The Psychology of Dementia Præcox/Chapter IV

by Carl Gustav Jung

 

CHAPTER IV.

Dementia Præcox and Hysteria.

a parallel.

To write an exhaustive comparison between dementia præcox and hysteria would be possible only if we knew more thoroughly the disturbances of the association activities of both diseases, and especially the affective disturbances in normal individuals. At present we are far from this. What I intend to do here is to recall the psychological resemblances based on the preceding discussions. As a later treatment of the association experiments in dementia præcox will show, an antecedent comparison between dementia præcox and hysteria is necessary in order to understand the manifestations of the associations in dementia præcox.

1. The Disturbances of the Emotions.

The more recent investigators of dementia præcox (Kraepelin, Stransky and others) group the emotional disturbances about the central point in the picture of the disease. On one side one speaks of emotional dementia, and on the other of an incongruity between ideation and affect (Stransky).

I do not speak here of terminal dementia as seen in the terminal stages of the disease which can hardly be compared to hysteria (they are two totally different diseases), but I limit myself to the apathetic conditions during the acute stages of the disorder. The emotional apathy so striking in many cases of dementia præcox has a certain analogy to the "belle indifférence" of many hysterics who describe their complaints with smiling serenity, thus giving a rather inadequate impression, or speak with equanimity about things which should really profoundly touch them. In Contributions VI and VIII of the "Diagnost. Assoz.-Stud." I endeavored to point out how the patients apparently speak unemotionally about things which to them are of the most intimate significance. This is especially striking in analyses where one occasionally discovers the reason for the inadequate behavior. So long as the complex connection which is under special inhibition does not become conscious, the patient may tranquilly speak about it in a rather light manner and without going into detail. This manner of light talking may result in a condition of evasion producing contrasting actions. I had a hysterical patient under observation who, whenever she was tormented by a depressing complex, entered upon an unbridled jovial behavior, thus repressing the complex. When she related anything very sad which really should have deeply moved her, she accompanied it by loud laughter. At other times she spoke with absolute indifference (the accent, however, betrayed her deliberateness) about her complexes as if they did not in the least concern her. The psychologic reason for this incongruity between the ideational content and the affect seems to be due to the fact that the complex is autonomous and allows itself to be reproduced only when it wishes. Hence we see that the "belle indifférence" of hysterics does not last very long but is suddenly interrupted sometimes by a wild emotional explosion, a crying spell, or something similar. We notice the same in the euphoric apathy of dementia præcox. Here, too, we see, from time to time, now an apparently unexpected moodiness, now a violent act, or a striking freak, which have nothing in common with the former indifference. Professor Bleuler and I have frequently noticed at our joint examinations that as soon as analysis succeeded in laying bare the complex, the apathetic or euphoric mask immediately disappeared and was replaced by an adequate affect often quite a stormy one, just as in hysteria when the sore spot is touched. There are, however, cases in which the obstructions defending the complex can in no way be penetrated. The patients then continually give contemptuous and meaningless answers, that is, they simply do not enter into the question, and the more direct bearing the questions have on the complex the less they answer.

Not seldom we see that after intentionally or unintentionally producing complex stimuli in apparently apathetic patients, there subsequently appears a reaction having a distinct relation to the stimulus. The stimulus therefore acted after a certain period of incubation. In my experience with hysterical cases I frequently observed that in conversation the patient spoke with an apparently affected indifference and superficiality about certain critical points so that this pseudo-self-control surprised me. But a few hours later I would be called to the ward because this very patient had fallen into a spell. It was then ascertained that the trend of the conversation subsequently attained an affect. The same thing can be seen in the origin of paranoid delusions (Bleuler). Janet^[1] observed in his cases that at the time of the event which should have really acted as an excitant they remained calm, but after a latent period of a few hours or even days the corresponding affect manifested itself. I can confirm this observation of Janet. Baelz^[2] observed on himself, during an earthquake, the manifestations which he calls "emotional paralysis."

The affective states without adequate ideational content which are so frequent in dementia præcox have likewise their analogies in hysteria. Let us for example recall the state of anxiety in obsessive neuroses! Here as a rule the ideation is so inadequate that even the patients recognize it by its logical instability and rate it as senseless, yet it seems to be the source of anxiety. That this is not so is shown by Freud, in a manner which until now has not been refuted and we can only confirm it. I recall the patient from Contribution VI of "Diagnost. Assoz.-Stud.," who had the obsession that she infected her minister and physician with her obsessive ideas. In spite of demonstrating to herself that this idea was totally unfounded and senseless, it did not cease to cause her intense anxiety. The frequent depressions in hysteria are in a great many cases referred by the patients to reasons which can only be predicated as concealing-reasons (Deckursachen). Really one deals with normal reflection and thought which is hidden in the repression. A young hysterical woman suffered from such a marked depression that at each answer she causelessly burst into tears. Her depression she obstinately and exclusively referred to a pain in her arm which she accidentally felt while at work. It was finally found that she had a love affair with a man who refused to marry her, which was the real cause of her constant vexation. Therefore before we state that the precocious dement is depressed for reasons inadequate we have to represent to ourselves the mechanisms existing in every normal person, which always tend to repress the unpleasant and to bury it as deeply as possible.

The explosive excitements in dementia præcox may be brought about in the same way as the explosive affects in hysteria. Every person treating hysteria is acquainted with the sudden affect and acute exacerbations of the symptoms. Frequently we are confronted with a psychological riddle and deem it sufficient to note "patient is again excited." But a careful analysis always discovers a clear reason for the excitement; now it is a careless remark from those about her, now a certain letter, or the anniversary of a critical event, etc. To liberate the complex, a mere nuance, perhaps only a symbol will suffice.^[3] So also in dementia præcox, by careful analysis one may frequently find the psychological thread leading to the cause of the excitement. Of course we do not find this in all cases, the disease is too opaque for that, but we have absolutely no reason to suppose that no sufficient connections exist.

That the affects in dementia præcox are probably not extinguished but only peculiarly transposed and blocked, we see on rare occasions when we obtain a complete catamnestic view of the disease.^[4] The apparently senseless affects and moodiness are subjectively explained by hallucinations and pathological fancies which can with difficulty or not at all be reproduced during the height of the disease because they belong to the complex. If a catatonic is constantly occupied by hallucinatory scenes which crowd themselves into his consciousness with elemental force and with a much stronger tone than the external reality, we can then without any further explanations readily understand that he is unable to adequately react to the questions of the physician. Furthermore, if the patient, as described by Schreber, perceives other persons in his environment as fleeting shadows of men, we can again understand that he is unable to react adequately to the stimuli of reality, that is, he reacts adequately, but in his own way.

The lack of self-control or the inability to control the affects is characteristic of dementia præcox. We find this defect wherever there is a morbidly enhanced emotivity, especially in hysteria, epilepsy, etc. The symptom only shows that there exists a marked disturbance of the ego-synthesis, that is, there exist powerul autonomous complexes which no longer submit to the hierarchy of the ego-complex.

