Chapter II: The Subject of the Previous Chapter Continued
7. The approach from psycho-analysis and the new psychology. This is the most difficult with which I have to deal, because I think it may be said without unfairness to the whole of the new psychology, that the validity of some of its essential first principles is still sub judice.
I cannot enter exhaustively into the teachings of Freud, Adler and Jung, and shall attempt only to give the reader some idea of their importance in regard to characterology.
Starting out from pathological states, the new psychology, with psycho-analysis, attempts to describe the leading unconscious conditions which, in conjunction, and often in conflict, with the conscious, act formatively on conduct and adaptation, whether in the healthy or the unhealthy.
In the hands of its chief exponents, this science has discovered a number of new facts concerning the human mind, although the object with which it set out — the discovery of a reliable psychotherapy, has not been altogether achieved.
Stated briefly, the psycho-analytical, or Freud's position, is this: We all have two levels to our minds — a conscious and an unconscious, the former being to the latter much as the part of an iceberg that protrudes from the water is to the part that is submerged, i.e. in a ratio of one to ten. The unconscious consists of various ingredients — racial memories and impulses, and individual experiences which have been repressed (i.e. desires, appetites and impulses that have been involuntarily driven back into the unconscious) either because their expression was impossible, or because it or they led to painful or intolerable situations. As, however, desires, appetites and impulses have instinctive energy behind them, they are not quiescent in repression. They are much more in the nature of fermenting liquors, constantly sending up bubbles to the surface and trying to express themselves in spite of everything. The guardian or censor at the door between the unconscious and the conscious is very severe, and allows nothing unsuitable to pass in waking hours, though during sleep he too seems to be somnolent, and allows much of the unconscious material to escape into the adjoining or conscious chamber — hence the importance of dreams as an indication to the contents of the unconscious. 1
Completely forgotten consciously, these repressed memories, experiences or desires, nevertheless bring to bear on consciousness all kinds of influences, direct or indirect, which consciousness as frequently misinterprets, although it acts in some way upon them.
Suppose, for instance, a female child has an unpleasant experience connected in some way with sex and hair, the memory of which becomes submerged in the unconscious. Although, as an adult, she may not be able to recall the incident, its survival as a repressed memory may influence her conscious life in ways she cannot understand, and always misinterprets.
Thus, it may cause her constantly to mislay or lose her muff or fur stole. It may make her vaguely disinclined to wear furs at all. This disinclination probably appears to her consciousness in the form of a dread of being too hot, or looking too bulky in furs.
The fact that when, possibly out of regard for the fashion of her day, she wears a muff or fur stole, she constantly loses it, she will explain in various ways that have nothing whatsoever to do with the real cause. One day her excuse will be that she witnessed an accident from her taxi-cab, another time that she had unexpectedly met a long-lost friend; or, again, she will blame a shop assistant for having been rude to her.
It will never occur to her that she constantly loses her muff or stole because a shameful or forbidden experience connected with hair has long lain repressed in her unconscious mind, causing her to try to forget about hair as urgently as she forgets about the associated shameful experience itself. And the reason why this will not occur to her is that her conscious mind is actually unaware of it. 2
Similar eccentricities of conduct, misinterpreted by consciousness, such as slips of the tongue and of the pen, 3 are constantly being caused by such unconscious memories, and from their
1 For Freud's own description of this censor, see GENERAL INTRODUCTION TO PSYCHO-ANALYSIS (New York, 1920, p. 256).
2 For innumerable similar examples, see Freud's PSYCHO-PATHOLOGY OF EVERYDAY LIFE (London, 1914, Chap. IX).
3 Ibid., Chaps. V and VI.
frequency we are complied to infer that, even in the healthy and so-called "normal", conscious life is influenced far more than most people are aware by their unconscious mind and its heterogeneous mass of buried experiences.
When the repression is of a more serious character, as, for instance, when it represents the incestuous desire of a boy for his mother (Freud's "Œdipus Complex"), or of a girl for her father (the "Electra Complex"), its effects on the life of the adult may be serious. He or she may hate the parent who stands in the way of reading the unconscious incestuous desire, without knowing exactly why. Thus a boy may hate a perfectly kind father and a girl a perfectly good mother, and explain the hatred by referring to utterly insufficient reasons — such as the father's way of coughing, or eating, or laughing, or his conceit, or his conversation, or his attitude to mother. The girl may try to account for her hatred of her mother by saying vaguely that she is too "self-centred", or too "short" with father, or too fond of Mrs. X, and so on.
