Our Nerves

7. Chapter VII

In which we go to the root of the matter

THE REAL TROUBLE

PIONEERS

Following the Gleam. Kipling's Elephant-child with the "'satiable curiosity" finally asked a question which seemed simple enough but which sent him on a long journey into unknown parts. In the same way man's modest and simple question, "What makes people nervous?" has sent him far-adventuring to find the answer. For centuries he has followed false trails, ending in blind alleys, and only lately does he seem to have found the road that shall lead him to his journey's end.

We may be thankful that we are following a band of pioneers whose fearless courage and passion for truth would not let them turn back even when the trail led through fields hitherto forbidden. The leader of this band of pioneers was a young doctor named Freud.

THE SEARCH FOR TRUTH

Early Beginnings. In 1882, when Freud was the assistant to Dr. Breuer of Vienna, there was brought to them for treatment a young woman afflicted with various hysterical pains and paralyses. This young woman's case marked an epoch in medical history; for out of the effort to cure her came some surprising discoveries of great significance to the open-minded young student.

It was found that each of this girl's symptoms was related to some forgotten experience, and that in every case the forgetting seemed to be the result of the painfulness of the experience. In other words, the symptoms were not visitations from without, but expressions from within; they were a part of the mental life of the patient; they had a history and a meaning, and the meaning seemed in some way to be connected with the patient's previous attitude of mind which made the experience too painful to be tolerated in consciousness. These previous ideas were largely subconscious and had been acquired during early childhood. When by means of hypnosis a great mass of forgotten material was brought to the surface and later made plain to her consciousness, the symptoms disappeared as if by magic.

A Startling Discovery. For a time Breuer and Freud worked together, finding that their investigations with other patients served to corroborate their former conclusions. When it became apparent that in every case the painful experience bore some relation to the love-life of the patient, both doctors were startled. Along with most of the rest of the world, they had been taught to look askance at the reproductive instinct and to shrink from realizing the vital place which sex holds in human life.

Breuer dropped the work, and after an interval Freud went on alone. He was resolved to know the truth, and to tell what he saw. When he reported to the world that out of all his hundreds of patients, he had been unable, after the most careful analysis, to find one whose illness did not grow from some lack of adjustment of the sex-life, he was met by a storm of protest from all quarters. No amount of evidence seemed to make any difference. People were determined that no such libel should be heaped on human nature. Sex-urge was not respectable and nervous people were to be respected.

Despite public disapproval, the scorn of other scientists, and the resistance of his own inner prejudices, Freud kept on. He was forced to acknowledge the validity of the facts which invariably presented themselves to view. Like Luther under equal duress, he cried: "Here I stand. I can do no other."

Freudian Principles. Gradually, as he worked, he gathered together a number of outstanding facts about man's mental life and about the psycho-neuroses. These facts he formulated into certain principles, which may be summed up in the following way.

1 There is no chance in mental life; every mental phenomenon--hence every nervous phenomenon--has a cause and meaning.

2 Infantile mental life is of tremendous importance in the direction of adult processes.

3 Much of what is called forgetting is rather a repression into the subconscious, of impulses which were painful to the personality as a whole.

4 Mental processes are dynamic, insisting on discharge, either in reality or in phantasy.

5 An emotion may become detached from the idea to which it belongs and be displaced on other ideas.

6 Sex-interests dominate much of the mental life where their influence is unrecognized. The disturbance in a psycho-neurosis is always in this domain of sex-life. "In a normal sexual life, no neurosis." If a shock is the precipitating cause of the trouble, it is only because the ground was already prepared by the sex-disturbance.

Freud was perhaps unfortunate in his choice of the word "sex," which has so many evil connotations; but as he found no other word to cover the field, he chose the old one and stretched its meaning to include all the psychic and physical phenomena which spring directly and indirectly from the great processes of reproduction and parental care, and which ultimately include all and more than our word "love."[33]

[Footnote 33: Freud and his followers have always said that they saw no theoretical reason why any other repressed instinct should not form the basis of a neurosis, but that, as a matter of fact, they never had found this to be the case, probably because no other instinct comes into such bitter and persistent conflict with the dictates of society. Now, however, the Great War seems to have changed conditions. Under the strain and danger of life at the front there has developed a kind of nervous breakdown called shellshock or war-neurosis, which seems in some cases to be based not on the repression of the instinct of race-preservation but on the unusual necessity for repression of the instinct of self-preservation. Army surgeons report that wounded men almost never suffer from shell-shock. The wound is enough to secure the unconsciously desired removal to the rear. But in the absence of wounds, a desire for safety may at the same time be so intense and so severely repressed that it seizes upon the neurosis as the only possible means of escape from the unbearable situation. In time of peace, however, the instinct of reproduction seems to be the only impulse which is severely enough repressed to be responsible for a nervous breakdown.]

