish to the extent that it might be 
 taken for one. The biologists have long ago called attention to 
 various short-cut devices, omissions, and distortions of the his- 
 toric stages that occur in the actual course of ontogenetic de- 
 velopment.^^ 
 
 With this- comment in mind on the theory of recapitulation 
 and the non-reversibility of the developmental process it is useful 
 for a comprehension of the organism as a whole to remember 
 that along with the process of development which expresses itself 
 in so many directions there goes hand in hand the process of 
 degeneration, a partial process, so to speak, which is responsible, 
 among other things, for the so-called rudimentary organs. As 
 certain aspects of the dynamics of development have been dis- 
 cussed so now there will be discussed from the point of view of 
 Child, the process of degeneration, or as he calls it, dedifferentia- 
 tion. In passing it may be mentioned that the process of dedif- 
 
 11 Marshall, A. M., Biological Lectures and Addresses. 
 
THE DYNAMICS OF THE ORGANISM 39 
 
 ferentiation is the ambivalent opposite of the process of differ- 
 entiation. 
 
 Differentiation is the process of growth, specialization, mor- 
 phogenesis and leads to senescence and death, while the process 
 of dedifferentiation is accompanied by physiological rejuvenes- 
 cence. In other words, the process of growth, differentiation, 
 specialization, or better the accumulation of function as struc- 
 ture, the structuralization of function, is accompanied by a grad- 
 ual slowing down of activity, of the metabolic rate. This is well 
 shown in the planarian worms. Starvation brings about a de- 
 differentiation in old worms. Now when these worms are fed 
 again they show by all tests that they have become younger. In 
 the same way Child shows by many examples that organic repro- 
 duction is preceded by dedifferentiation. For example, the for- 
 mation of so-called adventitious buds may take place in Begonia 
 from the epithelial cells of the leaf. The epithelial cells are 
 highly differentiated, but before the buds are formed they lose 
 their differentiated characters and resume an embryonic condi- 
 tion — they dedifferentiate. In more general terms, it would seem 
 that reproduction must be preceded by dedifferentiation. The 
 fertilized cell from which the organism is to develop, corre- 
 sponding to the resting stage in monocellular organisms, is rela- 
 tively undifferentiated. The process of differentiation starts only 
 after the slate has been wiped clean. Life issues naturally in 
 death and death quite as naturally in life. They are ambivalent 
 opposites. 
 
 In the former chapter certain processes were dwelt on that 
 make for the structure of the organism, namely, integration, 
 structuralization and individuation. These processes were de- 
 scribed, not because they are the only ones whch are active but 
 because they are fundamental to such an understanding of the 
 living organism as is attempted in this work and on the theory 
 that it is not the static, anatomical aspects of the organism that 
 need explaining but the dynamic and functional aspects. 
 
 In this chapter there have been discussed the dynamics of the 
 organism setting forth the principles of the conflict and of am- 
 bivalency. Conflict, as it has been described and illustrated, it 
 has been shown does not only occur at the psychological level, 
 as it is ordinarily conceived to, but is a universal aspect of all 
 
40 FOUNDATIONS OF PSYCHIATRY 
 
 nature, more particularly, for present purposes, of life. It has 
 been expresed in physics as the law of action and reaction which 
 are equal and in opposite directions : in biology by the theorem 
 of Le Chatelier: and in physiology by the canon of Fredericq. 
 In the realm of nervous reaction it is prominently in evidence 
 in the activating and inhibiting mechanisms of the hormones and 
 vegetative nervous apparatus. It has been shown also how, on 
 the basis of this concept of the conflict it is logically necessary to 
 consider the opposing forces as ambivalent opposites, in other 
 words, that amlbivalency is but another aspect of the conflict. 
 The conflict occurs only because two forces are opposed to each 
 other and these two forces are ambivalent opposites, they are but 
 the factors of the conflict, its necessary conditions. 
 
 And finally it has been indicated how in the intricate complex 
 of the organism, side by side with the tendencies that are making 
 for progress, development, evolution, dififerentiation there can be 
 recognized evidences of other factors at work making for disso- 
 lution, for dedififerentiation, and that these two sets of factors 
 can advantageously also be considered as ambivalent opposites 
 leading in directions which make ultimately for death or for life. 
 
CHAPTER IV 
 
 The Stratification of the Organism 
 
 The Physiological Level — The Psychological Level — The 
 Sociological Level 
 
 The Physiological Level. — Since the days of Hughlings Jack- 
 son it has been customary to speak of levels in connection with 
 the functions of the nervous system. This tendency has been 
 fixed and further developed by the work of Head in his studies, 
 especially of the sensory pathways. The difficulty about the con- 
 cept is that as a rule it is presented in a way altogether too formal, 
 too static because set forth in terms of structure. For present 
 purposes it is the underlying dynamic principle, rather than the 
 structure, which is important. The important principle is that 
 each level, to use a term which confusedly carries static implica- 
 tions, develops out of the one below into the one above ; and that 
 each controls the one below and is in turn controlled by the one 
 above. The energetics of this growth and development is, ex- 
 pressed in the most general terms, by opposition, or by conflict. 
 With the structuralization of the resultant pathways which are 
 necessary to the organism. This is the process already described 
 of laying down a dynamic gradient and evolution and develop- 
 ment involve an ever increasing number and complexity of such 
 gradients. Naturally it will be appreciated, as already indicated 
 in discussing Child's work, how these gradients arrange them- 
 selves in a functional hierarchy under the final dominance of the 
 head end. It is also quite as important to bear in mind that 
 many functions may have equal value so far as their placement 
 in such a hierarchy is concerned. 
 
 From the dynamic view-point, therefore, the organism may 
 be thought of as presented by the environment with an infinite 
 series of problems. The answer of the organism is the dynamic 
 gradient which gradient tends to be laid down in structure in pro- 
 portion to the strength and frequency of the stimulus which orig- 
 
 41 
 
42 FOUNDATIONS OF PSYCHIATRY 
 
 inally caused the outlining of its pathway. As gradients were 
 developed the relation of the organism to the environment 
 changed because it became a different sort of organism, new prob- 
 lems were presented, new gradients formed. Functionally, there- 
 fore, the organism may be thought of as a group of such gra- 
 dients which have been developed in answer to its problems 
 rather than anatomically as a group of organs. 
 
 The vegetative nervous apparatus is phylogenetically the 
 oldest part of the nervous system and the ambivalent character 
 of its reactions are clearly laid down in its structure. Its reac- 
 tions, too, are closely bound up with the emotional aspects of 
 mental life, in fact the affects are psychological reverberations of 
 its activities. The motives for conduct are fundamentally feel- 
 ing in character and represent cravings of the various autonomic 
 segments. The cerebro-spinal or projicient nervous system and 
 its associated voluntary apparatus are later developments which 
 insure a more accurate type of response and greater certainty in 
 exposing the appropriate receptors to stimuli adequate to neu- 
 trahze the cravings. There is here a close analogy to the proto- 
 pathic and epicritic mechanisms at the peripheral nerve level. 
 Protopathic sensibility is more primitive. In the field of sensi- 
 tivity to temperature it responds to extremes of temperature. 
 Fish, for example, live within certain fairly definite bounds as to 
 temperature. If a fish starts to swim in any given direction, say 
 either towards colder or warmer waters, it is of no special value 
 to it to be able to discriminate between small variations in tem- 
 perature. It needs only such temperature reactions as will keep 
 it out of water that is too warm or too cold for it to live in. 
 Therefore when the water temperature has reached a certain 
 ■ degree of warmth or coolness that fact is appreciated and the fish 
 turns back. This is the whole-or-nothing response that is so 
 characteristic of the protopathic type of sensibility. It is only 
 later in the course of development that the epicritic type of sensi- 
 bility is developed which is capable of analyzing the environment 
 much more accurately and, in the matter of temperature, for in- 
 stance, discriminating between minor degrees. This finer anal- 
 ysis, of course, makes it possible for a much more accurate adap- 
 tive response on the part of the organism. Man, for instance, 
 being acutely sensitive to temperature changes nevertheless can 
 
THE STRATIFICATION OF THE ORGANISM 43 
 
 live in any climatic extreme by adjusting his clothing to suit 
 the conditions. 
 
 The characteristics of this older form of sensibility as set over 
 against the later developed form show very well how much more 
 effective the latter is as a basis for accurate adjustment on the 
 basis of the exercise of a discriminating judgment as opposed to 
 the earlier more primitive type the psychological correlate of 
 which is feeling. These qualities are expressed by Head^ as fol- 
 lows : the whole or nothing type of reaction : affective tone rather 
 than sensory quality being the main result of the stimulus : ex- 
 tensity rather than intensity: absence of projection and relation 
 of the stimulus to the body rather than to an external object. 
 The first three of these are apparent in the illustration given of 
 the fish. The fourth there will be occasion to refer to more par- 
 ticularly later. It is quite characteristic of the affective as op- 
 posed to the intellectual aspects of the psyche. 
 
 The later developed projicient system with its more acutely 
 sensitive types of receptors capable of much more detailed and 
 accurate analysis of the environment, is epicritic in function. It 
 permits of greater nicety of adjustment through the activities of 
 the voluntary neuro-muscular apparatus and through the service 
 of the distance receptors, such as the eye and ear, tend to relate 
 the organism to an environment of ever widening boundaries in 
 both time and space. In contradistinction to the protopathic 
 function the epicritic response is characterized by being graded 
 within narrower limits of difference in degree of stimulus; by 
 sensory quality rather than by affective tone : by intensity rather 
 than extensity ; and by projection, that is by relation of the stim- 
 ulus to an external object, rather than to the body. 
 
 At this level, the sensory-motor level, there is also found evi- 
 dences of that ambivalency which is so clearly in evidence at the 
 vegetative nervous-system level. The innervation of the volun- 
 tary musculature, for example, is a double one in terms of any 
 particular act. In flexing the forearm on the arm not only are 
 the flexors contracted but the antagonists, the extensors, are re- 
 laxed and this relaxation of the extensors is quite as positive an 
 act as the contraction of the flexors. Further, during rest the 
 flexors and extensors are not flaccid but both sets of muscles are 
 
 1 Personal communication. 
 
44 FOUNDATIONS OF PSYCHIATRY 
 
 in a constant state of moderate tension, a condition which ob- 
 viously makes it easier to react more promptly in any direction 
 called upon that would be the case if for each reaction the muscle 
 had to be picked up from a state of absolute relaxation. The 
 musculature is thus, as a result of being constantly in tension, in 
 a position of maximum advantage to respond to any call made 
 upon it. 
 
 Here, as elsewhere, the various levels must not be thought of 
 as replacing each other in the sense that the higher supersedes 
 the lower. It is a matter of control and all the levels may be 
 acting at the same time. Peripheral sensitivity has qualities 
 which are contributed by both the protopathic and the epicritic 
 apparatus; the protopathic contributing more especially those 
 qualities which are known as afifective whale the epicritic con- 
 tribute those nicer discriminations upon which choice and judg- 
 ment depend. Then, too, even in the functioning of such organs 
 as the distance receptors both components in the resulting reac- 
 tions are found, the affective and the epicritic and there must be 
 assumed an underlying apparatus which corresponds to them. 
 There is evidence for this in many instances. In the peripheral 
 nerves, for example, there appear to be two kinds of nerve fibres 
 one of which seems to be more like the vegetative type and the 
 other more Hke the sensori-motor or cerebro-spinal type and it 
 seems fair to assume that the former is protopathic in function, 
 the latter epicritic. The same theory is probably true in other 
 nerves such as the optic and it is known, aside from the fine dis- 
 tinctions of which the eye is capable, what important affective 
 responses are conditioned by colors, in fact by sight in general. 
 
 The Psychological Level. — It must be apparent from the dis- 
 cussion up to this point that the psyche is not to be regarded as 
 an epiphenomenon but as a higher form of functional integration 
 developed in response to the demand of the constantly increas- 
 ing complexities of the environment. Of course the increasing 
 complexity of the environment has to be considered in a relative 
 sense. As the organism develops ways of responding to the 
 various aspects of the environment it itself becomes more com- 
 plex and because it is more complex it contacts with the environ- 
 ment at more points arid hence new demands are made upon it 
 which in turn create still further development of the ways of 
 
THE STRATIFICATION OF THE ORGANISM 45 
 
 response. For every problem solved twenty new problems de- 
 mand solution. The psyche is the last, the final answer, up to the 
 present time at least, to these increasing demands and presents 
 within itself and within the physical structure through which it 
 finds expression, the cortex, almost infinite possibilities of adjust- 
 ment and because almost infinite will undoubtedly serve as the 
 medium through which for hundreds of thousands of years to 
 come evolution will continue to find its expression as it has so 
 served for hundreds of thousands of years in the past. For the 
 purposes of this book, therefore, all metaphysical discussion as to 
 the nature of mind will be avoided and no distinction in kind will 
 be made between the mechanisms discovered at this level and the 
 mechanisms of lower levels. All may be omitted in thinking of 
 them as manifestations of energy as it works its way to the solu- 
 tion of the various problems presented on its path, to the over- 
 coming or to the offering of resistance in the various situations 
 upon which for the moment attention may be fixed. 
 
 The close analogy if not the homology which can be drawn 
 between mechanisms at the psychological level and mechanisms at 
 lower levels may with advantage be briefly illustrated. An indi- 
 vidual, faced with a specific problem of adjustment, may succeed 
 or he may fail. Short of complete failure he may substitute a 
 less efJEective form of adjustment or he may have to develop a 
 new adjustment to compensate him for an irretrievable loss. 
 Complete failure would result in the death of the individual. At 
 the psychological level this might be suicide : at the physiological 
 level it might be a cardiac decompensation : at the chemical level 
 it might be a failure to develop sufficient antibodies to counteract 
 an infection. A substitution form of reaction at the psycholog- 
 ical level might be the leading of a clerical life as a book-keeper 
 because the demands of a large family made it impossible to ac- 
 cumulate enough money to take the necessary time and stand the 
 necessary expense for equipment to lead the professional life of 
 choice : at the physiological level it might be the training of the 
 left arm to substitute for the right, lost by amputation: at the 
 chemical, metabolism level it might be the necessity for living on 
 war rations and substitute foods in place of a full diet. A com- 
 pensatory reaction at the psychological level might be a resort to 
 a religious life of contemplation as a compensation for the " slings 
 
46 FOUNDATIONS OF PSYCHIATRY 
 
 and arrows of outrageous fortune": at the physiological level 
 the development of great strength in the arms as compensation 
 for paralyzed legs : at the chemical level the over-secretion of one 
 endocrine gland to make up for defect in another. These illus- 
 trations are sufficient to showr the pragmatic advantages of not 
 attempting a metaphysical separation of mind and body but con- 
 sidering only the organism as a whole, the various mechanisms at 
 its disposal, and the problems of adjustment with which it is 
 faced. 
 
 From this point of view it will be useful to survey, briefly, 
 the development of the present day trends in psychology as illus- 
 trative of this tendency. 
 
 Psychology has quite naturally only lately come into its own 
 as a department of the biological sciences inasmuch as it deals 
 with the crowning achievement of biological evolution. Mind as 
 the last step in organic evolution (in the sense only that it is the 
 final group of mechanisms through which, for reasons already 
 cited, evolution predominantly expresses itself) is necessarily 
 the most complex and therefore comes in last for adequate scien- 
 tific treatment. Leaving out of consideration the realm of meta- 
 physical speculations psychology can be said to have come into 
 existence only about a generation ago. The earliest approach to 
 the problems of the mind were along the lines of what was then 
 called physiological psychology. This departure quite naturally 
 grew out of nervous physiology and in reality was only a refined 
 physiology because it dealt little if at all with real psychological 
 material but only with partial reactions of the individual as ex- 
 hibited, for example, in the organs of special sense or the simpler 
 neuro-muscular responses. It dealt with such questions, as the 
 range and the qualities of sensation, least perceivable differences, 
 reaction time and the simpler aspects of choice, judgment, atten- 
 tion. In interrogating the subject it dealt only with the obvious 
 and most easily accessible conscious material. 
 
 Later in the course of development there arose the school of 
 animal psychologists as a branch of the larger group of genetic 
 psychologists. The genetic problem was appreciated but largely 
 at a descriptive level and in the field of animal psychology the 
 objective methods of the laboratory were modified to serve. 
 
 Growing out of these tendencies and developing more or less 
 
THE STRATIFICATION OF THE ORGANISM 47 
 
 with them and somewhat as a reaction against their extremes 
 arose the school of behaviorists. This school saw the necessity 
 of considering the total reaction formula of the individual as 
 against the partial reaction formulae of the physiological psy- 
 chologists and insisted upon an objective approach to the prob- 
 lems as a reaction against the extreme advocates of introspection 
 and as a further development of the methods which had been 
 found useful in the field of animal psychology. The tendency 
 to discard the introspective data was a needless straining after 
 perfection of scientific method as if the testimony of introspec- 
 tion did not disclose facts, albeit psychological facts, quite as real 
 as any other facts, such as the facts of muscular contractions, 
 visibility, etc. 
 
 With the rise of the psychoanalytic school it became evident 
 that the psychological material could only be such by virtue of 
 the fact that it dealt with the reactions of the individual as a 
 whole, with the organism as a biological unity. In fact the dis- 
 tinction between psychology and physiology is based upon the 
 fact that the former deals with whole, the latter with partial re- 
 actions. In the realm of physiology the function of the muscle is 
 considered as muscle, of the sense organ as sense organ. The 
 region of psychology is only entered when an attempt is made to 
 answer such a question as "What is the man doing?" 
 
 In an adequate comprehension of the question "What is the 
 man doing?" is incorporated an understanding of the whole ex- 
 tent and meaning of psychology as a biological discipline. From 
 the discussion thus far it is evident that the organism is nothing 
 if not dynamic. Every part of it is in constant motion and these 
 motions are integrated mechanisms, or better, action-systems ever 
 in process of adjustment and adaptation. As Emerson" puts it, 
 "Life only avails, not the having lived. Power ceases in the 
 instant of repose; it resides in the moment of transition from a 
 past to a new state, in the shooting of the gulf, in the darting to 
 an aim. This one fact the world hates; that the soul becomes." 
 
 The two concepts individual and environment, far from being 
 mutually exclusive, can only be considered as the two elements 
 of a dynamic relation, of a constant interplay of forces, in which 
 their relative values are in a constant state of flux. From this 
 
 2 Self-Reliance. 
 
48 FOUNDATIONS OF PSYCHIATRY 
 
 point of view each concept has value, not intrinsically, but only 
 as an expression of the relation, and consciousness becomes an ex- 
 pression of this dynamic relation at the psychological level of 
 reaction. In qther words, consciousness can only be conceived 
 as the psychological aspect of action, the conduct or behavior of 
 the individual, or as Bergson^ puts it : " Consciousness means vir- 
 tual action." 
 
 From this point of view of consciousness as virtual action cer- 
 tain other reactions at the psychological level come in for a little 
 different consideration than that usually accorded them. Thus 
 perception, which is ordinarily regarded as in some way function- 
 ing to give us information about the environment, the individual 
 meanwhile remaining passive, can be much better understood if 
 it is conceived of as a preparation for action, yes, even as action 
 itself in its early, tentative, trying-out stages, again in the sense 
 of Bergson* when he says: "Our perceptions give us the plan 
 of our eventual action on things," or in another place -^ " The 
 objects which surround my body reflect its possible action upon 
 them." Memory, even, comes in for a like treatment so beau- 
 tifully and inimitably expressed by Bergson in his Creative Evo- 
 lution when he refers to the cerebral mechanism as being ar- 
 ranged so as to drive back into the unconscious almost the whole 
 of the past " and to admit beyond the threshold only that which 
 can cast light on the present situation." 
 
 Bergson therefore puts it* that "the fundamental law of 
 psychical life is the orientation of consciousness towards action " 
 and in his summing up of the situation says f " Consider percep- 
 tion, to begin with. The body, by the place which at each moment 
 it occupies in the universe, indicates the parts and the aspects of 
 matter on which we can lay hold : our perception, which exactly 
 measures our virtual action on things, thus limits itself to the 
 objects which actually influence our organs and prepare our 
 movements. Now let us turn to memory. The function of the 
 body is not to store up recollections, but simply to choose, in 
 order to bring back to distinct consciousness, by the real efficacy 
 
 ^ Matter and Memory. 
 * Creative Evolution. 
 " Matter and Memory. 
 ' Matter and Memory. 
 ^ Matter and Memory. 
 
THE STRATIFICATION OF THE ORGANISM 49 
 
 thus conferred on it, the useful memory, that which may com- 
 plete and illuminate the present situation with a view to ultimate 
 action." 
 
 For Bergson then' matter becomes "the aggregate of images, 
 and perception of matter these same images referred to the 
 eventual action of one particular image, my body." 
 
 The organism, therefore, must be conceived as in action ; and 
 action involves the overcoming of resistance. Again the principle 
 of ambivalency and in terms of the tendencies which lie back of 
 the opposing forces, of ambitendency. Speaking in terms of the 
 whole organism the answer to the question "What is the man 
 doing ? " must be an answer in terms that tell what he as a whole 
 is endeavoring to bring to pass. Psychology has ceased to deal 
 with partial reactions and can only reply by stating the psycho- 
 logical correlate of the total tendency, the tendency of the man 
 as a whole: and to this tendency expressed psyx:hologically the 
 term wish is applied. 
 
 The wish then has become the unit of consciousness and has 
 replaced the sensation of the older psychologists. As defined by 
 Holt* it is a "motor attitude," "a course of action which some 
 mechanism of the body is set to carry out," or in the words of 
 Paton," "a wish from the biological standpoint is nothing more 
 or less than an indication of the ' motor set ' determining the 
 direction of all our activities." All this absolutely justifies the 
 statement of HalP^ when he says: " Epistemologically speaking, 
 no one can know what he does not objectify." 
 
 With this conception of the psyche as the expression of the 
 integrated action systems of the whole individual there may again 
 be seen all of the mechanisms thus far considered in action. 
 
 Integration is in evidence when certain wishes are subordi- 
 nated, for the time being at least, to the orderly direction of liv- 
 ing to attain a well thought out goal. When, for example, time 
 and effort is spent to get such an education as will fit the indi- 
 
 8 Matter and Memory. 
 
 » Holt, E. B., The Freudian Wish. Pub. by Henry Holt and Co., New 
 York, 1915. 
 
 1" Paton, Stewart, Education in War and Peace. Pub. by Paul B. 
 Hoeber, New York, 1920. 
 
 " Hall, G. Stanley, Jesus, the Christ, in the Light of Psychology. Pub. 
 by Doubleday, Page and Co., New York, 1919. 
 
50 FOUNDATIONS OF PSYCHIATRY 
 
 vidual for the practice of medicine. Structuralization is in evi- 
 dence when the individual has so become the creature of habit, 
 of deeply channeled modes of response, that he continues to react 
 according to a given pattern even though all sorts of disturbing 
 factors tend to distract. Archimedes kept on at his problem 
 even though the streets were filled with the soldiers of the con- 
 quering Roman legions. Individuation is more prominently in 
 evidence at the psychological level than at any other. That uni- 
 fying principle which streams through the dynamic mosaic of the 
 human organism not only makes it different from a pile of bricks 
 but as it manifests itself in the kaleidoscopic arrangements in 
 hundreds of millions of individuals is just a little different in its 
 end result in each. The differences at the lower levels can not 
 be seen with the most powerful microscopes but at the higher 
 levels, the psychological, where the conditions are much more 
 complex and where each has worked out his solutions a little dif- 
 ferently by the use of faculties which are possessed in common 
 with all his fellows, they can at least be felt and often thus quite 
 clearly apprehended. A friend is loved, not because he is like 
 everybody else but because he is different. As for ambivalency 
 and ambitendency, they are found at every turn, involved in 
 every choice, every judgment, in the eternal "battle of motives" 
 that goes on ceaselessly as man forges ahead and solves his prob- 
 lems by overcoming the obstacles to adaptation. And finally the 
 total reaction formula is further complicated by the process of 
 dedifferentiation which is constantly going on here and there as 
 old ways of reacting have to be destroyed in order that new ways 
 may be built up. At the chemical and physiological levels this is 
 well illustrated by the gradual disafjpearance of the thymus gland 
 as the child approaches adulthood. At the psychological level it 
 is often in evidence at places in the career of an individual when 
 he has to abandon some method of reacting which has worked 
 fairly well up to a certain point, but then has to be replaced by 
 something better. When, for example, a young man abandons a 
 business career, sells his business, and starts going to school 
 again to learn a profession. 
 
 All these mechanisms are daily in evidence in the life of the 
 individual as it unfolds in the course of its development but they 
 are given a much deeper significance from the viewpoint of 
 
THE STRATIFICATION OF THE ORGANISM 5 1 
 
 genetic psychology as they are seen on a larger scale as they 
 operate in the development of the race. Inasmuch as the genetic 
 point of view which is at present of so much interest has devel- 
 oped largely as a product of psychopathology it will be useful to 
 review the leading facts in its development as they occur in the 
 history of psychiatry for the past one hundred years. 
 
 Psychiatry, until recent years, has been almost wholly in the 
 collection and description stage of development. In fact it is still, 
 for the most part, in this stage. Eighteenth Century psychiatry 
 grouped certain manifestations of mental illness together and 
 gave them a name much after the manner of the naturalist before 
 the theory of evolution. In fact the classification of mental dis- 
 eases was fashioned after the dichotomous system of classifica- 
 tion which has become so familiar in botany and zoology. If 
 a patient had certain symptoms at a given time then he was 
 said to have that mental disease to which these S3rmptoms corre- 
 sponded. In natural history, however, this method came a crop- 
 per in many instances when, for example, free swimming em- 
 bryonic forms were described as separate species. This mistake 
 was only remedied when the life history of the individual was 
 studied and the embryonic form was then seen for what it really 
 was, a stage in the development of the individual. Similarly, the 
 practice of calling a disease process by a certain name, depending 
 upon the symptoms that might be in evidence at a certain time, 
 that is from the point of view of a cross section of the individual 
 at that time, was equally descriptive and misleading. 
 
