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.

On examining a dream it was found to be peculiar in one respect: It was not an imaginative or fantastic composition, but a detailed and precise living over again of the scenes at the death bed: that is to say, it was a sort of somnambulistic state. In recalling this dream^[188] she could not for some time recover the ending. Finally it “broke through,” as she expressed it. The dream was as follows: First came many details of the vigil of the last night of the illness; then she went to her room and to bed to snatch a few moments’ sleep; she was waked up by the husband of the dying relative appearing in her room. He sat on the edge of her bed and said to her, “All is over.” Up to this point the facts of the dream were actual representations in great detail of the actual facts as they had occurred, but at this moment the dream presented a fact which had not occurred in the real scene; she suddenly, in the dream, sat up in bed and exclaimed, “My God! then I ought to have sent for the doctor!”

Here was the key to the intolerance for memories of the illness of the relative and the death-bed scene. What had happened was this: The question had arisen early in the illness whether or not a doctor should be sent for from London in consultation. The expense, owing to the distance, would have been considerable. The whole responsibility and decision rested upon the subject. Against the opinion of other relatives she had decided that it was inadvisable. After the fatal ending the question had arisen again whether or not she ought to have sent for the consultant and she had been tormented by the doubt as to whether she did right; was the fatal result her fault? Although she had reasoned with herself that her decision was good judgment and right still there had always lurked a doubt in her mind. She was also somewhat disturbed by the thought of what the husband’s opinion might be.

The real reason why she could not tolerate the memories of the last illness of this relative, and the psychogenesis of the symptoms now were plain: they were not grief but self-reproach with its instinct of self-abasement. The memories brought to her mind that the fault was her’s and with the thought came self-reproach. This self-reproach she was afraid of and unwilling to face. This fact she recognized and frankly confessed after the disclosures of the analysis.

Now follows the therapeutic sequel. The relative’s illness at the beginning was in no way of a dangerous nature and the proposed consultation had nothing to do with the question of danger to life. The death was due to purely an accidental factor and could not have been foreseen. When I assured her in hypnosis, with full explanation, that her decision had been medically sound, as it was, the change in her mental attitude was delightful to look upon. “Wasn’t it my fault! Wasn’t it my fault!” she exclaimed in excitement. Anxiety, dread, and depression gave way to exhilaration and joyousness. Thereupon she woke up completely relieved in mind, and retained the same feeling of joy, but without knowing the reason thereof. The explanation was repeated to her in the waking state and she then fully realized (as she did also in hypnosis) that her previous view was a pure subterfuge and fully appreciated the truth of the discovered reason for her inability to face her painful memories. The twilight states, the insomnia, and the distressing dreams, the anxiety, and other symptoms ceased at once.

Returning to the phobia for bells, in the light of all these facts, the patient’s belief that her mother’s death was her fault and the consequent self-reproach were obviously only a particular concrete example of a lifelong emotional tendency originating in the experiences of childhood to blame herself; and this tendency was the striving to express itself of the instinct of self-abasement (with the emotion of self-subjection) which, incorporated within “the self-regarding sentiment” (McDougall), was so intensely cultivated and had played so large a part in her life. Indeed this instinct had almost dominated her self-regarding sentiment and had given rise time and again to self-reproach for accidental happenings. It now specifically determined her attitude of mind toward the series of events which led up to the fatal climax and determined her judgment of self-condemnation and self-reproach. These last most probably received increased emotional force from the large number of roots in painful associations of antecedent experiences (particularly of childhood) in which the self-regarding sentiment, self-debasement, and self-reproaches were incorporated.^[189] Nevertheless the fear was of a particular concrete self-reproach. The general tendency was of practical consequence only so far as it explained the particular point of view and might induce other self-reproaches.

As a general summary of this study it would appear that we can postulate a larger setting to the phobia than the grief inspiring experiences attending her mother’s death. The unconscious complex included the belief that she was to blame and the sentiment of self-reproach, and the whole gave a fuller meaning to the ringing of bells in a tower. The fear besides being a recurring association was also a reaction to the subconsciously excited setting of a fancied truth or self-accusation. Although excited by towers and steeples the fear was really of self-reproach. Towers, steeples, and bells not only in a sense symbolized her mother’s death, but her own fancied fault. It was in this sense and for this reason that she dared not face such objects. The conscious and the unconscious formed a psychic whole.^[190]

Now in reaching these conclusions see how far we have traveled: Starting with an ostensible phobia for towers, we find it is more correctly one of ringing-of-bells, but without conscious association; then we reach a childhood’s tragedy; then a self-reproach on religious grounds; then a belief in a fault of childhood’s behavior culminating in a lifelong self-reproach—the causal factor and psychologically the true object of the phobia: and between this last self-reproach and the phobia no conscious association.