Later Developments. Little by little, the scientific world came to see that this wild theorizer had facts on his side; that not only had he formulated a theory, but he had discovered a cure, and that he was able to free people from obsessions, fears, and physical symptoms before which other methods were powerless. One by one the open-minded men of science were converted by the overpowering logic of the evidence, until to-day we find not only a "Freudian school," counting among its members many of the eminent scientists of the day, but we find in medical schools and universities courses based on Freudian principles, with text-books by acknowledged authorities in medicine and psychology. We find magazines devoted entirely to psycho-analytic subjects,[34] besides articles in medical journals and even numerous articles in popular magazines. Not only is the treatment of nervous disorders revolutionized by these principles but floods of light are thrown on such widely different fields of study as ancient myths and folk lore, the theory of wit, methods of child training, and the little slips of the tongue and everyday "breaks" that have until recently been considered the meaningless results of chance.

[Footnote 34: The Psychoanalytic Review and the International Journal of Psychoanalysis.]

A Searching Question. We find, then, that when we ask, "What makes people nervous?" we are really asking: "What is man like, inside and out, up and down? What makes him think, feel, and act as he does every hour of every day?" We are asking for the source of human motives, the science of human behavior, the charting of the human mind. It is hard to-day to understand how so much reproach and ridicule could have been aroused by the statement that the ultimate cause of nervousness is a disturbance of the sex-life. There has already been a change in the public attitude toward things sexual.

Training-courses for mothers and teachers, elementary teaching in the schools, lectures and magazine articles have done much to show the fallacy of our old hypersensitive attitude. Since the war, some of us know, too, with what success the army has used the Freudian principles in treating war-neurosis, which was mistakenly called shell-shock by the first observers. We know, too, more about the constitution of man's mind than the public knew ten years ago. When we remember the insistent character of the instincts and the repressive method used by society in restraining the most obstreperous impulse, when we remember the pain of such conflict and the depressing physical effects of painful emotions, we cannot wonder that this most sharply repressed instinct should cause mental and physical trouble.

What about Sublimation? On the other hand, it has been stated in Chapter IV that although this universal urge cannot be repressed, it can be sublimated or diverted to useful ends which bring happiness, not disaster, to the individual. We have a right, then, to ask why this happy issue is not always attained, why sublimation ever fails. If a psycho-neurosis is caused by a failure of an insistent instinct to find adequate expression, by a blocking of the libido or the love-force, what are the conditions which bring about this blocking? The sex-instinct of every respectable person is subject to restraint. Some people are able to adjust themselves; why not all? The question, "What makes people nervous?" then turns out to mean: What keeps people from a satisfactory outlet for their love-instincts? What is it that holds them back from satisfaction in direct expression, and prevents indirect outlet in sublimation? Whatever does this must be the real cause of "nerves."

THE CAUSES OF "NERVES"

Plural, not Singular. The first thing to learn about the cause is that it is not a cause at all, but several causes. We are so well made that it takes a combination of circumstances to upset our equilibrium. In other words, a neurosis must be "over-determined." Heredity, faulty education, emotional shock, physical fatigue, have each at various times been blamed for a breakdown. As a matter of fact, it seems to take a number of ingredients to make a neurosis,--a little unstable inheritance plus a considerable amount of faulty upbringing, plus a later series of emotional experiences bearing just the right relationship to the earlier factors. Heredity, childhood reactions, and later experiences, are the three legs on which a neurosis usually stands. An occasional breakdown seems to stand on the single leg of childhood experiences but in the majority of cases each of the three factors contributes its quota to the final disaster.

Born or Made? It used to be thought that neurotics, like poets, were born, not made. Heredity was considered wholly responsible, and there seemed very little to do about it. But to-day the emphasis on heredity is steadily giving way to stress on early environment. There are, no doubt, such factors as a certain innate sensitiveness, a natural suggestibility, an intensity of emotion, a little tendency to nervous instability, which predispose a person to nerves, but unless the inborn tendency is reinforced by the reactions and training of early childhood, it is likely to die a natural death.

CHILDHOOD EXPERIENCES

Early Reactions. Freud found that a neurotic is made before he is six years old. When by repeated explorations into the minds of his patients, he made this important discovery, he at first believed that the disturbing factor was always some single emotional experience or shock in childhood,--usually of a sexual nature. But Freud and later investigators have since found that the trouble is not so often a single experience as a long series of exaggerated emotional reactions, a too intense emotional life, a precocity in feeling tending toward fixation of childhood habits, which are thus carried over into adult life.

Fixation of Habits. Fixation is the word that expresses all this,--fixation of childish habits. A neurotic is a person who made such strong habits in childhood that he cannot abandon them in maturity. He is too much ruled by the past. His unconscious emotional thought-habits are the complexes which were made in childhood and therefore lack the power of adaptation to mature life.