These examples must suffice to show the far-reaching effects which a buried or unconscious memory may have on adult behaviour. And, as Freud claims that these repressions occur in very early childhood, when the child first learns that some of its desires or experiences are shameful or forbidden, it is not difficult to see how onerous is the task of unearthing these memories and bringing them to consciousness, more particularly when we remember that consciousness resists the process.
Bringing them to consciousness, however, and causing the patient to re-enact the whole complex of emotions associated with them (hence the word "complex"), constitutes Freud's alleged cure of the distressing or awkward symptoms to which they may give rise. 1
The attacks on Freud have come chiefly from an outraged public and a group of outraged scientists, who resented the notion that the sex instinct played such an important part in the lives of children whom hitherto the world of sentimentalists had
1 See PAPERS ON PSYCHO-ANALYSIS, by E. Jones, M.D. (London, 1918, p. 128): "The mode of action of the treatment . . . which is the overcoming, by means of psycho-analysis, of the resistances that are interposed against the making conscious of the repressed unconscious material, gives the patient a much greater control over the pathogenic material by establishing a free flow of feeling from the deeper to the more superficial layers of the mind, so that the energy investing the repressed tendencies can be diverted from the production of symptoms into useful, social channels."
liked to regard as "pure" and "innocent". This public, too, resented the extension of sexual reactions and feelings into spheres which, until Freud appeared, it liked to regard as "pure" — the sphere of the relationship of parent to child, and child to parent, the sphere of the relationship of child to child, brother to sister, and vice-versâ, the sphere of the relationship of the moral adult to the child, and so on.
When Freud says: "The mother would probably be terrified if it were explained to her that all her tenderness awakens the sexual impulse of her child and prepares its future intensity. She considers her actions as asexually 'pure'", 1 he is really guilty of understatement.
The fact is that the mother, when this was explained to her, was not only terrified, but outraged and angry, and she and her friends, both male and female, accused Freud of exaggerating the sex-factor in human life, of being obsessed by sex, and of polluting many of the most idyllic situations of life.
Such people, relying more on their outraged feelings than on their reason, forgot to inquire into the nature of Freud's researches. Freud dealt with repressions. Now there are not necessarily any repressions about harmless pastimes like playing the piano, toasting a slice of bread at the fire, or playing patience, unless some past shameful experience happens to be correlated with them. Why should there be? The very nature of Freud's inquiry inevitably led him to sex, because sex in civilized life happens to be a department about which there are many severe tabus. 2 The child at a tender age learns that it must not expose itself, must not talk of the functions connected with its anus and genitalia. Very early, therefore, a civilized child gathers that the region of the pubis in its body is a shameful, or at least a secret affair. It is not taught that it is shameful to handle a chair, or a toy or a ball; but it is taught that it is shameful to handle its genitalia. When dealing with repressions, therefore — and Freud made if quite clear that this was his province — he inevitably lighted upon a mass of sex and water-closet material in the unconscious, and very rightly said so.
1 THREE CONTRIBUTIONS TO THE THEORY OF SEX (trans. by A. Brill, New York, 1918, p. 82).
2 Freud points this out repeatedly, and puts it very plainly in his little monograph on DREAMS (trans. by Dr. Eder, London, 1924, p. 101), where, speaking of the sex instinct, he says: "No other class of instincts has required so vast a suppression at the behest of civilization as the sexual, whilst their mastery by the highest psychical processes is in most persons soonest of all relinquished."
We may quarrel with Freud tor having overlooked certain other shameful material in the unconscious — those factors, for instance, on which, as we shall see, Adler lays stress. We may quarrel with him, as I do, about the overweening claims he and his followers at first made regarding the therapeutical value of hi.s analysis. But to quarrel with him because in his investigations into repressions he lighted repeatedly on sex and water-closet experiences and desires, is not only unfair, it is idiotic. Regarding the quarrel with him which turns upon the alleged therapeutical value of his analysis (and this quarrel may, I think, be rightly engaged up to a point with his two disciples, Adler and Jung), perhaps the reader will appreciate a case of which I have first-hand knowledge; for I am one of the few who entertained doubts concerning his therapy long before he himself hinted at these doubts. 1
My own suspicions regarding the validity of the new psychologist's therapeutical claims were first aroused in the years 1918–1920, when, under my own eyes, a girl I knew very well steadily overcame certain distressing neurotic symptoms without psycho-analytical help and apparently merely by improving bodily functioning.
