Hysteria was known to the ancients and in fact is as old as the written history of mankind. Considered essentially a disease of women, it was given its present name which is derived from "hysteron," the Greek name for the womb. We know to-day that men also are victims of this malady, though it arises under somewhat different circumstances than is the case with the other sex. Men and women, living in the same world and side by side, are placed in greatly different positions in that world, are governed by different traditions and are placed under the influences of differing ambitions, expectations, hopes and fears. Hysteria arises largely out of the emotional and volitional reactions of life, and these reactions differ in the sexes.
It was a group of French neurologists, headed by Charcot--and including very illustrious men, such as Janet and Marie, who paid the first scientific attention to the disease. Under their analyses hysteria was defined as a mental disease in which certain symptoms appeared prominently.
1. Charcot especially paid attention to what are known as the attacks. The hysteric patient (usually a woman, and so we shall speak of the patient as "she") under emotional stress and strain, following a quarrel or a disagreement or perhaps some disagreeable, humiliating situation, shows alarming symptoms. Perhaps she falls (never in a way to injure herself) to the floor and apparently loses consciousness, closes her eyes, rolls her head from side to side, moans, clenches her fists, lifts her body from the floor so that it rests on head and heels (opisthotonic hysteria), shrieks now and then and altogether presents a terrifying spectacle. Or else she twitches all over, weeps, moans, laughs and shouts, and rushes around the room, beating her head on the walls; or she may lie or stand in a very dramatic pose, perhaps indicating passion or fear or anger. The attacks are characterized by a few main peculiarities, which are that the patient usually has had an emotional upset or is in some disagreeable situation, that she does not hurt herself by her falls, that consciousness is never completely abolished and fluctuates so that now she seems almost "awake" and then she seems almost in a complete stupor, and that the expression of emotion in the attack is often very prominent. These symptoms are readily differentiated from what is seen in epilepsy.[1]
[1] The French writers of the school of Babinski deny that the above symptom and even the majority of the following have a real existence in hysteria. The English, American and German neurologists and the rest of the French school describe hysteria substantially as I am here describing it.
2. The hysteric paralyses which are featured in all the literatures of the world are curious manifestations and often very stubborn. Following an accident (especially in industry and in war) and after some emotional difficulty there is a paralysis of some part of the body. The arm or some particular part of the arm cannot be moved by the will, is paralyzed; or else the difficulty involves one or both legs. Sometimes speech is gone, or the power of moving the head; occasionally the difficulty is with one side of the face, etc. Usually the paralysis comes on suddenly, but often it comes on gradually. Modern neurology soon discovered that these paralyses were quite unlike those seen when there is "real" injury to the brain, spinal cord or the peripheral nerves. They corresponded to the layman's idea of a part. Thus a paralysis of the arm ends at the shoulder, a paralysis of the feet at the ankle, and in ways not necessary to detail here differ from what occurs when the organic structure of the nervous system is involved. For example, the reflexes in hysteria are unaltered, and stiffness when it occurs is not the stiffness of organic disease. If a neurologist were to have a hysteric paralysis a very interesting problem in diagnosis would be presented.
Further, the paralysis yields in spectacular fashion to various procedures or else disappears spontaneously in remarkable fashion overnight. Paralyses of this type have disappeared under hypnosis, violent electric shocks, "magical" liniments, threats, prayers, the healer's, the fakir's, the doctor's personal influence; under circumstances of danger (a fire, a row, etc.); by pilgrimages to Lourdes, St. Anne de Beaupre, the Temple of Diana, the relic of a saint; by the influence of sudden joy, fear, anger; by the work of the psychoanalyst and by that of the osteopath! Every great religious leader and every savage medicine man beating a tom-tom has had to, prove his pretensions to greatness by healing the sick--so intensely practical is man--and he has proved his divinity by curing the hysterics, so that they threw away their crutches, or jumped blithely out of bed, or used their arms, perhaps for the first time in years. Hysteria has caused more talk of the influence of mind over body than all other manifestations of mental peculiarity put together. Wherever there is anything to be gained by hysteric paralyses, these appear in much greater frequency than under ordinary circumstances. Thus the possibility of recovering damages seems to play a role in bringing about a paralysis that defies treatment until the litigation is settled; similarly the possibility of being removed from the fighting line played a large part in the causation of war hysteric paralysis.
