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Jelliffe, S.E. (1934). British Journal of Medical Psychology. Psychoanal. Rev., 21(4):442-460.
Psychoanalytic Electronic Publishing: British Journal of Medical Psychology

(1934). Psychoanalytic Review, 21(4):442-460

Abstracts

British Journal of Medical Psychology

Smith Ely Jelliffe, M.D.

(Vol. 9, Part 1)

1.   Glover, Edward. The Psychology of the Psychotherapist. 1-17.

2.   Jones, Ernest. The Psychopathology of Anxiety. 17-26.

3.   Yellowlees, Henry. The rôle of Anxiety in the Psychoses and Psychoneuroses. 26-33.

4.   Hadfield, J. A. Anxiety States. 33-38.

5.   Wodehouse, Helen. Natural Selfishness and Its Position in the Doctrine of Freud. 38-60.

6.   Gordon, R. G. Personality Problems, Mental Illness, Suicide and Homicide. 60-67.

7.   Buchanan, D. N. Meskalinrausch. 67-89.

1.   Glover, E. Psychology of the Psychotherapist.-Rarely does the psychotherapist subject himself to the looking glass and the author suggests its occasional desirability. The subjective searching of the heart in view of the long continued effort of this type of therapy is more or less neglected. In the case of the psychotherapist, however, an understanding of the instrument, himself, is imperative. Hence the need for repeated scrutiny of one's own mental systems if this is to be made effective. Inasmuch as, with certain exceptions, the field of general medicine represents an almost unbroken line of defense against psychological means of approach and the persistence with which obvious psychological factors in treatment are plastered with the labels of ‘organic’ therapy, there might arise the suspicion if not the conviction that this neglect in itself might not be considered a little short of being psychotic. As Glover remarks, however, the general physician is not strictly speaking psychotic in his lack of reality feeling in this respect but approaches the conversion hysteria mechanism more closely. Most of the orthodox modes of treatment in clinical medicine are filled with the belief in magic. When recovery takes place a tribute to scientific method is offered. It is necessary to screen from himself his thaumaturgic proclivities. Another defense (projection of self-criticism of psychological myopia), through aspersion of the validity of psychological methods, is also close to hand. A second method of response is frequently seen. It takes on the character of a punishment. The patient is not excommunicated but is sent away to some specialist, or spa or what not. Or more actually some mutilation

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takes place. The teeth are pulled or the uterus is scraped or some other punitive device is carried out. In the case of the definitely neurotic this is absurd. Even in the case of organic admixtures it still remains questionable. The general behavior of the clinical therapists may be summarized under four heads. They are the persuasive, the magical, the exhortative or the negativistic (nothing the matter) types. All these smack of the primitive medicine man as the clinician takes advantage of the elaborate fačade of modern empirical methods to gratify his unconscious predilection and natural gift for magical procedure.

Is the psychotherapist in any better position in view of the claim to a more fundamental attitude toward disease processes? Not always says Glover. He may backslide to the magical but more often his reasoning becomes sloppy and he begins to “ginger,” meaning by this that he becomes pontifical at the worst, or he takes the easy pathway and calls his therapy reeducation, persuasion or by other fancy titles. The analytic therapist on the other hand goes out of his way to avoid any semblance of persuasion or exhortation. His ideal is objective as to the dynamics of the processes involved and is required of therapist and patient alike. The magical methods are better understood by the psychotherapist than the general practitioner, i.e., he is better acquainted with them historically and therefore presumably more on the alert to avoid the same. But magic and suggestion are so closely related that even the psychotherapist must be on the alert to control himself. The clinician has no such knowledge and is constantly playing the rôle of the primitive medicine man. Much endocrinology is of this nature.

To sum up: a clinical survey of subjective therapeutic tendencies indicates that there is, mutatis mutandis, a close resemblance between the attitudes of the general physician and those of the psychotherapist. In both cases the maximum amount of objectivity is exhibited on consultation and possibly at the commencement of treatment, but sooner or later this is liable to be brushed unceremoniously aside by an open ‘wish-formation.’ The tendency both direct and indirect is to convert an objective situation of illness into a subjective emotional crisis (a phenomenon described in analytical circles as ‘counter-transference’) and to react to this crisis in some characteristic way. The most highly rationalized attitude might be expressed affectively in these terms: “Do please get well for my sake” “It hurts me more than it hurts you”; a more authoritative attitude says: “Come, now, I insist.” These are on the whole parental in type. Failing success, these may be followed by regression to an omnipotent magical attitude, an attitude which corresponds closely to that adopted by the obsessional neurotic when faced by a disturbing excitation. In some cases the therapist's reaction of impatience to thwarting is so strong that he takes up an omnipotent attitude from the outset. Finally the stimulus of an unfulfilled wish may become pathogenic and lead to a decisive outburst of primitive negativism, and the severance of therapeutic

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relations. In both instances regression to primitive attitudes is skillfully cloaked by an access of apparent objectivity, but should this defense prove inadequate, the therapist is prepared to ease pressure by a system of projection. One can well understood why many clinicians are frankly contemptuous of what they consider the obscurantist attitude of the psychotherapist, or why the psychotherapist regards the clinician on occasion as a superstitious apothecary. We have only to reverse such projections to see that there is an irritant grain of truth at the core of these and other pearls of emotional catharsis. The clinician must defend his own tendency to gratify magical leanings in pharmacological disguise: the psychotherapist has more difficulty in adopting open magical means, but compensates for this by a tendency to lapse into a physiological outlook during psychological crises, especially to give assent to the disguises of conversion hysteria. So he maintains uneasy peace of mind by castigating the inadequacies of his more physiologically-minded colleagues.

