Part 29
In view of the foregoing we can now appreciate a fallacy which has been too commonly accepted in the interpretation of therapeutic facts. It is quite generally held that it is a necessity that the underlying unconscious complexes cannot be modified without bringing them to the “full light of day” by analysis. The facts of everyday observation do not justify this conclusion. The awakening of dormant memories of past experiences is mainly of importance for the purpose of giving us exact information of _what_ we need to modify, not necessarily for the purpose of effecting the modification. Owing to the fluidity of complexes, whether unconscious or conscious, our conscious ideas can become incorporated in unconscious complexes. This means that any new setting in which we may incorporate our conscious ideas to give them a new meaning becomes effective in the associations which these ideas have as a dormant complex. The latter is able to assimilate from the conscious any new material offered to it. Practical therapeutics and everyday experience abundantly have shown this. I have accomplished this, and I believe every therapeutist has done the same time and again. We should be cautious not to overlook common experience in the enthusiasm for new theories and dramatic observations. The difficulty is in knowing what we want to modify, and for this purpose analytical investigations of one sort or another are of the highest assistance, because they furnish us with the required information. If we recover the memories of the unconscious complex our task is easier, as we can apply our art with the greater skill.
When we speak of a setting to an idea we are not entitled to think of it as a sharply defined group of ideas, or sharply limited subconscious process. When we identify it with the residua of past experiences we are not entitled, on the basis of exact knowledge, to arbitrarily make up a selected cluster of residua which shall exclude those and include these residual elements of antecedent associated experiences, and dogmatically postulate the composition of the complex which we call the setting. Analysis by the very limitations of the method fails to permit of such arbitrary selection, and synthetic methods are not sufficiently exact for the purpose. All we can say is that from the residua of various past experiences a complex is sifted out to become the setting. And even then no process is entirely autonomous and entirely removed from the interfering, directing, and coöperative influence of other processes. Even with simple and purely physiological processes, such as the knee jerk, this is true. Although the knee jerk may be schematically conceived as a simple reflex arc involving the peripheral nerves and the spinal cord, nevertheless other parts of the nervous system—the brain and the spinal cord—provide coöperative processes which take part, and under special conditions take a very active part, in modifying the phenomenon. While we are justified, for the clarifying purposes of exposition, in schematizing the phenomenon by selecting the spinal reflex as the predominant process, yet we do not overlook the coöperative processes which may control and modify the spinal reflex. If this is true of purely physiological processes, it is still more true of the enormously more complex processes of human intelligence.
We may say, then, not only that with our present knowledge and our present methods we are not able to precisely differentiate the settings of ideas, but that it is highly improbable that settings as complexes of residua are with any preciseness functionally entirely autonomous and removed from the influence of other associative processes.
We need further investigations into the psychology and processes of settings, and until we have wider and more exact knowledge it is well not to theorize and still more not to dogmatize. It is an inviting field which awaits the psychologist.
Footnote 183:
In making the analysis, therefore, I was in no way antagonistic in my mind to the Freudian hypothesis.
Footnote 184:
I want to emphasize this point, because certain students, assuming the well-known alleged sexual symbolism as the meaning of steeples and towers, will read and have read such an interpretation into this phobia. As a matter of fact, although these objects had been originally alleged by the subject herself to be the object of the fear it was done thoughtlessly as the result of careless introspection. Later she clearly distinguished the true object. They were no more the object than the churches and schoolhouses themselves. They bore an incidental association only, and only indicated where the ringing of bells might be expected to be heard, having been an element in the original episode. Nor were bells, qua bells, the object of the phobia, but the ringing-of-bells of the kind that recalled the mother’s death. In other words, the fear was of bells with a particular meaning. Nor was the fear absolutely limited to tower-bells, for it transpired that the subject had refrained from having, as she desired, an alarm bell arranged in her house in the country (in case of fire, etc.), because of her phobia. (This note is perhaps made necessary by the violent shaking of the heads of my Freudian friends that I noticed at this point during the presentation of this case before the American Psychopathological Association.) See _Jour. Abn. Psychol._, Oct.-Nov., 1913.
Footnote 185:
This idea had its origin in a child’s fairy tale, and had been fostered by the governess as a useful expedient in enforcing good behavior. The child accepting the fairy legend believed the Eye of God was always on her and every one in the world, and observed all that each did or omitted to do. The legend excited her imagination, and she used to think about it and wonder how God could keep His eye on so many people as there were in the world. At a still earlier age, when she was about eight, she had thought her little brother’s death was also her fault, because she had neglected one night, at the time of his illness, God’s eye being upon her, to say her prayers. For a long time afterward she suffered similarly from self-reproach. It is interesting to compare the outgrowing with maturity of this self-reproach with the persistence of the later one, evidently owing to the reasons given in the text.
