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his waking life. Because he recognized this, for a long time he recorded only those dreams which he thought were asexual; as the resistances were breaking down during the analysis, he began to relate more and more of his dream life, until finally he recounted all that he could.
His behavior toward the members of the family left no room for doubt that the familial drama was fundamental. This topic was partly considered in the beginning of the paper. Ever since his mother remarried, his hatred toward his step-father has been so intense that he has insistently begged his mother to leave her husband. He became decidedly ambivalent toward her, as she continued to remain faithful to his hated rival. He loved her with as much ardor as he hated her; he despised her because she spurned his advances. Throughout the 13 years of love and hate he offered to provide what he considered a far more peaceful home for her than he alleged her husband was able to contribute. Yet, at no time has he been economically independent; he has continuously been supported by those at home, not, however, as far as he is aware, by the step-father. The truth is that the latter is not, and never has been, antagonistic to him and, moreover, he has steadily contributed a share toward Henry's support. Concomitant with the love for his mother, he has steadfastly refused to live at home. A short time after she remarried, he went to a distant city to live with a favorite sister, but within a few months he returned to his mother, because he developed the same feeling toward the sister's husband that he harbored against his step-father. From the age of 13 to 17 he was accustomed to leaving the home early in the morning and to returning late in the evening. His neurosis, insidiously growing more and more complete, was being gratified in a partial manner through attachments to clinics and physicians, until finally, when he was 17 years old the complexes assumed such huge proportions that he left home to go to a hospital. In the latter institution he became entirely obsequious to the physicians who fondled his neurosis, while he was resentful to those who tried to remove the
As stated previously upon his official discharge as a patient, when he was 18 years old, he remained in the hospital as an employee. The promotion had no perceptible effect on his neurosis. The unconscious strivings were so securely fixed to their modes of expression that removal from home and partial economic independence comprised but a thin veil. During his last year in college, he was discharged from the hospital; this step threw him back upon
the complete support of those at home. Out of respect for his neurosis, as his people thought, they were prevailed upon by him to pay for his maintenance, while he lived away from home. Yet, under careful analysis there was not a single feasible reason, save for his attitude toward the members of his family, why he could not have lived at home. Time and again the analyst tried to convince Henry that his feelings towards those at home were responsible for the situation, but just as often he failed (through his wish-life) to see the connection. The home was quiet throughout the day and in the evenings he could have studied in a quiet room. But, he rationalized, the house was in the lower part of the town and he preferred the upper; furthermore, the neighborhood was undesirable, although he professed not to know in virtue of what it was undesirable; again, he felt uneasy at home; this feeling, it was ascertained, was due solely to himself, not to any environmental conditions. He attributed it to the many neurotic symbols then prevalent, claiming that they were less intolerable elsewhere than at home.
All of the essential facts as brought out by the analysis have been carefully and repeatedly reviewed with the patient without the semblance of any sound appreciation of their value on his part. He believes that family influences may play a part in the lives of others, but in his case only the neurotic elements are of importance. His opinion of his illness is much the same as the opinion of the frank case of schizophrenia, who under psychoanalytic treatment claims that he should like to be rid of the disturbing factors, but he cannot because he is not responsible for their occurrences. The mechanism in Henry's case is that designated as projection, in that he fails to recognize that any part of his sickness may be due to factors over which he may have control. He considers that there is a congenital basis for the neurosis and that, therefore, he is powerless to do anything of a curative or of a palliative nature. The analyst feels that, even if there were well-founded reasons in the field of heredity or of congenitality, they could not explain his fundamental trend of interests, which comprises the wish to be guided in his life work by the infantile components formerly in the unconscious sphere.
From the standpoint of physical type, according to Kretschmer's conceptions, Henry is definitely of the asthenic type. Whether this has any connection with his "character" is open to question. It is possible that there may be some relationship between the body
build and the malignant-like features, that seem to resemble those observed in schizophrenia.
Henry has drawn from the sphere of intelligence almost exclusively to try to gain the consciously desired level of adaptation, while he has not made any wholesome efforts to convert the infantile emotional bonds into adult forms. Whatever success we have had in making him appear less neurotic has been due in largest measure to the more complete and advantageous application of the more genuinely intellectual processes. Or, expressed in another way, the sphere of intelligence was flexible and amenable to improvement, whereas the emotional sphere and its immediate constellations were rigid and unresponsive. We hope that he will be able eventually to turn some of the infantile libido in the direction of adult needs and experiences. That will form the therapeutic means by which we may be able to make him appear as a still better social unit.