Glover then goes on to a brief resume of the Freudian conception of the dynamic mental systems. Here there results three types of approach. Always on the side of peace and compromise the Ego makes free play of its peculiar defensive mechanism of repression, reaction formation and continues to daub the finished product with a liberal varnish of rationalization leaving here and there breathing holes which at one time give vent to eruptions from a more primitive volcanic core, at another, release those Super Ego rumblings which one is accustomed to recognize as pangs of conscience. The first task then of the analyst is to strip off the varnish of rationalization. Then one can get at the Id drive and size this up with its relation to the pleasure principle and finally determine the share of the Super Ego in its moralistic counter drives. The hallmarks of the primitive Ego is that it wants pleasure even if it must hallucinate it, to relieve tension. Here omnipotence or flight is the result. Much of the interest in psychology partakes of a bit of omnipotence, or magic. (All powerful -ness of thought.) (Note the schizophrenic's interest in philosophy and/or other omnipotent systems.) The psychotherapist is not immune to this trend. The suggestionist for example is worth observing as to these attributes. Such usually have magical belief in the spoken word (Ce passe, ce passe of Coue, for example). The Super Ego component in therapy is also to be looked into. Here fiats and anathemas are of ancient religious patterning. The peg of ethical and moral injunctions may be overhung with reproach banners. Here again the suggestion mechanism needs careful control. As is well known in analytic theory suggestion is dependent on Super Ego identification.

“To sum up: I believe that a study of the different components of mental structure enables us to classify the main tendencies of psychotherapy, and possibly, though this does not concern us at the moment, the main tendencies of psychology. It might be said that the heterogeneous group of pse'chotherapists could be roughly subdivided according to tendency

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into ego psychologists, super-ego psychologists, and id psychologists (or, as the anthropologist might call them ‘Medicine Men’). This sweeping generalization must be qualified by the statement that every psychotherapist exhibits qualities derived from all three systems and according to his method is bound either to exploit these qualities or to take steps to eliminate them.”

“I feel tempted to add here some reflections on the nature of psychological controversy in general and in particular on the urge to found an irreproachable ‘scientific’ psychology. Of course, the characteristics of the primitive ego and of the super-ego are reflected in all controversies, psychological or otherwise; they are represented by hostility, antagonism, dislike of new ideas, the exploitation of scientific discussion in the interests of internal conflict and so forth. But the most interesting reaction to study in relation to psychological controversy is that of the real ego. One would expect that the contribution of the real ego would be that of scientific outlook and objectivity. Nevertheless I think it is extremely unsafe to assume that the idea of ‘scientific psychology’ which perpetually hovers over psychological discussion is simply the result of a realistic demand for objectivity. We are warned against such a rash assumption by several important considerations. To begin with, our suspicions should be aroused by the mere fact that our critics, the clinical therapists (who, it is suggested, are often saved from conversion hysteria by their interest in organic disease), constantly reproach psychologists for their lack of scientific method. But in fact these reproaches very frequently arouse guilt on the psychologist's part rather than a justifiable tu quoque. Much of the feverish energy and psychological scrupulosity which has been and is still devoted to statistical method and measurement can be regarded as the psychologist's obsessional technique of pleading guilty to the charge.”

“A psychological system, which in the name of science refuses to take cognisance of the irrational, or to operate with the concepts of a primitive ego, has already committed the scientific howler of capitulating to inner stress.”

“But it would be manifestly one-sided to leave the problem of psychotherapeutic tendencies without some reference to what is in many respects the crux of the matter, viz., the nature of the subjective instinctual forces involved and the characteristic mechanisms employed in controlling them. In reviewing these forces it is customary to refer to various ‘component instincts.’ All schools of opinion would agree that impulses of curiosity and viewing tendencies play a large part in determining psychological interests and they are certainly gratified in some stage or other of all psychotherapeutic processes. Others again who believe in oral stages of libidinal development hold that psychotherapeutic labour involves considerable gratification of oral tendencies. But in the brief space remaining at my disposal, I think we might with advantage limit ourselves to

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the consideration of one group, viz., the impulses of aggression, mastery and destruction which in one particular combination have been described as the sadistic impulses. The problem might be put as follows: in what manner does any type of psychotherapeutic activity contribute to the control of these impulses? or again, how far does any one type reflect some existing subjective difficulty in controlling them?”

“In one simple case it can be seen that the result is an access of open aggression. The more violent forms of psychotherapeutic exhortation, especially when accompanied by direct or implied reproach and criticism, represent the most primitive form of reaction. It is true that some degree of contact with the patient is maintained, but it is a violent, and, one might say, sadistic form of contact. The patient's illness is a source of inner irritation to the therapist and since the latter cannot escape by flight, i.e., by refusing to have anything to do with the case, he aims at an immediate and violent cure, viz., the cure by attack. By so doing he provides a psychotherapeutic parallel to systems of clinical therapy which the lay public with considerable insight has described as ‘kill or cure.’ The dangers inherent in this situation are obvious: should the therapist have difficulty with his own sadistic urges, the existence of illness and suffering in the external world provides him with a focal point on which to project his own difficulties. The temptation then exists to avoid curing the patient in order to preserve the external excuse for projection. This reaction is most clearly illustrated in clinical medicine by those physicians whose main interest is in diagnosis and whose treatment is somewhat on the perfunctory side, the rationalization being that ‘patients really heal themselves.’”

