Part 25

Now, according to my observations, we find in the marginal zones of the content of consciousness conscious elements which in particular cases may even give a hitherto unsuspected meaning to the pathological idea. I have found in these zones thoughts which gave meaning to emotions and other symptoms excited by apparently inadequate objects. Thus, in H. O., attacks of recurrent nausea and fear almost prohibiting social intercourse were always due to thoughts of self-disgust hidden in the fringe.

Let us take a concrete case, that of a person who has a pathological fear and who, as we know is often the case, can give no explanation of his viewpoint. The fear may be that of fainting, or of thunderstorms, of a particular disease, say cancer, or of so-called “unreality” attacks, or what not. This so-called “fear” is of course an idea of self or other object linked with, or which occasions as a reaction, the strong emotion of fear. It recurs in attacks which are excited by stimuli, of one kind or another, that are associated with the idea. The patient can give no explanation of the _meaning_ of this idea that renders intelligible why it should occasion his fear. There is nothing in his consciousness, so far as he knows, which gives an adequate meaning to it.

Thus, for example, C. D. was the victim of attacks of fear; the attacks were so intense that at times she had been almost a prisoner in her house, in dread of attacks away from home; and yet she was unable even after two prolonged searching examinations to define the exact nature of the fear which was the salient feature of the attacks, or, from her ordinary memories, to give any explanation of its origin. She remembered many moments in the last twenty years when the fear had come upon her with great intensity, but she could not recall the date of its inception and, therefore, the conditions under which it originated; consequently nothing satisfactory could be elicited beyond an early history of “anxiety attacks” or indefinable fear of great intensity attached to no specific idea that she knew.

As a result of searching investigation by technical methods it was brought out that the specific object of the fear was _fainting_. When an attack developed, besides intense physiological disturbances and confusion of thought, there was in the content of consciousness a feeling that her mind was flying off into space and a definite thought of losing consciousness or fainting, and that she was going to faint. There was amnesia for these thoughts following the attacks. She never had fainted in the attacks and, as it later transpired, had fainted only once in her life. Here then, _dimly in the content_ of consciousness, was the object of the fear in an attack. But the object was afterwards forgotten; hence she could not explain what she was afraid of. Why fainting should be such a terrible accident to be feared she also could not explain.

The question now was, what possible meaning could fainting have for her that she so feared it? This she did not know.

Now, on still further investigation, I found that there was always in the fringe of consciousness during an attack and also during the anticipatory fear of an attack, _an idea and fear of death_. This, to use her expression, “was in the background of her mind”; it referred to impending fainting. It appeared then that in the fringe or ultra-marginal zone was the _idea of death as the meaning of fainting_. _Of this she was never aware._ It was really subconscious. It was the meaning of her idea of herself fainting. In consequence of this meaning fainting was equivalent to her own death. She would not have been afraid of fainting if she had not believed or could have been made to believe that in her case it did not mean death. We might properly say that the real object of the fear was death.

When this content of the fringe of attention was recovered, the patient voluntarily remarked that she had not been aware of the presence during the attacks of that idea, but now she remembered it clearly, and also realized plainly why she was afraid of fainting,—what she had not understood before. (It must be borne in mind that this meaning of fainting, as a state equivalent to death, did not pertain to fainting in general but solely to herself. She knew perfectly well that fainting in other people was not dangerous; it was only an unrecognized belief regarding a possible accident to herself.) Besides this content of the fringe of attention it was also easy to show that the fringe often included the thought (or idea) which had been the immediate excitant of each attack. Sometimes this stimulus-idea entered the focus of attention; sometimes it was only in the fringe. In either case there was apt to be amnesia for it, but it could always be recalled to memory in abstraction or hypnosis.

The content of consciousness taken as a whole, i.e., to include both the focus and the fringe of attention, then would adequately determine the meaning of this subject’s idea of fainting as applied to herself.

But why this meaning of fainting? It must have been derived from antecedent experiences. An idea can no more have a meaning without antecedent experiences with which it is or once was linked than can the word “parallelopipedon” have a geometrical meaning without a previous geometrical experience, or “Timbuctoo” a personal meaning without being set in a personal experience, whether of missionaries or hymn-books.