The lack of affective rapport so characteristic of dementia præcox we also freqauently meet in hysteria, where we are unable to chain the personality and penetrate into the complex. In hysteria, to be sure, this is only temporary, because the intensity of the complex is rather fluctuating, but in dementia præcox, where the complex is stable, we can get an affective rapport only for the moment if we get the power to penetrate into the complex. In hysteria we gain something by this penetration, but in dementia præcox we gain nothing, for immediately thereafter we are again confronted by the personality of dementia præcox just as cold and strange as before. Under certain circumstances one may by means of analysis even cause a flaring up of the symptoms. In hysteria, on the contrary, a certain loosening takes place when the analysis is over. Whoever has penetrated into the mind of a hysteric by means of analysis knows that he has thereby gained a moral power over the patient (this is also true of confessions among normal individuals). But in dementia præcox, no matter how thorough the analysis may be, everything remains as before. The patients cannot enter into the mind of the physician, they adhere to their delusional assertions, they attribute hostile motives to the analysis, they are, and in a word, they remain uninfluenced.

2. Characterological Abnormalities.

The characterological disturbances claim an important position in the symptomatology of dementia præcox, though one can really not speak of "dementia præcox character." Yet one might just as well speak of it as of a "hysterical character" into which, as every one knows, all kinds of prejudices are smuggled, such as moral inferiority and many similar ones. Hysteria creates no character, but only exaggerates the already existing qualities. In hysteria we find all temperaments, we have the egotistic and altruistic personalities; criminals and saints, sexually excited and sexually frigid natures, etc. Indeed what really characterizes hysteria is the existence of powerful complexes which are incompatible with the ego-complex. Under the characteriological disturbances of dementia præcox we might mention the embellishment; that is, mannerism, affectation, mania for originality, etc. This symptom we frequently meet in hysteria and especially often whenever the patients think themselves out of their social element. This embellishment is especially frequently seen in the form of pretentious and studied behavior among women of a lower station coming in contact with those socially above them, such as dressmakers, maids, servants, etc.; also among men who are dissatisfied with their social standing and who are attempting to put on the appearance of those of a higher education and more imposing station. These complexes readily connect themselves with aristocratic gaits, with literary and philosophic enthusiasms and "original" views and expressions. They manifest themselves in exaggerated manners, and especially in studied speech, such as bombastic expressions, technical terms, affected eloquence and high-sounding phrases. We therefore find this peculiarity especially in such cases of dementia præcox as entertain any form whatsoever of the delusion of social elevation (Delir der Standeserhöhung of v. Krafft-Ebing).

In this case the disease takes over the mechanism from the normal, that is, from the caricature of the normal (hysteria), but the embellishment contains nothing specific in itself. Such cases show a special inclination to neologisms which are employed as learned or otherwise distinguished sounding technical terms. One of my patients named them "power-words" (Machtwörter) and showed a special liking for all possible peculiar expressions which to her seemed quite pregnant. The "power-words" serve to elevate and garnish the personality as much as possible. The expressive emphasis of the "power-words" accentuates the value of the personality against doubt and enmity, hence they are frequently used in dementia præcox as defensive and conjuring formulæ. A precocious dement under my care, whenever the doctors refused to grant him anything, threatened them with the following words: "I grand duke Mephisto will lave you treated with blood revenge for Orang-Outang-representance." Others use the "power-words" to conjure the voice.^[5] (See, e. g., Schreber's "Denkwürdigkeiten.")

This embellishment is also expressed in gesture and writing; the latter, as is known, is especially decorated with all kinds of peculiar flourishes. We find a normal analogy to this, for example, in young girls who, out of capriciousness, imitate an especially marked or original script. Precocious dements frequently have a characteristic writing. The contrasting tendencies of their psyche are in a way expressed by their script, which is sometimes low and flowing, now precipitous, now large and now small. The same thing can readily be observed in temperamental hysterics, where one may demonstrate without any difficulty that the script variations begin at a complex. In the normal we also observe disturbances associated with complexes.

The tendency to embellishment is of course not the only source of neologisms. A great many originate from dreams and especially from hallucinations. Not seldom we meet with analyzable speech contaminations and sound-associations, the origin of which can be explained according to principles treated of in the receding chapters. (For excellent examples see Schreber.) The origin of the "word-salad" can be explained by Janet's conception of the "abaissement du niveau mental." Many patients who are somewhat negativistic and refuse to consider the questions show "etymological " inclinations, inasmuch as instead of answering they disjoint the question and eventually furnish it with sound-associations. This is nothing else than a transference and concealment of the complex. They do not wish to consider the questions and direct themselves therefore to the sound manifestations. (For the analogy of not taking up the stimulus word see Contr. VIII Diagnost. Assoz.-Stud.) There are many indications besides to show that the sound features of speech are more striking to precocious dements than to other patients, since they so frequently occupy themselves with word-dissection and interpretations.^[6] The unconscious shows a special tendency towards new speech formation. (See the "Himmelssprachen" of the classical somnambulists, and especially the interesting creations of Helene Smith.)^[7]

Regardlessness, narrow-mindedness, and an inaccessibility to persuasion, we find both in the normal and pathological spheres, especially when accompanied by affective causes. Under certain conditions there need only exist a firm religious or other conviction to make a person careless, cruel and narrow-minded. There is no necessity to assume for this an emotional dementia. On account of their excessive sensitiveness hysterics become egotistic and inconsiderate, and in this manner they torment themselves as well as their fellow beings. For this, too, there need be no dementia, it is simply a blinding through the affect. Indeed I must here again repeat the already often-mentioned restriction, namely, that between hysteria and dementia præcox there is only a resemblance of the psychological mechanism, but no identity. In dementia præcox these mechanisms reach much deeper perhaps because they are complicated by toxic effects.

The silly behavior of the hebephrenic finds its analogy in the Moria states^[8] of hysterics. I had under observation for some time a hysterical woman of high intelligence who frequently suffered from states of excitement during which she presented an exquisitely childish and silly behavior. This happened regularly whenever she was forced to repress sad thought-complexes: Janet is acquainted with this behavior which naturally appears in all gradations. He says: "These persons play a sort of comedy, they are young, naive, coaxing, they pretend complete ignorance and get to be quite like little children." ("Obsessions," p. 391.)

3. Intellectual Disturbances.

Consciousness in dementia præcox shows anomalies which have in many ways been compared to those of hysteria and hypnotism. Often there exist signs of narrowing of consciousness, that is, there is diminished clearness of one idea with abnormal increase of unclearness in all by-associations. Conforming to the views of various authors we may thus explain blind acceptation of ideas without inhibition or correction, a thing analogous to suggestion. Many would explain the peculiar suggestibility of catatonics (echo symptoms) on this basis. The only objection to be advanced against this view is the fact that there is considerable difference between normal and catatonic suggestibility. Normally we observe that the subject will, if possible, accurately adhere to the suggestion if he attempts to realize it, whereas in hysteria peculiar modifications may take place corresponding to the degree and kind of the disease. A suggested sleep may easily transform itself into a hysterohypnosis or into a hysterical dream-state, or the suggestions are only partially executed by the addition of unintentional by-actions.^[9] It is for this reason that hypnosis is less controllable in pronounced hysterics than in normal persons. The accidental in the suggestive manifestations of catatonics is still greater. Suggestibility often limits itself entirely to a motor sphere, resulting only in an echopraxia and often only in an echolalia. Verbal suggestion can rarely be carried out in dementia præcox, and even if it succeeds the effects are uncontrollable and as if accidental. There are always a number of strange elements mixed together with the normal suggestibility in dementia præcox. Nevertheless there is no reason why catatonic suggestibility, at least in its normal remnants, could not be reduced to the same psychological mechanism as in hysteria. We know that in hysteria the uncontrollable part of the suggestive effects is to be sought for in the autonomous complexes, and there is nothing against this being the case in dementia præcox. A capricious behavior similar to the one shown in suggestion is seen in dementia præcox in relation to other psycho-therapeutic measures, such as transfer, discharge,^[10] education by example, etc. That improvement in old catatonics when transferred to new sufroundings depends on psychological causes is shown by the fine and very valuable analyses of Riklin.^[11]

