"The macaque of both sexes is apt to display sexual excitement in the presence of friendly or harmless non-primates.
"It is possible that the homosexual behavior of young males is of the same biological significance as their mock combats. It is clearly of value as a defensive measure in both sexes. Homosexual alliances between mature and immature males may possess a defensive value for immature males, since it insures the assistance of an adult defender in the event of an attack." MEYER SOLOMON.
AN EXPERIMENTAL STUDY OF STUTTERING. By John Madison Fletcher. American Journal of Psychology, April, 1914; Vol. XXV, pp. 201-255.
This paper is a dissertation submitted to the faculty of Clark University, Worcester, Mass., in partial fulfilment of the requirements for the degree of Doctor of Philosophy. It is thus from the Psychological Laboratory of Clark University.
This interesting study of Fletcher includes some general remarks in the introduction, the question of differentiation and definition, the physiological aspects (including breathing, vocalization, articulation and accessory movements), psychophysical changes (including volumetric changes, changes in heart rate and galvanic changes), a consideration of the interpretation of the results, the psychological relations (including emotions, attitudes, imagery, responsibility for Aufgabe, psychoanalysis, and association), heredity and conclusions. A valuable bibliography is added, and seven illustrative plates complete the paper.
Fletcher would reserve the word "stammering" for mispronunciation or incorrect speech, this stutter being anatomical (due to malformation of one or more organs of articulation) or developmental (due to incorrect functioning of the organs of articulation resulting in certain cases of immaturity, such as lisping). Stammering, in this sense, is of no psychological interest. The reviewer is in favor of employing the terms "stammering" and "stuttering" synonymously, as is the practice in England and America. The writer (Fletcher) finds that he cannot accept the Freudian interpretation of stuttering which has been offered by a number of different members of that school.
Although the entire paper is of interest and of value to the student of psychopathology, the purposes of this review can best be served by citing the following conclusions of the author: The motor manifestations of stuttering are found to consist of asynergies in the three musculatures of speech-breathing, vocalization and articulation. Certain accessory movements, which tend to become stereotyped in each individual and which consist of tonic and clonic conditions of other muscles not involved in normal speech, accompany these asynergies. The type of asynergy and more particularly of accessory movements differ so widely that it is impossible to state that any special form of breathing, or articulation, or of vocalization is the fundamental factor in stuttering. Disturbances of pulse rate, of blood distribution and in psychogalvanic variations, appearing before, during and after the speaking interval, and the intensity of which varies approximately with the severity of the stuttering, accompany the motor manifestations of stuttering. The essential condition in stuttering is the complex state of mind, the quality rather than the intensity of these feeling states governing the rise of stuttering. Such feeling states as fear, anxiety, dread, shame, embarrassment, in fact, those feelings that tend toward inhibition and repression, are most likely to precede stuttering, and probably operate in a vicious circle as both cause and effect. The permanent condition of nervousness thought to be characteristic of stutterers should be regarded as effect rather than cause. The states of feeling that have to do with the production of stuttering vary in degree from strong emotions to mere attitudes or moods, the latter being often so slight in degree that it is difficult for the subject to report their presence. Stuttering also seems to be affected by the quality of mental imagery, by attention and by association. The affective and emotional experiences associated with the pronunciation of sounds rather than the nature of the sounds themselves determine the rise of stuttering. The author's final remarks are: "Stuttering, therefore, seems to be essentially a mental phenomenon in the sense that it is due to and dependent upon certain variations in mental state. Hence the study of stuttering becomes a specifically psychological problem; and it seems evident that a detailed analysis of all the various aspects of the phenomena of stuttering will furnish important contributions to general psychology." MEYER SOLOMON.
REVIEWS
THE FOUNDATIONS OF CHARACTER. By A. F. Shand. Macmillan and Company, London, 1914. Pp. xxx, 532.
In his preface the author says: "A great difficulty which I have found in the course of my work has been to collect the facts or observations of character on which I had to rely. Such material as I have obtained has been drawn much more from literature than from any other source; and this was inevitable, because psychology has hardly begun to concern itself with these questions." This reproach levelled against psychology rebounds on the author, for throughout the book he shows himself evidently unacquainted with those branches of psychology, notably the medical ones, that have contributed so brilliantly and extensively to the science of characterology. It need hardly be pointed out, further, that to rely on second-hand material, which cannot be checked, analysed, or immediately studied, as the living facts can is a procedure that is open to insuperable objections.