The neurotic symptoms in question were as follows: She would awake suddenly at night in the middle of a dream which always had the same content. She would be lying at the bottom of a deep well, the walls of which were closing in about her. This made her jump out of bed and thrust head and shoulders out of the nearest window for free air and for the experience of freedom. Obviously there was danger here. Given a window difficult to open, or actually fixed, and the sleeper, still only semi-conscious, might have thrust head and shoulders through a pane of glass and been badly cut.
Other symptoms were these: She could not sit in a close or stuffy restaurant, or room, or theatre, and could not make a journey in a closed carriage or cabin.
I had read two or three works of Freud at that time, and I diagnosed a hidden birth memory in the case, i.e. a repression of the experience of being born too arduously and slowly, with all the accompanying sensations of a high carbon-dioxide content in the blood.
1 He has recently said: "The future will probably attribute far greater importance to psycho-analysis as the science of the unconscious than as a therapeutic procedure" (E.B., 14th Ed., XVIII, p. 673).
In other words, she had the claustrophobia complex, which Freud traces to a repressed birth memory.
I explained all this to her and she checked my diagnosis by questioning her mother, who confessed that her birth had been a very difficult one.
But now observe what followed. Her symptoms continued as before. Meanwhile, however, she received help in tackling the trouble of constipation from which she had suffered for years, and ultimately succeeded in overcoming it without the help of daily aperients. As it dated from an attack of peritonitis many years previously, it took a long time to cure. But, as it gradually vanished, the symptoms of claustrophobia declined as well, until with its total suppression, no trace of claustrophobia remained.
I was not then, and am not now, sufficiently expert to explain all that happened. But, at the time, I strongly suspected that the distress caused by the long history of constipation, with the daily use of Irritant aperients, might have been an important factor in the genesis of the neurosis, and that probably other neuroses, which psychiatrists like Freud, Jung and Adler, describe as of purely psychogenic origin, have a similar history, i.e. they begin with a long period of psycho-physical distress.
I object, in any case, to this subdivision of mind and body, and to the practice of diagnosing so-called "mental" and so-called "physical" trouble. And when I hear and see that psycho-analysis is itself beginning to be less triumphant as a therapy than as a contribution to the science of the unconscious, 1 I ask myself whether perhaps my instinctive feeling that neuroses
1 The only purely objective and unbiassed study of the therapeutic results of psycho-analysis, that I know, is the review made by Drs. Leo Kessel and H. T. Hyman of 33 cases completely and competently analyzed. Of the "results, 16 were classified as failures, 17 were helped, and in 5 instances it is no exaggeration to say that the cure was specific." Of those that were merely helped, the report says: "The results were good, hut not startling, and at times the result was not specific but due to the modified circumstances" (normal sexual intercourse, etc.). The authors sum up the limitations of psycho-analysis as follows: (1) Its practice is limited to a small group of adequately trained physicians, who cannot possibly handle more than a small number of patients annually. (2)Where the need is greatest, in true psychoses and drug addictions, there is the least expectation of assistance. (3) Favourable results cannot be obtained in patients beyond the age of 40, or who are not well-to-do and unusually intelligent. "The average man in the street is totally unable to grasp or utilize this form of therapy", which "requires attendance from 3 to 6 hours a week for well over a year." The authors conclude by saying, "Despite our receptive attitude towards psycho-analysis as a form of therapy, in 12 years we have seen only a handful of patients who have benefited from the experiences" (J.A.M.A., 18.11.33, pp. 1612–1615). This is by no means the first and only valuation of this form of therapy. In 1930 the Berlin Psychoanalytical Institute published a review of 721 cases, and in 1929 the B.M.A. instituted an inquiry into psycho-analysis as a medical theory and procedure. But this review of Drs. Kessel and Hyman is the first impartial examination of results in definite cases.
of a purely psychogenic order were probably much less common than the new psychology supposes, was not on the whole justified. I may say that I had this feeling long before I had collected the facts which I am now going to set before the reader.
