Part 27

Dormant _dream_ complexes may give rise to similar phenomena. In a minor way everyone, probably, has experienced the persistence of the emotional effects of a dream after waking and after the memory of the dream has vanished. More commonly, of course, the dream is remembered, but in the cases of people who do not remember their dreams the phenomenon is precise. B. C. A., for example, does not as a rule remember her dreams, but nevertheless frequently awakes in a state of anxiety or exaltation which has considerable persistency. In hypnosis the dream which gives rise to the emotional state is recovered.

In pathological conditions these post-hypnotic, hysterical, dream, and other phenomena suggest, among other questions, whether in depressive and excited psychoses the affective element is not derived from submerged unconscious complexes. _Melancholias_, for example, may in some cases at least derive their feeling tone from such complexes.

Footnote 171:

Janet: The Mental States of Hystericals, pp. 289-290. Prince: The Dissociation, pp. 132-5, 262, 297–8, 324-5, 497.

Footnote 172:

The Unconscious, _Journal Abnormal Psychology_, April-May, 1909.

Footnote 173:

Morton Prince: (Psychotherapeutics; A Symposium. Richard G. Badger, Boston, 1910.) Also The Unconscious, _Journal of Abnormal Psychology_, April-May, and June-July, 1909.

Footnote 174:

See p. 178, Lecture VI.

Footnote 175:

Memory of them could only be obtained in abstraction and hypnosis.

Footnote 176:

Fear Neurosis, _Boston Med. and Surg. Journal_, September 28, 1898.

Footnote 177:

The Dissociation, see index, “Subconscious Ideas,” and “Subconscious Self.”

Footnote 178:

The Dissociation, loc. cit.

Footnote 179:

Ibid., p. 132.

Footnote 180:

It is worth noting that this interpretation is supported by the therapeutic result. The attacks completely and quickly ceased after the setting to her apprehensive idea was so altered, by one single explanation, that she no longer feared the loyalty of her friend.

Footnote 181:

The Dissociation, pp. 262, 297, 298 and 324, 325, 497; also The Unconscious, _Journal of Abnormal Psychology_, April-May, 1909.

Footnote 182:

Prince: The Unconscious, _Journal of Abnormal Psychology_, April-May and June-July, 1909.

LECTURE XIII TWO TYPES OF PHOBIA (_Obsessions Continued_)

_Type C_: In this type _the affect is linked with an idea as its object in consciousness but without meaning_, so that whenever this idea is awakened it is accompanied by the affect alone. Some of the phobias are the most common pathological exemplars. Nor is there anything in the content of consciousness which gives meaning to the idea as something that should occasion anxiety. The subject, in other words, does not know why he is afraid of the given object. In such cases the restoration of dormant memories will disclose antecedent experiences in which the idea is set and which explains the origin and meaning of the fear. Here again we have the principle shown in a clear cut way in conditions of alternating personality. For instance take the case of Miss B. An emotion, apparently paradoxical, would be aroused in BIV in connection with a strange person or place, or in consequence of a reference by some one to an unknown event. BIV, without apparent reason, would feel an intense emotion in connection with something or other which she did not remember to have ever heard or seen before. A face, a name, a particular locality where she happened to find herself would arouse a strong emotional effect without her knowing the reason. The memories of the experiences to which these emotions belonged were a part of BI’s life and could easily be recalled by her when the personalities again alternated and BI came into existence. When BIV came again these experiences, of course, would be forgotten and become dormant, but the emotions associated with the visual, auditory, and other images of a given person or place, or whatever it might be, would be liable to be aroused in her by the perception, in spite of the amnesia, whenever the given person or place, as it might be, came into her daily life. Here the conscious content of the psychosis consists of perception plus affect without meaning.

I formerly was inclined to interpret such paradoxical emotions on the principle of the simple linking of an affect to a perception. But when we consider that, on the reversion of the personality to BI the perception, meaning, and affect still remained organized as a conscious psychic whole, it is much more probable that the meaning took part as a subconscious process in the mechanism of BIV’s emotional psychosis and was responsible for the paradox. In the case of recurrent fears the antecedent experiences which contain their meaning are conserved as unconscious complexes. The psychosis differs clinically from types A and B only in that another conscious element has been added,—viz.: the idea of an object of the fear. It is consistent therefore to infer that the unconscious complexes are a submerged part of the mechanism by which the affect is maintained in association with the object. The conscious and the subconscious form a psychic whole.