 Descriptive psychiatry reached its climax with the school of 
 Kraepelin who, to correct the errors of his predecessors under- 
 took a study of the disease process in longitudinal section, that is 
 from the point of view of course and outcome. This followed 
 more nearly the method of the naturalist following the advent of 
 the theory of evolution. Even this method does not adequately 
 take into account all of the factors involved. It is still too narrow 
 a point of view from which to approach the problem. In fact it 
 still smacks of that same medieval attitude of mind which has 
 already been alluded to as being responsible for the consideration 
 of mind as something separate and apart from the body only in 
 this case it considers disease in that way. 
 
 Disease used to be considered, in fact still is, as something 
 
52 FOUNDATIONS OF PSYCHIATRY 
 
 that comes from without in some way and attacks the individual 
 and in medieval thought was thought of as a sort of devil tliat 
 took up its residence within the body. Disease is nothing of the 
 sort. Disease is only a manifestation of that dynamic interplay 
 between organism and environment when, for the time being at 
 least, the balance is on the wrong side of the ledger, when the 
 organism, for some reason, is losing out. It might be defined in 
 the same words which Schiller uses^'' to define evil when he says, 
 " Evil is that which resists the evolution of the world, and fights 
 a losing battle against the tendencies of things. It owes its per- 
 sistence simply to this, that the end is not yet, that the purpose of 
 the world process is still being achieved, that the discordant ele- 
 ments are still being harmonized, and that hence what is cannot 
 yet realize what ought to be." In other words, it is the process of 
 dedifferentiation on a large scale. It can readily be understood 
 how this is true, say of the changes incident to old age but it is 
 equally true of less obvious situations such as the infections. In- 
 fection does not equally afHict everyone, some are relatively im- 
 mune, others relatively susceptible. There is an underlying orien- 
 tation of the organism toward the infectious agent, vaguely 
 referred to as constitutional, which but exemplifies the fact that 
 the result is the outcome of the dynamic interplay between or- 
 ganism and environment. Then when the study of pathology is 
 approached it is found that there nothing is new. Disorder is 
 found among the normal physiological processes but nothing new 
 has been added to the situation. The only dififerences are quan- 
 titative, differences of more or less and not of kind. Pathology 
 is only the study of physiology modified by differences of em- 
 phasis here and there. 
 
 Disease is, therefore, not an extraneous something like a me- 
 dieval devil, but, a function of the dynamic interplay of organism 
 and environment and the study of disease alone, as disease, can 
 never give a complete account of the reasons for the symptoms. 
 This is more true, if degrees can be properly spoken of at all, in 
 the realm of mind than elsewhere because, as will be seen more 
 'fully later, the enviironment at this level, the social environment, 
 plays a predominant role. 
 
 12 Schiller, F. C. S., Riddles of the Sphinx. A Study in the Philosophy 
 of Humanism. Pub. by the Macmillan Co., Lt., London, 1912. 
 
THE STRATIFICATION OF THE ORGANISM 53 
 
 Therefore the next step brought the period of interpretative 
 psychiatry, the period upon which it is only now just entering. 
 From this point of view the disease, in this case the mental dis- 
 ease, can only be understood when it is appreciated how it has 
 developed as the result of certain stresses applied to a certain 
 personality make-up, and the symptoms then appear as the result 
 of the stress acting upon this make-up, and express in symbolic 
 form the way in which the personality, more particularly at its 
 weak points, has striven to meet the situation. Psychiatry, there- 
 fore, must busy itself, not with the study of a longitudinal section 
 of the disease process, its course and outcome, but with a longi- 
 tudinal section of the individual which shows how a given type of 
 personality make-up has reacted to a given type of stress, how it 
 has brought its assets and liabilities to the problem in hand, how 
 it is dealing with that problem, and how finally it solves it. 
 
 This is the type of psychology which is so much in evidence 
 now-a-days and has contributed so much to the practical psychi- 
 atrist, social worker, and vocational psychologist. A scientific 
 psychiatry, based upon a genetic psychology, must, however, delve 
 much deeper in its search for explanations. As already indicated 
 the head end is quite as old in historical development as the rest 
 of the organism. The psyche is not something which has been 
 added at a given point in the course of evolution but, in its pres- 
 ent form is the elaboration and final expression of the supremacy 
 of the head end. Therefore the history of the psyche is not con- 
 fined to the life time of the individual but stretches back over the 
 whole period of organic evolution just as does the history of the 
 body. Just as there can be no adequate understanding of the 
 body except there has been traced its development to its present 
 estate along the path of evolution so it is with the mind. From 
 this point of view child psychology would be comparable to em- 
 bryology; comparative psychology to comparative anatomy, and 
 paleopsychology to paleontology. The immediate explanation of 
 the adult psyche is found by tracing its development from the 
 child psyche; analogies are seen between the psychological reac- 
 tions of different peoples that may look very different on the sur- 
 face : and evidences are found of archaic nodes of response that 
 are quite like the reactions of primitive peoples. A brief illus- 
 tration of these features will make the matter clear. A man who 
 loses his temper and breaks the furniture is said to act in a child- 
 
54 
 
 FOUNDATIONS OF PSYCHIATRY 
 
 ish manner because children act towards the elements of their 
 environment as though they were personalities. But this very 
 tendency to personify the inanimate elements of the environment 
 is one of the most outstanding characteristics of savages so that 
 the conduct of the angry man has homologies not only in the re- 
 actions of the child but also in those of the savage. 
 
 The homologies which adult action has with childish and prim- 
 itive forms of reaction can be understood if the same attitude of 
 mind is assumed toward tihe psyche that has come to be assunjed 
 towards the body. This idea has already been set forth in the 
 description of the laying down of functional gradients. In the 
 original unicellular organism the functions of ingestion* diges- 
 tion, and egestion were pretty well shared by the whole proto- 
 plasmic mass. As the situation became more complex there were 
 built up certain organs which served those various functions or 
 parts of those functions more accurately. Thus the gastro-intes- 
 tinal tract was the solution of the organism, laid down in struc- 
 ture, of the function of ingestion ; the cardio-vascular organs the 
 structuralized solution of circulation; the kidney the solution of 
 certain problems of egestion ; the liver the solution of the function 
 of sugar metabolism, etc., etc. In quite the same way the instincts 
 may be considered as organs which have evolved as solutions of 
 the problems which confronted the organism at psychological 
 levels. As the organism became more complex the reverberations 
 of its needs, as they appeared at the psychological level, were or- 
 ganized into instincts which served to activate the whole organism 
 to obtain the necessary satisfactions. Thus the hunger instinct 
 and the sex instinct are specific activities of the organism which 
 originally responded to the need for food and reproduction by its 
 whole body, the inclusion of food particles by the cell, and re- 
 production by division. As the various functions have become 
 fixed in structure, that is laid down in different ways of response, 
 chemical, reflex, instinctive they have been left behind as living 
 issues, so that the energy of the organism may be made available 
 for new problems. This is the way in which the unconscious is 
 'formed. The unconscious represents the historical past and con- 
 tains those solutions which have become so thoroughly organised 
 as to form stepping stones for further progress.^' 
 
 1' White, Wm. A., The Unconscious. The Psychoanalytic Review, 
 Vol. II, No. I, January, 1915. 
 
THE STRATIFICATION OF THE ORGANISM 55 
 
 It is in this region of the unconscious that we find the struc- 
 turalized functions of the psyche. Those solutions which have 
 been reached by the race and therefore are common to all indi- 
 viduals just as the bodily organs, liver, spleen, kidneys, etc., are 
 common to all individuals. Jung^* designates this common ma- 
 terial as it expresses itself in action as instincts and as it condi- 
 tions intuition and apprehension as archetypes of apprehension. 
 The totality of instincts and archetypes of apprehension he calls 
 the "collective unconscious." 
 
 This collective unconscious is in a sense the common posses- 
 sion of mankind, or at least, people of the same degree of cul- 
 tural development would have the same collective background. 
 This collective unconscious has been spoken of as a racial memory 
 and in a sense of course it is, but to use the word memory here, 
 it seems, may well imply a misapprehension. It has been thought 
 of as memory because symbols are found in the unconscious that 
 are the same as those which are found in culturally more prim- 
 itive people and the same as those that are known from history to 
 have been prevalent, at least in the folk-lore and legends, in past 
 ages. The term memory, as ordinarily used, implies the revival 
 of a past experience of the individual but used in this sense would 
 apply to the past experiences of the race. It seems, therefore, 
 more helpful to think of the whole matter somewhat differently 
 although perhaps it may not be quite accurate to hold unequivo- 
 cally that the use of the term memory, in this broader sense, is 
 unwarranted. From this point of view it should not be said that 
 memory extends back, say one hundred thousand years, but that 
 when reality is dealt with by the same methods which were used 
 one hundred thousand years ago, that is, when it is dealt with 
 with the same mechanistic equipment, mental machinery, so to 
 speak, the same results are reached. This way of looking at the 
 matter touches the whole question of the stratification of the or- 
 ganism as that expression is used. When reality is dealt with 
 with a fully developed consciousness one result is obtained, when 
 an attempt to deal with it is made by lower, more infantile, more 
 primitive, more archaic mechanisms necessarily there is a dif- 
 ferent result. It is as if in printing, the paper — reality — was fed 
 
 i*Jung, C. G., Instinct and the Unconscious. The British Journal of 
 Psychology. Vol. X, Part I, November, 1919. 
 
56 FOUNDATIONS OF PSYCHIATRY 
 
 to a modern Hoe printing press and the final result was a sixteen 
 page newspaper accurately folded and ready for the news-stands ; 
 or the paper is fed to a simple custom press and the result is a 
 single page circular. The custom press could not do the work of 
 the more complicated machine, unless it could evolve into one, as 
 of course it has, in a sense ; while if the more complicated machine 
 undertakes the simple task it does so only by eliminating its more 
 highly complex mechanisms and so using only those parts that 
 are comparable to the simpler machine. The illustration is per- 
 haps a crude one, but the analogy is not simple and the attempt 
 to illustrate it at least shows that. , The Hoe press turning out a 
 one page circular is not operating just like the simpler machine 
 and in so functioning is not strictly analogous to it any more than, 
 as already indicated, a single cell of a metazoon is analogous to a 
 monocellular organism : the forty year old imbecile of the psycho- 
 logical age of six is not like the six year old child perhaps in any 
 other respect than his capacity to test up to the same level. The 
 analogy, therefore, is after all not so remote as it seemed at first, 
 for the complicating elements are seen elsewhere as well. An- 
 other example may make the matter still clearer. At a certain 
 stage in development the human embryo has gill slits. In some 
 cases these gill slits persist after birth and exist as pathological 
 anomalies of structure. Nevertheless the organism as a whole is 
 not at all fishlike nor do these slits function as they do in a fish. 
 They simply persist as defects of development and impair the full 
 functional activity of the organism as a whole. While in a cer- 
 tain sense they may be thought of as memories of a previous type 
 of structure still the general result is quite different from the re- 
 sult of memory as ordinarily thought of. In order that the an- 
 alogy may be correct the limits of the individual as ordinarily 
 conceived must be discarded and in his place must be put the con- 
 cept of the race. If it is appreciated that the individual is in fact 
 a part of a larger whole, the race, but only a point, so to speak, in 
 the organic phylum where for the time being the living forces are 
 nucleated, then the analogy is useful, perhaps it is more than an 
 analogy, perhaps it is an homology. 
 
 Such illustrations, however, do indicate that the oragnism car- 
 ries within itself distinct evidences of the pathway of develop- 
 ment along which it has come, of the various stages of develop- 
 
THE STRATIFICATION OF THE ORGANISM 
 
 57 
 
 ment through which it has passed. The law of recapitulation, 
 namely that ontogeny epitomizes philogeny, is true for the psyche 
 as well as for the body, although, as indicated, there are evidences 
 of short cuts, variations, and complications on the way. Notwith- 
 standing the intricacy of the problem it should be possible, if the 
 facts were available in sufficient number, to classify the psycho- 
 logical types of reaction from this point of view, to arrange them 
 in a hierarchy, in an order from the highest to the lowest, and 
 such a classification should be possible from both the ontogenetic 
 and the philogenetic standpoints, and finally the two classifica- 
 tions should show homologies at the several stages. It has al- 
 ready been indicated how the psychic reactions may be classified 
 as conscious and urux)nscious. Grasset^° has used this as a basis 
 and speaks of two psychisms, the superior psychism which in- 
 cludes the voluntary and conscious activities and the inferior 
 psychism which includes the automatic and unconscious activities. 
 
 The function 
 the real . . . 
 
 oi 
 
 11. 
 
 Disinterested 
 activity . . . . 
 
 action 
 
 effective action on reality {^^^l^^i 
 
 new action with feeling 
 
 fof 
 tof 
 
 attention 
 
 III. The functions of images 
 
 unity 
 liberty 
 
 ■perception with feeling of reality 
 certitude, belief 
 perception of new objects 
 perception of the f 
 
 person -| with feeling of reality 
 
 I with feeling of unity 
 presentation, perception and the utilization of the 
 present 
 
 habitual actions 
 
 f of the present 
 action without feeling -j of unity 
 
 [ of liberty 
 perception without the feeling of certainty and 
 with a vague feeling of the present 
 
 f purely representative memory 
 imagination 
 abstract reason 
 revery 
 
 IV. 
 
 The visceral emotional reactions-!^ 
 Useless muscular movements . 
 
 systematic 
 diffuse 
 
 /systematic 
 L diffuse 
 
 ^^ Grasset, Joseph, The Semi-Insane and the Semi-Responsible. 
 & Wagnalls Co., New York and London, 1907. 
 
 Funk 
 
58 FOUNDATIONS OF PSYCHIATRY 
 
 Janet" has attempted such a classification in somewhat more de- 
 tail. His classification is shown in the table on the preceding 
 page. Janet came at this classification from a study of the neu- 
 roses in which he saw the activity of the lower levels more or less 
 uncontrolled by adequately developed higher levels. 
 
 From this standpoint, namely, the psychopathological, the 
 psychoanalytic school has come to a classification of the develop- 
 mental stages of the individual, more especially as they relate to 
 his creative energies, that is, to his love tendencies. This classifi- 
 cation is at present still very general and needs to be filled in in 
 much more detail. It is based upon the progressive tendency in 
 the individual to more and more objectify his love interests and 
 the classification is therefore a classification of the nature of the 
 love objects which appear at the different stages of development. 
 At first the individual is auto-erotic, that is, he takes himself as 
 love object: he then seeks love objects outside himself but still 
 those most like himself, this includes the narcissistic and homo- 
 sexual types of objects of attraction : then he becomes distinctly 
 heterosexual, that is, lie is able to attain a love object, not like 
 himself, but of the opposite sex. This classification can be seen 
 to be a progress in the direction of the socialization of the in- 
 stincts and with reference to the particular tendencies" the social- 
 ization may proceed to such a degree of sublimation that the love 
 object is, to all intents and purposes at least desexualized. This 
 is what is seen, for example, in the more abstract interests of the 
 scientist. There are still lower and higher stages. Lower than 
 the auto-erotic stage of infancy is the stage best exemplified by 
 the foetus in utero in which, because it has no unsatisfied desires, 
 even its breathing, eating and all the rest being done for it by the 
 mother, can be said to be in a state of unconditioned omnipotence. 
 The higher stages include the most abstract results of social inte- 
 gration and express themselves in such functions as civic duty, 
 good citizenship, public benefactions, etc. 
 
 The homologies as between the individual development of the 
 psyche and the racial development are even more difficult to 
 
 18 Janet, Pierre, Les Obsessions et La Psychasthenie, Vol. I. Felix 
 Alcan, Paris, 1903. Nevroses et Idees Fixes, F^Hx Alcan. Paris, 1898, 
 Les Nevroses, E. Flamtnarion, Paris, 1909. 
 
 " Freud, S., Three Contributions to the Theory of Sex. Nervous and 
 Mental Disease Monograph Series, No. 7. 
 
THE STRATIFICATION OF THE ORGANISM 59 
 
 draw. Rather vaguely a period of animism may be defined dur- 
 ing which the child tends to personify the inanimate objects of its 
 environment in similar fashion to savages. There is also a period 
 of great interest in animals which corresponds to the important 
 part they have played in the history of the race. Similarly there 
 are distinct evidences of the use of magic. In fact if any aspect 
 of the developing psyche be studied it will be found to present 
 evidences of passing through stages quite similar in their mani- 
 festations to the phenomena which have become familiar in the 
 study of savages. To correlate all the evidence, however, and 
 arrange it in a hierarchy would be an extremely difficult problem 
 which, so far has not been at all satisfactorily accomplished. 
 Only the very broad outlines can be indicated. 
 
 Of course, too, it must always be remembered that the ad- 
 vance is not simply a linear advance; that it cannot be repre- 
 sented in two dimensions only but that it is three dimensional, 
 that many processes run parallel, some of which occupy the same 
 level in the hierarchy of functions and some of which do not, and 
 that progress in any one of these directions is often interrupted 
 by degeneration — dedifferentiation — limited or extensive as the 
 case may be. 
 
 Finally to come back to .the relations of ontogeny and phylog- 
 eny. The statement, as already indicated, that ontogeny repeats 
 phylogeny is, to say the least, misleading. That would mean that 
 there was an exact correspondence between a given stage in indi- 
 vidual development and a given stage in racial development. This 
 of ocurse is not so. The imbecile forty years of age but of the 
 psychological age of six years does not correspond to the child of 
 six any more than does the child of six correspond to a savage. 
 
 To come back to the example of the gill arches referred to 
 before. Occasionally persons are born with persistent gill slits 
 but no one would know that that is what they were if their de- 
 velopmental history had not been traced. The fact that these 
 are at one stage of development gill arches does not mean that 
 then the human animal is a fish or even that these structures are 
 headed towards fulfilling the function of supporting gills. In the 
 evolution of the vertebrates gills have given way to lungs as 
 organs which better solve the problem of the utilization of oxy- 
 gen. In man, however, there still persists embryonic traces of 
 
60 FOUNDATIONS OF PSYCHIATRY 
 
 the primitive splanchnocranium in the form of three pairs of gill 
 arches which although they disappear from view, are not entirely 
 lost for certain parts of the adult skeleton are directly derived 
 from them. These are certain parts of the hyoid apparatus and 
 the thyroid cartilage.^* It is true that the thyroid cartilage could 
 not be fully understood without this light shed from its develop- 
 mental history. Just how much is to be credited to ontogeny in 
 its explanation and how much to phylogeny is, however, a dif- 
 ferent question. The two processes, if processes they can be 
 called, are so inextricably intertwined. It seems .that a useful 
 attitude towards the whole situation can be attained if it is real- 
 ized that in the development of man, for example, the creative 
 energy has to utilize what it finds, in this case gill slits. If the 
 end were a fish the utilization of this material would be in one 
 way, but the end is a man so it has to be very differently used. 
 Just so much of the past as can be used for the present problem 
 is pressed into service, and the past so used is remoulded to serve 
 its new end. 
 
 The reason for this deflection to discuss the recapitulation 
 theory is because it is of very great importance for thinking 
 clearly in discussing the analogies between certain ways of think- 
 ing, particularly as seen emphasized in the realm of psychopathol- 
 ogy, and similar ways of thinking as seen in children and savages. 
 Archaic modes of reaction are spoken of rather loosely because 
 it is not really known just what is meant by archaic, just what 
 sort of reactions should be included in this term. It must be 
 clear from the argument thus far that to merely go back in the 
 history of the individual far enough is by no means to necessarily 
 insure an archaic type of reaction in the sense of a reaction older 
 in form than the individual. Similarly no matter to how recent a 
 date Jn the history of the individual a type of reaction belongs it 
 cannot be free from the influence of its racial background. Every 
 reaction must contain elements that can only be understood by 
 knowning the phylogenetic history back of them: while every 
 reaction must also contain elements which could only have been 
 contributed by the individual. 
 
 If this argument is correct the word archaic would have a 
 
 18 Walter, H. E., The Human Skeleton. An Interpretation. Pub. by 
 The Macmillan Company, New York, 1918. 
 
THE STRATIFICATION OF THE ORGANISM 6l 
 
 fairly definite meaning only its application in a particular instance 
 might be difficult. To come back again to the gill slits. Gill slits 
 which persisted in the adult human would be archaic because they 
 would represent a bit of the past which it had not been possible 
 to assimilate and make a part of the new plan, a bit of the past 
 which, so to speak, had become hopelessly side-tracked, its forces 
 unavailable for further progress. If the argument is right it may 
 be carried over into the psychological level and an archaic reac- 
 tion must be considered prognostically most serious although re- 
 gression as such, need not be, no matter how far back it goes. 
 The ontogentic content of a regressive psychosis is material con- 
 tributed by the past experiences of the individual and may be 
 brought under 'his control but the phylogenetic content transcends 
 the experiences of the individual, it dates its origin long before 
 his existence and has never been and very possibly never can be, 
 iat least fully, under his control. 
 
 To come back to the question of the hierarchy of psychological 
 functions. Both the schemes of Grasset and Janet are essentially 
 ontogenetic in principle. In fact very little is known of the phy- 
 logenesis of the psyche. From this point of view such onto- 
 genetic stratifications as autoeroticism, narcissism, homosexuality, 
 heterosexual object love ; such developmental periods in the his- 
 tory of thought as the animistic, religious, and scientific, paral- 
 leled perhaps roughly by the pathological phenomena of hysteria, 
 compulsion neurosis and paranoia, as caricatures respectively of 
 artistic creation, religion and philosophy; are but the larger 
 sub-divisions, the main epochs, each one of which needs to be 
 split up as a result of further investigation.^* Each one of these 
 stages as well as such prominent and characteristic aspects of 
 psychic life as have evident analogies with the savage mind such 
 as the aiU-powerfulness of thought, magic, anthropomorphism, 
 need to be studied as to both their ontogenetic and their phylo- 
 genetic components as has been shown by the illustration of the 
 gill-arches. When this is done, and in addition each one of the 
 various strata can be identified by its characteristic psycho- 
 logical fossils, then there will begin to be a basis upon which can 
 be formulated a psyohopathology which will give some indica- 
 tion through the symptoms of the seriousness of the illness and 
 the possibilities for recovery. 
 
 i» Freud, S., Totem and Taboo. New York, Moffat, Yard & Co., igig. 
 
62 
 
 FOUNDATIONS OF PSYCHIATRY 
 
 The difficulty of getting at the phylogenesis of the psyche by 
 any other means than by psychoanalysis, and that of course 
 means largely by implication and hypothesis, the difficulty of an 
 cibjective approach can be appreciated when it is realized that the 
 historical period covers only about one per cent, of man's racial 
 history.'"' Thus the earliest human race, the Trinil race dates 
 
 Succession of Human Industries and Cultures 
 
 V. Later Iron Age Europe, 500 B.C. to Roman Times 
 
 (La Tene Culture) 
 
 IV. Earlier Iron Age Europe, 1000-500 B.C. 
 
 (Hallstatt Culture) Orient, 1800-1000 
 
 III. Bronze Age Europe, about 2000-1000 
 
 Orient, about 4000-1800 
 II. New Stone Age, Neolithic 
 
 3. Late Neolithic and Copper Age 
 
 (Transition Period) Europe, about 3000-2000 
 
 2. Typical Neolithic Age 
 
 (Robenhausian, Swiss Lake-Dwellers), Europe, about 7000 
 I. Early Neolithic Stages 
 
 ( Carapignian Culture ) Europe 
 
 I. Old Stone Age, Palaeolithic 
 
 Upper Palseolithic i Europe 
 
 8. Azilian-Tardenodsian 
 
 7. Magdalenian (close of Post-glacial time) 
 6. Solutrean 
 
 S. Aurignacian (beginning of Post-glacial 
 time) 
 Lower Pakeolithic 
 
 4. Mousterian (fourth Glacial time) 
 
 u'S 
 
 about 
 about 
 
 12,000 
 16,000 
 
 3. Acheulean (transition to Shelters) 
 2. Chellean 
 I. Pre-Chellean (Mesvinian) 
 
 Eolithic. 
 
 0) > 
 
 •oU 
 
 .S-d 
 "i a 
 
 pi rt 
 
 •o 
 9 
 
 I TO 
 
 •o 
 a 
 a 
 
 about 40,000 
 
 about 100,000 
 
 back about five hundred thousand years. This Trinil race (Pithe- 
 canthropus erectus) was followed by the Heidelberg race (Homo 
 
 2" Osborn, H. F., Men of the Old Stone Age, their Environment, Life 
 and Art. New York, Charles Scribner's Sons, 1916. 
 
THE STRATIFICATION OF THE ORGANISM 63 
 
 heidelbergensis) ; then the Piltdown race, the "dawn man" 
 (Eoanthropus), antiquity estimated at from one hundred to three 
 hundred thousand years; then the Neanderthal race (Homo 
 neanderthalensis) , antiquity estimated as between twenty-five and 
 forty thousand years. This brings man to upper paleolithic times 
 With the Briinn, Grimaldi, Cro-Magnon, and Ofnet races, and to 
 recent Homo Sapiens. Only about the last one hundred thou- 
 sand years of this period has offered material for the study of the 
 cultural development of man. The succession of human cultures 
 is shown in the above table taken from Osborn.^^ 
 
 These cultural levels are of course only imperfectly known, 
 largely from remains of dwellings, implements, and art. It is 
 stimulating, however, to note that some of the art, which has 
 been referred to the upper paleolithic, very closely resembles 
 products of the highly individualistic movements in modern art. 
 Such a close resemblance indicates the possibilities of psychoanal- 
 ysis for uncovering some of these low cultural levels. At least 
 the immensity of the field for further investigation along these 
 lines is sufficiently indicated. 
 
 The Sociological Level. — Just as it has been already indicated 
 that the multicellular organism is not a mere aggregation of cells 
 so society is not a mere aggregation of individuals. Society is 
 made up of the various individuals plus the relations that main- 
 tain between them. In other words it is an organism, integrated 
 and structuralized just as are other organisms. 
 
 A comment upon the general subject of levels of integration 
 has been reserved for this place because it can be more forcefully 
 illustrated with the material at this level and because the illustra- 
 tion is so much more pertinent to the object of this book. The 
 smallest social group can be thought of as composed of two indi- 
 viduals A and B and the relation which maintains between them. 
 Now it may be assumed for the purposes of this illustration that 
 that relation is one of mutual friendship. Now this friendship is 
 a higher integration, it is a social integration and as such cannot 
 be fully explained by splitting it up into its component parts any 
 more than the organism can be fully explained by its component 
 cells. The organism as a whole is something more than the sum 
 of its parts, so friendship is something more than that which A 
 
 " Op. cit. 
 
