In the last chapter we have dealt with the general question of mental conflict, and have discussed one of the methods by which the mind may avoid the internal stress and accompanying disagreeable emotional tension which a state of conflict inevitably produces. This method, characterised by the formation in the mind of ‘logic-tight compartments’, accounts, as we have seen, not only for many of the phenomena observed in everyday life but also for some of the secondary phenomena met with in insanity.

Sometimes, however, this simple method of avoidance is not available, and the mind may then resort to other ways of freeing itself from the stresses and strains of conflict. The majority of these other methods are included under the general conception of ‘repression’, and we must now proceed to examine this conception and the various phenomena which it serves to explain.

The precise conditions under which the mechanism of the ‘logic-tight compartment’ can no longer be employed are at present imperfectly understood. The factors which play the principal part therein can, however, probably be summarised in the two following groups. First, the complexes at war with one another may be of such intrinsic importance and strength that the conflict between them cannot be concealed from the mind by the simple process of allowing each to pursue its own independent course and development. Secondly, the mind may be of a relatively more sensitive type which detects at once the unsatisfactory nature of this procedure.

The normal effect of a complex is to produce action. A train of activity is set in motion whose goal is the realisation of the desires and tendencies constituting the driving force of the complex. The complex finds a complete expression in the achieving of its ends. There is, however, another mode of expression by which satisfaction is often obtained, although that satisfaction is only partial and limited. This second mode of expression is the construction of phantasy. In phantasy—or, to use the more widely known term, day-dreaming—we do not seek to satisfy our complexes in the world of reality, but content ourselves with the building of pleasant mental pictures in which the complexes attain an imaginary fulfilment.

The distinction between these two modes, the direct and complete expression in action, and the partial expression in phantasy, may be clearly seen in the effects produced by the so-called ‘self-assertion complexes’. By the self-assertion complexes we mean those tendencies to aggrandisement of the self and the achieving of distinction amongst one's fellows which may be roughly grouped together under the heading of ‘ambition’. Their normal direct effect is to be seen in the individual's struggle to get on, and to obtain a position which will ensure to him the respect and admiration of others. In addition to the direct expression in action, however, these complexes may expend a variable portion of their energy in the construction of phantasy.

The attribute of the insane patient which is at once the most general, the most obvious, and the most striking, is his apparent irrationality. It is so evident that the delusions he exhibits are false beliefs, that the hallucinations have no objective reality, that the depression or exaltation is totally unjustified by the actual state of affairs. He is, moreover, so plainly impervious to the contradictions which his experience everywhere presents to him, and so absurdly obtuse to every argument and demonstration which our wits can devise. In the face of all this the superficial observer can only conclude that the root of the evil lies in the patient's incapacity to see reason, and that these grotesque symptoms have arisen simply because the mind has lost its ability to think rationally. To such an observer the essence of the matter is that the reasoning powers are diseased, and hence that the mind is capable of thinking any thought, however absurd and baseless it may be.

A more careful investigation, however, soon reveals facts which it is difficult to reconcile with this view. In many patients the reasoning powers seem to be in excellent order so long as they are applied to matters not immediately connected with the delusional system. Thus a patient who is firmly convinced that he is the son of George III may be capable of solving the most abstruse mathematical problems, and may perhaps fulfil duties in the hospital which demand the utmost nicety of judgment and discrimination.

If we now review the field which we have surveyed in the present volume, and consider the implements which have proved of value in the investigation of its details, we shall at once observe that there are two of those implements which have been pressed into service at almost every turn. These are the conceptions of dissociation and conflict, and their utility has been so great that it will be profitable to examine from a more comprehensive and general point of view the part which they play in mental life.

We have seen that a vast number of abnormal phenomena, ranging from hallucinations and delusions to the complicated phantasy productions described in the last chapter, are to be regarded as examples of dissociation. The mind has lost that homogeneity which is the ideal of the normal personality, and has become disintegrated into more or less independent portions, each pursuing its own course and development without reference to the welfare of the whole.

We have seen, moreover, that this disintegration has invariably owed its existence to the presence of a conflict. Homogeneity has disappeared because the mind contains elements which are incompatible with each other, and dissociation has arisen as a method of avoiding the storm and stress which the warring of these mutually hostile elements would otherwise inevitably produce. Dissociation is therefore to be regarded biologically as a refuge from the stress of conflict, and as one of nature's methods of dealing with conflicts which seem insoluble by other means.

