Serving a Purpose

A neurosis is a subconscious effort at adjustment. Like a physical symptom, it is Nature's way of trying to cure herself. It is an attempt to get equilibrium, but it is an awkward attempt and hardly the kind that we would choose when we see what we are doing.

Securing an Audience. Besides furnishing relief from too intense strain, a nervous breakdown brings secondary advantages that are at most only dimly recognized by the individual. One of the most intense cravings of the primitive part of the subconscious is for an audience; a nervous symptom always secures that audience. The invalid is the object of the solicitous care of the family, friends, physician, and specialist. Pomp and ceremony, so dear to the child-mind, make their appeal to the dissociated part of the personality. The repressed instincts, hungry for love and attention, delight in the petting and special care which an illness is sure to bring. Secretly and unconsciously, the neurotic takes a certain pleasure in all the various changes that are made for his benefit,—the dismantling of striking clocks, the muffling of household noises, the banishing of crowing roosters, and the changes in menu which must be carefully planned for his stomach.

Capitalizing an Illness. Then, too, a neurosis provides a way of escape from all sorts of disagreeable duties. It can be capitalized in innumerable ways,—ways that would horrify the invalid if he realized the truth. Much of the resentment manifested against the suggestion that the neurosis is psychic in origin is simply a resistance against giving up the unconsciously enjoyed advantages of the illness. An honest desire to get well is a long step toward cure.

The Right Kind of Symbolism. Sublimation itself is merely a symbolic expression of basic impulses. It follows the line of our make-up, which naturally and fundamentally is wont to let one thing stand for another and to express itself in indirect ways. Sublimation says: "If I cannot recreate myself in the person of a child, I will recreate myself in making a bridge, or a picture, or a social settlement,—or a pudding." It says: "If I cannot have my own child to love, I will adopt an orphan-asylum, or I will work for a child-labor law." It merely lets one thing stand for another and transfers all the passions that belong to the one on to the other, which is the same thing as saying that it gives vent to its original desire by means of symbolic expression.

The Case of Mrs. Y. There came to me a short time ago a little woman whose face showed intense fright. For several months she had spent much of the time walking the floor and wringing her hands in an agony of terror. In the night she would waken from her sleep, shaking with fear; soon she would be retching and vomiting, although she herself recognized the fact that there was nothing the matter with her stomach.

Part of the time her fear was a general terror of some unknown thing, and part of the time it was a specialized fear of great intensity. She was afraid she would choke her son, to whom she was passionately devoted. During the course of the treatment, which followed the lines of psycho-analysis to be described in the next chapter, I found that this fear had arisen one evening when she was lying reading by the side of her sleeping child. Suddenly, without warning, she had a sort of mental picture of her own hands reaching out and choking the boy. Naturally she was terrified. She jumped out of bed, decided that she was losing her mind and went into a hysterical state which her husband had great trouble in dispelling. After that she was afraid to be left alone with her children lest she should kill them.

Summary

Three Kinds of People. Absurd as it sounds, "nerves" turn out to be a question of morals; a neurosis, an affair of conscience; a nervous symptom an unsettled ethical struggle. The ethical struggle is not unusual; it is a normal part of man's life, the natural result of his desire to change into a more civilized being. The people in the world may be divided into three classes, according to the way they decide the conflict.

The Salt of the Earth. The second class of people decide the conflict in a way that satisfies both themselves and society. They give the victory to the higher trends and at the same time make a lasting peace by winning over the energy of the undesirable impulses. By sublimation they divert the threatening force to useful work and turn it out into real life, using its steam to make the world's wheels go round. Their love-force, unhampered by childish habits, is free to give itself to adult relationships or to express itself symbolically in socially helpful ways.

A neurotic is a normal person, "only more so." His impulses are the same impulses as those of every other person; his complexes are the same kind of complexes, only more intense. He is an exaggerated human being. He may be only slightly exaggerated, showing merely a little character-weakness or a slight physical symptom, or he may be so intensified as to make life miserable for himself and everybody near him. It is quantity, not quality, that ails him, for he differs from his steady-going neighbor not in kind but in degree. More of him is repressed and a larger part of him is fixed in a childish mold.

Tricking Ourselves. A neurosis is a confidence game that we play on ourselves. It is an attempt to get stolen fruit and to look pious at the same time,—not in order to fool somebody else but to fool ourselves.

Although the true meaning of a symptom is hidden, there is fortunately a clue by which it can be traced. Sometimes it takes the art of a psychic detective to follow the clues down, down through the different layers of the subconscious mind, until the troublesome impulses and complexes are found and dragged forth,—not to be punished for breaking the peace but to be led toward reconciliation. But "that is another story," and belongs to another chapter. We are approaching THE WAY OUT.

PART III—THE MASTERY OF "NERVES"

Since there are as many married neurotics as single, it is evident that even marriage is not a sure preventive of nervousness. License, on the other hand, can satisfy only a part of the individual's craving. Freud insists that the sex-instinct has a psychic component as well as a physical one, and that it is this psychic part which is most often repressed. He maintains that for complete satisfaction there must be psychic union between mates, and that gratification of the physical component of sex when dissociated from psychic satisfaction, results in an accumulation of tension that reacts badly on the whole organism.

Remaking Ourselves. As a matter of fact, the science of psychotherapy or mental treatment is simply the science of re-education,—a process designed to break up old unhealthy complexes which disrupt the forces of the individual, and to build up healthy complexes which adjust him to the social world and enable him to use his energy in useful ways.