The lucidity of consciousness in dementia præcox is subject to all possible forms of obscuration; it may change from perfect clearness to the deepest confusion. Through Janet we know that in hysteria the fluctuation of lucidity is almost proverbial. In hysteria we are able to distinguish two kinds of disturbances, momentary and persisting. The momentary disturbance may be a slight "engourdissement" of a few seconds duration, or it may be a momentary hallucinatory and ecstatic invasion likewise of very short duration. In dementia præcox we know the abrupt obstructions, the momentary "thought-deprivation," and the lightning-like hallucinatory incursions with bizarre impulses. The lasting disturbance of lucidity in hysteria we know in the form of somnambulistic states with numerous hallucinations or in the form of "lethargic" (Lowenfeld) or cataleptic conditions. In dementia præcox it is shown in the form of persisting hallucinatory phases with more or less marked confusion and in stuporous states.

Attention in dementia præcox is, so to say, regularly disturbed, but the same disorder also plays a great part in the realms of hysteria. Janet notes the following as to the "troubles de l'attention": "One can say that the main trouble exists not only in a suppression of the intellectual faculties, but in the difficulty of fixing the attention. Their mind is always distracted by some vague preoccupation and they never give themselves up entirely to the object which one assigns to them." As shown in the first chapter, the words of Janet may also be applied to dementia præcox. It is the autonomous complex which disturbs the concentration of the patients, it paralyzes all other psychic activities, a fact which curiously escaped Janet. What is striking in hysteria (just as in other affective states) is the fact that the patients always return to their "stories" (as in traumatic hysteria!) and that all their thoughts and actions are constellated by the complex only. A similar narrow-mindedness, but of the highest intensity, we frequently observe in dementia præcox, especially in the paranoid form. It is hardly necessary to give examples. Orientation in both diseases changes in a similar capricious manner. In dementia præcox, where one is not actually dealing with marked excitability and deep confusion, we often get the impression that the patients are only disturbed by illusions, but that in reality they are properly oriented. In hysteria we do not always receive the same impression, but we may convince ourselves that proper orientation exists by hypnotizing the patient. Hypnosis represses the hysterical complex and allows a reproduction of the ego-complex. As in hysteria, disorientation is due to the fact that some pathogenic complex pushes the ego-complex away from the reproduction, a thing which may happen instantaneously; likewise in dementia præcox it may readily happen that quite clear answers are often replaced at the very next moment by the most singular utterances.^[12] The lucidity of consciousness is especially injured in the acute stages where the patients often are in a real dream,^[13] that is, in a "complex-delirium."^[14]

The hallucinatory delirious phases may, as we have said, be placed parallel to hysteria (of course it must always be kept in mind that we deal with two different diseases). The content of the hysterical delirium, as we readily discover when we use Freud's method of analysis, is always a clear complex-delirium; that is, the pathogenic complex appears as self-acting and spends its vitality usually in the form of wish-realization.^[15]

In the corresponding acute phases of dementia praecox we do not have to look long in order to find similar things. Every psychiatrist knows the deliria of unmarried women who pass through betrothals, marriages, coitus, pregnancies and births. I content myself here with this allusion, reserving everything till later, when I shall return to these questions. They are of extra- ordinary importance for the determination of the symptoms.^[16]

We pass then to the realm of delusions and hallucinations. Both symptoms occur in all mental diseases and also in hysteria. One therefore deals with mechanisms which are universally formed and are set free by the most variable injuries. What chiefly interests us is the content of the delusions and hallucinations to which we may also add the pathological fancies. Here, too, hysteria, this most transparent disease, can help us. Obsessive ideas can be placed parallel to delusions; so may also the affective narrow-minded prejudices which are so often met with in hysteria, and the stubbornly asserted bodily pains and complaints. I cannot repeat the genesis of these hysterical and delusional assertions, I must presuppose a knowledge of Freud's investigations. The delusional assertions of the hysteric are transferences, that is, the accompanying affect does not belong to them but to a repressed complex, which is veiled in this manner. An indomitable obsessive idea only goes to show that a complex (generally sexual) is repressed; the same is true of the other stubbornly asserted hysterical symptoms. We now have a well-grounded hypothesis (I base this on many dozens of analyses), that an undoubtedly similar process exists in the delusional system of dementia præcox.^[17] To illustrate my view I will cite this simple example.

A thirty-two-year-old servant had her teeth extracted so as to have a complete new set inserted. During the night following the operation there appeared a marked condition of anxiety. She considered herself damned and lost forever because she had committed a great sin. She should not have had her teeth extracted. People should pray for her that God might forgive her sins. The following morning the patient was again quiet and continued her work, but during the succeeding nights the anxiousness increased. I investigated her antecedent history obtained from her employers in whose service she had been for a number of years. Nothing, however, was known and the patient denied any kind of emotivity in her former life and emphasized with great affect that the extraction of the teeth was the cause of her disease. The disease rapidly progressed and the patient, manifesting all the symptoms of catatonia, had to be committed. Then it was discovered that for many years she had been concealing an illegitimate child, of whose existence even her family had not the slightest knowledge. For a year past the patient had been acquainted with a man whom she wished to marry, but could not fully decide to do so, as she was constantly worried by the fear that her lover would cast her off on learning of her former life. Here, then, was the source of the anxiety, and at the same time it becomes clear why the affect was inadequate to the extraction of the teeth.

The mechanism of transference shows the way to the comprehension of the origin of a delusional assertion. This way, however, is made difficult on account of infinite impediments. The well known oddness of the delusions in dementia præcox barely admits of any analogies. Nevertheless we have essential facts in normal as well as in hysterical psychology to allow of at least approaching the most familiar delusional forms.

