CHAPTER II. The Psychopathological Approach

THE PSYCHOPATHOLOGICAL APPROACH

One of the standing obstacles in the path of personality research is the difficulty of describing the personality as a whole at any given cross-section of its development. In despair at the myriad difficulties of the task, academic psychology has long evaded the issue and concentrated its attention upon the minute exploration of detached aspects of the individual. The manuals of physiological psychology are full of painstaking accounts of how atomized aspects of the individual’s environment (the “stimuli”) modify the reactions of selected parts of the individual. What these manuals characteristically omit is a workable set of conceptions for the classification of the phenomena which are the objects of investigation in personality research. It is impossible to found a science of geology without inventing terms to distinguish plateaus, plains, mountains, and continental blocs, even though all these phenomena possess the common attributes of “matter.” What matters for the geologist is how the differences and not the likenesses come to pass. Much of the academic psychology, in its quest for precision and prestige, has quit studying the problem with which it is ostensibly engaged, and has substituted a minor field of physiology therefor. In so doing, it has lost any criterion for testing the relevance of the results of particular researches for the understanding of personality because it has no master concepts of personality.

The psychopathologist has never been able to evade the necessity of summing up the personality as a whole because he has been compelled to make important decisions about the future of the personality as a whole. The psychiatrist must continually decide whether John B and Mary C will, if released from careful supervision, commit suicide or murder, or whether they will be dependable members of the community. Thus the clinician has found it imperative to search for signs which have high predictive value in relation to the major social adjustments of the individual.

The psychopathologist has had the great advantage of seeing many trends of the personality which are normally subordinated to other trends when they have escaped from control and achieved Gargantuan proportions. The clinical caricature throws into imposing relief the constituent tendencies which make up the functioning person, and draws attention to their presence and their processes. “Normality” involves a complicated integration of many tendencies, a flexible capacity to snap from one mood, preoccupation, and overt activity to another as the changing demands of reality require. The pathological mind, if one may indulge in a lame analogy, is like an automobile with its control lever stuck in one gear: the normal mind can shift. One has a queer feeling as one passes around the wards of a hospital for the custody of the more seriously disordered patients that if one could assemble the scattered parts of the mind that one could create at least a single supermind. There in one corner is a melancholic who is stuck in the mood of despondency; in another corner is a manic who is expansive and elated; elsewhere is a man whose self-esteem has achieved cosmic dimensions; in the back wards is a deteriorated mind in perpetual repose. Every conceivable nuance of preoccupation and mood with which we are normally familiar seems to be dissatisfied with its minor rôle in a healthy integration, and intent upon autocratic mastery of the mind. The clinical caricature draws attention as sharply as possible to the components of the healthy mind. So every theory of pathological manifestations must presently become expanded or assimilated into a comprehensive account of human psychology.

The gross clinical material reveals the intimate interrelationships between soma and psyche. The patient who suffers from obsessive ideas may find relief from obsession by showing hysterical symptoms; and hysterical symptoms may clear up, only to make way for obsessive symptoms. “Pure pictures” are almost pure theories. The patient who is suffering from a definite organic lesion may complicate his troubles by “worry,” and “worry” may be one of the factors in bringing about a physical disease picture. There is evidence that psychological factors are among those significantly operating in such diseases as common colds, asthma, catarrh, hay fever, hyperthyroidism, gall-bladder trouble, gastro-intestinal ulcers, irregular menstruation, and sexual impotence.

Fresh vitality has come into modern psychology from the clinic. The psychopathological approach has gradually vindicated itself as more and more of its conceptions find a permanent place in the vocabulary of psychology and social science. Modern psychopathology is itself a recent development, and undoubtedly the most revolutionary figure is Sigmund Freud.

The spectacular and influential nature of Freud’s work is sufficient justification for devoting some space to a brief account of his standpoint and his innovation in method. As we shall have occasion to illustrate, his method is of more general application to practical problems of political research and political practice than is usually understood.

When Freud was a student in the University of Vienna, the triumphal progress of microscopic methods of studying cellular structure was sweeping all before it. Congeries of mental symptoms in the living were frequently found to be correlated with the discovery of certain definite cerebrospinal lesions on autopsy. The future seemed to rest wholly in the hands of those who used the dissecting knife and the lens. Before Freud graduated from the University, he became demonstrator to Brücke, the eminent physiologist; and he labored in the laboratory of Meynart, the distinguished psychiatrist of his day. Freud’s first publication was a result of laborious laboratory work.