The therapeutic procedure and results are instructive. As the fear was induced by a belief in a fancied fault exciting a self-reproach, obviously if this belief should be destroyed the self-reproach must cease and the fear must disappear. Now when all the facts were brought to light, the patient, as is usual, recognized the truth of them. She also recognized fully and completely the real nature of the fear, of the self-blame and of the self-reproach. There remained no lingering doubt in her mind, nevertheless the bringing to “the full light of day” of all this did not cure the phobia. As the first procedure in the therapeusis it was pointed out that it was contrary to common sense to blame herself for the heedlessness of a child; that all children were disobedient; that she would have been a little prig if she had been the sort of a child that never disobeyed, and that she would not have blamed any other child who had behaved in a similar way under similar circumstances, and so on. She simply said that she recognized all this intellectually as true and yet, although it was the point of view which she would take with another person in the same situation, it did not in any way alter her attitude toward herself. In other words the bringing to the full light of day of the facts did not cure the phobia. It was necessary to change the setting of her belief. To do this either the alleged facts had to be shown to be not true or else new facts had to be introduced which would give them a new meaning. This, briefly told, was done in the following way:

She was put into light hypnosis in order that exact and detailed memories of her childhood might be brought out. Then, through her own memories, it was demonstrated, that is to say, the patient herself demonstrated, that there was considerable doubt about her having had phthisis at all; that she was not taken to the usual places of “cures” for phthisis but sojourned in the gay and pleasant cities and watering places of Europe; that her mother really staid in Europe because she enjoyed it and made an excuse of her daughter’s health not to come home; that she might have returned at any time but did not want to do so; and that the fault lay, if anywhere, with her physician at home. When this was brought out the patient remarked, “Why, of course, I see it now! My mother did not stay in Europe on account of my health but because she enjoyed it, and might have returned if she had wanted to. I never thought of that before! It was not my fault at all!” After coming out of hypnosis the facts as elicited were laid before the patient; she again said that she saw it all clearly, as she had done in hypnosis, and her whole point of view was changed.

The therapeutics, then, consisted in showing that the alleged facts upon which the patient’s logical conclusions had been based were false. The setting thereby was altered, and a new and true meaning given to the real facts. The result was towers and steeples no longer excited fears, the phobia ceased at once—an immediate cure.^[191]

Type D. In this type the conscious psychosis consists of idea, meaning, affect, and physical disturbance. F. E. suffered from attacks of so-called “unreality” accompanied with intense fear. She was unable to give an intelligent explanation as to why she was afraid of the attacks—harmless in themselves—until it was brought out that there was in the background of her mind the thought that the attacks spelled insanity (or that she was likely to go insane) and also death. Following the attacks there was amnesia for these thoughts. Her fear really, then, was of insanity and death. The content of consciousness in the attacks contained the perception of herself as an insane person, thoughts which expressed the meaning of her attacks, and fear. (The usual physical disturbances of course accompanied the fear.) No amount of explanation of the harmlessness of the unreality syndrome sufficed to change her point of view, i.e., its meaning to her. But going further it was discovered that her self-regarding sentiment and her ideas of insanity and death were organized with a large number of fear-inspiring antecedent experiences which explained why she regarded the attacks as dangerous to her mentality and life; and why the biological instinct of fear was incorporated with the self-regarding sentiment. These experiences had long passed out of mind and there was no conscious association between them and her phobia, but they could be recalled as associative memories.^[192] The unreality attacks had for her two meanings which were within the content of consciousness, viz., 1, insanity, and 2, death. The first was derived from (a) antecedent girlhood and later experiences which had engendered the unsophisticated belief that having the mind fixed on one subject, as was obtrusively and painfully the case at one time, meant insanity: and (b), from the fact that the bewildering, irreconcilable, absurd thoughts, conflicts, and emotions in which the unreality attacks culminated meant insanity.