Delusions of reference have been thoroughly analyzed and explained by Bleuler.^[18] Feelings of reference are found where there is a markedly accentuated complex. It is the peculiarity of all strong complexes to assimilate as much as possible; it is also a known fact that at the time of a strong affect we often have a momentary feeling as if "some one noticed it." An acute affect will especially cause assimilations of quite indifferent occurrences from the environment and thus the coarsest errors of judgment result. When we meet with some mishap we are quite ready during our first outbursts of anger to assume that someone intentionally injured and insulted us. In hysteria such prejudice may establish itself for a long time, corresponding to the magnitude and duration of the affect, and through which, without anything further, slight delusions of reference result. From this to the delusional assumption of strange machinations is only a step. This road leads to paranoia.^[19] The incredible and grotesque delusions of dementia præcox are frequently with difficulty explained by the delusions of reference. If, for example, a precocious dement perceives everything taking place within and without him as unnatural and "concocted," we may assume a stronger disturbance than delusions of reference.^[20] There is evidently something in the apperception of dementia præcox which prevents normal assimilation. The apperception either lacks a nuance or possesses one too much, thus receiving a strange accentuation (Berze!). In the hysterical realms we find analogies to this in disturbances of the feelings of activity. Every psychic activity, aside from the tone of pleasure and pain, is accompanied by still another feeling-tone which qualifies it in its own particular way (Höffding). What we mean by this will be best explained by the important observations of Janet in psychasthenics. The decisions of volition and action are not accompanied by the same feeling as under normal conditions, but, for example, by "sentiments d'incomplétude": "The subject feels that the action is not completely finished, that something is lacking."^[21] Or every decision of volition is accompanied by a "sentiment d'incapacité": "These persons from the beginning experience painful feelings in the thought that it is necessary to act; they fear action above all things. Their dream, as they all say, is of a life where there will be nothing more to do."^[22] A most important abnormity of the feeling of activity in dementia præcox is the "sentiment d'automatisme."^[23] A patient expresses himself about it as follows: "I am unable to give an account of what I really do, everything is mechanical in me and is done unconsciously, I am only a machine."^[24]

Closely related to it is the "sentiment de domination."^[25] A patient describes this feeling as follows: "For four months I have had queer ideas; it seems to me that I am obliged to think and say them; someone makes me speak, someone suggests to me coarse words and it is not my fault if my mouth works in spite of me."

A precocious dement might talk in a similar manner. Hence one may be allowed to question whether we are not here dealing with dementia præcox. I carefully examined the lectures of Janet^[26] in order to see whether or not among his pathological material there were cases of dementia præcox. This might be quite possible in the works of French authors. But I found nothing that would point to the fact that the above cited patient was a case of dementia præcox. Moreover, we frequently hear such utterances from hysterics and somnambulists, and finally we hear similar expressions among many normal persons who are under the domination of an unusually strong complex, like poets and artists (see for example what Nietzsche says about the origin of Zarathustra).^[27] A good example of disturbance of feeling of activity is the "sentiment de perception incomplète."^[28] A patient says: "It is as though I see things through a veil, a mist, or through a wall which separates me from reality." A normal person who is under the immediate influence of a great affect might express himself in a similar manner. But precocious dements express themselves in a like manner when they speak about their indefinite perception of the environment ("It seems to me as if you are the doctor," "they say it was my mother," "it looks like Burghölzli, but it is not").^[29] The expression of Janet's patient, "The world appears to me like a gigantic hallucination," is true in the fullest sense also of precocious dements who always (especially in the acute stages) live, so to say, as in a dream, and they express themselves in a corresponding manner both during the disease and catamnestically.

The "sentiments d'incomplétude" are also especially related to the affects. A patient of Janet said: "It seems to me that I will not see my children again; everything leaves me indifferent and cold and I wish I could despair, cry out from pain; I know that I ought to be unhappy, but I do not arrive at that state; I have no more pleasure than pain; I know that a repast is good but I swallow it because it is necessary without finding in it the pleasure that I would have found before. There is an enormous thickness preventing me from feeling the moral impressions." Another patient says: "I would like to try to think of my little girl but I can not, the thought of my child barely passes through my mind and does not leave me any feeling."

I have repeatedly heard similar spontaneous utterances from hysterics as well as from precocious dements who were still able to give more or less information. A young catatonic woman who was forced to part from her husband and child under especially tragic circumstances, showed a total lack of emotion for all familiar reminiscences. I placed before her the whole very sad situation, and attempted to evoke an adequate feeling. While I spoke she laughed, when I finished she became calm for a moment and said, "I simply can not feel any more."

According to our conception, the "sentiments d'incomplétude," etc., are products of inhibition which emanate from an overwhelming complex. Whenever we are dominated by a complex it is only the ideas belonging to it which possess a full tone, that is, they alone possess perfect clearness, all other perceptions originating either from within or without are subject to an inhibition, through which they become indistinct, that is, they lose some feeling-tone. This is the basis for the resulting imperfection of the feeling of activity and finally for the want of emotion. These disturbances alone condition the feeling of strangeness. The reasoning faculty which is preserved in hysteria prevents the immediate outward projection as happens in dementia præcox. But if we by judgment facilitate the outward projection by allowing some superstitious ideas to creep in, there soon result explanations in the sense of a power coming from without. The clearest examples are given by the spirit mediums where a mass of insignificant things are referred to as transcendental causes; of course, it must be said that they are never as awkward and grotesque as in dementia præcox. We see something similar in normal dreams where there is outward projection with absolute certainty and ingenuousness. The psychological mechanisms of dreams and hysteria are most closely related to those of dementia preæcox. A comparison with dreams is therefore not too daring. In dreams we see how reality is spun with fanciful creations, how the pale memory pictures of the waking state assume tangible forms, and how the impressions of the environment adapt themselves to the sense of the dream. The dreamer finds himself in a new and different world which he has projected out of himself. Let the dreamer walk about and act like one awakened and we have the clinical picture of dementia præcox.

I am unable to discuss here in detail all delusions. I should like, however, to discuss briefly the well known delusions of influence. The idea of influencing of thought occurs in many forms, the most frequent being that of "thought-deprivation." The patients often complain that their thought is taken away^[30] whenever they wish to think or say something.^[31]

By the method of outward projection they frequently place the responsibility on some foreign agency. Externally "thought-deprivation" is manifested in the form of "obstructions."^[32] The examiner suddenly receives no answer to his questions and the patient then states that he is unable to answer as his thoughts were "taken away." The association experiments taught us that long reaction times and incorrect reactions ("mistakes") regularly appear where one deals with a complex-reaction. The strong feeling-tone inhibits the associations. This phenomenon more intensified is also found in hysteria where at critical points the patient "can simply think of nothing." This is almost thought-deprivation. The same mechanism is found in dementia præcox; here too thought is inhibited at complex-locations (be it in experiments or conversation). This can easily be seen in suitable cases when we at first speak about matters indifferent to the patient and later about things referring to the complexes. With the indifferent material the answers follow smoothly, while with the complexes one obstruction succeeds the other; the patients either refuse to answer or give deliberately affected evasions. Thus, no matter how patiently one tries, it is impossible to obtain detailed statements from a patient about her husband with whom she has lived unhappily, whereas about anything else she gives ready and detailed information.

Another phenomenon to be considered is impulsive thought. Singular and even senseless ideas crowd themselves into a patient's mind, about which he is obsessively forced to deliberate and ponder. An analogy to this we find in psychogenic obsessive thoughts. The patients regularly realize the absurdity of the thoughts, but are unable to repress them.^[33] The thought influences also manifest themselves as "inspirations."

That we have here a phenomenon which does not exclusively limit itself to dementia præcox is already shown by the word "inspiration," which designates a psychic event appearing wherever there exists an autonomous complex. We deal here with sudden invasions of complexes into consciousness. Inspirations are not at all unusual in religious people. The modern protestant theologians have gone so far as to call it "inner experiences." "Inspirations" are an every-day occurrence in somnambulism.