64 FOUNDATIONS OF PSYCHIATRY 
 
 contributes plus what B contributes. That which A and B con- 
 tribute are correlates but their relation is something more than 
 their sum. What is meant by this has already been sufficiently 
 illustrated in the discussion of the unity of the organism (Chapter 
 .II). Society, from this point of view, is also a unity. Social 
 facts cannot be adequately explained by psychological facts ; psy- 
 chological facts cannot be adequately explained by physiological 
 facts ; physiological facts cannot be adequately explained by chem- 
 ical facts. The facts at any level of integration need to be ex- 
 plained, and can only be fully explained, in terms of that level. 
 To attempt the reduction of complex situations to terms of less 
 complex situations without a due appreciation of this principle 
 leads to much loose thinking and has been responsible for many 
 false assumptions, such for example as the theory that conscious- 
 ness is secreted by the cortex. 
 
 Because man is a member of the social group he has to fit 
 himself into the scheme of that group and go along with its tend- 
 encies just as does the cell have to adjust itself and fit into the 
 general tendencies of the organism. In fact the individual man 
 is part and parcel of that higher integration, society, and he can 
 only be understood when it is realized that he is an organic part 
 of that larger whole, inextricably identified with it, as necessary 
 to it as it is to him. It is understandable, therefore, from the 
 study of the individual man that certain of his aspects can only 
 be understood when his relations to this larger whole are taken 
 into consideration. Man can only be understood as a social ani- 
 mal and therefore, the social organism must be understood in 
 order to appreciate adequately the part individual man plays in it. 
 This is an ambitious scheme but certain aspects of the situation 
 will repay consideration in this connection. 
 
 From this point of view of society as a higher form of or- 
 ganism certain results flow in explanation of the individual's psy- 
 chology. Just as the cells are agencies for carrying out the larger 
 plan of the organism as a whole so the individual humans are 
 agencies for carrying out the larger plan of society. What are 
 these larger plans? In general it is perfectly obvious that they 
 must include self-preservation and creative expansion, growth 
 and development. The individual must either fit into or fit out of 
 this general scheme, but how? The answer is found when in- 
 
THE STRATIFICATION OF THE ORGANISM 65 
 
 quiry is made into the standards he sets himself for conduct. His 
 conduct, when it in any way touches the wdfare of the state, is 
 right if it furthers those interests, wrong if it is opposed to them. 
 And the significant fact about this Tightness and wrongness of 
 conduct is that it is not merely a matter of the verdict of others 
 but that somehow the actor himself feels his conduct to be right 
 or wrong as the case may be. 
 
 This way of looking at society as a higher state of integration 
 than exists in any of its individual components seems to offer the 
 only means of explaining many facts of man's so-called moral 
 nature. Social tradition is passed on from generation to genera- 
 tion just as truly as the more obvious physical characteristics are 
 transmitted through the medium of the germ plasm, and their 
 practical working is as effectively insured by being incorporated as 
 inherent, affective tendencies in the individual. Only in this way 
 can be explained the relatively slight effect which severity of pun- 
 ishment apparently has upon the incidence of anti-social acts. 
 Either individuals have attained such a high point of social inte- 
 gration that the fear of punishment has little or no effect upon 
 their conduct, they will be moral anyway, or they have fallen so 
 far short in their social integration that the fear of punishment 
 cannot have any effect, they are controlled by lower instincts and 
 will be immoral in their conduct anyway. This is especially well 
 illustrated in certain forms of auto-erotic sexual indulgences. 
 The unfortunate victims of habits of this character are charac- 
 teristically asocial types, unhappy and depressed, frequently drift 
 into severe psychoses and may become actively suicidal though 
 there is no question of discovery or punishment involved. They 
 have a profound sense of inferiority as compared with others 
 which makes their lives intolerable at times, although they may 
 have practically no intellectual orientation towards the real nature 
 of their difficulties. Similarly with such crimes as homicide there 
 is no evidence that capital punishment has any effect in lessening 
 the nuumber of murders in a given community.^^ 
 
 The individual is so oriented towards those acts which, in 
 their general tendency are destructive to the herd that he feels 
 instinctively that they are wrong and if impelled to commit such 
 acts feels, also instinctively, a sense of personal guilt. The indi- 
 
 22 Bye, Raymond T. : Capital Punishment in the United States. Uni- 
 versity of Pennsylvania Thesis. 
 
66 FOUNDATIONS OF PSYCHIATRY 
 
 vidual is truly an agency through which the destinies of the more 
 highly integrated organism, society, works out its expression. 
 
 The degree to which the individual is subjected to the needs 
 of the herd is seen in high relief at times of war when he is called 
 upon to die that the State may live. The universality with which 
 this demand is met is the strongest possible proof of this thesis. 
 
 Here, at the social level, the final integration which is attained 
 is the result of conflict, the higher integration being the expres- 
 sion of the solution of the conflict in accordance with the Hegelian 
 formula, thesis, antithesis, synthesis. The solution therefore de- 
 rives from the elements of the conflict and expresses the opposing 
 tendencies. It is to be expected, therefore, that there will be 
 found at the social level the expression of the needs of the indi- 
 vidual as they are finally translated into the higher social integra- 
 tions. That this is so is obvious from even a casual survey of 
 the functions of social institutions. To illustrate, medicine stands 
 for man's desire for physical health, it represents his effort at 
 ■satisfying his desire for power through strength of body and his 
 desire to evade death and to be immortal : the dhurch correspond- 
 ingly is a result of his efforts towards spiritual immortality : the 
 various systems of insurance of life and property are but concrete 
 embodiments of his search for safety: the family is his solution 
 of his love motive: the law and the military organization are 
 vicarious agencies for saitisfying his aggressive instincts: educa- 
 tional institutions increase his sense of power at the psychological 
 level: art permits expression in other ways, and sojf on, the 
 illustrations might be indefinitely elaborated. 
 
 Similarly it can be seen how various of the sciences minister 
 to his needs and give them expression. The sciences of archae- 
 ology, ethnology, anthropology, philology, sociology and history 
 are all evidences of man's interest in himself, his past, his struc- 
 ture, his methods of expression. They represent avenues through 
 which his auto-erotism may find adequate sublimations just as the 
 social institutions before mentioned afford avenues for the social- 
 ization and development of his self-preservation and his love 
 instincts. 
 
 All of these social institutions and scientific disciplines do 
 more, however, than minister to a single trend. In each instance 
 they afford a means of expression for both the self-preservation 
 and the race-preservation instincts, for both the individualistic 
 
THE STRATIFICATION OF THE ORGANISM 6/ 
 
 and the social aims. To the extent that the study of medicine 
 helps a man to that knowledge which he can use to preserve his 
 own health and gives him that grasp on the laws of health which 
 makes him feel sure of his way, it reinforces his feeling of safety 
 and gives expression to his safety motive for conduct. To the 
 extent that he is able to contribute something to the sum total of 
 medical knowledge, and to the extent that he is able to help others 
 in a constructive way he is finding expression for his race-pre- 
 servative instinct, his creative energy. Both tendencies may find 
 expression at these social levels of integration and their opposing 
 aspects be harmoniously related to a common purpose. This 
 represents the true solution of a conflict by the development of a 
 higher integration and suffices until that higher integration itself 
 develops new problems which in time must reach a solution by 
 the same mechanisms 'but on a still higher plane. Thus does 
 progress take place onward and upward by the short steps of 
 hecessity. As Schiller aptly puts it:'' "both the complex struc- 
 ture of higher societies and their elaborate material machinery 
 are essentially contrivances for liberating force, and enabling 
 them to produce a higher intelligence, which shall be competent 
 to deal with higher problems." 
 
 The mechanisms at the social level are thus seen to be homol- 
 ogous with the mechanisms which have been described at the 
 other levels. Progressive integrations are the results of suc- 
 cessive conflicts and solutions: the conflict is between tendencies 
 of opposite sign (ambitendency) : solutions are laid down in tra- 
 dition, customs, social institutions (structuralisation) : the higher 
 societies are most developed, most complex, most individualized 
 (individuation) . 
 
 And finally in the same sense that the development of the in- 
 dividual epitomizes the evolution of the whole biological series 
 which has finally culminated in him so the development of society 
 does likewise. And just, as in the individual are found evidences 
 of degeneration and of vestigial organs, the same is true of 
 society. A decaying tradition involves quite the same principle 
 of dediilerentiation as the gradual reduction and disappearance 
 of an organ or the disappearance of a species in the course of 
 Organic evolution. 
 
 2s Schiller, F. C. S., Riddle of the Sphinx. A Study in the Philosophy 
 of Humanism. Macmillan Co., Ltd., London, 1912. 
 
CHAPTER V 
 The Region of Psychopathology 
 
 Pathology is often erroneosuly though of as being essentially 
 a scientific discipline which deals with phenomena essentially dif- 
 ferent from those dealt with in the study of the normal. It has 
 come to be recognized, however, that normal can mean nothing 
 other than usual and that the processes of disease are no different 
 in kind from those observed in health. The only differences are 
 differences of degree. The chemistry of a disordered state of 
 metabolism is chemistry nevertheless : the laws which govern the 
 combining powers of the elements are not changed, the only 
 change is that under altered conditions the end results differ. 
 Because a man falls off a ten story building is no reason for con- 
 sidering that the law of gravity has in some way become changed, 
 quite the contrary, it operates in exactly the same way only in 
 this instance the result is different from that usually observed 
 and recorded. 
 
 It is quite the same in the realm of psychopathology. The 
 laws which govern the mechanisms at the psychological level are 
 not abrogated or changed, only operating under different condi- 
 tions the end result is not a normal, that is not a usual result. And 
 by this is meant that the result does not make for adjustment and 
 adaptation but for a degree of failure, great or small, in these 
 respects. The questions which now present themselves are: 
 What is the field in which this failure manifests itself ? At what 
 level of integration does failure become evident? 
 
 It must be borne in mind before attempting to answer these 
 questions that the levels of integration thus far indicated are not 
 to be considered as hard and fast, not as definite in the sense of 
 each being clear cut and distinct from the others. Rather the 
 whole process of development is to be thought of as continuous 
 and the several levels only as artificially erected distinctions to 
 serve pragmatic ends. They are devices only for assisting think- 
 ing about the phenomena involved, for aiding in classifying, in 
 
 68 
 
THE REGION OF PSYCHOPATHOLOGY 69 
 
 arranging knowledge for practical purposes. With this caution it 
 is interesting to recall certain historical facts bearing upon the 
 present conception of what constitutes the matter of psycho- 
 pathology. 
 
 The word psychopathology is comparatively of recent use. It 
 is but a short time ago, for practical purposes, little more than a 
 generation or two, that the entire field of mental pathology was 
 generally thought of as included in the consideration of the in- 
 sane. Then too insanity was a very obvious, a very marked con- 
 dition. Insane people were crazy and had to be confined as a 
 matter of public safety. It was the social aspect of the situation 
 that commanded attention. There was little regard for the indi- 
 vidual insane person. The main thing was to protect society, 
 consideration for him was only incidental. Later in the story it 
 came to be appreciated that under this system of handling the 
 problem the patient was often, in fact quite generally abused. 
 The whole system which left him, as an individual, out of con- 
 sideration, was essentially repressive and the patient had little 
 chance to be heard or to have his real welfare looked after in 
 any systematic or constructive way. Later developments have 
 progressively more and more considered the individual's interests 
 and the insane asylum has gradually become a hospital. Con- 
 temporaneous with this change in the treatment of the so-called 
 "insane"^ the field of psychopathology was enlarged to include 
 a considerable group of minor psychoses and neuroses which 
 were more or less obviously mental problems but which were not 
 of such character or severity as to constitute a social menace and 
 the victims of which therefore did not endanger the public safety 
 and' therefore did not have to be confined. With this beginning 
 enlargement of the group which was recognized as presenting 
 problems of a psychopathological nature the attitude towards 
 mental problems generally became more comprehending and 
 mental problems of an increasingly subtle character came to be 
 included and so the cruder concept of insanity came to be dis- 
 carded or largely modified. The emphasis gradually shifted from 
 society to the individual. Again the pendulum is seen to swing 
 between opposite extremes, in this case between the individual and 
 
 1 For a discussion of the use of the word " insane " see my " Prin- 
 ciples of Mental Hygiene.'' The Macmillan Co., New York, 1917. 
 
70 FOUNDATIONS OF PSYCHIATRY 
 
 society. The interests of the individual and society frequently 
 run at cross purposes. When they have done so in the past, and 
 still, for that matter, society conies in for first consideration. 
 They are in this situation, however, the opposite factors in a 
 dynamic relationship and the important point that this reference 
 Ito insanity brings out is that it is just the indizAdual-society rela- 
 tion which is involved. It is because psychopathology deals with 
 this region, the borderland where the individual and the social 
 group contact, that so much emphasis has heretofore been placed 
 upon the social aspects of mental disease. There is still much 
 said and written about what constitutes legal insanity distinct 
 from mental disease as defined by the psychiatrist. There is the 
 constant battle between the legal representatives of the State 
 and of the accused to throw the question of mental disease either 
 out of consideration by the State through the use of the legal 
 concept of insanity or to compel the State to its acceptance by a 
 proof of the existence of mental illness and forcing its legal 
 recognition. The reasons for this constant conflict of opinion are 
 perfectly evident when it is realized that mental disease occupies 
 this intermediary position between individual and society. 
 
 That mental disease does in fact occupy this borderland will 
 be evident from a brief consideration of some of its symptoma- 
 tology. The recent advances in psychopathology have shown 
 that the symptoms of mental disease are largely the results of 
 efforts to gain expression for certain tendencies which are not 
 acceptable to the individual, which he often is not even willii^ 
 to recognize that he harbors. Because they are not recognized 
 or at least not permitted to come to open expression in action 
 they break out, when the pressure from the pent up energies is 
 sufficient, into all sorts of by-ways of expression. Even so, how- 
 ever, they are only able to get into the open, as it were, by donning 
 various disguises so that they are not recognized for the dis- 
 reputable characters they are thought to be by the host. This 
 disguise is the symbolism which permits these inhabitants of the 
 dark places to evade the moral censorship of the individual and 
 play their part. 
 
 All this is quite familiar to those acquainted with the psycho- 
 analytic point of view. But what is the standard of censorship 
 which the unwelcome desires cannot pass? In any case tihe ob- 
 
THE REGION OF PSYCHOPATHOLOGY 7 1 
 
 jection to them is based upon their lack of social value, or more 
 specifically upon their actual social danger.'^ In any case that a 
 tendency is denied expression it is because it is laboring under 
 the ban of a social taboo. The various stages in psycho-sexual 
 development which have already been referred to, such as the 
 autoerotic, the narcissistic, and the homosexual are all normal at 
 certain periods of childhood and do not activate any of the social 
 taboos against them. But if, for any reason, these tendencies are 
 not woven into the warp and woof of an advancing character de- 
 velopment, if the individual tends to remain fixed at these levels, 
 then the social taboos begin to be operative. Narcissistic tend- 
 dencies in a child are smiled at indulgently, in the adult they 
 become distinctly bad form at least, sometimes intolerable. A 
 simple example is at once comprehensible. A baby soils its 
 diapers, that is to be expected, no one would think of punishing 
 the baby. But let an adult do the same thing and the reaction is 
 quite different. Disgust and abhorrence push the offender, in the 
 feeling of his associates, quite outside the group. It is inconceiv- 
 able that any grown man should act so. No one can find anything 
 within themselves which corresponds to such a tendency and so 
 the offender seems different from the rest of people, he is anti- 
 social. This particular delinquency is quite common among 
 seriously ill mental patients and is one of the causes, because of 
 the reasons just given, why it is difficult to get persons who will 
 properly care for such patients and also why such care-takers so 
 often are guilty of aibusing patients. They not infrequently pun- 
 ish the patient cruelly for such conduct in response to the feel- 
 ings of disgust which it causes in them. 
 
 Take a few of the well known symptoms. The feeling of 
 inferiority of the neurotic is a feeling of not being on a par with 
 others, he is unable to meet his problems with the same efficiency 
 Chat he observes in others : the feeling of exaltation, on the con- 
 trary, is a feeling of superiority to others and when it takes the 
 form of a delusion of great wealth money must be recognized as 
 a symbol of power which has value only in a society, it would be 
 of no use to the lone individual on a desert isle, wealth makes its 
 possessor free from the limitations imposed by the social group : 
 the delusion of persecution is a cover symptom for an unsubli- 
 
 ^ This is why " insanity " is a matter for the courts. 
 6 
 
72 FOUNDATIONS OF PSYCHIATRY 
 
 mated homosexuality which is destructive to the interests of the 
 herd: the regressive infantile reactions are reactions away from 
 the demands of reality as represented by society: various delu- 
 sions such as result, for instance, in the invention of perpetual 
 motion machines, are cover symptoms for impotency, as is also 
 the delusion of marital infidelity, both disguises of a socially de- 
 structive handicap : and so on indefinitely. Mental disease is dis- 
 ease at the level of integration of the individual and society. It 
 is not a disease of society as such nor yet of man as an individual 
 solely, it is a disease of man as a social animal, it touches him in 
 his social integrations.' 
 
 Of course this is an attitude quite contrary to that purely 
 materialistic point of view which always seeks back of the symp- 
 toms for an explanation, which would explain the paretic psy- 
 chosis, for example, by syphilis. Syphilis only disintegrates iiit 
 machinery with which the individual must work out his salvation 
 and brings his difficulties into the foreground. Syphilis may be 
 the prime reason why an individual has a psychosis but the pathol- 
 ogy of paresis will never be able to tell why the paretic has the 
 delusion that he is worth untold millions or that he is God Al- 
 mighty. It has been pretty well shown that the specific character 
 of his delusions only receive their explanation when his person- 
 ality make-up is known, until the personality material is under- 
 stood that is involved in the struggle for expression which the 
 syphilis makes so much more difficult. 
 
 Attention has already been called to the principle involved. 
 The higher integration can never be explained fully by the lower 
 integrations. Every integration involves at least two factors and 
 the relation between them and in its essence the higher integration 
 is this relation. The properties of water cannot be explained 
 either by a study of oxygen or of hydrogen but only by the rela- 
 tion between them. Schiller* discusses this whole question quite 
 
 8 Carpenter in his recent book Pagan and Christian Creeds suggests 
 that the etymology of the word sin shows that it means to separate or 
 sunder. Atonement by a separation of the syllables thus at-one-moment 
 can be seen to imply a restoration of unity. Similarly a person suffering 
 from an intrapsychic conflict may be said to be not at one with Ijimself. 
 This is the basis of the use of the word schizophrenia for dementia precox, 
 which means a splitting of the personality. 
 
 * Riddles of the Sphinx. 
 
THE REGION OF PSYCHOPATHOLOGY 73 
 
 fully. He says, among other things : " Naturalism is sooner or later 
 doomed to failure. It leaves out the higher aspects of things and 
 in the end these carmot be omitted. For the objects of the phys- 
 ical sciences forming the lower orders in the hierarchy of exist- 
 ence, though more extensive, are less significant. The atoms of 
 the physicists may indeed be implied in the organization of con- 
 scious beings, but in a subordinate capacity: a living organism 
 exhibits actions which cannot be formulated by the laws of 
 physics alone ; man is material, but he is also a great deal more, 
 to wit, alive, psychical, and moral. Again, all bodies gravitate, 
 but the activities of living, to say nothing of rational, bodies can- 
 not be explained by the action of gravitation alone. So chemical 
 afifinities are presupposed in biological actions, but yet life is 
 something more than and beyond chemical afiSnity. Thus it is 
 the same inherent law of the method which is displayed, not only 
 the palpable inadequacy of explaining biological facts by chemical 
 or mechanical facts, but also in that of explaining the rational or 
 moral by mere biology. 
 
 "The naturalistic method, therefore, in trying to explain the 
 higher by the lower, constantly fails to include the whole of the 
 higher, and is constantly driven to deny what it cannot explain, 
 and to reduce the higher to the lower. But though at first it 
 seems plausible to explain the higher and fuller by something 
 which seems simpler because it is less significant, by dint of leav- 
 ing out its surplus meaning, this process becomes more and more 
 difficult the further it is carried, and if it were carried to its con- 
 sistent conclusion, it would be seen to refute itself. It would end 
 by explaining all things by that which is nothing in itself, and has 
 meaning only in relation to the things it is supposed to explain. 
 The further we carry our researches into the lower, the more it 
 appears that it is not really simple, but only vaguer and more in- 
 definite, and that the lack of differentiation indicates, not that we 
 have got down to the fundamental principles of the complex, but 
 that it arises from a confounding of all the distinctions which 
 enable us to comprehend the thing. 
 
 " To take only the one example of protoplasm, which is the 
 starting-point of biology (itself one of the higher sciences). For 
 biology protoplasm is ultimate : it can no longer be derived from 
 any lower and ' simpler ' form of life. It can be defined only in 
 
74 FOUNDATIONS OF PSYCHIATRY 
 
 terms of what it becomes or develops into. Yet this ' simple ' 
 protoplasm performs all the functions which in its dififerentiated 
 developments fall to the share of the most various structures and 
 the most various faculties. It sees and hears and smells and 
 tastes and feels, thinks and wills and moves, it absorbs and ex- 
 cretes, it grows and reproduces itself, and all without any dis- 
 coverable difiference of structure. What then have we gained by 
 deriving differences we can see and partly understand from hypo- 
 thetical differences which are invisible and incomprehensible? 
 Is the mystery lessened by being relegated to the mythical region 
 of the unknowable and imperceptible, and is it not in very deed 
 an explanation ignoti per ignotius?" 
 
 "Every step in advance does indeed mean a dropping away of 
 some lower activities, until all have disappeared. But each step 
 in advance also opens up new activities, and fuller realizations of 
 old activities, which progressively increase the total content of 
 life, and make the higher life richer and fuller than the lower. 
 But these, of course, are not visible from the standpoint of the 
 lower." 
 
 "things must be explained by their significance and purpose in- 
 stead of by their 'causes,' by their ideals instead of by their 
 potentialities." 
 
 " instead of being simpler and more susceptible of explanation, 
 the lower stages of the process are really the obscurer and more 
 unintelligible, because they do not so clearly exhibit the drift of 
 the process." 
 
 " The physical laws of nature are the earliest and lowest laws of 
 the world^rocess, the most ingrained habits of things, the first 
 attempts at the realization of its End, and so are the very last to 
 become intelligible. If we ever arrive at a teleological explana- 
 tion of them, it will be only after we have worked down to them 
 from the higher laws of the more complex phenomena. The 
 basis, in other words, for a teleological interpretation of nature 
 will not be found in sciences like physics and mechanics, but in 
 sciences like psychology, sociology, and ethics." 
 
THE REGION OF PSYCHOPATHOLOGY 75 
 
 To revert from this digression into the realm of methodology 
 to some further matters relating to this region between, so to 
 speak, the individual and society, this borderland wherein are 
 focalized the problems of psychopathology. It may seem that 
 such a region is rather tenuous, that it is immaterial, intangible, 
 all of which may be true, but its phenomena are none the less 
 real. It is a region of relations rather than of ponderables, but 
 relations are realities. The question is. How do these realities 
 function? How is the space between the individual and society 
 spanned so that the influence of each may be impressed upon the 
 other? The answer to these questions involves an inquiry into 
 the nature of the means of communication between individuals. 
 This means has usually been thought to be included in what was 
 commonly understood as language but it will be seen as soon as 
 the matter is examined more carefully that this is a very re- 
 stricted way of looking at the problem. The whole matter, how- 
 ever, may be approached by a consideration of language which, 
 however, will be given a much broader meaning than usual. 
 
 Language. — Language as usually thought of comprises the 
 words, spoken or written, which are used to convey thought. 
 Such a conception implies, although it does not so state, that 
 words are the only vehicles for conveying thoughts. This of 
 course is very obviously not true for aside from the sign lan- 
 guages of deaf-mutes it is known how significant are many ges- 
 tures, facial expressions particularly, which have not been re- 
 duced to any particular sign language scheme. Bearing only 
 these facts in mind it would seem quite proper to enlarge the con- 
 ception of language to include all methods of intercommunica- 
 tion, all ways of transmitting ideas, thoughts and feelings from 
 one person to others. From this broader standpoint language as 
 composed of spoken or written words becomes only one aspect of 
 the problem of translating thoughts into terms that can be under- 
 stood by others, it is, however, the most highly developed, the 
 most definite and accurate method and conveys the larger quota 
 of exact information. 
 
 To begin with the spoken and the written word. At first sight 
 it would seem that the word was a very accurate vehicle for the 
 transmission of thought, that it conveyed in a perfectly unequi- 
 vocal way just exactly what was intended. A glance at a vol- 
 
76 FOUNDATIONS OF PSYCHIATRY 
 
 uminous work of some twelve hundred pages dealing exclusively 
 iwith synonyms and antonyms dispells at once this illusion. The 
 finer variations in the accepted meanings of word are multitu- 
 dinous and the best choice of a word which most accurately fits 
 the thought is a constant problem of the writer. Language is at 
 best inaccurate, so much so that an unusually clear cut use of 
 words attracts attention. Such an example is that of the defini- 
 tion of network in Johnson's English Dictionary as, "anything 
 reticulated or decussated at equal distances, with interstices be- 
 tween the intersections." Even such a definition suggests that 
 some of the words used to define might themselves need to be 
 defined. Such words, for example, as "reticulated" and "de- 
 cussated," to say nothing of even the more difficult words "or," 
 " with," " the." The minute an attempt is made to define a word 
 it is realized what difficulties are involved and that after all what 
 is done is only to translate one word into others which themselves 
 are often quite as much in need of definition and so on ad in- 
 finitum until finally forced to pause and accept something for 
 granted in order to be able to start at all, a necessary precondi- 
 tion to getting anywhere. Aside from this evident inaccuracy 
 and indefiniteness in the meanings of words as they are found in 
 the dictionary the same words are used colloquially in different 
 senses. Then if examined further it will be found that they are 
 used by different groups of people, in special trades, for example, 
 in quite special senses, that they are used differently in different 
 places, and that they have developed different meanings from 
 those which they had a generation or more ago. Not only do 
 meanings change in these ways but they change on being trans- 
 lated from one language into another, and they are given quite 
 new variations in meaning from time to time as new develop- 
 ments in thought require new words ; already existing words are 
 frequently called upon to serve new functions before new terms 
 are invented and even new terms are old words, generally Greek 
 or Latin, used in new ways or new combinations. 
 