Footnote 186:
Another example of this idea and of the way it induced a psychosis is the following: She had an intense dislike to hearing the sound of running water. This sound induced an intense feeling of _unhappiness and loneliness_. This feeling was so intense that whenever she heard the sound of running water she endeavored to get away from it. The sound of a fountain or rainwater running from a roof, for example, would cause such unpleasant feelings that she would change her sleeping room to avoid them. Likewise drawing water to fill the bathtub was so unpleasant that she would insist upon the door being closed to exclude the sound. She could give no explanation of this psychosis. It was discovered in the following way: She had been desirous of finding out the cause, and we had discussed the subject. I had promised that I would unravel the matter in due time, after the other phobia had been cured. I then hypnotized her and, while she was in hypnosis and just after we had completed the other problem, she remarked that a memory of the running water association was on the verge of emerging into her mind. She could not get it for some time, and then, after some effort, it suddenly emerged. She described it as follows: “It was at Bar Harbor. She was about eight years of age. There was a brook there called Duck Brook. The older girls used to go up there on Sundays for a walk with the boys. I went with them one Sunday, accompanied by the governess, and was standing by the brook with a boy. It was a very noisy brook, the water running down from the hillside. While I was standing by the brook, watching the running water, the boy left me to join the other girls, who had gone off. I thought that was the way it would always be in life; that I was ugly, and that they would never stay with me. I felt lonely and unhappy. During that summer I would not join parties of the same kind, fearing or feeling that the same thing would happen. I stayed at home by myself, and when I refused to go it was attributed to sullenness. They did not know my real reasons. Ever since I have been unable to bear the sound of running water, which produces the feeling of unhappiness and loneliness, the same feeling that I had at that time. I thought then that it was all my fault, because I was ugly.” It was then tentatively pointed out at some length to the subject that as she now knew all the facts which had been brought to the “full light of day,” etc., she, of course, would no longer have her former unpleasant emotions from the sound of running water. Hereupon, to put the question to the test, I reached out my hand and poured some water from a caraffe, by chance standing by, into a tumbler, letting the water fall from a height to make a sound. At once she manifested discomfort, and sought to restrain me with her hand. Plainly the setting had to be changed. This was easily done by leading her to see that her childhood’s ideas had been proven by life’s experiences to be false. When this became apparent she laughed at herself, and the psychosis ceased at once.
Footnote 187:
Social Psychology.
Footnote 188:
This was done in hypnosis, the dream being forgotten when awake.
Footnote 189:
For instance, when I came to the therapeutics I found in abstraction that the patient did not want to give up her point of view “because,” as she said, “it forms an excuse so that when I feel lonely, if there is nothing else to be lonely about, I have that memory and point of view to fall back upon as something to justify my crying and feeling lonely and blue.”
When she now feels blue and cries, as happens occasionally, and she asks herself Why? then she drifts back in her mind to childhood and remembers she was lonely and then cries the harder. Then she vaguely thinks of her mother’s death being her fault. She likes therefore to hold on to this as a peg on which to hang any present feeling of blueness and loneliness.
Footnote 190:
Some, I have no doubt, will insist upon seeing in towers with bells a sexual symbol, and in the self-reproach a reaction to a repressed infantile or other sexual wish. But I cannot accede to this view first, because a tower was not only not the real object of the phobia, but not even the alleged object, which was the ringing of bells; secondly, because it is an unnecessary postulate unsupported by evidence, and, thirdly, because in fact, the associative memories of early life were conspicuously free from sex knowledge, wishes, curiosity, episodes and imaginings, nor was there any evidence of the so-called “mother complex” or “father-complex,” or any other sexual complex that I could find after a most exhaustive probing. The impulses of instincts other than sexual are sufficient to induce psychical trauma, insistent ideas, and emotion. To hold otherwise is to substitute dogma for the evidence of experience.
Footnote 191:
It is worth noting that between the bringing to the “full light of day” the facts furnished by the analysis and the cure a full year and a half elapsed, during which the phobia continued. The “cure” was effected at one sitting. The original study was undertaken on purely psychological grounds; the cure for the purpose of completing the study.
Footnote 192:
This account will be clearer if read in connection with the full analysis (“A Clinical Study of a Case of Phobia”), published in the _Jour, of Abn. Psychol._, October-November, 1912.
Footnote 193:
She was apprehensive of having inherited Bright’s disease from her father, who had convulsions.