I will not take the time to give the detailed results of the investigation by hypnotic procedures that followed. I will merely summarize by stating that the fear of death from fainting was a recurrent memory, i.e., _a recurrence of the content of consciousness_ of a moment during an incident that occurred more than twenty years before, when she was a young girl about 18 years of age. At the time as the result of a nervous shock she had fainted, and just before losing consciousness she definitely thought her symptoms meant death. At this thought she became frightened, and ever since she has been afraid of fainting. There was no conscious association between her phobia and this youthful episode. When the memory of the latter was recovered she remarked, “I wonder why I never thought of that before.”

But this again was not all. A searching investigation of the unconscious (residua) in deep hypnosis revealed the fact that death from fainting was organized with still wider experiences involving a fear of death. At the moment of the nervous shock just before fainting (_fancied as dying_) she thought of her mother who was dangerously ill from _cancer_ in an adjoining room, and a great fear swept over her at the thought of what might happen to her mother if she should hear of the cause of her (the patient’s) nervous shock and of her _death_. It further transpired that the idea of death and fear of it were set in a still larger series of experiences.[170] It had, indeed, dated from a childhood experience when she was eight years of age. At that time she was frightened when a pet animal died and a fear of death had been more or less continuously present in her mind ever since, but not always consciously so; meaning that it was sometimes in awareness and sometimes in the _ultra-marginal zone_ of consciousness. She had been able to conceal the fear until the fainting episode occurred and, as she in hypnosis asserted, fear afterward had continued to be present more or less persistently, although _she was not conscious of the fact when awake_ (excepting in the phobic attacks) and it had attached itself to various ideas of intercurrent illnesses. But these ideas could all be reduced to two, _fainting and cancer_. Ever since her mother’s illness and death she had a fear of death from cancer, believing she might inherit the disease. This thought and the fear it aroused had been constantly in her mind but never previously confessed. It was the real meaning of her fear of illness which had been conspicuous and puzzling to her physician. She had imagined that each illness might mean cancer, but had successfully concealed this thought. The idea of death and the fear it excited had thus become constellated in a large _unconscious_ complex derived from past experiences which included the fainting episode, her mother’s death from cancer and the possibility of having cancer herself. This last was still _consciously believed_ and was very real to her.

Without pursuing further the details it is evident that although the meaning of fainting—death—was in the fringe of consciousness and subconscious, it had as a setting a large group of fear-inspiring experiences, more particularly those involving cancer. But there was no conscious association between her fear of fainting and that of cancer. _Of this setting, during a phobic attack, only the ideas of fainting and fear-inspiring death enter the various zones of consciousness._

As to why this apparently unsophisticated idea of death still _persisted_ in connection with that of fainting is another problem with which we are not concerned at this moment. We should have to consider more specifically the content of the setting in which, besides the cancer-belief, probably subconscious self-reproaches would be found.

=Meaning may be the conscious elements of a functioning larger subconscious complex.=—However, whatever be its conscious constituents, obviously meaning must be derived from antecedent experiences and without such experiences no idea can have meaning. If, then, antecedent experiences determine the meaning of the idea, it is _theoretically_ possible, particularly with insistent ideas, that the conscious elements involved in meaning are, with many ideas at least, only part and parcel of a larger complex which is for the most part unconscious. That is to say, a portion of this complex—perhaps the larger portion represented by the residua of past experiences—would, under this hypothesis, be unconscious while certain elements would arise in consciousness as the meaning of a given idea. Under such conditions a hidden subconscious process would really determine the conscious setting which gives the meaning. The whole setting would be partly conscious and partly hidden in the unconscious. Such a mechanism may be roughly likened to that of a clock, so far as concerns the relation of the chimes and hands to the works concealed inside the case. Though the visible hands and the audible chimes appear to indicate the time, the real process at work is that of the hidden mechanism. To inhibit the chime or regulate the time rate the mechanism must be altered. And so with an insistent idea: The unconscious part of the complex setting must be altered to alter the meaning of the idea. Of course the analogy must not be carried too far as in the case of the clock the chimes and hands are only epiphenomena, while conscious ideas are elements in the functioning mechanism.