“Next in order of interest is the situation where the therapist does not permit any outward exhibition of sadism but as the result of reaction formations against sadistic drives is hampered by the necessity of alleviating external situations of suffering. I say hampered advisedly, because compulsive reactions of this sort tend to be satisfied by any change which can be read as a sign of improvement whether the change is actually to the patient's interests or not. Much of the drive to ‘alter’ patients' character traits or ‘improve’ them is of this nature. On the other hand, when sadistic drives have been modified by the mechanism of ‘turning on the self’ and when the therapist forges a bond of masochistic identification with his patient, the therapeutic outcome is almost as precarious and uncertain as when he has a positive sadistic urge to satisfy. In fact the whole problem of the patient's ‘negative therapeutic reaction,’ in both suggestive and analytic procedure, requires to be constantly checked by reference to the subjective mechanisms of the therapist. That certain types of patient are inaccessible in this respect is undeniable, but I hesitate to say how many cases are ultimately filed in statu quo because of the therapist's own sadistic difficulties.”

“To conclude: I believe that whilst all psychotherapists exploit or are

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liable to exploit subjective psychic reactions characteristic of all three great mental systems, the id, the super-ego, and the real ego, they may be roughly grouped in accordance with a preponderating tendency in favour of any one system. I believe that the suggestion group exhibits the most spontaneous and involuntary exploitation of unmodified superego tendencies with a continuous drag towards the methods of the primitive id system. And I believe that the differences between psychoanalysis and other analytic methods depend on the degree to which the rationalizing tendencies of the real ego are allowed to cover unmodified super-ego interests. So much from the point of view of mental organization. As far as instinctual drives are concerned, I believe that the most important group is the sadistic group and that the type of modification these drives undergo plays a large part in the choice of any one form of psychotherapy. Finally I believe that, major neuroses apart, every therapist tends to exploit (or must take steps to avoid exploiting) character traits patterned on anxiety, hysterical, obsessional or paranoidal mechanisms.”

2.   Jones, E. Psychopathology of Anxiety.-The first task here should be to attempt to clarify the relationships between allied concepts, those of anxiety, fear, dread, fright, panic, apprehensiveness, etc. In psycho-pathology the term ‘morbid anxiety,’ or ‘anxiety’ for short, is widely employed to designate a particular collection of phenomena, one which can be distinguished from those grouped under the name of fear. It was selected for this purpose partly because of its etymological relationship to the more expressive German word ‘Angst’ and partly because it, better than any other, refers to the state of mind rather than the attitude towards an object, this being the point one wishes to emphasize in the morbid condition in question. It is generally agreed that at least two features serve to make this distinction:

These two are noted as the disproportion between the external stimulus and the response, and disharmony between bodily and mental manifestations; a third may be added, i.e., an internal disharmony between the manifestations themselves. The claustrophobic is cited as an example of the first class. What is physiological fear of air raids and what pathological? Psychoanalysts, who have to investigate these states in great detail, have come to encouraging conclusions as regards mankind in this respect and take a very favorable view about its capacity to resist the stimulus of external danger without fear reactions being evoked, provided only that the internal functioning of the mind is healthy in a respect that will presently be mentioned. They thus present a very high standard of man's bravery and maintain as the result of their therapeutic experiences that very much of what passes for ‘normal’ timidity and apprehensiveness is really a neurotic and curable state of affairs. They are not content to take for granted many manifestations of fear that are commonly accepted as being within the range of the normal and they cannot help

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observing that there would appear to be what might be called a conspiracy of leniency on the part of society in this matter by which these manifestations are not scrutinized at all closely. It is plain that psychologists also have in the past been very willing to acquiesce in the same low standards and to take many manifestations of fear at face value; in consequence, misleading inferences have been drawn concerning the nature and extent of operation of the fear instinct. Consider in the second type the bodily signs such as dryness of mouth, sweating, polyuria without consciousness of fear. The anxious cardiac disturbances during the war offer another illustration of the disharmony; similarly diarrheas, impo-tency, sweating and flatulent dyspepsias are incorrectly appraised as of somatic origin. This prominence of bodily reaction as compared with conscious state should arouse curiosity as to the instinctive source of the dynamics involved since the outlet goes through organ rather than idea channels. Here measuring technics are faulty. Overexcitation with inhibition of action is seen in the third tendency.