We saw in Chapter IV that Nature takes great pains to develop in the child the psychic and physical trends which he will need later on in his mature love-life, and that this training is accomplished in a number of well-defined periods which lead from one to the other. If, however, the child reacts too intensely, lingers too long in any one of these phases, he lays for himself action lines of least resistance which he may never leave or to which he may return during the strain and stress of adult life.

In either case, the neurotic is a grown-up child. He may be a very learned, very charming person, but he is nevertheless dragging behind him a part of his childhood which he should have outgrown long ago. Part of him is suffering from an arrest of development,--not a leg or an arm but an impulse.

Precocious Emotions. The habits which tend to become fixed too soon seem to be of four kinds; the habit of loving, the habit of rebelling, the habit of repressing normal instincts, and the habit of dreaming. In each case it is the excess of feeling which causes the trouble,--too much love, too much hate, too much disgust, or too much pleasure in imagination. Exaggeration is always a danger-signal. An overdeveloped child is likely to be an underdeveloped man. Especially in the emotions is precocity to be deplored. A premature alphabet or multiplication table is not nearly so serious as premature intensity of feeling, nor so likely to lead later to trouble. Of course fixation in these emotional habits does not always lead to a serious breakdown. If the fixation is not too extreme, and if later events do not happen to accentuate the trouble, the arrest of development may merely show itself in certain weaknesses of character or in isolated symptoms without developing a real neurosis.

Let us examine each of these arrested habits and the excess emotion which sets the mold before it is ready for maturity.

Too Much Self-Love. In the chapter on the reproductive instinct, we found that the natural way to learn to love is by successively loving oneself, one's parents and family, one's fellows, and one's mate. If the love-force gets too much pleasure in any one of these phases, it finds it hard to give up its old love and to pass on to the next phase. Thus some children take too much pleasure in their own bodies or, a little later, in their own personalities. If they are too much interested in their own physical sensations and the pleasure they get by stimulating certain zones of the body, then in later life they cannot free themselves from the desire for this kind of satisfaction. Try as they may, they cannot be satisfied with normal adult relations, but sink back into some form of so-called sex-perversion.

Perhaps it is another phase of self-love which holds the child too much. If, like Narcissus, he becomes too fond of looking at himself, is too eager to show off, too desirous of winning praise, then forever after he is likely to be self-conscious, self-centered, thinking always of the impression he is making, unable ever to be at leisure from himself. He is fixed in the Narcissistic stage of his life, and is unadapted to the world of social relations.

Too Much Family-love. We have already spoken of the danger of fixation in the second period, that of object-love--the period of family relationships. The danger is here again one of degree and may be avoided by a little knowledge and self-control on the part of the parents. The little girl who is permitted to lavish too much love on her father, who does not see anybody else, who cannot learn to like the boys is a misfit. The wise mother will see that her love for her boy does not express itself too much by means of hugs and kisses. The mother who shows very plainly that she loves her little boy better than she loves her husband and the mother who boasts that her adolescent boy tells her all his secrets and takes her out in preference to any girl--that deluded mother is trying to take something that is not hers, and is thereby courting trouble. When her son grows up, he may not know why, but no girl will suit him, and he will either remain a bachelor or marry some older woman who reminds him subconsciously of his mother. His love-requirements will be too strict; he will be forever trying either in phantasy or in real life to duplicate his earlier love-experiences. This, of course, cannot satisfy the demands of a mature man. He will be torn between conflicting desires, unhappy without knowing why, unable either to remain a child or to become a man, and impelled to gain self-expression in indirect and unsatisfactory ways.

Since it is not possible in this space to recite specific cases which show how often a nervous trouble points back to the father-mother complex,[35] it may help to cite the opinions of a few of our best authorities. Freud says of the family complex, "This is the root complex of the neurosis." Jelliffe: "It is the foot-rule of measurement of success in life": by which he means that just so far as we are able at the right time to free ourselves from dependence on parents are we able to adjust ourselves to the world at large. Pfister: "The attitude toward parents very often determines for a life-time the attitude toward people in general and toward life itself." Hinkle: "The entire direction of lives is determined by parental relationships."

[Footnote 35: This is technically known as the Oedipus Complex.]

Too Much Hate. Besides loving too hard, there is the danger of hating too hard. If it sounds strange to talk of the hatreds of childhood, we must remember that we are thinking of real life as it is when the conventions of adult life are removed and the subconscious gives up its secrets.

Several references have been made to the jealousy of the small child when he has to share his love with the parent of the same sex. For every little boy the father gets in the way. For every little girl the mother gets in the way. At one time or other there is likely to be a period when this is resented with all the violence of a child's emotions. It is likely to be very soon repressed and succeeded by a real affection which lasts through life. But underneath, unmodified by time, there may exist simultaneously the old childish image and the old unconscious reaction to it, unconscious but still active in indirect ways.