 If the meanings of words are inquired into more closely it 
 will be found that the word stands for different meanings among 
 different peoples. The word horse for example stands for the 
 concept horse, and this concept is very different in different per- 
 sons according to their experiences. For example it is one thing 
 
THE REGION OF PSYCHOPATHOLOGY 77 
 
 to a man Who only owns horses for use in the delivery wagons of 
 his business : another thing to a western cow-iboy : still different 
 to a breeder of fine racing horses, and so on. Horse as a concept 
 and as a word is a symbol for a complex group of experiences of 
 a certain general kind and similarity and must necessarily differ 
 in each individual. 
 
 Thus the word, when it is examined as symbol, is seen to have 
 very little of that definiteness, that concreteness, that finality 
 which is ordinarily attributed to it. Its meaning lacks definite- 
 ness, it lacks fixity, but on the contrary seems to be in a state of 
 unstable equilibrium constantly changing under the influence of 
 the as constantly changing circumstances which influence it. But 
 it is this very ready responsiveness to every change in attitude 
 toward the thing symbolized that gives the word as symbol its 
 very great value. The rapidly changing thoughts and feelings as 
 they respond to the complex and ever varying changes that re- 
 sult from the interplay between the individual and his environ- 
 ment can always find expression in the wonderfully adaptive 
 symbolism of the word. In fact it is largely as a result of the 
 evolution of the symbol that man has come into his high estate. 
 Speech is the most momentous distinction between man and the 
 lower animals and speech which is made up of symbols both so 
 wonderfully responsive and so wonderfully expressive has opened 
 up possibilities for further development and evolution which, 
 viewed from the present at least, seem limitless. 
 
 The enormous possibilities of the utilization of the symbol are 
 at once apparent when such words are considered as God, 
 Heaven, Hell, religion, salvation, good, bad, right, wrong, and it 
 is realized how these symbols have retained their form unaltered 
 in the written and the spoken word but yet how vast has been the 
 change wrought in the concepts that lie behind them and which 
 they continue to express. 
 
 Another enormously important quality of the symbol is its 
 capacity to at once represent both the opposing elements of the 
 conflict and their union in a satisfactory solution. This is of the 
 very greatest importance in assisting to higher integrations. The 
 energy of the conflict may be nucleated in the symbol, gain ex- 
 pression and so clear the way for further progress." For ex- 
 
 » For a discussion of the functions of the symbol see my " Mechanisms 
 of Character Formation." The Macmillan Co., New York, 1916. 
 
78 FOUNDATIONS OF PSYCHIATRY 
 
 ample, a person is in doubt as between two procedures; their 
 merits are equal; each is advocated by a personal friend with 
 arguments of equal strength. How is the dilemma to be solved? 
 How is the energy of the individual which is imprisoned by inde- 
 cision to be released in action? There are of course many ways 
 and different individuals would reach a solution by different 
 routes. One way will be suggested. Every argument for the 
 two courses of action are to all intents and purposes of equal 
 weight but as between the two advisers one is chosen rather than 
 the other because more faith is reposed in him and the decision is 
 made and action released. The whole situation with its opposing 
 tendencies is gathered together in this one personality and sym- 
 bolized by the faith reposed in it, the energy of the conflict is 
 focalized and released through this symbol, the individual can 
 now act, his energies are not only released but he can proceed 
 now to other problems, he is no longer stalled by indecision. 
 
 If the reasons for the choice of one adviser rather than the 
 other is analyzed it will be found that they are unconscious: The 
 choice comes as the result of a feeling of confidence rather than 
 because of any intellectually worked out reason although quite 
 characteristically after the decision is made all sorts of reasons 
 will then be given to account for it. They may easily be the rea- 
 sons which were given in the first instance by the favored adviser 
 to which others may be added, but an examination of the whole 
 situation will demonstrate that they are reasons after the fact, 
 justification rather than reasons which lead to the final choice. 
 This is technically known as the process of rationalization. The 
 real reasons, however, will be found in the unconscious. What 
 may be the nature of these unconscious reasons ? 
 
 When a choice is made such as that described, the unconscious 
 motives will be found to depend upon factors which have been 
 long active in the personality. For example, the rejected adviser 
 will be found to resemble in some subtle way some one with whom 
 an unpleasant experience in the past is coupled or the accepted 
 adviser per contra will be found to resemble some one or some 
 series of persons in whose judgment capacity the individual has 
 had reason, as a result of experience, to repose confidence, per- 
 haps an older brother or the father. What is the nature of this- 
 resemblance ? 
 
THE REGION OF PSYCHOPATHOLOGY 79 
 
 The nature of the quahties exhibited by individuals which 
 relate them in sympathy or which, on the contrary, excite antip- 
 athy is of great importance. To suppose that feelings toward 
 others is altogether conditioned by what they say is to have a very 
 limited concept of the means of communication wihich exist be- 
 tween individuals, it is, in other words, to have a very contracted 
 idea of what constitutes language if language is meant to include 
 all the various methods of communication. To take the spoken 
 word alone, for instance, not only is its meaning very different 
 depending upon the circumstances under which it is spoken, but 
 what is more important, its meaning varies widely depending 
 upon the way in which it is spoken. Tlie inflection, pitch and 
 quality of the voice, the rapidity or slowness of the utterance, 
 promptness or hesitation are all important factors to be taken into 
 account. In addition there are innumerable accessory intimations 
 such as the expression of the face, whether it reinforces or con- 
 tradicts the spoken words, the attitude of the body; the presence 
 of blushing, pallor, trembling, sweating, tension of muscles, rigid- 
 ity of limbs, rapidity and depth of respiration and many other 
 visible signs all of which contribute to the final interpretation. 
 All these latter are much older than the spoken word and are 
 seen typically in the lower animals as characteristic poses of 
 anger, fear, hunger, curiosity, sexual excitement and have come 
 down in typical form as means of emotional expression which 
 through the unconscious serve as indications as to what the feel- 
 ing of others is and upon what relations to them should be 
 predicated. 
 
 If what has been said about the organism as a unity is recalled 
 it will be appreciated how consistently each part of the organism 
 must fit into the picture of the dominant attitude and how impos- 
 sible it must be for this picture to be other than a true one in 
 every one of its pai-ts if wisdom enough is possessed to read this 
 subtle language. As a matter of fact probibly every one does 
 read this language much more accurately than he knows but it is 
 the language of emotion read by the feelings, by intuition, rather 
 than a controlled intellectual interchange and when the postural 
 tensions and the spoken word contradict each other it is plain 
 which should be given credence. 
 
 To return to the illustration of the two advisers: It is just 
 
80 FOUNDATIONS OF PSYCHIATRY 
 
 when the advice given is contradicted by the unconsciously per- 
 ceived postural tensions, when the attitude of the adviser is felt 
 to be at variance with his advice, that a sense of distrust is felt ; 
 and just when both advice and posture display an attitude of 
 helpfulness and friendliness that correspondingly confidence is 
 felt. 
 
 It is this language of the feelings unconsciously expressed 
 and unconsciously perceived that forms the background of lan- 
 guage, the warp, upon which the more delicate and detailed pat- 
 tern of the spoken word is woven. This unconscious language is 
 the cement substance which binds the herd into a unity. The 
 spoken language permits of a more detailed and individualistic 
 relationship. Similar things might be said of it in comparison 
 with the word as was said of the protopathic as compared with 
 the epicritic type of response ; namely, it is extensive rather than 
 intensive, a whole or nothing response lacking epicritic definite- 
 ness, in other words it is general rather than specific. 
 
 Undoubtedly this language of the emotions is the medium by 
 means of which the traditions of the race are transmitted. From 
 this view point it is understandable how shame as a barrier 
 against certain types of conduct to which the child is impelled by 
 instinctive urges, curiosity and exhibitionistic trends, should be 
 expected in all children at apparently the same age. Such con- 
 duct is prejudicial to the interests of the race and such prejudices 
 embodied in the parents are passed on to the child through the 
 medium of the language of feeling. To attribute such results to 
 hypothetical determiners in the germ plasm is going further, to 
 say the least, than existing facts warrant and is substituting an 
 explanation which is more difficult to understand than the thing 
 explained. 
 
 To return to the methodological principle that the higher can 
 never be explained by the lower. The whole is something more 
 than the sum of the parts, it is those parts integrated and in har- 
 monious cooperation to a larger end. An emotion can never be 
 explained by neural processes or chemical actions. The neural 
 processes and the chemical actions may be contemporaneous but 
 they are only correlates, the emotion could not exist without them 
 but the emotion is something more, it involves their relation, a 
 higher integration. No scientific discipline, therefore, can be re- 
 
THE REGION OF PSYCHOPATHOLOGY 8 1 
 
 duced to terms of a discipline at a lower level of integration- 
 Psychology can never be explained in terms of neural processes, 
 chemistry or physics. This is the principle of the humanistic 
 philosophy. As Schiller puts it :* " After all, the world to be ex- 
 plained is the world as it appears to us; the life to be justified is 
 ours ; the sciences to be synthesized are human products called 
 into being by our interests and needs. Man, moreover, is the 
 highest of the beings he knows, though not the highest of those 
 he conjectures and postulates. He has, therefore, no other and 
 no better key to the mystery of being. To interpret humanly is 
 to interpret the lower by the higher, to interpret by a concrete 
 reality and not by an abstraction, to interpret progressively and 
 verifiably because in accordance with the progress of man's 
 knowledge and the growth of his experience." 
 
 The language of the feelings is undoubtedly of vastly greater 
 significance than is ordinarily thought: life is undoubtedly shot 
 through with it at every turn, and because it is shrouded in the 
 unconscious there is little recognition of its richness. It is, too, 
 the language of psychopathology, the language in which is ex- 
 pressed those difficulties and errors of adjustment of man as a 
 social animal, and the language which must be learmed if the dis- 
 orders of this region are to be understood. 
 
 » Riddles of the Sphinx. 
 
CHAPTER VI 
 
 The Nature of the Neuroses and the Psychoses 
 
 There were two conclusions reached in the last chapter with 
 which the matter of this chapter must be approached.. One wa.s 
 a conclusion of fact, namely, that the region of psychopathology 
 lies midway between the psychological and the social strata: the 
 other was a conclusion of method: namely, that all of the facts 
 of a given level of organization cannot be expressed in terms of 
 a lower level, but can only be resumed in terms of the higher 
 level. In other words a neurosis or a psychosis can only be under- 
 stood if it is possible to describe it in psycho-sociological terms. 
 The symptoms of mental disease display themselves in conduct, 
 they are expressed in hopes and fears, in delusions and obsessions 
 and none of these can be understood in terms, for example, of 
 metabolism. There may be, it is true, various physiological and 
 structural disorders and defects which are related to the mental 
 disease but they are in no sense causes but only correlates ; they 
 are coexistent and in time of origin often contemporaneous but 
 they cannot be considered as causes because they do not include 
 the supposed effect, that is the mental illness ; they are only parts 
 of the picture. Mental reactions are total reactions in the sense 
 that they are the expression of the tendency of the individual as 
 a whole, they express the final result of the integration of the 
 action systems and no part of the reacting individual can possibly 
 include the explanation for such a total response any more than 
 the written word can be adequately explained by one of the let- 
 ters composing it. In the same sense the total reaction can only 
 be fully understood by understanding all its parts, its structure, 
 how it is composed, but in the final result can receive its full ex- 
 planation only in the terms that belong to the final integration. 
 The end and aim of the individual must be understood as it is 
 sought to be compassed by his conduct in order to understand 
 how and why he falls short of its attainment. In this sense psy- 
 chiatry must be teleological. 
 
 82 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 83 
 
 These few words will serve as introduction to a description of 
 the nature of the neurosies and psychoses approaching existing 
 theories by such utilization of the historical evidence as serves to 
 throw light upon the present problem. 
 
 Just as the descriptive school of psychiatry reached its apex 
 and its culmination in Kraepelin so the description of the neu- 
 roses, or minor psychoses, reached their culmination in the work 
 of Janet. Janet's work, however, is of especial interest and im- 
 portance, because while it is acutely and brilliantly descriptive it 
 already begins to be something more than that, it begins to be 
 interpretative, and so marks a transition stage to present ways of 
 thinking. He distinctly recognized that the neuroses were dis- 
 eases without anatomical lesions and described them as being 
 wholly psychological. He recognized two great neuroses, 
 namely : hysteria and psychasthenia. His description of these and 
 some of his comments^ are of great interest. His definition of 
 hysteria is : " Hysteria is a form of mental depression character- 
 ized by the retraction of the field of personal consciousness and a 
 tendency to the dissociation and emancipation of the systems of 
 ideas and functions which by their synthesis constitutes the per- 
 sonality." He says further that:^ "The starting-point of hys- 
 teria is the same as that of most great neuroses, it is a depres- 
 sion, an exhaustion of the higher functions of the encephalon. 
 All the psychological operations do not present, as I repeat, the 
 same difficulty. There are some operations that are easy for all 
 kinds of reasons, first, because they are simple and only require 
 the union of a small number of elements; second, because they 
 are old, because their systematization was the work of our an- 
 cestors and is inscribed in strongly constituted organs. There 
 are some other functions that are difficult because, on the one 
 hand, they are very complex, because they necessitate the sys- 
 tematization of an infinite number of elements, and because, on 
 the other hand, they are very new and require a present synthesis, 
 not yet inscribed in the organism. Now, our nervous strength, 
 which we do not know at all, presents oscillations. When it is 
 high, we easily accomplish the operations of the second group, 
 
 1 Janet, P., Les Nevroses. Paris, 1909. 
 
 2 Janet, P., The Major Symptoms of Hysteria. The Macmillan Co., 
 New York, 1907. 
 
84 FOUNDATIONS OF PSYCHIATRY 
 
 we have an extended consciousness, we turn back from no new 
 study or action." 
 
 " The diminution, the lowering of the nervous tension, may bring 
 about a general lowering of all the functions, and especially of 
 the highest. This is what takes place in the psychasthenic neu- 
 roses, in which the localization on a special point exists in a 
 rather slight degree. 
 
 "With hystericals, in consequence of particular dispositions, 
 the lowering of the nervous strength produces, in some manner, 
 a superficial retraction, there is, as it were, an autonomy. Con- 
 sciousness, which is no longer able to perform too complex opera- 
 tions, gives up some of them." 
 
 " The function that disappears is the most complicated and 
 the most difficult for the subject." 
 
 Under the cap.tion psychasthenia, the other great neurosis he 
 describes, Janet includes the obsessions, impulsions, doubts, tics, 
 agitations, phobias, delirium of contact, anguishes, neurasthenias, 
 and the feeelings of strangeness and depersonalisation often de- 
 scribed under the name of cerebro-cardiac neuropathy or dis- 
 ease of Krishaber. He defines it as follows : " psychasthenia is a 
 form of mental depression characterized by a lowering of the 
 psychological tension, by a diminution of the functions which 
 permit action on reality and the perception of the real, by the 
 substitution of inferior and exaggerated operations under the 
 form of doubts, agitations, anguish and by obsessing ideas which 
 express the preceding troubles and which present themselves the 
 same characters." 
 
 Hysteria then is a retraction of the field of personal conscious- 
 ness with a tendency to dissociation dependent upon a depression 
 or exhaustion of the higher functions, a lowering of the nervous 
 tension, in which " the function that disappears is the most com- 
 plicated and the mo'st difficult for the subject." The analogy is 
 plainly to fatigue. 
 
 Psychasthenia is due to a lowering of the psychological ten- 
 sion in which it is the function of the real which suffers most and 
 this function of the real is precisely the highest function accord- 
 ing to Janet. The manifestations of psychasthenia are due to 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 85 
 
 variations of the psychological tension and to oscillations of the 
 mental level and produce symptoms in proportion to the lowering. 
 In Janet's scheme of the hierarchy of mental functions (Chap. 
 IV) the accurate estimation of reality stands highest, revery and 
 imagination come lower down and muscular movements last. As 
 the tension is lowered the reactions will tend to follow in the order 
 of the psycholdgical hierarchy. Here again the analogy is plainly 
 to fatigue. 
 
 Janet, from this background, discusses the nature of neuroses 
 in general.^ In the first place neuroses are mental illnesses with- 
 out lesion. In the second place they are diseases of the evolution 
 of the mental functions. In their consideration one has to take 
 into account the hierarchy of the functions and the question of 
 arrest in their evolution. In this latter respect one distinguishes 
 " the difference which exists between the deteriorations of the old 
 functions characteristic of dementia and the arrests of evolution 
 characteristic of the neuroses." He reaches the following defini- 
 tion of the neuroses : " The neuroses are maladies bearing on the 
 various functions of the organism, characterized by an alteration 
 of the superior parts of these functions, arrests in their evolution, 
 in their adaptation to the present movement, to the present state 
 of the exterior world and of the individual and by the absence of 
 deterioration of the old parts of these same functions which are 
 still able to express themselves very well in an abstract manner, 
 independent of present circumstances. To resume, the neuroses 
 are disorders of the various functions of the organism, charac- 
 terized by the arrest of development without deterioration of the 
 functions themselves." He adds that there is "tendency to re- 
 place the superior operations by the exageration of certain in- 
 ferior operations and above all by gross visceral disturbances." 
 
 From this exposition it is evident that Janet's point of view 
 is a distinct advance upon the simple descriptive method and a 
 decided attempt at the analysis of the symptoms and the formula- 
 tion of interpretations. He recognizes the neuroses as psycho- 
 logical and he approaches their interpretation from a genetic 
 standpoint. His analogy to fatigue is rather vague and it will be 
 seen how subsequent interpretations attempt to explain the failure 
 of the higher systems to function adequately. 
 
 ' Les Nevroses. 
 
86 FOUNDATIONS OF PSYCHIATRY 
 
 The work of Janet was taken up and developed in this country 
 largely by Sidis and Prince. The fact of dissociation was largely 
 emphasized and the connection shown between the dissociated 
 state and actual past experiences. This connection formed the 
 basis of a therapeutic procedure, the re-association of the dis- 
 sociated states, 
 
 At this point in the development of thought about the neu- 
 roses there came into the situation the investigations of Freud 
 who was the creator of the present psychoanalytic movement. It 
 is not necessary to trace the history of this movement nor to de- 
 scribe in detail its many contributions to the psychology of human 
 behavior in its various forms. Only a description of the prin- 
 cipal, important concepts which it has contributed will be 
 undertaken. 
 
 To begin with perhaps the most important single thing stressed 
 by Freud and his followers has been the deterministic attitude 
 towards psychological facts. No matter what the idea or feeling 
 it must have an adequate explanation in psychological terms. 
 No matter how apparently foolish it may be an adequate study of 
 all the conditions surrounding it will serve to explain it. No 
 longer is it possible to rest content with calling a given idea a de- 
 lusion or describing the products of a delirium as incoherent. 
 Such words only label the phenomena, they do not serve to throw 
 any light upon them, they offer nothing in the way of explanation. 
 It was by approaching the symptoms of the neuroses with the 
 absolute conviction that they had meaning and that that meaning 
 could be discovered that explanation slowly took the place of 
 labeling, and the further the search was carried the more under- 
 standable the symptoms became. 
 
 From the psychoanalytic viewpoint each psychic event was 
 seen to have a history, in fact the historical aspects of the psyche 
 as such were for the first time appreciated in other than a formal 
 academic way. In fact the historical aspects of psychological 
 facts became of prime practical importance in their understand- 
 ing and therefore in formulating any therapeutic attack. The 
 past of the psyche, through psychoanalysis, has come to have as 
 much significance as has for so long been accorded the past of 
 the body as incorporated in the sciences of embryology, com- 
 parative anatomy, and paleontology. This past has not only a 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 87 
 
 temporal significance but a much greater significance as ex- 
 pressed in terms of developmental progress. To understand the 
 meaning of a given psychic event or of the psyche as a whole 
 means, quite as in the case of the body, that the understanding 
 must be approached from a genetic point of view. 
 
 The genetic approach is not new to psychology but it was re- 
 vivified and made of vastly greater importance by the formula- 
 tion by the psychoanalytic school of the hypothesis of the uncon- 
 scious* The unconscious is the historical past of the psyche just 
 as the embryonic gill arches are a part of the historical past of 
 the body and like the gill arches, the evidence of its existence is 
 lost, except to the scientific explorer, because it comes to be woven 
 into the fabric of present living by being incorporated into those 
 functions with which present purposes are carried out. Just as 
 back of the thyroid cartilage in its historical development can be 
 i ound a gill arch, so back of a present character trait, such as a 
 peculiarity of speech or posture, may be found an unconscious 
 trait, for example, a feeling of inferiority. 
 
 The unconscious contains those tendencies and feeling atti- 
 tudes which have been left behind in the course of development. 
 They are left behind because in the course of development they 
 have to give way to new types of solution as the increasingly com- 
 plex environment makes more rigid demands for adjustment. 
 Reactions which work very well for the child become progressively 
 more and more impossible for the adult as the demands of reality 
 press more insistently for recognition. The older, more infantile 
 methods of response are gradually given up and as they are found 
 no longer to work the tendency to yield to them is repressed more 
 and more until they finally come to be no longer available. The 
 child who learns that it can get what it wants by crying for it is 
 forced to learn, as it grows older, that this way of getting its de- 
 sires satisfied works less and less effectively and finally has to 
 come to a more accurate evaluation of both its needs and its 
 capacities for satisfying them. Repression is one of the dominant 
 mechanisms which furthers cultural progress. 
 
 If for any reason some particular infantile mechanism has 
 worked more than ordinarily well the child gives it up more re- 
 
 * For a discussion of the Unconscious see my Mechanisms of Charac- 
 ter Formation. The Macmillan Co., New York, 1916. 
 
88 FOUNDATIONS OF PSYCHIATRY 
 
 luctantly and tends to pause over-long at that stage of develop- 
 ment to which this mechanism corresponds. If for example the 
 child is too much indulged it may not have had a sufHcient stim- 
 ulus to give up its method of gaining its satisfactions by crying 
 and so tends to keep on trying to satisfy its needs in that way, or, 
 if in later years the individual meets with rebuffs and failure, he 
 tends to revert to this reaction as an old and tried method which,, 
 in his experience in the past, has been found to work. This is the 
 mechanism of fixation which under certain circumstances of stress 
 conditions the form of response which is chosen as a consequence 
 of inefficiency, of meeting up with a situation in life which cannot 
 be effectively handled. Perhaps actual crying is not resorted to 
 but the reaction is of that general character and marks the symp- 
 tom as the product of the mechanism of regression. 
 
 Repression, fixation, and regression are fundamental mech- 
 anisms involved in the neuroses. How do these mechanisms work 
 and produce the symptoms? In order to explain this Freud de- 
 veloped the theory of the censorship. The unconscious tendencies 
 are asocial or antisocial in character and do not ally themselves 
 with the individual ideals. Therefore in seeking expression they 
 come into opposition with those ideals thus producing the intra- 
 psychic conflict. This conflict between the unconscious, egoistic, 
 asocial tendencies and the ego-ideal must come to some kind of 
 expression. The expression depends upon the relative strength 
 of the opposing forces. The ego-ideal may dominate in which 
 case the unconscious tendencies are repressed: the unconscious 
 tendencies may dominate in which case they come to open expres- 
 sion as is so often seen in the psychoses in such conduct as open 
 indulgence in auto-erotic activities : the two forces may, for a time 
 at least, be pretty accurately balanced against one another and 
 thus result doubts and indecision, or confusion: the two tendr 
 encies may alternately assume the supremacy ; a patient may yield 
 to his auto-erotic tendencies for a time until they have had a. 
 satisfying expression when the ego-ideal may again be able to 
 take charge of the situation : or a compromise of some sort may 
 be effected as is seen in the creation of an artificial world based 
 upon delusional interpretations. These are the typical reactions 
 in the psychoses. In the neuroses the conflict, so long as it re- 
 mains unresolved, results in the development of types of reactioa 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 89 
 
 which produce partial satisfaction to both tendencies, serve to 
 give some expression to the unconscious motives while not suffi- 
 ciently offending the ego-ideal to be altogether impossible and not 
 sufficiently offending social standards to make it necessary to in- 
 tern the patient. How are such compromises effected ? 
 
 The repression of the unconscious strivings does not eliminate 
 them from existence. They continue to seek some avenue of out-, 
 let iin expression. But inasmuch as they are inacceptable to the 
 ego-ideal they cannot come frankly into the field of conscious 
 awareness. They therefore react to the subterfuge of disguise, 
 they come to expression by a process of symbolization which, 
 while it allows them an outlet effectually prevents their recogni- 
 tion by their host. For example, an unconscious tendency to 
 cruelty may work itself off in a form of trenchant wit or the 
 censorship may utilize the very effective disguise of expressing 
 the tendency by its opposite, as hate against a particular person 
 may be expressed by an undue solicitude for his welfare and 
 safety. 
 
 All these are unsatisfactory, inadequate solutions of the con- 
 flict and tend to result in neuroses or psychoses. The reason for 
 the failure, hcxwever, is not expressed after the manner of Janet 
 ■ by assuming that the higher elements are unable to function 
 because thrown out of commission in some way analogous to 
 fatigue.^ According to Freud the difficulty is due to the conflict 
 of mutually opposed tendencies, and the result depends upon their 
 relative strength. In other words the conflict is between oppos- 
 ing wishes and the stronger wish wins out. The wish is the prac- 
 tical unit of mental life, and in the last analysis, the individual 
 does what he wishes to do. 
 
