By ARNOLD W. IZARD, M.A., M.D., B.C. (Cantab)

During the war psychoneurosis caused a great wastage of man power. Much light has been thrown on the working of the unconscious by recent medical and psychological investigations into the nature of certain pathological states. These investigations have proved that many cases of mental disorder are due to the conscious repression of experiences with which intense and disagreeable emotions have been associated.

While the tendency to repress and try to forget any unpleasant complex of ideas is perfectly natural and normal, in certain pathological cases not only does the unpleasant complex become more or less completely split off or dissociated from the rest of consciousness, but a great part of the patient’s previous experience may disappear, resulting in a dissociation of personality. During the war, for instance, this condition was frequently found in cases of “shell shock.”

In cases of neurasthenia, contrasting with those of shell shock in that they were usually caused, not by a sudden shock, but by long continued worry or anxiety, the unpleasant experiences and emotions are repressed more imperfectly and assume various disguised or symbolic forms.

But it should be observed even when the break of personality is more or less complete, it is never absolutely so—a great deal of the past experience is subconsciously present and may, by the employment of appropriate methods, be raised to the level of consciousness. In many cases of disordered personality, whether the repression be incomplete, due to long-continued mental strain, or more or less complete, as the result of some sudden shock, a cure may be effected by making the patient especially conscious of the repressed experiences that have produced the disorder. When repressed experiences have been revealed and the patient has become fully conscious of them and of their relation to his disorder, a rapid improvement in his condition generally follows.

Dejerine has pointed out: (1) All functions of the body may be disturbed by the improper interference of the mind. It is in this way that functional manifestations are created. (2) This interference of the mind has in almost every case some emotional cause for its origin. (3) Emotion may act by repeated actions. It then creates neurasthenia—the syndrome of emotional preoccupation. (4) Emotion may act by the sudden action of dissociation—under these conditions it results in hysterical symptoms. (5) The action of emotion can only take place on emotional soil. Neurasthenia, an affection of psychic origin, has nothing in common with the various asthenias of organic origin except its fatiguability.

Now it is a matter of common experience that when a strong emotion, such as fear, anxiety or apprehension enters consciousness it may be accompanied by physiological reactions, confusion of thought, vaso-motor disturbance, cardiac palpitation, increased perspiration, respiratory disturbance, tremors, muscular weakness, gastro-intestinal and urinary disturbances.

Now it may happen, and it often does, that one of these physiological disturbances may be so obtrusive as to be the predominant feature and mask the physical element, which may be overlooked—thus gastric or cardiac symptoms may not be recognised as manifestation of an emotion, but may be mistaken for true gastric or heart affections. This is more liable to happen in the anxiety neuroses— such as, for instance, fear of heart disease, of insanity, of cancer, of consumption, of syphilis and so forth—when the anxiety is spread over a long period recurring from time to time when awakened by some thought or stimulus.

Darwin in The Expression of Emotions has with master hand depicted the emotion of fear. “The frightened man at first stands like a statue, motionless and breathless, or crouches down as if to escape observation; the heart beats quickly and violently, so that it palpitates or knocks against the ribs; the skin becomes pale, due to constriction of the small arteries of the skin; perspiration exudes from it.. This exudation is all the more remarkable as the surface is then cold; hence the term ‘cold sweat.’ The superficial muscles shiver; the breathing is shallow and hurried, the salivary glands act imperfectly: the mouth becomes dry. One of the most marked symptoms is the trembling of all the muscles of the body, and this is often seen first in the lips. From this cause and from the dryness of the mouth the voice becomes husky or indistinct or may altogether fail. Obstupui steteruntque comae et vox faucibus haesit.”