Jealousy is very often united with the natural rebellion of a child against authority. The rebellion may, of course, be directed against either parent who is final in authority in the home. In most cases this is the father. As the impulse of self-assertion is usually stronger in boys than in girls, and as the boy's impulse in this direction is reinforced by any existing jealousy toward his father, we find a strong spirit of rebellion more often playing a subconscious part in the life of men than of women. The novelist's favorite theme of the conflict between the young man and "the old man" represents the conscious, unrepressed complex. More often, however, there is true affection for the father, while the rebellion which really belongs to the childish father-image is displaced or transferred to other symbols of authority,--the state, the law, the king, the school, the teacher, the church, or perhaps to religion and authority in general. Anarchists and atheists naturally rationalize their reasons for dissent, but, for all that, they are not so much intellectual pioneers as rebellious little boys who have forgotten to grow up.

Liking to be "Bossed." There is a worse danger, however, than too much rebellion, and that is too little rebellion. Sometimes this yielding spirit is the result of an overdose of negative self-feeling and an under-dose of positive self-feeling; but sometimes it is over-compensation for the repressed spirit of rebellion which the child considers wicked. Consciously he becomes over-meek, because he has to summon all his powers to fight his subconscious insurrection. Whether he be meek by nature or by training, he is likely to be a failure. Everybody knows that the child who is too good never amounts to anything. He who has never disobeyed is a weakling. Naturally resenting all authority, the normal individual, if he be well trained, soon learns that some authority is necessary. He rebels, but he learns to acquiesce, to a certain degree. If he acquiesces too easily, represses too severely his rebellious spirit, swings to the other extreme of wanting to be "bossed," he is very likely to end as a nervous invalid, unfitted for the battles of life. The neurotic in the majority of cases likes authority, clings to it too long, wants the teacher to tell him what to do, wants the doctor to order him around, is generally over-conscientious, and afraid he will offend the "boss" or some one else who reminds him of the father-image. All this carries a warning to parents who cannot manage their children without dominating their lives, even when the domination is a kindly one. Perhaps the modern child is in more danger of being spoiled than bullied, but analysis of nervous patients shows that both kinds of danger still exist.

Too Much Disgust. The third form of excessive emotion is disgust. The love-force, besides being blocked by a fixation of childish love and of childish reactions toward authority, is very often kept from free mature self-expression by a perpetuation of a childish reaction against sex. We hardly need dwell longer on the folly of teaching children to be ashamed of so inevitable a part of their own nature. Disgust is a very strong emotion, and when it is turned against a part of ourselves, united with that other strong impulse of self-regard and incorporated into the conscience, it makes a Chinese wall of exclusion against the baffled, misunderstood reproductive instinct, which is thrust aside as alien.

Restraint versus Denial. Repression is not merely restraint. It is restraint plus denial. To the clamoring instinct we say not merely, "No, you may not," but "No, you are not. You do not exist. Nothing like you could belong to me." The woman with nausea (Chapter V) did not say to herself: "You are a normal, healthy woman, possessed of a normal woman's desires. But wait a while until the proper time comes." Controlled by an immature feeling of disgust, she had said: "I never thought it. It cannot be."

The difference is just this. When an ungratifiable desire is honestly faced and squarely answered, it is modified by other desires, chooses another way of discharge, and ceases to be desire. When a desire is repressed, it is still desire, unsatisfied, insistent, unmodifiable by mature points of view, untouched by time, automatic, and capable of almost any subterfuge in order to get satisfaction. A repressed desire is buried, shut away from the disintegrating effects of sunlight and air. While the rest of the personality is constantly changing under the influence of new ideas, the buried complex lives on in its immaturity, absolutely untouched by time.

Childish Birth-theories. When a child's questions about where babies come from are met by evasions, he is forced to manufacture his own theories. His elders would laugh if they knew some of these theories, but they would not laugh if they knew how often the childish ideas, wide of the truth, furnish the material for future neuroses. Frink tells the story of a young woman who had a compulsion for taking drugs. Although not a drug-fiend in the usual sense, she was constantly impelled to take any kind of drug she could obtain. It was finally revealed that during her childhood she had tried hard to discover how babies were made, and had at last concluded that they grew in the mother as a result of some medicine furnished by the doctor. The idea had long been forgotten, only to reappear as a compulsion. The natural desire for a child was strong in her, but was repressed as unholy in an unmarried woman. The associated childish idea of drug-taking was not repellent to her moral sense and was used as a substitute for the real desire to bear a child.

Many of my patients have suffered from the effect of some such birth-theories. One young girl, twenty years old, was greatly afflicted with myso-phobia, or the fear of contamination. She spent most of her time in washing her hands and keeping her hands and clothing free from contamination by contact with innumerable harmless objects. When cleaning her shoes on the grass, she would kneel so that the hem of her skirt would touch the grass, lest some dust should fly up under her clothes. After eating luncheon in the park with a girl who had tuberculosis, she said that she was not afraid of tuberculosis in the lungs, but asked if something like tuberculosis might not get in and begin to grow somewhere else. Her life was full to overflowing of such compulsive fears.