 5 A modification of the theory of Janet has recently been revived by 
 W. H. R. Rivers in his paper Freud's Concept of the Censorship in The 
 Psychoanalytic Review for July, 1920. In this paper Rivers gives it as his 
 opinion that the symbolic distortion of unconscious wishes is not due to a 
 process resembling censorship nor is it for the purpose of disguising their 
 nature from the host, but that as the control of the upper psychic levels is 
 removed for any cause the lower levels function in their own chara<;teristic 
 way and their symbols, because belonging to a past which has been left 
 behind in the course of development, are simply not recognized. They 
 speak a strange language which is not understood, to be sure, but which is 
 not intended to be obscure or unintelligible. 
 
90 FOUNDATIONS OF PSYCHIATRY 
 
 The diflferences between the theories of Janet and of Freud are 
 after all not so great as the statement thus far would make them 
 appear. Janet has very well described the symptoms but he puts 
 them down as the result of a process analogous to fatigue. Freud 
 on the other hand sees them as the result of a conflict in which 
 the ego-ideal cannot adequately express itself because of the drag 
 back of unconscious tendencies. A little further insight into the 
 Freudian interpretation, however, discloses that the result of the 
 conflict must be the dissipation of a variable amount of psychic 
 energy into- unsatisfactory because inadequately expressive chan- 
 nels. It will be shown in the chapter which discusses therapeutics 
 that the objective of both is to make the energy thus lost available 
 for better ends. In other words it would be quite as possible to 
 draw the analogy of fatigue to explain the results of the Freudian 
 mechanisms. The difference between the two theories in this 
 respect is that the Freudian is broader and deeper and so more 
 pragmatically valuable than the theory of Janet because Janet 
 only notes the result as analogous to fatigue while Freud explains 
 how the etiological factors produce such a result. 
 
 Thus far the explanation has only been of the symptoms of 
 mental ill health. Freud further attempts to show that when the 
 unconscious tendencies are capable of gaining expression without 
 resorting to the sterilizing processes that result from an insoluble 
 conflict that the result is brought about by the process of sublimo 
 Hon and is satisfactory. This mechanism now needs to be briefly 
 explained. 
 
 As one of the results of attempting a practical handling of in- 
 dividual, concrete difficulties it became evident that the uncon- 
 scious tendencies which were inacceptable to the personality were, 
 practically in every instance, of a sexual nature. This pansex- 
 ualism has been the subject of the bitterest attacks upon the psy- 
 choanalysts, and has led to no little misunderstanding and been 
 responsible more than any other one thing in preventing an ac- 
 ceptance of their principles. The reason why the sexual element 
 is found so universally is because it is precisely the sexual crav- 
 ings that are most repressed in present day civilization and find 
 the greatest difficulty in gaining satisfactory expression. Further 
 than this the problem wHl not be discussed at this point. It re- 
 mains to be noted that the process of sublimation is a process that 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 9 1 
 
 permits these lower, concretely sexual cravings to come to ex- 
 pression at higher levels in ways that are socially acceptable and 
 that in this refining process the cravings lose much if not all of 
 their sexual character, are desexualized. Thus a curiosity which 
 at its lower level was a curiosity in reference to sexual matters 
 may in the slow process of growth and development be sublimated 
 so that its energies are made available and converted into, the 
 curiosity of the scientist : a delight in sensual odorsi might be sub- 
 limated, in a similar way, into a highly refined and technical in- 
 terest in perfumes : a cruelty instinct might find adequate expres- 
 sion at a level of social usefulness of the greatest value in the 
 work of the surgeon: an exhibitionistic tendency might be sub- 
 limated to minister to the very valuable social activities of the 
 actor and so on indefinitely. Sublimation therefore stands out as 
 the finished product of the successful resolution of the conflict 
 between forces of opposite sign, ambivalency, and as the mech- 
 anism by means of which the processes of integration, structural- 
 ization and individuation are carried along the path of differen- 
 tiation to ever higher ends. 
 
 The application of these psychoanalytic principles to man's 
 various activities and their use to explain the cultural progress 
 of the race over and beyond their more limited application in the 
 explanation of the neuroses and psychoses means that the same 
 mechanisms are at work in health as in disease, the only difference 
 being in the outcome, whether successful or unsuccessful. It 
 means too that these mechanisms must have, if the explanations 
 are correct, general biological validity. That this is so it has been 
 the function of this book to show and it is implied by the formu- 
 lation of the various mechanisms such as integration, structural- 
 ization, individuation, differentiation, conflict, ambivalency, and 
 the illustration of each at the various levels, physiological, psy- 
 chological, and sociological. 
 
 Jung in his departure from the strict application of the prin- 
 ciples laid down by Freud has laid more emphasis upon the pres- 
 ent moment. For him it is more important to inquire what is the 
 particular task the patient is endeavoring to avoid rather than to 
 analyze out the repressions and fixations. Regression to earlier, 
 relatively infantile modes of response is conditioned by the fact 
 that forward progress has become impossible. In the face of an 
 
92 FOUNDATIONS OF PSYCHIATRY 
 
 insurmountable obstacle to advance old ways of response which 
 were formerly satisfactory are reanimated. Jung therefore em- 
 phasizes the push back while Freud lays emphasis upon the drag 
 back. It would seem that both must be taken into account and 
 that the point to which regression returns, or in other words, the 
 old mechanism which is brought forward to do new service in 
 meeting the problem of the present, is determined by the fixation, 
 that is by the mechanism which in the previous history of the in- 
 dividual had proven satisfactory. The child that has learned that 
 it can get what it wants by crying for it will cry again for what 
 it wants when, as an adult, it finds that it cannot compass its 
 desires in any other way. 
 
 Jung also lays much more emphasis upon the race back of the 
 individual. Freud in his intensely practical way has always stuck 
 closely to the actual facts which could be discovered in the lives 
 of his patients. Jung is inf;lined to go further and explain these 
 facts by the processes which have been at work in the race. Freud 
 constructed the hypothesis of the unconscious. Jung has enlarged 
 upon this concept of a personal unconscious by the formulation 
 of the concept of a collective unconscious.'' This collective uncon- 
 scious is made up of the instincts, which " compel man to a con- 
 duct of life which is specifically human," and the archetypes of 
 apprehension which "coerce intuition and apprehension to forms 
 specifically human." Jung, therefore, as might be expected, pays 
 much more attention to mythology and folk lore in coming to an 
 understanding of human motives than to just the material derived 
 from the individual experiences of his patients. 
 
 He is, too, much more inclined to consider all psychological 
 phenomena as facts, albeit psychological facts, irrespective of 
 whether or not they correspond to actual objective experiences 
 as ordinarily conceived. Then too he often sees in the symptoms 
 evidences of archaic types of reaction, evidences of the influence 
 of the racial tendencies over and above what can be fully ex- 
 plained by the individual's own past. 
 
 Jung has therefore departed considerably from Freud in these 
 respects. He also has departed in the sense that he does not stress 
 the sexual nearly as much. In fact he posits a presexual stage in 
 
 *Jung, C. G., Instinct and the Unconscious. The British Journal of 
 Psychology, Vol. X. Part I. November, 1919. 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 93 
 
 development. While Freud has enlarged the concept sexual to 
 include a host of things which are only remotely or indirectly 
 sexual, Jung has still further enlarged it to include any and all 
 manifestations of creativeness, the creative instinct. 
 
 All these explanations thus far are in psychological terms and 
 refer to neuroses and psychoses, to distortions resulting from the 
 effort of the sexual instinct (Freud) or more broadly the creative 
 instinct (Jung) to gain adequate expression. Adler now comes 
 forward with a further hypothesis to account for the various dis- 
 tortions of the personality. 
 
 Adler's concept of the neuroses may be said to differ from the 
 concepts of Freud and Jung in its attempt to define their or- 
 ganic bases ; not that this concept is absent from either the Freud 
 or the Jung scheme. Freud especially has considered it, but 
 Adler makes the organic the basis of his whole consideration of 
 the neuroses, and the starting point of his therapeutic attack. 
 
 For Adler the fundamental psychological element in the neu- 
 roses is the feeling of inferiority, which feeling of inferiority in 
 every case founds in an inferior organ. The neurosis then con- 
 sists in an effort on the part of the individual to overcome this 
 feeling of inferiority, and its outward signs and symptoms are 
 the manifestations of those dexterities developed to this end. 
 This is the flight to safety, the effort to overcome the feeling of 
 inferiority, and because it becomes the primary object of the neu- 
 rotic it takes him away from reality on a false path. He spends 
 his life in endeavoring to overcome the feeling of inferiority 
 rather than in contact with reality. This is the fictitious goal of 
 the neurotic. 
 
 This concept can be very much better understood if it is con- 
 sidered in connection with and as part of the larger concept of 
 progressive integrations and adaptations as constituting the fun- 
 damental developmental process. If the psyche is made possible, 
 and in fact is the expression and the end result of all of the or- 
 ganic integrations which have gone to build up the organism, then 
 it must necessarily follow that every defect in this organic ma- 
 chinery must ultimately find its psychological expression. Every 
 defect of integration must offer an obstacle to that orderly devel- 
 opment which finally will present a well-rounded, well-ibalanced 
 capacity for psychological reactions, and such a defect must nee- 
 
94 FOUNDATIONS OF PSYCHIATRY 
 
 essarily, therefore, modify the character make-up of the indi- 
 vidual. And the way in which that modification takes place must 
 result from the way in which the defect is dealt with. The de- 
 fect may be side-tracked or circumnavigated, as it were, or it may 
 be assimilated in part or in whole, or it may be so gross as to drag 
 down the individual to its level, or it may, by the concentration 
 of the efforts of the individual in this particular limited area, 
 become the center of supernormal activities, so that the whole 
 gamut from idiocy to genius, at least from their pathological and 
 organic aspects, may thus be traced to organ inferiority. 
 
 The concept is a difficult one, and may be enlightened by a 
 further type of illustration. For example, Adler, in explaining 
 what he means by an inferior organ and the part it plays in the 
 individual psyche would have it that the inferior organ, so to 
 speak, hangs on to its childlike, infantile, inferior, relatively un- 
 developed ways of pleasure seeking, which, of course, if by pleas- 
 ure is understood the fulfillment of desire in its broadest way, can 
 practically only mean that the organ hangs on to that sort of 
 capacity to function which is only possible at its stage of develop- 
 ment so that, for example, the skin which in the polymorphous 
 perverse period of infancy is the avenue through which all sorts 
 of comforting and organically delicious sensations are transmitted 
 to the baby, may remain inferior, and, therefore, in the adult may 
 continue as a source of organic pleasure out of all proportion to 
 the part which it should play in a properly balanced picture of the 
 functions of the adult considered in their totality. There is the 
 familiar type of exquisite who bathes and perfumes himself 
 and wears silk underwear and all that sort of thing, because 
 he retains an autoerotic gratification in cutaneous stimulations 
 which he should have left behind to have become part of his de- 
 velopmental history, but which he has insisted upon dragging 
 along with him as he grew to adulthood. It is not easy to say, 
 and in fact there may be no evidence, that such a skin is inferior, 
 but this is the way in which it would be reasoned out from the 
 Adler viewpoint, and if instead of thinking of such a skin as has 
 been described the possibilities of cutaneous eruptions are thought 
 of, of the various pruritides and so forth, it will begin to be un- 
 derstood how skin inferiority may play its part in the later char- 
 acterological peculiarities of the individual. Sadger's illumi- 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 95 
 
 nating article in an early number of the Jahrbuch'' is suggested 
 for consideration in this particular. It will be noted in studies 
 of this sort that whereas the actual mechanism of the eruption 
 itself may remain more or less hazy that the distribution of the 
 lesions is of exceeding significance, particularly the pruritides, 
 the lesions of a senile eczematous variety and certain neurotic 
 erythemas and the like. Their localization about primary and 
 secondary sexual foci seems to be almost, if not quite conclusive 
 of their intimate psychological affiliations. 
 
 Another illustration of the same character may be taken from 
 the organ of hearing; how might it be expected that an inferior 
 organ of hearing would react from the Adlerian point of view ? 
 In the first place, if the organ of hearing was inferior it would be 
 expected that it would focalize the individual's feeling of inferior- 
 ity, in other words, that his apprehensiveness toward the world 
 of reality, his fear of contact with actual experience would tend 
 to focalize in the auditory zone, and if the development of this 
 particular individual's auditory functioning were traced back it 
 might be expected that it would disclose a history, as has already 
 been indicated, of banging on, so to speak, to infantile ways of 
 pleasure seeking. No-w to begin at the beginning and trace the 
 history through according to this theory. A child would be found 
 who was enormously interested in auditory experiences. Per- 
 haps there might be found a child who had heard forbidden 
 things in its very first years. Later on it might be expected to 
 find that such a child expressed its curiosity primarily, of course, 
 sexual curiosity, through its auditory apparatus and that it was 
 always listening and trying to get information from hearing what 
 other people were saying. As it grew to adulthood it might be 
 found that such an individual, retaining the same ways of pleas- 
 ure seeking, was perhaps interested in hearing obscene stories 
 and jokes. It is to be borne in mind that the ambivalent opposite, 
 the suppression (repression) of auditory stimuli is also a possible 
 type of reaction. Such a person might react to obscene jokes with 
 great emotional resentment. All the while there might be found 
 running along hand in hand with such a development a tendency 
 to suspicion of the environment, which would manifest itself by 
 
 ' Sadger, J. : Ueber Haut, Schleimhaut und Muskelerotik. Jahrbuch 
 fiir psychoanalytische und psychopathologische Forschungen. 
 
96 FOUNDATIONS OF PSYCHIATRY 
 
 a feeling of fear, apprehension and anxiety, in short of inferior- 
 ity. If he saw people talking together in an intimate way and 
 could not hear what they said, from that to the belief that they 
 were talking about him, would be an inconsiderable step to take. 
 And so it can be seen how slowly there is 'building up here the 
 picture of a paranoiac, with his ideas of suspicion, his delusions 
 of persecution, his hallucinations of hearing. And the hallucina- 
 tions of hearing of a paranoiac in which he hears people say all 
 sorts of disagreeable things to him if interpreted through their 
 symbolic significance will be seen to represent the same pleasure 
 seeking mechanisms that were openly manifested in childhood. 
 This is the sort of reasoning that has to be used to develop such 
 a character type as that found in paranoia on the basis of the 
 Adlerian concepts. 
 
 This recalls certain observations made some years ago upon 
 hallucinated persons,' taking them as they came into the hospital, 
 and in looking over the results of these observations it is very 
 interesting to discover that no hallucinated patient was found 
 with normal sense organs. The ears, for example, showed some 
 evidences of an old otitis media, or in older patients evidences of 
 sclerosis and contraction of the drum membrane, diminished 
 acuity of hearing, etc., etc. Such like evidences were found also 
 in other sense organs except that in some instances, and this is 
 also extremely interesting, the sense organ that was the particu- 
 lar recipient, so to speak, of the hallucinations was healthy but 
 it was shown that the stimulus for the hallucinations was derived 
 from another sense organ which was not healthy ; in other words, 
 the phenomenon of synaesthesis in which the first sensory change 
 occurred in a diseased sense organ and was manifested as an hal- 
 lucination in a healthy one. One instance in particular was that 
 of an hallucination of smell which resulted from the stimulation 
 of a congested and swollen lingual tonsil. 
 
 Still bearing in mind the general principle of psychical inte- 
 grations the Adlerian viewpoint must be accepted as stated. 
 Adler himself, especially in his work on organ inferiority, offers 
 a lot of evidence which is inconclusive, not to say flimsy at times, 
 or at least is flimsily presented. It makes no diflference, however, 
 
 'White, Wm. A., Hallucinations. Jour. Nerv, and Mental Dis., No- 
 vember, 1904. 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 97 
 
 as to whether he happens to have presented it well or not, the con- 
 cept must be accepted in the way stated. It is a concept which by 
 no means is limited to the explanation of certain character traits ; 
 it is a concept which in its broader significance compasses the 
 whole field of biological development. Child's theory of physio- 
 logical individuality defines individuality as all that which may 
 be included under the control of a metabolic or dynamic gradient. 
 Now of course, the metabolic and the dynamic gradient of the 
 human individual is the central nervous system. All may there- 
 fore be considered individual in him which remains subservient 
 to this centralized authority, and just as a group of cells may 
 spring into activity and throw off the yoke, so to speak, of this 
 central authority, set up a government of their own, develop per- 
 haps their own independent dynamic gradient, and become, there- 
 fore what is called a tumor, which is really from this point of view 
 a separate and of course, a parasitic individual, so a sense organ, 
 the eye for example, may do the same thing. An eye which in- 
 sists upon remaining at lower cultural levels of pleasure seeking, 
 as, for example, the eye of the young man who was arrested be- 
 cause he had' fixed a mirror on the end of a stick and went about 
 the street shoving this under women's skirts, a sort of periscopic 
 eye, the eye of such an individual which continues to seek pleas- 
 ure at such cultural levels may be considered as being in this same 
 way an anarchist in its tendencies toward the total integration, 
 perhaps not so much the eye when speaking in psychological 
 terms as what might better be termed the eye libido. So, such an 
 individual is sufifering, it might be said figuratively, speaking 
 from the point of view of an energy concept, from tumor of the 
 eye libido, He is suffering because his eye libido cannot be inte- 
 grated with the rest of his personality and be made subservient 
 to the larger ends of the individual as a whole, but continues to 
 manifest itself at infantile levels of pleasure seeking. It would 
 be interesting, not only to examine such an eye ophthalmologically 
 for evidences of inferiority, but by the Abderhalden technic. 
 
 The working out of the significance of the various neurotic 
 character traits is ringing the changes on the basic formulation of 
 what Adler calls the masculine protest. It is as if the neurotic 
 said to himself, " I wish to be a complete man." In this formula- 
 tion is seen a marked departure from the pansexualism of Freud 
 
98 FOUNDATIONS OF PSYCHIATRY 
 
 who traces the neuroses to a defective elaboration of the race- 
 preservative or sexual instinct. For Adler the basic feature is 
 the effort to overcome the feeling of inferiority by seeking safety, 
 the safety motive to conduct, and so is rather an expression of 
 the " will to power " or the self-preservative instinct. 
 
 For Adler as for Freud the neurosis or the psychosis is com- 
 parable to a work of art but it has been built up in response to a 
 fictitious goal which collects and unites into a group those psychic 
 elements of which it can make use, collecting only those which 
 promise results in the effort at the attainment of security. The 
 attempt to attain to the maximation of the ego fails because di- 
 rected along a false path. The neurosis or psychosis is therefore 
 a constructive creation, a compensation product, which however, 
 fails because of its false direction. 
 
 In his work on organ inferiority* the organic basis of this 
 psychological formulation is laid. In this work he has gone to 
 considerable pains in working over the psychological character- 
 istics of persons who have had demonstrably inferior organs, 
 either clinically evident or showing up at autopsy. From this 
 work he believes he has been able to show that the predominant 
 traits of character are the results of an effort on the part of the 
 individual to overcome a feeling of inferiority resulting from an 
 inferior organ. A classical example is that of the stammerer 
 Demosthenes who became the greatest orator of Greece. In his 
 later work on the neurotic constitution^" he has worked over the 
 psychological material in great detail. 
 
 This is the Adlerian concept, an exceedingly useful one and 
 pragmatically very valuable because it serves to bridge the gap 
 between the organicists and functionalists. As a method of ap- 
 proach to the neuroses it rather tends to lack that capacity for in- 
 dividualizing the patient's symptoms, which is of value. The 
 organic part of the situation is of little or no interest to the 
 patient, and in the way in which here set forth would, in a ma- 
 jority of cases, be incomprehensible. Actual feelings, actual 
 
 » Adler, A., Study of Organ Inferiority and Its Psychical Compensa- 
 tion, A Contribution to Clinical Medicine. Nerv. and Mental Dis. Mono- 
 graph Series, No. 24. 
 
 "Adler, A., The Neurotic Constitution. Outlines of a Comparative 
 Individualistic Psychology and Psychotherapy. Moffat, Yard & Co., New 
 York, 1917. 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES 99 
 
 strivings at the psychological level, emotional trends, desires, etc., 
 are the things that the patients can be brought to understand be- 
 cause they actually feel them. They can be brought into con- 
 sciousness and dealt with, and in this v^ay the approach along 
 more strictly Freudian lines is more valuable. The Adlerian con- 
 cept, however, is a broad formulation which is of great scientific 
 and philosophic value but not of the same therapeutic value in 
 dealing with the individual because for the most part one has to 
 deal with the capacity for psychological readjustments. The 
 Adlerian concept, on the other hand, is a constant reminder that 
 the capacity for psychological readjustment may depend, in the 
 last analysis, upon some assistance that can be offered from the 
 organic side, a reminder which should be taken seriously, quite 
 as seriously as the internist should take the suggestions of psy- 
 chogenesis. 
 
 Adler's theory was constructed to explain the psychological 
 symptoms of the neuroses and psychoses. It brought a much 
 needed emphasis to the organic side of the problem and made the 
 neurosis not only more understandable but more a part of the in- 
 dividual. The dissociated cravings were no longer parasitic but 
 correlated and integrated as parts of the individual as a whole. 
 To round out the concept, to come to an adequate appreciation of 
 how the symptoms of mental illness are expressions of the indi- 
 vidual as a whole, how the mechanisms involved are quite the 
 same as those which produce the phenomena of health, it is im- 
 portant to understand the principles on which the individual deals 
 with his organic cravings and show how the only difference be- 
 tween health and disease lies in the d^ree of success with which 
 this problem is met. Kempf has attempted to do this in his dis- 
 cussion of the autonomic apparatus and the personality.^^ His 
 theory runs as follows : The autonomic nervous system^^ is the 
 primitive nervous apparatus composed of two sets of mutually 
 opposed regulatory apparatuses which function as controls of the 
 smooth musculature, visceral and skeletal, and the glands. This 
 
 11 Kempf, E. J., The Autonomic Functions and the Personality. Nerv- 
 aus and Mental Disease Monograph Series, No. 28. 
 
 12 Kempf uses the term autonomic nervous system as synonymous with 
 the term vegetative nervous system to include the sympathetic (thoracico- 
 lumbar outflow), and what has been variously termed the extended vagus, 
 the midbrain, bulbar, and sacral sympathetic, the para-sympathetic, and the 
 autonomic. 
 
100 FOUNDATIONS OF PSYCHIATRY 
 
 system operates through the endocrine glands and their hormone 
 secretions to bring about balanced physiological interrelations 
 which play a most imiportant part in the integration of the or- 
 ganism as a whole. The needs of the organism, its tendencies, 
 trend's, are expressions of the directions of its several constituent 
 parts as integrated by the autonomic apparatus and the psycho- 
 logical reverberations of which are the affects. In other words 
 the autonomic apparatus registers the organic needs of the or- 
 ganism the psychological aspects of which are the affects. 
 
 Now, in the scheme of the entire individual, What part does 
 the cerebrospinal nervous system, or as Kempf prefers to call it, 
 in contrast to the autonomic nervous system, the projicient nerv- 
 ous system play? The projicient nervous system has been, so to 
 speak, erected as an apparatus for bringing about a satisfaction 
 of the organic needs. The projicient apparatus effects a relation 
 of the organism to reality through the medium of the extero- 
 ceptors and is therefore able to relate the organism to the environ- 
 ment in such a way as to bring to pass a satisfaction of its needs, 
 or to speak psychologically, of its affective cravings. Hunger, 
 i or example, is an affective craving testifying to an organic need. 
 The projicient apparatus so relates the organism to its environ- 
 ment as to secure food and thus satisfy, or bring about a neutral- 
 ization of, the craving. 
 
 The intimate interrelations of the autonomic and the pro- 
 jicient apparatuses is testified to not only by the presence of 
 autonomic centers in the cord, the bulb, and the mid-brain, but 
 by the recently fairly well established fact of the innervation of 
 the skeletal (voluntary, striped) musculature. Just as the auto- 
 nomic is the more primitive form of nervous system so the 
 smooth (involuntary) muscle fibre is the more primitive form of 
 muscle fibre and as the projicient nervous system has been devel- 
 oped to bring about such motor responses as will effect a neutral- 
 ization of organic needs so the voluntary musculature has been de- 
 veloped to respond to the dictates of the projicient nervous 
 system. The voluntary type of muscle consists of two parts 
 sarcoplasmatic substance which is innervated by the autonomic 
 system and, imbedded within this substance, the anisotropic disc 
 system which is innervated by the projicient nervous apparatus.^' 
 
 1' Ramsay Hunt, Progressive Atrophy of Globus Pallidus. Brain, Vol. 
 40, No. I. 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES lOI 
 
 From this it will be seen that Kempf is an ardent supporter of 
 the James-Lange theory of the peripheral origin of the emotions 
 so definitely testified to in the particular case of hunger by the 
 work of Cannon,^* who found by his fluoroscopic investigations 
 that the feeling of hunger occurred contemporaneously with cer- 
 tain contractions of the stomach. Motion thus becomes the end 
 and aim of integration and the precondition of effective adapta- 
 tion. All this Kempf thinks is an argument for the peripheral 
 origin of thought for from this point of view it can be said " that 
 in a certain sense we think with our muscles." 
 
 The integration of the various organic needs, each serving its 
 own ends, but in addition falling in line in the service of the ends 
 of the organism as a whole, lies at the basis of an efficient per- 
 sonality. Just as in society if the shoemakers should gain suf- 
 ficient power to impress their ways of reacting upon all the others 
 and cause everyone to minister to the function of making shoes, 
 society would be sick, so if any one of the inherent autonomic 
 cravings is disproportionately developed and so becomes able to 
 make the rest of the organism subservient to it, the individual 
 is sick. The healthy individual is one in which all of the organic 
 needs reach a satisfaction which is subservient to the larger good 
 of the whole organism. Correspondingly society is healthy when 
 the shoemakers, tailors, bakers, and all the rest are properly pro- 
 portioned in their several activities. 
 
 How do these matters get out of proportion? Here come up 
 for consideration the familiar problems of fixation, conflict, and 
 repression. Conflict is already seen to be due to an undue domi- 
 nance of some special organic need, or, translated into psycho- 
 logical terms, of some affective craving. In physiological terms 
 conflict represents the strivings of the parts of the organism for 
 the control of the final common (projicient) motor path for ad- 
 justment. Fixation, expressed in similar physiological terms, is 
 the result of conditioning the autonomic reflex. A child which 
 has been frightened and hurt by a doctor with a black beard may 
 afterwards exhibit fear of all men with black beards. The affect 
 of fear has been conditioned by the associated circumstances of a 
 man with a black beard. The fear mechanism has been rendered 
 
 1* Walter B. Cannon, Bodily Changes in Pain, Hunger, Fear and Rage. 
 New York and London, D. Appleton & Co., 1915- 
 
102 FOUNDATIONS OF PSYCHIATRY 
 
 especially vulnerable to the conditioning circumstance — man with 
 a black beard. 
 