As an instance let us take the following case of phobia. It was ostensibly one of church-steeples and towers of any kind. The patient, a woman about forty years of age, dreaded and tried in consequence to avoid the sight of one. When she passed by such a tower she was very strongly affected emotionally, experiencing always a feeling of terror or anguish accompanied by the usual marked physical symptoms. Sometimes even speaking of a tower would at once awaken this emotional complex which expressed itself outwardly in her face, as I myself observed on several occasions. Considering the frequency with which church and schoolhouse towers are met with in everyday life, one can easily imagine the discomfort arising from such a phobia. Before the mystery was unraveled she was unable to give any explanation of the origin or meaning of this phobia, and could not connect it with any episode in her life, or even state how far back in her life it had existed. Vaguely she thought it existed when she was about fifteen years of age and that it might have existed before that. Now it should be noted that an idea of a tower with bells had in her mind no meaning whatsoever that explained the fear. It had no more meaning than it would have in anybody’s mind. In the content of consciousness there was only the perception plus emotion and no corresponding meaning. Accordingly I sought to discover the origin and meaning of the phobia by the so-called psycho-analytic method.

When I attempted to recover the associated memories by this method, the mere mention of bells in a tower threw her into a panic in which anxiety, “thrills,” and perspiration were prominent. Before making the analysis I had constructed a theory in my mind to the effect that a phobia for bells in a tower was a sexual symbolism, being led to this partly by the suggestiveness of the object and partly by the fact that I had found symbolisms of a sexual kind in her dreams.[183]

Analysis was conducted at great length and memories covering a wide field of experiences were elicited. When asked to think of bells in a tower, or each of these objects separately, there was at first a complete blocking of thought in that her mind became a blank. Later, memories which to a large extent, but not wholly, played in various relations around her mother (who is dead) as the central object came into the field of consciousness. Nothing, however, was awakened that gave the slightest meaning to the phobia even on the wildest interpretation. The patient, who had been frequently hypnotized by another physician, tended during the analysis to go into a condition of unusually deep abstraction, to such a degree that on breaking off the analysis she failed to remember, save very imperfectly, the memories elicited. Such an abstraction is hypnosis.

Finally, after all endeavors to discover the genesis of the phobia by analysis were in vain, I tried another method. While she was in hypnosis I put a pencil in her hand with the object of obtaining the desired information through automatic writing. _While she was narrating some irrelevant memories of her mother_, the hand rapidly wrote as follows: “G.... M.... church and my father took my mother to Bi.... where she died and we went to Br.... and they cut my mother. I prayed and cried all the time that she would live and the church bells were always ringing and I hated them.”

When she began to write the latter part of this script she became depressed, sad, indeed anguished; tears flowed down her cheeks and she seemed to be almost heartbroken. In other words, it appeared as if she were subconsciously living over again the period described in the script. I say subconsciously for she did not know what her hand had written or why she was anguished. During the writing of the first part of the script she was verbally describing other memories; during the latter part she ceased speaking.

After awakening from hypnosis and when she had become composed in her mind she narrated, at my request, the events referred to in the script. She remembered them clearly as they happened when she was about fifteen years of age. It appeared that she was staying at that time in G.... M...., a town in England. Her mother, who was seriously ill, was taken to a great surgeon to be operated upon. She herself suffered great anxiety and anguish lest her mother should not recover. She went twice a day to the church to pray for her mother’s recovery and in her anguish declared that if her mother did not recover she would no longer believe in God. The chimes in the tower of the church, which was close to her hotel, sounded every quarter hour; they got on her nerves; she hated them; she could not bear to hear them, and while she was praying they added to her anguish. Ever since this time the ringing of bells has continued to cause a feeling of anguish. This narrative was not accompanied by emotion as was the automatic script.

It now transpired that it was the _ringing_ of the church bells, or the _anticipated ringing_ of bells, that caused the fear, and not the perception of a tower itself. When she saw a tower she feared lest bells should ring. This was the object of the phobia.[184] She could not explain why she had never before connected her phobia with the episode she described. This failure of association as we know is not uncommon, and in this case was apparently related to a determination to put out of mind an unbearable episode associated with so much anguish. There had been for years a more or less constant mental conflict with her phobia. The subject had striven not to think of or look at belfries, churches, schoolhouses, or any towers, or to hear the ringing of their bells, or to talk about them. She had endeavored to protect herself by keeping such ideas out of her mind. Before further analyzing the case there are two points which are well worth calling attention to:

1. When the subject subconsciously described the original childhood experience by automatic script there was intense emotion—fear—which emerged into consciousness without her knowing the reason thereof. When, on the other hand, she later from her conscious memories described the same experience there was no such emotion. In other words it was only when the conserved residua of the experience functioned consciously and autonomously as a dissociated, independent process that emotion was manifested. So long as the memories were described from the view-point of the matured adult personal consciousness there was no emotion. As a subconscious process they were unmodified by this later viewpoint. This suggests at least that when the phobia was excited by the sight or idea of a tower it was due likewise to a subconscious process and that this was one and the same as that which induced the experimental phobia.