The author repudiates any analytical approach to his problems, preferring what he terms "a concrete and synthetic conception of character," and so "avoids breaking up the forces of character into their elements, and being driven to consider the abstract problem of their mutual relation." His method consists in assuming the existence of these forces, as part of his working hypothesis, and in formulating general laws based on a study of them. As he himself puts it, "It is in the first place a method of discovery rather than of proof;-a method reaching no further than a tentative formulation of laws; for organising the more particular under the more general; for interpreting the generalised observations which every great observer of human nature forms for himself, and by this interpretation making some advance towards their organization. "It follows from this that the book is predominantly descriptive in nature, and in this field it must be said that the author has accomplished great work, one that will be of almost indispensable value to future students of the various emotions.
The book is really a study of the emotions rather than of character, and so we have to pay special attention to what the author has to say concerning them. As is well known, he formulated some years ago a special conception-it can hardly be called a theory-of the emotions, and the most novel part of the present work is the way in which this conception is expounded and elaborated in detail. He rejects the usual sense of the term in which it is taken to express a certain degree of elaboration of the affective aspect of the mind, and adopts a much wider definition in which the conative, affective, and cognitive aspects are all represented. "'Emotion' for us will connote not feeling abstracted from impulse, but feeling with its impulse, and feeling which has essentially a cognitive attitude, however vague, and frequently definite thoughts about its object." He distinguishes, none the less, between an emotion and the entire system to which it belongs. It is the part of the system that is present in consciousness, there being two other parts that are not; namely, the processes connected with it in the body, and the executive part concerned with its outward expression and modes of behaviour. The three main primary emotions are fear, anger, and disgust; other are curiosity, joy, sorrow, self-display, and self-abasement. The four emotional systems of anger, fear, joy and sorrow have an innate connection not only with one another, but also with every other primary system. Most of the book is taken up with a very detailed study of the emotions just enumerated, and in this study the author insists on the functional point of view, constantly enquiring into the dynamic aspects and tendencies of the emotion under consideration. This is perhaps the only respect in which it could be seen that the book was written within the last forty years.
Mr. Shand's view of the relation between the emotions and the instincts has led to an animated controversy with Dr. McDougall, published in the Proceedings of the Aristotelian Society for 1914-1915. According to the latter writer, every emotion has a corresponding instinct, and is merely the affective aspect of this instinct. Mr. Shand, on the contrary, holds that there are vastly more instincts than emotions, that a given instinct may enter into several different emotional systems, and that each emotional system may at various times, and according to its needs, make use of almost any number of different instincts. The reviewer is unable to determine whether these different points of view have any further implications than a difference in the definitions adopted by the two writers. McDougall obviously employs the term instinct in a much more comprehensive and inclusive sense than Shand does.
In the discussion of this interrelation there occurs, by the way, the following suggestive passage: "There are no fears so intense as those which arise in situations from which we cannot escape, where we are forced to remain in contemplation of the threatening events. There is no anger so intense as when the blood boils and all the sudden energy that comes to us cannot vent itself on our antagonist. The arrest of an instinct is that which most frequently excites the emotion connected with it; and therefore we feel the emotion so often before (or after: Reviewer) the instinctive behaviour takes place, rather than along with it." This seems to after-shadow the modern views on intrapsychical conflict and abreaction.