Finally we have another form of obstruction, "fascination" (an expression coined by one of my female patients). Sommer described this phenomenon as "optical fixation." We observe "fascination" in association experiments even outside of dementia præcox, especially in conditions of emotional stupidity. This condition may be evoked under circumstances by an experiment or through a complex stimulated during the experiment. The patients then begin to react (at least for a time) not to the stimulus word, but they simply name objects from the surroundings. I have especially noticed this in imbeciles, in normal persons during a strong affect, in hysterics at complex-locations and in dementia præcox.

"Fascination" is distraction to the environment in order to conceal the vacuum of inner associations or the complex producing the vacuum. It is the same in principle as breaking away from an unpleasant conversation by sudden diversion to some remote banality. As a starting point any object of the environment serves. We have therefore enough evidence to enable us to place the mechanism of "fascination" on a parallel with the normal.

Experience shows that all these disturbances appear in dementia præcox about the complex and belong to the measures of defense. Here we are also obliged to discuss negativism. The prototype of negativism is "obstruction" which, in some cases, gives the impression of an intentional refusal, just as the "I don't know" of hysterics. One can just as well speak of negativism when the patients refuse to answer questions. The passive negativism readily becomes active, whereby the patients also psychically defend themselves against the examination. If we exclude these cases where the negativism has generalized itself into a common state of defense, we find that in the still accessible cases the negativism as well as the obstructions are at complex-locations. As soon as the association experiment or the examination strikes the complex, that is, the tender spot, the patient refuses to answer and retreats, just as the hysteric uses all sorts of pretexts in order to conceal the complex. How great an inclination the catatonic symptoms have towards generalization is particularly shown in negativism. Whereas in hysteria, in spite of a repeatedly very strong and impeding negativism, we still find certain accessible tracts to the mind, the negativistic catatonic shuts himself in completely, so that at least for the moment there are no means of penetrating. Occasionally the negativism is called forth by a single critical question. A special form of negativism is the evasive speaking, which we know in a similar form in the Ganser symptom-complex. Here, just as there, one deals with a more or less unconscious refusal to enter into conversation, hence something similar to the fascination and thought-deprivation. The Ganser symptom-complex, as was shown by Riklin's and my own works, has its own good reasons; the patients wish to repress their complex. In dementia præcox it is probably due to the same thing. In the psychoanalysis of hysteria we regularly find that the by-speaking or circumlocution occurs at the complex; the same is found at the complexes of dementia præcox, only that here this symptom, as well as all the catatonic symptoms, show a tendency to generalization. The catatonic symptoms of the motor spheres can be conceived without any difficulty as radiating effects of generalization. This is probably true in the majority of cases. It is true, however, that catatonic symptoms appear in localized and general brain disturbances where one cannot very well think of a psychological nexus. But here we also see at least just as frequently hysterical manifestations, whose psychogenesis is otherwise an established fact. What we should learn from this is never to forget the possibility of thinking "the other way."

An hallucination is crudely an outward projection of a psychic element. Clinically we know all gradations from inspiration or pathological fancy to loud hallucinations of hearing or to plastic vision. Hallucinations are ubiquitous. Dementia præcox only sets in motion a preformed mechanism which normally regularly functionates in dreams. The hallucinations of hysteria, just as those of dreams, contain symbolically disfigured complex fragments. This also holds true^[34] of most of the hallucinations of dementia præcox, only that here they are pushed still further and are of a more dreamlike disfigurement. Disfigurements of speech, after the example of dream-paraphasias (comp. Freud, Stransky and Kraepelin), are extraordinarily frequent; most of them are contaminations. A patient who entertained delusions of sin, noticing a Japanese in the clinic, heard the voices call out "Japansinner" (Japansünder). It is remarkable that not a few patients who tend to form numerous neologisms and peculiar delusions, that is, who are under the complete domination of the complex, are often corrected by the voices. One of my patients, for example, was twitted by the voices about her grandiose delusions, or the voices commanded the patient to tell the physician who was occupying himself with her delusions that "he should not bother himself with these things." Another patient who has been in the hospital for a number of years and always speaks in a disdainful manner about his own family is told by the voices that "he is homesick." From this and numerous other examples I received the impression that the correcting voices are perhaps invasions of the repressed normal remnant of the ego-complex. That the normal ego-complex does not entirely perish, but is prevented from reproduction by the disease-complex, seems to me to be shown by the fact that during severe physical diseases or any other deep-going changes, the patients suddenly begin to react in a tolerably normal manner.^[35] Sleep disturbances are quite usual in dementia præcox and manifest themselves in a manifold manner. The dreams are often very vivid and we can readily understand that frequently patients are unable to properly correct them. Many patients draw their delusions exclusively from the dreams to which they attribute real validity.^[36] The part played by the vivid dreams of hysteria is well known. Besides disturbances by dreams, many other complex-fragments may disturb sleep, such as hallucinations, fancies, etc., just as hypnosis does in hysteria. Frequently patients complain about their unnatural sleep, which is not at all a real sleep, but an artificial rigidity. We hear similar complaints wherever there exists a strong affect which cannot be totally extinguished by sleep-inhibition and therefore accompanies sleep as a constant keynote (e. g., melancholia and depressive affects in hysteria). Not seldom intelligent hysterics feel the "complex-restlessness" in their sleep and can precisely detail it. A patient of Janet says: "There are always two or three of my personalities who do not sleep, nevertheless I have fewer personalities during sleep; there are some who sleep but little. These persons dream, but not the same dream. I feel that there are some who dream of different things." With these remarks the patient nicely expresses the feeling of the unrelenting and laboring autonomous complex which does not surrender to the sleep-inhibition of the ego-complex.

 

4. Stereotypy.

By stereotypy in its broadest sense we understand the persistent and constant reproduction of certain activities, such as verbigeration, catalepsy, persistent phrases, perseverations, etc. These manifestations belong to the most characteristic symptoms of dementia præcox. Yet stereotypy in the form of automatization is also one of the most usual manifestations in the development of the normal psyche (Spencer). All our abilities and the whole progress of our personality rest on automatization. The process leading to it is the following: In order to perform a certain activity we direct all our attention on the appertaining ideas and through this markedly accentuated tone we engrave the phases of the process into memory. The effect of frequent repetitions causes a "smoother" path, upon which the activity finally moves automatically almost without our aid. Only a slight impulse is necessary to immediately put the mechanism in motion. The same thing may take place in us passively through strong affects. We can be forced to certain action by affects; at first there is great inhibition, but later, on account of numerous repetitions of the affect, the inhibition becomes less and finally the reaction succeeds promptly even on a very slight impulse. This can especially be observed in the bad habits of children.

The strong feeling-tone creates tracks, whereby we again express the same things that we have said of the complex: Every complex has a tendency to autonomy and to independent living; it has a greater tendency to persist and to reproduction than indifferent thought; it has therefore the best prospect for becoming automatic. Hence if anything becomes automatic in the mind an antecedent feeling-tone must always be postulated for it.^[37] This is most clearly seen in hysteria, where we are able to trace all stereotypies (like convulsive attacks), absences, complaints and symptoms, to the underlying affects. In normal association experiments we find so-called perseverations regularly at complex-locations.^[38]

If a strong complex exists, there results a cessation of progress adapted to the environment, and associations gyrate altogether about the complex. This is generally so in hysteria where we meet the strongest complexes. The progress of personality is suspended and a great part of the psychic activity is spent in dressing the complex in every possible form (symptom-actions). It is not in vain that Janet calls attention to the general disturbances of the "obsédé," of which I will mention the following: "l'indolence, l'irrésolution, les retards, la fatigue, l'inachèvement, l'aboulie, l'inhibition, etc."^[39] If a complex succeeds in fixing itself, monotony results, especially the monotony of external symptoms. Who does not know the stereotyped and tiring complaints of hysterics? the obstinacy and invincibility of their symptoms? Just as a constant pain will always call forth the same monotonous plaintive sounds, so will a fixed complex gradually stereotype the whole mode of speech of the individual, so that we can finally know that day after day we will receive with mathematical accuracy the same answer to a certain question.