The second meaning (death) was derived from (a) the previous fixed idea (just referred to), organized with that of insanity—namely, an unsophisticated medieval idea of hell which was conceived of as the equivalent of death and which had excited an intense horror of both; and (b) from the fact that in the unreality attacks there was a struggling for air; struggling was in her mind, the equivalent of convulsions;^[193] convulsions of unconsciousness; and unconsciousness of death. All these various ideas and the intense fears which each gave rise to had become organized into a complex, and, in consequence of these antecedent experiences in which self took a prominent part, the instinct of fear—as I conceive the matter—became incorporated within the self-regarding sentiment. (Anything that aroused this sentiment tended to arouse the emotion of fear, as in another person it would tend to arouse the emotion of pride, or self-abasement.) At any rate this organized complex was the setting which gave the meaning to her phobia. There can be, I think, no manner of doubt about this. The patient herself explained her viewpoint through these ideas here briefly summarized. The only question is as to the mechanism of the phobia. Now as Type D, of which these cases are examples, differs clinically from the preceding three types only in the addition of one more element—meaning—to the conscious psychic whole, a consistent interpretation would seem to compel us to postulate also a functioning subconscious complex or setting and in this case of the antecedent experiences disclosed as a factor in the mechanism and a part of the psychic whole. Out of this complex emerged into consciousness the idea of insanity and death and fear as the meaning of the unreality syndrome, the whole constituting the phobia psychosis.

That there was in fact a subconsciously functioning process derived from this complex would seem to be almost conclusively shown by another phenomenon manifested. I refer to the vivid visualization of herself in a convulsion, struggling for air and manifesting fright, which she experienced in each attack. We have seen that such a visualization (i.e., a modified vision) is the expression (secondary images?) of a subconscious process (co-conscious ideas?). As a matter of fact this particular visualization was a pictorial representation of antecedent thoughts organized with thoughts of death and insanity and still conserved in the unconscious. We must believe, then, that it was these antecedent thoughts (in the first place her apprehension of inheriting Bright’s disease and convulsions from her father, and in the second place her conception of the unreality syndrome as a state which might possibly end in convulsions) which, functioning subconsciously, induced the quasi hallucinatory expression of themselves.^[194] It is difficult to get away from the conclusion that the remainder of the setting from which the ideas of insanity and death were derived also functioned as a subconscious process. Whether this process was conscious or unconscious is a secondary question which we need not consider.

In weighing the probabilities of this interpretation we should bear in mind that there were two conscious beliefs of which the patient was fully aware and which were very real to her; namely, the liability of becoming insane and to convulsions and death. The conative force of the instinct of fear linked to such ideas is quite sufficient to drive them to expression when out of mind and subconscious. Or expressed differently we may say that the fear was a reaction to these ideas which the patient dared not face.

We ought not, however, to be too sweeping in our generalizations and go further than the facts warrant. We are not justified in concluding that the linking of an affect to an idea always includes a subconscious mechanism. On the contrary, as I have previously said, probably in the great majority of such experiences, aside from obsessions, no such mechanism is required to explain the facts.

The Inability to Voluntarily Modify Obsessions.—We are now in a position on this theory to look a little more deeply into the structure and mechanism of an obsession and thereby realize why it is that the unfortunate victims are so helpless to modify or control them. Indeed this behavior of the setting could be cited as another piece of circumstantial evidence for the theory that the setting is largely unconscious and that only a few elements of it enter the field of consciousness. If we simply explain to a person who has a true obsession, i.e., an insistent idea with a strong feeling tone, the falsity of the point of view, the explanation in many cases at least has no or little effect in changing the viewpoint, though the patient admits the correctness of the explanation. The patient cannot modify his idea even if he will. But if the original complex, which is hidden in the unconscious and which gives rise to the meaning of the idea, is discovered, and so altered that it takes on a new meaning and different feeling tones, the patient’s conscious idea becomes modified and ceases to be insistent. This would imply that the insistent idea is only an element in a larger unconscious complex which is the setting and unconsciously determines the viewpoint. The reason why the patient cannot voluntarily alter his viewpoint becomes intelligible by this theory, because that which determines it is unconscious and unknown. He may not even know what his point of view is, owing to the meaning being in the fringe of consciousness.

If this theory of the mechanism is soundly established the difficulty of correcting obsessions becomes obvious and intelligible. It is also obvious that there are theoretically two ways in which an obsession might be corrected.