Jones then refers to the pre-Freudian discussions as practically obsolete save with those of certain neurologizing tendencies; toxins, hypothetical hereditary constitutional anlage in ‘centers,’ etc. Freud's first contribution was to separate a true ‘neurasthenia’ as complying with the chemical substrata of sexual stimulus and frustration, hence the classical anxiety neurosis formulation. The libido was posited as having chemical component factors. Thus the physiological basis of anxiety was generated from the physiological basis of libido by some process of chemical transformation. The phobias were more complex but retained a portion of the same devices. Freud refused to generalize and limited the conception to the morbid anxiety of the psychoneuroses. Dream anxiety has some complications for Jones not yet resolved. According to Jones, instincts are specific modes of reacting to the environment that have been evolved as such through ages of attempts at adaptation and, although their manifestations can, in the higher animals, be extensively modified, deflected and also fused with those of other instincts, this is a different thing from a radical transformation of one into another. Jones has, on the contrary, suggested that morbid anxiety is a perverted manifestation of the fear instinct which, in the case of neurotic conflicts, has been stimulated to activity as a protection against the threatening libido. This protective nature of anxiety has, of course, always been recognized by Freud, his view being that the ego when unable to deal otherwise with an overcharge of libido responded by converting it into anxiety and then proceeded, by the well-known mechanisms of phobia formation, to ‘bind’ this. It seemed to Jones unnecessary to postulate this change since the situation could be adequately described by simply saying that the anxiety was an expression of the ego's effort at defense. In his latest volume Freud has fully accepted this view and abandoned his previous more

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complicated one. We are thus brought back to the simple conflict between ego and libido in the course of which the former responds by, among other ways, developing a reaction of fear.

Morbid anxiety, as it is seen in the psychoneuroses, is a defensive reaction of the ego against the claims of unrecognized libido, which it projects on to the outside world-e.g., in the form of phobias-and treats as if it were an external object: it is, in a word, the ego's fear of the unconscious. But there appears to be an important difference between it and ‘real’ dread in that the latter concerns only the ego itself, arises only in connection with external danger to the ego, and has nothing to do with the abnormal mechanism of morbid anxiety. Here, however, as elsewhere, the line between physiologic and pathologic is not so absolute as might appear, and consideration of the matter leads one to examine more closely into the nature of real dread itself. This can be dissected into three components, and the whole reaction is not so appropriate and useful as is commonly assumed. The reaction to external danger consists normally of a mental state of fear, which will be examined further in a moment, and in various activities suited to the occasion-flight, concealment, defense by fighting or even sometimes by attacking. On the affective side there is to begin with a state of anxious preparedness and watchfulness, with its sensorial attentiveness and its motor tension. This is clearly a useful mental state, but it often goes on further into a condition of developed dread or terror which is certainly the very reverse of useful, for it not only paralyzes whatever action may be suitable, but even inhibits the functioning of the mind, so that the person cannot judge or decide what he ought best to do were he able to do it. The whole reaction of ‘real’ fear is thus seen to consist of two useful components and one useless one, and it is just this useless one that most resembles in all its phenomena the condition of morbid anxiety. Further, there is seen to be a complete lack of relation between development of dread and the degree of imminence of danger, nor does it bear any relation to the useful defensive activities. Thus, one does not flee because one is frightened, but because one perceives danger; in situations of extreme danger men very often respond with suitable measures of flight, fight, or what not, when they are not in the least degree frightened; on the other hand, the neurotic can be extremely frightened when there is no external danger whatever. The inference from these considerations is that even in situations of real danger a state of developed dread is not part of the useful biological mechanism of defense, but is an abnormal response akin to the neurotic symptom of morbid anxiety.

The view Jones put forward was that the only men who suffered from war shock were those whose libido, organized on a homosexual-narcissistic basis, was so attached to the ego as to become stimulated when the latter was threatened, i.e., in situations of real danger. The mechanism of the real anxiety in such situations is more complicated than might at first

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appear. It would be natural to suppose that the response of anxiety was one directly invoked by the stimulus of external danger, so that it would seem unnecessary to invoke any libidinal factor, narcissistic or otherwise.

Whatever may be the explanation, the fact seems clear enough: a threat causes a libidinal investment at the point threatened, as though-to speak figuratively-the libido protects itself by increasing its strength. The fear reaction on the part of the ego is secondary to this increase and clinically we find that at least as much morbid anxiety is a response to a libido excess provoked by threats as to that provoked by erotic excitation, a circumstance which if pondered on will yield many interesting ethical reflections. The anxiety of war shock, and probably also that of hypochondria, appears to belong wholly to this negative context and for the sake of clarity Jones recapitulates the steps in which he conceives it to appear. First, perception of external danger. Secondly, normal fear response of mental alertness and physical preparedness (glycogenic stimulation, etc.) Thirdly, an overinvestment of the ego with narcissistic libido as a protective response to the threatened danger. Fourthly, the evoking of ‘developed’ or morbid anxiety on the part of the ego as a response to the excess of narcissistic libido. This last response is obviously useless, and indeed detrimental, so far as the external danger is concerned and consideration of it brings one back to the question that Jones postponed earlier in his remarks, namely, the precise relation of it to the internal ‘danger’ of excessive libido.

Freud has directed attention to a still earlier situation in life from which many of the most characteristic features of anxiety would appear to be copied or perhaps even derived. That is the event of birth itself. In this bold and apparently far-fetched suggestion Freud was anticipated by no less a man than Erasmus Darwin. What seems to Jones to be needed is a careful correlation of the phenomena of birth and of morbid anxiety with the various manifestations of the fear instinct as seen in animals. Only in this way shall we get final light on the puzzling problem of the relation between internal danger and external danger, of the conflict between the interests of the individual organism and the threat provided by the activity of racial impulses.

3.   Yellowlees, Henry. The rôle of Anxiety in the Psychoses and Psychoneuroses.-The author would take up the discussion chiefly as to the ‘anxiety’ states in the psychoses and first points out the varying conceptions of psychiatric writers on ‘anxiety.’ Freud's ideas are on quite different lines. Here one would have to copy the author's citations which are derived from a few English works on psychiatry, Stoddart, Henderson, and Craig.