The task which lies before us is to explain how the psychological conception maybe applied to the phenomena of mental disorder, and to show that those phenomena are the result of definite psychological causes operating in accordance with definite psychological laws.

At the outset we encounter an obstacle which, though not perhaps peculiar to the subject we have chosen, offers exceptional difficulties on account of the conditions under which the subject has to be presented. We have to assume that our readers are ignorant, not only of the laws which govern the phenomena of mental disorder, but to a considerable extent of those phenomena themselves. Most readers will have some acquaintance with symptoms occurring in the minor forms of mental disorder known as ‘neuroses’, but few laymen have any practical experience of those occurring in the more pronounced forms of mental disorder included under ‘insanity’. The conception of the insane patient possessed by the public at large is exaggerated and inaccurate. Hence before we can proceed to the explanation of the symptoms which the insane patient exhibits, it is necessary that this erroneous conception should be corrected, and we must ensure that our readers have at any rate a superficial acquaintance with the phenomena which actually occur. It is to this preliminary task that the present chapter is devoted.

To describe in a complete and systematic manner the symptoms met with in the manifold varieties of insanity is obviously impossible within the limits of a small book.

We have described in the last chapter certain psychological laws which are constantly to be found in action both in the normal and in the insane mind. An attentive examination of the phenomena in which those laws are manifested, will convince us, however, that the position so far reached can in no sense be regarded as final. Further problems at once suggest themselves. Why is an individual sometimes aware of the complexes determining his thoughts and actions, and sometimes not so aware? Why does a complex in one instance express itself simply and immediately, in another by those devious routes which we have termed ‘indirect’? Why does the father's letter make my patient miserable about the two foreigners, instead of making him miserable about the father's treatment of himself? The answers to these questions involve two further psychological conceptions, those of ‘conflict’ and ‘repression’. These conceptions are of fundamental importance, and it will be necessary to examine them at considerable length.

Suppose that a complex is for some reason out of harmony with the mind as a whole, perhaps because of its intrinsically painful nature, perhaps because it prompts to actions which are incompatible with the individual's general views and principles. In such a case a state of ‘conflict’ arises, a struggle, as it were, between the complex and the personality. These two forces will tend mutually to inhibit each other, the mind will be divided against itself, and a paralysis of action will ensue.

It is necessary that we should clearly understand what is meant by the psychological conception of mental disorder, the relation it bears to the physiological conception, and the nature of its aims and methods. The consideration of these problems involves some preliminary acquaintance with the fundamental propositions upon which modern science is based, and inevitably leads to questions which are, strictly speaking, beyond the limits of our subject. But as no clear thinking in psychology is possible unless precise notions about these elementary matters have been previously acquired, we may perhaps be pardoned for temporarily trespassing upon the domain of philosophy.

It has been pointed out that modern science is attacking the problem of mental disorder along two different routes. The psychological conception treats the phenomena as states of mind, whereas the physiological conception treats them merely as manifestations of changes occurring in the brain. Now in this statement we are confronted with certain terms which, although loosely and erroneously used in ordinary language, have nevertheless a precise and definite signification. These terms are ‘science’, ‘mind’, ‘brain’, ‘physiology’, and ‘psychology’.

Everybody is aware that science is a method of acquiring knowledge, but everybody is not aware that this method is always one and the same, whatever the subject may be to which it is being applied. The scientist who devotes himself to psychology proceeds in exactly the same manner as the scientist who devotes himself to chemistry.

This introduction seeks to put before the reader a general sketch of the history of psychopathology from its beginnings to the position which it held in 1912, in order that he may be able to appreciate the place in the subject of the principles described in this book. It therefore attempts to cover a wider field than is proper to an introduction, and for this reason the uninstructed layman will probably find it more intelligible and useful if it is read after rather than before the book.

DEVELOPMENT OF PSYGHOPATHOLOGY PRIOR TO JANET

Psychopathology, the science which attempts to explain the problems of mental disorder by psychological principles and laws, is of comparatively recent growth, and can hardly be said to have existed before the last quarter of the nineteenth century. The remarkable phenomena produced by Mesmer and the other ‘magnetisers’ had aroused a widespread interest a hundred years earlier, and later investigators had demonstrated that these phenomena were due, not to the magnets, but to the suggestions communicated by the operator. These ‘suggestions’ were clearly causes of a psychological order, and it was therefore known that psychological causes were capable of bringing about definite changes in mind and body. Until the time of Gharcot (1825–93), however, this conception had not been applied to the problem of disease, and we owe to that investigator the first formulation of the view that certain disorders were due simply to the action of ‘ideas’.