3. A group of sensory phenomena is conspicuous in hysteria, sometimes combined with the paralyses and attacks but often existing alone. A part of the body will become curiously insensitive to stimulation. Thus one may thrust a pin into any part without evoking any pain and APPARENTLY without being felt; one may rub the cornea of the eye, that exquisitely sensitive part, without arousing a reaction; one may push a throat stick against the uvula as it hangs from the palate without arousing the normal and very lively reflex of "gagging." These insensitive areas, known as stigmata, played a very important role in the epidemic of witchcraft hunting of the sixteenth and seventeenth centuries, when the witch was so diagnosed if she felt no pain when a needle was thrust into her. Mankind has often enough worshiped the insane and mentally aberrant and has as often been diabolically cruel to them.
What has been stated of the paralyses is true of the insensitive areas; they correspond to an idea of a part and not to an anatomical unit. Thus a loss of sensation will reach up to the wrist (glove type) all around, front and back, or to the elbow or the shoulder, etc. No organically caused anaesthetic area ever does this, and so the neurologist is able, usually, to separate the two conditions. And the anaesthesias yield as do the hysteric paralyses to a variety of agents, from prayer and persuasion to a bitter tonic or a blow. I confess to a weird feeling in the presence of a hysteric whose arm can be thrust through and through with a needle without apparently suffering any pain, and it seems to me that this may be the explanation of the fortitude of those martyrs who have astonished and sometimes converted their persecutors by their sublime resistance to torture.
There has been described as part of hysteria the hysteric temperament. The characteristics of this temperament are the emotional instability, the strong desire for sympathy, the effort to obtain one's desire through weakness, through the appeal to the sympathy of others, an irritable egoism never satisfied and without firm purpose. It is true that the majority of peace-time hysterics show this peculiar temperament, but it is also true that the war-time hysterics often enough were of "normal" character, without prior evidence of weakness.
As I before mentioned, Freud became greatly interested in this group of patients and especially in the female patients, since in ordinary neurological practice the male hysteric is not common. Out of his experience and effort he built up a system of beliefs and treatment, the evolution of which is interesting, but which is not here important.
At the present time the Freudian doctrine hangs on the following beliefs:
1. That from the beginning to the end of life everything in the mental activities of man has a cause and a meaning, and that these causes and meanings may be traced back to infancy. No slip of the tongue is accidental; it has purpose and this purpose can be traced by psychoanalysis. So with hysteric phenomena: the paralyses, the sensory changes, all the queer and startling things represent something of importance and of value to the subconscious.
2. There is in man a subconscious mentality, having wills, purposes, strivings, desires, passions. These trends are the raw, native, uninhibited desires of man; they are our lusts, our crude unsocialized desires, arising out of a metaphysical, undifferentiated yearning called libido. In the Freudian "psychology" the libido is mainly sex desire and takes the form of homosexual feelings, incest feelings (desire for the father or for the mother--the oedipus complex), desire for the sister or brother.[1] (The human being, according to Freud, goes through three stages in his sex life: first, a sex attachment to himself marked by thumb sucking, masturbation, etc., second, an attachment to the same sex--homosexuality--and, finally, the attachment or desire for the opposite sex.) In the practical application of the Freudian psychology to the patients the sex conflicts (of which we shall speak shortly) are all important; the subconsciousness is largely taken up with sex and with efforts to obtain gratification for these sex desires.
[1] The Freudians would protest against this. Libido is the life energy,--but all the Freudian analyses of actual cases published make libido sex, and usually "perverse." (I put the perverse in quotations because I fear to be called prudish by Freudians.)
3. But, the theory continues, the conscious personality is the socialized personality, having aims and ends not consistent with desire for mother, homosexual cravings, lust for a married man or woman. So there ensues a battle between desire and inhibition. The inhibiting agent is a something called the censor, who pushes back into the subconsciousness the socially tabooed, the socially abhorrent desires; represses emotions and instincts that are socially out of order. But there is no real victory for the consciousness, for the complex (the name given to a desire or wish with its attendant ideas, emotions and motor manifestations) is still active, subconsciously changing the life of the person, causing him to make slips in his speech, expressing itself in his dreams and his work, and if sufficiently powerful, giving rise to nervous or mental disease of one type or another. Nothing is ever forgotten, according to Freud, and the reason our childhood is not voluntarily remembered is because it is full of forbidden desires and curiosities and the developing censor thrusts it all into the subconsciousness, where it continues to make trouble all the rest of the individual's life. In fact, a cardinal part of Freudianism (which he and his followers are lately modifying) is that it is the results of the "psychic traumata" (psychical injuries) of infancy and childhood that cause the hysteria of the adult; and these psychical traumata are largely (about ninety- nine per cent.) sexual.
