has from seventy to eighty per cent of cases of dementia præcox in his asylum then it becomes necessary to come to an understanding as to what he means by the term dementia præcox, in the same manner as it was necessary in the case of Stekel and Gross relative to melancholia and manic depressive insanity, and in the case of Freud relative to paranoia. In such cases our obscure terminology is a stumbling block. It is, however, remarkable that at the present day when in accordance with Kräeplin's views dementia præcox is continually narrowed to find that an observer like Jung meets such an enormous number of these

cases.

roses.

The retrospect we have taken is not consoling, perhaps a view of the future is more promising. Scientific strife stands for progress provided it does not turn into personal quarrels. Freud and his followers should see if they could not get equally satisfactory results without their "sexual investigations.' We, the opponents, gladly acknowledge their psychological work helping us to understand the neuBut it must be remembered that with all their analysis they have not succeeded in throwing any more light as to the real nature of hysteria. Psychoanalysis in itself is indispensable to the neurologist and psychiatrist. Sexual psychoanalysis, on the other hand, appears to many of us as objectionable or superfluous. We all recognize the importance of sexuality in normal human life as well as in disease. But, with the exception of rare cases, treatment should be directed to the suppression of the sexual representations and not to bring them to the surface. Education of the youth relative to sexual matters is indeed desirable, but the discussion of all possible perversions is objectionable.

I may conclude with the hope that the future is not far distant when no undue emphasis will be given the sexual factor, and when we will be able to come to an understanding without doing violence to the facts; and that not only should we learn from Freud, Jung, and Stekel, but that the latter should give earnest, critical consideration to the views of their opponents.

Freud, who sees in the hysterical symptom an expression of the most secret repressed desires of the patient (naturally the sexual desires), can proceed in no other way but to disclose in his analysis these most intimate secrets. But, as I have pointed out in my paper in 1907, his premises are wrong and are far from being applicable in all cases. But even if his premises were correct it is still open to question whether a method of treatment is justifiable which fixes the attention of the patient for months upon sexual experiences or pseudo-experiences, in waking and in dream states. If this method were the only one by which results could be obtained, then, as Aschaffenburg puts it, "it would have to be used in the same manner as we prescribe the most bitter medicine when we are convinced of its good effects, or we undertake mutilating surgical operations in order to prolong life." But Freud's method of treating hysteria is morally injurious even to the "hardened" hystericals (he certainly does not realize it or he would not apply the method). When Freud makes the statement that in no case of hysteria is purity of thought to be found, and that there is never the danger of corrupting an inexperienced maiden, it is to be classed with the numerous assertions for which he has offered no proof; and in the interest of our patients it were far better to avoid such generalizations. It is indeed dangerous (in spite of Sadger) to stamp a disease so that the diagnosis of hysteria carries with it a moral perversity. This, however, is the conclusion, surely not of physicians, but of laymen, who, thanks to the work. of several of Freud's followers, have been well informed about his doctrines. But even if every hysterical had such "knowledge" she ought to be questioned, and her perversity explained by any one rather than by the physician. At any rate, I can conceive of parents who would see their daughter hysterical for all her life rather than submit her to a sexual psychoanalysis lasting for years(!).

I may briefly summarize as follows:

1. We do not possess a therapy equally applicable in all cases of hysteria.

2. The cathartic method of Breuer and Freud has, from the theoretical standpoint, been very fruitful for the

psychology of hysteria; it is of practical value in certain cases of traumatic hysteria. The association studies of Jung and others deserve critical consideration.

3. The psychoanalytic method is surely not the only one that is of value in the treatment of hysteria, neurasthenia or obsessions. In so far as the method is connected with the detailed discussion of sexual matters and perversities, it is justly rejected by many authors.

4. Psychical treatment, as it is practised by those who do not belong to Freud's school, accomplishes as much as sexual psychoanalysis, but it must be aided according to the particular case by general therapeutic measures. applicable to functional neuroses and psychoses. (Training in work, hydro and electro therapy, dietetics, etc., and under certain conditions hypnosis.)

5. The procedure of those authors who carry on a propaganda in lay journals about this method of treatment, which at best is not proven, and which is rejected by many, deserves emphatic disapproval.

FUNDAMENTAL STATES IN PSYCHONEUROSIS*

I

BY BORIS SIDIS, M.A., PH.D., M.D., BOSTON

N the investigation of psychoneurosis the psychopathologist is confronted by some strikingly characteristic features. The symptoms are not isolated or disconnected, but appear in connected groups, in well-associated systems. The symptoms are logically related, being grouped round a nucleus which seems to guide and control the rest of the morbid manifestations. The disease, in spite of its manifold variations of symptoms, really presents a welltold story, with a central plot running through all its ramifications, with a hero and possibly a heroine round whom the main interest gravitates. Viewed from another standpoint we may say that we have here the evolution of a low form of parasitic personality. This parasitism is well brought out in the attitude of the patient towards those morbid mental states. He regards the whole system-complex as foreign to his personality.

Another important characteristic is the periodicity of the system. The morbid system runs in cycles. The patient tells that during the time of obsession the mind works in a circle. There is a sensory nucleus, a sharp attack lasting but a short period, followed by a long period of depression and worry. In most, if not in all cases, the origin of the obsession is unknown to the patient. The morbid mental state flashes lightning like on the patient's mind, keeps him spellbound in terror, and then suddenly disappears, to reappear on some other favorable occasion. Other states persist in consciousness for some time, but even in such cases periodicity of remissions is quite marked. This characteristic of periodicity is so marked that some writers describe such cases by the term "psycholepsy," while others classify them under the misused term of "psychic epilepsy." In order there should be no confusion with epileptic states I describe these morbid states as recurrent psychomotor

*Read before The American Psychological Association, Harvard University, Dec. 28, 1909.

states. These states do not belong to the patient's normal associative life, but appear to the patient himself as opposed to his usual normal life-activities, they appear to him as dissociated from the rest of his interests, from the rest of associations and psychomotor adjustments. He does not understand those dissociated states, wants to extrude them from his mind. Under certain conditions he is not even aware of them, since they either appear subconsciously, or swamp his personality during the whole period of their activity. The states are essentially subconscious, dissociated states, they come in attacks, in seizures, and manifest themselves, like vulcanic upheavals, with extraordinary violence and emotional disturbances. As pointed out in former works: "One general characteristic of these morbid psychomotor states is the fact of their recurrence with the same content of consciousness and with the same almost invariable psychomotor reactions. The patient thinks, feels, wills, and acts in the same way. Subconscious dissociated states belong to the type of recurrent moment-consciousness, a type characteristic of the lower forms of animal life, a low type that responds to the external environment with the same adjustments, with the same psychomotor reactions. From this standpoint we may regard the recurrent psychomotor states as a reversion to lower forms of consciousness. The suddenness of the attack, the uniformity of the manifestations of the symptom-complex, the uncontrollable overpowering effect on the patient's personal consciousness are all due to the same underlying condition, the dissociation of the patient's subconsciousness."

The nature of the subconsciousness, whether it be physiological or psychological, or both, we may leave to the speculations of the philosophical psychopathologist and metaphysical psychologist. Our present object is to note the clinical facts, describe them accurately, correlate them into generalizations, and use provisionally limiting concepts, much in the same way as the mathematician uses space or the physicist uses matter and ether. By the subconscious we simply indicate this fact of dissociative activities characterized by their recurrence and automatism, of which the person is often not directly cognizant.