Another conception peculiar to the author, first propounded in 1896, is that regarding the sentiments. Sentiments, in the author's sense, are "those greater systems of the character the function of which is to organize certain of the lesser systems of emotions by imposing on them a common end and subjecting them to a common cause." A constant conflict seems to go on between the organizing tendency of these sentiments and the tendency of the constituent emotions to achieve freedom and autonomous action, a conception quite in harmony with the modern views of "complex-action," although Shand's "sentiments" are far from being synonymous with either "complexes" or "constellations" in our sense. The implications that follow from his conception of the sentiments, and the importance he attaches to it, are well shown by the following interesting passages. "The result of the modification which the systems of the emotions undergo in man, and especially the multiplication of the causes which excite and sustain them, is (1) to make man the most emotional of animals, and (2) to render possible the debasement of his character. For that which is a condition of his progress is also a condition of his decline,-the acquired power of ideas over emotions, and the subsequent power of each indefinitely to sustain the other. Hence the existence of the emotions constitutes a serious danger for him though not for the animals, and the balance which is lost when the emotions are no longer exclusively under the control of those causes which originally excite them can only be replaced by the higher control of the sentiments. There are then three stages in the evolution of emotional systems; the first and primitive, in which they are under the control of the stimuli innately connected with their excitement, undergoing a certain change through individual experience, but not radically altered; the second, in which they become dangerous and independent systems; the third, in which they are organized under the control of the new systems which they are instrumental in developing." "There are three principal stages in the development of character. Its foundations are those primary emotional systems, in which the instincts play at first a more important part than the emotions; in them, and as instrumental to their ends, are found the powers of intelligence and will to which the animal attains. But even in animals there is found, some inter-organization of these systems, or, at least, some balance of their instincts, by which these are fitted to work together as a system for the preservation of their offspring and of themselves. This inter-organization is the basis of those higher and more complex systems which, if not peculiar to man, chiefly characterize him, and which we have called the sentiments, and this is the second stage. But character, if more or less rigid in the animals, is plastic in man: and thus the sentiments come to develop, for their own more perfect organization, systems of self-control, in which the intellect and will rise to a higher level than is possible at the emotional stage, and give rise to those great qualities of character that we name "fortitude," "patience," "steadfastness," "loyalty," and many others, and a relative ethics that is in constant interaction with the ethics of the conscience, which is chiefly imposed upon us through social influences. And this is the third and highest stage in the development of character, and the most plastic, so that it is in constant flux in each of us; and the worth that we ascribe to men in review of their lives, deeper than their outward success or failure, is determined by what they have here accomplished."
We have given some indication of the positive side of the book, one which deserves great praise for both its matter and style. On the negative side we have to remark on the following important omissions. As was mentioned to start with, no acquaintance whatever is shown with either the methods or findings of what may broadly be called medical psychology, the only psychology that has at its disposal the material on which a science of character could be founded. That the important work of Klarges on characterology is not considered may be accounted for by the fact that there is not a single German reference given in the whole book. In the second place, the genetic point of view is almost completely overlooked, one of cardinal importance in such a field. Thirdly, the whole subject of the unconscious is treated as non-existent. It is a complete misnomer to entitle a book on descriptive psychology "The Foundations of Character" when no notice whatever is taken of that region of the mind where the very springs of character take their source, and where the most fundamental features of character are to be found. Last, but not least, is the absence of any study of the sexual instinct and emotions, surely of cardinal importance for any investigation of character. Apart from the general contributions made by this instinct to character, one thinks of such clearly-cut pictures as the masochistic, voyeur, and anal types of character.
An inadequate index closes an unsatisfactory, though in many respects valuable, book. We note no fewer than twelve references to "Seneca," but none to "sex" or "shame;" sixteen to Hudson, but none to Freud, Janet, Prince, Adler, or Klarges. ERNEST JONES.
AN INTRODUCTION TO SOCIAL PSYCHOLOGY. By William McDougall. Published by John W. Luce & Co., Boston, 1910.
Although this book was published a few years ago, nevertheless it seems sufficiently important to the reviewer to have it brought prominently before psychopathologists.
In the introduction McDougall reminds us that the instincts are the prime movers, the mental forces, the sources of energy, the springs of human action, the impulses and motives which determine the goals and course of all human activity, mental and physical. These instincts, being the fundamental elements of our constitution, must be clearly defined, and their history in the individual and the race determined. For this purpose, comparative and evolutionary psychology is necessary, for the life of the emotions and the play of motives in mental life are the least susceptible of introspective observation and description. "The old psychologising," says McDougall, "was like playing 'Hamlet' with the Prince of Denmark left out, or like describing steam-engines while ignoring the fact of the presence and fundamental role of the fire or other sources of heat." A knowledge of the constitution of the mind of man is a prerequisite for any understanding of the life of society in any or all of its many aspects. And this applies to psychopathology. I venture to assert that had certain individuals read and digested a book of this sort it might have been a prophylactic against an exclusively sexual conception of human conduct.
The work is divided into two sections. Section one deals with the mental characteristics of man of primary importance for his life in society, while section two is concerned with the operation of the primary tendencies of the human mind in the life of societies. The successive chapters of the first section take up in order the following questions: the nature of instincts and their place in the constitution of the mind, the principal instincts and the primary emotions of man; some general or non-specific innate tendencies, the nature of the sentiments and the constitution of some of the complex emotions; the development of the sentiments; the growth of self-consciousness and of the self regarding sentiment; the advance to the higher plane of social conduct; and volition. In the second section the author considers the reproductive and the parental instincts, the instinct of pugnacity, the gregarious instinct, the instincts through which religious conceptions affect social life, the instincts of acquisition and construction, and there is a final chapter on imitation, play and habit.