4. Freudianism has borrowed the time-honored dictum that every sensation has a natural result in action and has elaborated it into the statement that every affective state, every desire and craving of whatever sort, needs a motor discharge, an avenue of outlet. If the desire or emotion is inhibited, its excitement is transferred with it into the subconscious and that excitement may attach itself to other excitements and break into consciousness as a mental disturbance of one type or another. If you can get at the complex by psychoanalysis, by dragging it to the light, by making it conscious, you discharge the excitement and health is restored. This originally was very important in the Freudian work and was called by the crude term of catharsis.
5. How can one get at these subterranean cravings and strivings, at the fact that originally one desired one's mother and was jealous of one's father, or vice versa? Here Freud developed an elaborate technique based on the following:
Though the censor sits on the lid of the subconsciousness, that wily self has ways and means of expression. In dreams, in humor, in the slip of the tongue, in forgetfulness, in myths of the race, in the symptoms of the hysteric patient, in the creations of writers and artists, the subconsciousness seeks to symbolize in innocent (or acceptable) form its crude wishes. By taking a dream, for example, and analyzing it by what is known as the free association method, one discovers the real meaning of the terms used, the meaning behind the symbol; and behind the apparent dream-content one sees revealed the wishes and disorganizing desires of the subconscious or the real person. For throughout Freud's work, though not so definitely expressed, there is the idea that the subconscious is by far the most important part of the personality, and that the social purposes, the moral injunctions and feelings are not the real purposes and real desires of the real personality.
In analyzing dreams, the symbols become quite standardized. The horses, dogs, beards, queer situations of the dream (falling, walking without clothes, picking up money, etc.), the demons, ghosts, flying, relate definitely to sex situations, sex organs, sex desires. (The Freudians are apt to deny this theoretically, but practically every dream of the thousands they publish is a sex dream of crude content.) Naturally a "pure" girl is quite shocked when told that because she dreamed she was riding a gray horse in a green meadow that she really has bad (and still is troubled by) incestuous desires for her father, but that is the way to cure her of her neurasthenia or fatigue or obsession of one kind or other.
I have not attempted a detailed account of the technique of free association, nor the Freudian account of humor, etc. There are plenty of books on the market written by Freud himself and his followers. Frankly I advise the average person not to read them. I am opposed to the Freudian account of life and character, though recognizing that he has caused the psychologist to examine life with more realism, to strip away pretense, to be familiar with the crude and to examine conduct with the microscope.
I do not believe there is an ORGANIZED subconsciousness, having a PERSONALITY. Most of the work which proves this has been done on hysterics. Hysterics are usually proficient liars, are very suggestible and quite apt to give the examiner what he looks for, because they seek his friendly interest and eager study. Wherever I have checked up the "subconscious" facts as revealed by the patient as a result of his psychoanalysis or through hypnosis, I have found but little truth. On the other hand, the Freudians practically never check up the statements of their patients; if a woman tells all sorts of tales of her husband's attitude toward her, or of the attitude of her parents, it is taken for granted that she tells the truth. My belief is that had the statements of Freud's patients been carefully investigated he would probably never have evolved his theories.
The Freudians have made no consecutive study of normal childhood, though they lay great stress on this period of life and in fact trace the symptoms of their patients back to "infantile trauma." Most of Freud's ideas on sex development can be traced to, the one four-and-a-half-years-old child he analyzed, who was as representative of normal childhood as the little chess champion of nine years now astounding the world is representative of the chess ability of the average child. Moreover, the basis of the technique is the free association, an association released from inhibitions of all kinds. There isn't any such thing, as Professor Woodworth has pointed out. All associations are conditioned by the physical condition of the patient, by his mood, by the nature of the environment he finds himself in, by the personality of the examiner and his powers of suggesting, his purposes and (very important) by the patient's purposes, which he cannot bid "Disappear!" As for the results of treatment, every neurologist meets patients again and again who have been "psychoanalyzed" without results. Moreover, psychoneurotic patients get well without treatment, as do all other classes of the sick, and the Christian Scientist, the osteopath and the chiropractic also have records of "cures."