Before I do this, however, I should like to state precisely the extent of my doubts concerning the psycho-analytical position.
I do not question the validity of Freud's science of the unconscious, nor do I doubt the reality of the complexes of which he speaks. Though I do not believe I have a conscious knowledge of more than one of these complexes — the Œdipus — I know all too well the nature of this complex and the great influence it has had on my life, to hesitate in acknowledging its possibility and power. I, therefore, accept Freud's claim that a complex may lead to a peculiar or faulty adjustment to the problems of life, although I doubt whether it often does so alone or single-handed.
Consequently, what I venture to doubt is that the difficulties arising in adult life as the supposed result of a complex, whether neuroses, or psychoses, or functional disorders of the organs, are as often of a psychogenic nature as the psycho-analysts allege, and whether we should not rather assume as more probable that all human beings have some, if not all, of the complexes, and that these, as a rule, become of importance in relation to neurotic behaviour or functional disorders, only when something else, some mechanical distress of long standing, has reduced the average nervous health to a low ebb.
The alert reader will say that I am here guilty of a dualism similar to that of the psycho-analyst himself. For I am really saying that almost all neuroses and functional disorders are of an organic or somatic nature, i.e. they originate in some congenital or acquired peculiarity or disorder of the body, which, by harassing the nerves for a long while, at last allows the complexes, otherwise inoffensive and latent, to assert themselves and crown the nervous irritability.
But even if I assume what seems to be a dualistic position here, surely it is one more justified than the psycho-analyses. The mind, as we know it, is a more recent acquisition than the body. In other words, the thoracic and abdominal viscera of Man do not differ nearly as much as does his brain from the corresponding organs in animals. In this sense, the human trunk is senior to the human brain, just as the human hand is senior to the nakedness of the human skin. Thus the functions of the various viscera have the momentum of sons behind them, and although I abide by the idea of the psycho-physical wholeness of Man, there is a hierarchy based on age, which suggests that the recently acquired habits of the human brain have not the momentum which those of the other organs have, just as the instinct of humanitarianism has not the momentum of that of sex.
If we are to suppose that one moves the other, or that trouble in one affects the other, it seems to me that the genesis of the trouble is likely to start very much more often in the older than in the newer mechanisms. In this sense I would suggest that only a small percentage of neuroses and psychoses and functional disorders of the organism, can have a purely psychogenic origin, and can be approached and removed by the psychological method — hence possibly the disappointments that have attended psycho-therapy based on this approach.
Now let us see what has been said and done to confirm this view, so important from the standpoint of character.
In the first place, Drs. G. R. Wilson and H. C. Marr make this significant remark: "Speaking generally, nearly every case of insanity is attended by a more or less profound disturbance of all the important bodily functions; and the more grave the insanity is going to be, the greater that disturbance is." 1 Secondly, Dr. Henry Devine writes as follows: "It is recognised that the psychoses must be the outcome of a malfunctioning organism." 2
But these statements, however authoritative, are too general. In an article on BIOCHEMISTRY AND MENTAL DISORDER, Dr. J. H. Quastel, Director of Research, Cardiff City Mental Hospital, says: "Mental disease is a symptom of underlying disease or physiological disturbances, the sites, the details, and the courses of which, in the majority of instances, are either unknown, or far from clear." And, "the clinical state 'insanity', whilst immediately referable to the brain, has to be considered as ultimately dependent upon the malfunctioning of various other organs and systems in the body." 3
1 E.M., VI, p. 595.
2 E.B. (14th Ed., XVIII, p. 722). I point out that I am deliberately neglecting the published attacks on psycho-analysis by medical men (Dr. MacBride's, for instance) in order to state my own personal doubts, supported by facts personally collected.