McDougall dividends the instincts into specific tendencies or instincts and general or non-specific tendencies. He calls attention to the abuse of the term "instincts" and himself defines an instinct as an inherited or innate psychophysical disposition which has the three aspects of all mental processes: the cognitive, the affective and the conative-or a knowing of some object or thing, a feeling in regard to it, and a striving towards or away from that object. "The continued obstruction of instinctive striving is always accompanied by painful feeling, its successful progress towards its end by pleasurable feeling, and the achievement of its end by a pleasurable sense of satisfaction." He reminds us that "the emotional excitement, with the accompanying nervous activities of the central part of the disposition, is the only part of the total instinctive process that retains its specific character and remains common to all individuals and all situations in which the instinct is excited." We may experience the emotional excitement and the impulse to the appropriate movements of an instinct or the re-excitement of an instinctive reaction in its affective and conative aspects without the reproduction of the original idea which led to its excitation. Pleasure and pain but serve to guide these impulses or instincts in their choice of means towards these ends.
One of McDougall's important conclusions is that "each of the principal instincts conditions some one kind of emotional excitement whose quality is specific or peculiar to it, and the emotional excitement of specific quality that is the affective aspect of the operation of any one of the principal instincts may be called a primary emotion." This is McDougall's definition of emotion.
McDougall then takes up for discussion and analysis the principal instincts and the primary emotions of man which include the following: the instinct of flight and the emotion of fear; the instinct of repulsion and the emotion of disgust; the instinct of curiosity and the emotion of wonder; the instinct of pugnacity and the emotion of anger; the instincts of self-abasement (or subjection) and of self-assertion (or self-display) and the emotions of subjection and elation (or negative and positive self-feeling); the parental instinct and the tender emotion, and such other instincts of less well-defined emotional tendencies as the instinct of reproduction (with sexual jealousy and female coyness), the gregarious instinct, the instincts of acquisition and construction; and the minor instincts of crawling, walking, rest and sleep. McDougall denies the existence of such instincts as those of religion, imitation, sympathy and play.
There then follows a consideration of some general or nonspecific innate tendencies or pseudo-instincts which are not specific instincts with special accompanying emotions, and this leads to the analysis of sympathy or the sympathetic induction of emotion, suggestion and suggestibility, imitation, play, habit, disposition and temperament.
The sentiments are now taken up for analysis and definition. A sentiment, according to McDougall, who accepts Shand's definition, is an organized system of emotional tendencies or dispositions centred about the idea of some object. Among the complex emotions not necessarily implying the existence of sentiments McDougall includes admiration, awe and reverence, gratitude, scorn, contempt and loathing, and envy. Among the complex emotions implying the existence of sentiments he considers reproach, anxiety, jealousy, vengeful emotion, resentment, shame, joy, sorrow and pity, happiness, surprise. The nature and the constitution of the sentiments and the complex emotions comes in for very illuminating analysis. The chapters on the growth of self-consciousness and of the self-regarding sentiment, the advance to the higher plane of social conduct, and volition are to be considered among the best chapters of this very excellent work. The discussion and analysis is very penetrating and clear. It is well worth while presenting the following abstract of the chapter on volition: All impulses, desires and aversions, motives or conations are of one of two classes: (1) from the excitement of some innate disposition or instinct; and (2) from excitement of dispositions acquired during the life of the individual by differentiation from the innate dispositions, under the guidance of pleasure and pain. When in the conflict of two motives the will is thrown on the side of one of them and we make a volitional decision, we in some way add to the energy with which the idea of the one desired end maintains itself in opposition to its rival. The idea of the self, or self-consciousness, is able to play its great role in volition only in virtue of the self-regarding sentiment. The conations, the desires and aversions, arising within this self-regarding sentiment are the motive forces which, adding themselves to the weaker ideal motive in the case of moral effort, enable it to win the mastery over some stronger, coarser desire of our primitive animal nature and to banish from consciousness the idea of the end of this desire.