This is not the place to discuss in further detail the Freudian ideas (the wish, the symbol, the jargon of transference, etc). The leading follower of Freud, Jung, has already broken away from the parent church, and there is an amusing cry of heresy raised. Soon the eminent Austrian will have the pleasure of seeing a half-dozen schools that have split off from his own,--followers of Bleuler, Jung, Adler and others.
There IS a subconsciousness in that much of the nervous activity of the organism has but little or no relation to consciousness. There are mechanisms laid down by heredity and by the racial structure that accomplish great functions without any but the most indirect effect on consciousness and without any control by the conscious personality. We are spurred on to sex life, to marriage, to the care of our children by instinct; but the instinct is not a personality any more than the automatic heartbeat is. We repress a forbidden desire; if we are successful and really overcome the desire by setting up new desires or in some other way, the inhibited desire is not locked up in a subterranean limbo. There is nothing pathological about inhibition, for inhibition is as normal a part of character as desire, and the social instinct which bids us inhibit is as fundamental as the sex instinct. Most conflicts are on a conscious plane, but most people will not admit to any one else their deeply abhorrent desires. To all of us, or nearly all, come desires and temptations that we would not acknowledge for the world. If a wise examiner succeeds in getting us to admit them, it is very agreeable to find a scapegoat in the form of the subconsciousness. I have often said this to students: if all our thoughts and conscious desires could be exposed, the most of us would almost die of shame. True, we do not clearly understand ourselves and our conflicts and explanation is often necessary, but that is not equivalent to the subconsciousness; it merely means that introspection is not sagacious.
Nor is it true, in my belief, that dreams are important psychical events, nor that the subconsciousness evades a censor in elaborating them. To what end would that be done? What would be the use of it? Suppose that Freud and his school had never been; then dreams would always be useless, for they would have no interpreter. Men have dreamed in the countless ages before Freud was born,--in vain. Think how the poor, misguided subconsciousness has labored for nothing,--and how grateful it should be to Freud! Dreams are results and have the same kind of function that a stomach-ache has.
Things, experiences are forgotten, and whether they are remembered or not depends upon the number of times they are experienced, the attention they are given, the use they are put to and the quality of the brain experiencing them. Disease and old age may lower the recording power of the brain so that experiences and sensations do not stick, and now and then the brain is hypermnesic so that things are remembered with surprising ease.
The conflicts of life are generally conscious conflicts, in my experience. Desires and lusts that one does not know of do no harm; it is the conflict which we cannot settle, the choice we cannot make, the doubt we cannot resolve, that injures. It is not those who find it easy to inhibit a desire or any impulse that are troubled, though they may and do grow narrow. It is those whose unlawful or discordant desires are not easily inhibited who find themselves the theater of a constant struggle that breaks them down. The uneasiness of a desire that arises from the activity of the sex organs is not a manifestation of a subconscious personality, unless we include in our personality our livers, spleen and internal organs of all kinds. Such an uneasiness may not be clearly understood by the individual merely because the uneasiness is diffuse and not localized. But there is no personality, Do will, wish or desire in that uneasiness; it may and does cause to arise in the conscious personality wills and wishes and desires against which there is rebellion and because of which there is conflict.
Upon the issue of the conflicts within the personality hangs the fate of the individual. Race-old lines of conduct are inhibited by custom, tradition, teaching, conformity and the social instinct and its allies. Here is a subject worthy of extended consideration.
Freud has done the thought of our times a great service in emphasizing conflict. From the earliest restriction laid by men on his own conduct, wrestling with desire and temptation has been the greatest of man's struggles. Internal warfare between opposing purposes and desires may proceed to a disruption of the personality, to failure and unhappiness, or else to a solidified personality, efficient, single-minded and successful. Freud's work has directed our attention to the thousand and one aberrant desires that we will hardly acknowledge to ourselves, and he has forced the professional worker in abnormal and normal mental life to disregard his own prejudices, to strip away the camouflage that we put over our motives and our struggles. Together with Jung and Bleuler, he has helped our science of character a great deal through no other method than by arousing it to action against him. In order to fight him, our thought has been forced to arm itself with the weapons that he has used.