As opportunity offered itself from day to day, I would catch her compulsive ideas in the very act of expressing themselves, and would pin her down as to the association and the source of her fear, always taking care not to make suggestions or ask leading questions. She was finally convinced out of her own mouth that her real fear was the idea of something getting into her body and growing there. Then she told how she had questioned her mother about the reproductive life and had been put off with signs of embarrassment. For a long time she had been afraid to walk or talk with a boy, because, not knowing how conception might occur, she feared grave consequences.

Very soon after the beginning of her conversations with me, the girl realized that her fear was really a disguised desire that something might be planted within and grow. With her new understanding of herself, her compulsions promptly slipped away. She began to eat and sleep, and to live a happy, natural life.

Chronic Repression. It takes first-hand acquaintance with nervous patients to realize how common are stories like these. Unnecessary repressions based on false training are the cause of many a physical symptom and mental distress which a little parental frankness might have forestalled.[36]

[Footnote 36: Parents who are eager to handle this subject in the right way are often sincerely puzzled as to how to go about it. No matter how complete their education, it is very likely to fail them at this critical point. For the benefit of such parents, let it be said with all possible emphasis that the first and most important step must be a change in their own mental attitude. If there is left within them the shadow of embarrassment on the subject of sex, their children will not fail to sense the situation at once. A feeling of hesitation or a tendency to apologize for nature makes a far deeper impression on the child-mind than do the most beautiful of half-believed words on the subject. And this impression, subtle and elusive as it may seem, is a real and vital experience which is quite likely to color the whole of the child's life. If you would give your children a fair start, you must first get rid of your own inner resistances. After that, all will be clear sailing.

In the second place, take the earliest opportunity to bring up the subject in a natural way. A young father told me recently that his little daughter had asked her mother why she didn't have any lap any more. "And of course your wife took that chance to tell her about the baby that is coming," I said. "Oh, no," he answered, "she did nothing of the kind. Mary is far too young to know about such things." There are always chances if we are on the look out for them--and the earlier the better. It has been noticed that children are never repelled by the idea of any natural process unless the new idea runs counter to some notion which has already been formed. The wise parent is the one who gets in the right impression before some other child has had a chance to plant the wrong one.

Then, too, we elders are judged quite as much by what we do not say as by what we do. Happy is the child who is not left to draw his own conclusions from the silence and evasiveness of his parents. The sex-instruction which children are getting in the schools is often good, but it usually comes too late--the damage is always done before the sixth year.

When it comes to the exact words in which to explain the phenomena of generation and birth each parent must naturally find his own way. The main point is that we must tell the truth and not try to improve on nature. If we say that the baby grows under the mother's heart and later the child learns that this is not true, he inevitably gets the idea that there is something not nice about the part of the body in which the baby does grow. What could be wrong with the simple truth that the father plants a tiny seed in the mother's body and that this seed joins with another little seed already there and grows until it is a real baby ready to come into the world? The question as to how the father plants the seed need cause no alarm. If brothers and sisters are brought up together with no artificial sense of false modesty, they very early learn the difference between the male and the female body. It is simple enough to tell the little child the function of the male structure. And it is easy to explain that the seeds do not grow until the little boy and girl have grown to be man and woman and that the way to be well and to have fine strong children is to leave the generative organs alone until that time. A sense of the dignity and high purpose of these organs is far more likely to prevent perversions--to say nothing of nervousness--than is an attitude of taboo and silence.]

A certain amount of repression is inevitable and useful, but a neurotic is merely an exaggerated represser. He represses so much of himself that it will not stay down.[37] He builds up a permanent resistance which automatically acts as a dam to his normal sex instinct and forces it into undesirable outlets.

[Footnote 37: "A neurosis is a partial failure of repression." Frink: Morbid Fears and Compulsions.]

A resistance is a chronic repression, repression that has become fixed and subconscious, a habit that has lost its flexibility and outlives its usefulness. It is a fixation of repression, and is built out of an over-strong complex or emotional thought habit, acquired during childhood, incorporated into the conscience and carried over into maturity, where it warps judgment and interferes with normal development because it is fundamentally untrue and at variance with the laws of nature.

Too Much Day-Dreaming. The fourth habit which holds back the adult from maturity and predisposes toward "nerves" is the habit of imagination. It need hardly be said that a certain kind of imagination is a good thing and one of man's greatest assets. But the essence of day-dreaming is the exact opposite; it is the desire to see things as they are not, but as we should like them to be,--not in order that we may bring them to pass, but for the mere pleasure of dreaming. Instead of turning a microscope or a telescope on the world of reality, as positive imagination does, this negative variety refuses even to look with the naked eye. To dream is easier than to do; to build up phantasies is easier than to build up a reputation or a fortune; to think a forbidden pleasure is easier than to sublimate. "Pleasure-thinking" is not only easier than "reality-thinking,"--it is the older way.