2. The phraseology of the script is noticeable. The account is just such as a child might have written. It reads as if the conserved thoughts of a child had awakened and functioned subconsciously.

From this history, so far as given, it is plain that the psychosis in one sense is a recurring antecedent experience or memory, but it is only a partial memory. The whole of the experience does not recur but only the emotion in association with the ringing of bells. The rest of that experience, viz., the idea of the possible death of her mother with its attendant grief and anguish associated with the visits to the church, the praying for recovery and finally the realization of the fatal ending—all that which originally excited the fear and _gave the ringing-of-bells-in-a-tower meaning_ was conserved as a setting in the unconscious. That the rest of the experience was conserved was shown by the fact that it could be recalled not only by automatic writing but, although not in association with the phobia, to conscious memory. From this point of view the fear of bells ringing may be regarded as a recurrence of the original fear—that of her mother’s death—now derived from a subconsciously functioning setting. The child was afraid to face her grief and so now the matured adult was also afraid.

From another point of view the ringing of bells may be regarded as standing for, or a symbol of, her mother’s death with which it was so intimately associated, and this symbol awakened the same fear as did originally the idea itself of the death. An object may still be the symbol of another, although the association between the two cannot be recalled. (The transference of the emotional factor of an experience to some element in it is a common occurrence; e. g., a fear of knives in a person who has had the fear of committing suicide.)

The discovered antecedent experiences of childhood then give a hitherto unsuspected meaning to the ringing of bells. It is a meaning—the _mise en scène_ of a tragedy of grief and a symbol of that tragedy. But was that tragedy with its grief the _real_ meaning of the child’s fear or, perhaps more correctly, the _whole_ of the meaning? And is it still the meaning in the mind of the adult woman? Does the mere conservation of a painful memory of grief explain its persistent recurrent subconscious functioning during twenty-five years, well into adult life, so that the child’s emotion shall be reawakened whenever one element (bell-tower) of the original experience is presented to consciousness? And, still more, can the persistence of a mere association of the affect with the object independently of a subconscious process explain the psychosis? Either of these two last propositions is absurd on its face as being opposed to the experience of the great mass of mankind. The vast majority of people have undergone disturbing, sorrowful or fear-inspiring experiences at some time during the course of their lives and they do not find that they cannot for years afterwards face some object or idea belonging to that experience without being overwhelmed with the same emotion. Such emotion in the course of time subsides and dies out. A few, relatively speaking, do so suffer and then, because contrary to general experience, it is called a psychosis.

We must, then, seek some other and adequate factor in the case under examination. When describing the episode in the church, the subject stated that on one occasion she omitted to go to church to pray and the thought came to her that if her mother died it would be due to this omission, and _it would be her fault_. The “eye of God”[185] she thought was literally upon her in her every daily act and when her mother did die she thought that it was God’s punishment of herself because of that one failure. Consequently she thought _that she was to blame for her mother’s death_; that _her mother’s death was her fault_. She feared to face her mother’s death, not because of grief—that was a mere subterfuge, a self-deception—but because she thought she was to blame; and she feared to face towers with bells, or rather the ringing of bells, because they symbolized or stood for that death (just as a tomb-stone would stand for it), and in facing that fact she had to face her own fancied guilt and self-reproach and this she dared not do. _This was the real fear_, the fear of facing her own guilt. The emotion then was not only a recurrence of the affect associated with the church episode but a _reaction to self-reproach_. The ringing of bells, somewhat metaphorically speaking, reproached her as Banquo’s ghost reproached Macbeth.

All this was the child’s point of view.

But I found that the patient, an adult woman, _still believed and obstinately maintained_ that her mother’s death was her fault. She had never ceased to believe it. Why was this? Why had not the unsophisticated belief of a child become modified by the maturity of years? It did not seem to be probable that the given child’s reason was the real adult reason for self-reproach. I did not believe it. A woman forty years of age could not reproach herself on such grounds. And, even if this belief had been originally the real reason, as a matter of fact she had outgrown the child’s religious belief. She was a thorough-going agnostic. Further probing brought out the following:

Two years before her mother’s death, the patient, then thirteen years old, owing to her own carelessness and disobedience to her mother’s instructions, had contracted a “cold” which had been diagnosed as incipient phthisis. By the physician’s advice her mother took her to Europe for a “cure” and was detained there (as she believed) for two years, all on account of the child’s health. At the end of this period a serious, chronic disease from which the mother had long suffered was found to have so developed as to require an emergency operation. The patient _still believed_ and argued that if her mother had not been compelled to take her abroad she (the mother) would have been under medical supervision at home, would have been operated upon long before and in all probability would not have died. Furthermore, as the patient had heedlessly and disobediently exposed herself to severe cold and thereby contracted the disease compelling the sojourn in Europe, she was to blame for the train of circumstances ending fatally.