Mott, who was in charge of the Maudseley, states:—“A large number of soldiers were admitted under my case suffering with severe neurasthenia. About 10 per cent. showed symptoms of Graves disease, palpable thyroids exophthalmos, van Graefe, and Mobius signs, fine tremors 9-10 per second (indistinguishable from the neurasthenic tremor), tachycardia, acocyanosis, hyperidrosis and hyperacusis shown by the starting reflex. In most cases the blood pressure was higher than normal, especially in cases where there was an anxiety neurosis. There were indications, therefore, of an increased amount of adrenalin in the blood, as there was undoubtedly an increase of thyroid secretion in many cases.”

That the increased secretion of adrenalin in the blood occurs as a result of fright has been shown experimentally by Canon and Elliott. This may be regarded as a bio-chemical defensive mechanism for self-preservation, for it raises the blood pressure and causes an increased quantity of glycogen to be converted into sugar—the energy substance of the muscles—thus enabling the animal to prepare for fight or flight. This is effected through the stimulus of the automatic centres in the medulla and splanchnic nerves.. Mott asks: may not the increased activity of the thyroid gland be regarded as a bio-chemical defensive action to restore the exhausted neurons?

In the mental manifestations the emotional element is naturally the most prominent and consists of a curious mixture of dread, pain, terror and anguish, and may vary from a slight awkwardness to indescribable dread. Thus a man may show astonishing general courage in the face of real dangers, such a man may win a V.C. and yet be terrified at making an after-dinner speech.

As Oppenheim grandiloquently observes: “Courage can reign in splendour in the cerebrum, while anxiousness is exercising an imperious mastery in the pons.” In the subconscious mind are the primitive instincts of which the three chief instincts are the sexual instinct, the instinct of self-preservation, and the instinct of nutrition. Some modern writers would add a fourth great primitive instinct, the herd instinct. There is much to be said in favour of the herd instinct—(1) Man is a gregarious animal. He is intolerant of solitude both in the mental and physical sphere; (2) he is more sensitive to the voice of the herd than to any other influence, it can inhibit or stimulate his thoughts and conduct, it is the source of his moral code , his ethics and his philosophy; (3) he is subject to the passions of the pack in his mob violence, and the passions of the herd in his panics; (4) he is remarkably susceptible to leadership; (5) his relations with his fellows are dependent upon the recognition of him as a member of the herd. Incidentally it may be said that the herd instinct is one of the greatest moral forces in the world to-day. We have many synonyms for it—“bad form,” “not playing the game,” “it isn’t done,” etc. If further proof of the herd instinct be wanted go to one of the mental hospitals and study a case of dementia. There the patient sits, out of tune with his environment, taking no interest in his surroundings, apathetic, slovenly, dirty, filthy in his habits. The voice of the herd no longer appeals to him, he has lost the herd instinct—the man is mad.

In the animal world we recognise three distinct forms of herd instinct—the aggressive, as illustrated by the wolf; the defensive, as illustrated by the sheep; and the industrial or socialized, as illustrated by the bee. The whole object of education is sublimation—that is, the diversion of the psychic energy of the primitive instincts, crude, imperative, selfish, and often cruel, so that they must be harnessed on to an impersonal social sphere. The whole mental history of the individual is a series of conflicts between the primitive instincts, but a healthy person emerges from this series of conflicts by managing to replace the primary personal activities and interests by external social ones, and the mental energy of the former constitutes one of the main driving forces for the later acquired one, being one of the chief bases for the whole later character of a person. This replacement is sublimation, where the energies, desires and interests which were originally personal have been sublimated on to an impersonal social sphere.

“Without the refining influences of education a child would remain selfish, jealous, impulsive, aggressive, immodest, dirty, cruel, egocentric, conceited, inconsiderate of the needs of others, unmindful of the complicated social standards that go to make up civilised society.”

Unfortunately the veneer of civilisation is very thin, and beneath it there remains throughout life a mass of crude, impulsive instincts, always struggling for expression. How thin this veneer is can readily be seen in children and in savages, during intoxication, in some forms of insanity, in chloroform and ether narcosis, and during hypnosis.