In these processes we find some of the normal prototypes for the stereotypy of dementia præcox.^[40] When we examine the origin of linguistic or mimic stereotypies, we often find the associated emotional content. Later the content always becomes more indistinct just as in the normal or in the hysterical automatism. But in dementia præcox the corresponding process seems to run a more rapid and thorough course, so that one soon reaches the vacuum as regards content and emotion.

As experience undoubtedly teaches, it is not only the complex-content that becomes stereotyped in dementia præcox, but also accidental material. It is known that the verbigerating patients will take up an accidental stray word and repeat it constantly. Heilbronner, Stransky and others justly interpret such phenomena as symptoms of association-vacuums. The motility stereotypies can also be easily interpreted in the same manner. We know that precocious dements suffer very frequently from associative obstructions ("thought-deprivation"). This disappearance of thought is found by preference around the complex. If then the complex plays the enormous role entrusted to it, it is to be expected that it very frequently absorbs many thoughts, and in this way disturbs the fonction du réel. In the place of the alienated realms it creates association-vacuums and those phenomena of perseveration which may be explained by the "vacuum."

It is a characteristic of most of the ontogenetically acquired automatisms that they are subjected to gradual changes. The anamneses of Tiquers (see Meige et Feindel, "Le Tic") afford many proofs of that. The catatonic automatisms are no exceptions, they too change slowly, frequently the transformation process taking years. The following examples will show what I mean.

A catatonic sang persistently for hours a religious song with the refrain "Hallelujah." Then she began to verbigerate for hours "Hallelujah," which gradually degenerated into "hallo," "oha," and finally she verbigerated "ha—ha—ha" accompanied by convulsive laughter.

In the year 1900 a patient combed his head a few hours every day in a stereotyped manner, so as to remove the "gypsum" which "was smeared into the hair" during the night. The following year he gradually stopped using the comb on his head. In 1903 the patient beat and scraped his chest with it, and at present he has reached the inguinal region.

In quite a similar manner the voices and delusions degenerate.^[41] In a like manner the "word-salad" originates. The original simple sentences become more and more complicated with neologisms, they are constantly loudly or quietly verbigerated and gradually become blurred, so that an unintelligible medley results which probably sounds similar to the "stupid chattering" with which many patients are affected.

A patient under my observation during convalescence from acute dementia præcox begins quietly to relate to herself how she packs her trunk, goes from the ward to the asylum gate, then to the street, and then to the railroad station; how she gets into the train and reaches her home, where her wedding is solemnized, etc. This story became more and more stereotyped, the individual halting places became mixed without any order, the sentences became imperfect, some were abbreviated to a single catch-word, and now after more than a year the patient only occasionally uses a catch-word; all other words she has replaced by "hm—hm—hm—" which she utters in a stereotyped manner with the same tone and rhythm as when she formerly told her story. At times when she becomes excited the former sentences reappear. We also know from hallucinatory patients that the voices in time become emptier and quieter, but when they become excited the voices regain in content and distinctness.

These gradually creeping changes are very distinctly seen in obsessive ideas (see Cont. VIII). Janet, too, speaks of the gradual changes of obsessive processes.^[42]

There are, however, stereotypies or rather stereotyped automatisms which from the very beginning do not show any psychic content by which they can be understood even symbolically. I am thinking especially now of the almost muscular manifestations of automatism, like catalepsy, or certain forms of negativistic muscular resistances. These exquisite catatonic symptoms, as has been already shown by many investigators, we also find in organic disturbances, such as paralysis, brain tumors, etc. Brain physiology, especially the well-known experiments of Goltz, teach that in vertebrates when the cerebrum is removed a condition of automatism par excellence results. Forel's experiments with ants (destroying the corpora quadrigemina) shows that automatism results when the greatest (and most differentiated?) part of brain tissue is removed. The debrained animal becomes the well-known "reflex machine," it remains either sitting or standing in a certain preferred attitude until it is forced by external stimuli to a reflex action. It is certainly a somewhat daring analogy when some cases of catatonia are compared to such reflex machines, although they frequently appeal to one as such. But when we go somewhat deeper and consider that in this disease a complex occupies almost all the associations, holding them persistently, that this complex is absolutely unassailable by psychological stimuli, that it is, as it were, split off from all external influences, it would then seem that the before mentioned analogy is of somewhat greater significance. The complex on account of its intensity lays claim to the brain activity in its greatest extent, so that a great number of impulses belonging to other spheres become dissipated. It can then be easily understood that on account of the predominance, the congealing of a complex, a condition will result in the brain which functionally at least will be more or less equal to a destruction of a great part of the brain. To be sure this hypothesis cannot be proven any further, but it may explain many things not reached by psychological analysis.

Summary.

Hysteria contains in its innermost essence a complex which could never be totally overcome; in a measure the psyche is brought to a standstill since it is unable to rid itself of the complex. Most of the associations go in the direction of the complex, and the chief function of psychic activity is to elaborate the complex in every possible direction. For this reason (in chronic stages) the individual is forced to retire more and more from an adaptation to the environment. The wish-dreams and wish-deliria of hysteria occupy themselves exclusively with the fulfilment of the wish-complex. Many hysterics succeed, after a time, in regaining equilibrium by conquering the complex and by avoiding new traumas.

In dementia præcox we likewise find one or more complexes which become tenaciously fixed. Here, too, we have complexes which can no longer be conquered. Whereas in hysteria there exists an unmistakable causal relation between the complex and the disease (a predisposition is presupposed), we are not at all clear about this in dementia præcox. We do not know whether, in predisposed cases, it is the complex that causes or sets free the disease, or whether at the moment of the outbreak of the disease, a definite complex is present which determines the symptoms. The more detailed and sharper the analysis, the more we see that in numerous cases at the onset of the disease there was a strong affect from which the initiatory moodiness developed. In such cases one feels tempted to attribute causal significance to the complex, but one must add the already mentioned restriction, that is, that the complex, besides its psychological effects, produces also an X (toxin?) which helps along the process of destruction. Yet I am fully cognizant of the possibility that the X may primarily result from other than psychological reasons or causes, and then seize the last remaining complex and specifically change it, so that it may seem as if the complex had causal effects. Be this as it may, the psychological consequences remain the same, namely, the psyche never rids itself of the complex. With the desolation of the complex an improvement takes place, but this is also accompanied by a destruction of a more or less greater portion of the personality, so that the precocious dement at best escapes with a psychic mutilation. The separation of the precocious dement from reality, the loss of interest in objective happenings, is not difficult to explain when we consider that he persistently stands under the ban of an invincible complex. He whose whole interest is chained by a complex must be like one dead to all surroundings. Janet's normal "fonction du réel" must cease with it. He who is possessed by a strong complex continues to think in the complex, he dreams with open eyes and psychologically no more adapts himself to his surroundings. That which Janet says about the "fonction du réel" in hysteria is, in a certain measure, also true in dementia præcox: "The patient constructs in his imagination small, very coherent and very logical stories; it is when reality is to be dealt with that he is no more capable of paying attention or of understanding." The greatest difficulty in these really not simple problems is the hypothetic X, the metabolic toxin (?) and its effects on the psyche. It is uncommonly difficult to characterize, in a measure, these effects from the psychological side. If I may be allowed to give expression to a supposition I would say that to me it seems that the effects most distinctly manifest themselves in the enormous tendencies towards automatization and fixation; in other words, in the persistence of complex effects. Accordingly, the toxin (?) is to be considered as a highly developed body which adheres everywhere to the psychic processes, especially to those which are emotionally accentuated, reinforcing and automatizing them. Finally it must be considered that the complex to a great extent absorbs the brain activity, on account of which something like a deencephalization takes place. The results of this may be the origin of those forms of automatism which are principally developed in the motor system.