All this was perfectly logical and true, assuming the facts as presented. Here then was the real reason for the patient’s persistent belief that her mother’s death was her fault and the persistent self-reproach. _It also transpired that all this had weighed upon the child’s mind and that the child had likewise believed it._ So the child had two reasons for self-reproach. One was neglecting to pray and the other was being the indirect cause of the fatal operation. Both were intensely believed in. The first based on the “eye of God” theory she had outgrown, but the other had persisted.

Summing up our study to this point: All these memories involving grief, suffering, self-reproach, bells and mother formed an unconscious setting which gave meaning to bells in towers and took part in the functioning to form a psychic whole. The conscious psychosis was first the emergence into consciousness of two elements only, the perception and the affect, and the fear was a reaction to self-reproach, a fear to face self-blame.

Now even if the mother’s death were logically, by a train of fortuitous circumstances, the patient’s fault, why did an otherwise intelligent woman lay so much stress upon an irresponsible child’s behavior? The child after all behaved no differently from other children. People do not consciously blame themselves in after life for the ultimate consequences of childhood’s heedlessness. According to common experience such self-reproaches do not last into adult life without some continuously acting factor.

A search in this case into the unconscious brought to light a persisting idea that when events in her life happened unfortunately it was due to her fault. It had cropped out again and again in connection with inconsequential as well as consequential matters. She had, for instance, been really unable on many occasions to leave home on pleasure trips for fear lest some accident might happen within the home and consequently it would be due to her fault; and if away she was in constant dread of something happening for which she would be to blame. It was not a fear of what might happen—an accident to the children, for example—but that it would be her fault. I have heard her, when some matter of apparently little concern had gone wrong, suddenly exclaim, “Was it my fault?” her voice and features manifesting a degree of emotion almost amounting to terror. When her brother died (still earlier, before her mother’s death) she had blamed herself for that death, as later with her mother, on the same religious grounds. This self-reproach for happenings, fancied as due to her fault, has frequently appeared in her dreams. It would take us too far afield to trace the origin and psychogenesis of this idea. Suffice to say, it can be followed back to early childhood when she was five or six years of age. She was a lonely, unhappy child. She thought herself ugly and unattractive and disliked and that so it always would be through life, and it was all her fault because she was ugly, as she thought.[186] The instinct of self-abasement (McDougall[187]) or negative self-feeling (Ribot) dominated the personality as the most insistent instinct and from its intensity within the self-regarding sentiment (McDougall) formed a sentiment of self-depreciation. She wanted to be liked and believed it to be her own fault that, as she fancied, she was not and never would be, and reproached herself accordingly. This sentiment of self depreciation with its impulse to render self-reproach has persisted, as with many people, all her life and has been fostered by unwise and thoughtless domestic criticism. The persistence to the present day of this impulse to self-reproach is shown in the following observation:

Quite recently this subject began to suffer from general fatigue, insomnia, distressing dreams, hysterical crying, indefinable anxiety and pseudo twilight states or extreme states of abstraction. In these states she became oblivious of her environment, did not hear the conversation going on about her, nor answer when directly spoken to. This became so noticeable that she became the jest of her companions. In these states her mind was always occupied with reveries (not fantasies), though mostly pleasant, regarding a very near relative who had died about six months previously. Her distressing dreams also concerned this relative. It appeared, therefore, probable, on the face of the symptoms that they were in some way related to this relative’s death.

Now it transpired, as I already knew, that the relative had died under somewhat tragic circumstances and that our subject’s experience during the last illness was unusually distressing and sorrowful. _This experience, she asserted, she could not bear to speak or even think about and over and over again had refused to do so and put it out of her mind. She further asserted that her reason for this attitude was the distressing nature of the scenes in which she took part._

Now I did not believe that this was the true reason, although given in good faith. It was improbable on its face. To say that a grown woman, forty years of age, could not do what every woman can do, tolerate sorrowful memories simply because they were sorrowful, and must perforce put them out of her mind, is sheer nonsense. There must be some other reason.