4.   Hadfield, J. A. Anxiety States.-This paper continues the discussion of this joint meeting of the Psychiatric Section of the Royal Society and the British Psychological Society in which he would provide the

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following framework: (a) There are innumerable patients who have very marked toxemic conditions, and may, indeed, die of them, without exhibiting the symptoms of anxiety; (b) There are, on the other hand, many people who appear to be in full health and vigor, strong, athletic, good business men, who yet suffer from a terrible sense of dread when in a lonely street, in a tube train, or in an open space; (c) Even if it be true that some toxic focus may be found in most cases of anxiety, such findings are quite unconvincing unless they are accompanied by control experiments of people who have not got anxiety states. Probably none of us would be entirely free from toxic foci of some sort when under the microscopic eyes of the pathologist; (d) The nature of the onset of each attack is also significant. One patient has an attack of dread only when he is in Regent Street; another when serving at tennis and looking up into the open sky; another only when traveling in a ‘bus, but not in a taxi or train. Is one to assume that the toxic condition suddenly becomes activated in Regent Street but never in Piccadilly Circus or even Leicester Square? Obviously, the patient has certain associations with Regent Street or the ‘bus, the recollections of which precipitate fear; (e) There is little doubt that one can entirely dispel a state of anxiety by Suggestion; indeed, from the symptomatic point of view, Suggestion is often a very effective method of cure. It is difficult to understand how Suggestion can have so marked an effect in restoring the patient to a condition of calm and confidence if this condition is due to a toxic state Is one to assume that the toxicity has been cured by Suggestion, and if not, how it is that the effects have disappeared? (f) With regard to the endocrine glands, there appears to be an intimate connection between anxiety states and disorders of the adrenals; and there are those who hold that anxiety states are due to the excessive secretion of these glands. After stating these he discusses the views of Jones.

5.   Wodehouse, Helen. Natural Selfishness and Its Position in the Doctrine of Freud.-After stating that Freud's conceptions offer valuable new points of departure for the psychology and philosophy of Education she would go on under the vague caption of Natural Selfishness to relate such to her reading of Freudian doctrines. As this is a critical and closely knit article, with extensive page-long quotation and argument and counter argument it is not possible to abstract it. The general drift is that for her Freud's discussions of narcissistic fixations leave many ambiguities, which from our reading of her article seem to show that the authoress has not distinguished clearly enough between the outward manifest conscious material and judgments and the unconscious dynamics, hence the discussion is not infused with the understanding of psychoanalytic practice.

6.   Gordon, R. G. Personality Problems, Mental Illness, Suicide and Homicide.-A general discussion with no mention of the illumination due

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to psychoanalysis of the dynamic factors which may bring about suicide or homicide.

7.   Buchanan, Douglas N. Meskalinrausch.-Peyotte buttons or mescal have been used for centuries as an intoxicating agent by natives of Mexico, at first chiefly in religious ceremonials and later as an indulgence much allied to the indulgence in opium, cocaine, betel, coffee or alcohol. The present paper offers a digest of some of the recent literature upon the psychological situations brought out by its use. There is nothing psychoanalytic.

(Vol. 9, Part 2)

1.   Flügel, J. C. On the Mental Attitude to Present Day Clothes. 97-149.

2.   Macauley, Eve. Some Notes on the Attitude of Children to Dress. 150-158.

3.   Howe, E. Graham. Compulsive Thinking as a Castration Equivalent. 159-178.

4.   Groddeck, Georg. Psychical Treatment of Organic Disease. 179-186.

1.   Flügel, J. C. Mental Attitude to Clothes.-This author has published a fascinating monograph on the Psychology of Clothing. The present 50-page contribution starts out from a questionnaire devised in 1928 to get a general view of the situation. Of 10,000 pamphlets distributed there were but 132 answers. The questionnaire is reprinted. The replies are arranged and classified and some slight psychoanalytic interpretations are to be obtained in the author's general summary of various loosely assembled groups. There is a group hostile to all kinds of clothing for any purpose. These apparently retain an early infantile attitude towards clothes. A second group and third trend seem to follow similar though less pronounced trends of little satisfaction in clothes. Several other groups show various types of satisfaction. They are the prudish, the protected, the supported. Then there are the narcissistic exhibitionists, the sublimated and the clothes-prigs.

2.   Macauley, Eve. Children and Dress.-The writer of this short paper carries on some of the previous inquiry through a study of 122 girls and 183 six to fifteen year old pupils in the elementary schools of the city of Exeter. Short essays on three topics were asked for: (a) What sort of clothes the children liked to wear at a party and why; (b) for every day and why; (c) what clothes are disliked and why. The papers were written anonymously and the answers discussed in an interesting and profitable manner. The only bit of psychoanalytic meat would seem to be the thought that up to the nine-ten year the unconscious impulse was probably in favor of nakedness.