Such a theory would afford an adequate explanation of the psychogenesis and mechanism of certain pathological ideas such as the phobia of C. D. At any rate, it is plain that an explanation of such ideas must be sought, on the one hand, in their meanings and in the antecedent experiences to which they are related, and, on the other, in the processes which determine their insistency or fixation.

The facts which support this theory, to which our studies have led us, we will take up for consideration in our next lecture.

Footnote 165:

It is very doubtful whether vivid awareness is a matter of intensity because, among other reasons, subconscious ideas of which the individual is entirely unaware and elements in the fringe may have decided intensity.

Footnote 166:

The development of amnesia seems to be inversely proportionate to the degree of awareness, provided there are no other dissociating factors, such as an emotional complex.

Footnote 167:

This is due to the well-known fact (demonstrated in a large variety of phenomena) that ideas dissociated from the personal consciousness awake may become synthesized as memories with this same consciousness in hypnosis.

Footnote 168:

See _Proceedings_, also _The Psychological Review_, March-May, 1905.

Footnote 169:

All pathological processes are only the normal under altered conditions.

Footnote 170:

Among them was the following: A few months later her mother died. C. D. was in the room with the body, her back turned toward the bed where the body lay. Suddenly she was startled by the window curtain blowing out of the window. The noise and the partial vision of the curtain gave her a start, for she thought the body had risen up in bed. At this point, while in hypnosis, C. D. remarked, “Ah! that explains the dream which I am always having. I am constantly having a frightful dream of my mother lying dead and rising up as a corpse from the bed. This dream always gives me a great terror.”

LECTURE XII SETTINGS OF IDEAS AS SUBCONSCIOUS PROCESSES IN OBSESSIONS

In our last lecture we were led to two conclusions: (1) that the conscious elements which are the meaning of an idea may be in the marginal zones; and (2) more important, that “meaning” may be only a part of a larger setting of antecedent experiences, which is an unconscious complex.

Let us now consider the further question raised in the theory finally proposed; namely, whether the submerged elements of a complex remain quiescent or _whether, in some cases at least, this portion functions subconsciously_ and takes part as an active factor in the whole process by which the meaning of an idea and its accompanying emotional tone invades the content of consciousness. If the latter be true, a hidden subconscious process would, according to the theory (to repeat what was previously said), really determine the conscious setting which gives the meaning. Such a mechanism was roughly likened to that of a clock. If such were the mechanism in insistent ideas, obsessions, and impulsions, it would, as I have intimated, explain their insistency, their persisting recurrence, the difficulty in modifying them, notwithstanding the subject realizes their falsity, the point of view often inexplicable to the subject, and the persistence of the affect. There is a constant striving of affective subconscious processes, when stimulated, to carry themselves to fulfilment. Consequently as we know from numerous observations, the feelings and emotions (pleasantness and unpleasantness, exaltation and depression; fear, anger, etc.) pertaining to subconscious processes tend to emerge into consciousness;[171] and likewise ideational constituents of the process often emerge into the fringe of the content of consciousness and even the focus of awareness. Given such a subconsciously functioning setting to an idea, it would necessarily tend by the impulsive force of its emotion to make the latter insistent, and resist the inhibiting control of the personal consciousness.

In the case of C. D., cited in the last lecture, we were led to the conclusion, as the result of analysis, that her insistent phobia might be due to the impulsive force of such subconscious complexes. The whole problem is a very difficult one, dealing as we are with complicated mechanisms and such elusive and fluid factors as conscious and subconscious processes. It is useless, therefore, to attempt to formulate the mechanisms with anything like scientific exactness.

It must be borne in mind, further, that the method of analysis (employed with C. D.), meaning thereby the bringing to light associated memories of past experiences, cannot positively demonstrate that those experiences take part as the causal factor in a present process. It can demonstrate the sequence of mental events, and, therefore, each successive link in a chain of evidence leading to the final act; or it can demonstrate the material out of which we can select with a greater or less degree of probability the factor which, in accordance with a theory—in this case that of subconscious processes—seems most likely to be the causal factor. Thus in the analysis of a bacterial culture we can select the one which seems on various considerations to be the most likely cause of an etiologically undetermined disease, but for actual demonstration we must employ synthetic methods; that is, actually reproduce the disease by inoculation with a bacterium. So with psychological processes synthetic methods are required for positive demonstration.