Volition, therefore, following McDougall, may be defined as the supporting or re-enforcing of a desire or conation by the cooperation of an impulse excited within the system of the self-regarding sentiment. The sentiment of self-control is the master sentiment for volition and especially for resolution. It is a special development of the self-regarding sentiment. The source of the additional motive power, which in the moral effort of volition is thrown upon the side of the weaker, more ideal impulse, is ultimately to be found in that instinct of self-display or self-assertion whose affective aspect is the emotion of positive self-feeling. These remarks are given more or less verbatim.
McDougall next analyzes strength of character which he differentiates from disposition and temperament which are innate. In section two, as stated previously, the author takes up for separate and more minute analysis the family (the reproductive and the parental) instincts, the instinct of pugnacity, the gregarious instinct, the instinctive bases of religion, and the instincts of acquisition and construction. Imitation, play and habit receive separate treatment in the final chapter.
The reviewer can freely recommend this book as one of the best, if not the best book of this sort that has come into his hands. His personal opinion is that it is the best. McDougall presents us with an acceptable and clean-cut classification of the instincts, emotions and sentiments, he accurately defines these terms, he gives the analysis and constitution of these instincts, emotions and sentiments, and develops the motive sources of human conduct. He adopts many original and novel standpoints. He is an independent thinker. He has here presented us with a book which, because of its clearness and its frank meeting of the problems, is of the utmost value to the psychopathologist and the psychiatrist. In fact the contents of just such a work as this should be the first lesson of every worker in this field. In this way only can he really begin to understand human conduct.
This work should find its place in the forefront of those books which should be read and digested by all workers in any of the social sciences.
For the reviewer it has been a genuine pleasure to read and to review this book and he most heartily recommends it to the reader of these pages. MEYER SOLOMON.
BOOKS RECEIVED
THE THEORY OF PSYCHOANALYSIS. By C. G. Jung. Pp. 133 and Index. Nervous and Mental Diseases Monograph Series, No. 19, 1915, $1.50.
PSYCHOLOGY AND PARENTHOOD. By H. Addington Bruce. Pp. IX plus 293. Dodd, Mead & Co., 1915. $1.25 net.
THE INDIVIDUAL DELINQUENT. By William Healy. Pp. XV plus 830. Little, Brown & Co., 1915. $5.00 net.
HUMAN MOTIVES. By J. J. Putnam. Pp. XVII plus 179. Little, Brown & Co., 1915. $1.00 net.
THE JOURNAL OF ABNORMAL PSYCHOLOGY
CONSTRUCTIVE DELUSIONS[*]
[*] Read at the sixth annual meeting of the American Psychopathological Association, May 5, 1915, New York City.
JOHN T. MACCURDY, M. D. Psychiatric Institute, Ward's Island
and
WALTER L. TREADWAY, M. D. Assistant Surgeon, U. S. Public Health Service
MOST psychiatrists state or tacitly assume that dementia praecox is a disease of a steadily progressive nature, where the first symptom of dementia is a signal for relentless degradation of the patient's mental capacity except in the sphere of the more mechanical, intellectual functions. Yet the experience of every institutional physician denies the universality of this deterioration, and the statistics in any good text book demonstrate that many cases are "chronic" rather than "deteriorating." Woodman[1] has made a careful study of 144 such chronic cases, and shows what a surprisingly large proportion of these develop a good adaptation to the artificial environment of the institution. So far as we know, however, no one has attempted to formulate any definite features of onset which could be taken as a guide in determining the gravity of the mental derangement. In fact Bleuler states categorically that "up to the present no correlation has been discovered between the symptoms of onset and the gravity of the outcome." Kraepelin has split off from dementia praecox a separate psychosis-Paraphrenia systematica-which he timidly defends as a clinical entity apparently because the course is a long one and the deterioration less marked than in dementia praecox. But he gives us no concise prognostic data; in fact one feels on reading his paper that the diagnosis must be made post hoc. This problem is manifestly of equal importance from the social and the scientific standpoint: until we can predict the outcome our treatment must be empiric and palliative; we confess ourselves ignorant of the disease process if we cannot make a prognosis.
[1] R. C. Woodman, N. Y. State Hospital Bulletin, Vol. II, No. 2, 1909.