3 LANCET, 31.12.32, p. 1417.
Then, on the purely psychological approach to mental disorders, Dr. Quastel says: "The best results, it appears to the writer, will come only through the combination of the two lines of inquiry, the one which determines the nature of the physiological abnormality and attempts to rectify it, and the other which deals with the details of the mental disorders and relates them to factors of a psychological or constitutional nature." 1
He then proceeds to describe the mental symptoms accompanying lack of oxygen in high altitudes. Such are, loss of judgment and memory, irritability and emotional instability. And he adds, "there seems to be little question that anoxæmia of the brain leads to irrational behaviour". Hence the psychological effects of narcotics which diminish "the rates of oxidation brought about in the brain". This they do, not by interfering with the access of oxygen to the brain, but with the mechanisms which result in the activation of lactic acid or pyruvic acid. 2 Then, speaking of the normal detoxication of tyramine by the liver, and of the liberation of this substance in the blood, if the detoxicating process becomes faulty, he adds: "It seems not impossible that many of the toxic confusional cases, so commonly encountered in mental hospitals, owe their disability to a phenomenon of this description." 3
The whole article should be read, but the following passages are surely most important: "It is evident that in manic-depressive disorders, a disturbance, most probably of the endocrine system occurs, which upsets the normal carbo-hydrate metabolism of the patient." 4
Dr. Quastel also refers to the successful thyroid-feeding of schizophrenic patients of "poor prognosis and of the chronic class", and to Zondek's recent work on the bromine content of the blood in manic-depressives, which he found to be 40 per cent lower than in normal cases, and present in all phases of their illness. This change in bromine level is supposed to be consequent on an endocrine disturbance.
Finally, speaking of the hydrolytic enzymes, affecting endocrine glands and cerebral cortex, in the blood of psychotics, he says: "Apparently the sera of manic-depressive cases show none of these enzymes, whereas those of schizophrenic and frankly organic psychoses contain the enzymes in variable quantities." 5 Another worker in this field. Dr. T. Stacey Wilson, claims that
1 Ibid.
2 Ibid.
3 Ibid., p. 1418.
4 Ibid.
5 Ibid., p. 1419.
he has rectified many cases of "a faulty attitude to the problems of life" through colon treatment, and he says that sometimes the change takes place comparatively suddenly. "As soon as the disturbing nervous impulses which arise in the colon cease," he says, "the mental cloud is dissipated and the patients outlook on life and touch with outward surroundings become normal." And, inviting a test of his statements, he concludes: "I feel confident that it will show that mental distress of various types is very frequently due to abnormal muscular activity of the colon, and is curable by medicinal and dietetic treatment without the aid of psycho-therapy." 1
Among the mental symptoms of colon hardening which he mentions are — mental depression and unhappiness, worry over some imaginary trouble (anxiety), phobias and obsessions, neurasthenia, visual hallucinations, suicidal impulses, etc. And among the possible causes of nerve strain and neurasthenia, he mentions: "errors of refraction . . . dropped kidneys . . . uterine displacements . . . labyrinthine vertigo of a moderate degree . . . dilated deep-thigh veins", etc. 2
Dr. R. C. Rutherford, Medical Superintendent of Farnham House, Finglas, Co. Dublin, also contributes to the subject. In an interesting article, he says: "There can be no question about the exceeding frequency with which subthyroidal symptoms are met with in a mental hospital. . . . For this reason I believe that every symptom of subthyroidism should be regarded with concern as to the mental future of the patient."
He also points out how often goitre is associated with psychosis, and says: "In a mental hospital receiving no cases of idiocy, one patient in every eight has some thyroid enlargement." And he adds: "I have noted for many years the frequency with which patients suffering from mental trouble can be found to have mothers or maternal aunts who suffer from goitre."
He then considers chronic sepsis as a factor in mental illness, and says of Dr. Graves, of the Birmingham Mental Hospital: "He has published the results of 1000 cases that have been examined by the Watson-Williams technique of sinus puncture and wash-out, with the result that 818 were found to show evidence of nasal sinus infection." 3
1 B.M.J., 6.5.33, p. 804.
2 TONIC HARDENING OF THE COLON (Oxford, 1927, pp. 25–27 and p. 36). For cases cured, see pp. 119–139. For treatment: pp. 35–52.
3 B.M.J., 29.7.33, pp. 188–189. See, however, INFECTION OF THE NASAL SINUSES AND TONSILS IN THE PSYCHOSES, by Dr. P. K. McCowan (LANCET, 14.10.33, pp. 853–855), in which, out of 807 cases at the Cardiff City Mental Hospital, only 24 had sinusitis.