 It is the subject of repression, however, which is most illu- 
 minated by this phySiiological viewpoint. In the struggle of the 
 component organic parts of the organism for the satisfaction of 
 their respective cravings the nervous system, more particularly 
 the autonomic, is conceived as having evolved according to the 
 principle laid down by Sherrington on the basis of mechanisms 
 of coordination of allied impulses and incoordination of antago- 
 nistic impulses. The illuminating work of Sherrington on the 
 contemporaneous innervation of the agonist and antagonist 
 muscles^' in bodily movement is well known and accepted. The 
 struggle of the various, often antagonistic, cravings of the auto- 
 nomic apparatus for the possession of the final common path 
 leads to conditions of tension — ^of the viscera (unstriped musde) 
 and of the voluntary musculature (unstriped component — sarco- 
 plastic substance).^" These states of tension produce conditions 
 of heightened visceral tonicity and various forms of postural 
 tonus. '■^ If the craving is unable, for any reason, to secure neu- 
 tralizing stimuli the increased visceral tonicities and postural ten- 
 sions conditioned by them continue. The energy of the repressed 
 affects is bound up in these visceral and postural tensions. Here 
 is the crux of Kempf 's contribution. The affects are the psycho- 
 logical reverberations, so to speak, of the autonomically condi- 
 tioned visceral and postural tonicities which thus become the phys- 
 iological aspects of the emotions, more especially of the uncon- 
 scious. Emotions are the results of cravings which are not for the 
 time being able to effect their expression by causing the projicient 
 nervous system to expose the necessary receptors to neutralizing 
 stimuli. The trends of the personality, the moods, affects, emo- 
 tions are the results of the autonomic pressure for satisfaction 
 of the organic needs. The sensory autonomic stream is the 
 coenesthetic background of the personality, the outward and evi- 
 dent aspects of what are representatives of the various strivings, 
 
 15 Charles S. Sherrington, The Integrative Action of the Nervous Sys- 
 tem. London, Archibald Constable & Co., Ltd., 1906. 
 
 i« Hunt, 1. c. 
 
 " C. S. Sherrington, Postural Activity of Muscle and Nerve. Brain, 
 Vol. 38, Pt. 3. T. W. Langelaan, On Muscle Tonus. Brain, Vol. 38, Pt. 3. 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES IO3 
 
 positive or negative, avertive (type fear) or acquisitive (type 
 love) of the organism to acquire satisfaction (neutralizing stim- 
 uli) for its various organic needs. 
 
 Character, personality from this point of view becomes then 
 the final result of the more or less effective compromises which 
 are struck in the general tendency of the several organic needs to 
 acquire an adequately balanced, integrated, expression. The psy- 
 chological background, the unconscious, is the final integration 
 of the sum of motor sets in the autonomic apparatus. These 
 motor sets, the physiological aspects of the dynamic components 
 of the personality, are relatively constant and permanent depend- 
 ing upon the unfatiguability of the nervous tonectic systems.^' 
 Further, these motor sets represent at the physiological level, 
 tendencies which need not be, and for the most part are not con- 
 scious in the sense of consciousness as awareness. Awareness 
 plays upon the content of the unconscious as a search light, bring- 
 ing first this and then that field within the area of its illumination, 
 it neither creates the content by illuminating it nor destroys it by 
 sweeping on to other regions and leaving it in obscurity. 
 
 This theory of Kempf 's goes far in the direction indicated by 
 Adler, namely, the direction of bringing the organicists and the 
 functionalists to a common ground of understanding and further 
 in wiping out the artificial distinctions which academic psychology 
 has so long made between those hypothetical entities, mind and 
 body, for " consciousness or awareness at any moment is the re- 
 action of the organism as a unity to the special activity of any one 
 or several of its receptor fields." It gives an explanation of the 
 possible relations that may exist between certain character traits, 
 more particularly certain pathological mental states and certain 
 physiological disturbances and even organic disorders. This way 
 of looking at the facts offers a new approach to the bafifling prob- 
 lem of the emotions and an indication that a further understand- 
 ing of them may be reached by a more careful analysis of their 
 physiological modes of expression in visceral tonicities and pos- 
 tural tensions. Such a knowledge would be invaluable in the 
 
 ^* William A. White, Some Considerations Regarding the Factor of 
 Fatigue with Reference to Industrial Conditions. Transactions of the Fif- 
 teenth International Conference on Hygiene and Demography, 1912. Am. 
 Jr. Med. Sci., Feb., 1913. 
 
104 FOUNDATIONS OF PSYCHIATRY 
 
 clinic by reversing the process and illuminatiing, in the evidence 
 of motor sets (attitudes, mannerisms, visceral disturbances, etc.), 
 the nature of the affective conflicts of which the patient is the 
 host. 
 
 Kempf briefly discusses, from this point of view, the major 
 emotions: fear, anger, shame, disgust, sorrow, joy, anguish, love, 
 jealousy and envy. He suggests that many pathological condi- 
 tions may be illuminated by an approach from this angle as, for 
 example, catatonia, functional cardiac disorders, convulsions, 
 myopathies. Certainly there can no longer be much doubt that 
 the study of the individual cannot be satisfactorily pursued by 
 leaving out of consideration the psychological (symbolic) level.^* 
 Only by an understanding of the individual as a whole can an 
 adequate comprehension of its several parts be reached because 
 those several parts are parts of the larger organic unity and their 
 meaning is merged indissolubly with it. The various physical 
 symptoms known as conversion phenomena have already reached 
 an explanation from the psychological approach; convulsions 
 (epilepsy) have more recently had much light thrown upon their 
 etiology by the same method of approach f such postural states 
 as produce facial asymmetry and peculiar positions of the body 
 are regularly submitted to scrutiny by the psychoanalyst; a host 
 of visceral conditions are already recognized as having some sort 
 of neuropathic determiners (spastic conditions in the gastro- 
 intestinal tract such as spastic colon, pylorospasm,' etc., which 
 may lead to organic changes such as gastric or duodenal ulcer) ; 
 it is entirely within reason to look for the psychogenic factors in 
 such diseases as diabetes mellitus, particularly the adrenalinogenic 
 type;^^ myopathies have already been suggested by LangeJaan, 
 and why not the muscular atrophies in general ? as determlined in 
 part at least by chronic postural tensions which, when another 
 cause is operative such as lues, may have rendered the muscle 
 groups concerned especially vulnerable. The suggestions in many 
 
 18 S. E. Jelliffe and W. A. White, Diseases of the Nervous System 
 (Introduction). Lea & Febiger, Philadelphia and New York, tHird 
 edition, 1919. 
 
 20 L. Pierce Clark, The Nature and Pathogenesis of Epilepsy. New 
 York Med. Jour., Feb. 27, March 6, 13, 20 and 27, 1915. 
 
 21 William A. White, Mechanisms of Character Formation. New 
 York, The Macmillan Co., 1916. 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES I05 
 
 directions, which have hitherto baffled the investigator, ^re cer- 
 tainly very seductive. 
 
 Finally the problem of sublimation is taken up from the same 
 point of vaew, which is really the point of view of energy distri- 
 bution. Progress from infancy to adulthood does not involve 
 changes of direction but the progressive substitution of new love 
 objects or the progressive refinements of the old. This substitu- 
 tion is successful when it proceeds along the path that brings to 
 the individual social esteem and Kempf makes much of the need 
 of social esteem as a dynamic factor in controlling the ways in 
 which expression may be sought. 
 
 This theory is a distinct contribution to the new psychiatry 
 which is rapSdly growing as the result, in very large part, of the 
 stimulus of the psychoanalytic movement. Whatever the rela- 
 tion of Kempf's views to Adler's theory of organ inferiority re- 
 mains to be seen but that it is a very much broader and all-inclu- 
 sive way of viewing the facts there can be no question. It marks 
 a distinct step in advance in laying a broader foundation for psy- 
 chiatry not only from the point of view of a better understanding 
 of the psychology of the emotions in particular and thdr rela- 
 tions to the conscious thinking (intellectual) functions but by 
 way of correlating the observed facts of psychology, especially 
 psychopathology, with other scientific disciplines, especially phys- 
 iology on the one hand and the humanities on the other. In these 
 times of portentous social readjustments it is of extreme impor- 
 tance to have guiding prlinciples along which to safely work and 
 thereby perhaps avoid many of the pitfalls of the obvious. 
 
 The substitution of the wish for the sensation as the unit of 
 psychic experience has been one of the most fruitful changes 
 which has been effected in the science of psychology. Kempf 
 translates the wish into terms of visceral tonus and postural ten- 
 sion and thus assists in a broader and more accurate comprehen- 
 sion of the structuralization of function. One of the most fruit- 
 ful sources of further investigation will be along the lines of 
 similar formulations for those disturbances which are grouped 
 under the general designation of the endocrinopathies, not only 
 the acute disturbances but the more or less chronic and fixed sets 
 of the organism along certain metabolic types of activity and 
 structural peculiaritlies. The utility of such an approach to the 
 
I06 FOUNDATIONS OF PSYCHIATRY 
 
 problems presented by an acute thyreopathy of psychogenic origin 
 seems more or less obvious. Why should there not also be found 
 a characteristic picture at the symbolic level for such a condition 
 as that comprised in Frohlich's syndrome? Of course one might 
 not expect results from a psychotherapeutiic approach to an in- 
 fectious form of thyroiditis but it is in just such distinctions that 
 the skill of the all-round physician is manifest. Perhaps even in 
 such cases an analysiis of the psychic factors which might operate 
 to stimulate the thyroid mechanism might not be altogether amiss. 
 Certainly in many cases of tuberculosis, and other forms of 
 chronic visceral disease, a complete understanding of the picture, 
 the end result, is quite imposslible without encompassing the 
 entire life history of the individual, understanding the, so to 
 speak, setting in which the disease occurs — ^the determination of 
 the psychologlical component. The more this is done the more it 
 is appreciated that the psyche cannot be longer left out of con- 
 sideration. The habits of life which have rendered the patient a 
 fitting host for certain pathological types of reaction can surely 
 have much light thrown upon them by a psychological approach 
 to their explanation. The results from such studies, while per- 
 haps they might not be of much value to the already afflicted 
 patient, would surely offer invaluable suggestions as to pro- 
 phylaxis. 
 
 Based upon this formulation of the nature of the neuroses 
 and psychoses Kempf has constructed a mechanistic classification 
 which sets forth the mechanisms involved instead of grouping 
 symptoms together into nosological categories. This tends to 
 focus the attention upon the process rather than upon the etiolog- 
 ical factors, pathological lesions, descriptive aspects or the name 
 and is therefore essentially dynamic in conception and more help- 
 ful for purposes of psychotherapy. 
 
 It will be noted that the designations benign and pernicious 
 are not based upon the outcome as is usual but depend upon the 
 patient's attitude towards his wishes or cravings, whether he 
 recognizes thdir personal source or, on the contrary, blames an 
 external or impersonal cause. This distinction is very useful and 
 quite in accord with the descriptive differences between a neu- 
 rosis and a psychosis as set forth by Adler. In the neurosis the 
 patiient is striving for an unattainable ideal but the pursuit does 
 
Fold out 
 
MEGHAN 
 
 .jX^ l\,\JiDIliJ 
 
 AND PSYCHOSES— PRODUCED BY DISTORTION OF AUTONOMIC-iS 
 
 Diagnostic Classification 
 
 Benign. 
 (Tendency to ac- 
 cept the personal 
 source of the 
 wishes or crav- 
 ings which cause 
 the distress or 
 psychosis.) 
 
 Suppression 
 
 Neuroses. 
 
 Mechanistic Differences 
 
 Clear to vague con- 
 sciousness of the 
 nature and effect 
 of the ungratl- 
 fiable affective 
 cravings. 
 
 2 
 U 
 
 o 
 
 Q 
 O 
 
 Hi 
 Pi 
 
 o 
 a 
 
 H 
 
 u 
 
 < 
 
 Repression 
 
 Neuroses. 
 
 Compensatory 
 
 Neuroses. 
 
 Pernicious. 
 (Tendency to op- 
 pose or refuse to 
 accept the per- 
 sonal source of 
 the wish or crav- 
 ing, to hate those 
 who would attri- 
 bute a personal 
 source, to blame 
 an external or 
 impersonal cause.) 
 
 Regression 
 
 Neuroses. 
 
 Vague conscious- 
 ness to total un- 
 consciousness of 
 the nature and 
 influence of the 
 ungratifiable af- 
 fective cravings. 
 
 Common Symptom 
 
 Distressing hyper- 
 tensions or hypo- 
 tensions of auto- 
 nomic (visceral) 
 segments (mild to 
 severe) . 
 
 Persistent striving 
 to develop potent 
 functions and win 
 social esteem ini- 
 tiated by fear of 
 impotence or loss 
 of control of aso- 
 cial cravings. 
 
 Failure to com- 
 pensate but re- 
 gression to a pre- 
 ceding more com- 
 fortable, irre- 
 sponsible level 
 permitting wish- 
 fulfilling fancies, 
 postures and in- 
 dulgences. 
 
 The above symp- 
 toms plus func- 
 tional distortions 
 of the projicient 
 apparatus and 
 changes in reac- 
 tivity to the sense 
 organs. 
 
 Usually some of 
 the above symp- 
 toms plus vigor- 
 ous compulsions 
 or inspirations to 
 strive directly or 
 indirectly for 
 specific environ- 
 mental-social con- 
 ditions and potent 
 functions. 
 
 Decrease of power) to coordinate, persistent 
 thoughts, preoccupation, unpleasant dreams, 
 insomnia, errors, accidents, scalp pains, head- 
 ache, dizziness, stiffness or weakness of ex- 
 ternal muscles of eyes, back of neck, limbs, 
 back, tongue, pharynx, increased or decreased 
 secretion of glani|^ of mouth, stomach; 
 dyspnea, tachycardia, high blood pressure, 
 loss of or freakisiaiess of appetite, hyper- 
 chlorrhydria, diarrhea, constipation, dys- 
 menorrhea, amenorrhea, sexual impotence, 
 poUakiuria, hyperi&itability of diseased struc- 
 tures; decrease of energy, or efficiency, or 
 ability to learn. 
 
 Amnesias (specific).!? 
 
 Anesthesias, — specific, localized, general. 
 
 Hyperesthesias, paresthesias. 
 
 Postural tensions — spastic, flaccid. 
 
 Simulations of postures, functions. 
 
 Convulsions without loss of consciousness. 
 
 Eliminations of segments or functions, recurring 
 incoordinations, errors, accidents. 
 
 Misinterpretations, misrepresentations. 
 
 Fixed preferences, aversions, phobias, com- 
 pulsions, obsessions (acceptable to the ego), 
 mannerisms, attitudes, fetiches, symbols 
 rituals, habits, sexual reactions. 
 
 Cravings for certain stimuli — esthetic, sexual 
 
 Dissociation 
 
 Neuroses. 
 
 The uncontrollable 
 cravings domi- 
 nate the person- 
 ality despite the 
 efforts of the ego 
 to prevent it. 
 
 Distressing visceral 
 tensions, rare, but 
 persistent main- 
 tenance of char- 
 acteristic affec- 
 tive attitudes of 
 the prenatal in- 
 fantile or preadol- 
 escent stage. 
 
 Symptoms of dis- 
 tressing visceral 
 tensions, with or 
 without function- 
 al distortions, 
 with or without 
 eccentric defenses 
 or compensations, 
 with (see next 
 space). 
 
 Usually eccentric personal, vocational, pro- 
 fessional, religious-artistic, mechanical, com- 
 mercial, philosopl^al striving, sexual -striv- 
 ings (pimps, seducers, white slavers). Ec- 
 centric penitent acts, reforms, reconstruc- 
 tions, solicitious interests, confessions, hyper- 
 conscientiousness, obsessions, divine inspira- 
 tions, occult powers. Increased muscle 
 tensions, high blood pressure, tachycardia, 
 exophthalmic tensions. Exhibitionistic dress, 
 voice, manners, heedless spending, grand 
 unsubstantiated claims, eccentric modesty, 
 curiosity, etc. 
 
 Hyperative glands — thyroid, adrenals, sex, 
 glycohemia, glycosuria. 
 
 Common 
 
 Fear of respons 
 
 bility for havii 
 
 the relief 'of, 
 
 ings. 
 Fear of competit 
 
 functional or o 
 
 orities. 
 Fear of pain, ir 
 
 money, honor. 
 Fear of violating 
 
 tions or transfe 
 Love of unobta: 
 
 sponsive or per 
 Hate, shame, di: 
 
 avoidable objec 
 
 Same as above, 
 occurring undei 
 critical physiolo 
 vironmental coj 
 cessitating imni 
 or forgetting, aa 
 exposure of si 
 wishes, indulge 
 dais, asocial cr 
 ures, inferioritie 
 
 Fear of loss of sej 
 and domination 
 cravings, fear ot 
 of fear, fear of 
 object, fear of 
 censure, ridicu 
 organic failure. 
 
 Hyperactive glan 
 adrenals, sex. 
 
 Glycohemia, glyc 
 
 Evasion of responsibility, general inefficiency, 
 wandering, hoboisra, home sickness, indiffer- 
 ence, apathy, childish day dreams. Lowered 
 muscle tonus, no capacity to compensate to 
 win esteem, muteness, amotility, indifference 
 to cleanliness, order, system, coSperation, 
 failure, hopeless depression, suicide, pre- 
 adolescent, infantile, prenatal, attitudes. 
 Indulgence in excretory erotic play, fancies, 
 childish destructiveness. 
 
 Sensory derangements, delusions, hallucina- 
 tions, environmental and social disorienta- 
 tion, uncontrollable preoccupation, confusion, 
 delirium, stupor, anxiety, apprehension, panic 
 at loss of self-control, wild or systematic 
 compensatory striving, bluffing, raging as a 
 defense against the uncontrollable cravings, 
 defensive compulsion to systematize signs, 
 remarks, proofs of exogenous influences, un- 
 controllable, unacceptable obsessions, pho- 
 bias, mannerisms, impulses, postures, rituals, 
 (distressing the ego) heedless yielding to 
 excretory erotic cravings, fancies of pre- 
 adolescent or infantile nature. 
 
 Infantile love fh 
 of irreplaceable 
 permanent, insi 
 obstacles to th 
 ings; blotting 
 astrous or shar 
 ences, or the 
 development < 
 cravings, partit 
 erotic. 
 
 Irrepressible, ui 
 asocial or pe 
 mental cravingi 
 
 Inability to prev( 
 disguised era 
 breaking throu 
 resistance h 
 fatigue, discour 
 pressing dom 
 others, seducti 
 physical shod 
 means of 
 metabolic dysti 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES IO7 
 
 not lead to an open conflict with reality, reality is only an ob- 
 stacle ; in the psychosis the patient does not act as though he were 
 striving for some end but as though that end had already been 
 attained. For example, the neurotic strives for power, the psy- 
 chotic is the emperor, the President of the Unlited States. 
 
 The neuroses are then divided into suppression, repression, 
 compensation, regression and dissociation types. These terms are 
 sufficiently explained by the table. They represent a scale in the 
 seriousness of the situation. It is important to appreciate that 
 these terms do not necessarily apply to the whole psyche but only 
 to that aspect which is involved in the difficulties. A person with 
 a marked compensatory psychosis might be able to hve and func- 
 tion quite effectively so long as the particular region of the psy- 
 chosis was not invaded. Patients with marked delusions are 
 often able to work very efifectively and steadily under circum- 
 stances that do not call upon them for undue adjustments in that 
 psychological territory which the delusion has been evolved to 
 protect. 
 
 With regard to all of these conditions it would seem that the 
 depth of regression or the depth of the point of fixation is a 
 factor, perhaps the most important one, in the seriousness of the 
 neurosis or psychosis. Kempf has indicated that the only factor 
 is the attitude of the patient towards his cravings as indicated. It 
 seems hardly possible that this can be the only factor. It would 
 seem that the depth from which the disturbance radiates must 
 play the important part. If the discussion of the nature of the 
 archaic material is recalled it would seem that another element is 
 suggested. Every psychological state must have an aspect due to 
 the personal experiences of the individual 'but must also have an 
 aspect which is contributed by the experience of the race, and the 
 two, while fusing, must be different. The gill arches of the 
 human embryo, for example, belong to the developmental history 
 of the individual, they also have an aspect which allies them with 
 the early ancestors of the race. As already indicated it would 
 seem that their subsequent history depends upon which factor 
 receives the most emphasis. The psychotic who can bring things 
 to pass by thinking them so harks back in his regressive tend- 
 encies to the infantile period of the all-powerfulness of thought, 
 but there was a similar period in the history of the race and it 
 
I08 FOUNDATIONS OF PSYCHIATRY 
 
 may well be that whether the same tendency, the will to power, 
 produces a neurosis or a psychosis in the sense of Adler depends 
 upon which aspect receives the greater emphasis. In other words 
 it is the prominence of the phylogenetic factor which makes the 
 experience seem strange and prevents its recognition by the patient 
 as having a personal source. In the same way didusions and be- 
 havior which contain a considerable amount of this archaic ma- 
 terial seem unpsychological because normal persons cannot feel 
 themselves into such experiences. This is the line along which 
 Jung's work is particularly illuminating though it is still a matter 
 of research. It may well be that the unanalyzable residual of 
 unconscious material represents this phylogenetic factor and that 
 for its explanation the services of the anthropologist and -the 
 philologist will have to be sought. 
 
 Kempf further has made a most useful correlation, in this 
 table, of the physiological disturbances which run parallel with 
 the psychological mechanisms. He is an advocate of the James- 
 Lange theory of the emotions, explaining the emotions as sec- 
 ondary to the set of the action systems for a given task of ex- 
 pression. In this sense the emotions are the reverberations in 
 consciousness of the various action tensions. Inasmuch as it is 
 often difficult to decide which comes first, the conscious expe- 
 rience or the motor set, and inasmuch, further, as the psycho- 
 logical is only expressive of the reaction of the individual as a 
 whole while the particular tension is only the activation of that 
 part of his machinery pressed into service for the particular end 
 it would seem quite as logical to interpret them as different aspects 
 of the same whole and as being contemporaneous rather than as 
 occupying positions of cause and effect. This is only another 
 suggestion which seems in line with that more comprehensive 
 consideration of the problem which does not make artificial dis- 
 tinctions either between mind and body .or between individual 
 and society and assists that larger viewpoint of psychopathology 
 as a disturbance in the region of the individual-society relation 
 as laid down in the last chapter. From this point of view, of the 
 individual-society relation, the emphasis in the psychosis can be 
 seen to be upon the aspect of social adjustment, the failure of 
 which tends to eliminate the individual from the herd as a useful, 
 functioning member; while in the neurosis the emphasis is upon 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES I09 
 
 the personal side of the relationship, failure being reflected in the 
 individual as unhappiness. The socialization of instinctive tend- 
 encies makes for better adjustment to the herd on the one hand 
 and for a greater measure of happiness on the other. 
 
 From this larger viewpoint it is apparent that the personahty, 
 as an energy system, can no longer be neglected in the study of 
 the individual, either by the psychiatrist or the internist on the 
 one hand or by the sociologist on the other, if all the factors that 
 enter into a given problem of abnormal behavior are to be uncov- 
 ered and the several parts they play adequately evaluated. Like 
 all new concepts it commends itself as possibly offering explana- 
 tions for that group of diseases, and those aspects of disease 
 which have, up to the present time, defied explanation. 
 
 Certain of the endocrinopathies (particularly thyroid and 
 adrenal) at once suggest this angle of approach as offering prob- 
 lems of adjustment whidi have as yet not been sufficiently or- 
 ganized to be laid down in structure. Various visceral disorders 
 such as spasms (pylorospasm, spastic constipation) suggest a 
 similar , approach in which the spasm can be understood as con- 
 fining the energy of an organic craving which is unable to gain an 
 outlet in expression by commanding a final, common motor path. 
 This is the physiological mechanism at the basis of what the psy- 
 choanalysts call fixation and repression. Some of the myopathies 
 invite study from the point of view of postural tensions. More 
 massive phenomena such as epilepsy and catatonic states come in 
 for like consideration while in the more obvious functional types 
 of cardiac disorder, the conversions of hysteria and in a host of 
 so-called hysterical symptoms the presence of a psychogenic 
 factor is already accepted. More clearly defined disease types 
 such as diabetes suggest further study along these lines, while 
 such organic conditions as chronic nephritis, pulmonary tubercu- 
 losis, and even cancer may have their etiology illuminated by a 
 closer study of the life histories of those in whom they develop 
 with a view to discovering the dynamic factors which have been 
 at work through the life of the individual, and, operating as long- 
 continued stresses finally broken down the organic compensations 
 in certain directions. Many chronic diseases may well be total 
 life reactions which can only be fully understood when the psy- 
 chological as well as the somatic symptomatology is taken into 
 account. 
 
no FOUNDATIONS OF PSYCHIATRY 
 
 Just as these disease problems can be advantageously ap- 
 proached from this angle so can other similar problems be per- 
 haps illuminated in the same way, for example, the problem why 
 certain etiological factors, for instance, the tubercle bacillus^ 
 should attack the lung in one person, the kidney in another, etc. 
 This opens up for consideration the whole, great question of indi- 
 vidual types of susceptibility to disease, a question which it 
 would seem cannot be solved without at least taking into consid- 
 eration the organism as a whole. The study, for example, of the 
 relation of certain types of pulmonary tuberculosis to the shut-in 
 type of character and the dynamic factor back of this character 
 trait which may well be of more importance than the tubercle 
 bacillus itself because primary, because offering a point of attack 
 in prophylaxis, and because, unless dealt with, making a cure im- 
 possible. It has been in the past usual to explain such problems 
 by heredity but this stamps the issue as final and irremedial and. 
 steriUzes effectually all therapeutic effort. 
 