Children gratify many of their desires simply by imagining them gratified. Much of the difficulty of later life might be avoided if the little child could be taught to work for the accomplishment of his pleasures rather than to dream of them. The normal child gradually abandons this "pleasure-thinking" for the more purposeful thinking of the actual world, but the child who loiters too long in the realm of fancy may ever after find it hard to keep away from its borders. His natural interest in sex, if artificially repressed, is especially prone to satisfy itself by way of phantasy.

Turning back to Phantasy. In later life, when the love-force for one reason or another becomes too strong to be handled either directly or indirectly in the real world, there comes the almost irresistible impulse to regress to the infantile way and to find expression by means of phantasy. After long experience Freud concluded that phantasy lies at the root of every neurosis. Jung says that a sex-phantasy is always at least one determiner of a nervous illness, and Jelliffe writes that the essence of the neurosis is a special activity of the imagination.

Such a statement need not shock the most sensitive conscience. The very fact that a neurosis breaks out is proof that the phantasies are repellent to the owners of them and are thrust down into the subconscious as unworthy. In fact, every neurosis is witness to the strength of the human conscience. No phantasy could cause illness. It is the phantasy plus the repression of it that makes the trouble, or rather it is the conflict between the forces back of the phantasy and the repression. The neurosis, then, turns out to be a "flight from the real," the result of a desire to run away from a difficulty. When a problem presses or a disagreeable situation is to be faced, it is easier to give up and fall ill than to see the thing through to the end. Here again, we find that nervousness is a regression to the irresponsible reactions of childhood.

Maturity versus Immaturity. We have been thinking of the main causes of "nerves" and have found them to be infantile habits of loving, rebelling, repressing, and dreaming. We have tried to show that these habits are able to cause trouble because of their bearing on that inevitable conflict between the ancient urge of the reproductive instinct and the later ideals which society has acquired. If this conflict be met in the light of the present, free from the backward pull, of outgrown habits, an adjustment is possible which satisfies both the individual and society. We call this adjustment sublimation. This is rather a synthesis than a compromise, a union of the opposing forces, a happy utilization of energy by displacement on more useful ideas. But if the conflict has to be met with the mind hampered by immature thinking and immature feeling; if the demands of the here-and-now are met as if it were long ago; if unhealthy and untrue complexes, old loves and hates complicate the situation; if to the necessary conflict is added an unnecessary one; then something else happens. Compromise of some kind must be made, but instead of a happy union of the two forces a poor compromise is effected, gaining a partial satisfaction for both sides, but a real one for neither. The neurosis is this compromise.

LATER EXPERIENCES

The Last Straw. The precipitating cause may be one of a number of things. It may be entirely within, or it may be external. Perhaps it is only a quickening of the maturing instincts at the time of adolescence, making the love-force too strong to be held by the old repressions. Perhaps the husband, wife, or lover dies, or the life-work is taken away, depriving the vital energy of its usual outlets. Perhaps the trigger is pulled by an emotional shock which bears a faint resemblance to old emotional experiences, and which stimulates both the repressing and repressed trends and makes the person at the same time say both "Yes," and "No."[38] Perhaps physical fatigue lets down the mental and moral tension and makes the conflict too strong to be controlled. Perhaps an external problem presses and arouses the old habit of fleeing from disagreeable reality. Any or all these factors may cooperate, but not one of them is anything more than a last straw on an overburdened back. No calamity, deprivation, fatigue, or emotion has been able to bring about a neurosis unless the ground was prepared for it by the earlier reactions of childhood.

[Footnote 38: "The external world can only cause repression when there was already present beforehand a strong initial tension reaching back even to childhood."--Pfister: Psychoanalytic Method, p. 94.]

THE BREAKDOWN ITSELF

"Two Persons under One Hat." We can understand now why a neurotic can be described in so many ways. We often hear him called an especially moral, especially ethical person, with a very active conscience; an intensely social being, unable to be satisfied with anything but a social standard; a person with "finer intellectual insight and greater sensitiveness than the rest of mankind." At the same time we are told that a neurosis is a partial triumph of anti-social, non-moral factors, and that it is a cowardly flight from reality; we hear a nervous invalid called selfish, unsocial, shut in, primitive, childish, self-deceived. Both these descriptions are true to life. A neurosis is an ethical struggle between these two sets of forces. If the lower set had triumphed, the man would have been merely weak; if the higher set had been victorious, he would have been strong. As it is, he is neither one nor the other,--only nervous. The neurosis is the only solution of the struggle which he is able to find, and serves the purpose of a sort of armed armistice between the two camps.