This more programmatic than exhaustive review of the parallels between hysteria and dementia præcox may probably sound hypothetical to those readers not accustomed to Freud's views. By no means do I intend to give here anything conclusive, but rather something preparatory in order to support and simplify the illustrations in the following experimental investigation.

1. If I identify here the cases described by Janet in his Obsessions with hysteria, it is because I cannot differentiate Janet's obsessed from hystericals.
2. Allg. Ztschr. f. Psych., Bd. 58, p. 717.
3. Thus Riklin mentions the following instructive example: A hysterical patient periodically vomited all milk she took. The analysis during hypnosis showed that while patient lived with a relative he once assaulted her sexually as she went to the stable to fetch some milk. "Ibi homo puellam coagere conatus est, ut semen, quod masturbatione effluebat, ore reciperet." During the week after the hypnosis patient nearly always vomited what milk she took, though she had total amnesia for the hypnosis. Analytische Untersuchungen der Symptom und Assoziationen eines Falles von Hysteric. Psych.-Neurol. Wochenschr., 1905.
4. See Forel: Autobiography of a case of acute mania, and Schreber: Denkwürdigkeiten eines Nervenkranken. Mutze, Leipzig.
5. Resembles the "Conjurations" of Janet (Les Obsessions).
6. Forel's patient (Arch. f. Psych., XXXIV) was forced to make many such interpretations, thus, for example, she interpretated the name Vaterlaus as "pater laus tibi." A patient of mine complained of the allusion which was made by means of the food. He had lately found in his food a linen thread (Leinenfaser). He guessed that it referred to Fräulein Feuerlein (an earlier acquaintance) with whom however he had certainly had no intimate relations. One of my patients complained one day to me that he could not understand what "a green figure" had to do with him. He got this idea because they put chloroform into his food (chloros, forma).
7. In examinations of unconscious writing ("Psychographie") it can especially be well observed how the unconscious plays with the presentations. The words are not seldom written in a reversed sequence of letters or there are singular conglomerations of words in otherwise clear sentences. Under constellations of spiritualistic convictions attempts are made towards formation of a new language. The most prominent medium known is Helene Smith (comp. Flournoy, Des Indes à la Planète Mars). Similar manifestations I have reported in my work: Zur Psych, u. Path, sog. occulter Phänomene.
8. Fürstner: Arch. f. Psych., Bd. XXXI.
9. For some time I treated a hysterical patient who suffered from intense depression, headaches, and total inability to work. Whenever I suggested to her to find pleasure in work and to be more cheerful, she was, on the following day often abnormally happy, laughed incessantly, and had a strong impulse to work so that she worked till late in the night. On the third day she was profoundly exhausted. The happy disposition appearing without any motive was unpleasant to her because she constantly thought of nonsense and silly jokes, and laughed impulsively.

   An example of hystero-hypnosis can be found in my work, Ein Fall von hysterischem Stupor bei einer Untersuchungsgefangenen. Journ. f. Psych, u. Neur., 1902.

10. See Bleuler: Frühe Entlassungen. Psych. Neur. Wochenschr., 1905.
11. Über Versetzungsbesserungen. Psychiatr. Neurol. Wochenschr., 1905.
12. A nice example of momentary variations in hysteria is found in the work of Riklin: Über den Ganserschen Symptomencomplex. Psych, neur. Wochenschr., 1904. He shows that a patient manifested correct or delusional orientation depending on the manner of questioning. The same thing can happen spontaneously when the complex is excited by a stimulus. Riklin reports a corresponding experimental case in Cont. VII of the Diag. Assoz.-Stud. where at a critical stimulus word a dreamy state occurred and held on for some time. The pathological fancies are principally the same thing, as e. g., the automatic insertions in the language or writing in somnambulism (See Flournoy).
13. See E. Meyer: Beitrag zur Kenntnis der akut entstandenen Psychosen. Berlin, 1899.
14. I recall the fact that a normal dream is always a "complex-delirium"; i. e., its content is determined by one or more complexes which are actual. Freud as we know has shown this. If one analyses his dreams by the Freud method he immediately sees the justification for the expression "complex-delirium." A great many dreams are wish fulfilments. Endogenous dreams exclusively concern complexes while exogenous ones; i. e., those influenced or produced during sleep by physical stimuli are as far as I have observed until now, blendings of complex constellations with more or less symbolic elaboration of bodily sensations.
15. Ganser's dreamy states and the deliria of somnambulists furnish good examples. Comp. Riklin: Psych.-Neur. Wochenschr., 1904. Jung, Jour. f. Psych, u. Neur., 1902 u. 1903. A fine example of complex-delirium with misinterpretations is given by Weiskorn: A twenty-one year old primipara refers to her labor pains as follows; grasping her abdomen she asks: "Who presses me here?" The descent of the caput she refers to as a hard passage of the bowels. Transitorische Geistesstörungen beim Geburtsakt., Diss., Bonn, 1897. v. Krafft-Ebing reports transparent deliria, Lehbr. and C. Meyer in Jahrb. f. Psych., XI, p. 236. Clear complex-deliria are the semi or unconscious fanciful creations of the hysterics described by Pick (Jahrb. f. Psych, u. Neur., XIV, p. 280) as well as the romances of Helene Smith described by Flournoy and the somnambulists observed by me. Another clear case is found by Bohn (Ein Fall von doppeltem Bewusstsein, Dissert., Breslau, 1898).
16. Riklin in his works on Versetsungsbesserungen has already given some contributions worth mentioning (Psych. Neur. Wochenschr., 1905). As an example I cite one of his cases: Miss M. S. twenty-six years old, educated and intelligent, six years ago passed through a brief psychosis, but has so well recovered that she was discharged as cured and the diagnosis of dementia præcox was not made. Before the present attack she fell in love with a composer from whom she took singing lessons. Her love soon reached a passionate height accompanied by periods of insane excitement. She was then brought to the Burghölzli asylum. At first she looked upon her confinement and her new experiences in the asylum as a descent into the underworld. She got this idea from her teacher's last composition which was "Charon." Then after this purifying passage through the underworld she interpreted everything happening about her in the sense of vicissitudes and struggles which she had to undergo in order to become united with her lover. Patient then considered another patient as being her lover and for a couple of nights went into her bed. She then thought herself pregnant, felt and heard twins in her womb, a girl resembling herself and a boy resembling the father. Later she thought that she gave birth to a child and had hallucinations of having a child in bed. With this the psychosis came to a close. She had found a solacing substitute for reality. She soon became quiet, her behavior freer, the rigidity in her attitude and gait disappeared and she readily gave catamnestic information, so that her statements could be well compared with those in the hospital records.
17. Godfernaux in his psychological analysis of Magnan's délere chronique à évolution systématique finds at its base mostly an effective disturbance: "In reality the thought of the patient is passive; he orients himself without taking into account all of his conceptions in the direction prescribed by his affective state."