Fortunately, minds can be changed. It is easier to make over an unhealthy complex than to make over a weak heart, to straighten out a warped idea than to straighten a bent back. Remarkable indeed have been some of the transformations in people who are supposed to have passed the plastic period in life. While it is true that some persons become "set" in middle life, and almost impervious to new ideas, it is also true that a person at fifty has more richness of experience upon which to draw, more appreciation of the value of the good, than has a person at twenty. If he really wants to change himself, he can do wonderful things by re-education.

Various Methods. As there are a number of schools of medicine, so there are a number of distinct methods of psychotherapy, each with its own theories and methods of procedure, and each with its ardent supporters. These methods may be classified into two groups. The first group includes those methods, hypnosis and psycho-analysis, which make a thorough search through the subconscious mind for the buried complexes causing the trouble, and might, therefore, be called "re-education with subconscious exploration." The other group, includes so-called explanation and suggestion, or methods of "re-education without subconscious exploration," which content themselves with making a general survey and building up new complexes without going to the trouble of uncovering the buried past. Although the theory and the technique vary greatly, the aim of all these methods is the same,—the readjustment of the individual to life.

Hypnosis. The method by which most of the important early discoveries were made is hypnosis, or artificial sleep, a method by which the conscious mind is dissociated and the subconscious brought to the fore. It was through hypnosis that Freud, Janet, Prince, and Sidis made their first investigations into the nature of nervousness and worked their first cures. With the conscious mind asleep and its inhibitions out of the way, a hypnotized patient is often able to remember and to disclose to the physician hidden complexes of which he is unaware when awake. Hypnosis may thus be a valuable aid to diagnosis, enabling the physician to determine the cause of troublesome symptoms. He may then begin to make suggestions calculated to break up the old complexes and to build new ones, made up of more healthful ideas, desirable emotions and happy feeling-tones. As we have seen, a hypnotized subject is highly suggestible. His counter-suggestions inactivated, he believes almost anything told him and is extremely susceptible to the doctor's influence.

Since nervousness is a state of exaggerated suggestibility and abnormal dissociation, many psychologists believe that it is unwise to employ a method which heightens the state of suggestibility and encourages the habit of dissociation. They feel that it is wiser to use less artificial methods which rest on the rational control of the conscious mind and make the patient better acquainted with his own inner forces and more permanently able to cope with new manifestations of those forces. They believe that the character of the patient is strengthened and his morale raised by methods which increase the sovereignty of reason and decrease the role of unreasoning suggestibility.

In this way, thoughts in consciousness and in the upper layers of the subconscious are connected by a series of associations, forming links in invisible chains that lead to the deepest, most repressed ideas. Even a dissociated complex has some connection with the rest of the mind, if we only have the patience to discover it. Therefore, by adopting a passive attitude, by simply letting his thoughts wander, by talking out to the physician everything that comes to his mind without criticizing or calling any thought irrelevant or far-fetched, and without rejecting any thought because of its painful character, the patient is helped to trace down and unearth the troublesome complex which may have been absolutely forgotten for many years. He is helped to relive the childhood experiences back of the over-strong habits which lasted into maturity.

The trouble is that he has overlooked the word "disguised." Like wit and some figures of speech, a dream says something different from what it means. It deals in symbols. Its "manifest content" may be merely a fantastic and impossible scene without apparent rhyme or reason, but the "latent content," the hidden meaning, always expresses some urgent personal problem. Although the dream may seem to be impersonal and unemotional, it nevertheless deals in every case with some matter of vital concern to the dreamer himself. It is a condensed and composite picture of some present problem and of some related childish repressed wish which the experiences of the preceding day have aroused.

As Frink says, a dream is like a cartoon with the labels omitted—absolutely unintelligible until its symbols are interpreted. Although some dreams whose symbolism is that which man has always used, can be easily understood by a person who knows, many dreams are meaningless, even to an experienced analyst, until the patient himself furnishes the labels by telling what each bit of the picture brings to his mind. The dream, as a rule, merely furnishes the starting-point for free association.

One of my patients blocked on the word "long." Instead of saying "short" or "pencil" or "road" or "day" or any other word which might naturally be associated with "long," she laughed and said that no word would come. Finally an emotional memory came to light. It seems that this woman had been courted by a man whom she unconsciously loved, but whom she had "turned down" because she was ambitious for a career. After the man had moved to another town, my patient heard that he was engaged to another girl. She then realized that she loved him and began to long for him with her whole heart. The meaningful word "long" thus led us to one of the emotional memories for which we were seeking.

During an analysis a patient of mine who had a mother-in-law situation on her hands told me a dream of the night before. "I dreamed that my mother-in-law, who has really been very ill, was taken with a sinking-spell. I rushed to the telephone to call the doctor, but found to my terror that I could not remember his number." "What is his number?" I asked, knowing that she ought to know it perfectly. "Two-eight-nine-six," she answered at once. The number really was 2876. Asleep and awake, her repressed desire for release from the mother-in-law's querulous presence was attempting to have its way. In the dream, she avoided calling the doctor by forgetting his number entirely. Awake, she evaded the issue by remembering a wrong number. In the dream she thinly disguised her desire by displacing the anxious emotion from the sense of her own guilty wishes to the idea of the mother-in-law's death. When confronted with this interpretation, the woman readily acknowledged its truth.