From the study of borderland and neurotic conditions, especially as regards those with schizophrenic-like elements, it seems possible that the factors operating to bring about dissociated mental syndromes may be more clearly recognized. The overwhelming attachment of libidinal forces to infantile unconscious elements may result in an almost complete severance of affectivity from those intellectual processes useful to adult behavior. In the case of Henry, the emotional manifestations were almost exclusively devoted to the deeply regressive experiences, scarcely any sharing in his intellectual pursuits. The emotion (fear) was constant, though the setting changed much and often. He was fearful at home, when alone or with others; he was fearful when away from home; at work or at school, at play or at the theater the same type of emotion persisted.
Save for that part of his intellectual functioning that served to act as a cloak to the infantile emotional attachments, his intellectual processes were confined to the symbols that represented the unconscious wishes. Indeed, the entire sphere of intelligence comprised a blanket rationalization. The reduction of large realms of associated material to single words or thoughts is analogous to the condensation so frequently seen in schizophrenia. We may take as an example any one of Henry's symbols; he was attracted to all moving vehicles; on analysis the main trend turned to all automobiles; then to doctors' automobiles; a doctor's automobile, a particular type of a doctor's automobile; a doctor who owned that type; the doctor himself; the doctor's assurances that he need not fear; if he need not fear, he could happily retain the underlying funda
mental wish, viz., to relieve the earliest experiences with his mother. Through such a hierarchy of symbolisms he was able to veil the origin of his life efforts. Furthermore, as each successive step in the symbolic structure was replaced by a new and more disguised one, the equivalent emotional values were likewise replaced. In its final representation the formula, deprived of the intervening symbols, as they had been by Henry, was this: All automobiles gave pleasure, because they meant the preservation of mother-son unity. The last sentence sounds extremely illogical; it is thoroughly unintelligible until the latent meanings are understood. One of our cases of schizophrenia uttered smilingly such phrases as the following: "Not when you see the point, I don't know how it comes; I never ordered to go home-you must like it-mother fed all the dogs and cats-I did all I could-they can't go fishing like they did. There are no flowers, no friends. Rub me up and rub me down. Tell the truth, never mind. I will fix them like a roaring lion." The patient was smiling and happy as she related the above. It was definitely ascertained that the remarks referred to her attitude toward her parents, when she was a child; furthermore, she was expressing in symbolic language the solution of the problem, as she would like to have had it; hence, the happy mood. What we coinmonly designate as "inappropriate mood reaction" becomes with full knowledge of all the associations an appropriate mood reaction; we cannot understand the new language, because it is purely individualistic; it is the possession of the one who has devised it, until we have studied and translated it, when we also can speak understandingly with the patient.
To us dissociation of emotional and intellectual processes comprises a highly complex symbolic representation, the understanding of which can be attained only by knowledge of the entire career of the individual, and more particularly by the orderly correlation of the symbolic forms of expression.
A CRITICAL DISCUSSION OF THE CONSTITUTIONAL
ANOMALIES OF EPILEPTICS
BY L. PIERCE CLARK, M. D., NEW YORK
In recent years two widely divergent groups of investigators into the nature and cause of epilepsy have arisen. The first and apparently most widely accepted group has taken the old histopathologic cortico-marginal gliosis and placed such morphologic findings as a part of the symptomatic pathology of the whole disease process. In other words the findings at autopsy are held to be but effects of a still more obscure causation. The next quest of the morphologic researchers has been to indict the basic (systemic) metabolic defects and often to indicate that those obscure defects are still more remotely conditioned upon endocrine imbalance. These and similar investigators have gradually extended their scientific scope until a more functional view of the whole problem has resulted and it is frequently summarized as the psychobiologic view of the organism as a whole as applied to the interpretation of the epileptic constitution. However seemingly psychological such views appear, they are really not so but are relatively static in concept and still deeply conditioned upon preformed patterns of vital modes of response for the total organism. To break away from such essentially biologic concepts a new group has appeared that approximates the whole issue for the instinctive aspects of the dynamic or psychoanalytic standpoint. This viewpoint is still undergoing great changes constantly and is hardly beyond the experimental stage. Perhaps my own work during the past decade gives the best summary of the general trend in this latter direction. Inasmuch as this is essentially a psychological one of the whole problem many readers may be willing only to concede at present that the personality and nature of the epileptic is to be thus explained and not the frank aspects of his seizure phenomena. However this may be I may here set down cogently the main argument of this more known hypothesis before taking up the chief purpose of this anthropologic critique. I have crystallized the general formulation of a host of investigators in this field and placed the general characteristics of the epileptic succinctly and categorically under the designation of epileptic constitution or makeup. This constitution, I maintain, is not brought about as a result of epileptic seizures solely as the majority of investigators in this field have heretofore maintained but that his essential char