    Le sentiment et la pensée, p. 8.

18. Affektivität, etc. Compare also Neisser: Allg. Ztschr. f. Psych., Bd. LIII.
19. Compare Marguliés: Monatschr. f. Psych, u. Neur., Bd. X, and Gierlich: Arch. f. Psych., Bd. XL. See Nervous and Mental Disease Monograph Series No. 2, Studies in Paranoia, for a translation of Gierlich's article.
20. A precocious dement under my care finds everything artificial; what the doctor tells him, what the other patients do, the cleaning in the ward, the food, etc., all are artificial. It is all done by "one of his persecutors" who has a princess "by the head and thus blabs to the people what they are to do."
21. Obsessions et Psychasthénie, V. I, p. 264.
22. L. c., p. 266.
23. L. c., p. 272.
24. Comp. Ball, Revue scientifique, 1882, II, 43.
25. Janet, l. c., p. 273.
26. Works, Vol. VI, p. 482.
27. Works, Vol. VI, p. 482.
28. Janet, l. c., p. 282.
29. Excellent examples can also be found in Shreber's, Denkwürdigkeiten.
30. An original form of thought-deprivation is reported by Klinke: "A patient's thoughts are made to come out by the passing to and fro of the other patients in the ward."
31. Also in hysterics these manifestations are not at all rare, as I have observed. Janet calls them "éclipses mentales" (T. complains of often feeling a singular arrest of her thought, she loses her ideas), l. c., p. 369.
32. "Theories," like those, for instance, of Rogues de Fursac, only verify the fact. "The most suitable term is perhaps that of psychic interference. The two opposed tendencies annul each other, as contrary waves do in physics." (Cited after Claus: Catatonie et Stupeur, Bruxelles, 1903.) See also Mendel: Leitfaden der Psych., p. 55.
33. An analogy of this is Janet's "rêverie forcée" in his "Obsédés," l. c., p. 154: "J. feels that at certain moments all his life concentrates itself into his head, that the rest of his body is as if asleep, and that he is forced to think enormously without being able to stop himself. The memory becomes extraordinarily and excessively developed so that it is impossible to direct it by attention." Compare also the case in Beitrag VI of Diag. Assoz. Stud.
34. During the absence of her fiancé a girl was seduced. She concealed it from her fiancé. More than ten years later she was afflicted with dementia præcox. The disease began by feeling that people entertained suspicions against her morality, and that she heard voices talking about her secret, which finally compelled her to make a confession to her husband.

    Many patients state directly that the "sin register" is read for them with all its details and that voices "know everything" and take it up with them. It would therefore seem very strange that most of the patients are unable to give satisfactory information about their hallucinations. It is due here to the reproduction of the complexes which, as we have seen, are under special inhibitions.

35. A patient who was quite inaccessible and who always greeted the doctors in the most scurrilous manner fell ill with a grave gastroenteritis. With the onset of the disease he became completely changed, he was patient and grateful, obeyed all requests and always gave polite and precise information. His convalescence manifested itself by his again becoming monosyllabic and shut in, and one fine morning he signalled his complete recovery by receiving the doctor with the following: "Here comes again one of the flock of dogs and apes who wishes to play the Saviour."
36. Compare Sante de Sanctis: Die Träume, Halle, 1901, and Kazowsky: Neuro. Zentr.-Bl., 1901, p. 440.

    We have a patient who entertains the most manifold sexual delusions which exclusively originate from dreams, as we were able to convince ourselves on numerous occasions. Patient simply takes the contents of her dreams which are all very vivid and plastic, as real, and corresponding to the dream she becomes abusive, querulous and complaining, but only in writing. In her general behavior she is nice and orderly in contradistinction to the contents of her letters and writings.

37. As previously stated attention belongs under the collective idea of Gefühlston (feeling tone).
38. Occasionally the complex-content continues to persevere. In the majority of cases, however, there exists only one persevering disturbance which may perhaps be ascribed to the fact that the complex through distraction leaves an association-vacuum. This similarity occurs in the distraction experiments where, on account of a vacuum of association, one despairingly resorts to antecedent associations. If, however, as in the cases of Heilbronner, somewhat more difficult questions are given, it may result in an emotion and serves the same purpose as a complex. The association-vacuum is primary, inasmuch as there exist no fluent associations to the stimulus ideas in question. In the normal it is the complex which mostly perseveres.
39. Janet, l. c., p. 335 ff., p. 349, says: "This more or less complete stoppage of certain actions is one of the most essential phenomena in the mental states of the obsessed" (p. 105). "These forced operations are not normal. They are the operations of thought, of action, and of emotion, which are at once excessive, sterile, and of inferior kind."
40. Pfister (Über Verbigeration. Vortrag auf der Versammlung des Deutsch. Ver. f. Psychiatrie in München, 1906. Ref. Neurol.-Psychiatr. Wochenschr., No. 7, 1906) asks whether the stereotypies or the verbigerations have psychological motives or not. He however leaves the question open. Pfister seems to be of the same opinion as we; that each stereotypy has an ideational content as its basis, which, however, on account of its morbidly disturbed manner of expression manifests itself in a distorted manner. ("It is conceivable that ideation stereotypies have an impulse to express themselves, but in their places there is a reproduction of senseless phrases and neologisms. This is due to the simultaneous existence of the decaying and exciting processes in the central apparatus of speech which make their clear manifestation impossible, and instead of stereotyped thoughts [as results of paralogic-paraphasic malformations] only unintelligible remnants come to view.") There is still another way in which the decay of speech can undermine the manifestations of correct ideation stereotypies, and that is, that (on account of the disturbances in the recoinage of ideas and thoughts both in word and speech) through the monotonous repetition of ideas no equivalent speech formation can be incited. In the conversion of thought to expression of speech, numerous paralogic derailments occur, the presentations become erroneously associated, changing everywhere, so that, forthwith, in place of the thought stereotypy which remains hidden, there is a reproduction of constantly changing nonsense.
41. Compare especially Schreber: Denkwürdigkeiten. Schreber describes very well how the contents of the auditory hallucinations become grammatically abbreviated.
42. Janet, l. c., p. 125. A female patient says: "Formerly I used to look back in memory in order to know whether I ought to reproach myself for something, in order to reassure myself about my conduct—but now it is not at all the same thing. I always recall what I have done a week or two weeks ago, and I see the things exactly, but I have absolutely no interest in seeing them."

    In this example the deviation from the content proper is especially noteworthy.