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3.   Howe, E. G. Compulsive Thinking and Castration.-An inquiry which began with thoughts about “the highbrow” and its psycho-pathology which seems related to obsessive thinking. Having read McCurdy's paper he began to go over his material. McCurdy's idea that compulsive thinking was an escape from a loss. He would change it to an escape by a loss, i.e., escape from guilt by a castration mechanism the equivalent of which is by de-emotionalization and intellectualization. Five cases are briefly discussed: (1) A clergyman of forty-eight, three years married. He had to repeat certain phrases, three of which, Damn you God, There can't be a God, and Damn the Church, were particularly distressing. He was a bright scholar and a mistake was made in adding his marks at college which deprived him of winning. It came out but was not rectified. He then lost his voice and developed anxiety and a pain in the left groin. This tends to recur when ‘up against it.’ He always felt he would be discriminated against. He was the youngest of eleven children, his father dying when he was one and a half years old. He had much ‘mother love’ and slept in her bed until seven. He became a great reader and student and then must ‘become like Christ.’ The messianic identification was definitely a compensation for the CEdipus wish.

A second-twenty-four year old policeman. For two years he had to “weigh every word he spoke.” Words like P, Y, or G with tails must be avoided. Other compulsive ideas of fidgeting, shaking off an idea, putting things straight, etc., were also present. He was an only son with a sister four years older. He was lonely and a dreamer and masturbated violently since infancy. His father died when he was four. He was always constipated. He had high ambitions. He was keen on engineering, specially on ‘perpetual motion.’ He wanted a sexless marriage. Analysis showed marked mother fixation. The masturbation was a compromise between emotional satisfaction and emotional castration.

A third case of an unmarried woman of forty-three who was determined to give up tea drinking or else suicide. She drank only six cups a day. At ten she ran away to drown herself. “It would have been better if my father had killed me.” I was nipped in the bud. She increased her tea drinking-from once to twice a day. She could not travel by train, she was always falling near the platform edge. She cried day and night and frequently thought of falling out of the fourth story window. She cut down all her food-it must be raw-otherwise it was poison. Tea was the ‘tempter’ She was an able woman, a good cook, yet not able to eat what she cooked. Here there was purity of life and diet but a restricted-i.e., a castrated purity. The compulsion to drink tea is the cry of strangled life for freedom. But freedom is forbidden on pain of death. She was a middle child in a mixed family of nine. Her father a local total abstinence and Band of Hope upholder. At home he was a drunkard. His wife a Calvinist, even tea was not allowed in the house. The patient only tasted it at twelve. She became a rebel and always was

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top dog in civil service examinations. In analysis a memory of four came out when her mother made to cut out her tongue for what she thought was a lie. She ran away that day. On her return her father was by the fire with a red hot poker. He asked her about the ‘lie’ and went through a threat with the poker. An interesting relationship between her food and drink and amenorrhea is noted.

A schoolmaster of thirty-seven, an only son with two younger sisters. He became engaged and then had a hypomanic episode. He was compelled to define the infinite, to know the plan of life. I am always seeking. I read and read and think and think. He feared reality. He was still under treatment. Other important details are too numerous to abstract.

The last case a young university graduate, a double first became suicidal. He was a compulsive thinker, self-analytic and self-destructive. A lengthy series of notes illustrate this interesting case, poems, etc.

The author summarizes his study as follows: (1) There is a group of cases, varying between particular obsessional ideas and general obsessional thinking, in which the act of thinking has become compulsive in motive, excessive in degree and exaggerated in value. These cases are alluded to in this paper as “compulsive thinkers “; (2) The underlying unconscious motive is escape from the conflict of an unsolved emotional problem, which is due to a greater or less degree of “parent fixation.” The escape is by way of a “castration “or de-emotionalization process, in which genital values become transferred to thinking processes in general; (3) The symptom complex of the compulsive thinker is suggestive of the dementia precox type: namely, an escape from reality into “thinking” of a compulsive character, emotional regression and sexual maladjustment, isolation, martyrdom, self-punishment, castration symbolism and suicidal tendencies. It may also present to a greater or less degree obsessional characteristics, but in their most subtle forms these may be no more than a striving for logical perfection and systematic completeness; (4) The “inviolable personality” which Dr. McCurdy noted is a very marked feature of the compulsive thinker and is due to the transference of genital value to the thinking process. Thinking is all in all to the compulsive thinker, and his thoughts are cherished as if they were himself. For the same reason he is extremely resistive to criticism and shows the rigidity of character which Dr. McCurdy notes. He is primarily self-centered and self-seeking, and, if he leads, must lead from a distance, his leadership being autocratic and not cooperative, and itself more important than the cause. On the other hand, the sadism which is noted in Dr. McCurdy's obsessional thinkers is not a very marked feature of these cases; (5) Psychotherapy is peculiarly difficult, for the following reasons among others: (a) The critical faculty is itself involved in the compulsion; (b) The inviolable personality must be violated, and when threatened always tends to revert again to defend itself by compulsive

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thinking; (c) Fear of emotional reality, which is the foundation of and motive for the whole scheme, is so strong as to cause fear of recovery, and sanity to be feared as being itself insane. This would again be utilized and exaggerated by a masochistic factor; (d) The subtlety and widespread character of the process make analysis peculiarly difficult; (6) Compulsive thinking is more than a problem in individual psycho-pathology, for its principle permeates the foundations of society and threatens it with suicide, through the underlying castration motive. Compulsive thinkers tend to become the teachers of the race. The result is the dogmatic commendation of overintellectualization, emotional maladjustment, mechanization and a confusion of precept that threatens the root of the true principles of education, religion and sound psychological development, which must be emotional freedom and growth; (7) In a scientific method, reason and mathematical accuracy are not enough, for the motive of each may be unconscious and compulsive, seeking an escape from the problem which they seem to try to solve. The beginning and the end of life is a problem of emotional development, and faith and love must be the beginning and the end of our search for truth.