We have _available synthetic methods in hypnotic procedures_. These give, it seems to me, positive results of value. If a subject is hypnotized and in this state a complex is formed, it will be found that this complex will determine, after the subject is awakened, the point of view and therefore the meaning of the central idea when it comes into consciousness, and this though the subject has complete amnesia for the hypnotic experience. In this manner, if the idea is one which previously had a very definite and undesirable meaning which we wish to eradicate, we can organize a complex which shall include that idea and yet give it a very different meaning, provided it is one acceptable to the subject.

To take simple examples, and to begin with a hypothetical case, but one which in practice I have frequently duplicated: A subject is hypnotized and although, in fact, the day is a beautifully fair one we point out that it is really disagreeable because the sunshine is glowing and hot; that such weather means dusty roads, drought, the drying up of the water supply, the withering of the foliage, that the country needs rain, etc. We further assert that this will be the subject’s point of view. In this way we form a cluster of ideas as a setting to the weather which gives it, fair as it is, an entirely different and unpleasant meaning and one which is accepted. The subject is now awakened and has complete amnesia for the hypnotic experience. When attention is directed to the weather it is found that his point of view, for the time being at least, is changed from what it was before being hypnotized. The perception of the clear sky and the sunlight playing upon the ground includes secondary images of heat, of dust, of withered foliage, etc., such as have been previously experienced on disagreeable, hot, dusty days, and some of the associated thoughts with their affects suggested in hypnosis arise in consciousness; perhaps only a few, but, if he continues to think about the weather, perhaps many. Manifestly the new setting formed in hypnosis has been switched into association with the conscious perceptions of the environment and has induced the secondary images and associated thoughts, emotions, and feelings which give meaning. But it is equally manifest, though many elements bubble up, so to speak, from the unconscious setting into consciousness, that most of this setting remains submerged in the unconscious.

In similar fashion I made a subject regard, metaphorically speaking, as a cesspool for sewage a river which was being converted into a beautiful water park by a dam.[172] It is scarcely necessary to cite additional observations.

Manifestly such phenomena belong to the well-known class of so-called “suggested post-hypnotic phenomena.” These we have already seen (solution of problems predetermined actions, &c., Lecture VI) require the postulate of a subconscious process. It is therefore difficult to resist the conclusion that, when the suggested phenomenon is the “meaning” of an idea, this also involves a subconscious process—that a hypnotically organized setting functioning subconsciously ejects the meaning into consciousness. In other words, the unconscious setting is a part of the whole “psychosis” or complex, a factor in the functioning mechanism; it is dynamic and not merely static, and is a functioning part of the “psychic whole” of the given ideas (sign, perception, and meaning). To use the analogy of the clock, the unconscious part of the complex corresponds in a way to the works and determines what shall appear in consciousness. In the case of the ideas of everyday life, and particularly of pathological insistent ideas, unconscious complexes can be shown, by methods of analysis and by interpretation, to be existent and to be settings. We therefore infer that they similarly take part in the functioning process of ideation. But, as I have said, as any idea has many different settings and associated complexes, it is difficult to determine by this method with positiveness which setting or other complex, if any, is _in activity_ and takes part in the process. Hence the different theories that have been offered to explain the precise psychogenesis of insistent ideas.

=Therapeutic application.=—By similar procedures in a very large number of instances, for therapeutic purposes, I have changed the setting, the viewpoint, and the meaning of ideas without any realization on the patient’s part of the reason for this change. This is the goal of psychotherapy, and in my judgment the one fundamental principle common to all technical methods of such treatment, different as these methods appear to be when superficially considered.

It is obvious that in everyday life when by arguments, persuasion, suggestion, punishment, exhortation, or prayer we change the viewpoint of a person, we do so by building up complexes which shall act as settings and give new meanings to his ideas. I may add, if we wish to sway him to carry this new viewpoint to fulfilment through action we introduce into the complex an emotion which by the driving force of its impulses shall carry the ideas to practical fruition. This is the art of the orator in swaying audiences to his views. Shakespeare has given us a classic example in Marc Antony’s speech to the Roman populace.

The practical application to therapeutics of these principles of rearranging the setting of a perception by artificial complex building may be seen from the following actual case, which I have already cited in previous contributions.[173]