 In addition to all these problems it is of course of practical' 
 importance to inquire into the methods employed of making actu- 
 ally existing disease or deformity fit into the needs of the indi-^ 
 vidual for expression, how a disease may be made an asset rather 
 than a liability. For example, a deformity is made an excuse for 
 idleness and a shut-'in type of behavior; a lost arm is an excuse 
 for living on charity; a resemblance to a great man, even in his. 
 defects, is used to bolster up an excessive egotism. Disease and 
 deformity are often utilized by the neurotic instead of being part 
 and parcel of the whole pricture of the neurosis. 
 
 These lines of research suggest that the question which should 
 be asked of the disordered human machine is. What is the indi- 
 vidual trying to do? This question recognizes that the organism 
 is an integrated whole which has a numerous machinery at its. 
 command for bringing to pass its aims which are registered in 
 the psyche as desires, wishes. It is in every way quite as appro- 
 priate to question the human organism in this way as it is tO' 
 question a group of such organisms in that integration to which 
 we give the name of nation. The people have a right to ask, for 
 example, with what motives the several nations, the United 
 States, England, France, Germany, come to the peace table. Just 
 as the various representations, diplomatic moves, dexterities of 
 
THE NATURE OF THE NEUROSES AND THE PSYCHOSES III 
 
 the several delegates to the peace conference can only be adequately 
 understood if the national motives back of them are known, so 
 the various disorders of function of the several organs of the in- 
 dividual can only be adequately and fully understood when they 
 are appreciated as parts of the complex mosaic of the individual, 
 as mechanisms which are directed to the larger ends of the indi- 
 vidual as a whole. 
 
 Psychiatry, by its unremitting emphasis on the stvidy of the 
 personality make-up, first to explain disease and later as neces- 
 sary to understand the symptoms of disease when it does develop, 
 has, by finally pressing physiology into its service, effected a union 
 which for the first time really begins to recognize the importance 
 of considering the individual as a whole. Internal medicine has 
 thought that it was considering the individual as a whole, as a 
 biological unit, when it considered all of the organs and perhaps 
 the most obvious of the personality traits. The study of the per- 
 sonality from the two opposite angles, the psychological and the 
 physiological, has demonstrated the inadequacy of this assump- 
 tion and indicated quite clearly that between these two lines of 
 approach much more is comprised than heretofore suspected. 
 Psychiatry is the first medical specialty which at all adequately 
 approaches the problem of the whole individual. It will remain 
 for sociology to appreciate what it has to gain by a study in this 
 region of the individual-society relation. It has much to gain 
 from psychiatry as psychiatry has from internal medicine and for 
 the very best results there needs to be a practical cooperation of 
 all. As psychology needs to be humanized so psychiatry needs to 
 be socialized. 
 
CHAPTER VII 
 
 Therapeutics 
 Action — Objectification — Transference — ResymboHzation 
 
 The individual and the environment, far from being mutually 
 exclusive, can only be considered as the two elements of a dy- 
 namic relation, of a constant interplay of forces, in which their 
 relative values are in a constant state of flux. Objectively this 
 relationship is expressed in terms of adaptation; subjectively it 
 is expressed in terms of happiness ; in any case the organism is in 
 action and can only be understood when so considered and the 
 various aspects of the psyche have come to be defined from this 
 point of view. For example Watson^ speaks of behavior as " the 
 integrated response of muscles and glands " and says that : " The 
 behaviorist is interested in integrations and total activities of the 
 individual." 
 
 Action then is the function of the living organism but where 
 action follows stimulus instantly and without hesitation there is 
 the type of action known as reflex, with which there is associated 
 little or no consciousness or feeling. When, however, for any 
 reason, there is a delay between the stimulus and the appropriate 
 action then there appears the phenomenon of consciousness. It 
 is as Harrison puts it,^ " just in this interval, this space between 
 perception and reaction, this momentary halt, that our mental 
 life, our images, our ideas, our consciousness, and assuredly our 
 religion and our art, is built up." 
 
 Ordinarily perception is thought of as giving information 
 about the environment which may be used in subsequent action. 
 From this point of view, however, it must fit into the larger con- 
 cept of the acting organism. Instead, therefore, of acting in 
 accord with perception those aspects of the environment are per- 
 
 1 Watson, J. B., Psychology from the Standpoint of a Behaviorist. 
 Philadelphia, J. B. Lippincott & Co. 
 
 2 Harrison, Jane Ellen, Ancient Art and Ritual. New York, Henry 
 Holt & Co. 
 
 112 
 
THERAPEUTICS II3 
 
 ceived which are necessary to carry out contemplated actions. 
 Perception is therefore the early stage of action. As Bergson 
 puts it :^ " Our perceptions give us the plan of our eventual action 
 on things," or in another place:* "The objects which surround 
 my body reflect its possible action upon them." Memory, even, 
 comes in for a like treatment so beautifully and inimitably ex- 
 pressed by Bergson in his Creative Evolution when he refers to 
 the cerebral mechanism as being arranged so as to drive back 
 into the unconscious almost the whole of the past " and to admit 
 beyond the threshold only that which can cast light on the present 
 situation." 
 
 Bergson therefore puts it^ that " the fundamental law of psy- 
 chical life is the orientation of consciousness towards action" 
 and in his summing up of the situation says :° " Consider percep- 
 tion, to begin with. The body, by the place which at each moment 
 it occupies in the universe, indicates the parts and the aspects of 
 matter on which we can hold: our perception, which exactly 
 measures our virtual action on things, thus limits itself to the 
 objects which actually influence our organs and prepare our 
 movements. Now let us turn to memory. The function of the 
 body is not to store up recollections, but simply to choose, in order 
 to bring back to distinct consciousness, by the real efficacy thus 
 conferred on it, the useful miemory, that which may complete 
 and illuminate the present situation with a view to ultimate 
 action." 
 
 For Bergson then'' matter becomes " the aggregate of images, 
 and perception of matter these same images referred to the 
 eventual action of one particular image, my body." 
 
 Perception, memory, are then only aspects of the body in 
 action. Consciousness, that is self-consciousness, only arises 
 when there is some delay in passing into action, when there is 
 some obstacle, or in other words when there is some conflict.' 
 The needs of the organism are not by any means always reduced 
 
 * Creative Evolution. 
 
 * Matter and Memory, 
 s Matter and Memory. 
 
 * Matter and Memory. 
 ' Matter and Memory. 
 
 8 For a discussion of the nature of consciousness see my Mechanisms 
 of Character Formation. 
 
114 FOUNDATIONS OF PSYCHIATRY 
 
 to one. There are often conflicting needs and it is during the 
 period of conflict when these needs are endeavoring, so to speak, 
 to translate themselves into action, when they are contending for 
 the final common pathway to gain adequate expression, that con- 
 sciousness arises. Consciousness arises at moments of conflict and 
 is the expression at the psychological level of conflict when the 
 opposing forces are contending for the mastery of the individual 
 as a whole. These contending factors are wishes in the sense of 
 Holt,' who considers a wish as a " motor attitude," " a course of 
 action which some mechanism of the body is set to carry out." 
 
 Just as consciousness arises at moments of conflict when there 
 is some delay in translating desire into action which is appropriate 
 to neutralize it, so does emotion arise under the same circum- 
 stances. In fact desire can only mean that efifective action has 
 not as yet taken place. Hunger can only exist so long as food is 
 not partaken of, as soon as it is, as soon as action has taken place 
 that is appropriate to the stimulation by the gastric contractions, 
 hunger ceases to exist. Fear is of something that may happen; 
 anger is a preparation to attack; love is a desire to possess the 
 loved object. "Man never is but always to be blest." Emotions 
 are reflections or reverberations of the set of the action systems. 
 
 In the course of evolution as the relation between organism 
 and environment becomes very much more complex the delay 
 between the autonomic craving and the action necessary to neu- 
 tralize the craving, between wish and appropriate action, is more 
 and more emphasized. For the first time desire does not trans- 
 late itself automatically and reflexly into action but there appears 
 instead several possible courses of action and with it the feeling 
 of freedom to choose which one shall be followed.^" Carpenter 
 
 » Holt, E. B., The Freudian Wish. 
 
 loin considering the individual as an integrated complex of action 
 systems the hypothesis of G. H. Parker is interesting as set forth in his 
 recent work, The Elementary Nervous System ; namely, that in the course 
 of evolution muscle tissue develops before nervous tissue. He finds this 
 to be the fact in sponges which have a primitive type of muscle tissue 
 unaccompanied by nervous elements. In other words they have effectors 
 but no receptors or connectors. There is also found a sluggish form of 
 transmission which may be the forerunner of nervous pathways of dis- 
 charge. This primitive muscle tissue is the beginning and the most primi- 
 tive constituent of the neuromuscular mechanism around which the other 
 elements subsequently evolve. 
 
THERAPEUTICS II5 
 
 in a recent book^^ while recognizing the necessity of the develop- 
 ment, looks upon the change from the automatic, unconscious 
 types of animal mind to the state of self-consciousness as the 
 origin of all man's misery and suffering and looks forward to a 
 time when he shall be so in harmony with nature that self-con- 
 sciousness will slip away and leave him again in full freedom 
 to live. 
 
 To return to perception. Perception is most acute when con- 
 sciousness is most acute and is most in evidence in connection 
 with entirely new situations; it sinks to a negligible quantity in 
 association with automatic activities. Looked at from the point 
 of view as giving " the plan of our eventual action on things " 
 percention can be seen to be but the objectification of desires. If 
 the individual is hungry he sees food, the rest of the environment 
 passes by without notice unless it serves to facilitate or interiere 
 with getting the food. It is the perception of the food which 
 gives the plan of action on the environment. The longer action 
 is delayed the more acute the perception and the accompanying 
 state of consciousness so that it may be well said in the words of 
 Hall :^^ " Epistemologically speaking, no one can know what he 
 does not objectify." 
 
 Wishes, interests, therefore, in the sense of autonomic crav- 
 ings, needs, come thus to be objectified. And the course of de- 
 velopment could well be followed by noting the objects in which 
 the individual becomes progressively interested. This is the mech- 
 anism of objectification. 
 
 This gives a form of idealism which does not deny objective 
 reality, but which does realize that objects of reality can have no 
 meaning for the individual until he perceives them, but as this 
 perception is already a part of his action upon them it is because 
 he has projected his attention, his interest upon them for the pur- 
 pose of bringing about a better adjustment in relation to them, 
 that they are perceived, and further, that perception is a process 
 of objectification is seen when it is realized that what is perceived 
 depends upon the particular motor set toward the object, in other 
 words, what action is contemplated with reference to it. 
 
 11 Carpenter, Edward; Pagan and Christian Creeds, Their Origin and 
 Meaning. New York, Harcourt, Brace and Howe, 1920. 
 
 12 Hall, G. Stanley: Jesus, the Christ, in the Light of Psychology. 
 
Il6 FOUNDATIONS OF PSYCHIATRY 
 
 This mechanism of objectification is important to understand 
 because it is fundamental in the process of psychotherapy when it 
 figures under the name of transference. Transference, or the 
 transfer, as it is called, has been a subject much discussed of late 
 in connection with that method of psychotherapy known as psy- 
 choanalysis. It is understood then to be the projection of the 
 patient's affects upon the analyst, the physician, and is known as 
 positive transfer when the affects are the love interests (creative), 
 and negative transfer when the affects are antipathic (hate, de- 
 structive interests). The positive transfer means in general that 
 the patient does not unburden himself, bare his soul, discover his 
 intimate self to one who is indifferent to him. That he can only 
 do this to one for whom he has regard, in whom he has confidence 
 and for whom he has respect. Then again the variations in the 
 quality of the transfer, its positive or negative quality, is further 
 explained by the fact that the patient objectifies his loves and 
 hates in the person of the physician and in the course of the anal- 
 ysis. As the different aspects of his personality are dealt with 
 the patient reacts towards the physician as he had reacted in his 
 past towards those persons in his milieu for whom he thus fdt 
 love and hate. The physician thus acts like a catalyser drawing 
 forth the emotions of the patient and representing in his own per- 
 son those persons who in the past had been the objects of those 
 emotions. 
 
 These phenomena of the transfer, although exclusively dis- 
 cussed by the psychoanalytic school, are, however, by no means 
 confined to the psychoanalytic situation. As a matter of fact they 
 are the phenomena of all personal relationships; they are in evi- 
 dence in all friendships — positive transfers — and in all enmities — 
 negative transfers : and they are particularly important as effect- 
 ing the relations of physician and patient. It is not only the psy- 
 choanalyst who has to d^l with the transfer but every physician, 
 the only difference is that the analyst is conscious of the transfer 
 and sees in it something which can be effectively used to advance 
 the cure, while other physicians are unconscious of its existence 
 and either get in difficulties which they do not understand or else 
 produce results which are inexplicable or attributed erroneously 
 to some agency which had nothing to do with producing them. 
 
 This latter aspect of the transfer is of very great importance 
 
THERAPEUTICS II7 
 
 in the field of therapeutics today, as it always has been in the past. 
 Faith in the physician has always been recognized as a valuable 
 adjuvant but to the wide ramifications of this faith and its results 
 physicians as well as laymen have usually been quite blind. To 
 realize that patients only consult the physician in whom they 
 have confidence and that from such a source they meet sugges- 
 tions half-way and accept encouragement in a spirit of coopera- 
 tion, are commonplaces and only touch the surface of this impor- 
 tant problem. 
 
 To begin with, transference is one aspect of the process of 
 objectification, and objectification, as already described, is the 
 projection of interest and a necessary process in development, 
 and the nature of the objects upon which the interest is projected 
 is an indication of the stage of development reached. For ex- 
 ample the child projects its interest upon dolls, the youth upon 
 sports, the young man upon his business or profession, the middle 
 aged man of some leisure upon art and literature, the old man 
 upon the past. 
 
 Now one of the important aspects of mental illness is that 
 some of the interests of the patient tend to remain at a low level 
 of development, that is, they tend to remain relatively infantile 
 and these infantile interests are relatively self-centered, that is, 
 selfish as compared with the more completely objectified interests 
 of the adult. The transfer of interest upon the physician, there- 
 fore, helps the interests of the patients to release themselves from 
 their selfish fixations and to become objectified. The physician is 
 the bridge over which the patient's interests may pass from him- 
 self to the outer world of reality. It not only helps in this way 
 but it helps further because the physician is the objectified symbol 
 of the patient's desire for health and therefore is peculiarly 
 capable of attracting the self-centered interest. More than that, 
 health involves a getting away from infantile, selfish interests 
 and so in seeking health the objectification tends to be lifted, to a 
 higher plane. 
 
 The physician not only symbolizes the patient's desire for 
 health but he stands also as an objectification of the patient's 
 father or rather of the father's image (imago) as it was originally 
 formed in the mind of the child and has since become uncon- 
 scious. The father of the infant was to all intents and purposes 
 
Il8 FOUNDATIONS OF PSYCHIATRY 
 
 a God, all-powerful, capable of bringing anything to pass. The 
 child looked up to the father with complete faith in his ability to 
 take care of it, to vanquish all its foes, to provide all its pleasures. 
 The physician, therefore, symbolizing this original attitude of the 
 child for the father, stirs the reverberations of that authority 
 which the father once had and can so command the faith of the 
 patient that his interests will be turned from lower to higher 
 levels, the process of objectification will be progressive and away 
 from infantile and selfish interests. In the psychoanalytic situa- 
 tion the physician becomes the repository, so to speak, of the af- 
 fects of the patient and so represents each person in turn, as 
 revived in the course of the analysis, who had an emotional in- 
 terest for the patient. It is the power of love and authority or 
 perhaps the authority of love. 
 
 In the mentally ill patient the fixation of the interests at sel- 
 fish levels produces self-indulgences which give pleasure, then 
 this pleasure tends to increase the selfish interests which are 
 gratified by self-indulgence, and so a vicious circle is established 
 which tends to constantly plunge the patient to developmentally 
 lower and lower levels of pleasure seeking and rob him more and 
 more of the capacity for effective dealing with reality. The 
 patient who is constantly resorting to narcotics to escape from 
 reality finds the experince so pleasant that it is frequently re- 
 peated with a progressive lessening of the thought of inter- 
 fering objections from his better self. Some strong emotional 
 appeal (love interest) is necessary to break the vicious circle and 
 redirect the energies and interests in a new channel and thus 
 make the energy again available for progress. The physician 
 is able to do this because he stands as the symbol of love and au- 
 thority, he is the symbol of the patient's ideal. It is because of 
 this mechanism of cure that any method of treatment, no matter 
 what form it takes, Perkin's tractors to laying on of hands, will 
 cure somebody. The cure can only be understood when the per- 
 sonal element is taken into consideration. This element is also 
 of great importance in estimating the results in general medical 
 practice. First one and then another drug or operation is cred- 
 ited with excellent results but practically never are the psycho- 
 logical factors involved given due consideration. Only when they 
 are will an adequate estimate of the effectiveness of therapeutic 
 agents be possible. 
 
THERAPEUTICS II9 
 
 Another aspect of the phys-ician as symbol which is impHed 
 in what has already been said is that as ideal he attracts the in- 
 terests and tendencies of the patient to expression at a higher 
 level and therefore helps to detach them f rom> these lower levels 
 of fixation which, after all, is the reason for the illness. In the 
 vicious circle of alcoholism, for example, the analysis shows the 
 patient how he is misusing his energies and how he can better 
 employ them. The authority of the physician (transfer) en- 
 ables him to make the start. The important reason for making 
 explicit this particular aspect of the situation is that it involves a 
 very important element in the treatment. Just as the most impor- 
 tant characteristic for the parent to possess is a real love for the 
 child, irrespective of any intellectual orientation towards the 
 problem of the parent-child relation, so the most important single 
 characteristic for the physician to possess is a sincere desire to 
 help the patient. In other words, the character of the physician 
 is perhaps of more importance than his skill in the details of 
 technique. While this statement may be subject to many qualifi- 
 cations in general it is at least a safe principle to proceed upon. 
 The continuous presence of a good example to iollow in the per- 
 sonality of the physician is a constant stimulus to progress. For 
 this ■ reason the physician should not be too intimate with the 
 patient for fear of impairing the ideal which can hardly ever 
 stand too close examination. 
 
 The reason for the above statement is the existence of those 
 very possibilities for apprehending the real motives of others al- 
 ready referred to in the discussion of language. The unconscious 
 is keenly alive to the real motives of others and constitutes a 
 great background of information which furnishes those subtle 
 instructions that makes one feel instinctively at harmony or in 
 opposition to others as their friendly or hostile motives are un- 
 consciously sensed. The unconscious, as it were, has myriad 
 feelers reaching in all directions into the surrounding personal 
 environment and furnishing most valuable information for guid- 
 ance. There recently appeared a play on the movie screen which 
 disclosed only the feet and lower part of the legs of the actors. 
 The play lasted about twenty minutes, the actors were numerous, 
 and the situations many, but at no time was there the slightest 
 doubt as to just what was going on. If the feet can furnish so 
 
120 FOUNDATIONS OF PSYCHIATRY 
 
 much information the entire body is surely as informing. There- 
 fore the possession of a carefully intellectualized technique by 
 the analyst is not enough, he must be an essentially constructive 
 person with a sincere desire to help, possessed of that quality of 
 sympathy which is never led astray by the unessential but always 
 insisting upon the best of which the patient is capable. 
 
 To this background of feeling which forms the principal 
 means of contacting with the personal environment and which, 
 as the unconscious, forms the great mass of the common posses- 
 sion of all, the upper consciousness is highly sensitive and keenly 
 responds in all its changes which are expressed on this level in 
 symbolic form. The psychological level is the level of the symbol, 
 which at once reflects the integrations below and, serving as their 
 final expression, also serves to explain them. Therefore at all 
 times the tendencies of the individual are expressed at the sym- 
 bolic level and as their tendencies vary so do the symbols which 
 express them vary. This variation of symbol which expresses the 
 individual at the psychological level is the process of resym- 
 bolization. 
 
 This process of resymbolization furnishes the outer evidence, 
 at the psychological level, of the various changes in the total re- 
 action formula of the individual. The symbol indicates the con- 
 clusion, so to speak, which has been reached as a result of the 
 conflict of opposing tendencies. A repressive conclusion pro- 
 duces a symbol in which the repressive tendency can be traced, a 
 creative and progressive conclusion will shadow forth corre- 
 sponding qualities in the symbol ; a failure to reach a conclusion 
 because the conflicting tendencies are of equal force will produce 
 a symbol which can be translated as meaning doubt ; various de- 
 fensive tendencies, compromises, projections, rationalizations, are 
 symbolically expressed. For example, the productions of de- 
 mentia precox show frequently and characteristically symbols of 
 regression; the delusions of the paranoiac are compensatory; 
 those of the prison psychosis frequently of a defensive character. 
 
 The process of resymbolization is nothing more than the proc- 
 ess of clothing thought in symbols ; as the thought changes so do 
 the symbols change. 
 
 Bertschinger" has called attention to the part this process 
 
 1' Bertschinger, H., Processes of Recovery in Schizophrenia. The 
 Psychoanalytic Review, Vol. Ill, No. 2, April, 1916. 
 
THERAPEUTICS 121 
 
 plays in the getting well of certain schizophrenics. He has de- 
 scribed three ways of getting well ; namely, by correction of the 
 delusions, by evasion of the complex, and by resymbolization of 
 wishes which are inacceptable to the consciousness but neverthe- 
 less can not be denied expression. By resymboHzation in the 
 form of the delusions they both gain a certain acceptance and a 
 degree of expression. The delusion of persecution, mechanism 
 of projection, is the best recognized example. The conversion 
 of psychical into bodily symptoms as seen in hysteria can be 
 similarly explained. In fact the whole range of delusional ex- 
 periences are but resymbolizations made in response to the de- 
 mand that a certain degree of social value should attach to the 
 symbol. 
 
 The way in which this process works in bringing about re- 
 covery is well illustrated by the story told by Clark of the Japanese 
 woman who lost all her sons in the war. The loss was too much 
 to adjust to all at once so she kept on setting their places at the 
 table just as if nothing had happened. Then she dropped out 
 one place, then after a while another, and then another, until 
 finally they were all gone and so by diluting the affect was able to 
 make an adjustment to it. 
 
 This mechanism was, too, shown by a patient who had been 
 guilty of a deliquency in her early childhood which had been the 
 cause of her neurosis. She had for years tried to bring herself 
 to confess her sin to her brother but while she was still trying to 
 make up her mind to do this her brother died. In telling the story 
 she identified the physician as her brother, that is, she resym- 
 bolized her brother and thus by confessing to him she accom- 
 plished what she had been trying to do for so many years and 
 was cured. 
 
 This resymbolization is a process familiar in every day 
 thought. The politician who will not accept a bribe will take 
 five thousand dollars he finds in his coat pocket. He convinces 
 himself that he does not know who put it there and so can not 
 return it. Why should he not use it ? Many of the present day 
 facts of psychology have always been known by the poet and 
 artist but it was necessary to clothe them in their present S3mi- 
 bolic form, to resymbolize them, before they were recognized by 
 the scientist. 
 
122 FOUNDATIONS OF PSYCHIATRY 
 
 Resymbolization of social and legal concepts is constantly- 
 taking place and in general the resymbolization is indicative of 
 the various stages reached in the advance of the social conscious- 
 ness although, of course, from time to time the reverse process 
 is in evidence. In this process of resymbolization selfishness be- 
 comes altruism, charity becomes benevolence, duty becomes a 
 privilege in the forward progress of human ideals. The con- 
 trary factors of the conflict unite in a synthesis at a higher level 
 and are expressed by a dififerent symbol. Language gives these 
 symbols concrete form and at once the mould of language begins 
 to be stretched as the symbol expands in meaning until finally it 
 is no longer able to stretch further and a new symbol arises to 
 express the new meaning. The constant efifort to express thought 
 clearly in words helps in the very effort to clarify the thinking 
 and frequently results in the formulation of new terms. Each 
 new thought movement, therefore, tends to develop its own pecu- 
 liar set of language symbols to suit its own particular purposes. 
 
CHAPTER VIII 
 
 The Social Problem 
 
 Elevation — Rationalization — Sublimation — The Socialisation of 
 
 Strivings 
 
 The process of progressive resymbolization described in the 
 last chapter is the outward evidence of sublimation which is the 
 process of the continued refinement of the conflict as its suc- 
 cessive solutions are carried to higher and higher levels of ad- 
 justment. Resymbolization and sublimation thus stand in the 
 service of constant readjustment to progressively higher levels 
 and thus in the service of cultural advance. Every adjustment 
 to a higher level, however, is not sublimation. The energy of a 
 repressed desire is often transferred to a higher method of ex- 
 pression which, however, is not a sublimation but only an eleva- 
 vation, to use the term proposed by Pfister.^ 
 
 In sublimation the succeeding higher ways of expression are 
 each in turn satisfactory. The child that begins by making mud 
 pies, then takes to clay modelling and drawing, studies archi- 
 tecture and engineering, becomes a builder and an architect has 
 found full expression all along the line which led him straight in 
 the path to an ever increasing efficiency in the expression of ever 
 higher creative ideals. This is the true process of sublimation. 
 
 The history of the individual with a repression, however, is 
 quite different. Take for example the young woman who, disap- 
 pointed in her love life, has had to renounce and repress her cre- 
 ative sexuality. The higher levels of expression, in such a case, 
 are cut ofif from utilization. Because, however, she can not fully 
 express herself it does not mean that her cravings in this respect 
 are stilled and become non-existent. Quite the contrary, they are 
 as strong as ever but they must now find some other, some aber- 
 rant way to gain expression. They find a way by a process analo- 
 
 iPfister, Oskar, The Psychoanalytic Method. Moffat, Yard & Com- 
 pany, New York, 1917. 
 
 123 
 
124 FOUNDATIONS OF PSYCHIATRY 
 
 gous to short circuiting. They drain off at other levels of 
 activity, but in a symbolically disguised form. Because their way 
 to higher levels is blocked, and because their activity at lower 
 levels is inacceptable to the individual, they can only gain their 
 expression under the guise of being something else than they 
 really are. Such a young woman may easily become a prude 
 thus reacting by the opposite tendency against her sexuality. In 
 the role of a prude she finds herself called upon to be a bitter 
 critic of all forms of sexual freedom or display even in their 
 most innocent and often useful forms, she constantly harps upon 
 such subjects as modesty, and takes soundly to task all her 
 friends and associates for being offenders. She is shocked by 
 the nude in art, by the tendencies of the modem drama, by the 
 new dances, and by a host of other tendencies which she sees 
 about her and which all testify to, as she thinks, the degeneration 
 of modern society. 
 