While materialism reigned, psychological phenomena were degraded to the status of trivial epiphenomena. But at this very time a revival of psychogeneticism arose in French psychiatry under the impetus of Charcot. Charcot had achieved eminence in pathological anatomy before he turned in middle life to the study of mental maladies. By 1883 he had demonstrated the possibility of producing hysterical symptoms by means of ideas (verbal stimuli). Time and again he hypnotized individuals and produced muscular contractures, hypersensitivity, and hyposensitivity, together with allied symptoms of hysteria.

Breaking away from the laboratories of Vienna, Freud journeyed to the Salpêtrière Hospital in Paris to work with Charcot, where he stayed from the autumn of 1886 to the spring of 1887. Here he was thrown in touch with the current of ideas which was giving concrete content to the notion of the “out of conscious” and its dynamic consequences for human behavior. Pierre Janet was busily accumulating the observations which were published to the world in 1889 under the title, L’automatisme psychologique. Early chapters appeared in the Revue philosophique as early as 1886.

Freud had just missed a spectacular rise to fame when he failed to recognize the anaesthetic possibilities of cocaine in surgery. He published a review of the literature on cocoa; and a young Vienna colleague, Koller, struck by some of the data which Freud had assembled, announced the discovery in 1884 which immortalized his name in medical history. Freud pondered for many years on why the idea should have eluded him, and perhaps his desertion of the laboratory was due to his sense of partial failure.

In Paris he acquired a point of view which was bound to bring him into conflict with the materialistic pundits of Vienna. Hypnotism was itself looked upon as an artifice of charlatans. Wagner-Jauregg reflected the ruling tradition when, only a few years ago, he said, “The trouble with hypnotism is that you never know who is pulling the other fellow’s leg.” Freud was met by derisive laughter when he announced at the Medical Society of Vienna that male hysterics were to be found in Paris. For hysteria, as one of the pedants reminded him, was philologically derived from “hysteron,” meaning uterus, and therefore couldn’t possibly occur in males. This was an echo of the days when hysteria was supposed to be due to a migratory uterus and women were turned upside down to bring it back in place.

In 1881 and 1882 Breuer had treated a girl suffering from hysteria, and his interest was renewed in the case in conversation with Freud. Breuer remembered that when he treated the patient under hypnosis, she recalled the first episode in which a symptom had appeared, related it with every evidence of excitement, and discovered on waking that the symptom had disappeared. Breuer and Freud began to study hysteria from this point of view and published their results. Charcot had demonstrated that ideas could cause hysteria; Breuer had found that the discovery of pathogenic ideas could cure hysteria.

In 1889 Freud returned to France, this time to the other center of hypnotic research, Nancy, where Liébeault and Bernheim were doing remarkable things. Freud here saw something the full significance of which did not at once dawn upon him.

A subject was hypnotized and given a “post-hypnotic suggestion” to raise an umbrella at a certain signal after coming out of hypnosis. The subject was then awakened from hypnosis, and presently, when the stipulated signal was given, obediently raised the umbrella, although still inside the room. When asked why he raised the umbrella, he said that he wanted to see whether it was his or not. Thus did he rationalize (a concept later developed) the gratification of an impulse which he did not himself at first recognize. When challenged to explain himself, he merely produced a plausible interpretation of his own conduct.

The immense significance of this train of events is great enough. It at once raises the searching question: To what extent are we in ignorance of our own motives and accustomed to improvise merely plausible explanations of and to ourselves? But an even more notable phenomenon occurred. If the subject was asked again and again to try to remember why he raised the umbrella, he sooner or later recalled (to his own surprise) that he had been commanded to do it.

The full import of this observation did not instantly dawn on Freud. But he continued to have difficulties with the patients whom he sought to hypnotize. They sometimes held out against his suggestions, even though they had accepted them many times before, and seriously impeded the progress of the search for the traumatic episode. He gradually abandoned hypnosis, leaving the patient in a waking state in a relaxed position with instructions to report every incident connected with the early appearance of the symptom under investigation. Vestiges of the hypnotic technique remained as late as 1895, when he would still lay his hand on the patient’s forehead as a stimulus to recollection.

This method also encountered crippling difficulties. A patient would sometimes lie for hours without saying a word, totally unable to recover a relevant reminiscence. To meet this obstacle, Freud presently hit upon the simple expedient upon which he thenceforth relied. He instructed the patient to say anything and everything that popped in his head, regardless of its propriety, logic, or triviality.