Continuing, Dr. Rutherford says: "Chronic sepsis in any portion of the body, and especially that located in the sinuses of the nasal passages, would appear to be so common in mental illness as almost to make it more than suspicious that it may be an essential factor for the production of disease. . . . Thus there are two important factors which would appear to me to be most liable, in combination, to produce a mental disease. First, a deficiency in the nature of a subthyroid condition of the system; and, secondly, the presence of a focus of septic infection essentially of a chronic nature." 1
Dr. Rutherford, bearing out the claims of an investigator like Dr. Stacey Wilson, points to the frequency of gastric disturbances and constipation as factors in the etiology of mental disease, "especially melancholia", and he adds, "I have known some patients make a complete recovery within a few days following the administration of an enema." 2
Another writer. Dr. Sara M. Jordane, of Boston, U.S.A., in a recent article on "The Unstable Colon and Neurosis", says among other things: "Since there is a definite percentage of patients . . . who show clear-cut improvement in their neurogenic symptoms, it is assumed that the condition of colonic dysfunction may precipitate in a fatigued patient symptoms of neuroses, and that when the normal physiological condition is restored the associated symptoms are relieved." 3
Dr. K. Platanow, of Leipzig, in a recent article, rejects Stekel's view that vomiting in pregnancy is necessarily of psychogenic origin, i.e. anxiety neurosis in Freud's sense. Dr. Platanow treated 62 cases by simple suggestion in the waking state or under hypnosis, and in 80 per cent of cases with success. He concludes that the symptom is a somatic rather than a psychic manifestation, and since such a minor psycho-therapeutic measure as suggestion is capable of influencing these cases, he claims that resort to psycho-analysis is not necessary. 4
Platanow's claim is less significant from the standpoint I am advancing than from the standpoint of the thorough-going anti-Freudian who rejects psycho-analysis altogether. But at least it adds to the evidence which shows that many disorders claimed
1 Op. cit., p. 189.
2 Ibid., p. 190.
3 J.A.M.A., 31.12.32, p. 2236.
4 Ibid., 11.2.33, p. 462 (in a report on the ZENTRALBLATT FÜR GYNÄKOLOGIE, Leipzig. Dec., 1932).
by the psycho-analysts as accessible to their therapy are not even of psychogenic origin.
Turning now to Pavlov, of Leningrad; in a recent letter he writes: "First of all, one sees that neuroses are possible to obtain and without difficulty [in dogs], if only one has an animal in whose make-up there is not a proper balance between its fundamental reactions of nervous activity — as yet not further analysed physiologically — that is, between the excitatory and inhibitory processes." And he concludes: "what my associates and I have found with our animals is elemantal physiological phenomena — the limit of physiologic analysis (in the present state of our knowledge). At the same time it is the prime and most fundamental basis of human neurosis and serves as the truest interpretation and understanding of it." 1
Now it is important for the reader to distinguish sharply between neurogenic and so-called psychogenic origins to neuroses and dysfunctions.
The fact that Pavlov points out that a neurosis may be due to a faulty balance between the excitatory and inhibitory processes of the nervous system, is no argument in favour of the psycho-analyst's claim; for according to the latter, a mass of shameful, or painful experiences, unexpressed desires, ideas, buried memories, etc., which he suppressed in the unconscious, is quite sufficient to account for a whole process of disturbances ending in neuroses, psychoses and somatic dysfunctions, and they claim that these morbid phenomena, which the individual has been forced through repression to store up in the unconscious, are curable by the technique of deep analysis.
When, therefore, Pavlov speaks of congenital imbalance between the excitatory and inhibitory processes in a dog, he is not concerned with this unconscious material of the psycho-analysts, although he is speaking in the terminology of nerves and nerve systems. In a word, while the psycho-analysts may be said to emphasize ideological matter and experience, Pavlov stresses an abnormality in the functioning or actual structure of the nerves — a very different matter. I hope the distinction is clear, for it is extremely important.