 All of these reactions of the prude are reactions at a higher 
 level than her repressed cravings would take if unhampered by 
 her intrapsychic censorship so long as the higher means of ex- 
 pression remain closed. Her reactions, therefore, are not sub- 
 limations but elevations. 
 
 See how subtly this works, for while she is obviously arrayed 
 with all her forces against the various forms of manifest sex- 
 uality of which she is the self constituted critic still the very fact 
 of the constant tendency within her which makes her never lose 
 a chance to criticize has made her eagle eyed for sexuality so 
 that she is able to see it even when it does not exist. She has 
 therefore created a role for herself which permits her to occupy 
 herself constantly with the hated subject. In fact her prudery is 
 but a disguise in which she may safely occupy herself continu- 
 ously with sexuality but in the form of a censor instead of a 
 votary. She has, in a subtle and clever way, succeeded in gain- 
 ing expression for her interests in a way which successfully 
 disguises her real intent, not only to others, but more important 
 still, to herself. This is the mechanism at the basis of hypocrisy 
 and while it has its uses it is a long way from that all round satis- 
 fying type of expression which evidences a well rounded char- 
 acter m:ake-up. It is a neurotic device, and one so common that 
 it is of extreme importance to understand "for evaluating many 
 
THE SOCIAL PROBLEM I25 
 
 forms of activity, particularly as seen in certain types of social 
 reformers. 
 
 It is obvious that the ambivalent opposite of the prude, the 
 type of reaction which would follow if there were no repression 
 and consequent elevation, would be a yielding to the cravings, 
 which, being denied their outlet above, would find expression at 
 lower levels. Such expressions, which it can be seen must be 
 of a relatively infantile character, although as heretofore ex- 
 plained their infantile character is masked because of the adult 
 setting, might take the form of an open, unabashed interest in 
 obscenity and vulgarity, a frank yielding to such interests rather 
 than an over correction of them by suppression and elevation. 
 
 In either case, the prude or the decadent, if an explanation 
 were sought for the conduct it would at once be forthcoming. 
 The explanation would be full and logical somewhat in propor- 
 tion to the intellectual resources of the individual but there would 
 be an explanation. As in the case of the symbolic disguise, how- 
 ever, the explanation is meant for home consumption mainly, it 
 is an explanation after the fact so to speak. Some one has said 
 that reason is for the purpose of explaining what we do and so it 
 it is in this case. One does what one wants to do and then pro- 
 ceeds to find a good reason for having done so. This is the proc- 
 ess of rationalisation which, although not by any means always or 
 often obviously, yet frequently, if not always, is a process of jus- 
 tification. This process is the intellectual reverberation of repres- 
 sion and elevation and serves to assist further in the process of 
 distortion and disguise. In sublimation the various integrations 
 follow along the line of the expanding personality and afford 
 satisfactory expression for its cravings at successively higher 
 levels. The intellectual reverberations are free from indirec- 
 tions and never the servants of a repressed and pent up affect. 
 A laboratory scientist, as a result of his e3q)erimentations, can 
 calmly and judicially discuss the effects of alcohol on the human 
 organism; an individual whose whole fortune is invested in its 
 manufacture and sale can hardly be expected to. This is the 
 basis of prejudice and forms a very fertile soil for the growth of 
 rationalizations. The scientist, in this illustration, gives his rea- 
 sons which he^backs up by the facts brought out by his experi- 
 ments : the other tends to make his arguments stick by the force 
 
126 FOUNDATIONS OF PSYCHIATRY 
 
 of their utterance and deals in glittering generalities of statement 
 which again he backs up by emphatic pronouncements and ap- 
 peals to feeling rather than to facts, as if a statement could be 
 made true by mere force of utterance. This is the infantile ap- 
 peal to magic which once produced results. At one time in his 
 life by merely making enough noise when he was hungry the food 
 was forthcoming. The method once so useful is resorted to 
 when the higher levels of discharge, that is good reasons, are not 
 available. It is one of those reactions which testify to a lingering 
 conviction of the all-powerfulness of thought, to the continued 
 existence of a Jehovah complex, a feeling of omnipotence which 
 is relinquished with such difficulty because it is so satisfying and 
 its relinquishment involves such painful realizations and renun- 
 ciations. 
 
 Sublimation is the name given to the results of continuous 
 successful solutions of conflicts along the lines of the most ef- 
 fective unfolding of the personality. Its ambivalent opposite is 
 regression and its more or less successful imitator is elevation. 
 The successfully sublimated, well rounded personality would be 
 neither a prude nor a decadent but would accept sexuality in a 
 simple and unprejudiced way and be able to see it in the general 
 scheme of things as a great force for good, as a power second 
 to none through which the higher aspirational strivings could 
 find expression. In as much as in the progress of evolution and 
 development there are no hiatuses but a gradual unfolding, 
 whether it be conceived as taking place by a sense of infinitesimal 
 changes or by saltatory mutations, there can be no great breach 
 between man and the lower animals on the one hand or man 
 and society on the other. Society is but the expression of a 
 higher series of integrations and, as already pointed out, psycho- 
 logical defects of adjustment can only be adequately understood 
 when they are considered as reactions of man as a social animal. 
 Sublimation therefore is in line with civilization for as man ad- 
 vances on the path of successively higher integrations his prob- 
 lems come more and more to involve his relations with his 
 fellows. Relations which themselves are on the way to ever 
 greater complexities as the lower integrations are successfully 
 negotiated. Sublimation comes therefore to mean more and more 
 a socialization of man's cravings, desires, wishes, and represents 
 
THE SOCIAL PROBLEM 127 
 
 man's answer to the problem of adjustment, the problem of at- 
 tempting his ideals. Regression, on the other hand, which is the 
 opposite of sublimation, is a movement away from socialization. 
 It calls forth reactions which are relatively infantile but occurring 
 in an adult setting are seen to belong to a type of reaction which 
 should have been left behind on the path of development, as, 
 therefore having either no social value or being positively socially 
 harmful and are therefore stamped with the disapproval of 
 society. As a foreign body taken into the animal economy is 
 expelled by vomiting, purging, or by the more involved method 
 of inflammation and abscess formation, so by analogy the anti- 
 social or asocial individual is similarly extruded by the more vio- 
 lent methods as applied to the criminal classes or by the milder 
 methods as applied to the so-called insane, methods which can 
 only be improved upon as a result of a wider knowledge of these 
 classes and what they mean and by a further realization that 
 much of the energy side-tracked by them and given over to de- 
 structive activities is salvable for purposes of social value.'' In 
 fact rare and highly valuable personalities are not infrequently 
 caught up in an emotional jam which can be relieved and when 
 relieved will release energies of rarest worth. All of the mech- 
 anisms discussed in this chapter ; namely, sublimation, elevation, 
 rationalization, are expressions of an effort toward socialization, 
 the integration of man into an organism of a higher order — 
 society. 
 
 2 For a discussing of these classes see my Principles of Mental Hy- 
 giene. The Macmillan Company, New York, 1917. 
 
CHAPTER IX 
 
 Conclusion 
 
 The development of the scientific principles underlying that 
 department of the practice of medicine that deals with mental dis- 
 eases — ^psychiatry — has led to a new and a more comprehensive 
 concept of the human animal which is of the utmost importance 
 not only to psychiatry but to medicine in general and also to the 
 consideration of man as a social animal — to sociology. Just as 
 the biologist has concluded that " species are essentially nothing 
 else than stages of evolution interrupted at definite points in the 
 developmental path,"^ so it is equally correct to interpret the in^- 
 dividual as a concrete locus where for the time being the life 
 forces are nucleated and to realize that for his adequate under- 
 standing such a concept, that no longer considers him as an entity 
 but as related in a dynamic way to the forces of nature in general 
 and the life forces in particular, is necessary. From this point 
 of view the individual becomes a problem in energetics and his 
 successes, failures, and compromises indications of the way in 
 which he has been able to utilize the life forces. 
 
 From this more comprehensive approach it is no longet 
 enough that the individual should be studied ^y a method that is 
 predominantly analytical, that considers his separate parts, his 
 organs, as such and attempts to define their functions and dis- 
 eases out of relation with the whole vast problem of the part he 
 is playing in the larger scheme of things. A pragmatically teleo- 
 logical attitude is necessary that attempts to understand what the 
 organism is striving to bring to pass in order to adequately eval- 
 uate the forces and the tendencies found operating. The human . 
 organism is striving for a dififerent goal from a horse, a fish, or 
 an invertebrate and each individual has a goal slightly different 
 from his fellows. Only when the goal is known can there be a 
 
 ^ Eimer, Th., On Orthogenesis and the Impotence of Natural Selection 
 in Species-Formation. The Open-Court Publishing Company, Chicago, 
 1898. 
 
 128 
 
CONCLUSION 129 
 
 full appreciation of the part each organ is playing in the attempt 
 to reach it. 
 
 In this broad concept of living beings the play of forces can 
 be seen to follow laws already familiar in other departments of 
 learning but obscured in the field of the psyche 'because clothed 
 in different symbols which are not calculated to emphasize their 
 similarity. Ideas and emotions are only beginning to be thought 
 of as subject to laws in any way analogous to the laws that gov- 
 ern the distribution of energy as they have been worked out in 
 the realm of physics. However this may be it soon becomes evi- 
 dent in tracing the strivings of the organism and the nature of 
 the obstacles it has to overcome to effect its purposes that it 
 behaves in every way as if subject to such laws although, in this 
 region, they are not as yet subject to quantitative measurement. 
 
 In the previous chapters the phenomena of the striving or- 
 ganism have been traced as it fought its way along the evolutional 
 pathway and the manifestations of those strivings have been in- 
 dicated as they occurred at what have been termed, solely of 
 course for pragmatic purposes, its different levels. It goes with- 
 out saying that in a dynamic concept of the organism such as has 
 been built up in this book no levels, as such, could possibly have 
 a concrete, definite existence. They are only conceived of as 
 series of phenomena that partake preponderantly of particular 
 characteristics and are used in order to more readily deal with 
 the facts. Like words they are crystallizations where no crys- 
 tallization exists, or like the separate pictures of a cinematographic 
 film they are fixed representations of what in reality are moving 
 elements of a constantly changing series but brought into exist- 
 ence because of the necessities imposed by the method of han- 
 dling facts. 
 
 In this moving equilibrium the important forces that are con- 
 cerned as they operate to produce certain effects and are met by 
 resistances, antagonistic forces operating in opposition, have been 
 traced by their manifestations, and the broad analogies between 
 actions and reactions as they occur at the different levels have 
 been pointed out. From this point of view the organism is con- 
 ceived of as being the host of innumerable forces which tend to 
 produce each its respective results and the sum total of all of 
 them acting and reacting upon one another gives the picture of 
 
130 FOUNDATIONS OF PSYCHIATRY 
 
 the dynamic organism working out its destiny as conditioned by 
 their final pattern. 
 
 And finally, for the purpose of psychiatry, the final patterns 
 of all of these strivings find their expression in reverberations, 
 symbolic correlates, at the psychological level and the symbol 
 expresses in an over-determined and tremendously condensed 
 form what is going on in terms of the tendencies of the organism 
 as a whole, as a unity. 
 
 In tracing the evolution of these symbolic correlates they are 
 found to express a well defined tendency to the gradually increas- 
 ing control of intelligence over the more purely affective qualities 
 of the psyche, a gradually increasing field of conscious awareness 
 and an increasing capacity for logical reasoning and volitional 
 regulation. Thinking by means of crude analogies is replaced by 
 logical reasoning and the roots of the sciences in magic finally 
 produce the flower of the modern scientific disciplines with their 
 elaborate experimental verifications. 
 
 When man arrives upon the scene he comes to his problems 
 with the heritage of millions of years of organic evolution, mil- 
 lions of years of struggling with problems of adjustment, and 
 with the solutions which have been reached during all these long 
 ages laid down in his structure. Structures are but the precipi- 
 tates of functions. To the extent that these structures represent 
 effective solutions of these problems, such problems as nutritioii 
 as solved by the gastro-intestinal system, the problem of the 
 utilization of oxygen as solved by the respiratory system, the 
 structures and functions concerned are relatively stable and little 
 likely to be severely disturbed by anything less than unusual and 
 extraordinary forces. But at the psychological level matters are 
 different. Here the structures, mental mechanisms, are relatively 
 young and so less stable ; the problems which have to be met are 
 more complex and less uniform in character so that inadequacies 
 are more firequently developed. The chances that the organism 
 will develop defects of adjustment are, other things equal, much 
 greater at the psychological or psycho-sociological level than they 
 are at the physiological level. Even when there are defects of 
 structure and function, that is at the anatomical and physiological 
 levels, the inadequacies that are developed are often, at least, to be 
 attributed to the demands that are made upon the organism from 
 
CONCLUSION 131 
 
 above, the psycho-social demands, rather than to the actual defects 
 themselves which, in such cases, are often not so great but that 
 the organs could function well enough at a level of lessened re- 
 quirements. It is the everlasting striving upward, the push of 
 that vital urge which drives all living things to their utmost that 
 stresses the machine to its limits and develops its inadequacies. 
 The medicine of the future must learn to read the signs at the 
 symbolic — 'psychological — ^level more accurately, to learn from 
 them the nature, the quality, and the strength of those strivings 
 at the only level where, from present knowledge at least, they 
 manifest themselves, so as to learn what the problem is with which 
 the individual is confronted and so learn how to assist more in- 
 telligently with its solution. To be able to do this will require 
 the broadest, the most profound understanding of man, not only 
 structurally and functionally but also in terms of his past. " Let 
 no one think he has shaken off the past : We are in and of it, if 
 we are also of ourselves. Our thoughts and the images in which 
 we clothe them, what ancestry they trail out of a dim and ever 
 lengthening distance, back through Rome to Greece, and through 
 Greece backward still and eastward to the valleys of the Nile and 
 the Euphrates. And there the receding trail only begins, for 
 further back it passes, not ceasing, only to our blindness vanish- 
 ing in a remote and semihuman past. It is well to recognize the 
 pit from which we have been digged."^ It is with the heritage 
 from this past that he has to meet the problems that arise from 
 "the human need for adjustment between the instincts and 
 faculties of human nature and the powers conceivably controlling 
 its accomplishment and destiny."' 
 
 With this heritage from the past of structures and functions, 
 of instincts and traditions each man is called upon to face prob- 
 lems of adjustment both from within and from without which 
 in their main general features are fundamentally alike for all 
 but which on the other hand are, in their individual ramifications, 
 different for each one. The degree of his success or his failure 
 is a function of the whole complex of the interplay of all the 
 factors concerned. In any case, no matter how great his success 
 
 2 Taylor, H. O. : Prophets, Poets, and Philosophers of the Ancient 
 World. The Macmillan Co., New York, 1919. 
 
 3 Taylor, op. cit. 
 
132 FOUNDATIONS OF PSYCHIATRY 
 
 may be at first, each solution reached brings a host of new prob- 
 lems in its wake and ultimately everyone finally comes to a point 
 where no further progress is possible and failure begins. Life 
 ultimately issues in death but death only that life may begin again 
 and begin at a point a little further on so that the solutions of 
 succeeding generations may reach a little further forward on the 
 path of progress. On the way which leads to the death of the 
 individual minor deaths and rejuvenations are occurring to com- 
 plicate the picture. Organs are discarded, goals have to be aban- 
 doned, failures have to be accepted, desires must be renounced 
 and often out of renunciation comes a better adjustment, a new 
 and clearer vision. So life and death go hand in hand in the in- 
 dividual as they do in the race and out of each the other grows, 
 but another aspect of the great becoming. 
 
 The practice of psychiatry concerns itself with these partial 
 death tendencies as they manifest themselves at the symbolic 
 level. The neurosis or psychosis is an expression of the block- 
 ing of the instinctive tendencies of the individual because they 
 cannot become assimilated to his conscious purposes and the en- 
 ergy they contain be utilized in forward living activities. The 
 drive of these tendencies remains an emotional one which, striv- 
 ing to gain expression, meets with stabilized ways of traditional 
 thinking to which it is inacceptable. In their effort to gain con- 
 scious expression they are forced to a seeming conformity with 
 conventional ways of thinking and so in their real nature remain 
 obscure and unintelligible to their host. 
 
 In the progress of cultural developnient repression is utilized 
 to drive the expression of these tendencies from conscious aware- 
 ness and keep them in the realm of the unconscious and this 
 mechanism remains effective so long as the strength of the indi- 
 vidual is sufificient. But if for any reason such as an undue in- 
 fantile fixation the pleasure premium attached to these instinctive 
 strivings is unduly strong, or the obstacles to their sublimated 
 expression unduly great, or the power of resistance to their de- 
 mands is weakened by illness, fatigue, or mental or physical pain 
 and suffering they gain the ascendant, outward conformity to 
 traditional and conventional ways of thinking becomes impossible. 
 The balance has been destroyed and mental illness is the result. 
 
CONCLUSION 133 
 
 The goal of psychotherapeutics as well as that of further cul- 
 tural development is to make possible greater knowledge, to 
 enable the individual to see through and around his emotional 
 ways of thinking and therefore, instead of attempting to blind 
 himself to his affective needs being willing to examine them as 
 containing possible reservoirs of energy which can be made prac- 
 tically available in satisfactory ways. Conscious, rational and 
 voluntary control is sought as a substitute for blind affective 
 ways of reaction. To effect this change the physician as teacher 
 temporarily reproduces the parent-child relationship with his 
 patient in all those aspects that spell confidence, respect, affec- 
 tionate regard, absolute trust, and through the power of such an 
 affective relationship he is able to direct the thought of his patient 
 into those channels that assist him to emancipate himself from 
 childlike ways of thinking and feeling and towards the conscious 
 and voluntary assumption of adult responsibilities. 
 
 In the effort to effect this result it is necessary to examine 
 with great care and in minute detail the mental content of the 
 patient in order to help him to come to an understanding of the 
 nature and quality of his strivings as well as the character of the 
 obstacles to their fulfillment as expressed in the psychological 
 symbolism. The physician also must needs devote some atten- 
 tion to the quality of the somatic machinery with which the 
 patient has to operate in order to gain the fullest understanding 
 of his assets and liabilities and all of the ways in which he may 
 render assistance. The practice of psychiatry from this point 
 of view demands the broadest possible survey of the patient's 
 bodily and mental equipment and as such is as yet only in its in- 
 fancy. In this sense psychiatry bids fair to become the great 
 unifying medical specialty which emphasizes the necessity for a 
 consideration of the organism as a whole in the most compre- 
 hensive meaning of such a concept, recognizing and giving proper 
 weight to its heritage from the past on the one hand and appre- 
 ciating, on the other hand, the nature of its strivings to become 
 integrated with its fellows in the super-organism, society. It is 
 only by tracing the mechanisms of adjustment free from the 
 limitations to thought which are set by pragmatically developed 
 but artificial distinctions involved in classifications of knowl- 
 edge, such as those between the individual and the phylum, be- 
 
134 FOUNDATIONS OF PSYCHIATRY 
 
 tween body and mind, between individual man and society, it is 
 only by being able in thinking to transcend such limitations that 
 the dynaimic concept of struggling aspiring man as set forth in 
 this book is made possible and therefore that the conclusions 
 which flow from such a concept can be brought to bear upon the 
 problems of psychiatry. 
 
INDEX 
 
 All or nothing, 42 
 
 Ambitendency, 29, 50 
 
 Ambivalency, 28 
 
 American school psychopathology, 
 vii 
 
 Animal psychologist, 46 
 
 Archaic material, 107 
 
 Archaic modes, 60 
 
 Archaic types, 35 
 
 Auto-erotic, 58 
 
 Autonomic, 31 
 
 Autonomic apparatus and the per- 
 sonality, 99 
 
 Behaviorists, 47 
 
 Cell theory, 13 
 Censorship, 70, 88 
 Centralized authority, 22 
 Chromosomes, 15 
 Chronic visceral disease, 106 
 Collective unconscious, 55 
 Compensation, 107 
 Consciousness, 48 
 Conscious control, 8 
 Conflict, 28, 88 
 Cravings, 30 
 Cruelty, 6, 7 
 
 Dedifferentiation, j,"] 
 Descriptive psychiatry, 51 
 Deterministic attitude, 86 
 Disgust, 71 
 Dissociation, 86 
 Dissociation types, 107 
 Drag back, 92 
 Dynamic gradient, 17 
 Dynamics of the organism, 28 
 
 Elementalistic theory, 12 
 Elevation, 123 
 
 Emotions, 33, loi 
 Endocrine glands, 32, 109 
 Entelechy, 13 
 Environment, 7, 47 
 Epicritic mechanisms, 42 
 Evolution, 8 
 
 Family, 66 
 
 Feeling of inferiority, 92 
 
 Fictitious goal, 93 
 
 Fixation, 88 
 
 Flight to safety, 93 
 
 Head end, 22 
 
 Homosexuality, 61 
 
 Hormones, 19 
 
 Hunger, 36 
 
 Hypothesis of the unconscious, 87 
 
 Hysteria, 83 
 
 Ideas, 33 
 Individuation, 23 
 Individual-society relation, 70 
 Inferior organ, 93 
 Instincts, 33 
 Integration, 14 
 
 Justification, 125 
 
 Language, 75 
 Law, 66 
 Levels, 41 
 
 Masculine protest, 97 
 Mechanistic classification, 106 
 Memory, 113 
 
 Mental disease, idea of, 10, 70 
 Mental reactions, 82 
 Military, 66 
 Mind and body, i 
 Motor attitude, 49 
 
 135 
 
136 
 
 FOUNDATIONS OF PSYCHIATRY 
 
 Multiplication of effects, 30 
 Mutations, 8 
 
 Narcissism, 6i 
 Nature of mind, 34 
 Neuroses, 82 
 New psychology, S 
 
 Rationalization, 78, 123, 123 
 Recapitulation theory, 38; 60 
 Reflex, 24 
 
 Regression, 72, 88, 107 
 Repression, 87, 102, 107 
 Resymbolization, 112, 120 
 Reversible, 37 
 
 Objectification, 112 
 Organ inferiority, 98 
 Organismal theory, 12 
 Ontogeny, 59 
 
 Parallel path of opposites, 32 
 
 Partial reactions, 2 
 
 Personality, 4, 109 
 
 Phylogeny, 59 
 
 Physiological level, 41 
 
 Physiological unity, 22 
 
 Polar differentiation, 18 
 
 Possession, 10 
 
 Postural tensions, log 
 
 Prejudice, 125 
 
 Principle of ambivalency, 29 
 
 Principle of the conflict, 29 
 
 Projicient system, 36 
 
 Protopathic, 42 
 
 Psychasthenia, 83 
 
 Psyche, 21 
 
 Psychiatry, 51 
 
 Psychiatry, foundations of, vii 
 
 Psychiatry, philosophy of, vi 
 
 Psychiatry, study of, i 
 
 Psychoanalytic movement, 86 
 
 Psychoanalytic school, 47 
 
 Psychological level, 44 
 
 Psychopathological, 58 
 
 Psychopathology, 68 
 
 Psychopathology, American school, 
 
 vii 
 Psychoses, 82 
 Psycho-sexual, 71 
 Push back, 92 ■ 
 
 Scratch-reflex, 25 
 
 Self-determination, 26 
 
 Social problem, 123 
 
 Socialization, 41, 61, 127 
 
 Society, 65 
 
 Special creation, 11 
 
 Speech, 77 
 
 Starvation, 39 
 
 Stomach, 36 
 
 Stratification of the organism, 41 
 
 Stress-diagram, 29 
 
 Striped muscle, 36 
 
 Structuralization, 16 
 
 Structuralization of function, 21 
 
 Sublimation, 90, 123, 126 
 
 Suppression, 107 
 
 Symbol, 77 
 
 Symbolization, 89 
 
 Symmetry, 18 
 
 Sympathetic, 31 
 
 Teleological, 82 
 Therapeutics, 112 
 Total reactions, 3 
 Transference, 112, 116 
 Transmission of energy, 20 
 
 Unity of organism, 10 
 
 Vegetative nervous system, 31 
 Visceral disorders, 109 
 Visceral tonicity, 102 
 
 Whole-or-nothing response, 42 
 Wish, 10 
 
Outlines of Psychiatry 
 
 A Text-book of mental disease especially adapted for use in teach- 
 ing and which aims at helpingr the student beyond the point 
 of view of mere description and introduces him to the 
 more dynamic interpretative formulations. 
 
 By 
 WILLIAM A. WHITE, M. D. 
 
 Washington, D. C. 
 
 Eighth Edition 
 Price $4.00 
 
 NERVOUS AND MENTAL DISEASE PUBLISHING COMPANY 
 3617 Tenth Street, Northwest Washington. D- C. 
 
Volume VIII April, ly-^i Number! 
 
 The 
 
 Psychoanalytic 
 Review 
 
 H Sournal H)evote& to an 
 inn^erstanMng of Ibuman Conouct 
 
 EDITED AND PUBLISHED BY 
 
 WILUAM A. WHITE, M.D., and SMITH ELY JBLUPPB, M.D. 
 
 CONTENTS 
 
 ORIGINAL ARTICLES 
 
 The Rudiments of Character. D. Fossytb. 
 
 A Psychoanalytic Study of Manic-Depressive Psychosis. L. Dooley. 
 
 The Group Treatment of Dementia Prxcox. E. W. Lazell. 
 
 The Death of Pan. J. S. Van Teslaar. 
 
 A New Reading of Tennyson's " The Lotos-Eaters." M. K STRONa 
 ABSTRACTS: Varia: Book Reviews. 
 
 Issued Quarterly: $6.00 per Volume, 
 
 Single Numbers, $1.75 
 
 Foreign, $6.60 
 
 COPyKIOBT 1921 
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 NERVOUS AND MENTAL DISEASE PUBLISHINQ COMPANY 
 
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 under the Act ol March 3, 1879.