It is possible to make certain a priori speculations as to prognostic criteria based on classification and what that implies. We know that pure paranoia is not a deteriorating psychosis-that it does not necessarily preclude the possibility of considerable social usefulness-and that it grades off almost imperceptibly into dementia praecox. The features differentiating these two diseases should therefore supply us with data for determining the prognosis. A case undoubtedly, praecox, which shows markedly the differential features of paranoia, should have a proportionately better outlook. In a vague way our common sense uses this standard when it makes us "feel" that the case will have a long course which shows a relatively well retained personality in conjunction with praecox symptoms. But "feelings" are hardly objective criteria. What symptoms may we make use of? We may say that the praecox patient as opposed to the paranoia has a poverty or inappropriateness of affect, a scattering of thought and a lack of systematization in his delusions. The weakness of will on which Kraepelin lays so much stress may be included, though that can probably be derived from the scattering of thought. What of these symptoms may be analyzed for our purpose? Affect changes and dissociation in the stream of thought are themselves signs of the deterioration we wish to predict; to make use of them we should have at hand some theory as to the relation between their quality and quantity, and that we have not. There remains the content of the psychosis, a definitely objective material with which to work. This is naturally a big problem-almost as wide as insanity itself-and one brief communication cannot pretend to solve it. What we wish to do is merely to put forward tentatively the claim of one type of delusion formation to prognostic value.
Now if delusions are to be an index to deterioration they must in some way hold a mirror to the changes in the personality, repeat them or prefigure them. If we generalize our conception of functional dementia, we can say that one of its most striking features is a destruction of the faculty of appropriate reaction, a loss of what one may term the sense of reality. The patient in direct proportion to the degree of his dementia loses his capacity to recognize the reality of his environment or his relationship to it, and builds up more and more a world of his own in which he lives untroubled by the demands of adaptation. No one who has ever argued with a paranoic will forget how keen a sense of reality he may retain, how logical his arguments are, and how reasonable his delusions appear, if only some one point be granted. With the praecox, however, the opposite impression may be quite as striking. His delusions are bizarre, inconsistent, kaleidoscopic; he has no logical explanation and cannot even state them consecutively. And all gradations from pure paranoia to dementia praecox seem to have corresponding losses in the sense of reality as embodied in delusions.
May we not hope to find in the content of the psychosis some objective criterion as to the degree in which the sense of reality is lost, with all that it implies?
But what takes the place of the sense of reality or what causes it to go? With what tendency of the psychotic individual is it in conflict? The answer is a psychological truism-the indulgence in fancies. Imagination, of course, is essential to every human being, no purposeful action can be instituted without its first being carried out in imagination. Phantastic thinking begins when the subject fails to apply the test of reality to his mental image and exclude it if it be not adapted to realization. If environment or internal inhibitions prevent this realization, however, the craving: lying back of the fancy must be diverted to a more practical channel-the normal solution-or the fancy must persist in spite of its impracticability. This latter process is the germ of the psychosis. But not its development. A certain compromise may be reached-he who digs for gold in his back-yard is not so crazy as he who reaches out his hand for the moon. Nor is the paranoic who chooses to put his interpretation on the surliness of his employer as far estranged from reality as the praecox who recognizes his employer in the person of the physician. The content of the psychosis may then express the relative strength of the two antagonistic factors, sense of reality and fancy, the two factors whose relative importance decide the issue for sanity or insanity.
It is easier to imagine than to act, so no human being is free of this tendency. But what does the normal man do? He diverts these thoughts into channels where fancy has a legitimate place-he writes romances; he imagines himself using an instrument to talk with his friend miles away and invents the telephone; he imagines a better society than the one which galls him, and writes a "Utopia"; above all he theorizes and speculates. According to his age or ability these speculations give us alchemy or chemistry, astrology or astronomy, magic or religion, spiritism or psychology, the were-wolf or psycho-analysis, phrenology or psychiatry, and so on. Now three generalizations can be made about these primitive or elaborated philosophizings: first, they all represent a constructive tendency; second, the degree to which this constructive tendency is exhibited is historically a measure of the cultural development of any age, an index of the development of the sense of reality of the time, that is, the particular speculation is not only accepted as reasonable but has its practical application for the period; and third, the more primitive forms of these speculations are represented in the delusions of insane, particularly dementia praecox, patients. Following a suggestion of Dr. Hoch we have termed these ideas "constructive delusions." As they correspond to what was historically a compromise between reality and phantasy, they should represent a corresponding mildness or severity in the psychosis where they appear. Our observations-far from being extensive-have so far demonstrated this that we feel justified in offering the hypothesis that when such delusions are present one can base a mild prognosis on their presence with a rather specific relationship between the crudity of construction and the degree of deterioration. It must be borne in mind, however, that we make no claim as to the invariable presence of such delusions when marked deterioration does not take place. We hope only to show that when present this particular form of content may constitute a valuable prognostic guide, as it represents the degree to which the patient has gone in recapitulating the history of his civilization.