By ARNOLD W. IZARD, M.A., M.D., B.C. (Cantab)

During the war psychoneurosis caused a great wastage of man power. Much light has been thrown on the working of the unconscious by recent medical and psychological investigations into the nature of certain pathological states. These investigations have proved that many cases of mental disorder are due to the conscious repression of experiences with which intense and disagreeable emotions have been associated.

While the tendency to repress and try to forget any unpleasant complex of ideas is perfectly natural and normal, in certain pathological cases not only does the unpleasant complex become more or less completely split off or dissociated from the rest of consciousness, but a great part of the patient’s previous experience may disappear, resulting in a dissociation of personality. During the war, for instance, this condition was frequently found in cases of “shell shock.”

In cases of neurasthenia, contrasting with those of shell shock in that they were usually caused, not by a sudden shock, but by long continued worry or anxiety, the unpleasant experiences and emotions are repressed more imperfectly and assume various disguised or symbolic forms.

But it should be observed even when the break of personality is more or less complete, it is never absolutely so—a great deal of the past experience is subconsciously present and may, by the employment of appropriate methods, be raised to the level of consciousness. In many cases of disordered personality, whether the repression be incomplete, due to long-continued mental strain, or more or less complete, as the result of some sudden shock, a cure may be effected by making the patient especially conscious of the repressed experiences that have produced the disorder. When repressed experiences have been revealed and the patient has become fully conscious of them and of their relation to his disorder, a rapid improvement in his condition generally follows.

Dejerine has pointed out: (1) All functions of the body may be disturbed by the improper interference of the mind. It is in this way that functional manifestations are created. (2) This interference of the mind has in almost every case some emotional cause for its origin. (3) Emotion may act by repeated actions. It then creates neurasthenia—the syndrome of emotional preoccupation. (4) Emotion may act by the sudden action of dissociation—under these conditions it results in hysterical symptoms. (5) The action of emotion can only take place on emotional soil. Neurasthenia, an affection of psychic origin, has nothing in common with the various asthenias of organic origin except its fatiguability.

Now it is a matter of common experience that when a strong emotion, such as fear, anxiety or apprehension enters consciousness it may be accompanied by physiological reactions, confusion of thought, vaso-motor disturbance, cardiac palpitation, increased perspiration, respiratory disturbance, tremors, muscular weakness, gastro-intestinal and urinary disturbances.

Now it may happen, and it often does, that one of these physiological disturbances may be so obtrusive as to be the predominant feature and mask the physical element, which may be overlooked—thus gastric or cardiac symptoms may not be recognised as manifestation of an emotion, but may be mistaken for true gastric or heart affections. This is more liable to happen in the anxiety neuroses— such as, for instance, fear of heart disease, of insanity, of cancer, of consumption, of syphilis and so forth—when the anxiety is spread over a long period recurring from time to time when awakened by some thought or stimulus.

Darwin in The Expression of Emotions has with master hand depicted the emotion of fear. “The frightened man at first stands like a statue, motionless and breathless, or crouches down as if to escape observation; the heart beats quickly and violently, so that it palpitates or knocks against the ribs; the skin becomes pale, due to constriction of the small arteries of the skin; perspiration exudes from it.. This exudation is all the more remarkable as the surface is then cold; hence the term ‘cold sweat.’ The superficial muscles shiver; the breathing is shallow and hurried, the salivary glands act imperfectly: the mouth becomes dry. One of the most marked symptoms is the trembling of all the muscles of the body, and this is often seen first in the lips. From this cause and from the dryness of the mouth the voice becomes husky or indistinct or may altogether fail. Obstupui steteruntque comae et vox faucibus haesit.”