4.   Groddeck, G. Psychical Treatment of Organic Disease.-In psychical treatment one is trying to influence the “Es “-i.e., the totality of the patient, physical and psychical, the universe which is himself, his microcosmos. It is the Es (It) alone which determines whether it will use this medical treatment as a means of healing and every form of treatment will fail which has not won the approval of the patient's “Es.” The author then develops his well known ideas as in his “Book of the It.”

Three cases are given in illustration. The first a woman with renal colic. In the earlier days his treatment by deep and violent massage was successful in having her pass the stones but they kept on coming-100 or more until in 1913 when he added psychotherapy since which time-to her death in 1925 no more stones were formed. Why she had stones is interestingly outlined.

A second case of uterine polyp and a third case of surgical significance, in which field Groddeck thinks there is the greatest need for psychotherapy, are then given in detail which should be read in the original.

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(Vol. 9, Part 3)

1.   Seligman, C. G. Temperament, Conflict and Psychosis in a Stone-Age Population. 187-202.

2.   Campion, George G. The Thalamo-Cortical Circulation of Neural Impulse. 203-217.

3.   Burke, Noel H. M., and Miller, Emanuel. Child Mental Hygiene-Its History, Methods and Problems. 218-242.

4.   Connell, E. H. An Analysis of Psychosexual Divalence in Women. 243-257.

5.   Rizzolo, Attilio. Cold Stimulation of a Peripheral Region and the Excitability of the Cerebral Cortex. 258-262.

Money-Kyrle, R. Critical Abstract of G. Roheim's paper “After the Death of the Primal Father.” 263-274.

1.   Seligman, C. G. Stone Age Psychology.-This is an intriguing anthropological paper dealing with some Papuo-Melanesian peoples and their make-up. They are impulsive, suggestible and suicidal. His conclusions are as follows: (1) The population studied, i.e., of that part of Papua known until a few years ago as British New Guinea, is admittedly of an excitable and extravert disposition; (2) In spite of this and the frequency of suicide, both impulsive and ceremonial, there is no evidence of the occurrence of mental derangement, other than brief outbursts of maniacal excitement, among natives who have not been associated with white civilization; (3) Fatal instances of insanity are cited in which the immediate cause (as evidenced by the history and delusions) was financial responsibility in connection with Europeans; (4) In other instances (non-fatal) the difficulty has been in the religious field; (5) Of late years a series of religious cults has arisen. These are characterized by hysterical dissociation and mass contagion, and in all except one there is evidence of the important part played by the conflict between old and new religious ideas.

2.   Campion, G. G. Thalamo-Cortical Circulation of Neural Impulse.-This is an anatomical-physiological paper in which the author advances the argument that the cortico-thalamic and thalamo-cortical fiber tracts are essential to the circulation of thought.

3.   Burke, N. H. M., and Miller, E. Child Mental Hygiene.-An historical paper on the development of this movement with a description of the foundation of a Clinic in Great Britain.

4.   Connell, E. H. Psychosexual Divalence in Women.-A general article dealing with myths and images, myths as projected dreams, relation between the complex, myth and dream, mythology of the female castration complex which is illustrated in the story of Horus, phylogeny of the complex, economic basis for female inferiority, special case of

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women felt as an inferiority, etc. Two cases are briefly reported. One already discussed, Eyes and Nose Case-approached through word association tests (see Cambridge Univ. Med. Soc. Mag., May, 1923).

5.   Rizzolo, A. Cold Stimulation and the Cortex.-A physiological paper.

Money-Kyrle. This is a very satisfactory and informing abstract of Géza Róheim's paper “After the Death of the Primal Father” from Imago, Vol. 9. The Osiris legend is gone into in great detail and its reconstruction and analogies well discussed. The obsessional neurotic and the medicine man relationships are particularly suggestive, especially when read in connection with Glover's fine paper in Part 1 of Vol. 9 of this magazine-(q.v. abstract).

The main points in Roheim's paper are summarized as follows: The story and the funeral rites of Osiris, especially when compared with similar myths and customs, record a series of primal crimes followed by brother wars. These primal events left engrams in the race which account both for primitive customs and neurotic symptoms. When the primal father was eaten he was introjected and became the ego-ideal, whose conflict with the actual-ego lives on in the self-punishments of the primitive mourner and in the self-reproaches of the melancholic. These internal conflicts are repetitions both of the primal revolution and of the brother war. The war of the brothers gave place to a war with strangers, and for this reason primitive mourning rites are followed by expeditions of revenge, and melancholia is followed by mania. The periodicity of melancholia and mania is also a survival of the periodicity of the non-rutting and the rutting periods. The ego-ideal, that is, the introjected primal father, inhibited genital impulses and thereby caused oral and anal regressions. Those individuals in whom such regressions were permanent became magicians, obsessional neurotics, degree of repression and sublimation of these pregenital impulses. By eating the primal father, the brothers identified him with the mother whose milk they had once drunk. Hence the initiate's ceremonial repetition of the primal crime was distorted to symbolize, not only parricide, but also coitus and rebirth. The corpse of the primal father, by acquiring a maternal character in addition to its own, became the object of both active and passive homosexual desires. Because these desires could not be fulfilled they were projected and gave rise to totemism, anxiety hysteria and paranoia