This book lays no claim to be a comprehensive treatise upon the psychology of insanity. The number of independent schools of thought existing at the present day, and the fundamental divergence in their methods of investigation, make it obviously impossible to compress such a treatise into the limits of a small volume. All that has been attempted here is the presentation of certain recent developments in abnormal psychology which have already yielded results of fundamental importance, and which seem to offer an exceptionally promising field for further investigation.

An endeavour has been made to develop the subject-matter of the book in a systematic manner, so that the general principles which it is sought to establish may appear in as clear a light as possible. The adoption of the systematic method in a work of this size, however, renders a somewhat dogmatic mode of presentation inevitable. It is necessary, therefore, to warn the reader that many of the theories to which he will be introduced have not as yet been firmly established, and that they are to be regarded rather as suggestive hypotheses which will ultimately require considerable alteration and improvement.

It must be clearly understood, moreover, that no attempt has been made to cover the whole field of insanity. On the contrary, certain sections of that field have been more or less arbitrarily selected, mainly on the ground that they yield fruitful results to psychological methods of investigation.

In the preceding chapter the phenomena produced by the repression of a complex were divided into two groups, those due to the indirect expression of the complex itself, and those due to the presence of a resistance or censure which prevents the complex exercising its normal direct effect. In all the examples hitherto considered the symptoms present could without much difficulty be assigned to one or other of these two groups. It will nevertheless be obvious that this distinction is largely artificial, and that in the formation of each symptom the factors of indirect expression and resistance both take part. The symptoms may be regarded, in fact, as a compromise between the two factors in question. The complex struggles to express itself, while the resistance endeavours to prevent it achieving its end. The symptom is finally evolved as a compromise between the two opposing forces. In each of the examples cited in the last chapter, however, one of the two components seemed to play a preponderating part in the compromise produced, so that the symptom could be classified as belonging to the corresponding group.

The group of symptoms to which we must now direct our attention, those due to the mechanism of ‘projection’, exhibit this preponderance of one component to a less marked degree, and the phenomena belonging to it are best regarded as instances of compromise formation in which the parts played by the two opposing forces are approximately equal.

In the preceding chapter we have collected together certain of the more prominent phenomena of mental disorder. To the uninitiated eye they appear as a chaos of disconnected facts, each seemingly independent of all the rest. A careful examination will show, however, that there are certain general attributes common to many of the symptoms displayed by our patients. With the aid of these general attributes it is possible to classify the phenomena into groups, and thereby to reduce the confusion to some sort of order.

Firstly, the conditions described as mental deficiency and dementia may be placed in a separate group. They depend, as we have seen, upon an absolute quantitative defect of mental capacity, and are in this respect fundamentally different from all the other phenomena dealt with in chapter III. These conditions are generally accompanied by a correlated defect in the structure of the brain, and it must be frankly confessed that, in the present state of knowledge, the psychological conception is of relatively little value in the study of their causation, and that the physiological conception is a far more profitable instrument of investigation. It is true, of course, that psychology is compelled to take account of such quantitative defects of mental capacity, and that it is able to explain the relation which they bear to many of the other phenomena of insanity, but the questions involved are complicated and difficult, and cannot be satisfactorily considered without presupposing a considerable practical acquaintance with the subject.

In chapter III we have described some of the phenomena to be observed in various morbid states of mind, and in chapter IV we have endeavoured to arrange these phenomena into groups. This process of classification has enabled us to reduce the original chaos into some sort of order, and to obtain a comprehensive view of the facts of our subject. We have discovered, for example, that many of the manifestations of mental disorder are to be regarded as cases of dissociation of consciousness—the stream of consciousness is divided into independent currents no longer combined into one harmonious whole. So far, however, no attempt has been made to explain why these phenomena occur. We have seen that the imaginary voices which torture the hallucinated patient are nothing but split-off portions of his own consciousness, but we have assigned no reason to account for a portion of consciousness being split off in this abnormal manner, nor have we explained why the hallucinatory voice should make remarks of one character rather than another. We have found, in fact, that certain events occur, but we are still altogether in the dark as to why they occur.

The reader who has clearly understood the general principles enunciated in chapter II will at once perceive that we have carried out the first two steps of the method of science, but have as yet made no attempt to proceed to the third step.