Mott, who was in charge of the Maudseley, states:—“A large number of soldiers were admitted under my case suffering with severe neurasthenia. About 10 per cent. showed symptoms of Graves disease, palpable thyroids exophthalmos, van Graefe, and Mobius signs, fine tremors 9-10 per second (indistinguishable from the neurasthenic tremor), tachycardia, acocyanosis, hyperidrosis and hyperacusis shown by the starting reflex. In most cases the blood pressure was higher than normal, especially in cases where there was an anxiety neurosis. There were indications, therefore, of an increased amount of adrenalin in the blood, as there was undoubtedly an increase of thyroid secretion in many cases.”

That the increased secretion of adrenalin in the blood occurs as a result of fright has been shown experimentally by Canon and Elliott. This may be regarded as a bio-chemical defensive mechanism for self-preservation, for it raises the blood pressure and causes an increased quantity of glycogen to be converted into sugar—the energy substance of the muscles—thus enabling the animal to prepare for fight or flight. This is effected through the stimulus of the automatic centres in the medulla and splanchnic nerves.. Mott asks: may not the increased activity of the thyroid gland be regarded as a bio-chemical defensive action to restore the exhausted neurons?

In the mental manifestations the emotional element is naturally the most prominent and consists of a curious mixture of dread, pain, terror and anguish, and may vary from a slight awkwardness to indescribable dread. Thus a man may show astonishing general courage in the face of real dangers, such a man may win a V.C. and yet be terrified at making an after-dinner speech.

As Oppenheim grandiloquently observes: “Courage can reign in splendour in the cerebrum, while anxiousness is exercising an imperious mastery in the pons.” In the subconscious mind are the primitive instincts of which the three chief instincts are the sexual instinct, the instinct of self-preservation, and the instinct of nutrition. Some modern writers would add a fourth great primitive instinct, the herd instinct. There is much to be said in favour of the herd instinct—(1) Man is a gregarious animal. He is intolerant of solitude both in the mental and physical sphere; (2) he is more sensitive to the voice of the herd than to any other influence, it can inhibit or stimulate his thoughts and conduct, it is the source of his moral code , his ethics and his philosophy; (3) he is subject to the passions of the pack in his mob violence, and the passions of the herd in his panics; (4) he is remarkably susceptible to leadership; (5) his relations with his fellows are dependent upon the recognition of him as a member of the herd. Incidentally it may be said that the herd instinct is one of the greatest moral forces in the world to-day. We have many synonyms for it—“bad form,” “not playing the game,” “it isn’t done,” etc. If further proof of the herd instinct be wanted go to one of the mental hospitals and study a case of dementia. There the patient sits, out of tune with his environment, taking no interest in his surroundings, apathetic, slovenly, dirty, filthy in his habits. The voice of the herd no longer appeals to him, he has lost the herd instinct—the man is mad.

In the animal world we recognise three distinct forms of herd instinct—the aggressive, as illustrated by the wolf; the defensive, as illustrated by the sheep; and the industrial or socialized, as illustrated by the bee. The whole object of education is sublimation—that is, the diversion of the psychic energy of the primitive instincts, crude, imperative, selfish, and often cruel, so that they must be harnessed on to an impersonal social sphere. The whole mental history of the individual is a series of conflicts between the primitive instincts, but a healthy person emerges from this series of conflicts by managing to replace the primary personal activities and interests by external social ones, and the mental energy of the former constitutes one of the main driving forces for the later acquired one, being one of the chief bases for the whole later character of a person. This replacement is sublimation, where the energies, desires and interests which were originally personal have been sublimated on to an impersonal social sphere.

“Without the refining influences of education a child would remain selfish, jealous, impulsive, aggressive, immodest, dirty, cruel, egocentric, conceited, inconsiderate of the needs of others, unmindful of the complicated social standards that go to make up civilised society.”

Unfortunately the veneer of civilisation is very thin, and beneath it there remains throughout life a mass of crude, impulsive instincts, always struggling for expression. How thin this veneer is can readily be seen in children and in savages, during intoxication, in some forms of insanity, in chloroform and ether narcosis, and during hypnosis.