To the modern psycho-physiologist, the central nervous system is as much the individual organism as his visible nose or eyes. His psyche is merely an invisible and his body a visible
1 J.A.M.A., 17.9.32, pp. 1012–1013.
manifestation of the same organism. In the words of Dr. E. Miller, "Mind divorced from body is as inconceivable as body divorced from mind." 1 Or, as Dr. Arthur J. Hall puts it: "Although for the sake of convenience it is customary to make a distinction between mental and bodily disorders, such separation of the two is physiologically unsound. Every disorder, however slight or localized, must give rise to reactions in every part of the organism," 2
Finally, in this all too brief summary of the more salient facts against the too-sweeping acceptance of a psychogenic origin to neuroses, psychoses and organic dysfunction, there are the conclusions of Dr. Trigant Burrow, who, in "A Phylogenetic Study of Insanity in its Underlying Morphology", says:—
"A laboratory study of man and his reactions as a total process gives indication that the false ideas, the delusions and phobias, the mood-alternations of elation and depression, the emotional conflicts, the repressions and over-accentuations characteristic of mental disease, all are but reflections of an impairment that is deeper seated within the organism. This impairment consists in tensions, alterations and disturbances that affect definite body processes. In a word, the conflict or disparity present in mental disorders consists in a discrepancy between those feelings and sensations which belong to that circumscribed segment of the organism located in the cephalic region with its secondarily acquired ideas and images. As this conflict consists in a disparity between two clearly denned body zones, it is a physiological disparity. Such a condition is perceptible and remediable only through recourse to physiologic methods of repair and not through a program which attempts to exchange ideas for ideas and images for images." 3
I therefore deprecate the dualistic standpoint of the new psychologists, when they speak of a "psychogenic" origin to neuroses, etc., and when they claim that these can be removed by a one-sided concentration on the psyche. I suggest that this is a heresy, and should like to sum up my argument as follows:—
(1) Because the human organism is one psycho-physical whole, it is unlikely that an abnormality which appears as merely psychological can have only a psychogenic origin.
(2) It is even more unlikely that an abnormality which appears
1 T.M.B., p. 14.
2 B.M.J., 27.1.34, p. 133. A paper on BODILY DISEASES IN MENTAL DISORDERS.
3 J.A.M.A., 4.3.33, p. 651. See also same writer's remarks on p. 650. The whole article, in fact, supports my thesis.
as merely somatic (indigestion, constipation, nausea, etc.) can have only a psychogenic origin.
(3) A more acceptable point of view would be that disorders of any kind are psycho-physical, i.e. they originate in a joint disorder of soma and psyche — the two being distinguished only methodologically — and that anxiety exhibited in the mind is always an expression of an anxiety already existing in the tissues owing to some long-existing dysfunction. The fact that the anxious person soon finds purely psychological factors to account for his anxiety — grief over a family death, or over loss of money, or over fear of the future owing to loss of money, etc. — has nothing to do with the point. I should doubt whether continued anxiety in any man, no matter how severe a "mental" blow he may have had, is ever possible unless his organism is already suffering from some obscure and well-established dysfunction.
(4) But an even more acceptable point of view would be to say that disorders of the psychosome, although simultaneously psychological and physiological, do not become apparent in any neurosis, psychosis or well-established dysfunction until they are of long standing, at which time it is preposterous to look for the source in only one side of the organism, because:—
(a) Small beginnings in somatic disturbances are rarely perceptible, although there are innumerable agencies eminently calculated to produce them. These may be congenital anomalies such as a slight though unusual disproportion between certain important organs; abdominal bands now so frequently found at autopsy in different degrees in different people, causing intestinal stasis; endocrine imbalance; mechanical faults caused by faulty co-ordination of the organism in action and inaction; 1 neurological faults caused by the neglect of the inhibitory process of the nervous system and the over-stimulation of the excitatory process; faulty hygiene and forms of exercise and so on. (See also a few obscure causes of dysfunction and neuroses suggested by Dr. Stacey Wilson above, p. 305, and Dr. Burrow in his conclusions, p. 308.)
The onset of the physical symptoms is usually slow and obscure in most of these conditions. When the symptoms are well-established and result from some mechanical fault in the body (such as visceroptosis, often caused by faulty use of self) they have usually had a long history, which must have had an exasperating influence on the psyche.
1 See my HEALTH AND EDUCATION THROUGH SELF-MASTERY (London, 1933).