SERVING A PURPOSE

If a neurosis is a compromise, if it is the easiest way out, if it serves a purpose, it must be that the individual himself has a hand in shaping that purpose. Can it be that a breakdown which seems such an unmitigated disaster is really welcomed by a part of our own selves? Nothing is more intensely resented by the nervous invalid than the accusation that he likes his symptoms,--and no wonder. The conscious part of him hates the pain, the inconvenience, and the disability with a real hatred. It is not pleasant to be ill. And yet, as it turns out, it is pleasanter to be ill than it is to bear the tension of unsatisfied desire or to be undeceived about oneself. Every symptom is a means of expression for repressed and forgotten impulses and is a relief to the personality. It tends to the preservation of the individual, rather than to his destruction. The nervous invalid is not short-lived, but his family may be! It has been said that a neurosis is not so much a disease as a dilemma. Rather might it be said that the neurosis is a way out of the dilemma. It is a harbor after a stormy sea, not always a quiet harbor, but at least a usable one. Unpleasant as it is, every nervous symptom is a form of compensation which has been deliberately though unconsciously chosen by its owner.

Rationalizing Our Distress. Among other things, a nervous symptom furnishes a seemingly reasonable excuse for the sense of distress which is behind every breakdown. Something troubles us. We are not willing to acknowledge what it is. On the other hand, we must appear reasonable to ourselves, so we manufacture a reason. Perhaps at the time when the person first feels distress, he is on a railroad train. So he says to himself, "It is the train. I must not go near the railway"; and he develops a phobia for cars. Perhaps at the onset of the fear he happens to have a slight pain in the arm. He makes use of the pain to explain his distress. He thinks about it and holds on to it. It serves a purpose, and is on the whole less painful than the feeling of unexplained impending disaster which is attached to no particular idea. Perhaps he happens to be tired when the conflict first gets beyond control. So he seizes the idea of fatigue to explain his illness. He develops chronic fatigue and talks proudly of overwork. In every case the symptom serves a real purpose, and is, despite its discomfort, a relief to the distressed personality.

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.

This characteristic of finding pleasure in personal ministrations is plainly a regression to the infantile phase of life. The baby demands and obtains the center of the stage. Later he has to learn to give it up, but the neurotic gets the center again and is often very loth to leave it for a more inconspicuous place.

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 purposive character of a nervous illness is well illustrated by two cases reported by Thaddeus Hoyt Ames.[39] A young woman, the drudge of the family, suddenly became hysterically blind, that is, she became blind despite the fact that her eyes and optic nerves proved to be unimpaired. She remained blind until it was proved to her that a part of her welcomed the blindness and had really produced it for the purpose of getting away from the monotony of her unappreciated life at home. She naturally resented the charge but finally accepted it and "turned on" her eyesight in an instant. The other patient, a man, became blind in order to avoid seeing his wife who had turned out to be not at all what he had hoped. When he realized what he was doing, he decided that there might be better ways of adjusting himself to his wife. He then switched on his seeing power, which had never been really lost, but only disconnected and dissociated from the rest of his mind.

[Footnote 39: Thaddeus Hoyt Ames: Archives of Ophthalmology, Vol. XLIII, No. 4, 1914.]

That the conscious mind has no part in the subterfuge is shown by the fact that both patients gave up their artificial haven as soon as they saw how they had been fooling themselves. The fact remains that every neurosis is the fulfilment of a wish,--a distorted, unrecognized, unsatisfactory fulfilment to be sure, but still an effort to satisfy desire. As Frink remarks, "A neurosis is a kind of behaviour." We always choose the conduct we like. It is a matter of choice. Does not this answer our question as to why some people always take unhealthy suggestions? If we take the bad one, it is because it serves the need of a part of our being.

SIGN LANGUAGE

Talking in Symbols. We have several times suggested that a nervous symptom is a disguised, indirect expression of subconscious impulses. It is the completeness of the disguise which makes it so hard for us to realize its true meaning. It takes a stretch of the imagination to believe that a pain in the body can mean a pain in the soul, or that a fear of contamination can signify a desire to bear a child. But in all this we must not forget the primitive, childlike nature of the instinctive life.

The savage and the child do not think as civilized man thinks. Savage or child thinks in pictures; he acts his feelings; he groups things according to superficial resemblances, he expresses an idea by its opposite; he talks in symbols. We still use these devices in poetic speech and in everyday thought. A wedding-ring stands for the marriage bond; the flag for a nation; a greyhound for fleetness; a wild beast for ferocity; sunrise for youth; and sunset for old age. "The essence of language consists in the statement of resemblance. The expression of human thought is an expression of association."[40]

[Footnote 40: Trigant Burrow: Journal of American Medical Association, Vol. LXVI, No. II, 1916.]