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(Vol. 9, Part 4)

1.   Blacker, C. P. Life and Death Instincts. 277-302.

2.   Fairbaien, W. R. D. Some Points of Importance in the Psychology of Anxiety. 303-313.

3.   Ladell, R. Macdonald. The Neurosis of Dr. Samuel Johnson. 314-323.

4.   London, L. S. Traumatization of the Libido. 324-344.

1.   Blacker, C. P. Life and Death Instincts.-Death may be conceived in a mechanical sense as wearing out. This the author calls the necessitarian concept. It may be conceived as the product of a wish. This he would call the instinctual conception. He then would seek to circumscribe the concept instinct, among its many groupings, three of which may be outlined, the biological, the psychological, and the behavior-istic. He would discuss the biological and psychological conceptions more in detail; Freud's “Beyond the Pleasure Principle” belonging in the latter group. In this work he writes, “Perhaps this belief (necessitarian concept) is also one of those illusions that we have fashioned for ourselves so as to endure the burden of existence.” Freud further goes on, our author quotes, to draw an antithesis between the two conceptions. Hence the ‘wish’ aspect of dying, or as Bernard Shaw puts it, “the bad habit” of dying. Biologically, death as useful to the species, is much involved in Weismann's germ plasm immortality notion. This is the structural foundation for Eros, whereas the soma is that for the death instinct. Weismann's views are quoted at length. Thus “In my opinion life became limited in its duration not because it was contrary to its very nature to be unlimited, but because an unlimited persistence of the individual would be a luxury zvithout having a purpose.” Blacker would discuss this general notion as to biological advantage in such a situation. When, if ever, does it conduce to the survival of a species for its constituent members to become senescent and sterile? The open competition in Nature meets with variation, overmultiplication and the merciless hostility of the environment. Genetics specializes on the first, neo-malthusian researchers on the second and ecologists on the third [the outlines of the science of ecology in the psychical sphere have yet to be formulated, S. E. J.]. Blacker then takes up the psychological definitions of instinct holding that Freud could have made a better case with vertebrates than with the protozoa in his arguments. He apparently overlooks Freud's illustration of the ‘salmon’ as in the “Ego and the Id “and also overlooks Freud's comments on fusion and defusion of the instinctive libido cathexes. (These are considered later.) Blacker's illustration of fusion (reciprocal innervation of Sherrington?) in the activities of the

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sympathetic and parasympathetic systems is excellent. The possible causes of certain defusions are mentioned. Animals in captivity for instance who mope and die when the environmented cathexis is lost or (introverted). Death seems the penalty for differentiation. (See Carrel's experience with embryonic tissues.) To return to Freud's “Beyond the Pleasure Principle” and the repetition compulsion, thus, “We see that children repeat in their play anything that has made a great impression on them in actual life, and that they thereby abreact the strength of the impression, and, so to speak, make themselves master of the situation” and later it turns out we are able to regulate the gratification of our instincts only after we have acquired some control over them. The two tasks of the psyche then are first repetitive, during which some control of our reactions is obtained and second the discharge of the instincts in such a way as to relieve instinct tension. From both of these functions does Freud infer the existence of death instincts. The author thinks that so far as the pleasure principle is concerned this is true, but considers its application to the repetitive principle to be far fetched. He then goes on in an elaborate manner to try to demonstrate this. The argument is too close, interwoven and intricate to abstract But it strikes the reviewer that the general argumentation is not altogether sound, chiefly in that criticism proceeds from the beginning rather than from the end of the formulations. The author concludes his paper with a very neat and interesting though purely speculative hypothesis why animals die in captivity and why human beings suicide which dispenses with the theory of specific death instincts. The author's paper is entirely formal and nowhere shows any realization of the concrete psychoanalytic material upon which the formulations are founded.

2.   Fairbairn, W. R. D. The Psychology of Anxiety.-This paper deals with the discussion of Jones on Anxiety (see Brit. Jl. Med. Psych., Vol. 9, Part 1). The author states he is in general agreement with Jones but, believes that psychoanalytic psychology should get in closer touch with general psychology. He then writes a general paper with some consideration of McDougall's and Drever's ideas on instinct and other semi-academic speculative ideas regarding instinct psychology. There is no actual concrete case material under survey.

3.   Ladell, R. M. Samuel Johnson's Neurosis.-A delightful descriptive account of this celebrated man's psychological idiosyncrasies as taken, naturally, from the Boswellian biography, also notes of Joshua Reynolds. The author's diagnosis is anxiety hysteria, and he says he read Cheyne's classic because Johnson stated he was helped by it. Ladell does not seem to be able to translate himself back into that period (1733). Our author also thinks Johnson was impotent (i.e., phallically). The paper is not very thorough nor profound.

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4.   London, L. S. Traumatization of the Libido.-A continuation of the author's conception as already having appeared in the Psychoanalytic Review, April, 1929. Two case histories are offered with detailed dream analysis material.

5.   An excellent critical review of MacCurdy's Common Principles in Psychology and Physiology is offered by Flugel.

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Article Citation

Jelliffe, S.E. (1934). British Journal of Medical Psychology. Psychoanal. Rev., 21(4):442-460

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