Freud found that all ramblings of his patient could furnish him with clues to the underlying and unavowed impulses of the sufferer. He became able to guess the nature of the buried episode in which the impulse had received its present type of manifestation. Thus the patient might begin by saying that she had seen a red-headed man in the street and that she always despised red-headed men--except of course her dear brother. Day after day apparently random allusions would build out the picture of her great interest in anything reminiscent of her brother’s looks and acts, all of which would be bitterly condemned. But if she were asked directly, she would maintain that her brother was a fine, upstanding man, and a credit to the family.

The analyst, after listening to the eddies of talk, and noting the patterns along which they seemed to whirl, would presently locate a hidden rock beneath the innocent surface of the stream--in this case, an unacknowledged load of hatred against her brother. Bit by bit, stories of real or fancied childhood tyranny would come floating along the stream. Then suddenly, amid tears and violent gestures, might come the story of a long-forgotten incident which involved an intimate aggression on the part of the brother. The patient, manifestly relieved, might speedily recover from her hysterical disabilities and return to the active responsibilities of life.

Freud’s theory of what he saw began modestly enough, leaned heavily upon Charcot, Bernheim, and Breuer, and was mostly founded upon observations made upon patients who were handled by hypnosis and not by the new procedure which later was called psychoanalysis. He published a contribution to the theory of the psychoneuroses in which he laid down the proposition that a distinction could be drawn between one group, the anxiety neuroses, which depended on mental conflict, and the actual neuroses, which were not due to mental conflict but to masturbation and coitus interruptus. In the first case, mental energy was converted into bodily symptoms, and in the latter case bodily energy was supposed to be converted into bodily symptoms. In Freud’s early articles there is little to forecast the course which he was to follow as his brilliant imagination viewed the behavior of the individual from the new vantage ground which he had discovered.

Whether his particular theories survive or fall, the standpoint which he achieved by ruthlessly applying his method is of the greatest value. His method, which grew from the necessities of an exasperated physician, led him systematically to treat every manifestation of the individual as part of a related whole. Freud’s mental set had been furnished by the data of hypnosis, which seemed to show that patients suffer from reminiscences. When he dropped hypnosis and tried to force recollections, his mental set had not altered, for he was still in search of the original, the traumatic episode. When he asked his patients to say anything that came into their heads, he was still hunting the elusive memory of a definite early experience. But quite without realizing it, his original mental set had widened, and with momentous consequences for his own subsequent development. If one were given to exaggerations, one could say that the world of psychological investigation had suddenly begun to turn on a new axis.

What was the nature of this new mental set? Intently watching his patients, not for word for word accounts of what had happened, and looking upon everything else as “irrelevant,” Freud learned to look for meanings and not for reports. Every dream, every phrase, every hesitation, every gesture, every intonation, every outburst began to take on significance as possible allusions to the “traumatic” episode. Allusions to hated objects, reminiscent of a brother, failure to mention a hated sister until days had passed, although other members of the family had been passed in review--every deviation from comprehensiveness--was eagerly scrutinized for the clue it might afford.

The technique of therapy consisted in using clues to facilitate the patient’s search for relief. The problem was to discover the nature of the patient’s conflict and to volunteer interpretations for the sake of helping the patient to dare to bring into full consciousness the unavowed impulse which had once frightened his socially adjusted self into frantic repression. This involved the interpretation of the symptom as a compromise product of the patient’s ideal of conduct; and the out-of-conscious impulse, which, though denied access to the full consciousness of the sufferer, possessed enough strength to procure partial gratification. The symptom was thus a symptom of conflict between the socially adapted portion of the self and the unadapted impulses of the personality, and the symptom was a compromise between partial gratification of the illicit and partial punishment by the conscience. The particular form of the “conflict” depended upon the traumatic experience and the antecedent history of the individual.

