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VIEWS OF THE FREUDIAN SCHOOL

Recently the Freudian school has endeavored to penetrate more deeply to the nucleus of the problem and to solve it. Freud has delimited what he calls obsessional or compulsion neurosis (Zwangsneurosis), which is classed under psychasthenia by the French and under neurasthenia by others. The Freudians regard this as a distinct neurosis, sometimes complicated by neurasthenic or hysterical symptoms. The characteristic symptom is a feeling of compulsion. The symptoms may be motor (obsessional acts, impulsions), sensory (obsessional hallucinations or sensations), ideational (obsessions), and affective (obsessive emotions, particularly doubt and fear). In this condition we find that there is an excessive psychical significance attached to certain thoughts. Obsessions are characterized by dissociations from the main personality. They thus exist in the unconsciousness. The original unconscious mental processes have brought about, by displacement, an excess of psychical significance to these thoughts. Ernest Jones[6] states that Freud found, by his work in psychoanalysis, that obsessions represented, symbolically, the return of self-reproaches of ancient, infantile and early childhood origin, which had been repressed and buried until the obsession made its appearance. "They always refer to active sexual performances or tendencies;" and, as Jones further explains, "there occurs early in life an exaggerated divorce between the instincts of hate and love, and the conflict and antagonism between the two dominate the most important reactions of the person. A fundamental state of doubt, an incapacity for decision, results from this paralyzing doubt. The patient oscillates between the two conditions of not being able to act (when he wants to), and of being obliged to act (when he doesn't want to). The symptom symbolizes the conflicting forces. These are not, as in hysteria, fused into a compromise-formation,

but come to separate and alternating expression; one set of manifestations, therefore, symbolizes the repressed forces, another the repressing."

To put the matter plainly, the Freudians contend that obsessions are symbolical representations of the repressed sexual activities and tendencies of infantile and early childhood origin. It must be remembered that the Freudians employ the term sexual in a very broad sense, including under it the most indirect and distant physical, mental and moral reverbations. conscious or "unconscious," of the relations between the sexes. The sexual impulse is here conceived of as having incestuous, bisexual and polymorphous perverse sexual tendencies. The word sexual is not only used as synonymous with love, but practically all emotional surgings, all feelings, all affectivity, all sense-cravings and bodily heavings are classed by certain members of the Freudian school as sexual. This latter interpretation and extension of the connotation generally accorded by us to the term sexual we surely have no right to give it.

Clark, of New York City, is the author who has carried out the Freudian idea to its ultimate conclusion. I refer to his series of three papers[7] in the Medical Record, and call particular attention to his last (third) paper in which he has fully elaborated his theory of the meaning of tics.[8]

Clark's conception of the meaning of tic movements and of the mental state characteristic of ticquers must be here given. Although not denying the basic neurotic constitution present in ticquers, Clark sums up by giving the following definite and fully developed theory:

"The ticquer has a strong sexual attachment; this is so strong that the love instinct ineffectually sublimates the hate instinct and in the warring conflict doubt and physical and psychic inadequacy arise. The situation continues and generates mental, and physical infantilism, which in turn

make for increased feelings of tension. Motor and psychic restlessness succeed. The motor expression manifests itself most often in habit movements of disguised sexual significance (autoerogenous pleasures) a form of physical stereotypy, in its broadest psychophysical meaning. The mental state often pari passu takes up obsessive thinking and various physical acts and thoughts are formed as defense mechanisms, born of conscious guilt. The motor habits are usually inhibited or displaced in part, and the tic remains as a motor symbol, usually in itself non-sexual, as a fragment of the former complete habit movement. The mechanism of the completely evolved tic is either a conversion (hysteric) or substitution (obsessive) mechanism or both."

By these who have studied Freudism this will, in a way, be understood. For these who have not it may be more difficult of understanding without somewhat further elaboration or explanation. In this connection I must again mention that the Freudians include tics under their obsessive (obsessional) neuroses. The theory of the mental mechanisms and evolution of these states is given in the attached quotation, which is taken verbatim from Clark's paper.

"The affect of the painful idea does not become transformed into physical symptoms, as in the conversion mechanism of hysteria, but affixes itself to other ideas not in themselves unbearable, thus producing by this false relationship a substitutive symptom or obsession.