It should be understood that we are not describing highly unusual cases; many such have been published. A highly typical one is given by Freud in his analysis of the Schreber case.[2] In this extremely stimulating paper Freud puts forward the claim that all delusions are an attempt at regaining health on the part of the psyche. From a broad psychological standpoint, this is undoubtedly true but the generalization is too wide to be of any practical psychiatric value. Moreover, by choosing for analysis a case which was neither dementia praecox nor paranoia but a combination of the two, he reaches conclusions which are valuable additions to our knowledge of psychotic processes but merely confuse the issue as to the specific mechanisms of paranoia and dementia praecox. In Schreber a profound psychotic reaction corresponded to crude formulations of his fancies, whereas, when he built these ideas into constructive speculations, he became relatively sane and an efficient citizen. If Freud had emphasized the point that this later formulation was more than a vehicle for the cruder thoughts, that it contained components which were potentially of social value, which implied a broader contact with the world-had he done this-then the present paper would be superfluous.
[2] Psychoanalytische Bemerkungen uber einen autobiographischen beschrieben Fall von Paranoia (Dementia paranoides). Jahrb. f. psychoanalyt. u. psychopath. Forschungen, Jahrg. III.
The first case we wish to present, John McM., is at present thirty-six years of age, unmarried, a Catholic. For at least nine years he has been objectively psychotic, though, according to his own account his delusional habit of thought began seventeen years ago. He had little education but made the most of it and has read widely (for one of his station) on such topics as socialism. He was always somewhat distant and did not make friends easily. From early childhood he was antagonistic towards his father and brother and, since his mother's death six years ago, to whom he was strongly attached, towards an aunt as well. He has struck both his father and his aunt. His antagonism towards his father is of great importance as a determinant for his later symptoms. When young he feared him, as he grew older disputed his authority and, according to the father, always disobeyed him. He was always shy with women and, as we shall see, his first conflict in the sexual sphere was solved by a psychotic reaction. Once an efficient salesman, for the past nine years he has drifted from one position to another. As he says himself, he lost ambition after he decided not to get married, and concluded he would not attempt to gain worldly possessions, but merely enough to subsist on. His early life showed not so much tendency towards elation and depression as towards imaginative thinking with a leaning towards day-dreaming and "mysteries." Of late years his reading has been confined to sexual topics, as discussed by various quacks, astrology, phrenology, Christian Science, and religion. Although he said he discovered God for himself he never gave up the Catholic religion. Gradually his energy has been so engrossed by these interests that he lost position after position as a result of continually talking of his ideas to his fellow workers or employers. This tendency eventually led to his commitment, but as long ago as 1906 a physician said he was insane. For the past six years he has been cross, stubborn and self-willed so that none of family dared to speak to him. He even left home and took a furnished room by himself. In spite of this evident anti-social tendency he speaks of himself as having been filled during this period with a great hope; he has been looking into the future and content that he will reach the goal and sees happiness in the future. For some months he had talked much of the world coming to an end and said that those who had money should spend it as it would soon do them no good. He wanted every one to divide his money with him as, he said, everything belonged to God. Many people were against him and he wrote letters about this to various officers. It was when he showed some of these to an assemblyman that he was advised to go to Observation Pavilion.
When he arrived at Manhattan State Hospital he was quiet and agreeable, cooperated readily with his examination and seemed to take his incarceration as a matter of course, though he has always had mild arguments to prove that he should be allowed parole. A certain degree of deterioration is evidenced by his failure to make much of an effort in this direction, although such effort would be immediately successful. In his manner he was quiet, occasionally somewhat affected and when talking of his ideas was apt to assume an expression bordering on ecstasy. At no time did he show an inappropriate affect or any evidence of scattering or flight. He could talk quite objectively of his idea. He had had only one halucinatory experience and even it should, perhaps, be called merely an illusion. "On the 14th of March, 1912," he said "I came face to face with God Almighty. He spoke in a Jewish dialect and was dressed as a carpenter." The patient was in the Cathedral at the time and that night he had a vision of this man, though this may have been just a dream. He also heard Bishop H. speak of the man who had come to prepare the world for the second coming of Christ. The bishop looked at this patient which meant that he, the patient, was the man.