Footnote 194:
It is quite possible that this subconscious process induced the unreality syndrome in which struggling for air was the salient symptom.
Footnote 195:
I am excluding conditions like split personalities, automatic writing, etc., and refer rather to normal mental processes.
LECTURE XIV THE PHYSIOLOGICAL MANIFESTATIONS OF EMOTION
Emotion,[196] more particularly fear, plays so large a part in the psychogenesis and symptomatology of the psychoses that it is desirable to have a clear realization of its physiological and psychological manifestations and of the disturbances of the organism which it can induce. It is not necessary for our purpose to discuss the various theories of the nature of emotion that have been propounded; we need deal only with the _manifestations_ of emotion and its effect upon the organism.[197] We will consider the physiological manifestations first.
When a strong emotion is awakened in consciousness there are a large number of physiological reactions, for the most part visceral, which can be noted. Some of these may be graphically recorded and measured by means of instruments of precision. These physiological reactions are numerous and have been extensively described by Féré[198] among others. The earlier work of Mosso upon the disturbances of the respiration and vasomotor apparatus induced by sensory stimulation is well known.
More recently considerable experimental work has been done, particularly by German investigators, to determine the influence of affective states upon the circulation and respiration.
Modifications of the _peripheral circulation_, manifested through pallor or turgescence of the skin and measured by changes recorded by the plethismograph in the volume of the limbs; modifications of the volume of the _heart_ and of the rhythm and force of the beats recorded by the sphygmograph, and of arterial tension measured by the sphygmomonometer are common phenomena. (Fear is more particularly accompanied by pallor, and shame by turgescence—blushing. Anger in some is manifested by pallor and in others by turgescence, and so on.) Changes in rate of the heart-beats belong to popular knowledge. It is not so well known, even to physiologists that the volume of the heart may be affected by emotion. In several series of observations made under conditions of emotional excitement upon a large number of healthy men, candidates for civil service appointments, I recorded in a high percentage not only alterations in the rate and rhythm and force of the heart-beat, but temporary dilatation of the heart lasting during the period of excitement.[199] This dilatation in some cases was sufficient to lead to insufficiency of the mitral valve and to give rise to murmurs. The examination was purposely conducted so as to induce a high degree of emotional excitement, at least in many men. In another series of observations (not published) the arterial tension was measured, and it was found, as would be expected, that an increase of tension accompanied the cardiac excitation under emotion.[200]
As to the _respiratory apparatus_ the effect of emotion in altering the rate and depth of respiration may be shown by the pneumograph; by this method the effects of slight emotion that otherwise would escape observation may be detected. Such a disturbance of respiration is shown in the tracing, Fig. 2.
That emotion will profoundly affect the respiration has of course been common knowledge from time immemorial, and has been made use of by writers of fiction and actors for dramatic effect. The same may be said of modifications of the functioning of the whole respiratory apparatus, including the nostrils and the mouth; and likewise of the decrease or increase of secretions (dryness of the mouth from fear, and “foaming” from anger). These are among the well known physiological effects of emotions.
Increase of _sweat_ sometimes amounting to an outpour, and alterations in the amount of the various _glandular secretions_ (_salivary_, _gastric_, etc.), and _rigor_ are important phenomena.
The remarkable researches of Pawlow[202] and his co-workers in Russia on the _work of the digestive glands_, and those of Cannon[203] in America on the _movements of the stomach and intestines_ have revealed that these functions are influenced in an astonishing degree by psychical factors.
Although it has long been known that the sight of food under certain conditions would call forth a secretion of gastric juice in a hungry dog (Bidder and Smith, 1852), and common observation has told us that emotion strongly affects the gastrointestinal functions, increasing or diminishing the secretions of saliva and gastric juice, and even producing dyspeptic disturbances and diarrhœa, it has remained for Pawlow and his co-workers to demonstrate the important part which the “appetite,” as a psychical state, plays in the process of digestion. In hungry dogs a large quantity of gastric juice, rich in ferment, is poured out when food is swallowed, and even at the sight of food, and it was proved that this outpouring was due to psychical influences. Simply teasing and tempting the animal with food cause secretions, and food associations in the environment may have the same effect. “If the dog has not eaten for a long time every movement, the going out of the room, the appearance of the attendant who ordinarily feeds the animal—in a word, every triviality—may give rise to excitation of the gastric glands.” (Pawlow, p. 73.) This first secreted juice is called “appetite juice,” and is an important factor in the complicated process of digestion. “The appetite is the first and mightiest exciter of the secretory nerves of the stomach.” (Pawlow, p. 75.) Pawlow’s results have been confirmed in man by Hornborg, Umber, Bickel, and Cade and Latarjet. The mere chewing of appetizing food, for instance, is followed by a copious discharge of gastric juice, while chewing of rubber and distasteful substances has a negative result. Depressing emotions inhibit the secretion of juice (Bickel). More than this, Cannon,[204] in his very remarkable experiments on the movements of the stomach and intestines, found that in animals (cat, rabbit, dog, etc.), gastric peristalsis is stopped whenever the animal manifests signs of rage, distress, or even anxiety. “Any signs of emotional disturbance, even the restlessness and continual mewing which may be taken to indicate uneasiness and discomfort, were accompanied in the cat by total cessation of the segmentation movements of the small intestines, and of antiperistalsis in the proximal colon.” Bickel and Sasaki have confirmed in dogs these emotional effects obtained by Pawlow and Cannon.