1. A new setting with strong affects may be artificially created so that the perception acquires another equally strong meaning and interest.

2. The second way theoretically would be to bring into consciousness the setting and the past experiences of which the setting is a sifted residuum, and reform it by introducing new elements, including new emotions and feelings. In this way the old setting and point of view would become transformed and a new point of view substituted which would give a new meaning to the perception.

Now in practice both these theoretical methods of destroying an obsession are found to work, although both are not always equally efficacious in the same case. In less intense obsessions where the complex composing the setting is only partially and inconsequently submerged, and to a slight degree differentiated from the mass of conscious experiences, the first and simpler method practically is amply sufficient. We might say that the greater the degree to which the setting is conscious and the less the degree to which it has acquired, as an unconscious process, independent autonomous activity the more readily it may be transformed by this method.

On the other hand in the more intense obsessions, where a greater part of the setting is unconscious, has wide ramifications and has become differentiated as an independent autonomous process, the more difficult it is to suppress it and prevent its springing into activity whenever excited by some stimulus (such as an associated idea). In such instances the second method is more efficacious. It is obvious that, so long as the setting to a central idea remains organized and conserved in the unconscious, the corresponding perception and meaning are always liable under favoring conditions (such as fatigue, ill health, etc.) to be switched into consciousness and replace the new formed perception. This means of course a recurrence. Nevertheless medical experience from the beginning of time has shown that this is not necessarily or always the case. The technique, therefore, of the treatment of obsessions will vary from “simple explanations” (Taylor) without preliminary analysis to the more complicated and varying procedures of analysis and re-education in its many forms.

Affects.—Here a word of caution in the interpretation of emotional reactions is necessary. In the building of complexes, as we have seen, an affect becomes linked to an idea through an emotional experience. The recurrence of that idea always involves the recurrence of the affect. It is not a logical necessity that the original experience which occasioned the affect should always be postulated as a continuing subconscious process to account for the affect in association with the idea. It is quite possible, if not extremely probable, that in the simpler types, at least, of the emotional complexes, the association between the idea and affect becomes so firmly established that the conscious idea alone, without the coöperation of a subconscious process, is sufficient to awake the emotion; just as in Pawlow’s dogs the artificially formed association between a tactile stimulus and the salivary glands is sufficient to excite the glands to activity, or as in human beings the idea of a ship by pure association may determine fear and nausea, the sound of running water by the force of association may excite the bladder reflex, or an ocular stimulus the so-called hay fever complex. So in word-association reactions, when a word is accompanied by an affect-reaction the word itself may be sufficient to excite the reaction without assuming that an “unconscious complex has been struck.” The total mechanism of the process we are investigating must be determined in each case for itself.

In the study and formulation of psychological phenomena there is one common tendency and danger, and that is of making the phenomena too schematic and sharply defined, as if we were dealing with material objects. Mental processes are not only plastic but shifting, varying, unstable, and undergo modifications of structure almost from moment to moment. We describe a complex schematically as if it had a fixed, immutable, and well-defined structure. This is far from being the case. Although there may be a fairly fixed nucleus, the cluster, as a whole, is ill defined and undergoes considerable modification from moment to moment. New elements enter the cluster and replace or are added to those which previously took part in the composition. An analogy might be made with a large cluster of electric lights arranged about a central predominant light, but so arranged that individual lights could be switched in and cut out of the cluster at any moment and different colored lights substituted. The composition and structure of the cluster, and the intensity and color of the light, could be varied from moment to moment, yet the cluster as a cluster maintained. We might carry the analogy farther and imagine the cluster to be an advertising sign which had a meaning—the advertisement. This meaning might or might not be altered by the changes in the individual lamps.

The same indefiniteness pertains to the demarcation between the conscious and the subconscious. What was conscious at one moment may be subconscious the next and vice versa. Under normal conditions there is a continual shifting between the conscious and subconscious. I have made numerous investigations to determine this point, and the evidence is fairly precise, and to me convincing, that this shifting continually occurs,^[195] as might well be inferred on theoretical grounds. Nor, excepting in special pathological and artificial dissociated conditions, is the distinction between the conscious and subconscious at any moment always sharp and precise; it is often rather a matter of vividness and shading, and whether a conscious state is in the focus of attention or in the fringe. Experimental observation confirms introspection in this respect.

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.