Far more important than these therapeutic elaborations is the shift in standpoint which made them possible. Since Freud was on the search for the literal by way of the symbolic, he raised hitherto neglected manifestations of human behavior to the dignity of significant symbols, wrote them out, and introduced them into the literature of human behavior. There could be no sharper illustration of the prepotency of “mental set” for the seeing of “facts” than the difference between the clinical reports of Freud and Janet. Freud, convinced that the eluctable energies of the organism could betray themselves in every image and in every gesture, painstakingly recorded the dreams and day-fantasies of his patients. Janet, who continued to assume that dreams were nonsensical confusions attributable to the diminished tension of the sleeping organism, seldom made any allusion to dreams. His pellucid description of grimaces, gestures, sentiments, and theories of his patients led back to relatively recent moments when the patient failed of adjustment. This failure of the patient to mobilize his energies in smooth adaptation to the exigencies of social reality was then imputed to a defective biopsychical mechanism, to a lowered “psychological tension,” due to a miscellany of possible causes, among which was mentioned “the exhaustive effects of emotional excitement.” Therapy consisted in restoring the capacity of the individual to mobilize and deploy his energies at the highest “levels” of adjustment. This was to be achieved by a variety of means--by hypnotic suggestion, rest in a simplified environment, and the usual repertory of the psychotherapist.

But the golden flash of psychological insight eluded Janet. At bottom he had little respect for the concrete reality of the mental life of his patients. Although he talked the language of psychogeneticism, it had a poor and not a rich connotation in his mind. I think this is due to his too exclusive reliance upon hypnotism, for the mental set of the hypnotist is derogatory to most of the concrete productions of the patient. The patient, one feels with a shrug, will presently come to the important experience; why take the superimposed material too seriously? Then, too, the patient may be put in order by direct command. Janet relates with some pride how people in the waiting-room of his office would marvel when a woman, bent nearly double, would be admitted into his sanctum, presently to emerge, erect and cured--until the effect wore off.

Freud learned a new respect for the concrete reality of mental life in his concentrated effort to divine the hidden conflict without resorting to hypnosis. His weakness as a hypnotist was in a sense the beginning of wisdom. A patient who is deeply hypnotized is but infrahuman. Barring commands which do violence to the moral code of the individual, the subject will passively execute the commands of the hypnotist. The patient descends from a complicated “nearly normal” person to a waxy caricature of a human being. The unhypnotized patient of Freud is in relatively full possession of all the resources of the ordinary waking self, and must be dealt with as a complex human being.

The widest gateway to psychoanalytic development became the study of dreams. And here again we are dealing with something which came, not from laborious reflection upon underlying concepts, but from the urgencies of the clinical situation. Just as we found that Freud had taken up a new post of observation in practice before he discovered its implications in theory, we find that in such a detail as the investigation of dreams, his theoretical preoccupations contributed less than his everyday necessities. Freud’s patients continually thrust their dreams upon him; and he, now in pursuit of clues to what lay behind, presently took them seriously, and found in them many helpful indications of unspoken things. He would assist the free-fantasies of the patient by asking what came into his mind about any detail of the dream, and he attentively followed the long chains of superficially meaningless associations.

It began to appear that Freud had stumbled upon, and then brilliantly elaborated the possibilities inherent in, a new way of using the mind. He trained his patients in a technique of free-fantasy which they could subsequently use for themselves as a supplement to the logical technique which society ostensibly tries to foster. It at once appeared that he had discovered a method of thinking which was applicable far beyond the confines of the clinic and which could be added to the repertory of the mind.

The interpretation of dreams was the bridge which brought Freud from the confines of the clinic to the analysis of the whole psychology of individual development. The dreams of patients and the dreams of non-pathological persons showed such homogeneity of symbolism that the gap between the “normal” and the “sick” seemed to close. Popular lore already furnished a clue to dreams as wish-fulfilments, whether found in the “well” or “ill,” but popular lore also treated them as reminiscences, prophecies, and omens, or as confusions, depending on the transitory context of the moment. Freud had a double orientation in dealing with the individual. He regarded him as motivated in the present by impulses which eluded his own consciousness. He regarded these motivations as having achieved their present form in concrete historical events in the life of the individual. The nature of the present could be made clear to the conscious mind if the organizing episode could be recalled. This recall could be greatly facilitated by paying special attention to the “irrational” or non-adjustive aspects of the person’s present conduct. The “irrational” would seem rational enough if the unacknowledged motives were made manifest, and if the historical as well as the contemporary allusions were sought after. Sooner or later the unrecognized motives would disclose themselves in consciousness, if the individual waited attentively; but the process could be greatly helped by using a different style of thinking than the logical.

No one has more dramatically and repeatedly shown the limitations (as well as the advantages) of logical procedures of thought than Freud. No one has made a more important contribution to the technique of supplementing logical thought by other methods of thought than Freud. This is the aspect of Freud’s work which has immediate and constant relevance to political as to every other sort of thinking, and to which it is important to devote more extended consideration.