" . . . In all such obsessive neurotics the transformed reproaches which have escaped repressions are always connected with some pleasurably accomplished sexual act of childhood but may be almost entirely lost. The obsessive acts really represent the conflict between impulses of opposite instincts, love and hate, which are usually of equal value. The warring conflict engendered makes for a curiosity to discover the meaning of life forces (sexual largely) and the desire to know the end thereof. The nuclear-complex of all this is a precociousness of emotional life and an intensive fixation on one or the other parent or brother or sister. The intensive love fixation waxes the stronger as the unconscious hate requires increased barriers against its breaking through into the main or everyday personality. As a result

of these conflicts the will is partially weakened, there is an incapacity for resolution, first in the realm of love alone; then later succeeds a diffusion or displacement of the mechanism all over the field of activity. A series of secondary defense mechanisms are now brought in and these may enable the obsessive person to get square in a limited way (as religious practices enable many to do). Some special adaptation is required sooner or later, and the individual, having used up all the helps, then falls back upon the different forms of obsessive acts and thinking. Thus the obsessive neurosis is generated."

Clark then proceeds to explain:

"If one is not permitted to draw deductions from a few data as to the further genesis of the tic disorders, we may still hold out a tentative hypothesis, pieced together from many sources that a certain type of nervous make-up is inherited. In such the emotional life is precocious much beyond the intellectual faculties. The ticquer in infancy has the emotional feelings of love and hate of an adult. Their very precociousness aids the parental fixation and adhesion, and makes it the more difficult for the libido to detach itself at the proper age. One should bear in mind that the parental fixation in itself does not directly produce the mishaps of adult life but this small fault in infancy generates wider and wider maladaptations as development progresses. It is these latter glaring faults and trends that make for the character defects, and these really break down the final effort at adaptations and adjustments producing the tic or obsessive disorder. But the essential nucleus of the defect is lack of balance, precocious parental fixation, and continued attachment to the parent-stem, that makes the adult defect possible. The very infantile precociousness of the emotions argues for the hereditary transmission of destructive temperamental qualities. Here, as elsewhere in tracing hereditariness in so-called functional nervosities, one should take as the unit character for study the mental traits or trends and exclude definite disease entities applied to ancestral disorders. I believe it is not too suppositious to think that many of these variant individuals are really atavistic in makeup and have continued from one generation to

another special defective traits of emotional makeup which are fortunately denied the average individual."

The writer cannot understand how the theory which he has taken the trouble to so fully present in the above quotations can be maintained. Jones and Clark both assert that the tics or habit spasms as probably of the same nature as the obsessions in general. Moreover, Jones agrees that "familiar examples of compulsion in a slight degree are the obsessive impulses to touch every other rail of an iron fence as one walks past, to step on the cracks between the flagstones of the pavement, or not to step on them, and so on." A little reflection will show us the impossibility and illogicality of viewing all these conditions as being fundamentally of sexual origin. Let us follow the argument. If tics are of sexual derivation, as the Freudians here openly maintain, then it must follow that those familiar examples of compulsion, such as the obsessive impulse to touch every other post, etc., are likewise of sexual origin. This conclusion is forced upon us, since, even according to Jones, the only difference between the marked tics and the lesser manifestations is one of degree.[9] Now, these slighter impulsive tendencies to which we have here referred are very frequent in all children and by no means infrequent in grown-ups. They are habitual movements, which may be of transient duration only or may, by repeated performance, develop into more or less fixed habits. If, then, these habits are of sexual significance, it must follow that all other habits, especially if associated with a certain degree of consciousness or awareness, are in like manner symbolical of the past infantile and early childhood sexual activities and tendencies. This conclusion is, as is seen, inevitable, if we believe in the Freudian theory of the pathogenesis of the tics. However, since this leads us to a reductio ad absurdum, we must, of course, reject the explanation which has been offered by the Freudian school.