The association may be so accidental and superficial as to seem absurd to another person, or it may be so fundamental as to express the universal thought of man from the beginning of time. Many of the signs and symbols which crop out in neurotic symptoms and in normal dreams are the same as those which appear in myths, fairy tales and folk-lore and in the art of the earlier races.

A Secret Code. When the denied instincts of a man's repressed life insist on expression, and when the shocked proprieties of his repressing life demand conformity to social standards, the subconscious, held back from free speech, strikes a compromise by making use of figurative language. As Trigant Burrow says, if the moral repugnance is very strong, the disguise must be more elaborate, the symbols more far-fetched. The symbols of nervous symptoms and of dreams are a "secret code," understood by the sender but meaningless to the censoring conscience, which passes them as harmless.

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 Wrong Kind of Symbolism. A nervous disorder is an unfortunate choice of symbols. Instead of spiritualizing an innate impulse, it merely disguises it. The disguise takes a number of forms. One of the commonest ways is to act out in the body what is taking place in the soul. The woman with nausea converted her moral disgust into a physical nausea, which expressed her distress while it hid its meaning. The girl who was tired of seeing her work, and the man who wanted to avoid seeing his wife chose a way out which physically symbolized their real desire. A dentist once came to me with a paralyzed right arm. He had given up his office and believed that he would never work again. It turned out that his only son had just died and that he was dramatizing his soul-pain by means of his body. His subconscious mind was saying, "My good right arm is gone," and saying it in its own way. Within a week the arm was playing tennis, and ever since it has been busy filling teeth. There were, of course, other factors leading up to the trouble, but the factor which determined its form was the sense of loss which acted itself out through the body.

Sometimes, as we have seen, the disguise takes another form. Instead of conversion into a physical symptom, it lets one idea stand for another and displaces the impulse or the emotion to the substitute idea. The girl with the impulse to take drugs fooled her conscience by letting the drug-taking idea stand for the idea of conception. The girl with the fear of contamination carried the disguise still farther by changing the desire into fear,--a very common subterfuge.

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.

During the analysis it was discovered that what she had been reading on that first night was the thirteenth verse of the ninety-first Psalm. "Thou shalt tread upon the lion and the adder. The young lion and the dragon thou shalt trample under foot." To her the adder meant the snake, the tempter in the Garden of Eden, and hence sex. What she wanted to choke was her own insistent sex urge of which the child was the symbol and the result. On later occasions she had the same sort of hallucinations in connection with another child and on sight of a brutish kind of man who symbolized to the subconscious mind the sex-urge, of which she was afraid. Not so much by what her mother had said as by what she had avoided saying, and by her expression whenever the subject was mentioned, had she given her little daughter a fundamentally wrong idea of the reproductive instinct. Later when the girl was woman grown she still clung to the old conception, deploring the sex-part of the marriage relation and feeling herself too refined to be moved by any such sensual urge. But the strong sex-instinct within her would not be downed. It was so insistent as to be an object of terror to her repressing instinct, which could not bring itself to acknowledge its presence. The fear that came to the surface was merely a disguised and symbolic representation of this real fear which was turning her life into a nightmare.

The nausea and vomiting in this woman seemed to be symbolic of the disgust which she felt subconsciously at the thought of her own sex-desires, but sometimes the physical disturbances which accompany such phobias are the natural physical reactions to the constant fear state. Indigestion, palpitation, and tremors are not in themselves symbolic of the inner trouble but may be the result of an overdose of the adrenal and thyroid secretions and the other accompaniments of fear. In such cases the real symptom is the fear, and the physical disturbance an incidental by-product of the emotional state. In any case a nervous symptom is always the sign of something else--a hieroglyph which must be deciphered before its real meaning can be discovered.

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 Primitive. The first class merely capitulate to their primitive desires. They may not be nervous, but it is safe to say that they are rarely happy. The voice of conscience is hard to drown, even when it is not strong enough to control conduct. Happily it often succeeds in making us miserable, when we desert the ways that have proved best for our kind. The "immoral" person has not yet "arrived"; he simply disregards the collective wisdom of society and gives the victory to the primitive forces which try to keep man back on his old level. We cannot break the ideals by which man lives, and still be happy.

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.

Nervous People. To the third class belong the people who have not finished the fight. These are the folk with "nerves," the people in whom the conflict is fiercest because both sides are too strong. The victory goes to neither side; the tug of war ends in a tie. Since the energy of the nervous person is divided between the effort to repress and the effort to gain expression, there is little left for the external world. There is plenty of energy wasted on emotion, physical symptoms, phantasy, or useless acts symbolizing the struggle.

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.

No nervous symptom is what it seems to be. It is an arch pretender. It pretends to be afraid of something it does not fear at all, or to ignore something that interests it intensely. It pretends to be a physical disease, when primarily it has nothing to do with the body; and the person most deluded is the one who "owns" the symptom. Its purpose is to avoid the pain of disillusionment and to furnish relief to a distracted soul which dares not face itself.

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.