The effect of the emotions on the digestive processes is so important from the standpoint of clinical medicine that I quote the following summary of published observations from Cannon: "Hornborg found that when the boy whom he studied chewed agreeable food a more or less active secretion of the gastric juice was started, whereas the chewing of indifferent material was without influence.
"Not only is it true that normal secretion is favored by pleasurable sensations during mastication, but also that unpleasant feelings, such as vexation and some of the major emotions, are accompanied by a failure of secretion. Thus Hornborg was unable to confirm in his patient the observation of Pawlow that mere sight of food to a hungry subject causes the flow of gastric juice. Hornborg explains the difference between his and Pawlow’s results by the difference in the reaction of the subjects to the situation. When food was shown, but withheld, Pawlow’s hungry dogs were all eagerness to secure it, and the juice at once began to flow. Hornborg’s little boy, on the contrary, became vexed when he could not eat at once, and began to cry; then no secretion appeared. Bogen also reports that his patient, a child, aged three and a half years, sometimes fell into such a passion in consequence of vain hoping for food, that the giving of the food, after calming the child, was not followed by any secretion of the gastric juice.
"The observations of Bickel and Sasaki confirm and define more precisely the inhibitory effects of violent emotion on _gastric secretion_. They studied these effects on a dog with an œsophageal fistula, and with a side pouch of the stomach which, according to Pawlow’s method, opened only to the exterior. If the animal was permitted to eat while the œsophageal fistula was open the food passed out through the fistula and did not go to the stomach. Bickel and Sasaki confirmed the observation of Pawlow that this sham feeding is attended by a copious flow of gastric juice, a true ‘psychic secretion,’ resulting from the pleasurable taste of the food. In a typical instance the sham feeding lasted five minutes, and the secretion continued for twenty minutes, during which time 66.7 c. c. of pure gastric juice was produced.
"On another day a cat was brought into the presence of the dog, whereupon the dog flew into a great fury. The cat was soon removed, and the dog pacified. Now the dog was again given the sham feeding for five minutes. In spite of the fact that the animal was hungry and ate eagerly, there was no secretion worthy of mention. During a period of twenty minutes, corresponding to the previous observation, only 9 c. c. of acid fluid was produced, and this was rich in mucus. It is evident that in the dog, as in the boy observed by Bogen, strong emotions can so profoundly disarrange the mechanisms of secretion that the natural nervous excitation accompanying the taking of food cannot cause the normal flow.
"On another occasion Bickel and Sasaki started gastric secretion in the dog by sham feeding, and when the flow of gastric juice had reached a certain height the dog was infuriated for five minutes by the presence of the cat. During the next fifteen minutes there appeared only a few drops of a very mucous secretion. Evidently in this instance a physiological process, started as an accompaniment of a psychic state quietly pleasurable in character, was almost entirely stopped by another psychic state violent in character.
"It is noteworthy that in both the positive and negative results of the emotional excitement illustrated in Bickel and Sasaki’s dog the effects persisted long after the removal of the exciting condition. This fact Bickel was able to confirm in a girl with œsophageal and gastric fistulas; the gastric secretion long outlasted the period of eating, although no food entered the stomach. The importance of these observations to personal economics is too obvious to require elaboration.
“Not only are the secretory activities of the stomach unfavorably affected by strong emotions; the movements of the stomach as well, and, indeed, the movements of almost the entire alimentary canal, are wholly stopped during excitement.”[205]
So you see that the proverb, “Better a dinner of herbs where love is than a stalled ox and hatred therewith,” has a physiological as well as a moral basis.
Nearly any sensory or psychical stimulus can be artificially made to excite the _secretion of saliva_ as determined by experimentation on animals by Pawlow.