Perhaps I should also mention the fact that all of these symptoms or tendencies which one finds in ticquers occur

in other individuals who do not present tics; and, furthermore, that all normal individuals possess these qualities or tendencies in varying degrees of intensity and in varying combinations, and that this applies to adults as well as to children, although, of course, they are seen most characteristically in children. I may further add that the difference between the mental infantilism which we find present in the tic psychoneurosis and that which we observe in other (normal and abnormal) conditions is one of degree rather than of kind. Therefore, the most we can say of the mental condition in ticquers is that there is an exaggeration of the mental infantilism or a fixation at or tendency toward regression to this type of thinking or of reaction. And this leads us to the further conclusion—and it is this point which I desire to bring out in this connection—namely, that since the difference between the mental infantilism in all of these conditions is relative, being one of degree and of proportionate relationship or at any rate of genesis, evolution and meaning, it naturally follows that what is in the conclusions of Clark, as mentioned above, asserted to be an absolute and basic principle or truth applicable to the tics, must consequently be true, but in different degree, of all the other conditions of a similar or allied nature. Surely the motive source is fundamentally the same in all of these conditions.

Furthermore, tics occur in animals, especially in horses; and the whole picture, physical and mental, of tics in horses resembles that which we find in human beings, particularly idiots and imbeciles, with tics. And the ultimate, fundamental meaning and motive source of tics in man is and must be the same as that of tics in horses.

To put Clark's idea in a nut-shell, it may be said that he believes that the primary purpose of tics is not that of a protective, defense mechanism against unpleasant situations in life but that of obtaining really pleasurable gratifications to the psyche, these autopleasurable acts being based on inherent defects and having a sexual significance in the sense in which sexuality is conceived by Freud. The protective, defense mechanism is, according to this view, but secondary to the primary and

fundamental purpose of obtaining the autopleasurable gratifications to the psyche.

Although approving of the analytic and genetic tendency displayed by Freud, Clark and the Freudian school in general, it is regrettable to me that the analytic tendency and reconstructive efforts of the Freudians in the field of neurology and psychopathology have been seriously marred by their insistence on forcing all observed physical and psychical phenomena and reactions into line with their fixed sexual theories and their special psychology, which is basically wrong in many fundamental and important standpoints.

The writer will agree with the Freudians that there must be a cause for the appearance of these tics. This cause existed in the past. It has in the course of time been forgotten, but still exists somewhere in the subconsciousness or memory. This forgetting has been brought about by a process of dissociation from the original exciting cause. But the writer will not agree that this dissociation has been, of necessity, brought about by psychic repression on the part of the individual, that by psychoanalysis the condition can be traced back to the sexual activities or tendencies of infantile or early childhood origin, or that the condition may be cured when the original cause is made known to the patient through psychoanalysis, without the training of the will so necessary in this condition.

Thus the analytic tendency of the Freudian school is to be highly commended. But this analysis should not be limited to sexual analysis, but should include a consideration of all of man's instincts. Nor should the analysis be limited to present-life psychic factors alone, but should be viewed from a psychobiological standpoint. In this way only will all antecedent causative factors—physical and mental—be included in our analytic observation and speculation.

To fully discuss or to prove the error of Clark in his conclusions would necessarily lead me into a general discussion of Freudism, which I cannot do in this place, since the ramifications are too numerous and the problems involved would lead to lengthy and tiresome discussion, pro and con. I must, however, mention the exclusively sexual

standpoint assumed by the Freudian school in their interpretations of physical and psychical activities, their classifying of all activities characterized by a certain rhythmicity and periodicity, and accompanied by a certain degree of satisfaction—in other words of all autopleasurable activities—as sexual (in the Freudian sense), and the neglect of comparative and behavioristic psychology with proper consideration for man's phylogeny and ontogeny or of his true genetic history, from the racial and world history and not alone from the individualistic psychological standpoint. As a matter of fact the conception of sexuality assumed by Freud and his followers has undergone many changes and is by no means definite and clean cut in its outlines. A criticism of the conception of sexuality cannot be entered upon here. I may merely state that what is an absolute and fixed law for the tics, what is the fundamental and basic explanation or theory of the genesis and meaning of the tics must apply also to all habit movements wherever and whenever they occur, and, in like manner, to all habit formations of whatever nature. And since our habits are but the prolongations of our instincts, the latter also would be included within the purview of the same generalization. In other words, if all tics have a sexual meaning, then all instincts, which means the vital energy of man, has the same meaning. This question I have discussed in another place[10] and cannot enter upon here.

Without further elaboration or discussion I am content to give the Freudian conception to you as I have outlined it above and to let it stand for what it is worth.

I may say that in the physical aspect of tics we have a specific somatic manifestation which, if explained, should, in a way, be the gateway toward the understanding of the many somatic symptoms which we find in the psychoneuroses and psychoses.